Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibodies and immune complex depositions, has been known that it could be aggravated during pregnancy. We report a case who developed massive pericardial effusion, pleural effusion, and proteinuria during the second trimester of pregnancy. This patient had a history of leukopenia for several years and showed several features of SLE before pregnancy, however, no specific diagnosis was made before pregnancy. High dose oral glucocorticoid with intravenous immunoglobulin administration was done, but serositis and nephritis did not improve. The induced abortion and the use of immunosuppresive agent resulted in remission. We emphasize the importance of the early diagnosis and management of SLE before pregnancy in the patients with the features of autoimmune disease such as leukopenia, skin lesion and Raynaud phenomenon for successful outcome.
Abortion, Induced ; Antigen-Antibody Complex ; Autoantibodies ; Autoimmune Diseases ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Immunoglobulins ; Leukopenia ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Nephritis* ; Pericardial Effusion ; Pleural Effusion ; Pregnancy Trimester, Second ; Pregnancy* ; Proteinuria ; Raynaud Disease ; Serositis* ; Skin

BACKGROUND: To assess the effect and toxicity of low-dose paclitaxel in patients with metastatic or recurrent gastric cancer with measurable lesions as first-line chemotherapy. METHODS: Patients with measurable metastatic or recurrent gastric cancer were eligible in this study. Paclitaxel and cisplatin were intravenously infused for 3h, at a dose of each 135 mg/m2 and 60 mg/m2, every 3 weeks and then this regimen was repeated until intolerable toxicity or disease progression. Objective tumor responses, duration of response, time to disease progression, and toxicity profile were evaluated in this study. RESULTS: Total 31 patients were enrolled in this study between May 2001 and January 2004. Sixteen patients had ECOG performance status (PS) 1, eleven had PS 2 and four had PS 3. A total of 122 cycles (median 3, range 1~12) were administered. Eleven (35%, 11/31) objective partial responses (PR) were observed and the remaining 19 patients showed stable (9 patients, 30%) and progressive disease (11 patients, 35%). The response rate was 35% (95% confidence interval, 18~51%). The estimated median survival was 8.1 months, median response duration was 5.3 months and median progression-free survival was 3.3 months. Severe toxicities were uncommon. There were 14 episodes (11.5%) of grade 3-4 neutropenia. Grade 3 nausea and vomiting occurred in 4%. Grade 3 peripheral neuropathy occurred in 3.3%. CONCLUSION: This low dose paclitaxel regimen (135 mg/m2) showed comparable results with previously published high-dose paclitaxel regimen (175~250 mg/m2) used in metastatic or recurrent gastric cancer and the toxicity was minimal.
Cisplatin ; Disease Progression ; Disease-Free Survival ; Drug Therapy* ; Humans ; Nausea ; Neutropenia ; Paclitaxel* ; Peripheral Nervous System Diseases ; Stomach Neoplasms* ; Vomiting

Idiopathic hyperammonemia is a rare and serious complication of intensive cytoreductive chemotherapy for hematologic malignancies as well as after autologus or allogeneic bone marrow transplantation (BMT). A 42-year-old woman with Philadelphia chromosome positive acute lymphoblastic leukemia was undertaken unrelated BMT. Fourteen days later, the patient developed hallucination, mental confusion, lethargy, incoordination and stupor. Laboratory tests revealed normal serum aminotransferases. The serum ammonia level is moderately increased. Parenteral alimentation was discontinued to lower protein intake and treatment with lactulose, metronidazole, carnitine, and flumazenil was started. Also, hemodialysis was performed. Despite of these appropriate therapies, she died of idiopathic hyperammonenia at twenty-two days after allogeneic BMT.
Adult ; Ammonia ; Ataxia ; Bone Marrow Transplantation* ; Bone Marrow* ; Carnitine ; Drug Therapy ; Female ; Flumazenil ; Hallucinations ; Hematologic Neoplasms ; Humans ; Hyperammonemia* ; Lactulose ; Lethargy ; Metronidazole ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Renal Dialysis ; Stupor ; Transaminases

Coronary artery embolization is an extremely rare and potentially lethal complication of atrial myxomas. We observed of a case of left atrial myxoma associated with acute anteroseptal and inferior myocardial infarction. A transthoracic echocardiographic study revealed the presence of an echogenic, mobile mass, compatible with myxoma in the left atrium. Coronary angiography disclosed abrupt occlusions of the distal left anterior descending artery and the right coronary artery. The tumor was successfully removed surgically after medical treatment and the patient was doing well post operatively at 6-month follow-up.
Arteries ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Embolism ; Follow-Up Studies ; Heart Atria ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myxoma*

Chronic acalculous cholecystitis is a diagnosis of exclusion in patients complaining acalculous biliary pain. The possible causes of acalculous biliary pain are chronic gallbladder (GB) inflammation, GB dysfunction, cholesterolosis, cystic duct stenosis or microlithiasis. Recently, laparoscopic cholecystectomy is the choice of treatment for acalculous biliary pain. We experienced a 32-year-old woman whose initial symptoms were right upper quadrant pain and nausea only. The abdominal computed tomography, DISIDA scan, and upper and lower endoscopic examinations were nonspecific. Up to 48 hours after endoscopic retrograde cholangiopancreatography, contrast emptying of GB was delayed, implying dysfunctional GB. As the patient's right upper quadrant pain and tenderness became aggravated, the laparoscopic cholecystectomy was done and the final diagnosis of chronic acalculous cholecystitis was confirmed.
Acalculous Cholecystitis/*radiography ; Adult ; *Cholangiopancreatography, Endoscopic Retrograde ; Chronic Disease ; *Contrast Media ; English Abstract ; Female ; Gallbladder Emptying ; Humans

Mitochondria are important intracellular organelles that produce energy for cellular development, differentiation, and growth. Mitochondrial DNA (mtDNA) presents a 10- to 20-fold higher susceptibility to genetic mutations owing to the lack of introns and histone proteins. The mtDNA repair system is relatively inefficient, rendering it vulnerable to reactive oxygen species (ROS) produced during ATP synthesis within the mitochondria, which can then target the mtDNA. Under conditions of chronic inflammation and excess stress, increased ROS production can overwhelm the antioxidant system, resulting in mtDNA damage. This paper reviews recent literature describing the pathophysiological implications of oxidative stress, mitochondrial dysfunction, and mitochondrial genome aberrations in aging hematopoietic stem cells, bone marrow failure syndromes, hematological malignancies, solid organ cancers, chronic inflammatory diseases, and other diseases caused by exposure to environmental hazards.
DNA, Mitochondrial/*genetics/metabolism ; Hematologic Diseases/genetics/*pathology ; Humans ; *Inflammation ; Mitochondria/genetics ; Mutation ; Neoplasms/genetics/*pathology ; Oxidative Stress ; Reactive Oxygen Species/metabolism

BACKGROUND/AIMS: Gastroesophageal reflux disease is one of the most common and frequent chronic disease requiring considerable cost. We investigated the medical care costs in the erosive reflux disease (ERD) and non-erosive reflux disease (NERD). METHODS: The risk factors and the direct medical care costs were analyzed retrospectively in the ERD (178 patients) and NERD (183 patients) groups for a follow up period of 2 years. RESULTS: Logistic regression analysis showed that the ERD was more frequent in the groups of male gender, alcohol consumption, higher body mass index (> or =25 kg/m2), hiatal hernia, and higher triglyceride levels (> or =150 mg/dL). The direct medical care costs per person for 2 years were found to be $384.8 (ERD) and $412.9 (NERD) without statistically significant differences (p = 0.364). However, 9.3% (17/183) of the NERD patients had visited the emergency room compared to 3.4% (6/178) of the ERD patients (p = 0.029). In addition, more NERD patients were hospitalized than ERD patients (p = 0.006), and because of the longer hospitalization period, the medical costs in NERD patients were higher than ERD patients (p = 0.038). CONCLUSIONS: In spite of the different risk factors for ERD and NERD, total direct medical care costs were similar between the ERD and NERD group. However, more visits to emergency room and longer hospitalization period with more hospitalization costs in NERD patients account for the differences in medical service and usage distribution between the 2 groups.
Alcohol Drinking ; Body Mass Index ; Chronic Disease ; Emergencies ; Follow-Up Studies ; Gastroesophageal Reflux ; Health Care Costs ; Hernia, Hiatal ; Hospitalization ; Humans ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors

We evaluated the association of the APOE polymorphism with serum C-reactive protein levels and white blood cell count in two large population-based studies in Korean. The datasets included the Dong-gu study (n = 8,893) and the Namwon Study (n = 10,032). APOE genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism. Multivariable linear regression analysis was performed to evaluate the relationship of APOE genotypes with C-reactive protein levels and white blood cell count with adjustments for age, sex, body mass index, smoking, diabetes, hypertension, and serum lipids. In the multivariate model, carriers of E3E4 or E4E4 genotype had significantly lower C-reactive protein levels compared with carriers of E3E3 genotype group (0.50 mg/L vs. 0.67 mg/L; 0.37 mg/L vs. 0.67 mg/L, respectively, for the Dong-gu Study and 0.47 mg/L vs. 0.66 mg/L; 0.45 mg/L vs. 0.66 mg/L, respectively, for the Namwon Study). However, there was no difference in white blood cell count among APOE genotypes. We found that the APOE E4 allele is associated with lower C-reactive protein levels, but not white blood cell count. Our results suggest that APOE genotype may influence C-reactive protein levels through non-inflammatory pathway.
Aged ; Apolipoproteins E/*genetics ; C-Reactive Protein/*metabolism ; Female ; Genetic Association Studies ; Genotype ; Humans ; Inflammation/*blood/immunology ; Leukocyte Count ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide/genetics ; Prospective Studies ; Republic of Korea

The purpose of this study was to examine the association between the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and bone mineral density (BMD). Two large cohort studies were performed: the Dong-gu Study (3,621 men and 5,409 women) and the Namwon Study (3,703 men and 5,672 women). We assessed lumbar spine and femoral neck BMD by dual-energy X-ray absorptiometry. Genotypes were determined by real-time polymerase chain reaction. Multiple linear regression analysis was performed to evaluate the association between MTHFR C677T and BMD, adjusting for age, weight and height. The MTHFR C677T genotype frequencies for CC, CT, and TT genotypes were 34.5, 48.7, and 16.8%, respectively, in the Dong-gu Study and 33.6, 49.2, and 17.2%, respectively, in the Namwon Study. There are no significant differences between the MTHFR C677T genotype and the BMD at the lumbar spine and femoral neck in men or women in both cohorts.
Absorptiometry, Photon ; Aged ; Alleles ; *Bone Density ; Cohort Studies ; Female ; Femur Neck/radiography ; Gene Frequency ; Genotype ; Humans ; Lumbar Vertebrae/radiography ; Male ; Methylenetetrahydrofolate Reductase (NADPH2)/*genetics ; Middle Aged ; Polymorphism, Single Nucleotide

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.
Absorptiometry, Photon ; Apolipoproteins E ; Asian Continental Ancestry Group ; Bone Density ; Cohort Studies ; Dataset ; Female ; Femur Neck ; Genotype ; Humans ; Jeollabuk-do ; Male ; Polymorphism, Genetic ; Spine