Dissection of the interventricular septum by aneurysm of sinus of Valsalva is a rare lesion and has poor prognosis. However, it can be diagnosed noninvasively with echocardiography and managed well by surgical repair. A 55 year old female was readmitted due to aggravated exertional dyspnea. She was implanted with permanent pace-maker due to complete atrioventricular (AV) block of recent onset at a community hospital. Previous diastolic murmur near aortic area was changed to a new continuous murmur. The diagnosis of an aneurysm of sinus of Valsalva dissected into the interventricular septum was confirmed by routine two-dimensional echocardiography. The neck of the aneurysm was closed primarily with patch and aortic valve replacement was done. The pro-gnosis was good. The finding of AV block of recent onset and obscure origin in a young patient should alert the physician to the possibility of an aneurysm of sinus of Valsalva and warrants systematic echocardiography.
Aneurysm* ; Aortic Valve ; Atrioventricular Block* ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Heart Murmurs ; Hospitals, Community ; Humans ; Middle Aged ; Neck ; Prognosis ; Sinus of Valsalva*

Massive hydrothorax is uncommon but well recognized complication of peritoneal dialysis. Possible mechanisms include a disorder of lymphatic drainage, pleuro-peritoneal pressure gradient, and congenital diaphragmatic defects. Hydrothorax in a CAPD patient caused by infiltrative disease or malignancy is very rare. Recently, two cases of hydrothorax in CAPD patients caused by systemic amyloidosis involving diaphragm were reported. However, no case of pleuro-peritoneal communication secondary to HCC infiltrating diaphragm was reported. This case was of a hydrothorax due to HCC in a CAPD patient. We performed video-assited thoracoscopic resection of diaphragmatic mass, diaphragmatic repair and thoracoscopic talc pleurodesis. This case showed that malignancy might be considered as a cause of a hydrothorax in a CAPD patient.
Carcinoma, Hepatocellular

BACKGROUND/AIMS: The prevalence of malignancies associated with human immunodeficiency virus (HIV) is rapidly increasing. The aim of the present study was to identify clinical features associated with malignancies in South Korean patients infected with HIV. METHODS: From January 1990 to June 2007, we reviewed an electronic database containing pathological reports obtained from HIV-infected patients and then retrospectively analyzed a total of 27 malignancy cases treated at four different institutions. RESULTS: Among 683 patients infected with HIV, malignant diseases were diagnosed in 27 cases (4.0%). Twenty-five of these patients were male, and the median age was 48 (range; 24-76). At the time of diagnosis, the median CD4+ lymphocyte count was 42/uL (range 3-339). Acquired immune deficiency syndrome (AIDS)-defining malignancies were diagnosed in 13 patients (48%) and non-AIDS-defining malignancies were diagnosed in 14 patients (52%). Two patients each were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the pre-highly active anti-retroviral therapy (HARRT) period. In contrast, 11 patients (48%) and 12 patients (52%) were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the HARRT period, respectively. Among AIDS-defining malignancies, non-Hodgkins lymphoma was the most frequently observed (9/13), followed by Kaposi's sarcoma (4/13). Among the 9 patients with non-Hodgkins lymphoma, diffuse large B-cell lymphoma was most common (5/9), followed by primary CNS lymphoma (3/9) and Burkitt's lymphoma (1/9). Gastrointestinal (GI) malignancies [i.e., gastric cancer (3/14), rectal cancer (3/14), and esophageal cancer (1/14)] and hepatocellular carcinoma (3/14) were the most commonly observed among the non-AIDS-defining malignancies. Other observed non-AIDS-defining malignancies were thyroid cancer (1/14), tonsillar cancer (1/14), angiosarcoma (1/14), and eccrine cancer (1/14). Finally, median CD4+ lymphocyte counts at the time of diagnosis were significantly different (18 vs. 114/uL, p=0.001) between AIDS-defining malignancies and non-AIDS-defining malignancies. CONCLUSIONS: Malignancies were diagnosed in 4.0% of patients infected with HIV. This study showed similar rates of incidence between AIDS-defining and non-AIDS-defining malignancies. Non-Hodgkins lymphoma was the most frequently observed malignancy, whereas GI malignancies and hepatocellular carcinoma were common among non-AIDS-defining malignancies.
Acquired Immunodeficiency Syndrome ; Burkitt Lymphoma ; Carcinoma, Hepatocellular ; Electronics ; Electrons ; Esophageal Neoplasms ; Hemangiosarcoma ; HIV ; Humans ; Incidence ; Lymphocyte Count ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Male ; Prevalence ; Rectal Neoplasms ; Retrospective Studies ; Sarcoma, Kaposi ; Stomach Neoplasms ; Thyroid Neoplasms ; Tonsillar Neoplasms

Rheumatoid arthritis (RA)is a multisystemic inflammatory disease with a prevalance of approximately 1%of the population.The use of disease modifying anti-rheumatic drug (DMARD)is an essential regimen for the treatment of RA. Among DMARDs,methotrexate (MTX)is used worldwide with confirmed effectiveness.However,cytopenia,pulmonary injury,and hepatic toxicity are a few side effects limiting its use.In addition,although the oncogenic potential of MTX is low,several cases have been reported.Recently an increased risk of developing lymphoproliferative disorders has been reported in patients with RA. The incidence is higher in elderly individuals with severe longstanding seropositive RA,those with Sjogren's or Felty's syndrome,and in patients with RA treated with prolonged low dose MTX.We describe a case of RA who developed non-Hodgkin's lymphoma during low dose MTX therapy.
Aged ; Arthritis, Rheumatoid* ; Humans ; Incidence ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Lymphoproliferative Disorders ; Methotrexate*

OBJECTIVE: To determine whether polymorphisms of the Vitamin D receptor (VDR)gene,known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians,might also relate to the risk of OA and osteoporosis in Korean postmenopausal women METHODS: A population of 130 postmenopausal women,including 76 healthy controls and 54 knee OA patients,were studied using anteroposterior radiographs of the knee,which were graded for OA according to the Kellgren classification system.The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I,Bsm I,and Apa I.Femoral neck bone mineral density (BMD)was assessed in all participants by dual energy X-ray absorptiometry . RESULTS: VDR genotype frequency distributions in Koreans were much different from Caucasian's both in the OA group and the control group.Especially, "t t", "B B" and "A A" genotype were very rare,prominently differentiating from Caucasians.But within Koreans,no significant differences in VDR genotype frequencies were observed between OA cases and controls.VDR genotype was not significantly associated with the radiographic grades of OA.And there were no significant relationships of VDR genotype with BMD scores in each group. CONCLUSION: In Korean postmenoposal women,the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD.VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because :(1)there is no correlation of VDR genotypes with the radiographic severity of OA ;and (2)there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian's .
Absorptiometry, Photon ; Bone Density ; Classification ; Digestion ; Female ; Genotype ; Humans ; Knee* ; Neck ; Osteoarthritis* ; Osteoporosis ; Polymerase Chain Reaction ; Prevalence ; Receptors, Calcitriol

OBJECTIVES: There are a number of preceding epidemiological studies reporting gender differences in the genetic etiology of alcohol dependence. The author investigated gender difference in the frequencies of ADH2 and ALDH2 genoypes between the patients with alcohol dependence and normal control. METHODS: The subjects were 141 alcohol dependent patients (104 males, 37 females) and 138 normal control (79 males, 59 females). The frequencies of 1/1 and 1/2+2/2 (2+ afterward) genotypes for ADH2 and ALDH2 were investigated in male and female between alcohol dependence and normal control group. DNA was extracted from WBC in peripheral venous blood and PCR-RFLP method was used out for genotyping. RESULTS: First, the frequency of ADH2 1/1 genotype was significantly higher in alcohol dependent patients than normal control in both genders. Second, while there was no gender difference in the frequency of ADH2 1/1 genotype in normal controls, in the patient group however, the frequency was significantly higher in females than males. Third, in male subjects with alcohol dependence, the frequency of ALDH2 1/1 genotype was significantly higher than in male normal control subjects. On the other hand, in female subjects with alcohol dependence, the frequency of ALDH2 2+ genotype was significantly higher than in female normal control subjects. CONCLUSION: These results suggest that while the risk of alcohol dependence is predominantly affected by ALDH2 1/1 genotype in male, the female ADH2 1/1 genotype is mainly associated with the risk of alcohol dependence. This means that there are gender differences in the genetic etiology of alcohol dependence.
Alcoholism* ; DNA ; Epidemiologic Studies ; Female ; Genotype* ; Hand ; Humans ; Male

PURPOSE: This study was designed to evaluate early parenchymal changes of acute cerebral ischemia / infarct by using T2-weighted, diffusion-weighted, and calculated apparent diffusion coefficient (ADC) MR imaging. MATERIALS AND METHODS: The brain MR images were successfully obtained 30, 60, 90, 120, 150 and 180 minutes after intraarterial administration of Lipiodol (0.4 - 0.6 ml) into the common carotid artery in 10 of 11 cats (91%). T2-and diffusion-weighted images and ADC were analyzed and compared with histopathologic findings. RESULTS: High signal intensity on T2-weighted and diffusion-weighted images was found in one cerebral hemisphere 30 minutes after Lipiodol injection, which tended to increase with time until 3 hours. Subcortical white matter showed higher signal intensity than cortical gray matter since 30 minutes after embolization. ADC images showed decreased signal intensity in the embolized hemisphere, which tended to decrease until 3 hours. Microscopic findings of the area corresponding to the abnormal signal intensity on MR images revealed varying degrees of edema in the gray and white matters involved. CONCLUSION: It is suggested that Lipiodol can be used as a good embolic agent causing early ischemic changes in experimental models. In addition to T2-weighted images, diffusion-weighted and ADC images can provide the further informations in the evaluation of the early parenchymal changes of cerebral infarct.
Animals ; Brain ; Brain Ischemia ; Carotid Artery, Common ; Cats* ; Cerebrum ; Diffusion ; Edema ; Ethiodized Oil* ; Magnetic Resonance Imaging* ; Models, Theoretical