In Vivo Effects of Preservative-free and Preserved Prostaglandin Analogs: Mouse Ocular Surface Study

PURPOSE: Chronic use of topical hypotensive agents induces several side effects caused by preservatives. The purpose of this study was to evaluate the effects of prostaglandin analogs with varying concentrations of benzalkonium chloride (BAC), preservative-free (PF), and alternative preservatives on mouse corneal tissue. METHODS: Thirty-five, 8- to 10-week-old female C57BL/6 mice (five mice for each group) were used for this study. To the control group, we applied normal saline, and to each drug-treated group we applied 0.02% BAC, bimatoprost 0.01% (with BAC 0.02%), latanoprost 0.005% (with BAC 0.02%), travoprost 0.004% (with 0.001% polyquad) or tafluprost 0.0015% with/without 0.001% BAC, once a day (9 p.m.) for 4 weeks. Corneal fluorescein staining was evaluated in all groups. After harvest, the corneal tissues were embedded in paraffin and then Hematoxylin-Eosin stain was performed for histopathological examination. Immunofluorescence staining was done against TNF-alpha, IL-6, HLA DR, pJNK, and pAkt. RESULTS: In corneal fluorescein staining, severe punctate epithelial keratitis was seen in the groups of 0.02% BAC, 0.02% BAC containing bimatoprost 0.01% and latanoprost 0.005%. The surface desquamation, irregular surface, loss of cell borders, anisocytosis and stromal shrinkage were observed in the groups of BAC-containing eye drops. Moreover, the groups treated with BAC-containing eye drops have high inflammatory markers, significantly decreased cell viability-related signal, pAkt, and higher apoptosis-inducing signal, pJNK, than the control group. On the other hand, travoprost 0.004% and PF tafluprost 0.0015% have less cellular morphologic changes, lower inflammation, and higher cellular viability than BAC-containing formulations. CONCLUSIONS: Corneal damage, increased inflammation and apoptosis and low cell viability were observed in BAC-containing groups. PF or alternatively preserved glaucoma medications seem to be a reasonable and viable alternative to those preserved with BAC.

Veratrum patulum intoxication developed in a group of twenty-three patients / 대한내과학회지

Veratrum patulum is a perennial plant with toxicity, which grows wild in the high mountain areas of Korea. Various types of steroidal alkaloids contained in Veratrum patulum are known to cause symptoms such as nausea, vomiting, bradycardia and hypotension. Twenty-three patients were admitted to our center with chief complaints of nausea and vomiting after ingesting leaves of Veratrum patulum. The mean age of the group was 44 years old and was comprised of 19 males and 4 females. Some patients showed hypotension and bradycardia with symptoms such as dizziness. Ten patients with severe bradycardia coupled with other symptoms received atropine administration. Nausea and vomiting were improved after the administration of anti-emetics. Blood pressure and the pulse rate were all normalized on the day after admission, and all of the patients were discharged without any symptoms.

The Relevance of Serum Ghrelin Concentration to Severity of Acute Pancreatitis

BACKGROUND/AIMS: Ghrelin has recently been reported as exerting a protective effect in the damaged pancreas in rats. We investigated the correlation between severity of acute pancreatitis and serum ghrelin concentrations. METHODS: Blood samples were collected three times (at admission, after 48 hours, and at discharge) from patients admitted with acute pancreatitis. We divided the patients into nonrisk and risk groups. The risk group was defined as the presence of at least one of following risk factors for severe acute pancreatitis: Ranson's score > or =3, acute physiology and chronic health evaluation (APACHE) II score > or =8, C-reactive protein (CRP) > or =150 mg/L, and CT severity index (CTSI) > or =4. Serum ghrelin concentrations were measured with RIA kit and analyzed based on clinical and biochemical parameters. RESULTS: A total of 53 patients was enrolled in this study: 28 in the nonrisk group and 25 in the risk group. At admission, the ghrelin concentration was significantly higher in the risk group (286.39+/-272.19 vs 175.96+/-138.87 pg/mL [mean+/-SD], p=0.049). However, the ghrelin concentration did not differ significantly between the two groups after 48 hours (p=0.450) and at discharge (p=0.678). The overall ghrelin concentration was significantly lower at admission than at discharge (240.65+/-247.96 vs 369.41+/-254.27 pg/mL, p=0.001). CONCLUSIONS: Patients with risk factors for severe acute pancreatitis have higher serum ghrelin concentrations.

A case of Zollinger-Ellison syndrome with MEN-1 / 대한내과학회지

Zollinger-Ellison syndrome (ZES) is a clinical syndrome caused by excessive gastric acid secretion by gastrinoma, characteristically causing peptic disease and/or gastroesophageal reflux disease. Approximately one third of patients with gastrinoma have multiple endocrine neoplasia type 1 (MEN-1). A 56-year-old man was admitted for abdominal pain and diarrhea lasting for 2 weeks. The endoscopic findings revealed severe reflux esophagitis and multiple ulcers at the bulb and second portion of the duodenum. He was diagnosed as ZES based on typical clinical features such as markedly elevated fasting gastrin level (> or =1,263 pg/mL) and findings from a CT scan and somatostatin receptor scan. Pathologic findings after the operation revealed malignant gastrinoma. He was confirmed to have parathyroid adenoma and MEN-1. Despite antisecretory therapy with proton pump inhibitors, an esophageal stricture developed, and we performed esophageal balloon dilatation and stent insertion.

MRI Measurement of the Distal Femur for Determining the Rotational Alignment in TKA

PURPOSE: The purpose of the current study was to investigate the relationship between the angles made by the reference axes on the axial magnetic resonance (MR) images and to provide information for determining the rotational alignment of the femoral component in total knee arthroplasty. MATERIALS AND METHODS: We analyzed 194 magnetic resonance (MR) images to measure the posterior condylar angle, the condylar twist angle and the difference between the posterior condylar angle and the condylar twist angle. We then evaluated the relationship between these angular measurements. RESULTS: The condylar twist angle averaged 6.09degrees, the posterior condylar angle averaged 2.95degrees and the difference between the posterior condylar angle and the condylar twist angle was 3.14degrees. There were no differences in these angles based on gender and age. CONCLUSION: In the cases that the center of the medial epicondyle is difficult to clearly identify during TKA, the femoral rotational resection angle can be determined by subtracting 3degrees from the condylar twist angle.

Preliminary Study on Performance Evaluation of a Stacking-structure Compton Camera by Using Compton Imaging Simulator / 의학물리

A Compton camera, which is based on the geometrical interpretation of Compton scattering, is a very promising gamma-ray imaging device considering its several advantages over the conventional gamma-ray imaging devices: high imaging sensitivity, 3-D imaging capability from a fixed position, multi-tracing functionality, and almost no limitation in photon energy. In the present study, a Monte Carlo-based, user-friendly Compton imaging simulator was developed in the form of a graphical user interface (GUI) based on Geant4 and MATLAB (TM). The simulator was tested against the experimental result of the double-scattering Compton camera, which is under development at Hanyang University in Korea. The imaging resolution of the simulated Compton image well agreed with that of the measured image. The imaging sensitivity of the measured data was 2~3 times higher than that of the simulated data, which is due to the fact that the measured data contains the random coincidence events. The performance of a stacking-structure type Compton camera was evaluated by using the simulator. The result shows that the Compton camera shows its highest performance when it uses 4 layers of scatterer detectors.

A Case of Invasive Candidal Colitis in a Neutropenic Patient / 대한소화기내시경학회지

The candida species are considered as resident microflora in healthy persons. Yet in immunocompromised patients, candida can cause opportunistic invasive fungal infections. A 67-year-old woman presented to the hospital with abdominal pain and diarrhea. On admission, the laboratory studies revealed profound neutropenia, and the abdominal computed tomography showed thickened walls of the ascending colon and terminal ileum. The patient's fever and clinical symptoms continued for 5 days in spite of the empirical antibiotic therapy. We performed colonoscopy and obtained biopsy specimens at the ulcer lesions of the ascending colon and terminal ileum. The histology showed that candida hyphae had invaded to the lamina propria of the colonic mucosa. After antifungal treatment, her clinical symptoms subsided and the follow-up colonoscopic findings showed improvement. Therefore, we suggest that invasive candidal colitis should be considered in the differential diagnosis of neutropenic enterocolitis.

Endoscopic findings and clinicopathological characteristics of signet ring cell carcinoma of the stomach / 대한내과학회지

BACKGROUND: Signet ring cell carcinoma (SRCC) of the stomach has a young age prevalence and is associated with advanced gastric cancer (AGC) on diagnosis and a poor prognosis. However, the clinical and histopathological characteristics of the disease have been controversial and its endoscopic characteristics are not clear. Thus, we examined the clinical, endoscopic and histopathological characteristics of SRCC of the stomach and analyzed them in comparison with non-signet ring cell carcinoma (NSRCC). METHODS: We retrospectively investigated the medical records of cases definitely diagnosed as stomach cancer by upper gastrointestinal endoscopy or radical gastrectomy from March 1996 to May 2006, and statistically analyzed the clinical, endoscopic and histopathological characteristics of the SRCC and NSRCC group selected at random. RESULTS: During the study period, 1,840 patients were diagnosed as stomach cancer, and 117 (6.4%) of the patients were found to have SRCC. Clinically, the SRCC group showed a higher frequency in female (p=0.005), those aged below 60 years (p<0.001), non-smokers (p=0.031) and non-drinkers (p=0.045), and endoscopically the SRCC group was higher in the percentage of lesions located in the body part of stomach (p=0.003), the Helicobacter pylori (H. pylori) infection rate (p<0.001) and the Borrmann 4 type AGC (p=0.003). Significant independent characteristics of SRCC identified through multivariate analysis were an age below 60 years, H. pylori infection and a Borrmann 4 type AGC. CONCLUSIONS: The endoscopic and clinicopathological characteristics of SRCC of the stomach are relatively young age on diagnosis, a high H. pylori infection rate, and a high percentage of Borrmann 4 type AGC.

Successful treatment of acute ischemic colitis with stent insertion / 대한내과학회지

Mesenteric ischemia is rare and is often diagnosed late. Fatal complications or acute ischemic events can occur in the absence of proper treatment. Any sensitive and specific tests are not available for functional diagnosis of mesenteric ischemia until now. If another causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (CT angiography, Doppler US, and MR angiography) suggests mesenteric ischemia. Until the 1990s, open surgery was considered the only treatment of choice. Percutaneous transluminal angioplasty (PTA) was reserved for patients to whom surgery carried a high risk. However, open surgery carries a non-egligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimal invasive treatment option for obtaining good long term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of mesenteric ischemia. We describe the successful application of PTA to the inferior mesenteric artery stenosis by using drug eluting stent.

Two Cases of FitziHugh-Curtis Syndrome in Acute Phase / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been defined as perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhoeae and Chlamydia trachomatis. In the acute phase, patients usually complain of severe right upper quadrant pain of sudden onset. The pain is sharp, pleuritic and most intense at the level of the right lower rib margin and thus it is frequently confused with acute cholecystitis or pleurisy. Definitive diagnosis of Fitz-Hugh-Curtis syndrome needs invasive procedures such as laparoscopy or laparotomy, but considering that Fitz-Hugh-Curtis syndrome is a benign condition that can be cured by oral administration of appropriate antibiotics, noninvasive diagnosis is desirable. Recently, we have experienced two cases of Fitz-Hugh-Curtis syndrome in acute phase accompanied with sharp and pleuritic right upper quadrant pain. In one case, pelvic inflammatory disease was not definite, so at first we mistook it for acute cholecystitis and reactivation of chronic hepatitis B. In the other case, Fitz-Hugh-Curtis syndrome followed the preceding, typical pelvic inflammatory disease. Both cases were diagnosed noninvasively and treated successfully by oral administration of antibiotics.

The Comparative Study Of Cancer Incidence Between Urban And Rural Area In Gangneung: Gastric Cancer, Hepatoma And Lung Cancer / 대한내과학회지

BACKGROUND: Since most of epidemiologic studies of cancer disease in Korea are on the basis of data from large hospitals in metropolitan area, they neither represent the separate district, nor reflect the characters of rural area. We aimed to help prevent cancer and present control strategies in good accordance with regional features by evaluating the epidemiologic characters of cancers and performing a comparative study between urban and rural area. METHODS: We retrospectively reviewed the medical records of newly diagnosed cancer patients from January 1997 to December 2000 in Gangneung Asan Hospital, who resided in Gangneung city on diagnosis and investigated their pathologic results, radiologic findings, risk factors, stages, treatment modalities, etc. On the basis of them, we estimated incidence rates including crude rates and age standardized rates and compaed the differences between urban and rural area. RESULTS: The numbers of newly diagnosed cancer patients during this period were 367 in gastric cancer, 186 in hepatoma and 177 in lung cancer. The age standardized annual incidence rates of gastric cancer were estimated to be 49.7/17.8 (M/F) in urban area and 52.7/25.9 (M/F) in rural area per 100,000 persons. In hepatoma, the rates were 28.4/6.3 in urban and 36.3/6.5 in rural area and in the case of lung cancer, 23.5/6. 1 in urban and 32.0/7.4 in rural area. As a consequence, the age standardized annual incidence rates of rural area were higher than those of urban area in all the three cancers and the diffences were statistically significant except female hepatoma and lung cancer. However, risk factor survey among cancer patients revealed only difference in the amount of alcohol consumption associated with hepatoma, between urban and rural area. CONCLUSION: In rural area, the age standardized incidence rates were significantly higher than those of urban area in Gangneung city except female hepatoma and lung cancer. Moreover, in rural area, cancers were detected as more advanced state. Hence, preventive measures fit for these features were required urgently. In addition, more investigations about risk factors were needed to discover the cause of difference, including environmental and host factors which were not covered in this study.