Multiple Cavitary Pulmonary Nodules Caused by Mycobacterium intracellulare / 가정의학회지

Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.

Acute Pancreatitis Associated with Intraductal Tubulopapillary Neoplasm of the Pancreas / 이화의대지

Intraductal tubulopapillary neoplasm (ITPN) of the pancreas has been recently reported. It is very rare, therefore clinical behavior and prognosis has not yet been characterized. We experienced a case of ITPN of the pancreas which presented with acute pancreatitis and treated with Whipple's operation. Histopathologic finding showed papillary hyperplasia with carcinomatous change. The tumor recurred after 47 month of operation, and she underwent total pancreatectomy. Pathologic finding revealed tubulopapillary growth with high grade dysplasia. Immunohistochemial staining was not performed, however gross and microscopic findings were compatible with ITPN of the pancreas. We report a case of ITPN of the pancreas.

Acute Pancreatitis Associated with Intraductal Tubulopapillary Neoplasm of the Pancreas / 이화의대지

Intraductal tubulopapillary neoplasm (ITPN) of the pancreas has been recently reported. It is very rare, therefore clinical behavior and prognosis has not yet been characterized. We experienced a case of ITPN of the pancreas which presented with acute pancreatitis and treated with Whipple's operation. Histopathologic finding showed papillary hyperplasia with carcinomatous change. The tumor recurred after 47 month of operation, and she underwent total pancreatectomy. Pathologic finding revealed tubulopapillary growth with high grade dysplasia. Immunohistochemial staining was not performed, however gross and microscopic findings were compatible with ITPN of the pancreas. We report a case of ITPN of the pancreas.

A Case of Welder's Lung Disease and Concurred Non-Tuberculotic Mycobacterial Infection Confirmed with Thoracoscopic Lung Biopsy / 결핵및호흡기질환

Pulmonary siderosis, or Welder's lung disease is an occupational lung disease caused by iron-inhalation. Diagnosis of pulmonary siderosis is based on occupational history of the patient, radiologic findings, and pathologic findings of iron-laden macrophages within lung tissue or broncho-alveolar lavage fluid. We observed a case of a 43 years-old welder diagnosed with pulmonary siderosis via thoracoscopic lung biopsy. Sputum culture along with pathology also identified a non-tuberculotic mycobacterial infection with a sputum culture and the pathologic findings. The patient was treated with anti-tubercular medication and cessation of iron-exposure. And his condition improved within a few months.

Usefulness and Limitation of 2010 ACR/EULAR Classification Criteria in Korean Patients with Early RA

OBJECTIVE: The 2010 New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for rheumatoid arthritis (RA) was raised to identify patients with early RA and replaced the 1987 ACR classification criteria. The aims of this study are to assess the availability of new classification criteria and to evaluate its potential limitation. METHODS: A total of 408 patients with newly diagnosed RA were included from 13 secondary or tertiary hospitals in South Korea. The symptom duration was less than 12 months before the diagnosis of RA. RA was defined as either 1987 ACR classification criteria or new 2010 ACR/EULAR criteria. We compared the full details of both classification criteria. RESULTS: The mean symptom duration was 5.1 months. The majority (76.2%) of the patients were female. Two hundred and seventy three patients (66.9%) fulfilled both of the 2010 and 1987 classification criteria. Forty-seven (14.7%) of the 320 patients fulfilling the 1987 criteria did not fulfill the new classification criteria. On the other hand, eighty-eight (24.4%) of the 361 patients fulfilling the 2010 ACR/EULAR classification criteria did not fulfill the 1987 ACR criteria. Thirty-six (55.4%) of the 65 patient with seronegative RA failed to meet the 2010 classification criteria. In case of seropositive RA (n=343), 85 additional patients (24.8%) could be diagnosed as RA using new classification criteria. CONCLUSION: The new 2010 ACR/EULAR classification criteria enable physicians to diagnose more patients with early RA via the help of serology. However, the sensitivity for the diagnosis of seronegative RA is projected to decrease.

Risk Factors for Low Bone Mineral Density in Korean Patients with Systemic Lupus Erythematosus

OBJECTIVE: To determine the degree and risk factors for decreased bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE). METHODS: One hundred and one patients with SLE and 57 age- and gender- matched healthy controls were enrolled in this study. The BMD was measured by dual energy X-ray absorptiometry (DXA). The laboratory findings and clinical variables evaluated in the SLE patients consisted of disease duration, SLE disease activity index (SLEDAI), and medications, including mean and cumulative dose of glucocorticoid. At the time of the clinical and laboratory assessment, the levels of serum osteocalcin, serum FSH/LH, urine deoxypyridinoline (DPD), and serum cytokines, such as IL-6 and soluble receptor activator of NF-kB ligand (RANKL), were determined in SLE patients using a enzyme-linked immunosorbent assay. RESULTS: The BMD T score decreased in patients with SLE compared to the healthy controls (-1.11 versus -0.41, p=0.001 at lumbar spine, -0.84 versus -0.01, p<0.001 at femur neck, -1.20 versus -0.45, p<0.001 at total hip, respectively). Osteoporosis and osteopenia was present in 16.8% and 46.5% of patients, respectively. Multiple regression analysis revealed a low BMD in the lumbar spine to be associated with increased FSH, low BMI and cumulative glucocorticoid dose. A low BMD in the hip and femur neck was associated with increased FSH, low BMI, and duration of glucocorticoid. On the other hand, the levels of osteocalcin, deoxypyridinoline (DPD), IL-6, and soluble RANKL were similar in patients with a low BMD and those with normal BMD. CONCLUSION: Osteoporosis and osteopenia are more common in young Korean SLE patients than in control subjects. Elevated FSH, low BMI, and the use of glucocorticoid are independent risk factors linked to a decreased BMD in Korean patients with SLE.

The Feasibility of an Ex-vivo Sentinel Lymph Mapping Using Preoperative Radioisotope Injection in Cases of Extraperitoneal Rectal Cancer

PURPOSE: The purpose of this research was to evaluate the feasibility of sentinel lymph node (SLN) mapping involving transanal injection with an ex-vivo mapping in patients with rectal cancer. METHODS: Between April 2007 and December 2009, 20 consecutive patients with T1-3, N0-1 clinical stage rectal cancer preoperatively underwent a SLN procedure using submucosal 99mTc-phytate injection. All the patients underwent a total mesorectal excision. After the standard surgical resection, all specimens were identified on lymphoscintigraphy, and bench work was done to pick up the sentinel node basin. All the lymph nodes (non-SLNs and SLNs) were examined using conventional hematoxylin and eosin staining and immunohistochemistry with anti-cytokeratin antibodies. RESULTS: SLNs were identified from 19 of 20 patients with rectal cancer. The total number of sentinel nodes retrieved from the surgical specimens was 29, and the mean number per patient was 1.6 (range, 0 to 4). In three patients, the SLN was the only positive lymph node. There was one false-negative case with a sensitivity of 88.8% and two upstaged cases (20.0%). The SLN samples from rectal cancer are mainly localized in the pararectal region, but aberrant nodes receive direct drainage from the rectal cancer. On planar lymphoscintigraphy, 15.7% of all patients had aberrant lymphatic drainage to the sigmoid mesenteric or sigmoid lymph node station. CONCLUSION: In conclusion, the intraoperative transanal injection for ex-vivo SLN navigation is a safe, feasible surgical modality in patients with rectal cancer. Large studies are warranted to determine the clinical significance of the SLN concept and micrometastasis in rectal cancer.

A Case of NK/T Cell Lymphoma Mimicking Limited Form of Wegener's Granulomatosis / 대한류마티스학회지

It is occasionally difficult to distinguish Wegener's granulomatosis (WG) from other diseases including malignancy, tuberculosis, and various types of vasculitis because of the overlapping symptoms and signs. We report on a patient with NK/T cell lymphoma who was treated with a limited form of WG. At his first visit, he presented with left foot drop and recurrent nasal swelling. Necrosis and massive infiltration of inflammatory cells were identified on a nasal tissue biopsy. Sural nerve biopsy findings also showed infiltration of inflammatory cells in both the endoneurium and perivascular area; thus, a diagnosis of a limited form of WG was made. After combination therapy with a glucocorticoid and oral cyclophosphamide was initiated, his condition completely recovered without recurrence for the next 2 years. However, he visited the hospital again for recurrence of nasal swelling. Repeated biopsy of nasal tissues, combined with an immunophenotypic analysis revealed NK/T cell lymphoma. The possibility of NK/T lymphoma should be considered when evaluating a limited type of WG, which shows atypical findings on biopsy as well as recurrent deterioration, as a suboptimal dose of immunosuppressive therapy may mask its expression and lead to a poor prognosis.

Diabetic Cheiroarthropathy / 대한류마티스학회지

No abstract available.

Efficacy of Computerized Cognitive Rehabilitation Training for Inpatients with Schizophrenia : A Pilot Study / 신경정신의학

OBJECTIVES : The primary purpose of this study was to investigate the effects of computerized cognitive rehabilitation training on inpatients with schizophrenia in the rehabilitation unit. METHODS : Thirty-eight patients with schizophrenia from the Yongin Mental Hospital Rehabilitation Ward were randomly assigned either to a computerized cognitive rehabilitation group or to a control group. The rehabilitation group received 12 sessions of computerized cognitive rehabilitation training (Cog-Trainer) over 3 months. This training program consisted of ten units, each of which consisted of 3 levels, practice, application, and advanced. Neurocognitive functions were assessed at the beginning and end of the training period. Cognitive measures included Span of Apprehension (SPAN), Continuous Performance Test (CPT), Digit Span, Trail Making Test, and the Stroop Test. RESULTS : Compared to controls, subjects receiving computerized cognitive rehabilitation training experienced a significant improvement in attention, concentration, and working memory. CONCLUSION : These results indicate that computerized cognitive rehabilitation training can contribute to improvement in cognitive function of patients with schizophrenia. Further study to generalize these results is required.

Intracranial Hypotension with Spontaneous CSF Leakage in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Headaches are not only one of the 19 different neuropsychiatric syndromes in SLE but also the most common chief complaint of patients with neuropsychiatric lupus. Approximately 50% of patients with SLE are presumed to have neuropsychiatric phenomena during their illness. There're no specific serological, radiological or histological biomarkers to confirm the clinical diagnosis of neuropsychiatric lupus. Therefore, physicians tend to try controlling lupus activity especially when the origins of the headache in patients with lupus are difficult to define. However, neuropsychiatric lupus can only be diagnosed after excluding other causes which is the point. A 47-year-old woman with lupus presented to the emergency department with the sudden onset of postural headache with nausea and vomiting. Through CSF tapping and CT myelography, intracranial hypotension with spontaneous CSF leakage was revealed. Her symptoms promptly improved after therapy using an epidural blood patch. Intracranial hypotension with spontaneous CSF leakage is rare disease, and it has never been reported in patients with SLE before. This case emphasizes the importance of finding out the origin of a headache in patients with lupus.

Utility of CT colonography in detecting colon polyps as a colon cancer screen / 대한내과학회지

BACKGROUND/AIMS: CT colonography is a rapid and safe imaging method for detecting polyps in the colon and rectum. We assessed the efficacy of CT colonography in colorectal polyp detection. METHODS: We prospectively studied 84 subjects (mean age 55.7+/-11.1 years; 52 men, 32 women) undergoing CT colonography followed by colonoscopy. Based on the results of CT colonography, all polyps were classified by size (any size, and those larger than 5, 7, and 10 mm) and were checked for location, morphology, and histological characteristics. We determined the sensitivity and specificity of CT colonography using colonoscopy as a reference standard with a segmental unblinding method. RESULTS: A total of 56 lesions were identified in 26 of 79 subjects undergoing both CT colonography and conventional colonoscopy. The sensitivities of CT colonography for polyps of any size, and larger than 5, 7, and 10 mm were 60.7%, 70.5%, 75.9%, and 81.8%, respectively. The per-subject sensitivities of CT colonography for the polyps of any size, and larger than 5, 7, and 10 mm, were 80.7%, 95.0%, 93.3%, and 90.9%, respectively. The per-subject specificities of CT colonography for polyps were 86.8%, 89.8%, 95.3%, and 100.0%, respectively. The sensitivities of CT colonography for flat, sessile, and pedunculated polyps were 30.8%, 85.0%, and 90.0%, respectively. CONCLUSIONS: CT colonography is a useful diagnostic method for screening colorectal neoplasias larger than 7 mm diameter, showing 75.9% sensitivity and 71.0% positive predictive value.

Three cases of Philadelphia (Ph) chromosome positive acute myeloid leukemia (AML) treated with imatinib mesylate (Glivec, STI571) and allogeneic hematopoietic stem cell transplantation after induction chemotherapy / 대한내과학회지

The Ph-chromosome is the hallmark of chronic myelogenous leukemia (CML), but it has also been reported infrequently for de novo AML. This cytogenetic variant of AML is characterized by a poor prognosis associated with extraordinary drug resistance. Experience with the use of imatinib mesylate for Ph-chromosome-positive de novo AML is limited because of the rarity of the disorder. Thus, allogeneic hematopoietic stem cell transplantation (HSCT), as a post-remission therapy, should be considered. In three patients with Ph-chromosome-positive AML, we achieved complete remission with induction chemotherapy and the use of an imatinib cycle as an interim therapy. Subsequently, all patients received consolidation chemotherapy followed by imatinib cycles, bridging the time to allogeneic HSCT. All patients were successfully transplanted, and have been in excellent condition, with a median follow-up duration of 15 months (range, 2-25 months). We report on these cases and present the treatment strategy of induction chemotherapy, maintenance with imatinib mesylate, and final allogeneic HSCT as a representative paradigm for the treatment of Ph-chromosome-positive de novo AML.

A Case of Unruptured Rudimentary Horn Pregnancy / 대한주산의학회잡지

No abstract available.

A Case of Cervical Pregnancy Treated with Intramuscular Methotrexate Injection / 대한산부인과학회잡지

Cervical pregnancy is a rare form of ectopic gestation in which the blastocyst implants in the cervical mucosa below the histologic cervical os. Because of the serious vaginal bleeding, hysterectomy was usually done in the management of cervical pregnancy. Howerver, conservative treatment is desirable for women who want to be pregnancy in the future. Methotrexate has been utilized recently for conservative management of cervical pregnancy. We report a case of cervical pregnancy which was treated succesfully with intramuscular methotrexate injection.

Biological Monitorings of Workers Exposed to Toluene diisocyanate / 대한산업의학회지

Toluene diisocyanate (TDI) is widely used in the production of flexible polyurethane foams, as well as in the formulation of polyurethane paints and coatings. The commercial material is generally a mixture of 2,4- and 2,6-TDI, the predominant mix being 80% 2,4 and 20% 2,6-TDI. The 2,4-isomer is considerably more reactive than the 2,6-TDI at ambient temperatures due to steric factors involving the positions of the isocyanate groups relative to the ring methyl group. Because of this difference in the reactivities of the isomers, it seemed probable that there might be an increase in the amount of 2,6-TDI offgased relative to the 2,4-isomer. Therfore a relative enrichment of the 2,6-TDI has been found in industrial atmospheres. Toluene diamines, which are metabolites of TDI, in urine have a linear relation with exposure to TDI, so that urianry TDA could be used as a biological index of the exposure to TDI. This study was conducted to investigate the distribution of TDI isomer in industrial atmospheres and to propose proper biological monitoring methods by identifying the relationships between the environmental TDI exposure and concentration of TDA in urine. Concentrations of 2,4-TDI and 2,6-TDI in air were 4.38microgram/m3 and 25.43microgram/m3, respectively. The Threshold Limited Value of 40microgram/m3 was exceeded for the 2,6-TDI in about 46.8% (22samples) of the samples, while the 2,4-TDI was not at all exceeded. The ratio between 2,4-TDI and 2,6-TDI varied in air samples in the range, of 2.4%:97.6%-51.0%:49.0%. There was an enrichment of 2,6-TDI in air relative to the 2,4-TDL Concentrations of 2,4-TDA and 2,6-TDA in urine were 1.31microgram/g creatinine and 4.16microgram/g creatinine, respectively. The ratio between 2, 4-TDA and 2,6-TDA varied in urine samples in the range of 1.4%:98.6%-99.9%:0.1%. There was an enrichment of 2,6-TDA in urine relative to the 2,4-TDA. No relation between the concerations of TDA isomer in urine and concerations of TDI isomer in air was found. Above results of this study, workers were more exposed to the 2,6-TDI relative to the 2,4-TDI in industrial atmospheres. Therefore, the establishment of TLV for 2,6-TDI should be considered. Also, the further studies on biological monitorigs of workers exposed to TDI should be continued.

Light and electron microscopic study of tumor cells in carcinoma of cervix uteri after intravenous administration of cisplatin and 5 - fluorouracil / 대한산부인과학회잡지

No abstract available.

A case of treatment of unruptured tubal pregnancy by laparoscope guided injection of prostaglandin F2 alpha / 대한산부인과학회잡지

No abstract available.