PURPOSE: Infliximab is currently used for the treatment of active Crohn's disease (CD). We aimed to assess the efficacy and safety of infliximab therapy and to determine the predictors of response in Korean patients with CD. MATERIALS AND METHODS: A total of 317 patients who received at least one infliximab infusion for active luminal CD (n=198) and fistulizing CD (n=86) or both (n=33) were reviewed retrospectively in 29 Korean referral centers. Clinical outcomes of induction and maintenance therapy with infliximab, predictors of response, and adverse events were evaluated. RESULTS: In patients with luminal CD, the rates of clinical response and remission at week 14 were 89.2% and 60.0%, respectively. Male gender and isolated colonic disease were associated with higher remission rates at week 14. In week-14 responders, the probabilities of sustained response and remission were 96.2% and 93.3% at week 30 and 88.0% and 77.0% at week 54, respectively. In patients with fistulizing CD, clinical response and remission were observed in 85.0% and 56.2% of patients, respectively, at week 14. In week-14 responders, the probabilities of sustained response and remission were 94.0% and 97.1%, respectively, at both week 30 and week 54. Thirty-nine patients (12.3%) experienced adverse events related to infliximab. Serious adverse events developed in 19 (6.0%) patients including seven cases of active pulmonary tuberculosis. CONCLUSION: Infliximab induction and maintenance therapy are effective and well tolerable in Korean patients with luminal and fistulizing CD. However, clinicians must be aware of the risk of rare yet critical adverse events.
Colonic Diseases ; Crohn Disease* ; Humans ; Infliximab* ; Male ; Phenobarbital ; Referral and Consultation ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary

The authors report a rare case of retroperitoneal ganglioneuroma discovered incidentally in a 47-year-old male during abdominal computed tomogaphy(CT) evaluation. The clinical features and findings of the complementary examinations, which included radiological assessment, abdomen CT and lumbar spine magnetic resonance image with contrast enhancement are presented, as well as the pathology findings. The tumor, 10x10x6cm in size, was well encapsulated and total removal was made. Histopathological diagnosis of retroperitoneal ganglioneuroma was confirmed.
Abdomen ; Diagnosis ; Ganglioneuroma* ; Humans ; Male ; Middle Aged ; Pathology ; Spine

OBJECTIVE: The cytokine interleukin-6(IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants. The objective of this study is to determine whether serum IL-6 and cerebrospinal fluid(CSF) IL-6 levels were elevated at time of admission after head injury, serum IL-6 and CSF IL-6 levels related temporally to clinical improvement, severity of head injury with Glasgow Coma Scale(GCS) score and increased intracranial pressure(IICP). METHODS: All 21 patients(19 males and 2 females) with brain injury, managed in our institute between Aug 1996 and Jun 1998 were included in this study. Serum samples from all the 21 patients and CSF samples from 12 patients with low GCS score were analyzed for IL-6. IL-6 determination with enzyme-linked ELISA kits obtained from Quantikine(r). RESULTS: The values of IL-6 in serum and CSF in 21 patients with GCS score between 4 and 14(mean=9) were observed for 3-5 days after head injury. Peak elevation of serum IL-6 was observed on first day(8.2+/-4.9pg/ml) and then decreased to 4.0+/-3.6pg/ml on fifth day. Serum IL-6 levels decreased significantly faster in patients with GCS score of 8 through 11, compared with those of GCS score below 8. The patients showed markedly elevated and variable CSF IL-6 levels on admission(46.6+/-4.2pg/ml;normal, below 20.6+/-5.8pg/ml). CONCLUSION: This study demonstrates that the IL-6 level is related to the severity of traumatic brain injury.
Acute-Phase Proteins ; Adult* ; Brain Injuries ; Cerebrospinal Fluid* ; Coma ; Craniocerebral Trauma* ; Enzyme-Linked Immunosorbent Assay ; Head* ; Humans ; Interleukin-6* ; Intracranial Pressure ; Male

OBJECTIVE: The cytokine interleukin-6(IL-6) plays a major role in initiating the acute phase response, especially in the production of acute phase reactants. The objective of this study is to determine whether serum IL-6 and cerebrospinal fluid(CSF) IL-6 levels were elevated at time of admission after head injury, serum IL-6 and CSF IL-6 levels related temporally to clinical improvement, severity of head injury with Glasgow Coma Scale(GCS) score and increased intracranial pressure(IICP). METHODS: All 21 patients(19 males and 2 females) with brain injury, managed in our institute between Aug 1996 and Jun 1998 were included in this study. Serum samples from all the 21 patients and CSF samples from 12 patients with low GCS score were analyzed for IL-6. IL-6 determination with enzyme-linked ELISA kits obtained from Quantikine(r). RESULTS: The values of IL-6 in serum and CSF in 21 patients with GCS score between 4 and 14(mean=9) were observed for 3-5 days after head injury. Peak elevation of serum IL-6 was observed on first day(8.2+/-4.9pg/ml) and then decreased to 4.0+/-3.6pg/ml on fifth day. Serum IL-6 levels decreased significantly faster in patients with GCS score of 8 through 11, compared with those of GCS score below 8. The patients showed markedly elevated and variable CSF IL-6 levels on admission(46.6+/-4.2pg/ml;normal, below 20.6+/-5.8pg/ml). CONCLUSION: This study demonstrates that the IL-6 level is related to the severity of traumatic brain injury.
Acute-Phase Proteins ; Adult* ; Brain Injuries ; Cerebrospinal Fluid* ; Coma ; Craniocerebral Trauma* ; Enzyme-Linked Immunosorbent Assay ; Head* ; Humans ; Interleukin-6* ; Intracranial Pressure ; Male

We present a case of recurrent extraventricular neurocytoma with malignant glial differentiation in left temporoparietal area. A 37-year-old man with presentation of generalized seizure had undergone biopsy of brain tumor in left parietal area in 1987, which revealed extraventricular neurocytoma and radiotherapy was followed. Postoperative course was uneventful until eleven years after biopsy, when he became gradually aphasic and right hemiplegic. Brain CT and MRI revealed enlargement of tumor with peritumoral edema and calcifications. He underwent subtotal tumor removal in 1998. Microscopic examination of second biopsy specimen revealed presence of large areas composed of anaplastic glial cells with frequent mitosis, nuclear pleomorphism, large eosinophilic cytoplasm and eccentric nuclei, resembling gemistocytes, which were strongly immunoreactive to glial fibrillary acidic protein(GFAP) but not to synaptophysin(SNP). Also focal areas of neuronal cells were found, which were immunoreactive to SNP but not to GFAP. These histologic findings imply that this recurred tumor was a high grade, mixed tumor with divergent differentiation of neuronal and astrocyte lineage. We report a rare case of extraventricular cerebral neurocytoma with malignant glial differentiation with review of the literature.
Adult ; Astrocytes ; Biopsy ; Brain ; Brain Neoplasms ; Cytoplasm ; Edema ; Eosinophils ; Glial Fibrillary Acidic Protein ; Humans ; Magnetic Resonance Imaging ; Mitosis ; Neurocytoma* ; Neuroglia ; Neurons ; Rabeprazole ; Radiotherapy ; Seizures ; Synaptophysin

Intraorbital pseudotumors are inflammatory lesions of the orbit of unknown etiology, which initially mimic an orbital neoplasm. The authors report a case of intraorbital pseudotumor presenting with painful exophthalmos. A 45-year-old male patient had a two-week history of acute progressive exophthalmos and diplopia. Right orbit was explored through transcranial route and the mass was biopsied, which revealed dense inflammatory cells and fibrosis. He subsequently underwent corticosteroid therapy and symptoms improved gradually. The literatures were reviewed.
Diplopia ; Exophthalmos ; Fibrosis ; Humans ; Male ; Middle Aged ; Orbit ; Orbital Neoplasms ; Orbital Pseudotumor

OBJECTIVE: Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. METHODS: Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. RESULTS: In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p =0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p < 0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p < 0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. CONCLUSION: Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.
Aneurysm ; Anticonvulsants ; Craniotomy ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Neurologic Manifestations ; Risk Factors ; Rupture ; Seizures* ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

OBJECTIVE: Angiogenesis, the proliferation of capillary endothelial cells, is a vital component in the development, progression, and metastasis of many human tumors. Vascular endothelial growth factor(VEGF) is an endothelial cell-specific mitogen and induces angiogenesis and vascular permeability. The features of glioblastoma, distinct from low grade astrocytomas, are the presence of necroses and vascular endothelial proliferation. In this study, we investigated VEGF expression in the different grades of astrocytomas and determined whether VEGF expression correlates with development of glioblastoma and progression of astrocytomas. PATIENTS AND METHODS: Forty seven patients with astrocytic tumors(24 males and 23 females), aged 3 to 65 years, were evaluated. Immunohistochemical staining was carried out using labelled streptavidin biotin method and primary antibody was a antirabbit polyclonal Ab against N-terminus region of VEGF165(Oncogene research product, MA, USA). Immunoreactivity(IR) was classified into no IR(absent or a trace of stain), moderate IR and intense IR by level of staining amount and intensity. RESULTS: Six pilocytic astrocytomas showed 3 no IR and 3 moderate IR, 10 astrocytomas showed 2 no IR, 6 moderate IR and 2 intense IR, 12 anaplastic astrocytomas showed I no IR, 7 moderate IR and 4 intense IR and 19 glioblastomas showed 1 no IR, 11 moderate IR and 7 intense IR. Immunoreactivity was significantly different between low and high grade of tumors but there was no significant difference between anaplastic astrocytomas and glioblastomas. Gemistocytic tumor cells represented the predominent VEGF-immunoreactive cell types, as compared with compactly-arranged small tumor cells. In glioblastomas VEGF IR was observed in both perinecrotic and vital tumor areas. CONCLUSION: VEGF seems to be a important angiogenic factor in anaplastic astrocytomas and glioblastomas and VEGF expression may contribute to neovascularization of human astrocytomas.
Angiogenesis Inducing Agents ; Astrocytoma ; Biotin ; Capillary Permeability ; Endothelial Cells ; Glioblastoma ; Humans ; Male ; Necrosis ; Neoplasm Metastasis ; Streptavidin ; Vascular Endothelial Growth Factor A*

No abstract available.

No abstract available.