Effects of L-ascorbic acid on the production of pro-inflammatory and anti-inflammatory cytokines in C57BL/6 mouse splenocytes / 고신대학교의과대학학술지

OBJECTIVE: The imbalance between pro-inflammatory and anti-inflammatory cytokines may underlie different pain states. Although ascorbic acid is the most important physiological antioxidant that affects host defense mechanisms and immune homeostasis, there is limited information on the effects of ascorbic acid on the production of cytokines. METHODS: In this study, we investigated the in vitro effect of L-ascorbic acid (AA) on the production of pro-inflammatory and anti-inflammatory cytokines by stimulating C57BL/6 mouse splenocytes with the polyclonal activators lipopolysaccharide or concanavalin A. RESULTS: AA significantly downregulated the expression of IL-6, IL-12, and TNF-alpha at 48 h and 72 h in mouse splenocytes treated with a combination of polyclonal activators and AA. AA treatment also resulted in upregulation of IL-4 and IL-10 at 72 h. These findings demonstrated that AA significantly potentiated production of anti-inflammatory cytokines whereas there was an inverse association between AA and expression of pro-inflammatory cytokines in mouse splenocytes. CONCLUSION: AA may have potential applications in the reduction of inflammatory pain because of its function in modulating the production of cytokines. However, further in vivo investigations are necessary to elucidate the mechanisms involved.

The Association Between Serum GGT Level and Bone Mineral Density in Postmenopausal Women / 고신대학교의과대학학술지

OBJECTIVES: The aim of this study was to identify the relationship between serum gamma-glutamyltransferase (GGT) and bone mineral density (BMD) in postmenopausal women. METHODS: We evaluated 200 postmenopausal women who were visiting a health promotion center at a university hospital from January 2009 to December 2011. Their current medical diseases and medication history were collected through medical records. Basic physical examinations and laboratory tests were performed on all subjects. RESULTS: The levels of serum GGT within their normal range were positively correlated with waist circumference (P = 0.01), triglycerides (P <0.001), alkaline phosphatase (P = 0.009), and uric acid (P = 0.01). The serum GGT within their normal range were negatively associated with the femur neck BMD (P = 0.002). In adjusted analysis including age and body mass index, the BMD of the femur neck was more strongly associated with a high-normal serum GGT level among the postmenopausal women as compared with those with a low-normal serum GGT level (P = 0.02). CONCLUSIONS: Serum GGT within its normal range is negatively correlated with the BMD in the femur neck among postmenopausal women. It can be useful for selecting a group that is at high risk for the bone fracture regardless of the underlying mechanism.

Association of Intern and Resident Burnout with Self-Reported Medical Errors / 가정의학회지

BACKGROUND: Burnout is a common problem for interns and residents. It may be related to medical error, but little is known about this relationship. The purpose of this study was to determine the association between burnout and perceived medical errors among interns and residents. METHODS: The study group consisted of interns and residents working in a university hospital in Busan. Data were provided by 86 (58.5%) of 147 interns and residents. They completed a questionnaire including self-assessment of medical errors, a linear analog self-assessment of overall quality of life (QOL), fatigue, the Epworth Sleepiness Scale (ESS) score, the Maslach Burnout Inventory, and a validated depression screening tool. RESULTS: According to univariate logistic regression analyses, there was an association between perceived medical errors and fatigue (odds ratio [OR], 1.37 per unit increase; 95% confidence interval [CI], 1.12 to 1.69; P < 0.003) and ESS scores (OR, 1.13 per unit increase; 95% CI, 1.03 to 1.23; P < 0.009). Perceived medical errors were also associated with burnout (ORs per 1-unit change; emotional exhaustion OR, 1.07; 95% CI, 1.02 to 1.13; P < 0.005; depersonalization OR, 1.11; 95% CI, 1.02 to 1.21; P < 0.013), a negative depression screen (OR, 0.29; 95% CI, 0.11 to 0.76; P < 0.013), and overall QOL (OR, 0.80; 95% CI, 0.70 to 0.98; P < 0.033). In multivariate logistic regression analyses, an association was identified between perceived medical errors and emotional exhaustion (OR, 1.06; 95% CI, 1.00 to 1.11; P < 0.046) when adjusted for ESS, and depersonalization (OR, 1.01; 95% CI, 1.01 to 1.19; P < 0.04) when adjusted for fatigue. CONCLUSION: Higher levels of burnout among interns and residents were associated with perceived medical errors.

Various Diet on Immune and Nutrition of Gastrointestinal Surgical Patients / 고신대학교의과대학학술지

Malnutrition is an important condition at the elective surgical patient. Malnutrition results in the dysfunction of immune system by impairing the function of neutrophils and lymphocytes. Following gastrointestinal surgical stress, patients experience some degree of immunosuppression, increasing their risk for acquired infectious morbidity and mortality. Immune and nutrition related with infection and hospital stay in elective gastrointestinal surgical patients. Several specific nutrients such as arginine, glutamine, omega-3 fatty acids, zinc, and vitamin D, influence immunological parameters in patients undergoing surgery in laboratory and clinical studies. In conclusion, immune and nutrition may decrease infectious complication rates. However, the treatment effect varies depending on the patient population and the intervention. Further research needs to define the underlying mechanism by which immune and nutrition may be harmful and to identify which products and which patients are associated with clinical benefit.

The Functional Food Usage and Relation with Fatigue for Male Workers / 가정의학회지

BACKGROUND: Fatigue is a common problem in male workers as they have responsibilities in both role in home and in work place. The use of functional food has been one of the popular choices for fatigue recovery. This study was conducted to investigate the prevalence of functional food usage and its relationship with fatigue in male workers. METHODS: The study subjects were male workers seen for health check up at a university hospital in Busan from May to July 2009. They completed a questionnaire including social factor, occupational factor, life style, functional food usage and disease status. The subjects were divided into groups according to fatigue severity. RESULTS: Among 770 subjects, 267 (34.7%) consumed functional food daily. Most of them used functional food to recover fatigue as a supplement nutrition by their wife's or surrounding person's recommendation. There were significant difference between fatigue and non-fatigue group in age, occupation satisfaction, alcohol drinking, and insomnia. The prevalence of fatigue was 37.8%. The functional food usage significantly increased with fatigue severity scale (P < 0.001). CONCLUSION: Fatigue is common problem in male workers. The functional food usage is relation with fatigue severity.

Complaints of Fatigue and Dietary Life in Medical Students / 가정의학회지

BACKGROUND: Fatigue is a common problem in medical students and is thought to be related to poor academic performance. Fatigue is expected to be highly related to dietary habits, but previous research was not enough. Therefore, the aims of this study were to investigate the relationship between dietary habits and the prevalence of fatigue and also to give an update on basic research data for improving academic performance in medical students. METHODS: The study group consisted of 170 healthy second-year medical students attending three university school of medicine in Busan. They completed a questionnaire dealing with fatigue (Fatigue Severity Scale), dietary habits, lifestyle, and academic performance. RESULTS: On multivariate logistic regression analyses, skipping breakfast (completely skipping breakfast everyday versus having breakfast everyday; odds ratio 7.23; 95% confidence interval, 2.07 to 25.28; P = 0.002) was positively correlated with the complaints of fatigue. CONCLUSION: Skipping breakfast was associated with the complaints of fatigue in medical students.

The Effects of Hormone Therapy and Alen- dronate on Bone Mineral Densities and Bone Metabolism of Postmenopausal Osteopenia

BACKGROUND: There have been bone mass studies for the treatment of osteoporosis, nonetheless, little attention has been paid to the management of osteopenia. This study was to evaluate the effects of estrogen, alendronate and their combination on bone mineral density and bone metabolism in the postmenopausal women with osteopenia. METHODS: A total of 150 healthy regional patients with osteopenia from Busan were enrolled in prospective randomized clinical trial and randomly assigned to receive conjugated equine estrogen (group I), alendronate (group II), or combination of the two (group III). Assessments included BMD of L2-4 spines and femur neck by DEXA and markers of bone turnover including serum osteocalcin, total alkaline phosphatase and urine deoxydyridinoline (Dpd). BMD and markers of bone turnover were re-evaluated at 6 and 12 months after the treatment. RESULTS: BMD of the lumbar spines increased significantly at 12 months after treatment in the three groups (P<0.05). BMD of the femur neck increased at 12 months after treatment in the three groups, but significantly in group III (P<0.05). Serum osteocalcin decreased at 12 months after treatment in the three groups, but only significantly in group III. Urine Dpd decreased at 12 months after treatment in three groups, but significantly in group, II and III (P<0.05). Serum total alkaline phosphatase decreased at 12 months after treatment in only group III (P<0.05). There was more favorable benefit for group III in BMD of the lumbar spines and serum osteocalcin and urine Dpd at 12 months after treatment compared to group, II and III (P<0.05). CONCLUSION: These results indicated a favorable benefit of conjugated equine estrogen, alendronate, or combination of the two in BMD and important markers of bone turnover. The combined treatment with conjugated equine estrogen and alendronate was more effective in postmenopausal women with osteopenia. Long-term studies are required to confirm these results.

Laparoscopic Enucleation of a Pancreatic Mucinous Cystadenoma

We report a case of a 52-year-old man in whom a cystic pancreatic tumor was successfully removed by laparoscopic enucleation. The patient had a followup CAT-scan for a resolving right upper lobe pneumonia which demonstrated a unilocular hypodense 3.9x2.2 cm sized cyst in the uncinate process of the pancreas. He had a laparoscopic biliopancreatic diversion with duodenal switch in July 2002, and also had laparoscopic cholecystectomy for cholelithiasis in December 2003. Laparoscopic intraoperative ultrasonography revealed a solitary cystic tumor in the inferior portion of pancreatic head. Laparoscopic enucleation of the tumor was performed using Ultracision(R) between the cyst outer wall and the normal pancreatic parenchyma. The operative time was 160 minutes, the estimated blood loss was 20 ml, and there were no perioperative complications. The patient's postoperative course was uneventful, and he was discharged on the first postoperative day. The histopathologic diagnosis showed a mucinous cystadenoma. We reported a new technique for safe management of small cystic tumors located on surface of the pancreas.

A Case of Adenoid cystic Carcinoma in the Uterine Cervix / 대한산부인과학회지

Adenoid cystic carcinoma is an uncommon adenocarcinoma type which affects mainly the salivary gland and respiratory system. In the female reproductive tract it occurs more commonly in Bartholin's gland and than in uterine cervix. Almost patients are postmenopausal women. The main presenting complaint is vaginal spotting having an abnormal pap smear. It has been diagnostically confused with adenoid basal carcinoma which has a somewhat different clinical course and pathology. The treatment should be individualized to the patients by local recurrence or distant metastasis. It shows relatively unfavorable survival. Recently we experienced a case of adenoid cystic carcinoma arising in the cervix after menopause, so we report this case with a brief review of literature.

Nutritional Status in Elderly Gastric Carcinoma

BACKGROUND: Malnutrition is one of the important factors influencing morbidity and mortality in elderly patients with gastric carcinoma. METHODS: Since September to December 2001, we investigated the nutritional parameters of 44 elderly patients with gastric carcinoma by measuring anthropometric and biochemical blood indices and assessing dietary intake along with subjective global assessment. RESULTS: The mean body mass index of subjects was below the physical average of korea on the base of 64 years old. The ratio of carbohydrate, protein and lipid to energy intake was 74.0:13.5:12.5(%). There were significantly positive correlations between three groups according to subjective global assessment and height, body weight, 1 month weight loss %, 6 month weight loss %, body mass index, transferrin and nutrient intake, such as energy, protein and niacin. CONCLUSION: Mean nutrient intake, such as total energy, protein and niacin appear to be related of subjective global assessment in elderly subjects. Nutritional assessment by nutrient intake should be done in elderly patients with gastric carcinoma and be supplied with adequate nutrition for them.

Upper Gastrointestinal Endoscopy without Topical Pharyngeal Anesthesia

BACKGROUND: Many endoscopists generally use topical pharyngeal anesthesia as a premedication for upper gastrointestinal endoscopy. However, the use of topical pharyngeal anesthesia for upper GI endoscopy has been debated since its inception. The purpose of this study was to compare the effect of no premedication to the effect of a lidocaine premedication. METHODS: One hundred consecutive examinees scheduled for diagnostic upper endoscopy, divided into two group 50, were randomly assigned to receive topical lidocaine spray or without. The test group involved subjects not using topical pharyngeal anesthesia and the control group involved subjects using it without sedation. The collected Data included intubation time (seconds), procedure time (minutes), pulse rate, blood pressure, the difficulty of the endoscopy (VAS), anxiety (STAI), and discomfort. Examinees were also asked whether they would agree to another endoscopy if their doctor thought it was medically necessary. RESULTS: In the response to the amount of cough, belching, bloating or the degree of difficulty in endoscopic procedure, there was no statistically significant difference between the test group and the control group. The intubation time was significantly different comparing the no-premedication group versus lidocaine premedication group. However, the procedure time was not significantly different. In the normotensive group, the changes of systolic blood pressure during endoscopy were significantly higher in the test group than in the control group. CONCLUSION: Evaluating all variables, there was no statistically significant difference between the test group and the control group.

Rapid Detection of Mycoplasma pneumoniae and Antimicrobial Susceptibilities of the M. pneumoniae Isolates

The throat swabs obtained from 1,098 adults and 432 children patients with respiratory diseases were examined for Mycoplasma pneumoniae infection detected by culture and polymerase chain reaction (PCR). Antimicrobial susceptibilities of the resulting 60 M. pneumoniae isolates were evaluated by testing minimum inhibitory concentrations (MICs) of erythromycin, minocycline, tetracycline, josamycin, sparfloxacin, ofloxacin, and ciprofloxacin by a broth micro-dilution method. In a preliminary screening, the detection rate of M. pneumoniae by PCR was 29.2% (277/948) for the adults and 28.3% (90/318) for the children. In the second survey, the isolation rate of M. pneumoniae by culture was 29.3% (44/150) for the adults, and 14.0% (16/114) for the children. The PCR detection rate was 36.7% (55/150) for the adults and 23.7% (27/114) for the children. The MIC90s of the M. pneumoniae isolates were 0.015 mg/ml for erythromycin, lower than 0.03 mg/ml for josamycin, 0.06 mg/ml for sparfloxacin and minocycline, 0.12 mg/ml for tetracycline, 0.5 mg/ml for ofloxacin and CFC-222, and 1.0 mg/ml for ciprofloxacin. The isolates were susceptible to erythromycin, josamycin, sparfloxacin, minocycline, tetracycline, and ofloxacin, but the 63.3% of them was resistant to ciprofloxacin. These results indicate that the PCR method has a significant potential as a rapid and sensitive method for early detection of M. pneumoniae infection in clinical specimens as compared with the culture method, but the PCR method could not provide any information concerning the biological chracteristics of M. pneumoniae strains. Erythromycin, josamycin, sparfloxacin, minocycline, and tetracycline could be recommended as the antimicrobial agents of choice in Korea.

A Case of Leiomyoma of the Vagina / 대한산부인과학회잡지

The leiomyoma of the uterus is most common benign genital tumor in women of reproductive age but occurs in the vagina rarely and may be confused with a variety of vaginal tumors. A preoperative diagnosis is seldom made. Recently we experienced a case of vaginal leiomyoma arising in the anterior vagina wall and concomitant uterine leiomyoma, so we report this case with a brief review of literature.

A Case of Intussusception of the Cecum and Appendix Due to Endometriosis Mistaken as a Cecal Tumor / 대한산부인과학회잡지

We report a case of intussusception of the cecum and appendix arising in pericecal endometriosis that are mistaken as a cecal tumor preoperatively. At the other OBGY clinic, the 1st lapalotomy was performed for management of leiomyoma but pelvic organs were adhesion severely and palpation mass in the cecum and appendix. The patient was transfer to our hospital for evaluation and treatment of mass. We investigated to intestine closely and diagnosis was cecal tumor colonoscopically. Total hystrectomy and iliocecectomy was performed successfully and discovered intussusception of the cecum and appendix due to endometriosis mistaken as a cecal tumor in operative field. Postoperatively, this case was diagnosed in pericecal endometriosis histologically.

The propensity to depression in Korean internet users

BACKGROUND: The goals of this study are to evaluate the propensity to depression in Korean internet users associated with internet using environment and attempt to aid proper management of internet users in the field of family practice. METHODS: A group of 1,674 subjects who replied to internet research were selected from March 26 to 28, 1999. Making use of CES-D-K for Korean internet users, we investigated the propensity to depression. At the same time, general characteristics, internet using environmental characteristics were investigated and their relationship was assssed. RESULTS: The CES-D-K score was 16.19. The CES-D-K score was significantly higher in females, in younger age and low education level group(P<0.001). There was no significance between CES-D-K score and region. In internet using environmental characteristics, the CES-D-K score was significantly higher in low velocity users, long internet using time per day group (P<0.001). There was no significance between CES-D-K score and internet using year. CONCLUSION: There was a significant correlation between internet using velocity, internet using time per day and the propensity to depression. Therefore, family physician should think about the correlation of the propensity to depression and internet using environment, if internet users have symptoms of depression.

Long term effects on oral progestogen (medroxyprogesterone acetate) on the bone mineral densities and the level of serum lipid metabolism during estrogen replacement therapy in postmenopausal women

BACKGROUND: In postmenopausal women, progestogen should be added to protect the endometrium from hyperplasia or carcinoma induced by the unopposed estrogen. However, the effects of progestogen on bone mineral densities and serum lipodproteins have not been precisely evaluated in Korean postmenopausal women. METHODS: To evaluate the effects of progestogen on bane mineral densities and serum lipoprotein in estrogen rephcement therapy, we canducted a 2-year trial of long conjugated equine estrogen(conjugated estrogen 0.625mg/day) with or without cyclic progestogen(MPA 5mg/day for 12 days) in 120 postmenopausal women. In all subjects, bone mineral density was measured in lumbar vertebra(L2-L4) and femur neck using dual energy X-ray absorptiometry(DEXA) and serum lipoprotein was measured from the beginning of the treatment, 12 manths, and 24 manths later, respectively. RESULTS: BMD of femur neck in both groups increased but not significantly compared to basal level at 12 months and/or 24 months of treatment. As for BMD of lumbar spine, it increased significantly in both groups. Both groups showed a significant decrease in the levels LDL cholesterol, but there was no statistical significance in serum triglycerids. Conjugated estrogen plus MPA group in constrast to conjugated estrogen only group showed a significant decrease in total cholesterol levels. CONCLUSIONS: These results suggest that the addition of MPA of the daily of 5mg for 12 days cyclically in estrogen replacement treatment appear to be effective in postmenopausal women with protection on bone mineral density and maintenance of long-term favorable effects on serum lipoprotein.