BACKGROUND/AIMS: The widespread use of cytotoxic chemotherapy and immunosuppressants has resulted in reactivation of hepatitis B virus (HBV) recently becoming an issue. Although rituximab (an anti-CD20 monoclonal antibody) has revolutionized the treatment of lymphoma, recent reports have suggested that rituximab therapy increases the risk of viral-mediated complications, and particularly HBV reactivation. This study analyzed real clinical practice data for rituximab-related HBV reactivation. METHODS: Between January 2005 and December 2011, 169 patients received treatment with rituximab. Screening status of the HBV infection and frequency of preemptive therapy were determined in these patients, and the clinical features of HBV reactivation were analyzed. RESULTS: Seventy-nine of the 169 patients with chronic or past HBV infection were selected for evaluation of HBV reactivation. Of the 90 patients who were excluded, 22 (13.0%) were not assessed for HBsAg and anti-HBc, and 14 (8.3%) were not assessed for anti-HBc due to seronegativity for HBsAg. The selected patients were divided into those with chronic HBV infection (n=12) and those with past HBV infection (n=67); six patients (7.6%) experienced HBV reactivation. Eight patients received preemptive therapy, but three patients (37.5%) underwent HBV reactivation. Although HBsAg seropositivity was an independent risk factor for HBV reactivation (P=0.038), of the six patients with HBV reactivation, two (33.3%) had past HBV infection and three (50%) died of liver failure. CONCLUSIONS: The findings of this study demonstrate that adherence to guidelines for screening and preemptive therapy for HBV reactivation was negligent among the included cohort. Attention should be paid to HBV reactivation in patients with past as well as chronic HBV infection during and after rituximab therapy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies/blood ; Antibodies, Monoclonal, Murine-Derived/*adverse effects/therapeutic use ; Antineoplastic Agents/adverse effects/*therapeutic use ; Child ; Child, Preschool ; Hepatitis B/etiology/mortality/virology ; Hepatitis B Core Antigens/immunology ; Hepatitis B Surface Antigens/blood ; Hepatitis B virus/*physiology ; Humans ; Lymphoma/*drug therapy ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Risk Factors ; *Virus Activation ; Young Adult

A preliminary study was performed to investigate the staining characteristics of trabecula. endothelial cells with low density lipoprotein (LDL) and acetylated low density lipoprotein (Ac-LDL) labeled with a fluorescent probe, 1, 1`- dioctadecyl-3,3,3`, 3`- tetramethyl-indocarbocyanine perchlorate (Dil). Trabecular endothelial cells revealed a strong fluorescence with Dil-LDL, which was contradictory to the previous results obtained from other types of endothelial cells. These cells also showed a moderate fluorescence with Dil-Ac-LDL. Scleral fibroblasts and keratocytes showed a moderate to strong fluorescence with Dil-LDL and a weak fluorescence with Dil-Ac-LDL. Corneal endothelial cells revealed a very weak background fluorescence with Dil-LDL and a moderate fluorescence with Dil-Ar-LDL. Therefore, these four kinds of cells could not be definitely differentiated depending only on the staining characteristics with Dil-LDL and Dil-Ac-LDt.
Animals ; Cattle ; Endothelium/cytology ; Fluorescent Dyes/*diagnostic use ; Lipoproteins, LDL/*metabolism ; Trabecular Meshwork/*metabolism

PURPOSE: To analyze the clinical and radiologic results after total knee arthroplasties using down-sizing femoral prosthesis for tight fitting in patients over 75 years old. SUBJECTS AND METHODS: The study tracked the histories of 99 elderly patients aged 75 and over who underwent total knee arthroplasties with at least five years of follow-up from January 1st, 2005 to December 31st, 2007. The average age of the 99 patients was 78.58 years, and 17 women an 82 men patients underwent 78 cases of total knee arthroplasties on the right and 77 cases of total knee arthroplasties on the left. The HSS score and VAS scoring systems were introduced for clinical analysis. We compared the results of the width of the radiolucent line in 7 sections around the femoral component, 7 sections around the tibia component and 5 sections in the patella component using the American Knee Society Radiographic Evaluation and Scoring system respectively. RESULT: The average period of postoperative follow-up study was 6.2 years. The average femoral prosthesis size in preoperative measurement was 2.41 while the size selected in surgery was 1.89. The average VAS score decreased from 8.15 in preoperative measurement to 2.85 in postoperative measurement. Clinical significant loosening or dislocation of femoral prosthesis was not observed. Although the radiolucent line was observed in 5 cases, the score was less than 4. CONCLUSION: Total knee arthroplasties using down-sizing femoral prosthesis does not increase osteolysis and dislocation of femoral prosthesis but does reduce pain and help patients return to normal activities. Therefore this study showed that total knee arthroplasties using down-sizing femoral prosthesis helped elderly patients aged 75 and over.
Aged* ; Arthroplasty ; Dislocations ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Osteolysis ; Patella ; Prostheses and Implants ; Tibia

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and cisplatin for intractable advanced hepatocellular carcinoma (HCC) may have survival benefits. We aimed to determine the efficacy and safety of HAIC for advanced HCC as first-line therapy. METHODS: A total of 54 patients who received only HAIC with 5-fluorouracil (750 mg/m2 on days 1-4) and cisplatin (25 mg/m2 on days 1-4) for advanced HCC from Jan. 2009 to Dec. 2011 were selected. According to Child-Pugh class, the overall survival (OS), progression-free survival (PFS), and adverse events after HAIC were investigated retrospectively. RESULTS: Median OS and PFS between the Child-Pugh A group (n=24) and the Child-Pugh B/C group (n=30) were 8.7 (95% confidence interval [CI]: 4.7-12.7) vs. 3.7 months (95% CI: 2.0-5.3), and 7.1 (95% CI: 3.8-10.4) vs. 3.6 months (95% CI: 2.0-5.2), respectively. Although median OS and PFS were not statistically significant between the two groups (P=0.079, P=0.196), the Child-Pugh class B/C tended to influence poor OS. Serious adverse events > or = grade 3 occurred frequently in both groups (83.3 vs. 96.7%, P=0.159). Responders (22.2%, complete or partial response) significantly differed in median OS, compared to non-responders (13.1 vs. 4.4 months, P=0.019). Achievement of complete or partial response was an independent prognostic factor of OS (hazard ratio: 0.4, 95% CI: 0.2-0.8, P=0.011). CONCLUSIONS: Achievement of response after HAIC provide a survival benefit in patients with advanced HCC, but HAIC should be administered cautiously in patients with Child-Pugh class B/C, because of a relatively low survival and high incidence of serious adverse events.
Adult ; Aged ; Anemia/etiology ; Antineoplastic Agents/adverse effects/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy ; Cisplatin/adverse effects/*therapeutic use ; Diarrhea/etiology ; Disease-Free Survival ; Drug Therapy, Combination ; Female ; Fluorouracil/adverse effects/*therapeutic use ; Humans ; Infusions, Intra-Arterial ; Kaplan-Meier Estimate ; Liver Neoplasms/*drug therapy ; Male ; Middle Aged ; Neutropenia/etiology ; Retrospective Studies ; Severity of Illness Index ; Thrombocytopenia/etiology ; Treatment Outcome

Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.
Aged ; Creatinine/blood ; Foot/pathology ; Gangrene/*etiology ; Hepatitis C, Chronic/complications ; Humans ; Liver Cirrhosis/complications/diagnosis ; Liver Diseases/*diagnosis/drug therapy ; Lypressin/adverse effects/*analogs & derivatives/therapeutic use ; Male ; Osteomyelitis/*etiology ; Severity of Illness Index ; Toe Phalanges/radiography ; Vasoconstrictor Agents/*adverse effects/therapeutic use

Adhesive capsulitis of the shoulder joint is a common disorder characterized by a gradual increase of pain and limitation in range of motion of the shoulder joint. The pathophysiological process involves fibrous inflammation of the capsule leading to capsular thickening and contracture. Intra-articular corticosteroid injection is commonly performed in patients with adhesive capsulitis. However, there is no consensus as to the best injection site. Corticosteroid injection sites for the treatment include posterior capsule approach, rotator interval approach, multi-site, and subacromial injection. All injection methods lead to improvement in adhesive capsulitis cases. In this review article, we provide an overview of current corticosteroid injection methods for adhesive capsulitis.

PURPOSE: To compare the performance of a total knee arthroplasty with either a PFC Sigma fixed bearing or a rotating platform in the same patient. MATERIALS AND METHODS: 48 cases (24 patients) that received a PFC Sigma fixed bearing and a rotating platform in both knees, one in each knee. The knee score, functional score, activity level, radiologic analyses through fluoroscope , varus/valgus stress, and subjective satisfaction evaluation were performed at the last follow up in the same patient. RESULTS: There were no significant differences in the knee score, functional score, activity level, radiological findings through fluoroscope, and subjective satisfaction. In the varus/valgus stress views, 3 cases of lateral femoral condylar lift-off were observed in the fixed bearing type and 6 cases of lateral femoral condylar lift-off were observed in the rotating platform type. CONCLUSION: In cases of total knee arthroplasty with PFC Sigma fixed bearing and with rotating platform performed in the same patient, there were no significant differences in the clinical, radiological and subjective satisfaction. However, it is considered that the fixed bearing is more stable in terms of medial and lateral femoral condylar lift-off with varus and valgus stress than rotating platform. Therefore long term follow-up would be necessary.
Arthroplasty* ; Follow-Up Studies ; Humans ; Knee*

It has been well known that dilated cardiomyopathy (D-CMP) has characterized by systolic dysfunction of left ventricle (LV). But there are few studies about LV diastolic and right ventricular (RV) dysfunction in D-CMP. The purpose of this study is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The purpose of this tudy is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The gated blood pool scan (GBPS) was undertaken in 14 patients with D-CMP and 14 normal controls. The results are as follows : 1) Compared to normal controls, the global and regional ejection fraction of LV were significantly reduced (P<0.001) in D-CMP. But, there was no significant difference in LV ejection time between the two groups. 2) Peak filling rate and peak filling time were significantly reduced (P<0.001, P<0.05) in D-CMP 3) Global ejection fraction of RV was also significantly reduced in D-CMP compared to normal controls (P<0.001) But there was no significant difference in ejection rate of right ventricle between the two groups. 4) There was close correlation (R=0.802) between ejection fraction and filling rate of LV : filling rate was also reduced as ejection fraction decreased. And LV filling rate was also reduced with reduction of ejection rate. It is concluded that D-CMP shows diastolic impairment as well as systolic pumping failure and this systolic dysfunction is accounted for the diastolic impairment in D-CMP. And D-CMP shows also right ventricular dysfunction in almost all cases, as well as left ventricular dysfunction.
Cardiomyopathy, Dilated* ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right

SLE is an acute and/or chronic disease of a complex autoimmune nature affecting the skin, joints, serous membranes, kidney, central nervous system, cardiovascular system, and other organs of the body. Cardiac abnormalities are one of the most important clinical manifestations of SLE, contributing significantly to the morbidity and morality of the disease. We report a woman, a 30-year-old with SLE, who developed symptoms and echocardiographic signs of dilated cardiomyopathy. She had a history of acute myocardial infartion 7 months ago and has taken cyclophosphamide pulse therapy owing to lupus nephritis. The diagnosis of the condition was based only on clinical and echocardiographic grounds without coronary angiography or endomyocardial biopsy. She received high dose steroid (methylprednisolone pulse therapy 1mg/kg for 3 days) and conservative therapy for heart failure. The association of SLE with dilated cardiomyopathy has not been described with review of previous literatures. For the probable causes of her dilated cardiomyopathy, we suggest that they are due to coronary arteritis or cyclophosphamide-induced myocarditis with regard to her past history of myocardial infartion and cyclophosphamide therapy for lupus nephritis. The incidence of dilated cardiomyopathy, complicated with SLE is rare, but it has ap increased risk for unfavorable outcome. It reserves to pioneer the method of early diagnosis and management which will improved the morbidity and mortality of the disease.
Adult ; Arteritis ; Biopsy ; Cardiomyopathy, Dilated* ; Cardiovascular System ; Central Nervous System ; Chronic Disease ; Coronary Angiography ; Cyclophosphamide ; Diagnosis ; Early Diagnosis ; Echocardiography ; Female ; Heart Failure ; Humans ; Incidence ; Joints ; Kidney ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Morals ; Mortality ; Myocarditis ; Serous Membrane ; Skin

PURPOSE: To evaluate the effect of posterior cruciate ligament retaining total knee arthroplasty on its clinical results in patients with varus deformity. MATERIALS AND METHODS: We analyzed clinical and radiologic results of the 61 cases (39 patients) with varus deformity more than 15 degrees retrospectively. The average follow up period was 6.1 years (range, 5~8 years old). The cases were divided into posterior cruciate ligament retaining group A (42 cases) and substituted group B (19 cases). RESULTS: There was no statistically significant difference between two groups in Knee Society knee score (A group: 88.1, B group: 88.9), functional score (A group: 79.3, B group: 75.6) activity level (A group: 67.5, B group: 62.5), flexion contracture (A group: 4.5 degree, B group: 4.9 degree), tibiofemoral angle (A group: 4.7 degree, B group: 5.2 degree) and roentgenographic findings. Patients with PCL retaining knees showed significantly increased activity levels in going up and down stairs, and walking. CONCLUSION: It is considered that the preservation of the posterior cruciate ligament is better than the substitution of the ligament if technical problems are solved.
Arthroplasty* ; Congenital Abnormalities* ; Contracture ; Follow-Up Studies ; Humans ; Knee* ; Ligaments ; Posterior Cruciate Ligament ; Retrospective Studies ; Walking