Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Arthritis, Rheumatoid ; Classification ; Epidemiology ; Female ; Humans ; Incidence ; Insurance, Health ; Korea ; Lupus Erythematosus, Systemic ; Male ; Pregnancy ; Prevalence ; Venous Thrombosis

BACKGROUND: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial and venous thrombosis or pregnancy morbidity in patients with persistent antiphospholipid antibodies. However, nationwide population-based epidemiology studies regarding APS are still unavailable. METHODS: We analyzed claims data extracted from the Korean Health Insurance and Review Agency (HIRA) covering more than 52 million Koreans, between January 1, 2008, and December 31, 2017. Patients diagnosed with APS, as determined by the Korean Classification of Disease, 7th edition (D68.6), and a rare intractable disease program (V253), were identified in HIRA. RESULTS: A total of 3,088 newly diagnosed incident cases of 1,215 men and 1,873 women were identified during 2009–2016. The mean age was 44.6 ± 16.6 (men, 47.4 ± 16.3; women, 42.8 ± 16.6) years. The incidence was 0.75 per 105 person-year (95% confidence interval, 0.73–0.78). The prevalence in 2016 was 6.19 per 105 people. For incident cases, women showed incidence peak at ages of 30–39 years and 70–79 years, whereas for men, it was highest at ages of 70–79 years only. Of all patients, 1,766 (57%, 810 men and 956 women) had primary APS, 1,322 (43%, 405 men and 917 women) had secondary APS, and 845 (27%, 216 men and 629 women) were associated with systemic lupus erythematosus (SLE). CONCLUSION The incidence of APS differs according to age groups and gender. The incidence of primary APS was higher than that of secondary APS in both gender. Furthermore, as already reported, secondary APS is highly associated with SLE; however, we observed that rheumatoid arthritis is also highly related.

PURPOSE: The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy. MATERIALS AND METHODS: This retrospective analysis is based on the data of 814 patientswith stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model. RESULTS: A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] –, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2–subtype. CONCLUSION: LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2–patients is notable and worthy of further investigation.
Breast Neoplasms* ; Breast* ; Cohort Studies* ; Drug Therapy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoadjuvant Therapy ; Prognosis ; Receptor, Epidermal Growth Factor ; Recurrence ; Retrospective Studies* ; Survival Rate ; Triple Negative Breast Neoplasms

Langerhans cell histiocytosis (LCH) is a proliferative disease that shares phenotypic characteristics with Langerhans cells (LCs) and involves multiple organs. Here, we report a case of LCH in a 36-year-old male simultaneously involving the lungs and thoracic spine. Chest computed tomography (CT) showed multifocal thin-walled cysts and ill-defined nodular opacities primarily in the bilateral upper and middle lung lobes that fluctuated with smoking. Despite improvement of pulmonary lesions after smoking cessation, osteolytic lesion of thoracic vertebra was aggravated. Symptoms were not improved after nerve block, suggesting vertebral instability that necessitated surgical mass removal and posterior fusion. Microscopically diffuse proliferation of immature, rounded LCs and inflammatory cell infiltration was noted. Although pulmonary LCH in an adult is a benign disease that is usually resolved spontaneously after smoking cessation, surgical treatment should be considered in a case of spinal LCH.
Adult ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Langerhans Cells ; Lung ; Male ; Nerve Block ; Smoke ; Smoking ; Smoking Cessation ; Spine ; Thorax

Untreated massive hemoptysis, especially in patients with tuberculous-destroyed lung, is a serious complication resulting in considerable morbidity and mortality. We report a case of a patient who had active tuberculosis and a destroyed left lung with massive bleeding. He was transferred to our clinic with intubation of a right-sided Robertshaw double lumen tube and right upper lobe collapse likely due to tube malposition that was presented on chest X-ray. Because hemoptysis had persisted after bronchial arterial embolizaton, we replaced the double lumen tube with a conventional endotracheal tube and inserted an endobronchial blocker into the left main bronchus through an endotracheal tube guided by bronchoscopy to prevent aspiration of blood into the right lung. Left pneumonectomy was performed and hemotpysis was ceased. We suggest that the use of an endobronchial blocker followed by surgery may be a safe and effective modality of treatment in patients with persistent bleeding after bronchial arterial embolization.
Bronchi ; Bronchoscopy ; Hemoptysis ; Hemorrhage ; Humans ; Intubation ; Lung ; Pneumonectomy ; Thorax ; Tuberculosis

Mycobacterium szulgai is a rare nontuberculous mycobacterium found in Korea. It is an opportunistic pathogen and is usually isolated from patients with a history of alcoholism, chronic pulmonary disease, or an immunocompromising condition. We present here a case of M. szulgai isolated from a patient with a history of pulmonary tuberculosis. A 54-year-old man was admitted with dyspnea and febrile sensation. He had a history of pulmonary tuberculosis which occurred 30 years earlier and treatment with anti-tuberculosis medication. His chest computed tomography scan showed cavitary consolidation in both upper lungs. A sputum acid-fast bacilli (AFB) smear was positive and anti-tuberculous medication was started. However, a polymerase chain reaction for mycobacterium tuberculosis was negative and anti-tuberculous medication was stopped. M. szulgai was isolated on 3 separate sputum and bronchial wash fluid AFB cultures. He was treated with clarithromycin, rifampicin, and ethambutol. After 1 month, a sputum AFB smear and culture became negative and no additional M. szulgai were isolated during a 16-month treatment.
Alcoholism ; Clarithromycin ; Dyspnea ; Ethambutol ; Humans ; Invasive Pulmonary Aspergillosis ; Korea ; Lung ; Lung Diseases ; Middle Aged ; Mycobacterium ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Rifampin ; Sensation ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

It is very rare for an exocervical adenocarcinoma to metastasize to the lung parenchyma and pleura. A 54-year-old woman was admitted with dyspnea and left pleural effusion on chest X-ray. She had a history of exocervical adenocarcinoma 3 years previously and was treated with hysterectomy, chemotherapy, and radiation therapy. Last year, she was diagnosed with a left vestibular schwannoma and underwent subtotal mass removal surgery. After admission, metastatic adenocarcinoma of the pleura was diagnosed by video-assisted thoracic surgery biopsy. We herein report the rare case of exocervical adenocarcinoma that presented as a metastatic lesion to the pleura 3 years after the initial diagnosis.
Adenocarcinoma ; Biopsy ; Dyspnea ; Female ; Humans ; Hysterectomy ; Lung ; Middle Aged ; Neoplasm Metastasis ; Neuroma, Acoustic ; Pleura ; Pleural Effusion ; Pleural Neoplasms ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thorax

BACKGROUND: To evaluate chest CT findings of pandemic influenza A/H1N1 pneumonia without co-infection. METHODS: Among 56 patients diagnosed with pandemic influenza A/H1N1 pneumonia, chest CT was obtained in 22 between October 2009 and Februrary 2010. Since two patients were co-infected with bacteria, the other twenty were evaluated. Predominant parenchymal patterns were categorized into consolidation, ground glass opacity (GGO), and mixed patterns. Distribution of parenchymal abnormalities was assessed. RESULTS: Median age was 46.5 years. The CURB-65 score, which is the scoring system for severity of community acquired pneumonia, had a median of 1. Median duration of symptoms was 3 days. All had abnormal chest x-ray findings. The median number of days after the hospital visit that Chest CT was performed was 1. The reasons for chest CT performance were radiographic findings unusual for pneumonia (n=13) and unexplained dyspnea (n=7). GGO was the most predominant pattern on CT (n=13, 65.0%). Parenchymal abnormalities were observed in both lungs in 13 cases and were more extensive in the lower lung zone than the upper. Central and peripheral distributions were identified in ten and nine cases, respectively. One showed diffuse distribution. Peribronchial wall thickening was found in 16 cases. Centrilobular branching nodules (n=7), interlobular septal thickening (n=4), atelectasis (n=1), pleural effusion (n=5), enlarged hilar and mediastinal lymph nodes (n=6 and n=7) were also noted. CONCLUSION: Patchy and bilateral GGO along bronchi with predominant involvement of lower lungs are the most common chest CT findings of pandemic influenza A/H1N1 pneumonia.
Bacteria ; Bronchi ; Coinfection ; Dyspnea ; Glass ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Lung ; Lymph Nodes ; Pandemics ; Pleural Effusion ; Pneumonia ; Pneumonia, Viral ; Pulmonary Atelectasis ; Thorax ; Tomography, X-Ray Computed

Androgen deprivation therapy, which is the standard treatment for metastatic prostate cancer, includes nonsteroidal antiandrogenic drugs, such as flutamide, nilutamide and bicalutamide. Of them, bicalutamide rarely induces interstitial pneumonia. We report a case of bicalutamide-induced interstitial pneumonia. A 68-year old male diagnosed with prostate cancer and multiple bone metastases presented with dry cough and low grade fever for 3 days. He had taken bicalutamide (50 mg/day) for 13 months. High resolution computed tomography revealed ground glass opacity in his right upper lung. The laboratory studies showed no eosinophilia in the serum and bronchoalveolar lavage fluid. Despite the use of antimicrobial agents for 2 weeks, the extent of the lung lesions increased to the left upper and right lower lung. He had no environmental exposure, collagen vascular disease and microbiological causes. Under the suspicion of bicalutamide-induced interstitial pneumonia, bicalutamide was stopped and prednisolone (1 mg/kg/day) was initiated. The symptoms and radiologic abnormalities were resolved with residual minimal fibrosis.
Anilides ; Anti-Infective Agents ; Bronchoalveolar Lavage Fluid ; Collagen ; Cough ; Environmental Exposure ; Eosinophilia ; Fever ; Fibrosis ; Flutamide ; Glass ; Humans ; Imidazolidines ; Lung ; Lung Diseases, Interstitial ; Male ; Neoplasm Metastasis ; Nitriles ; Prednisolone ; Prostatic Neoplasms ; Tosyl Compounds ; Vascular Diseases

Nephrotic syndrome has been reported to accompany a malignancy. Since the first case of the nephrotic syndrome associated with extra-renal malignancy was reported in 1922, only a few cases of nephrotic syndrome accompanying other malignancies have been reported. Previous reports on such cases indicated a pattern of improvement in nephropathy as malignancy improved. But the cases of resolved nephropathy with aggravated cancer have scarcely been documented. Here we report a case of a 69 year-old male with nephrotic syndrome accompanying non-small cell lung cancer, whose proteinuria was normalized after chemotherapy while his cancer was aggravated.
Carcinoma, Non-Small-Cell Lung ; Deoxycytidine ; Humans ; Male ; Nephrotic Syndrome ; Proteinuria