Tumour-induced hypoglycemia is usually caused by insulinoma or non-islet-cell neoplasm, such as hemangiopericytoma, fibrosarcoma, mesotheliomas. Most of the neoplasms in non-islet-cell tumour-induced hypoglycemia are mesenchymal type, and have a common features, including large-sized, slow-growing and metastatic involvement of the liver. The mechanisms of hypoglycemia in metastatic liver disease are not clearly defined, and liver failure secondary to hepatic metastasis or insulin or insulin-like mediated process are considered. Glucagon stimulation test has been used to distinguish between insulin-mediated or insulin-like-mediated hypoglycemia and hypoglycemia induced by liver failure. We experinced a case of hypoglycemia in a patient of hemangiopericytoma with liver metastasis in which glucagon stimulation test was used for proper evaluation. We compare this case with previously reported cases, and present here with brief review of literatures.
Fibrosarcoma ; Glucagon ; Hemangiopericytoma* ; Humans ; Hypoglycemia* ; Insulin ; Insulinoma ; Liver ; Liver Diseases ; Liver Failure ; Mesothelioma ; Neoplasm Metastasis*

Pseudopolyp is a common association of ulcerative colitis but may also occur in Crohn's disease, ischemic colitis and infective colitis. Pseudopolyps are results of the repair process, representing islands of granulation tissue surrounded by mucosa with ulceation. When a pseudopolyp is larger than 1.5 cm, it is often called a "giant pseudopolyp". Such lesions of inflammatory origin are often confused with polypoid carcinoma or infiltrating submucosal malignancy. We report a case of asymptomatic Crohn's disease as giant pseudopolyposis mimicking malignancy on sigmoid colon, with a review of relevant literatures.
Colitis ; Colitis, Ischemic ; Colitis, Ulcerative ; Colon, Sigmoid ; Crohn Disease* ; Fistula* ; Granulation Tissue ; Islands ; Mucous Membrane

Autoimmune hepatitis in children is a rare and severe inflammatory disease of unknown etiology, and progress to cirrohosis and liver failure, generally is responsive to immunosuppressive therapy. It is more prevalent in women than men, and characterized by the presence of circulating autoantibodies, a high serum globulin. Extrahepatic manifestations such as thyroiditis, ulcerative colitis, glomerulonephritis and autoimmune hemolytic anemia, are associated. We report, to our knowledge, the first case of autoimmune hepatitis in conjunction with choledochal cyst and pancreatitis in 11-year-old female patient. At the time of diagnosis, she suffered from acute upper abdominal pain, jaundice, and pallor. Laboratory findings showed Cooms positive hemolytic anemia, hypergammaglobulinemia, hyperbilirubinemia, and high serum transaminases. Antinuclear antibody was of homogeneous type. In liver biopsy, cellular infiltrates largely lymphocytes were noted. Treatment with corticosteroids induced clinical, biochemical remission, but subsequent withdrawal leaded to relapse. Incidentally choledochal cyst were found and then acute pancreatitis developed. After management for acute pancreatitis, surgical resection of cyst with hepatojejunostomy was performed.
Abdominal Pain ; Adrenal Cortex Hormones ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Antibodies, Antinuclear ; Autoantibodies ; Biopsy ; Child ; Choledochal Cyst* ; Colitis, Ulcerative ; Diagnosis ; Female ; Glomerulonephritis ; Hepatitis, Autoimmune* ; Humans ; Hyperbilirubinemia ; Hypergammaglobulinemia ; Jaundice ; Liver ; Liver Failure ; Lymphocytes ; Male ; Pallor ; Pancreatitis* ; Recurrence ; Thyroid Gland ; Thyroiditis ; Transaminases

PURPOSE: This study was designed to explore the perceptions of quality nursing care among nurses. METHOD: The data were analyzed using content analysis. The data were collected from 19 nurses who worked at diverse clinical areas in 8 general and university hospitals with over 400 beds. RESULT: 1. The attributes of quality nursing care were categorized into 7 hierarchies in the order of 'caring' (40.65%), 'specialty' (29.03%), 'nurse attainments' (15.48%), 'patient- centered nursing management' (6.45%), 'sincerity' (5.16%), 'kindness' (2.58%), 'satisfaction' (0.65%). 2. The concept of quality nursing care were defined as 'giving a satisfaction both to patients and nurses through patient-centered nursing management with specialty and caring in the ground of the kindness and sincerity'. CONCLUSION: Based on there findings, we suggest that the study results should be used for development of a quality assurance tool in nursing practice, patient care in hospital setting, education of nurses and nursing students. In addition, further repeated studies need to be conducted.
Education ; Hospitals, University ; Humans ; Nursing Care* ; Nursing* ; Patient Care ; Patient-Centered Care ; Students, Nursing

The potential hepatotoxicity of herbal remedies and/or health foods is usually ignored in daily life. There have been cases showing the toxic hepatitis and renal failure associated with the ingestion of raw carp bile. We experienced a case of toxic hepatitis without any evidence of renal failure that was associated with carp juice ingestion. The clinical manifestations were characterized by nausea and vomiting after the ingestion of carp juice for 3 months. The diagnosis of toxic hepatitis was made on the basis of the patient's history, laboratory data, RUCAM (Russel Uclaf Causality Assessment) and the results of ultrasonography guided liver biopsy. The patient showed rapid improvement after instituting supportive therapy.
Male ; Korea ; Humans ; Hepatitis, Toxic/*etiology ; *Carps ; *Bile ; Animals ; Adult

The term MYH9-related disorders indicates a group of autosomal dominant illnesses, formerly known as May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome and Epstein syndrome, caused by mutations of MYH9, the gene encoding for the heavy chain of non-muscle myosin IIA (NMMHC-IIA). We experienced a family with macrothrombocytopenia without leukocyte inclusion. A 5-year-old girl was found to have macrothrombocytopenia incidentally. Her father also had macrothromtocytopenia, but had been suffering from hearing loss and chronic renal failure. Meticulous search by light and electron microscopy failed to detect leukocyte inclusions. To our knowledge, these cases seem to be the first description of autosomal dominant Epstein giant platelet syndrome in Korea.
Bernard-Soulier Syndrome* ; Child, Preschool ; Fathers ; Female ; Hearing Loss ; Humans ; Kidney Failure, Chronic ; Korea ; Leukocytes ; Microscopy, Electron ; Nonmuscle Myosin Type IIA

Isolated relapse of myeloid leukemia as a granulocytic sarcoma(GS) following allogeneic bone marrow transplantation(BMT) is very rare manifestation, and usually associated with a poor prognosis. We report a case of isolated intracranial GS in an infant with myelodysplastic syndrome(MDS) following unrelated BMT. A 7 month-old girl was diagnosed with refractory anemia with excess blasts (RAEB). During observation for a couple months several GS developed in the scalp and blast counts in BM increased. Induction chemotherapy resulted in partial remission of BM but GS disappeared. Four months after diagnosis, an unrelated BMT was undertaken. Engraftment was uneventful. On D+160, an intracranial GS of 6.5 cm in size developed. A craniotomy and tumor removal was done. There was no evidence of relapse in BM with complete chimerism. Reinduction chemotherapy using IDA-FLAG resulted in profound neutropenia with pneumonia. She succumbed to respiratory failure despite leukocyte recovery. The optimal management for isolated relapse as GS following BMT should be established.
Infant ; Male ; Female ; Humans ; Bone Marrow Transplantation

Mycobacterium fortuitum is a rare pathogen, frequently found in water, soil, animals and plant materials. It can cause infections involving skin, soft tissue and skeletal system after direct inoculation of the pathogen through surgical traumas, punctures and injections. We report a case of infrapatellar bursitis caused by M. fortuitum in an immunocompetent, 42-year-old female, which occurred after bicycle trauma. She experienced marked improvement after surgical excision and debridement of the wound site and antimicrobial therapy.
Adult ; Animals ; Bursitis ; Debridement ; Female ; Humans ; Mycobacterium ; Mycobacterium fortuitum ; Plants ; Punctures ; Skin ; Soil

Mycobacterium fortuitum is a rare pathogen, frequently found in water, soil, animals and plant materials. It can cause infections involving skin, soft tissue and skeletal system after direct inoculation of the pathogen through surgical traumas, punctures and injections. We report a case of infrapatellar bursitis caused by M. fortuitum in an immunocompetent, 42-year-old female, which occurred after bicycle trauma. She experienced marked improvement after surgical excision and debridement of the wound site and antimicrobial therapy.
Adult ; Animals ; Bursitis ; Debridement ; Female ; Humans ; Mycobacterium ; Mycobacterium fortuitum ; Plants ; Punctures ; Skin ; Soil

BACKGROUND: Diamond Blackfan anemia (DBA), characterized by impaired red cell production, is a rare condition that is usually symptomatic in early infancy. The purpose of this study was to assess nationwide experiences of DBA encountered over a period of 20 years. METHODS: The medical records of 56 patients diagnosed with DBA were retrospectively reviewed from November 1984 to July 2010. Fifteen institutions, including 13 university hospitals, participated in this study. RESULTS: The male-to-female ratio of patients with DBA was 1.67:1. The median age of diagnosis was 4 months, and 74.1% were diagnosed before 1 year of age. From 2000 to 2009, annual incidence was 6.6 cases per million. Excluding growth retardation, 38.2% showed congenital defects: thumb deformities, ptosis, coarctation of aorta, ventricular septal defect, strabismus, etc. The mean hemoglobin concentration was 5.1+/-1.9 g/dL, mean corpuscular volume was 93.4+/-11.6 fL, and mean number of reticulocytes was 19,700/mm3. The mean cellularity of bone marrow was 75%, with myeloid:erythroid ratio of 20.4:1. After remission, 48.9% of patients did not need further steroids. Five patients with DBA who received hematopoietic transplantation have survived. Cancer developed in 2 cases (3.6%). CONCLUSION: The incidence of DBA is similar to data already published, but our study had a male predilection. Although all patients responded to initial treatment with steroids, about half needed further steroids after remission. It is necessary to collect further data, including information regarding management pathways, from nationwide DBA registries, along with data on molecular analyses.
Anemia ; Anemia, Diamond-Blackfan ; Aortic Coarctation ; Bone Marrow ; Congenital Abnormalities ; Diamond ; Erythrocyte Indices ; Heart Septal Defects, Ventricular ; Hemoglobins ; Hospitals, University ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Registries ; Reticulocytes ; Retrospective Studies ; Steroids ; Strabismus ; Thumb ; Transplants