Small Cell Lung Cancer with Mutation of Epidermal Growth Factor Receptor in Patients with Lung Adenocarcinoma Resistant to Gefitinib / 대한내과학회지

Most epidermal growth factor receptor (EGFR) gene mutations are detected in lung adenocarcinomas. In contrast, these mutations have rarely been reported in small cell lung cancer (SCLC). We herein report two cases of EGFR-mutant SCLC transformed from and combined with lung adenocarcinoma. In one case, SCLC appeared to be transformed from EGFR mutant 19-del adenocarcinoma when the patient became resistant to gefitinib. The other patient had combined EGFR-mutant 19-del SCLC and adenocarcinoma at the initial diagnosis, which was resistant to gefitinib at multiple sites. Further comparative molecular analyses of these histologically distinct tumors would provide useful information regarding the role of EGFR mutation in the pathogenesis of SCLC. In conclusion, despite the presence of the same EGFR mutation, gefitinib was not effective in treatment of SCLC. Therefore, confirmation of SCLC cell morphology may become an important means of predicting resistance to EGFR tyrosine kinase inhibitors in addition to common secondary genetic alterations.

Endogenous Endophthalmitis by Aspergillus in a Patient with Multiple Myeloma / 대한진단검사의학회지

A 40-year-old man who had been treated for multiple myeloma, complained of decreased visual acuity of the left eye on the 30th day of admission. The nucleotide sequences of a fungal PCR product from vitreous fluid showed 99% homology with Aspergillus fumigatus (AY373851). Aspergillus spp. was isolated from vitreous fluid culture, also. Rapid diagnosis and intervention are critical elements for the Aspergillus endophthalmitis; therefore, it would be helpful to combine the fungal PCR with conventional fungus culture for clinically indicated specimens.

A Case of Eosinophilic Meningitis Associated with Idiopathic Hypereosinophilic Syndrome

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease characterized by peripheral blood eosinophilia and eosinophilic infiltration of multiple organs, including the nervous system. The neurologic manifestations in hypereosinophilic syndrome are variable, but eosinophilic meningitis as a manifestation has not been well documented in IHES. We report a case of eosinophilic meningitis associated with IHES, which showed a good response to steroid treatment.

Microbial Features and Antibiotic Prophylaxis of Prosthetic Joint Infection / 감염

BACKGROUND: Success in orthopedic implant surgery relies on reducing infection by preventive methods including antibiotic prophylaxis. The lack of published data on orthopedic implant infections with methicillin-resistance Staphylococcus aureus (MRSA) and methicillin-resistance coagulase-negative staphylococcus (MRCNS) makes it difficult to choose correct prophylactic antibiotics. We therefore reviewed the etiology of prosthetic joint infection and the effectiveness of current antibiotic prophylaxis. METHODS: We reviewed retrospectively the clinical notes and microbial records of patients with prosthetic joint infection who had admitted in Asan Medical Center from June 1989 to July 1999. RESULTS: During a eleven-year period, prosthetic joint infections occurred in 18 (0.9%) of 2,028 patients who received a total hip or total knee arthroplasty at Asan Medical Center (AMC). The cephalosporins were administered to most of patients before surgery for prophylaxis. Twenty two patients were referred to our institution because of prosthetic joint infection. Thirty five patients had positive bacteriological cultures from tissue removed at the time of surgery or joint aspiration. Staphylococci were the most common pathogens and accounted for twenty four (68.8%) of the 35 isolates. Seven (50%) of the fourteen isolates of coagulase-negative staphylococci were MRCNS. Eight (80 %) of the ten ioslates of S. aureus were MRSA. Gram-negative bacilli accounted for five (14.3%) of the isolates and included Escherichia coli, Serratia marcescens, Pseudomonas aeruginosa. CONCLUSION: First-or second-generation cephalosporins were effective prophylatic antibiotics in total hip or total knee arthroplasty because the rate of prosthetic joint infections was low (0.9%). But the prevalence of MRCNS or MRSA prosthetic joint infection was high, we must consider glycopeptides prophylaxis if there is, or has been, infection or carriage with MRCNS or MRSA.