A Case of Visual and Auditory Hallucinations during Intravenous Voriconazole Therapy / 감염과화학요법

Voriconazole is a triazole with broad spectrum antifungal activity, and it is currently considered to be the first-line agent for the treatment of invasive aspergillosis. We report here on a case of visual and auditory hallucinations during intravenous treatment with voriconazole in association with a high trough level. A 28-year-old man with acute myelogenous leukemia was admitted for re-induction remission chemotherapy. During the persistent neutropenic fever, intravenous voriconazole was administered for the suspected invasive fungal pneumonia. He began to have visual hallucinations on the 1st day and auditory hallucinations on the 3rd day of voriconazole therapy. The plasma peak and trough concentration levels of voriconazole were 9.9 and 7.4 microg/ml, respectively, on the 3rd day. The hallucinations resolved after changing to amphotericin B deoxycholate, and the plasma concentration of voriconazole dropped to less than 0.5 microg/ml. The genotype of the CYP2C19 alleles was classified as a heterozygous extensive metabolizer. We suggest that therapeutic drug monitoring of voriconazole is indicated for a case that is suspicious for a voriconazole-related adverse event.

Photodynamic therapy using topically applied 5-aminolevulinic acid for treatment of cervical cancer / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate the treatment effects of a topical application of 5-aminolevulinic acid (5-ALA) for photodynamic therapy (PDT) to treat cervical cancer. METHODS: We first investigated the effects of 5-ALA cream according to application time. And to find the effective 5-ALA concentration and the distribution times in vivo, 20% 5-ALA cream was topically applied to the tumor of the nude mouse. We then observed the distribution of 5-ALA via fluorescence measurement with using a 532 nm diode laser. 25 nude mice were divided into Control, ALA, Laser, and PDT group. To evaluate the PDT effect at cancer lesion, we applied 20% 5-ALA cream to the tumor by the same method, and the PDT was done by using a 632 nm diode laser at the time of the peak level of fluorescence. We checked the changes of the volume of cancer for 30 days, and then biopsy was done. RESULTS: The effective post-irradiation time after topical ALA application was 9 hours. In the PDT group, 40% (4/10) of the mice showed decreased tumor size. CONCLUSION: The maximum PpIX fluorescence at 9 hours after local applicationof 5-ALA cream was checked. And PDT group did not show any statistical difference than control group in the growth of tumor size than control group. However responding cases (4/10) of PDT group showed the meaningful decrease of tumor size than control group (P<0.05).

A Case of Citrobacter braakii Sepsis Complicated with Hepatocellular Carcinoma / 감염과화학요법

Citrobacter species is a gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. Citrobacter braakii refers to the genomospecies 6 of the Citrobacter freundii complex. There are no detailed studies on infections caused by this newly identified specific genetic species in Korea. We herein report a case of a patient with hepatocellular carcinoma who, after undergoing transcatheter arterial chemoembolization, developed biloma which later progressed to C.braakii sepsis and did not respond to treatment. To our knowledge, this is the first reported case in Korea on C. braakii infection resulting in septic shock in a patient with malignancy in Korea.

Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Interstitial lung disease (ILD) is one of the common extra-articular manifestations of rheumatoid arthritis (RA). Bronchiolitis obliterans with organizing pneumonia (BOOP) is one type of ILD, and this is characterized by the proliferation of granulation tissue in the bronchioles, alveolar ducts and some alveoli and interstitial infiltration by chronic inflammatory cells. It develops as a manifestation of RA or as a side effect of anti-rheumatic drugs in patients with RA. We experienced a 41-year-old female patient with RA who developed BOOP during the treatment with methotrexate and bucillamine. She presented with cough and sputum for several months and pleuritic chest pain for one week. The chest radiograph showed bilateral multifocal consolidations. She received thoracoscopic biopsy and her pulmonary infiltrations resolved after the treatment with corticosteroid.

A Case of the Uterus Didelphys with Unilateral Obstructed Hemivagina / 대한산부인과학회잡지

Uterus didelphys with unilateral obstructed hemivagina is indeed a very rare congenital anomaly due to M llerian duct malformation. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An accurate and prompt diagnosis is of importance to permit treatment and to assure the future fertility of the patient. The simple and adequate treatment of the condition is incision of the obstructed vaginal septum providing adequate drainage of the retained blood. We report a case of uterus didelphys with obstructed hemivagina with brief review of the literature.

Immunohistochemical Analysis for p53 and TGF-beta Expression Pattern in Ovarian Epithelial Tumors / 대한산부인과학회잡지

OBJECTIVE: To verify the pattern of p53 and TGF-beta protein expression in benign and malignant epithelial ovarian tumors. METHODS: An immunohistochemical technique was applied to formalin-fixed paraffin-embedded samples of 22 benign and 9 malignant epithelial ovarian tumors using p53 monoclonal antibody and TGF-beta polyclonal antibody. Expressions of p53 and TGF-beta protein in two histological types were compared, and correlated with clinico-pathologic findings of the respective cases. RESULTS: p53 immunoreactivity of high or intermediate degree was detected in 2 out of 22 benign (9%) and 5 out of 9 malignant (55%) cases. On the other hand, intermediate to high TGF-beta expression was found in 17 out of 22 benign (77%), and 3 out of 9 malignant (33%) cases. The prevalence differences of p53 and TGF-beta expression between benign and malignant groups were statistically significant (p<0.05). In addition, the prevalence of immunoreactivities of p53 and TGF-beta in malignant tumor didn't show any association with age, tumor size, histologic types and stage. CONCLUSION: Our results suggest that p53 expression and loss of TGF-beta expression may play an important role in the malignant transformation of ovarian epithelial cells. However further studies seem to be necessary to know the exact relationship between their roles.

A Case of Lymphocytic Hypophysitis Occurred in The Third Trimester of Pregnancy / 대한산부인과학회잡지

Lymphocytic hypophysitis is a rare but important cause of pituitary hypofunction which predominantly affects young women in the peripartum period. It is believed to be an autoimmune disorder with an association with other autoimmune disorders. Clinically, it presents most frequently with symptoms and signs attributable to pituitary hypofunction, headache, visual disturbance and amenorrhea. It is difficult to distinguish lymphocytic hypophysitis from a pituitary adenoma on preoperative imaging. So the diagnosis must be confirmed pathologically. The frozen section must be done for saving the risk of permanent hypopituitarism that would have attended a more radical debulking procedure. If lymphocytic hypophysitis is confirmed by frozen section, extensive surgical debulking may not be necessary. A 31-year-old woman presented during the third trimester of pregnancy in July of 2003 with headache, vomiting and gradually progressive bilateral visual loss. There was a large 8 shaped homogeneous sellar mass on MR images before delivery. The subtotal excision of tumor was done via transsphenoidal surgery three weeks after cesarean delivery. Visual field testing revealed marked resolution of her visual field defects in both eyes. We report a case of lymphocytic hypophysitis occurred in the third trimester of pregnancy with a brief review of literatures.

Two Cases of Blue Nevus in the Endocervix of the Uterus / 대한산부인과학회잡지

Blue nevus of the endocervix is an uncommon lesion. Blue nevus commonly occurs on the skin of hands and feet, occasionally it has been observed in the mucosa of the oral cavity, and rarely observed in the uterine cervix, vagina, prostate, lymph nodes, and even breast. Most of them have been discovered incidentally. Our two cases (in 41 years and 45 years) were also incidentally found in the endocervix of the uterus, which were obtained by total abdominal hysterectomy under the diagnosis of leiomyoma. The expressions of S-100 protein in the blue nevus were noted. We report them with review of literatures.