We reviewed forty renal biopsies from 39 patients of rheumatoid disease with urinary abnormalities. Pathologic findings were as follows : 11 cases with normal or minor glomerular abnormalities(MGA), 10 with membranous glomerulonephropathy, 6 with IgA nephropathy, 4 with mesangial proliferative glomerulonephritis, 3 with renal amyloidosis, 2 with interstitial nephritis, 2 with minimal change disease(MCD), 1 with focal segmental glomerulosclerosis, and 1 with microscopic polyangiitis. Among 11 cases with MGA both in light and immunofluorescent microscopy, 8 cases were analyzed morphometrically with electron micrographs to determine the variation of thickness of the glomerular basement membrane. The mean GBM thickness was 334.5+/-76nm and was not statistically significantly different to that of control(391+/-39 nm, p>0.05). Of these, one case showed diffuse attenuation of GBM(175.1+/-27.6nm) to meet the criteria of thin basement membrane disease. Also, another case showed normal finding. Mean GBM thickness of the remaining 6 cases, excluding these 2 cases, was 344.7+/-31.3nm. The proportion of attenuated foci (less than 300nm) was increased ranging from 30.3% to 40.5% of total measurements of GBM(control 11.4 %, p<0.02). Another cases with distinct renal diseases also showed segmental attenuation of GBM (22-30.3%). In conclusion, the renal manifestations were variable in patients with rheumatoid disease and segmental thinning of GBMs was noted in most cases, which may evoke idiopathic hematuria during the course of RA. The renal morphologic lesion in RA patients with isolated proteinuria and those with hematuria can not be accurately predicted on the basis of clinical symptoms and signs. Prospective long-term studies are necessary to determine the nature and consequences of the condition.
Amyloidosis ; Arthritis, Rheumatoid* ; Basement Membrane ; Biopsy ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Microscopic Polyangiitis ; Microscopy ; Nephritis, Interstitial ; Proteinuria

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

With increasing life expectance and improvement of the overall health of the elderly, the understanding of geriatric disease becomes an important aspect of medical services. In the elderly, the frequencies of hypertension, DM, & anemia are increased according to aging and renal function is decreased progressively. As screening test for cervical cancer Papanicolaou smear is recommended due to its cost-effective benefits in females. In age-adjusted elderly male and female study populations, authors investigated the alterations of the above diseases, hypercholesterolemia, liver disease, obesity, & proteinuria distributions. METHODS: This study included 1,181 aged 40 years (600 males, 581 females) visitors between January 1, 1997 and December 31, 1997 in National Medical Center, Seoul, South Korea. Authors divided these populations into two large groups such as group A and B. Group A was composed of 40-59 years, group B 60 years and older. Group A and B were subdivided into 4 subgroups each other, such as A-1, A-2, A-3 and A-4, B-1, B-2, B-3 and B-4 by means of age-adjusted dividing scale. We used our inclusion criteria to define each disease. RESULTS: Hypertension was the most common disease in males of group B, but obesity was in females. The age-adjusted frequencies of hypertension, anemia, obesity & proteinuria were increased according to aging in the elderly aged 60 years and older. Though hypercholesterolemia revealed non-specific distribution in each group, increased frequency was observed in females compared to males in group B. With increasing their age, abnormal findings of Papanicolaou smear were found in females of group B. CONCLUSIONS: As the frequencies of hypertension, anemia, obestiy, proteinuria & abnormal findings of Papanicolaou smear were increased in the elderly aged 60 years and older as increasing their age. Much more attentions and follow up plans for these disease should be needed in the elderly.
Aged* ; Aging ; Anemia ; Attention ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Liver Diseases ; Male ; Mass Screening ; Obesity ; Papanicolaou Test ; Proteinuria ; Seoul ; Uterine Cervical Neoplasms

BACKGROUND: Atrial fibrillation(AF) is the common and importand arrhythmia in the eldery. Because the distribution of cardiovascular disease changes according to age group and era, the distribution of underlying diseases in patients with AF also tends to change. The purpose of this study is to identify the difference between the eldery(> or = 65yr) and the young adult(<65yr) patients with AF in distribution of underlying disease. METHODS: 218 patients with AF diagnosed by routine EKG and Holter minitoring from Jan. 1996 to Dec 1998 in National Medical Center was evaluated. Their medical records were reviewed retrospectively in aspect of age, sex, developmental form & underlying disease of AF. In detail. last two subjects were investigated in two separate age group and at the same time, relation between them studied. RESULTS: The majority of age group with AF was 65~74yr(40.4%) and the eldery patient was 59.7%. Acute paroxysmal form and chronic persistent form was 21.1% and 78.9% respectively. There was no significant difference in development form of AF between the eldery and young adult group(chi2=1.45, p=0.227) The common underlying disease were hypertension(33.4%), congestive heart failure(32.1%), rheumatic valvular heart diseas(20.2%). ischemic heart disease(14.2%), hyperthyroidism(6.9%), COPD(4.1%), and lone AF(10.1%). In the eldery patients. hypertension is the most common underlying disease(42.3%) and congestive heart failure, ischemic heart disease, rheumatic valvular heart disease, and COPD were 36.2%, 21.5%, 10.8%, 6.9% respectively. In the young adult group-, rheumatic valvular heart disease was the most common(34%), and congestive heart failure, hypertension, ischemic heart disease, and hyperthyroidism were 26.1%, 20,5%, 3.4%, 10.2% respectively(chi2 = 62.71, p = 0.000). wheares ischemic heart disease, COPD, hyperthyroidism, stress, trauma, acute alcohol intoxication and lone AF were more common in acute paroxysmal AF, but hypertension, congestive heart failure, reumatic valvular heart disease were more common in chronic persistent AF(chi2 = 93.75, p = 0.000). CONCLUSION: Among underlying disease of AF. hypertension, congestive heart failure, ischemic heart disease were markedly increased and rheumatic valvular heart disease was decreased than previous reports in Korea. Hypertension, congestive heart failure, ischemic heart disease, COPD were more common in the eldely and as to rheumatic valvular heart disease, hyperthyroidism, and lone AF were in the young adult. Thus it showed significant difference in underlying desease between the eldery & the young adult as well as acute paroxysmal & chronic persistent form.
Aged* ; Arrhythmias, Cardiac ; Cardiovascular Diseases ; Electrocardiography ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Valve Diseases ; Humans ; Hypertension ; Hyperthyroidism ; Korea ; Medical Records ; Myocardial Ischemia ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Young Adult

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.
Abdomen ; Acute Kidney Injury* ; Antibodies, Antinuclear ; Arthritis, Rheumatoid ; Aspartate Aminotransferases ; Breast Neoplasms* ; Breast* ; Dermatitis ; Dermatomyositis* ; Exanthema ; Eyelids ; Forearm ; Forehead ; Fructose-Bisphosphate Aldolase ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Muscle Weakness ; Muscle, Skeletal ; Myoglobin ; Myositis ; Nose ; Renal Dialysis ; Rhabdomyolysis* ; Sepsis

BACKGROUND AND OBJECTIVES: Tranilast is an anti-allergic drug that suppresses the release of cytokines, such as platelet-derived growth factor, transforming growth factor-beta and interleukin-1beta. It has recently become known to be effective in the prevention of restenosis following PTCA (percutaneous transluminal coronary angioplasty). SUBJECTS AND METHODS: One hundred forty two consecutive patients with angina who underwent PTCA between Jan 1999 and Jul 2000 at Chonnam National University Hospital were analyzed prospectively. Thirty patients (Tranilast group:60.8+/-7.7 years, M:F=22:8, 41 lesions) out of 48 who received 300 mg tranilast for 3 months following PTCA and who underwent follow-up CAG (coronary angiogram), were compared with 61 patients (Control group:58.1+/-11.0 years, M:F=52:9, 82 lesions) out of 94, 94 who did not receive tranilast but did undergo follow-up CAG. RESULTS: The restenosis rate per lesion was significantly lower in the Tranilast group than in the Control group on the 6-month follow-up CAG (Tranilast vs. Control group:19.5% vs. 40.2%, p=0.021). The minimal luminal diameter was significantly larger in the Tranilast group as compared to the Control group (1.99+/-0.76 vs. 1.50+/-0.83 mm p=0.002). One patient of the Tranilast group suffered from liver dysfunction and stopped medication. CONCLUSION: The oral administration of tranilast is safe and effective in the prevention of restenosis following PTCA in patients with angina.
Administration, Oral ; Angioplasty, Balloon, Coronary* ; Coronary Disease ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-1beta ; Jeollanam-do ; Liver Diseases ; Phenobarbital ; Platelet-Derived Growth Factor ; Prospective Studies

BACKGROUND: To compare the effects of low dose and high dose of statin treatment on endothelial function and carotid intima-media thickness (IMT) in patients with variant angina (VAP). METHODS: A total of 70 patients with VAP were divided into two groups; atorvastatin 10 mg treatment group (group I: n = 35, 54.2 +/- 12.5 years) versus atorvastatin 40 mg treatment group (group II: n = 35, 52.6 +/- 9.8 years). Flow mediated vasodilation (FMD) of the brachial artery and IMT of the carotid artery were compared between the groups after 6 months of statin treatment. RESULTS: The baseline FMD and carotid IMT were not different between the groups. After 6 months of statin therapy, FMD was significantly improved in both groups (7.7 +/- 2.5% to 8.9 +/- 2.2% in group I, p = 0.001, 7.9 +/- 2.7% to 9.5 +/- 2.8% in group II, p < 0.001), but the degree of FMD change and FMD at 6 month were not different between the groups. Carotid IMT were not changed in both groups after 6 months of statin therapy. CONCLUSION: The use of statin for 6 months significantly improved endothelial function in patients with VAP, but carotid IMT was not changed. The use of high dose statin did not show significant additional benefit as compared with the use of low dose statin. The present study suggested that statin therapy would be beneficial in the treatment of VAP.
Atorvastatin Calcium ; Brachial Artery ; Carotid Arteries ; Carotid Intima-Media Thickness ; Heptanoic Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Pyrroles ; Vasodilation

BACKGROUND: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. METHODS: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9+/-9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43+/-0.14 mg/dL) on admission and Group II (n=122, 59.1+/-10.4 years, male 83.6%) with elevated CRP (> or = 1.0 mg/dL, mean value=3.50+/-0.93 mg/dL) on admission. RESULTS: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4+/-10.5 to 52.0+/-9.0%, 1.52+/-1.13 to 2.77+/-0.55, p<0.001 vs Group II; 50.1+/-11.2 to 52.7+/-9.7, 1.55+/-1.11 to 2.76+/-0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). CONCLUSION: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.
C-Reactive Protein* ; Humans ; Incidence ; Inflammation ; Jeollanam-do ; Male ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prognosis ; Shock, Cardiogenic ; Survival Rate

BACKGROUND AND OBJECTIVES: Brachytherapy is a promising method in the prevention and treatment of coronary stent restenosis. We sought to observe the therapeutic effects of a radioactive balloon loaded with Holmium-166 (166Ho) in a porcine coronary stent restenosis model. Materials and Methods: A radioisotope of (166Ho) was coated on the balloon surface using a polyurethane coating (20 Gy in 0.5 mm depth). Stent overdilation injuries were performed in two coronary arteries in 8 pigs. Four weeks after the stent overdilation injury, radiation therapies were performed using a control balloon dilation in one coronary artery (Group I:n = 8) and a 166Ho-coated balloon in the other coronary artery in each pig (Group II:n = 8). Follow-up coronary angiogram and histopathologic assessment were performed at 4 weeks after the therepy was administered. RESULTS: Laboratory findings did not differ significantly between the pre-treatment baseline and the measurements taken after radiation. On quantitative coronary angiogram, the coronary artery diameters were not significantly different between the two groups before stenting or at 4 and 8 weeks after stenting. On histopathologic analysis, injury score, internal elastic lamina area and lumen area did not differ significantly between the two groups. The neointimal area was 1.78 +/- 0.11 mm2 in group I and 1.36 +/- 0.12 mm2 in group II (p=0.017), and the histopathologic area of stenosis was 35.1 +/- 1.6% in Group I, 27.6 +/- 1.9% in Group II (p=0.005). CONCLUSION: A treatment of beta-radiation in a stented porcine coronary artery using radioactive Ho-166 coated balloon inhibits stent restenosis without any side effects.
Brachytherapy ; Constriction, Pathologic ; Coronary Disease ; Coronary Restenosis ; Coronary Vessels ; Follow-Up Studies ; Hyperplasia* ; Polyurethanes ; Radiation Injuries ; Radioisotopes ; Stents* ; Swine

BACKGROUND: It is known that prolonged QRS duration (QRSd) in a 12-lead ECG is associated with decreased left ventricular (LV) systolic function in patients with dilated cardiomyopathy. Development of LV systolic dysfunction and prolongation of paced QRSd are often observed in patients with permanent pacemakers (PPM). However, the significance of prolonged paced QRSd in patients with PPM is not determined. METHODS: We studied sixty-four patients (male:female=27:37, mean age=57.6+/-15.4 years) who had been on PPM (DDD: 15, VDD: 18, VVI: 31) for more than one year (mean: 68.2+/-44.0 months). LV function was normal before implantation of PPM. The 12-lead ECG and echocardiography were recorded prior to implantation, immediately after implantation and at the last follow-up. RESULTS: Paced QRSd did not significantly increase during the follow-up period. LVEF at the last follow-up (LVEF-FU) was significantly lower than that prior to implantation (59.3+/-11.5% vs. 64.9+/-10.1%, p<0.001). Eleven (17.2%) patients developed LV systolic dysfunction (LVEF<50%) during the follow-up period. Paced QRSd at the last follow-up and diabetes mellitus were correlated with LV systolic dysfunction (R2=0.302, p<0.001). There was a significant negative correlation between the paced QRSd and LVEF-FU (r=-0.451, p<0.01) and between change of paced QRSd and that of LVEF during follow-up (r=-0.419, p<0.01). LVEF-FU was reduced more in patients with paced QRSd >or=180 ms than in patients without (44.4+/-12.0% vs. 61.7+/-9.5%, p<0.001). In predicting LV systolic dysfunction with the paced QRSd (cut-off value: 180 ms), sensitivity, specificity, positive and negative predictive values were 60.0%, 88.7%, 50.0% and 99.2%, respectively. The paced QRSd at the last follow-up was significantly correlated with paced QRSd immediately after implantation (r=0.542, p<0.01). CONCLUSION: LV systolic dysfunction after long-term right ventricular apical pacing may develop. Prolongation of paced QRSd 180 ms during follow-up may suggest development of LV systolic dysfunction. New technologies to minimize prolongation of paced QRSd should be investigated to prevent LV systolic dysfunction after permanent ventricular pacing.
Cardiomyopathy, Dilated ; Diabetes Mellitus ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ventricular Dysfunction, Left* ; Ventricular Function