BACKGROUND: Rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) is one of the effective chemotherapeutic regimens for patients with advanced stage marginal zone lymphoma (MZL). However, prognostic factors that affect the outcome of treatment for MZL are not well understood. METHODS: Between August 2006 and June 2013, patients with newly diagnosed stage III and IV MZL treated with R-CVP as a first-line therapy from 15 institutions were retrospectively analyzed. Patients' clinical and laboratory data at diagnosis were collected by review of medical records. RESULTS: A total of 80 patients were analyzed. Bone marrow involvement was observed in 30% cases. Twelve patients (15%) had nodal MZL, and 41.3% patients exhibited multiple mucosa-associated lymphoma tissue sites. Overall response rate was 91.3%, including 73.8% achieving complete response. Advanced MZL patients treated with R-CVP showed a 3-year progression-free survival (PFS) rate of 69.6%. Prognostic markers significantly affecting PFS in univariate analysis were platelet to lymphocyte ratio (PLR, <95 vs. ≥95, P=0.014), serum albumin (≤3.9 vs. >3.9 g/dL, P=0.008), and the International Prognostic Index (IPI) score (1 vs. 2–4, P=0.032). In multivariate analysis, only PLR (<95 vs. ≥95, HR 0.367, 95% CI, 0.139–0.971, P=0.043) was an independent risk factor for PFS. CONCLUSION: PLR ≥95 at diagnosis is an independent prognostic marker for PFS in advanced stage MZL patients treated with R-CVP. This marker may aid clinicians in predicting the response to R-CVP chemotherapy in stage III and IV MZL patients.
Blood Platelets* ; Bone Marrow ; Cyclophosphamide* ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Lymphocytes* ; Lymphoma* ; Medical Records ; Multivariate Analysis ; Prednisone* ; Prognosis ; Retrospective Studies ; Risk Factors ; Rituximab* ; Serum Albumin ; Vincristine*

In order to examine the prevalence of Cryptosporidium infection in wild rodents and insectivores of South Korea and to assess their potential role as a source of human cryptosporidiosis, a total of 199 wild rodents and insectivore specimens were collected from 10 regions of South Korea and screened for Cryptosporidium infection over a period of 2 years (2012-2013). A nested-PCR amplification of Cryptosporidium oocyst wall protein (COWP) gene fragment revealed an overall prevalence of 34.2% (68/199). The sequence analysis of 18S rRNA gene locus of Cryptosporidium was performed from the fecal and cecum samples that tested positive by COWP amplification PCR. As a result, we identified 4 species/genotypes; chipmunk genotype I, cervine genotype I, C. muris, and a new genotype which is closely related to the bear genotype. The new genotype isolated from 12 Apodemus agrarius and 2 Apodemus chejuensis was not previously identified as known species or genotype, and therefore, it is supposed to be a novel genotype. In addition, the host spectrum of Cryptosporidium was extended to A. agrarius and Crosidura lasiura, which had not been reported before. In this study, we found that the Korean wild rodents and insectivores were infected with various Cryptosporidium spp. with large intra-genotypic variationa, indicating that they may function as potential reservoirs transmitting zoonotic Cryptosporidium to livestock and humans.
Animals ; Animals, Wild/*parasitology ; Cryptosporidiosis/*parasitology ; Cryptosporidium/classification/*genetics/*isolation & purification ; Feces/parasitology ; Genotype ; Insectivora/*parasitology ; Molecular Sequence Data ; Murinae ; Phylogeny ; Republic of Korea ; Rodent Diseases/*parasitology

In order to study the treatment of aneurysms, the technique of making experimental aneurysms in laboratory animals must be established. In our study, to examine the feasibility of making experimental aneurysm and selective angiography on the common carotid artery in rabbits and to determine the size of experimental aneurysm after surgery, saccular aneurysms were fashioned on the right common carotid artery in 17 rabbits using a vein pouch technique. Selective angiography of the common carotid artery was performed immediately after surgery, and at 1 week, 4 weeks, and 8 weeks after surgery. Also, histological changes in the aneurysms were observed. In 16 rabbits with established successful experimental aneurysm, no differences were found in diet intake and behavior before and after surgery. The patency of the carotid artery was confirmed by selective angiography. The average size of the aneurysm immediately after surgery was similar to that of 1 week postoperatively in selective angiography, however it increased with time at 4weeks and 8 weeks. Histologically, infiltration of inflammatory cells and hemorrhage were found at the junction of the carotid artery and the vein pouch at 1 week, which disappeared at 4 weeks and 8 weeks. This study suggests experimental saccular aneurysm using the vein pouch technique might form aneurysms similar to that of the human in its properties such as increment of size, and selective angiography might be suitable for assessment of experimental aneurysm. Therefore, this animal model may be suitable for investigating new treatment methodologies for human aneurysms.
Aneurysm ; Angiography ; Animals, Laboratory ; Carotid Arteries ; Carotid Artery, Common ; Diet ; Hemorrhage ; Humans ; Models, Animal ; Rabbits ; Veins

Ma-huang (Ephedra sinica) is a herb that exhibits sympathomimetic activity. We report a patient with acquired myopathy following ingestion of a Ma-huang-based herbal remedy for 6 months. A 50-year-old woman was admitted for progressive muscular weakness. An electrodiagnostic study and muscle biopsy sampling revealed generalized active myopathy with nonspecific inflammation. It appears that Ma-huang, along with Raynaud's phenomenon and pericardial effusion, may be a causative agent of myopathy. As such, attention should be paid to the possibility that herbal medication with Ma-huang can result in myopathy.
Biopsy ; Eating ; Ephedra ; Female ; Humans ; Inflammation ; Middle Aged ; Muscle Weakness ; Muscles ; Muscular Diseases ; Pericardial Effusion

BACKGROUND AND OBJECTIVES: Previous studies that used physiologic parameters have shown that coronary angiography is not always accurate in the evaluation of intermediate lesions. We sought to evaluate the outcomes of Korean patients for whom revascularization was deferred according to their fractional flow reserve (FFR). SUBJECTS AND METHODS: FFR was measured in 107 intermediate lesions (visually estimated percent stenosis: 40-70%) in 102 consecutive patients (68% males, mean age: 62+/-9 years). The one-year cardiac adverse outcomes (cardiac death, myocardial infarction or target vessel revascularization) of all the patients and the long-term outcomes of the patients for whom revascularization was deferred according to the FFR were evaluated. RESULTS: The mean percent diameter stenosis was 57+/-11% and the FFR was 0.82+/-0.10. Only 25 lesions (23%) had a FFR <0.75. There was no significant difference in the 1-year cardiac event rates between the FFR > or =0.75 group and the FFR <0.75 group (10.4% vs. 13.0%, respectively, p=0.49). There was a tendency of a lower incidence of 1-year cardiac events in the medical treatment group than in the revascularizaton group (8.0% vs. 20.0%, respectively, p=0.10). In the 69 patients with FFR-guided deferral of revascularization, the long-term (mean follow-up duration: 41+/-11 months) cardiac event-free survival rate was 86%. CONCLUSION: The measurement of FFR seems to be a useful guide for decision making and it may reduce unnecessary intervention in Korean patients who suffer with intermediate stenosis.
Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Decision Making ; Disease-Free Survival ; Follow-Up Studies ; Fractional Flow Reserve, Myocardial ; Glycosaminoglycans ; Humans ; Incidence ; Male ; Myocardial Infarction ; Stents

Isolated tuberculous hepatic abscess is rare and surgical treatment is often needed when the size of abscess is large or increasing, when abscess is resistant to antituberculous medication or undergoing secondary change. We report an unusual case of recurrent tuberculous hepatic abscess following surgical resection and antituberculous medication. A 67-year-old woman was admitted due to right upper abdominal pain. She had operation history of segmental resection of the liver due to tuberculous hepatic abscess refractory to antituberculous medication. Preoperative abdominal CT scan demonstrated a enlarging multifocal cystic lesion at segment 8 of the liver in spite of antituberculous medication. Right lobectomy was done and the biopsy revealed caseous necrosis and acid-fast bacilli on microscopic finding. Second- line antituberculous medication was started and no evidence of recurrence was noted.
Abdominal Pain ; Abscess ; Aged ; Biopsy ; Female ; Hepatectomy* ; Humans ; Liver ; Liver Abscess* ; Necrosis ; Recurrence ; Tomography, X-Ray Computed

PURPOSE: Despite recent progress in the procedures of revascularization, acute limb ischemia continues to account for a wide variety of complications, culminating very often in limb loss or death. These poor results after treatment of acute limb ischemia still remains a major challenge in vascular surgery. METHOD: To evaluate the clinical characteristics and risk factors for early limb loss in acute limb ischemia, the clinical data of 87 limbs (8 upper and 79 lower limbs) in 83 patients. that underwent revascularization for acute limb ischemia at Yeungnam University Hospital from January 1995 to February 2003 were analyzed retrospectively. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects predictive of amputation free survival. RESULT: The patients, 78 males and 9 females, ranged from 30 to 83 years of age, with a mean age of 67. The highest incidence occurred among people in their 50s and 60s. The underlying causes of acute limb ischemia were arterial embolism in 42 limbs (42/87, 48.2%), arterial thrombosis in 36 (36/87, 41.3%), bypass graft occlusion in 9 (9/87, 10.3%). The primary sources of embolism were cardiac origin in 25 cases (25/42, 59.5%), aneurysmal origin in 2 (2/42, 4.8%) and unknown origin in 15 (15/42, 35.7%). As for the severity of ischemia according to SVS/ISCVS classification, 40 limbs (40/87, 46.0%) were classified as category IIa, 39 (39/87, 44.8%) as category IIb, and 8 (8/87, 9.2%) as category III. For the treatment, 66 thromboembolectomies (including 20 cases treated with intraoperative thrombolytic therapy), 19 arterial bypasses and 2 catheter directed thrombolytic therapies were performed. There were 13 major amputations and 8 mortalities at 6 months after revascularization. Cumulative 15 day, and 1, 2, 4, and 6-month amputation-free survival rate of all survival patients were 88.8%, 85.7%, 83.9%, 83.9% and 81.4% respectively. Among the univariate analysis of 26 clinical variables, 10 factors were identified as being associated with amputation-free surviva: age (P=0.01), preoperative tissue gangrene (P=0.03), preoperative skin color change (P=0.00), preoperative muscle status (P=0.00), preoperative motor and sensory deficit (P=0.00, P=0.00), severity of ischemia by clinical category (P=0.00), symptom duration (P=0.02), length of occlusion (P=0.01), and cause of occlusion (P=0.01). In multivariate analysis, age (P=0.04), and preoperative skin color change (P=0.00) predicted a poorer response to therapy. The major limb amputations were performed in 2 limbs (2/41, 4.9%) of the emboli group, and 11 limbs (11/42, 26.2%) of the thrombi group. For the limb with thrombosis, the major limb amputations were performed in 9 limbs (9/26, 34.6%) of the thromboembolectomy group and in 2 limbs (2/16, 1.3%) of the arterial bypass group. CONCLUSION: These results suggest that prompt and appropriate treatment is critically important in the management of acute limb ischemia. In thrombi cases Especially, a more aggressive surgical approach may be necessary for limb salvage.
Amputation ; Aneurysm ; Catheters ; Classification ; Embolism ; Extremities* ; Female ; Gangrene ; Humans ; Incidence ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Skin ; Survival Rate ; Thrombolytic Therapy ; Thrombosis ; Transplants

BACKGROUND: Craniopharyngioma is a suprasellar or intrasellar epithelial neoplasm that occurs in both children and adults. It accounts for 1.2 to 3 % of intracranial tumors with an incidence of 0.5 to 2 cases per one million populations each year. Recently, it has been postulated that it may have two pathogenetically separate subtypes, which are adamantinous and papillary craniopharyngioma, and that their clinical features may be different. However, there are some disagreements in this postulation. Therefore, we studied 22 consecutive patients with craniopharyngioma to evaluate the differences in clinical features and MRI findings between two subtypes. METHODS: We studied 22 patients with histologically proven craniopharyngioma after surgery at Samsung Medical center from 1995 to 1999. Thirteen patients were male, and nine patients were female. The average age was 30 years, with a range from 1 to 58 years. We divided 22 patients into two histopathologically separate subtypes; adamantinous and papillary subtypes. We compared the clinical features and MRI findings of two subtypes by reviewing medical records. RESULTS: Out of 22 patients with craniopharyngioma, 19 patients had an adamantinous subtype and 3 patients had a papillary subtype. The adamantinous subtype occurred frequently in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype located in suprasellar or intrasellar portion as well as extrasellar portion, while the papillary subtype was restricted to the suprasellar location. The average tumor size of the adamantinous subtype was 3.7 cm, with a range from 1.4 to 6.0 cm, which was larger than that of the papillary subtype (average size 1.8 cm with a range from 1.5 to 2.3 cm, p< 0.05). The adamantinous subtype was predominantly cystic, while the papillary subtype was predominantly solid (p< 0.05). There were no significant differences in the preoperative clinical features and the postoperative complications between two subtypes. CONCLUSION: The adamantinous subtype had two peaks of occurrence in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype was larger and had cystic portion, while the papillary subtype was smaller and had solid portion. The preoperative clinical features and the postoperative complications between two subtypes seemed not to be different.
Adult ; Child ; Craniopharyngioma* ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Male ; Medical Records ; Neoplasms, Glandular and Epithelial ; Postoperative Complications

No abstract available.
Humans ; Idarubicin* ; Induction Chemotherapy* ; Leukemia, Myeloid, Acute*

The incidence of a primary central nervous system (CNS) lymphoma in western countries is about 1% of all the intracranial tumors and has increased 2.2% over the last decade. A similar pattern of increased frequency is observed in Korea. Although most CNS lymphomas in western countries are high grade tumors carrying poor prognosis, the clinicopathologic features of the Korean CNS lymphoma have not been well studied. We report clinicopathological features of 18 cases of histologically proven primary brain lymphoma. The mean age of the patients was 50 years and there was no sex difference. The clinical and radiological characteristics included multiple site of occurrence, infrequent extracranial spread, and frequent seeding via cerebrospinal fluid. No patients were immune-compromised host. Of 18 cases, 15 cases were of B-lineage and 2 cases were of T-lineage. According to REAL classification, there were 12 cases of diffuse large B cell lymphoma, two cases of B cell lymphomas of small lymphoid cell, and two cases of peripheral T cell lymphoma, unspecified. The remaining subtypes were not subclassified because of inadequate material. Pleomorphic cytologic features and necrosis of varying extent were frequent in the cases of diffuse large B-cell lymphoma. These results suggest that overall clinicopathologic features of primary malignant lymphomas of the central nervous system in Korea are similar to those of western countries.
Brain ; Central Nervous System* ; Cerebrospinal Fluid ; Classification ; Humans ; Incidence ; Korea ; Lymphocytes ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, T-Cell, Peripheral ; Necrosis ; Prognosis ; Sex Characteristics