Sarcoidosis is multisystem granulomatous disorder of unknown etiology presenting most freguently with bilateral hilar lymphadenopathy, pulmonary infiitration, and skin or eye lesion. Nervous system is involoved clinically in approximately 5% of cases. Cranial neuropathy is the most frequent problem, and a peripheral facial nerve palsy is the single most common abnormlality which is often bilateral. About 12 cases of sarcoidosis have been reported in Korea but there was no case of neurosarcoidosis. We report a case of neurosarcoidosis manifested by facial diplegia and with bilateral hilar enlargement verified by transbronchial lung biopsy. And her heart is suspected to be involved with sarcoidosis, too.
Biopsy ; Cranial Nerve Diseases ; Facial Nerve ; Heart ; Korea ; Lung ; Lymphatic Diseases ; Nervous System ; Paralysis ; Sarcoidosis ; Skin

Saphena varix is very rare disease that characterized by isolated distention of the saphenous vein below the sapheno-femoral junction. Saphena varix must be differentiated from other medical problems that can cause a groin mass. A 49-year-old man presented with a palpable mass on the right upper thigh and he'd had the mass for 6 months. There was no history of trauma, and the mass was especially noticeable when he was standing. On the physical examination, a 5 cm-sized soft, nontender, compressible mass was detected at the right upper medial thigh near the femoral foramen. Doppler sonography showed a saccular venous dilatation of the great saphenous vein just below the saphenofemoral junction. On computed tomography, there were superficially dilated veins in the right thigh and calf, a focal saccular aneurysm at the proximal segment of the right greater saphenous vein and no evidence of deep vein thrombosis. Aneurymal excision and stripping of the greater saphenous vein were performed. No complication was observed at the 2 week follow-up.
Aneurysm ; Dilatation ; Follow-Up Studies ; Groin ; Hernia, Femoral ; Humans ; Middle Aged ; Physical Examination ; Rare Diseases ; Saphenous Vein ; Thigh ; Varicose Veins ; Veins ; Venous Thrombosis

Abdominal vascular injury after blunt trauma does not occur very frequently. Penetrating trauma is the most common cause (90%) of abdominal vascular injury. A 57-year-old male presented with abdominal pain and color change of the right lower leg after blunt trauma. The physical examination showed rigid tenderness in the entire abdomen and no pulse in the right femoral artery. Computed Tomography (CT) demonstrated the acute aortic dissection, which extended from the infrarenal aorta to the iliac artery and there was embolic occlusion below the right common iliac artery. He underwent endarterectomy after thrombectomy, fasciotomy and small bowel segmental resection. A 65-year-old male presented with abdominal pain after an auto-bicycle crash. On the physical examination, there was tenderness and rebound tenderness noted on the entire abdomen. The CT done outside our hospital demonstrated an intramural hematoma around the descending aorta. He underwent small bowel and sigmoid segmental resection and S-colostomy. On day 1 after operation, he complained of sudden abdominal pain. He then developed the signs of acute liver and renal failure. His condition deteriorated rapidly with conservative management, and he died on day 2.
Abdomen ; Abdominal Pain ; Aged ; Aorta ; Aorta, Thoracic ; Colon, Sigmoid ; Endarterectomy ; Femoral Artery ; Hematoma ; Humans ; Iliac Artery ; Leg ; Liver ; Male ; Middle Aged ; Physical Examination ; Renal Insufficiency ; Thrombectomy ; Vascular System Injuries

OBJECTIVE: To investigate the the effects of interleukin-17 (IL-17)on the production of vascular endothelial growth factor (VEGF)from cultured rheumatoid arthritis synoviocytes. METHODS: Fibroblast-like synovial cells(FLS)were prepared from the synovial tissues of rheumatoid arthritis patients and cultured in the presence of IL-17, IL-17 with or without transforming growth factor-beta(TGF-beta),tumor necrosis factor-alpha(TNF-alpha)and interleukin-1 beta(IL-1 beta).VEGF levels were determined in the culture supernatants by sandwitch ELISA. RESULTS: Stimulation of FLS by serial concentration of IL-17,TGF-beta,TNF-alpha,IL-1 beta increased the production of VEGF by 2.1-2.7,2.2-3.0,2.0-2.9,2.3-3.1 fold over the constitutive levels of unstimulated FLS.Stimulation of FLS by IL- 17 with TGF-beta or TNF-alpha or IL-1 beta also increased the production of VEGF accord-ing to culture periods by 1.6-1.8,1.1-1.9,1.5-1.7 fold over the levels stimulated with TGF-beta or TNF-alpha or IL-1 beta,respectively.This results indicated that IL-17 increased the effect of TGF-beta,TNF-alpha,IL-1 beta on FLS,leading synergistic enhancement of VEGF production. CONCLUSION: IL-17 may be involved in the neovascularization in rheumatoid synovitis by enhancing the production of VEGF.
Arthritis, Rheumatoid* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-1 ; Interleukin-17* ; Interleukin-1beta ; Necrosis ; Synovitis ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Vascular Endothelial Growth Factor A*

OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage IB cervical cancer. METHODS: From January 1993 to December 2007, a total of 100 patients of stage IB were enrolled in this study who had at least two of the following three intermediate risk factors (deep stromal invasion, lymphovascular space involvement, and large tumor size) after radical hysterectomy and all patients had no high risk factors and no radiotherapy. Of these patients, 22 patients had surgery only and 78 patients had cisplatin-based combination chemotherapy as adjuvant therapy postoperatively to improve survival. Kaplan-Meier survival curves and Cox's proportional-hazards regression model and log-rank test were used for survival analysis and to estimate the impact of prognostic factors on survival. RESULTS: The mean age was 52 years (range, 28 to 76 years). The overall survival rate of all intermediate tumors are 92% (92/100). Surgery only group is 81.8% (18/22) and adjuvant chemotherapy group is 94.9% (74/78). Comparison of survival between two groups revealed significant statistical difference in both univariant and multivariant survival analysis (P<0.05). The main toxicities of adjuvant chemotherapy were bone marrow suppression (18%), nausea and vomiting (5.2%) and alopecia in etoposide-cisplatin chemotherapy group (100%) but most side effects of postoperative adjuvant chemotherapy were transient, reversible and within acceptable limits to all patients. CONCLUSION: Cisplatin based combined adjuvant chemotherapy for intermediate risk tumors after radical hysterectomy is promising with significant improvement of overall survival and with acceptable toxicity profile.
Alopecia ; Bone Marrow ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy, Combination ; Humans ; Hysterectomy ; Kaplan-Meier Estimate ; Nausea ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Survival Rate ; Uterine Cervical Neoplasms ; Vomiting

Objectives: This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model. Methods: After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu’s responses were organized into 4 phases and evaluated by applying the response model. Results: In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation–based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing. Conclusions This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

Objectives: The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. Methods: Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. Results: In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. Conclusions The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

BACKGROUND: Although many anti-diabetic drugs have been used to control hyperglycemia for decades, the efficacy of commonly-used oral glucose-lowering agents in Korean type 2 diabetic patients has yet to be clearly demonstrated. METHODS: We evaluated the efficacy of glimepiride, metformin, and rosiglitazone as initial treatment for drug-naive type 2 diabetes mellitus patients in a 48-week, double-blind, randomized controlled study that included 349 Korean patients. Our primary goal was to determine the change in HbA1c levels from baseline to end point. Our secondary goal was to evaluate changes in fasting plasma glucose (FPG) levels, body weight, frequency of adverse events, and the proportion of participants achieving target HbA1c levels. RESULTS: HbA1c levels decreased from 7.8% to 6.9% in the glimepiride group (P<0.001), from 7.9% to 7.0% in the metformin group (P<0.001), and from 7.8% to 7.0% (P<0.001) in the rosiglitazone group. Glimepiride and rosiglitazone significantly increased body weight and metformin reduced body weight during the study period. Symptomatic hypoglycemia was more frequent in the glimepiride group and diarrhea was more frequent in the metformin group. CONCLUSION: The efficacy of glimepiride, metformin, and rosiglitazone as antidiabetic monotherapies in drug-naive Korean type 2 diabetic patients was similar in the three groups, with no statistical difference. This study is the first randomized controlled trial to evaluate the efficacy of commonly-used oral hypoglycemic agents in Korean type 2 diabetic patients. An additional subgroup analysis is recommended to obtain more detailed information.
Body Weight ; Diabetes Mellitus, Type 2 ; Diarrhea ; Fasting ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypoglycemic Agents ; Metformin ; Plasma ; Sulfonylurea Compounds ; Thiazolidinediones

Objective: To investigate the effects of a herb complex extract (HCE) prepared from Cornus officinalis Sieb. Et Zucc., Eriobotrya japonica Lindley, and olive leaves on immune response of mouse spleen NK cells in vitro and in vivo analysis. Methods: The activity of natural killer (NK) cells was measured in splenocytes and YAC-1 cells. Mice were immunosuppressed using cyclophosphamide (5 mg/kg body weight). Three different doses of HCE (200, 400, and 800 mg/kg body weight) and red ginseng extract (800 mg/kg body weight) which was used as standard immunomodulatory herb were administered orally for 4 weeks. The body weight, dietary, water intake, organs (liver, thymus, and spleen) weight, completed blood count, and cytokines (tumor necrosis factor alpha, interferon gamma, and interleukin-2) production was measured. Results: At the maximum concentration of HCE, the activity of NK cells was increased by 48.5%. HCE increased liver, spleen, and thymus weights without altering numbers of white blood cells, lymphocytes, and neutrophils in a cyclophosphamide-induced immunosuppression rat model. However, HCE recovered the inhibited cytokine expression; HCE (800 mg/kg) increased cytokines levels. The results indicate the immune enhancement potential of this HCE. Conclusion: The HCE enhances immunity by increasing NK cell activity, regulating cytokine levels, and maintaining spleen weight. Therefore, it may be used as a potential immunity enhancer.