Temporal Arteritis with Diagnostic Brain Magnetic Resonance Imaging

Purpose@#To report a case of arteritic anterior ischemic optic neuropathy diagnosed with brain magnetic resonance imaging (MRI) for temporal arteritis instead of temporal artery biopsy.Case summary: An eighty-three years old female visited our clinic for right blurred vision for 2 weeks ago with occipital headache for 4 months and mastication problems. Initial best corrected visual acuity was 0.1 in right eye. She had right inferior altitudinal visual field defect and superior pale optic disc swelling with few cotton wool spots were checked. In serologic tests, erythrocyte sedimentation rate, C reactive peptide, and rheumatoid factor were increased, and fluorescent antinuclear antibody was positive. We performed high resolution brain MRI which could find superficial temporal artery’s luminal signal. In MRI image, we could find loss of intraluminal signal intensity void with total luminal obstruction. We assumed as arteritic anterior ischemic optic neuropathy and high dose intravenous steroid was done. Visual acuity of right eye was 0.9 and central scotoma was improved 1 week after intravenous steroid. We changed to oral steroid with tapering and added oral azathioprine. After 11 months of oral steroid use, her visual acuity was 0.9 in right eye and inferior altitudinal visual field defect was much improved. @*Conclusions@#A patient suspected anterior ischemic optic neuropathy was diagnosed by brain MRI with abnormalities in superficial temporal artery. Visual acuity and visual field defect were improved by steroid and immunosuppressive treatment for arteritic anterior ischemic optic neuropathy.

Factors Related to Regional Variation in the High-risk Drinking Rate in Korea: Using Quantile Regression / 예방의학회지

Objectives@#This study aimed to identify regional differences in the high-risk drinking rate among yearly alcohol users in Korea and to identify relevant regional factors for each quintile using quantile regression. @*Methods@#Data from 227 counties surveyed by the 2017 Korean Community Health Survey (KCHS) were analyzed. The analysis dataset included secondary data extracted from the Korean Statistical Information Service and data from the KCHS. To identify regional factors related to the high-risk drinking rate among yearly alcohol users, quantile regression was conducted by dividing the data into 10%, 30%, 50%, 70%, and 90% quantiles, and multiple linear regression was also performed. @*Results@#The current smoking rate, perceived stress rate, crude divorce rate, and financial independence rate, as well as one’s social network, were related to the high-risk drinking rate among yearly alcohol users. The quantile regression revealed that the perceived stress rate was related to all quantiles except for the 90% quantile, and the financial independence rate was related to the 50% to 90% quantiles. The crude divorce rate was related to the high-risk drinking rate among yearly alcohol users in all quantiles. @*Conclusions@#The findings of this study suggest that local health programs for high-risk drinking are needed in areas with high local stress and high crude divorce rates.

Temporal Arteritis with Diagnostic Brain Magnetic Resonance Imaging

Purpose@#To report a case of arteritic anterior ischemic optic neuropathy diagnosed with brain magnetic resonance imaging (MRI) for temporal arteritis instead of temporal artery biopsy.Case summary: An eighty-three years old female visited our clinic for right blurred vision for 2 weeks ago with occipital headache for 4 months and mastication problems. Initial best corrected visual acuity was 0.1 in right eye. She had right inferior altitudinal visual field defect and superior pale optic disc swelling with few cotton wool spots were checked. In serologic tests, erythrocyte sedimentation rate, C reactive peptide, and rheumatoid factor were increased, and fluorescent antinuclear antibody was positive. We performed high resolution brain MRI which could find superficial temporal artery’s luminal signal. In MRI image, we could find loss of intraluminal signal intensity void with total luminal obstruction. We assumed as arteritic anterior ischemic optic neuropathy and high dose intravenous steroid was done. Visual acuity of right eye was 0.9 and central scotoma was improved 1 week after intravenous steroid. We changed to oral steroid with tapering and added oral azathioprine. After 11 months of oral steroid use, her visual acuity was 0.9 in right eye and inferior altitudinal visual field defect was much improved. @*Conclusions@#A patient suspected anterior ischemic optic neuropathy was diagnosed by brain MRI with abnormalities in superficial temporal artery. Visual acuity and visual field defect were improved by steroid and immunosuppressive treatment for arteritic anterior ischemic optic neuropathy.

Factors Related to Regional Variation in the High-risk Drinking Rate in Korea: Using Quantile Regression / 예방의학회지

Objectives@#This study aimed to identify regional differences in the high-risk drinking rate among yearly alcohol users in Korea and to identify relevant regional factors for each quintile using quantile regression. @*Methods@#Data from 227 counties surveyed by the 2017 Korean Community Health Survey (KCHS) were analyzed. The analysis dataset included secondary data extracted from the Korean Statistical Information Service and data from the KCHS. To identify regional factors related to the high-risk drinking rate among yearly alcohol users, quantile regression was conducted by dividing the data into 10%, 30%, 50%, 70%, and 90% quantiles, and multiple linear regression was also performed. @*Results@#The current smoking rate, perceived stress rate, crude divorce rate, and financial independence rate, as well as one’s social network, were related to the high-risk drinking rate among yearly alcohol users. The quantile regression revealed that the perceived stress rate was related to all quantiles except for the 90% quantile, and the financial independence rate was related to the 50% to 90% quantiles. The crude divorce rate was related to the high-risk drinking rate among yearly alcohol users in all quantiles. @*Conclusions@#The findings of this study suggest that local health programs for high-risk drinking are needed in areas with high local stress and high crude divorce rates.

Alterations of Colonic Contractility in an Interleukin-10 Knockout Mouse Model of Inflammatory Bowel Disease

BACKGROUND/AIMS: Inflammatory bowel disease is commonly accompanied by colonic dysmotility and causes changes in intestinal smooth muscle contractility. In this study, colonic smooth muscle contractility in a chronic inflammatory condition was investigated using smooth muscle tissues prepared from interleukin-10 knockout (IL-10(-/-)) mice. METHODS: Prepared smooth muscle sections were placed in an organ bath system. Cholinergic and nitrergic neuronal responses were observed using carbachol and electrical field stimulation with L-NG-nitroarginine methyl ester (L-NAME). The expression of interstitial cells of Cajal (ICC) networks, muscarinic receptors, neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) was observed via immunofluorescent staining. RESULTS: The spontaneous contractility and expression of ICC networks in the proximal and distal colon was significantly decreased in IL-10(-/-) mice compared to IL-10(+/+) mice. The contractility in response to carbachol was significantly decreased in the proximal colon of IL-10(-/-) mice compared to IL-10(+/+) mice, but no significant difference was found in the distal colon. In addition, the expression of muscarinic receptor type 2 was reduced in the proximal colon of IL-10(-/-) mice. The nictric oxide-mediated relaxation after electrical field stimulation was significantly decreased in the proximal and distal colon of IL-10(-/-) mice. In inflamed colon, the expression of nNOS decreased, whereas the expression of iNOS increased. CONCLUSIONS: These results suggest that damage to the ICC network and NOS system in the proximal and distal colon, as well as damage to the smooth muscle cholinergic receptor in the proximal colon may play an important role in the dysmotility of the inflamed colon.

Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease

PURPOSE: Peripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in PAOD. This study aimed to evaluate these issues for PN and to establish the importance of screening as additional treatment target for PN in PAOD. MATERIALS AND METHODS: A total of 52 limbs with PAOD were enrolled from January 2011 to December 2012. PN was divided into radiculopathy, ischemic PN (IPN), and diabetic PN (DPN), based on electromyographic findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors. RESULTS: The prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). In terms of subtypes of PN, the prevalence rate of radiculopathy and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 limbs (73.3%) among 30 diabetic limbs. There was no significant correlation between each type of PN and ischemic symptoms. Our analysis showed that coronary artery disease (CAD) was a significant risk factor (P=0.01) for IPN, however, did not identify any significant risk factors for DPN. CONCLUSION: This present study indicated that most patients with PAOD had PN and CAD was a risk factor for IPN. In particular, PAOD with diabetes represented a higher prevalence for DPN. Our study suggests that PN should be evaluated and considered as another treatment target in patients with PAOD.

Microscopic colitis in a single center study: clinical feature & characteristics / 대한내과학회지

BACKGROUND/AIMS: Collagenous colitis (CC) and lymphocytic colitis (LC) are characterized by chronic diarrhea and normal radiologic and endoscopic findings. These are currently not uncommon entities whose incidence in increasing as more clinicians take biopsies from macroscopically normal colons. The purpose of this study was to examine the clinical features and characteristics in microscopic colitis. METHODS: From January 2003 to December 2006, medical records were reviewed from 80 patients with chronic diarrhea, who had normal colonoscopic findings but underwent biopsy. Patients with microscopic colitis were identified by reviewing the pathology databases and by reviewing biopsies. RESULTS: Microscopic colitis was diagnosed in 12 patients (15%). Six patients with CC (Male:Female=2:4, mean age 54+/-20.1 years) and 6 patients with LC (Male:Female=5:1, mean age 51.2+/-21.4 years) were identified. Autoimmune disease was diagnosed in 4 patients (33%). Drug-induced disease was suspected in 3 patients (25%). The inciting drugs were NSAIDs, ticlopidine, ranitidine, and acarbose. Complete or partial resolution of diarrhea was achieved in all patients, including spontaneous resolution in 2 patients. Antidiarrheal drugs, mesalazine, and cholestylamine were highly effective in both diseases. Recurrence of symptoms occurred in 2 patients (17%). They are taking medicine at present. CONCLUSIONS: Microscopic colitis is a relatively common cause of chronic diarrhea that appears to be increasing in incidence. We reported clinical features, characteristics, treatment, and response of microscopic colitis in our experience.