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Background and Objectives@#Inherited arrhythmia (IA) is a more common cause of sudden cardiac death in Asian population, but little is known about the genetic background of Asian IA probands. We aimed to investigate the clinical characteristics and analyze the genetic underpinnings of IA in a Korean cohort. @*Methods@#This study was conducted in a multicenter cohort of the Korean IA Registry from 2014 to 2017. Genetic testing was performed using a next-generation sequencing panel including 174 causative genes of cardiovascular disease. @*Results@#Among the 265 IA probands, idiopathic ventricular fibrillation (IVF) and Brugada Syndrome (BrS) was the most prevalent diseases (96 and 95 cases respectively), followed by long QT syndrome (LQTS, n=54). Two-hundred-sixteen probands underwent genetic testing, and 69 probands (31.9%) were detected with genetic variant, with yield of pathogenic or likely pathogenic variant as 6.4%. Left ventricular ejection fraction was significantly lower in genotype positive probands (54.7±11.3 vs. 59.3±9.2%, p=0.005). IVF probands showed highest yield of positive genotype (54.0%), followed by LQTS (23.8%), and BrS (19.5%). @*Conclusions@#There were significant differences in clinical characteristics and genetic yields among BrS, LQTS, and IVF. Genetic testing did not provide better yield for BrS and LQTS. On the other hand, in IVF, genetic testing using multiple gene panel might enable the molecular diagnosis of concealed genotype, which may alter future clinical diagnosis and management strategies.
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Background and Objectives@#Recurrence rates after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients are not low especially in non-paroxysmal AF. The diameter of left atrium (LA) has been widely used to predict the recurrence after RFCA for decades. However, LA diameter represents structural remodeling of LA and does not reflect electrical remodeling. We aimed to determine the predictive value of electrical remodeling of LA which is represented by the amount of low voltage zone (LVZ). @*Methods@#We performed a retrospective cohort analysis of AF patients who underwent de novo RFCA in a single-center. @*Results@#A total of 3,120 AF patients with de novo RFCA were analyzed. Among these patients, 537 patients underwent an electroanatomic mapping with bipolar voltage measurement of LA.The diameter of LA and flow velocity of LA appendage (LAA) differed significantly according to quartile group of LVZ area and percentage: patients with high LVZ had large LA diameter and low LAA flow velocity (p<0.001). Freedom from late recurrence (LR) was significantly lower in patients with high LVZ area and percentage (p<0.001). The diameter and surface area of LA had area under curve (AUC) of 0.592 and 0.593, respectively (p=0.002 for both). The predictive value of LVZ area (AUC, 0.676) and percentage (AUC, 0.671) were both superior compared with LA diameter (p=0.011 and 0.027 for each comparison). @*Conclusions@#In conclusion, LVZ can predict freedom from LR after RFCA in AF patients. Predictive value was higher in parameters reflecting electrical rather than structural remodeling of LA.
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Background@#s/Aims: This study was performed to reveal the usefulness of the trabecular bone score (TBS) in assessing bone strength in patients with ankylosing spondylitis (AS) in comparison with dual-energy X-ray absorptiometry (DXA) methods. @*Methods@#A total of 215 AS patients (75.8% male) were enrolled from a single university hospital in Korea. Demographic and clinical information were assessed. Patients completed X-rays of the cervical and lumbar spine (L-spine), and spinal ankyloses were quantified using the modified Stoke AS Spine Score (mSASSS). Hip, anteroposterior and lateral L-spine bone mineral density (BMD) and TBS were assessed by DXA methods. Clinical characteristics and bone strength measurement results were compared between male and female AS patients. The accuracy of each bone strength evaluation method in predicting Fracture Risk Assessment Tool (FRAX) scores indicating moderate or higher fracture risk was compared by receiver operating characteristic curves in patients aged ≥ 40 years. Correlations between each bone strength measurement method and mSASSS were examined. @*Results@#Male patients showed higher mSASSS and less prevalent peripheral joint involvement compared to female patients (p < 0.05). TBS, hip BMD, and L-spine lateral BMD showed comparably high areas under the curve (AUCs) for predicting FRAX-major osteoporotic fractures (MOF) ≥ 10% (AUC ranged 0.72 to 0.76). TBS negatively correlated with mSASSS in both male and female patients (p < 0.01). @*Conclusions@#TBS could predict the risk of MOF and is not influenced by spinal osteoproliferation in AS patients, even in those with advanced spinal changes.
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Objective@#The aim of this pilot study was to investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate ( 99m Tc-MDP) for diagnosing osteomyelitis (OM). @*Materials and Methods@#Twenty-one patients with suspected OM were enrolled retrospectively. Three-phase bone scan (TPBS), early-phase SPECT/CT (immediately after blood pool planar imaging), and delayed-phase SPECT/CT (immediately after delayed planar imaging) were performed. The final diagnoses were established through surgery or clinical follow-up for over 6 months. We compared three diagnostic criteria based on (I) TPBS alone, (II) combined TPBS and delayed-phase SPECT/ CT, and (III) early-phase SPECT/CT alone. @*Results@#OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/ accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. @*Conclusion@#This pilot study demonstrated the potential of using the early-phase SPECT/CT to diagnose OM. Based on the results, prospective studies with a larger sample size should be conducted to confirm the efficacy of early-phase SPECT/CT.
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Background@#Spinal cord injury (SCI) is a serious clinical condition that impacts a patient's physical, psychological, and socio-economic status. The aim of this pilot study was to evaluate the effects of training with a newly developed powered wearable exoskeleton (Hyundai Medical Exoskeleton [H-MEX]) on functional mobility, physiological health, and quality of life in non-ambulatory SCI patients. @*Methods@#Participants received 60 minutes of walking training with a powered exoskeleton 3 times per week for 10 weeks (total 30 sessions). The 6-minute walking test (6MWT) and timedup-and-go test (TUGT) were performed to assess ambulatory function. The physiological outcomes of interest after exoskeleton-assisted walking training were spasticity, pulmonary function, bone mineral density, colon transit time, and serum inflammatory markers. Effects of walking training on subjective outcomes were estimated by the Korean version of the Falls Efficacy Scale—International and the 36-Item Short-Form Health Survey version 2. @*Results@#Ten participants finished 30 sessions of training and could ambulate independently.No severe adverse events were reported during the study. After training, the mean distance walked in the 6MWT (49.13 m) was significantly enhanced compared with baseline (20.65 m). The results of the TUGT also indicated a statistically significant improvement in the times required to stand up, walk 3 m and sit down. Although not statistically significant, clinically meaningful changes in some secondary physiological outcomes and/or quality of life were reported in some participants. @*Conclusion@#In conclusion, this study demonstrated that the newly developed wearable exoskeleton, H-MEX is safe and feasible for non-ambulatory SCI patients, and may have potential to improve quality of life of patients by assisting bipedal ambulation. These results suggest that the H-MEX can be considered a beneficial device for chronic non-ambulatory SCI patients.
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Background@#s/Aims: This study was performed to reveal the usefulness of the trabecular bone score (TBS) in assessing bone strength in patients with ankylosing spondylitis (AS) in comparison with dual-energy X-ray absorptiometry (DXA) methods. @*Methods@#A total of 215 AS patients (75.8% male) were enrolled from a single university hospital in Korea. Demographic and clinical information were assessed. Patients completed X-rays of the cervical and lumbar spine (L-spine), and spinal ankyloses were quantified using the modified Stoke AS Spine Score (mSASSS). Hip, anteroposterior and lateral L-spine bone mineral density (BMD) and TBS were assessed by DXA methods. Clinical characteristics and bone strength measurement results were compared between male and female AS patients. The accuracy of each bone strength evaluation method in predicting Fracture Risk Assessment Tool (FRAX) scores indicating moderate or higher fracture risk was compared by receiver operating characteristic curves in patients aged ≥ 40 years. Correlations between each bone strength measurement method and mSASSS were examined. @*Results@#Male patients showed higher mSASSS and less prevalent peripheral joint involvement compared to female patients (p < 0.05). TBS, hip BMD, and L-spine lateral BMD showed comparably high areas under the curve (AUCs) for predicting FRAX-major osteoporotic fractures (MOF) ≥ 10% (AUC ranged 0.72 to 0.76). TBS negatively correlated with mSASSS in both male and female patients (p < 0.01). @*Conclusions@#TBS could predict the risk of MOF and is not influenced by spinal osteoproliferation in AS patients, even in those with advanced spinal changes.
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Objective@#The aim of this pilot study was to investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate ( 99m Tc-MDP) for diagnosing osteomyelitis (OM). @*Materials and Methods@#Twenty-one patients with suspected OM were enrolled retrospectively. Three-phase bone scan (TPBS), early-phase SPECT/CT (immediately after blood pool planar imaging), and delayed-phase SPECT/CT (immediately after delayed planar imaging) were performed. The final diagnoses were established through surgery or clinical follow-up for over 6 months. We compared three diagnostic criteria based on (I) TPBS alone, (II) combined TPBS and delayed-phase SPECT/ CT, and (III) early-phase SPECT/CT alone. @*Results@#OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/ accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. @*Conclusion@#This pilot study demonstrated the potential of using the early-phase SPECT/CT to diagnose OM. Based on the results, prospective studies with a larger sample size should be conducted to confirm the efficacy of early-phase SPECT/CT.
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Background@#Spinal cord injury (SCI) is a serious clinical condition that impacts a patient's physical, psychological, and socio-economic status. The aim of this pilot study was to evaluate the effects of training with a newly developed powered wearable exoskeleton (Hyundai Medical Exoskeleton [H-MEX]) on functional mobility, physiological health, and quality of life in non-ambulatory SCI patients. @*Methods@#Participants received 60 minutes of walking training with a powered exoskeleton 3 times per week for 10 weeks (total 30 sessions). The 6-minute walking test (6MWT) and timedup-and-go test (TUGT) were performed to assess ambulatory function. The physiological outcomes of interest after exoskeleton-assisted walking training were spasticity, pulmonary function, bone mineral density, colon transit time, and serum inflammatory markers. Effects of walking training on subjective outcomes were estimated by the Korean version of the Falls Efficacy Scale—International and the 36-Item Short-Form Health Survey version 2. @*Results@#Ten participants finished 30 sessions of training and could ambulate independently.No severe adverse events were reported during the study. After training, the mean distance walked in the 6MWT (49.13 m) was significantly enhanced compared with baseline (20.65 m). The results of the TUGT also indicated a statistically significant improvement in the times required to stand up, walk 3 m and sit down. Although not statistically significant, clinically meaningful changes in some secondary physiological outcomes and/or quality of life were reported in some participants. @*Conclusion@#In conclusion, this study demonstrated that the newly developed wearable exoskeleton, H-MEX is safe and feasible for non-ambulatory SCI patients, and may have potential to improve quality of life of patients by assisting bipedal ambulation. These results suggest that the H-MEX can be considered a beneficial device for chronic non-ambulatory SCI patients.
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Purpose@#This study aimed to identify the prevalence of fatigue and its associated factors leading to the fatigue among Korean commercial airline pilots. @*Methods@#An anonymous, web-based questionnaire collecting data on sleep related characteristics was completed by airline pilots. The final 1,029 samples of completed questionnaires were analyzed. The association of the risk factors with fatigue was determined using logistic regression analysis. @*Results@#The prevalence of fatigue was 60% (Fatigue Severity Scale index≥3.2), disturbed sleep 28% (Pittsburgh Sleep Quality Index≥9), daytime sleepiness 17% (Epworth Sleepiness Scale≥10), and sleep apnea (Berlin Questionnaire≥2) 11%. Thefully adjusted logistic regression showed that quality of life (odds ratio [OR]=0.16, confidence interval [CI]=0.11–0.24), daytime sleepiness (OR=1.26, CI=1.18–1.34), sleep quality (OR=1.44, CI=1.29–1.61), mental workload (OR=1.10, CI=1.05–1.14),vigorous physical activity (OR=0.82, CI=0.72–0.92), late starts (OR=1.25, CI=1.06–1.46) and average weekly flying hours (OR=1.02, CI=1.00–1.03) were associated with higher levels of fatigue. @*Conclusion@#Lower quality of life, disturbed sleep, more subjective sleepiness, shorter sleep duration, higher mental workload, less vigorous physical activity, frequent late starts, and longer flying hour were shown to be risk factors for fatigue in airline pilots.These findings should be taken into account in the development of sleep and fatigue countermeasures for airline pilots.
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Syncope, defined as a transient loss of consciousness, is commonly clinical encountered in patients of all ages at emergency and outpatient clinics. However, syncope shares various clinical features with other diseases (e.g., epilepsy), and the explicit cause may be difficult to identify because testing (e.g., electrocardiography) cannot be performed during a syncopal episode. Syncope due to a cardiac disorder may lead to a fatal outcome such as sudden cardiac death, whereas neurally mediated syncope has a much more favorable prognosis. Herein, we classify the causes of syncope and provide the clinical approach for each, focusing on recently updated guidelines.
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The medical fitness of pilots is part of the civil aviation safety scenery. This study aimed to analyze the health problems occurring among Korean commercial pilots. Three data sources were used to identify the health problems: 7,574 aviation medical examination data, 5,400 sick leaves and 39 cases of a decrease in medical fitness during flight duty period and layover of Korean commercial pilots who have been working for K airline from Jan. 1, 2016 to Dec. 31, 2018. This study was retrospectively analyzed using SPSS 22 statistical program. Waiver of medical certificates was an average 11.9% of total issuance for 3 years, with a denial of 0.1%. The leading cause of denial of medical certificates was predominantly of cardiovascular cause (55.6%). Mild respiratory and digestive disease accounted for 82% of total sick prevalence and 68% of total sick days. The psychiatric and cardiovascular disease were ranked high according to the number of days lost per case. The most common cause of decrease in medical fitness during flight duty period was acute abdominal pain (36.4%) and musculoskeletal disorder (40%) when staying abroad. Aeromedical emphasis on minimizing cardiovascular risk remains appropriate. Major pilot health problems identified in this study should be considered in establishing pilot health promotion programs for aviation safety.
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PURPOSE: To investigate the correlation between the tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA).METHOD: 2P-BS including technetium-99m-methylene diphosphonate blood pool and bone phase imaging in 402 consecutive patients with clinically suspected RAwere retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed. Clinical suspected tenosynovitis was evaluated on physical examination. Rheumatoid factor, anti-cyclic citrullinated protein antibody, C-reactive protein, and estimated sedimentation rate were obtained. Radiographic findings were also used to define early and established arthritis.RESULTS: Tenosynovitis pattern was detected in 12.7%(51/402 patients) on 2P-BS.A total of 94.1%(48/51) were diagnosed as RA vs. 5.9% (3/51) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 85.4% (41/48) had early arthritis and 14.6% (7/48) had established arthritis. On physical examination, tenosynovitis was suspected in 21.9% (88/402). A total of 56.8% (50/88) belonged to the RA group and 43.2% (38/88) to the non-RA group. The tenosynovitis pattern of 2P-BS and physical examination showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of odds ratio which was highest among the RA-associated factors.CONCLUSION: Tenosynovitis pattern on 2P-BS was more commonly detected in the RA group and was more frequently associated with early arthritis pattern. Therefore, 2P-BS could give additional information for the detection of subclinical tenosynovitis in early or preclinical RA patients.
Subject(s)
Humans , Ankle , Arthritis , Arthritis, Rheumatoid , C-Reactive Protein , Classification , Fingers , Methods , Odds Ratio , Physical Examination , Radionuclide Imaging , Retrospective Studies , Rheumatoid Factor , Tenosynovitis , Toes , WristABSTRACT
Histiocytic sarcoma is a rare hematologic malignancy, with very few cases of primary histiocytic sarcoma of the breast described in English scientific literature. Herein, we describe a case of primary histiocytic sarcoma of the breast in a 75-year-old woman, with no clinical history of malignant tumors, who presented with a palpable solitary breast mass. Microscopically, the resected breast mass showed large pleomorphic cells, some multinucleated giant cells, and admixed inflammatory components. The pleomorphic tumor cells further showed a diffuse, noncohesive growth pattern, an abundant eosinophilic cytoplasm, and strong and diffuse immunoreactivity for cluster of differentiation (CD) 68 and CD163. Furthermore, a whole-body positron-emission tomography/computed tomography using deoxy-2-[¹⁸F]fluoro-D-glucose performed after surgery showed no other masses or lesions. After surgical excision, the patient was followed up, and no evidence of tumor recurrence or metastasis was noted.
Subject(s)
Aged , Female , Humans , Breast , Cytoplasm , Eosinophils , Giant Cells , Hematologic Neoplasms , Histiocytes , Histiocytic Sarcoma , Neoplasm Metastasis , RecurrenceABSTRACT
PURPOSE@#To investigate the correlation between the tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA).METHOD: 2P-BS including technetium-99m-methylene diphosphonate blood pool and bone phase imaging in 402 consecutive patients with clinically suspected RAwere retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed. Clinical suspected tenosynovitis was evaluated on physical examination. Rheumatoid factor, anti-cyclic citrullinated protein antibody, C-reactive protein, and estimated sedimentation rate were obtained. Radiographic findings were also used to define early and established arthritis.@*RESULTS@#Tenosynovitis pattern was detected in 12.7%(51/402 patients) on 2P-BS.A total of 94.1%(48/51) were diagnosed as RA vs. 5.9% (3/51) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 85.4% (41/48) had early arthritis and 14.6% (7/48) had established arthritis. On physical examination, tenosynovitis was suspected in 21.9% (88/402). A total of 56.8% (50/88) belonged to the RA group and 43.2% (38/88) to the non-RA group. The tenosynovitis pattern of 2P-BS and physical examination showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of odds ratio which was highest among the RA-associated factors.@*CONCLUSION@#Tenosynovitis pattern on 2P-BS was more commonly detected in the RA group and was more frequently associated with early arthritis pattern. Therefore, 2P-BS could give additional information for the detection of subclinical tenosynovitis in early or preclinical RA patients.
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PURPOSE@#To investigate whether a correlation exists between the semi-quantitative breast-specific gamma imaging (BSGI) findings and dynamic contrast-enhanced (DCE) MRI parameters assessed by a computer-aided evaluation program.@*MATERIALS AND METHODS@#Semi-quantitative index of the lesion to non-lesion (L/N) ratio in BSGI and DCE-MRI parameters was assessed by a computer-aided evaluation program, where 47 cases of invasive breast cancer were obtained. Correlations between the L/N ratio and DCE-MRI parameters were assessed by a computer-aided evaluation program. Tumor diameter (cm), angio-volume (cc), degree of initial peak enhancement (%), persistent enhancement proportion (%), and washout enhancement proportion (%) were analysed. The relationships between the L/N ratio and DCE-MRI parameters were evaluated by a univariate and multivariate regression analysis.@*RESULTS@#The mean L/N ratio of the 47 tumors was 3.63 ± 2.19 (range: 1–13.1). The L/N ratio was higher in tumors with larger diameters (p < 0.001), increased angio-volume (p < 0.001), higher degree of initial peak enhancement (p = 0.005) and increased washout enhancement proportion (p = 0.004). In the multivariate regression analysis, angio-volume (cc) and washout enhancement proportion (%) were associated with L/N ratio (p = 0.007 and p = 0.024, respectively).@*CONCLUSION@#There was a correlation between the semi-quantitative L/N ratio in BSGI and DCE-MRI parameters assessed by a computer-aided evaluation program for breast cancer.
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PURPOSE: To identify differences between three-phase bone scan and SPECT/CT (TBS) and WBC SPECT/CT (WS) and compare diagnostic accuracies of each modality in patients with suspicious post-traumatic osteomyelitis (OM).METHODS: Twenty-one patients with suspicious post-traumatic OM were enrolled. All patients performed TBS and WS within 1 week. Foci ofMDP andWBC accumulation were divided into three categories: bone (OM), soft tissue (soft tissue inflammation; STI), negative for inflammation (NI). Confirmative diagnosis was made upon operative pathology or long-term clinical follow-up.RESULTS: Of 21 patients, four OM, eight STI, nine NI were finally diagnosed. TBS diagnosis was correct in three of four positive cases and nine of 17 negative cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of TBS were 75 %, 52.9 %, 57.1 %, 27.3 %, 90 %. WS diagnosis was correct in two of four positive cases and 17 of 17 negative cases. Sensitivity, specificity, accuracy, PPV, NPV were 50 %, 100 %, 81.0 %, 100 %, 89.5 %. Twelve of 21 cases showed agreement between TBS and WS. TBS misdiagnosed nine cases (six STI and two NI as eight OM; one OM as one STI), while WS misdiagnosed four cases (two OM as two STI; two STI as two NI). Combining results from TBS and WS led to better diagnostic accuracy (91.7 %) than either TBS or WS alone.CONCLUSION: TBS and WS showed moderate agreement in assessment of clinically suspected post-traumatic OM. WS better evaluated inflammation than TBS. WS tended to underestimate inflammation whereas TBS tended to overestimate inflammation. Combining TBS and WS enhanced diagnostic accuracy.
Subject(s)
Humans , Diagnosis , Diagnosis, Differential , Follow-Up Studies , Inflammation , Osteomyelitis , Pathology , Sensitivity and Specificity , Sexually Transmitted DiseasesABSTRACT
The rapid development of medical imaging technologies has greatly enhanced the utility of nuclear medicine imaging modalities over the last decade. Hybrid imaging technology merging computed tomography (CT) with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) allows superimposing the physiologic data obtained by SPECT or PET on the detailed anatomy of CT, yielding a better understanding of the disease status and improving diagnostic performance. However, the conventional whole body bone scan and three phase bone scan still have their own distinct role as diagnostic imaging, reflecting the changes of bone metabolism in benign and malignant diseases, including rheumatic diseases. A review of each nuclear medicine imaging technique and clinical applications in various conditions of rheumatic diseases will be presented in this article.
Subject(s)
Diagnostic Imaging , Metabolism , Nuclear Medicine , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , Rheumatic Diseases , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-PhotonABSTRACT
Urticarial vasculitis is a rare disorder that principally manifests with recurrent urticarial, sometimes hemorrhagic, skin lesions and/or angioedema. Its clinical presentation is not always limited to cutaneous lesions and it can potentially affect other organs, such as the joints, lungs, kidneys, and eyes. Systemic involvement can either be present at the onset of disease or develop over time. In cases with systemic manifestations, urticarial vasculitis is more likely to be associated with a low complement level. We present the case of a teenage boy with hypocomplementemic urticarial vasculitis syndrome (HUVS) that occurred shortly following swine-origin influenza A virus infection in 2009. Afterwards, HUVS was systemically complicated with myositis and membranous nephropathy that developed several months and about 2 years after its onset, respectively. A combination of glucocorticoid and immunosuppressive agents has been used to effectively control disease activity.
Subject(s)
Humans , Male , Angioedema , Complement System Proteins , Glomerulonephritis, Membranous , Immunosuppressive Agents , Influenza A virus , Joints , Kidney , Lung , Myositis , Skin , VasculitisABSTRACT
The purpose of this study was to investigate the correlations between tumor-to-background ratio (TBR) obtained from breast-specific gamma imaging (BSGI) and the prognostic factors of breast cancer. Sixty-seven patients with invasive ductal carcinoma who underwent preoperative BSGI were enrolled. The BSGI images were visually scored from 1 to 5 according to a breast imaging reporting and data system (BIRADS). The TBR results obtained from positive BSGI images were compared according to the following prognostic factors: tumor size; axillary lymph node metastasis; nuclear grade (NG); histologic grade (HG); subtype; Ki-67; and the expression profile of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Among 67 images, 60 were classified as a positive finding (sensitivity 89.6%). A higher TBR value was significantly correlated with tumor size ≥ 2 cm (P = 0.001), axillary lymph node metastasis (P = 0.007), high HG (P = 0.029), negative PR status (P = 0.036), and Ki-67 ≥ 14% (P = 0.007). The TBR showed a significant difference between the luminal A and non-luminal A subtypes (P = 0.007). On multivariate analysis, TBR had a high correlation with tumor size ≥ 2 cm, axillary lymph node metastasis, and negative PR status (P = 0.003, 0.048, and 0.030, respectively). A high TBR on BSGI was significantly correlated with poor prognostic factors of breast cancer. Luminal A subtype, a breast cancer subtype with more favorable prognosis, was associated with a low TBR on BSGI.
Subject(s)
Humans , Breast Neoplasms , Breast , Carcinoma, Ductal , Estrogens , Information Systems , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Phenobarbital , Prognosis , Radionuclide Imaging , ErbB Receptors , Receptors, ProgesteroneABSTRACT
No abstract available.