1 case of imported Plasmodium vivax malaria with delayed manifestations due to inadequate chemoprophylaxis / 대한내과학회지

Malaria is the world's most important parasitic infec tion. Although it has been eradicated from temperate zones including Korea , increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It beco mes important to provide general personal protective me asures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria . We recently experienced a case of imported Plasmodium vivax malaria with delayed mani festations due to inadequate chemoprophylaxis. A 53- year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.

Autonomic Dysfunction in Chronic Renal Failure / 대한내과학회지

OBJECTIVES : Impaired autonomic function in patients with chronic renal failure has been well documented in a number of studies to assess the degree of cardiovascular autonomic dysfunction and to assess the relationship with plasma catecholamines. The purpose of the present study was to evaluate the prevalence of autonomic dysfunction and to determine the effect of autonomic dysfunction on the increment of plasma catecholamine, dialysis-induced hypotension and hypotension during chronic dialysis. METHODS: We measured the degree of autonomic damage and the concentration of plasma catecholamines in 20 patients on maintenance hemodialysis, 12 pre- dialysis patients with chronic renal failure and 20 normal controls using a standardized battery of five cardiovascular reflex tests. RESULTS: 1) In normal controls, 70% of cases had a normal or early parasympathetic abnormalities however in patients with chronic renal failure, 45.2% of patients had severe abnormalities. The prevalence of autonomic dysfunction was 62.5% and there was significant correlation between sympathetic and parasympathetic score in patients with chronic renal failure. 2) Although overall autonomic function was not different in two chronic renal failure groups, the magnitude of heart rate response to Valsalva maneuver was increased and the magnitude of fall of blood pressure in response to standing-up was reduced in dialyzed patients compared with nondialyzed patients. 3) Patients with autonomic dysfunction was older and had higher postdialysis concentration of plasma norepinephrine than those with normal autonomic function. 4) In dialyzed patients, predialysis concentration of plasma norepinephrine at rest varied widely and was significantly related to the duration of dialysis. Postdialysis concentration of norepinephrine was significantly correlated with the degree of parasympathetic damage. 5) There were no significant differences in autonomic damage or plasma catecholamines whether dialysis- induced hypotension and hypotension in chronic hemodialysis or not. CONCLUSION : Disturbances of autonomic nerve system are common in chronic renal failure with distinct abnormalities of parasympathetic function and additional sympathetic dysfunction. Elevated plasma norepinephrine seems to be related to the compensatory response of sympathetic nerve system to parasympathetic damage. Impairment of autonomic function does not appear specifically related to dialysis-induced hypotension or hypotension in chronic dialysis.

Spontaneous Submucosal Dissection of the Esophagus: A case report / 대한소화기내시경학회지

A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry identified the lower esophageal sphincter as having no response to swallow. Barium swallow showed typical esophagograms of double barrelled esophagus or mucosal stripe. An endoscopic examination revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slitlike mucosal tears were seen on the lower esophagus. Subsequent fasting and total parenteral nutrition for several weeks failed to bring about any improvement in his symptoms. So, as a treatment, primary closure of the upper opening of the false channel was performed under general anesthesia. Soon after the surgical procedure, the patients symptoms disappeared except for mild dysphagia. He was discharged after oral intake had been judiciously commenced with fluids and soft diets. During his follow-up in the out-patient department, he was examined and found to have no specific symptoms including fever or dysphagia. Moreover, there was great improvement from the massive dissection of the esophagus on esophagogram.

Spontaneous Submucosal Dissection of the Esophagus: Report of 1 Case / 대한흉부외과학회지

A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry showed that there was no relaxation of lower esophageal sphincter to swallowing. There was double barrelled esophagus or mucosal stripe appearance on esophagogram. Endoscopy revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slit-like mucosal tears was seen on the lower esophagus. There after, fasting and total parenteral nutrition for several weeks failed to bring about any changes in his symptoms. So, as treatment, primary closure of the upper opening of the false lummen was performed under general anesthesia. Soon after the surgical procedure, the patient's symptoms were improved except for mild dysphagia. He was discharged after oral intake had been juduciously commenced with fluids and soft diet subsequently. During follow-up in out-patient department, he had no specific symptoms including fever or dysphagia and massive dissection of the esophagus was improved on esophagogram. We report the experience of a case of spontaneous submucosal dissection of the esophagus which required conservative and surgical management.

A Case of Infective Endocarditis with Mycotic Aneurysms / 대한내과학회지

Cerebral mycotic aneurysms have been noted in 2-10% of cases of bacterial endocarditis and account for 2.5-6.2% of all intracerebral aneurysms. Mycotic aneurysms were reported to occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Symptomatic mycotic aneurysms are now uncommon. Early or late hemorrhage correlates better with the presence of pyogenic arteritis and uncontrolled S, aureus infection. Early cerebral hemorrhage is usually associated with S. aureus arteritis, is not amenable to surgery, and carries a high mortality. Control of the infection dramatically decreases the risk of embolism in infective endocarditis patients. Recurrent emboli are not common after adequate antimicrobial treatment of the underlying infection. Recently, we experienced a case of infective endocarditis in which angiographically demonstrated mycotic aneurysm had been resolved with adequate antibiotic therapy.

Changes of Specific Immunogloblins Against Dihperia Toxoid After DPT Vaccination

No abstract available.