Background: The aim of the present study was to evaluate the prognostic significance of B-cell lymphocyte kinase (BLK) expression for survival outcomes in diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP. Methods: We retrospectively analyzed the medical records of 89 patients from two tertiary referral hospitals. The expression of BLK, SYK, and CDK1 were evaluated in a semiquantitative method using an H-score, and the proportions of BCL2 and C-MYC were evaluated. Results: A total of 89 patients received R-CHOP chemotherapy as a first-line chemotherapy. The expression rates of BLK in tumor cells was 39.2% (n = 34). BLK expression status was not significantly associated with clinical variables; however, BLK expression in tumor cells was significantly associated with the expression of both C-MYC and BCL2 (p = .003). With a median follow-up of 60.4 months, patients with BLK expression had significantly lower 5-year progression-free survival (PFS) and overall survival rates (49.8% and 60.9%, respectively) than patients without BLK expression (77.3% and 86.7%, respectively). In multivariate analysis for PFS, BLK positivity was an independent poor prognostic factor (hazard ratio, 2.208; p = .040). Conclusions Here, we describe the clinicopathological features and survival outcome according to expression of BLK in DLBCL. Approximately 39% of DLBCL patients showed BLK positivity, which was associated as a predictive marker for poor prognosis in patients who received R-CHOP chemotherapy.

Female ; Forced Expiratory Volume ; Humans ; Linear Models ; Lung ; Male ; Radiography, Thoracic ; Spirometry ; Vital Capacity

PURPOSE: Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. METHODS: A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. RESULTS: Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs (P< 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs (P= 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P= 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. CONCLUSION: This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.
Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Epidemiologic Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Length of Stay ; Mortality ; Referral and Consultation ; Risk Factors ; Stevens-Johnson Syndrome ; Thrombocytopenia ; Valproic Acid

BACKGROUND: Tuberculosis (TB) is a major health problem, and accurate and rapid diagnosis of multidrug-resistant (MDR) and extended drug-resistant (XDR) TB is important for appropriate treatment. In this study, performances of solid and liquid culture methods were compared with respect to MDR- and XDR-TB isolate recovery and drug susceptibility testing. METHODS: Sputum specimens from 304 patients were stained with Ziehl-Neelsen method. Mycobacterium tuberculosis (Mtb) isolates were tested for recovery on Löwenstein-Jensen (LJ) medium and the BacT Alert 3D system. For drug susceptibility testing of Mtb, isolates were evaluated on M-KIT plates and the BacT Alert 3D system. RESULTS: The recovery rates were 94.9% (206/217) and 98.2% (213/217) for LJ medium and the BacT Alert 3D system, respectively (kappa coefficient, 0.884). The rate of drug resistance was 13.4% for at least one or more drugs, 6.0% for MDR-TB and 2.3% for XDR-TB. M-KIT plate and BacT 3D Alert 3D system were comparable in drug susceptibility testing for isoniazid (97.7%; kappa coefficient, 0.905) and rifampin (98.6%; kappa coefficient, 0.907). Antibiotic resistance was observed using M-KIT plates for 24 of the total 29 Mtb isolates (82.8%). CONCLUSION: The liquid culture system showed greater reduction in the culture period, as compared with LJ medium; however, drug susceptibility testing using M-KIT plates was advantageous for simultaneous testing against multiple drug targets.
Diagnosis ; Drug Resistance ; Drug Resistance, Microbial ; Extensively Drug-Resistant Tuberculosis ; Humans ; Isoniazid ; Korea* ; Methods ; Mycobacterium tuberculosis* ; Mycobacterium* ; Rifampin ; Sputum ; Tertiary Care Centers* ; Tuberculosis

Vaginal intraepithelial neoplasia III, is a relatively rare disease. Consequently standard treatments for this disease were not established until recently. Although several convenient methods, such as laser ablation, 5-fluorouracil topical injection, and radiation therapy, have been applied for treating these lesions, surgical treatments, including vaginectomy, have not yet been attempted, as they would likely be accompanied by technical difficulties and various complications. Herein, we report a case of refractory vaginal intraepithelial neoplasia III in the vaginal vault that was successfully treated with a total vaginectomy.
Fluorouracil ; Laser Therapy ; Rare Diseases

PURPOSE: The impact of obesity on the surgical outcomes of Asian patients undergoing laparoscopic colon surgery is not clear. The purpose was to evaluate the outcome of laparoscopic surgery in obese Asian patients with colon cancer.METHODS: We retrospectively reviewed the prospectively collected data of 1,740 consecutive patients who underwent laparoscopic surgery for colon cancer between January 2008 and December 2010. Patients were classified according to the categories proposed by the International Obesity Task Force, Non-obese (body mass index [BMI]<25.0 kg/m2), Obese-I (BMI, 25.0–29.9 kg/m2), and Obese-II (BMI≥30 kg/m2). Surgical outcomes, including open conversion, operative time, and postoperative hospital stay, were compared in the Non-obese, Obese-I, and Obese-II patients.RESULTS: Of the 1,192 patients in the study, 812 (68.1%), 360 (30.2%), and 20 (1.7%), were classified as Non-obese, Obese-I, and Obese-II, respectively. The Obese-II group had higher conversion rates (10.0% vs. 3.6% and 1.6%, P=0.008) and, longer operative times (180.35 vs. 162.54 and 147.84 minutes, P<0.001) than the Obese-I and Non-obese group. However, the other postoperative outcomes were not significantly different. The overall survival and disease-free survival were not significantly different between groups (P=0.952). Multivariate analysis showed that the independent risk factor for conversion were BMI, total operative time, previous operative history, and cancer perforation.CONCLUSION: The outcomes of laparoscopic colon surgery in obese patients are similar to those of non-obese patients, offering all the benefits of a minimally invasive approach. However, the conversion rate was higher in obese patients. It is therefore very important for surgeons to be aware of these risks during laparoscopic colon surgery in obese patients.
Advisory Committees ; Asian Continental Ancestry Group ; Colectomy ; Colon ; Colonic Neoplasms ; Disease-Free Survival ; Humans ; Laparoscopy ; Length of Stay ; Multivariate Analysis ; Obesity ; Observational Study ; Operative Time ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Surgeons

BACKGROUND/AIMS: Esophageal cancer and dysplasia are relatively rare in Korea, compared to other Far Eastern countries. So, the feasibility and safety of endoscopic treatments for these diseases is not well established in Korea. This study aimed to assess the technical feasibility, safety and the clinical outcomes of endoscopic treatment for esophageal epithelial lesions. MATERIALS AND METHODS: Between April 2005 and March 2013, 25 esophageal epithelial lesions from 22 patients were treated with endoscopic treatment such as endoscopic submucosal dissection or endoscopic mucosal resection. RESULTS: Of the 25 lesions, 11 lesions were treated with endoscopic submucosal dissection (ESD) (ESD group) and 14 lesions with endoscopic mucosal resection (EMR group). In the ESD group, the diagnosis was squamous cell carcinoma in 7 patients (64%), high grade dysplasia in 3 patients (27%), and low grade dysplasia in 1 patient (9%). In the EMR group, thediagnosis was squamous cell carcinoma in 8 patients (57%), high grade dysplasia in 2 patients (14%), and low grade dysplasia in 4 patients (29%). En bloc resection rates were 100% in ESD and 42.9% in EMR, respectively. For the median 12 months follow up period, there was no recurrence in the ESD group. However, there were three recurrences in the EMR group. CONCLUSIONS: Endoscopic treatment for esophageal epithelial lesions is safe and feasible therapeutic modalities. Especially, ESD can provide higher rate of en bloc and curative resection for early esophageal cancer and dysplasia.
Carcinoma, Squamous Cell ; Diagnosis ; Esophageal Neoplasms ; Follow-Up Studies ; Humans ; Korea ; Recurrence

OBJECTIVE: To analyze the incidence of gestational diabetes mellitus (GDM) and its clinical implication of glycosuria identified in 2nd trimester pregnancy. METHODS: This study included pregnant women who had undertaken the 50 g oral glucose tolerance test (50 g OGTT) between 24 and 28 weeks gestation and delivered at term (N=704). Blood and urine sample were collected and analyzed for glucose level, one hour after 50 g OGTT. We applied women to 100 g OGTT if their blood glucose level after 50 g OGTT were more than 140 mg/dL. We compared blood glucose level, rate of GDM, birth weight and number of macrosomia at different urine glucose levels. Urine glucose level were measured by urine dipstick test and grouped to trace, 1+, 2+, 3+, and 4+, which were corresponding to 100, 250, 500, 1,000, 2,000 mg/dL. RESULTS: Women with glycosuria after 50 g OGTT were 258/704 (36.6%). Mean blood glucose levels were 117+/-23 mg/dL, 128+/-20 mg/dL, 135+/-23 mg/dL, 132+/-17 mg/dL, 139+/-25 mg/dL, 153+/-45 mg/dL, mean birth weight 3.29+/-0.40 kg, 3.25+/-0.40 kg, 3.27+/-0.41 kg, 3.34+/-0.35 kg, 3.28+/-0.41 kg, 3.33+/-0.40 kg, and numbers of macrosomia (> or =4.0 kg) 20 (4.5%), 3 (4.8%), 1 (1.8%), 2 (4.2%), 3 (6.7%), 0 (0%) at glycosuria level of negative, trace, 1+, 2+, 3+ and 4+ respectively. Glycosuria level was correlated significantly with blood glucose level (P=0.000), but not with birth weight and macrosomia (P=0.838, 0.881). The rate of GDM was 7/55 (12.7%), 2/48 (4.7%), 7/45 (15.6%), 8/48 (16.7%) in glycosuria level of 1+, 2+, 3+, 4+ and their relationship was statistically significant (P=0.000, AUC=0.734, 95%CI 0.638-0.830). In the cut off value of glycosuria 1+ or greater, sensitivity and positive predictive value were 72.7 and 12.2%. CONCLUSION: Glycosuria correlates well with blood glucose level and GDM prevalence but not with birth weight.
Birth Weight ; Blood Glucose ; Diabetes, Gestational ; Female ; Glucose ; Glucose Tolerance Test ; Glycosuria ; Humans ; Incidence ; Pregnancy ; Pregnant Women ; Prevalence

Kimura's Disease is a very rare, chronic inflammatory disorder with an unknown etiology, and this illness is primarily seen in young Asian males. The typical clinical features consist of painless subcutaneous masses in the head or neck region, and especially in the salivary gland and submandibular region. It is often accompanied with a regional lymphadenopathy, peripheral blood eosinophilia and elevated serum IgE levels. Histologically, it is characterized by prominent germinal centers in the involved lymph nodes, together with eosinophilic infiltration in these lymph nodes. The treatment modalities for this disease are steroid therapy, radiation therapy and surgical excision. Its clinical course is of a benign nature. We report here on a case of a 28 year old man who had a soft tissue mass in his left arm. We excised this mass and the microscopy confirmed that he suffered from Kimura's disease on microscopic examination in his left distal arm.
Arm ; Asian Continental Ancestry Group ; Eosinophilia ; Eosinophils ; Germinal Center ; Head ; Humans ; Immunoglobulin E ; Lymph Nodes ; Lymphatic Diseases ; Male ; Microscopy ; Neck ; Salivary Glands

PURPOSE: We wanted to analyze the effects of tourniquet pressure on the postoperative thigh pain and blood loss of patients who undergo total knee arthroplasty. MATERIALS AND METHODS: This prospective randomized study focused on one-hundred sixty-one unilateral total knee arthroplasties that were done with using a tourniquet. The tourniquet pressures were 300 mmHg in group I (seventy-four cases) and 100 mmHg higher than the systolic blood pressure in group II (eighty-seven cases). We analyzed the postoperative thigh pain with using a visual analog scale (VAS), and we assessed the hemoglobin levels and the hematocrits. RESULTS: The incidence of postoperative thigh pain in group II was statistically lower than that of group I. The intensity of the postoperative thigh pain of group II was lower than that of group I at both 6 hours and 72 hours after surgery. There were no statistical differences in blood loss between the two groups. CONCLUSION: Using a tourniquet pressure of 100 mmHg above the systolic blood pressure during total knee arthroplasty can reduce the postoperative thigh pain. When comparing the above technique with a TKA using 300 mmHg of tourniquet pressure, there was no statistically significant difference of the postoperative blood loss.
Arthroplasty ; Blood Pressure ; Hemoglobins ; Humans ; Incidence ; Knee ; Prospective Studies ; Thigh ; Tourniquets