BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

Kimura disease is a rare chronic inflammatory disorder of unknown etiology, suggestive of an allergic or autoimmune mechanism, which presents mainly as soft tissue masses in the head and neck area in young Asian males. Blood tests show eosinophilia and an elevated immunoglobulin E; the typical pathologic findings are lymphoid follicular hyperplasia, interfollicular eosinophilic infiltration, and vascular hyperplasia. There is no standard treatment; surgical resection is preferred and systemic steroid or radiotherapy is used to treat disease relapses. Kimura disease in unusual sites has been reported, but there are few cases with long-term observations because of its benign nature. Here, we present the case of a female with recurrent Kimura disease; we follow her progress for about 5 years after surgical resection of masses in the right groin area, an unusual site, with a brief review of the literature.
Angiolymphoid Hyperplasia with Eosinophilia ; Asian Continental Ancestry Group ; Eosinophilia ; Eosinophils ; Female ; Groin ; Head ; Hematologic Tests ; Humans ; Hyperplasia ; Immunoglobulins ; Male ; Neck ; Recurrence

The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.
Anemia, Hemolytic ; Arthralgia ; Fever ; Headache ; Hepatitis C, Chronic ; Humans ; Interferon-alpha ; Interferons ; Korea ; Lung Diseases, Interstitial ; Pancytopenia ; Polyethylene Glycols ; Recombinant Proteins ; Ribavirin

The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.
Anemia, Hemolytic ; Arthralgia ; Fever ; Headache ; Hepatitis C, Chronic ; Humans ; Interferon-alpha ; Interferons ; Korea ; Lung Diseases, Interstitial ; Pancytopenia ; Polyethylene Glycols ; Recombinant Proteins ; Ribavirin

BACKGROUND: Lichen-derived glucans have been known to stimulate the functions of immune cells. However, immunostimulatory activity of glucan obtained from edible lichen, Umbilicaria esculenta, has not been reported. Thus we evaluated the phenotype and functional maturation of dendritic cells (DCs) following treatment of extracted glucan (PUE). METHODS: The phenotypic and functional maturation of PUE-treated DCs was assessed by flow cytometric analysis and cytokine production, respectively. PUE-treated DCs was also used for mixed leukocyte reaction to evaluate T cell-priming capacity. Finally we detected the activation of MAPK and NF-kappaB by immunoblot. RESULTS: Phenotypic maturation of DCs was shown by the elevated expressions of CD40, CD80, CD86, and MHC class I/II molecules. Functional activation of DCs was proved by increased cytokine production of IL-12, IL-1beta, TNF-alpha, and IFN-alpha/beta, decreased endocytosis, and enhanced proliferation of allogenic T cells. Polymyxin B, specific inhibitor of lipopolysaccharide (LPS), did not affect PUE activity, which suggested that PUE was free of LPS contamination. As a mechanism of action, PUE increased phosphorylation of ERK, JNK, and p38 MAPKs, and enhanced nuclear translocation of NF-kappaB p50/p65 in DCs. CONCLUSION: These results indicate that PUE induced DC maturation via MAPK and NF-kappaB signaling pathways.
Dendritic Cells ; Endocytosis ; Glucans ; Interleukin-12 ; Lichens ; Lymphocyte Culture Test, Mixed ; NF-kappa B ; p38 Mitogen-Activated Protein Kinases ; Phenotype ; Phosphorylation ; Polymyxin B ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

A number of case reports on occupational asthma caused by herbal medicines have been issued, for example, on Sanyak, Chunkung, Banha, and Brazilian ginseng. Recently, cases of occupational asthma induced by Sanyak and Korean ginseng have been reported, but the pathogenic mechanisms involved are unknown. This study was carried out to evaluate the immunologic mechanism underlying Korean ginseng-induced occupational asthma. A patient engaged in Korean ginseng wholesale was referred for recurrent dyspnea, wheezing, and nasal symptoms, which were aggravated at work. Allergen bronchial provocation testing to Korean ginseng extract showed a typical immediate response, and skin prick testing to Korean ginseng extract also showed a strong positive response. Moreover, serum-specific IgE levels to Korean ginseng extract were significantly higher than in controls. Enzymelinked immunosorbent assay (ELISA) inhibition tests showed a dose-dependent inhibition by Korean ginseng, but not by Dermatophagoides farinae, wheat flour, or Chinese balloon flower. Sodium dodecylsulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and immunoblotting revealed four specific Immunoglobulin E (IgE) binding components at 26, 30, 47, and 60 kDa, which were not bound by control sera. These results strongly suggest that occupation asthma induced by Korean ginseng is induced via an IgE-mediated mechanism.
Animals ; Asthma/diagnosis/*etiology/*immunology ; Bronchi/metabolism ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay/methods ; Flour ; Flowers ; Humans ; Hypersensitivity/*diagnosis ; Immunoglobulin E/analysis/*chemistry ; Korea ; Occupational Diseases/diagnosis/*etiology/*immunology ; Panax/*adverse effects ; Pyroglyphidae/metabolism ; *Skin Tests

Wernicke's encephalopathy is a relatively underestimated disorder caused by a deficiency of thiamine and manifests with a classical triad of ocular abnormalities, ataxia, and mental-status changes. Specific laboratory tests are unavailable and the disease remains a clinical diagnosis. Among paraclinical studies, magnetic resonance imaging is currently considered the most valuable method to confirm a diagnosis of Wernicke's encephalopathy. Treatment is based on supplementation of thiamine that is administered parentally. We report a case of Wernicke's encephalopathy that was treated with thiamine and showed the characteristic clinical findings, as well as an extremely rare symptom of severe dysphagia that improved concurrently with neurological recovery. Only a few cases of dysphagia in Wernicke's encephalopathy have been reported worldwide.
Ataxia ; Deglutition Disorders ; Humans ; Magnetic Resonance Imaging ; Parents ; Thiamine ; Thiamine Deficiency ; Wernicke Encephalopathy

The most common cause of small-bowel obstructions in adults is postoperative adhesions. However, strangulation of the small intestine in a patient without history of laparotomy is a rare condition. We experienced an unusual case of a small-bowel obstruction secondary to omental encasement in a patient without previous history of abdominal surgery or acute inflammatory process in the abdomen.
Abdomen ; Adhesives* ; Adult ; Humans ; Intestinal Obstruction ; Intestine, Small ; Ischemia ; Laparotomy ; Omentum*

BACKGROUND: Inflammation has been demonstrated to be an important risk factor for the development of cardiovascular disease (CVD). The relationship of the peripheral leukocyte count to the severity of stable angina remains to be clarified. The present study analyzed the relationship of the peripheral leukocyte count to the severity of stable angina determined by coronary angiography. METHODS: The data from 108 patients with stable angina, and 92 subjects with normal coronary angiograms were reviewed, and the role of the peripheral leukocyte count as a risk factor for stable angina evaluated. In addition, the correlation of the peripheral leukocyte count and the severity of stable angina, as assessed by the Gensini's score in the stable angina group, were analyzed. RESULTS: Age, the prevalence of hypertension and diabetes, and the fasting blood sugar were significantly higher, and the HDL was lower in the stable angina than the control group. A multivariate analysis showed that a peripheral leukocyte count over 6, 800/mm3 was an independent variable, but with no statistical significance (p=0.067), and diabetes (OR=3.02, 95% CI: 1.29~7.02) and old age (OR=3.62, 95% CI: 1.33~9.87) were independent risk factors for stable angina. A positive correlation between peripheral leukocyte count and Gensini's score was noted in the stable angina group even after adjusting for age, fasting blood sugar, blood pressure and lipid profiles (R2=0.198, p=0.015). CONCLUSION: An increased peripheral leukocyte count is considered not so much an indicator of the pathogenesis of stable angina, but as a predictor for disease progression. Furthermore, it is considered that the above correlation will be helpful in screening high-risk groups that require relatively active interventional therapy.
Adult ; Aged ; Angina Pectoris/*blood/epidemiology/*radiography ; *Coronary Angiography ; Cross-Sectional Studies ; Female ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Risk Factors ; Severity of Illness Index

PURPOSE: Wilms tumor is the most common malignant renal tumor in children. We investigated the epidemiology, clinical features and treatment outcome of the children with Wilms tumor in Korea during the recent 10 years. METHODS: Two hundred forty six patients were enrolled between January 1991 and December 2000 from 26 major hospitals in Korea. The data regarding the clinical features including sex, age, pathologic type, prognostic factor and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed, The differences between groups were analyzed by log-rank test. RESULTS: There were 130 males and 116 females. The incidence between the age of 1~4 years was the highest with 66.2%. The annual incidence rate per 1, 000, 000 population varied from 1.9 to 2.1. The 10 years overall survival rate according to sex, clinical stage, pathologic type and relapse were as follows: 88.6% in male, 90.9% in female, 100% in stage I, 94.7% in stage II, 92.1% in stage III, 63.4% in stage IV, 85.7% in stage V, 95.3% in favorable histology, 64.1% in unfavorable histology, 94.8% in non-relapse, and 40.9% in relapse. The relapse rate was 12%. The 10 years overall survival rate of 246 patients were 89.1%. CONCLUSION: Our results could provide the most recent and important clinical information on Wilms tumor of children in Korea.
Child ; Epidemiology* ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Wilms Tumor*