Detrimental Effects of Endovascular Intervention in Active Rheumatoid Vasculitis

Balloon angioplasty can cause shear stress and tear of the vascular endothelium during mechanical dilatation, leading to increased inflammation and coagulation reactions of the vascular endothelium. Herein, a worst case of active rheumatoid vasculitis is described, where due to progressing ischemic necrosis of the leg, endovascular intervention was unavoidably performed in the presence of active rheumatoid vasculitis. After percutaneous balloon angioplasty, the patient developed recurrent thrombotic occlusion of the leg arteries, and finally, limb amputation resulted in despite vigorous treatment including medication, immunosuppression, catheter-directed thrombolysis, and post-thrombolysis anticoagulation. This case report indicates that endovascular intervention may be detrimental to the active rheumatoid vasculitis. Until the development of treatment guideline to prevent or control inflammatory reaction, endovascular intervention for the active rheumatoid vasculitis may not be appropriate as a first line therapy even though there is progressing ischemic necrosis.

The Laterality of Deep Vein Thrombosis in the Pelvic and Lower Extremity Veins

PURPOSE: This study aimed to determine whether deep vein thrombosis (DVT) predominantly occurred on a particular side in the pelvic and lower extremity veins. MATERIALS AND METHODS: Among 259 consecutive patients with leg swelling, 65 were confirmed to have DVT in the pelvis and lower extremities, and enrolled in this study. The serum levels of initial D-dimer, antithrombin III, tissue plasminogen activator, factor VIII, proteins C and S, anticardiolipin antibodies immunoglobulin (Ig) G and IgM and lupus anticoagulant were measured and analyzed retrospectively. Lower extremity venous system was divided into 11 anatomic segments on each side, and thrombotic involvement in each segment was recorded to determine the laterality of thrombotic involvement for each patient. The presence of thrombus in a specific vein was assigned using a Thrombus Scoring System (TSS) score of 1. Predominant direction was determined based on the TpSS score for each side. RESULTS: Left-side predominat DVT (57%) was most frequent. Patients with both-side equivalent DVT had the highest total TSS score (P=0.022). The predominant side was significantly different between men (right 44.1%) and women (left 74.2%) (P=0.022). Patients with both-side equivalent DVT had the highest mean age (69.3+/-9.9 years) as well as the highest mean levels of initial D-dimer (13.8+/-20.7 microg/mL) and anticardiolipin antibody IgM (13.4+/-22.8 MPL) indicating increased coagulability. CONCLUSION: In the current study, left-side predominant DVT is most frequent in pelvis and lower extremities, and this phenomenon is more apparent in women. And both-side equivalent DVT is associated with the most advanced age and hypercoagulability.

Ehlers-Danlos Syndrome Type IV and the Management of Its Vascular Complication / 대한혈관외과학회지

Ehlers-Danlos syndrome type IV (EDS IV), the vascular type of EDS, is an inherited connective tissue disorder due to abnormal procollagen III synthesis by mutation of the COL3A1 gene. EDS is classified into 6 types based on clinical, biochemical, and molecular characteristics. Among them, EDS IV has the worst prognosis because of the major vascular catastrophes and the difficulty of vascular repair due to fragile connective tissue. Arterial, digestive, or uterine ruptures are the main lethal symptoms of EDS IV, and thin translucent skin, extensive bruising, and characteristic facial appearance are the other major symptoms. Although many successful results have been reported after open surgery or endovascular repair for EDS IV, surgical or endovascular procedures are still challenging to perform and sometimes are associated with serious hemorrhagic complications in EDS IV patients. In general, open surgery is not recommended except in an emergency situation, and conservative treatment is the preferred strategy for the treatment of vascular complications in EDS IV. Aneurismal diseases are observed in many EDS IV patients, and abdominal aortic aneurysm and iliac arterial aneurysm are the frequent presentations. Therefore, when treating patients with aneurysms, the vascular surgeon should consider the high possibility of connective tissue disease, especially EDS IV. Without the preoperative recognition of EDS IV, routine surgical or endovascular procedures may result in major bleeding and subsequent increased morbidity and mortality. In this article, the characteristics, clinical outcomes, and treatment strategies of EDS IV are reviewed.

Serious Bleeding Complication Due to the Use of Low-molecular-weight heparin to treat a Traumatic Patient with Acute Renal Failure

Trauma is an important risk factor for a pulmonary thromboembolism, and anticoagulation is essential to prevent deep vein thrombosis (DVT) in patients with trauma. Low-molecular-weight heparin (LMWH) is excreted in the kidney; therefore, using LMWH in patients with renal insufficiency may increase the risk of bleeding complication. The following case describes a 55-year-old traffic accident victim who had massive bleeding and underwent a laparotomy for bleeding control. The patient had acute renal failure, and enoxaparin was administered for the prophylaxis of DVT. Although the patient suffered from serious complications such as pericardial hematoma, the patient recovered without sequellae and was discharged at day 84.

Serious Bleeding Complication Due to the Use of Low-molecular-weight heparin to treat a Traumatic Patient with Acute Renal Failure

Trauma is an important risk factor for a pulmonary thromboembolism, and anticoagulation is essential to prevent deep vein thrombosis (DVT) in patients with trauma. Low-molecular-weight heparin (LMWH) is excreted in the kidney; therefore, using LMWH in patients with renal insufficiency may increase the risk of bleeding complication. The following case describes a 55-year-old traffic accident victim who had massive bleeding and underwent a laparotomy for bleeding control. The patient had acute renal failure, and enoxaparin was administered for the prophylaxis of DVT. Although the patient suffered from serious complications such as pericardial hematoma, the patient recovered without sequellae and was discharged at day 84.

Metachronous Ovarian Metastases Following Resection of the Primary Gastric Cancer

PURPOSE: We performed this study to evaluate the clinical presentation as well as the proper surgical intervention for ovarian metastasis from gastric cancers and these tumors were identified during postoperative follow-up. This will help establish the optimal strategy for improving the survival of patients with this entity. MATERIALS AND METHODS: 22 patients (3.2%) with ovarian metastasis were noted when performing a retrospective chart review of (693) females patients who had undergone a resection for gastric cancer between 1981 and 2008. The covariates used for the survival analysis were the patient age at the time of ovarian relapse, the size of the tumor, the initial TNM stage of the gastric cancer, the interval to metastasis and the presence of gross residual disease after treatment for Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and they were compared by means of the Log-Rank test. RESULTS: The average age of the patients was 48.6 years (range: 24 to 78 years) and the average survival time of the 22 patients was 18.8 months (the estimated 3-year survival rate was 15.8%) with a range of 2 to 59 months after the diagnosis of Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of the patients with gross residual disease (P=0.0003). In contrast, patient age, the size of ovarian tumor, the initial stage of gastric adenocarcinoma, the interval to metastasis and adjuvant chemotherapy were not prognostic indicators for survival after the development of ovarian metastasis. CONCLUSIONS: Early diagnosis and complete resection are the only possible hope to improve survival. As the 3-year survival rate after resection of Krukenberg tumor is 15.8%, it seems worthwhile to consider performing tumorectomy as the second cytoreduction.

Comparison of the Risk Factors for Arterial Stiffness between Extremity Muscular and Abdominal Elastic Arteries

PURPOSE: Muscular artery differs from elastic artery in physical properties and constituents of the arterial wall. To investigate the difference between muscular and elastic arteries, we measured the pulse wave velocities (PWVs) in lower extremity muscular arteries (femoral ankle PWV, faPWV) and abdominal elastic arteries (brachial femoral PWV, bfPWV), and searched for the relationships between the PWVs of muscular, elastic arteries and the risk factors of arteriosclerosis. METHODS: 184 normal volunteers were enrolled in the study. Among them, the ratios of male/female, smoker/non-smoker, and hypertension/normal were 81/103, 66/118, and 63/121, respectively. Using volume plethysmography, faPWV and bfPWV were measured. The risk factors of arteriosclerosis in this study were age, gender, smoking, hypertension, body mass index, low density lipoprotein, high density lipoprotein, triglyceride, hemoglobin A1C, and white blood cell. RESULTS: The PWVs of lower extremity muscular arteries (faPWVs) were significantly faster than those of abdominal elastic arteries (bfPWVs) (right, P<0.001; left, P<0.001) Multiple regression analysis revealed that the independent risk factors of the PWV were age (right, P<0.001; left, P<0.001) and gender (right, P=0.008; left, p=0.014) in abdominal elastic arteries. However, in lower extremity muscular arteries, hypertension (right, P<0.001; left, P<0.001) as well as age (right, P<0.001; left, P<0.001) and gender (right, P=0.009; left, P=0.001) were other significant independent risk factors. CONCLUSION: The PWVs of lower extremity muscular arteries were significantly faster than those of abdominal elastic arteries. The significance of hypertension in faPWV suggests that hypertension is an important risk factor in inducing arterial stiffness, especially in lower extremity muscular arteries.

The Relationship between Brachial Ankle Pulse Wave Velocity and Complement 1 Inhibitor

Complement 1 (C1) inhibitor is an acute phase protein with anti-inflammatory properties. The aim of the present study was to elucidate the relationship between brachial ankle pulse wave velocity (baPWV), the parameter of arterial stiffness, and C1 inhibitor. One hundred subjects were randomly enrolled in this study. Data about baPWV, age, gender, hypertension, smoking, and body mass index (BMI) were measured. Blood tests for total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, hemoglobin A1c, erythrocyte sedimentation rate, C-reactive protein, complement 3, and C1 inhibitor were performed. Based on the Pearson correlation, the C1 inhibitor showed a positive relation to the baPWV (P<0.001). Multiple regression analysis revealed the significant predictors of baPWV were not only the conventional risk factors of arteriosclerosis and/or atherosclerosis, such as age (P<0.001), gender (P<0.001), hypertension (P<0.001), and BMI (P=0.006), but also the acute phase protein, C1 inhibitor (P=0.025). In conclusion, C1 inhibitor is associated with arterial stiffness through its association with increased inflammation.

The Relationship between Brachial Ankle Pulse Wave Velocity andAtherosclerotic Risk Factors

PURPOSE: Aging and atherosclerotic changes enhance the stiffness of the arterial wall, and the pulse wave travels faster in stiffer vessel. Measurement of the brachial ankle pulse wave velocity (baPWV) is a non-invasive method for evaluating the stiffness of the vessel wall. We investigated the relation between the baPWV and risk factors for atherosclerosis. METHOD: We studied 180 subjects (38 male and 142 female; mean age 46 years, range 24 to 76 years). The instrument used for evaluating the baPWV was a Vasoguard (VIASYS Healthcare, Dublin, Ohio, USA), and measurements were performed in the right arm and in both ankles. Data were analyzed using Pearson correlation, t-test, and multiple regression analysis. Multiple regression analysis was performed for age, sex, smoking, hypertension, height, weight, body mass index (BMI), total cholesterol, LDL, HDL, TG, and HbA1c. RESULT: Right and left baPWVs were significantly increased (P<0.05) in subjects with the following risks: older age, high body weight, high BMI, high total cholesterol, high LDL, high TG, high HbA1c, and low HDL. Right and left baPWVs were also significantly increased (P<0.05) in male subjects with a history of smoking and hypertension. Multiple regression analysis showed that age, sex, and LDL were independent determinants of the right and left baPWVs. CONCLUSION: This study provides evidence that increased age, male gender, and high serum LDL levels are risk factors that contribute to arterial stiffness. Measurement of the baPWV may be a useful method for evaluating vascular status.

Comparison of Intra-gall Bladder and Intra-common Bile Duct Injection of Collagenase Solution for Mouse Pancreatic Islet Isolation

PURPOSE: A high yield of viable pancreatic islets is an essential prerequisite for the study of pancreatic islet transplantation. The purpose of this study is to compare the yield between intra-gall bladder (intra-GB) and intra-common bile duct (intra-CBD) injection of collagenase solution for isolation of mouse pancreatic islets. METHODS: The mice were divided into two groups, the intra-GB and intra-CBD groups, and each group included twelve mice, respectively. Collagenase solution was injected via the gallbladder in the intra-GB group mice, while this was done via the common bile duct in the intra-CBD group. After removal and digestion of the mouse pancreases, the pancreatic islets were isolated by Ficoll density gradient centrifugation and hand picking. RESULTS: The intra-GB group yielded 121.67+/-39.86 IEQs, and the intra-CBD group reveled 168.17+/-29.23 IEQs. There was a statistically significant difference in islet yield between the two groups (P=0.005, Mann-Whitney Test). The purities of the isolated islets were 86.42+/-3.99% for the intra-GB group and 87.17+/-4.47% for the intra-CBD group, and there was no difference between the two groups (P=0.755, Mann- Whitney Test). CONCLUSION: Both the intra-GB and intra-CBD groups yielded an average of >120 IEQs. However, the intra-CBD group revealed a higher yield than the intra-GB group for isolating mouse pancreatic islets.

Portal Vein Transfusion Increases Pancreatic Islet Allograft Survival in Mice

PURPOSE: Considering the complications of nonspecific immunosuppression, as well as the availability of insulin, heavy immunosuppressive treatment to pancreatic islet transplantation patients is not justified. Antigen administration via the portal vein has been demonstrated to induce immunosuppression, and may present a possible mechanism for the induction of tolerance. Using a mouse model, without any immunosuppressive treatment, the islet allograft survivals were compared between portal venous transfusion and portal venous saline injection groups. METHODS: Six C57BL/6J mice were used as pancreatic islet donors per Balb/c recipient mouse. Islets were harvested by digestion of the pancreata with collagenase, with subsequent Ficoll density gradient separation. Recipient mice were divided into two groups: seven mice received a portal venous injection of 0.1 cc saline (PVS) and eight a portal venous transfusion of 0.1 cc donor blood (PVT). Islets were transplanted into the subcapsular space of the left kidney. Transplantation failure was determined if the transplanted mouse failed to show a blood glucose level less than 200 mg/dl at 24 hours after the transplantation; these mice were not included in the statistics. Rejection was determined when the normalized blood glucose level (<200 mg/dl) returned to above 300 mg/dl. RESULTS: The mean islet equivalent numbers (IEQ) of the seven PVS and eight PVT mice were 893+/-262 and 911+/-288, respectively. The islet allograft survival of the PVS group ranged between 1 to 9 days; whereas, that of the PVT group ranged between 6 to 16 days. The PVT group showed significantly higher islet allograft survival than the PVS group (P=0.0443). CONCLUSION: A portal venous transfusion prolonged the islet allograft survival.

Buerger's Disease in Korea

PURPOSE: Buerger's disease (Thromboangiitis obliterans, TAO) is characterized by non- atheromatous inflammatory disease, and segmental inflammatory thrombotic occlusions of the small & middle-sized arteries and veins of the upper or lower extremities. Any epidemiological study of Buerger's disease in Korea has not been carried out until now. This study was undertaken to investigate the incidence of Buerger's disease in Korea among the patients suffering with arterial disease. METHODS: We collected and analyzed the data on 11,128 patients who were admitted to or visited the participating 22 hospitals for chronic arterial diseases throughout the major region of the South Korea from January 1986 to December 2003. The clinical diagnostic inclusion criteria for Buerger's disease were the followings: (1) a history of smoking or tobacco abuse; (2) an age of onset less than 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration) or-superficial phlebitis; and (5) the absence of arteriosclerotic risk factors other than smoking. RESULTS: The incidence rate of Buerger's disease among the arterial disease (11,128 patients) was 93 patients (0.83%) when the strict criteria of Shionoya was applied. 699 male-patients (6.55%) and 30 female patients (4.12%) who met the less strict criteria (the extended clinical diagnostic criteria group) were also reviewed. The 4th and 5th decades were the most common ages with-249 patients (34.2%) and 222 patients (30.5%) respectively, being found at these ages. The mean age was 40.4+/-1.6 years (age range: 16~83 years) and this was similar in both the strict criteria group and the less strict criteria group. CONCLUSIONS: This study suggests there was a low incidence of Buerger's disease in Korea among the patients who visited the participating hospitals when the strict diagnostic criteria were used. The incidence was lower than expected even when the less strict criteria were used. The more accurate incidence of Buerger's disease among the general population can be obtained by performing careful prospective study that is participated in by not only vascular surgeons, but also the other medical specialists with utilizing the strict diagnostic criteria.

Expression of MIP-1alpha mRNA in Kupffer Cells and Serum MIP-1alpha Post Portal Vein Transfusion / 대한이식학회지

PURPOSE: Portal vein transfusion (PVT) has been known to induce immunosuppression or tolerance and Kupffer cell was identified to play an important role in the phenomenon. The purposes of this study were investigating PVT effect on gene regulation in Kupffer cells and subsequent change in serum cytokine. METHODS: For investigating the effect of PVT, Kupffer cells were isolated from the mice (BalbC) of six groups; 1 hour sham operation (S), 1 hour portal vein saline injection (PVS), 1 hour PVT, 24 hour S, 24 hour PVS, and 24 hour PVT groups. Each group was composed of 3 mice. Total RNAs isolated from Kupffer cells were subjected to RT-PCR differential display. The bands of 24 hour group showing increased expression was cloned for the sequencing analysis. RESULTS: Macrophage inflammatory protein 1 alpha (MIP-1alpha) was identified from the bands of increased expression. In PVT groups, increased expression of MIP-1alpha mRNA in Kupffer cells coincided with elevated serum level of MIP-1alpha. CONCLUSION: MIP-1alpha may be one of the important cytokines involved in PVT induced immunosuppression or tolerance.

Sequential Change of Nitric Oxide Synthase in Rat Hippocampus after Kanic Acid-induced Seizure / 대한해부학회지

We have investigated the neural cell damage and the change in the expression of NOS in the rat hippocampus, one of the brain structures most vulnerable to seizures. Rats were injected with kainic acid (KA) and sacrificed 6 h, 1 d, 3 d and 6 d after KA administration. The neural cell damage and the expression pattern of NOS was studied using silver impregnation, NADPH-diaphorase (NADPH-d) histochemistry and reverse transcription-polymerase chain reaction (RT-PCR) analysis. Silver impregnation revealed that kainic acid caused pyramical cell damage which was most severe in the CA1/CA2 subfield and hilus and to a lesser degree in the CA3 region. The optical densities of NADPH-d-positive neurons in the CA1, CA3 and dentate gyrus (DG) regions of the hippocampus were shown to have increased in samples obtained 1 d and 3 d after injection of KA. The number of NADPH-d-positive neurons in the CA1 and CA3 regions of the hippocampus was shown to have decreased in samples obtained 3 d and 6 d after injection of KA. However, the number of NADPH-d-positive neurons in the DG region did not change significantly. The increase in the levels of nNOS, iNOS and eNOS mRNA reached maximal values in samples obtained 1 d after KA treatment. Our findings indicate that the KA-induced seizures induce neural cell damage, increase NOS activity and upregulate the expression of NOS mRNA, which suggests the possibility of a functional role of NOS in bringing about changes in the cells in the hippocampus following seizures.

Spinal Cord Compression Caused by a Metastatic Bone Tumor in Buerger's Disease Patient / 대한마취과학회지

Buerger's disease (thromboangiitis obliterans) is an inflammatory, nonatherosclerotic, occlusive disease of small- and medium-sized arteries and veins that involves distal vessels of the extremities. Patients show symptoms related to ischemia of distal lower extremities and upper extremities (claudication, gangrene, rest pain, distal cyanosis). We report a case of progressive ascending motor weakness of the lower extremities in a Buerger's disease patient due to a metastatic bone tumor on the T3 level after lumbar epidural block and continuous cervical epidural block.

Antiphospholipid Syndrome with Deep Vein Thrombosis

PURPOSE: Antiphospholipid syndrome is a disorder of recurrent vascular thrombosis, recurrent abortion, thrombocytopenia, neurologic disorders associated with the elevation of antiphospholipid antibodies. The aim of our study was to characterize the patient profile and frequency of antiphospholipid syndrome in patients with deep vein thrombosis of the lower legs. METHOD: From January 1998 to December 1999, 25 patients with the lower leg swelling were classified according to their risk factors. Deep vein thrombosis was confirmed by radiologic diagnosis such as duplex ultrasonography or venography. The items for the identification of hypercoagulability were antithrombin III, protein-C, protein-S, lupus anticoagulant, anticardiolipin antibody (IgG). For the differential diagnosis of systemic lupus erythematosus, we tested antinuclear antibody and anti-dsDNA for the patients with positive results of antiphospholipid antibodies. Antiphospholipid syndrome was diagnosed according to its criteria. RESULT: Of the 25 patients with the lower leg swelling, 17 patents (68%) were revealed to have deep vein thrombosis. In that 17 patients, 8 patients showed hypercoagulabilities including 4 patients (24%) with positive test for lupus anticoagulant, 1 patient (6%) with combined multiple abnormalities of protein C and protein S deficiencies and lupus anticoagulant positivity, 2 patients (12%) with antithrombin III deficiencies, 1 patient (6%) with protein C deficiency, and there was no patient with IgG type anticardiolipin antibody positivity. According to the American Rheumatism Association criteria (ARA), there was no patient with systemic lupus erythematosus, but we could find out 1 patient (6%) who met the dagnostic criteria of antiphospholipid syndrome. CONCLLUSION: In our study, 6% (1of 17) of patient with the lower leg deep vein thrombosis revealed antiphospholipid syndrome. We described the clinical profile and diagnostic process of antiphospholipid syndrome in this study.

Counseling for Breast Disease Using the Internet

PURPOSE: Rapid progress in the development of communication devices has enabled us to use large amounts of various kinds of medical information, regardless of time or place. Today, in Korea there are many homepages on the web which provide medical information, hospital information, and counseling on medical fields in Korea, but more detailed recent medical informations, better quality control, and a greater variety of communication skills are needed. Methods and RESULTS: We analysed the data on the web from November 1998 to October 1999 about breast cancer clinic. The frequent questions were about breast mass (44%), breast pain (29%), and counseling on breast cancer (25%). The most frequent users were in their 3rd decade (55%), 4th decade (8%), and unknown age cases (23%). The average number of visitors on web was 454 per month. CONCLUSION: In near future, we believe that use of the web as an information source will grow rapidly and the most of the people in Korea will use internet. For that purpose, we should realize that virtual space is a reality, and we should use it as an effective technique for educating the public.

A case of sclerosing encapsulating peritonitis presenting a huge pseudocyst formation in end stage renal failure on the maintenance hemodialysis / 대한내과학회지

Sclerosing encapsulating peritonitis(SEP) is now a well-recognised, but uncommon complication of chronic ambulatory peritoneal dialysis(CAPD). The etiology is unclear, but SEP is believed to be multifactorial. The most important factors seem to be the length of time on peritoneal dialysis and previous episodes of peritonitis. Anorexia, nausea, vomiting, weight loss, abdominal pain, and a reduction of the ability of the peritoneum to act as a dialyzing membrane are the usual presenting problems. We experienced one case of SEP presenting a huge pseudocyst in the patient of end stage renal failure on the maintenance hemodialysis for 5 years, even though he had a history of CAPD for 5 years. So we report this case with review of the literature.

Plasma Exchange in the Treatment of Cyclosporine Induced Hemolytic Uremic Syndrome Following Kidney Transplantaion / 대한임상병리학회지

Hemolytic uremic syndrome is characterized by a triad of clinical findings including microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The precise etiology and pathogenesis of hemolytic uremic syndrome are not established by now. According to clinical reports, hemolytic uremic syndrome is associated with infection(bacteria, virus), connective tissue disease, malignancy, drug and pregnancy. Recently, many investigators have reported that cyclosporine induces hemolytic uremic syndrome. Cyclosporine is one of the immunosuppressants that are essential for kidney transplantation. We experienced one case of hemolytic uremic syndrome that developed after kidney transplantation receiving cyclosporine. A 43-yr-old woman with end-stage renal failure received kidney transplantation from her daughter. After operation, she received cyclosporine for immunosuppression and thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure were developed. She was diagnosed as cyclosporine induced hemolytic uremic syndrome and plasma exchange was started with fresh frozen plasma. The plasma exchange was done 16 times and the clinical symptoms were improved. We present this case with review of literatures.

Clinical Characteristics of Angiocentric Immunoproliferative Lesions in Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The histologic features of polymorphic reticulosis are identical to those of sinonasal "angiocentric immunoproliferative lesions" (AILs) which are characterized by angiocentric and angioinvasive lymphoid infiltrates with a wide range of cytologic atypia. 1) This report was conducted to further define the clinicopathological nature of this lesion and evaluate the important prognostic factors and therapeutic strategies. MATERIALS AND METHODS: The clinical features and therapeutic outcomes of 22 patients with AILs were reviewed. Histologic grading was performed by using previously reported criteria (Grade I-III).2) To clarify the cell origin of AIL, immunohistochemical studies were performed in 21 cases. RESULTS: On the slide review, 10 cases were Grade II and 12 cases were grade III which showed characteristic histologic features similar to those of peripheral T-cell lymphoma. On immunohistochemical studies, neoplastic cells of all patients had a T-cell phenotype. The difference in primary treatment results according to the histologic grade, clinical staging and therapeutic modalities was not significant statistically. The overall 5 year survival rates were 58%. CONCLUSION: Our results suggest strongly that quite a significant portion of AIL may be in fact T-cell lymphoma. The only significant prognostic factor that predicts better survival is the achievement of initial complete response.