Tumor Margin Infiltration in Soft Tissue Sarcomas: Prediction Using 3T MRI Texture Analysis

Purpose@#To determine the value of 3 Tesla (T) MRI texture analysis for predicting tumor margin infiltration in soft tissue sarcomas. @*Materials and Methods@#Thirty-one patients who underwent 3T MRI and had a pathologically confirmed diagnosis of soft tissue sarcoma were included in this study. Margin infiltration on pathology was used as the gold standard. Texture analysis of soft tissue sarcomas was performed on axial T1-weighted images (WI) and T2WI, fat-suppressed contrast-enhanced (CE) T1WI, diffusion-weighted images (DWI) with b-value of 800 s/mm², and apparent diffusion coefficient (ADC) was mapped. Quantitative parameters were compared between sarcomas with infiltrative margins and those with circumscribed margins. @*Results@#Among the 31 patients with soft tissue sarcomas, 23 showed tumor margin infiltration on pathology. There were significant differences in kurtosis with the spatial scaling factor (SSF) of 0 and 6 on T1WI, kurtosis (SSF, 0) on CE-T1WI, skewness (SSF, 0) on DWI, and skewness (SSF, 2, 4) on ADC between sarcomas with infiltrative margins and those with circumscribed margins (p ≤ 0.046). The area under the receiver operating characteristic curve based on MR texture features for identification of infiltrative tumor margins was 0.951 (p < 0.001). @*Conclusion@#MR texture analysis is reliable and accurate for the prediction of infiltrative margins of soft tissue sarcomas.

Mediastinal Lymph Node Metastasis from Head and Neck Cancer: Predictive Factors and Imaging Features

Purpose@#To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. @*Materials and Methods@#We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. @*Results@#Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). @*Conclusion@#Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.

Mediastinal Lymph Node Metastasis from Head and Neck Cancer: Predictive Factors and Imaging Features

Purpose@#To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. @*Materials and Methods@#We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. @*Results@#Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). @*Conclusion@#Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.

SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC. @*Materials and Methods@#Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%). @*Results@#Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5). @*Conclusion@#Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.

Preliminary results of entire pleural intensity-modulated radiotherapy in a neoadjuvant setting for resectable malignant mesothelioma

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). MATERIALS AND METHODS: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. RESULTS: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). CONCLUSION: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.

High-Dose Thoracic Re-irradiation of Lung Cancer Using Highly Conformal Radiotherapy Is Effective with Acceptable Toxicity / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Thoracic re-irradiation (re-RT) of lung cancer has been challenged by the tolerance doses of normal tissues. We retrospectively analyzed local control, overall survival (OS) and toxicity after thoracic re-RT using highly conformal radiotherapy, such as intensity modulated radiotherapy and stereotactic body radiotherapy. MATERIALS AND METHODS: Thirty-one patients who received high-dose thoracic re-RT were analyzed. Doses were recalculated to determine biologically equivalent doses. The median interval to re-RT was 15.1 months (range, 4.4 to 56.3 months), the median initial dose was 79.2 Gy₁₀ (range, 51.75 to 150 Gy₁₀), and the median re-RT dose was 68.8 Gy₁₀ (range, 43.2 to 132 Gy₁₀). RESULTS: Eighteen (58.1%) and eleven (35.5%) patients showed loco-regional recurrence and distant metastasis, respectively, after 17.4 months of median follow-up. The 1-year and 2-year local control rates were 60.2% and 43.7%, respectively. The median loco-regional recurrence-free-survival (LRFS) was 15.4 months, and the median OS was 20.4 months. The cumulative and re-RT biologically equivalent dose for α/β=10 (BED₁₀) doses were the most significant prognostic factors. Cumulative BED₁₀ ≥145 Gy₁₀ and re-RT BED₁₀≥68.7 Gy₁₀ were significantly associated with longer OS (p=0.029 and p=0.012, respectively) and LRFS (p=0.003 and p=0.000, respectively). The most frequent acute toxicity was grade 1-2 pulmonary toxicity (41.9%). No acute grade 3 or higher toxicities occurred. CONCLUSION: Our results show that high-dose thoracic re-RT of lung cancer can be safely delivered using highly conformal radiotherapy with favorable survival and acceptable toxicity. An optimal strategy to select patients who would benefit from re-RT is crucial in extending the indications and improving the efficacy with a sufficiently high dose.

Prognostic Value of Leptin in Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: Most terminally ill cancer patients die from cancer anorexia-cachexia syndrome. This study evaluated a prognostic role of plasma leptin levels in terminally ill cancer patients. METHODS: This study enrolled 69 terminally ill cancer patients who were aged above 20 years old from July 2009 to July 2010. For univariate analysis, an association between leptin levels and patient's characteristics or other variables was examined using Spearman's correlation analysis, Wilcoxon's rank-sum test or Kruskal-Wallis test, as appropriately. For multivariable analysis, Cox's proportional hazard regression model was used to evaluate a clinical significance of plasma leptin levels as a prognostic factor and to determine factors which affect the risk of death in terminally ill cancer patients. RESULTS: A statistically significant positive correlation between plasma leptin levels and survival time was found. Univariate Cox's proportional hazard regression analyses also showed a moderately significant association between plasma leptin levels and survival time. However, after adjusting variables for sex, white blood cell counts, total bilirubin, AST, ALT, albumin and CRP levels, plasma leptin levels were not significantly associated with survival time. CONCLUSION: No significant association was found between plasma leptin levels and survival time in terminally ill cancer patients. However, this study suggested a prognostic value of plasma leptin levels in gastrointestinal cancer patients.

Retraction: Development of osteoporosis and the imbalance of RANKL/OPG in ankylosing spondylitis / 대한내과학회지

No abstract available.

Development of osteoporosis and the imbalance of RANKL/OPG in ankylosing spondylitis / 대한내과학회지

BACKGROUND: To determine the bone mineral density (BMD), serum soluble receptor activator of the nuclear factors kappa B ligand (sRANKL) and the osteoprotegerin (OPG) levels in patients with ankylosing spondylitis (AS), and to determine their relationship with disease activity indexes. METHODS: The disease activity was evaluated by the Bath Ankylosing Spondylitis Disease Activity Score Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Spondylitis Patient Global Score (BAS-G). The BMD was measured by dual energy X-ray absorptiometry. Serum levels of sRANKL and OPG were measured by the sandwich enzyme-linked immunosorbent assay. RESULTS: Osteoporosis and osteopenia of the femoral neck were found in 33% and 41%, respectively. BMD of femoral neck showed a negative correlation with disease activities. The serum levels of sRANKL were higher in patients with AS than in controls, and the ratio of sRANKL to OPG was also elevated in AS, but had no correlation with disease activity. The sRANKL/OPG ratio tended to be higher in patients with lower BMD. CONCLUSIONS: BMD was reduced in 79% of AS patients and reflected disease status. The sRANKL/OPG ratio was upregulated in patients with AS and it appears to be related to BMD and radiological changes. These results suggest that the imbalance between RANKL and OPG might be involved in the pathogenesis and clinical courses of AS.

Ultrasonographic Assessment of Calcaneal Enthesopathies in Seronegative Spondyloarthropathies / 대한류마티스학회지

OBJECTIVE: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). METHODS: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. RESULTS: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. CONCLUSION: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.

Elevated Serum Levels of Vascular Endothelial Growth Factor in Behcet's Syndrome / 대한류마티스학회지

OBJECTIVE: Vascular endothelial growth factor (VEGF) is a potent endothelium-specific cytokine and stimulates inflammation and angiogenesis. Vascular endothelial dysfunction is one of the characteristic features of Behcet's syndrome. We previously demonstrated the possible involvement of proinflammatory cytokines (TNF-alpha, IL-15, MIF) and chemokines (IL-8, MCP-1, MIP-1alpha) in the etiopathogenesis of Behcet's syndrome and its association with disease activity. In this study, we assesed VEGF levels in patients with Behcet's syndrome and its relation with disease activity. METHODS: Serum VEGF levels of 65 patients with Behcet's syndrome and 35 healthy control volunteers were measured by enzyme-linked immunosorbent assay. The level of MIF and IL-8 were also measured in 41 pateints. Among the 65 patients, 18 patients were in active state of disease which was classified according to clinical finding. RESULTS: The mean serum VEGF levels were higher in patients of Behcet's syndrome than control subjects (332.7 pg/mL vs. 234.4 pg/mL, p=0.004) and patients with active disease hadsignificantly higher level of VEGF than inactive disease (377.8 pg/mL vs. 265.0 pg/mL, p<0.05). There is no difference in the mean serum level of VEGF between Behcet's syndrome with vascular complication and without vascular complication. Serum level of VEGF showed strong positive correlation with MIF (r=0.57, p=0.001). CONCLUSION: Serum VEGF levels are elevated in patients with Behcet's syndrome, particularly in active state and have positive correlation with MIF. These results suggest that the increased VEGF levels in serum of Behcet's syndrome patients may participate, like other proinflammatory cytokines and chemokines, in the pathogenesis of Behcet's syndrome.

Angioleiomyoma Presenting as Painless Prepatellar Mass / 대한류마티스학회지

No abstract available.

A Case of Bladder Cancer in a Patient with Systemic Lupus Erythematosus Treated with Oral Cyclophosphamide / 대한류마티스학회지

Cyclophosphamide, a cytotoxic alkylating agent, is widely used in various benign diseases like systemic lupus erythematosus (SLE), Wegener's granulomatosis, rheumatoid arthritis, nephrotic syndrome as well as in malignancies and organ transplantation. Cyclophosphamide is metabolized in the liver to various chlormethine metabolites and acrolein, which mediates the toxic effect to the urothelium and can cause hemorrhagic cystitis, bladder fibrosis, and has also been associated with urothelial malignancies including bladder cancer. It is known that SLE is not associated with an increased risk for the development of most of the solid tumors. But it has been suggested that the risk of the bladder cancer increases in patients with benign diseases such as SLE treated by cyclophosphamide. There are only very few reports of cyclophosphamide-induced bladder cancer in SLE so far. We report a case of a patient who developed bladder cancer 13 years after cyclophosphamide was given as therapy for SLE. This case shows that careful observation and urologic evaluation is undoubtedly important for patients treated with cyclophosphamide.

Occurrence of tuberculous pleurisy associated with infliximab therapy / 대한내과학회지

Infliximab is a chimeric antibody against tumor necrosis factor-alpha and it can be used in the treatment of ankylosing spondylitis. Tumor necorosis factor-alpha is a potent proinflammatory cytokine and plays a key role in the host response against tuberculosis. Infliximab is known to be effective on active ankylosing spondylitis but it can also cause reactivation of latent tuberculosis. Physicians should screen patients for latent tuberculous infection or disease before prescribing the drug. We experienced a case of tuberculous pleurisy after taking infliximab in a patient suffering from ankylosing spondylitis. We present the case with a review of literature.

A case of jejunal hemorrahage from metastatic renal cell carcinoma / 대한내과학회지

A 68-year-old man who had suffered left nephrectomy 6 years previously for renal cell carcinoma presented with a 6-week history of melena episodes. Physical examination and laboratory data were irrelevant. Gastroduodenoscopy and colononoscopy could not reveal a bleeding focus. An angiography was undertaken, which confirmed the presence of an abnormal tumor staining at the jejunum. For the preoperative evaluation, a small bowel study showed an about 2 cm sized eccentric filling defect at mesenteric side wall of distal jejunum in the left lower quadrant. A CT scan also showed a heavily enhancing bowel wall thickening. Small bowel resection was performed, and a 3 X 3 cm ulceroinfiltrating jejunal lesion was found which microscopically consisted of a proliferation of trabeculated clear cells. He had an unremarkable postoperative recovery. A follow-up CT scan at 3 months later showed no evidence of recurrence.

A Case of Scleroderma Preceded by Esophageal Carcinoma / 대한류마티스학회지

Scleroderma is rare disease of unknown etiology characterized by fibrosis of skin and internal organs such as lung, gastrointestinal tract, kidney, heart and so on. The association between scleroderma and malignancy has been a controversy during recent years. We report a 77-year old female who had scleroderma and squamous cell carcinoma of esophagus. She was diagnosed as esophageal carcinoma and then sclerotic skin change developed in both hands and feet 3 months later. We present this case with a review of literatures.

The Role of Blind Protected Specimen Brushing (PSB) in Intubated Patients / 결핵

BACKGROUND: In intubated patients, cultures of endotracheal aspirates (EA) are apt to contamination throughout the endotracheal tube. Therefore, the identification of etiologic agents via conventional EA cultures is not always reliable. In order to differentiate a pulmonary infection from a non-infectious disease, and to identify the true etiologic agent of acute pulmonary infection, blinded protected specimen brushing (PSB) was used, and its efficacy evaluated. METHODS: In 51 intubated patients, with suspected pneumonia, blind PSB were performed, and the results compared with blood and EA cultures. A protected specimen brush was introduced through the endotracheal tube, and settled at the affected large bronchus. A specimen brush was introduced to the expected region using the blind method. The tip of the brush was introduced with an aseptic technique after vigorously mixed for 1 minute in 1cm3 of Ringer's lactate solution. The specimens were submitted for quantitative culture within 15 minutes, with a culture being regarded as positive if the colony forming units were above 103/ml. RESULTS: Of the 51 patients, 15 (29.4%) had community-acquired pneumonia (CAP), 27 (52.9%) hospital-acquired pneumonia (HAP) and 9 (17.6%) non-infectious diseases. The sensitivity and specificity of the quantitative PSB culture for the diagnosis of pneumonia were 52.4 and 88.9%, respectively. The sensitivity and specificity of EA were 78.6 and 77.8%, respectively. The blind PSB was superior to the EA for the identification of true etiologic agents. Of 53 episodes of 27 HAP patients, MRSA (Methicillin-resistant staphylococcus aureus) (41.5%) was the most common causative agent followed by Pseudomonas aeruginosa (15.1%), Klebsiella sp. (7.5%) and Acinetobacter sp. (7.5%). CONCLUSIONS: As a simple, non-invasive diagnostic modality, the blind PSB is a useful method for the differentiation of a pulmonary infection from non-infectious diseases and to identify the etiologic agents in intubated patients. A blind PSB can be performed without bronchoscopy, so is safer, more convenient and cost-effectiveness for patients where bronchoscopy can not be performed.

The Effect of Ischemic Preconditioning on Long-term Prognosis in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The brief repetitive periods of ischemia and reperfusion before a myocardial infarction appears to precondition the heart, making it more resistant to subsequent longer periods of ischemia. This phenomenon is known as ischemic preconditioning (IP). We studied the long-term effects of IP in patients with acute myocardial infarction. SUBJECTS AND METHODS: Between January 1991 and August 1993, we examined, prospectively, 113 consecutive patients who had an acute myocardial infarction and arrived to the hospital within 6 hours after the onset of chest pain. IP was defined as prodromal angina within 24 hours before the myocardial infarction. Patients were divided 2 groups:Non-IP group and IP group. Clinical characteristics, laboratory findings, coronary angiographic findings, cardiac events, and mortality at admission and during follow-up were compared between these two groups. RESULTS: The IP group had 64 patients while the Non-IP group had 49. In terms of risk factors for ischemic heart disease, hypertension was more common in the IP group (p<0.05). Peak serum creatine kinase level of the IP group was 1,387.0+/-1,255.0 IU/L and that of the Non-IP group was 2,372.7+/-2,420.5 IU/L (p<0.05). The time interval between the onset of infarction and peak creatine kinase level was shorter in the IP group than in the Non-IP group (10.6+/-4.8 hours vs. 7.1+/-4.6 hours;p<0.05). For cardiac events during the follow-up period, there were more incidences of congestive heart failure and reinfarction in the IP group than in the Non-IP group (p<0.05). Mortality rate did not differ between the two groups. Univariate analysis identified five factors predictive of 3-year mortality: age, sex, coronary angiogram frequency, hypertension, and smoking. However, none of these factors were independently associated with death in the multivariate analysis. CONCLUSION: Close monitoring for cardiac events may be necessary for patients who have had IP before myocardial infarction as they had a higher incidence for congestive heart failure and reinfarction during the follow-up.

Two Cases of Autoimmnune Hepatitis Associated with Systemic Lupus Erythematosus / 대한간학회지

Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disease of unknown cause associated with circulating autoantibodies and high serum globulin level. Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complex, affecting multiple organs including the liver, kidney, and CNS. The difference between the hepatic involvement of SLE and autoimmune hepatitis has not been clearly defined in the past due to similarities in clinical and biochemical features. A scoring system for the diagnosis of AIH has been established, and AIH and SLE-associated hepatitis have been defined as two different entities, although both have the same autoimmune features such as polyarthralgia, hypergammaglobulinemia and circulating autoantibodies. AIH has been considered to occur infrequently in SLE. We report two cases of AIH which simultaneously satisfied the criteria of SLE.

Prevalence and Clinical Outcome of Penicillin-resistant Pneumococcal Pneumonia / 결핵

BACKGROUND: The incidence of penicillin-resistant streptococcus pneumoniae(PRSP) accounts for almost 70% of all pneumococcal pneumonia cases in Korea. It is still unclear as to whether the efficacy of penicillin or equally active beta-lactam agents is compromised in PRSP pneumonia. This study investigated the prevalence of PRSP in community-acquired pneumonia and its clinical course. METHODS: A total of 42 patients with community-acquired pneumococcal pneumonia were evaluated from July 1999 to May 2001. The cultured strains of Streptococcus pneumoniae were divided into susceptible, intermediately resistant, and resistant strains by an E-test, and the effect of the clinical course was investigated. RESULTS: From a total of 42 patients, 22 (52.4%) patients had an intermediate resistance (MIC 0.1-1 microgram/ml) and six (14.3%) showed a high resistance (MIC> or =2.0 microgram/ml) with current penicillin susceptibility categories. However, according to the classification of the DRSPTWG (Drug Resistant Streptococcus pneumoniae Therapeutic Working Group), there were 11 cases (26.2%) of intermediate resistance and no case of high resistance. Under empirical antimicrobial treatment, there was no difference in the clinical outcome between the penicillin susceptible and resistant group. CONCLUSION: The clinical outcome of PRSP pneumonia with empirical therapy was acceptable. These results suggest that the current MIC breakpoint for penicillin resistance in Streptococcus pneumoniae has been set at a very low level and penicillin resistance according to the NCCLS classification does not significantly influence the outcome of the empirical treatment for pneumococcal pneumonia.