Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.
Aged ; Critical Care ; Fever ; Hematoma ; Hemorrhage ; Humans ; Immunoglobulins ; Leukocyte Count ; Leukocytosis ; Multiple Myeloma ; Respiration ; Respiratory Insufficiency ; Thorax

Adventitial cystic disease of the popliteal artery is a rare disorder that causes localized stenosis or occlusion by compression of the vessel lumen. The disease produces lower extremity claudication, typically in young and middle-aged men. We report a case of the adventitial cystic disease of the popliteal artery in a 55-year-old man with symptom of left calf claudication. Diagnosis was done by ultrasound, angiography, and magnetic resonance imaging. The patient was treated with resection of the diseased popliteal artery followed by interposition of saphenous vein graft. Postoperatively, the symptom and sign resolved completely.
Angiography ; Constriction, Pathologic ; Diagnosis ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Popliteal Artery* ; Saphenous Vein ; Transplants ; Ultrasonography

OBJECTIVE: The purpose of this study was to analyze the transverse dental compensation in reference to the maxillary and mandibular basal bones using cone-beam computed tomography (CBCT) and evaluate the correlations between transverse dental compensation and skeletal asymmetry variables in patients with skeletal Class III malocclusion and facial asymmetry. METHODS: Thirty patients with skeletal Class I (control group; 15 men, 15 women) and 30 patients with skeletal Class III with menton deviation (asymmetry group; 16 men, 14 women) were included. Skeletal and dental measurements were acquired from reconstructed CBCT images using OnDemand3D 1.0 software. All measurements were compared between groups and between the deviated and nondeviated sides of the asymmetry group. Correlation coefficients for the association between skeletal and dental measurements were calculated. RESULTS: Differences in the ramus inclination (p < 0.001), maxillary canine and first molar inclinations (p < 0.001), and distances from the canine and first molar cusp tips to the midmaxillary or midmandibular planes (p < 0.01) between the right and left sides were significantly greater in the asymmetry group than in the control group. In the asymmetry group, the ramus inclination difference (p < 0.05) and mandibular canting (p < 0.05) were correlated with the amount of menton deviation. In addition, dental measurements were positively correlated with the amount of menton deviation (p < 0.05). CONCLUSIONS: Transverse dental compensation was correlated with the maxillary and mandibular asymmetry patterns. These results would be helpful in understanding the pattern of transverse dental compensation and planning surgical procedure for patients with skeletal Class III malocclusion and facial asymmetry.
Compensation and Redress* ; Cone-Beam Computed Tomography* ; Facial Asymmetry* ; Humans ; Male ; Malocclusion* ; Molar

Leiomyosarcoma (LMS) within the scrotum is a rare malignant genitourinary tumor in adults. Due to its rarity, a consensus on a clear approach to diagnosis and treatment guidelines has not yet been reached. We present a case of a paratesticular LMS in a 64-yearold man with a painless swelling of the right scrotum. Scrotal ultrasound and pelvic MRI were performed and revealed an extratesticular mass with a heterogeneous appearance.The patient underwent a right radical orchiectomy, and the mass was confirmed to be LMS, originating from the right spermatic cord. Preoperative diagnosis of LMS is challenging since it has overlapping clinical and imaging features with other sarcomas. MRI is a valuable imaging modality for the definitive characterization of the tumor. To provide timely and appropriate treatment, the correlation of the patient’s clinical information and imaging findings is necessary.

BACKGROUND: Hypertrophy of podocytes is observed in type 2 diabetic patients. Cellular hypertrophy requires combined effects of various mitogen- induced entry into the cell cycle and subsequent cell cycle arrest at the G1/S interphase. This cell cycle arrest is mediated by various cyclin-dependent kinase inhibitors (CKIs). We investigated the effect of angiotensin II receptor blocker (ARB) treatment on podocyte hypertrophy and CKIs expression in cultured podocytes stimulated by long-term high glucose. METHODS: Immortalized mouse podocytes were cultured in media containing 5.6 mM normal glucose (NG), 30 mM high glucose (HG), or NG+angiotensin II (AII, 10(-7)M) for 7 days with or without ARB (L-158,809, 10(-6)M). Cellular hypertrophy was assessed by measurement of cellular protein/cell counts, and CKIs mRNA and protein expression were assessed by reverse-transcription polymerase chain reaction (RT-PCR) and Western blot, respectively. RESULTS: Cellular hypertrophy was induced in podocytes exposed to HG or AII compared to NG cells and this HG-induced cellular hypertrophy was inhibited with ARB treatment by 70% (p<0.05). In addition, there were 1.5-fold and 2.0 fold increases in p27Kip1 mRNA and protein expression, respectively, in HG-stimulated podocytes compared to NG- treated cells (p<0.05). p27Kip1 mRNA and protein expression were also increased in cultured podocytes stimulated by AII by 156% and 199%, respectively (p<0.05). ARB treatment ameliorated HG-induced increase in p27Kip1 mRNA by 75% and protein expression by 70% (p<0.05). In contrast, there were no significant changes in p21Cip1 and p57Kip2 protein expression in cultured podocytes exposed to HG or AII. CONCLUSION: High glucose induced significant cellular hypertrophy and increased p27Kip1 mRNA and protein expression in cultured mouse podocytes, and these changes were effectively inhibited by ARB treatment.
Mice ; Animals

BACKGROUND: Hypertrophy of podocytes is observed in type 2 diabetic patients. Cellular hypertrophy requires combined effects of various mitogen- induced entry into the cell cycle and subsequent cell cycle arrest at the G1/S interphase. This cell cycle arrest is mediated by various cyclin-dependent kinase inhibitors (CKIs). We investigated the effect of angiotensin II receptor blocker (ARB) treatment on podocyte hypertrophy and CKIs expression in cultured podocytes stimulated by long-term high glucose. METHODS: Immortalized mouse podocytes were cultured in media containing 5.6 mM normal glucose (NG), 30 mM high glucose (HG), or NG+angiotensin II (AII, 10(-7)M) for 7 days with or without ARB (L-158,809, 10(-6)M). Cellular hypertrophy was assessed by measurement of cellular protein/cell counts, and CKIs mRNA and protein expression were assessed by reverse-transcription polymerase chain reaction (RT-PCR) and Western blot, respectively. RESULTS: Cellular hypertrophy was induced in podocytes exposed to HG or AII compared to NG cells and this HG-induced cellular hypertrophy was inhibited with ARB treatment by 70% (p<0.05). In addition, there were 1.5-fold and 2.0 fold increases in p27Kip1 mRNA and protein expression, respectively, in HG-stimulated podocytes compared to NG- treated cells (p<0.05). p27Kip1 mRNA and protein expression were also increased in cultured podocytes stimulated by AII by 156% and 199%, respectively (p<0.05). ARB treatment ameliorated HG-induced increase in p27Kip1 mRNA by 75% and protein expression by 70% (p<0.05). In contrast, there were no significant changes in p21Cip1 and p57Kip2 protein expression in cultured podocytes exposed to HG or AII. CONCLUSION: High glucose induced significant cellular hypertrophy and increased p27Kip1 mRNA and protein expression in cultured mouse podocytes, and these changes were effectively inhibited by ARB treatment.
Mice ; Animals

Mesenteric vein thrombosis is a rare disease that can be fatal, as it can cause ischemia or infarction of bowels. The mortality rate is 13~50%. The predisposing factors of mesenteric vein thrombosis are numerous, and one of them is diverticulitis. Diverticulitis is a rare disease and mesenteric vein thrombosis caused by diverticulitis has not been reported in Korea. We report a patient with superior mesenteric vein thrombosis associated with diverticulitis of ascending colon, and it was diagnosed by computed tomography and barium enema. After antibiotic therapy, the thrombosis was resolved and the patient was completely recovered.
Barium ; Causality ; Colon, Ascending ; Diverticulitis* ; Enema ; Humans ; Infarction ; Ischemia ; Korea ; Mesenteric Veins* ; Mortality ; Rare Diseases ; Thrombosis*

BACKGROUND: The interaction between killer immunoglobulin-like receptors (KIRs) and HLA class I regulates natural killer (NK) cell cytotoxicity and function. The impact of NK cell alloreactivity through KIR in liver transplantation remains unelucidated. Since the frequency of HLA-C and KIR genotypes show ethnic differences, we assessed the impact of HLA-C, KIR genotype, or KIR-ligand mismatch on the allograft outcome of Korean liver allografts. METHODS: One hundred eighty-two living donor liver transplant patients were studied. Thirty-five patients (19.2%) had biopsy-confirmed acute rejection (AR), and eighteen (9.9%) had graft failure. The HLA-C compatibility, KIR genotypes, ligand-ligand, and KIR-ligand matching was retrospectively investigated for association with allograft outcomes. RESULTS: Homozygous C1 ligands were predominant in both patients and donors, and frequency of the HLA-C2 allele in Koreans was lower than that in other ethnic groups. Despite the significantly lower frequency of the HLA-C2 genotype in Koreans, donors with at least one HLA-C2 allele showed higher rates of AR than donors with no HLA-C2 alleles (29.2% vs 15.7%, P=0.0423). Although KIR genotypes also showed ethnic differences, KIR genotypes and the number of activating KIR/inhibitory KIR were not associated with the allograft outcome. KIR-ligand mismatch was expected in 31.6% of Korean liver transplants and had no impact on AR or graft survival. CONCLUSIONS: This study could not confirm the clinical impact of KIR genotypes and KIR-ligand mismatch. However, we demonstrated that the presence of HLA-C2 allele in the donor influenced AR of Korean liver allografts.
Adult ; Alleles ; Asian Continental Ancestry Group/*genetics ; Female ; Genotype ; Graft Rejection ; Graft Survival ; HLA-C Antigens/*genetics ; Homozygote ; Humans ; Killer Cells, Natural/cytology/immunology ; Ligands ; *Liver Transplantation ; Male ; Middle Aged ; Proportional Hazards Models ; Receptors, KIR/chemistry/*genetics/metabolism ; Republic of Korea ; Tissue Donors ; Transplantation, Homologous

OBJECTIVE: To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients. METHODS: A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling. RESULTS: DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients. CONCLUSION: CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.
Abdomen ; Diagnosis, Differential ; Edema* ; Femoral Vein ; Humans ; Leg* ; Ligaments ; Pelvis ; Phlebography* ; Rehabilitation* ; Retrospective Studies ; Ultrasonography ; Venous Thrombosis*

The ichroma Chikungunya virus (CHIKV) IgG/IgM (Boditech Med Inc., Chuncheon, Korea) is a newly developed rapid lateral flow immunoassay for detection of anti- CHIKV-IgG/ IgM. This study conducted with thirty-six anti-CHIKV IgG positive sera, 57 anti-CHIKV IgM positive sera and 163 anti-CHIKV IgG/IgM negative sera which were confirmed by commercial enzyme-linked immunosorbent assays (ELISAs) (Inbios CHIKjj Detect™ IgM Capture ELISA, Inbios CHIKjj Detect™ IgG ELISA (InBios International Inc., Seattle, WA, USA), Anti-CHIKV ELISA (IgM), Anti- CHIKV ELISA (IgG) (Euroimmun, Lübeck, Germany)). The ichroma detected all 36 anti-CHIKV IgG and 57 anti-CHIKV IgM positivity (100% sensitivity). For 163 anti-CHIKV IgG/IgM negative sera, the ichroma showed one false positive for IgM (99.4% specificity). The ichroma showed no cross-reactivity and no interference. The ichroma demonstrated good diagnostic performance compared to the current ELISAs.