No abstract available.
Epithelium* ; Humans* ; Insulin*

Angioimmunoblastic lymphadenopathy (AILD) is a systemic disease clinically characterized by fever, generalized lymphadenopathy, hepatosplenomegaly, polyclonal gamma-globulinemia and Cooms' positive hemolytic anemia. The lymph node in AILD reveals a polymorphic feature consisting of a proliferation of small vessels, immunoblasts and plasma cells and acidophilic interstitial material. Progression into immunoblastic sarcoma is reported as high 35% of the patient with AILD. Nathwani et al have observed not only malignant transformation of AILD in sequential tissue examination, but also the coexistence of AILD and immunoblastic lymphoma in the same lymph node or at different sites in the same patient. Multiple clusters or islands of compactly arranged large lymphoid cells constitute the initial histologic evidence of immunoblastic sarcoma. Immunoblastic sarcoma is a large cell lymphoma conceptually related to transformed T-and B-lymphocytes of the extrafollicular compartment of the immune system, which proignosis is poor. We have recently experienced a case of immuno blastic sarcoma arising in angioimmunoblastic lymphadenopathy in a 24-year-old woman. She had history of multiple enlarged lymph nodes in the inguinal, axilla and supraclavicular areas. Previous lymph node biopsies revealed reactive change. Six month later, right axillary lymph node biopsy reveled AILD with focal clusters of immunoblasts. Subsequent lymph node biopsy at the same site revealed diffuse immunoblasic sarcoma, B-cell type. A case presentation with histologic findings and a brief review of literature were done.
Female ; Humans ; Biopsy

We describe a case of an acute heart transplant rejection treated with triple immunosuppression and plasmapheresis, resulting in evidence of improved clinical manifestation and hemodynamics. This case suggests that plasmapheresis may be useful in the treatment of possible acute humoral(vascular) rejection in heart transplantation.
Graft Rejection* ; Heart Transplantation ; Heart* ; Hemodynamics ; Immunosuppression ; Plasmapheresis*

Chronic pain is associated with disabling physical and emotional symptoms. Patients with chronic pain utilize more health services, have an impaired sense of well-being and frequently experience anxiety or depression. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life. Treatment of chronic pain involves a comprehensive approach using medication and functional rehabilitation. The usual approach for mild to moderate pain is to start with nonopioid analgesics. Also, trying antidepressant drugs for sleep loss and gabapentin for neuropathic pain or fibromyalgia is appropriate. For moderate to severe chronic pain, opioid analgesics can be used without any serious side effects if adequately used at the right dosage. It is important to provide guidance on the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, in order to avoid gastrointestinal, renal, and cardiovascular complications. Mechanisms of analgesia, drug selection, and recommendations for clinical usage for the management of chronic pain are reviewed in this paper.
Acetaminophen ; Amines ; Analgesia ; Analgesics ; Analgesics, Non-Narcotic ; Analgesics, Opioid ; Antidepressive Agents ; Anxiety ; Chronic Pain ; Cyclohexanecarboxylic Acids ; Depression ; Fibromyalgia ; gamma-Aminobutyric Acid ; Health Services ; Humans ; Liver ; Neuralgia ; Psychotropic Drugs ; Quality of Life

Biliary atresia (BA) is a major cause of extrahepatic biliary obstruction in children. Malnutrition is a significant clinical problem in children with BA. BA may induce the malabsorption of fat and fat-soluble vitamins, resulting in cholestasis and an impaired nutritional status. For the treatment of BA, it is most important to reconstruct the bile flow as early as possible by performing a Kasai portoenterostomy. After the Kasai operation, growth and nutrition are restored, but to follow normal growth and development, it is necessary to evaluate the nutritional status and support. Therefore, the purpose of nutritional support in children with BA is to normalize growth and development, prevent further liver damage and deterioration of the patient's nutritional status, avoid vitamin and mineral deficiencies, and improve the quality of life of patients.
Avitaminosis ; Bile ; Biliary Atresia* ; Child ; Cholestasis ; Growth and Development ; Humans ; Liver ; Malnutrition ; Miners ; Nutritional Status ; Nutritional Support* ; Quality of Life ; Vitamins

BACKGROUND AND OBJECTIVES: Diabetes is associated with a unique form of cardiomyopathy in the absence of atherosclerosis. The mechanisms of diabetic cardiomyopathy have not been defined, but is associated with early left ventricular (LV) diastolic dysfunction following an altered LV contractile performance. However, less attention has been paid to the right ventricular (RV) diastolic function in diabetes. Therefore, the changes in the RV ans LV filling dynamics, in patients with early type 2 diabetes, were investigated. SUBJECTS AND METHODS: The transtricuspid and trans-mitral flows were assessed by transthoracic Doppler echocardiography, at maximal inspiration and expiration, in 48 subjects (mean age: 62+/-9 years, M:F=16:32) with type 2 diabetes (Type 2 DM group) and 34 normal subjects (control group ; mean age:59+/-9 years, M:F=15:19, ranging from 45-75 years of age) with normal LV systolic function and ECG at rest. Subjects with diabetic complication, nephropathy (Cr >1.5 mg/dL), LVH and COPD were excluded. RESULTS: The mitral E/A ratio and DT (deceleration time) showed no significant difference between the type 2 DM and control groups. The LV and RV systolic functions also showed no significant difference between the two groups. However, the type 2 DM group had a lower tricuspid E/A ratio (0.98+/-0.25 vs. 1.17+/-0.21, p<0.001) and a longer tricuspid DT (241+/-65 msec vs. 208+/-51 msec, p=0.016) than the control group. CONCLUSION: The right ventricular diastolic function is frequently abnormal in early type 2 diabetes. This suggests that right ventricular diastolic dysfunction may be an important predictor for the early detection of diabetic cardiomyopathy.
Atherosclerosis ; Cardiomyopathies ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Heart Ventricles ; Humans ; Pulmonary Disease, Chronic Obstructive

BACKGROUND/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.
Alanine Transaminase ; DNA ; Drug Resistance ; Guanine ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Medical Records ; Polymerase Chain Reaction ; Retrospective Studies

OBJECTIVE: The purpose of this study is to evaluate the clinicopathologic characteristics of the torsion of the ovarian tumor in postmenopausal women. METHODS: We reviewed the medical records of 20 postmenopausal patients with a postoperative diagnosis of torsion of the ovarian tumor in Department of Obstetrics and Gynecology, Hanyang University Hospital from January 1989 to December 1998. RESULTS: The postmenopausal patients with torsion of the ovarian tumor constitute 20/94 (21.3%) of all adnexal torsion patients encountered during this period. The mean (+/-SD) age of the 20 patients was 63.5+/-9.0 years, with a range of 52-90 years. The mean time since menopause was 16.5+/-10.3 years, with a range of 1-39 years. The mean parity was 5.4+/-2.0 (range of 3-10). Lower abdominal pain (65%) was the most frequently presenting symptom, palpable mass(20%) or diagnosed mass(15%) being the second. But, in 20% of cases there was no lower abdominal pain. The torsion occurred at the right side in 11cases (55%) and at the left side in 9 cases. The most frequent degree of torsion was those cases that was rotated twice (720 degrees). The neoplasms undergoing torsion ranged in diameter between 5cm and 30cm and the most prevalent size was 6 to 10 cm (8 cases). Most of the patients (17cases) were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy. The tumors that produce torsion varied histologically and the most common type was cystic teratoma (in 5 cases), simple cyst(in 3 cases), serous cystadenoma(in 2 cases), mucinous cystadenoma(in 2 cases). CONCLUSIONS: In our study, ovarian tumor torsion occurring in postmenopausal patients constituted approximately 20% of all torsion patients, therefore adnexal torsion should be considered when a postmenopausal woman presents with lower abdominal pain. When torsion is diagnosed, total abdominal hysterectomy and bilateral salpingo-oophorectomy is the usual treatment for postmenopausal patients. Histologically, in more than 90% of cases, the tumors that produce torsion were benign. If cancer is evident, more extensive surgery is required.
Abdominal Pain ; Diagnosis ; Female ; Gynecology ; Humans ; Hysterectomy ; Medical Records ; Menopause ; Mucins ; Obstetrics ; Parity ; Teratoma

The primary malignant tumor of the peritoneum also known as primary peritoneal carcinoma or primary peritoneal papillary serous carcinoma is rare and involves the peritoneum, especially the pelvic peritoneum of female patients. It is difficult to differentiate histologically between papillary mesothelioma, primary ovarian tumor and primary peritoneal carcinoma. We report two cases of the primary peritoneal carcinoma with clinical presentation and histologic characteristics.
Diagnosis, Differential ; Female ; Humans ; Mesothelioma ; Peritoneum*

Coronary arteriovenous fistula is a rare congenital coronary artery anomaly in adults. Most such fistula drain into a right heart chamber or into the pulmonary artery. Congenital left coronary artery-left ventricle fistula is even more uncommon. Aortography and selective coronary angiography are still the diagnostic mode of choice. However, recent studies have demonstrated that two-dimensional echocardiography with or without Doppler color flow imaging is a useful noninvasive tool in the diagnosis of coronary artery fistula. A 29 year-old female who had an exertional dyspnea, chest pain, and continuous diastolic murmur was referred to our hospital for further evaluation. The transthoracic two-dimensional and color Doppler echocardiography revealed a dilated left coronary artery which was drained into left ventricle. The coronary angiography showed that the left circumflex artery was very dilated and tortuous, and contrast medium passed from the left circumflex artery into the left ventricular cavity via a fistula. However, the right coronary artery and the left anterior descending artery were normal. We reported a case of an echocardiographically documented fistula between the left circumflex coronary artery and the left ventricle in young woman.
Adult ; Aortography ; Arteries ; Arteriovenous Fistula ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Dyspnea ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Color ; Female ; Fistula* ; Heart ; Heart Murmurs ; Heart Ventricles ; Humans ; Pulmonary Artery