Korean Journal of Internal Medicine最新文献

Follicular lymphoma (FL) is the most common type of indolent lymphoma, and the prognosis is favorable for most patients. However, FL remains generally incurable, and relapse is common. Patients are at risk of developing treatment-resistant lymphoma, particularly when early disease progression occurs or transformation to aggressive lymphoma takes place. Furthermore, lymphoma is the leading cause of death among patients with FL, emphasizing the need for more effective treatment strategies. This review summarizes therapeutic approaches for FL, with a focus on therapies currently in development. Recent biological insights have driven the emergence of highly effective treatments, including novel immune and targeted therapies. Clinical trials are assessing the efficacy of these novel approaches, which are increasingly used in earlier line settings. In the future, FL therapy is expected to rely less on chemotherapeutic methods, extend remission, and potentially enable cures for a growing number of patients.

Background/aims: Cytomegalovirus (CMV) disease in the upper gastrointestinal (UGI) tract frequently occurs in immunocompromised patients. However, data regarding UGI CMV disease in non-transplant patients compared with those in transplant recipients are limited. Therefore, we compared the clinical characteristics, endoscopic findings, and outcomes of UGI CMV disease in non-transplant patients with those in transplant recipients.

Methods: We reviewed the medical records of patients diagnosed with UGI CMV disease between May 1999 and January 2022. UGI CMV disease was defined as symptoms or signs of gastrointestinal disease with typical findings of CMV inclusion body and positive immunochemistry stain or CMV polymerase chain reaction from the endoscopic biopsy specimen.

Results: Among the 219 eligible patients, 132 (60.3%) were transplant patients. Age, male sex, and Charlson Comorbidity Index were significantly higher in the non-transplant group than in the transplant group. The most common symptoms were pain and odynophagia (43.8%). Transplant recipients more frequently experienced UGI CMV disease in the stomach than non-transplant patients, typically presenting as erosions or mucosal hyperemia. However, non-transplant patients more commonly experienced UGI CMV disease in the esophagus than transplant recipients, typically presenting as ulcers. The transplant group had a significantly higher clinical response than the non-transplant group.

Conclusion: UGI CMV disease in transplant patients can be present in the stomach in various forms, including ulcers or erosions. In transplant patients suspected of UGI CMV disease, conducting an esophagogastroduodenoscopy with tissue biopsy in any area where even the slightest mucosal abnormality is observed is essential to facilitate a prompt diagnosis.

Background/aims: Asthma is characterized by chronic inflammation. Inhaled corticosteroids (ICS) remain the cornerstone of anti-inflammatory therapy, targeting both the large and small airways.

Methods: This randomized open-label crossover trial included 30 patients receiving step 3 inhaled medication according to the Global Initiative for Asthma (GINA). Patients received beclomethasone/formoterol (BDP/F) for maintenance and reliever therapy for 6 weeks, followed by budesonide/formoterol (BUD/F) for 6 weeks, or vice versa, with a 4-week washout period in between. Assessments at each visit included the Asthma Control Test (ACT), Asthma Control Questionnaire, Quality of Life Questionnaire for Adult Korean Asthmatics, and pulmonary function test. The primary endpoint was the change in forced expiratory flow between 25% and 75% of vital capacity (FEF25-75% pred).

Results: Twenty-four patients (15 females, mean age 39.3 years) completed the study. The changes in FEF25-75% pred were comparable between BDP/F and BUD/F (5.79 ± 38.34 vs. -1.36 ± 14.93, p = 0.399). No significant differences were observed between the BDP/F and BUD/F groups in terms of improvement in asthma control or quality of life. However, in the subgroup of patients with positive methacholine bronchial provocation tests, BDP/F significantly improved ACT scores compared to BUD/F (0.92 ± 2.25 vs. -1.31 ± 3.04, p = 0.044).

Conclusion: Our study demonstrated that extrafine ICS treatment provided no significant advantage over non-extrafine ICS in improving small airway obstruction or overall asthma control in moderate asthma. This suggests that factors other than particle size may contribute to treatment outcomes.

Background/aims: This study evaluated the clinical utility of serum periostin measured at diagnosis in reflecting activity at diagnosis and predicting all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).

Methods: This study included 76 patients with AAV whose serum periostin was measured from sera collected and stored at diagnosis. The correlation of either serum periostin or the Birmingham Vasculitis Activity Score (BVAS) with other variables was evaluated. Cumulative survival rates were compared using Kaplan-Meier survival analysis. The variables at diagnosis were compared between deceased and surviving patients. Hazard ratios were obtained by Cox proportional hazard analysis.

Results: The median age of the 76 patients was 64.0 years and 60.5% were female. The median BVAS and serum periostin were 5.0 and 10.9 ng/mL, respectively. Five of the 76 patients (6.6%) died. Serum periostin was independently correlated with cross-sectional BVAS, the Vasculitis Damage Index (VDI), white blood cell count, and serum albumin. Patients with serum periostin ≥ 15.9 ng/mL at diagnosis had a significantly lower cumulative survival rate than those without. In addition to high VDI, dyslipidaemia frequency, and C-reactive protein, deceased patients showed higher serum periostin than surviving patients. In multivariable Cox analysis, however, only dyslipidaemia rather than serum periostin was identified as an independent predictor of all-cause mortality.

Conclusion: This study is the first to demonstrate that serum periostin at diagnosis could independently reflect cross-sectional BVAS and further partially contribute to all-cause mortality prediction in patients with AAV.

Background/aims: This study aimed to investigate co-occurrence and clinical characteristics of sexually transmitted infections (STIs) and pelvic inflammatory disease (PID) in women hospitalized for acute pyelonephritis (APN).

Methods: This single-center retrospective study reviewed medical records of inpatients with APN from January 2019 to February 2023 and identified records of 142 patients who were referred to a gynecologist to evaluate gynecological diseases including STIs.

Results: Of the 142 patients, 47 were tested positive for sexually transmitted pathogens in nucleic acid amplification testing, confirming the presence of STIs. In patients with APN, those with STIs were more likely to have lower abdominal pain or cervical motion tenderness (CMT) on pelvic examination and leukocytosis (> 14.5 × 109/L) than those without STIs. Of the 93 patients who underwent pelvic examination, 34 had CMT with one or more of additional criteria for the clinical diagnosis of PID, such as abnormal vaginal discharge and leukorrhea confirmed by microscopic examination, which could be clinically diagnosed as PID.

Conclusion: In sexually active women with APN, it is important to evaluate the possibility of STIs and PID, considering several risk factors such as lower abdominal pain, abnormal vaginal discharge, CMT, and leukocytosis.

Background/aims: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are associated with the development of hyperkalemia. We evaluated the relationship between the serum aldosterone-to-potassium ratio (APR) and the risk of developing hyperkalemia in patients with chronic kidney disease (CKD) receiving ACEIs or ARBs.

Methods: One hundred eighty-six patients with stage 3-4 CKD receiving an ACEI or ARB for at least 3 months were evaluated. Serum aldosterone and potassium concentrations were measured simultaneously, and serum APR was calculated (ng/mL per mmol/L). Patients were divided into two groups for comparison according to the median value above or below 2.42. The primary outcome was the difference between the two groups in the development of hyperkalemia (defined as a serum potassium level > 5.5 mmol/L). Incidence rates and risk factors of hyperkalemia were assessed.

Results: During the follow-up period, 144 hyperkalemic events in 81 patients (43.5%) were identified, yielding an incidence rate of 24.6 events/100 person-years. The incidence rate was significantly higher in patients with a low serum APR than in patients with a high APR (35.8 events/100 patient-years vs. 12.9 events/100 patient-years, p < 0.001). In addition, diabetes mellitus, history of hyperkalemia, CKD progression during the follow-up period, and low serum APR were predictors of the development of hyperkalemia.

Conclusion: Low serum APR was associated with the occurrence of hyperkalemia in patients with CKD receiving ACEIs or ARBs, suggesting that the identification of patients administered these drugs who are at high risk for hyperkalemia may be achieved using this index.

Patients with inflammatory bowel disease (IBD) are at increased risk of herpes zoster (HZ), particularly those receiving immunosuppressive treatments such as corticosteroids, thiopurines, and biologics, which elevate the likelihood of varicella-zoster virus reactivation. Despite this, vaccination rates among patients with IBD remain low. Shingrix, a recombinant zoster vaccine, is generally preferred because of its high efficacy (> 90%) and safety profile in immunocompromised individuals, unlike the live attenuated zoster vaccine (Zostavax). This review underscores the importance of HZ vaccination for patients aged ≥ 50 years, as well as for younger patients receiving high-risk therapies such as JAK inhibitors. Tailored vaccination strategies based on individual risk factors, including disease severity, medication use, and ethnicity, may enhance prevention. Given the higher incidence of HZ in certain populations, such as those in Korea, vaccination recommendations should be adapted accordingly. Further research is needed to evaluate the long-term effectiveness of Shingrix in younger patients with IBD to ensure sustained protection and prevent complications, such as postherpetic neuralgia.

Background/aims: As the number of lower gastrointestinal endoscopies and high-risk examinees increases, the incidence of adverse events associated with these endoscopies has also increased. Medical disputes and lawsuits related to adverse events are rapidly increasing.

Methods: Medical disputes related to lower gastrointestinal endoscopy that had been filed in Korean Medical Dispute Mediation and Arbitration Agency (K-medi) from April 2012 to August 2020 were evaluated with the corresponding medical records and written appraisal. Facilities, patients, procedures, adverse events, and outcome-related variables related to medical disputes were analyzed.

Results: As the number of lower gastrointestinal endoscopies in Korea increases each year, the number of medical disputes related to lower gastrointestinal endoscopy appraised by K-medi has also increased yearly during the same period. Among the 121 cases analyzed, 86 (71.1%) were conciliated and 35 (28.9%) were cosigned by prosecution. Perforations accounted for the largest proportion of cases (93 cases, 76.9%). Most patients (n = 119, 98.3%) underwent non-emergent procedures, and only 10 (8.3%) underwent them for therapeutic purposes. Approximately one-fifth of the patients (n = 25, 20.7%) died.

Conclusion: The number of medical disputes related to lower gastrointestinal endoscopy are increasing. To prevent this, it is important to review the data on existing cases and establish specific response guidelines.

There are sex-related differences in the pathophysiology and phenotype of heart failure (HF) as well as the pharmacokinetics and pharmacodynamics of drugs between women and men due to biological differences, such as heart and vessel size, response to blood volume and pressure, body water and muscle compositions, and dominant sex hormones. Therefore, target drug doses required to achieve the same clinical effect differ between the sexes, while there may also be sex-related differences in side effects of a given drug at the same dose. These biological differences have been reflected in the results of clinical trials. Moreover, women have been underrepresented in pharmacological therapy trials as well as having lower device implantation rates than men. Therefore, the currently recommended target doses of medications based on clinical trials may not be appropriate for women. Although guidelines for HF have been standardized since the last major revision in 2021, most do not differentiate by sex. This review focuses on evidence regarding sex-related differences in multiple aspects of HF, including epidemiology, pathophysiology, clinical features, treatment, and prognosis, highlighting the need for sex-specific treatment guidelines.