BACKGROUND: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. METHODS: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) (2.6 ≤ DAS28 < 3.2). RESULTS: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (−0.38 vs. −0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). CONCLUSION: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Asian Continental Ancestry Group* ; Demography ; Follow-Up Studies ; Humans ; Joints ; Korea* ; Multicenter Studies as Topic* ; Prescriptions ; Rheumatic Diseases ; Rheumatoid Factor ; Treatment Outcome

BACKGROUND AND OBJECTIVES: We compared the efficacy and safety of valsartan and rosuvastatin combination therapy with each treatment alone in hypercholesterolemic hypertensive patients. SUBJECTS AND METHODS: Patients who met inclusion criteria were randomized to receive 1 of the following 2-month drug regimens: valsartan 160 mg plus rosuvastatin 20 mg, valsartan 160 mg plus placebo, or rosuvastatin 20 mg plus placebo. The primary efficacy variables were change in sitting diastolic blood pressure (sitDBP) and sitting systolic blood pressure (sitSBP), and percentage change in low-density lipoprotein-cholesterol (LDL-C) in the combination, valsartan, and rosuvastatin groups. Adverse events (AEs) during the study were analyzed. RESULTS: A total of 354 patients were screened and 123 of them were finally randomized. Changes of sitDBP by least squares mean (LSM) were -11.1, -7.2, and -3.6 mm Hg, respectively, and was greater in the combination, as compared to both valsartan (p=0.02) and rosuvastatin (p<0.001). Changes of sitSBP by LSM were -13.2, -10.8, and -4.9 mm Hg, and was greater in the combination, as compared to rosuvastatin (p=0.006) and not valsartan (p=0.42). Percentage changes of LDL-C by LSM were -52, -4, and -47% in each group, and was greater in the combination, as compared to valsartan (p<0.001), similar to rosuvastatin (p=0.16). Most AEs were mild and resolved by the end of the study. CONCLUSION: Combination treatment with valsartan and rosuvastatin exhibited an additive blood pressure-lowering effect with acceptable tolerability, as compared to valsartan monotherapy. Its lipid lowering effect was similar to rosuvatatin monotherapy.
Blood Pressure ; Drug Therapy, Combination ; Humans ; Least-Squares Analysis ; Rosuvastatin Calcium ; Valsartan

In this article, on page 230, Fig. 2A needs to be corrected.

OBJECTIVE: To validate the usefulness of a diffusional anisotropic capillary array phantom and to investigate the effects of diffusion tensor imaging (DTI) parameter changes on diffusion fractional anisotropy (FA) and apparent diffusion coefficient (ADC) using the phantom. MATERIALS AND METHODS: Diffusion tensor imaging of a capillary array phantom was performed with imaging parameter changes, including voxel size, number of sensitivity encoding (SENSE) factor, echo time (TE), number of signal acquisitions, b-value, and number of diffusion gradient directions (NDGD), one-at-a-time in a stepwise-incremental fashion. We repeated the entire series of DTI scans thrice. The coefficients of variation (CoV) were evaluated for FA and ADC, and the correlation between each MR imaging parameter and the corresponding FA and ADC was evaluated using Spearman's correlation analysis. RESULTS: The capillary array phantom CoVs of FA and ADC were 7.1% and 2.4%, respectively. There were significant correlations between FA and SENSE factor, TE, b-value, and NDGD, as well as significant correlations between ADC and SENSE factor, TE, and b-value. CONCLUSION: A capillary array phantom enables repeated measurements of FA and ADC. Both FA and ADC can vary when certain parameters are changed during diffusion experiments. We suggest that the capillary array phantom can be used for quality control in longitudinal or multicenter clinical studies.
Anisotropy ; Diffusion Magnetic Resonance Imaging/*instrumentation/*methods ; Diffusion Tensor Imaging/*instrumentation/*methods ; Humans ; *Phantoms, Imaging ; Research Design ; Signal-To-Noise Ratio

PURPOSE: Our experience of laparoscopic radical prostatectomy, for clinically localized prostate cancer, is reported. MATERIALS AND METHODS: Between July 2001 and August 2002, laparoscopic radical prostatectomy was performed on 16 patients with clinically organ confined prostate cancer. Their mean age, preoperative PSA and Gleason score for the biopsy specimens were 63.9 years old, 12.2ng/ml and 5.6, respectively. The "Montsouris" operation technique was followed, and an urethrovesical anastomosis performed with 5 to 10 interrupted sutures. RESULTS: Mean operation time and hospital stay were 347 minutes, ranging from 250 to 500, and 8.3 days, ranging from 3 to 12. Conversion to open surgery was necessary in one case due to difficulty with the urethrovesical anastomosis. Three cases needed a blood transfusion with a mean of 2.3 units. Mean postoperative period of an indwelling Foley catheter was 15.4 days (5-36). The intraoperative complications related to the operation procedures were one epigastric artery injury and two vesicle injuries. There was a positive surgical margin in five cases. The postoperative pathological evaluations comprised of 1 pT0, 5 pT2a, 3 pT2b and 7 pT3a. The PSA value decreased to less than 0.5ng/ml after the laparoscopic radical prostatectomy, with the exception of one case. CONCLUSIONS: Although the mean operation time was still longer than that of conventional open procedures, an intraoperative magnified vision allows for more precise and safer dissections and a meticulous urethrovesical anastomosis. We believe the operative time will decrease further with more experience. The perioperative morbidity with the laparoscopic radical prostatectomy was low. The continence following a laparoscopic radical prostatectomy was comparable to that after an open radical prostatectomy. These results show that a laparoscopic radical prostatectomy can be an acceptable treatment option for localized prostate cancer.
Biopsy ; Blood Transfusion ; Catheters ; Conversion to Open Surgery ; Epigastric Arteries ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Neoplasm Grading ; Operative Time ; Postoperative Period ; Prostate ; Prostatectomy* ; Prostatic Neoplasms ; Sutures

Pelvic actinomycosis is a chronic suppurative and granulomatous disease with multiple abscess and draining sinus tracts caused by Actinomyces, a Gram-positive, anaerobic, non-acid-fast bacterium. Pelvic actinomycosis is a rare disease, but it is more common with intrauterine device users than others. The symptoms and signs of pelvic actinomycosis are variable, from asymptomatic to mimicking the symptoms and signs of pelvic mass or acute peritonitis, and sometimes it is difficult to discriminate pelvic malignancy from actinomycosis. Identifying the typical "sulfur granule" with hematoxylin-eosin stain and detecting the actinomycotic colony in Gram stain may suggest the diagnosis. We have experienced a case of pelvic actinomycosis complicated by right tuboovarian abscess in a 39-year-old woman using intrauterine device and report it with brief review of literatures.
Abscess* ; Actinomyces ; Actinomycosis* ; Adult ; Diagnosis ; Female ; Humans ; Intrauterine Devices ; Peritonitis ; Rare Diseases

Pelvic actinomycosis is a chronic suppurative and granulomatous disease with multiple abscess and draining sinus tracts caused by Actinomyces, a Gram-positive, anaerobic, non-acid-fast bacterium. Pelvic actinomycosis is a rare disease, but it is more common with intrauterine device users than others. The symptoms and signs of pelvic actinomycosis are variable, from asymptomatic to mimicking the symptoms and signs of pelvic mass or acute peritonitis, and sometimes it is difficult to discriminate pelvic malignancy from actinomycosis. Identifying the typical "sulfur granule" with hematoxylin-eosin stain and detecting the actinomycotic colony in Gram stain may suggest the diagnosis. We have experienced a case of pelvic actinomycosis complicated by right tuboovarian abscess in a 39-year-old woman using intrauterine device and report it with brief review of literatures.
Abscess* ; Actinomyces ; Actinomycosis* ; Adult ; Diagnosis ; Female ; Humans ; Intrauterine Devices ; Peritonitis ; Rare Diseases

OBJECTIVE: We analyzed the clinical and endocrinological results of the transsphenoidal microsurgery for ACTH secreting pituitary adenomas. MATERIALS AND METHODS: From October 1995 to August 2000, 18 patients underwent transsphenoidal microsurgery for Cushing's disease. We analyzed the surgical results of 17 patients, one patient who was previously operated from other hospital was excluded. Age of the patients were 18 to 61 years old(mean 37.7), male to female ratio was 1: 3.3, and follow-up period was 3 to 50 months(mean 20.3). The selection of candidates for transsphenoidal exploration was based on endocrinologic criteria. Magnetic resonance imaging was the preferred radiologic test. Selective inferior petrosal sinus sampling of adrenocorticotropic hormone futher refined the diagnosis when endocrinologic and radiologic procedures were not definitive. RESULTS: Results of the preoperative endocrinological test were: level of serum ACTH 29.4 to 225ng/dL(mean 93.88ng/dL); serum cortisol 11.9 to 47.5ng/dL(mean 27.49ng/dL); 24-hour urine free cortisol 235 to 1019ng/day(mean 571.0ng/day). Inferior petrosal sinus sampling for ACTH was performed in 11 patients and all were confirmed by Cushing's disease and we could predict the laterality of the tumor in 9 of 11 patients. We performed transsphenoidal selective adenomectomy in 5 patients, adenomectomy and subtotal hypophysectomy in 2 patients, adenomectomy and partial hypophysectomy in 9 patients, and in the remaining one patient, hemihypophysectomy followed by total hypophysectomy due to remission failure. Fifteen of 17 patients(88.2%) showed endocrinological remission. Glucocorticoid replacement therapy was performed in all the patients who showed remission for 1 to 24 months(mean 5.9 months), and 6 patients received steroid over 6 months. CONCLUSION: We conclude that the direct demonstration of a tumor in the pituitary gland by MRI is the most important and definitive diagnostic tool and the location of a mass should be confirmed with increased level of ACTH by the inferior petrosal sinus sampling. Transsphenoidal microsurgery is effective treatment modality for Cushing's disease and the immediate postoperative evaluation of the surgical resection of the tumor is very important. The patients should show hypocortisolism, decreased, subnormal serum ACTH and cortisol levels and 24-hours urine free cortisol. We performed 18 transsphenoidal microsurgery for Cushing's disease in 17 patients and 15 patients(88.2%) showed endocrinological remission.
ACTH-Secreting Pituitary Adenoma ; Adrenocorticotropic Hormone ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hydrocortisone ; Hypophysectomy ; Magnetic Resonance Imaging ; Male ; Microsurgery* ; Petrosal Sinus Sampling ; Pituitary Gland

Since the Inoue balloon was first introduced for percutaneous mitral valvuloplasty (PMV) in 1984, this procedure has come into widespread use because of its effectiveness, simplicity, and reduced exposure to X-ray radiation. It's the procedure's complications include cardiac tamponade, atrial septal defect, thromboembolism, ventricular perforation, mitral regurgitation, and rarely balloon rupture. We report a case of Inoue balloon deformity during PMV in 62-year old woman with rheumatic mitral stenosis. Echocardiography revealed severe rheumatic mitral stenosis with a valvular area of 0.95 cm2 (by pressure half-time method), and an Echo score of 10 points. The PMV with Inoue balloon 28 mm was performed. We inflated the balloon to 28 mm in diameter first, and to 29 mm second. A bulging deformity with asymmetrical overinflation of one side of both proximal and distal balloon was recognized. A bulging deformity at the proximal part of Inoue balloon after second inflation. Balloon was not ruptured. Following completion of the procedure, the mitral valve area increased to 1.8 cm2. Moderate mitral regurgitation (grade II) was newly developed. This may be the first case of asymmetrical one side inflation and focal bulging deformity reported in Korea.
Cardiac Tamponade ; Congenital Abnormalities* ; Echocardiography ; Female ; Heart Septal Defects, Atrial ; Humans ; Inflation, Economic ; Korea ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Rupture ; Thromboembolism

No abstract available.
Arteries* ; Atherectomy*