Reanalysis of membranoproliferative glomerulonephritis patients according to the new classification: a multicenter study

BACKGROUND: All types of membranoproliferative glomerulonephritis (MPGN) are progressive diseases with poor prognoses. Recently, a newly proposed classification of these diseases separated them into immune complex- and complement- mediated diseases. We investigated the frequency of C3 glomerulonephritis among previously diagnosed MPGN patients. METHODS: We conducted a retrospective study of patients diagnosed with MPGN at three tertiary care institutions between 2001 and 2010. We investigated the incidence of complement-mediated disease among patients diagnosed with MPGN. Progressive renal dysfunction was defined as a 50% reduction in the glomerular filtration rate or the need for renal replacement therapy. RESULTS: Among the 3,294 renal biopsy patients, 77 (2.3%) were diagnosed with MPGN; 31 cases were excluded, of which seven were diagnosed with systemic lupus nephritis, and the others were not followed for a minimum of 12 months after biopsy. Based on the new classification, complement-mediated MPGN was diagnosed in two patients (4.3%); only one patient developed progressive renal dysfunction. Among the immune complex-mediated MPGN patients, 17 patients developed progressive renal dysfunction. Serum albumin and creatinine levels at the time of MPGN diagnosis were risk factors of renal deterioration, after adjusting for low C3 levels and nephrotic syndrome. CONCLUSION: Complement-mediated glomerulonephritis was present in 4.3% of patients previously diagnosed with MPGN.

Ferritin as a predictor of decline in residual renal function in peritoneal dialysis patients

BACKGROUND/AIMS: Aims: Inflammation is an important factor in renal injury. Ferritin, an inflammatory marker, is considered an independent predictor of rapid renal progression in patients with chronic kidney disease. However, the relationship between ferritin and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD) remains unclear. METHODS: We reviewed the medical records of patients who started PD between June 2001 and March 2012 at Soonchunhyang University Bucheon Hospital, Korea. A total of 123 patients were enrolled in the study. At 1 month after the initiation of PD, RRF was determined by a 24-hour urine collection and measured every 6 months thereafter. Clinical and biochemical data at the time of the initial 24-hour urine collection were considered as baseline. RESULTS: The RRF reduction rate was significantly greater in patients with high ferritin (ferritin > or = 250 ng/mL) compared with those with low ferritin (ferritin < 250 ng/mL; -1.71 +/- 1.36 mL/min/yr/1.73 m2 vs. -0.84 +/- 1.63 mL/min/yr/1.73 m2, respectively; p = 0.007). Pearson correlation analysis revealed a significant negative correlation between the baseline serum ferritin level and the RRF reduction rate (r = -0.219, p = 0.015). Using multiple linear regression analysis and adjusting for other risk factors, baseline serum ferritin was an independent factor for the RRF reduction rate (beta = -0.002, p = 0.002). CONCLUSIONS: In this study we showed that a higher ferritin level was significantly associated with a more rapid RRF decline in patients undergoing PD.

Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is a well-established intervention to palliate malignant pain. We report a patient who developed hepatic and splenic infarction and bowel ischemia following EUS-CPN. A 69-year-old man with known lung cancer and pancreatic metastasis was transferred for debilitating, significant epigastric pain for several months. The patient underwent EUS-CPN to palliate the pain. After the procedure, the patient complained continuously of abdominal pain, nausea, and vomiting; hematemesis and hematochezia were newly developed. Abdominal computed tomography revealed infarction of the liver and spleen and ischemia of the stomach and proximal small bowel. On esophagogastroduodenoscopy, hemorrhagic gastroduodenitis, and multiple gastric ulcers were noted without active bleeding. The patient expired on postoperative day 27 despite the best supportive care.

Spontaneous Renal Hematoma Caused by Hypertension with Left Ventricular Hypertrophy

Spontaneous renal hematoma is rare. We report a 43-year-old man presented with sudden left flank pain and severe hypertension. Renal hematoma was confirmed on computed tomography. Renal angiography showed no active bleeding or vascular malformation. Echocardiography showed severe concentric left ventricular hypertrophy. Hypertension was the only cause for the condition. Symptoms and size of the hematoma decreased on antihypertensive medication and conservative treatment. Severe hypertension might have a role for developing renal hematoma.

The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis

BACKGROUND/AIMS: Accurate diagnosis of drug-induced liver injury (DILI) is difficult without considering the possibility of underlying diseases, especially autoimmune hepatitis (AIH). We investigated the clinical patterns in patients with a history of medication, liver-function abnormalities, and in whom liver biopsy was conducted, focusing on accompaniment by AIH. METHODS: The clinical, serologic, and histologic findings of 29 patients were compared and analyzed. The patients were aged 46.2+/-12.8 years (mean+/-SD), and 72.4% of patient were female. The most common symptom and causal drug were jaundice (58.6%) and herbal medications (55.2%), respectively. RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase, total bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase levels were 662.2+/-574.8 U/L, 905.4+/-794.9 U/L, 12.9+/-10.8 mg/dL, 195.8+/-123.3 U/L, and 255.3+/-280.8 U/L, respectively. According to serologic and histologic findings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited significantly higher AST levels (537.1+/-519.1 vs. 1043.3+/-600.5 U/L), globulin levels (2.7+/-0.4 vs. 3.3+/-0.5 g/dL), and prothrombin time (12.9+/-2.4 vs. 15.2+/-3.9 s; P<0.05). Antinuclear antibody was positive in 7 of 21 cases of DILI and all 8 cases of AIH (P=0.002). The simplified AIH score was 3.7+/-0.9 in the DILI group and 6.5+/-0.9 in the AIH group (P<0.001). CONCLUSIONS: Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of AIH should be considered.

Diagnosis of a Malignant Tumor in a Patient with an Adnexal Mass Using Endoscopic Ultrasound Elastography

Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. Endoscopic ultrasonography elastography (EUS-EG) is a promising imaging technique with a high accuracy for the differential diagnosis of solid pancreatic tumors. However, to date EUS-EG has not been used to provide complementary information for biologic behavior of adenxal mass. We report our experience of EUS-EG in a patient with adnexal mass.

Comparison of the Efficacy and Safety between Transradial and Transfemoral Percutaneous Coronary Intervention in Patients with Ischemic Heart Disease

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of transradial percutaneous coronary intervention (TRI) compared with transfemoral percutaneous coronary intervention (TFI) in patients with ischemic heart disease. METHODS: We reviewed retrospectively the medical records including imaging data of the patients with ischemic heart disease who underwent TRI or TFI from January 2007 to December 2009 in Soonchunhyang University Seoul Hospital. We compared major adverse cardiac and cerebrovascular events (MACCEs) including death, myocardial infarction, revascularization, stent thrombosis, and cerebrovascular accident during follow-up period. We also compared procedure related vascular complications including hematoma, arteriovenous fistula, pseudoaneurysm, and infection. RESULTS: Total number of patients was 347 (256 patients of TRI and 91 patients of TFI). There were no significant differences in the rate of MACCEs between two groups. There were significantly less procedure-related vascular complications in TRI group (3.1% vs. 11.0%, P=0.010). CONCLUSION: TRI is as effective as TFI with no difference in the rate of MACCEs in patients with ischemic heart disease. TRI is superior to TFI in safety with reduction of vascular complications.

Intradermal Nevus on the Lower Lip / 대한피부과학회지

Melanocytic nevi of the lower lip are rare benign melanocytic tumors. They can be classified in four types (junctional, compound, intradermal, blue). Among these 4 types, the intradermal type (sometimes referred to as intramucosal or subepithelial type) is the most common type. We report here on a case of intradermal nevus that developed on the lower lip of an 87-years old female patient who presented with a 0.8 cm-sized, partially crusted nodule.

A Case of Mantle Cell Lymphoma with Skin Metastasis / 대한피부과학회지

Mantle cell lymphoma is a malignant lymphoma derived from a subset of B-cells that are localized in the mantle area of the lymphoid follicle. Extranodal involvement is frequent, and especially in the bone marrow, spleen, gastrointestinal tract and Waldeyer's ring, but skin is rarely affected. A 47-year-old male presented with a 40 day history a nodule on the abdomen on the abdomen. The histopathologic examination showed numerous atypical, small to medium sized lymphoid cells in the entire dermis. Immunohistochemically, the tumor cells were positive for CD20, CD5, CD79a and cyclin D. Our patient showed complete disappearance of his skin lesions and lymphadenopathy after combination chemotherapy.

A Case of Seborrheic Keratosis Developing on the Scapha of the Ear Auricle / 대한피부과학회지

Seborrheic keratoses are the most common benign epidermal tumor of the skin and a frequent focus of patient concern because of their variable appearance. Seborrheic keratoses may arise on any non-mucosal surface, including the face, scalp, and trunk. However, it rarely occurs on the ear, especially on the scapha. We report a case of a 42 year-old female patient presenting with 1 cm, brownish pedunculated nodule of seborrheic keratosis on the scapha.

A Survey on the Topical Steroid Prescriptions of Dermatologists / 대한피부과학회지

BACKGROUND: A recent survey on dermatology outpatients, which assessed their knowledge and behavior for topical steroid use, showed that topical steroids were often used without sufficient information or guidelines. OBJECTIVE: Our study aimed to evaluate the general pattern of which dermatologists prescribe topical steroids, the prevalence of topical steroid phobia among the dermatology outpatients and the way dermatologists managed such patients. METHODS: 236 dermatologists, including those in private clinics and those in the secondary and tertiary hospitals, were asked via mail or e-mail to fill in a questionnaire on their topical steroid prescription. RESULTS: About sixty percent of the total respondents answered that they prescribed topical steroid to more than half of their outpatients, with excluding those patients who came to the office for cosmetic purposes. Most respondents informed their patients about their prescription of topical steroids (85.61%), they explained the mechanism of its action and the clinical effects (65%), the potency and duration of application (70%), and the side effects (82%). But most respondents forgot or did not tell their patients about their steroid formulation (46%), the optimal amount to apply (74%) and the means and duration of optimal storage (82%). 45% of the respondents assumed that more than half of the outpatients to have topical steroid phobia. Yet 80% of the respondents replied that less than 10% of their outpatients had experienced side effects of topical steroids. 73% of the respondents in private clinics and 62% in secondary and tertiary hospitals were influenced by the patients' negative attitude on topical steroid prescription. CONCLUSION: The results show that the information on topical steroids, in terms of formulation, the optimal amounts to apply and the means and duration of optimal storage, were not sufficiently provided by dermatologists. The topical steroid phobia of patients has been exaggerated despite the low incidence of side effects.

Cyclosporine Treatment in a Patient with Concurrent Autoimmune Urticaria and Autoimmune Hepatitis

Patients with autoimmune urticaria show a higher rate of seropositivity for other autoantibodies and often have a history of autoimmune conditions. They also tend to have more severe symptoms and to have a poor response to conventional antihistamine treatment. Autoimmune hepatitis is a chronic inflammatory disorder in which progressive liver injury is thought to be the result of a T-cell-mediated immunologic attack against liver cells in genetically predisposed individuals. While the association between autoimmune urticaria and other autoimmune disorders such as thyroid disease is well known, there has been no reported case of autoimmune urticaria concomitant with autoimmune hepatitis. We report a case of autoimmune urticaria concurrent with autoimmune hepatitis, which was successfully treated with cyclosporine.

A Case of Post-radiation Therapy Exfoliative Dermatitis Developing in a Patient with Kaposi's Sarcoma / 대한피부과학회지

We report a case of an 82-year-old man who developed exfoliative dermatitis (ED) after receiving radiation therapy for Kaposi's sarcoma of the right foot. One month after irradiation, pruritic erythema appeared within the radiation field and then, evolved into ED. An evaluation to identify the underlying cause discovered no factors likely to cause ED. The skin lesions gradually resolved over a period of one month with the use of narrow band ultraviolet B therapy, oral antihistamines, and low potency topical glucocorticoids. No recurrence has been observed during one year of follow-up. We concluded that this was a rare case of generalized ED occurring after radiation therapy.

A Case of Microcystic Adnexal Carcinoma on the Scalp / 대한피부과학회지

Microcystic adnexal carcinoma is a rare, locally aggressive tumor with a high potential for local recurrence. It usually presents in elderly patients as a solitary, slowly growing, firm, indurated plaque on the face, and particularly on the upper lip or central face. It has occasionally been found in extra-facial locations, including the nipple, axilla and lower extremities, yet scalp involvement has been rarely reported. Histopathologically, it is a poorly circumscribed dermal tumor that shows both follicular and ductal differentiation, and it may extend into the subcutis and skeletal muscle. We report here on a case of microcystic adnexal carcinoma at an unusual site: the scalp. A 42-year-old woman presented with a 6-month history of a painful, solitary, 1 cm-sized, firm, fixed, dome-shaped nodule on the scalp, and this was accompanied by ulceration and oozing. A biopsy specimen demonstrated features of microcystic adnexal carcinoma, with both follicular and ductal differentiation. Immunohistochemical staining for CEA (carcinoembryonic antigen) was positive in the ductal structures, but this was negative in the follicular structures.

A Case of Microcystic Adnexal Carcinoma on the Scalp / 대한피부과학회지

Microcystic adnexal carcinoma is a rare, locally aggressive tumor with a high potential for local recurrence. It usually presents in elderly patients as a solitary, slowly growing, firm, indurated plaque on the face, and particularly on the upper lip or central face. It has occasionally been found in extra-facial locations, including the nipple, axilla and lower extremities, yet scalp involvement has been rarely reported. Histopathologically, it is a poorly circumscribed dermal tumor that shows both follicular and ductal differentiation, and it may extend into the subcutis and skeletal muscle. We report here on a case of microcystic adnexal carcinoma at an unusual site: the scalp. A 42-year-old woman presented with a 6-month history of a painful, solitary, 1 cm-sized, firm, fixed, dome-shaped nodule on the scalp, and this was accompanied by ulceration and oozing. A biopsy specimen demonstrated features of microcystic adnexal carcinoma, with both follicular and ductal differentiation. Immunohistochemical staining for CEA (carcinoembryonic antigen) was positive in the ductal structures, but this was negative in the follicular structures.

A Case of Cutaneous Involvement of T-cell Lymphoblastic Lymphoma / 대한피부과학회지

Lymphoblastic lymphoma is a malignant neoplasm of precursor lymphocytes with a B- or T cell phenotype. T cell lymphoblastic lymphoma is a clinically aggressive disease with frequent involvement of extranodal sites, but the involvement of the skin is rare. The clinical appearance of skin lesions usually includes single or multiple papular or nodular lesions preferentially located on the head and neck. Herein, we report the case of a 31-year-old man presenting with skin involvement of T cell lymphoblastic lymphoma. The lesions manifested as asymptomatic, multiple, round, reddish brown macules, and patches on both extremities. Histology examination showed dense, diffuse infiltration of medium sized lymphoid cells into the entire dermis. The tumor cells had irregular nuclei, finely dispersed chromatin, inconspicuous nucleoli, scant cytoplasm, and expressed TdT, CD3 and CD5.

Megakaryocyte Colony Formation of Fetal Liver Cells

PURPOSE: This study was undertaken to obtain basic data about the megakaryocyte colony formation of fetal liver cells by using immunocytochemical staining and ex vivo culture with growth factors. METHODS: The mononuclear cells were isolated from fetal liver and bone marrow with idiopathic thrombocytopenic purpura(ITP) and pancytopenia. These mononuclear cells were cultured in MegaCultTM-C(Stem Cell Tech, Canada) media in the presence of growth factors and CFU-Megakaryocyte(CFU-Mk) colonies were counted on day 12. The expansion of CD34+ and CD41+ cell was analyzed by flow cytometry after 5 days incubation using flask culture. RESULTS: The numbers of CFU-Mk colonies of mononuclear cells obtained from fetal liver in the 11th week gestational age were more than those in the 19th week specimens; growth factors could not enhance the colony expansion in all cases. Total numbers of CFU-Mk colony of fetal liver cells were higher than bone marrow from ITP or pancytopenia groups. The numbers of pure or large CFU-Mk colonies of fetal liver cells were also higher than bone marrow specimens. The rate of CD34+ cell expression of fetal liver was increased after flask culture and the enhancement effect of epression was seen only in cases which added thrombopoietin. The rate of CD41+ cell expression of fetal liver was increased after incubation, but the enhancement effect of growth factors was unclear. CONCLUSION: This study revealed good results about the megakaryocyte colony assay of fetal liver mononuclear cells using MegaCultTM-C media. This study suggests that the fetal liver could be a good source of megakaryocytic progenitor cells for clinical application in hematopoietic stem cell transplantation.

Clinical Studies of Measles Prevalence in Western Kyungnam District in 2000

PURPOSE: To investigate the feature of the range of measles in 2000, we studied epidemics of the measles in western Kyungnam District. METHODS: Among 489 patients under 15 years of age who visited or were admitted to in our hospital from January to December in 2000, we selected 344 patients whose measles IgM antibody was positive. We investigated age, monthly incidence, clinical features, vaccination history, and measles IgG antibody. RESULTS: Patients under 12 months of age occupied the largest proportion(36.9%). Patients firstly occurred in May and geometrically increased from October. Fever, cough and rashes were observed in all patients but conjunctivitis in 54.9%, Koplik spot in 23.8%. The first vaccination ratio was 41.8%. Compared with the number of patients and the first vaccination ratio, the first vaccination ratio was the lowest under 12 months of age. After that age group, the number of patients was decreased as the first vaccination ratio was increased. Among 152 patients sampled for measles IgG antibody, 35 patients had received the first vaccination and 6 patients had received the second vaccination. Among 35 patients who received the first vaccination, 22(62.9%) patients were negative of measles IgG antibody. Among 6 patients who received the second vaccination, 3(50%) patients were negative. CONCLUSIONS: Measles patients under 12 months still dominated. Therefore, routine vaccination of single measles vaccine, is currently done at 6 month when measles are prevalent, should be considered. High first vaccination failure suggests problems of vaccines itself, transport and storage rather than vaccination methods. Therefore a thorough investigation should be made.