A Case of Acquired Amegakaryocytic Thrombocytopenia Responding to Immunosuppressive Therapy / 대한혈액학회지

Acquired amegakaryocytic thrombocytopenia is a relatively rare bone marrow failure disorder characterized by severe thrombocytopenia associated with a total absence or a marked reduction in the number of bone marrow megakaryocytes. We report a case of acquired amegakaryocytic thrombocytopenia. A 39-year old man admitted our hospital because of gingival bleeding and purpura on the thigh, his initial complete blood cell counts were white blood cell 5.6 103/micro liter hemoglobin 9g/dL, and platelet 1 103/micro liter On the bone marrow study, megakaryocyte was not observed and cytogenetic analysis of marrow was 46, XY, inv(9). (p11q13). Other autoimmune markers were negative. The patient received steroid therapy during 8 weeks, but there was no significant improvement and then he received immunosuppressive therapy with antithymocyte globulin and cyclosporin-A. Thereafter the platelet count increased to 80 103/micro liter, and this level continued for 10 months

The Relationship of Serum Angiotensin Converting Enzyme (ACE), Angiotensin II and Clinical Markers in the Idiopathic Interstitial Pneumonia / 결핵

BACKGROUND: There have been several studies showing that angiotensin II and the angiotensin convertingenzyme (ACE) contribute to the activation of fibroblast including the pulmonary fibrosis, and apoptosis of the al veolar epithelium in idiopathic intersititial pneumonia. This study was performed to identify the relationship between the serum angiotensin II. ACE and the pulmonary function test (PFT), the dyspnea score, and the cell fraction of the bronchoalveolar lavage fluid (BALF). METHODS: Twenty three patients with idiopathic interstitial pneumonia from March, 1999 to October, 2001 at Gachon medical school were enrolled in this study. They were divided into IPF(UIP) (16) and NSIP (7) group. Twelve of the idiopathic interstitial pneumonia patients (UIP : 5, NSIP: 7) were diagnosed by an open lung biopsy, 11 of IPF patients were diagnosed by the American Thoracic Society (ATS) diagnostic criteria. The PFT values, dyspnea score, serum ACE and angiotensin II were measured, and a bronchoscopy was performed to obtain the BALF. RESULTS: Of all the patients, 7 were in the normal range and 14 showed an increase in the serum level of angiotensin II. In terms of the serum ACE level, 14 patients had an increased level. The DLCO% of the angiotensin II. increased group was significantly lower than the not-increased group (p=0.021). Other factors did not correlate with the serum ACE or the angiotensin II increased group and not-increased group. CONCLUSION: These results suggest that an increased angiotensinII serum level may be associated with in crease in the of alveolar capillary block in the progression of pulmonary fibrosis in idiopathic interstitial pneumonia.

Two Cases of Microscopic Polyangiitis with Honeycomb Lung / 결핵

Microscopic polyangiitis is a systemic small-vessel vasculitis that is associated primarily with necrotizing glomerulonephritis and pulmonary capillaritis. A recurrent and diffuse alveolar hemorrhage due to pulmonary capi llaritis is the main clinical manifestation of lung involvement. Recently, an interstitial lung disease that mimics idiopathic pulmonary fibrosis was reported to be rarely associated with microscopic polyangiitis. Here we report two patients with microscopic polyangiitis who showed a honeycomb lung at the time of the initial diagnosis with a brief review of relevant literature.

A Case of Adrenocortical Adenoma Causing Cushing's Syndrome with Contralateral Nonfunctioning Adenoma / 대한내분비학회지

We report the case of a 43-year-old woman with Cushing's syndrome showing bilateral adrenococortical adenomas. We performed bilateral selective adrenal vein samplings. Hypersecretion of cortisol on the left sided adrenal tumor was observed, but no evidence of cortisol hypersecretion from the adrenal tumor on the right side was observed. The left adrenal tumor was resected selectively, but the right adrenal gland was reserved. The left adrenal tumor was histologically diagnosed as a adrenal adenoma without any evidence of nodular hyperplasia. Following the resection of the left adrenal gland, no cortisol hypersecretion from the remaining adrenal tumor on the right side was observed until now, suggesting that a selective adrenalectomy of functioning adenoma may be an acceptable treatment modality.

A Case Intestinal Mucormycosis Healing of Ulcer after Only Amphotericin B Treatment / 대한소화기내시경학회지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection and usually occur in immunocompromised patients. Rhinocerebral and pulmonary disease are the common forms but intestinal infection is an extremely rare form of the disease. Invasive intestinal mucormycosis is usually fatal, therefore, few cases reported survival after early diagnosis and surgical resection combined with antifungal treatment. Because of high mortality after surgery, the healing of ulcers caused by intestinal mucormycosis has not previously observed in immunocompromised host. We reported a case of the intestinal mucormycosis that had been healed the ulcer and symptomatic improvement after only amphotericin B.

A Study of Clinical Investigations of Pulmonary Tuberculoma / 결핵

BACKGROUND: A pulmonary tuberculoma is one of the most common causes of a solitary pulmonary lesion. Treating a tuberculoma is still controversial and there are few reports on antituberculosis chemotherapy. In this study, the clinical findings and changes in the size of tuberculomas on a radiograph after completing antiuberculosis chemotherapy was investigated. METHODS: The medical records, an chest radiographs of 18 pulmonary tuberculoma patients who were admitted to the Gachon medical school, Ghil medical center between April 1998 and August 2001, were reviewed. The symptomatic changes were recorded and the size of the tuberculomasl following treatment were compared. To compare the size, the long distance of each tuberculoma on the chest radiographs were measured and the additional radiological findings of calcification, satellite nodules and cavities were investigated. RESULTS: Fifteen patients were men and 3 were women. The median age was 46(24-74). Among these 18 patients, 14 patients had clinical symptoms. The other 4 patients were diagnosed incidentally as during a routine chest radiograph. The mean size of the tuberculomas on the initial plain chest film was 4.3+/-2.3cm(range : 1.7-10cm)and after 6 months treatment, it had decreased to 1.68+/-2.00cm(range : 1.5-6.5cm)(P<0.05). At least 6 months of antituberculosis chemotherapy resulted in the findings of a tuberculoma with a disappearance in 9, a decreased size in 4, and no change in 5 on the chest radiograph. Calcifications were found in 3 patients on the initial chest film and the chest CT and all calcified tuberculomas had disappeared after treatment. CONCLUSIONS: A lthough a pulmonary tuberculoma can remain as an inactive lesion for a long time, if it is confirmed by pathological or bacteriological methods, antituberculosis chemotherapy will be beneficial despite the presence of calcification.