A Pediatric Case of Toxic Hepatitis Induced by Hovenia Dulcis / 대한소아소화기영양학회지

Toxic hepatitis is a rare but devastating disease in children. Herbs are widely used in oriental medicine to treat various symptoms in Korea, however, several herbs have been reported to induce liver injury. We report a case of toxic hepatitis induced by Hovenia dulcis in a 3-year-old boy. He complained of nausea, abdominal discomfort, and jaundice. The patient had consumed water boiled with hovenia dulcis for about 1 year prior to presentation. A diagnosis of toxic hepatitis was made based on his history, laboratory data, viral markers, ultrasonography, and biopsied liver tissue. We administered supportive management for acute fulminant hepatitis but his symptoms and liver function progressed. He was transferred to another hospital for further evaluation and consideration for liver transplantation. Because acute liver failure due to herbs or dietary supplement taken for a long time is often fetal, it is important to make early diagnosis and stop taking the drug as soon as drug induced liver injury is suspected.

A Comparison of Autologous and Homologous Transfusions in Spinal Fusion

Autologous transfusion has been used to overcome adverse effects of homologous transfusion. Clinical studies evaluating general orthopaedic postoperative results have been designed to compare these transfusion methods. However, few studies have evaluated postoperative results in spinal fusion surgeries, which have larger blood loss volumes. The purpose of this study is to determine if there are differences in postoperative infection and clinical results of spinal fusion with autologous, as compared to homologous, blood transfusion. A total of 62 patients who underwent instrumented spinal fusion and received autologous (n = 30) or homologous (n = 32) transfusions were reviewed. Information on gender, age, preoperative and 3-day postoperative hematologic features, total transfused units, segmental estimated blood loss, transfused units, and surgery time were collected. In addition, postoperative infection data on wound infection, pneumonia, urinary tract infection, cellulitis, and viral disease, incidence and duration of fever, as well as clinical results, fusion rates, and patient feedback were collected. No differences in postoperative infection and clinical results were found between the two types of transfusions; however, homologous transfusion was associated with an increased number of total units transfused, longer duration of fever, and decreased patient satisfaction regarding the transfusion.

A Comparison of Autologous and Homologous Transfusions in Spinal Fusion

Autologous transfusion has been used to overcome adverse effects of homologous transfusion. Clinical studies evaluating general orthopaedic postoperative results have been designed to compare these transfusion methods. However, few studies have evaluated postoperative results in spinal fusion surgeries, which have larger blood loss volumes. The purpose of this study is to determine if there are differences in postoperative infection and clinical results of spinal fusion with autologous, as compared to homologous, blood transfusion. A total of 62 patients who underwent instrumented spinal fusion and received autologous (n = 30) or homologous (n = 32) transfusions were reviewed. Information on gender, age, preoperative and 3-day postoperative hematologic features, total transfused units, segmental estimated blood loss, transfused units, and surgery time were collected. In addition, postoperative infection data on wound infection, pneumonia, urinary tract infection, cellulitis, and viral disease, incidence and duration of fever, as well as clinical results, fusion rates, and patient feedback were collected. No differences in postoperative infection and clinical results were found between the two types of transfusions; however, homologous transfusion was associated with an increased number of total units transfused, longer duration of fever, and decreased patient satisfaction regarding the transfusion.

Partial HPRT Deficiency Due to a Missense Mutation in the HPRT Gene

An 8-month-old male infant presented with persistent, gross, orange-colored crystals in his urine. His physical and neurological development was normal. Laboratory study showed hyperuricemia, hyperuricosuria and urate crystaluria. He was determined to have partial hypoxanthine-guanine phosphoribosyl transferase(HPRT) deficiency. The molecular genetic analysis revealed a missense mutation in the patient's HPRT gene. By sequencing the patient's cDNA, we identified an A-to-G transition at nucleotide 239, resulting in the replacement of Aspartate with Glycine at amino acid 80 in the HPRT. To our knowledge, this mutation has not previously been reported. Our patient is now being placed on allopurinol therapy, and has had no problem since. Partial HPRT deficiency has been known to cause recurrent acute renal failure without the phenotypic features of Lesch-Nyhan syndrome. Therefore, we think that early diagnosis and treatment are very crucial in preventing acute renal failure.

Primary Transitional Cell Carcinoma of the Prostate / 대한비뇨기과학회지

Primary transitional cell carcinoma of the prostate is a rare tumor. It implies no pre-existing or concomitant bladder tumor and arises from indifferent or reserve cell, lying between the luminal epithelium and the basement membrane of the periurethral ducts. A review of 125 patients with carcinoma of the prostate presenting to this hospital in the 10 years between Jan. 1980 and Dec. 1990 revealed 5 patients(4%) with primary transitional cell carcinoma arising within the prostate Clinical presentations were similar to prostatic adenocarcinoma, but hematuria was found in 4 of 5 patients(80%). PSA was elevated in one of 4 cases. Both diagnosis and histological pattern of invasion were all made by TURP. Histologically, all patients had both prostatic stromal and ductal and acinar involvements of transitional cell carcinoma, and had metastases at the time of diagnosis. One patient was lost during follow-up. Mean survival time of 4 patients was 20.5 months after diagnosis. In conclusion, when primary transitional cell carcinoma of the prostate is suspected, transurethral resection of the prostate should be performed to provide sufficient material to determine the exact histological extent of malignant cells. Because the patients with stromal involvement had extremely poor survival, we suggest that such patients, even though they do not have metastases at presentation, should be offered neoadjuvant chemotherapy before radical cystoprostatectomy.