Miliary tuberculosis and necrotizing tuberculous fasciitis – An unusual coexistence in a rheumatoid arthritis patient

We report a case of a 65‐year‐old Korean female patient with rheumatoid arthritis, who presented with extensive necrotizing fasciitis of the gluteus muscles, as an unusual initial manifestation of miliary tuberculosis. The patient had been previously treated with conventional disease‐modifying antirheumatic drugs and low‐dose steroids for 7 years. However, she recently developed fever, warmth and painful swelling in her right buttock. Magnetic resonance imaging indicated necrotizing fasciitis of the gluteus muscles and a fasciectomy specimen revealed a Mycobacterium tuberculosis infection. Two weeks after a fasciectomy, miliary tuberculosis of the lung was diagnosed by high resolution chest computed tomography. Soft tissue infection due to M. tuberculosis should be included as a differential diagnosis in the immunocompromised host. Clinicians should be alert to the possibility of miliary tuberculosis even in the absence of respiratory symptoms and normal chest radiograph.     

Occult nodal metastasis in patients with non‐small cell lung cancer at clinical stage IA by PET/CT

Background and objective: The introduction of ¹⁸F‐FDG PET/CT has enhanced the diagnostic accuracy of nodal staging for non‐small cell lung cancer (NSCLC). We analysed risk factors for occult nodal metastasis in patients with clinical stage IA NSCLC as determined by ¹⁸F‐FDG PET/CT. Methods: Data for 147 patients diagnosed as clinical stage IA NSCLC by PET/CT from 2005 to 2007 were retrospectively reviewed. All study patients underwent ¹⁸F‐FDG PET/CT for lung cancer staging. They also underwent cervical mediastinoscopy or systematic lymph node dissection. Results: Cervical mediastinoscopy was performed in 78 patients (53.1%), and N2 involvement was detected in 3.8% (3/78) of these patients. Thoracotomy with systematic lymph node dissection was done in 144 patients. Four patients (2.8%, 4/144) were diagnosed with N2 disease after systematic lymph node dissection. Total N2 involvement was 4.8% (7/147). As 9.5% (14/147) of study patients had N1 disease, 14.3% (21/147) of patients had occult nodal (N1 or N2) metastasis. In univariate analyses, larger tumour size and a higher primary tumour maximum standardized uptake value >7.3 (SUV_max) were associated with occult nodal metastasis. Multivariate analysis demonstrated that a primary tumour SUV_max >7.3 was an independent predictor of occult nodal metastasis (odds ratio: 7.574; P = 0.001). Conclusions: Preoperative PET/CT scans contribute to reduce the frequency of occult nodal metastasis compared with those reported in the pre‐PET/CT era. The higher SUV_max in primary tumour was an independent predictor of occult nodal metastasis in patients with clinical stage IA NSCLC by PET/CT.     

Subjective food intake ability in relation to the Mixing Ability Index in Korean adults

Summary This study examined the association between the subjective food intake ability (FIA) using a questionnaire with 30 types of foods and the objective Mixing Ability Index (MAI) using a two‐coloured wax cube. A total of 147 subjects (32 males, 115 females, mean age: 54·9 ± 20·7) were enrolled in this study. The FIA for 30 food types and the key food intake ability (KFIA) for five key food types were obtained using a self‐assessed questionnaire to evaluate the subjective chewing ability. The objective chewing ability was evaluated by asking the subjects to chew a wax cube for 10 strokes. The MAI was calculated by image analysis of the chewed wax cube. The Pearson’s correlation between the subjective FIA and objective MAI was analysed according to age and number of post‐canine teeth lost. The FIA for the 30 foods and five key food types showed a moderate correlation with the MAI (r = 0·51, 0·55, respectively, P < 0·01). The KFIA of the denture wearing group (r = 0·44, P < 0·01) and over 60‐year‐old group (r = 0·49, P < 0·01) showed a significantly higher correlation with the MAI than the other groups. In conclusion, there was a moderate correlation between the subjective FIA and objective MAI in Korean adults.     

Post-transplant lymphocele: An unusual cause of acute urinary retention mimicking urethral injury

Retroperitoneal pelvic lymphoceles are one of the most common complications following renal transplantation, and usually present with a palpable mass, ipsilateral leg edema, hydronephrosis caused by ureteral obstruction, decreased renal function and cutaneous lymphatic fistula. However, lymphocele rarely causes acute urinary retention. In this study, we describe a case of a patient who developed acute urinary retention after renal transplantation mimicking urethral injury. When a transplanted patient demonstrates the inability to void, one should consider bladder outlet obstruction resulting from lymphocele as a possible cause.     

Case of congenital esophageal stricture by ganglioneuroma and acro‐flexural hyperpigmentation: A coincidence?

Congenital hyperpigmentation in the acro-genital area and simultaneous occurrence of ganglioneuroma in the esophagus have yet to be reported. Herein, we report a 4-month-old girl presenting with feeding difficulty by esophageal ganglioneuroma and symmetrically distributed brown pigmented patches on the lips, axillae, dorsa of fingers and toes, and genital area. Although the esophageal stricture was resolved by surgical removal of ganglioneuroma, her skin manifestations remained for over 2 years.     

Two cases of pyodermatitis-pyostomatitis vegetans

Pyodermatitis-pyostomatitis vegetans (PPV) is a rare chronic pustular and vegetating mucocutaneous dermatosis. The oral lesions present as multiple, friable and yellowish pustules, which form "snail tracts" and rupture easily. The cutaneous lesions begin as crusted erythematous papulopustules that coalesce to form large vegetating plaques, usually in the axillae, genital area and scalp. Cutaneous lesions usually develop at the same time as the oral lesions or thereafter. PPV is usually considered as a specific marker for inflammatory bowel disease since the concurrence of PPV and inflammatory bowel disease has been reported in approximately 70% of cases. We report two patients who showed typical clinical and histopathological features of PPV, but were not accompanied by inflammatory bowel disease.     

Effect of hepatocyte volume on energy status in the cirrhotic rat liver

To evaluate the effect of reduced hepatocyte volume on liver energy status, the relationship between the morphologically quantified hepatocyte volume and biochemical parameters, and the difference in nuclear density between the parenchyma and stroma were assessed in rat livers with thioacetamide-induced cirrhosis. The ratio of hepatocytes to whole liver tissue, defined as the ‘hepatocyte area ratio', and the nuclear densities of the parenchyma and stroma were calculated microscopically with an image analysing system. Adenine nucleotide, protein and DNA contents, and the ornithine carbamoyltransferase activity in the liver were assayed. In the cirrhotic group, adenine nucleotide content, protein content and ornithine carbamoyltransferase activity were positively correlated with the hepatocyte area ratio, whereas DNA content was negatively correlated with this ratio. The adenylate energy charge of the cirrhotic liver was maintained at a constant level regardless of the ratio. Adenine nucleotide content, protein content and ornithine carbamoyltransferase activity per fractional ‘hepatocyte area ratio’ in cirrhotic livers were significantly lower than in control livers. The nuclear density of the stroma was significantly greater than that of the parenchyma. These results suggest that the lowered energy status in the cirrhotic liver is not caused by reduced hepatocyte volume but rather by impaired hepatocyte metabolism. In addition, the morphological measurement with an image analysing system was found to be useful for evaluating the effects of decreased hepatocyte volume on biochemical derangements in cirrhotic tissue.     

No ancillary finding is valid to distinguish a primary ovarian hepatoid carcinoma from metastatic hepatocellular carcinoma

Primary ovarian hepatoid carcinomas (POHC) are extremely rare. Especially rare are those with phenotypic properties of hepatocellular carcinoma (HCC) and an absence of clinical evidence of hepatic tumor. We report a case of a POHC with a common microscopic, immunophenotypic, and ultrastructural property of HCC in the absence of a liver mass. It is extremely difficult to differentiate POHC from metastatic HCC using any kinds of ancillary studies, with the exception of clinical identification of a hepatic tumor.     

Usefulness of an age-adjusted body shape index in Korean children and adolescents

BACKGROUND: The aim of the present paper was to determine the usefulness of an age-adjusted anthropometric index of body shape for the assessment of obesity in Korean children and adolescents aged 10-15 years. METHODS: The population sample was composed of 556 boys and 489 girls who completed an interview survey, anthropometry, and medical examination for the Korean National Health and Nutritional Survey conducted in 1998. An age-adjusted anthropometric index, body shape index standard deviation score (BSI-SDS), was derived from waist-to-hip ratio divided by height (WHR/Ht) and its common standard deviation according to Asayama et al. (1997). Serum levels of lipids, glucose, and liver function markers were defined as abnormal if they were above the 90th percentile of the study population. Using logistic regression analysis, the odds ratios of having a lipidemic, diabetic, or liver complication on increasing BSI-SDS were estimated. RESULTS: For both boys and girls, lipidemic and liver complications had statistically significant odds ratios associated with increasing BSI-SDS. With 1 unit increase in BSI-SDS, the odds ratios of lipidemic complications were 1.5 and 1.3, respectively, for boys and girls, and the odds ratios of liver complications were 1.3 and 1.4, respectively, for boys and girls. CONCLUSIONS: A new measure developed by Asayama et al., BSI-SDS, is a useful marker of obesity in addition to body mass index among Korean children and adolescents aged 10-15 years.     

专题演讲-W2药物与食物危险性评估的新方法

Dietary supplements need to show statistically sound evidence for the claimed health effect, and this often requires high dose of the material which in turn raises the safety concern regardless of whether it has been traditionally used or not, since it frequently exceeds the traditional use.