The Effects of Social Anxiety, Self-Esteem, and Depression on Suicidal Ideation in Korean Adolescents / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the manner by which social anxiety symptoms, self-esteem, and depression influence suicidal ideation in adolescents. METHODS: This study involved 1320 middle school students. All participants completed several self-assessment questionnaires. Correlations among variables were assessed, and multiple regression analysis was performed to evaluate the relationships between variables and suicidal ideation. Finally, a structural equation model was used to determine the pathways by which the tested variables can influence suicidal ideation. RESULTS: Symptoms of social anxiety were positively correlated with depression and suicidal ideation, but were negatively correlated with self-esteem. Additionally, multiple regression analysis revealed that social anxiety symptoms, depression, and self-esteem were significantly related to suicidal ideation. The influence of social anxiety symptoms on suicidal ideation was associated with an increase in depression, whereas self-esteem acted as an intermediary between social anxiety symptoms and depression. CONCLUSION: The results of the present study demonstrate that social anxiety symptoms can directly increase depression and lower self-esteem, which in turn can increase the risk of suicidal ideation. Thus, it may be possible to prevent depression and ultimately lower the risk of suicide in adolescents by pursuing programs designed for the early detection of social anxiety symptoms and by using intervention programs that improve self-esteem.

The Effects of Mental Fitness, Social Support and Psychological Distress on Suicidal Idea of People with Schizophrenia Using Community Mental Health Services / 신경정신의학

OBJECTIVES: The objective of this study was to analyze the relationships of psychological distress, social support, mental fitness and suicidal idea among patients of chronic schizophrenia using community mental health services. METHODS: This study was conducted in patients who visited the mental health services in Daejeon from October to December 2011. In total, 395 chronic schizophrenic patients were evaluated using Mental Fitness Scale (MFS), Kessler Psychological Distress Scale (K10), and Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: Results showed that 37% (n=146) of patients had suicidal ideas and 63% (n=249) of patients did not have suicidal ideas. The group that had suicidal ideas showed significantly lower scores on MFS, K10, and MSPSS than the group with no suicidal ideas (p=0.000). Logistic regression analysis showed a significantly lower score on MFS, K10 for the suicidal ideation group than the group with no suicidal ideas. CONCLUSION: These results suggest that health care providers should consider mental fitness and psychological distress, in order to prevent suicidal idea of schizophrenic patients.

A Case of Hepatic Peribiliary Cysts in a Patient with Alcoholic Liver Cirrhosis / 대한소화기학회지

Hepatic peribiliary cysts (HPCs) are characterized by cystic dilatations of the peribiliary glands located throughout the branches of the biliary systems. Specifically, they are mainly located along the hepatic hilum and major portal tracts. The natural history and prognosis of HPCs are uncertain. In fact, almost all HPCs have been discovered incidentally during radiological examination or autopsy, and they are considered to be clinically harmless. Recently, several cases of HPCs associated with obstructive jaundice or liver failure were reported in patients with pre-existing liver disease in several studies. However, until now there have been no reports of such a case in Korea. Herein, we report a case of HPCs that show a disease course with a poor prognosis. These HPCs developed in a 47-year-old man with progressive alcoholic liver cirrhosis.

The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries

BACKGROUND/AIMS: It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. METHODS: A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. RESULTS: Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38degrees C, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was significantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD. CONCLUSIONS: This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.

Ileal Stenosis Occurred 3 Months after Blunt Abdominal Trauma / 대한소화기학회지

We present a case of ileal stenosis with delayed presentation 3 months after car accident. Ileal stenosis after blunt abdominal trauma is a rare clinical entity. We present CT and small bowel series 3 months after trauma. Image showed segmental thickening of intestinal wall and proximal bowel dilation. At surgery, a stenotic bowel loop was adjacent to a fibrotic mesentery. Histological examination showed ulcers, inflammatory cells and fibroblasts infiltrated to the muscularis mucosae, submucosa, and mesentery. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischemic bowel stenosis may result from even small tears and contusions of mesentery. Posttraumatic intestinal stenosis should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.

A Case of Tuberculous Peritonitis Developed during Chemotherapy for Tuberculous Pleurisy as Paradoxical Response / 대한소화기학회지

After the start of anti-tuberculous treatment, paradoxical worsening of tuberculous lesions has been described. However, abdominal tuberculosis as paradoxical response is relatively rare. This report describes the 26-year-old female who suffered from peritoneal tuberculosis while treating tuberculous pleurisy with anti-tuberculous medications. It was considered as paradoxical response, rather than treatment failure or else. She was successfully managed with continuing initial anti-tuberculous medications. When a patient on anti-tuberculous medications is presented with abdominal symptoms, the possibility of paradoxical response should be considered to avoid unnecessary tests and treatments, which may result in more suffering of the patient. Herein, we report a case of peritoneal tuberculosis as paradoxical response while treating tuberculous pleurisy.

A Case of Corrosive Injury-Induced Pharyngeal Stricture Treated by Endoscopic Adhesiolysis Using an Electrosurgical Knife

Here, we report a case of corrosive injury-induced pharyngeal stricture in a 69-year-old female, which was successfully treated with endoscopic adhesiolysis using an electrosurgical knife. The patient had ingested sodium hydroxide in an attempted suicide, and immediate endoscopy revealed corrosive injuries of the pharynx, esophagus, and stomach. When a liquid diet was permitted, she complained of nasal regurgitation of food. Follow-up endoscopy revealed several adhesive bands and a web-like scar that did not allow passage of the endoscope into the hypopharyngeal area. For treatment of the hypopharyngeal stricture, the otolaryngologist attempted to perform an excision of the fibrous bands around the esophageal inlet using microscissors passed through an esophagoscope, but this procedure was not effective. We then dissected the mucosal adhesion and incised the adhesive bands using an electrosurgical knife. After this procedure, nasal regurgitation of food no longer occurred. To our knowledge, this case is the first report of endoscopic adhesiolysis with an electrosurgical knife in a patient with a corrosive injury-induced pharyngeal stricture.

A Case of Chlamydia trachomatis Peritonitis Mimicking Tuberculous Peritonitis / 대한소화기학회지

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.

A Case of Stercoral Perforation of Sigmoid Colon Diagnosed by Colonoscopy / 대한소화기내시경학회지

Stercoral perforation of the colon is a rare disease. Yet, in recent times, the number of reported cases has increased because of the growing elderly population. Stercoral perforation of the colon usually occurs in the elderly or bedridden patients with chronic constipation. Stercoral perforation may cause a massive hemorrhage or peritonitis. The prognosis of stercoral perforation is poor, as the reported postoperative mortality is 35~40%. So, early diagnosis and proper treatment are very important for improving survival. However, making an early diagnosis may be difficult because of the nonspecific initial symptoms. We experienced a case of stercoral perforation that was diagnosed by colonoscopy. The defect was in the sigmoid colon, and it was covered with peritoneum. The patient completely recovered after resection and anastomosis of the perforated colon. We report here on this case with a review of the relevant literature.

Clinical Factors Predicting for Neoplastic Transformation of Gastric Hyperplastic Polyps / 대한소화기학회지

BACKGROUND/AIMS: Hyperplastic polyps (HPs) are the most common cause of all benign epithelial gastric polyps, constituting 30 to 93%. Although gastric HPs are usually considered as benign lesions compared with adenoma, neoplastic transformation has been known to occur rarely. We aimed to identify the clinical factors of gastric HPs predicting for neoplastic transformation. METHODS: Between January 2002 to August 2010, a total of 274 gastric HPs, which had been removed by endoscopic polypectomy or surgical resection from 210 patients, were analyzed retrospectively. RESULTS: Neoplastic transformation was found in 15 cases (5.5%) of 274 HPs including 10 cases of low grade dysplasia (3.7%), 2 cases of high grade dysplasia (0.7%) and 3 cases of adenocarcinoma (1.1%). Neoplastic transformations were significantly associated with >1 cm in size (n=10 [66.7%] vs. n=91 [35.1%], p=0.024), with pedunculated shape (n=9 [60.0%] vs. n=62 [23.9%], p=0.002), with previous history of gastrectomy (n=3 [20.0%] vs. n=3 [1.2%], p=0.002) and with synchronous neoplastic lesions occurring elsewhere in the gastric mucosa (n=5 [33.3%] vs. n=31 [12.0%], p=0.021). However, no significant difference was found between HPs with and without neoplastic transformation in terms of age, sex, number of polyps detected per patient, location, macroscopic appearance such as erosion, hyperemia. CONCLUSIONS: Neoplastic transformation of gastric HPs had significant relationships with >1 cm in size, pedunculated shape, postgastectomy state, and synchronous neoplastic lesion. Therefore, endoscopic polypectomy should be considered in these HPs to avoid the risk of missing HPs with neoplastic potential.

A Case of Spontaneous Regression of Hepatocellular Carcinoma with Multiple Lung Metastases / 대한소화기학회지

Spontaneous regression of hepatocellular carcinoma (HCC) is extremely rare. We report a case of 67-year-old man having HBV-associated HCC with multiple lung metastases which regressed spontaneously. The patient had single liver mass and received surgical resection. The mass was confirmed as HCC histopathologically. Nine years after surgical resection, a 3.3 cm sized recurred HCC was detected on the resection margin in CT scan. Transarterial chemoembolization (TACE) was performed 3 times, and lung metastases developed thereafter. The patient received 2 more sessions of TACE, however, metastatic lung nodules were in progress very rapidly. We decided to stop TACE and followed the patient regularly without any anti-cancer treatment. Nine months after development of lung metastasis, the size and number of metastatic lung nodules decreased and were not detected anymore after 14 months. Serum alpha-fetoprotein levels also decreased to normal range and no viable tumor was noted in the liver. The patient is still alive 12 years after the first diagnosis of HCC and 16 months after lung metastasis developed.

A case of hemophagocytic syndrome complicated by acute viral hepatitis A infection / 대한간학회지

Hemophagocytic syndrome (HPS) is a rare but serious condition that is histopathologically characterized by activation of macrophage or histiocytes with hemophagocytosis in bone marrow and reticuloendothelial systems. Clinically it presents with high fever, hepatosplenomegaly, pancytopenia, liver dysfunction, and hyperferritinemia. Hepatitis A virus is a very rare cause of secondary HPS. We report a case of a 22-year-old woman infected by hepatitis A virus who was consequently complicated with HPS. She presented typical clinical features of acute hepatitis A, and showed clinical and biochemical improvements. However, HPS developed as a complication of acute hepatitis A and the patient died of intraperitoneal bleeding caused by hepatic decompensation and disseminated intravascular coagulation.

A Case of Duodenal Amyloidosis Accompanied with Candidiasis that was Diagnosed by Endoscopy / 대한소화기내시경학회지

This report describes a case of a 63-year-old female who suffered from gastrointestinal amyloidosis. The patient presented with abdominal pain, nausea, vomiting and watery diarrhea for a week. Previously, the patient had been treated for rheumatoid arthritis. Endoscopy showed the presence of erythematous mucosa and yellowish exudates in the bulb, a finding that was compatible with duodenal candidiasis. Colonoscopy showed diffuse erythematous and easy friability in the entire colon, a finding suggestive of infectious colitis. The pathology report indicated that the lesion had amyloid, which was stained by Congo red. Endoscopic findings of amyloidosis are non-specific, such as friable mucosa, granulation, polyp, erosion and ulceration. Therefore, it is difficult to diagnose amyloidosis with endoscopic findings. However, if the patient has risk factors of secondary amyloidosis such as rheumatoid arthritis, gastrointestinal amyloidosis based on the endoscopic finding should be considered. We report a case of duodenal amyloidosis accompanied with candidiasis, which has not been previously reported.

An Adult Case of Small Bowel Intussusception Caused by Hemangioma Presenting with Intestinal Bleeding / 대한소화기학회지

Intussusception is primarily a disease of children, and is relatively rare in adults. Unlike childhood intussusception, adult intussusception has an identifiable leading lesion such as malignant or benign neoplasm. However, intussusception caused by hemangioma is very rare. There were few cases of small bowel intussusception caused by hemangioma in adults, but those reports were presented with abdominal pain. This report describes a 65-year-old female who suffered from small bowel intussusception caused by hemangioma presenting with intestinal bleeding. Upper gastrointestinal endoscopy and colonoscopy were performed, but bleeding focus was not found. Abdominal computed tomography showed the target sign of small bowel with a leading point of mass. This mass turned out to be a hemangioma after the small bowel resection. Therefore, small bowel intussusception by hemangioma should be also considered as a bleeding focus when an adult patient presented intestinal bleeding without bleeding focus in the stomach and colon. Herein we report a case of small bowel intussusception caused by hemangioma presenting with intestinal bleeding.

Endoscopic Treatment of Main Pancreatic Duct Transection, Accompanied with Pseudocyst after Abdominal Trauma, with Using Pancreatic Duct Stent: A Case Report / 대한소화기내시경학회지

Pancreatic trauma is uncommon, but this is associated with high mortality and morbidity rates. Unrecognized main pancreatic duct injury results in early complications such as fistula, pseudocyst, abscess, hemorrhage and pancreatitis. The management of traumatic pseudocyst includes observation, external drainage, internal drainage and operation. The treatment modality is determined by the site and extent of the injury to the main pancreatic duct. Pancreatic stents have been widely used to treat pancreatic diseases such as pancreatitis, pseudocyst, fistula and stricture. Pancreatic stenting has been proven to be effective in the treatment of traumatic pseudocyst associated with the partial rupture of the main pancreatic duct. Surgical treatment is currently the main stay of therapy for complete transection of the main pancreatic duct accompanied with pseudocyst, but the role of pancreatic stenting has not been established. Herein we present our clinical experience with endoscopic treatment for main pancreatic duct transection, accompanied with pseudocyst after abdominal trauma, with using a pancreatic stent.

Co-circulation of Two Genotypes of Hepatitis A Virus from Sporadic Cases in Northeastern Area of Seoul, Korea / 대한진단검사의학회지

BACKGROUND: In previous studies, most hepatitis A virus (HAV) isolates had been genotype IA in Korea. Recently, a small number of different genotypes were reported with an upsurge of acute hepatitis by HAV. We investigated the distribution of HAV genotypes. METHODS: RNA was extracted from anti-HAV IgM positive sera which were collected from March 2007 to February 2008 at a tertiary care hospital in Northeastern Seoul, Korea. Nested reverse transcription (RT)-PCR and direct sequencing for VP1/P2A region of the HAV were performed. RESULTS: A total of 699 cases with suspected acute hepatitis were tested for anti-HAV IgM, and positive results were obtained in 56 sera (8.0%), which were collected 2 to 15 days (median, 7 days)after the onset of symptoms. Of the 56 seropositive samples, 52 (92.9%) were positive for HAV RNA, among which 28 isolates (53.8%) belonged to genotype IA and the remaining 24 (46.2%) belonged to genotype IIIA. Both IA and IIIA genotypes were isolated from 6-7 neighboring administrative districts throughout the year without geographic or seasonal restrictions. CONCLUSIONS: Co-circulation of two distinct HAV genotypes (IA and IIIA) was observed from the northeastern Seoul for the year studied.

Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC). METHODS: The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline. RESULTS: The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). CONCLUSIONS: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria.

Clinical manifestations of autoimmune liver diseases in Korea / 대한내과학회지

BACKGROUND: Autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), and autoimmune cholangiopathy (AIC) are major classes of liver diseases currently considered autoimmune. We investigated the clinical, biochemical, and immunologic findings in Korean patients with these disease entities. METHODS: We retrospectively analyzed 47 patients with AIH, 27 with PBC, 3 with Overlap syndrome, 15 with AIC, and 5 with PSC. RESULTS: About 90% of the patients were women, while 40% in PSC. The mean age of onset ranged from 47 to 57 years, while it was 28 years in PSC. Fatigue and jaundice were the most frequent manifestations at diagnosis. In AIH, 13% of patients had an acute onset and 1 died of fulminant hepatic failure. The serum level of IgG was elevated in 67.5%, and antinuclear antibody and anti-smooth muscle antibody were detected in 95.7% and 43.2%. Fifty eight per cent of the patients who received immunosuppressive therapy showed a complete response. In patients with PBC, the level of IgM was elevated in 75% and all of the patients were positive for anti-mitochondrial antibody. Biochemical remission was observed in 37% on ursodeoxycholic acid therapy. Except for the negative anti-mitochondrial antibody, the clinical and biochemical features in AIC were not different from those in PBC. CONCLUSION: Autoimmune liver diseases are not rare in Korea. Considering that these entities are potentially treatable diseases, a high index of suspicion is needed, especially in patients negative for the serologic markers of viral hepatitis.

A Case of Candida parapsilosis Arthritis / 대한의진균학회지

Candida parapsilosis was not considered pathogenic, until it had been reported as the cause of the fatal case of infective endocarditis in intravenous narcotic addicts in 1940. More recently this species has emerged as an important nosocomial pathogen in many clinical infections, such as fungemia, endocarditis, endophthalmitis, septic arthritis, and peritonitis. Among them C. parapsilosis arthritis is still very rare, which is mainly caused by invasive procedures such as prosthetic arthroplasty, intraarticular steroid injection and contamination of hyperalimentation solutions. We experienced a 53 year-old male patient who had chronic elbow pain and was diagnosed as the first case of C. parapsilosis arthritis in Korea. Herein we report the case with a review of the literature.

Icteric Type Hepatocelluar Carcinoma for Which Cholangioscopic Ethanol Injection Was Effective / 대한소화기내시경학회지

Hepatocellular carcinoma often invades the portal or hepatic veins, but rarely proliferates in the bile duct. Since curative resection is rarely possible in these cases, conservative therapy has been the sole modality. Herein, we report a case of icteric type hepatocellular carcinoma for which cholangioscopic ethanol injection was effective. By only transcatheter arterial chemoembolization in this patient, obstructive jaundice and intermittent cholangitis were not relieved. Therefore, we performed ethanol injection into the intraductal hepatoma mass under percutaneous transhepatic cholangioscopic guidance. As a result of therapy, he had been well without jaundice and cholangitis for 9 months until die.