Analysis of the Clinicopathological Characteristics of Gastric Cancer in Extremely Old Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Gastric cancer is the third-leading cause of cancer-related death in Korea. As the Korean population is ageing, the number of extremely old patients with this disease is increasing. This study examined the clinicopathological characteristics of gastric cancer in extremely old (over 85 years) patients who received treatment or conservative observations and compared the treatment outcomes according to the treatment modality. MATERIALS AND METHODS: A total of 170 patients over 85 years of age were diagnosed with gastric cancer. Of these, 81 underwent treatment for gastric cancer and 89 received conservative observations. The clinicopathological characteristics of the treatment and conservative groupswere compared. RESULTS: The mean age of the patients was 86.5 years. The conservative group included significantly more patients with older ages, macroscopically advanced cancer and upper-middle located cancer. The overall survival rate of the treatment group was significantly higher than that of the conservative group. The disease-specific mortality rate was significantly lower in the treatment group than in the conservative group. Multivariate analysis revealed the clinical course, alarm sign, and macroscopic classification to be independent prognosis factors. CONCLUSION: By itself, the chronological age should not be used as a strategy to determine whether treatmentwill be administered for gastric cancer. Patients who have early gastric cancer or lower-risk preexisting comorbidities should not be discouraged from treatment, even if they are older than 85 years.

Efficacy of Adalimumab in Korean Patients with Crohn's Disease

BACKGROUND/AIMS: Adalimumab is effective for both remission induction and the maintenance of Crohn's disease (CD) in Western countries. We evaluated the efficacy of adalim-umab in the conventional step-up treatment approach for CD in Korea. METHODS: We retrospectively reviewed 62 patients with CD who were treated with adalimumab. Their Crohn's disease activity index (CDAI) was measured at weeks 4, 8, and 52. Clinical remission was defined as a CDAI score <150. Induction and maintenance outcomes were analyzed. RESULTS: Forty-one patients (66.1%) achieved a reduction of 70 CDAI points at week 8. Among them, 28 (45.2%) achieved clinical remission at week 8, 20 (32.3%) maintained remission at week 52. The absence of prior anti-tumor necrosis factor (TNF) therapy and Montreal classification L1 at baseline predicted clinical remission at week 8 in the multivariate logistic regression analysis. In the Cox proportional hazards model, the hazard ratio for the secondary loss of response during maintenance therapy after clinical remission induction was significantly higher in patients who showed initial mild CDAI severity or Montreal classification A3. CONCLUSIONS: In our study, anti-TNF therapy-naive and Montreal classification L1 were associated with adalimumab efficacy as induction therapy in CD. Further studies are warranted to determine the prognostic factors for the long-term response after adalimumab therapy.

Dactylitis in a Patient with Psoriatic Arthritis Treated with Infliximab / 대한내과학회지

Dactylitis is a hallmark feature of psoriatic arthritis. It is usually managed with non-steroidal anti-inflammatory drugs and oral corticosteroids. Some cases have been treated successfully with intravenous corticosteroids or some disease-modifying antirheumatic drugs. Recently, inflximab has been reported as an effective treatment for dactylitis that is resistant to conventional treatment. This report describes a 37-year-old man with psoriatic arthritis who had multiple dactylitis on both thumbs and great toes. He was resistant to conventional treatment but was effectively treated with infliximab. This report highlights the effectiveness of infliximab for dactylitis, and the usefulness of blood pool imaging from bone scans as a method for determining treatment response.

Clinicial Significance of Spontaneous Pneumomediastinum in Dermatomyositis/Polymyositis / 대한류마티스학회지

OBJECTIVE: Pneumomediastinum (PnM), a rare complication of dermatomyositis and polymyositis (DM/PM), is sporadic and has an unclear pathogenesis. PnM is almost always associated with interstitial lung disease (ILD), and is a poor prognostic factor in inflammatory myositis patients. We studied the prevalence of PnM in Korean DM/PM and its clinical significance. METHODS: We retrospectively studied the medical records of 161 patients diagnosed with DM/PM meeting Bohan-Peter's criteria at Hanyang University Hospital for Rheumatic Diseases from 1995 to 2010. We collected following findings; demographic data, diagnosis, lung involvement, cause of death, and duration from diagnosis to death. RESULTS: One hundred nineteen patients (73.9%) were DM and 42 patients (26.1%) were PM. Eighty three patients (51.6%) developed ILD at diagnosis or during follow up. Eighteen patients (11.2%) died because of ILD aggravation, infection, or malignancy. The mean duration from diagnosis to death was 11.5 months, with 10 patients (6.2%) dying from from ILD aggravation but none with spontaneous PnM. 6 patients (3.7%) presented with PnM, and it was associated with ILD worsening in all cases. PnM resolved with O2 inhalation, corticosteroids, and/or immunosuppressive agents after 11 weeks (mean) of therapy. CONCLUSION: PnM is rare but associates with DM and aggravation of ILD. PnM does not usually cause fatalities and can be cured by appropriate therapy.

A Case of Ankylosing Spondylitis with Spinal Metastasis of Cholangiocarcinoma / 대한류마티스학회지

Back pain is the most common symptom of ankylosing spondylitis (AS). The aggravation of back pain in AS patients is usually thought to be a flare-up of the disease activity. We report here on the case of a 31-year-old AS patient with low back pain. The lesions of this patient were unexpectedly diagnosed as metastatic spinal tumor due to cholangiocarcinoma. In a patient with AS, an acute aggravation of low back pain may be due to other pathologic conditions such as osteoporotic vertebral fracture, vertebral discitis and metastatic bone disease. Therefore, when a patient with AS presents with nonspecific low back pain, a physician should consider the above mentioned conditions.