Impact of Skeletal Muscle Loss and Visceral Obesity Measured Using Serial CT on the Prognosis of Operable Breast Cancers in Asian Patients

Objective@#This study aimed to investigate the impact of baseline values and temporal changes in body composition parameters, including skeletal muscle index (SMI) and visceral adipose tissue area (VAT), measured using serial computed tomography (CT) imaging on the prognosis of operable breast cancers in Asian patients. @*Materials and Methods@#This study retrospectively included 627 Asian female (mean age ± standard deviation [SD], 53.6 ± 8.3 years) who underwent surgery for stage I–III breast cancer between January 2011 and September 2012. Body composition parameters, including SMI and VAT, were semi-automatically calculated on baseline abdominal CT at the time of diagnosis and follow-up CT for post-treatment surveillance. Serial changes in SMI and VAT were calculated as the delta values. Multivariable Cox regression analysis was used to evaluate the association of baseline and delta SMI and VAT values with disease-free survival. @*Results@#Among 627 patients, 56 patients (9.2%) had breast cancer recurrence after a median of 40.5 months. The mean value ± SD of the baseline SMI and baseline VAT were 43.7 ± 5.8 cm2 /m2 and 72.0 ± 46.0 cm2 , respectively. The mean value of the delta SMI was -0.9 cm2 /m2 and the delta VAT was 0.5 cm2 . The baseline SMI and VAT were not significantly associated with disease-free survival (adjusted hazard ratio [HR], 0.983; 95% confidence interval [CI], 0.937–1.031; p = 0.475 and adjusted HR, 1.001; 95% CI, 0.995–1.006; p = 0.751, respectively). The delta SMI and VAT were also not significantly associated with disease-free survival (adjusted HR, 0.894; 95% CI, 0.766–1.043; p = 0.155 and adjusted HR, 1.001; 95% CI, 0.989–1.014; p = 0.848, respectively). @*Conclusion@#Our study revealed that baseline and early temporal changes in SMI and VAT were not independent prognostic factors regarding disease-free survival in Asian patients undergoing surgery for breast cancer.

Comparison of Neuropathic Pain in Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis

3) of the pain in domains of tingling/prickling sensation (p=0.024), mechanical allodynia (p=0.027), sudden pain attacks (p=0.018), and thermal hyperalgesia (p=0.002) were significantly more frequent in NMOSD compared to MS patients. Among the patients experiencing pain with a neuropathic component, total pain-related interference (p=0.045) scores were significantly higher in NMOSD patients than in MS patients. In daily life, pain interfered with normal work (p=0.045) and relationships with other people (p=0.039) more often in NMOSD patients than in MS patients. Although pain medication was prescribed more frequently in NMOSD patients, the percentage of patients experiencing medication-related pain relief was lower in those patients.CONCLUSIONS: The severity of neuropathic pain and the pain-related interference in daily life were greater in NMOSD patients than in MS patients. Individualized analgesic management should be considered based on a comprehensive understanding of neuropathic pain in these patients.

Real-World Effectiveness of Disease-Modifying Therapies in Korean Patients with Relapsing Multiple Sclerosis

BACKGROUND AND PURPOSE: This study assessed the long-term outcomes of disease-modifying therapies (DMTs) in Korean multiple sclerosis (MS) patients treated in real-world clinical settings in Korea. METHODS: We retrospectively evaluated the medical records of 160 patients with an initial diagnosis of clinically isolated syndrome or relapsing-remitting MS who were treated for at least 2 years. A status of 3 for no evidence of disease activity (NEDA3) was defined as no relapse, disability progression, or active lesions in annual magnetic resonance imaging (MRI) evaluations. RESULTS: Patients who were initially treated with interferon β (n=152), glatiramer acetate (n=6), or teriflunomide (n=2) were included. The mean disease duration was 8.2 years. Compared to pretreatment, annualized relapse rates were significantly reduced after treatment [from 1.0±0.8 to 0.2±0.4 (mean±standard deviation), p < 0.001]. At the follow-up, 79 patients (49%) had changed their treatment regimen due to lack of efficacy (33%), side effects (14%), or other reasons (2%). Disability progression was observed in 18% of the patients over a mean treatment duration of 5.7 years. After 2 years, NEDA3 was observed in 38% of the patients. Loss of NEDA3 at 2 years was associated with long-term disability progression [odds ratio (OR)=17.975, p=0.003]. Poor response to first-line treatment was independently associated with a delay in treatment from disease onset (OR=1.238, p=0.049) and 10 or more brain lesions in the initial MRI (OR=3.648, p=0.047). CONCLUSIONS: This study has provided real-world evidence that DMTs are effective in reducing disease activity and disability progression in Korean MS patients.

A Single Center Experience for a Feasibility of Totally Laparoscopic Living Donor Right Hepatectomy

Liver transplantation from living donors is a potential treatment for end-stage liver disease. With advancement of laparoscopic techniques and development of surgical devices, laparoscopic liver resection is becoming increasingly popular because of the minimal invasiveness and excellent cosmetic outcomes. However, owing to technical difficulties, pure laparoscopic donor hepatectomy develops relatively slowly. Pure laparoscopic donor hepatectomy has the great advantage of reducing morbidity, minimizing tissue trauma, and improving postoperative pain and cosmetic outcome. However, pure laparoscopic donor hepatectomy may result in a longer operation time and increased risk of bile duct injury. With continuous technical development and building experience for standardization of the technique, pure laparoscopic donor hepatectomy is expected to be further expanded in the future.

Cardiomyopathy in Patients with Myasthenia Gravis Crisis

Myasthenia gravis (MG) crisis is a life-threatening condition characterized by respiratory failure requiring intubation and mechanical ventilation. Cardiac problem in patients with MG crisis is a rare condition, presenting as cardiomyopathy, arrhythmia, heart failure and sudden death. We report two cases that developed arrhythmia and stress-induced cardiomyopathy during MG crisis episodes.

Neutralizing Antibodies Against Interferon-Beta in Korean Patients with Multiple Sclerosis

BACKGROUND AND PURPOSE: Patients treated with interferon-beta (IFN-β) can develop neutralizing antibodies (NAbs) against IFN-β that can negatively affect the therapeutic response. This study assessed the prevalence of NAbs and the impact of NAb positivity on the therapeutic response to IFN-β in Korean patients with multiple sclerosis (MS). METHODS: This was a multicenter study involving 150 MS patients from 9 Korean medical centers who were treated with IFN-β for at least 6 months. Sera that had not been influenced by acute treatment were assessed for NAbs using a luciferase reporter gene assay. To evaluate the association between persistent positivity for NAbs and disease activity, NAbs were tested at 2 different time points in 75 of the 150 patients. Disease activity was defined as the presence of clinical exacerbations and/or active MRI lesions during a 1-year follow-up after NAb positivity was confirmed. RESULTS: NAbs were found in 39 of the 150 (26%) MS patients: 30 of the 85 (35%) who were treated with subcutaneous IFN-β-1b, 9 of the 60 (15%) who were treated with subcutaneous IFN-β-1a, and 0 of the 5 (0%) who were treated with intramuscular IFN-β-1a. Thirty of the 39 patients exhibiting NAb positivity were tested at different time points, and 20 of them exhibited persistent NAb positivity. Disease activity was observed more frequently in patients with persistent NAb positivity than in those with transient positivity or persistent negativity [16/20 (80%) vs. 4/55 (7%), respectively; p < 0.001]. When disease activity was compared between patients with persistent and transient NAb positivity, the difference was unchanged and remained statistically significant [16/20 (80%) vs. 2/10 (20%), p=0.004]. CONCLUSIONS: These results further support that persistent NAb positivity is associated with disease activity in MS patients treated with IFN-β.

Relationship between the Hospital Visit-to-Operation Time Interval and the Risk of Appendiceal Perforation and Clinical Outcomes

PURPOSE: The aim of this study was to investigate the relationship between the elapsed time from hospital visit to operation and perforation risk and surgical site infection (SSI). METHODS: We conducted a single-center, retrospective cohort study using 986 patients who underwent appendectomy between Jan. 2009, and Dec. 2013. We divided hospital visit-to-operation time into multiple sessions and analyzed the statistical differences in univariate and multivariate analysis. RESULTS: Nine-hundred and ninety-six patients were admitted due to appendicitis and 986 (98%) patients underwent an appendectomy. Perforation occurred in 13.2% (n=130) of these patients. Patients with greater than 12 hours of elapsed time between their visit to hospital and surgery demonstrated a higher perforation rate than those who underwent surgery within 12 hours from their visit to the hospital. Upon logistic regression analysis, appendectomy timing was a predictors of appendiceal perforation (adjusted odds ratio, 1.04; 95% confidence interval, 1.00~1.07; p=0.04). The SSI rate of the patients who underwent appendectomy within 12hrs was lower than those who underwent surgery more after than 12 hrs, but hospital visit-to-operation time was not a statistically significant predicting factor of SSI (adjusted odds ratio, 0.99; 95% confidence interval, 0.93~1.05; p=0.796). CONCLUSION: A delay more than 12 hrs between the visit to a hospital and surgery was significantly associated with an increased risk of perforation of the appendix. However, it was not associated with an increase in the risk of SSI. Prompt surgical treatment is needed to decrease the risk of perforation.

Solo Single-Incision Laparoscopic Appendectomy versus Conventional Single-Incision Laparoscopic Appendectomy

No abstract available.

Subacute Combined Degeneration Caused by Chronic Atrophic Gastritis with Spurious Elevation of Vitamin B12 Level

We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.

Ultrasound Evaluation of Ulnar Neuropathy at the Elbow Caused by a Mass Lesion / 대한임상신경생리학회지

Ulnar neuropathy at the elbow (UNE) may seem easy to diagnose when the characteristic clinical manifestations are present, and electrodiagnostic studies have high sensitivity, although they are non-localizing in some cases and unable to reveal structural lesions. Ultrasonography is noninvasive and able to find the exact location of the lesion and visualize perineural structures. We present two cases of UNE in which we found hypoechoic mass lesions near medial epicondyle with ultrasonography and discuss its usefulness in diagnosis of UNE.

Spinal Cord Neurosarcoidosis after Cervical Compressive Myelopathy

Sarcoidosis is a multisystem noncaseating granulomatous disease that usually involves the respiratory system. It can involve any part of the central nervous system, but spinal-cord involvement is extremely rare. There have been a few of reports on the coexistence of compressive myelopathy and spinal-cord sarcoidosis, and compressive myelopathy may be associated with the development of inflammatory granuloma in spinal-cord sarcoidosis. We report a 65-year-old man who presented with gait disturbance due to spinal-cord sarcoidosis after compressive myelopathy.

Cerebral Cortex Involvement in Neuromyelitis Optica Spectrum Disorder

BACKGROUND AND PURPOSE: Brain lesions involving the cerebral cortex are rarely described in patients with neuromyelitis optica spectrum disorder (NMOSD), in contrast to multiple sclerosis. We investigated cerebral cortex involvement using conventional brain magnetic resonance imaging (MRI) in anti-aquaporin-4 (AQP4)-antibody-positive NMOSD patients. METHODS: The study enrolled 215 NMOSD patients who were seropositive for the anti-AQP4 antibody from 5 referral hospitals, and retrospectively analyzed their demographic, clinical, and MRI findings. Abnormal cerebral cortex lesions on brain MRI were identified by a neuroradiologist and two neurologists using consensus. RESULTS: Most of the 215 enrolled patients (87%) were female. The median age at onset was 22.5 years (range: 15-36 years) and the mean follow-up duration was 123 months. Brain lesions were found in 143 of 194 patients (74%) in whom MRI was performed during follow-up. Brain lesions involving the cerebral cortex were identified in 6 of these 194 patients (3.1%). Five of the patients were female, and the six patients together had a median age of 29 years (range: 15-36 years) at the time of lesion presentation. Three of them showed leptomeningeal enhancement in the lesions. At presentation of the cortex-involving lesions, five of these patients were not being treated at the time of presentation, while the sixth was being treated with interferon-beta. CONCLUSIONS: Although rare, cortical involvement occurs in NMOSD and is commonly combined with leptomeningeal enhancement. We speculate that this occurs only in patients who are not treated appropriately with immunosuppressant drugs.

Optic Neuritis in a Patient with Bickerstaff's Brainstem Encephalitis

No abstract available.

Eosinophilic Polymyositis and DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome by Antitubercular Agents

Eosinophilic polymyositis (EPM) is a heterogeneous disorder characterized by eosinophilic infiltration into skeletal muscles. EPM is occasionally associated with a systemic disease, such as hypereosinophilic syndrome, connective tissue disease, or parasitic infection. However, EPM is rarely reported in drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. We experienced a 17-year-old female who presented with EPM with DRESS syndrome associated with taking antitubercular agents.

Tolosa-Hunt Syndrome with Contralateral Diffuse Pachymeningeal and Soft Tissue Enhancement

No abstract available.

Tolosa-Hunt Syndrome with Contralateral Diffuse Pachymeningeal and Soft Tissue Enhancement

No abstract available.

Fronto-Ethmoidal Mucocele with Diplopia in Myasthenia Gravis Patient

No abstract available.

Fronto-Ethmoidal Mucocele with Diplopia in Myasthenia Gravis Patient

No abstract available.

Reduction of Disease Activity in Patient with Relapsing-Remitting Multiple Sclerosis after Switching to Teriflunomide from Interferon Beta

No abstract available.

Reduction of Disease Activity in Patient with Relapsing-Remitting Multiple Sclerosis after Switching to Teriflunomide from Interferon Beta

No abstract available.