A case of biphenotypic acute leukemia with expression of the AML1-ETO gene rearrangement

Biphenotypic acute leukemia (BAL) is a subtype of acute leukemia that expresses two different mmunophenotypic lineages, most commonly myeloid and either B- or T-lymphoid lineages. This entity has been defined by a scoring system proposed by the European Group for the Immunological Characterization of Leukemias (EGIL). The prognosis of BAL is regarded as being worse than either acute lymphoid or myeloid leukemia that does not show lineage ambiguity. However, a treatment strategy for BAL has not yet been established. We experienced a case of BAL with the t(8;21) translocation, a favorable cytogenetic rearrangement in acute myeloid leukemia (AML). The patient was successfully treated with cytarabine and anthracycline for induction and consolidation. The quantitative value of the AML1-ETO gene decreased after achieving complete hematologic remission. Thus, the AML1-ETO gene rearrangement in BAL may be associated with an acceptable response to the treatment strategy for AMLope

Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit.

To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.ope

The Importance of the Simple Chest X-ray Tend to Make Careless Interpretation: with a Case of Mediastinal Tumor

The middle mediastinum contains several important organs and pluripotent cells. It is difficult to make a definitive diagnosis in patients with middle mediastinal tumors due to a wide range of diseases. The likelihood of malignancy is influenced primarily by the following factors: patient age, size, tumor location, and the presence or absence of symptoms. We describe a case of a middle mediastinal tumor, which was suspected on chest x-ray; chest computed tomography revealed the eccentric mass of distal esophagus. This case emphasizes the diagnostic importance of the chest x-ray to the physicians. The possible differential diagnoses are reviewed.ope

Utility of Routine Culture for Tuberculosis from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in a Tuberculosis Endemic Country

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique developed to allow mediastinal staging of lung cancer and also to evaluate intrathoracic lymphadenopathy. In a tuberculosis-endemic area, tuberculosis should be considered as an etiology of mediastinal lymphadenopathy. The aim of this study was to investigate the utility of the routine culture for tuberculosis from specimens of EBUS-TBNA. METHODS: We prospectively performed routine culture for tuberculosis from aspiration or core biopsy specimens got from 86 patients who had undergone EBUS-TBNA due to mediastinal lymphadenopathy between March 2010 and March 2011. RESULTS: A total of 135 lymph node aspiration and 118 core biopsy specimens were included in this analysis. We confirmed the malignancy in 62 (72.9%), tuberculosis in 7 (8.1%), sarcoidosis in 7 (8.1%), asperogillosis in 2 (2.3%) and pneumoconiosis in 2 (2.3%) patients. One lung cancer patient had pulmonary tuberculosis coincidentally and 5 patients had unknown lymphadenopathy. The number of positive culture for Mycobacterium tuberculsosis by EBUS-TBNA is 2 (1.5%) from 135 lymph node aspiration specimens and 2 (1.7%) from 118 core biopsy specimens. Out of eight patients confirmed with tuberculosis, only one patient had positive mycobacterial culture of aspiration specimen from EBUS-TBNA without histopathologic diagnosis. CONCLUSION: These results propose that routine culture for tuberculosis from EBUS-TBNA may not provide additional information for the diagnosis of coincident tuberculous lymphadenitis. However, if there is any possibility of tuberculous lymphadenopathy or pulmonary tuberculosis, it should be considered to perform EBUS-TBNA in patients who have negative sputum AFB smears or no sputum production.ope

A Case of Squamous Cell Carcinomatous Lung Abscess with Multiple Metastatic Abscesses

Among the bronchogenic carcinomas, especially squamous cell carcinoma and large cell carcinoma frequently present with cavitation, which may result from tumor necrosis. Cavitary lesions of the tumor are occasionally associated with infection and misdiagnosed as benign lung abscess owing to the partial responsiveness to antibiotics. It is very difficult to distinguish the carcinomatous abscess from the benign lung abscess, because of their similar clinical and radiologic features. Delay in diagnosis of underlying lung cancer may result in poor outcome. Therefore, clinicians should remember that the patients with highly suspicious carcinoma of the lung should undergo further precise examinations to find out malignant cellsope

A Case of Bronchilolitis Obliterans Organizing Pneumonia in a Patient with Ulcerative Colitis.

The ulcerative colitis is a chronic inflammatory bowel disease with an unknown etiology. The major symptoms of ulcerative colitis are diarrhea, abdominal pain and hematochezia. However, arthritis, skin disorders, hepatobiliary inflammation and uveitis are occasionally recognized as systemic complications. Although there are few reports of coexistent pulmonary and inflammatory bowel disease, the lung is not generally considered to be a target organ in ulcerative colitis. We report a patient with ulcerative colitis-related bronchilolitis obliterans organizing pneumonia confirmed by video-assisted thoracoscopic surgery, who responded to corticosteroid therapy.ope

A Case of Prothionamide Induced Hepatitis on Patient with Multi-Drug Resistant Pulmonary Tuberculos

The prevalence of multi-drug resistant tuberculosis (MDR-TB), which is resistant to isoniazid and rifampin, has been increasing in Korea. And the side effects of 2nd line anti-tuberculosis medications, including drug-induced hepatitis, are well known. Although prothionamide (PTH) is one of the most useful anti-TB medications and although TB medication-induced acute hepatitis is a severe complication, there are only a few published case reports about prothionamide induced hepatitis. In this case report, a 22 year old male was diagnosed with pulmonary MDR-TB and was administered 2nd line anti-TB mediations, including PTH. Afterwards, he had a spiking fever and his liver enzymes were more than 5 times greater than the upper limit of the normal range. He was then diagnosed with drug-induced hepatitis by liver biopsy. His symptoms and liver enzyme elevation were improved after stopping PTH. Accordingly, we report this case of an association between PTH and acute hepatitisope

A Case of Pneumonia with Septic Shock Due to Nocardia farcinia in Liver Transplant Patient

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient's initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.ope

A Case of Henoch-Shonlein Purpura Caused by Rifampin

Rifampin is one of the first line drugs for treating tuberculosis, but it might be associated with serious adverse effects, including renal failure. We report here on a case of a 57-year-old patient who developed Henoch-Shonlein purpura during antituberculosis therapy that included rifampin. The patient converted to negative on the AFB smear for tuberculosis two weeks after the initial administration of antituberculosis medication. After treatment for 60 days, this patient was diagnosed with Henoch-Shonlein purpura by the purpura lesion on the lower legs, the leukocytoclastic vasculitis, the renal impairment and the pathological examination. After stopping rifampin, the skin lesions disappeared in about 10 days and his renal function gradually improved. This case study showed that Henoch-Schonlein purpura can be caused by rifampin during antituberculosis therapy and we recommend that the use of rifampin should be restrained when clinical symptoms of Henoch-Shonlein purpura are observedope

Cortical bone thickness and root proximity at orthodontic mini-implant sites : A study using 3-dimensional reconstructed CT images

본 연구의 목적은 전치에서 구치에 이르는 상·하악 치아간의 피질골 두께와 치근간 거리를, 치조정으로부터의 높이와 각도 부여에 따라 측정함으로써 교정용 임플란트(미니 임플란트) 식립시에 참고할 수 있는 해부학적 지도와 임상적 지침을 제공하는 것이다. 연구를 위해 성인 28명(남자 14명, 여자 14명)의 CT를 촬영하였고 V-works 4.0™을 이용하여 이를 3차원 영상으로 전환하였다. 상, 하악 중절치에서 제2대구치에 이르는 모든 치아 사이를 치간 접촉점을 지나면서 교합 평면에 수직이 되도록 잘라 90° 단면을 형성한 후 치조정으로부터 2, 4, 6, 8 mm 높이에서 0, 15, 30, 45°의 각도를 주어 피질골의 두께를 측정하였다. 또한 치조정으로부터 2, 4, 6, 8 mm 높이에서 교합 평면에 평행하게 잘라 90° 단면을 만든 후 V-works 4.0™내 거리 계측 도구를 이용해서 치근간 거리를 측정하였다. 측정 결과 피질골의 두께는 상악에서 1-1, 1-2 사이가 각각 평균 1.34 ± 0.05 mm, 1.65 ± 0.29 mm로 다른 부위에 비해 작은 값을 가지고 있었다. 하악은 5-6과 1-1 사이, 6-7과 1-1, 1-2, 2-3 사이에서 유의한 차이를 보였고 (P &amp;lt;.05), 전치부에서 구치부로 갈수록 두꺼워지는 경향을 보였다. 또한 상악과 비교했을 때 전치부에서는 유의한 차이가 없었으나 3-4 사이 이후에서는 하악의 피질골이 유의하게 두꺼운 값을 가졌다 (P &amp;lt;.05). 각도를 부여했을 때 치조정으로부터 2 mm 높이를 제외한 대부분의 위치에서 각도가 증가함에 따라 피질골의 두께가 지수 함수적으로 증가하는 경향을 보였다. 4~6 mm 높이에 식립시 상, 하악 모두에서 30~45° 이상의 각도를 부여해야 피질골 보유량(engage 양)에 유의한 차이를 보이는 것으로 나타났다. 치근간 거리 측정 결과 상악에서는 -통계학적으로 차이를 설명할 수는 없지만- 2-3, 5-6 사이가, 하악에서는 4-5, 5-6, 6-7 사이가 치근 손상 없이 미니 임플란트를 식립하기에 적절한 위치라고 볼 수 있었다. 하악 1-1과 1-2 사이는 미니 임플란트 식립을 위한 충분한 치근간 거리를 제공하지 못하는 것으로 나타났다.;This study was designed to evaluate cortical bone thickness and root proximity at orthodontic mini-implant site and so to provide an anatomical map and clinical guidelines for mini-implant placement. CT images were taken from 28 subjects (male 14, female 14) and reconstructed by V-works 4.0™ into three-dimensional images. From central incisor to 2nd molar, buccal inter-radical cortical bone thickness and distance between the roots were measured at 2, 4, 6, 8 mm height from alveolar crest. Cortical bone thickness at 4 angles (0° , 15° , 30°, and 45°)were also measured. The results were as followings. 1. In maxilla, cortical bone thickness between 1 and 1, 1 and 2 were 1.34 ± 0.05 mm, 1.65 ± 0.29 mm respectively, which were somewhat relatively thin compared with the other site. In mandible, significant differences were found between 5-6 and 1-1, 6-7 and 1-1, 1-2, 2-3 (P &amp;lt;.05) respectively. Cortical bone thickness in mandible was increased gradually from anterior to posterior region and was significantly larger than maxilla except 1-1, 1-2, 2-3 (P&amp;lt;.05). 2. In proportion as angulation increases, cortical bone thickness increased exponentially and it was statistically significant except at 2 mm height from alveolar crest. At 4~6 mm height, more than 30~45° angulation in maxilla and mandible may be effective in increasing cortical bone-implant contact. 3. Inter-radical space between 2 and 3, 5 and 6 in maxilla (although statistical differences could not be explained) and inter-radical space between 4 and 5, 5 and 6, 6 and 7 in mandible are considered as appropriate sites for mini-implant implantation without root damage. Clinically, when give an insertion angle at orthodontic implant site, operator must consider whether cortical bone thickness is enough to cover mini-implant and whether it can provide enough space for tooth movement without root damage. Individually different anatomical variations must be considered also. Because root proximity between lower incisors can not provide enough spaces for mini-implant, implantation at these site must be avoided if possible, and if needed, operator must implant at the site which is as far as possible from alveolar crest with sufficient insertion angle.Ⅰ. 서론 = 1 Ⅱ. 연구대상 및 방법 = 3 A. 연구대상 = 3 B. 연구방법 = 3 1. CT 촬영 및 V-works 4.0™을 이용한 3차원 영상의 형성 = 3 2. 피질골 두께의 측정 = 5 3. 치근간 거리의 측정 = 6 4. 통계 분석 = 7 Ⅲ. 연구결과 = 8 Ⅳ. 고찰 = 21 Ⅴ. 결론 = 30 참고문헌 = 31 ABSTRACT = 3