A Case of Primary Hepatic Lymphoma Mimicking Hepatitis / 대한간학회지

We report here on a case of non-Hodgkin's lymphoma in which liver involvement was the predominant clinical manifestation. A healthy 44-year-old man presented with upper abdominal pain, hepatosplenomegaly, thrombocytopenia, elevated AST, ALT and bilirubin, and marked elevation of lactate dehydrogenase and alkaline phosphatase. The abdominal CT scan showed only diffuse hepatosplenomegaly and uneven contrast enhancement of the spleen without any definite mass of the liver and spleen. US-guided aspiration biopsy of liver and the histologic examination confirmed a diagnosis of non-Hodgkin's lymphoma, the diffuse large B cell type. Bone marrow biopsy showed the infiltration of malignant lymphoma cells. PET-CT showed an increased FDG uptake of the liver, spleen and long bones. The patient was treated with combination regimen of cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy. Even in the absence of a mass lesion or lymphadenopathy, primary hepatic or hepatosplenic lymphoma should be considered in differential diagnosis of hepatitis or liver cirrhosis, especially for patients with diffuse hepatosplenomegaly and markedly elevated LDH.

A Case of Henoch-Schonlein Purpura Associated with Gastric Ulcer Bleeding / 대한소화기내시경학회지

Henoch-Schonlein purpura is a systemic leukoclastic vasculitis that predominantly affects small vessels. This results in purpura, abdominal pain, arthralgia and occasional sometimes nephritis. Gastrointestinal involvement occurs in 50~75% of the patients. The small bowel and colon are relatively commonly affected, but the gastric involvement is rare. Endoscopic findings include mucosal edema, hemorrhagic changes, erosions and superficial ulcers. However, deep gastric ulcers are rarely observed in Henoch-Schonlein purpura and have not been reported yet. We report a patient with typical Henoch-Schonlein purpura who presented with melena due to bleeding from multiple deep gastric ulcers and got improved with administration of high dose corticosteroid.

Comparison of Clinical Efficacy between Nonsteroidal Anti-inflammatory Drugs and Acetaminophen in Knee Osteoarthritis according to Ultrasonographic Findings / 대한류마티스학회지

OBJECTIVE: To compare the clinical efficacy between nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen in knee osteoarthritis according to ultrasonographic findings. METHODS: We administered 12 mg of NSAIDs (lornoxicam) plus misoprostol 300microgram or 1,950 mg of acetaminophen in 40 randomly selected patients who fulfilled the ACR criteria for knee osteoarthritis. The effectiveness of these drugs on osteoarthritis was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. In addition, we performed ultrasonography of the knee joints and assessed length of capsular distension, length of medial and lateral osteophyte, amount of joint effusion, and the presence of synovial proliferation. RESULTS: There were significant correlations between WOMAC score and length of capsular distension and length of medial/lateral osteophyte. At 6 weeks, both lornoxicam and acetaminophen-treated patients had significant lower levels of WOMAC score compared to the entry into the trial (p or =0.7 cm) or severe medial osteophyte (length of osteophytes > or =0.4 cm) showed better responses to lornoxicam than to acetaminophen in terms of the reduction of WOMAC score (p=0.008 for severe capsular distension, p=0.03 for severe medial osteophyte). However, in the subgroup with mild forms of capsular distension (<0.7 cm) or medial osteophytes (<0.4 cm), no difference was found in the reduction of WOMAC score 6 weeks after treatment with lornoxicam versus acetaminophen. CONCLUSIONS: Patients with osteoarthritis of the knee had significantly greater improvements in pain score over 6 weeks with lornoxicam than with acetaminophen, particularly in patients with severe forms of capsular distension and medial osteophyte on joint ultrasonography. Ultrasonography could be an useful tool to determine the usage of NSAIDs versus acetaminophen in knee osteoarthritis patients.

Correlation between Sonographic Severity and Biochemical Markers of Synovium and Cartilage in Knee Osteoarthritis Patients / 대한류마티스학회지

OBJECTIVE: Ultrasonography has benefit in detecting soft tissue abnormalities within the joints, which cannot be assessed by conventional X-ray. In this study, we investigated the relationship between soft tissue and/or bony abnormalities on ultrasonography and biochemical markers of synovium and cartilage in knee osteoarthritis (OA) patients METHODS: Fifty-one knee OA patients who fulfilled the ACR criteria were enrolled in this study. Knee ultrasonography was performed in affected knee joints with a 12 MHz linear probe to assess the presence of effusion, synovial proliferation, capsular distension, length of osteophytes, and thickness of cartilage. At the same time, the serum levels of hyaluronic acid (HA) and cartilage oligomeric protein (COMP) were measured by ELISA and serum osteocalcin levels were determined by RIA. RESULTS: The patients with longer medial osteophytes showed higher levels of serum HA and COMP than those with shorter ones. Serum HA levels were significantly higher in patients with larger amount of effusion and/or synovial proliferation, suggesting inflammatory changes within the joint, than those without. In addition, the severity of capsular distention was also correlated well with serum HA and COMP levels. However, the length of lateral osteophytes and thickness of femoral cartilage were not correlated with serum HA or COMP levels. Serum osteocalcin levels did not show any association with above ultrasonographic parameters, either. CONCLUSIONS: Using knee ultrasonography, we demonstrated that serum HA and COMP levels were elevated in more severe OA patients than less severe patients. This result suggests that detailed pathologic changes in the soft tissue and/or bone of OA joints on ultrasonography are being directly reflected to biochemical markers measured in the peripheral blood.