Primary Sjogren's syndrome is a chronic autoimmune disorder characterized by xerostomia and keratoconjunctivitis sicca result from lymphocytic infiltrations of salivary and lacrimal glands.It may accompany by the wide spectrums of extraglandular symptoms,such as musculoskeletal,pulmonary,renal,intestinal,hematologic,and nervous system.However,overt cardiac manifestations are very rare and are documented only a few cases sporadically. We report a patient with primary Sjogren's syndrome who developed reversible congestive heart failure as part of a myocarditis.A 39-year-old woman with primary Sjogren's syndrome developed fatigue,dyspnea,and abdominal discomfort.An echocardiography revealed global hypokinetic left ventricle with markedly decreased ejection fraction (EF=39%),abnormal restrictive filling pattern,secondary tricuspid valve insufficiency and no pericardial effusion or thickening.A myocardial biopsy disclosed myocardial degeneration with lymphocyte infiltration.Following treatment with digitalis,diuretics,ACE inhibitor and corticosteroid,the symptoms of congestive heart failure improved.A repeat echocardiography showed an improved ventricular contractility and recovered both diastolic (normalized E/A ratio)and systolic (EF=50%)functions.
Adult ; Biopsy ; Echocardiography ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Keratoconjunctivitis Sicca ; Lymphocytes ; Myocarditis* ; Pericardial Effusion ; Sjogren's Syndrome* ; Tricuspid Valve Insufficiency ; Xerostomia

PURPOSE: To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment. MATERIALS AND METHODS: In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites. RESULTS: The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (> or =37 U/mL) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001). CONCLUSION: Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Celiac Artery ; Cystic Duct ; Disease-Free Survival ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Ligaments ; Mesenteric Artery, Superior ; Multivariate Analysis ; Prognosis ; Radiotherapy, Adjuvant* ; Recurrence ; Risk Factors ; Survival Analysis ; Survival Rate

Low grade MALT lymphoma of stomach is associated with H. pylori infection in more than 90% of cases, and eradication of H. pylori leads to regression of the low grade MALT lymphoma in 60~90% of cases. On the contrary, high grade MALT lymphoma is thought to be independent from H. pylori for growth and usually is thought to require antitumor chemotherapy. However, there have been recent reports of high grade MALT lymphoma regressing after H. pylori eradication. We experienced and are reporting a case of high grade MALT lymphoma arising in the background of low grade MALT lymphoma that showed complete regression after H. pylori eradication.
Drug Therapy ; Helicobacter pylori* ; Helicobacter* ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Stomach

PURPOSE: The aim of this study was to examine the expression of E-cadherin, beta-catenin, Cdx2, MMP7 in gastric cancer and to evaluate the clinical significance of these molecules in tumor recurrence within 2 years of pT2 and N1/N2 gastric cancer. METHODS: In 122 patients who underwent radical resection of gastric cancer, we investigated the association between the expression of these molecules and clinicopathologic factors by immunohistochemistry. The included criteria were pT2 and N1 or N2 (6th AJCC TNM). RESULTS: The expression of MMP7 was significantly associated with N stage (N1 vs. N2) (P=0.011). The negative expression of beta-catenin was strongly correlated with tumor recurrence within a 2-year period. However, the expression of these molecules was not related with recurrent sites. Multivariate analysis demonstrated that negative expression of beta-catenin was an independent predictor for tumor recurrence within 2 years (OR 2.366; 95% CI 1.056~5.297; P=0.036). CONCLUSION: Negative expression of beta-catenin may serve as a significant indicator for predicting tumor recurrence within a 2-year period in pT2 and N1/N2 gastric cancer.
beta Catenin ; Cadherins ; Humans ; Immunohistochemistry ; Multivariate Analysis ; Recurrence ; Stomach Neoplasms

Extrapulmonary small cell carcinoma is a highly malignant and poorly differentiated neuroendocrine tumor. The overall incidence in the United States is approximately 0.1~0.4%. Moreover, small cell carcinoma of the liver is extremely rare and few cases have been reported in the literature. We experienced a 65-year-old woman with a 15 cm hepatic mass, which was localized in the left lobe of a noncirrhotic liver. The mass was confirmed as small cell carcinoma by immunohistochemical staining of a biopsy specimen. Other possible primary sites were excluded by radiologic and endoscopic evaluations. The patient was treated with combination chemotherapy. She was in partial response on the last follow-up visit.
Aged ; Biopsy ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Incidence ; Liver ; Neuroendocrine Tumors ; United States

Wegener's granulomatosis is a rare disease that pathologically causes necrotizing granulomatous vasculitis in the arterioles and venules and it can invade the whole body. In addition, it is difficult to distinguish between a nontuberculous mycobacteria infection that shows manifestations of granuloma and Wegener's granulomatosis. There has been no reported on a patient who had the 2 abovementioned two diseases at the same time. A 69 year old male patient had Wegener's granulomatosis that had invaded the prostate. He also had a scrotal swelling and back pain. He had manifestations of granulomatous infection on the scrotum and spine biopsies. However, there was no clinical evidence of Wegener's granulomatosis. As a result, we examined him for other diseases that can cause a granuloma. Consequently, he was also diagnosed as suffering with a nontuberculous mycobacteria infection. We report here on this case and we review the relevant medical literature.
Arterioles ; Back Pain ; Biopsy ; Granuloma ; Humans ; Male ; Nontuberculous Mycobacteria ; Prostate ; Rare Diseases ; Scrotum ; Spine ; Stress, Psychological ; Vasculitis ; Venules ; Wegener Granulomatosis

PURPOSE: Primary gastrointestinal lymphoma is the most common form of extranodal lymphoma. The clinical features, histological distributions, treatment results and prognosis of the primary intestinal lymphoma were evaluated. METHODS: A retrospective study was performed on 62 patients with primary intestinal lymphoma, as defined by Lewin's criteria, from May 1990 to February 2002. The WHO classification and Ann Arbor staging system were used for histological classification and staging, respectively. RESULTS: The sex ratio of the patients was 43: 19 (male: female), and the median age was 54 years. Abdominal pain, a palpable mass, and bleeding were the most frequent symptoms on presentation. The ileocecal area was the most frequent pathological site. Fifty-three cases were non- Hodgkin's lymphoma of B-cell origination; all of the remaining were T-cell originated. The mean survival period of B-cell and T-cell originated were 59.3 and 14.3 months, respectively (P<0.05). The 5 year survival rates of the patients in stage IE and IIE, and stage IIIE and IVE, were 52.4 and 32.6%, respectively (P=0.03). Six patients received surgery, 17 chemotherapy, and 39 surgery with adjuvant chemotherapy. Among the patients confined to stage IE and IIE, the 3 year survival rates of the surgery and surgery with adjuvant chemotherapy groups were 34 and 84%, respectively (P=0.0049). CONCLUSION: Primary gastrointestinal lymphoma of B-cell origination was predominant in relation to the WHO classification and revealed a better prognosis when compared to the T-cell originated lymphoma. For the patients with localized intestinal lymphoma, multimodality treatment (surgery with adjuvant chemotherapy) is preferred to the sole administration of chemotherapy.
Abdominal Pain ; B-Lymphocytes ; Chemotherapy, Adjuvant ; Classification ; Drug Therapy ; Hemorrhage ; Hodgkin Disease ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Prognosis ; Retrospective Studies ; Sex Ratio ; Survival Rate ; T-Lymphocytes

BACKGROUND AND OBJECTIVES: The inflammatory reaction is affected by the genotype or phenotype of genes related with inflammation modulating cytokines and allergen metabolizing enzyme. This study was performed to investigate the relationship between N-acetyl transferase 2 (NAT2), tumor necrosis factor-alpha(TNF-alpha), transforming growth factor-beta(TGF-beta) and the allergic rhinitis in Korea. SUBJECTS AND METHOD: One hundred forty five allergic rhinitis patients and 167 controls were included. Venous blood samples were collected and the genotypes were analyzed by PCR technique. NAT2 phenotypes were designated as 'high', 'medium' and 'low' by known genotype-phenotype relationship. TNF-alpha genotypes were classified as 'A/A', 'A/G' and 'G/G'. TGF-beta genotype was classified as 'Arg/Arg', 'Arg/Pro' and 'Pro/Pro'. These data were analyzed by SAS for windows ver 8.02. RESULTS: The phenotype of NAT2 and genotype of TGF-beta showed no significant effect on allergic rhinitis. G/G or G/A genotype of TNF-alpha significantly increases the risk of allergic rhinitis. High activity phenotype of NAT2 showed higher level of total serum IgE. CONCLUSION: Genetic factors including TGF-beta are important in the development of allergic rhinitis in Korea. NAT2 phenotype affect allergic reaction.
Cytokines ; Genotype* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inflammation ; Korea* ; Necrosis ; Phenotype ; Polymerase Chain Reaction ; Rhinitis* ; Transferases ; Transforming Growth Factor beta* ; Tumor Necrosis Factor-alpha*

Background: This study aimed to evaluate exposure to various hazardous substances emitted by incineration facilities and their likely effect on the health for residents of Bugi-myeon, Cheongju, Korea, which has three incineration facilities. Methods: Heavy metals, polycyclic aromatic hydrocarbons (PAHs), and dioxin concentrations in the air and soil of exposed and control areas were measured. Moreover, the exposure levels to harmful substances and its effects on health were investigated in 1,124 exposed and 232 control adults. Results: PAHs and dioxin concentrations in the air in the exposed area were significantly higher than in the control area. Urinary cadmium and PAHs metabolite concentrations were significantly higher in the exposed group than in the control group. The exposure group also had a higher prevalence of depression and self-reported allergic symptoms than the control group. Conclusion The possibility of residents in Bugi-myeon being exposed to hazardous substances at incineration facilities cannot be ruled out. To prevent them from further exposure to hazardous substances, it is necessary to prohibit the expansion of additional incineration facilities in this area and to implement continuous monitoring projects for residents

Placental chorioangioma is a benign non-trophoblastic tumor of the placenta that can have various adverse effects on the mother and fetus depending on its size. Chorioamniotic membrane separation is rare condition of detachment between the amniotic membrane and chorionic membrane. Chorioamniotic membrane separation after the second trimester of pregnancy is usually occurs after invasive procedures or may occur spontaneously; it is mostly associated with fetal abnormalities. Here, we report a case of chorioamniotic membrane separation that might be occurred caused by the seromucinous secretion from a placental chorioangioma.
Amnion ; Chorion ; Female ; Fetus ; Hemangioma* ; Humans ; Membranes* ; Mothers ; Placenta ; Pregnancy ; Pregnancy Trimester, Second