Pulmonary embolism (PE) is a serious clinical problem in patients with acquired risk factor such as cancer, immobilization, recent trauma and surgery. However PE may occur in hereditary thrombophilia like protein S deficiency which is caused by PROS1 gene mutation. The author reports a case of pulmonary embolism in a 33-year-old man with protein S deficiency and PROS1 gene mutation. Genetic analysis of the patient showed mutation 1063C→T in exon 10 of PROS1 gene, resulting in a substitution of arginine by cystine at position 355 (R355C).
Adult ; Arginine ; Cystine ; Exons ; Humans ; Immobilization ; Protein S Deficiency ; Pulmonary Embolism* ; Risk Factors ; Thrombophilia

Although intraosseous ganglion of the carpal bones is an uncommon lesion, it can be a cause of chronic wrist pain. Especially, pathologic fracture as complication of idiopathic intraosseous ganglion of the lunate is extremely rare. We report a rare case of idiopathic intraosseous ganglion with pathologic fracture of the lunate that was successfully treated by curettage and autogenous cancellous bone graft.
Bone Cysts* ; Carpal Bones ; Curettage ; Fractures, Spontaneous* ; Transplants ; Wrist

A 58-year-old male patient was admitted with the weakness feeling of right upper extremity. The patient, who had been done the replacement of prosthetic mitral and aortic valves 17 years ago, is taking a warfarin to prevent the systemic thromboembolism. On admission, laboratory tests revealed that the prothrombin time international normalized ratio (PT INR) was abnormal as 6.21, serum creatinine level increased to 10.46 mg/dL. The renal biopsy was performed to find the cause of Acute Kidney Injury (AKI). Biopsy Specimens showed the evidence of acute tubular injury and glomerular hemorrhage: red blood cells (RBCs) in Bowman space and numerous occlusive RBC casts in tubules. We experience a case of AKI as a result of the inappropriate warfarin monitoring, which is developed by the glomerular hemorrhage and renal tubular obstruction through RBC casts. We suggest that patients with warfarin therapy need to monitor the kidney function and blood coagulation indicators carefully.
Acute Kidney Injury* ; Anticoagulants ; Aortic Valve ; Biopsy ; Blood Coagulation ; Creatinine ; Erythrocytes ; Heart Valves* ; Heart* ; Hemorrhage ; Humans ; International Normalized Ratio ; Kidney ; Male ; Middle Aged ; Prothrombin Time ; Thromboembolism ; Upper Extremity ; Warfarin*

To introduce a case of Centeral Retinal Artery Occlusion in Gas Tamponade State after Viterctomy for the treatment of Retinal Detachment. A 47-year-old male patient with histories of LASEK surgery 15 years ago and cataract surgery 8 years ago visited our clinic with complaints of sudden visual disturbance in his right eye. He was diagnosed as regmatgenous retinal detachment and underwent pars plana vitrectomy, endolaser photocoagulation, 14% C3F8 gas tamponade, and subtenon triamcinolone injection. After the surgery, the retina was well attached and the visual acuity was improved from finger count 30cm at post-operative day 1 to 0.08 after the 2 weeks of surgery. Intraocular pressure was maintained 20~25 mmHg by Brimonidine/timolol eye drop treatment. The best corrected visual acuity was reduced to hand motion at post-operative day 15. Retinal arteriol attenuation and pale optic disc with 1/3 gas filled vitreous cavity was identified at post-operative day 30. Post-operative 2 years, visual acuity was non light perception with severe narrowing of arteriole and diffuse retinal pigment epithelial atrophy; no retinal vascular flow was observed on fluorescein angiography. Gas tamponade state after viterctomy for the treatment of retinal detachment at high myopia may be risk factors of central retinal artery occlusion.
Arterioles ; Atrophy ; Cataract ; Fingers ; Fluorescein Angiography ; Hand ; Humans ; Intraocular Pressure ; Keratectomy, Subepithelial, Laser-Assisted ; Light Coagulation ; Male ; Middle Aged ; Myopia ; Retina ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinal Detachment* ; Retinaldehyde* ; Risk Factors ; Triamcinolone ; Visual Acuity ; Vitrectomy

Aspergillosis of the central nervous system from sinonasal origin is rare in immunocompetent hosts. Due to the rarity of the cases in immunocompetent hosts, only few cases are reported in the previous literature. But, some cases reported diversity of clinical presentations in immunocompetent hosts. Aspergillosis of the central nervous system from sinonasal origin, bony invasion with only orbit or cranial base was more common than intracerebral aspergillosis in immunocompetent hosts. In this type of disease, although maxillary sinus is more commonly involved, sphenoid sinus and clivus are unusual sites for aspergillosis of central nervous system. Because of the anatomical position of sphenoid sinus, it is associated with poor prognosis with intracranial extension. We reported a case of the aspergillosis of central nervous system involving clivus in the immunocompetent host who was misdiagnosed as metastatic tumor or plasmacytoma due to the unusual location and host factor.
Aspergillosis* ; Brain Neoplasms ; Central Nervous System* ; Cranial Fossa, Posterior ; Immunocompetence ; Maxillary Sinus ; Neuroaspergillosis ; Orbit ; Plasmacytoma ; Prognosis ; Skull Base ; Sphenoid Sinus

Endobronchial hemorrhage is common complication of bronchoscopic biopsy. There are several hemostatic methods including cold saline irrigation, topical vasoactive substance instillation, tranexamic acid treatment, and balloon tamponade. Insertion of balloon catheter into bronchoscopic working channel is relatively simple and useful method for the selective hemostasis. Here, we report a case of 75-year-old female patient who had hemorrhage during endobronchial biopsy with flexible bronchoscopy. Since primary treatments such as cold saline irrigation and epinephrine instillation had been failed to stop hemorrhage, balloon catheter was immediately inserted into the bleeding site for temporal hemostasis. And then, bronchial artery embolization was followed for the additional treatment of hemorrhage. We suggest to use balloon catheter as a bridge therapy before bronchial artery embolization.
Aged ; Balloon Occlusion* ; Biopsy ; Bronchial Arteries* ; Bronchoscopy ; Catheters ; Epinephrine ; Female ; Hemorrhage* ; Hemostasis ; Humans ; Tranexamic Acid

Hypereosinophilic syndrome (HES) is defined as peripheral eosinophilia, organ involvement of eosinophils and exclusion of other disorders or dysfunction. HES is subclassified as myeloproliferative variant, T-lymphocytic, overlap, idiopathic, familial and associated type according to the new classification using molecular and immunologic markers. HES presenting with gastrointestinal symptoms is very rare but characterized by peripheral eosinophilia, eosinophilic infiltration of the gastrointestinal tract with other organs such as liver and bone marrow. We report a rare case of idiopathic HES in 18-year-old adolescent who presented with gastrointestinal symptoms including abdominal pain, diarrhea and ascites which resolved rapidly with corticosteroid therapy. HES should be included in the differential diagnosis of abdominal pain and ascites in children and adolescents.
Abdominal Pain ; Adolescent* ; Ascites ; Biomarkers ; Bone Marrow ; Child ; Classification ; Diagnosis, Differential ; Diarrhea ; Eosinophilia ; Eosinophils ; Gastrointestinal Tract ; Humans ; Hypereosinophilic Syndrome* ; Liver

The Bronchial fistula is caused by infection, malignancy, trauma, inflammatory disease and foreign body. The bronchonodal fistula by endobronchial tuberculois is very rare complication. The authors present a 70-year-old man presented with hoarseness and sore throat. This patient diagnosed with endobronchial tuberculosis, which was complicated by bronchonodal fistula by sputum acid fast bacilli stain, bronchoscopy, and chest computed tomography. The patient was treated with antituberculosis therapy for 1 year, and follow up bronchoscopy and radiologic study showed regression of bronchonodal fistula.
Aged ; Bronchial Fistula ; Bronchoscopy ; Fistula* ; Follow-Up Studies ; Foreign Bodies ; Hoarseness ; Humans ; Pharyngitis ; Sputum ; Thorax ; Tuberculosis*

Distal renal tubular acidosis (RTA) caused by autoimmune nephritis occurs in up to 25% of patients with Sjögren's syndrome. However, patients with hypokalemic paralysis are sometimes overlooked, because most symptoms of autoimmune nephritis in Sjögren's syndrome are mild. We present a case of hypokalemic paralysis in a 54-year-old female who also had dry eyes and mouth, and Raynaud's phenomenon. Further evaluation, including autoantibody tests, revealed distal RTA with Sjögren's syndrome as the cause of hypokalemia. Distal RTA diagnosis was made based on normal anion gap hyperchloremic metabolic acidosis, alkaline urine with positive urine anion gap, high transtubular potassium concentration gradient (TTKG), positive anti-La antibody, and symptoms of sicca complex. The patient's symptoms resolved following treatment with intravenous and oral potassium, immunosuppressants, and steroids. This case illustrates that distal RTA and Sjögren's syndrome should be considered in cases of hypokalemic paralysis.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Renal Tubular* ; Diagnosis ; Female ; Humans ; Hypokalemia ; Immunosuppressive Agents ; Middle Aged ; Mouth ; Nephritis ; Paralysis* ; Potassium ; Steroids

No abstract available.