Epstein-Barr Virus Positive Follicular Lymphoma of Lymph Node

Epstein-Barr virus (EBV) infection has been associated with a number of lymphoid malignancies, including endemic Burkitt's lymphoma, some classical Hodgkin's lymphoma, diffuse large B-cell lymphoma, extranodal NK/T cell lymphoma, and angioimmunoblastic T-cell lymphoma. A 59-year-old woman underwent an excisional biopsy for a left axillary mass under suspicion of malignant lymphoma. A preoperative radiological study revealed multiple enlarged lymph nodes at the left axilla, mesentery, and the left external iliac chain with hypermetabolism on a positron emission tomography-computed tomography scan. She was histologically diagnosed with EBV-positive follicular lymphoma (FL, grade 3a) and received the R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone) chemotherapy regimen. Herein, we report a rare case of EBV associated FL of lymph node with its review of literature.

Korean Guidelines for Treating Chronic Myelogenous Leukemia - The Korean Society of Hematology Chronic Myelogenous Leukemia Working Party / 대한내과학회지

BACKGROUND/AIMS: The first edition of the Korean treatment guidelines for chronic myelogenous leukemia (CML) was published in 2006. We intend to update those guidelines to include the use of next-generation tyrosine kinase inhibitors (TKIs). METHODS: New guidelines were developed in 2012 based on the results of a survey and a consensus meeting of various Korean experts, the reports of recent clinical studies, and updated guidelines from external study groups. RESULTS: An assessment of risk factors is strongly recommended before treating newly diagnosed chronic phase CML. Imatinib, dasatinib, and nilotinib are reimbursable in Korea as first-line treatments, and the patient's age, comorbidities, and possible adverse events should be considered in the choice of treatment. Molecular studies are recommended for assessing treatment efficacy instead of invasive cytogenetic response evaluations, and an early response is believed to correlate with a good prognosis. Second-line TKIs can be considered for patients who fail or are intolerant of first-line therapy, pending analysis of ABL tyrosine kinase mutation status. For treating advanced stages, a combination of TKIs with cytotoxic agents and hematopoietic cell transplantation is recommended. The adverse effects of TKI therapy can be managed via dose reduction and supportive care, or switching to an alternate TKI. CONCLUSIONS: The use of TKIs has improved the outcome of CML treatment. Treatment-free remission after discontinuing TKIs might be possible in select patients who achieve sufficient response, indicating that curative treatment for CML can be expected in the future.

A Case of Hepatic Portal Venous Gas Caused by Clostridium perfringens in a Patient with Mesenteric Atriovenous Malformation and Portal Hypertension

Hepatic portal venous gas (HPVG) is a rare disease presenting as acute abdomen. The presence of the air in the portal vein has been associated with a mortality rate of more than 75%. Because of high mortality rate, most HPVG requires emergent surgical interventions and intensive medical management. HPVG is most commonly caused by mesenteric ischemia but may have a variety other causes. Clostridium perfringens is the most common pathogen of gas forming bacteria that can cause of HPVG, but Clostridium perfringens blood stream infection with HPVG is not yet reported in Korea. We experienced a case of HPVG caused by Clostridium perfringens blood stream infection at mesenteric venous hemangioma with portal hypertension due to mesenteric arteriovenous malformation.

The Trends and Status of Work-related Musculoskeletal Diseases under Korean Worker's Compensation System / 한국직업건강간호학회지

PURPOSE: This study was conducted to analyze the characteristics of work-related musculoskeletal diseases (MSD) and the factors for approving MSD by the parts of the body. METHODS: The analysis was done using the data which were drawn from the Industrial Accident Compensation Insurance that is operated by the Korea Worker's Compensation & Welfare Service. The data were composed of total cases related to the work-related diseases from 2006 to 2009. In addition, MSD data input by an investigator were collected. The factors associated with MSD were analyzed using x2 and multiple logistic regression. RESULTS: MSD approved cases have increased since 2006 and the proportion of the approved work-related MSD cases in the workers with work-related diseases in 2009 were 33.4%. Spinal approved cases were the highest percentage and upper and lower extremities cases gradually increased. The factors for approving upper extremity were found to be age, company size, type of industry, working duration, and in the case of spine to be company size and heavy lifting. CONCLUSION: Work-related MSD have increased and the factors that affected MSD by the parts of the body varied. Management strategy must be established to prevent MSD by the parts of the body.

Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital

PURPOSE: Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. METHODS: We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. RESULTS: The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. CONCLUSION: Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

What Strategy Can be Applied to the Patients with Culture Positive Tuberculosis to Reduce Treatment Delay in a Private Tertiary Healthcare Center? / 감염과화학요법

BACKGROUND: The contribution of the private sector to the treatment of tuberculosis (TB) is getting larger, and the private sector pays more attention to individualized, intensive care than patient monitoring or education, which would improve the microbiological cure rate or at least completion of treatment. We aim in this paper to assess the impact of the improved monitoring of patient on the treatment outcome in the private tertiary healthcare center. MATERIALS AND METHODS: We compared the data of the positive sputum cultures for TB from March 1, 2003 to March 31, 2006 (37 months) with that data from July 1, 2007 to August 31, 2008 (14 months) in single private tertiary healthcare center in the Republic of Korea (ROK). In the latter period, we notified physicians of the new culture-confirmed cases via a cellular phone short-massage-service (SMS) to prevent delayed recognition of positive cultures and we gave calls to patients to encourage treatment adherence and to complete the whole schedule of medication. RESULTS: After the intervention, initiation of anti-TB medication increased from 86.3% to 94.5% (P<0.05), the interval to medication from the first culture results was shortened from 22.9 days to 5.6 days (P=0.19) and the rate of treatment complication increased from 57.4% to 68.1% (P<0.01). CONCLUSION: Our results showed a possible strategy to improve the completion of treatment in a university hospital. Health care providers in the private sector should to improve success by better notification and monitoring in addition to their existing advanced medical resources.

The Influencing Factors of Influenza Vaccination in the Elderly Participating in Lifetime Transitional Health Examination

PURPOSE: The purpose of this study was to investigate the influencing factors of influenza vaccination in the elderly participating in lifetime transitional health examination. METHODS: This study was a secondary analysis of data collected from lifetime transitional health examination (for 66-year-old people) conducted by the National Health Insurance Corporation (NHIC) from January 1 to December 31, 2008. Questionnaires were received from NHIC to obtain information regarding gender, chronic diseases, health-related behaviors, and ADL. A total of 255,333 participants who responded all the questions in the questionnaire were included in the analysis. Collected data were analyzed by descriptive statistics, chi2 test, and multiple logistic regression. RESULTS: The influenza vaccine coverage rate in 66-year-old people was 66.1%. The influenza vaccine coverage rate was higher in female elders and those with hypertension, diabetes, heart disease or past smoking, and lower in those with stroke, current smoking, drinking, no-exercise or ADL-dependency. CONCLUSION: Strategies for improving the influenza vaccination coverage rate in the elderly are needed. The strategies should give priority to the elderly with current smoking, drinking, and no-exercise, and home visiting programs are needed for the elderly with stroke and ADL-dependency.

Clinical outcomes of erlotinib, gefitinib, or pemetrexed in patients with non-squamous, non-small-cell lung cancer / 대한내과학회지

BACKGROUND/AIMS: This study compared the clinical benefits of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) with pemetrexed to identify the clinical parameters that correlated with response. METHODS: A retrospective chart review examined patients who were 1) treated with EGFR TKI or pemetrexed, 2) diagnosed with advanced non-squamous non-small-cell lung cancer, and 3) previously treated with platinum-based chemotherapy in Soonchunhyang Bucheon Hospital. RESULTS: Sixty-one patients (18 erlotinib, 18 gefitinib, 25 pemetrexed) were investigated from February 2002 to August 2009. The median follow-up period was 37 months (7~97 months). Overall, their median age was 63 years, 41 patients were non-smokers, 57 patients had adenocarcinoma, and 55 patients were at stage IV. Twenty-one patients received the study drugs as second-line chemotherapy, and others as third-line or more. No significant differences in the overall response rate (erlotinib 33.3% vs. gefitinib 38.9% vs. pemetrexed 20.0%) and progression-free survival (erlotinib 1.9 months vs. gefitinib 3.0 months vs. pemetrexed 2.9 months) were found among the three groups. Female gender was related to a good response to EGFR TKIs (p=0.047). Skin rash in the erlotinib group (p=0.037) and adenocarcinoma in the pemetrexed group (p=0.02) were related to improved progression-free survival. Few side effects were reported. CONCLUSIONS: Both EGFR TKIs and pemetrexed therapy for non-squamous non-small-cell lung cancer were efficient and tolerable after the failure of first-line platinum-based chemotherapy. Further prospective studies are needed to validate the predictive role of the suggested clinical parameters in this study.

Initial Therapy with High-Dose Dexamethasone for Patients with Idiopathic Thrombocytopenic Purpura

BACKGROUND: Corticosteroids have been widely used for treatingidiopathic thrombocytopenic purpura (ITP) as a first-line treatment. Several different pulsed high-dose dexamethasone therapies for adult ITP have been reported on. We assessed the effectiveness of a single course of high dose dexamethasone as first-line treatment for adult patients with ITP. METHODS: The subjects of the study were previously untreated adult patients with newly diagnosed ITP and who had a platelet count of less than 20,000/microliter or a platelet count less than 50,000/microliter. High-dose dexamethasone at a dose of 40mg/day for four consecutive days was given orally. A response was defined as an increase in the platelet count of at least 30,000/microliter and a platelet count of more than 50,000/microliter by day 10 after the initial treatment. A sustained response was defined as a platelet count of more than 50,000/microliter that was maintained for six months after the initial treatment. RESULTS: Twenty two patients were eligible. The median platelet count before treatment was 19,000/microliter. Seventeen patients (77%) among the 22 patients achieved an initial response by day 10: the mean platelet count 10 days after the initial treatment was 144,000/microliter (range: 51,000 to 428,000/microliter). Among the patients with a response, 4 (23.5%) had a sustained response, and the other 13 (76.5%) relapsed within six months. All the patients well tolerated the high-dose dexamethasone treatment. CONCLUSION: A single course of high-dose dexamethasone is effective as an initial treatment for adults ITP patients, although the response duration is short. To maintain the response, repeated high-dose dexamethasone treatment may be needed or other alternative therapies can be considered.

Short & Long-term Repopulating Capacity of Cord Blood Cells That Are Stored Overnight before Cryopreservation / 대한수혈학회지

BACKGROUND: Umbilical cord blood (UCB) is generally stored overnight and it undergoes a CD34 positive selection process the next day for reducing the cost and due to the convenience. We intended to determine whether overnight storage of cord blood cells affects the short and long-term repopulating capacity. METHODS: Five individuals' UCB samples were analyzed by colony assay, apoptotic cell counts and long term bone marrow culture. All the samples were divided to four groups, which were the fresh group (immediate use of harvest), the overnight storage group (overnight storage at room temperature after harvest), the immediate cryopreservation group (immediate cryopreservation after harvest) and the overnight cryo group (cryopreservaton after overnight storage at room temperature after harvest). RESULTS: The number of colony forming units-granulocyte macrophage (CFU-GM) was 116.2+/-20.1 in the fresh group and 90.8+/-15.8 in the overnight storage group (P=0.07). The number of CFUs-GM was similar between the immediate and overnight cryo groups (P=0.79). The immediate cryo group showed a significantly lower number of CFUs-GM as compared to that of the fresh group (P=0.03). The apoptotic cells were detected at 21+/-6.8% in the fresh group and this was 24.2+/-2.4% in the overnight storage group (P=0.32), and this was similar between immediate and overnight cryo groups (P=0.80). The fresh group had a significantly lower number of apoptotic cells compared to that of the immediate cryo group (P=0.02). After long term stromal-based culture, the mean production of CFU-GM colonies was similar between all the groups (P>0.05). CONCLUSION: These results support the continue use of overnight storage of UCB before cryopreservation as a convenient, cost reducing measure.

Loop Colostomy with Not Everted Fashion for Rectal Cancer

PURPOSE: An anastomotic leak after resection of rectal cancer is a omnious complication. The diverting stoma is performed to avoid this serious complication. However, a diverting stoma and a stoma reversal are associated with significant morbidity and a small mortality. As stoma-related complications are associated with a delay of adjuvant therapy for advanced rectal cancer, minimal stoma-related morbidity is mandatory for rectal cancer patients. A safe and simple dissection of the stoma is known to be associated with less morbidity at stoma closure. Since in a loop colostomy of a not everted fashion, it is easy to construct and dissect the peristomal site at colostomy reversal, this study evaluated the usefulness of a protective loop colostomy of a not everted fashion in rectal cancer. METHODS: We reviewed the clinical records of 71 cases of loop colostomy closure for rectal cancer between January 1996 and December 2004. The clinical data, including indications for the stoma, the clinicopathologic features of the patients and their general conditions, the data for patients receiving adjuvant therapy, stoma-related morbidity, stoma-closure-related morbidity, and perioperative data were examined. RESULTS: Indications for stoma creation are the discretion of the surgeon (n=22), poor bowel preparation (n=21), unstable anastomosis (n=16), bowel obstruction (n=6), and anastomotic leakage (n=6). The stoma-related morbidity rate for a non-eversion colostomy was 5.6%. Morbidity events were peristomal erythema (n=2), prolapse (n=1), and parastomal hernia (n=1) requiring surgery. The stoma-closure-related morbidity rates was 9.9%. In the 45 patients undergoing adjuvant therapy, colostomy closure was performed during adjuvant therapy in 39 patients. Major complications, such as anastomotic leakage or abscess following reversal of the non-eversion colostomy, occurred in 1 of the 71 patients (1.4%). The average operating time and the blood loss for clostomy closure were 89.5 minutes and 202.3 ml, respectively. A simple closure of the loop colostomy was performed in 51 patients (71.8%). CONCLUSIONS: Based on our results, a non-eversion colostomy may be considered due to the ease of construction and reversal if a temporary diverting stoma for rectal cancer is indicated.

Phase II Study of Docetaxel and Cisplatin as First-line Chemotherapy in Patients with Recurrent or Metastatic Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Palliative chemotherapy for patients with recurrent or metastatic gastric cancer has been shown to have a survival benefit. Docetaxel monotherapy has achieved appreciable results for treating gastric cancer. We investigated the clinical efficacy and feasibility of a docetaxel and cisplatin combination regimen for patients suffering with recurrent or metastatic gastric cancer. MATERIALS AND METHODS: Patients with histologically proven, bidimensionally measurable lesions of recurrent or metastatic gastric cancer, and they had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 and no prior palliative chemotherapy were eligible for this study. The combination chemotherapy regimen consisted of docetaxel 75 mg/m2 plus cisplatin 75 mg/m2 on day 1, and this was repeated every 3 weeks until disease progression. RESULTS: 32 patients were enrolled from 2002 to 2005. The objective response rate was 31.3% (95% confidenceinterval (CI): 14.2~48.2%) with no CR. The disease control rate was 59.4%. At a median follow up of 38.9 months, the median overall survival was 7.4 months (95% CI: 6.3~8.5). The median time to progression was 4.7 months (95% CI: 3.1~6.3). During a total of 106 cycles, grade 3 or 4 hematological toxicities were observed as follows: neutropenia (39 of 106 cycles) and anemia (3 of 106 cycles). The grade 3 or 4 non-hematological toxicities included anorexia (18.9%) and nausea/vomiting (21.7%). CONCLUSION: Docetaxel and cisplatin combination chemotherapy showed promising anti-tumor activity and this was well tolerated as a first-line treatment for patients with recurrent or metastatic gastric cancer. Further large, randomized phase III studies are warranted.