Crohn Disease ; diagnosis ; drug therapy ; Humans ; Remission Induction

Myasthenia Gravis is a chronic disease characterized by excessive fatiguability of striated muscle. The illness has a tendency to exacerbation and to the periods of spontaneous remission. The auther observed a case of ocular myasthenia gravis who has gained spontaneous remission 5 years after from the onset, and reviewed the references related to this disease.
Chronic Disease ; Muscle, Striated ; Myasthenia Gravis* ; Remission, Spontaneous

OBJECTIVETo analyze the clinical features, therapeutic methods and prognosis of primary breast lymphoma (PBL).

METHODSTwenty-one PBL patients treated in Ruijin Hospital from January 2003 to December 2013 were included in this study, with 17 diffuse large cell lymphoma (DLBCL), 1 mucosa-associated lymphoid tumor (MALT), 1 follicular lymphoma (FL), 1 Burkitt lymphoma and 1 subcutaneous peniculitis T-cell lymphoma according to the WHO 2008 classification. Of 21 patients, only one patient with MALT has bulged tumor mass (>7 cm), other patients had tumor mass <5 cm. Six patients had core needle biopsy of tumor, 2 modified radical operation, and others tumor excision for diagnosis. All the patients received chemotherapy. The impacts of surgery, rituximab and prophylaxis with lumbar puncture on the outcomes of patients were analyzed. Survival was estimated using Kaplan-Meier method and compared by log-rank test. All the results were analyzed by SPSS 10.0.

RESULTSAmong 21 PBL patients, 19 achieved complete remission (CR), 1 partial remission (PR) and 1 disease progression (PD). Followed-up till July 2014, with median follow-up of 14 months (6-75 months), only one patient died, with 3-year survival of 92.3%. Compared with chemotherapy alone, the progression-free survival (PFS) of combination therapy (surgery plus chemotherapy) was significant longer (P=0.015), but without statistic differences of CR rate and overall survival (OS) between two groups. Among the 20 patients with CD20-positive tumor cells, 17 received Rituximab. PFS and OS, as well as CR rate of PBL had no difference between the treatment with and without Rituximab. The incidence of central nervous system (CNS) infiltration had no difference between patients with and without CNS prophylaxis through lumber-puncture and intrathecal injection.

CONCLUSIONWith the common subtype of DLBCL, PBL patients had good outcome. Surgery, as a method to obtain tumor samples for diagnosis, could not prolong OS of patients. Therefore, radical operation shouldn't be recommended. PBL was reported to have high risk of CNS events, but prophylaxis with lumber puncture and intrathecal injection couldn't decrease the incidence of CNS infiltration.

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical characteristics and course of Korean patients with Crohn's disease (CD). METHODS: A total of 113 patients who were newly diagnosed as having CD at the Asan Medical Center between October 1989 and December 2001 were included. RESULTS: The male to female ratio was 1.9:1 and the mean age at diagnosis was 24.2 +/- 7.8 years. The disease location was the small bowel in 19.5%, the large bowel in 11.5%, and the both small and large bowels in 69.0% of the patients. Empirical anti-tuberculous medications were administered to 53 cases (46.9%). Major complications of CD were intestinal obstruction (25.7%) and perianal fistula (42.5%). The cumulative remission rate was 75.7% at 1 year and 80.7% at 3 years from diagnosis. The cumulative relapse rate was 30.7% at 1 year and 53.0% at 3 years from remission. The cumulative operation rate was 11.5% at 1 year and 13.1% at 3 years from diagnosis. CONCLUSIONS: There are no differences in the remission and recurrence rates between Korean and Western patients with CD. Although the cumulative operation rate seems to be lower in Korea than in Western countries, the cause of the difference is uncertain. Further studies are needed to determine the characteristics of CD in Korea.
Adolescent ; Adult ; Crohn Disease/complications/*diagnosis/therapy ; English Abstract ; Female ; Humans ; Korea ; Male ; Remission Induction

PURPOSE: Anorectal lesions in patients with Crohn's disease (CD) are difficult to manage because of frequent recurrences and complications. The aim of this study is to evaluate the relationship between anorectal lesions and CD and to analyze the methods of management and the results of anorectal lesions. METHODS: The records of 33 patients with CD who had anorectal lesions, who visited our institution from July 2001 to June 2007, were reviewed retrospectively. RESULTS: CDs involving the small and the large bowel in 24 patients, the small bowel in 4 patients, the large bowel in 4 patients, and only the anorectum in 1 patient. Twenty-two patients (75.9%) were diagnosed as CD with unusual anorectal findings: unhealed wound or delayed healing of wound after the initial anal operation, multiple ulcers or fissures, broad based or friable fistula tract, non-cryptoglandular type of fistula, multiple fistula tracts, and recurrent or concurrent fistula. The predominant type of anorectal lesion was a perianal fistula (28 patients, 84.8%). Twelve out of 45 anal specimens (26.7%) showed noncaseating epithelioid granulomas, characteristic findings of CD. Conservative treatment was performed in 7 patients (21.2%), anorectal operations in 26 patients (78.8%). Twelve of those 26 patients underwent multiple operations. Anorectal operations were performed as follows: incision and drainage (8), fistulotomy or fistulectomy (17), muscle-preserving surgery (7), seton drainage (12), and modified Hanley's procedure (1). All anorectal operations, except those for an abscess, were performed after induction of remission of the CD. Satisfactory results were achieved in 29 patients (87.9%). CONCLUSION: In patients with unusual anorectal lesions, a diagnostic work-up for CD should be performed. Anorectal lesions with CD may be properly managed using several different methods, depending on the anorectal conditions and the activity of the CD.
Abscess ; Crohn Disease ; Drainage ; Fistula ; Granuloma ; Humans ; Recurrence ; Remission Induction ; Retrospective Studies ; Ulcer

Myasthenia gravis is a chronic disease characterized by voluntary muscle weakness and fatigue. Myasthenia gravis was first described by Thomas Willis in 1672. The etiology of myasthenia gravis is not clarified but recently it has been suggested that it is an autoimmune disease. Ocular myasthenia gravis is characterized clinically by blepharoptosis and external ophthalmopleia. The illness has a tendency to exacerbation and spontaneous remission. The authors observed a case of severe ocular myasthenia gravis which had developed total external ophthalmoplegia. And we reviewed the literature of recent years related to myasthenia gravis, particulary for its etiology, clinical course, pathology, diagnosi, treatment, and prognosis.
Autoimmune Diseases ; Blepharoptosis ; Chronic Disease ; Fatigue ; Muscle, Skeletal ; Myasthenia Gravis* ; Ophthalmoplegia* ; Pathology ; Prognosis ; Remission, Spontaneous

PURPOSE: Exclusive enteral nutrition (EEN) therapy effectively induces clinical remission in Crohn's disease (CD). It remains unclear, however, whether partial enteral nutrition (PEN) can maintain remission. This study was performed to determine the abilities of oral EEN and oral PEN to induce and maintain clinical remission in pediatric patients with CD, respectively. MATERIALS AND METHODS: Pediatric patients with CD who received oral EEN at a single center in 2000-2014 were identified retrospectively. Remission rates of the EEN and PEN during the 2 years study period were determined. Risk factors for EEN and PEN failure were identified. RESULTS: Of the 66 patients who started EEN, 61 (92%) completed the course. Clinical remission was achieved in 88% (58/66) of the patients. All 58 patients with remission continued with PEN: 43 (74%) were treatment adherent. The cumulative remission rates at 1 and 2 years were 67% and 52%, respectively. Differing from EEN, limited therapeutic efficacy of PEN was shown in severe CD patients. Female gender associated significantly with non-adherence. CONCLUSION: Oral EEN and PEN effectively induced and maintained remission in a pediatric population. Non-adherence was a limiting factor in the success of therapy.
Adolescent ; Child ; Crohn Disease/*therapy ; Enteral Nutrition/*methods ; Female ; Humans ; Male ; Remission Induction ; Retrospective Studies

The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.
Colitis, Ulcerative ; Colon ; Crohn Disease ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Rectum ; Remission Induction ; Short Bowel Syndrome

The role and efficacy of exclusive enteral nutrition (EEN) in the treatment of luminal Crohn's disease (CD) has been well established over the last 2 decades. Consequently, in many centers nutritional therapy is now considered first line therapy in the induction of remission of active CD. However, the use of nutritional therapy in complicated CD has yet to be fully determined. This article aimed to review case reports and clinical trials published in the last decade that have considered and evaluated nutritional therapy in the setting of complicated CD in children and adults. Published literature focusing upon the use of nutritional therapy as part of medical therapy in the management of complicated CD were identified and reviewed. Although there continue to be various interventions utilized for complicated CD, the currently available literature demonstrates that nutritional therapies, especially EEN, have important roles in the management of these complex scenarios. Further assessments, involving large numbers of patients managed with consistent approaches, are required to further substantiate these roles.
Adult ; Child ; Crohn Disease ; Enteral Nutrition ; Humans ; Intestinal Fistula ; Intestinal Obstruction ; Phenobarbital ; Remission Induction

OBJECTIVETo investigate the expression of E2F1 gene in patients with acute leukemia(AL) and its clinical significance.

METHODSSeventy-two AL patients treated in March 2015 -March 2016 in our hospital were selected, and 24 healthy people were selected as controls. RT-PCR and Western blot were applied to determine the level of E2F1 gene transcription and expression, and the statistical analysis was performed to reveal the clinical value of E2F1 gene.

RESULTSThe relative expression levels of E2F1 gene and protein in bone marrow of AL patients was higher than that in control group (P<0.05). The levels of WBC, β-MG and LDH in the patients with high expression of E2F1 gene were higher than those in patients with low expression of E2F1 gene(P<0.05), but the E2F1 gene expression did not correlate with sex, fever, fatigue, bone marrow blast ratio, peripheral blood blasts ratio (P>0.05). The complete remission (CR) of patients with low expression of E2F1 was significantly higher than that of patients with high expression of E2F1(P<0.05). And the drug resistance in the patients with low expression of E2F1 gene was lower than that of patients with high expression of E2F1 gene (P<0.05). The expression level of E2F1 gene decreased significantly in patients with symptomatic remission after treatment (P<0.05). The expression levels of E2F1 gene in M1, M2 and M5 patients decreased significantly after treatment (P<0.05). Kaplan-Meier survival analysis showed that OS and DFS in the patients with low expression of E2F1 gene were higher than those in patients with high expression (P<0.05). Multivariate Cox regression analysis showed that the age and E2F1 gene were the independent influencing factors of OS (P<0.05); the sex and E2F1 gene were the dependent factors of DFS (P<0.05).

CONCLUSIONThe expression level of E2F1 gene in patients with AL has been found to be higher, the higher level of E2F1 gene closely relates with AL patients, E2F1 gene can be used as a biological target for the clinical treatment of AL.