A Case of Fanconi's Syndrome Due to Chinese Herb Nephropathy: Differences between European and Asian CHN / 대한신장학회잡지

We encountered one case of Chinese Herb Nephropathy in Korea. But clinical feature of our case was different from those of CHN in Belgium. The purpose of this case report was clarified the features of CHN in Asia. The subjects consisted of a patient diagnosed as interstitial nephritis in Hanyang University Hospital and of those reported in the literature in Asia and Belgium. We investigated the clinical and histological features of CHN patients in Asia and compared them with the Belgian cases. The remarkable differences were as follows; (1) relatively high prevalence in males compared with Belgian cases, (2) digestion with multiple object and mode in Asia, (3) Most of renal failure in Asia were improved or were in stable status. (4) Fanconi's syndrome was found in most cases of Asia. In conclusion, CHN in Asia has some characteristics distinguished from Belgian Chinese Hreb Nephropathy. These findings could indicate that susceptibility to aristolochic acid may be different among races. Furthermore, it is likely that different components of AA could cause different features, that the amount of ingested AA, mode in digestion, or interaction with other components except nephrotoxic agent such as AA might reflect clinical pictures. Other hypothesis may be some other toxic substances affecting the clinical findings although they are not identified at present. Further studies must be undertaken to clarify these differences.

A case of microscopic polyangiitis combined with pulmonary silicosis / 대한내과학회지

Microscopic polyangiitis (MPA) is a distinct type of systemic small vessel vasculitis affecting small sized vessels with few or no immune deposit and no granulomatous inflammation. Cause or pathogenetic mechanism of MPA has been unknown but association with silicon or silica exposure or pulmonary silicosis has been reported rarely and supports hypothesis that environmental factors are important modulating or triggering factors of the vasculitis in the indivisual who may be genetically predisposed. We report a case of microscopic polyangiitis with underlying pulmonary silicosis in 43 year-old male. He was admitted due to hemoptysis, dyspnea, fever and bilateral pulmonary infiltration with underlying small nodular densities in whole lung field and egg-shell calcification of both hilar areas. Laboratory findings showed hematuria, proteinuria and rapid deterioration of renal function. Renal biopsy revealed focal segmental necrotizing glomerulonephritis with early cellular crescents accompanied with membranous glomerulonephropathy and perinuclear-antineutrophil cytoplasmic antibody was positive. Under the diagnosis of MPA, he has been managed with high dose steroid, cyclophosphamide and hemodialysis. Chest infiltration decreased and hemoptysis and hypoxia was improved but renal function was not recoverd and he needed regular hemodialysis continuously.

Small Cell Neuroendocrine Carcinoma of the Uterine Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study was to analyze the clinical characteristics and prognosis of small cell uterine cervical carcinoma with neuroendocrine differentiation. METHODS: Patient's medical records were reviewed retrospectively who were diagnosed as small cell carcinoma of uterine cervix and were treated at Hanyang University Hospital between 1972 and 1997. RESULTS: Between 1972 and 1997, of 1164 patients who were diagnosed as invasive cervical cancer, there were 10 cases of small cell carcinoma of uterine cervix in the department of obstetrics and gynecology, Hanyang University Hospital. The incidence of small cell carcinoma in invasive cervical cancer was 0.9% (10/1164). Of 10 small cell carcinoma, seven(70%) were neuroendocrine types which were identified with several kinds of immunohistochemical stains (Chromogranin, Grimelius, and/or NSE). The age of these 7 patients ranged from 34 to 63 years (mean 49). Two were in stage Ib, 3 in stage lla, I in stage IIIb, and 1 in stage IVb. Patients with stage Ib-IIb (n 5) received 3-5 courses of neoadjuvant VBP chemotherapy (vinblastine, bleomycin and cis-platinum) followed by radical hysterectomy with pelvic and paraaortic node dissection. One IIIb patient was managed with concurrent chemo-radiation(3 cycles of cis-platinum & 5-FU) followed by 6 courses of chemotherapy. One IVb patient was treated by palliative chemotherapy with 8 cycles of VBP chemotherapy. Of 5 paticn(s who underwent surgery, none showed pelvic lymph node metastases. These 7 patients were folk>wed for 8 - 62 months (average: 20 months). During this period, 5 patients died of disease hetween 8 and 62 months later and 2 patients are still alive for 12 (stage Ib) and 26 months (stage Ib), respectively. In the contrary, of 3 patients without neuroendocrine differentiation, who underwent neoadjuvant VBP chemotherapy followed by radical hysterctomy with pelvic and paraaortic node dissetion or concurrent chemo-radiation, two stage IIb patients are still alive for 58 and 74 months, and one IIIb patient died of disease 12 months later. CONCLUSION: In summary, neuroendocrine differentiation seemed to adversely affect the prognosis and longterm survival of small cell carcinoma of uterine cervix. So, for this high risk group, more aggressive therapy would be need to improve outcome. However, as the number of patients were small in our study, further study with large number of patients are warranted.