• Childhood Kidney Diseases
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• 제20권2호
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• pp.92-96
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• 2016

Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) is the most common vasculitis in children, mainly affecting the small vessels of the skin, joints, gastrointestinal tract, and kidneys. Although most cases of HSP resolve spontaneously without sequelae, serious nephrological and intestinal problems may occur in some cases. We experienced a case of HSP complicated by simultaneous intussusception and nephritis in a 14-year-old boy who developed a sudden abdominal pain and gross hematuria on the 11th day after onset of the disease. Imaging studies revealed intussusception that required emergency laparotomy. Despite treatment with steroid and angiotensin-converting enzyme inhibitors, nephritis and nephrosis progressed for 4 weeks, and renal biopsy was performed to confirm the diagnosis. Cyclosporin A therapy was started, and remission of proteinuria was achieved after 5 months. However, the nephritis recurred and worsened to end-stage renal failure during 15 years of follow-up.

• 한국임상수의학회지
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• 제36권6호
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• pp.353-357
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• 2019

A two-year-old spayed female Persian cat demonstrated weight loss, anorexia, and vomiting for one week. Hematologic findings suggested chronic renal failure. Radiography and ultrasonography revealed severe bilateral renomegaly with hypoechoic nodules and subcapsular hypoechoic rim. Fine needle aspiration of the kidney revealed malignant lymphoma. The cat received in-hospital treatment for chronic renal failure for seven days, followed by chemotherapy (cyclophosphamide, vincristine, and prednisolone). The cat tolerated chemotherapy well and chronic kidney disease was alleviated. However, complete remission was not achieved. After 93 days of treatment, the cat exhibited anisocoria and mental dullness. Brain magnetic resonance imaging revealed hypertrophy and enhancement of cranial nerves. Chemotherapy was replaced with lomustine (10 mg orally), and two weeks later, cytosine arabinoside (50 mg/㎡ subcutaneously), twice daily for consecutive days. Five days after substitution chemotherapy, the patient showed anemia due to severe intestinal bleeding and died. Post-mortem examination and histopathologic analysis confirmed renal T-cell lymphoma with metastasis to the central nervous system, colon, and nasal cavity. Survival time was 117 days after the diagnosis of renal lymphoma.

• Radiation Oncology Journal
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• 제29권4호
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• pp.252-259
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• 2011

Purpose: To evaluate retrospectively the survival outcome, patterns of failure, and complications in patients treated with postoperative chemoradiotherapy (CRT) in advanced gastric cancer. Materials and Methods: Between January 2000 and December 2006, 80 patients with advanced gastric cancer who received postoperative concurrent CRT were included. Pathological staging was IB-II in 9%, IIIA in 38%, IIIB in 33%, and IV in 21%. Radiotherapy consisted of 45 Gy of radiation. Concurrent chemotherapy consisted of a continuous intravenous infusion of 5-fluorouracil and leucovorin on the first 4 days and last 3 days of radiotherapy. Results: The median follow-up period was 48 months (range, 3 to 83 months). The 5-year overall survival, disease-free survival, and locoregional recurrence-free survivals were 62%, 59%, and 80%, respectively. In the multivariate analysis, significant factors for disease-free survival were T stage (hazard ratio [HR], 0.278; P = 0.038), lymph node dissection extent (HR, 0.201; P = 0.002). and maintenance oral chemotherapy (HR, 2.964; P = 0.004). Locoregional recurrence and distant metastasis occurred in 5 (6%) and 18 (23%) patients, respectively. Mixed failure occurred in 10 (16%) patients. Grade 3 leukopenia and thrombocytopenia were observed in 4 (5%) and one (1%) patient, respectively. Grade 3 nausea and vomiting developed in 8 (10%) patients. Intestinal obstruction developed in one (1%). Conclusion: The survival outcome of the postoperative CRT in advanced gastric cancer was similar to those reported previously. Our postoperative CRT regimen seems to be a safe and effective method, reducing locoregional failure without severe treatment toxicity in advanced gastric cancer patients.

• Journal of Yeungnam Medical Science
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• 제39권2호
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• pp.133-140
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• 2022

Background: Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. Methods: A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes. Results: The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery. Conclusion: Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

• Clinical and Experimental Pediatrics
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• 제57권11호
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• pp.465-471
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• 2014

Inflammatory bowel disease (IBD) is a chronic relapsing disorder of unknown etiology, which is believed to be multifactorial. Recently, the incidence of pediatric IBD has steeply increased in Korea since 2000. Poorly controlled disease activity can result in complications such as intestinal fistulae, abscess, and stricture, as well as growth retardation and delayed puberty in children. Because of a lack of confirmative tests, various diagnostic modalities must be used to diagnose IBD. Onset age, location, behavior, and activity are important in selecting treatments. Monogenic IBD must be excluded among infantile and refractory very-early-onset IBD. Early aggressive therapy using biologics has recently been proposed for peripubertal children to prevent growth failure and malnutrition.

• Childhood Kidney Diseases
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• 제7권1호
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• pp.82-85
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• 2003

저자들은 18개월된 남자 환아에서 아메바성 장염 후 급성 신부전, 미세혈관성 용혈성 빈혈, 혈소판 감소증의 전형적 용혈성 요독 증후군이 발생한 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Annals of Geriatric Medicine and Research
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• 제22권4호
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• pp.200-203
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• 2018

Strongyloides stercoralis is an intestinal nematode that occurs sporadically in temperate areas like Korea. People who are in the immunosuppressed state, over the age of 65 or under the corticosteroid therapy are at risk for developing Strongyloides hyperinfection syndrome. Acute respiratory distress syndrome (ARDS) with alveolar hemorrhage is a rare presentation of Strongyloides hyperinfection. A 78-year-old man had been irregularly injected corticosteroid on his knees, but did not have any immunosuppressive disease. He was initially diagnosed with ARDS and septic shock. Bronchoalveolar lavage (BAL) fluid was bloody and its cytology revealed helminthic larvae identified as S. stercoralis. Results of Cytomegalovirus polymerase chain reaction (PCR), Pneumocystis jirovecii PCR, and Aspergillus antigen testing of the BAL fluid were positive. The clinical progress quickly deteriorated with multiple organ failure, shock and arrhythmia, so he finally died. This is a rare case of ARDS in an older patient without any known immunosuppressive conditions, with alveolar hemorrhage and S. stercoralis being found via BAL.

• Experimental and Molecular Medicine
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• 제50권11호
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• pp.14.1-14.14
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• 2018

The link between antibiotic treatment and IF-associated liver disease (IFALD) is unclear. Here, we study the effect of antibiotic treatment on bile acid (BA) metabolism and investigate the involved mechanisms. The results showed that pediatric IF patients with cholestasis had a significantly lower abundance of BA-biotransforming bacteria than patients without cholestasis. In addition, the BA composition was altered in the serum, feces, and liver of pediatric IF patients with cholestasis, as reflected by the increased proportion of primary BAs. In the ileum, farnesoid X receptor (FXR) expression was reduced in patients with cholestasis. Correspondingly, the serum FGF19 levels decreased significantly in patients with cholestasis. In the liver, the expression of the rate-limiting enzyme in bile salt synthesis, cytochrome P450 7a1 (CYP7A1), increased noticeably in IF patients with cholestasis. In mice, we showed that oral antibiotics (gentamicin, GM or vancomycin, VCM) reduced colonic microbial diversity, with a decrease in both Gram-negative bacteria (GM affected Eubacterium and Bacteroides) and Gram-positive bacteria (VCM affected Clostridium, Bifidobacterium and Lactobacillus). Concomitantly, treatment with GM or VCM decreased secondary BAs in the colonic contents, with a simultaneous increase in primary BAs in plasma. Moreover, the changes in the colonic BA profile especially that of tauro-beta-muricholic acid ($T{\beta}MCA$), were predominantly associated with the inhibition of the FXR and further altered BA synthesis and transport. In conclusion, the administration of antibiotics significantly decreased the intestinal microbiota diversity and subsequently altered the BA composition. The alterations in BA composition contributed to cholestasis in IF patients by regulating FXR signaling.

• Journal of Gastric Cancer
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• 제15권4호
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• pp.246-255
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• 2015

Purpose: The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER. Materials and Methods: This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex-matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions. Results: The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open-type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diagnosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P<0.05). Conclusions: Open-type atrophy, moderate-to-severe IM, and H. pylori eradication failure were significantly associated with metachronous lesions. However, eradication failure was significantly associated with dysplasia, but not carcinoma, in the metachronous group. Thus, H. pylori eradication may play an important role in preventing metachronous lesions after ER for precancerous lesions before carcinomatous transformation.

• Journal of Yeungnam Medical Science
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• 제14권2호
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• pp.393-398
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• 1997

1987년 5월에서 1997년 10월까지의 영남대학교 의과대학 부속병원에서 임상적으로 선천성 중장 회전 이상을 의심하여 방사선학적으로 진단되고 수술을 시행한 17명의 환아를 대상으로 임상소견과 수술 기록 및 방사선학적 소견을 후향적으로 분석한 결과는 임상적인 주된 증상은 구토나 구토를 동반한 복통이었으며, 수술 소견상 16명의 환아에서 선천성 중장 회전 이상이 확진되었고, 1명의 환아에서 중장 회전 이상 없이 윤상 췌장으로 진단되었다. 모든 환아에서 상부 위장관 조영술과 바륨 관장술을 시행한 결과, type I인 경우가 3명, type IIA가 2명, type IIC가 1명, type IIIA가 5명, type IIIc가 4명이었으며 이중에서 type IA로 진단된 1명은 수술 소견상 윤상 췌장으로 확인되었다. 수술로 확진된 16명의 환아중 13명은 상부 위장관 조영 소견에서 선천성 중장 회전 이상이 진단되었고 3명의 환아에서는 상부 위장관 조영 소견은 확실하지 않았으나 바륨 관장 소견상 선천성 중장 회전 이상이 증명되었다. 결론적으로 선천성 중장 회전 이상은 중장 염전과 장 괴사와 같은 치명적인 합병증으로 출생 첫 주에 높은 사망률을 보이기 때문에 조기 진단이 매우 중요하며, 임상적으로 선천성 중장 회전 이상이 의심되면 상부 위장관 조영술을 먼저 실시해야 하고 십이지장 공장 접합부가 정상적으로 위장 유문부와 같은 축상에 있는지 우측 측사위 촬영에서 확인해야된다. 비록 정상 소견을 보일지라도 위음성이 있을 수 있으므로 반드시 바륨 관장술을 실시해서 압박, 사위, 좌측와위 촬영에서 맹장과 회장 말단부의 위치를 확인해야 될 것으로 생각된다.