We report an unusual case of primary extranodal non-Hodgkin's lymphoma combined with sinusitis in an AIDS patient. A 39-year-old male presented with sinusitis as initial manifestation. A nasal endoscopy revealed nasal polyposis with mucopurulent discharge in both middle meatus and paranasal sinus (PNS) CT scans demonstrated pansinusitis without lamina papyracea or skull base defect. He received antiretroviral and antibiotics therapy due to low CD4 count representing immunocompromised state. The patient was not followed up for observation and he returned with reduced right visual acuity and diplopia, and proptosis after 6 months. A PNS CT scan showed bilateral sinonasal polyposis with pansinusitis and soft tissue density in the right orbit and frontal lobe through bone defect of lamina papyracea and skull base. Endoscopic sinus surgery for orbital decompression and biopsy of intraorbital mass was performed under general anesthesia. The mass was infiltrated into orbital contents and was confirmed as an diffused large B-cell lymphoma with anaplastic variant. The patient received radiotherapy because his general condition was poor. Proptosis and ocular pain were decreased; however, he complained of a persistent headache. Brain CT and MRI showed diffused parenchymal edema around brain abscess in the right frontal lobe. Stereotactic evacuation of the right brain abscess was performed. He has no specific complaints for the last 14 months and antiretroviral therapy is concluded at the present.
Acquired Immunodeficiency Syndrome ; Adult ; Anesthesia, General ; Anti-Bacterial Agents ; B-Lymphocytes* ; Biopsy ; Brain ; Brain Abscess ; CD4 Lymphocyte Count ; Decompression ; Diplopia ; Edema ; Endoscopy ; Exophthalmos ; Frontal Lobe ; Headache ; Humans ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin ; Magnetic Resonance Imaging ; Male ; Orbit ; Radiotherapy ; Sinusitis* ; Skull Base ; Tomography, X-Ray Computed ; Visual Acuity

The ovarian hyperstimulation syndrome is a rare but serious complication of ovulation induction therapy with gonadotropin. The clinical manifestations are generalized edema, ascites with pleural effusion and may become life-threatening in severe cases. The pathophysiology is still unknown therefore, the treatment should be symptomatic and conservative. We report a case of severe OHSS with massive right pleural effusion in excess of ten liters after human menopausal gonadotropin therapy because of secondary infertility. Fluid and electrolyte imbalances were corrected and albumin was administered. A right chest tube was placed for a total of sixteen days, draining eleven liters of pleural effusion totally, resulting a dramatic decrease of pleural effusion and improvement of symptoms.
Ascites ; Chest Tubes ; Edema ; Female ; Gonadotropins ; Humans ; Infertility ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction ; Pleural Effusion*

PURPOSE: This study aims to figure out the changes of the prevalence and management of carotid arterial occlusive diseases (CAOD), abdominal aortic diseases (AAA), and arterial diseases of the lower extremities (LAOD) in Korea over the past 5 years. METHODS: Data were extracted from the Health Insurance Review and Assessment Service during the period from 2008 to 2012. RESULTS: The number of patients with CAOD increased by about 30% every year. From the year 2008, the number of open surgeries (OS) and endovascular treatments (ET) increased by more than 20% during each of the first 2 years and by 10% every year for 3 years thereafter for CAOD. ET was preferred to OS and occupied 77%-79% of the total number of procedures. The number of patients with AAA increased by 11%-17% every year. ET for AAA occupied 52% of the total number of procedures in 2008 and gradually increased to 70% in 2012. The number of patients who were diagnosed with LAOD fluctuated over the five years. The total number of procedures to treat LAOD increased each year by 20%-25%. ET for LAOD constantly increased by 18%-24% each year and occupied 80%-95% of the total number of procedures. CONCLUSION: It is evident that the incidence of vascular diseases will be increasing as our society ages, not to mention its care costs. The need for long-range plans and guidelines are urgent.
Aortic Aneurysm ; Aortic Diseases ; Arterial Occlusive Diseases ; Carotid Stenosis ; Endovascular Procedures ; Humans ; Incidence ; Insurance, Health* ; Korea* ; Lower Extremity ; Peripheral Arterial Disease ; Prevalence ; Vascular Diseases

Idiopathic intracranial hypertension, a syndrome of obscure origin, occurs particularly in fat adolescent girls and young women. The usual symptoms are headache, blurred vision, a vague dizziness, horizontal diplopia and transient visual obscurations etc., and ophthalmoscopic examination reveals papillederma, due to increased ICP. Visual field testing usually shows slight peripheral constrictions with enlargement of the blind sports. CSF pressure is elevated in the range of 250 to 450 mm of water. Radiological or the other laboratory tests show no specific abnormalities. Treatment for idiopathic intracranial hypertension is focused on early detection and prevention of vision loss, the only permanent morbidity. Many different modes of medical treatment, including weight reduction, repeated lumber puncture, corticosteroids, diuretics, glycerol or carbonic anhydrase inhibitors, have successfully been tried up to 90% of the patients. In the remaining patients, particularly in those with measurable impairment of vision that does not respond to conventinal medical therapies, surgical procedure should be considered. We report a case of idiopathic intracranial hypertension successfully treated with optic nerve sheath fenestration.
Adolescent ; Adrenal Cortex Hormones ; Carbonic Anhydrase Inhibitors ; Constriction ; Diplopia ; Diuretics ; Dizziness ; Female ; Glycerol ; Headache ; Humans ; Optic Nerve* ; Pseudotumor Cerebri* ; Punctures ; Sports ; Visual Field Tests ; Water ; Weight Loss

OBJECTIVE: The clinical outcomes according to the radiological results after cervical total disc replacement (TDR) are not well established. Here, the authors reviewed the clinical results according to the asymmetry in radiographs. METHODS: This retrospective analysis included patients after TDR (Mobi-C(R) disc) with at least 12 months follow up, and the clinical and radiological data were obtained preoperatively and postoperatively for 12 months. Clinical outcome measures numerical rating scale (NRS) score for neck pain, visual analog scale (VAS) for arm pain, and the Oswestry disability index (ODI) value. The asymmetries of TDRs were evaluated on the anterior-posterior (AP) and the lateral radiographs, and the radiographic adjacent segment degenerations were evaluated for 12 months. RESULTS: A total of 24 patients (one level cervical TDR; 10 male and 14 female; aged 41.50+/-8.35 years) were included in this study. The clinical results including NRS for neck pain, VAS for arm pain, and ODIs were similar between the normal and asymmetrized TDRs in AP and lateral radiographs. The radiographic adjacent segment degenerations were significantly increased in deviated TDRs (AP>10 mm asymmetry and lateral>10 mm asymmetry). CONCLUSION: Asymmetrical location of TDR is not related to the clinical outcomes, but related to the risk of radiographic adjacent disc segment degeneration.
Arm ; Arthroplasty* ; Axis, Cervical Vertebra* ; Female ; Follow-Up Studies ; Humans ; Male ; Neck Pain ; Outcome Assessment (Health Care) ; Retrospective Studies ; Total Disc Replacement ; Visual Analog Scale

Giant cell granuloma is an uncommon bony lesion in the head and neck region that most commonly affects the maxilla and mandible. Although it is a benign disease process, it can also be locally destructive. The most common treatment for giant cell granuloma is surgery, ranging from simple curettage to resection. More recently, nonsurgical treatments have been reported. Systemic calcitonin and intralesional glucocorticosteroids have shown varying degrees of success and, when successful, have reduced the necessity for major reconstructive surgery, thus preventing any large surgical defects. We report a case of giant cell granuloma of the maxilla that responded favorably to treatment with surgical excision, followed by intralesional injection of steroid.
Calcitonin ; Curettage ; Follow-Up Studies ; Giant Cells ; Granuloma, Giant Cell ; Head ; Injections, Intralesional ; Mandible ; Maxilla ; Maxillary Sinus ; Neck ; Steroids

Objective: To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community. Methods: We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home. Results: No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO2max) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO2max at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years. Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

Objective: To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community. Methods: We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home. Results: No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO2max) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO2max at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years. Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

BACKGROUND AND OBJECTIVES: Mast cell is a key cell in the pathogenesis of allergic rhinitis. It is expected that apoptosis of mast cell is an important step that can lead to treatment of allergic rhinitis. Meanwhile, the cyclosporin A (CsA) is immunosuppresant agent to inhibit the action of various immune cells. The purpose of this study is to identify whether CsA directly induces apoptosis of mast cells in vitro. MATERIALS AND METHOD: After the culture of p815 cells, mouse mastocytoma cells, the cells were treated with 1 micrometer, 2 micrometer, 5 micrometer, and 10 micrometer CsA, and then LD50 of p815 cells were calculated by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide) assay. For identification of apoptosis of p815 cells, electrophoresis and flow cytometry after CsA treatment were done and morphological changes in light microscope was observed. We also quantified apoptotic cells by TUNEL assay and Hoechst stain. RESULTS: The LD50 of p815 cells is 9.87 micrometer after CsA treatment during 24 hours, 6.11 micrometer during 48 hours and 6.21 micrometer during 72 hours. With the higher concentration of CsA treatment, the greater effect on apoptosis of p815 cells was revealed. We observed laddering pattern for DNA fragmentation in electrophoresis. Nuclear fragmentation and chromatin condensation of p815 cells was observed under the light microscope. Results of flow cytometry were similar to the MTT assay results. Quantification of apoptotic p185 cells by TUNEL assay and Hoechst stain were calculated. CONCLUSION: Apoptosis of mast cells can be induced by CsA treatment in vitro.
Animals ; Apoptosis* ; Chromatin ; Cyclosporine* ; DNA Fragmentation ; Electrophoresis ; Flow Cytometry ; In Situ Nick-End Labeling ; Lethal Dose 50 ; Mast Cells* ; Mastocytoma ; Mice ; Rhinitis

Background: To compare the muscle strength of patients with a hip fracture according to the presence of sarcopenia after surgery and the correlation of measured values between a Biodex and surface electromyography (sEMG) in postoperative measurement of muscle strength. Methods: Seventy-one patients who underwent hip fracture surgery were included in this study. Muscle mass was measured using dual energy X-ray absorptiometry and the grip strength was evaluated using a dynamometer. The diagnosis of sarcopenia followed the Asian Working Group for Sarcopenia criteria. We evaluated the Biodex to assess muscle strength according to the presence of sarcopenia and at the same time measured the sEMG to evaluate the correlation of muscle strength between Biodex and sEMG. Results: We assigned 34 patients with sarcopenia and 37 without sarcopenia to 2 groups. In the comparison of muscle strength using Biodex and sEMG between the 2 groups, it was confirmed that muscle strength of sarcopenia group was decreased compared with that of the non-sarcopenia group, although there was no statistical significance between the groups. However, Biodex and sEMG showed very close correlation with muscle strength in all variables. Conclusions We suggest that using sEMG for the evaluation of muscle strength after hip fracture surgery may be an excellent tool alternative to isokinetic testing machines such as the Biodex.