BACKGROUND/AIMS: Type 2 autoimmune pancreatitis (AIP) has been considered extremely rare in East Asia. This study aimed to clarify the prevalence, clinical characteristics and radiological findings of type 2 AIP highlighting patients presenting as acute pancreatitis in a single center. METHODS: Type 2 AIP patients were classified according to International Consensus Diagnostic Criteria. Radiological findings were compared between type 2 AIP presenting as acute pancreatitis and gallstone pancreatitis. RESULTS: Among 244 patients with AIP, 27 (11.1%) had type 2 AIP (definite, 15 [55.5%] and probable 12 [44.5%]). The median age of patients with type 2 AIP was 29 years (interquartile range, 20 to 39 years). Acute pancreatitis was the most common initial presentation (n=17, 63%) while obstructive jaundice was present in only one patient. Ulcerative colitis (UC) was associated with type 2 AIP in 44.4% (12/27) of patients. Radiological pancreatic imaging such as delayed enhancement of diffusely enlarged pancreas, homogeneous enhancement of focal enlargement/mass, absent/minimal peripancreatic fat infiltration or fluid collection, and multifocal main pancreatic duct narrowings were helpful for differentiating type 2 AIP from gallstone pancreatitis. During follow-up (median, 32.3 months), two patients (2/25, 8%) experienced relapse. CONCLUSIONS: In South Korea, type 2 AIP is not as rare as previously thought. Overall, the clinical profile of type 2 AIP was similar to that of Western countries. Type 2 AIP should be considered in young UC patients with acute pancreatitis of uncertain etiology.
Colitis, Ulcerative ; Consensus ; Far East ; Follow-Up Studies ; Gallstones ; Humans ; Jaundice, Obstructive ; Korea ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Prevalence ; Recurrence

In the version of this article initially published, the fifth author's name was stated as “Joo Nam Lee.

PURPOSE: This study assessed the association between eye symptoms (enophthalmos or diplopia) and site of damage, volume, deviated inferior rectus muscle (IRM) and type of fracture with computed tomography (CT). The intent is to anticipate the prognosis of orbital trauma at initial diagnosis. METHODS: Forty-five patients were diagnosed with fractures of the inferior wall of one orbit. Fracture area, volume of displaced tissue, deviated IRM, and type of fracture were evaluated from coronal CT by one investigator. The association of those variables with the occurrence of eye symptoms (diplopia and enophthalmos) was assessed. RESULTS: Of 45 patients, 27 were symptom-free (Group A) and 18 had symptoms (Group B) of enophthalmos and/or diplopia. In Group B, 12 had diplopia, one was enophthalmos, and five had both. By CT measurement, group A mean area was 192.6 mm2 and the mean volume was 673.2 mm3. Group B area was 316.2 mm2 and volume was 1,710.6 mm3. The volume was more influential on symptom occurrence. Each patient was categorized into four grades depending on the location of IRM. Symptom occurrence and higher grade were associated. Twenty-six patients had trap-door fracture (one side, attached to the fracture), and 19 had punched-out fracture (both sides detached). The punched-out fracture was more strongly associated with symptoms and had statistically significantly higher area and volume. CONCLUSION: In orbital trauma, measurement of fracture area and volume, evaluation of the deviated IRM and classification of the fracture type by coronal CT can effectively predict prognosis and surgical indication.
Classification ; Diagnosis ; Diplopia ; Enophthalmos ; Humans ; Orbit ; Orbital Fractures* ; Prognosis ; Research Personnel

PURPOSE: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. METHODS: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang's classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. RESULTS: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. CONCLUSION: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.
Classification ; Clinical Protocols ; Depression ; Facial Bones ; Fractures, Bone ; Fractures, Comminuted ; Humans ; Maxillary Fractures ; Nasal Bone* ; Orbit ; Orbital Fractures ; Orthopedics ; Pain, Postoperative ; Prevalence ; Retrospective Studies*

BACKGROUND: Gestational diabetes mellitus (GDM) is a hyperglycemic condition caused by increased insulin resistance and impaired insulin secretion during pregnancy. It is known to be temporary, but it can cause perinatal complications in the mother and baby. Additionally, it may progress to type 2 diabetes mellitus (T2DM). In the present study, we evaluated the risk factors for complications and progression to T2DM in patients with GDM. METHODS: The study included 130 pregnant women who were diagnosed with GDM at gestational weeks 24-28 in 2011. Body mass index and the levels of glucose, total cholesterol, lipoproteins, and coagulation factors (von Willebrand factor and plasminogen activator inhibitor-1) were assessed in all patients. RESULTS: The level of high-density lipoprotein (HDL) was significantly lower and the triglyceride/HDL ratio and coagulation factor levels were significantly higher in the group of patients with perinatal complications compared to those in the group of patients without complications. After delivery, the level of HDL was lower and the value of homeostasis model assessment of insulin resistance (HOMA-IR) was higher in women with impaired glucose metabolism compared to those in women with normal glucose metabolism. In logistic regression analysis, perinatal complications were independently associated with HDL and PAI-1 levels (OR = 0.929 and 1.101, respectively). CONCLUSION: The findings of our study show that the levels of HDL and coagulation factors are notable risk factors of perinatal complications. Additionally, we showed that lower HDL level may influence the progression to T2DM. Large-scale population studies are needed to verify our findings.
Blood Coagulation Factors ; Body Mass Index ; Cholesterol ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Diabetes, Gestational* ; Female ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Lipoproteins ; Lipoproteins, HDL ; Logistic Models ; Metabolism ; Mothers ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Risk Factors* ; von Willebrand Factor

A left internal mammary artery to vein fistula was found incidentally in a 32-year-old woman with a continuous murmur. There was no significant history of trauma and no cardiac symptoms. A percutaneous embolization with vascular plug and coil was performed.
Adult ; Arteriovenous Fistula ; Embolization, Therapeutic ; Female ; Fistula ; Heart Murmurs ; Humans ; Mammary Arteries ; Veins

Percutaneous device occlusion of secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. A variety of devices have been used successfully. However, all of them have limitations. We report our experience with two devices used to close multiple ASDs.
Cardiac Catheterization ; Heart Septal Defects ; Heart Septal Defects, Atrial

BACKGROUND: Paraquat is extremely toxic chemical material, which generates reactive oxygen species (ROS), causing multiple organ failure. In particular, paraquat leads to irreversible progressive pulmonary fibrosis. Exaggerated cell deaths exceeding the normal repair of type II pneumocytes leads to mesenchymal cells proliferation and fibrosis. This study examined the followings; i) whether or not paraquat induces cell death in lung epithelial cells; ii) whether or not paraquat-induced cell deaths are apoptosis or necrosis; and iii) the effects of N-acetylcysteine, dexamethasone, and bcl-2 on paraquat-induced cell deaths. METHODS: A549 and BEAS-2B lung epithelial cell lines were used. The cell viability and apoptosis were evalluated using a MTT assay, Annexin V staining was monitored by fluorescence microscopy, The level of bcl-2 inhibition was examined by establishing stable A549 pcDNA3-bcl-2 cell lines throung the transfection of pcDNA3-bcl-2 with the mock. RESULTS: Paraquat decreased the cell viability in A549 and BEAS-2B cells in a dose and time dependent manner. The Annexin V assay showed that apoptosis was the type of paraquat-induced cell death. Paraquat-induced cell deaths was significantly inhibited by N-acetylcysteine, dexamethasone, and bcl-2 overexpression. The cell viability of A549 cells treated with N-acetylcysteine, and dexamethasone on the paraquat-induced cell deaths were increased significantly by 10 ~ 20%, particularly at high doses. In addition, the cell viability of A549 pcDNA3-bcl-2 cells overexpressing bcl-2 was significantly higher than the untransfected A549 cells. CONCLUSION: Paraquat induces apoptotic cell deaths in lung epithelial cells in a dose and time dependent manner. The paraquat-induced apoptosis of lung epithelial cells might occur through the mitochondrial pathway.
Acetylcysteine ; Annexin A5 ; Apoptosis ; Cell Death* ; Cell Line ; Cell Survival ; Dexamethasone ; Epithelial Cells* ; Fibrosis ; Lung* ; Microscopy, Fluorescence ; Multiple Organ Failure ; Necrosis ; Paraquat ; Pneumocytes ; Pulmonary Fibrosis ; Reactive Oxygen Species ; Transfection

BACKGROUND: Paclitaxel is highly beneficial anticancer drug for the treatment of non-small cell lung cancer and has shown remarkable radiosensitizing effect in vitro. We evaluated whether concurrent chemoradiation therapy with weekly paclitaxel (60 mg/m2) could be tolerated and effective in the treatment of locally advanced non-small cell lung cancer (NSCLC). METHODS: Twenty-two stage III (IIIA:6, IIIB:16) NSCLC patients were treated with weekly administration of paclitaxel (60 mg/m2) on days 1, 8, 15, 22, 29, and 36 in addition to concurrent radiation therapy of 54 Gy. After the initial phase of concurrent chemoradiation, patients received additional two cycles of consolidation chemotherapy with paclitaxel (175mg/m2)/cisplatin (75 mg/m2) or paclitaxel (175 mg/m2)/carboplatin (6AUC) every 3 weeks. RESULTS: Overall response rate was 81.8% (18/22) with 9.1% (2/22) of complete response and 72.7% (16/22) of partial response rate. Two patients (9.1%) died of chemoradiation-induced pneumonitis after completion of therapy. In total, grade 3 toxicities included pneumonitis (22.7%), esophagitis (22.7%), neuropathy (13.6%), and neutropenia (13.6%). The median survival time was 15 months and 2-year overall survival were 31.8%. CONCLUSION: Concurrent chemoradiation therapy with weekly paclitaxel in locally advanced NSCLC showed good local response, but survival rate was not completely satisfactory due to potentially fatal chemoradiati1on-induced pneumonitis.
Carcinoma, Non-Small-Cell Lung* ; Consolidation Chemotherapy ; Esophagitis ; Humans ; Neutropenia ; Paclitaxel* ; Pneumonia ; Radiation-Sensitizing Agents ; Survival Rate

18 trisomy(Edwards syndrome) is a fatal disease with a congenital heart anomaly. Patients usually receive less aggressive care because caregivers expect them to die very young. Although they have a very poor prognosis due to severe multi-organ dysfunction, symptomatic simple cardiac anomaly with left to right shunt can be repaired. We experienced a case of 18 trisomy with ventricular septal defect and patent ductus arteriosus. He showed prolonged dyspnea and tachypnea after the ligation of patent ductus arteriosus in a previous hospital. In our hospital, the ventricular septal defect was closed because his parents insisted on aggressive treatment. After surgery, the symptoms were relieved and he was discharged in a condition satisfactory to his parents and the medical team.
Caregivers ; Ductus Arteriosus, Patent ; Dyspnea ; Heart ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Humans ; Ligation ; Parents ; Prognosis ; Tachypnea ; Trisomy*