Immunoglobulin G4 (IgG4)-related disease (IgG4RD) is a relatively recently recognized entity that is histopathologically characterized by an extensive infiltration of lymphocytes and IgG4-positive plasma cells with dense fibrosis. IgG4RD is now known to affect any organ system, and a few cases of gastrointestinal lesions have also been reported. However, solitary IgG4RD of the stomach is still very rare. Furthermore, as it can mimic malignant conditions, it is important to recognize this disease to avoid unnecessary surgery. Herein, we present a case of IgG4RD presenting as an isolated subepithelial mass in the stomach.
Fibrosis ; Granuloma, Plasma Cell* ; Immunoglobulins* ; Lymphocytes ; Plasma Cells ; Stomach* ; Unnecessary Procedures

BACKGROUND: The purpose of this study is to find out the effect of ApoE genotype on the relationship between nutritional risk and cognition of the elderly in a community. METHODS: A total of 996 subjects (343 men and 653 women) aged 60~91 years were analyzed from preliminary data of GDEMCIS (Gwangju Dementia and MCI Study). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history, K-SGDS (Korean version of Short Form Geriatric Depression Scale), K-MMSE (Korean version-Mini Mental State Examina- tion), and NSI (Nutritional Screening Initiative) checklist. We also examined blood pressure, fasting serum glucose, lipid profile, body mass index, and ApoE genotyping. RESULTS: 649 subjects (65.2%) were on good nutritional state (NSI score < or = 2) and 347 subjects (34.8%) were on moderate or high nutritional risk (NSI score > or = 3). On multiple logistic regression analysis, moderate or high nutritional risk was associated with an increa- sed risk for cognitive impairment (K-MMSE score < or = 17) after adjustment with age, sex, K-GDS and educational level in the absence of ApoE epsilon4 allele (OR 1.78, 95% CI 1.15-2.77). CONCLUSION: These results suggest that nutritional risk may be associated with cognitive function in the elderly only in the absence of ApoE epsilon4 allele.
Aged* ; Alleles ; Apolipoproteins E* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Checklist ; Cognition* ; Dementia ; Depression ; Fasting ; Genotype* ; Humans ; Logistic Models ; Male ; Mass Screening ; Surveys and Questionnaires

OBJECTIVE: The purpose of this study is to find out the effect of ApoE genotype in correlation between metabolic syndrome and cognition of the elderly in the community. METHODS: A total of 1,305 subjects (440 men and 865 women) aged 60-98 years were analyzed from preliminary data of Gwangju Dementia and MCI Study (GDEMCIS). The metabolic syndrome was assessed as defined by the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history, family history of dementia and stroke, and Korean version-Mini Mental State Examination (K-MMSE). We also examined ApoE genotype and analyzed associated factors with metabolic syndrome. RESULTS: These Metabolic syndrome was present in 28.6% of the subjects (13.4% of men and 36.3% of women). On multiple logistic regression analysis, low serum HDL cholesterol was associated with an increased risk for cognitive impairment (K-MMSE score < or = 17) adjusted by age, sex, educational level, and smoking in the presence of ApoE epsilon4 allele (OR 0.95, 95% CI 0.92-0.99). CONCLUSION: These results suggest that serum HDL cholesterol may affect cognitive function in the elderly in the presence of ApoE epsilon4 allele.
Adenosine Triphosphate ; Adult ; Aged* ; Alleles ; Apolipoproteins E ; Cholesterol ; Cholesterol, HDL ; Cognition* ; Dementia ; Education ; Genotype ; Gwangju ; Humans ; Logistic Models ; Male ; Surveys and Questionnaires ; Smoke ; Smoking ; Stroke

BACKGROUND/AIMS: The combination therapy of peginterferon (PEG-IFN) and ribavirin is the standard treatment for hepatitis C virus (HCV) infection. However, few trials have involved patients with cirrhosis. The purpose of this study was to elucidate the efficacy and safety of treatment with PEG-IFN and ribavirin in patients with cirrhosis associated with HCV infection. METHOD: A total of 65 patients were treated with PEG-IFN alpha-2a/ribavirin (n=32) or PEG-IFN alpha-2b/ribavirin (n=33). PEG-IFN alpha-2a and PEG-IFN alpha-2b were administered at doses of 180 microg/week and 1.5 microg/kg/week, respectively, and ribavirin was administered orally at doses of 800-200 mg. Patients with HCV genotype 1 and genotype non-1 were treated for 48 and 24 weeks, respectively. The treatment response was assessed based on the sustained virologic response (SVR). RESULTS: The early virologic response (EVR), end-of-treatment response (ETR), and SVR were 70.0%, 52.0%, and 24.0%, respectively, in genotype 1 (n=50). In genotype non-1 (n=15), the ETR was 53.3% and the SVR was 33.3%. The overall SVR did not differ with genotype (1 vs non-1, 24.0% vs. 33.3%; P=0.471) or between decompensated cirrhosis and compensated cirrhosis (20.0% vs. 27.3%, P=0.630). Ten patients developed cirrhotic complications during the treatment, and 11 stopped treatment due to treatment-related adverse events. CONCLUSION: The combination therapy of PEG-IFN and ribavirin exhibited a low efficacy in cirrhotic patients with HCV infection and was associated with frequent serious complications. However, with careful management of complications, the therapy may have a considerable efficacy in some patients with cirrhosis and HCV infection.
Aged ; Antiviral Agents/adverse effects/*therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon Alfa-2a/adverse effects/*therapeutic use ; Interferon Alfa-2b/adverse effects/*therapeutic use ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Neutropenia/etiology ; Platelet Count ; Polyethylene Glycols/adverse effects/*therapeutic use ; RNA, Viral/blood ; Retrospective Studies ; Ribavirin/adverse effects/*therapeutic use ; Severity of Illness Index ; Treatment Outcome

We present the case of a 34-year-old man with acute biphenotype leukemia that co-expressed B-lymphoid and myeloid antigen after the diagnosis of pulmonary alveolar proteinosis (PAP). The diagnosis of PAP was established by Periodic Acid-Schiff reaction staining on the Video Associated Thoracoscope guided lung biopsy and biphenotype leukemia was revealed by immunohistochemical stains of the blasts harvested from the bone marrow biopsy. Supposedly, PAP follows a hematologic malignancy, yet this case shows the reverse sequence.
Adult ; Biopsy ; Bone Marrow ; Coloring Agents ; Hematologic Neoplasms ; Humans ; Leukemia ; Lung ; Periodic Acid-Schiff Reaction ; Pulmonary Alveolar Proteinosis ; Thoracoscopes