Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis

PURPOSE: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). MATERIALS AND METHODS: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model. RESULTS: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573). CONCLUSION: RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.

Systemic Sclerosis Associated with Non-small Cell Lung Cancer and Papillary Thyroid Cancer: Case Report and Literature Review / 대한내과학회지

We report the case of a 52-year-old patient with rheumatic vascular disease (systemic sclerosis), non-small cell lung cancer, and papillary thyroid cancer. Malignant tumors have been described in 3-11% of systemic sclerosis cases. Several studies have demonstrated an increased frequency of cancer, especially lung and breast cancer, in patients with systemic sclerosis, but the association of systemic sclerosis with malignancy is controversial. To our knowledge, however, no case of both lung and thyroid cancer associated with systemic sclerosis has been reported. We present a rare case of double primary cancer in systemic sclerosis, with a literature review.

Cervical Intramedullary Neurenteric Cyst in an Elderly Patient

Intraspinal neurenteric cysts are rare congenital lesions that may occur either alone or in the context of a complex malformative disorder including vertebral, visceral and cutaneous abnormalities. Most of these lesions have an intradural extramedullary location. Rarely, intramedullary neurenteric cysts not associated with other malformations have been reported. A 72-year-old woman presented with a 5-year-history of progressive paraparesis(I/II), urinary retention. A magnetic resonance(MR) image revealed a C6-C7 intramedullary cystic lesion which was located ventrally to the spinal cord and no other spinal abnormalities. The cystic lesion were subtotally removed through posterior approach. On histopathological examination, fibrous connective tissue surrounded by cuboidal cells which contained mucin vacuoles were consistent with neurenteric cyst. Postoperative MR image showed the decompression of the spinal cord. Postoperatively, neurological deficits were improved. We report a case of neurenteric cyst occured in highly old age and unusual location.

Frequency of Aneurysmal Subarachnoid Hemorrhage in Perimesencephalic Subarachnoid Hemorrhage and Need of 4-vessel Angiography

OBJECTIVE: In this study, each of the frequency of nonaneurysmal perimesencephalic subarachnoid hemorrhage(N-PMSH), and the clinical and radiologic features, incidence and location of aneurysmal perimesencephalic subarachnoid hemorrhage(A-PMSH), based on aneurysmal rupture and nonaneurysmal subarachnoid hemorrhage in patients with spontaneous subarachnoid hemorrhage, are investigated for clinical application. METHODS: Patients who showed perimesencephalic subarachnoid hemorrhage, among the 388 patients with subarachnoid hemorrhage admitted into the our hospital from March 1994 to November 2002, were extracted ; and their charts and angiographies were examined retrospectively. They were divided into two groups - aneurysmal perimesencephalic subarachnoid hemorrhage group and nonaneurysmal perimesencephalic subarachnoid hemorrhage group - and comparative analysis was conducted on the clinical patterns and radiologic characteristics of each group. RESULTS: There were 22 patients(5.68%) with perimesencephalic subarachnoid hemorrhage(PMSH) among 388 patients with spontaneous subarachnoid hemorrhage. Of the 22 PMSH, 8 patients(36%) were aneurysmal PMSH(A-PMSH), 14 patients(64%) were nonaneurysmal PMSH(N-PMSH). N-PMSH occurred not only in the posterior circulation(5 cases), but also in the anterior circulation(3 cases). There was no difference in the CT features of PMSH between aneurysmal and nonaneurysmal cause. CONCLUSION: According to the above results, 4-vessel angiography is essential for patients with perimesencephalic subarachnoid hemorrhage, and CTA and MRA can be used as assisting diagnosis methods.

Determination of the Pterional Approach Side According to the Direction of the Aneurysm and the Configuration of the H-complex in Anterior Communicating Artery Aneurysms

OBJECTIVE: We proposed to study factors influencing the determination of operative side for easier and more successful clipping in the pterional approach to anterior communicating artery aneurysms and to determine the highest priority of factors in relation to the direction of the aneurysm. METHODS: The present study was conducted retrospectively in 91 patients with anterior communicating artery aneurysm who were operated on between January 1996 and December 2002. A1 dominancy, the size and the direction of aneurysms, the configuration of the H-complex especially the relative locations of both A2 segments in the coronal plane and the presence or absence of accompanying aneurysms were determined by angiogram. The degree of operative difficulty and factors influencing difficulty were reviewed with operative records and videos. RESULTS: In antero-inferior projecting aneurysms, when approached from the side of A1 dominancy, safe and easy clipping resulted(45/46cases). In superior projecting aneurysms, approaches from the side of the ipsilateral proximal A2 posterior to the contralateral A2 yielded favorable results(25/25cases), although the side was A1 non-dominant side. In some cases with posterior projecting aneurysms, approaches from the side of the posteriorly located A2 segment were inappropriate. CONCLUSION: In anterior communicating artery aneurysmal surgery, the A1 dominant side for antero-inferior projecting aneurysms and the side of the ipsilateral proximal A2 posterior to the contralateral A2 for superior projecting aneurysms should be considered prior to other factors. In posterior projecting aneurysms, angiographic analysis for the side where operator can observe the aneurysmal neck directly is required.