Angioimmunoblastic lymphadenopathy (AILD) is a systemic disease clinically characterized by fever, generalized lymphadenopathy, hepatosplenomegaly, polyclonal gamma-globulinemia and Cooms' positive hemolytic anemia. The lymph node in AILD reveals a polymorphic feature consisting of a proliferation of small vessels, immunoblasts and plasma cells and acidophilic interstitial material. Progression into immunoblastic sarcoma is reported as high 35% of the patient with AILD. Nathwani et al have observed not only malignant transformation of AILD in sequential tissue examination, but also the coexistence of AILD and immunoblastic lymphoma in the same lymph node or at different sites in the same patient. Multiple clusters or islands of compactly arranged large lymphoid cells constitute the initial histologic evidence of immunoblastic sarcoma. Immunoblastic sarcoma is a large cell lymphoma conceptually related to transformed T-and B-lymphocytes of the extrafollicular compartment of the immune system, which proignosis is poor. We have recently experienced a case of immuno blastic sarcoma arising in angioimmunoblastic lymphadenopathy in a 24-year-old woman. She had history of multiple enlarged lymph nodes in the inguinal, axilla and supraclavicular areas. Previous lymph node biopsies revealed reactive change. Six month later, right axillary lymph node biopsy reveled AILD with focal clusters of immunoblasts. Subsequent lymph node biopsy at the same site revealed diffuse immunoblasic sarcoma, B-cell type. A case presentation with histologic findings and a brief review of literature were done.
Female ; Humans ; Biopsy

BACKGROUND: Although maximal exercise stress tests are widely used in the athletic and medical fields, studies on professional soccer players are few. The purpose of our study is to observe the cardiopulmonary response to maximal exercise loading and the AT in professional soccer players. METHODS: Maximal exercise stress tests were carried out by a ramp protocol using a treadmill on 20 professional soccer players with a mean age of 25.2 years and with over 10 career years. The tests were also done on 21 college students majoring in physical education with a mean age of 19.4 years, which served as the control group. The AT was determined by the V-slope method. RESULTS: In the players, the VO2 max, VCO2 max and O2 pulse max were significantly larger than those in the control group, and the HR max was smaller for their ages. The VE max, VT max and RP max showed not much difference between the 2 groups but the VE max/VO2 max and VE max/VCO2 max were significantly lower in the players. The AT was larger in the players but the AT/VO2 max was essentially similar to that of the control group. CONCLUSION: Our study reveals that the professonal soccer players, despite their mean ages were approximately 6 years older than the subjects in the control group, had larger VO2 max and VCO2 max, and smaller HR max for their ages. The VE max was similar in both groups. This suggests that the players have higher aerobic capacity than the control group and exchange respiratiory gases more efficiently.
Architectural Accessibility ; Child ; Exercise Test ; Gases ; Humans ; Physical Education and Training ; Soccer* ; Sports

Collagenofibrotic glomerulopathy is a relatively rare glomerular disease characterized by the accumulation of spiraled frayed collagen fibrils in mesangial and subendothelial areas. Clinically, patients with the disease usually present with moderate proteinuria and edema. They tend to have hypertension and their renal function deteriorates slowly. We report the case of a patient with collagenofibrotic glomerulopathy who also had Takayasus arteritis and presented with hypertension, proteinuria and dyspnea on exertion. Electron microscopy of the renal biopsy revealed massive accumulation of peculiar collagen fibers and immunohistology using monoclonal antibodies to collagen type III revealed positive stain in glomerular tufts.
Biopsy

Collagenofibrotic glomerulopathy is a relatively rare glomerular disease characterized by the accumulation of spiraled frayed collagen fibrils in mesangial and subendothelial areas. Clinically, patients with the disease usually present with moderate proteinuria and edema. They tend to have hypertension and their renal function deteriorates slowly. We report the case of a patient with collagenofibrotic glomerulopathy who also had Takayasus arteritis and presented with hypertension, proteinuria and dyspnea on exertion. Electron microscopy of the renal biopsy revealed massive accumulation of peculiar collagen fibers and immunohistology using monoclonal antibodies to collagen type III revealed positive stain in glomerular tufts.
Biopsy

Supravalvular aortic stenosis is an uncommon congenital narrowing of the ascending aorta that may be localized or diffuse, originating at the superior margin of the sinuses of Valsalva just above the level of the coronary arteries. The most common complication of supravalvular aortic stenosis is early onset of intimal hyperplasia and atherosclerosis of the coronary arteries. The coronary arterial lesions of supravalvular aortic stenosis are dilatation or coronary artery ostial obstruction. We experienced a case of supravalvular aortic stenosis combined with right coronary artery ostial obstruction. A 21 year-old female patient was admitted because of exertional dyspnea and chest pain for 2 months. Cardiac catheterization showed a narrowing of ascending aorta with prominent calcification in the lesion and moderate aortic valve insufficiency. The peak to peak left ventricular-supravalvular aortic pressure gradient was 54 mmHg. Selective coronary angiography revealed as a complete obstruction of the ostium of the right coronary artery. Surgical correction was performed successfully. Postoperative left ventricular-supravalvular aortic pressure gradient was decreased to 22 mmHg. Postoperative clinical course was favorable and she was discharged with good condition. We present a case of supravalvular aortic stenosis combined with right coronary artery ostial obstruction with a review of literatures.
Aorta ; Aortic Stenosis, Supravalvular* ; Aortic Valve Insufficiency ; Arterial Pressure ; Atherosclerosis ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels* ; Dilatation ; Dyspnea ; Female ; Humans ; Hyperplasia ; Young Adult

Primary renal angiosarcoma is a rare and fatal malignant tumor. About 20 cases have been reported in the literature, but there has been no report of renal angiosarcoma in Korea. A 67-year old man with end-stage renal disease was admitted to the hospital for left flank pain. A computed tomography examination revealed a subcapsular hemorrhage in the left kidney. The patient was discharged after 2 weeks of observation. However, at 6 weeks after the discharge, the patient revisited the outpatient clinic due to aggravating pain, and a left nephrectomy was performed. The histopathological diagnosis was angiosarcoma. Three weeks after the nephrectomy, a re-operation was performed because of uncontrolled intra-abdominal bleeding. The surgical findings revealed massive metastasis. The patient died of an uncontrolled hemorrhage about 1 week after the second surgery. To our knowledge, this is the first report of a renal angiosarcoma in a patient with end-stage renal disease. It should be noted that a renal angiosarcoma may be a cause of a retroperitoneal hematoma.
Aged ; Ambulatory Care Facilities ; Diagnosis ; Dialysis ; Flank Pain ; Hemangiosarcoma* ; Hematoma ; Hemorrhage ; Humans ; Kidney ; Kidney Failure, Chronic* ; Korea ; Neoplasm Metastasis ; Nephrectomy ; Renal Insufficiency

OBJECTIVE: The Ubiquitous Spaced Retrieval-based Memory Advancement and Rehabilitation Training (USMART) program was developed by transforming the spaced retrieval-based memory training which consisted of 24 face-to-face sessions into a self-administered program with an iPAD app. The objective of this study was to evaluate the feasibility and efficacy of USMART in elderly subjects with mild cognitive impairment (MCI). METHODS: Feasibility was evaluated by checking the satisfaction of the participants with a 5-point Likert scale. The efficacy of the program on cognitive functions was evaluated by the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery before and after USMART. RESULTS: Among the 10 participants, 7 completed both pre- and post-USMART assessments. The overall satisfaction score was 8.0+/-1.0 out of 10. The mean Word List Memory Test (WLMT) scores significantly increased after USMART training after adjusting for age, educational levels, baseline Mini-Mental Status Examination scores, and the number of training sessions (pre-USMART, 16.0+/-4.1; post-USMART, 17.9+/-4.5; p=0.014, RM-ANOVA). The magnitude of the improvements in the WLMT scores significantly correlated with the number of training sessions during 4 weeks (r=0.793; p=0.033). CONCLUSION: USMART was effective in improving memory and was well tolerated by most participants with MCI, suggesting that it may be a convenient and cost-effective alternative for the cognitive rehabilitation of elderly subjects with cognitive impairments. Further studies with large numbers of participants are necessary to examine the relationship between the number of training sessions and the improvements in memory function.
Aged ; Alzheimer Disease ; Cognitive Therapy ; Computer User Training ; Dementia ; Education* ; Humans ; Learning ; Memory* ; Mild Cognitive Impairment ; Rehabilitation*

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

PURPOSE: Valproic acid (VPA) has been used as an anticonvulsant for a long time. Recently, there are many reports on VPA activity with regards to intracellular signal transduction, including differentiation, proliferation, and apoptosis. We experienced several hematologic toxicities during the long-term use of VPA. Therefore, we investigated whether VPA has effects on short-term or long-term hematopoiesis with respect to differing concentrations. METHODS: We obtained bone marrow mononuclear cells (BMMNC) from a 5 week old female C3H/He strain mouse. The BMMNC were cultured in semi-solid media mixed with VPA according to the concentrations of colony forming unit for granulocyte-monocytes (CFU-GM). The concentrations of VPA were used as follows: 0.01 mM, 0.1 mM, 1 mM, and 10 mM (therapeutic level: 0.07~1.1 mM). We performed long-term liquid culture under VPA to compare the frequency of long-term culture initiating cells (LTC-IC) according to various VPA levels. RESULTS: The number of CFU-GM was highest with 1 mM of VPA (45.2+/-13.5), with higher therapeutic level than control (25.7+/-11.9), in 0.01 mM of VPA (26.5+/-12.1) and in 0.1 mM of VPA (26.6+/-12.2). In 10 mM of VPA, a toxic level of VPA, was the lowest at 1.6+/-1.1 (P< 0.01). In long-term culture, the frequency of LTC-IC was increased in 0.1 mM of VPA (67.7+/-16.3%), lower therapeutic level than in control (5.5+/-10.6%). In 1 mM of VPA, the high therapeutic level decreased to 81.6+/-9.3%. With toxic levels of VPA, 10 mM, there was no hematopoiesis. CONCLUSION: The VPA might enhance short-term hematopoiesis at high therapeutic levels, while preserving LTC-IC in long-term hematopoiesis under low therapeutic concentrations. Therefore, we suggest that VPA to be used within a low therapeutic level to escape from hematopoietic suppression when using VPA as long-term medication for seizure control.
Animals ; Apoptosis ; Bone Marrow ; Female ; Granulocyte-Macrophage Progenitor Cells ; Hematopoiesis ; Humans ; Mice* ; Seizures ; Signal Transduction ; Stem Cells ; United Nations ; Valproic Acid*

BACKGROUND: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Although postoperative AF is regarded as benign, transient and self-limited, it has been associated with increased morbidity, thromboembolic events and an increased duration and cost of hospitalization. MATERIAL AND METHOD: From January 1994 to December 2007, 190 patients that had isolated CABG surgery were divided into two groups. Group 1 (n=139) involved those who had postoperative atrial fibrillation, and group 2 (n=51) did not have any such events. We reviewed the medical records retrospectively including the incidence of postoperative AF, patient characteristics, surgery related factors and the outcome of the patients with postoperative AF. RESULT: The frequency of postoperative AF was 26.8%, the conversion rate to regular sinus rhythm before discharge was 82.4%; 82.4% of the AF developed within the first three postoperative days. Although the postoperative AF group was significantly older and had a prolonged postoperative Intensive care unit (ICU) stay, there was no difference in the aortic crossclamp time or duration of hospitalization. No spontaneous defibrillation at declamping, and longer duration of cardiopulmonary bypass were significantly related to the development of postoperative AF. However, postoperative treatment with a beta blocker was associated with a decreased incidence of postoperative AF. The multivariate analysis showed that age and ICU stay were significantly associated with the development of POAF. Spontaneous defibrillation and postoperative beta blocker treatment were significantly associated with a decreased frequency of POAF. CONCLUSION: AF after CABG surgery is a common complication associated with increased morbidity and a longer ICU stay. Therefore, various strategies aimed at reducing AF, and its complications, such as postoperative treatment with a beta blocker should be considered.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Transplants