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Portal vein tumor thrombosis (PVTT) is an uncommon condition in which tumor cells expand into the vessels, causing blood clot formation in the portal vein. PVTT is mainly associated with hepatocellular carcinoma, leading to an unfavorable prognosis; however, it can also develop in patients with other cancer types. Herein, we report a case of metastatic renal cell carcinoma diagnosed by a blind liver biopsy in a patient with dynamic computed tomography-confirmed portal vein thrombosis and cholangiopathy. This case illustrates the importance of systematic surveillance with routine laboratory tests and contrast-enhanced imaging studies on patients with cancer to detect potential liver infiltration of metastatic cancer.
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Purpose@#This study examined the incidence and time of onset of retinopathy in premature infants in Korea. @*Methods@#The medical records of premature infants admitted to the neonatal intensive care unit from 2006 to 2018 were reviewed retrospectively. Stages 1 and 2 were classified as mild retinopathy and stages 3 and 4 were considered severe. The incidence, severity, time of diagnosis, associations between retinopathy and birth weight and also gestational age, and clinical characteristics of the treated infants were analyzed. @*Results@#The incidence of retinopathy was 10.9% with an average time of diagnosis at 34.92 weeks postmenstrual age; the frequency of severe retinopathy was 44.97%. Birth weight and gestational age were significantly lower in premature infants with retinopathy than in normal infants. In addition, birth weight was significantly lower in those with severe retinopathy than in those with mild retinopathy. For birth weight and gestational age, the incidence and severity of retinopathy tended to be higher in those with birth weights less than 1,000 g and gestational ages of less than 27 weeks. Of the infants, 4.51% underwent laser photocoagulation; the times of diagnosis, progression to type 1 retinopathy, and treatment were 33.75, 35.06, and 36.04 weeks postmenstrual age, respectively. @*Conclusions@#The incidence and severity of retinopathy of premature infants increased in those with birth weights less than 1,000 g and gestational ages less than 27 weeks. Such infants should be monitored carefully between 32 to 36 weeks of postmenstrual age, when retinopathy is mainly diagnosed.
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Purpose@#To report ocular findings in a patient with Scheie syndrome.Case summary: A 28-year-old male who was diagnosed with Scheie syndrome ten years ago visited our ophthalmology clinic. The man was diagnosed with Scheie syndrome based on normal intelligence, a coarse face, cardiac valve problems, and reduced α-L-iduronidase, heparan sulfate and dermatan sulfate levels on urinalysis. An ophthalmic examination showed that the best-corrected visual acuities were 0.25 and 0.2, while the intraocular pressures were 11 and 12 mmHg, in the right and left eyes, respectively. An anterior segment examination was normal except for corneal clouding (grade II). Fundus examination revealed bony spicule pigmentation in the peripheral retina and vessel attenuation in both eyes. Parafoveal photoreceptor loss was revealed by optical coherence tomography. In addition, scotopic and photopic electroretinographic responses were decreased, and the visual field decreased in accordance with the photoreceptor cell loss. @*Conclusions@#Clinicians should consider a diagnosis of Scheie syndrome when examining a patient with characteristic ocular findings and general symptoms.
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BACKGROUND/AIMS: Although forceps biopsy is performed for suspicious gastric tumors during endoscopy, it is difficult to determine treatment strategies for atypical gastric glands due to uncertainty of the diagnosis. The aim of this study was to investigate clinical implications and risk factors for predicting malignancy in atypical gastric glands during forceps biopsy. METHODS: We retrospectively reviewed medical records of 252 patients with a diagnosis of atypical gastric gland during forceps biopsy. Predictors of malignancy were analyzed using initial endoscopic findings and clinical data. RESULTS: The final diagnosis for 252 consecutive patients was gastric cancer in 189 (75%), adenoma in 26 (10.3%), and gastritis in 37 (14.7%). In the multivariate analysis, lesion sizes of more than 10 mm (odds ratio [OR], 3.021; 95% confidence interval [CI], 1.480 to 6.165; p=0.002), depressed morphology (OR, 3.181; 95% CI, 1.579 to 6.406, p=0.001), and surface nodularity (OR, 3.432; 95% CI, 1.667 to 7.064, p=0.001) were significant risk factors for malignancy. CONCLUSIONS: Further evaluation and treatment should be considered for atypical gastric gland during forceps biopsy if there is a large-sized (>10 mm) lesion, depressed morphology, or surface nodularity.
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Humanos , Adenoma , Biopsia , Diagnóstico , Endoscopía , Mucosa Gástrica , Gastritis , Registros Médicos , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas , Instrumentos Quirúrgicos , IncertidumbreRESUMEN
BACKGROUND/AIMS: Elevated carbohydrate antigen (CA) 19-9 level may be unable to differentiate between benign and malignant pancreatobiliary disease with obstructive jaundice. The study aims to determine the clinical interpretation and the diagnostic value of CA 19-9 level in pancreatobiliary diseases with coexistent obstructive jaundice. METHODS: We retrospectively reviewed the data of 981 patients who underwent biliary drainage due to obstructive jaundice following pancreatobiliary disease at Sanggye Paik Hospital for 5 years. 114 patients with serial follow-up data for CA 19-9 level were included in this study (80 patients with malignancy and 34 patients with benign diseases). We compared the levels of CA 19-9 levels and the biochemical value before and after biliary drainage. RESULTS: The rate of CA 19-9 elevation (>37 U/mL) was significantly different between the benign group and the malignant group (59% vs. 90%, p=0.001). Despite the decrease in serum bilirubin after biliary drainage, CA 19-9 levels remained elevated in 12% of patients in the benign group and in 63% of patients in the malignant group (p<0.001). Finally, 12% of patients in the benign group turned out to have malignant disease. A receiver operating characteristic analysis provided a cut-off value of 38 U/mL for differentiating benign disease from malignant disease after biliary drainage (area under curve, 0.787; 95% confidence interval, 0.703 to 0.871; sensitivity, 62%; specificity, 88%). CONCLUSIONS: This study suggested that we should consider the possibility of malignant causes if the CA 19-9 levels remain high or are more than 38 U/mL after resolution of biliary obstruction.
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Humanos , Bilirrubina , Antígeno CA-19-9 , Drenaje , Estudios de Seguimiento , Ictericia Obstructiva , Estudios Retrospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
Mycobacterium avium complex (MAC) comprises M. intracellulare and M. avium. MAC usually causes pulmonary diseases in individuals with intact immunity, disseminated disease in patients with acquired immunodeficiency syndrome, and cervical lymphadenitis. It can also cause cutaneous disease, but musculoskeletal infection is rare. Herein, we present a case of vertebral osteomyelitis due to M. intracellulare in an elderly immunocompetent patient who underwent vertebroplasty. The patient was successfully treated with antimycobacterial drugs without surgical intervention. MAC should be considered as a causative pathogen of vertebral osteomyelitis when the patient has a history of vertebroplasty.
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Anciano , Humanos , Síndrome de Inmunodeficiencia Adquirida , Enfermedades Pulmonares , Linfadenitis , Complejo Mycobacterium avium , Infección por Mycobacterium avium-intracellulare , Mycobacterium , Micobacterias no Tuberculosas , Osteomielitis , VertebroplastiaRESUMEN
Nontyphoidal Salmonella infection often results in acute gastroenteritis, but extraintestinal infection presenting as a subdural empyema is unusual. We report a case of a 67-year-old man diagnosed with a subdural empyema caused by Salmonella group B that developed after evacuation of a subdural hematoma. To our knowledge, this is the first such case report in Korea.
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Anciano , Humanos , Empiema Subdural , Gastroenteritis , Hematoma Subdural , Corea (Geográfico) , Infecciones por Salmonella , SalmonellaRESUMEN
Staphylococcus lugdunensis is a coagulase-negative staphylococcus. However, it causes various clinically important human infections and behaves similar to Staphylococcus aureus. S. lugdunensis reportedly causes infective endocarditis, skin and soft tissue infection, bone and joint infection, septicemia, endarteritis, urinary tract infection, ocular infection, and peritonitis. There are no reports of septic arthritis by this organism in Korea. We presented a case of septic arthritis due to S. lugdunensis in an elderly patient with diabetes mellitus after an intra-articular injection.
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Anciano , Humanos , Artritis , Artritis Infecciosa , Diabetes Mellitus , Endarteritis , Endocarditis , Infecciones del Ojo , Inyecciones Intraarticulares , Articulaciones , Articulación de la Rodilla , Prótesis de la Rodilla , Rodilla , Corea (Geográfico) , Peritonitis , Sepsis , Piel , Infecciones de los Tejidos Blandos , Staphylococcus , Staphylococcus aureus , Staphylococcus lugdunensis , Infecciones UrinariasRESUMEN
Here, we report a case of newly diagnosed diabetes, with concurrent pancreatic cancer manifested as hyperglycemic crisis, and aggravated by urinary tract infection. We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and clinical findings in an elderly patient with hyperglycemic emergency. A review of the documents involving pancreatic tumors and hyperglycemic hyperosmolar state, which is an acute complication of diabetes mellitus, is presented. In the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. In addition, this discussion should be more carefully considered in the aged people group.
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Anciano , Humanos , Diabetes Mellitus , Urgencias Médicas , Neoplasias Pancreáticas , Infecciones UrinariasRESUMEN
The scabies mite is an ectoparasite, which is able to infest humans. The incidence of scabies decreased during the past 20 years in Korea. However, the incidence is likely to increase again, and may be delayed or missed diagnosis recently. Its clinical presentation is typical, although in a host with compromised immune system, like the mentally retarded and elderly patients, the clinical presentation may be altered. Because a delay in diagnosis may induce rapid spread of the scabies mite, immediate diagnosis and treatment are necessary. We report two cases of scabies in elderly patients from different nursing homes. These patients were transferred to our center for treatment of pneumonia and chronic renal disease. They revealed pruritus and skin rashes after the treatment of further underlying diseases. We consulted to a dermatologist because of worsening symptoms, despite an application of medication with antihistamine and topical steroid, scabies was diagnosed. The symptom improved with topical 1% gamma-benzene hexachloride, an effective scabies drug. We suggest that geriatrists should suspect scabies who presents with pruritus that is persistent or resistant to conventional treatment, especially patients transferred from nursing homes.
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Anciano , Humanos , Enfermedad Crónica , Exantema , Sistema Inmunológico , Huésped Inmunocomprometido , Incidencia , Corea (Geográfico) , Hexaclorociclohexano , Personas con Discapacidades Mentales , Ácaros , Casas de Salud , Neumonía , Prurito , Insuficiencia Renal Crónica , EscabiosisRESUMEN
In periesophageal abscesses, the inflammatory reaction occurs on the surrounding esophagus and pus cavity formation accompanies complications of endoscopic procedures or esophageal perforation induced by sharp foreign bodies. Here, we report the treatment of a periesophageal abscess with endoscopic ultrasonography-guided incision and drainage, and broad-spectrum antibiotics. Follow-up endoscopy revealed no lesion other than the incision scar. We report a case of periesophageal abscess that was treated non-surgically and review the relevant literature.
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Absceso , Antibacterianos , Cicatriz , Drenaje , Endoscopía , Endosonografía , Perforación del Esófago , Esófago , Estudios de Seguimiento , Cuerpos Extraños , SupuraciónRESUMEN
Brunner's gland hyperplasia, also known as Brunner's gland adenoma, polypoid hamartoma, or Brunneroma, is a rare proliferative lesion arising from the Brunner's glands of the duodenum. These lesions have been described previously as benign, with no malignant potential. We report a case of Brunner's gland hyperplasia in the duodenum that was discovered incidentally during the endoscopic evaluation of anal bleeding. Histopathological examination of this Brunner's gland hyperplasia revealed well-marked, low-grade dysplasia. This case suggests a dysplastic stage with malignant potential in the natural history of Brunner's gland hyperplasia.
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Adenoma , Glándulas Duodenales , Duodeno , Hamartoma , Hemorragia , Hiperplasia , Historia NaturalRESUMEN
Bacterial meningitis is rarely complicated by an intradural spinal abscess, and recurrent meningitis is an uncommon presentation of a spinal intramedullary abscess. Here, we report a 63-year-old patient with recurrent meningitis as the first manifestation of an underlying spinal intramedullary abscess. To the best of our knowledge, no previous report has been issued on recurrent meningitis accompanied by a spinal intramedullary abscess in an adult. In this article, the pathophysiological mechanism of this uncommon entity is discussed and the relevant literature reviewed.
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Adulto , Humanos , Persona de Mediana Edad , Absceso , Meningitis , Meningitis BacterianasRESUMEN
Behcet disease is a multisystemic disorder characterized by a chronic relapsing triple symptom complex of recurrent oral ulceration, genital ulceration, and ocular inflammation. The onset of Behcet disease is rare in old age as is whole colon involvement. We recently saw a 78-year-old female patient examined to have intestinal Behcet disease with diffuse colon ulcers. She was admitted due to multiple oral ulcers, genital ulcers, low abdominal pain, and hematochezia. Colonoscopy showed multiple well-demarcated, large, deep, bleeding ulcers from the cecum into the descending colon. The patient was diagnosed with Behcet disease and treated with steroid, colchicine, and mesalazine. This paper describes a case of Behcet disease with unusual intestinal distribution.
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Anciano , Femenino , Humanos , Dolor Abdominal , Síndrome de Behçet , Ciego , Colchicina , Colon , Colon Descendente , Colonoscopía , Hemorragia Gastrointestinal , Hemorragia , Inflamación , Mesalamina , Úlceras Bucales , ÚlceraRESUMEN
A phytobezoar is the most common type of bezoar, which is a gastrointestinal mass composed of vegetable. A persimmon is a common cause of a phytobezoar. The majority of bezoars are found in the stomach, with the small intestine being the next most commonly involved site. The colon is a rare site for a bezoar. Recently, we experienced a colonic bezoar that caused colonic obstruction in a 66-year-old female patient who took persimmons regularly. The patient came to the hospital because of abdominal pain and distension. To differentiate a tumor or other problems that can cause intestinal obstruction, we performed an abdominal computed tomography scan and found an ovoid intraluminal mass with a mottled gas pattern in the distal descending colon. A large impacted bezoar was seen in the sigmoid colon, which was completely obstructed, and it was successfully removed by using colonoscopy.
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Anciano , Femenino , Humanos , Dolor Abdominal , Bezoares , Colon , Colon Descendente , Colon Sigmoide , Colonoscopía , Diospyros , Obstrucción Intestinal , Intestino Delgado , Porfirinas , Estómago , VerdurasRESUMEN
Hyperkalemic periodic paralysis is characterized by episodic flaccid paralysis of the skeletal muscles due to an increase in serum potassium concentrations. Primary hyperkalemic periodic paralysis is caused by point mutations in SCN4A, encoding a voltage-gated skeletal muscle sodium channel. However, hyperkalemia-related diseases, such as renal failure, adrenal insufficiency, hypoaldosteronism, and chronic diuretic use, can induce secondary hyperkalemic periodic paralysis. Diagnosis of this disease is based on clinical features, nerve conduction studies, and a DNA sequence analysis. In cases of diagnostic uncertainty, a provocation test can be used to ensure the correct diagnosis. Here, we report a case of secondary hyperkalemic periodic paralysis with hyperkalemia that was induced by diabetic nephropathy, and review the relevant literature.
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Insuficiencia Suprarrenal , Nefropatías Diabéticas , Sacarosa en la Dieta , Hiperpotasemia , Hipoaldosteronismo , Músculo Esquelético , Conducción Nerviosa , Parálisis , Parálisis Periódica Hiperpotasémica , Mutación Puntual , Potasio , Insuficiencia Renal , Análisis de Secuencia de ADN , Canales de Sodio , IncertidumbreRESUMEN
Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.
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Humanos , Dolor Abdominal , Absceso , Colon Descendente , Colonoscopía , Cuerpos Extraños , Tracto Gastrointestinal , Hemorragia , Dispositivos IntrauterinosRESUMEN
The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
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Anciano , Humanos , Pared Abdominal , Absceso , Fiebre , Gastrostomía , Ileus , Corea (Geográfico) , Apoyo NutricionalRESUMEN
OBJECTIVE: To study the acromial type, acromial angle, acromial tilt and subacromial distances which known as extrinsic factors of subacromial impingement syndrome in groups of subacromial impingement syndrome and normal control. METHOD: The radiography of shoulder named shoulder series composed of AP view, arch view and impingement view was performed in thirty patients with subacromial impingement syndrome and ninety persons with normal adult and we measured the acromial type, acromial angle, acromial tilt, subacromial distances and subacromial spur. RESULTS: Mean subacromial distances of impingement group were 11.3+/-2.4 mm in AP view, 11.1+/-2.5 mm in arch view and those of normal control group were 11.1+/-2.2 mm in AP view, 10.4+/-1.9 mm in arch view. Incidences of acromial type I,II,III in impingement group were 15 (50%), 10 (33.3%), 5 (16.7%) respectively and those in normal control group were 20 (22.2%), 46 (51.1%), 24 (26.7%) respectively. Incidence of subacromial spur was 19 (63.3%) in impingement group and 52 (57.8%) in normal control group. Mean subacromial spur size was 10.0+/-5.4 mm in impingement group and 12.4+/-4.5 mm in normal control group. Mean acromial angle was 27.1+/-8.3 degree in impingement group and 29.1+/-8.7 degree in normal control group. Mean acromial tilt was 28.0+/-6.39 degree in impingement group and 31.8+/-3.4 degree in normal control group. CONCLUSION: No significant statistical difference between subacromial impingement syndrome group and normal control group in acromial type, acromial angle, acromial tilt and subacromial distance known as extinsic factors of subacromial impingement syndrome.
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Adulto , Humanos , Incidencia , Radiografía , Hombro , Síndrome de Abducción Dolorosa del HombroRESUMEN
Toxic epidermal necrolysis(TEN) is a bullous disorder affecting mainly basal layers of epidermis by hypersensitive reaction. It is rarely reported in infants under six months of age. It can be developed by drug, infection, and vaccination, which makes it difficult to differentiate from staphylococcal scalded skin syndrome(SSSS) especially in early infancy. We report a case of TEN in a 6-week-old infant with short bowel syndrome receiving total parenteral nutrition. A male infant(birth weight 2,570gm at 37 weeks) whose mother had polyhydramnios with bilous vomiting at birth was evaluated. Barium and histologic study showed total aganglionosis. Surgical resection was performed at 3 days of life and subsequently short bowel syndrome developed. Total parenteral nutrition via central venous catheter was done due to feeding intolerance. Staphylococcus aureus was cultured from blood at 37days of life, and we administered vancomycin. As multiple scaly eruption and fever developed at 47days of life, we were suspicious of SSSS. Blood culture done at 47days of life revealed Pseudomonas aeruginosa and skin biopsy showed the split at dermoepidermal junction at light microcopy and confirmed the diagnosis of TEN. Despite discontinuation of antibiotics, the infant did not improve and died due to shock at 54days of life. We emphasized that in case of acute, severe exfoliative disease in early infancy, the diagnosis of TEN should be considered and that skin biopsy should be performed to make the correct diagnosis.