Two Cases of Nuclear Protein in Testis Midline Carcinomas of Sinonasal Tract / 대한이비인후과학회지

Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare and aggressive tumor that is genetically characterized by chromosomal rearrangement of the NUT gene. NMC predominantly involves the midline structures of the body and the sinonasal tract is considered a preferential site. While the optimal management of NMC is unclear, more than 80% of patients will die within one year of their diagnosis despite intensive treatment. We report two cases of NMC of the sinonasal tract. Histopathologic results of the punch biopsy showed undifferentiated and poorly differentiated carcinoma. NUT immunohistochemical staining results were positive. Multimodal treatments including surgery, radiotherapy, and chemotherapy were performed. We also present a literature review to compare with the present cases. In our cases, we emphasize the importance of the early diagnosis and intensive treatment of NMC.

Comparison of Outcomes between 7-French and 10-French Plastic Stents for Patients with Biliary Tract Cancer / 대한췌담도학회지

BACKGROUND/AIM: There is little data on whether plastic stents with a larger diameter are patent for longer than small stents in patients with bile duct cancer. The aim of this study was to compare the stent survival between 7-French (Fr) and 10-Fr plastic stents and evaluate the factors affecting stent survival. METHODS: Patients with biliary obstruction due to biliary tract cancer were enrolled at Yonsei University Wonju College of Medicine from January 2010 to October 2014. RESULTS: A total of 215 patients (7-Fr:10-Fr = 89:126 patients) were retrospectively enrolled. The primary tumor sites were common bile duct (n = 111), hilar (n = 45), and ampulla of Vater (n = 59). Rates of stent migration and stent obstruction were not different between the two groups. The median duration of stent survival was 3.3 months in the 7-Fr group and 5.9 months in the 10-Fr group (p = 0.543). The diameter of the stent did not have an effect on stent survival (hazard ratio 1.11, 95% confidence interval 0.71-1.73, p = 0.649). CONCLUSIONS: 7-Fr and 10-Fr stents have similar rates of stent migration and stent obstruction. The stent survival of 7-Fr was not inferior to 10-Fr stents in the management of biliary tract cancer.

A Case of 2-Month-Old Infant with Lobular Capillary Hemangioma

Lobular capillary hemangioma (LCH) in the nasal cavity, previously known as pyogenic granuloma, is an extremely rare benign vascular tumor in infants. LCH is a rapidly growing lesion that has a bleeding tendency due to its excessive vascularity. The authors experienced a case of LCH of the nasal cavity in a 2-month-old infant that was totally resected via the endoscopic approach after preoperative embolization. Therefore, we report this case with a brief review of the literature.

Clinical Implications of the Serum Apelin Level on Portal Hypertension and Prognosis of Liver Cirrhosis

BACKGROUND/AIMS: Levels of serum apelin (s-apelin), an endogenous ligand for angiotensin-like receptor 1, have been shown to be related to hepatic fibrosis and hemodynamic abnormalities in preclinical studies. We investigated the clinical implications of s-apelin as a noninvasive prognostic biomarker for chronic liver disease (CLD). METHODS: From January 2009 to December 2012, 215 CLD patients were enrolled and underwent clinical data collection, hepatic venous pressure gradient (HVPG) measurement, and liver biopsy. s-apelin was detected with a human total apelin enzyme-linked immunosorbent assay kit. All patients were prospectively observed during the median follow-up period of 23.0±12.9 months for decompensation and mortality. RESULTS: A total of 42 patients (19.5%) died during the follow-up period. s-apelin was significantly correlated with measurements of liver stiffness (R2=0.263, p<0.001) and collagen proportional area (R2=0.213, p<0.001) measured from liver biopsy tissue and HVPG (R2=0.356, p<0.001). In a multivariate analysis using a Cox regression hazard model, s-apelin was a weakly significant predictor of decompensation (hazard ratio [HR], 1.002; p<0.001) and mortality (HR, 1.003; p<0.001). CONCLUSIONS: s-apelin showed a significant relationship with CLD severity. However, its significance as a noninvasive biomarker for disease severity and prognosis was weak.

A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome

BACKGROUND/AIMS: Newer P2Y12 inhibitors, such as prasugrel and ticagrelor, have greater antiplatelet efficacy but may increase the risk of bleeding. In this study, we compared the pharmacodynamic efficacy of prasugrel and ticagrelor in East Asian patients with acute coronary syndrome (ACS). METHODS: We selected 83 ACS patients undergoing percutaneous coronary intervention who were discharged with 90 mg ticagrelor twice daily (n = 24), 10 mg prasugrel daily (n = 39) or 5 mg prasugrel daily (n = 20). After 2 to 4 weeks, on-treatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU < or = 275) and Caucasian (85 < PRU < or = 208) criteria for assessing the therapeutic window of OPR. RESULTS: OPR was lowest in the ticagrelor group, followed by the 10 mg prasugrel and 5 mg prasugrel groups (49.1 ± 29.9 vs. 83.7 ± 57.1 vs. 168.5 ± 60.8, respectively; p < 0.001). The 5 mg prasugrel group had the highest proportion of patients with OPR values within the therapeutic window, followed by the 10 mg prasugrel and ticagrelor groups (90.0% vs. 46.2% vs. 12.5%, respectively; p < 0.001 for East Asian criteria; 60.0% vs. 43.6% vs. 12.5%, respectively; p < 0.001 for Caucasian criteria). CONCLUSIONS: Short-term administration of 5 mg prasugrel facilitated maintenance within the therapeutic window of OPR compared with the 10 mg prasugrel and ticagrelor groups. Thus, 5 mg prasugrel daily may be the optimal antiplatelet regimen for stabilized East Asian ACS patients.

A Case of Rheumatoid Arthritis with Chronic Eosinophilic Pneumonia Associated with Eosinophilic Pleural Effusion

We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.

The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data

BACKGROUND/AIMS: Liver stiffness measurement (LSM) has been proposed as a non-invasive method for estimating the severity of fibrosis and the complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard for assessing the presence of portal hypertension, but its invasiveness limits its clinical application. In this study we evaluated the relationship between LSM and HVPG, and the predictive value of LSM for clinically significant portal hypertension (CSPH) and severe portal hypertension in cirrhosis. METHODS: LSM was performed with transient elastography in 59 consecutive cirrhotic patients who underwent hemodynamic HVPG investigations. CSPH and severe portal hypertension were defined as HVPG > or =10 and > or =12 mmHg, respectively. Linear regression analysis was performed to evaluate the relationship between LSM and HVPG. Diagnostic values were analyzed based on receiver operating characteristic (ROC) curves. RESULTS: A strong positive correlation between LSM and HVPG was observed in the overall population (r2=0.496, P or =10 mmHg) was 0.851, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for an LSM cutoff value of 21.95 kPa were 82.5%, 73.7%, 86.8%, and 66.7%, respectively. The AUROC at prediction of severe portal hypertension (HVPG > or =12 mmHg) was 0.877, and the sensitivity, specificity, PPV, and NPV at LSM cutoff value of 24.25 kPa were 82.9%, 70.8%, 80.6%, and 73.9%, respectively. CONCLUSIONS: LSM exhibited a significant correlation with HVPG in patients with cirrhosis. LSM could be a non-invasive method for predicting CSPH and severe portal hypertension in Korean patients with liver cirrhosis.

The Effect of Hemodialysis on Intraocular Pressure, Retinal Nerve Fiber Layer Thickness and Corneal Thickness

PURPOSE: To compare the intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness and central corneal thickness (CCT) in healthy individuals and patients with chronic renal failure (CRF) undergoing hemodialysis, and to evaluate the changes in each parameter before and after hemodialysis in patients with CRF. METHODS: Thirty-six eyes of 36 patients with CRF undergoing hemodialysis were included in the hemodialysis group and 54 eyes of 54 healthy subjects were recruited as the control group. All subjects underwent a complete eye examination, including best-corrected visual acuity (BCVA), slit lamp examination, dilated funduscopic examination, gonioscopy, automated perimetry, IOP measurement, corneal pachymetry, and evaluation of RNFL thickness. In the hemodialysis group, IOP, RNFL thickness, and CCT were measured again within 1 hour of hemodialysis. RESULTS: Age, sex, BCVA, cup-to-disc ratio, IOP, and CCT were not statistically different between the 2 groups. The RNFL of the hemodialysis group was statistically significantly thinner than the control group (p < 0.001). The IOP decreased from 16.52 +/- 2.95 mm Hg to 14.88 +/- 2.03 mm Hg after hemodialysis (1.63 +/- 3.27 mm Hg; p = 0.005). The changes in RNFL thickness and CCT were not statistically significant (p = 0.148, p = 0.352). CONCLUSIONS: In CRF patients with hemodialysis, RNFLs were thinner in the control group and hemodialysis induced significant IOP reduction. The results from the present study should be considered for the proper evaluation of ocular disorders in CRF patients with hemodialysis.