A Case of Chronic Inflammatory Demyelinating Polyneuropathy in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterized by symmetrical weakness, impaired sensation, absent or diminished tendon reflexes, an elevated cerebrospinal fluid protein level and nerve-conduction studies that show demyelination. The occurrence of CIDP in patients with systemic lupus erythematosus (SLE) has been rarely reported. We experienced a case of a 33 year-old woman with SLE and she presented with fever, abdominal pain, a tingling sensation of both of her hands and feet, and symmetrical weakness in both the proximal and distal extremities. Her symptoms had persisted for over 1 months before she visited our department. The CSF examination showed an elevated protein level and the nerve conduction studies revealed demyelination. Her symptoms showed minimal improvement with high dose steroid and immunoglobulin therapy, but she responded to cyclophosphamide therapy.

A case of rheumatoid arthritis with Sjogren's syndrome presenting as a tonic pupil / 대한내과학회지

Sjogren's syndrome is an autoimmune disease that presents mainly as dry eyes and mouth, and occasionally with extra-glandular symptoms. A peripheral neuropathy is present in 10~30% of the cases with extra-glandular symptoms, although a tonic pupil caused by destruction of the ciliary ganglion is rare. We report a case of rheumatoid arthritis with Sjogren's syndrome presenting as a tonic pupil. A 29-year-old woman was admitted for evaluation of polyarthralgia and a tonic pupil. On physical examination, she had polyarthritis involving the jaws, shoulders, wrists, and hands. Her pupils were anisocoric and did not react to light, but constricted promptly to pilocarpine. Biopsy of the minor salivary gland showed lymphocyte infiltration. Rose-Bengal stain was positive. She was diagnosed with rheumatoid arthritis with Sjogren's syndrome and treated with prednisolone and hydroxychloroquine. Three months later, her polyarthritis had improved markedly, but she still had a tonic pupil.

Changes of pulse wave velocity findings and the effects of folic acid treatment on homocysteine levels in End Stage Renal Disease / 대한내과학회지

BACKGROUDN: In end-stage renal disease (ESRD) patients, cardiovascular disease (CVD) is a major cause of morbidity and mortality. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Several studies suggest that lowering plasma homocysteine may improve endothelial dysfunction, a marker of atherothrombotic risk. Pulse wave velocity (PWV) is a useful diagnostic tool to access endothelial dysfunction, and is widely used screening test for atherosclerosis. METHODS: We measured fasting total plasma homocysteine (tHcy) in 84 hemodialysis patients and 21 peritoneal dialysis patients. Subjects were assigned to two groups. Group I (tHcy or =20 umol/L) consisted of 26 ESRD patients who have taken high dose folate (5 mg/day). For 15 Group I patients and 5 Group II patients, pulse wave doppler velocity (PWV) measurements were taken before and after 3 months of folate treatment. RESULTS: The mean tHcy concentration was higher in the ESRD patients (82 HD: 16.9+/-6.4 mol/L, 20 PD: 18.0+/-16.7 mol/L). The pulse wave velocity (PWV) was faster in ESRD patients-19 HD: Aorta (Ao)-PWV 8.98+/-1.4, lower extremities (LE)-PWV 10.15+/-1.3, upper extremities (UE)-PWV 8.80+/-0.8 (m/s); 8 PD: Ao-PWV 9.32+/-1.8, LE-PWV 10.64+/-1.4, UE-PWV 9.24+/-0.7 (m/s). The PWV increased in ESRD patients with coronary heart disease and who had a history of angioplasty because of thrombosis or stenosis of vascular access. There was a significant reduction in hyperhomocysteinemia after 3 months in the high dose folate supplement group as compared to the usual dose folate supplement group with a significant statistical difference between the two groups. (15 Group I patients: 13.9+/-4.9 mol/L->13.5+/-6.1 for 5 Group II patients: 34.3+/-27.5 mol/L->23.0+/-5.9 mol/L (p0.05, paired t-test). CONCLUSIONS: We assume that PWV and homocysteine concentration have some correlation and both studies are available as part of screening tests for atherosclerosis in ESRD. Although no significant interval change was detected for the PWV, this finding suggests that high-dose folate supplementation was helpful to minimize the risk of cardiovascular disease associated with hyperhomocysteinemia in ESRD patients.

Association of metabolic syndrome with the pulse wave velocity / 대한내과학회지

BACKGROUND: Atherosclerotic cardiovascular disease and metabolic syndrome are both rapidly increasing in Koreans due to the new westernized eating habits and the aging of the population. The pulse wave velocity (PWV) reflects arterial stiffness and it may be used as an indicator of atherosclerosis. This study was conducted to investigate the association of the PWV with metabolic syndrome. METHODS: Among 1438 persons who visited the Internal Medicine Clinic or Health Center of a general hospital in Seoul, Korea, 384 adults (age range: 30-69 years old) were selected as study subjects. Those patients with cardiovascular disease or other systemic disease were excluded, but the patients with hypertension and diabetes mellitus were included. Ninety four (25.4%) subjects were classified as patients with metabolic syndrome when jointly applying the WHO Asia-Pacific criteria and NCEP ATPIII criteria. RESULTS: The PWV was higher in the older aged group and in the men compared to the other group. The greater the number of diagnostic criteria of the metabolic syndrome subjects had, the higher was their PWV. After adjustment for age, gender, blood pressure, BMI and fasting blood glucose, a PWV change of 1.0 m/sec increased the risk of metabolic syndrome by 1.31 times (95% CI: 0.81-2.09). The risk of metabolic syndrome was 7.62 times higher among the subjects with a PWV greater than 7.5 m/sec (95% CI: 1.07-54.42), as compared with that of subjects with a PWV less than 7.5 m/sec. CONCLUSIONS: The PWV may independently increase the risk of metabolic syndrome as a non-linear pattern. A prospective study needs to be conducted to confirm the meaning of PWV as a risk factor for metabolic syndrome, and especially to determine the cut off point.

A Cases of Primary Lung Abscess Due to Candida albicans in Malnourished Patient

Candida albicans as being ubiquitous human commensals produce a broad range infections depending on host immunity and its virulency, ranging from usually local mucous membrane infection to disseminated fatal candidiasis with multisystem organ failure. Recently, candidiasis of deep organ are an increasingly important nosocomial infection. Candida lung abscess is rare relatively. Most commonly, it has been stated that they are found accompanied by hematogenously disseminated candidiasis particularly in immuno- suppressed patient. Primary lung abscess caused by C. albicans has been reported in less then 15 case in worldwide, and therapeutic guideline is poorly defined. We experienced a case of a primary lung abscess by C. albicans which may developed after aspiration of oropharyngeal contents as the mechanism of entry in a malnourished elderly patient and which was treated successfully with drainage of the abscess following by administration of fluconazole for 4 weeks. Herein we report the case with a review of the literature.

Cases of Pathology-Proven Lung Adenocarcinoma Presenting as Pneumonic Pattern

Lung adenocarcinoma is the cancer originated in terminal bronchiole or alveolar epithelium and its incidence is on the increase. The most common radiologic pattern of lung adenocarcinoma is peripheral nodule or mass, but it can be showed various findings such as hilar mass, consolidation, atelectasis or multicentric lesions. Sometimes it is difficult to differentiate lung adenocarcinoma from other diseases, especially pneumonia. We experienced three patients with lung adenocarcinoma, just only presented as pneumonic consolidation on chest X-ray and CT scan. The clinician should consider seriously lung adenocarcinoma including bronchioloalveolar carcinoma in patients who did not respond to antibiotics. And in such cases, pathologic diagnosis must be perfomed at proper time to confirm disease.