Antibiotic-Induced Acquired Factor V Inhibitor / 대한내과학회지

Acquired factor V inhibitor is a rare condition with a variety of clinical manifestations that range from no bleeding symptoms to life-threatening hemorrhage or thromboembolic events. Treatment is determined by the clinical course and focuses on controlling the hemorrhagic event and decreasing the antibody titer if bleeding symptoms are present. We report herein a case involving a 70-year-old man who developed acquired factor V inhibitor after antibiotic administration (11-day course of ceftriaxone and successive 5-day course of piperacillin-tazobactam) for pneumonia. His condition was characterized by elevated prothrombin and activated partial thromboplastin times without bleeding events. Coagulation factor assays revealed undetectable factor V activity and a factor V inhibitor level of 3.29 Bethesda units. After cessation of the antibiotics, both the prothrombin and activated partial thromboplastin times gradually normalized.

Clinico-hematologic Findings of Leukemic Bone Marrow Involvement in Korean Patients with Non-Hodgkin Lymphoma

BACKGROUND: The purpose of the present study was to investigate the clinico-hematological findings of bone marrow (BM) involvement and leukemic phase in Korean patients with non-Hodgkin lymphoma (NHL). METHODS: We included 791 patients with NHL that were classified with the WHO (2008) criteria. Laboratory data, bone marrow histomorphologic features and medical records were reviewed. Leukemic phase was defined as when the proportion of neoplastic lymphoid cells comprised more than 10% of leukocytes in the peripheral blood or more than 25% of nucleated cells in the BM. RESULTS: We found that 21.7% (172/791) of the patients had BM involvement, and 6.2% (49/791) developed leukemic phase of the disease. NHL subtypes showing high frequencies of leukemic phase development were mantle cell lymphoma (40%), angioimmunoblastic T cell lymphoma (40%), lymphoblastic lymphoma (36.4%), and Burkitt lymphoma (26.1%). Compared to B-cell type, T-cell type of NHL showed significantly higher frequencies of BM involvement (18.6% vs 30.9%; P=0.0004) and leukemic phase development (4.8% vs 10.3%, P=0.008). Complete remission rate was significantly lower in leukemic (55.6%) than in non-leukemic (85.9%) group of patients (P=0.0002), whereas relapse rate was not different between the two groups. Death rate was higher in leukemic (46.9%) than in non-leukemic (30.1%) group of patients, and the 5-yr overall survival probability was significantly lower in leukemic group (P=0.02). CONCLUSIONS: The incidence of leukemic phase development in NHL was lower in Korean patients than that reported for Western populations and higher in T-cell lymphoma. We confirmed that the presence of leukemic phase in NHL patients is associated with a poor prognosis.

A Case of Plasmodium vivax Malaria Complicated with Acute Renal Failure, Jaundice and Thrombocytopenia / 대한신장학회지

Malaria is caused by four species of the genus Plasmodium. Plasmodium vivax malaria is the most common malarial infection in Korea and usually has benign clinical course. However, serious complications such as severe anemia, pulmonary edema, acute renal failure are reported in Plasmodium vivax malaria. We report a case of Plasmodium vivax malaria complicated with acute renal failure, jaundice and thrombocytopenia. A 56-year-old male was transferred to our hospital with acute renal failure, jaundice and thrombocytopenia. 10 days before admission, he had intermittent fever, chill, myalgia, and was treated with some medications under the impression of URI. Laboratory findings showed that hemoglobin was 11.5 g/dL, platelet 44,000/mm3, blood urea nitrogen 73 mg/dL, creatinine 4.0 mg/dL, total bilirubin 5.2 mg/dL, direct bilirubin 4.0 mg/dL. Serologic tests for leptospirosis, rickettsia, EB virus and CMV were negative. Ring form trophozoites were found in red blood cells, suggesting Plasmodium vivax malaria. Following anti-malarial therapy, acute renal failure, jaundice and thrombocytopenia were recovered to normal. From this case, malarial infection should be included as a differential diagnosis in a febrile patient with acute renal failure, jaundice and thrombocytopenia.

Late Hematoma after Breast Augmentation

Late capsular hematoma is one of the rare complication of augmentation mammoplasty. Although the cause has not unfolded yet, the possible damage of capsular vessels chafed against the textured prostheses is questioned. Reviewing the literatures, we present a 23-year-old female subjects to incidental swelling of the right breast a year later after augmentation mammaplasty with saline-filled textured prostheses. An MRI study confirmed intracapsular fluid collection sparing the prostheses. The exploration was followed and serosanguinous fluids was drained out of the intracapsular space, and then the existing prostheses were replaced with the smooth surface ones. In the 9 months since the last surgery the patient remained well without any further problem. Intensive massage of the breasts might be accounted to the probable cause of late hematoma in this case.

New Trends in Reduction Mammaplasty

In Korea, reduction mammaplasty had not been performed because of ugly final scar. Recent decade, the number of patients who are suffering from large breast with back, neck, shoulder pain has been increased. And plastic surgeons are concerning about that kind of operarion. The inverted T method has been standard method for reduction mammaplasty. Many European and Brazilian plastic surgeons have developed their own methods with good results. Recent trend is focusing on the shape, projection, and scar of the breast, not on the design of skin excision. We discussed about various methods of reduction mammaplasty and their modifications which are fit for above principle.

Wound Dressing after CO2 Laser Resurfacing using a New Dressing Material: Medifoam(R)

CO2 laser resurfacing procedure on the face is an increasingly popular and highly effective for patients with facial rhytids and scarring. And there is a variety of dressing materials available for wound care after CO2 laser resurfacing. Among the dressing method, the authors have been used the Medifoam(R) (Il Dong Pharmaceutical Ltd. and Biopol Ltd.,Seoul, Korea; a hydrocelluar semi-permeable dressing material) after CO2 laser resurfacing. A total of 20 patients were treated for scar face and wrinkles (mainly scar face including small pox scar face) with ultra-pulsed CO2 lasers (Coherent, Palo Alto, USA). No pretreatment was done. The basic protocol of laser resurfacing was that, first pass was 300mJ on the shoulder of scar, second pass with 250-200mJ, and feathering with 150mJ. Immediately after the procedure, the wound must be cleansed and dried well so that the Medifoam(R) sticks better and early contamination is avoided. Medifoam(R) was fixed to wound surface using surgical tape or surgi-net. First dressing change was done after 24-48hours according to the amount of exudates. Because of the high absorption ability of the Medifoam(R), dressing change was not necessarily needed on postoperative day 1. Another dressing changes were done on days 3, 6, 9 postoperatively for evaluating wound healing and observation. The epithelialization was usually completed within 9 days in all cases. During the dressing change, there were no exudates outside, less crust, and less thin layer of gel formation on the wound surface than any other dressing materials. Also there was no detachment of reepithelialized layer on removing the dressing materials. The use of the Medifoam(R) after CO2 laser resurfacing accelerates the healing time, reduces the pain and anxiety of the patients due to exudation, reduces the inconvenience of the patients and surgeons by less dressing changes, and reduces the cost.