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A Case of Transition of Polycythemia Vera to Chronic Neutrophilic Leukemia.

Seung Soon LEE ; Joon Ho MOON ; Jun Wook HA ; Young Kyung LEE ; Jin Seok AHN ; Dae Young ZANG ; Hyo Jung KIM

The Korean Journal of Internal Medicine.2004;19(4):285-288.

Chronic Neutrophilic Leukemia (CNL) is a rare myeloproliferative disorder characterized by a persistent increase of mature peripheral neutrophils, myeloid hyperplasia in bone marrow, hepatosplenomegaly, elevated neutrophil alkaline phosphatase (NAP) and absence of Philadelphia chromosome, with no evidence of infection or malignancy sufficient to mimic a leukemoid reaction. CNL has been associated with multiple myelomas in many reported cases, but transition of Polycythemia Vera (PV) to CNL is very rare. An 81-year-old female patient, who had undergone intermittent phlebotomy following the diagnosis of PV 8 years previously, was admitted to our hospital due to lower back pain. A physical examination showed a splenomegaly 2cm below the costal margin, with tenderness of the thoracic and lumbar spine area. A peripheral blood examination showed a WBC count of 91, 800/micro L (neutrophil 88%) with a rare immature form, hemoglobin of 9.1 g/dL and a platelet count of 1, 661, 000/micro L. Her NAP score was 58. The bone marrow examination showed 95% cellularity, with an M: E ratio of 10: 1, increased megakaryocytes with normal morphology and the absence of myelofibrosis. Chromosomal studies showed no Philadelphia chromosome. A radiological examination showed compression fractures of the vertebrae and spinal cord compression. No underlying disease causing a leukemoid reaction was detected. With iron replacement, the hemoglobin level failed to increase over 12 g/dL. Therefore, it was concluded to be a transition of PV to CNL. After administration of hydroxyurea and vertebroplasty, the symptom improved and the WBC count was sustained below 40, 000/micro L.
Aged ; Aged, 80 and over ; Female ; Humans ; Leukemia, Neutrophilic, Chronic/*etiology ; Polycythemia Vera/*complications

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The First Case of Primary Retroperitoneal Mucinous Cystadenoma in Korea: A Case Report.

Byung Wook MIN ; Jong Man KIM ; Jun Won UM ; Eung Seok LEE ; Gil Soo SON ; Seung Joo KIM ; Hong Young MOON

The Korean Journal of Internal Medicine.2004;19(4):282-284.

Primary mucinous cystic cystadenomas of the retroperitoneum are very rarely encountered, and there have been only about 30 cases reported in the literature. The histogenesis of primary mucinous cystadenomas is unclear. Most authors suggested that it develops through mucinous metaplasia in a pre-existing mesothelium-lined cyst. Complete surgical excision is the only treatment and it is required for the final diagnosis and cure. We present here a case report of a 38-year-old Korean woman with primary retroperitoneal cystadenoma. It was a thin-walled, multilocular cyst with a dominant loculus that measured 10.0 X 7.5 X 5.5 cm3 in size, and to the best of our knowledge, this is the first such case to be reported in in Korea.
Adult ; Cystadenoma, Mucinous/*diagnosis/surgery ; Female ; Humans ; Retroperitoneal Neoplasms/*diagnosis/surgery

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Association of sleep quality in Behcet disease with disease activity, depression, and quality of life in Korean population.

Jimin LEE ; Sung Soo KIM ; Hye Jin JEONG ; Chang Nam SON ; Ji Min KIM ; Yong Won CHO ; Sang Hyon KIM

The Korean Journal of Internal Medicine.2017;32(2):352-359. doi:10.3904/kjim.2016.367

BACKGROUND/AIMS: Sleep disturbance is prime concern in patients with Behcet disease. The purpose of this study was to find out the effects of sleep quality, in Korean patients suffering from Behcet disease. We further investigated the relationship between depression, quality of life and the clinical findings of Behcet disease. METHODS: The study was performed by the cross-sectional design. Sleep quality was assessed by the Korean version of Pittsburgh sleep quality index (PSQI). Disease activity of Behcet disease was evaluated by Behcet disease current activity form (BDCAF). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2). Quality of life was assessed by the Korean version of the Leeds Behcet disease quality of life measure (BDQoL). RESULTS: Among the 100 patients studied, 42% reported poor sleep quality (PSQI ≥ 9). These patients have a higher BDI-2, total BDCAF and pain visual analogue scale (VAS) score (p < 0.001, p = 0.022, and p = 0.005). Considering BDCAF, the frequency of genital ulcer was significantly higher (p = 0.01). Behcet was higher in females. The BDQoL was lower in poor sleeper group (p = 0.004 and p < 0.001). Among 7 PSQI components, daytime dysfunction was higher in patients with high disease activity (p = 0.03). Total PSQI score were strongly correlated with BDCAF, BDI-2, BDQoL, and pain VAS score (p = 0.02, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: Low sleep quality is directly associated with disease activity, depression, and quality of life in Korean patients with Behcet disease.
Behcet Syndrome* ; Depression* ; Female ; Humans ; Quality of Life* ; Ulcer

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Association of biofilm production with colonization among clinical isolates of Acinetobacter baumannii.

Seong Yeol RYU ; Won Ki BAEK ; Hyun Ah KIM

The Korean Journal of Internal Medicine.2017;32(2):345-351. doi:10.3904/kjim.2015.287

BACKGROUND/AIMS: The pathogen Acinetobacter baumannii is increasingly causing healthcare-associated infections worldwide, particularly in intensive care units. Biofilm formation, a factor contributing to the virulence of A. baumannii, is associated with long-term persistence in hospital environments. The present study investigates the clinical impact of biofilm production on colonization and acquisition after patient admission. METHODS: Forty-nine A. baumannii isolates were obtained between August and November 2013 from Keimyung University Dongsan Medical Center, Daegu, Korea. All isolates were obtained from sputum samples of new patients infected or colonized by A. baumannii. The microtiter plate assay was used to determine biofilm formation. RESULTS: Twenty-four A. baumannii isolates (48%) demonstrated enhanced biofilm formation capacity than that of the standard A. baumannii strain (ATCC 19606). All isolates were resistant to carbapenem, 38 isolates (77%) were collected from patients in an intensive care unit, and 47 isolates (95%) were from patients who had been exposed to antibiotics in the previous month. The median duration of colonization was longer for biofilm-producing isolates than that of the biofilm non-biofilm producing isolates (18 days vs. 12 days, p < 0.05). Simultaneous colonization with other bacteria was more common for biofilm-producing isolates than that for the non-biofilm producing isolates. The most prevalent co-colonizing bacteria was Staphylococcus aureus. CONCLUSIONS: Biofilm-producing isolates seem to colonize the respiratory tract for longer durations than the non-biofilm producing isolates. During colonization, biofilm producers promote co-colonization by other bacteria, particularly S. aureus. Additional research is required to determine possible links between biofilm formation and nosocomial infection.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; Bacteria ; Biofilms* ; Colon* ; Cross Infection ; Daegu ; Humans ; Intensive Care Units ; Korea ; Patient Admission ; Respiratory System ; Sputum ; Staphylococcus aureus ; Virulence

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Clinicopathologic significance of tumor microenvironment CD11c, and FOXP3 expression in diffuse large B-cell lymphoma patients receiving rituximab, cyclophosphamide, anthracycline, vincristine, and prednisone (R-CHOP) combination chemotherapy.

Seul LEE ; Dong Hyun KIM ; Sung Yong OH ; So Yeon KIM ; Myeong Seok KOH ; Ji Hyun LEE ; Suee LEE ; Sung Hyun KIM ; Jong Young KWAK ; Min Gyoung PAK ; Mi Ha JU ; Hyo Jin KIM ; Jin Sook JEONG

The Korean Journal of Internal Medicine.2017;32(2):335-344. doi:10.3904/kjim.2015.161

BACKGROUND/AIMS: CD11c is a dendritic cell marker in humans, which potentially induces a cytotoxic effect on lymphoma cells. Forkhead boxP3 (FOXP3) is a regulator of T lymphocyte in the microenvironment of the lymphoma. The principal objective of this study was to determine whether the tumors' microenvironment expressions of CD11c and FOXP3 are predictive of clinical outcomes in diffuse large B-cell lymphoma (DLBCL) patients receiving treatment with rituximab, cyclophosphamide, anthracycline, vincristine, and prednisone (R-CHOP) combination chemotherapy. METHODS: The study population consisted of 100 patients with DLBCL. The CD11c and FOXP3 expression in primary tumors' microenvironment were evaluated using an immunohistochemistry (IHC). RESULTS: CD11c and FOXP3 expression positivity in microenvironment were 25% and 35%, respectively. Each one counted for 1 point. In CD11c and FOXP3 stain, positive was counted as 0 and negative was 1. The points were separated into low risk (0 to 1) and high risk (2) groups. Only the extranodal DLBCL patient group analysis conveyed significant differences of progression-free survival (p = 0.019) and overall survival (p = 0.039) between the two groups. CONCLUSIONS: We can achieve possible clinical significance of lymphoma tumor microenvironments through CD11c and FOXP3 IHC stains in extranodal DLBCL patients receiving R-CHOP therapy.
B-Lymphocytes* ; Coloring Agents ; Cyclophosphamide* ; Dendritic Cells ; Disease-Free Survival ; Drug Therapy, Combination* ; Humans ; Immunohistochemistry ; Lymphocytes ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Prednisone* ; Rituximab* ; Tumor Microenvironment* ; Vincristine*

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Sleep duration and chronic kidney disease: The Korean Genome and Epidemiology Study (KoGES)-Kangwha study.

Hansol CHOI ; Hyeon Chang KIM ; Joo Young LEE ; Ju Mi LEE ; Dong Phil CHOI ; Il SUH

The Korean Journal of Internal Medicine.2017;32(2):323-334. doi:10.3904/kjim.2015.400

BACKGROUND/AIMS: Sleep duration affects health in various ways. The objective of this study was to investigate the associations of sleep duration with chronic kidney disease (CKD) in a Korean adult population. METHODS: This cross-sectional analysis was conducted for total of 1,360 participants who completed baseline health examinations for the Korean Genome and Epidemiology Study-Kangwha study in 2010 to 2011. Sleep habits were measured by an interviewer-assisted questionnaire. Sleep duration was calculated based on the number of hours per day participants had slept over the past 1 year. CKD was defined as either proteinuria or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Multiple logistic regression models were applied to examine associations between sleep duration and CKD. RESULTS: Women with very long sleep duration (≥ 9 hours/day) were at significantly increased odds for having high serum creatinine (odds ratio [OR], 2.936; 95% confidence interval [CI], 1.176 to 7.326), low eGFR (OR, 3.320; 95% CI, 1.372 to 8.034), and CKD (OR, 3.112; 95% CI, 1.315 to 7.363), compared those with a typical sleep duration (7 to < 8 hours/day), after adjusting for sociodemographic status, socioeconomic status, health behaviors, comorbidities, and sleep quality. Among women, for every 1 hour increase in sleep duration per day, there was a 24.6% increase in the presence of CKD (OR, 1.246; 95% CI, 1.019 to 1.523). However, among men, sleep duration was not significantly associated with CKD. CONCLUSIONS: Very long sleep duration was independently associated with a higher prevalence of CKD among Korean women. Gender may influence this association.
Adult ; Comorbidity ; Creatinine ; Cross-Sectional Studies ; Epidemiology* ; Female ; Genome* ; Glomerular Filtration Rate ; Health Behavior ; Humans ; Logistic Models ; Male ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic* ; Social Class

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Effects of metformin on hyperglycemia in an experimental model of tacrolimus- and sirolimus-induced diabetic rats.

Jian JIN ; Sun Woo LIM ; Long JIN ; Ji Hyun YU ; Hyun Seon KIM ; Byung Ha CHUNG ; Chul Woo YANG

The Korean Journal of Internal Medicine.2017;32(2):314-322. doi:10.3904/kjim.2015.394

BACKGROUND/AIMS: Metformin (MET) is a first-line drug for type 2 diabetes mellitus (DM); its effect on new-onset diabetes after transplantation caused by immunosuppressant therapy is unclear. We compared the effects of MET on DM caused by tacrolimus (TAC) or sirolimus (SRL). METHODS: DM was induced by injection of TAC (1.5 mg/kg) or SRL (0.3 mg/kg) for 2 weeks in rats, and MET (200 mg/kg) was injected for 2 more weeks. The effects of MET on DM caused by TAC or SRL were evaluated using an intraperitoneal glucose tolerance test (IPGTT) and by measuring plasma insulin concentration, islet size, and glucose-stimulated insulin secretion (GSIS). The effects of MET on the expression of adenosine monophosphate-activated protein kinase (AMPK), a pharmacological target of MET, were compared between TAC- and SRL-treated islets. RESULTS: IPGTT showed that both TAC and SRL induced hyperglycemia and reduced plasma insulin concentration compared with vehicle. These changes were reversed by addition of MET to SRL but not to TAC. Pancreatic islet cell size was decreased by TAC but not by SRL, but addition of MET did not affect pancreatic islet cell size in either group. MET significantly increased GSIS in SRL- but not in TAC-treated rats. AMPK expression was not affected by TAC but was significantly decreased in SRL-treated islets. Addition of MET restored AMPK expression in SRL-treated islets but not in TAC-treated islets. CONCLUSIONS: MET has different effects on hyperglycemia caused by TAC and SRL. The discrepancy between these drugs is related to their different mechanisms causing DM.
Adenosine ; AMP-Activated Protein Kinases ; Animals ; Cell Size ; Diabetes Mellitus, Type 2 ; Glucose Tolerance Test ; Hyperglycemia* ; Insulin ; Islets of Langerhans ; Metformin* ; Models, Theoretical* ; Plasma ; Protein Kinases ; Rats* ; Sirolimus ; Tacrolimus

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Association between thyroid autoimmunity and Helicobacter pylori infection.

Yun Mi CHOI ; Tae Yong KIM ; Eui Young KIM ; Eun Kyung JANG ; Min Ji JEON ; Won Gu KIM ; Young Kee SHONG ; Won Bae KIM

The Korean Journal of Internal Medicine.2017;32(2):309-313. doi:10.3904/kjim.2014.369

BACKGROUND/AIMS: There have been controversial reports linking Helicobacter pylori infection to autoimmune thyroid disease (AITD). However, data regarding the relationship are limited for Asian populations, which have an extremely high prevalence of H. pylori infection. We performed this study to investigate the association between H. pylori infection and AITD in Koreans. METHODS: This study involved adults aged 30 to 70 years who had visited a health promotion center. A total of 5,502 subjects were analysed. Thyroid status was assessed by free thyroxine, thyroid stimulating hormone, and anti-thyroid peroxidase antibody (TPO-Ab). Immunoglobulin G (IgG) antibodies to H. pylori were measured as an indication of H. pylori infection. We compared the prevalence of TPO-Ab in subjects with and without H. pylori infection. RESULTS: H. pylori IgG antibodies were found in 2,875 subjects (52.3%), and TPO-Ab were found in 430 (7.8%). Individuals positive for H. pylori Ab were older than those negative for H. pylori Ab (p < 0.01). The proportion of females was significantly higher in the TPO-Ab positive group (41.0% vs. 64.2%, p < 0.01). Prevalence of TPO-Ab positivity was higher in subjects with H. pylori infection (8.6% vs. 7.00%, p = 0.03), and this association was significant after adjusting for age, sex, and body mass index (odds ratio, 1.02; 95% confidence interval, 1.00 to 1.03; p = 0.04). CONCLUSIONS: In our study, prevalence of TPO-Ab positivity is more frequent in subjects with H. pylori infection. Our findings suggest H. pylori infection may play a role in the development of autoimmune thyroiditis.
Adult ; Antibodies ; Asian Continental Ancestry Group ; Autoimmunity* ; Body Mass Index ; Cross-Sectional Studies ; Female ; Health Promotion ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Peroxidase ; Prevalence ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis, Autoimmune ; Thyrotropin ; Thyroxine

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Qualitative and quantitative results of interferon-γ release assays for monitoring the response to anti-tuberculosis treatment.

I Nae PARK ; Tae Sun SHIM

The Korean Journal of Internal Medicine.2017;32(2):302-308. doi:10.3904/kjim.2016.199

BACKGROUND/AIMS: The usefulness of interferon-γ release assays (IGRAs) in monitoring to responses to anti-tuberculosis (TB) treatment is controversial. We compared the results of two IGRAs before and after anti-TB treatment in same patients with active TB. METHODS: From a retrospective review, we selected patients with active TB who underwent repeated QuantiFERON-TB Gold (QFN-Gold, Cellestis Limited) and T-SPOT.TB (Oxford Immunotec) assays before and after anti-TB treatment with first-line drugs. Both tests were performed prior to the start of anti-TB treatment or within 1 week after the start of anti-TB treatment and after completion of treatment. RESULTS: A total of 33 active TB patients were included in the study. On the QFN-Gold test, at baseline, 23 cases (70%) were early secreted antigenic target 6-kDa protein 6 (ESAT-6) or culture filtrate protein 10 (CFP-10) positive. On the T-SPOT. TB test, at baseline, 31 cases (94%) were ESAT-6 or CFP-10 positive. Most of patients remained both test-positive after anti-TB treatment. Although changes in interferon-γ release responses over time were highly variable in both tests, there was a mean decline of 27 and 24 spot-forming counts for ESAT-6 and CFP-10, respectively on the T-SPOT.TB test (p < 0.05 for all). CONCLUSIONS: Although limited by the small number of patients and a short-term follow-up, there was significant decline in the quantitative result of the T-SPOT. TB test with treatment. However, both commercial IGRAs may not provide evidence regarding the cure of disease in Korea, a country where the prevalence of TB is within the intermediate range.
Follow-Up Studies ; Humans ; Interferon-gamma Release Tests ; Korea ; Prevalence ; Retrospective Studies ; Tuberculosis

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Clinical significance of serum vascular endothelial growth factor in young male asthma patients.

Hea Yon LEE ; Kyung Hoon MIN ; Sang Min LEE ; Ji Eun LEE ; Chin Kook RHEE

The Korean Journal of Internal Medicine.2017;32(2):295-301. doi:10.3904/kjim.2014.242

BACKGROUND/AIMS: Vascular endothelial growth factor (VEGF) is an important mediator of angiogenesis. However, little is known about the potential use of serum levels of VEGF as a biomarker for asthma. We investigated the differences in VEGF levels among normal controls, stable asthma patients, and those with exacerbation of acute asthma. All subjects were young males. METHODS: We measured VEGF levels in each patient group, and examined any serial changes in those with acute exacerbation. RESULTS: VEGF levels were significantly higher in stable asthmatic patients and even more so in acute asthmatic patients, compared to healthy controls. However, there was no correlation between VEGF levels and forced expiratory volume in 1 second in patients with stable asthma. In addition, there were no correlations between VEGF levels and asthma control test scores. In patients with acute exacerbation, VEGF levels significantly increased during the acute period; their levels decreased gradually at 7 and 14 days after treatment. CONCLUSIONS: Compared to normal control patients, the serum levels of VEGF were elevated in stable asthma patients and even more elevated in patients with acute exacerbation. However, the role of VEGF as a biomarker in stable asthma is limited. In patients with acute exacerbation, VEGF levels were associated with clinical improvements.
Asthma* ; Forced Expiratory Volume ; Humans ; Male* ; Vascular Endothelial Growth Factor A*

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