Effect of Transverse Sinus Stenting on Diffuse Leukoencephalopathy with Idiopathic Intracranial Hypertension

A diagnosis of idiopathic intracranial hypertension (IIH) can be made after excluding secondary causes. As stenosis of transverse sinuses is often revealed with IIH patients, transverse sinus stenting is used to release intracranial hypertension. It is rare to find a case of leukoencephalopathy secondary to IIH. Herein, we describe a case of diffuse leukoencephalopathy with IIH, which improved after stent insertion in the transverse sinus.

Patterns of Cerebrospinal Fluid Biomarkers and Amyloid Positron Emission Tomography in a Patient with Cerebral Amyloid Angiopathy-Related Inflammation

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a distinct subset of cerebral amyloid angiopathy characterized by the auto-inflammatory response to amyloid-laden small arteries of cerebral cortex and leptomeninges. Clinical features include cognitive-behavioral change, headache, focal neurologic deficits and seizure. Because anti-inflammatory treatments can rapidly relieve neurologic symptoms, early diagnosis is critical. Herein, we report a CAA-RI case with distinct laboratory findings of a decreased cerebrospinal fluid amyloid beta 1-42 level and relatively reduced florbetaben uptake in the focal inflammatory lesion during the acute phase of CAA-RI.

Patterns of Cerebrospinal Fluid Biomarkers and Amyloid Positron Emission Tomography in a Patient with Cerebral Amyloid Angiopathy-Related Inflammation

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a distinct subset of cerebral amyloid angiopathy characterized by the auto-inflammatory response to amyloid-laden small arteries of cerebral cortex and leptomeninges. Clinical features include cognitive-behavioral change, headache, focal neurologic deficits and seizure. Because anti-inflammatory treatments can rapidly relieve neurologic symptoms, early diagnosis is critical. Herein, we report a CAA-RI case with distinct laboratory findings of a decreased cerebrospinal fluid amyloid beta 1-42 level and relatively reduced florbetaben uptake in the focal inflammatory lesion during the acute phase of CAA-RI.

Cerebral Infarction Caused by Direct Cardiac Tumor Emboli Mixed with Thrombus

Cerebral infarction in cancer patients is often caused by thrombosis due to hypercoagulability, and in some cases, caused by direct tumor embolism. We report the case of cerebral infarction due to direct tumor embolism mixed with thrombus. Biopsy of blood clots obtained during thrombectomy is important for diagnosis. If there is a high risk of thrombosis among cancer patients with cerebral infarction, the use of appropriate antithrombotic agents along with maintaining a certain level of platelets should be considered.

Cerebral Infarction Secondary to Vascular Infiltration of Glioblastoma Confirmed in High-Resolution Vessel Wall MRI

Acute cerebral infarction secondary to glioblastoma is rarely reported, and its mechanism is still controversial. Vascular infiltration of malignant cell, direct mass effect and local procoagulant effect were considered as main pathophysiology. We report a case of glioblastoma-related cerebral infarction documented by high resolution vessel wall magnetic resonance imaging, which reveals concentric enhancement of arterial wall and intraluminal thrombus without direct compression. These findings suggest tumor cell infiltration of intracranial vessels is one of the important mechanisms of glioblastoma-related cerebral infarction.

Immunohistochemical Expression of Epithelial-Mesenchymal Transition Markers in Early Gastric Cancer: Cancer Tissue versus Noncancer Tissue

BACKGROUND/AIMS: Epithelial-mesenchymal transition (EMT) is a developmental process, wherein the epithelial cells show reduced intercellular adhesions and acquire migratory fibroblastic properties. EMT is associated with downregulation in epithelial marker expression, abnormal translocation of E-cadherin, and upregulation in mesenchymal marker expression. Here, we investigated the immunohistochemical (IHC) expression of EMT markers in early gastric cancer (EGC) between cancer and noncancer tissues. METHODS: Tissue samples were prospectively obtained from 19 patients with EGC that underwent endoscopic submucosal dissection (ESD). We compared the expression level of transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF), E-cadherin, α-smooth muscle actin (α-SMA), and vimentin between cancer and noncancer tissues using IHC. Among the 19 patients, 15 patients had follow-up biopsy at 3 months after ESD for EGC. RESULTS: Cancer tissues presented higher values of EMT mesenchymal markers (α-SMA/vimentin/TGF-β/VEGF) than the noncancerous tissues (p<0.05) that were significantly low after ESD (p<0.05). No significant correlation was reported for tumor location and initial Helicobacter pylori infection. CONCLUSIONS: The mesenchymal expression of EMT markers was higher in the cancerous tissues than in the noncancer tissues.

Tissue factor expression is associated with recurrence in patients with non-metastatic colorectal cancer

PURPOSE: Previous studies have addressed the role of the hypercoagulable state in the pathogenesis of cancer progression and metastasis. In this study, we investigated the association between coagulation factors, including tissue factor (TF) expression, platelet count, and fibrinogen level, and disease recurrence in patients with non-metastatic colorectal cancer.METHODS: Patients who underwent curative resection for stage II or III colorectal cancer between 2000 and 2007 were included in this study. Data from a prospectively maintained database were retrospectively reviewed. TF expression was determined by immunohistochemistry using an anti-TF monoclonal antibody. The Kaplan-Meier method was used to estimate 5-year disease-free survival.RESULTS: TF was highly expressed in 257 of 297 patients (86.5%). TF expression was not significantly associated with the platelet counts (P=0.180) or fibrinogen level (P=0.281). The 5-year disease-free survival rate was lower in patients with high TF expression than in patients with low TF expression (72.3% vs. 83.9%, P=0.074). In Cox hazard analysis, high TF expression was an independent risk factor for tumor recurrence (hazard ratio [HR] 2.446; 95% confidence interval [CI], 1.054–5.674; P=0.037). Undifferentiated histologic type (HR, 2.911; 95% CI, 1.308–6.481; P=0.009), venous invasion (HR, 2.784; 95% CI, 1.431–5.417; P=0.003), and lymph node metastasis (HR, 2.497; 95% CI, 1.499–4.158; P < 0.001), were also significantly associated with disease recurrence.CONCLUSION: TF expression is associated with a recurrence in patients with non-metastatic colorectal cancer. However, further studies are required to clarify the underlying mechanisms relating TF expression with oncologic outcomes and its potential role as a therapeutic target.

Clinical Outcomes of the Endoscopic Treatments for the Early Esophageal Carcinoma and Dysplasia

BACKGROUND/AIMS: Esophageal cancer and dysplasia are relatively rare in Korea, compared to other Far Eastern countries. So, the feasibility and safety of endoscopic treatments for these diseases is not well established in Korea. This study aimed to assess the technical feasibility, safety and the clinical outcomes of endoscopic treatment for esophageal epithelial lesions. MATERIALS AND METHODS: Between April 2005 and March 2013, 25 esophageal epithelial lesions from 22 patients were treated with endoscopic treatment such as endoscopic submucosal dissection or endoscopic mucosal resection. RESULTS: Of the 25 lesions, 11 lesions were treated with endoscopic submucosal dissection (ESD) (ESD group) and 14 lesions with endoscopic mucosal resection (EMR group). In the ESD group, the diagnosis was squamous cell carcinoma in 7 patients (64%), high grade dysplasia in 3 patients (27%), and low grade dysplasia in 1 patient (9%). In the EMR group, thediagnosis was squamous cell carcinoma in 8 patients (57%), high grade dysplasia in 2 patients (14%), and low grade dysplasia in 4 patients (29%). En bloc resection rates were 100% in ESD and 42.9% in EMR, respectively. For the median 12 months follow up period, there was no recurrence in the ESD group. However, there were three recurrences in the EMR group. CONCLUSIONS: Endoscopic treatment for esophageal epithelial lesions is safe and feasible therapeutic modalities. Especially, ESD can provide higher rate of en bloc and curative resection for early esophageal cancer and dysplasia.

The impact of pegylated interferon and ribavirin combination treatment on lipid metabolism and insulin resistance in chronic hepatitis C patients

BACKGROUND/AIMS: Lipid profile and insulin resistance (IR) are associated with hepatitis C virus (HCV) and may predict the chronic hepatitis C (CHC) treatment response. The aim of this study was to determine the association between CHC treatment response and lipid profile and IR change during treatment. METHODS: In total, 203 CHC patients were reviewed retrospectively between January 2005 and December 2011 at Soon Chun Hyang University Hospital. The lipid profile, homeostasis model for assessment (HOMA) of IR (HOMA-IR), and HOMA of beta cells (HOMA-beta) were evaluated before interferon plus ribavirin therapy (BTx), at the end of treatment (DTx), and 24 weeks after the end of treatment (ATx). RESULTS: A sustained virologic response (SVR) was achieved by 81% of all patients (49/60), 60% (n=36) of whom possessed genotype 1, with the remainder being non-genotype-1 (40%, n=24). Apart from age, which was significantly higher in the non-SVR group (SVR, 48.0+/-11.2 years, mean+/-SD; non-SVR, 56.6+/-9.9 years; P2.5), HOMA-IR was significantly changed at DTx in the SVR group. CONCLUSIONS: LDL-C appears to be associated with HCV treatment in SVR patients. Furthermore, eradication of HCV may improve whole-body IR and insulin hypersecretion, as well as high baseline insulin resistance (HOMA-IR >2.5).

A Case of Gastrointestinal and Cervical Lymph Nodal Kaposi's Sarcoma in a Patient with Acquired Immunodeficiency Syndrome

Kaposi's sarcoma was the first malignancy to be recognized as a cancer defining acquired immunodeficiency syndrome (AIDS). Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions but it may be widely disseminated internally such as digestive, respiratory organ, spleen, or lymph node. The incidence of Kaposi's sarcoma in patients with AIDS has declined in the era of effective antiretroviral therapy (ART), and cases of disseminated Kaposi's sarcomas have rarely been reported in Korea. Chemotherapy is usually used in symptomatic or rapidly progressive disease, and interferon-alpha can be applied as a treatment option. We report a successfully treated case of gastrointestinal and cervical lymph nodal Kaposi's sarcoma in a patient with AIDS who had combined treatment with ART, interferon-alpha, and paclitaxel.

A Case of Septic Knee Arthritis Caused by Salmonella Enteritidis

Salmonella septic arthritis in a healthy, immunocompetent patient is extremely rare. We experienced a case of septic arthritis of the knee caused by Salmonella Group D in a patient with Non-small cell lung cancer. A 43-year-old female receiving steroid therapy for treatment of Non-small cell lung cancer with metastasis to the spinal cord complained of painful swelling of the right knee joint. Culture of synovial fluid obtained by aspiration yielded growth of Salmonella Group D. The patient was treated with ceftriaxone; however, she expired on the ninth day after treatment.

Successful Pregnancy and Childbirth in a Patient with Diabetic Kidney Disease Receiving Hemodialysis

Pregnancy outcomes for women uncontrolled diabetes mellitus are poor. Women with chronic kidney disease and end-stage renal disease, if pregnant, will develop pregnancy-related complications. In the case of severe renal failure and diabetes mellitus, the incidence of prematurity, low birth weight, and neonatal death increases. Despite these risks, there have been few reported cases of successful pregnancy outcomes for these women. Adherence to a schedule of strict glucose monitoring, blood pressure and volume control, correction of anemia, and intensive hemodialysis may play important roles in the management of these women. Successful pregnancy and childbirth in a patient with diabetic kidney disease receiving hemodialysis have not been previously reported in Korea, to our knowledge. Herein, we report a case of a successful pregnancy outcome in a patient with diabetic end-stage renal disease undergoing hemodialysis.

Infective Endocarditis with Cerebral Infarction in a Hemodialysis Patient with Failed Renal Allograft / 대한신장학회지

Infective endocarditis is a dreaded complication in dialysis or kidney transplantation patients, with high morbidity and mortality. Despite the improved early survival of the transplanted kidney with new immunosuppressive agents, the number of patients returning to dialysis after a failed renal allograft is increasing. There is no consensus on the optimal management of immunosuppression in patients with a failed allograft. Continued immunosuppression is associated with infection, and the rapid discontinuation of immunosuppression may lead to acute rejection. Therefore, it is important to taper the immunosuppression properly in patients with a failed renal allograft. We report on a hemodialysis patient with a failed renal allograft who had a cerebral infarction following infective endocarditis. The patient was treated successfully with antibiotics and valve replacement.