Concurrence of Sjogren's Syndrome in a Patient with Chlamydia-induced Reactive Arthritis: An Unusual Finding

A 40-year-old Korean man presented with painful swelling and tenderness of both ankle joints as well as the plantar surfaces of both feet, along with inflammatory back pain, and a purulent discharge from the urethral orifice. The patient also complained of sicca-like symptoms including dry eyes and dry mouth. An immunological analysis revealed a high titer of rheumatoid factor, positive results for antinuclear antibody and anti-Ro antibody, and a positive result for HLA-B27. An antibody titer for Chlamydia was also significantly increased. Positive results of the Schirmer's test and for keratoconjunctivitis sicca were confirmed by an ophthalmologist. These clinical manifestations were compatible with Chlamydia-induced reactive arthritis (ReA) accompanied by Sjogren's syndrome (SS). This is the first report of the combination of these two distinct disease entities in the Korean population.

Optimal Cut-off Value of PIVKA-II for Diagnosis of Hepatocellular Carcinoma: Using ROC Curve / 대한간학회지

BACKGROUND/AIMS: Protein induced by vitamin K absence or antagonist-II (PIVKA-II), also known as des-carboxyprothrombin (DCP), can be used as an alternative tool to alpha-fetoprotein (AFP) for surveillance of hepatocellular carcinoma (HCC). The aims of the present study were to compare PIVKA-II levels between the patients with HCC and patients with non-HCC chronic liver disease, to evaluate the correlation of PIVKA-II and AFP in HCC patients, and finally to estimate the optimal cut-off value for PIVKA-II for the diagnosis of HCC with using the receiver operating characteristic (ROC) curve. METHODS: A total of 227 consecutive patients with HCC (n=42) or chronic liver disease (n=185) were enrolled in this study. HCC was diagnosed histologically or by imaging such as computed tomography, magnetic resonance imaging or angiography. The serum PIVKA-II and AFP levels were measured by electrochemiluminoimmunoassay with using the Haicatch PIVKA-II kit and by immunoradiometric assay, respectively. RESULTS: The PIVKA-II level in the HCC patients was significantly higher than the non-HCC chronic liver disease patients (903.0+/-1156.7 vs. 111.7+/-211.0 mAU/ mL, respectively, P<0.01). PIVKA-II and AFP showed a statistical correlation in HCC patients (r=0.46, P<0.01). The sensitivity and specificity of PIVKA-II for the diagnosis of HCC were 66.7% and 74.1%, respectively, and when tasted together with AFP, the sensitivity was increased by 85.7%. For the ROC curve of PIVKA-II in HCC patients, the specificity of a 250 mAU/mL level of PIVKA-II was 95%. CONCLUSIONS: PIVKA-II was as useful surveillance tool for differentiating HCC from chronic liver disease, and a PIVKA-II value of 250 mAU/ mL was proposed as a significant cut-off value for diagnosis of hepatocellular carcinoma.

Microbiological Identification and Distribution of Metal Components in Suspended Particulate Matter during Yellow Sand Phenomena at TaeAn Region in 2003 / 결핵및호흡기질환

BACKGROUND: Airborne particles during Yellow Sand phenomena are known to be associated with the respiratory disease. The purpose of this study was to evaluate the concentration and metal component properties of Yellow Sand particles and compare with airborne microbial concentration and species in non Yellow Sand and Yellow Sand phenomena. METHODS: Samplings were carried out in 2002 in Seosan, during non Yellow Sand and Yellow Sand phenomena. Samples were taken using the 8-stage Cascade impactor and metallic elements were analyzed by XRF. Those were culture on the media for bacterial and fungal culture and celline for virus. RESULTS: The concentration of total suspended particulate matter were respectively 80.2microgram/m3, 40.3microgram/m3 in non Yellow Sand and Yellow Sand phenomena. The concentration of metallic elements such as Ca, Fe, Cu and Zn in Yellow Sand phenomena were higher than its in non Yellow Sand. Two bacteria, Bacillus species and Staphylococcus were grown in two periods. In both periods, several fungal spores(Mucor species, Cladosporum, Alternaria, Aspergillus, Penicillium, and Alternaria species) were identified. The differences of bacteria and fungus species not observed in Yellow Sand and non Yellow Sand. Any viruses were not isolated in between both periods. CONCLUSIONS: The concentration of total suspended particulate matter and some metallic elements in Yellow Sand phenomena were higher than its in non Yellow Sand. The difference of bacteria and fungus species was not observed in non Yellow Sand and Yellow Sand phenomena.

A case of primary pulmonary botryomycosis by Gemella morbilium / 대한내과학회지

Botryomycosis is a chronic supprative disease with characteristic granules formation in the pus caused by bacteria and frequently is mistaken for a fungal infection. Pulmonary botryomycosis can resemble actinomycosis, tuberculosis, or invasive carcinoma by causing a mass lesion with constitutional symptoms. We report a case of pulmonary botryomycosis in a 43 years old man. He had a cavitary lesion of the right upper lobe and diagnosis was confirmed by percutaneous needle aspiration. The specimen demonstrated multiple clusters of bacteria within abscess that best were visualized by gram staining. Cultures of the biopsy materials yielded pure growth of Gemella morbilium. The patient recovered quickly after antibiotics treatment for 3 weeks.

Concurrent Chemoradiation with Weekly Paclitaxel in Locally Advanced Non-small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: Paclitaxel is highly beneficial anticancer drug for the treatment of non-small cell lung cancer and has shown remarkable radiosensitizing effect in vitro. We evaluated whether concurrent chemoradiation therapy with weekly paclitaxel (60 mg/m2) could be tolerated and effective in the treatment of locally advanced non-small cell lung cancer (NSCLC). METHODS: Twenty-two stage III (IIIA:6, IIIB:16) NSCLC patients were treated with weekly administration of paclitaxel (60 mg/m2) on days 1, 8, 15, 22, 29, and 36 in addition to concurrent radiation therapy of 54 Gy. After the initial phase of concurrent chemoradiation, patients received additional two cycles of consolidation chemotherapy with paclitaxel (175mg/m2)/cisplatin (75 mg/m2) or paclitaxel (175 mg/m2)/carboplatin (6AUC) every 3 weeks. RESULTS: Overall response rate was 81.8% (18/22) with 9.1% (2/22) of complete response and 72.7% (16/22) of partial response rate. Two patients (9.1%) died of chemoradiation-induced pneumonitis after completion of therapy. In total, grade 3 toxicities included pneumonitis (22.7%), esophagitis (22.7%), neuropathy (13.6%), and neutropenia (13.6%). The median survival time was 15 months and 2-year overall survival were 31.8%. CONCLUSION: Concurrent chemoradiation therapy with weekly paclitaxel in locally advanced NSCLC showed good local response, but survival rate was not completely satisfactory due to potentially fatal chemoradiati1on-induced pneumonitis.

Three Cases with Cutaneous Polyarteritis Nodosa / 대한류마티스학회지

Systemic polyarteritis nodosa is a necrotizing vasculitis that involves small and medium-sized muscular arteries in the multiple organ systems, whereas cutaneous polyarteritis nodosa (CPAN) is a localized disease characterized by necrotizing vasculitis of small and medium-sized arteries in the skin without life-threatening organ involvement. CPAN is usually limited to skin, muscle, and joints. It is chronic but takes a benign course. The most common cutaneous manifestations include nodules, ulcers and a livedo reticularis pattern on the extremities. We describe three cases with CPAN showing necrotizing vasculitis on the skin without systemic symptoms or visceral involvement. In Korea, most previously published cases with CPAN have shown a good response to a short term of corticosteroids or colchicine administration. However, two of our three patients required another immunosuppressive agent in addition to corticosteroids to manage their intractable skin lesions, and the remaining one showed a good response to a short course of prednisolone. In addition, there was one patient with CPAN having hepatitis B surface antigen, which might be associated with his refractory skin disease.

An Epidemiologic Investigation on the Mode of Transmission of the Lethal Salmonellosis Outbreak in Hamyang County / 한국역학회지

An outbreak of Salmonella enteritidis epidemic involving about 200 inpatients of gastroenteritis and 1 death occurred among about 750 participants from Hamyang County who attended 4 wedding lunch parties at one buffet restaurant on April 25, 1999. There were also many patients including 1 death among about 500 participants outside Hamyang County who attended same parties. Person to person interviews made to 155 inpatients revealed that distribution of incubation periods was between 1 to 34 hours with median time, 13-14 hours. A retrospective cohort study was conducted to investigate the mode of transmission. Telephone interviews were made to party participants (except 61 inpatients who already had been interviewed personally) on symptoms and on which they had eaten among 40 served foods including water at the parties and data among 288 persons were available for the analyses. One hundred and ninety one interviewees had more than two symptoms among symptoms of diarrhea(more than 3 times), abdominal pain, and fever, which gave an attack rate of 66.3%(191/288). The relative short incubation period and high attack rate suggested the presence of higher infecting dose in this epidemic. Logistic regression analysis revealed that the probable infective foods were boiled cockle, gamju, boiled midodok, fried rices, eomook, and boiled pig's trotter. Salmonella enteritidis were identified in the specimens of boiled cockle, cooked beef, and uncooked beef. Only boiled cockle was both an epidemiological and microbiological infective food. There might be cross-contaminations between several served foods, which meant presence of many contaminated foods by Salmonella enteritidis with different stage of their multiplications. Efforts to inspect food service areas and educate foodhandlers in good personal hygiene and proper foodhandling practices should be strengthened to reduce the incidences of salmonellosis in Korea.

A study on Performing Time of Neurobehavioral Test in Workers exposed to Organic Solvents / 예방의학회지

This study was performed to see whether neurobehavioral tests was affected by the exposure-free time in the workers chronically exposed to organic solvents. Thirty-four female workers were participated and four items among neurobehavioral core test battery of World Health Organization, including digit span, Santa Ana Dexterity, digit symbol, Benton Visual Retention, were administered to the workers. Test was conducted three times-preshift on Monday, preshift on Weekday and during shift on Weekday-per person and the interval of tests was 2 weeks. Digit span forward, Santa Ana Dexterity, digit symbol, and Benton Visual Retention showed significant decrements by performing time, especially during shift on Weekday versus preshift on Monday and preshift on Weekday. In addition, the score at preshift on Weekday was significantly lower than preshift on Monday, in preferred Santa Ana Dexterity and digit symbol. Generally, those who were exposed to high concentration, over 50 years and under 6 years of education showed marked decrease of score at during shift. So, it would be desirable that neurobehavioral test is conducted at preshift on Monday and items related to short term memory could be considerable to be done at preshift on Weekday.

Lead Levels in Maternal and Umbilical Cord Blood / 대한산업의학회지

This study was conducted to evaluate the blood lead levels in 141 pregnant women who were not occupationally exposed to lead and their umbilical cord, arid to identify some differences in blood lead levels by living area. ; The subjects-were all delivered at St. Benedict Hospital in Pusan and the blood lead levels were measured by graphite furance atomic absorption spectrophotometer. The summarized results were as follows. 1. The geometric mean lead levels in maternal and cord blood were 8.0+/-1.8microgram/dl, 5.0+/-0.6lmicrogram/dl respectively. 2. Lead levels in maternal (8.7+/-1.7microgram/dl) and cord blood(5.4+/-0.7microgram/dl) of industrial area(n=24) were higher than residential area(n= 124) which were 7.9+/-1.7microgram/dl and 5.0+/-0.6microgram/dl respectively (p<0.05). 3. Maternal blood lead concentration was significantly correlated to cord blood lead concentration (r=0.6090, p<0.001), but other variables (maternal age, paternal smoking, birth weight, etc) were not correlated.