Comparison of Optic Neuritis with Seropositive Myelin Oligodendrocyte Glycoprotein Antibody and Seropositive Neuromyelitis Optica Antibody

Purpose@#To compare clinical outcomes of Korean patients with seropositive myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related optic neuritis (ON) and those with neuromyelitis optica antibody (NMO-IgG)-related ON. @*Methods@#Medical records were analyzed retrospectively among patients diagnosed with ON from January 2018 to June 2020, who were positive for MOG-IgG or NMO-IgG on serological tests. Clinical manifestations and outcomes were collected and compared between the two groups. @*Results@#The study included 14 eyes of 10 MOG-IgG positive patients, and 38 eyes of 25 NMO-IgG positive patients. Final visual acuity differed significantly between the two groups (p = 0.002), and the proportion of patients with no light perception was higher in the NMO-ON group (11%) compared with the MOG-ON group (0%). The mean deviation value on visual field tests also showed a significant difference between NMO-ON and MOG-ON groups (-18.98 ± 12.36 dB versus -10.17 ± 10.03 dB, respectively; p = 0.018). The recurrence rate was 42% in the NMO-ON group and 79% in the MOG-ON group (p = 0.020). @*Conclusions@#The clinical outcomes of NMO-ON and MOG-ON patients differed significantly. MOG-ON patients were more likely to experience a relapse. Patients with NMO-ON were given a poor visual prognosis despite having a lower recurrence rate than those with MOG-ON.

Comparison of Optic Neuritis with Seropositive Myelin Oligodendrocyte Glycoprotein Antibody and Seropositive Neuromyelitis Optica Antibody

Purpose@#To compare clinical outcomes of Korean patients with seropositive myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related optic neuritis (ON) and those with neuromyelitis optica antibody (NMO-IgG)-related ON. @*Methods@#Medical records were analyzed retrospectively among patients diagnosed with ON from January 2018 to June 2020, who were positive for MOG-IgG or NMO-IgG on serological tests. Clinical manifestations and outcomes were collected and compared between the two groups. @*Results@#The study included 14 eyes of 10 MOG-IgG positive patients, and 38 eyes of 25 NMO-IgG positive patients. Final visual acuity differed significantly between the two groups (p = 0.002), and the proportion of patients with no light perception was higher in the NMO-ON group (11%) compared with the MOG-ON group (0%). The mean deviation value on visual field tests also showed a significant difference between NMO-ON and MOG-ON groups (-18.98 ± 12.36 dB versus -10.17 ± 10.03 dB, respectively; p = 0.018). The recurrence rate was 42% in the NMO-ON group and 79% in the MOG-ON group (p = 0.020). @*Conclusions@#The clinical outcomes of NMO-ON and MOG-ON patients differed significantly. MOG-ON patients were more likely to experience a relapse. Patients with NMO-ON were given a poor visual prognosis despite having a lower recurrence rate than those with MOG-ON.

Verbal Auditory Agnosia Developed after Unilateral Temporal Lobe Infarction / 대한이비인후과학회지

Stroke results in sudden loss of function related to its damaged portion. When this occurs in temporal lobe, the function of hearing and listening may be affected, although receptive language processing is affected while hearing perception is relatively spared. This is called as “central deafness.” It has been known that hearing ability is seldom impaired in the case of temporal lobe stroke except in the case of bilateral lesions. However, we experienced a 72-year-old, right-handed woman who presented with both sudden hearing difficulty due to unilateral temporal lobe infarctions after suddenly not being able to respond to any verbal questions except environmental sounds. Pure-tone audiometry showed both flat sensorineural hearing loss of mild degree in both ears but she could not understand any verbal sound. Brain MRI demonstrated extensive ischemic infarcts in the left temporal lobes involving primary auditory cortex. She was diagnosed as verbal auditory agnosia and has received speech-language therapy.

Comparisons of Heart Rate Variability Parameters between Depressive Disorder and Trauma and Stressor Related Disorders / 생물치료정신의학

Objectives@#：Depression and stress-related response is common symptoms in mental health outpatients. The purpose of this study was to investigate the differences of change in heart rate variability parameters between patients with depressive disorder and those with trauma and stressor related disorders. @*Methods@#：We conducted a retrospective chart review of outpatients from 2014 to 2020 in Anxiety and Stress Outpatients Clinic of National Center for Mental Health. A total of 381 patients with depressive disorder and trauma and stressor related disorders were selected as dataset. Each parameter of 5-min analysis of Heart Rate Variability from the first and second visit was analyzed according to diagnosis. @*Results@#：At the first visit, root mean square of the differences of successive normal to normal intervals indicators showed significant differences between depressive disorder, and trauma and stressor related disorders. The change of Heart Rate Variability indicators for each group showed the following results: Significant differences between the first and second visit were found in standard deviation of normal to normal intervals, root mean square of the differences of successive normal to normal intervals, and low frequency among patients with the depressive disorder. Patients with trauma and stressor related disorders showed significant differences in root mean square of the differences of successive normal to normal intervals, high frequency between each visit. @*Conclusions@#：Our results suggest the changes in Heart Rate Variability parameters between first visit and second visit in both depressive disorders and trauma and stressor related disorders. However, further research should examine factors that influence the differential changes of Heart Rate Variability parameters.

Clinical Features of Staphylococcal Scalded Skin Syndrome Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus in Changwon City, Korea, during 2006 and 2015

PURPOSE: We investigated the clinical features and epidemiology of staphylococcal scalded skin syndrome (SSSS) from year 2006 to 2015 in Changwon city, Korea. METHODS: We reviewed medical records of 69 patients diagnosed with SSSS from year 2006 to 2015. Antibiotic susceptibility testing was performed by agar dilution method. Methicillin-resistant Staphylococcus aureus (MRSA) was phenotypically identified by oxacillin susceptibility testing and genotypically confirmed by the existence of the mecA gene. RESULTS: The median age of patients was 2.0 years (range 0.2–6 years). Three (4.3%), 53 (76.8%), and 13 (18.9%) patients showed the generalized type, the intermediate type, and the abortive type, respectively. Patients occurred throughout the year, but most patients occurred between July and October. MRSA was isolated from 54 of the 60 patients regardless of the clinical types. All patients recovered without any complications. CONCLUSIONS: There was a constant occurrence of SSSS patients caused by MRSA in Changwon area during 2006 and 2015. It is needed to constantly monitor the occurrence of patients with SSSS.

Diagnostic Utility of Polymerase Chain Reaction for Acanthamoeba in Contact Lens-related Keratitis with Epithelial Defects

PURPOSE@#To report contact lens related Acanthamoeba keratitis with corneal epithelial defect cases which were diagnosed using polymerase chain reaction (PCR).CASE SUMMARY: A 51-year-old male visited our hospital for loss of visual acuity and ocular pain in both eyes. He had been wearing therapeutic contact lenses in both eyes for 4 days prior to his visit, and showed a corneal epithelial defect with corneal edema in both eyes. The corneal edema did not improve after treatment for bacterial and herpes keratitis, so we conducted PCR for Acanthamoeba using the aqueous fluid in the anterior chamber, which showed positive results. A 32-year-old male complained of low visual acuity and ocular pain in both eyes. He had a history of corneal erosion. He had been wearing therapeutic contact lenses in both eyes for 3 days prior to his visit for a corneal epithelial defect. We suspected recurrent corneal erosion syndrome, but PCR for Acanthamoeba of the corneal scraping showed positive results. A 26-year-old female visited our hospital for ocular pain, and discomfort in her left eye. Because of severe dry eye, she had been wearing therapeutic contact lenses for 6 weeks prior to her visit. Her left eye showed corneal infiltration and epithelial defects. The left cornea scraping was positive for bacteria, and PCR for Acanthamoeba also showed positive results.@*CONCLUSIONS@#Clinicians should consider the use of PCR for the early diagnosis of Acanthamoeba keratitis in contact lens-related keratitis with corneal epithelial defects.

Clinical characteristics and outcomes of varicella zoster virus infection in children with hematologic malignancies in the acyclovir era

BACKGROUND: Although intravenous acyclovir therapy is recommended for varicella zoster virus (VZV) infection in immunocompromised children, the clinical characteristics and outcomes of VZV infection in the acyclovir era have rarely been reported. METHODS: The medical records of children diagnosed with varicella or herpes zoster virus, who had underlying hematologic malignancies, were retrospectively reviewed, and the clinical characteristics and outcomes of VZV infection were evaluated. RESULTS: Seventy-six episodes of VZV infection (herpes zoster in 57 and varicella in 19) were identified in 73 children. The median age of children with VZV infection was 11 years (range, 1-17), and 35 (46.1%) episodes occurred in boys. Acute lymphoblastic leukemia was the most common underlying malignancy (57.9%), and 90.8% of the episodes occurred during complete remission of the underlying malignancy. Acyclovir was administered for a median of 10 days (range, 4-97). Severe VZV infection occurred in 16 (21.1%) episodes. Although the finding was not statistically significant, a previous history of hematopoietic cell transplantation (HCT) appeared to be associated with the development of more severe episodes of herpes zoster (P=0.075). CONCLUSION: Clinical characteristics of VZV infection in immunocompromised children were not significantly different from those without it, and clinical outcomes improved after the introduction of acyclovir therapy. However, risk factors for severe VZV infection require further investigation in a larger population and a prospective setting.

Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report / 대한마취과학회지

Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.

A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure / 대한소화기학회지

A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.

A Case of Endoscopic Full-Thickness Resection in a Patient with Gastric High-Grade Dysplasia Unsuitable for Endoscopic Submucosal Dissection

Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8x0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.

The Effect of Family Meals on the Emotional and Behavioral Problems of Children

This study analyzed the effect of family meals on the psychological problems of children. We performed focus group interviews (FGI) on the basic characteristics of family meals, and chose several scales (such as Child Behavior Checklist (CBCL), self-esteem, and a daily hassles questionnaire), to measure the psychological variables. We collected data from 442 dyads (mother-child) and used 440 from dyads. In our results, the frequency of family meals affected the psychological problems of children, especially aggression and emotional instability. The atmosphere during meals also affected depression/anxiety, concentration difficulties, emotional instability, self-esteem, peer relationships, and sociality. There were significant correlations between meal atmosphere, family bonding, maternal personality, and psychological problems of children. We performed covariation analysis to examine and control the influence of family bonding and maternal personality; despite controlling for these variables, family meals still influenced children's psychological problems. We conclude that the family meal is a significant variable that impacts the emotional and behavioral problems of children and stress the importance of frequent family meals.

The Effect of Elapsed Time on the Quantity of mRNA in Skin: A Study to Evaluate the Potential Forensic Use of mRNA to Determine the Postmortem Interval / 대한법의학회지

Ribonucleic acid (RNA) has potential use in forensic science for the determination of postmortem interval. We report the first study on serial sampling of messenger RNA (mRNA) from surgical specimens to determine if there is a correlation between mRNA quantity and elapsed time. Skin tissues were collected from modified radical mastectomy specimens. After a defined period of time, bisected skin sections were cut and frozen in liquid nitrogen. Serial collection of the specimens was conducted, and frozen sections were obtained from all samples. Quantitative real-time reverse transcription-polymerase chain reaction was performed using the extracted RNA to measure the transcriptional activity of 2 selected housekeeping genes. The selected loci were mRNA sequences that exhibited time-dependent quantitative changes in a previous study. We collected 44 samples from 9 different patients, with 3-10 samples collected per patient. The amount of mRNA transcripts present in the serial samples showed a weak time-dependent correlation trend only in some cases. Further studies to evaluate different target mRNA sequences are necessary, as is exploration of additional methods to evaluate mRNA transcript degradation.

Antibiotic-Associated Diarrhea in 3 to 6 Month Old Infants with Febrile Urinary Tract Infections / 소아감염

PURPOSE: This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. METHODS: Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008 to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. RESULTS: Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin (3rd CS) single therapy was used for 102 patients (69.4%), the 3rd CS and non-3rd CS combination therapy for 24 (16.3%), and non-3rd CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P=0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P=0.717, P=0.830). Although the frequency of diarrhea was higher for the 3rd CS and non-3rd CS combination therapy subgroup with 9.25+/-5.30 times/day than the other two subgroups (7.58+/-2.97 times/day in 3rd CS single therapy subgroup, 6.75+/-4.40 times/day in non-3rd CS combination therapy subgroup), there was no statistical significance (P=0.078). CONCLUSION: AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.

Bilateral Diffuse Radiation Pneumonitis Caused by Unilateral Thoracic Irradiation: A Case Report

Radiation therapy is one of the most important therapeutic modalities for the treatment of lung cancer. Radiation pneumonitis is one of the important complications associated with radiotherapy for lung cancer. Radiation pneumonitis is generally limited to the irradiated lung and is manifested by the insidious onset of dry cough, dyspnea, and mild fever, resulting in damage and edematous changes of alveolar structures on histologic inspection. Clinically, diffuse bilateral radiation pneumonitis accompanied with acute symptoms after unilateral thoracic irradiation appears very rarely. Histopathologic examinations for the diagnosis of out-of-field radiation pneumonitis are rarely performed. We herein describe a case of extensive bilateral radiation pneumonitis which developed acutely after salvage radiotherapy for squamous cell carcinoma in the left upper lobe of the lung. The condition was confirmed by a diagnostic help of histopathologic findings.

Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.

Early Adenocarcinoma Arising from Traditional Serrated Adenoma in the Colon / 대한소화기내시경학회지

A serrated adenoma is a precursor lesion for some cases of microsatellite unstable colorectal carcinoma (CRC). The serrated neoplasia pathway has been associated with carcinogenesis of serrated adenoma, which is different from the traditional adenoma-carcinoma sequence. The serrated neoplasia pathway accounts for 10~15% of CRCs, and these tumors typically demonstrate microsatellite instability. Cases of a CRC arising from a serrated adenoma have been rarely identified with the recent recognition of the serrated neoplasia pathway. However, these cases are not frequently reported in Korea, because this concept has only been recently emphasized. We report a case of an early adenocarcinoma arising from a traditional serrated adenoma of the colon, which was diagnosed and treated by a colonoscopic polypectomy.

A Case of Chronic Neuropathic Pseudo-obstruction of the Colon / 대한소화기내시경학회지

Colonic pseudo-obstruction, which is characterized by repetitive episodes or continuous symptoms and signs of a bowel obstruction, is a rare disease that results in colorectal dilatation without any obstructing lesions. Cases with neuropathic chronic colonic pseudo-obstruction have rarely been reported in Korea. We report a case of neuropathic colonic pseudo-obstruction, which results in decreased number of interstitial cells of Cajal and hypoganglionosis, in a 50-year-old man with chronic constipation accompanied by megacolon.

A Case of Colonic Obstruction Due to Phytobezoars / 대한소화기내시경학회지

Colonic phytobezoars are defined as conglomerate masses of fruit or vegetable matter in the colon, and these have rarely reported as a cause of colon obstruction. Because it is extremely rare, its correct diagnosis might be delayed even with the aid of abdominal computed tomography. We report here on a case of diagnosed colonic obstruction due to colonic phytobezoars in a 67-year-old female with diabetic end stage renal disease and chronic constipation. Although abdomino-pelvic computed tomography did not demonstrate the presence of phytobezoars, multiple phytobezoars impacted in the colon were found and these were removed by colonoscopy. This is a rare case in that colonic obstruction due to phytobezoar was diagnosed early and it was treated by colonoscopy.

The effects of the oxygen flow rate on heart rate variability in the PACU after TIVA

BACKGROUND: Oxygen increases the cardiac vagal tone, blood pressure, systemic vascular resistance and vascular tone in healthy adults.This study assessed the autonomic tone according to different oxygen flow rates via different types of masks with using the heart rate variability (HRV) in the PACU after total intravenous anesthesia (TIVA). METHODS: We prospectively studied 27 patients after TIVA in the PACU.The 5 L group received oxygen via a simple mask with an oxygen rate of 5 L/min and the 10 L group received oxygen via a mask with a reservoir bag at a rate of 10 L/min in the PACU. We evaluated the HRV at the point of stabilization before anesthesia (BL), 5 min in the PACU (PACU 5), 30 min in the PACU (PACU 30) and 60 min in the PACU (PACU 60). RESULTS: In the 5 L group, the nuHF was increased to 42.4 +/- 24.2 at 60 min in the PACU as compared with 27.1 +/- 19.1 at 5 min in the PACU.In the 5 L group, the LFHFr was decreased to 2.3 +/- 2.1 at PACU 60 as compared with 6.6 +/- 9.7 at PACU 5 and the nuLF was decreased to 56.9 +/- 23.2 at PACU 60 as compared with 72.9 +/- 19.0 at PACU 5.There were no significant changes between the two groups at PACU 5, PACU 30 and PACU 60.The oxygen saturation was increased at PACU 60 compared with PACU 5 in the two groups. CONCLUSIONS: These finding indicates that 1 h of oxygen administration with 5 L/min during emergence from anesthesia increased the relative vagal tone, and the arterial blood pressure is stable irrespective of the oxygen flow rate.

The Relationship between Brachial Ankle Pulse Wave Velocity and Complement 1 Inhibitor

Complement 1 (C1) inhibitor is an acute phase protein with anti-inflammatory properties. The aim of the present study was to elucidate the relationship between brachial ankle pulse wave velocity (baPWV), the parameter of arterial stiffness, and C1 inhibitor. One hundred subjects were randomly enrolled in this study. Data about baPWV, age, gender, hypertension, smoking, and body mass index (BMI) were measured. Blood tests for total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, hemoglobin A1c, erythrocyte sedimentation rate, C-reactive protein, complement 3, and C1 inhibitor were performed. Based on the Pearson correlation, the C1 inhibitor showed a positive relation to the baPWV (P<0.001). Multiple regression analysis revealed the significant predictors of baPWV were not only the conventional risk factors of arteriosclerosis and/or atherosclerosis, such as age (P<0.001), gender (P<0.001), hypertension (P<0.001), and BMI (P=0.006), but also the acute phase protein, C1 inhibitor (P=0.025). In conclusion, C1 inhibitor is associated with arterial stiffness through its association with increased inflammation.