Occurrence and Molecular Identification of Microcotyle sebastis Isolated from Fish Farms of the Korean Rockfish, Sebastes schlegelii

Microcotyle sebastis is a gill monogenean ectoparasite that causes serious problems in the mariculture of the Korean rockfish, Sebastes schlegelii. In this study, we isolated the parasite from fish farms along the coasts of Tongyeong, South Korea in 2016, and characterized its infection, morphology and molecular phylogeny. The prevalence of M. sebastis infection during the study period ranged from 46.7% to 96.7%, and the mean intensity was 2.3 to 31.4 ind./fish, indicating that the fish was constantly exposed to parasitic infections throughout the year. Morphological observations under light and scanning electron microscopes of the M. sebastis isolates in this study showed the typical characteristics of the anterior prohaptor and posterior opisthaptor of monogenean parasites. In phylogenetic trees reconstructed using the nuclear 28S ribosomal RNA gene and the mitochondrial cytochrome c oxidase I gene (cox1), they consistently clustered together with their congeneric species, and showed the closest phylogenetic relationships to M. caudata and M. kasago in the cox1 tree.

The Relationship between Gastroesophageal Reflux Disease and Chronic Periodontitis

BACKGROUND/AIMS: The most common cause of chronic periodontitis is poor oral hygiene. Gastroesophageal reflux disease (GERD) enhances the proximal migration of gastric contents and may cause poor oral hygiene. We hypothesized that GERD may increase thse risk of chronic periodontitis and investigated this potential relationship. METHODS: A retrospective cross-sectional study was conducted in outpatients between January 1, 2010, and April 30, 2012. GERD was defined as being present based on at least two of the following criteria: etiologic agent(s), identifiable signs and symptoms, and consistent anatomic alterations. A total of 280 patients with chronic periodontitis and 280 controls were analyzed. Information regarding patient demographics and other potential confounding factors for chronic periodontitis were collected through individual medical records. RESULTS: GERD was revealed to be independently associated with an increased incidence of chronic periodontitis (odds ratio [OR], 2.883; 95% confidence interval [CI], 1.775 to 4.682). The other three variables of dental caries (OR, 1.531; 95% CI, 1.042 to 2.249), tobacco use (OR, 2.335; 95% CI, 1.461 to 3.730), and history of medication (calcium channel blocker, cyclosporine, or phenytoin) (OR, 2.114; 95% CI, 1.160 to 3.854) were also determined to be independent risk factors. CONCLUSIONS: The present study supported our hypothesis that GERD can be a risk factor for chronic periodontitis.

Observer Variability in Gastric Neoplasm Assessment Using the Vessel Plus Surface Classification for Magnifying Endoscopy with Narrow Band Imaging

BACKGROUND/AIMS: Recent studies have demonstrated that magnifying endoscopy with narrow band imaging (ME-NBI) facilitates differentiation of early gastric cancer from gastric adenoma using vessel plus surface (VS) classification. This study estimated the interobserver and intraobserver agreement of endoscopists using the Yao VS classification system for the gastric mucosal surface. METHODS: We retrospectively reviewed patients who underwent endoscopic submucosal dissection or endoscopic mucosal resection, and selected cases in which preoperative ME-NBI was conducted. Before testing endoscopists, a 20-minute training module was given. Static ME-NBI images (n=47 cases) were presented to seven endoscopists (two experts and five trainees) who were asked to assess the images in 20 seconds using the Yao VS classification system. After 2 weeks, the endoscopists were asked to analyze the images again. The kappa statistic was calculated for intraobserver and interobserver variability. RESULTS: The mean kappa for intraobserver agreement was 0.69 (experts, 0.74; trainees, 0.64). The mean kappa for interobserver agreement was 0.42 (experts, 0.49; trainees, 0.40). CONCLUSIONS: We obtained reliable results as assessed by observer variability, with only brief training on VS classification. The VS classification appears to provide an objective assessment of ME-NBI for trainees who are not familiar with ME-NBI.

Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis / 고신대학교의과대학학술지

OBJECTIVES: Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC). METHODS: We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010. RESULTS: Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026). CONCLUSIONS: ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.

Four Endoscopic Predictors of Carcinoma as a Final Diagnosis after Endoscopic Resection of Forceps Biopsy-proven Gastric Adenomas

BACKGROUND/AIMS: Previous studies have reported that the frequency of re-diagnosing as carcinoma after endoscopic resection of gastric adenoma ranges between 6% and 47%. Therefore, specific endoscopic findings have been used to predict re-diagnosing as carcinoma after endoscopic resection of gastric adenoma at our center. We evaluated whether there is a use for these indicators for predicting carcinoma as a final diagnosis in forceps biopsy-proven adenomas. MATERIALS AND METHODS: We investigated 378 tissue samples from 308 patients. Classification of specimens as adenoma and carcinoma was based on postresection specimen. Endoscopic findings were reviewed for tumor location, size, gross appearance, surface nodularity, central concavity, surface color, and presence of ulcers. These variables were analyzed and compared between the adenoma group (275 cases) and the carcinoma group (103 cases), assigned based on post-resection diagnosis. RESULTS: The mean patient age was 61, and 227 of the patients were male. The mean lesion diameter was 14.9+/-8.1 mm in the adenoma group and 17.9+/-9.3 mm in the carcinoma group. A lesion size of 15 mm or greater, depressed appearance, surface nodularity, central concavity, and presence of high-grade dysplasia were all independently associated with re-diagnosing as carcinoma after endoscopic resection. CONCLUSIONS: Lesion size of 15 mm or greater, depressed-type appearance, central concavity, and nodular surface are feasible predictors of carcinoma as a final diagnosis in forceps biopsy-proven adenomas. Physicians need to recommend immediate endoscopic resection for forceps biopsy-proven adenomas with these four independent features so as not to miss the optimal window for treatment.

Four Endoscopic Predictors of Carcinoma as a Final Diagnosis after Endoscopic Resection of Forceps Biopsy-proven Gastric Adenomas

BACKGROUND/AIMS: Previous studies have reported that the frequency of re-diagnosing as carcinoma after endoscopic resection of gastric adenoma ranges between 6% and 47%. Therefore, specific endoscopic findings have been used to predict re-diagnosing as carcinoma after endoscopic resection of gastric adenoma at our center. We evaluated whether there is a use for these indicators for predicting carcinoma as a final diagnosis in forceps biopsy-proven adenomas. MATERIALS AND METHODS: We investigated 378 tissue samples from 308 patients. Classification of specimens as adenoma and carcinoma was based on postresection specimen. Endoscopic findings were reviewed for tumor location, size, gross appearance, surface nodularity, central concavity, surface color, and presence of ulcers. These variables were analyzed and compared between the adenoma group (275 cases) and the carcinoma group (103 cases), assigned based on post-resection diagnosis. RESULTS: The mean patient age was 61, and 227 of the patients were male. The mean lesion diameter was 14.9+/-8.1 mm in the adenoma group and 17.9+/-9.3 mm in the carcinoma group. A lesion size of 15 mm or greater, depressed appearance, surface nodularity, central concavity, and presence of high-grade dysplasia were all independently associated with re-diagnosing as carcinoma after endoscopic resection. CONCLUSIONS: Lesion size of 15 mm or greater, depressed-type appearance, central concavity, and nodular surface are feasible predictors of carcinoma as a final diagnosis in forceps biopsy-proven adenomas. Physicians need to recommend immediate endoscopic resection for forceps biopsy-proven adenomas with these four independent features so as not to miss the optimal window for treatment.

Submucosal Tumor-like Early-stage Mucinous Gastric Carcinoma: A Case Study / 대한소화기학회지

Mucinous gastric carcinoma (MGC) is an unusual histologic subtype, and early detection of MGC is very rare. Early-stage MGC appears as an elevated lesion resembling a submucosal tumor (SMT) due to abundant mucin pools in the submucosa or mucosa. We report a rare case of SMT-like early-stage MGC. Tumor type was predicted preoperatively based on characteristic endoscopic findings, in which an SMT-like mass was observed at the gastric fundus. The tumor was covered by nearly normal mucosa, but with an opening allowing for the passage of copious mucus discharge. A total gastrectomy with Roux-en-Y esophagojejunostomy was subsequently performed. Histopathology of the tumor revealed early-stage (lamina propria) mucinous adenocarcinoma.

Reinterpretation of Follow-Up, High-Resolution Manometry for Esophageal Motility Disorders Based on the Updated Chicago Classification

The aim of this study was to assess changes between primary classification of esophageal motility disease and follow-up classification by high resolution manometry (HRM) and to determine whether previously classified diseases could be recategorized according to the updated Chicago Classification published in 2011. We reviewed individual medical records and HRM findings twice for each of 13 subjects. We analyzed primary and follow-up HRM findings based on the original Chicago Classification. We then reclassified the same HRM findings according to the updated Chicago Classification. This case series revealed the variable course of esophageal motility disorders; some patients experienced improvement, whereas others experienced worsening symptoms. Four cases were reclassified from variant achalasia to peristaltic abnormality, one case from diffuse esophageal spasm to type II achalasia and one case from peristaltic abnormality to variant achalasia. Four unclassified findings were recategorized as variant achalasia. In conclusion, esophageal motility disorders are variable and may not be best conceptualized as an independent group. Original classifications can be recategorized according to the updated Chicago Classification system. More research is needed on this topic.

Case Series of Mycobacterium Abscessus Infections Associated with a Trigger Point Injection and Epidural Block at a Rural Clinic / 한국역학회지

OBJECTIVES: The aim of this report is to investigate Mycobacterium abscessus infections at a rural clinic and carry out a surveillance program to determine the extent and source of these infections. METHODS: The authors conducted an active surveillance investigation of 36 patients who had visited the clinic since 1 July 2008. Clinical specimens were collected from the patients and an envirnmental investigation. Pulsed-field gel elctrophoresis (PFGE) was performed for comparing with M. abscessus isolates from the patients. RESULTS: Six specimens were obtained from the 6 patients respectively and 22 environmental samples were obtained. M. abscessus was isolated from the wounds of two patients, and various nosocomial pathogens, but not M. abscessus, were isolated from the surrounding environment. Two strains of M. abscessus from patients were identical as a result of PFGE. CONCLUSION: Infection control education including proper hand hygiene should be emphasized for physicians performing invasive procedures. There also needs to be more attention for invasive procedures management, including trigger point injection and epidural block in rural clinics.

Clinical Significance of the Rectus Abdominis Muscle Free Flap for Large Diabetic Ulcer and Necrosis of the Foot

The purpose of this study was to present the clinical significance of rectus abdominis free muscle flap for large sized diabetic ulcer and necrosis of the foot to salvage limb. From June 2000 to February 2006, eleven patients were included in our study. There were seven males and four females with a mean age of 58.3 years (48~65) at the surgery. All had a history of diabetics and subsequent huge soft tissue defect caused by necrotizing abscess formation around the foot and the ankle. After complete debridement of large sized, infected necrotic tissue, susceptible intravenous antibiotics and wound care were done. After control of infection, confirmed by clinical and laboratory findings, the rectus abdominis free muscle flap was applied to cover remained large soft tissue defect and to prevent the recurrence of infection. All flaps survived and it provided satisfactory coverage for the soft tissue defect on the foot and the ankle area for a mean of 41.1 months (24~85) follow up period. All except of one patients did not have any recurrence of infection on the operation site and could salvage their limbs. The rectus abdominis free muscle flap could be recommended for large sized soft tissue defect after necrotizing abscess in diabetic foot to salvage major limb.

Endoscope-guide Infusion of Sodium Phosphate: A Novel Bowel Cleansing Method, Efficacy and Safety Comparisons with Polyethylene Glycol / 대한소화기내시경학회지

BACKGROUND/AIMS: Single full-dose oral sodium phosphate (NaP) on the examination day instead of a conventional divided-dose has been used in some patients to reduce burdens and sleep disturbance caused by bowel movement. However, this treatment may be inconvenient to some patients who are adversely affected by the full dose or its-related symptoms. This study compared the quality of bowel preparation, side effects, and patient's acceptance after a full-dose of NaP into the duodenum under an endoscopic examination and with those from conventional polyethylene glycol (PEG). METHODS: A total of 60 admitted patients receiving both endoscopy and colonoscopy each day were divided randomly into two groups and given either PEG 4 L (n=33) or an endoscopic infusion of NaP 90 mL (n=27). Before and after the bowel preparation and 1 day later, the blood pressure, body weight, and serum biochemical parameters were measured. In addition, a detailed questionnaire was used to assess the patient's side effects. The quality of bowel cleansing was assessed by a single endoscopist who was blinded to the type of preparation used. RESULTS: Although changes in the serum biochemical parameters (phosphate: increase, potassium: decrease) were observed in the NaP group, all were normalized after 1 day without side effects. There were significant difference in symptoms after the preparation, such as vomiting, but this was not serious. The suction volume was significantly lower in the NaP group. CONCLUSIONS: A duodenal infusion of NaP might be used as a new bowel cleansing method in patients having trouble with other procedures.

A Case of Esophageal Submucosal Dissection that Developed during Conscious Sedation Endoscopy / 대한소화기내시경학회지

Esophageal submucosal dissection is a rare condition, resulting in the separation of the submucosa and muscle layer by mucosal laceration and bleeding. Possible causes are external trauma, foreign body entrapment, endoscopic instrumentation and even spontaneous dissection. Typical endoscopic findings show a false lumen from the torn mucosa and a muscle layer in the false lumen. Esophagography shows a "double barrelled" appearance. A dissection can be resolved with conservative management. We experienced a case of a submucosal dissection of the esophagus with perforation, an unusual complication of conscious sedation endoscopy.

A Case of a Bleeding Dieulafoy's Lesion in a Duodenal Diverticulum Treated by Endoscopic Hemoclipping / 대한소화기내시경학회지

A duodenal diverticulum is common and usually originates in the second portion of the duodenum. The majority of diverticula are asymptomatic; however, they may sometimes present with symptoms such as obstruction, hemorrhage, perforation, jaundice and pancreatitis. Active bleeding from a duodenal diverticulum is rare, and moreover, Dieulafoy's lesion as a cause is quite rare with very few cases reported so far. The use of endoscopic methods instead of surgery in achieving hemostasis has been on the increase with the widespread use and improvement in endoscope instrumentation and accessories. Of these methods, the use of endoscopic hemoclipping for Dieulafoy's lesion is considered more effective and safe than the use of other methods, such as injection and thermal methods. We report here a case of a bleeding Dieulafoy's lesion in a duodenal diverticulum treated by endoscopic hemoclipping.

A Case of Esophago-mediatinal Fistula Due to Esophageal Tuberculosis / 결핵및호흡기질환

The esophagus is a rate site for rarely involved site of tuberculosis. The most common cause of esophageal tuberculosis is secondary involvement from adjacent tuberculous lymphadenitis. Esophago-nodal or esophagobronchial fistulas may be formed when tuberculous lymph nodes erode the adjacent esophageal or bronchial wall. We report a patient diagnosed with esophageal tuberculosis, which was complicated by an esophago-mediastinal fistula, by endoscopy, sputum acid fast bacilli (AFB) stain, chest computed tomography (CT), and an esophagogram. The patient was treated with antituberculous agents and chest CT and endoscopy showed that the fistula had closed completely.

A Case of Pyrazinamide Induced Fulminant Hepatic Failure / 결핵및호흡기질환

Standard antituberculous therapy, including isoniazid (INH), rifampin, ethambutol, and pyrazinamide (PZA), is widely used to treat active tuberculosis. The most important side effect is hepatotoxicity. In a standard four-drug regimen, PZA was the most common cause of drug-induced hepatitis and was dose-related. The incidence of drug-induced hepatitis is high at doses of 40~70 mg/kg per day but has fallen significantly since the recommended dose was reduced. Liver toxicity induced by PZA is rare at doses of 25 mg/kg per day or less. PZA-induced fulminant hepatic failure is also rare but fatal. We report a case of fulminant hepatic failure caused by a re-challenge of PZA.

A Case of Idiopathic Myelofibrosis Associated with Acromegaly Patient / 대한내분비학회지

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.

A Case of Idiopathic Myelofibrosis Associated with Acromegaly Patient / 대한내분비학회지

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.

A Case of Relapsed Subarachnoid Racemose Cysticercosis Successfully Treated with Albendazole

The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.

A Case of Relapsed Subarachnoid Racemose Cysticercosis Successfully Treated with Albendazole

The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.

Total Hip Arthroplasty with Hydroxyapatite-coated ABG(R) Hip Prosthesis: Minimum 5 Year Follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip arthroplasty (THA) with a hydroxyapatite (HA)-coated ABG(R) (AnatomicalBenoist Giraud, Howmedica, Europe) hip prosthesis. MATERIALS AND METHODS: From March 1992 to December 1996, we performed 204 total hip arthroplasty with HA-coated hip prosthesis. This study included 142 hips. The causes of THA were osteonecrosis of the femoral head (122 hips), osteoarthritis (16 hips) and infectionsequalae (4 hips). Clinical results were evaluated using Harris hip score. We observed osteointegration, cortical hypertrophy, reactiveline around femoral stem, subsidence, polyethylene wear, osteolysis and radiolucent line around acetabular cup on the follow-up radiographs. RESULTS: Harris hip score was an average of 84.5 points at last follow-up. Only one femoral stem was revised for loosening. Reactive lines around uncoated portion of femoral stem was observed in 70 hips. The cortical hypertrophy was observed at zone 2, 3, 5 and 6 in 46hips. Forty-five acetabular cups (31.7%) were revised. The causes of cup revision were polyethylene liner wear and osteolysis (24 hips), loosening (19 hips) and recurrent dislocation (2 hips). CONCLUSION: We found that the HA-coated ABG(R) femoral stem had high survival rate at minimum 5 years follow-up after THA, but acetabularcup had high revision rate for loosening and osteolysis.