Verbal Auditory Agnosia Developed after Unilateral Temporal Lobe Infarction / 대한이비인후과학회지

Stroke results in sudden loss of function related to its damaged portion. When this occurs in temporal lobe, the function of hearing and listening may be affected, although receptive language processing is affected while hearing perception is relatively spared. This is called as “central deafness.” It has been known that hearing ability is seldom impaired in the case of temporal lobe stroke except in the case of bilateral lesions. However, we experienced a 72-year-old, right-handed woman who presented with both sudden hearing difficulty due to unilateral temporal lobe infarctions after suddenly not being able to respond to any verbal questions except environmental sounds. Pure-tone audiometry showed both flat sensorineural hearing loss of mild degree in both ears but she could not understand any verbal sound. Brain MRI demonstrated extensive ischemic infarcts in the left temporal lobes involving primary auditory cortex. She was diagnosed as verbal auditory agnosia and has received speech-language therapy.

A Case of Unilateral Hyperlucent Lung by Main Bronchus Obstruction / 결핵

A 32-year-old woman was admitted to the hospital complaining of cough, sputum, and chest discomfort for the past ten days. The radiologic findings were transradiant left lung with reduced number and size of vessels, mediastinal shifting to the right at expiration, matched entilation-perfusion defect on ventilation-perfusion scan, and diffuse hypoplasia of the left pulmonary artery and its branches on pulmonary angiography. We describe a case of unilateral hyperlucent lung by main bronchus obstruction in a patient who presents with a clinical picture suggestive of Swyer-James syndrome.

Spontaneous Rupture of Mediastinal Teratoma into Adjacent Tissues / 결핵

Mediastinal teratomas are rare and represent less than 10 per cent of all mediastinal tumors. Almost all arise in the anterosuperior mediastinal compartment, and most symptoms, when present, result from compression of adjacent structures. They contain different tissues derived from all three germinal layers, with the prevalence of ectodermal elements which can include hair, teeth and sebaceous material. Benign teratomas may rupture into adjacent organs. Up to 36% of all mediastinal teratomas rupture, most frequently into the lung and bronchial tree, followed by the pleural space, pericardial space, or great vessels. The signs and symptoms of a ruptured teratoma vary with the structures involved. We report a case of mediastinal teratoma ruptured spontaneously in a 18 year old female who experienced 4 or 5 times of hemoptysis for 1 year and sudden onset of pleural effusion, pericardial effusion and pneumonia.

Biliary Ascariasis with Choledocholithiasis and Biliary Pancreatitis: Endoscopically Treated / 대한소화기내시경학회지

A 60-year-old man with biliary ascariasis accompanied by choledocholithiasis and biliary pancreatitis, is herein reported. His chief complaints were epigastric pain, nausea, and vomiting. He had a past history of eating raw fish and vegetables. An endoscopic retrograde cholangiopancreatography (ERCP) revealed multiple CBD stones and a live ascaris adult worm in the common bile duct which was not detected by an abdominal CT. The management of biliary obstruction caused by Ascaris lumbricoides has usually been surgical, but this report describes the endoscopic removal of the ascaris located in the common bile duct.

A case of "scleroderma renal crisis" developed from diffuse scleroderma / 대한내과학회지

Polymyositis is an inflammatory, autoimmune disease of the skeletal muscle characterized by symmetrical, proximal muscle weakness, elevated muscle enzymes, and characteristic features on electromyogram and muscle biopsy. The kidneys are generally spared and myoglobinuric renal failure is very rare in polymyositis. There have been infrequent reports of polymyositis developing myoglobinuric renal failure secondary to rhabdomyolysis. The flare-up may occur in polymyositis, usually manifest within several weeks to months of achieving a remission. But, rhabdomyolysis and myoglobinuric renal failure was a very rare feature of the relapse of polymyositis. We present a case report of patient with polymyositis who initially presented and relapsed as rhabodomyolysis that lead to myoglobinuric, oliguric renal failure and required transient dialytic support.

A Case of Pulmonary Alveolar Proteinosis Associated With Silicosis / 결핵

Pulmonary alveolar proteinosis is characterized by the accumulation of PAS positive lipoproteinaceous or amorphous proteinaceous material in the alveolar space with spared delicate septal architecture of the lung interstitium and impaired gas exchange of alveoli. We experienced a case of secondary pulmonary alveolar proteinosis in a 41 year old male patient who have occupational history of engagement as a mason over 4year. He compalined exertional dyspnea and chest discomfort, and presented fine inspiratory crackle at both lower lung field, numerous fine nodular denisties in both lung field with peripheral sparing. Light microscopic finding of lung tissue obtained by transbronchial lung biopsy revealed homogenous eosinophilic colloid-like luminal content in the alveolar space, and electron microscopy of bronchoalveolar lavage fluid concentrate showed electron-dense multilamellated structures. To treat the disease, we tried whole lung lavage of right lung with isotonic saline under general anesthesia. After whole lung lavage of right lung, he showed markid improvement of symptom and partial improvement of chest X-ray findings. The patient has been followed for 12 month until now, with no evidence of aggravation

Basal Serum Biochemical Markers as a Predictor of Survival in Patients Undergoing Hemodialysis / 대한신장학회잡지

To investigate the influence of first six-month mean for serum biochemical markers, albumin, cholesterol, triglyceride, inorganic phosphate, BUN, creatinine, on survival in hemodialysis, we retrospectively analyzed the 57 patients who were monitored from the start of HD for more than 6 months between January 1988 and December 1995. Exclusion criteria were as follows: transfer to CAPD, transplantation or another dialysis center, HD for less than 6 months, non-compliant, death due to malignant disease, accident and self-withdrawal. The patients were divided into two groups according to the demographic characteristics and the median value of first six-month mean for serum biochemical markers. The mean age was 46.7+/-11.7 year, male-to female ratio was 1.6:1, diabetics were 12 (21.1%), and mean follow-up duration was 39.0+/-26.4 months. Among them 30 patients (52.6%) were died. Diabetic patients had significantly lower 1 year (63.6 vs. 88.8%, p<0.05) and 3 year survival rate (19.1 vs. 62.2%, p<0.05) than non-diabetic patients. Low serum albumin(<3.5g/dl), low serum cholesterol(<130mg/dl) and low serum P (<5.0mg/dl) groups were significantly lower 1 and 3 year survival rate than high serum albumin (63.6 vs. 97.0%; 25.5 vs. 74.6%, p<0.05), cholesterol (71.4 vs. 88.0%; 38.1 vs. 60.8%, p<0.05) and p (71.9 vs. 96.3% ; 47.1 vs. 62.9%, p<0.05) groups, respectively. There were no differences in survival rate according to sex, BUN, TG, and creatinine. By Cox's proportional hazard model, low serum albumin(odds ratio 1.98), cholesterol(odds ratio 1.60), and P(odds ratio 2.09) group were independent risk factors for early death. Low serum albumin level at the start of HD maintained during the follow-up period. Cholesterol and P showed similar results. In conclusion, basal serum biochemical markers associated with visceral protein depletion such as low serum albumin, cholesterol and P seem to be early predictors of mortality in hemodialysis patients.