A Case of Primary Cardiac Lymphoma Mimicking Acute Coronary and Aortic Syndrome

Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.

Exposure Level of Trichloroethylene in Stevens-Johnson Syndrome Due to Occupational Exposure: 3 Case Reports and a Review of Other Cases / 대한산업의학회지

BACKGROUND: Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure were limited in the previous case reports and the reported exposure values were also diverse. We reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From the study results, we intended to clarify the relationship between TCE exposure level and Stevens- Johnson syndrome. CASE REPORT: Case 1. A 24-year-old Filipino female worker developed a skin rash 35 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 22.0 to 32.3 ppm (personal exposure level) with TWA. Case 2. A 47-year-old Korean male worker developed a skin rash, 20 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of hepatic failure and sepsis 42 days after the onset of the first symptom. He had no previous history of taking medicine or viral infection. The work environment measured 30.1 ppm (personal exposure level) and 116.5~229.7 ppm (area exposure level close to the degreasing machine) with TWA. Case 3. A 22-yearold Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged 37 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 107.2 ppm (personal exposure level) with TWA. DISCUSSION: These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency of the latency period in symptoms and the possibility of sensitization in low-level exposure, we recommend that the first specific health examination also should be conducted 1 month after workers have commenced working.

A Case-study of a Plastering and Waterproof Worker Suffering from Silicosis and Lung Cancer / 대한산업의학회지

OBJECTIVES: We report on a case-study of a silicosis sufferer with lung cancer, who was exposed to cement dust through plastering and waterproof work in the construction industry. METHODS: We reviewed his personal history including employment, medical record and estimated level of carcinogenic materials in the work place in order to evaluate the possible source of his lung cancer. RESULTS: The patient was a non-smoker and there was no family history of lung cancer. His medical record did not reveal anything of concern. He was exposed to cement dust while he had worked for 20 years as a plasterer and waterproof worker. After complaining of chest pain, he was examined and subsequently diagnosed with lung cancer (RUL, adenocarcinoma; cT4N2M1). He was treated in a hospital for 3 months before passing away. Radiological evaluation by high resolution computed tomography (HRCT) revealed micronodules with a profusion category 1 (p/p, 1/1) in the perilymphatic distribution, which indicated silicosis. Small amounts of cement dust which included silica was identified by environmental evaluation of his work place. He never worked with asbestos related material, which was confirmed by HRCT examination. CONCLUSIONS: We concluded that the patient's silicosis with lung cancer was an occupational-caused disease due to exposure to cement dust.

A Case of Submucosal Tumor-like Early Gastric Adenocarcinoma Diagnosed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

In rare cases, early gastric cancer resembles the endoscopic features of a submucosal tumor (SMT). A correct histological diagnosis is difficult with repeated biopsy specimens because they are covered with normal mucosa. Some features known to suggest malignant SMT include a size greater than 3 to 5 cm, a rapid growth rate, echoheterogeneity and irregular margins on endoscopic ultrasonography (EUS). Various techniques including US-guided biopsy, partial removal by an endoscopic snare excision, as well as EUS with a fine needle aspiration were used to enhance the diagnostic accuracy. We recently experienced a case of early gastric cancer, presenting as a submucosal tumor-like lesion, which was confirmed by endoscopic mucosal resection. We report this case with a review of the relevant literature.

Endoscopic Treatment of Benign Hypopharyngeal Tumors / 대한소화기내시경학회지

During endoscopy, most endoscopists insert endoscopes into the esophagus without visual aid in order to minimize the discomfort to patients. However, studies have shown that visual guided insertion imposes little discomfort, is safe and can increase the diagnostic rate of abnormal pathology of the throat. As for the treatment of hypopharyngeal lesions, cases of endoscopic treatment are rare and any guidelines have not been clearly defined yet. However, endoscopic treatment may be feasible in selected cases. Several procedures, such as endoscopic mucosal resection with cap (EMR-C) and saline injection polypectomy can be applied. We experienced seven patients who had benign hypopharyngeal masses that were removed endoscopically without serious complications. Compared to surgical treatment, endoscopic removal of the benign hypopharyngeal tumors does not require general anesthesia; it is simple, less invasive and less costly. Therefore, endoscopy should be regarded as a treatment option. However, further studies are required before widespread application of endoscopic removal for the definitive treatment of hypopharyngeal masses, including malignancies.

The Effect of Vitrectomy and its Combined Procedures on the Progression of Cataract in Phakic Eyes

PURPOSE: This study was to evaluate the effect of vitrectomy and combined procedures on the progression of cataract in previously vitrectomized eyes. METHODS: The authors reviewed the medical records of 47 patients (48 eyes) who had undergone pars plana vitrectomy followed by cataract surgery and had been followed up for 3 months or longer. The mean follow-up period was 10.5 months. The degree of lens opacity was compared before vitrectomy when the progression of cataract was diagnosed and before cataract surgery using LOCS III. The interval between vitrectomy and cataract surgery was analyzed by age, causative disease, operation procedure, and combined procedure, retrospectively. RESULTS: The degrees of lens opacity at preoperative examination of vitrectomy were 0.31 (Nuclear color/ opalescence) and 0.10 (posterior subcapsular opacity). The mean interval between vitrectomy and the time of diagnosis of development or progression of cataract was 2.1 months, and the degrees of lens opacity at that time were 1.29 and 0.69. The degrees of lens opacity at preoperative examination of cataract surgery were 3.44 and 2.00. The mean interval between vitrectomy and cataract surgery was 11.3 months with a range of 1 to 33 months. The mean intervals in the eyes with gas tamponade (C3F8 or SF6) and silicone oil tamponade were 10.3 and 7.7 months, respectively, but in cases with only vitrectomy was 15.8 months. There was significant difference in each group (P=0.003). CONCLUSIONS: Preoperative visual acuity and internal limiting membrane removal were good prognostic factors in idiopathic macular hole surgery. Functional success group showed constant improvement of visual acuity in postoperative 2 years.

Corneal Endothelial Changes in Patients with Traumatic Hyphema

PURPOSE: In patients with traumatic hyphema, we investigated the changes of corneal endothelium and the associated ocular complications that might attribute to endothelial damage. MATERIALS & METHODS: We reviewed the medical records of 67 patients(67 eyes) who had been admitted and treated for blunt ocular trauma with hyphema between February 1997 and June 2000. One month after injury, endothelial photographs of both eyes of each patient were taken with specular microscope to compare the endothelium of the injured eyes with that of the normal fellow eyes. The endothelial parameters were studied in relationship to various complications to see the relationship between the complications and the endothelial damage. RESULTS: Compared with the fellow uninjured eyes, the injured eyes had a mean decrease in endothelial cell density (ECD) of 5.6% (P=0.015). Nine patients had significant corneal edema with epithelial defect on initial admission, which was defined as corneal impact lesion. In the group with the corneal impact lesion, the mean ECD decrease was 23.1% (P=0.016) and the mean coefficient of variation (COV) increase was 24.8% (P=0.01). With other variables such as the amount of hyphema and the degree of angle recession, statistically significant results could not be obtained. In 20 patients on long-term follow-up examination (mean 36.7 months after the injury), the injured eyes had a mean increase in ECD of 2.5% compared to the result on initial examination. This change was minimal and statistically not significant. CONCLUSION: In patients with traumatic hyphema, this study showed reduced endothelial cell densities in the injured eyes compared to the normal fellow eyes. In particular, statistically significant decrease in ECD was noted to be associated with corneal impact lesion.

The Effect of Mitomycin C(MMC) on Sinus Mucosal Openings in Rabbits

PURPOSE: This experimental study investigates the effect of mitomycin C(MMC) on the healing of sinus mucosal opening. METHODS: One hundred and twenty rabbits were used and divided into 8 groups of fifteen rabbits. A small(1.35 mm) or large(2.7 mm) diameter mucosal opening was created by drilling in the medial wall of the left maxillary sinus of rabbits and treated with MMC at a concentration of 0.2 or 2.0 mg/ml for 5 or 30 minutes. Five rabbits from each group were sacrificed at 1,2 & 4 weeks. The size of a remained mucosal opening was measured and light and electron microscopic examination were performed. RESULTS: After comparing the sizes of remained mucosal openings among the small opening groups(group 1,3 & 5), group 5 maintained larger opening at 2 weeks than the control group(P<0.05). Light microscopy of the specimens showed inflammatory and degenerative changes. The bone of the maxillary sinus exhibited minimal change induced by MMC. Scanning electron micrographs showed heterochromatin in nuclei and mitochondrial swelling of the epithelium. CONCLUSIONS: The MMC was effective in maintaining a larger mucosal opening than control group at least for 2 weeks following surgery.

Diffuse pulmonary nodular lesions persisting for 5 years / 결핵

Diffuse pulmonary nodular lesions have many causes. When they are caused by infection, the likely organisms are M. tuberculosis and various fungi. Silicosis, eosinophilic granuloma and pulmonary metastasis should be considered for differential diagnosis. Differential diagnosis needs detailed clinical history, physical examination and various laboratory tests. A case of persistent diffuse pulmonary nodular lesions which had persisted 5 years is reported. The patient was a 25 years old man with minimal pulmonary symptoms. Detailed past history and physical examination suggested thyroid tumor. Chest radiography showed numerous evenly sized well-defined nodules scattered in entire lung fields. Previous chest X-rays showed similar nodular lesions, which had lasted for 5 years. The number of nodules was slightly increased. Neck CT showed heterogenous mass in left lobe of thyroid gland and multiple lymphadenopathies along both internal jugular chains. Total thyroidectomy was performed. A case of lung metastasis which progressed slowly in papillary thyroid cancer is reported.

Vitrectomy for Vitreous Hemorrhage Associated with Branch Retinal Vein Occlusion

Fifty-two eyes with vitreous hemorrhages caused by branch retinal vein occulusion underwent pars plana vitrectomy. The vIsion was improved postoperatively in 50 of 52 eyes(96.2%) and no change or worsened in 2 eyes. Regarding postoperative visual acuity 73% showed 0.1 or better, and 0.5 or better in 25%. The lens opacity, the most common surgical complication occured in 14 of 43 phakic eyes, and the incidence of later lens opacification increased as the follow-up lengthened. Other surgical complications were retinal tear in 2 eyes, recurrent vitreous hemorrhage in 3 eyes and secondary glaucoma in 2 eyes. Thirty-two eyes revealed postoperative visual acuity less than 0.3, in which 20 eyes showed maculopathy as the cause of poor visual outcome, and surgical complications in 16 eyes. The level of vision depends lagely upon the macular function.

Early Surgery Extraventricular Drainage, Cisternal Drainage with Nimodipine Irrigation and Intravenous Nimodipine for Ruptured Intracranial Aneurysms

During the eleven months from September, 1989 to July, 1990, a total of 118 subarachnoid hemorrhage(SAH) patients were admitted. Among these, in 2 cases, the etiology was unknown and another 8 cases of Hunt & Hess clinical grade V patients died in the emergency room or intensive care unit within 24 hours after admission. The remaning 108 cases were managed with protocol as follows. 1) Surgery was done within 9 days after the SAH(total 67 cases) : Extraventricular drainage(EVD) was performed and a cisternal drainage(CD) catheter was positioned during surgery. EVD, CD nimodipine irrigation(0.4mg) through the CD catheter, and intravenous injection(IV) of nimodipine(1~2mg/hr)continued for 13days after the SAH. 2) Surgery was done after the 9th SAH day due to late transfer neurology or other hospitals or posterior circulation aneurysms(32 cases), and 9 cases refused surgery : Nimodipine was used orally(240mg/day) in 35 cases and an IV route(1~2mg/hr) in 6 cases. Total management outcome and results were obtained as follows. 1) A total unsatisfactory management outcome was 18.52%(serve disabled : 4.63%, vegetative : 0.93%, death : 12.96%. In the surgical cases only, 40.8%, 1.02%, 9.19%, respectively). 2) An unsatisfactory surgical outcome in cases following surgery after the 9th SAH day was 6.24%(severe disabled : 3.12%, death : 3.12%). 3) An unsatisfactory management outcome in cases of admission grades I & II following surgery within the 9th SAH day or those non-surgical patients was 19.15%(severe disabled : 4.25%, death : 14.89%. In surgical cases only 2.33%, 9.30%, respectively). 4) An unsatisfactory management outcome in cases of admission grades III & IV with surgery within the 9th SAH day or non-surgical patients was 29.63%(severe disabled : 7.41%, vegetative : 3.70%. death : 18.52%. In surgical cases only 9.09%, 4.55%, 13.64%, respectively). One case of admission grade V died. 5) Causes of unsatisfactory outcome were vasospasm : 9 cases(8.33%), SAH itself : 4 cases, rebleeding : 3 cases, surgical complication : 1 case, medical complication : 1 case, anesthesia : 1 case, and head trauma : 1 case. 6) Complications in management protocol with EVD, CD, CD nimodipine irrigation, and IV of nimodipine were transient hypotension(1 case) and meningitis(5 cases). These complications were improved without sequelae with discontinuing the IV of nimodipine and using antibiotics. We concluded that this protocol may improved the total management outcome of aneurysmal SAH patients, especially poor grade patients(Hunt & Hess grade III & IV) without significant complications. However, in spite of this protocol, the leading cause of an unsatisfactory outcome is vasospasm.