OBJECTIVE: Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment. METHODS: We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level. RESULTS: The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was 13.6±7.0 years. The risk factors for surgically treated AAS development were the serum CRP level (p=0.005) and radiographic hand joint erosion (p=0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion (p<0.001) and young age at RA diagnosis (p=0.04). CONCLUSION: The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.
Arthritis, Rheumatoid* ; C-Reactive Protein ; Diagnosis* ; Hand ; Humans ; Joints ; Methotrexate ; Propensity Score ; Retrospective Studies ; Rheumatoid Factor ; Rheumatology ; Risk Factors* ; Spine

OBJECTIVE: Rheumatoid arthritis (RA) is known to involve the cervical spine up to 86%. It often causes cervical instability like atlantoaxial subluxation (AAS), subaxial subluxation, and vertical subluxation (VS). In order to find the relation between RA and cord compression, we will evaluate the characteristics and risk factors of basilar invagination (BI) and cervicomedullary junction (CMJ) compression.METHODS: From January 2007 to May 2015, 12667 patients administrated to Hanyang University Medical Center. Four thousand three hundred eighty-six patients took cervical X-ray and 250 patients took cervical computed tomography or magnetic resonance imaging. Radiologic parameters, medication records were obtained from 242 patients. Multivariate logistic regression analysis was performed with correlation of CMJ compression, basin-dental interval (BDI), basin-posterior axial line interval (BAI), pannus formation, BI, and AAS.RESULTS: In the point of CMJ compression, atlantodental interval (ADI), posterior-atlantodental interval, BAI, AAS, and BI are relatively highly correlated. Patients with BI have 82 times strong possibility of radiologic confirmed CMJ compression, while AAS has 6-fold and pannus formation has the 3-fold possibility. Compared to the low incidence of BI, AAS and pannus formation have more proportion in CMJ compression. Furthermore, wrist joint erosion was correlated with VS and AAS.CONCLUSION: BI has a very strong possibility of CMJ compression, while AAS and pannus formation have a high proportion in CMJ compression. Hence bilateral wrist joint erosion can be used as an indicator for the timing of screening test for cervical involvement. We suggest the early recommendation of cervical spine examination for the diagnosis of cervical involvement in order to prevent morbidity and mortality.
Academic Medical Centers ; Arthritis, Rheumatoid ; Diagnosis ; Humans ; Incidence ; Logistic Models ; Magnetic Resonance Imaging ; Mass Screening ; Mortality ; Risk Factors ; Spine ; Wrist Joint

BACKGROUND AND OBJECTIVES: Right-sided infective endocarditis (RtIE) occurs in about 5-10% of total infective endocarditis cases. In western countries, many cases of RtIE are related to drug addiction. However, there been only scant reports of right-sided infective endocarditis in Korea. The aim of the study was to identify the clinical characteristics of RtIE, such as frequency, predisposing risk factors, causative organisms and in-hospital mortality in Korea. SUBJECTS AND METHODS: All episodes diagnosed as infective endocarditis, between 1989 and 2003, at the Asan Medical Center were retrospectively reviewed using Duke's criteria. A total of 308 patients were diagnosed as infective endocarditis. RESULTS: RtIE was found in 34 patients (11.0%), with a mean age of 44.1+/-15.0 years. Fifteen patients had congenital heart diseases. However, several in-hospital invasive procedures and skin injuries were the most common predisposing risk factors in patients with uncorrected congenital heart disease (group A), whereas unknown causes were most common in patients without uncorrected congenital heart disease (group B). The most common causative organisms in groups A and B were Streptococcus viridans (6/15, 40%) and Staphylococcus aureus (13/19, 68.4%), respectively. In group A, the location of vegetations was variable according to the turbulent flow, but was exclusively at the tricuspid valve in group B. There were 6.7% (1/15) and 26.3% (5/19) inhospital mortalities in groups A and B, respectively (p=0.196). CONCLUSION: No drug addict with RtIE was seen. The most important predisposing risk factor in patients with RtIE was the presence of uncorrected congenital heart disease. The predisposing risk factors, causative organisms and the locations of vegetation in patients with RtIE differed according to the patient's uncorrected congenital heart disease.
Chungcheongnam-do ; Endocarditis* ; Endocarditis, Bacterial ; Heart Defects, Congenital ; Heart Diseases ; Hospital Mortality ; Humans ; Korea* ; Retrospective Studies ; Risk Factors ; Skin ; Staphylococcus aureus ; Substance-Related Disorders ; Tricuspid Valve ; Viridans Streptococci

Gastrointestinal involvement has been reported to occur in about 5 to l0% of patients with lymphoma. The most common gastrointestinal site for a lymphoma is the stomach, followed by the small intestine and ileocecal region. When lymphoma is found in the esap us, generally it is with contiguous involvement of the gastric fundus, the cervical node, secondary to mediastinal lymph node compression, or a late manifestation of advanced desease. Such cases cannot be labeled as primary esophageal lymphoma. A search of the literature reveals that there have been about 20 or more published cases classified as esophageal lymphoma. However, more than ten cases are indistingishable from the case of distal esophageal involvement by gastric lymphoma. In 1935, Chiolero described a case of midesophageal stricture, which at autopsy was consistent with Hodgkin's disease for the first time. Berman reported an authentic case of primary histiocytic lymphoma confined to the lower esophagus. Only six or more cases were reported in literature until the present time. Here, a 30-year-old man with substernal discomfort was shown to have a mass lesion on the esophagus. The mass was proved to be malignant lymphoma on the histologic examination. This may be the first report dealing with spontaneous regression of maligant lymphoma of the esophagus possibly associated with the use of cimetidine.
Adult ; Autopsy ; Cimetidine ; Constriction, Pathologic ; Esophagus* ; Gastric Fundus ; Hodgkin Disease ; Humans ; Intestine, Small ; Lymph Nodes ; Lymphoma* ; Lymphoma, Large B-Cell, Diffuse ; Stomach

BACKGROUND: Several lymphocytic populations, such as natural killer(NK) cells and lymphokine-activated killer (LAK) cells, are involved in immunosurveillance against tumors. Whereas the biological significance of the regional lymph node as a tumor barrier remains unclear, the clinical prognostic relevance of the neoplastic infiltration of these nodes is accepted. It appears that lymph node metastasis are more frequent in lung cancer than in other cancers because of impaired defensive mechanisms in the regional lymph nodes. However little is known about the immunologic function of regional lymph node lymphocytes in patients with lung cancer. Although there is general agreement that the NK and LAK activities of peripheral blood mononuclear cells(PBMC) decreases in patients with various solid and leukemic tumors, this decrease remains unclear with regard to the NK and LAK activities of their regional lymph node mononuclear cells(LNMC). We performed this study to determine the NK and LAK acti vities of regional lymph node, and to compare with those of peripheral blood in patients with lung cancer. METHODS: We measured the NK and LAK activities of PBMC and LNMC that were extirpated at lung cancer operations in 17 patients with lung cancer by 4 hour 51Cr-release assay using K562, Raji cell and allogenous lung cancer cell line(NCIH1092) as a target cell. E:T ratio were 12.5:1, 25:1, and 50:1. RESULTS: 1. Recombinant interleukin-2 induced strong cytotoxic activities against various target cells in PBMC and LNMC. 2. In patients with lung cancer, NK and LAK activities against K562 and allogenous lung cancer cell line(NCIH 1092) were lower than those of PBMC. 3. Against Raji cell, NK activities were not signifi cantly different between PBMC and LNMC, but LAK activities were significantly lower than those of PBMC. 4. NK activities against K562, Raji, and NCIH1092 cell were not significantly different between in patients with early stage and advanced stage lung cancer. 5. LAK activities of PBMC and LNMC against K562, Raji, and NCIH1092 cell were significantly lower in pa tients with advanced stage than those in patients with early stage lung cancer. CONCLUSION: NK and LAK activities of LNMC in patients with lung cancer were lower than those of PBMC, but the cytotoxicity was markedly increased after culture with rIL-2.
Humans ; Interleukin-2 ; Killer Cells, Natural ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Lymphocytes ; Monitoring, Immunologic ; Neoplasm Metastasis

Broncho-esophageal fistula(BEF) is an uncommon clinical entity which can cause severe suppurative lung disease. Acquired fistulas between the esophagus and tracheobronchial tree are relatively uncommon. They are caused by many diseases including malignancy and chronic inflammation such as tuberculosis and have favorable outcome with proper treatment. To our knowledge, there has been no description of patients with BEF due to the bronchiectasis. We report a case of broncho-esophageal fistula in association with bronchiectasis in a 35-year-old male patient with hemoptysis. Bronchoscopy revealed mild bleeding from the superior segment of the right lower lobe without specific endobronchial lesion. Barium esophagogram could not confirm the fistula. The diagnosis of a broncho-esophageal fistula was established by an esophagogastroscopy using fistulogram and subsequent bronchoscopy, in which the communication between the bronchial tree and the esophagus was demonstrated by instilling dye selectively through the fistulous opening using esophagogastroscopy and visualizing the fistula and the bronchial tree. The patient was treated with resection of the right lower lobe, extirpation of the diverticulum and surgical closure of the bronchial defect and fistula, but he suffered from pneumonia thereafter and eventually expired due to sepsis and multiple organ failure.
Adult ; Barium ; Bronchiectasis* ; Bronchoscopy ; Diagnosis ; Diverticulum ; Esophagus ; Fistula* ; Hemoptysis ; Hemorrhage ; Humans ; Inflammation ; Lung Diseases ; Male ; Multiple Organ Failure ; Pneumonia ; Sepsis ; Tuberculosis

Orbital apex syndrome (OAS) is a rare disease that presents with a complex of symptoms, including ophthalmoplegia, ptosis and visual loss. Due to the poor prognosis, making a prompt diagnosis and administering the appropriate treatment must be initiated without delay if OAS is suspected. We report here on a case of a patient with sphenoid fungal balls, and he presented with acute visual loss and ophthalmoplegia.
Aspergillosis ; Fungi ; Humans ; Ophthalmoplegia ; Orbit ; Prognosis ; Rare Diseases ; Sphenoid Sinus

BACKGROUND: Peroxisome proliferator activated receptor-gamma (PPAR-gamma) is a nuclear receptor that regulate adipocyte differentiation and modulate intracellular insulin-signaling events. As such, PPARgamma is a candidate gene for several human disorders including obesity and type 2 diabetes mellitus. The objective of our study was to examine the relationship between genetic variation of PPARgamma2 and diabetes and obesity in Korean subjects. METHODS: We studied 99 subjects with type 2 diabetes mellitus, 128 obesity patients and 97 controls. Screening for mutation at codon 12 and 115 of PPARgamma2 were carried out by PCR-RFLP analyses. Statistical significance was evaluated by Chi-square test. RESULTS: The allele frequency of the Pro12Ala PPARgamma2 variant were 0.05 in controls, 0.06 in type 2 diabetes group, and 0.07 in obesity group (p=0.47). Pro115Gln variant were only proline homozygote in all groups. Genotype frequencies were also similar and conformed to expectations of the Hardy-Weinberg rule. The presence of PPARgamma2 gene variant was no associated with concentrations of total cholesterol, triglyceride, HDL-cholesterol, and also with fasting glucose. CONCLUSION: We concluded that the Pro12Ala and Pro115Gln PPARgamma2 missense mutation may not be associated with type 2 diabetes mellitus and obesity in Korean patients.
Adipocytes ; Cholesterol ; Codon ; Diabetes Mellitus, Type 2* ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Gene Frequency ; Genetic Variation ; Genotype ; Glucose ; Homozygote ; Humans ; Liver Cirrhosis ; Mass Screening ; Mutation, Missense ; Obesity* ; Peroxisomes ; PPAR gamma* ; Proline ; Triglycerides

PURPOSE: Graft-Versus-Host Disease (GVHD) is a rare (0.1~2%) but severe complication after liver transplantation (LT). It is the most lethal complication after LT and there are currently no effective preventive or therapeutic measures available. Approximately 90 such cases have been reported in the literature, but only one case has been reported in Korea. METHODS: We performed a retrospective analysis of 767 patients who underwent LT (living donor:deceased donor=554:213) at Seoul National University Hospital, Korea from 1998 to 2009. Four patients (4/767, 0.52%) with histologically proven GVHD were found. The diagnosis of GVHD was made according to observing macrochimerism in the peripheral blood and the affected tissue biopsy. RESULTS: Four patients underwent LT due to Hepatitis B virus-related liver cirrhosis and two of these patients had coexisting hepatocellular carcinoma. Three patients received livers from deceased donors and one received a liver from a live donor. All their blood matching were identical. The first diagnosed case underwent human leukocyte antigen (HLA) typing only after LT and it showed complete one-way donor-recipient HLA matching. The onset of GVHD occurred between 10 days and 55 days after LT. All the patients developed high-grade fever, skin rash, neutropenia, diarrhea and the main signs and symptoms related to GVHD. All the patients died because of sepsis despite intensive treatment. CONCLUSION: GVHD after LT is an extremely rare and fatal complication and it is difficult to diagnose. Therefore, we should perform pre-transplant HLA matching and try to establish an early diagnosis for patients who are clinical suspicious of having GVHD. Further study in this area is needed and physicians need to be alert to detect this malady.
Carcinoma, Hepatocellular ; Chimerism ; Diarrhea ; Early Diagnosis ; Exanthema ; Fever ; Graft vs Host Disease ; Hepatitis B ; Humans ; Korea ; Leukocytes ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Neutropenia ; Retrospective Studies ; Sepsis ; Tissue Donors

OBJECTIVE: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. MATERIALS AND METHODS: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. RESULTS: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). CONCLUSION: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.
Adrenal Gland Neoplasms/pathology/*radiography/*radionuclide imaging/secondary ; Adult ; Aged ; Biopsy ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Lung Neoplasms/pathology/*radiography/*radionuclide imaging ; Male ; Middle Aged ; Positron-Emission Tomography/*methods ; Radiopharmaceuticals/*diagnostic use ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods