Journal Detail Information

1

Cite

Share

A case of aseptic meningoencephalitis in adult-onset Still's disease.

Jong Shin WOO ; Na Ri YUN ; Yeon Ah LEE ; Sang Hoon LEE ; Hyung In YANG ; Seung Jae HONG

Korean Journal of Medicine.2008;74(2):220-204.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology, affecting mainly young adults,characterized by a high spiking quotidian fever, arthralgia or arthritis, evanescent salmon-colored maculopapular rash. It affects almost all organs, but neurological manifestations of AOSD are rare and could be responsible for a delay in diagnosis. We describe a case of AOSD who developed aseptic meningoencephalitis without any infectious cause. A 23-year-old woman was admitted because of high quotidian fever, arthralgia, maculopalpular rashes, leukocytosis with increased ferritin. During treatment by prednisolone, she suddenly developed status epilepticus. The brain image, electroencephalogram, and cerebrospinal fluid analysis did not show any abnormality including evidence of infection. After methyprednisolne pulse therapy, her clinical symptoms and laboratory tests including ferritin dramatically improved, and she could be discharged. To our knowledge, this is the first reported case of aseptic meningoencephalitis in a patient with AOSD in Korea.
Arthralgia ; Arthritis ; Brain ; Electroencephalography ; Exanthema ; Female ; Ferritins ; Fever ; Humans ; Leukocytosis ; Meningoencephalitis ; Neurologic Manifestations ; Prednisolone ; Status Epilepticus ; Still's Disease, Adult-Onset ; Young Adult

2

Cite

Share

Two cases of infliximab treatment in Patients with Behcet's disease and intractable colon ulcers.

Jun Cheol YOON ; Jun Hyuk SEO ; Do Hwae PARK ; Sun Taek CHOI ; Young Ho SUNG ; Chan Woo LEE ; Dong Ho OH

Korean Journal of Medicine.2008;74(2):213-219.

Behcet's disease is a chronic disease characterized by recurrent systemic vasculitis. The pathogenesis remains unclear. This disease involves various organs of the body and it can have a variety of symptoms with an unpredictable course. The diagnosis of Behcet's disease is made in patients with oral and genital ulcers and uveitis. In addition, gastrointestinal symptoms are frequently present; however, intestinal ulcers are infrequent. The most common extra-oral sites of gastrointestinal involvement are ileocecal and colon lesions. The lesions are typically resistant to medical treatment and frequently recur after surgical treatment. Here we present two cases treated with the monoclonal antibody anti-tumor necrosis factor (TNF) and regression of all symptoms.
Antibodies, Monoclonal ; Chronic Disease ; Colon ; Humans ; Necrosis ; Systemic Vasculitis ; Ulcer ; Uveitis ; Infliximab

3

Cite

Share

A case of small cell carcinoma of the uterine cervix.

Hee Jin SEONG ; Ju Youn KIM ; Sang Min LEE ; Young Rok DO ; Hong Suk SONG

Korean Journal of Medicine.2008;74(2):208-213.

Small cell carcinoma of the uterine cervix is a rare malignancy representing less than 5% of all cases of cervical carcinoma. It is clinically characterized by frequent early nodal and distant metastasis. Survival is relatively poor with hysterectomy alone. Currently, there is no consensus for the optimal management of small cell carcinoma of the uterine cervix. Most patients are treated with a multimodality approach, using chemotherapy and radiotherapy. We treated a 32-year-old woman with primary small cell carcinoma of the uterine cervix. The pelvic MR imaging showed a 3 cm mass in the uterine cervix and no evidence of other abnormalities in the adnexa. The patient treated with a radical hysterectomy alone and adjuvant therapy was not provided. Five months later, the patient had recurrent disease with multiple bone and liver metastases. We treated the patient with cisplatin and etoposide combination chemotherapy. Here we report the case of a primary small cell carcinoma of the uterine cervix with rapid progression after surgical treatment alone and review the medical literature.
Adult ; Carcinoma, Small Cell ; Cervix Uteri ; Cisplatin ; Consensus ; Etoposide ; Female ; Humans ; Hysterectomy ; Liver ; Neoplasm Metastasis

4

Cite

Share

A case of lemierre syndrome poorly responsive to medical treatment.

Tae Yun HEO ; Bock Hyun JUNG ; Nae Sun RYOU ; Hyoung Chu JOUNG ; Min Hyung CHO ; Mi Hye KIM ; Dae Sik RYU

Korean Journal of Medicine.2008;74(2):203-207.

Lemierre syndrome is a rare clinical condition that is characterized by anaerobic oropharyngeal infections leading to septic thrombophlebitis of the internal jugular vein and frequent secondary metastatic infections. The accurate diagnosis and treatment, for early stage disease, is important because it may be associated with a high mortality rate if untreated. We present the case of a 34-year-old man who presented with a history of typical for the diagnosis of Lemierre syndrome. Supportive care with antibiotics did not improve the clinical condition. The clinical course improved after treatment with IV anticoagulant and surgical thrombectomy. In addition, he had the antiphospholipid syndrome, which is known to be a common cause of acquired arterial or venous thrombosis. Therefore, in this patient the associated antiphospholipid syndrome might precipitate an internal jugular venous thrombophlebitis after an oropharyngeal infection or might account for the poor response to medical treatment.
Adult ; Anti-Bacterial Agents ; Antiphospholipid Syndrome ; Empyema ; Humans ; Jugular Veins ; Lemierre Syndrome ; Pneumonia ; Thrombectomy ; Thrombophlebitis ; Venous Thrombosis

5

Cite

Share

A case of leptomeningeal metastasis from adenocarcinoma of the lung improved by treatment with Gefitinib.

Sung Ken YU ; Won Jong PARK ; Chan Soh PARK ; Hyun Jung CHIN ; Kyeong Cheol SHIN ; Jin Hong CHUNG ; Kwan Ho LEE

Korean Journal of Medicine.2008;74(2):198-202.

Leptomeningeal metastasis occurs in approximately 1% of patients with non-small cell lung cancer and this is an extremely serious complication. Without treatment, the median survival of patients is 4~6 weeks. The treatment options currently available are limited and achieve only modest results. Gefitinib was recently approved for the treatment of advanced/refractory non-small cell lung cancer. In addition, there have been case reports showing activity of gefitinib against brain metastasis in non-small cell lung cancer patients. However, there is limited data on the ability of gefitinib to cross the blood-brain barrier. We report the case of a patient with leptomeningeal metastasis from adenocarcinoma of the lung that had a dramatic response to gefitinib treatment.
Adenocarcinoma ; Blood-Brain Barrier ; Brain ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung ; Neoplasm Metastasis ; Quinazolines

6

Cite

Share

Acute pulmonary edema during endovascular stenting of a patient with non-malignant superior vena cava syndrome: A case report.

Eun Kyung BAEK ; Ji Young OH ; Min Jung KANG ; Gil Ja SHIN ; Soon Nam LEE ; Ick Mo CHUNG ; Wook Bum PYUN

Korean Journal of Medicine.2008;74(2):192-197.

The superior vena cava (SVC) syndrome results from the disturbance of blood flow in superior vena cava caused by the obstruction. The most common etiology of this condition is the external compression by a malignant tumor. Other causes include thrombus from a pacemaker, defibrillator or central venous catheters. The conventional treatment is radiation and chemotherapy. Recently stenting has been used as a first-line therapeutic strategy for non-malignant cases with balloon and self-expanding stents. In our report, a 77 year-old woman had the SVC syndrome without identification of an underlying disease. A percutaneous endovascular intervention was performed. The stent was placed successfully but just after the procedure, the venous return immediately increased and acute pulmonary edema developed. The patient improved after intravenous diuretics and oxygen. Here we report our experience and review the medical literatures for the management of the non-malignant SVC syndrome, with percutaneous endovascular intervention and the rare complication of pulmonary edema.
Central Venous Catheters ; Defibrillators ; Diuretics ; Female ; Humans ; Oxygen ; Pulmonary Edema ; Stents ; Thrombosis ; Vena Cava, Superior

7

Cite

Share

A case of anomalous origin of left main artery from right aortic sinus of Valsalva in patient with patent ductus arteriosus.

Hyung Joon JOO ; Soon Jun HONG ; Jin Seok KIM ; Hui Nam PAK ; Wan Joo SHIM ; Seung Yong SHIN ; Do Sun LIM

Korean Journal of Medicine.2008;74(2):188-191.

The finding of a left main coronary artery arising from the right sinus of Valsalva is a rare congenital anomaly. The clinical course of patients with a congenital anomaly of the coronary artery may be compromised depending on its anatomic relationship with adjunctive structures. Some anomalous origins of the left main coronary arteries arising from right aortic sinus of Valsalva have been associated with angina pectoris and sudden death, especially if their pathways are between the pulmonary artery and the aorta. We report a rare case with a combined congenital anomalous origin of the left main coronary artery arising with the right coronary artery simultaneously from the right aortic sinus of Valsalva in a patient with a patent ductus arteriosus. The left main coronary artery was extremely long because its pathway went in front of the pulmonary artery. There was no evidence of artherosclerosis or dynamic stenosis on the angiogram.
Angina Pectoris ; Aorta ; Arteries ; Constriction, Pathologic ; Coronary Vessels ; Death, Sudden ; Ductus Arteriosus, Patent ; Humans ; Pulmonary Artery ; Sinus of Valsalva

8

Cite

Share

Comparison of the Naranjo and WHO-Uppsala Monitoring Centre criteria for causality assessment of adverse drug reactions.

Myoung Kyun SON ; Yong Won LEE ; Han Young JUNG ; Seung Woo YI ; Kwang Hoon LEE ; Seung Up KIM ; Jae Heon JEONG ; Jae Jun PARK ; Jung Won PARK ; Chein Soo HONG

Korean Journal of Medicine.2008;74(2):181-187.

BACKGROUND/AIMS: Several criteria have been proposed to increase the objectivity, reliability and validity of causality assessment of adverse drug reactions (ADR). We compared the Naranjo probability scale and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality categories to evaluate the validity and clinical usefulness of these criteria. METHODS: We evaluated 100 ADR cases with the Naranjo probability scale and the WHO-UMC causality categories. The Spearman rank coefficient was used to determine the correlation of these criteria. The evaluation of the ADR was categorized into four groups for the Naranjo system: definite, probable, possible, and doubtful, and six groups for the WHO UMC: certain, probable, possible, unlikely, conditional/unclassified, and unassessable. RESULTS: The criteria used form these two systems showed some differences when compared with the same ADR cases. The Spearman rank coefficient was 0.519 (p<0.001) and the agreement was 55% between the Naranjo probability scale and the WHO-UMC causality categories. The Naranjo probability scale includes measurements for drug concentration, objective evidence of ADR, ADR to previous exposures, responses to placebo, and the dose adjustment of drugs. However, few cases were evaluated for all of these measures. CONCLUSIONS: The Naranjo probability scale may be helpful for assessing unexpected ADRs and useful for evaluators with little experience. However, some of the items are not utilized and there are discrepancies when compared with the WHO-UMC causality criteria.
Drug Toxicity ; Reproducibility of Results ; World Health ; World Health Organization

9

Cite

Share

Intravenous Anti-D immunoglobulin treatment of adult chronic immune thrombocytopenic purpura (ITP).

Hye Jeong KIM ; Yunjin JUNG ; Eui Nam HWANG ; Young Hoon KIM ; Jin Sung CHOI ; Seung Hyun NAM ; Bong Seog KIM ; Do Yeon OH ; Sung Soo YOON ; Sun Yang PARK

Korean Journal of Medicine.2008;74(2):176-180.

BACKGROUND/AIMS: Immune thrombocytopenic purpura (ITP) is an autoimmune disease that is mediated by anti-platelet antibodies. Based on the pathogenesis of ITP we evaluated the efficacy of intravenous anti-D immunoglobulin for adult chronic ITP. METHODS: Fourteen patients (4 without splenectomy and 10 with splenectomy) with refractory chronic ITP were treated with 50-70 microgram/kg of intravenous anti-D immunoglobulin only once. Treatment effects were evaluated by measuring the platelet counts and hemoglobin levels. RESULTS: Five patients (36%) showed a response; improvement in the platelet count lasted for on average 7 days (range: 2~24 days). There were no serious adverse effects. CONCLUSION: Anti-D immunoglobulin, which is associated with an Fc receptor blockade, appeared to be safe and effective for the treatment of adults with chronic ITP. Further studies are needed to confirm these findings and define further potentially effective treatment protocols with intravenous anti-D immunoglobulin.
Adult ; Antibodies ; Autoimmune Diseases ; Clinical Protocols ; Hemoglobins ; Humans ; Immunoglobulins ; Isoantibodies ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Receptors, Fc ; Rho(D) Immune Globulin ; Splenectomy

10

Cite

Share

Blood glucose analysis in patients on continuous ambulatory peritoneal dialysis with Icodextrin.

Se Hee YOON ; Nak Won CHOI ; Sung Ro YUN

Korean Journal of Medicine.2008;74(2):170-175.

BACKGROUND/AIMS: Icodextrin (glucose polymer) is metabolized by a-amylase to oligosaccharides such as maltose and maltotriose. The presence of these metabolites could have an effect on the enzymatic glucose measurement especially the glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) based method. Patients treated with icodextrin are at risk for inaccurate blood glucose measurements. In this study we measured the blood glucose with different methods and analyzed the results to determine the test accuracy. METHODS: The blood glucose was measured, in seven outpatients and in seven inpatients using icodextrin, by the glucose hexokinase laboratory technique method as well as the GDH-PQQ method (Accu Chek Active)at the same time. To estimate an icodextrin residual effect, after discontinuing icodextin, the blood glucose was measured by the two methods after 48 hours in 4 inpatients. RESULTS: In seven outpatients the blood glucose was overestimated by the Accu Chek Active method (mean difference 68 mg/dL, p value 0.012). In seven inpatients the mean difference in the glucose was 56 mg/dL at 6am, 52 mg/dL at 11am, 52 mg/dL at 4pm, and 50 mg/dL at 9pm by the two different methods. In the four inpatients after changing their dialysate, the mean difference in the glucose was 58 mg/dL after 10 hours, 45 mg/dL after 24 hours, 24 mg/dL after 34 hours, and 26 mg/dL after 48 hours. CONCLUSION: Blood glucose was overestimated by the GDH-PQQ method and the inaccuracies were observed for more than 48 hours.
Blood Glucose ; Glucans ; Glucose ; Glucose 1-Dehydrogenase ; Hexokinase ; Humans ; Hypoglycemia ; Inpatients ; Maltose ; Oligosaccharides ; Outpatients ; Peritoneal Dialysis, Continuous Ambulatory ; Trisaccharides

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share