Chronic Pancreatitis Associated with Liver Infarction and Inferior Pancreaticoduodenal Artery Pseudoaneurysm / 대한췌담도학회지

Liver infarction is rare because of dual blood supply of the liver with hepatic artery and portal vein. And its occurrence as a complication of chronic pancreatitis is rarer. We present a case of chronic pancreatitis complicated by liver infarction and inferior pancreaticoduodenal artery pseudoaneurysm. A 31-year-old female with alcoholism presented with severe acute epigastric pain. Serum amylase and lipase were 203 IU/L and 78 IU/L, respectively. Initial computed tomography (CT) scan showed peripancreatic infiltration, fluid collection, right portal vein thrombosis, and a large wedge-shaped low attenuation in the right hepatic lobe. The patient has been treated with heparin. Follow-up CT scan done after 4 days of heparin treatment demonstrated a pseudocyst with internal hemorrhage and a pseudoaneurysm. Angiography revealed a pseudoaneurysm in inferior pancreaticoduodenal artery. Coil embolization of the artery was done. The patient has been discharged without complication. Follow-up CT scan showed resolution of liver infarction, portal vein thrombosis and pseudoaneurysm.

Chronic Pancreatitis Associated with Liver Infarction and Inferior Pancreaticoduodenal Artery Pseudoaneurysm / 대한췌담도학회지

Liver infarction is rare because of dual blood supply of the liver with hepatic artery and portal vein. And its occurrence as a complication of chronic pancreatitis is rarer. We present a case of chronic pancreatitis complicated by liver infarction and inferior pancreaticoduodenal artery pseudoaneurysm. A 31-year-old female with alcoholism presented with severe acute epigastric pain. Serum amylase and lipase were 203 IU/L and 78 IU/L, respectively. Initial computed tomography (CT) scan showed peripancreatic infiltration, fluid collection, right portal vein thrombosis, and a large wedge-shaped low attenuation in the right hepatic lobe. The patient has been treated with heparin. Follow-up CT scan done after 4 days of heparin treatment demonstrated a pseudocyst with internal hemorrhage and a pseudoaneurysm. Angiography revealed a pseudoaneurysm in inferior pancreaticoduodenal artery. Coil embolization of the artery was done. The patient has been discharged without complication. Follow-up CT scan showed resolution of liver infarction, portal vein thrombosis and pseudoaneurysm.

Analysis of risk factor and clinical characteristics of angiodysplasia presenting as upper gastrointestinal bleeding

BACKGROUND/AIMS: Angiodysplasia is important in the differential diagnosis of upper gastrointestinal bleeding (UGIB), but the clinical features and outcomes associated with UGIB from angiodysplasia have not been characterized. We aimed to analyze the clinical characteristics and outcomes of angiodysplasia presented as UGIB. METHODS: Between January 2004 and December 2013, a consecutive series of patients admitted with UGIB were retrospectively analyzed. Thirty-five patients with bleeding from angiodysplasia were enrolled. We compared them with an asymptomatic control group (incidental finding of angiodysplasia in health screening, n = 58) and bleeding control group (simultaneous finding of angiodysplasia and peptic ulcer bleeding, n = 28). RESULTS: When patients with UGIB from angiodysplasia were compared with the asymptomatic control group, more frequent rates of nonantral location and large sized lesion (≥ 1 cm) were evident in multivariate analysis. When these patients were compared with the bleeding control group, they were older (mean age: 67.94 ± 9.16 years vs.55.07 ± 13.29 years, p = 0.03) and received less transfusions (p = 0.03). They also had more frequent rate of recurrence (40.0% vs. 20.7%, p = 0.02). CONCLUSIONS: Non-antral location and large lesions (≥ 1 cm) could be risk factors of UGIB of angiodysplasia. UGIB due to angiodysplasia was more common in older patients. Transfusion requirement would be less and a tendency of clinical recurrence might be apparent.

HIV-Infected Patients with Osteoporotic Fractures: A Case Report and Review of the Literature / 대한내과학회지

The average life expectancy of human immunodeficiency virus (HIV)-infected patients has improved dramatically following the advent of highly active anti-retroviral therapy. However, this increased life expectancy has led to a greater incidence of non-acquired immune deficiency syndrome related diseases, including cardiovascular diseases and other malignancies. Increased bone fragility is also a significant concern, with the incidence of osteoporosis and osteoporotic fractures 3- and 2-times more likely, respectively, among HIV-infected patients. Bone mineral density screenings for osteoporosis will therefore become more important as the HIV-infected population ages. Here, we describe six cases of osteoporotic fractures in HIV-infected patients in Korea.

Pulmonary Cryptococcosis That Mimicked Rheumatoid Nodule in Rheumatoid Arthritis Lesion / 결핵및호흡기질환

Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules (2.5x2.1x2 cm) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoracic computed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.

A Case of Early Esophageal Cancer Treated by Photodynamic Therapy in a Patient with Liver Cirrhosis Accompanied by Esophageal Varix / 대한소화기내시경학회지

Photodynamic therapy (PDT) is a non-invasive treatment for cancer that works through a photochemical effect after the administration of a photosensitizer. At first, PDT had been used for the relief of obstructive symptoms caused by exophytic esophageal cancer or for control of tumor overgrowth. Recently, several investigators have reported the use of PDT in early esophageal cancer with encouraging results. This report describes a case of a 52-year-old man with early esophageal cancer, who had a long history of liver cirrhosis with esophageal varix. The patient was treated successfully with PDT using porfimer sodium as the photosensitizer. PDT is an alternative to surgical treatment of early esophageal cancer, especially in patients with liver cirrhosis.

A Case of Ankylosing Spondylitis Accompanied by Chronic Myelogenous Leukemia / 대한류마티스학회지

Ankylosing spondylitis (AS) is occasionally accompanied by hematological malignancies such as myelodysplastic syndrome, acute myelogenous leukemia, or multiple myeloma. Chronic myelogenous leukemia (CML) is a myeloproliferative disorder associated with Philadelphia chromosome and is usually treated with imatinib, which inhibits tyrosine kinases. Although there have been reports of CML cases accompanied by several rheumatic diseases such as rheumatoid arthritis, Behcet's disease, systemic sclerosis, or undifferentiated spondylopathy, no studies have reported a case of CML with AS. We experienced a 50-year-old male patient who presented with buttock and low back pain and was diagnosed with both AS and CML. Magnetic resonance imaging showed sacroiliitis along with abnormal marrow infiltration, and a bone marrow biopsy confirmed the CML diagnosis. He was treated with imatinib, which was effective for the CML but not for the AS. This is the first case report of AS accompanied by CML.

A Case of Post-transplant Lymphoproliferative Disorder Manifested as Native Kidney Mass / 대한신장학회지

Post-transplant lymphoproliferative disorder (PTLD) following solid organ transplantation is an important form of post-transplant malignancy. PTLD is typically associated with Epstein-Barr virus (EBV) and occurs in the setting of immunosuppression resulting in a deficiency of EBV-specific cytotoxic T lymphocytes. PTLD encompasses heterogeneous lymphoproliferative diseases, from polyclonal proliferation resembling infectious mononucleosis to aggressive monomorphic proliferation such as diffuse large B-cell lymphoma. Clinically, PTLD is usually manifested as lymph nodal mass or extranodal mass of solid organs such as liver, transplanted kidney, tonsil, bone marrow or spleen. The authors experienced very rare case of PTLD manifested as a single mass in a native kidney. According to a review of the literature, this is a rare case of PTLD which developed in a native kidney after kidney transplantation. Initially under the impression of renal cell carcinoma, unilateral nephrectomy of the native kidney had performed, and after confirmed as PTLD by histologic diagnosis the patient had treated with reduction of immunosuppressants and chemotheraphy for PTLD, and eventually has got in complete remission.

A Case of Bilateral Emphysematous Pyelitis in a Diabetic End-stage Renal Disease Patient Undergoing Peritoneal Dialysis Therapy / 대한신장학회지

Emphysematous pyelitis is uniquely characterized by gas-forming infection restricted to the renal collecting system. This disease entity is uncommon, and shows preferred occurrence in patients with diabetes mellitus or urinary tract obstruction. We report a case of bilateral emphysematous pyelitis in a diabetic end-stage renal disease patient undergoing peritoneal dialysis therapy. The patient was treated by medical treatment only and then recovered from infection, and she has maintained peritoneal dialysis until today. The authors report this case as a successful medical treatment for emphysematous pyelitis accompanying multiple risk factors, such as diabetes mellitus, amorphous medullary kidney stones, and even underlying maintaining peritoneal dialysis.

A Case of Intramural Duodenal Hematoma after the Use of the Endoscopic Epinephrine Injection Method for Duodenal Ulcer Bleeding in a Chronic Renal Failure Patient undergoing Maintenance Hemodialysis / 대한소화기내시경학회지

An intramural duodenal hematoma has been mostly reported as a consequence of trauma. It can also result from a hematological disorder, anticoagulant drug use and a post-therapeutic endoscopic procedure. Common symptoms of patients with an intramural duodenal hematoma are vomiting and abdominal pain. An intramural duodenal hematoma is rarely accompanied with pancreatitis and cholangitis due to intestinal obstruction. A diagnosis is made by esophagogastroduodenoscopy and the use of an abdominal CT scan. An intramural duodenal hematoma is mainly treated with conservative therapy but it may sometimes be treated with a surgical procedure. We report one case of an intramural duodenal hematoma after performing a therapeutic endoscopic procedure in a chronic renal failure patient undergoing maintenance hemodialysis.