PURPOSE: Surgical resection of isolated hepatic or pulmonary metastases of colorectal cancer is an established procedure, with a 5-year survival rate of about 50%. However, the role of surgical resections in patients with both hepatic and pulmonary metastases is not well established. We aimed to analyze overall survival of these patients and associated factors. METHODS: Data retrospectively collected from 66 patients who underwent both hepatic and pulmonary metastasectomy after colorectal cancer surgery from August 2002 through August 2013 were analyzed. In univariate analysis, the log-rank test compared patient survival between groups. P < 0.1 was considered indicative of significance. Multivariate analysis of the significance data using a Cox proportional hazard model identified factors associated with overall survival. The synchronous group (n = 57) was defined as patients who had metastasectomy within 3 months from primary colorectal cancer surgery. The remaining nine patients constituted the metachronous group. RESULTS: Median follow-up was 126 months from the primary colorectal cancer surgery. The 5-year survival was 73.4%. There was no difference in overall survival between the synchronous and metachronous groups, consistent with previous studies. Distribution (involving one hemiliver or both, P = 0.010 in multivariate analysis) of liver metastases and multiplicity of the pulmonary metastasis (P = 0.039) were predictors of poor prognosis. CONCLUSION: Sequential or simultaneous resection of both hepatic and pulmonary metastasis of colorectal cancer resulted in good long-term survival in selected patients. Thus, an aggressive surgical approach and multidisciplinary decision making with surgeons seems to be justified.
Colorectal Neoplasms* ; Decision Making ; Follow-Up Studies ; Humans ; Liver* ; Lung* ; Metastasectomy ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Surgeons ; Survival Rate

We report two cases of systemic lupus erythematosus (SLE) in myasthenia gravis (MG) patients who had undergone thymectomy. SLE developed in the patients 3 months or 13 yr after thymectomy, and polyarthritis was the main clinical manifestation of SLE. Both patients fulfilled at least four of the revised criteria for the classification of SLE. In this report, we describe two postthymectomy lupus patients and perform a comparative review of previous cases.
Adult ; Female ; Human ; Lupus Erythematosus, Systemic/*diagnosis/etiology ; Myasthenia Gravis/*diagnosis/therapy ; Thymus Gland/*surgery ; Time Factors

We investigated the compliance of Korean patients using tumor necrosis factor (TNF) inhibitors to treat rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation. The study population comprised 114 RA and 310 AS patients treated with TNF inhibitors at a single tertiary center for at least 1 yr from December 2002 to November 2011. Of the 114 RA patients, 64 (56.1%) discontinued their first TNF inhibitors with a mean duration of 18.1 months. By contrast, 65 of 310 patients (21.0%) with AS discontinued their first TNF inhibitors, with a mean duration of 84 months. Although the survival rate did not differ among the three TNF inhibitors in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. In addition, RA patients who received corticosteroids in combination with TNF inhibitors were more likely to discontinue their TNF inhibitors. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials.
Adult ; Aged ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antirheumatic Agents/*therapeutic use ; Arthritis, Rheumatoid/*drug therapy/mortality ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin G/therapeutic use ; Male ; Middle Aged ; Proportional Hazards Models ; Receptors, Tumor Necrosis Factor/therapeutic use ; Sex Factors ; Spondylitis, Ankylosing/*drug therapy/mortality/radiography ; Tertiary Care Centers ; Treatment Refusal ; Tumor Necrosis Factors/*antagonists & inhibitors/metabolism

We investigated the compliance of Korean patients using tumor necrosis factor (TNF) inhibitors to treat rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation. The study population comprised 114 RA and 310 AS patients treated with TNF inhibitors at a single tertiary center for at least 1 yr from December 2002 to November 2011. Of the 114 RA patients, 64 (56.1%) discontinued their first TNF inhibitors with a mean duration of 18.1 months. By contrast, 65 of 310 patients (21.0%) with AS discontinued their first TNF inhibitors, with a mean duration of 84 months. Although the survival rate did not differ among the three TNF inhibitors in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. In addition, RA patients who received corticosteroids in combination with TNF inhibitors were more likely to discontinue their TNF inhibitors. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials.
Adult ; Aged ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antirheumatic Agents/*therapeutic use ; Arthritis, Rheumatoid/*drug therapy/mortality ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin G/therapeutic use ; Male ; Middle Aged ; Proportional Hazards Models ; Receptors, Tumor Necrosis Factor/therapeutic use ; Sex Factors ; Spondylitis, Ankylosing/*drug therapy/mortality/radiography ; Tertiary Care Centers ; Treatment Refusal ; Tumor Necrosis Factors/*antagonists & inhibitors/metabolism

Eosinophilic polymyositis is a rare form of inflammatory muscle disease associated with peripheral blood and/or tissue eosinophilia. Most patients respond to glucocorticoids, however some show poor prognosis, leading to mortality. A 28-year-old female was admitted to our hospital because of myalgia and motor weakness of the upper and lower extremities. Laboratory findings showed significantly elevated levels of muscle enzymes and inflammatory lesions in both thigh muscles were demonstrated on magnetic resonance imaging. A diagnosis of eosinophilic polymyositis was based on histological findings, which showed diffuse eosinophilic infiltration into perivascular spaces in the endomysium and perimysium, and necrosis of myofibers. High-dose methylprednisolone treatment improved the clinical symptoms and muscle enzymes. However, on tapering the glucocorticoid dose, clinical and laboratory findings were exacerbated. After the addition of methotrexate and azathioprine, the symptoms and muscle enzymes recovered without relapse. Here, we report on a case of eosinophilic polymyositis, which responded to immunosuppressants.
Adult ; Azathioprine ; Diagnosis ; Eosinophilia ; Eosinophils* ; Female ; Glucocorticoids ; Humans ; Immunosuppressive Agents* ; Lower Extremity ; Magnetic Resonance Imaging ; Methotrexate ; Methylprednisolone ; Mortality ; Muscles ; Myalgia ; Myositis ; Necrosis ; Polymyositis* ; Prognosis ; Recurrence ; Thigh

Neuropsychiatric manifestations in patients with systemic lupus erythematosus are fairly common, with a prevalence of 37~95%. Among 19 neuropsychiatric manifestations, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is quite rare, and is characterized by progressive, symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes. Generally, plasma exchange and intravenous immunoglobulin are the main treatment modalities. Here, we report a case of AIDP in a 29-year-old SLE patient, who was fully recovered with a treatment of high-dose glucocorticoid and immunosuppressive agents. Ours case suggests that AIDP should be treated differently in SLE patients to avoid disastrous results.
Adult ; Central Nervous System ; Guillain-Barre Syndrome* ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Lupus Erythematosus, Systemic* ; Muscle Weakness ; Plasma Exchange ; Polyradiculoneuropathy ; Prevalence ; Reflex, Stretch

It has been suggested that there is an increased risk of cancer in patients with systemic lupus erythematosus (SLE), even when cytotoxic drugs are not used. The coincidence of plasma cell tumor and lupus nephritis has been documented in animal models, but multiple myeloma is rarely associated with SLE in humans. No case of multiple myeloma in SLE has been reported in Korea. We report a case of multiple myeloma in a patient with SLE. The patient was a 49-year-old woman, who had polyarthralgia for 2 years. Progressive, painful swelling in both elbow joints developed 3 months before admission. The diagnosis of SLE was based on the findings of nondeforming arthritis, neutropenia, and positive ANA and anti-Sm antibody. Laboratory studies showed hypergammaglobulinemia and an elevated serum immunoglobulin (Ig) G level. Serum protein electrophoresis disclosed an M spike and serum immunoelectrophoresis showed a monoclonal IgG lambda type. Bone marrow aspiration revealed 15% plasma cells. Therefore, we diagnosed this patient as having multiple myeloma and SLE simultaneously.
Arthralgia ; Arthritis ; Bone Marrow ; Diagnosis ; Elbow Joint ; Electrophoresis ; Female ; Humans ; Hypergammaglobulinemia ; Immunoelectrophoresis ; Immunoglobulin G ; Immunoglobulins ; Korea ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Middle Aged ; Models, Animal ; Multiple Myeloma* ; Neutropenia ; Plasma Cells ; Plasmacytoma

A 31-year-old man who had been prescribed etanercept over a 3-year period for treatment of ankylosing spondylitis presented with newly developed dry cough, chills, myalgia, and weight loss. Chest computed tomography showed multiple reticulonodular pulmonary infiltrates and bilateral mediastinal, hilar, and peribronchial lymphadenopathy. Biopsy of a paratracheal lymph node revealed chronic granulomatous inflammation without necrosis, and the serum angiotensin-converting enzyme level was elevated. Sarcoidosis was diagnosed. His laboratory and radiological findings, and clinical symptoms improved only after discontinuation of etanercept without treatment. Although etanercept-induced sarcoidosis is rare, this case report suggests that sarcoidosis should be considered in the differential diagnosis of patients treated with the tumor necrosis factor inhibitor.
Adult ; Biopsy ; Chills ; Cough ; Diagnosis, Differential ; Etanercept* ; Humans ; Inflammation ; Lymph Nodes ; Lymphatic Diseases ; Myalgia ; Necrosis ; Sarcoidosis* ; Spondylitis, Ankylosing ; Thorax ; Tumor Necrosis Factor-alpha ; Weight Loss

OBJECTIVE: To evaluate the laboratory and clinical manifestations of Sjögren's syndrome (SS) association with chemokine (C-X-C motif) ligand 1 (CXCL1) expression in the ductal and acinar salivary gland epithelial cells (SGEC) of the minor salivary glands. METHODS: The sociodemographic data of 106 SS patients was obtained, and the glandular and extraglandular manifestations of the disease documented. The minor salivary glands were biopsied and the laboratory findings analyzed. European League Against Rheumatism SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) scores were obtained during biopsy. An immunohistochemical approach was used to define the expression of CXCL1 in the salivary glands. RESULTS: Of 106 patients, the minor salivary glands of 22 patients (20.7%) stained positively for CXCL1. Such CXCL1-positive patients exhibited higher ESSDAI scores at the time of biopsy than the CXCL1-negative patients (3.86±2.27 vs. 2.64±1.62, p=0.015). Lymphadenopathy was more frequently observed in CXCL1-positive patients, compared with CXCL1-negative patients (31.8% vs. 9.5%, p=0.014). No differences between groups were identified in terms of sociodemographic characteristics, laboratory data, or the extent of the glandular manifestation of SS. CONCLUSION: The expression of CXCL1 within the ductal and acinar SGEC of SS patients is associated with lymphadenopathy and elevated clinical disease activity. CXCL1 may play an important role in the disease activity and prognosis of SS.
Biopsy ; Chemokine CXCL1* ; Chemokines ; Epithelial Cells ; Humans ; Lymphatic Diseases ; Prognosis ; Rheumatic Diseases ; Salivary Glands ; Salivary Glands, Minor*

The aim of this study was to assess and validate the Korean version of the Boston Carpal Tunnel Questionnaire (K-BCTQ) in patients with carpal tunnel syndrome (CTS). After translation and cultural adaptation of the BCTQ to a Korean version, the K-BCTQ was administered to 54 patients with CTS; it was administered again after 2 weeks to assess reliability. Additionally, we administered K-DASH and EQ-5D to assess construct-validity. In a prospective study of responsiveness to clinical change, 29 of 54 patients were treated by ultrasonography-guided local corticosteroid injection therapy. The internal consistency of the K-BCTQ was high (Cronbach's alpha: 0.915) and the intra-class correlation coefficients were 0.931 for the symptom severity scale (P<0.001) and 0.844 for the functional severity scale (P<0.001). The construct-validity between the symptom severity scale and the K-DASH, and between the functional severity scale and the K-DASH were significantly correlated (both P<0.001). Clinical improvement was noted in 29 patients with injection therapy. The effect size of symptom severity was 0.67, and that of functional severity was 0.58. In conclusion, the K-BCTQ shows good reliability, construct-validity, and acceptable responsiveness after local corticosteroid injection therapy (Clinical trial number, KCT0000050).
Adrenal Cortex Hormones/*administration & dosage ; Carpal Tunnel Syndrome/*drug therapy ; Disability Evaluation ; Humans ; Injections ; Outcome Assessment (Health Care) ; Prospective Studies ; *Questionnaires ; Republic of Korea ; Severity of Illness Index ; Triamcinolone Acetonide/*administration & dosage ; Ultrasonography