A Case of Successful Treatments of Venous Leg Ulcers in Secondary Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent arterial or venous thrombosis, and pregnancy loss. A 57-year-old woman was admitted for aggravation of both leg ulcers. Venogram showed chronic venous obstructions at both lower extremities, and chest x-ray and computed tomography revealed serositis in pericardium and pleura. The laboratory tests revealed pancytopenia, and positive tests for antinuclear antibody, anti-dsDNA antibody, lupus anticoagulant and anticardiolipin antibody, which led to a diagnosis of antiphospholipid syndrome secondary to systemic lupus erythematous. After medical treatments by anticoagulation and immunosuppression, and surgical managements including subtotal skin graft and local flap surgery, leg ulcers had been successfully treated without recurrence. Recognition of antiphospholipid syndrome as a cause of venous ulcer and the treatment plans including anticoagulation and surgical management is important in proper managementsope

(The) effect of early diagnosis and treatment on the disease activity and joint damages in Korean patients with rheumatoid arth

의학과/석사[한글]목적: 류마티스 관절염은 발병 초기부터 관절의 손상이 진행되므로, 초기부터 적극적인 치료를 시작하는 것이 중요하다. 본 연구에서는 치료 시기가 류마티스 관절염의 질병 활성도 및 관절 손상에 미치는 영향에 대해 알아보고자 한다.방법: 세브란스 병원에서 2002년 1월부터 2005년 2월까지 류마티스 관절염을 처음 진단받은 242명의 환자들(남성 50명, 여성 192명, 평균 연령 49.7±13.5세)을 대상으로 2006년 2월에 후향적 분석을 통해 조사하였다. 증상이 발현된 시점부터 류마티스 관절염을 진단받은 시점까지 소요기간은 평균 21.2±25.4 개월이었고, 대상 환자들을 12개월의 소요기간을 기준으로 조기 류마티스 관절염 환자군과 지연 류마티스 관절염 환자군으로 나누었다. 진단 당시의 검사실 소견, 방사선 소견 및 임상적 특징 등에 대해 조사하였다. 적혈구침강속도(erythrocyte sedimentation rate, ESR) 및 C-반응단백(C-reactive protein, CRP)은 진단 후 1년간의 검사결과를 곡선 아래 영역(area under the curve, AUC)의 총합으로 구하였고, 치료 후 추적 관찰한 방사선 소견을 비교하였다.결과: 조기와 지연 류마티스 관절염 환자군은 각각 136명과 106명이었다. 조기 류마티스 관절염 환자군에서 진단 시 연령과 ESR과 혈소판 수치가 유의하게 낮았으며 혈색소 수치가 유의하게 높았다. ESR(p=0.02), CRP(p=0.02)의 AUC을 비교하였을 때에도 조기 류마티스 관절염 환자군에서 유의하게 낮았다. 진단 당시 방사선학적 관절의 손상 정도를 평가한 modified Sharp score는 조기 류마티스 관절염 환자군에서 지연 류마티스 관절염 환자군에 비해 유의하게 낮은 값을 보였다(6.3±13.4 vs. 15.8±26.1, p=0.01). 평균 19.3±9.9개월 간 치료 후 방사선 사진으로 추적 관찰한 92명 환자들(조기 47명, 지연 45명)의 modified Sharp score(32.4±20.7 vs. 59.1±38.1, p=0.02)와, 추적 관찰한 시점과 진단시의 modified Sharp score 차이(40.8±17.1 vs. 23.6±17.6, p=0.02)도 조기 류마티스 관절염 환자군에서 유의하게 낮았다결론: 조기에 류마티스 관절염 치료를 시작하는 것이 질병의 활성도와 방사선학적 관절 손상의 정도가 더 양호하다는 것을 확인할 수 있었다. [영문]Objective: We investigated the effect of the early diagnosis and treatment on the disease activity and joint damage in patients with rheumatoid arthritis (RA).Methods: We enrolled 242 RA patients (male 50 patients, female 192 patients, mean age 49.7±13.5 years old) in this study. They were divided into two groups according to lag-time to diagnose RA from the onset of symptoms. 136 RA patients whose lag-time did not exceed 12 months were classified into early diagnosed RA group and 106 RA patients whose lag-time over 12 months were classified into delayed diagnosed RA group. Evaluation include age, sex, duration of morning stiffness, the number of swollen and tender joints, rheumatoid factor, common blood counts, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) at the time of diagnosis. Disease activity was assessed by sums of ESR and CRP during first year after diagnosis were calculated through area under the curve (AUC). Radiological joint damage were evaluated using modified Sharp score.Results: At the time of diagnosis, the age of patients, ESR and platelet counts were significantly decreased, and hemoglobin level and hematocrit were significantly increased in early diagnosed RA group. Early diagnosed RA group showed lower sums of ESR and CRP than delayed diagnosed RA group significantly. Modified sharp score at the time of diagnosis and after treatment were significantly lower in early diagnosed RA group than delayed diagnosed RA group. The difference of modified sharp score between at the time of diagnosis and after treatment were lower in early diagnosed RA group than delayed diagnosed RA group too.Conclusions: The early diagnosis and treatment of RA reduced extent of joint damage and provoked better response to treatment significantly.ope

Clinical Characteristics of Membranous Glomerulonephritis Developed after Renal Transplantation

Purpose: Survival rate after renal transplantation has increased due to the development of new immunosuppressive agents and operative techniques. Therefore, chronic complications have increased. Membranous glomerulonephritis (MGN) is one of the common glomerular diseases diagnosed in transplanted kidneys. The exact impact of posttransplantation MGN on the risks for graft loss and long-term graft outcomes is not defined clearly. Risk factors to predict a poor outcome are not well established. Methods: The retrospective analysis was performed in 20 patients with posttransplantation MGN based on renal biopsy among 2,375 patients who underwent kidney transplantation in Shinchon Severance Hospital from April 1979 to December 2003. Results: After renal transplantation, five patients had de novo MGN and three patients had recurrent MGN. MGN was diagnosed by biopsy at 38.0+/-25.0 months after transplantation. (5~99 months) The duration of graft survival was 115.5+/-52.4 months. The lower was BUN level at 1 month after transplantation, the longer was the interval between renal transplantation and diagnosis of MGN. But donor age, dialysis duration, creatinine at diagnosis of MGN and immunosuppressive agents were not significantly related with the time from transplantation to diagnosis. In 10 cases, renal function was aggravated gradually and the other 10 cases, renal function remained stable. Graft loss occurred in 7 of 20 patients. Five of seven patients with graft loss transferred to peritoneal dialysis and the other 2 patients transferred to hemodialysis. Conclusion: De novo MGN and recurrent MGN can develop at any time after transplantation. Graft outcome is variable, with some patients progressing to graft failure, and others maintaining stable graft function. In conclusion, MGN after renal transplantation was more likely to occur in male. Aggressive evaluation such as renal biopsy will be needed when accompanied by hypertension and proteinuria. Renal function of de novo MGN will be maintained with proper immunosuppressive agents and conservative management.restrictio