Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0x6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.
Adult ; Azathioprine/*therapeutic use ; Colonoscopy ; Combined Modality Therapy ; Crohn Disease/complications/*drug therapy ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Immunosuppressive Agents/*therapeutic use ; Liposarcoma/complications/*pathology/surgery ; Male ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Incidentally detected focal 18F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy. METHODS: We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy. RESULTS: PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia). CONCLUSIONS: Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.
Adenocarcinoma/pathology/radiography/radionuclide imaging ; Adenoma/pathology/radiography/radionuclide imaging ; Adult ; Aged ; Colonic Neoplasms/pathology/*radiography/*radionuclide imaging ; Colonic Polyps/pathology ; Colonoscopy ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Male ; Middle Aged ; Multimodal Imaging ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Several dietary factors, such as antioxidant vitamins, have potential roles in the development of obstructive lung diseases. However, the results of studies on the relationships between dietary factors and obstructive lung diseases are inconsistent. The aim of this study was to determine which nutrients are related to airway obstruction (AO) in the Korean population. METHODS: We used data obtained as part of the Korean National Health and Nutrition Examination Survey (NHANES II) in 2001. Analysis was restricted to 1,005 adults who were 18 years of age and older, who had two or more acceptable spirometry curves, and who had participated in the nutrition examination survey. AO was defined as the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) of less than 0.7. RESULTS: Of the 1,005 study subjects, 78 (7.8%) had AO. Statistically significant factors associated with AO were 55 years of age or older (p = 0.032), central obesity (p = 0.047), hypertension (p < 0.001), smoking of 20 pack-years or more (p < 0.001), low income (p < 0.001), and low dietary protein intake expressed as a ratio of protein to recommended dietary allowance for Koreans (p = 0.037). Multiple logistic regression analyses revealed four factors that were independently associated with AO: smoking of 20 pack-years or more (odds ratio [OR], 5.801; p < 0.001), hypertension (OR, 3.905; p < 0.001), low protein intake (OR, 0.992; p = 0.004), and low income (OR, 1.962; p = 0.018). CONCLUSIONS: In the Korean NHANES, smoking, hypertension, and low income were related to AO. Among dietary factors, only low protein intake was associated with AO.
Adult ; Airway Obstruction/*epidemiology ; Antioxidants/administration & dosage ; Body Mass Index ; Cross-Sectional Studies ; Dietary Proteins/administration & dosage ; Female ; Forced Expiratory Volume ; Humans ; Logistic Models ; Male ; Malnutrition/*epidemiology ; Middle Aged ; Minerals/administration & dosage ; Nutrition Surveys ; Obesity/epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Smoking/*epidemiology ; Spirometry ; Vital Capacity ; Vitamins/administration & dosage

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.
Aged ; Arthralgia ; Depression ; Family Practice ; Fatigue ; Female ; Humans ; Hypertension ; Leg ; Male ; Prevalence ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Snoring ; Stroke

Pheochromocytoma is a rare endocrine tumor arising from the chromaffin tissue, and it is able to produce and secrete catecholamines. Lymph nodes, liver, lung and bone are the most frequent sites of metastasis. We report here on a case of pheochromocytoma arising from the dura in a patient who was surgically treated for bilateral pheochromocytoma five years previously.
Catecholamines ; Humans ; Liver ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Pheochromocytoma*

To evaluate the clinical significance of autoantibodies to three major epithelial cytokeratins (CK) -- CK8, CK18, and CK19 -- we compared 66 patients with toluene diisocyanate (TDI)-induced asthma (group I) with three control groups: 169 asymptomatic exposed subjects (group II), 64 patients with allergic asthma (group III), and 123 unexposed healthy subjects (group IV). Serum IgG, specific for human recombinant CKs, were measured by ELISA (enzyme linked immunosorbent assay), and ELISA inhibition tests were performed. The existence of these antibodies was confirmed by IgG immunoblot analysis. Anti-TDI-HSA (human serum albumin) IgE and IgG antibodies were measured by ELISA in the same set of the patients. The prevalence of CK8, CK18, and CK19 auotantibodies in group I was significantly higher than in the other three groups. Results of the ELISA inhibition test showed significant inhibition with the addition of three CKs in a dose-dependent manner. No significant association was found between CK autoantibodies and the prevalence of anti- TDI-HSA IgG and IgE antibodies. These results suggest that autoantibodies to CK18 and CK19 can be used as serologic markers for identifying patients with TDI-induced asthma among exposed workers.
Toluene 2,4-Diisocyanate/*toxicity ; Sensitivity and Specificity ; Occupational Diseases/chemically induced/*diagnosis ; Middle Aged ; Male ; Keratins/*immunology ; Keratin-8/immunology ; Keratin-19/immunology ; Keratin-18/immunology ; Immunoblotting ; Humans ; Female ; Enzyme-Linked Immunosorbent Assay ; Biological Markers/blood ; Autoantibodies/*blood ; Asthma/chemically induced/*diagnosis ; Adult

BACKGROUND AND PURPOSE: Left ventricular hypertrophy (LVH) and increased common carotid artery intimamedia thickness (IMT) are known target organ damages of hypertension. However, the relation between LVH and carotid artery IMT is not well defined in Korea. Thus, the purpose of this study is to evaluate the association of common carotid artery IMT and luminal diameter (LD) with LVH (LV mass) in patients with hypertension. METHOD: LV mass was measured by echocardiography and IMT and LD of right and left common carotid artery were measured by high resolution ultrasound in non-hypertensive subjects (n=24), patients with known hypertension without LVH (n=22) and hypertension with LVH (n=22). Data obtained were adjusted statistically for age. RESULTS: Mean IMT (in mm) were 0.51+/-0.12 in non-hypertension group, 0.61+/-0.09 in hypertension without LVH group and 0.73+/-0.13 in hypertension with LVH group (age adjusted p<0.0001 by ANCOVA). Mean systolic and diastolic IMT/LD ratios were 0.077+/-0.015 and 0.089+/-0.018 in non-hypertensive group, 0.052+/-0.015 and 0.09+/-0.014 in hypertension without LVH group, and 0.085+/-0.015 and 0.104+/-0.022 in hypertension with LVH group (p=0.063 for systolic ratio and 0.137 for diastolic ratio). CONCLUSION: These findings suggest that there is a significant correlation between carotid artery intima-media thickness and LVH in hypertensio.
Carotid Arteries* ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Echocardiography ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Korea ; Phenobarbital ; Ultrasonography

Adult-onset Still's disease (AOSD) is a multi-systemic inflammatory disorder characterized by high spiking fever, evanescent salmon-colored rash, arthralgia or arthritis, leukocytosis and the involvement of various organs. However, leukopenia is rarely associated with AOSD. It may be due to hemophagocytic syndrome, which usually present with acute febrile illness, pancytopenia, hepatosplenomegaly, and hyperferritinemia. We report a case of 28-year-old man with AOSD and leukopenia. There is no evidence of other causes of cytopenia and hemophagocytosis in bone marrow examination. Leukopenia can be the initial presentation of AOSD.
Adult ; Arthralgia ; Arthritis ; Bone Marrow Examination ; Exanthema ; Fever ; Humans ; Leukocytosis ; Leukopenia* ; Lymphohistiocytosis, Hemophagocytic ; Pancytopenia ; Still's Disease, Adult-Onset*

Episodic angioedema with eosinophilia is characterized by recurrent angioedema, urticaria, fever, weight gain and hypereosinophilia. Although this syndrome shows similarities to idiopathic hypereosinophilic syndrome, it differs in that it has good prognosis and has no organ involvement. The pathogenesis is unclear, but IL-5 is thought to be major cytokine of pathogenesis. It has benign course with spontaneous remission or low-dose prednisolone treatment. Here, we describe a patient whose clinical and laboratory features are similar to those observed in episodic angioedema with eosinophilia.
Angioedema* ; Eosinophilia* ; Fever ; Humans ; Hypereosinophilic Syndrome ; Interleukin-5 ; Prednisolone ; Prognosis ; Remission, Spontaneous ; Urticaria ; Weight Gain

Recently, duplex sonography has been used as a screening test for the evaluation of carotid arterial disease. If an occlusion of atherosclerosis is located at the bifurcation of the common carotid artery or the lower portion of the internal carotid artery, the luminal change may be directly visualized on high-resolution B-mode sonography or color-Doppler images. But when the lesion is located at the high cervical, petrous or cavernous protion of the internal carotid artery, it is difficult to directly visualize the lesion with the sonography. The purpose of this paper is to evaluate the indirect changes on the Doppler patterns of both common carotid arteries with clamping of an internal carotid artery. Thirty common carotid arteries in fifteen normal rabbits were examined with duplex ultrasonography using high-resolution real-time imaging and 7.5MHz pulsed-wave Doppler flow measurements with velocity waveform analysis. Systolic velocity (SV) was 45.4±8.4cm/sec, end-diastolic velocity (EDV) 15.3±4.9cm/sec and resistative index(RI) 0.66±0.08 in the common carotid artery before clamping of the internal carotid artery. SV was 26.3±7.8cm/sec, EDV 6.0±5.2cm/sec and RI 0.78±0.18 in the ipsilateral common carotid artery and SV was 56.6±13.0cm/sec, EDV 22.3±8.2cm. sec and RI 0.61±0.10 in the contralateral common carotid artery after clamping of the internal carotid artery. During clamping of the internal carotid artery, the difference between SV of bilateral common carotid arteries was 30.3±13.8cm/sec and EDV 16.3±9.2cm/sec. There was no difference of the velocity patterns of the common carotid artery between preclamping and declamping of the internal carotid artery. In conclusion, lower SV and EDV in a common carotid artery than that in contralateral side on Doppler patterns strongly suggests an occlusion of ipsilateral internal carotid artery.
Atherosclerosis ; Carotid Artery Diseases ; Carotid Artery, Common* ; Carotid Artery, Internal* ; Constriction* ; Mass Screening ; Phenobarbital ; Rabbits ; Ultrasonography