BACKGROUND: We have studied the 67Ga SPECT to determine the activity of pulmonary tuberculosis, especially in patients with minimal extent of the disease on chest radiographs. Because active minimal pulmonary tuberculosis is sometimes difficult to diagnose by means of initial chest X-ray, sputum examination and 67Ga planar imaging, we compared 67Ga planar imaging with SPECT to evaluate minimal pulmonary tuberculosis activity. METHODS: 67Ga planar imagings and SPECTs of 69 patients suspected of minimal pulmonary tuberculosis by the initial chest X-ray were performed and compared to each other. Active pulmonary tuberculosis was defined by a positive AFB smear and/or culture in the sputum and changes shown on the serial chest X-ray findings. RESULTS: 1)67Ga planar imaging imagings showed positive uptakes in 24 patients and no uptakes in 13 patients, which confirms active pulmonary tuberculosis. But SPECT imagings showed positive uptakes in 25 patients and no uptakes in 12 patients. 2) Patients confirmed with inactive pulmonary tuberculosis showed no up-take on 67Ga planar imaging. Only one of the 32 patients confirmed as having inactive pulmonary tuberculosis showed positive uptake on 67Ga SPECT imaging. CONCLUSIONS: According to the results of our study, 67Ga planar imaging and SPECT are both sensitive in detecting the activity of minimal pulmonary tuberculosis. The difference between the two methods is not statistically significant, and the negative predictive value of the 67Ga SPECT is not higher than that of 67Ga planar imaging.
Humans ; Radiography, Thoracic ; Sputum ; Thorax ; Tomography, Emission-Computed, Single-Photon* ; Tuberculosis, Pulmonary*

Gastropleural fistula is a very rare disorder, caused by various conditions, such as trauma and postoperative complication, subphrenic abscess, malignancy, hiatal hernia. The major causes of the gastropleural fistula have changed from trauma and subphrenic abscess to postoperative complication of malignant disorders. We report a case of empyema that developed respiratory failure caused by gastropleural fistula in a middle age woman with review of related articles.
Empyema ; Female ; Fistula* ; Hernia, Hiatal ; Humans ; Middle Aged ; Postoperative Complications ; Respiratory Insufficiency* ; Subphrenic Abscess

Dermatomyositis is an autoimmune disorder characterized by symmetrical proximal muscle weakness and muscle atrophy due to chronic inflammation and degeneration of skeletal muscle. Psoriasis is a chronic, systemic disease with cutaneous manifestation characterized by infiltration of inflammatory cells in both the dermal and epidermal compartments of the skin. Dermatomyositis and psoriasis are autoimmune-mediated disorders. But, dermatomyositis associated with psoriasis has not been reported in Korea. We experienced a case of dermatomyositis associated with the psoriasis and as such we are reporting the case with literature reviews.
Dermatomyositis* ; Inflammation ; Korea ; Muscle Weakness ; Muscle, Skeletal ; Muscular Atrophy ; Psoriasis* ; Skin

Metastatic cancer from breast cancer is not uncommon and it often involves multiple organs. Gastric metastasis from breast cancer is much rarer than lung, bone and lymph node metastasis. Most of the symptoms are nonspecific, so it is not easy to differentiate primary gastric cancer from gastric metastasis from the breast. In particular, gastric and breast cancers are the two most common cancers among Korean women, so efforts should be made to distinguish primary gastric cancer from gastric metastasis because treatment and prognosis are very different between two. A few cases have been reported in Korea concerning gastric metastasis from breast cancer. We report here a case of gastric metastasis from infiltrating duct carcinoma of the breast.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Korea ; Lung ; Lymph Nodes ; Neoplasm Metastasis* ; Prognosis ; Stomach Neoplasms ; Stomach*

BACKGROUND: Acute renal infarction is an uncommon disease which is often delyed or missed due to its rarity and unspecific clinical presentation. METHODS: In order to evaluate the clinical features and to elucidate diagnostic or therapeutic options, we analyzed the medical records of 23 patients who were admitted to Pusan National University Hospital from January, 1995 to July, 2004 and diagnosed as renal infarction. RESULTS: The mean age of the patients was 57.3 18.4 years and male to female ratio was 0.91:1. Underlying diseases were cardiovascular disease (n=18), tumor embolism (n=1), vasculitis (n=1), post kidney transplantation thrombosis (n=1), and trauma(n=1). One patient did not have any underlying disease. Initial symptoms were abdominal or flank pain (61%), fever (35%), anorexia (35%), nausea (26%), vomiting (17%), gross hematuria (9%), and oliguria (4%). On physical examination, costovertebral angle tenderness (43%), abdominal tenderness (9%), and hypertension (35%) were noted. Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (87%), ALT (83%), CK (22%), and creatinine (>1.4 mg/dL, 17%). Imaging diagnosis of renal infarction included renal angiography, isotope renal scan, computed tomography or ultrasonography. CT was done in 17/23 cases and useful in diagnosis of renal infarction. Nine patients were treated with heparin or warfarin. Thrombolysis was done in 3 patients. Others were treated conservatively. CONCLUSIONS: In a patients with an increased risk of thromboembolism, flank or abdominal pain, microscopic hematuria, and an elevated serum LDH are strongly supportive of diagnosis of renal infarction. Under such circumstances, enhanced CT is essential for the early diagnosis of renal infarction.
Abdominal Pain ; Angiography ; Anorexia ; Busan ; Cardiovascular Diseases ; Creatinine ; Diagnosis ; Early Diagnosis ; Female ; Fever ; Flank Pain ; Hematuria ; Heparin ; Humans ; Hypertension ; Infarction* ; Kidney Transplantation ; Male ; Medical Records ; Nausea ; Neoplastic Cells, Circulating ; Oliguria ; Physical Examination ; Renal Insufficiency ; Thromboembolism ; Thrombosis ; Ultrasonography ; Vasculitis ; Vomiting ; Warfarin

No abstract available.
Craniocerebral Trauma* ; Head* ; Humans ; Tomography, Emission-Computed, Single-Photon*

Spontaneous pneumomediastinum is a benign condition, caused by alveolar rupture and associated with many clinical conditions. There are numerous reports of spontaneous pneumomediastinum associated with various origins such as bronchial asthma, labor and a mechanically obstructed airway. A 20-year old woman visited our outpatient clinic because of a productive cough and dyspnea. A pneumomediastinum was seen on the chest radiograph and acid fast bacilli were observed on the sputum study. Endobronchial tuberculosis was diagnosed by bronchoscopy and improved with antituberculous treatment. Here, we report a case of spontaneous pneumomediastinum as a complication of endobronchial tuberculosis and review the medical literature.
Ambulatory Care Facilities ; Asthma ; Bronchoscopy ; Cough ; Dyspnea ; Female ; Humans ; Mediastinal Emphysema* ; Radiography, Thoracic ; Rupture ; Sputum ; Tuberculosis* ; Young Adult

There are many kinds of herbal medication available in Korea, and some of them have been reported to be related with renal failure. However, the simultaneous occurrence of toxic hepatitis and acute renal failure associated with herbal medicine has rarely been reported. A 26-year-old male was admitted with a sudden onset of jaundice and generalized weakness after taking two doses of herbal medication. A physical examination revealed no abnormalities other than scleral icterus. The patient's blood chemistry demonstrated a blood urea nitrogen level of 91 mg/dL, a creatinine level of 13 mg/dL, an AST of 212 IU/L, an ALT of 1,528 IU/L and a bilirubin level of 8.5 mg/dL. Renal biopsy showed interstitial edema and an infiltration of neutrophils and lymphocytes with preserved glomeruli and vascular structure; these findings were consistent with administering medical supportive care without renal replacement therapy. He was discharged on the 8th hospital day. This case provides the possibility of development of hepatitis and renal failure due to herbal medication. We propose that a meticulous history taking for determining the herbal medications a patient has taken should be done for those cases of simultaneous toxic hepatitis and renal failure that are without any obvious cause in Korea.
Acute Kidney Injury ; Adult ; Bilirubin ; Biopsy ; Blood Urea Nitrogen ; Chemistry ; Creatinine ; Drug-Induced Liver Injury* ; Edema ; Hepatitis ; Herbal Medicine ; Humans ; Jaundice ; Korea ; Lymphocytes ; Male ; Neutrophils ; Physical Examination ; Renal Insufficiency ; Renal Replacement Therapy

Hepatoid adenocarcinoma (HAC) of the stomach is a rare neoplasm consisting of both adenocarcinomatous and hepatocellular carcinoma (HCC)-like foci; the latter of which showed the full spectrum of morphological and functional features of HCC. Numerous cases of HAC have been reported in a variety of primary organs, the stomach is one of the most common sites. HAC is associated with an increased serum alpha-fetoprotein (AFP) level and a strong tendency for lymphatic and venous invasion. Because of early hepatic metastasis, prognosis seems less favorable than more common types of adenocarcinoma. Here, we report a case of synchronous double primary cancer, consisting of hepatoid adenocarcinoma of the stomach and adenocarcinoma of the rectum.
Adenocarcinoma* ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Neoplasm Metastasis ; Prognosis ; Rectum ; Stomach

"Portal biliopathy" is a terminology used to describe the biliary, ductal and gallbladder wall abnormalities seen in patients with portal hypertension. These changes are predominantly seen in patients with extrahepatic portal vein obstruction (EHPVO), and they include abnormalities (stricture and dilatation) of both the extra and intrahepatic bile ducts, and varices of the gallbladder. The majority of the patients are asymptomatic, but these changes occasionally become significant and give rise to overt obstructive jaundice and they possibly contribute to the development of choledocholithiasis and cholangitis. Asymptomatic patients do not need any treatment. If there is persistent elevation of alkaline phosphatase or ductal dilatation on ultrasonography, ERCP or MRCP can be performed to detect choledocholithiasis or biliary stricture. We present here a 43-year-old male patient for whom portal biliopathy with accompanying multiple intrahepatic duct stones was diagnosed by MRCP and choledocoscopy.
Adult ; Alkaline Phosphatase ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis ; Constriction, Pathologic ; Dilatation ; Gallbladder ; Humans ; Hypertension, Portal ; Jaundice, Obstructive ; Male ; Portal Vein ; Ultrasonography ; Varicose Veins