Endoscopic Findings and Follow-Up of Gastric MALT Lymphoma / 대한내과학회지

Gastric mucosa-associated lymphoid tissue (MALT) lymphomas comprise over 50% of primary gastric non-Hodgkin lymphomas and show an increasing incidence. Pathogenesis is often related to Helicobacter pylori infection (HPI). Howevere, endoscopic findings of MALT lymphoma are nonspecific and diagnosis is difficult by the naked eye due to various endoscopic appearances such as erosion, erythema, ulceration, atrophy and submucosal mass. Diagnosis is based on the histopathologic evaluation of multiple, deep and repeated biopsies taken from normal and any abnormal appearing sites of the stomach. Endoscopic ultrasound (EUS) can aid in accurate diagnosis, staging, and prediction of prognosis in gastric MALT lymphoma. After treatment of primary gastric lymphoma, EUS produces conflicting results that are not as accurate as endoscopy with biopsy. Therefore, EUS is not mandatory during follow-up. A first evaluation of lymphoma regression should be performed 3-6 months after completion of treatment. Further follow-up should be performed every 4-6 months thereafter until complete remission of lymphoma is documented. Gastroscopy with multiple biopsies has to be performed. Additionally, the initial sites of lymphoma involvement should be checked by appropriate methods. If complete remission of gastric MALT lymphoma is achieved, follow-up gastroscopies with biopsies seem advisable.

Invasive Tracheobronchial Aspergillosis : Case Reports and a Literature Review / 감염과화학요법

Invasive tracheobronchial aspergillosis (iTBA) is an uncommon clinical manifestation of invasive aspergillosis and this is usually limited to the large airways. Its pathophysiology and clinical features are obscure, but some fatal cases of iTBA in immunocompetent patients have also been reported. We describe 4 cases of iTBA in the patients with hematologic malignancies, that was early diagnosed by bronchoscopy, a computed tomography and successfully treated by proper antifungal treatment. And we also review the cases of iTBA reported in Korea.

A Case of Disseminated Aspergillosis Presenting Solely as Multiple Cutaneous Lesions in an Acute Leukemia Patient / 감염과화학요법

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients with hematological malignancies. While the development of new effective antifungals and advancement of diagnostic techniques have lead to improved outcomes, relapse of IA in patients with subsequent immunosuppression is emerging as a major issue. The primary IA site is the most common relapse site, but disseminated infection from the lung to multiple organs, including the brain, thyroid, liver, spleen, kidney, bone, heart valve, and skin, can often occur in patients with severe immunosuppression. Furthermore, relapsing or disseminated IA have very poor outcomes. We report a case of disseminated IA presenting as multiple cutaneous lesions without involvement of any other organs in an acute leukemia patient. The patient had suffered from prior invasive pulmonary aspergillosis, which was treated successfully. The multiple skin lesions were fully resolved after antifungal therapy for 6 weeks.

The "Five-in-Seven" Guiding Technique to Overcome Proximal Coronary Tortuosity During Primary Percutaneous Coronary Intervention

No abstract available.

Huge Infected Thrombus of Right Atrium Related to Hemodialysis Catheter / 대한신장학회지

There has been an increase in the use of central venous catheters for temporary hemodialysis. Infected thrombus of right atrium is a rare but life-threatening complication of the central venous catheterization. A 35-year-old female hemodialysis patient was admitted with fever and dyspnea. She had been inserted tunneled hemodialysis catheter 2 months before. Blood cultures revealed methicillin- resistant Staphylococcus aureus. Chest CT showed multi-focal pneumonia and 4 cm sized huge thrombus in the right atrium. Echocardiography demonstrated same thrombus attached to the catheter tip in the right atrium. The catheter could not be removed because of high risk of pulmonary thromboembolism. Despite intravenous vancomycin treatment, the patient died from esophageal varix bleeding.

A Case of Tuberculosis-associated Hemophagocytic Syndrome during Antituberculosis Medication for Tuberculous Pericarditis / 결핵및호흡기질환

A 63-year old woman was admitted to our hospital for an evaluation of thrombocytopenia. She had been diagnosed with tuberculous pericarditis three months earlier in a local clinic and treated with anti-tuberculosis medication. Two months later, thrombocytopenia developed. The medication was subsequently stopped because it was suspected that the anti-tuberculosis medication, particularly rifampin, might have caused the severe platelet reduction. However, the thrombocytopenia was more aggravated. A bone marrow biopsy was performed, which showed moderate amounts of histiocytes with active hemophagocytosis. This finding strongly suggested that the critical thrombocytopenia had been caused by hemophagocytic syndrome, not by the side effects of the anti-tuberculosis medication. Furthermore, the development of hemophagocytosis might have been due to an uncontrolled tuberculosis infection and its associated aberrant immunity. Therefore, she was started with both standard anti-tuberculosis medication and chemotherapy using etoposide plus steroid. One month after the initiation of treatment, the thrombocytopenia had gradually improved and she was discharged in a tolerable condition. At the third month of the follow-up, her platelet level and ferritin, the activity marker of hemophagocytic syndrome, was within the normal range.