BACKGROUND AND OBJECTIVES: There are conflicting results about ciliary activity in chronic rhinosinusitis (CRS). And dynamic movements reacting to various stimuli in sinusitis mucosa have been studied rarely. This study was designed to investigate the ciliary activity according to the severity of sinusitis and clinical symptoms. We aimed to identify the dynamic ciliary activity in response to purinergic stimulation in sinusitis. SUBJECTS AND METHOD: Nasal mucosal samples were obtained from 44 CRS and 20 normal subjects. We measured ciliary beat frequency (CBF) in the basal and activated status. For evaluating the correlation of CBF with clinical findings, nasal symptoms, endoscopic findings, CT findings, allergy tests, and olfactory tests were reviewed. RESULTS: No significant differences were found in basal CBF between normal and CRS mucosa. However, the CBF stimulated by ATP in normal and CRS mucosa showed marked differences: both the maximal increase and duration of increased CBF by ATP were significantly reduced in CRS mucosa. The olfactory test showed significant correlation with basal CBF, but the presence of allergy or nasal symptoms did not show significant correlation with the basal CBF. The CT score and presence of nasal polyposis showed negative correlation with the basal CBF (p<0.05). CONCLUSION: The basal CBF of normal and CRS mucosa showed no difference. However, dynamic ciliary activity responding to purinergic stimulation was markedly attenuated in sinusitis mucosa. The severity of sinusitis and presence of polyposis negatively affected CBF.
Adenosine Triphosphate ; Hypersensitivity ; Mucous Membrane ; Sinusitis

The heart disease during gestation complicates approximately 0.5-1.5% of pregnancies. The common cause of heart disease during gestation is acquired rheumatic valvular lesions and congenital heart defects. In contrast, infective endocarditis during pregnancy or the puerperium is quite rare, with fewer than 100 cases reported over the past 50 years. We present a case of bacterial endocarditis complicated by severe tricuspid valvular insufficiency and associated septic pulmonary emboli. Therapy consisted of cesarean section at 32 weeks gestation followed by tricuspid valvular replacement, removal of vegetation and primary closure of congenital ventricular septal defect.
Cesarean Section ; Endocarditis ; Endocarditis, Bacterial* ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Ventricular ; Postpartum Period ; Pregnancy*

It is known that rheumatoid arthritis (RA) patients show increased incidence of multiple myeloma (MM), despite its rarity. Only one case of MM with seronegative RA was reported in Korea, thus far. We report a case of MM with seropositive RA. The patient was a 66 year old female who had been diagnosed with seropositive RA 4 years ago. Over the last 1 month, the patient experienced general weakness and weight loss of 10 kg. It was found that her serum creatinine had increased and her urine analysis showed proteinuria. To evaluate renal failure and proteinuria, renal biopsy, bone marrow biopsy and electrophoresis were carried out. A diagnosis of myeloma cast nephropathy was made. We report this rare case of MM represented as acute renal failure during the treatment for RA, and include a review of the literature.
Acute Kidney Injury* ; Arthritis, Rheumatoid* ; Biopsy ; Bone Marrow ; Creatinine ; Diagnosis ; Electrophoresis ; Female ; Humans ; Incidence ; Korea ; Multiple Myeloma* ; Proteinuria ; Renal Insufficiency ; Weight Loss

OBJECTIVE: The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria. METHODS: Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement. RESULTS: Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP). CONCLUSION: Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.
Arthritis, Rheumatoid ; Biological Products ; Biopsy ; Humans ; National Health Programs