OBJECTIVE: The 2010 New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for rheumatoid arthritis (RA) was raised to identify patients with early RA and replaced the 1987 ACR classification criteria. The aims of this study are to assess the availability of new classification criteria and to evaluate its potential limitation. METHODS: A total of 408 patients with newly diagnosed RA were included from 13 secondary or tertiary hospitals in South Korea. The symptom duration was less than 12 months before the diagnosis of RA. RA was defined as either 1987 ACR classification criteria or new 2010 ACR/EULAR criteria. We compared the full details of both classification criteria. RESULTS: The mean symptom duration was 5.1 months. The majority (76.2%) of the patients were female. Two hundred and seventy three patients (66.9%) fulfilled both of the 2010 and 1987 classification criteria. Forty-seven (14.7%) of the 320 patients fulfilling the 1987 criteria did not fulfill the new classification criteria. On the other hand, eighty-eight (24.4%) of the 361 patients fulfilling the 2010 ACR/EULAR classification criteria did not fulfill the 1987 ACR criteria. Thirty-six (55.4%) of the 65 patient with seronegative RA failed to meet the 2010 classification criteria. In case of seropositive RA (n=343), 85 additional patients (24.8%) could be diagnosed as RA using new classification criteria. CONCLUSION: The new 2010 ACR/EULAR classification criteria enable physicians to diagnose more patients with early RA via the help of serology. However, the sensitivity for the diagnosis of seronegative RA is projected to decrease.
Arthritis, Rheumatoid ; Female ; Hand ; Humans ; Republic of Korea ; Rheumatic Diseases ; Tertiary Care Centers

Endoscopic drainage of pancreatic pseudocysts is the initial treatment of choice for symptomatic pancreatic pseudocysts and nonresolving pseudocysts. Recently, endoscopic ultrasound (EUS) has been used as a guide for transmural entry and the safer drainage of pancreatic pseudocysts. We report a case of therapeutic linear array EUS-guided pseudocyst drainage without the use of fluoroscopy in a patient with portal hypertension.
Drainage* ; Fluoroscopy* ; Humans ; Hypertension, Portal ; Pancreatic Pseudocyst* ; Ultrasonography

BACKGROUND/AIMS: Treatment of pancreatic duct stones by extracorporeal shockwave lithotripsy (ESWL) serves as a nonsurgical treatment modality in patients with stones that are located in upstream of the strictures or in patients with impacted stones. We present the results of ESWL in endoscopically unretrievable pancreatic duct stones in the past 2 years. METHODS: Between January 2002 and December 2003, 58 patients with chronic pancreatitis were treated by ESWL for pancreatic duct stones. ESWL was performed with an electrohydraulic lithotripter ultrasound focusing system. RESULTS: The mean number of shockwave treatments was 2.5, and the patients received 4,578 (1,527-10,155) shockwave discharges with a mean energy of 15.8 kV. Fragmentations of the stones were achieved in 54 patients (93.2%), and complete clearance of the stones were noticed in 27 patients (46.6%). Fragmentation of stones equal or less than 3 mm in diameter was associated with successful removal of stones (p<0.05). Complete relief of pain occurred in 32 patients (55.2%). The procedures were well tolerated and no patient had significant complications such as acute pancreatitis. CONCLUSIONS: ESWL is an effective and a safe procedure for endoscopically unretrievable main pancreatic duct stones. ESWL combined with endoscopic therapy can increase the success rate of nonsurgical removal of pancreatic duct stones in patients with chronic pancreatitis.
Adolescent ; Adult ; Aged ; Calculi/*therapy ; English Abstract ; Female ; Humans ; *Lithotripsy ; Male ; Middle Aged ; Pancreatic Diseases/*therapy ; *Pancreatic Ducts ; Pancreatitis, Chronic/complications

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a spectrum of conditions ranging from benign to malignant. It is known that the biologic behavior of IPMT is slower and less aggressive than that of pancreatic ductal carcinoma. We report a case of IPMT of pancreas resected 5 years after diagnosis. The carcinoma remained localized without evident stromal invasion or lymph node metastasis with the background of adenoma, suggesting a adenomacarcinoma sequence. This is a case report that may be helpful to study the natural history of IPMT, particularly slow progression of IPMT.
Adenoma ; Carcinoma, Pancreatic Ductal ; Diagnosis* ; Lymph Nodes ; Mucins* ; Natural History ; Neoplasm Metastasis ; Pancreas*

The mucin-hypersecreting bile duct tumor is rare and its clinical, radiologic, and pathologic features are not well known. We report the case of mucin-hypersecreting biliary papillomatosis with malignant transformation including review of 11 korean literatures. A 65-year-old female was admitted to our hospital with fever, chills, and right upper quadrant pain. A CT scan showed marked dilatation of left intrahepatic duct with intraductal filling defects. During endoscopic retrograde cholangiograpy, mucin from the ampulla was observed and dilated common bile duct with multiple amorphous filling defects was noted. Cholangioscopy revealed muliple coral-like mucosal papillary projections with large amount of mucin in the left intrahepatic ducts. The patient underwent left lobectomy, and the biopsy revealed intraductal papillary adenocarcinoma in the background of papillary adenoma.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Adenoma ; Aged ; Bile Ducts ; Biopsy ; Chills ; Common Bile Duct ; Dilatation ; Female ; Fever ; Humans ; Mucins ; Papilloma* ; Tomography, X-Ray Computed

Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Gallstone ileus is frequently proceeded by an episode of acute cholecystitis. The resulting inflammation and adhesions facilitate the erosion of the offending gallstone through the gallbladder wall forming a cholecystoenteric fistula and allowing the passage of the gallstone. Fifty five-year-old, 71-year-old, and 74-year-old female patients were admitted to the Asan Medical Center for nausea, vomiting, and nonspecific abdominal pain. Erect abdominal plain film revealed several moderately dilated loops of small bowel with air fluid levels. Computed tomography showed the classic triad of findings of gallstone ileus. Dilated loops of small bowel, air in the biliary tree and an ectopic stone in the ileum were demonstrated. These impacted stones were removed by surgical intervention.
Abdominal Pain ; Aged ; Biliary Tract ; Cholecystitis, Acute ; Chungcheongnam-do ; Female ; Fistula ; Gallbladder ; Gallstones* ; Gastrointestinal Tract ; Humans ; Ileum ; Ileus* ; Inflammation ; Nausea ; Vomiting

Primary lung lymphoma is an uncommon tumor, which constitutes 0.5% of primary lung cancer, and 3% of extranodal lymphoma. The most frequent radiologic presentation of pulmonary parenchymal lymphoma is single mass or nodule. But we have experienced a case which was radiologically presented as patchy lung infiltration at first, and then progressive multiple reticulonodular infiltrations in lung. A 48-year-old woman was admitted to the hospital because of fever and cough. Chest PA obtained on admission revealed multiple patchy infiltration. Eventually, open lung biopsy was performed and the specimen disclosed extranodal NK/T cell lymphoma, and in bone marrow aspiration, hemophagocytosis was present. We report a case of primary extranodal NK/T cell lung lymphoma presented as patchy lung infiltrations, which was treated with chemotherapy.
Biopsy ; Bone Marrow ; Cough ; Drug Therapy ; Female ; Fever ; Humans ; Lung Neoplasms ; Lung* ; Lymphoma* ; Middle Aged ; Thorax

BACKGROUND: It has been reported that younger patients with lung cancer have characteristic features that differ from those in older patients. The prognosis for young patients with this disease is controversial. This study aimed to determine the clinicopathological characteristics, the survival rate, and the risk factors associated with the overall survival rate in younger patients with lung cancer. METHODS: The records of 120 young(age≤40) patients with histologically confirmed lug cancer in the Korea Cancer Center Hospital(KCCH) between Jan. 1992 to 1998, 120 older(age>40) patients were randomly selected as the controls. RESULTS: More female patients(45.0% vs. 20.0%, p<0.001) and more adenocarcinoma cases(64.2% vs. 38.3%, p<0.001) were found in the younger group, when compared to the older patients. In NSCLC, advanced disease(stage III B and IV) was more common in the younger patients(90.2%) than in the older patients(62.7%) (p<0.001). The Median survival was 8.6 months in the younger patients and 12.2 months in the older(p=0.003). In a multivariate analysis, only the advanced-stage was an independent negative prognostic factor. CONCLUSION: Lung cancer in the younger age group presents with a more advanced stage resulting in a poor survival rate, which suggests that lung cancer in this population is more aggressive than in older patients.
Adenocarcinoma ; Female ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Multivariate Analysis ; Prognosis ; Risk Factors ; Survival Rate

No abstract available.
Shigella sonnei* ; Shigella*

BACKGROUND: We experienced an outbreak of typhoid fever in Chunju area which manifested as severe symptoms and signs, and variable complications. To chracterize the epidemic and to identify a possible source of infection, the clinical findings of patients from the outbreak were analyzed, and the patterns of antimicrobial susceptibility and phage typing of Salmonella Typhi isolates were determined. METHODS: We analyzed a total of 232 patients from the outbreak who admitted to Chunju Presbyterian Medical Center during 1996 August through October. The medical records of the patients were reviewed retrospectively. All isolates of S. Typhi from the outbreak were analyzed for serotyping, antibiogram, and phage typing. Phage typing were performed using Vi- phages for 50 strains isolated from the patients who showed atypical clinical manifestations and unusal complications. RESULTS: The outbreak attacked mainly young femalegroup. The complications observed were: 155 casesof hepatitis, 47 pancytopenia, 20 acute pancreatitis, 13 urinary tract infection, 12 intestinal hemorrhage, 5 disseminated intravascular coagulation, 4 meningitis, 3 septic shock, 2 sensorineural hearing loss, 2 myocardial ischemia, 2 pneumonia, 1 stillbirth, and 1 death. S. Typhi were isolated in 129 cases including 111 from blood, 17 stool and 1 urine. All isolates were susceptible to all antimicrobial agents tested. All 50 isolates from severe patients with unusal complications were identified as Salmonella, serogroup D1, serotype Typhi, phage type D1. CONCLUSIONS: We experienced an outbreak of typhoid fever associated with severe, atypical symptoms and unusual complications, caused by Salmonella, serogroup D1, serotype Typhi, phage type D1.
Anti-Infective Agents ; Bacteriophage Typing ; Bacteriophages ; Disseminated Intravascular Coagulation ; Hearing Loss, Sensorineural ; Hemorrhage ; Hepatitis ; Humans ; Jeollabuk-do* ; Medical Records ; Meningitis ; Microbial Sensitivity Tests ; Myocardial Ischemia ; Pancreatitis ; Pancytopenia ; Pneumonia ; Protestantism ; Retrospective Studies ; Salmonella ; Salmonella typhi ; Serotyping ; Shock, Septic ; Stillbirth ; Typhoid Fever* ; Urinary Tract Infections