In 2006, we find 7 new cases and one relapse case, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. In new cases, the mean age is 59.3, mean BI is 3.3+, mean O.D. of PGL-I antibody is 0.941, numbers of TTC repeat are 13(3 cases), 11(2 case), 12(1 cases), and 31(1 case), and of GACATC repeats are 4(5 Koreans) and 3(2 foreigners). In relapse case, a 45 years-old male patient is revealed that BI is 5+, O.D. of PGL-I antibody is 1.096, numbers of TTC repeat are 12 and GACATC repeats are 4.
Biopsy ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lepromin ; Leprosy ; Male ; Middle Aged ; Recurrence ; Skin

Liver transplantation for patients with hepatocellular carcinoma (HCC) within the Milan criteria generally yields a 4-year overall survival rate of 75% and 4-year recurrence free survival rate of 83%. But, many HCC patients present with the disease beyond the Milan criteria. On the other hands, the overall survival of patients with advanced HCC with portal vein invasion is very poor. We report a case of successful living donor liver transplantation for advanced HCC with portal vein invasion by down-staging through radioembolization, hepatic arterial infusion chemotherapy, and stereotactic body radiation therapy.
Carcinoma, Hepatocellular* ; Drug Therapy* ; Hand ; Humans ; Liver Neoplasms ; Liver Transplantation* ; Liver* ; Living Donors* ; Portal Vein ; Recurrence ; Survival Rate

PURPOSE: The significance of metabolic syndrome (MS) was recently raised as a risk factor in chronic kidney disease (CKD). Diabetes and hypertension are not only well known diagnostic criteria for MS, but also risk factors for CKD. However, the association between MS and CKD in patients without diabetes and hypertension is unknown. METHODS: A total of 9586 subjects who registered in the health check service at Samsung Medical Center between January 2004 and December 2005 were included. MS was defined according to the criteria of the revised ATP III, and CKD was defined by the reduction of the glomerular filtration rate or the appearance of albuminuria. RESULTS: The prevalence of MS was 9.0% of study subjects. CKD was noticed in 6.2% of the subjects without MS, and 13.1% with MS. MS was a significant determinant of CKD {Odd ratio (OR) 1.80 and 95% confidence interval (CI) 1.42-2.28, p<0.001}. Compared with subjects lacking components of MS, subjects with one, two, three, four or five components of MS had a higher risk of acquiring CKD (OR, 1.04, 1.43, 1.89, 2.48, 3.29, Respectably). The relationship between each component of MS and CKD was different according to sex and age groups. Abdominal obesity was a significant determinant for CKD in female subjects, while high fasting glucose levels were a significant determinant in younger subjects (<60 years) (p<0.05). CONCLUSION: Even in non-diabetic and non-hypertensive adults, MS is independently associated as a risk factor for CKD.
Adenosine Triphosphate ; Adult* ; Albuminuria ; Fasting ; Female ; Glomerular Filtration Rate ; Glucose ; Humans ; Hypertension ; Metabolic Syndrome X ; Obesity, Abdominal ; Prevalence ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Risk Factors

PURPOSE: There were experimental evidences supporting that intrarenal activation of the renin-angiotensin system contributes to increase BP, proteinuria and urinary angiotensinogen (UAGT) excretion. The purpose of this prospective, open label, controlled study was to investigate the effect of losartan on proteinuria and UAGT excretion in chronic non-diabetic proteinuric (0.4 to 2.0 g/day) renal disease with normal renal function (glomerular filtration rate, GFR>60 mL/min/1.73m2). METHODS: Thirty two patients were randomly allocated to the losartan group (100 mg/day; n=17) or the control group (n=15). Systolic BP, diastolic BP, estimated GFR, urinary protein to creatinine ratio (UP/Cr), UAGT and plasma angiotensinogen (PAGT) level were compared between two groups at baseline, 6 months and 12 months. RESULTS: UP/Cr (1.13+/-0.36 g/g vs. 1.07+/-0.34 g/g) was similar in two groups at baseline. Target BP (<140/90 mmHg) was maintained in both groups. After 6 months, UP/Cr (0.63+/-0.35 g/g vs. 0.97+/-0.41 g/g, p<0.01) was significantly decreased in the losartan group compared to the control group. In addition, UAGT (baseline 1.0) was noticeably suppressed in the losartan group (0.72+/-0.42 vs. 1.07+/-0.81, p=0.13). However, PAGT was not changed in both groups. Moreover, our study at 12 months period has demonstrated continuous suppression of UP/Cr (0.79+/-0.53 g/g vs. 1.00+/-0.50 g/g, p=0.06) and UAGT (0.60+/-0.51 vs. 1.51+/-1.36, p<0.05) in the losartan group. UP/Cr was highly correlated with UAGT (Correlation Coefficient=0.74, p<0.01), but not with PAGT. CONCLUSION: Losartan not only induced a remarkable decrease in proteinuria but also contributed a reduction in UAGT in patients with chronic non-diabetic proteinuric renal disease.
Angiotensinogen ; Creatinine ; Filtration ; Humans ; Losartan ; Plasma ; Prospective Studies ; Proteinuria ; Renin-Angiotensin System

Primary reninism is a rare cause of hypertension manifesting along with hypokalemia. A high level of plasma renin activity and a high level of serum aldosterone are the whole markers of primary reninism. Upon making the diagnosis of primary reninism, other more common causes of aldosteronism must be differentiated, such as renovascular hypertension and primary aldosteronism. Primary reninism is commonly caused by juxtaglomerular cell tumor, which is one of the curable causes of hypertension, and this can be successfully treated by conservative surgery. We report here on a case of primary reninism that was caused by juxtaglomerular cell tumor that developed in a 22-year-old female patient. She was recently diagnosed with hypertension and hypokalemia. She had markedly elevated plasma renin activity and an increased serum aldosterone concentration. Computed tomography revealed a mass located in the right kidney and selective renal vein sampling suggested that the mass was secreting an excess of renin. Right nephrectomy was done and her hypertension with hypokalemia was successfully treated. We report here a case of primary reninism that presented with juxtaglomerular cell tumor along with a review of the literature
Aldosterone ; Diagnosis ; Female ; Humans ; Hyperaldosteronism ; Hypertension* ; Hypertension, Renovascular ; Hypokalemia* ; Kidney ; Nephrectomy ; Plasma ; Renal Veins ; Renin* ; Young Adult

Sarcoidosis is a systemic granulomatous disorder of unknown cause. The isolated noduar type muscular sarcoidosis without other systemic involvement is very rare in Korea. We report a case of sarcoidosis presented with myofasciitis. A 46-year-old man visited hospital with painful nodular swelling on the right arm for 1 month. We performed a humerus MRI and it revealed irregular shaped subcutaneous mass infiltrating along the fascial plane. The biopsy of triceps mass showed non-caseating granuloma of muscle and fascia. To find out the cause of granuloma, we checked chest CT scan and found out some enlargement of mediastinal lymph nodes. The biopsy also demonstrated non-caseating granulomas. It had no cancerous component and culture for microorganisms were all negative. He was diagnosed as sarcoidosis and given NSAID. On follow up evaluation, the size of mass was decreased.
Arm ; Biopsy ; Fascia ; Fasciitis ; Follow-Up Studies ; Granuloma ; Humans ; Humerus ; Korea ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Myositis ; Sarcoidosis* ; Tomography, X-Ray Computed

Adenovirus is one of the major viral cause of upper respiratory tract infection. Life-threatening adenovirus pneumonia is often reported in neonates, young children and immunocompromised hosts. It can rarely occur in previously healthy adults. Because there is no report on adenovirus pneumonia in adult patients in Korea, we report two cases of adenovirus pneumonia which developed in adult women. Despite of intravenous antibiotics therapy, the respiratory distress worsened and mechanical ventilation was applied. Microbiological tests for bacteria or fungi were negative. A high-resolution chest computed tomography showed bilateral patch ground-glass opacification. Subsequently, open lung biopsy specimen revealed diffuse alveolar damage and adenovirus was documented with immunohistochemical stain. Treatment with cidofovir led to prompt clinical improvement in our cases.
Adenoviridae Infections ; Adenoviridae* ; Adult ; Anti-Bacterial Agents ; Bacteria ; Biopsy ; Child ; Female ; Fungi ; Humans ; Immunocompromised Host ; Infant, Newborn ; Korea ; Lung ; Pneumonia* ; Respiration, Artificial ; Respiratory Tract Infections ; Thorax

Purpose: The purpose of this study was to determine the lowest Tl-201 dose that does not reduce the image quality of myocardial perfusion SPECT (MPS) by Poisson resampling simulation. Methods: One hundred and twelve consecutive MPS data from patients with suspected or known coronary artery disease were collected retrospectively. Stress and rest MPS data were resampled using the Poisson method with 33%, 50%, 67%, and 100% count settings. Two nuclear medicine physicians assessed the image quality of reconstructed data visually by giving grades from − 2 to + 2. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were obtained on the workstation. Image quality grades and semi-quantitative scores were then compared among these resampled images. Results: The proportions of “adequate” image quality were 0.48, 0.75, 0.92, and 0.96 for the groups of images with 33%, 50%, 67%, and 100% data, respectively. The quality of the resampled images was significantly degraded at 50% and 33% count settings, while the image quality was not different between 67 and 100% count settings. We also found that high body mass index further decreased image quality at 33% count setting. Among the semi-quantitative parameters, SSS and SRS showed a tendency to increase with a decline in count. Conclusion Based on the simulation results, Tl-201 dose for MPS can be reduced to 74 MBq without significant loss of image quality. However, the SSS and SRS can be changed significantly, and it needs to be further verified under the different conditions.

PURPOSE: The prevalence of coronary artery disease and left ventricular hypertrophy (LVH) is higher in patients with chronic kidney disease (CKD) than in the general population. In the general population, BNP, NT-proBNP, and cTnT are useful markers of cardiac disease. Recently, studies on biomarkers in patients with CKD have been reported. However, the effect of renal disease on these markers is still uncertain particularly in hemodialysis patients. We investigated the potential of BNP, NT-proBNP, and cTnT as biomarkers of cardiac disease in hemodialysis patients. Methods: We prospectively studied 27 hemodialysis patients without cardiovascular event within the last 6 months. We performed an echocardiography and blood samples for plasma BNP, NT-proBNP and cTnT. RESULTS: Median BNP, NT-proBNP, and cTnT level (pg/mL) were 433, 10,598, and 0.021, respectively. NT-proBNP was correlated with BNP (r=0.940, p=0.000) and cTnT (r=0.504, p=0.009). There was a negative correlation between BNP and left ventricular ejection fraction (LVEF) (r=-0.502, p=0.008), between NT-proBNP and LVEF (r=-0.556, p=0.003), and between cTnT and LVEF (r=-0.513, p=0.007). There was a positive correlation between BNP and LV mass index (LVMI) (g/m2) (r=0.619, p=0.001). Also, a positive correlation between NT-proBNP and LVMI was shown (r=0.718, p=0.000). There was an insignificant positive correlation between cTnT and LVMI (r=0.369, p=0.063). Albumin, cholesterol, LDL-cholesterol, and NT-proBNP had an independent effect on LVEF (R2=0.80). Age, body mass index, LDL-cholesterol, NT-proBNP, and cTnT had an independent effect on LVMI (R2=0.78). Conclusion: BNP, NT-proBNP, and cTnT may be as a noninvasive diagnostic or prognostic marker of cardiac disease in stable hemodialysis patients.
Biomarkers ; Body Mass Index ; Brain* ; Cholesterol ; Coronary Artery Disease ; Echocardiography ; Heart Diseases* ; Humans ; Hypertrophy, Left Ventricular ; Natriuretic Peptide, Brain* ; Natriuretic Peptides ; Plasma ; Prevalence ; Prospective Studies ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Stroke Volume ; Troponin T* ; Troponin*

BACKGROUND: Circulating levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) have been used to identify and monitor myocardial dysfunction in patients with various cardiac diseases. However, its clinical significance in patients with chronic renal failure (CRF) is uncertain because NT-proBNP clearance may be affected by renal function. METHODS: We studied 331 patients with CRF (eGFR <60 mL/min/1.73m2) admitted to Samsung Medical Center between March 2003 and March 2005, in whom both NT-proBNP measurement and echocardiography were performed within a week. RESULTS: Mean value of eGFR was 29+/-15 mL/ min/1.73m2 and median value of NT-proBNP was 6,971 pg/mL. NT-proBNP levels increased with declining eGFR (p<0.05). NT-proBNP levels were also elevated in patients with left ventricular hypertrophy (LVH), systolic dysfunction and diastolic dysfunction. In multiple regression analysis, ejection fraction (beta=-0.373, p>0.01) was strong independent correlate of NT-proBNP, eGFR (beta=-0.358, p<0.01), left ventricular mass index (beta=0.126, p>0.01) and diastolic dysfunction 2 or higher (beta=0.171, p< 0.05) were also independent correlates of NT-proBNP. Receiver-operating characteristic (ROC) analyses demonstrated NT-proBNP to be 75% sensitive and 76% specific for the detection of left ventricular systolic dysfunction, as indicated by area under the ROC curve of 0.78 (p<0.05), with NT-proBNP cutoff concentration of 25,000 pg/mL. CONCLUSION: Circulating NT-proBNP levels increased with declining renal function. However, its level were significantly correlated with LVH, systolic and diastolic dysfunction in patients with CRF. The measurement of NT-proBNP levels might be useful to predict left ventricular dysfunction in patients with CRF.
Echocardiography ; Heart Diseases ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic* ; Plasma* ; ROC Curve ; Ventricular Dysfunction, Left ; Ventricular Function, Left*