Background/Aims: The aim of this study was to investigate long-term post-discontinuation outcomes in patients with rheumatoid arthritis (RA) who had been treated with tumor necrosis factor-α inhibitors (TNF-αi) which was then discontinued. Methods: Sixty Korean patients with RA who participated in a 5-year GO-BEFORE and GO-FORWARD extension trials were included in this retrospective study. Golimumab was deliberately discontinued after the extension study (baseline). Patients were then followed by their rheumatologists. We reviewed their medical records for 2 years (max 28 months) following golimumab discontinuation. Patients were divided into a maintained benefit (MB) group and a loss-of-benefit (LB) group based on treatment pattern after golimumab discontinuation. The LB group included patients whose conventional disease-modifying antirheumatic drug(s) were stepped-up or added/switched (SC) and those who restarted biologic therapy (RB). Results: The mean age of patients at baseline was 56.5 years and 55 (91.7%) were females. At the end of follow-up, 23 (38.3%) patients remained in the MB group. In the LB group, 75.7% and 24.3% were assigned into SC and RB subgroups, respectively. Fifty percent of patients lost MB after 23.3 months. Demographics and clinical variables at baseline were comparable between MB and LB groups except for age, C-reactive protein level, and corticosteroid use. Restarting biologic therapy was associated with swollen joint count (adjusted hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.01 to 3.55) and disease duration (adjusted HR, 1.12; 95% CI, 1.02 to 1.23) at baseline. Conclusions Treatment strategies after discontinuing TNF-αi are needed to better maintain disease control and quality of life of patients with RA.

Colonic diffuse ganglioneuromatosis is a benign neoplastic condition characterized by disseminated, intramural, or transmural proliferation of neural elements involving the enteric plexuses, sometimes associated with von Recklinghausen's disease and other multiple tumor syndromes. Colonic diffuse ganglioneuromatosis is usually large, ranging from 1 to 17 cm, and thus can distort the surrounding tissue architecture as well as infiltrate the adjacent bowel wall. However, colonic diffuse ganglioneuromatosis is an exceptional finding in adults and only individual cases are reported in the literature. Herein, we report two unusual cases of adult patients with colonic diffuse transmural ganglioneuromatosis presenting as a large subepithelial tumor.
Adult ; Aged ; Colon/metabolism/*pathology ; Colonoscopy ; Ganglioneuroma/*diagnosis/metabolism/pathology ; Humans ; Immunohistochemistry ; Male ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

Variceal bleeding occurs primarily in the esophagus or stomach in patients with liver cirrhosis, but can also occur rarely in the duodenum. Duodenal variceal bleeding has a high mortality and poor prognosis due to heavy blood flow originating from the portal vein (PV) and the technical difficulty of hemostatic procedures. Treatments including endoscopic sclerotherapy, endoscopic ligations, endoscopic clipping and transjugular intrahepatic portosystemic shunt have been tried, with only moderate and variable success. A percutaneous transsplenic approach offers another way of accessing the PV. Here we report a case of successfully treated duodenal variceal bleeding by percutaneous transsplenic embolization.
Aged ; Duodenum ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/*diagnosis ; Gastrointestinal Hemorrhage/*therapy ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Male ; Portal Vein/diagnostic imaging ; *Portasystemic Shunt, Transjugular Intrahepatic ; Recurrence ; Tomography, X-Ray Computed

BACKGROUNDDanshen (Radix Salvia miltiorrhizae) has been used as a traditional medicine in Asia for treatment of various microcirculatory disturbance related diseases. Tanshinones are mainly hydrophobic active components, which have been isolated from Danshen and show various biological functions. In this study, we observed the neuroprotective effect of tanshinone I (TsI) against ischemic damage in the gerbil hippocampal CA1 region (CA1) after transient cerebral ischemia and examined its neuroprotective mechanism.

METHODSThe gerbils were divided into vehicle-treated-sham-group, vehicle-treated-ischemia-group, TsI-treated-sham-group, and TsI-treated-ischemia-group. TsI was administrated intraperitoneally three times (once a day for three days) before ischemia-reperfusion. The neuroprotective effect of TsI was examined using H&E staining, neuronal nuclei (NeuN) immunohistochemistry and Fluoro-Jade B staining. To investigate the neuroprotective mechanism of TsI after ischemia-reperfusion, immunohistochemical (IHC) and Western blotting analyses for Cu, Zn-superoxide dismutase (SOD1), Mn-superoxide dismutase (SOD2), brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-I (IGF-I) were performed.

RESULTSTreatment with TsI protected pyramidal neurons from ischemia-induced neuronal death in the CA1 after ischemia-reperfusion. In addition, treatment with TsI maintained the levels of SOD1 and SOD2 as determined by IHC and Western blotting in the CA1 after ischemia-reperfusion compared with the vehicle-ischemia-group. In addition, treatment with TsI increased the levels of BDNF and IGF-I determined by IHC and Western blotting in the TsI-treated-sham-group compared with the vehicle-treated-sham-group, and their levels were maintained in the stratum pyramidale of the ischemic CA1 in the TsI-treated-ischemia-group.

CONCLUSIONTreatment with TsI protects pyramidal neurons of the CA1 from ischemic damage induced by transient cerebral ischemia via the maintenance of antioxidants and the increase of neurotrophic factors.

Animals ; Antioxidants ; metabolism ; Blotting, Western ; Brain Ischemia ; drug therapy ; metabolism ; Brain-Derived Neurotrophic Factor ; metabolism ; Diterpenes, Abietane ; therapeutic use ; Gerbillinae ; Hippocampus ; metabolism ; Immunohistochemistry ; Insulin-Like Growth Factor I ; metabolism ; Male ; Nerve Growth Factors ; metabolism ; Superoxide Dismutase ; metabolism ; Superoxide Dismutase-1

OBJECTIVE: The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. METHODS: A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. RESULTS: Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. CONCLUSION: In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.
Carotid Arteries ; Carotid Stenosis ; Embolic Protection Devices ; Humans ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents ; Stroke

BACKGROUND: In support of safe and appropriate utilization of blood products, the Korean Ministry of Health and Welfare and the Korean Society of Blood Transfusion developed transfusion guidelines in 2009. We evaluated the appropriateness of blood transfusions on the basis of these proposed guidelines. METHODS: We investigated the awareness of the 2009 proposed guidelines and the transfusion guidelines currently in use through a questionnaire administered to the physicians of a tertiary care hospital. We provided the 2009 proposed transfusion guidelines through summarized pop-ups for each blood product that appeared in the hospital information system whenever a physician ordered blood products, and promoted the guidelines by posting it on the bulletin board and the hospital information system for one month. Evaluation of the appropriateness of blood transfusion was conducted by reviewing the medical records of patients who were transfused within one month before and one month after the promotion. Further, we also examined the rates of blood wastage and return. RESULTS: Rates of appropriately transfused blood products changed from 29.4% to 33.1% for red blood cells, from 16.9% to 68.9% for platelets, and from 54.8% to 33.3% for fresh frozen plasma. The decreased appropriate transfusion rate of fresh frozen plasma might be due to the small number of transfusions performed during the short study period. The rates of blood wastage and return decreased from 1.77% to 1.21% and from 3.91% to 3.00%, respectively. CONCLUSIONS: Promotion of the new transfusion guidelines lowered the incidence of inappropriate transfusions. Continuous promotion and establishment of these guidelines after adjustments according to the status of each hospital are necessary.
Blood Platelets ; Blood Transfusion ; Erythrocytes ; Hospital Information Systems ; Humans ; Incidence ; Medical Records ; Plasma ; Surveys and Questionnaires ; Tertiary Healthcare

BACKGROUND/AIMS: Intussusception is uncommon in adults compared with children. The present study aimed to review our experience of adult intussusceptions and discuss the preoperative diagnosis and management. METHODS: A retrospective review was performed for 25 patients, at least 18 years old. These patients were diagnosed as intestinal intussusceptions at Hallym University Sacred Heart Hospital from January 1999 to October 2010. RESULTS: There were 14 male and 11 female with a mean age of 55 years. The most common symptom was abdominal pain. The preoperative diagnostic rate was 92% because of the use of an abdominal computed tomography (CT) and an ultrasound. A total of 9 (36%) patients had enteroenteric intussusception, 8 had ileocolic, 1 had ileocecal and 7 patients had colocolic intussusception. A discrete pathologic process was present in 22 (88%) patients and the remaining 3 (12%) patients were idiopathic. There were 12 small bowel lesions and 10 colonic lesions. Neoplasms were the most common etiology of intussusceptions. Of the cases with a defined colonic cause, 8 (80%) were malignant. Overall, 12 (48%) patients underwent primary resection of the intussusception without prior reduction, 11 (44%) patients had reduction of their intussusception followed by resection. CONCLUSIONS: Adult colonic intussusception is usually associated with malignancy. All patients with obstruction of unknown cause or lead point on CT should consider surgical exploration.
Abdominal Pain ; Adult ; Child ; Colon ; Female ; Heart ; Humans ; Intussusception ; Male ; Retrospective Studies

Lesions with coronary artery aneurysm (CAA) can become complicated during percutaneous coronary intervention. Here, we report a case of a 78-year-old man who developed a rupture, and spontaneous sealing of the CAA occurred after stent implantation, as shown by computed tomography coronary angiography.
Aged ; Aneurysm ; Congenital Abnormalities ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels ; Drug-Eluting Stents ; Ear ; Humans ; Percutaneous Coronary Intervention ; Rupture ; Stents

OBJECTIVE: Superior cerebellar artery (SCA) aneurysms are regarded as being as difficult to treat surgically as posterior circulation aneurysms. We describe here a series of 33 of these aneurysms treated with microsurgery or embolization. METHODS: Between June 1997 and August 2007, 33 patients (9 men, 24 women; age, 29 to 76 years) with SCA aneurysms underwent microsurgical (n = 12) or endovascular (n = 21) treatment. Twenty two patients presented with subarachnoid hemorrhage. Thirty aneurysms were located in the junction between the SCA and the basilar artery (BA), two in the proximal SCA (S1) and one in the distal SCA (S2-3). RESULTS: Of the 29 SCA aneurysms, located in the junction between the SCA and BA, which were available on conventional angiography, 20 were lateral-superior, six lateral-horizontal, two lateral inferior, and one posterior type. Of the 12 patients treated microsurgically, eight had clinically excellent or good outcomes. Causes of poor outcomes included initial poor clinical status (n = 2), infarction due to parent artery compromise (n = 1), and artery of Heubner injury due to surgery for a coexisting anterior communicating artery aneurysm (n = 1). Of the 21 patients treated endovascularly, 17 had clinical good or excellent outcomes. Causes of clinically poor outcomes included initial poor clinical status (n = 2) and infarction due to thrombosis of exposed coil mesh (n = 1). One patient underwent embolization resulted in death due to vasospasm. Three patients required additional embolization for coil compaction. CONCLUSION: There was no morbidity related to perforator injury, regardless of the treatment modality. Embolization or microsurgery is an effective modality, with relatively low procedural morbidity and mortality rates.
Aneurysm ; Angiography ; Arteries ; Basilar Artery ; Humans ; Infarction ; Intracranial Aneurysm ; Male ; Microsurgery ; Parents ; Subarachnoid Hemorrhage ; Thrombosis

OBJECTIVES: This study was carried out to define the relationship between the characteristics of tinnitus and hearing threshold (puretone and speech) in workers with noise induced hearing loss (NIHL). METHODS: A total of 189 cases(378 ears) from workers with compensation claims for NIHL during 2004-2009 were investigated. Various factors, including age, work carriers, body mass index (BMI), blood pressure, noise exposure level of worksite hearing threshold, speech discrimination score, pitch match, and loudness of tinnitus were analyzed. RESULTS: The average hearing threshold of all subject was 44.2 dBHL, puretone audiometry thresholds in subjects with tinnitus were lower than the non-tinnitus group (except at 8000 Hz). Using speech audiometry, the tinnitus group showed a lower speech recognition threshold and speech discrimination score. The tinnitus group also had an average tinnitus frequency of 4195.2 Hz, loudness of 73.6 dB, and tinnitus sensation average of 6.0 dBSL. These frequencies of tinnitus were in the lowest puretone audiometry frequencies. Tinnitus loudness had a strong relationship with puretone and speech audiometry thresholds. CONCLUSIONS: In cases beyond moderate hearing loss, the tinnitus group had a better puretone (except 8000 Hz) and speech hearing status, and most comfortable loudness (MCL) level. In addition, puretone and speech audiometry thresholds increase with tinnitus loudness.
Audiometry ; Audiometry, Speech ; Blood Pressure ; Body Mass Index ; Compensation and Redress ; Hearing ; Hearing Loss ; Noise ; Sensation ; Speech Perception ; Tinnitus ; Workers' Compensation ; Workplace