A Case of Pancreatic Cancer with Markedly Elevated Serum Immunoglobulin G4 / 대한췌담도학회지

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer is often difficult due to similar clinical manifestations and radiological findings. Serum immunoglobulin G4 (IgG4) is a marker to differentiate AIP from pancreatic cancer. Although serum IgG4 can be elevated in 10% of patients with pancreatic cancer, most of serum IgG4 elevation in pancreatic cancer is limited within two times of upper normal limit. Herein, we report a case of pancreatic cancer with markedly elevated serum IgG4 over six times of upper normal limit that needed steroid trial to differentiate from AIP.

Successful Treatment of Bleeding Duodenal Varix by Percutaneous Transsplenic Embolization / 대한소화기학회지

Variceal bleeding occurs primarily in the esophagus or stomach in patients with liver cirrhosis, but can also occur rarely in the duodenum. Duodenal variceal bleeding has a high mortality and poor prognosis due to heavy blood flow originating from the portal vein (PV) and the technical difficulty of hemostatic procedures. Treatments including endoscopic sclerotherapy, endoscopic ligations, endoscopic clipping and transjugular intrahepatic portosystemic shunt have been tried, with only moderate and variable success. A percutaneous transsplenic approach offers another way of accessing the PV. Here we report a case of successfully treated duodenal variceal bleeding by percutaneous transsplenic embolization.

Spontaneous Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema Complicating H1N1 Virus Infection / 대한내과학회지

Since April 2009, outbreaks of the new influenza A (H1N1) virus have occurred worldwide. The spectrum of disease caused by H1N1 infection ranges from non-febrile, mild upper respiratory tract illness to severe or fatal pneumonia. Rapidly progressive respiratory diseases, such as acute respiratory distress syndrome and renal or multi-organ failure, have accounted for severely affected inpatients. Complex cases involving myocarditis, encephalitis, and myositis have been described. However, pulmonary air-leak syndrome, consisting of spontaneous pneumomediastinal emphysema, pneumothorax, and subcutaneous emphysema complicating pneumonia with the H1N1 virus, has not previously been reported in Korea. Here, we report a case of pulmonary air-leak syndrome complicating H1N1 infection that was resolved with an antiviral agent, high-flow oxygen, and fluid therapy.

A Case of Paclitaxel Induced Scleroderma in a Patient with Ovarian Cancer

Paclitaxel takes effects as an anti-neoplastic agent by interfering with microtubules and then blocking cell growth. It has been used to treat patients with lung, ovarian, breast, head and neck cancer, and advanced forms of Kaposi's sarcoma. Along with its reputation as an effective chemotherapeutic drug, paclitaxel has numerous adverse effects. Among them, cutaneous adverse effects of paclitaxel include pruritis, bullous fixed eruption, onycholysis, and transient erythrodysesthesia. Only several cases of scleroderma-like lesions have been reported throughout the world, and in Korea, only one case of paclitaxel induced scleroderma has been reported in 2006. We report a case of paclitaxel induced scleroderma in an 83-year old woman with ovarian cancer. After administration of paclitaxel and cisplatin, the patient presented with edema in both brachial areas, Raynaud's phenomenon, and sclerotic skin lesions in both extremities.

Austrian Syndrome with a Delayed Onset of Heart Failure

A 59-year-old man treated with pneumococcal meningitis 4 months ago was hospitalized for acute heart failure and performed aortic valve replacement by rupture of aortic valve. The frequent association of pneumococcal meningitis and endocarditis is known as Austrian syndrome. Though Austrian syndrome is a clinically rare disease, the evolution of pneumococcal endocarditis is very aggressive and associated with high mortality, and early recognition for evidence of endocardial lesion in patients with pneumococcal meningitis is important to reduce the complications and mortality rate.

Incidence and prognosis of disseminated intravascular coagulation in patients with severe sepsis or septic shock / 대한내과학회지

BACKGROUND/AIMS: We investigated the incidence and prognosis of disseminated intravascular coagulation (DIC) using DIC scoring system in patients with severe sepsis or septic shock. METHODS: Patients admitted to the intensive care unit (ICU) in a tertiary hospital for severe sepsis or septic shock were enrolled from Mar. 2008 to Feb. 2009. Using the International Society on Thrombosis and Haemostasis (ISTH) criteria, we calculated DIC score at three time points (Day 0, Day 1, and Day 2). RESULTS: Among 111 patients with severe sepsis or septic shock, 89 (severe sepsis, 8; septic shock, 81) were enrolled. Mean DIC score at ICU admission was 3.3+/-1.3 and the incidence of overt DIC (DIC score > or = 5) during the first 48 hours was 33.8% (27/89). Sequential Organ Failure Assessment (SOFA) score was well correlated with DIC score and was higher in patients with overt DIC than in those without. The ICU, hospital and 28-day death rates in patients with overt DIC were 63.0%, 66.7%, and 63.0%, respectively, which were significantly higher than in those without overt DIC. In multivariate analysis, Simplified Acute Physiology Score (SAPS) II was significantly associated with hospital death (p=0.002), and the occurrence of overt DIC showed a borderline significance (p=0.053). CONCLUSIONS: Using the ISTH criteria for DIC, the incidence of overt DIC was 33.8% in patients with severe sepsis or septic shock. The occurrence of overt DIC was associated with a higher organ failure score and hospital outcomes.