Rheumatic manifestations in non-Hodgkin's lymphoma (NHL) are common but actual arthritis as a presenting feature appears to be very rare. We experienced a case of NHL presenting as polyarthritis in a 24-year-old woman. Eight months ago she was admitted to the hospital due to polyarthritis and skin rash. She had pleural and pericardial effusion. Antinuclear antibody was positive and rheumatoid factor was negative. Joint X-ray showed periarticular osteopenia at both knees, wrists, hands and feet. Prednisolone, salsalate and anti-tuberculosis drugs were administered under the impression of either probable lupus or rheumatoid arthritis and pleural tuberculosis. After then pleuropericardial effusion and skin rash improved. But polyarthralgia persisted and she developed right cervical lymphadenopathy. On her second admission she was found to have a round mass in left lower lung field and multiple mediastinal lymph node enlargement. Cervical lymph node biopsy revealed non-Hodgkin's lymphoma. She received 8 cycles of systemic chemotherapy until 1996 July. NHL was remitted completely and polyarthralgia disappeared. We report a case of non-Hodgkin's lymphoma presenting as polyarthritis and literatures are reviewed.
Antibodies, Antinuclear ; Arthralgia ; Arthritis* ; Arthritis, Rheumatoid ; Biopsy ; Bone Diseases, Metabolic ; Drug Therapy ; Exanthema ; Female ; Foot ; Hand ; Humans ; Joints ; Knee ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma, Non-Hodgkin* ; Pericardial Effusion ; Prednisolone ; Rheumatoid Factor ; Tuberculosis, Pleural ; Wrist ; Young Adult

The effects of chimeric monoclonal antibodies (cMAbs), prostaglandin E, (PGE,), and indomethacin (INDO) on antibody-dependent cellular cytotoxicity (ADCC) against human squamous cell carcinoma of head and neck (SCCHN) cell line were examined. Using the PCI-50 SCCHN cell line as target and normal human peripheral blood mononuclear cells as effector, ADCC was enhanced by the treatment of cMAbs (1.25 p,g/ml), but was inhibited by exogenous PGE (5 X 10' M). The effects of cMAb and PGE were dose-dependent. Maximal suppression of activity occured when PGE was present during the entire 4-hr 'Cr-release assay period, whereas pretreatment of effector cells with PGE had minimal inhibitory effect after washing. These results indicate that decreased ADCC seen with SCCHN targets treated with PGE is related to post-binding events, such as binding of effector and target cells. Pre-treatment of effector cells with INDO (1 ug/ml) resulted in restoration of NK activity which was inhibited by PGE. Our in vitro results suggest that INDO can increase tumor cell killing by the reversal of the suppression for many imrnune functions by PGE.
Antibodies, Monoclonal ; Antibody-Dependent Cell Cytotoxicity ; Carcinoma, Squamous Cell* ; Cell Line ; Head* ; Homicide ; Humans* ; Indomethacin ; Neck* ; Prostaglandins E

Mycosis fungoides(MF) is representative of cutaneous lymphoma and over many years progresses to plaques and tumors steadily. The extent and type of skin lesions at initial diagnosis and the presence of extracutaneous involvement are predictive indicators of survival in MF patients. Patients with limited plaque lesions are the least likely to have extracutaneous involvement and thus have the longest survival similar to the control population. We report a case of 45-year-old woman, who developed multiple subcutaneous nodules in normally appearing skin during photochemotherapy (PUVA). She had been treated with PUVA for the limited pre-mycotic skin lesions (T1 stage), which themselves showed good response to the treatment. She experienced the insidious course of early stage, but thereafter rapidly progressed to the tumor stage unusually during treatment.
Diagnosis ; Female ; Humans ; Lymphoma ; Middle Aged ; Mycosis Fungoides* ; Photochemotherapy ; Skin

Background: The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. Methods: We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. Results: The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%–98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%–98.8%). Conclusions The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.

BACKGROUND/AIMS: Histoacryl forms hard substances in an instance after a brief exposure to polar liquid, blood or body temperature. This often causes obstruction of injector and endoscopic channel. Furthermore, splashed Histoacryl during injection can lead to accidental loss of vision. We propose a new convenient method of Histoacryl-lipiodol sequential injection and report the results. METHODS: From May 2001 to August 2004, sequential injector method was performed in treating consecutive thirty gastric varices patients. Histoacryl (S.G. 1.0) 1 mL and lipiodol (S.G. 1.28) 1~1.5 mL are filled in 2.5 mL disposable syringe with 16 gauge needle, which are separated into two compartments by specific gravity difference. The injector attached side of charged syringe is gently placed upward and the piston is pushed after the lesion site puncture. Then, normal saline is promptly infused to wash out and the needle is withdrawn. RESULTS: There were 26 males and 4 females. 4 had active bleeding and 26 had the stigmata of bleeding. Varices types were Lg-c in 10, Lg-cf in 16 and Lg-f in 4 patients and the Child-Pugh classification were A in 17%, B in 53% and C in 30%. The average amount was 1.53 mL. Initial hemostasis rate was 97%, 3 of patients re-bled in 4 weeks and 2 patients later. One patient died after the procedure and a case of procedure related bacteremia has occurred. CONCLUSIONS: Histoacryl-lipiodol sequential injection by specific gravity difference is convenient and safe. Also, it carries less damage to the instruments.
Bacteremia ; Body Temperature ; Christianity ; Classification ; Enbucrilate ; Esophageal and Gastric Varices* ; Ethiodized Oil ; Female ; Hemorrhage* ; Hemostasis ; Humans ; Male ; Needles ; Punctures ; Specific Gravity ; Syringes ; Varicose Veins

BACKGROUND: Both Helicobacter pylori (H. pylori) cagA, vacA, iceA genotype and host IL-1B/IL-1RN polymorphisms play a role in determining the clinical consequences of H. pylori infection. This study aimed to investigate whether there might be any combinations of H. pylori cagA, vacA, iceA genotype and host IL-1B/IL-1RN polymorphisms that are particularly associated with the occurrence of gastric carcinoma in Korean patients. METHODS: This study population was comprised of 239 patients with H. pylori infection: 122 with gastric carcinoma and 117 with gastritis only. DNA was isolated from gastric biopsy sample and H. pylori cagA, vacA and iceA genotype were determined by PCR. IL-1B-511 polymorphisms were genotyped by PCR-RFLP and IL-1RN polymorphisms were analyzed with variable number of tandom repeat after PCR. RESULTS: H. pylori cagA, vacA, and iceA genotype were not associated with an increased risk for gastric carcinoma. IL-1B-511*T carriers and IL-1RN*2 carriers did not show increased risk for gastric carcinoma. On combination of bacterial/host genotypes, cagA+/IL-1B-511*T carriers and cagA+/IL-1RN*2 carriers, vacA s1/IL-1B-511*T carriers, vacA s1/IL-1RN*2 carriers, vacA m1/IL-1B-511*T carriers, vacA m1/IL-1RN*2 carriers, iceA1/IL-1B-511*T carriers, iceA1/IL-1RN*2 carriers showed no increased risk of gastric carcinoma. CONCLUSIONS: Combined H. pylori cagA, vacA, iceA genotype and host IL-1B/IL-1RN polymorphisms shows no increased risk of gastric carcinoma. Therefore, it seems other endogenous or exogenous factors may play more important role in the development of gastric carcinoma in Korean.
Biopsy ; DNA ; Gastritis ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Interleukin-1* ; Interleukin-1beta* ; Polymerase Chain Reaction ; Stomach Neoplasms

PURPOSE: Recently, the importance of early diagnosis and early treatment has been increasing, and there are many cases where tumors have been discovered incidentally. However, due to lack of reports regarding pancreatic cases, the clear management plan remains in dispute. This study attempted to analyse pancreatic cases so as to offer a management direction. METHODS: From October 1994 to May 1999, we experienced 28 cases of incidentally discovered pancreatic tumors and those cases were reviewed retrospectively. RESULTS: In regards to initial referrals for diagnosis, 19 cases were from general medical examinations, and 9 cases were referred due to symptoms or signs not related to their tumors (2 cases with hepatitis B, 2 cases with lung lesions, 1 case with a gastric leiomyosarcoma, 1 case with vaginal bleeding, 1 case with acute enteritis, 1 case with a toothache and 1 case with a headache). Twenty cases were initially detected from abdominal US, 3 cases from abdominal CT, 2 case from chest CT, 2 case from the simple abdomen, and 1 case from CA 19-9 investigation. The accuracies for diagnosing the precise type of tumor were CT 42.3% (11/26), ERCP 15.3% (2/13), abdominal US 12.5%, and (3/24). Postoperative pathologies included 7 serous cystadenomas, 6 solid-pseudopapillary tumors, 4 mucinous cystic neoplasms, 4 nonfunctioning islet cell tumors, 2 intraductal papillary mucinous neoplasms, 2 simple cysts, 1 ductal adenocarcinoma, 1 benign retension cyst, and 1 pseudocyst. Among these were 5 malignant neoplasms (3 nonfunctional islet cell tumors, 1 ductal adenocarcinoma, and 1 mucinous cystic neoplasm), and 17 cases (60.7%) were premalignant tumors. All cases were treated with a pancreatic resection, and postoperative follow-up was carried out for a period of 3-66 months. During thisperiod, no recurrence or mortality was noted other than 1 case of liver metastasis 12 months postoperatively for ductal adenocarcinoma. CONCLUSION: Although presence of a ductal adenocarcinoma is rare in incidentally discovered pancreatic tumors pancreatic incidentaloma is common in premalignant neoplasms. Therefore, even in asymptomatic cases, aggressive surgical resection is necessary for accurate diagnosis and early treatment.
Abdomen ; Adenocarcinoma ; Adenoma, Islet Cell ; Cholangiopancreatography, Endoscopic Retrograde ; Cystadenoma, Serous ; Diagnosis ; Dissent and Disputes ; Early Diagnosis ; Enteritis ; Follow-Up Studies ; Hepatitis B ; Leiomyosarcoma ; Liver ; Lung ; Mass Screening* ; Mortality ; Mucins ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Pathology ; Recurrence ; Referral and Consultation ; Retrospective Studies ; Tomography, X-Ray Computed ; Toothache ; Uterine Hemorrhage

Subacute necrotizing lymphadenitis is a benign form of lymphadenitis that was first described in Japan by Kikuchi in 1972. It mainly affects young women and usually manifests as fever and lymphadenopathy. Although it is a benign self-limited lymphadenitis, it has been misdiagnosed as malignant lymphoma. Histologically, involved lymph nodes contain a necrotizing process characterized by patch, well-circumscribed area with eosinophilic fibrinoid material. There is a striking degree of karyorrhexis and an absence of granulocyte with paucity of plasma cell. We expereinced a case of subacute necrotizing lymphadenitis in a 3 year old boy. There was spontaneous resolution of fever and lymphadenopathy, and now he keeps doing well.
Child* ; Child, Preschool* ; Eosinophils ; Female ; Fever ; Granulocytes ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Japan ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Lymphoma ; Male* ; Plasma Cells ; Strikes, Employee

PURPOSE: To compare the accuracy of digital subtraction images acquired by two different methods different in positioning four reference points for geometrical standardization. MATERIALS AND METHODS: A total of 36 digital radiographic images of 6 volunteers were taken at the areas of the incisor, premolar, and molar of both the maxilla and mandible using the Digora system. Each image was moved 4 mm vertically and horizontally. Four oral and maxillofacial radiologists performed digital subtraction radiography between the paired images before and after movement using Emago (Oral Diagnostic Systems, Amsterdam, The Netherlands) and Sunny (Biomedisys Co., Seoul, Korea). The standard deviation of the internal gray value in Region of Interest (ROI) was statistically analyzed between the two programs using the paired t-test. RESULTS: The standard deviation of pixel gray values from the digital subtraction images using the Sunny program were lower than that of the Emago program (p<0.05). All observers showed significant differences between each other when the Sunny program was used (p<0.05), but one observer showed a significantly higher score than other observers when they used Emago (p<0.05). The standard deviations of premolar area from both Sunny and Emago programs were significantly higher than those of anterior and molar regions (p<0.05). CONCLUSION: The subtracted images using the Sunny program were more accurate and sensitive than those taken using the Emago program.
Bicuspid ; Incisor ; Mandible ; Maxilla ; Molar ; Radiography* ; Radiography, Dental, Digital ; Seoul ; Subtraction Technique ; Volunteers

There has been a worldwide pandemic infection of influenza A (H1N1) since June 2009. A 23-year-old female presented with fever and sore throat and was diagnosed as having influenza A (H1N1) infection. After 2 days of illness, she had headache, nausea, and neck stiffness. Cerebrospinal-fluid findings were consistent with viral infection, and brain MRI revealed intense signals in both frontotemporal cortices. During her illness she developed repetitive seizures, which were considered to be status epilepticus.
Brain ; Encephalitis ; Encephalitis, Viral ; Female ; Fever ; Headache ; Humans ; Influenza, Human ; Nausea ; Neck ; Pandemics ; Pharyngitis ; Seizures ; Status Epilepticus ; Young Adult