A retrospective study was conducted to determine the mortality, causes and risk factors for death among HIV-infected patients receiving antiretroviral therapy (ART) in Korea. The outcomes were determined by time periods, during the first year of ART and during 1-5 yr after ART initiation, respectively. Patients lost to follow-up were traced to ascertain survival status. Among 327 patients initiating ART during 1998-2006, 68 patients (20.8%) died during 5-yr follow-up periods. Mortality rate per 100 person-years was 8.69 (95% confidence interval, 5.68-12.73) during the first year of ART, which was higher than 4.13 (95% confidence interval, 2.98-5.59) during 1-5 yr after ART. Tuberculosis was the most common cause of death in both periods (30.8% within the first year of ART and 16.7% during 1-5 yr after ART). During the first year of ART, clinical category B and C at ART initiation, and underlying malignancy were significant risk factors for mortality. Between 1 and 5 yr after ART initiation, CD4 cell count < or = 50 cells/microL at ART initiation, hepatitis B virus co-infection, and visit constancy < or = 50% were significant risk factors for death. This suggests that different strategies to reduce mortality according to the time period after ART initiation are needed.
Anti-Retroviral Agents/*adverse effects/*therapeutic use ; Antiretroviral Therapy, Highly Active/adverse effects ; CD4 Lymphocyte Count ; Cause of Death ; Coinfection ; Female ; HIV Infections/*drug therapy/*mortality/virology ; Humans ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Although a decrease in acquired immunodeficiency syndrome (AIDS)-related mortality has been documented in highly active antiretroviral therapy (HAART) era, there are no published data comparing specific causes of death between pre-HAART and HAART era in Korea. Mortality and cause of death were analyzed in three treatment periods; pre-HAART (1990-1997), early-HAART (1998-2001), and late-HAART period (2002-2011). The patients were retrospectively classified according to the treatment period in which they were recruited. Although mortality rate per 100 person-year declined from 8.7 in pre-HAART to 4.9 in late-HAART period, the proportion of deaths within 3 months of initial visit to study hospital significantly increased from 15.9% in pre-HAART to 55.1% in late-HAART period (P < 0.001). Overall, 59% of deaths were attributable to AIDS-related conditions, and Pneumocystis pneumonia (PCP) was the most common cause of death (20.3%). The proportion of PCP as cause of death significantly increased from 8.7% in pre-HAART to 31.8% in late-HAART period (P < 0.001). Despite of significant improvement of survival, there was still a high risk of early death in patients presenting in HAART era, mainly due to late human immunodeficiency virus (HIV) diagnosis and late presentation to care.
Acquired Immunodeficiency Syndrome/mortality ; Adult ; *Antiretroviral Therapy, Highly Active ; Cause of Death/*trends ; Female ; HIV Infections/drug therapy/*mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pneumonia, Pneumocystis/mortality ; Republic of Korea ; Retrospective Studies

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the dignosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.
Duodenal Ulcer/*complications/diagnosis ; Endoscopy, Gastrointestinal ; Humans ; Male ; *Mesenteric Veins ; Middle Aged ; Peptic Ulcer Hemorrhage/*complications ; Protein C Deficiency/*complications/diagnosis ; Tomography, X-Ray Computed ; Venous Thrombosis/*diagnosis/etiology/ultrasonography

BACKGROUND/AIMS: A number of studies have reported wide variability in the colonoscope insertion time among patients who had prior abdominal surgery. The aim of this study was to investigate the effect of abdominal surgery on colonoscope insertion time. METHODS: The subjects were 192 patients with prior abdominal surgery, among 3,600 patients who underwent a colonoscopy at Samsung Changwon Hospital from May 2008 to May 2010. We collected the following data: insertion time, age, gender, height, weight, BMI, waist circumference, method of abdominal surgery, and the degree of bowel cleanliness. Previous abdominal operations were divided into colectomy, non-colectomy abdominal surgery, pelvic surgery, and laparoscopic surgery groups. RESULTS: The average colonoscope insertion time in patients with prior abdominal surgery (7.73+/-5.95 min) was longer than that of the non-surgery group (6.4+/-3.88 min). Patients in the colectomy groups were older and had a shorter insertion time (5.11+/-3.32 min) than patients in the other groups. CONCLUSIONS: Insertion of a colonoscope in patients with previous abdominal surgery was more difficult than that in the control group, except the colectomy group.
Colectomy ; Colonoscopes ; Colonoscopy ; Humans ; Laparoscopy ; Waist Circumference

BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (> or = 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (> or = 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS). RESULTS: During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp > or = 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp > or = 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp > or = 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.
Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Bone Marrow/*pathology ; Combined Modality Therapy ; Female ; *Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Multiple Myeloma/mortality/pathology/*therapy ; Plasma Cells/*pathology ; Predictive Value of Tests ; Retrospective Studies ; Transplantation, Autologous

BACKGROUND: Bortezomib has significant activity in treating multiple myeloma (MM). The risk of herpes zoster (HZ) has been reported to increase significantly with bortezomib treatment, but the predisposing factors for HZ are not clear. This study is a retrospective analysis of the relevant risk factors for HZ in Korean MM patients treated with bortezomib. METHODS: Sixty-six patients with refractory or relapsed MM who underwent chemotherapy with bortezomib were included in the study. Prophylactic antiviral drugs were not used for treatment. The following parameters were reviewed: age, gender, stage and type of MM, extent of previous treatment, history of HZ, duration from the time of diagnosis to the time of bortezomib treatment initiation, and absolute lymphocyte counts (ALC) at the time of bortezomib treatment initiation. RESULTS: The incidence of HZ was 16.7%. There were no intergroup differences between the HZ-positive and the HZ-negative groups with regard to a history of HZ, number of previous treatments, and exposure to steroids before bortezomib treatment. The median duration from the time of MM diagnosis to the time of bortezomib treatment initiation in the HZ-positive group was significantly shorter than that in the HZ-negative group. The median ALC at the time of bortezomib initiation in the HZ-positive group was significantly lower than that in the HZ-negative group. CONCLUSION: Bortezomib itself might act as a risk factor for HZ by inhibiting cell-mediated immunity, and patients with low ALC at the time of bortezomib treatment initiation were at greater risk of HZ during bortezomib treatment.
Antiviral Agents ; Boronic Acids ; Herpes Zoster ; Humans ; Immunity, Cellular ; Incidence ; Lymphocyte Count ; Multiple Myeloma ; Protease Inhibitors ; Pyrazines ; Retrospective Studies ; Risk Factors ; Steroids ; Bortezomib

Cowden's disease, a rare autosomal dominant disorder characterized by benign hamartomatous overgrowth of various tissues, increases the risk of cancer of the thyroid, breast, endometrium, prostate, and possibly other organs. Generally, germline mutations in the coding sequence for PTEN are found in 80% of patients with Cowden's disease. Here we report a rare case of incidentally discovered gastric polyposis during esophagogastroscopy for medical screening in a patient with a history of surgery for breast and thyroid cancer. Identifyng the mutation in the PTEN gene to a diagnosis of Cowden's disease.
Breast ; Clinical Coding ; Endometrium ; Endoscopy ; Female ; Germ-Line Mutation ; Hamartoma Syndrome, Multiple ; Humans ; Mass Screening ; Prostate ; Thyroid Neoplasms

Acquired hemophilia is a rare but potentially life-threatening hemorrhagic disorder caused by the development of autoantibodies against coagulation factor VIII. Concentrates of human factor VIII, desmopressin, activated prothrombin complex concentrates, recombinant activated factor VII can all be used to control episodes of acute bleeding. The recent availability of bypassing agents like recombinant activated factor VII has been shown to be clinically safe and effective as treatment for acute bleeding. In this case report, a 67 year-old male patient with Rh negative blood type developed gross hematuria and bleeding after transurethral resection due to prostatic hypertrophy. After vesicocutaneous fistular reduction operation, post-operative bleeding was presented. The acute bleeding was controlled successfully by the combined treatment with recombinant activated factor VII (Novo seven(R)) and prednisone.
Autoantibodies ; Blood Coagulation Factors ; Deamino Arginine Vasopressin ; Factor VIIa ; Factor VIII ; Hematuria ; Hemophilia A ; Hemorrhage ; Hemorrhagic Disorders ; Humans ; Male ; Prostatic Hyperplasia ; Prothrombin

Behcet's disease is a relapsing inflammatory disorder characterized by vasculitis of unknown cause and has been reported rarely in association with malignant diseases. In most cases the autoimmune nature of Behcet's disease and the long-term immunosuppressive therapy for disease control have been proposed to be responsible for malignant transformation. Although a few cases of various solid tumor and myelodysplastic syndrome have been reported in association with Behcet's disease, acute leukemia has seldom been associated with Beh?et's disease in Korea. We report a case of 38-year-old man with acute myeloblastic leukemia association with a Behcet's disease who had not received long-term treatment.
Acute Disease ; Adult ; Humans ; Korea ; Leukemia ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes ; Vasculitis

We present the case of a 34-year-old man with acute biphenotype leukemia that co-expressed B-lymphoid and myeloid antigen after the diagnosis of pulmonary alveolar proteinosis (PAP). The diagnosis of PAP was established by Periodic Acid-Schiff reaction staining on the Video Associated Thoracoscope guided lung biopsy and biphenotype leukemia was revealed by immunohistochemical stains of the blasts harvested from the bone marrow biopsy. Supposedly, PAP follows a hematologic malignancy, yet this case shows the reverse sequence.
Adult ; Biopsy ; Bone Marrow ; Coloring Agents ; Hematologic Neoplasms ; Humans ; Leukemia ; Lung ; Periodic Acid-Schiff Reaction ; Pulmonary Alveolar Proteinosis ; Thoracoscopes