Case of Ischemic Colitis Associated with Pseudoephedrine

Ischemic colitis is the consequence of a sudden reduction in colon blood supply, which in turn results in ischemic injury. The splenic flexure and rectosigmoid junction are the areas most often affected. Ischemic colitis occurs with greater frequency in the elderly and is caused by various medications and procedures. Pseudoephedrine acts as a vasoconstrictor directly affecting adrenal receptors of nasal mucous membrane. Pseudoephedrine occasionally causes vascular insufficiency due to intense vasoconstriction, even at standard doses. Ischemic colitis associated with pseudoephedrine has been reported in other countries,, but it has never been reported in Korea. In this paper, we describe 3 cases of ischemic colitis that occurred after taking pseudoephedrine for nasal congestion.

Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease / 전남의대학술지

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease / 전남의대학술지

We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.

Changes of Clinical Benefit and Subjective Wellbeing after Switching to Extended Release Quetiapine Furmate (Quetiapine XR) in Patients with Schizophrenia: Naturalistic, Observational Study (CLIMAX Study) / 대한정신약물학회지

OBJECTIVE: The aim of this study was to demonstrate changes of clinical benefit and subjective wellbeing after once-daily extended release quetiapine furmate (quetiapine XR) in patients with schizophrenia. METHODS: In a naturalistic, observational, and multicentric study, 1,494 patients with schizophrenia who switched to quetiapine XR (flexible dosing) due to insufficient efficacy or intolerance were recruited. Clinical Global Impressions-Clinical Benefit (CGI-CB), CGI-Severity (CGI-S), CGI-Improvement (CGI-I) and Subjective Wellbeing under Neuroleptic Treatment Scale (SWN-K) were assessed at baseline and after 8 weeks treatment. We also examined factors related to changes of CGI-CB and SWN-K scores using linear regression analysis. RESULTS: Among 1,494 patients, 1,342 patients (89.8%) completed this study and 1,204 patients (80.6%) without protocol violation were included in the analysis. The mean dose of quetiapine XR was 416.9+/-205.8 mg/day at the initiation and continuously increased to 591.6+/-228.3 mg/day until week 5. At the endpoint, the mean dose of quetiapine XR was 580.24+/-382.24 mg/day. Both CGI-CB and CGI-S scores were significantly decreased after 8 weeks (both p<0.0001) and 745 patients (61.9%) achieved clinical benefit. Mean CGI-I scores were 2.49+/-0.80 and the response rate defined as CGI-I< or =2 was 51.6%. Subjective wellbeing scores were increased after 8 weeks (p<0.0001). Improvements of CGI-CB and subjective wellbeing were associated with quetiapine XR dosages as well as age and baseline scores. CONCLUSION: After switching to quetiapine XR, 61.9% of patients with schizophrenia who had a history of unsatisfactory treatment (efficacy or tolerance) showed clinical benefit and subjective wellbeing was significantly increased. Regarding that dosages of quetiapine XR were associated with improvements of clinical benefit and subjective wellbeing, active treatment strategies with higher dosages of quetiapine XR could be suggested in the real field.

Ganglion-like Lesions of the Foot on the Ultrasonography / 대한족부족관절학회지

PURPOSE: The authors have experienced various lesions that simulate ganglion of the foot on the ultrasonography. The purpose of this study is to evaluate ultrasonographic findings of soft tissue lesions, which were interpreted as ganglion but confirmed as different lesions in the foot. MATERIALS AND METHODS: We reviewed a database of patients with ganglion on the ultrasonography from two different institutions. There were 109 patients who underwent both ultrasonography and surgical confirmation. Twenty one lesions were identified, of which initial interpretation on the ultrasonography included ganglion which pathology revealed to be different lesions. All images were evaluated by one musculoskeletal radiologist, regarding size, margins, internal echogenicity of lesions, and presence of posterior enhancement. RESULTS: Of 21 lesions, there were 6 fibrous tumors including fibroma, giant cell tumor of tendon sheath, and fibromatosis, 3 hemangiomas, 2 epidermal inclusion cysts, 2 chondromas, 2 angioleiomyomas, 1 trichilemal cyst, 1 neurofibroma, 1 granular cell tumor, 1 neurilemmoma, 1 neuromyxoma, and 1 nodular hidradenoma. Mean size of the lesion was 1.1 cm. Margins were smooth in 10, mild lobulation in 8 and marked lobulation in 3 lesions. Lesions were hypoechoic in 16, anechoic in 4 and isoechoic in 1 case. Posterior acoustic enhancement was definitely present in 5 lesions. CONCLUSION: On the ultrasonography, various soft tissue lesions of the foot may be confused with ganglion. During surgical resection care should be given even to a simple ganglion as it might turn up to be a solid lesions such as fibrous tumors.

Overexpression of Transforming Growth Factor-beta1 in the Valvular Fibrosis of Chronic Rheumatic Heart Disease

For the purpose of determining the pathogenic role of transforming growth factor-beta1 (TGF-beta1) in the mechanism of chronic rheumatic heart disease, we evaluated the expression of TGF-beta1, proliferation of myofibroblasts, and changes in extracellular matrix components including collagen and proteoglycan in 30 rheumatic mitral valves and in 15 control valves. High TGF-beta1 expression was identified in 21 cases (70%) of rheumatic mitral valves, whereas only 3 cases (20%) of the control group showed high TGF-beta1 expression (p<0.001). Additionally, increased proliferation of myofibroblasts was observed in the rheumatic valves. High TGF-beta1 expression positively correlated with the proliferation of myofibroblasts (p=0.004), valvular fibrosis (p< 0.001), inflammatory cell infiltration (p=0.004), neovascularization (p=0.007), and calcification (p<0.001) in the valvular leaflets. The ratio of proteoglycan to collagen deposition inversely correlated with TGF-beta1 expression in mitral valves (p=0.040). In conclusion, an ongoing inflammatory process, the expression of TGF-beta1, and proliferation of myofibroblasts within the valves have a potential role in the valvular fibrosis, calcification, and changes in the extracellular matrix that lead to the scarring sequelae of rheumatic heart disease.

Clinical significance of insulin-like growth factor-1 receptor expression in stage I non-small-cell lung cancer: immunohistochemical analysis

BACKGROUND/AIMS: The insulin-like growth factor (IGF) system has been implicated in tumor growth, invasion, and metastasis. However, reports on the IGF-1 receptor (IGF-1R) based on radioimmunoassays are conflicting, and its prognostic implications in non-small-cell lung cancer (NSCLC) are still controversial. METHODS: Seventy-one paraffin-embedded tissue sections from stage I NSCLC patients were stained using a mouse monoclonal antibody against human IGF-1R. RESULTS: The intensity and frequency of IGF-1R expression on the membrane and cytoplasm of cancer cells was evaluated and scored using a semiquantitative system. IGF-1R expression was detected in nine of 71 (12.7%) cases. No significant relationship was found between clinical/histopathological parameters and IGF-1R expression. None of the patients whose tumor expressed IGF-1R had experienced distant metastasis or cancer-related death, although the difference did not reach statistical significance. CONCLUSIONS: We conclude that IGF-1R expression may not be a major prognostic factor for stage I NSCLC.

Surgical Treatment of the Pulmonary Nodular Lymphoid Hyperplasia: A case report / 대한흉부외과학회지

Nodular Lymphoid hyperplasia of the lung has a very low incidence and both the nomenclature and this disease entity have changed since its appearance in the 1960s. It has recently been classified as lymphoid hyperplasia of the B cell associated lymphoid tissue. Ground glass opacity was incidentally diagnosed in the right lower lobe of the a 60 year old male and he underwent right lower lobe lobectomy. The opacified lesion in the chest CT was diagnosed as nodular lymphoid hyperplasia under microscopic examination.

The Prevalence of Human Papillomavirus Infection in Korean Non-Small Cell Lung Cancer Patients

Human papillomavirus (HPV) infection is a co-carcinogen of lung cancer and contributes to its pathogenesis. To evaluate the prevalence of HPV infection, polymerase chain reaction (PCR) was employed to detect HPV 16, 18, and 33 DNA in tumor tissues of 112 patients with non-small cell lung cancer (NSCLC) who underwent curative surgery from Jan. 1995 to Dec. 1998 at Severance Hospital, Seoul, Korea. The patients consisted of 90 men and 22 women. Nineteen patients were under 50 years old (17%), and 92 patients (82%) were smokers. Fifty-three patients had adenocarcinomas, while 59 patients had non-adenocarcinomas. Early stage (I and II) cancer was found in 64 patients (57.1%) and advanced stage (III and IV) found in 48 (42.9%). The prevalence of HPV 16, 18, and 33 were 12 (10.7%), 11 (9.8%), and 37 (33.0%), respectively. Smoking status, sex, and histologic type were not statistically different in the presence of HPV DNA. The presence of HPV 16 was more common in younger patients and HPV 18 was more common in advanced stage patients. This study showed that the prevalence rate of HPV 16 and 18 infections in NSCLC tissue was low, suggesting HPV 16 and 18 infections played a limited role in lung carcinogenesis of Koreans. However, the higher prevalence of HPV 33 infections in Korean lung cancer patients compared to other Asian and Western countries may be important and warrants further investigation.

Basal Cell Carcinoma of the Nipple-areolar Complex

Basal cell carcinoma (BCC) occurring on sun-protected regions is an uncommon phenomenon. BCC of the nipple is an exceedingly rare event, often mistaken for Paget's disease. BCC is the most common human malignancy of the skin cancer, accounting for approximately 75% of all nonmelanoma skin cancers diagnosed in the United States. Most BCCs are sporadic and occur on the sun-exposed areas of the head and neck. Rarely, these tumors have been reported to develop in non-sun-exposed areas, such as the axilla, perineum, and nipple, in the absence of any known history of exposure to ionizing radiation or arsenic, and without any known alterations in immune surveillance or hereditary disorders that are known to increase one's risk of BCC. BCC of the nipple-areola complex is very rare. Only 24 cases were reported in the literature and the most of these cases arose in men. Most of the cases were treated with wide excision. We report on a case of BCC of the nipple-areola complex in a 73-year-old man, treated with total mastectomy with low axillary node dissection.

A Case of Pulmonary Metastasis of a Dermatofibrosarcoma Protuberans / 결핵및호흡기질환

Dermatofibrosarcoma protuberans (DFPS) is a locally aggressive skin tumor with a very low incidence in the general population. This tumor has a remarkable tendency to recur, However, a metastasis is rare. We report a case of DFPS with a pulmonary metastasis in 28-year-old man. The pulmonary metastasis developed 5 years after a complete resection of the primary skin tumor. We reviewed the clinical manifestations and treatment of DFPS, and highlight the need for a long-term follow-up examination for metastases after a wide excision of these lesions.

Investigation of the Bovine Leukemia Virus Proviral DNA in Human Leukemias and Lung cancers in Korea

The bovine leukemia virus (BLV) is the causative agent of enzootic bovine leucosis. This study investigated the presence of the BLV in leukemia (179 acute lymphoblastic leukemia, 292 acute myeloid leukemia and 46 chronic myelogenous leukemia cases) and 162 lung cancer patients (139 adenocarcinoma, 23 squamous cell carcinoma) to determine if the BLV is a causative organism of leukemia and lung cancer in Koreans. A BLV infection was confirmed in human cells by PCR using a BLV-8 primer combination. All 517 cases of human leukemia and 162 lung cancer were negative for a PCR of the BLV proviral DNA. In conclusion, although meat has been imported from BLV endemic areas, the BLV infection does not appear to be the cause of human leukemia or lung cancer in Koreans. These results can be used as a control for further studies on the BLV in Koreans.

A Feasibility Study of Adenosine Triphosphate-based Chemotherapy Response Assay (ATP-CRA) as a Chemosensitivity Test for Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: A chemosensitivity test can reflect the differences in responses of individual cancer patients to chemotherapeutic agents. The adenosine triphosphate-based chemotherapy response assay (ATP-CRA)is an accurate method, which does not require a large amount of tissue specimen. So far, no studies have evaluated the utility of the ATP-CRA in Korea. Therefore, we investigated the clinical usefulness of the ATP-CRA in 53 patients with lung cancer. MATERIALS AND METHODS: Tumor tissues were obtained from bronchoscopic biopsies or surgical resections. The validity of ATP-CRA was assessed focusing on the success rate, experimental error level (intraassay mean coefficient of variation [CV]) and reproducibility. RESULTS: The overall success rate of ATP-CRA was 90.6% (48/53). Normal cells were effectively eliminated from the tumor tissues with the use of ficoll gradient centrifugation and immunomagnetic separation, which was confirmed using loss of heterozygosity analysis of the 3p deletion. The mean CV of ATP assays was 10.5+/-4.6%. The reproducibility of ATP assays was 94+/-3.8%. The results of the ATP assays were reported to physicians within 7 days of specimen collection. More than 6 anticancer drugs were tested on the tumor specimens obtained from bronchoscopic biopsies. CONCLUSION: The ATP-CRA is a stable, accurate and potentially practical chemosensitivity test in patients with lung cancer.

Retinoic Acid Receptor-beta Expression in Stage I Non-Small Cell Lung Cancer and Adjacent Normal Appearing Bronchial Epithelium

Retinoic acid receptor- (RAR-beta) is induced by and mediates the growth-inhibitory and apoptotic effects of retinoic acid (RA), suggesting that loss of RAR-betaexpression may be one of the critical events involved in the carcinogenesis/ progression of non-small cell lung cancer (NSCLC) and in the responsiveness to retinoid chemotherapy. However, recent contradictory reports that the expression of RAR-beta is associated with poor clinical outcome, and the fact that treatment of serum-deprived type 2 alveolar cells with RA leads to a stimulation of cell proliferation, require the verification of RAR-beta as a biomarker of chemoprevention or prognosis. The expression status of RAR-beta in cancer cells and adjacent normal appearing bronchial epithelium from 39 patients, diagnosed as stage I NSCLC and undergone a curative lung resection, was analyzed in paraffin-embedded tissue sections by IHC staining. The normal appearing bronchial epithelium of 14 out of 33 (42.4%) specimens expressed RAR-beta, whereas 22 out of the 39 (56.4%) stage I NSCLC specimens expressed RAR-beta. RAR-beta was more frequently expressed in the adenocarcinoma (72.7%) than in the squamous cell carcinoma (31.3%) (p=0.026). Neither the expression status in normal appearing adjacent tissue nor that in the tumor tissue had prognostic implications. The higher expression of RAR-beta in cancer tissue, the focal and uneven distribution in normal appearing adjacent bronchial epithelium, and inconsistency with the corresponding tumor tissue, suggest that the expression status of RAR-beta as a biomarker for chemoprevention/early diagnosis or the prognosis of NSCLC requires further consideration.

Proximal Radio-Ulnar Translocation Associated with Elbow Dislocationon: Case Report / 대한정형외과학회잡지

A translocation of the proximal radius and ulna combined with a posterior dislocation of the elbow is quite rare. To the best of our knowledge, the only case with this condition, who had been treated using a closed method was reported by MacSween in 1978. This paper reports a ten-year-old girl who fell from a desk onto her outstretched left hand. The initial radiographs showed a simple posterior dislocation of the elbow. However, the radiographs taken after the closed reduction revealed a translocation of both forearm bones. It was possible to relocate both bones using a closed method, and the patient recovered from the associated ulnar nerve palsy at five weeks post-trauma. At the follow-up examination three months post-trauma, the nerve was found to be fully regenerated using electromyography and a nerve conduction study, and the patient regained the full range of elbow motion without pain. When a posterior dislocation of the elbow occurs, close attention is needed in order to detect the combined translocation of the proximal radio-ulnar joint. If treated early, a closed reduction leads to a good result. However, a careful physical examination and a thorough investigation of the radiographs are necessary.

Multiple Cavitary Pulmonary Metastases from Cholangiocarcinoma / 결핵

Because a cavitary pulmonary metastasis is rare, it may not be readily identified. However, various types of cancers can metastasize to the lung in the form of cavities. We report a case of a multiple cavitary metastases to the lung from a cholangiocarcinoma in a 60-year-old man. He complained of generalized weakness and a poor oral intake for 2 months. The plain chest radiography and the chest computed tomography showed multiple small thick-walled cavities and nodules the both lungs. A bronchoscopic examination revealed a focal irregularly elevated surface of the mucosa at the orifice of the superior segment of the right lower lobe and the biopsy demonstrated an infiltrative metastatic adenocarcinoma. The abdomen-pelvis computed tomography showed an ill-marginated and irregularly low-dense area in the right lobe of the liver and a diffuse dilatation of the peripheral intrahepatic bile ducts. The esophagogastroscopy and colonoscopy showed no abnormal findings. It was concluded that the cholangiocarcinoma of the liver metastasized to the lung in the form of cavities. Thereafter, the patient underwent six cycles of the systemic chemotherapy with gemcitabine and cisplatin, and the follow-up imaging studies showed a partial response.

Diagnosis and Treatment of Primary Mediastinal Tumors and Cysts: Forty-two years report in a University Hospital / 결핵

BACKGROUND: The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. METHODS: This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985~2002) and compared them to the report of the previous 25-year result (1960~1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. RESULTS: During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. CONCLUSION: These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.

Clinical Features of Bronchogenic Large Cell Carcinoma Confirmed by Surgical Resection

BACKGROUND: To define the final outcome of large cell carcinomas (LCC) after surgical treatment, the histopathology, clinical features and follow-up results of 28 cases were reviewed. METHODS: Twenty eight patients, with LCC that underwent a surgical resection between 1986 and 2001, at the Severance Hospital, were retrospectively reviewed. We analyzed clinical data, radiological findings, pathologic findings, treatment modalities, and survival. RESULTS: The prevalence of LCC was 2.9% (29 cases) among the surgically resected primary lung cancer cases (1003 cases) during the 15 year period of the study. The mean age of the patients was 59 years old, with 25 male cases. There were 23 smokers, smoking an average of 33 pack years. A cough was the most frequent symptom. There were 15 cases located in the peripheral part of the lung and 26 consisted of a lobulated mass. From a chest CT scan, 26 cases had necrotic portions, which appeared to be low density. The postoperative stages were IA, IB, IIB, IIIA and IV in 1 (3.6%), 11 (39.3%) 8 (28.5%), 7 (25%), 1 case (3.6%), respectively. The concordance rate of the pre- and postoperative stage was 43%. The median survival time and 5 year-survival rate were 54.5 months and 45%, respectively. CONCLUSION: Our results suggested that a LCC in the lung was predominant in males, and equally located at the center and periphery of the lung in the surgically resected cases. To define the treatment outcome and risk factors of a LCC of the lung, further multicenter studies are needed.

A Case of Endobronchial Hodgkin's Disease / 결핵

The endobronchial presentation of Hodgkin's disease is defined as : 1) having the histological features of Hodgkin's disease, irrespective of the biopsy site, and 2) a bronchoscopic visualization of an endobronchial tumor at the time of the initial diagnosis1. The presentation of Hodgkin's disease, as an endobronchial lesion, is very uncommon, with only a few isolated cases having been reported, and no accurate incidence is available. An endobronchial lymphoma must be considered when patients present with an endobronchial tumor, as careful staging and treatment may lead to a cure and avoid of the need for major surgery. Also, when patients, with a known lymphoma, present with respiratory symptoms, they should be considered for a bronchoscopy to avoid understaging of the disease. Herein, a case of endobronchial Hodgkin's disease, in a 20-year-old woman, is reported.

Clinical Features of Pulmonary Large Cell Neuroendocrine Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was performed to investigate the clinical features of large cell neuroendocrine carcinomas (LCNEC). MATERIALS AND METHODS: We retrospectively reviewed the histopathology and clinical information of 37 patients with LCNEC, diagnosed between June 1992 and May 2002 at the Severance Hospital, and performed immunohistochemical (IHC) staining. RESULTS: The prevalence of LCNEC among primary lung cancers was 0.3%, 37 out of 13, 012 cases over a 10 year period. The mean age was 61+/-12 years old, with 34 (92%) males and 3 (8%) females. 30 patients smoked, with an average of 42 packs per year. A cough was the most frequent symptom. The tumor was located at the periphery of the lung in 24 cases (65%). Among the 30 cases that underwent surgery, 4 were diagnosed pathological stage IA, 11 IB, 1 IIB, 13 IIIA and 1 IIIB. The 7 clinically non-operable cases were IIIB in 3, and IV in 4. The positive rates of CD56, thyroid transcription factor-1 (TTF-1), chromogranin A, synaptophysin and 34betaE12 for tumor cells were 88.9, 55.6, 42.1, 31.6 and 21.1%, respectively, from the IHC staining. The median survival time and 5 year-survival rate were 24 months and 27%, respectively. The group that underwent surgery had a better prognosis than those that did not. CONCLUSION: The positive rates for the tumor markers varied, but those of the CD56 and TFT-1 were the highest. The possibility of LCNEC needs to be evaluated for the following situations: small cell carcinomas located at the periphery and not responding chemotherapy, small cell carcinomas diagnosed by percutaneous needle aspiration, poorly differentiated non-mall cell carcinomas, with uncertain histologic type, and unclassified neuroendocrine tumor, etc.