1.Rupture of a Superior Mesenteric Artery Pseudoaneurysm Presenting with Asymptomatic Anemia.
Joo Sung KIM ; U Ram JIN ; Gil Ho LEE ; SuHyun HWANG ; Yeonkyung LEE ; Kihyun LIM ; Sun Gyo LIM
Korean Journal of Medicine 2015;88(5):560-563
Anemia is a common cause of referrals to gastroenterologists. Only a small number of anemia cases result from vascular abnormalities. Visceral artery aneurysms and pseudoaneurysms are rare forms of vascular disease that have significant potential for rupture, resulting in potentially life-threatening hemorrhaging. We present the case of a 70-year-old female patient with a pseudoaneurysm of the superior mesenteric artery complicated with rupture, who had no abdominal pain and only anemia.
Abdominal Pain
;
Aged
;
Anemia*
;
Aneurysm
;
Aneurysm, False*
;
Arteries
;
Female
;
Humans
;
Mesenteric Artery, Superior*
;
Referral and Consultation
;
Rupture*
;
Vascular Diseases
2.Metformin induced acute pancreatitis and lactic acidosis in a patient on hemodialysis.
Yeon Kyung LEE ; Kihyun LIM ; Su Hyun HWANG ; Young Hwan AHN ; Gyu Tae SHIN ; Heungsoo KIM ; In Whee PARK
Yeungnam University Journal of Medicine 2016;33(1):33-36
Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.
Acidosis
;
Acidosis, Lactic*
;
Amylases
;
Diabetes Mellitus
;
Diabetic Nephropathies
;
Female
;
Humans
;
Hypertension
;
Insulin
;
Lactic Acid
;
Lipase
;
Metformin*
;
Middle Aged
;
Nausea
;
Pancreatitis*
;
Renal Dialysis*
;
Sitagliptin Phosphate
;
Vomiting
3.Delayed Diagnosis of Traumatic Ventricular Septal Defect in Penetrating Chest Injury: Small Evidence on Echocardiography Makes Big Difference.
Kihyun JEON ; Woo Hyun LIM ; Si Hyuck KANG ; Iksung CHO ; Kyung Hee KIM ; Hyung Kwan KIM ; Yong Jin KIM ; Dae Won SOHN
Journal of Cardiovascular Ultrasound 2010;18(1):28-30
Cardiac trauma from penetrating chest injury is a life-threatening condition. It was reported that < 10% of patients arrives at the emergency department alive. Penetrating chest injury can cause serious damage in more than 1 cardiac structure, including myocardial lacerations, ventricular septal defect (VSD), fistula between aorta and right cardiac chamber and valves. The presence of pericardial effusion (even a small amount) on the initial echocardiography might be the only clue to serious cardiac damage in the absence of definite evidence of anatomical defect in heart. We here present a case, in which clear diagnosis of VSD and pseudoaneurysmal formation was delayed a few days after penetrating chest injury due to the lack of anatomical evidence of damage.
Aneurysm, False
;
Aorta
;
Delayed Diagnosis
;
Echocardiography
;
Emergencies
;
Fistula
;
Heart
;
Heart Septal Defects, Ventricular
;
Humans
;
Lacerations
;
Pericardial Effusion
;
Thoracic Injuries
;
Thorax
4.A Case of Small Bowel Perforation Associated with Sclerosing Encapsulating Peritonitis in Patient with Intermittent Peritoneal Dialysis (IPD).
Dongmee LIM ; Wonmin HWANG ; Sehee YOON ; Wanho KIM ; Kihyun RYU ; Hyunyong SONG ; Sungro YUN ; Daesung YOON ; Dongjyn JUNG
Korean Journal of Nephrology 2004;23(6):1035-1039
Sclerosing ecapsulating peritonitis (SEP) first described by Gandhi and Humyn at 1980 is generally recognized, but uncommon complication of continous ambulatory peritoneal dialysis (CAPD) and the prognosis is very poor. A 62-year old female was admitted to our hospital with chief complaint of abdominal pain, nausea, vomiting. On physical examination, abdominal pain was not detected. Abdominal CT demonstrated paralytic ileus and adhesion in proximal ileum. She underwent adhesilolysis of ileum and repair of perforated ileum. We experienced one case of SEP presenting small bowel perforation and peritonitis in patient with IPD. We report this case with review of the literature.
Abdominal Pain
;
Female
;
Humans
;
Ileum
;
Intestinal Pseudo-Obstruction
;
Middle Aged
;
Nausea
;
Peritoneal Dialysis*
;
Peritonitis*
;
Physical Examination
;
Prognosis
;
Tomography, X-Ray Computed
;
Vomiting
5.Asymptomatic Right Coronary Artery-to-Pulmonary Artery Fistula Incidentally Detected by Transthoracic Echocardiography.
Woo Hyun LIM ; Si Hyuck KANG ; Kihyun JEON ; Iksung CHO ; Kyung Hee KIM ; Sung Wook HWANG ; Hyung Kwan KIM ; Dae Won SOHN
Journal of Cardiovascular Ultrasound 2009;17(3):106-109
In this case report, we describe a 71-year-old woman with right conal coronary artery-to-pulmonary trunk fistula. She visited the outpatient clinic of the nephrology department for long-term management of renal dysfunction. On transthoracic echocardiography (TTE) conducted as a part of cardiac evaluation, an abnormal Doppler color flow taking a course toward echocardiographic probe was incidentally detected outside the main pulmonary trunk, giving an impression of congenital coronary arteriovenous (AV) fistula. Computed tomography coronary angiography confirmed the presence of congenital coronary AV fistula from a conal branch of the right coronary artery to the main pulmonary trunk in the form of a ground cherry. Although the direction of Doppler color flow is not usual (i.e. toward, not away from, echocardiographic probe) in this case, congenital coronary AV fistula should be in the first priority among potential diagnoses when an abnormal Doppler color flow was found near the main pulmonary trunk on TTE.
Aged
;
Ambulatory Care Facilities
;
Arteries
;
Arteriovenous Fistula
;
Coronary Angiography
;
Coronary Vessel Anomalies
;
Coronary Vessels
;
Echocardiography
;
Female
;
Fistula
;
Humans
;
Nephrology
;
Physalis
6.A Case of Pediatric Nephrolithiasis Associated with Topiramate Treatment.
Kyung Taek HONG ; Hye Won RYU ; Kihyun DOO ; Jae So CHO ; Anna CHO ; Byung Chan LIM ; Jong Hee CHAE ; Ki Joong KIM ; Yong Seung HWANG ; Hee HWANG
Journal of the Korean Child Neurology Society 2010;18(1):112-116
Topiramate is an antiepileptic drug widely used to treat various seizures, mood disorders and migraine based on its various pharmacological mechanisms. Even though nephrolithiasis is listed as one of its side effects, there have been no cases reporting nephrolithiasis caused by use of topiramate on Korean pediatric patients. Since the use of topiramate is increasing in many patients, the possibility of nephrolithiasis after the treatment needs to be considered. Here, we report our experience in correcting neprholithiasis by simply discontinuing topiramate without administering any additional treatments.
Anticonvulsants
;
Fructose
;
Humans
;
Migraine Disorders
;
Mood Disorders
;
Nephrolithiasis
;
Seizures
7.Renal Artery Embolization in Patients with Polycystic Kidney Disease.
Kihyun LIM ; Joo Sung KIM ; Gil Ho LEE ; Je Hwan WON ; Gyu Tae SHIN ; Heungsoo KIM ; In Whee PARK
Korean Journal of Medicine 2015;88(4):453-458
Polycystic kidney disease (PCKD) is the most common life-threatening genetic disease that causes kidney failure worldwide. Patients with autosomal dominant PCKD notice an increase in abdominal size as the kidney cysts grow and present with gastrointestinal and pulmonary symptoms. Surgical therapy, percutaneous drainage, sclerotherapy, cyst decompression, and laparoscopic fenestration have been used to treat the symptoms, but the results are often unsatisfactory. We recruited five patients with PCKD. Each patient complained of severe abdominal discomfort, and had a poor quality of life. In these patients, we performed renal artery embolization. After the procedure, all of the patients were discharged without severe complications. Follow-up abdominal computed tomography was performed 3-6 months after the procedure, and we were able to confirm a reduction in the size of both kidneys. In addition, the clinical symptoms improved in all five patients.
Decompression
;
Drainage
;
Follow-Up Studies
;
Humans
;
Kidney
;
Polycystic Kidney Diseases*
;
Quality of Life
;
Renal Artery*
;
Renal Insufficiency
;
Sclerotherapy
8.A case of Fanconi syndrome accompanied by crystal depositions in tubular cells in a patient with multiple myeloma.
Do Hee KIM ; A Young LIM ; Hye Bin GWAG ; Ji Hyeon LEE ; Ki Sun JUNG ; Keol LEE ; Wooseong HUH ; Dae Joong KIM ; Yoon Goo KIM ; Ha Young OH ; Kihyun KIM ; Gee Young KWON ; Jung Eun LEE
Kidney Research and Clinical Practice 2014;33(2):112-115
Fanconi syndrome (FS) is a rare condition that is characterized by defects in the proximal tubular function. A 48-year-old woman was admitted for evaluation of proteinuria. The patient showed normal anion gap acidosis, normoglycemic glycosuria, hypophosphatemia, and hypouricemia. Thus, her condition was compatible with FS. The M peak was found behind the beta globulin region in urine protein electrophoresis. Upon bone marrow examination, we found that 24% of cells were CD138+ plasma cells with kappa restriction. From a kidney biopsy, we found crystalline inclusions within proximal tubular epithelial cells. Thereafter, she was diagnosed with FS accompanied by multiple myeloma. The patient received chemotherapy and autologous stem cell transplantation, and obtained very good partial hematologic response. However, proximal tubular dysfunction was persistent until 1 year after autologous stem cell transplantation. In short, we report a case of FS accompanied by multiple myeloma, demonstrating crystalline inclusion in proximal tubular cells on kidney biopsy.
Acid-Base Equilibrium
;
Acidosis
;
Beta-Globulins
;
Biopsy
;
Bone Marrow Examination
;
Crystallins
;
Drug Therapy
;
Electrophoresis
;
Epithelial Cells
;
Fanconi Syndrome*
;
Female
;
Glycosuria
;
Humans
;
Hypophosphatemia
;
Immunoglobulin kappa-Chains
;
Kidney
;
Middle Aged
;
Multiple Myeloma*
;
Plasma Cells
;
Proteinuria
;
Stem Cell Transplantation
9.Clinical features and outcomes of systemic amyloidosis with gastrointestinal involvement: a single-center experience.
A Young LIM ; Ji Hyeon LEE ; Ki Sun JUNG ; Hye Bin GWAG ; Do Hee KIM ; Seok Jin KIM ; Ga Yeon LEE ; Jung Sun KIM ; Hee Jin KIM ; Soo Youn LEE ; Jung Eun LEE ; Eun Seok JEON ; Kihyun KIM
The Korean Journal of Internal Medicine 2015;30(4):496-505
BACKGROUND/AIMS: The gastrointestinal (GI) tract often becomes involved in patients with systemic amyloidosis. As few GI amyloidosis data have been reported, we describe the clinical features and outcomes of patients with pathologically proven GI amyloidosis. METHODS: We identified 155 patients diagnosed with systemic amyloidosis between April 1995 and April 2013. Twenty-four patients (15.5%) were diagnosed with GI amyloidosis using associated symptoms, and the diagnoses were confirmed by direct biopsy. RESULTS: Among the 24 patients, 20 (83.3%) had amyloidosis light chain (AL), three (12.5%) had amyloid A, and one (4.2%) had transthyretin-related type amyloidosis. Their median age was 57 years (range, 37 to 72), and 10 patients were female (41.7%). The most common symptoms of GI amyloidosis were diarrhea (11 patients, 45.8%), followed by anorexia (nine patients, 37.5%), weight loss, and nausea and/or vomiting (seven patients, 29.2%). The histologically confirmed GI tract site in AL amyloidosis was the stomach in 11 patients (55.0%), the colon in nine (45.0%), the rectum in seven (35.0%), and the small bowel in one (5.0%). Patients with GI involvement had a greater frequency of organ involvement (p = 0.014). Median overall survival (OS) in patients with GI involvement was shorter (7.95 months; range, 0.3 to 40.54) than in those without GI involvement (15.84 months; range, 0.0 to 114.53; p = 0.069) in a univariate analysis. A multivariate analysis of prognostic factors for AL amyloidosis revealed that GI involvement was not a significant predictor of OS (p = 0.447). CONCLUSIONS: The prognosis of patients with AL amyloidosis and GI involvement was poorer than those without GI involvement, and they presented with more organ involvement and more advanced disease than those without organ involvement.
Adult
;
Aged
;
Amyloid Neuropathies, Familial/*diagnosis/immunology/mortality/pathology/therapy
;
Biomarkers/analysis
;
Biopsy
;
Female
;
Gastrointestinal Diseases/*diagnosis/immunology/mortality/pathology/therapy
;
Gastrointestinal Tract/immunology/*pathology
;
Humans
;
Immunoglobulin Heavy Chains/analysis
;
Immunoglobulin Light Chains/analysis
;
Kaplan-Meier Estimate
;
Male
;
Middle Aged
;
Multivariate Analysis
;
Predictive Value of Tests
;
Prognosis
;
Proportional Hazards Models
;
Republic of Korea
;
Retrospective Studies
;
Risk Factors
;
Serum Amyloid A Protein/analysis
;
Time Factors
10.Pulmonary Complications After Hematopoietic Stem Cell Transplantation.
Do Hyoung LIM ; Jeeyun LEE ; Hong Ghi LEE ; Byeong Bae PARK ; Kyong Ran PECK ; Won Sup OH ; Sang Hoon JI ; Se Hoon LEE ; Joon Oh PARK ; Kihyun KIM ; Won Seog KIM ; Chul Won JUNG ; Young Suk PARK ; Young Hyuck IM ; Won Ki KANG ; Keunchil PARK
Journal of Korean Medical Science 2006;21(3):406-411
Despite advanced effective prophylaxes, pulmonary complications still occur in a high proportion of all hematopoietic stem cell recipients, accounting for considerable morbidity and mortality. The aim of our study was to describe the causes, incidences and mortality rates secondary to pulmonary complications and risk factors of such complications following hematopoietic stem cell transplantation (HSCT). We reviewed the medical records of 287 patients who underwent either autologous or allogeneic HSCT for hematologic disorders from February 1996 to October 2003 at Samsung Medical Center (134 autografts, 153 allografts). The timing of pulmonary complications was divided into pre-engraftment, early and late period. The spectrum of pulmonary complications included infectious and non-infectious conditions. 73 of the 287 patients (25.4%) developed pulmonary complications. Among these patients, 40 (54.8%) and 29 (39.7%) had infectious and non-infectious conditions, respectively. The overall mortality rate from pulmonary complications was 28.8%. Allogeneic transplant, grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were the risk factors with statistical significance for pulmonary complications after HSCT. The mortality rates from pulmonary complications following HSCT were high, especially those of viral and fungal pneumonia, diffuse alveolar hemorrhage and idiopathic pneumonia syndrome.
Transplantation, Homologous
;
Transplantation, Autologous
;
Transplantation Conditioning
;
Middle Aged
;
Male
;
Lung Diseases/*etiology
;
Lung/microbiology
;
Humans
;
Hematopoietic Stem Cell Transplantation/*adverse effects
;
Graft vs Host Disease
;
Female
;
Bacterial Infections/etiology
;
Aged
;
Adult
;
Adolescent