A case of MALT lymphoma of the thyroid accompanying Hashimoto's thyroiditis / 대한내과학회지

Primary thyroid lymphomas constitute of up to 5% of all thyroid malignancies. Recently, mucosa-associated lymphoid tissue (MALT) lymphoma are relatively recognized as a B cell subset of non-Hodgkin's lymphoma. MALT-lymphomas are thought to develop from acquired lymphocytic tissue during the course of a chronic inflammatory or autoimmune process. In the thyroid , which is normally devoid of lymphocytic tissue, chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT type. The clinical presentations include the enlarging of the neck mass, dysphagia, hoarsenes and choking or cold thyroid nodule. We report a case of MALToma of the thyroid accompanied by Hashimoto's thyroiditis with a review of the literature.

Incidence of coronary anomaly in coronary angiography / 대한내과학회지

BACKGROUND: Coronary anomalies are found incidentally, in which anatomy is altered but physiology is normal; that is, coronary blood flow is normal. However, certain anomalies are associated with myocardial ischemia or infarction, heart failure, and sudden death. METHODS: From February 1988 to February 2000, 3534 cases have been catheterized, among them we experienced 28 cases of coronary anomalies. The incidence of coronary anonalies and clinical characteristic were evaluated. RESULTS: The incidence of coronary anomalies was 0.79% and in 28 cases of coronary anomalies, 5 cases of anomalous origin from the aorta (0.14%), 2 cases of coronary artery aneurysm (0.16%) and 21 cases of coronary arteriovenous fistula (CAVF,0.59%) were found. In 5 cases of anomalous origin from the aorta, 4 cases showed that right coronary artery originated from left coronary sinus of Valsalva, 1 case showed that left circumflex coronary artery originated from right coronary sinus of Valsalva. All of coronary artery aneurysm were found in right coronary artery. In 21 cases of CAVF, 28 sites of fistula were found and 14 sites originated from right coronary artery (50%), 6 sites from left circumflex coronary altery (21.5%), 6 sites from left anterior-descending coronary artery, 2 sites from left main coronary artery (7%). 13 sites of CAVF drained into pulmonary artery (46%), 10 sites into right atrium (36%), 5 sites into right ventricle (18%). In 7 cases which had double CAVF, 4 cases were originated from bilateral coronary artery, 3 cases were originated from single coronary artery. In 10 cases CAVF without other cardiac lesion, 4 cases confirmed ischemic heart disease. CONCLUSION: In our study, CAVF is most common coronary anomaly and without other cardiac disease CAVF may develope ischemic cardiac disease.

Incidence of coronary anomaly in coronary angiography / 대한내과학회지

BACKGROUND: Coronary anomalies are found incidentally, in which anatomy is altered but physiology is normal; that is, coronary blood flow is normal. However, certain anomalies are associated with myocardial ischemia or infarction, heart failure, and sudden death. METHODS: From February 1988 to February 2000, 3534 cases have been catheterized, among them we experienced 28 cases of coronary anomalies. The incidence of coronary anonalies and clinical characteristic were evaluated. RESULTS: The incidence of coronary anomalies was 0.79% and in 28 cases of coronary anomalies, 5 cases of anomalous origin from the aorta (0.14%), 2 cases of coronary artery aneurysm (0.16%) and 21 cases of coronary arteriovenous fistula (CAVF,0.59%) were found. In 5 cases of anomalous origin from the aorta, 4 cases showed that right coronary artery originated from left coronary sinus of Valsalva, 1 case showed that left circumflex coronary artery originated from right coronary sinus of Valsalva. All of coronary artery aneurysm were found in right coronary artery. In 21 cases of CAVF, 28 sites of fistula were found and 14 sites originated from right coronary artery (50%), 6 sites from left circumflex coronary altery (21.5%), 6 sites from left anterior-descending coronary artery, 2 sites from left main coronary artery (7%). 13 sites of CAVF drained into pulmonary artery (46%), 10 sites into right atrium (36%), 5 sites into right ventricle (18%). In 7 cases which had double CAVF, 4 cases were originated from bilateral coronary artery, 3 cases were originated from single coronary artery. In 10 cases CAVF without other cardiac lesion, 4 cases confirmed ischemic heart disease. CONCLUSION: In our study, CAVF is most common coronary anomaly and without other cardiac disease CAVF may develope ischemic cardiac disease.

Evaluation of emphysema in asthma patients using high-resolution CT / 대한내과학회지

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. RESULTS: Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). CONCLUSION: These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.

Evaluation of emphysema in asthma patients using high-resolution CT / 대한내과학회지

BACKGROUND: Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. METHODS: We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. RESULTS: Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). CONCLUSION: These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.

The Significance of Gastroesophageal Reflux Disease (GERD) Symptoms in Patients with Reflux Esophagitis / 대한소화관운동학회지

BACKGROUND/AIMS: The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. METHODS: Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. RESULT: Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score > 14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p < 0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. CONCLUSION: It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.

A Case of recurrent adult onset still's disease with interstitial pneumonitis / 대한내과학회지

Adult onset Still's disease(AOSD) is characterized by a high spiking fever, a transient rash, and arthritis. The clinical features include lymphadenopathy, hepatospleno-megaly, serositis, and sore throat. Leukocytosis is generally marked, but rheumatoid factor and ANA tests are negative. Respiratory system involvement is more common in AOSD than it is in childhood. The most common symptom is pleuritic chest pain with or without effusions. Rare cases of interstitial pneumonitis accompanied by AOSD have been reported. We report a case of AOSD with interstitial pneumonitis, which developed in two consecutive years and was successfully controlled with coriticosteroid therapy.