The presence of simple renal cysts is associated with an increased risk of albuminuria in young adults

Background/Aims@#The prevalence of simple renal cysts increases with age; however, they are occasionally found in adults aged < 40 years. This cross-sectional study evaluated the clinical significance of simple cysts in young adults, focusing on their associations with hematuria and albuminuria. @*Methods@#Adults aged < 40 years who underwent comprehensive medical examination between January 2005 and December 2013 were included. Simple renal cysts were identified by ultrasonography. @*Results@#Renal cysts were found in 276 of the 5,832 subjects (4.7%). Subjects with medullary sponge kidney (n = 1) or polycystic kidney disease (n = 5) were excluded. A single cyst and multiple cysts were found in 234 (4.0%) and 42 (0.7%) subjects, respectively. Age, high systolic blood pressure, and history of hypertension were independent risk factors for the presence of simple cysts. Simple cysts were not associated with an increased prevalence of hematuria. However, subjects with cysts showed a higher prevalence of albuminuria than those without (11.3% vs. 4.5%, p < 0.001). Multivariate analysis revealed that the existence of simple renal cysts was associated with a 2.30-fold increased prevalence of albuminuria (95% confidence interval, 1.512 to 3.519; p < 0.001) independent of other risk factors. @*Conclusions@#In young adults, the presence of simple renal cysts was independently associated with an increased prevalence of albuminuria. The causal relationship needs to be elucidated in further studies.

Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea

BACKGROUND: Based on scientific evidence, the Korean National Health Examination recommends age 40 as an appropriate time for screening. However, awareness of the health examination itself or of the appropriate age for screening has not been discussed extensively with examinees. This study aims to evaluate the perception about age at the start and end of periodic health examinations (PHE). METHODS: A self-administered survey was completed by 887 subjects who visited either the health promotion center or the outpatient clinic at a university hospital in Korea between February 15 and May 18, 2016. Participants were divided into two groups: 587 were periodic health examinees, and 300 were visitors to the family medicine clinic. Their awareness of PHE was compared using the Chi-square test and multiple logistic regression. RESULTS: Both groups had similar (P>0.05) perceptions regarding the awareness, knowledge and usefulness of the PHE. Both groups preferred to continue taking a PHE with no upper limit on the age when it could be taken. This tendency was more prominent among subjects with higher levels of education and household income. In both groups with individuals under age 50 said that the appropriate age to begin screening is 40 or younger. CONCLUSIONS: The perception regarding the ages at which to start and end the PHE was confirmed according to the subject of visit; a wider range of appropriate ages was preferred than is included in the current recommendations.

A Case of Cryptococcal Tenosynovitis in a Patient with Wegener's Granulomatosis / 대한류마티스학회지

Cryptococcosis, a disseminated illness due to Cryptococcus neoformans in most case, is an opportunistic systemic fungal infection that frequently infects the immunosuppressed host. Although it can cause disease in immunocompetent as well as immunocompromised hosts, the later group, particulary those with cell-mediated immune defects, are the greatest risk for severe disseminated disease. Cryptococcal tenosynovitis is extremely rare, with only 2 cases previously documented in the English literature. In this paper we report a case of cryptococcal tenosynovitis with multiple lung nodules in the setting of cryptococcemia in a patient with Wegener's granulomatosis who has been treated with steroid, oral cyclophosphamide for one year.

A case of calcium pyrophosphate dihydrate deposition disease causing compressive cervical myelopathy / 대한내과학회지

Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structure. Spinal involvement in CPPD deposition disease is rare. We reported a rare case of CPPD deposition disease that caused compressive cervical myelopathy. A 57-year-old woman was admitted to the hospital with 1 week history of progressive paresis of the right upper and lower extremities. Computed tomography showed the round and nodular calcified ligamentum flavum. Magnetic resonance imaging showed a low intensity epidural mass pressing and distorting the cervical cord at C-4 and 5 levels on both T1 and T2- weighted images. Radiographic findings were consistent with calcification of the ligamentum flavum in the C-4 and 5 levels causing cord compression. The lesion was eventually removed by hemilaminectomy. The mass was composed of a very hard crystal like calcified deposition in the ligamentum flavum. The histopathological evaluation of the exicised ligamentum flavum revealed the characteristic crystals of CPPD.

Chorea in Systemic Lupus Erythematosus: Evidence for Bilateral Putaminal Hypermetabolism on F-18 FDG PET / 대한핵의학회잡지

PURPOSE: We describe a 54-year-old woman with systemic lupus erythematosus (SLE) who suddenly presented with chorea and had positive antiphospholipid antibodies. F-18 FDG PET showed abnormally increased glucose metabolism in bilateral putamen and primary motor cotex. Tc-99m ECD SPECT also showed abnormally increased regional cerebral blood flow in bilateral putamen. She was treated with corticosteroid and aspirin after which the symptoms improved. Four months later, follow up F-18 FDG PET showed improvement with resolution of hypermetabolism in bilateral putamen. This case suggests that striatal hypermetabolism is associated with chorea in SLE.

A Case of Salmonella paratyphi Infection Manifested as Duodenal and Terminal Ileal Ulcers / 대한소화기내시경학회지

Infection due to Salmonella typhi and Salmonella paratyphi is called enteric fever which is manifested by fever, abdominal pain, and intermittently other gastrointestinal symptoms like vomiting and diarrhea. Although Salmonella species may invade any site of the gastrointestinal tract, it usually invades terminal ileum. The pathologic manifestation of salmonellosis may vary from nonspecific mucosal change (erythema, edema, ulceration etc.) of invaded site to intestinal perforation or hemorrhage. However, the report of upper gastrointestinal invasion by Salmonella species is rare, and confirmation by tissue culture is difficult because gastric acid and the normal propulsive peristaltic flow of the small bowel help to limit the bacterial populations of the upper gastrointestinal tract. We report here a case of Salmonella paratyphi infection proven by tissue culture in a 26-year-old man who presented with fever and watery diarrhea and was found to have multiple duodenal and terminal ileal ulcers.

A Case of Asymptomatic, Anicteric Early-stage Intrahepatic Ductal Cholangiocarcinoma / 대한소화기내시경학회지

Asymptomatic intrahepatic early-stage bile duct carcinoma without jaundice is difficult to diagnose because it does not have any characteristic clinical signs and symptoms. The clinical implication of early-stage intrahepatic ductal cholangiocarcinoma is great, because it allows curative resection and excellent long-term survival. Recently we experienced early-stage intrahepatic cholangiocarcinoma which was incidentally detected by a clue of elevated serum alkaline phosphatase and gamma-GT without jaundice and any symptoms. Abdominal US showed focal intrahepatic bile duct dilatation. ERCP could not demonstrate the lesion, while MRCP revealed the obstructed duct (S6) with proximal dilatation. For evaluation of a focal intrahepatic stricture, PTCS examination and biopsy were done. With the help of MRCP and PTCS, the lesion was diagnosed as papillary adenocarcinoma preoperatively. The patient was underwent right liver lobectomy and confirmed early-stage intrahepatic ductal adenocarcinoma and she is well-being without cancer recurrence for a follow-up period of 1 year.

A case of myasthenia gravis in a patient with diffuse systemic sclerosis developed during D-penicillamine treatment / 대한류마티스학회지

D-penicillamine has been used to reduce skin thickening and prevent the development of significant organ involvement in the treatment of scleroderma. This drug has a number of serious adverse reactions including glomerulonephritis with nephrotic syndrome, aplastic anemia, thrombocytopenia, and myasthenia gravis. A 44-year-old woman was admitted for weakness of the extremity muscle during repeated use. Eight months before admission, she visited dermatology department of our hospital. She was diagnosed as having scleroderma. D-penicillamine was started for the treatment of skin lesions. Based on the fluctuation of proximal muscle weakness, high titer of acetylcholine receptor antibody and definite decremental response of Jolly test, she was diagnosed as myasthenia gravis. D-penicillamine was discontinued because of the suspicion of D-penicillamine induced myasthenia gravis. Muscle weakness improved after D-penicillamine was withdrawn. The development of reversible myasthenia gravis may be regarded as a part of general predisposition for autoimmune disease related to the D-penicillamine therapy.

A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb Presenting with Obstructive Jaundice / 대한소화기내시경학회지

The common bile duct classically enters the posteromedial aspect of the second part of the duodenum through an oblique, 1 to 2 cm long intramural tunnel. Some case reports of the common bile duct emptying into other sites including the fourth part of the duodenum, the pyloric canal, stomach and duodenal bulb have appeared in the literature. We report a case of a 40-year-old man who showed anomalous drainage of the common bile duct into the duodenal bulb presenting with obstructive jaundice and duodenal ulcer. This patient required choledochoenteric anastomosis to relieve obstructive jaundice and abdominal pain. We report the case with a review of other cases in Korean literature.