We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Eosinophilia ; Eosinophils* ; Exudates and Transudates ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Lung ; Middle Aged ; Oxidoreductases ; Pleural Effusion* ; Pulmonary Eosinophilia* ; Steroids ; Thorax

PURPOSE: To determine the added value of dynamic subtraction magnetic resonance (MR) imaging for the localization of prostate cancer. MATERIALS AND METHODS: We examined 21 consecutive patients who underwent MR imaging in 3T unit with a phased-array body coil and then had radical prostatectomy. After T2-weighted fast spin-echo imaging, we performed a contrast-enhanced dynamic 3D gradient-echo imaging consisting of pre-contrast, 2 successive early-phased (first imaging was started just after the appearance of contrast material in the aortic bifurcation followed by second imaging 35 seconds after the initiation of first imaging) and one 5-minute delayed post-contrast series. Subtraction of pre-contrast images from corresponding post-contrast images of each phase was performed on the console. RESULTS: On ROC analysis, the overall accuracy (Az value) of dynamic imaging combined with subtraction imaging was higher than T2-weighted imaging (p = 0.001) or conventional dynamic imaging alone (p = 0.074) for localization of cancer foci regardless of their zonal locations. Among pathologically verified 81 lesions, the mean volume of detected lesions with the subtraction images (n = 49, 0.69cm3) was smaller than with T2-weighted images (n = 14, 1.05cm3) or conventional dynamic images (n = 43, 0.71cm(3)). CONCLUSION: For localization of small prostate cancer, additional subtraction for the dynamic imaging could be superior to both T2-weighted imaging and un-subtracted dynamic imaging.
Aged ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prostate/pathology ; Prostatic Neoplasms/*diagnosis/pathology ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. MATERIAL AND METHOD: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7+/-6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve. Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III~IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7+/-5.4 (7 to 24) months. RESULT: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4+/-3.5 mm preoperatively to 33.2+/-3.4 mm postoperatively (p<0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. CONCLUSION: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.
Aneurysm ; Aorta* ; Aortic Valve Stenosis ; Aortic Valve* ; Bicuspid ; Dilatation* ; Echocardiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Recurrence ; Sutures*

OBJECTIVE: To evaluate the causes, methods of delivery, and maternal complications in cases of fetal death in utero(FDIU) at Samsung Medical Center. METHODS: There were 92 cases of FDIU among 25,195 deliveries at Samsung Medical Center during 7 years from 1994 to 2001. In these cases, perinatal autopsy and placental biopsy was performed in 35 and 71 cases, respectively. All the clinical informations were obtained by reviewing medical records retrospectively. RESULTS: The overall incidence of FDIU was 0.37%. Most of FDIU occurred in 25 to 29 years old group(43.5%). Recurrence rate of FDIU was 3.3%. Most of FDIU were low birth weight(79.3%) and preterm(79.6%). The modes of delivery were induced labor(68.5%), laparotomy(18.5%), and the spontaneous delivery(13.0%). The causes of FDIU were chorioamnionitis(15.2%), placental abruption(14.1%), severe preeclampsia(11.9%), congenital and chromosomal anomaly(6.5%), but it was unexplained in 27.2%. There were 25 cases with maternal complications and the most common complications were intra-/postpartum fever(18.5%), postpartum hemorrhage(8.7%) and DIC(8.7%). CONCLUSION: The causes of FDIU could not be determined in only about 1/4 cases at Samsung Medical Center. Since FDIU recurred in 3.3%, thorough studies including perinatal autopsy and chromosomal study must be made on stillborn infants and placenta to determine the recurrent causes.
Adult ; Autopsy ; Biopsy ; Fetal Death* ; Humans ; Incidence ; Infant ; Medical Records ; Parturition ; Placenta ; Postpartum Period ; Recurrence ; Retrospective Studies

PURPOSE: The purpose of this article is to analyze the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. METHOD: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal angioplasity (PTA) and femorofemoral bypass (n=18) as well as aortobifemoral bypass (n=12) and iliofemoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 cm in length with no more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofemoral bypass was done within 3 to 5 days after PTA or stenting. RESULT: The mean age was 61.2 years. The Indications of femorofemoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation. The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. CONCLUSION: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral bypass in these patients.
Academic Medical Centers ; Angioplasty* ; Arterial Occlusive Diseases* ; Constriction, Pathologic ; Humans ; Hypertension ; Iliac Artery ; Korea ; Myocardial Ischemia ; Pathology ; Pulmonary Disease, Chronic Obstructive ; Stents ; Tissue Donors

PURPOSE: Of the cancers in childhood, leukemia is the most frequent one. For the desirable control of childhood leukemia, the basic data for the incidence has a great importance. The authors made a report about the incidence of leukemia in childhood, which analyzed the data from 126 cases in Kyongnam province, Korea, during 1991~1995. METHODS: The data were obtained from 126 new cases of childhood leukemia who had been living in the Kyongnam province and were diagnosed at the 26 university hospitals or general hospitals in the Kyongnam area and other cities from 1991 to 1995. RESULTS: The age-and-sex adjusted annual incidence rate per 100,000 population during 1991~1995 varied from 1.82 to 2.86, and cumulative annual incidence rate was 2.41 (male 2.26 and female 2.57 respectively). Male to female sex ratio was 1:1 in total cases. By the major types of childhood leukemia, the cases were composed of acute lymphocytic leukemia 70.6%, acute myelocytic leukemia 26.9% and chronic myelocytic leukemia 2.5%. The cumulative annual incidence rate per 100,000 population (crude rate) during 1991~1995 were 2.77 in Ulsan city, 2.62 in Chinju city and 2.34 in the whole area of Kyongnam province. CONCLUSION: It was concluded that the age-and-sex adjusted annual incidence rate per 100,000 of childhood in Kyongnam province was 2.41, which was lower than that in Pusan city in the same period. And, there was no significant difference of the cumulative annual incidence rate between Ulsan area and Chinju area in the same period.
Busan ; Female ; Gyeongsangnam-do* ; Hospitals, General ; Hospitals, University ; Humans ; Incidence* ; Korea* ; Leukemia* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Sex Ratio ; Ulsan

Vibrio vulnificus, a halophilic vibrio is an estuarine gram-negative bacteria that is associated with severe and frequently fatal wound infections and life-threatening septicemia. Bacteriocins are defined as antibacterial substance produced by various species of bacteria which are usually active against closely related organisms. Bacteriocins have found widespread application in epidemiological studies as specific markers of bacteria. It was proposed by Ha et al. (1990. J. Korean. Soc. Microbiol. 25: 586.) to give the bacteriocins produced by V. vulnificus the name "vulnificins". In the present study, a total of 72 strains of V. vulnificus isolated from patients and oysters were subjected to screen potential producers and indicators of vulnificin, applying ultraviolet induction method. Sensitivity of several strains of Serratia marcesans, Pseudomonas aeruginosa, Shigella flexneri, Salmonella typhi and Yersinia enterocolitica to vulnificins were also examined out. All the tested strains of V. vulnificus produced vulnificins active against indicator strains with various different inhibitory patterns. The spectrum of vulnificin activity and sensitive spectrum of indicator strains were considerably broad. Interestingly, almost all strains of S. marcescens, P. aeruginosa, Salmonella sp., Shigella sp. and Y. enterocolitica tested were sensitive to 1-7 vulnificin(s). Taken together, the present study demonstrated that all of the isolates of V. vulnificus produced vulnificins and that 8 good vulnificin producers and 10 good indicators were detected. These strains can be employed efficiently for establishing vulnificin typing scheme of V. vulnificus and for the detection of bacteriocinogeny and sensitivity in V. vulnificus. Biological role of vulnificin remains to be further elucidated.
Bacteria ; Bacteriocins ; Gram-Negative Bacteria ; Humans ; Ostreidae ; Pseudomonas aeruginosa ; Salmonella ; Salmonella typhi ; Sepsis ; Serratia ; Shigella ; Shigella flexneri ; Vibrio vulnificus* ; Vibrio* ; Wound Infection ; Yersinia enterocolitica

OBJECTIVE: To analyse neonatal outcomes of the very low birthweight infants born to women who underwent an indicated preterm delivery and spontaneous preterm delivery. METHODS: We performed an observational study of 150 very low birthweight(<1500 grams) infants delivered at Samsung Medical Center. The study population was limited to singleton infants without major congenital anomalies. The primary reason for delivery was categorized as indicated preterm delivery or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: Univariate analyses showed some survival benefits in infants born to women who underwent indicated preterm delivery. Selected neonatal outcomes, however, did not differ between the groups in the multiple logistic regression analysis. CONCLUSION: There was no survival advantage to the very low birthweight infants born to women who underwent an indicated preterm delivery compared to those born to women with spontaneous preterm delivery.
Female ; Humans ; Infant* ; Logistic Models ; Observational Study

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) has been useful in evaluating submucosal lesions of the upper gastrointestinal tract as well as providing guidelines for therapeutic plans. Large proportions of submucosal tumors are diagnosed as stromal tumors. Most are benign, but a significant proportion of them could be malignant. There are a few reports concerning EUS findings as being predictive of malignancy. The aim of this study was to evaluate specific EUS features favoring malignancy in stromal tumors of the UGI tract. METHODS: From January, 1992 to June, 1997, thirty-three cases appeared involving stromal tumors (18 benign, 15 malignant (including 8 STUMP)), and were either surgically (27 cases) or endoscopically (6 cases) resected. Videotapes and photographs were reviewed and EUS features that favored the malignancy were analyzed.
Endosonography* ; Upper Gastrointestinal Tract* ; Videotape Recording

Protein-calorie malnutrition is common in CAPD patients and is associated with increase in morbidity and mortality in CAPD patients. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein losses through peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross- sectional study on clinically stable 115 patients (63 males and 52 females) who have been on CAPD for more than 2 years, and assessed nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Patients were divided into 4 groups according to the results of standard peritoneal equilibration test (PET). The results were as follows: 1) The patients were divided into 4 groups according to the PET results: high transporter (n=16, 14%), high average transporter (n=38, 33%), low average transporter (n=50, 43%), and low transporter (n=11, 10%). 2) The mean age of the patients was 50.1+/-11.6 years (range, 19-75) with sex ratio (M:F) 1.2:1 and mean duration of dialysis was 57.5+/-27.8 months (range, 24-135). The mean body weight (Bwt) was 59.2+/-8.9kg, percent ideal body weight (%IBW) was 104.7+/-15.6%, %lean body mass (LBM)/Bwt was 82.1+/-11.1%, and malnourished patients by subjective global assessment (SGA) were 32.2% (38/115). 3) The mean BUN, creatinine, total protein, and albumin level of the patients were 54.5+/-13.1mg/dL, 12.3+/-3.0mg/dL, 6.7+/-0.8g/dL, and 3.8+/-0.6g/dL, respectively. 4) There were no significant differences in age, sex ratio, CAPD duration, peritonitis rate, %LBM/ Bwt, and SGA among the 4 groups. 5) Total protein (g/dL) and albumin (g/dL) levels in high transporters were 6.4+/-0.5, 3.5+/-0.4, respectively, and they were significantly lower than those of low transporters (7.2+/-0.6, 4.2+/-0.5) (P<0.05). 6) 24 hour dialysate protein (g/day) and albumin (g/day) losses were significantly higher in high transporters (8.10+/-1.85, 4.19+/-1.23) compared to those of low transporters (5.07+/-1.85, 2.78+/-0.99) (P<0.05). 7) The level of IGF-1 (ng/mL) was significantly lower in high transporters (150.5+/-86.2) compared to that of low transporters (310.3+/-162.1) (P<0.05). 8) The level of BUN (mg/dL), Cr (mg/dL) were also lower in high transporters (45.4+/-13.1, 10.1+/-2.0) than those of low transporters (61.6+/-18, 14.7+/-2.7), but there were no significant differences in Hct, total cholesterol, prealbumin, and transferrin among the 4 groups. 9) There were no statistically significant differences in Kt/Vurea, RRF, NPCR, dietary calorie and protein intakes among the 4 groups. 10) Anthrometric parameters such as TSF, BSF, MAC and LBM measured by three different methods (LBMCr, LBMimp, LBManthro) didn't show any significant differences among the 4 groups. In conclusion, increased peritoneal permeability may not adversely affect SGA and anthropometric status of long-term CAPD patients, although it is associated with lower serum albumin, creatinine, and IGF-1 level. Clinical significance of these findings remains to be elucidated.
Body Weight ; Cholesterol ; Creatinine ; Dialysis ; Humans ; Ideal Body Weight ; Insulin-Like Growth Factor I ; Male ; Malnutrition ; Membranes ; Mortality ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Permeability ; Prealbumin ; Protein-Energy Malnutrition ; Serum Albumin ; Sex Ratio ; Transferrin ; Urea