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Transjugular intrahepatic portasystemic shunt (TIPS) is a procedure that inserts an expandable metallic stent into the liver parenchyme by transjugular catheterization. During the past decade, TIPS has been accepted as an alternative to the surgical shunt procedure for controlling the complications of portal hypertension and has become more widely performed. Complications of TIPS include encephalopathy, bleeding, deterioration of liver function and infection. Although periprocedual sepsis has been known since the early days of TIPS stenting, infection by the TIPS device itself has only recently been recognized because of its rare occurrence. The definition of endotipsitis makes it possible to classify it into two groups: definite and probable infection. We report a case of probable endotipsitis with relapsing bacteremia after TIPS for uncontrolled varix bleeding. If relapsing bacteremia without any other clearly attributable source occurs in a patient with TIPS, the possibility of endotipsitis is considered.
Bacteremia ; Catheterization ; Catheters ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver ; Portasystemic Shunt, Surgical ; Portasystemic Shunt, Transjugular Intrahepatic* ; Sepsis ; Stents ; Varicose Veins

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Cases of extramedullary relapse after alloBMT in AML1/ETO positive AML.

Chin Kook LEE ; Mee Kyoung KIM ; Myung Jun SONG ; Ki Seong EOM ; Hee Je KIM ; Woo Sung MIN ; Chun Choo KIM

Korean Journal of Medicine.2006;70(2):226-231.

The occurrence of granulocytic sarcoma as a pattern of relapse after allogenic bone marrow transplantation (allo-BMT) is rare. We report two AML1/ETO positive patients with granulocytic sarcoma as a pattern of relapse after allo-BMT. The first case is 39-year-old woman who had lower back pain without any abnormal peripheral blood exam. MRI showed a paraspinal mass, and the pathologic report was granulocytic sarcoma. The second case is 34-year-old woman who had breast humps without any abnormal peripheral blood exam. CT showed multiple breast masses, and the pathologic report was granulocytic sarcoma. We believe that this is the first cases report of extramedullary relapse after allo-BMT in AML1/ETO positive AML in Korea. These cases suggest that we should be aware of the possibility of an extramedullary relapse in bone marrow transplant recipients with AML1/ETO positive AML.
Adult ; Bone Marrow ; Bone Marrow Transplantation ; Breast ; Female ; Humans ; Korea ; Low Back Pain ; Magnetic Resonance Imaging ; Recurrence* ; Sarcoma, Myeloid ; Transplantation

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A case of endobronchial aspergilloma in patient with collapse of right middle lobe.

Woo Youn EOM ; Nam In KIM ; Soo Woong KIM ; Byoung Hoon LEE ; Sang Hoon KIM ; Young Soo AHN ; Man Sil PARK

Korean Journal of Medicine.2006;70(2):221-225.

Pulmonary aspergilloma usually results from the ingrowths of the colonized Aspergillus in the damaged bronchial tree, pulmonary cyst or cavities of patients with underlying lung diseases. We experienced a case of endobronchial aspergilloma developed in a healthy female patient with asymptomatic collapse of right middle lobe (RML). She visited our clinic with intermittent hemoptysis for one year. The chest X-ray and HRCT showed severe collapse of the RML and multiple calcifications of peribronchial nodes around the proximal part of RML bronchus. Bronchoscopy revealed an aspergilloma in theorifice of the lateral segmental bronchus of RML. Patient had undergone RML and right lower lobe resection because of recurrent hemoptysis in spite of medical therapy. After surgery patient's symptoms were relieved. We present this unusual case with a review of the literature.
Aspergillosis ; Aspergillus ; Bronchi ; Bronchoscopy ; Colon ; Female ; Hemoptysis ; Humans ; Immunocompetence ; Lung Diseases ; Thorax

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A successful stenting of the coarctation of aorta in a patient with acute pulmonary edema.

Sun Ho HWANG ; Myung Ho JEONG ; Weon KIM ; Won Heum SHIM ; Han Gyun KIM ; Wan KIM ; Jung Chae KANG

Korean Journal of Medicine.2006;70(2):216-220.

Coarctation of aorta is a rare vascular disorder which is one of causes of secondary hypertension. Since the early 1990s stenting in the coarctation of aorta has been introduced as an alternative treatment method, there were a few cases which were treated by stent implantation for the coarctation of the aorta in Korea. But the case which was treated using stent in congestive heart failure with pulmonary edema has never been reported. We report on successful management of a 64-year-old female patient, who presented with acute heart failure and pulmonary edema due to severe aortic coarctation. After endotracheal intubation, aortogram was performed, which revealed a severe narrowing in the distal thoracic aorta with a peak systolic pressure gradient of 100 mmHg across the lesion. Stent implantation was performed with 24x100 mm self-expandable Nitinol-S stent after predilation with 10x40 mm balloon. After stenting, patient's symptom and sign of congestive heart failure were remarkably improved and endotracheal intubation tube was able to be removed. And no significant adverse cardiac events observed during a nine-month clinical follow-up.
Angioplasty ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Blood Pressure ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Intubation, Intratracheal ; Korea ; Middle Aged ; Pulmonary Edema* ; Stents*

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Aortic dissection presenting as fever of unknown origin.

Su Nyoung CHOI ; Sung Ji PARK ; Tae Jung KWON ; Young Ran KANG ; So Ra PARK ; Chung Whan KWAK ; Jin Yong HWANG

Korean Journal of Medicine.2006;70(2):213-215.

Aortic dissection most often presents with the severe chest pain and may have variable symptoms including fever. However, fever of unknown origin as the predominant manifestation of aortic dissection seems to be extremely rare. We report the case of a patient who sustained a prolonged spiking fever with unknown origin for 17 days following acute aortic dissection. The case serves as a reminder that prolonged fever may be the principal residual sequelae after aortic dissection.
Chest Pain ; Fever of Unknown Origin* ; Fever* ; Humans

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A case of extensive hemorrhagic colitis after docetaxel-based combination chemotherapy.

Hyun Jeong SHIM ; Sang Hee CHO ; Joon Kyoo LEE ; Jae Sook AHN ; Deok Hwan YANG ; Yeo Kyeoung KIM ; Ik Joo CHUNG

Korean Journal of Medicine.2006;70(2):207-212.

Gastrointestinal complications are frequently followed by combination chemotherapy. Based on recent reports, colitis is very rare but serious complication associated with taxane based chemotherapy. Despite of aggressive management, clinical course of colitis associated with chemotherapy is potentially fatal. We report the first case in Korea who was developed extensive colitis after docetaxel-based chemotherapy. A man aged 58 years with recurrent oral cavity carcinoma received chemotherapy with docetaxel, cisplatin and 5-fluorouracil (5-FU). On the 7th day of first cycle of chemotherapy, he complained of abdominal pain and fever, followed by hypotension because of large amount of hematochezia. Abdominal CT and colonoloscopy revealed extensive pancolitis with bleeding. He underwent two times of transarterial embolization with microcoils and gelform. Nevertheless these managements, bleeding foci were remained. Then, colonoscopic hemostasis such as hemoclipping and epinephrine injection were performed and fully recovered after 6 weeks.
Abdominal Pain ; Cisplatin ; Colitis* ; Drug Therapy ; Drug Therapy, Combination* ; Epinephrine ; Fever ; Fluorouracil ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Hypotension ; Korea ; Mouth ; Tomography, X-Ray Computed

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Acute myelogenous leukemia in the elderly (>or=60): retrospective study of 115 patients.

Hyun Choon SHIN ; Im Il NA ; Tak YUN ; Keun Wook LEE ; Eun Gee SONG ; In Sil CHOI ; Do Youn OH ; Jee Hyun KIM ; Jong Seok LEE ; Sung Soo YOON ; Seonyang PARK ; Byoung Kook KIM ; Noe Kyeong KIM

Korean Journal of Medicine.2006;70(2):196-206.

BACKGROUND: Acute myelogenous leukemia (AML) is frequently encountered in elderly patients whereas intensive chemotherapy yield lower rate of complete remission (CR) and survival than young patients. This study was aimed to review the clinical features and treatment outcomes of elderly patients (>or=60) with AML. METHODS: We respectively reviewed the clinical features, laboratory findings and outcomes of treatment from the medical records of 115 patients with the elderly AML (>or=60), admitted in Seoul National University Hospital, between Jan.1995 and Dec.2004. RESULTS: Their median age was 66 (60~86) years with male predominance (M:F=68:47). Complete response rate in patients with conventional chemotherapy was 66.7% (42 of 63 patients; 95% CI 50.2~78.4). Median overall survival (OS) was 5.2 months with clinical benefit in the conventional chemotherapy group, compared to supportive or palliative group (11.5 vs 0.9months; p<0.0001). In between two age groups, the sixties (n=69) showed higher CR rate (69.0 vs 61.9%; p=0.9) and longer median overall survival (7.0 vs 4.4months; p=0.8) than patients group of the seventies (n=38) but without statistical significance. CONCLUSIONS: Conventional induction chemotherapy improved survival rate than palliative or supportive treatment.
Aged* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia, Myeloid, Acute* ; Male ; Medical Records ; Prognosis ; Retrospective Studies* ; Seoul ; Survival Rate

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Clinical characteristics and predictors of acute oliguric renal failure in hemorrhagic fever with renal syndrome.

Young Keun KIM ; Sang Cheol LEE ; Chang Soo KIM ; Sang Taek HEO ; Chang Min CHOI ; June Myung KIM

Korean Journal of Medicine.2006;70(2):190-195.

BACKGROUND: Hemorrhagic fever with renal syndrom (HFRS), caused by hantaviruses infection, develops acute renal failure (ARF) of variable severity. Because oliguric ARF is severe form, associated with more complications and hemodialysis requirement, we investigated the characteristics and predictors of oliguric ARF in HFRS patients. METHODS: From Oct. 2000 to Dec. 2004, Sixty one patients, admitted at Armed Forces Capital Hospital, with typical clinical feature of HFRS and serologically confirmed hantaan virus infection were studied. The medical records were reviewed retrospectively and patients were categorized into oliguric and nonoliguric ARF group according to urine output (<400 mL/24h). We compared clinical symptoms, signs, laboratory findings and clinical course between two groups. RESULTS: Twenty four patients (39.3%) categorized into oliguric ARF group and 37 patients (60.7%) into nonoliguric ARF group. There were no significant differences in age, duration from onset to hospital, clinical symptoms and signs. But, leukocyte count, platelet count, serum sodium, potassium, creatinine, AST, ALT on admission, maximun leukocyte count and minimum platelet count showed significant differences. Maximun serum creatinine was 10.8+/-2.4 mg/dL in oliguric ARF, 4.7+/-2.1 mg/dL in nonoliguric ARF (p<0.001). Hemodialysis was required with 21 patients (87.5%) in oliguric ARF and 2 patients (5.4%) in nonoliguric ARF. Risk of oliguric ARF in HFRS increased when laboratory findings on admission were as follows; leukocyte count>or=15x10(9)/L (RR 2.36 [95% CI 1.19-4.67]), platelet countor=110IU/L (RR 3.10 [95% CI 1.43-6.73]) and microscopic hematuria>or=5/HPF (RR 3.68 [95% CI 1.24-10.91]). CONCLUSIONS: HFRS patients with oliguric ARF showed more elevation of serum creatinine and more requirement of hemodialysis than HFRS patients with non-oliguric ARF and leukocyte count, platelet count, AST and microscopic hematuria on admission were helpful to predict the development of oliguric ARF in HFRS patients.
Acute Kidney Injury ; Arm ; Blood Platelets ; Creatinine ; Fever ; Hantaan virus ; Hantavirus ; Hematuria ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Leukocyte Count ; Leukocytes ; Medical Records ; Oliguria ; Platelet Count ; Potassium ; Renal Dialysis ; Renal Insufficiency* ; Retrospective Studies ; Sodium

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