Prevalence of and Risk Factors for Gastrointestinal Diseases in Korean Americans and Native Koreans Undergoing Screening Endoscopy

BACKGROUND/AIMS: In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. METHODS: In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. RESULTS: The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. CONCLUSIONS: Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.

Job analysis and satisfaction of dietitians, nutrition teacher in school foodservice by school type in Gwangju and Jeonnam area

The objective of this study was to examine job performance and importance, and job satisfaction of school foodservice dietitians, nutrition teacher in Jeonnam and Gwangju area according to the school types (elementary school, middle school, high school). A total of 646 questionnaires were distributed, 244 questionnaires were analyzed using SPSS 12.0 for a descriptive analysis, t-test and ANOVA. There were significant differences between the school dietitians', nutrition teachers' job performance and importance in all areas of the job analysis for all school types. In the foodservice management/evaluation and nutrition education area, elementary and middle school foodservice dietitians, nutrition teacher showed a significantly higher performance, compared to that of high school dietitians, nutrition teacher. Nutrition education was recognized by elementary and middle school dietitians, nutrition teacher to be more significantly important than that of high school dietitian, nutrition teacher. Elementary school foodservice dietitians, nutrition teacher was most satisfied with their job condition. Dietitian working in middle school was least satisfied with the salary and compensation. These results suggest that appropriate curriculum should be structured according to foodservice dietitians, nutrition teacher of the school type for improving the work efficiency. In order to increase the job satisfaction, the employment status of school dietitian should be guaranteed by the government and school officials, especially in the middle and high schools.

A Case of Malignant Fibrous Histiocytoma That Metastasized to the Skin / 대한피부과학회지

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma. It is regarded as an undifferentiated pleomorphic sarcoma with an unproven histogenesis. It most commonly occurs in the skeletal muscles of the extremities or the retroperitoneum of adults. It often metastasizes to the lungs, lymph nodes, bones and liver, but rarely to the skin. We report here a case of malignant fibrous histiocytoma that metastasized to the skin.

Expression of Claudin-1 in the Fetal Skin during the Developmental Stage / 대한피부과학회지

BACKGROUND: Claudins are integral membrane proteins at tight junctions of simple epithelium and have an important role in cell-cell adhesion and barrier function. Their altered expression modifies the biological function and behavior of epithelial cells. OBJECTIVE: The purpose of this study was to observe the distribution and the degree of expression of claudin-1 during fetal skin development. METHODS: The expression of claudin-1 in the fetal skin was analyzed after immunohistochemical stain was performed on paraffin embedded tissue of sole and scalp of 34 human fetuses, ranging from 10 to 39 weeks of gestational age, using anti-human monoclonal antibody against the claudin-1. RESULTS: Claudin-1 appeared strongly in the sole skin at the 12th week of gestation thereafter expressed more in middle layer in epidermis of the sole and the scalp. Inner root sheaths and early hair germ cells were strongly positive in fetal hair development. Eccrine gland epithelium was positive in later stages. Focal positive expression in superficial layer and strong in middle layer were noted in oral mucosa side of the lip. CONCLUSION: Claudin-1 showed slightly different expression in skin and oral mucosa and has a important role in the development of tight junction and barrier formation in skin and mucosa during fetal stage.

A Case of Pseudoangiomatous Spindle Cell Lipoma / 대한피부과학회지

Spindle cell lipoma, an entity first described in 1975, accounts for about 1.5% of adipocytic neoplasms and is outnumbered by conventional benign lipomas by approximately 60 to 1. We report an unusual pseudoangiomatous variant of spindle cell lipoma on the right thigh of a 78-year-old man. The lesion had the features of typical spindle cell lipoma which was composed of mature fat cells and uniform spindle cells in a mucoid matrix with collagen bundles. In addition, the lesion exhibited irregular, branching spaces with villiform connective tissue projections, giving a striking angiomatoid appearance. Immunohistochemically, the spindle cells were positive for CD34, and lining cells of pseudoangiomatous spaces were negative for CD31, factor VIII-Ag.

A Case of Leukocytoclastic Vasculitis after Use of Sorafenib (Nexavar(R)) / 대한피부과학회지

Sorafenib (Nexavar(R)) is an oral multikinase inhibitor that was recently approved for use in metastatic renal cancer. It is currently undergoing investigation for the treatment of locally advanced renal cancer and in other tumor types. It has a broad spectrum of activity in treating multiple tyrosine kinases, including angiogenic factors VEGFR and PDGFR. Common cutaneous toxicities experienced with sorafenib include facial and scalp erythema, hand-foot syndrome, splinter hemorrhages, and alopecia. We report a case of a 57 year-old man diagnosed as renal cell carcinoma with distant metastaisis, who developed a leukocytoclastic vasculitis on the extremities after use of sorafenib.

A Case of Borderline Tuberculoid Leprosy with Type 1 Reaction / 대한피부과학회지

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.

A Case of Scalp Metastasis Manifested as the Presenting Sign of Thyroid Carcinoma / 대한피부과학회지

Cutaneous metastasis from the papillary thyroid carcinoma is rare. An otherwise asymptomatic 57-year-old man presented with a 3 year history of a steadily-enlarging scalp nodule. The histopathologic features showed a complicated pattern of follicular architecture formed by papilliform fibrovascular stroma. The tumor cells stained positive for thyroglobulin. A subsequent thyroid sonogram revealed multiple nodules in both lobes and resection of the thyroid gland identified papillary thyroid carcinoma. The solitary scalp nodule was presenting sign of an occult thyroid carcinoma. We report a case of cutaneous metastasis from the papillary thyroid carcinoma.

Pattern of Lymph Node Metastasis on the Prophylactic Central Neck Node Dissection in Management of Papillary Carcinoma of Thyroid / 대한내분비외과학회지

PURPOSE: In papillary thyroid carcinoma, lymph node metastasis at presentation does not seem to affect survival adversely, but does increase the risk of loco-regional tumor recurrence. The benefits of prophylactic central neck node dissection (PCND) have not been clearly demonstrated so far and should be weighed against the potential risks of the procedure. The aims of this study are as follows; to determine the frequency and the pattern of the lymph node metastasis and the risk factors influencing the metastasis to level VI lymph nodes, and to determine the necessity of the contralateral central lymph node dissection. METHODS: A retrospective analysis had been carefully performed over 68 patients with papillary carcinomas undergoing total thyroidectomy with PCND during the period from July 1, 2000 to August 31, 2002. In addition to the analyses of the incidence and the pattern of central lymph node metastasis, we statistically analyzed the correlation between lymph node metastases and the risk factors such as tumor size, age, lymphatic tumor emboli, vascular tumor emboli, perithyroidal soft tissue invasion, and multifocality, etc. RESULTS: The mean age was 46 years (22~76) and the tumor size ranged from 0.2 to 9 cm (mean 2.2 cm). The micropapillary carcinoma was detected by pathological findings in 10 patients (14.7%). The lymphatic tumor emboli and vascular tumor emboli occurred in 8 patients (11.8%) and 2 patients (2.9%) respectively. Thirty eight patients (55.9%) showed perithyroidal tissue invasion. The mean number of harvested lymph nodes in level VI was 13.7 (6~32). Among 68 patients, lymph node metastasis occurred in 49 patients (72.1%) and the mean number of metastatic lymph node was 5.4. Among the patients with metastasis, the rate of metastasis among the harvest nodes amounted to 39.0%. Metastasis to Delphian nodes was detected in 2 patients (2.9%). In addition, 15 patients (22.1%) showed metastatic contralateral central nodes. Patients less than 40 years old tend to have more metastatic lymph nodes (P=0.012). Futhermore, the patients with tumor larger than 2 cm increased incidence of lymph node metastasis (P=0.036). CONCLUSION: After the prophylactic central neck nodes dissection in case of papillary carcinoma patients, metastatic lymph nodes were found in 72.1%. In conclusion, we would like to recommend prophylactic central neck node dissection to papillary carcinoma patients in order not only to prevent local recurrence but to avoid the difficulties of reoperation, especially for those with high risk for nodal involvement (less than 40 years old or more than 2 cm of tumor size). Because of the relatively high incidence of contralateral central lymph nodes metastasis, we suggest the importance of dissection of contralateral central lymph nodes along with unilateral central.

A Case of Chondroid Syringoma with Follicular Differentiation / 대한피부과학회지

Chondroid syringoma, also known as `mixed tumor of the skin', is a kind of acquired hamartoma of folliculosebaceous-apocrine lineage. Histologically, it is characterized by the biphasic pattern, with epithelial structures enveloped by abundant stroma. We report a case of chondroid syringoma, as an asymptomatic nodule, on the upper lip of a 55-year-old male. Histologically, the tumor had both epithelial components with follicular differentiation and myxochondroid stroma.

Treatment of Major Vascular Injuries

PURPOSE: Major vascular injuries are frequently a challenging problem, jeopardizing patient or limb survival. We performed this retrospective study to establish an optimal management plan for major vascular injuries. METHOD: Our subjects consisted of 38 cases treated for major vascular injury between January 1999 and December 2002 at Gil Medical Center. The cause of injury, location, clinical presentations, treatment modalities and prognosis were reviewed. RESULT: The mean age was 48.6 years (range 18~76) and the male-to-female ratio was 1.5:1. There were 34 arterial injuries and 11 venous injuries, including 7 cases with both injuries. The causes of injury were iatrogenic in 22 cases, traffic accident in 7, stab injury in 5, industrial injury in 3, and fall injury in 1. In the iatrogenic injuries, 15 cases were due to angiography or vascular interventional procedures, 6 to other operations, and 1 to arterial catheter for pressure monitoring. The types of arterial injuries were pseudoaneurysm in 16 cases, laceration in 7, thrombosis in 6, transection in 2 and arteriovenous fistula (AVF) in 3. The venous injury types were laceration in 6 cases, AVF in 3, and thrombosis and transection in 1 each. We performed various types of revascularization operation in 26 cases and radiologic intervention in 12. There was no hospital mortality or unexpected major amputation. CONCLUSION: Recently, as a consequence of the widespread application of vascular interventional procedures, the incidence of iatrogenic vascular injuries has increased. The factors for successful management of major vascular injuries are early diagnosis, earlier involvement of a vascular surgeon in the patient care, and prompt revascularization either by surgery or interventional procedure.

Early Result of Laparoscopic Colorectal Surgery

PURPOSE: The aim of this study is to assess the safety and the efficacy of laparoscopic colorectal surgery compared to those of conventional open surgery and to determine the feasibility of laparoscopic colorectal surgery based on oncologic principles. METHODS: From March 2001 to January 2002, 27 consecutive patients were assessed for the possible use of laparoscopic surgery. Thirty patients were included in the open group. Forty-seven patients were included in the laparoscopic group. The decision regarding the suitability of a patient for the procedure was made by the surgeon. RESULTS: Laparoscopic surgery was attempted on 47 patients, and in 31 patients, it was completed successfully. Patients who underwent laparoscopic surgery required a smaller dose of analgesics and had an earlier bowel passage recovery and shorter hospital stay than patients who underwent open surgery. The mean operation times for the open group, the conversion group, and the laparoscopic group were 252 min, 269 min, and 272 min respectively (P>0.05). There was no difference in the number of lymph nodes dissected nor the length of the distal margin of the resected bowel in the case of anterior resection and low anterior resection of the laparoscopic group compared to the open and the conversion groups (P>0.05). Complications in the laparoscopic surgery group were anastomosis site leakage and bowel obstruction. In the open group, wound infection, urinary retention, anastomosis site leakage and bowel obstruction were found. The morbidities of the open group, the conversion group, and the laparoscopic group were 23.3%, 37.5%, and 12.9%, respectively. One mortality was observed in the conversion group. CONCLUSIONS: In this study, there is no evidence that the laparoscopic technique is inadequate for following the cancer surgery principle, So laparoscopic colorectal surgery is a safe and feasible treatment. The overall morbidity and mortality in this study were acceptable. Sufficient lymph node dissection and distal margin of the resected bowel were accomplished with laparoscopic surgery. Further long-term follow up, however, will be necessary to confirm the value of this technique.

The Effects of a Combination of Nicardipine and Esmolol on Blood Pressure and Heart Rate after Endotracheal Intubation in Hypertensive Patients / 대한마취과학회지

BACKGROUND: This study was designed to determine the efficacy of a combined use of esmolol and nicardipine for blunting hypertension and tachycardia after tracheal intubation in hypertensive patients. METHODS: Forty-five hypertensive patients were randomly divided into three group: group E (esmolol 0.5 mg/kg, n = 15), group N (nicardipine 30microgram/kg, n = 15), group EN (esmolol 0.25 mg/kg, nicardipine 15microgram/kg, n = 15). All patients received midazolam 0.5 mg/kg, and glycopyrrolate 0.2 mg IM for premedication. Fentanyl 1microgram/kg was injected before induction of anesthesia, and then esmolol, nicardipine, or the mixed drugs were administrated as an IV bolus and immediately followed by the induction drugs: thiopental 5 mg/kg, and succinylcholine 1 mg/kg. Endotracheal intubation was performed 90 seconds after injection of the experimental drugs. Thereafter 50% Nitrous Oxide in oxygen and 2 vol % enflurane were inhaled. BP and HR were recorded at the resting state, before fentanyl injection (base {T0}), after injection test drug (T1), after induction (T2), immediately after intubation (T3), 2 min (T4), 3 min (T5), 4 min (T6), and 5 min (T7) after intubation. RESULTS: There was a significant attenuation in SBP, MBP, DBP after tracheal intubation on the nicardipine and mixed groups compared to the esmolol group. HR was significantly lower in the esmolol and mixed groups than in the nicardipine group after tracheal intubation. CONCLUSIONS: Combined administration of esmolol (0.25 mg/kg) and nicardipine (15microgram/kg) was effective in attenuating an increase of BP and HR during tracheal intubation in hypertensive patients.

Comparison of Three Doses of Isobaric Ropivacaine Mixed with Fentanyl during Spinal Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: We evaluated the appropriate dose of spinal isobaric 0.75% ropivacaine with fentanyl for cesarean section. METHODS: Forty-five healthy term parturients scheduled for an elective cesarean section randomly received 14, 16, 18 mg of 0.75% isobaric ropivacaine intrathecally, which was mixed with fentanyl 20microgram. Sensory blockade variables such as time to L1 block, max. block height, time to max block height, and time to recovery to L1 were assessed. Motor blockade variables such as time to Bromage scale 3, motor recovery time (Bromage scale 3 to 1) and muscle relaxation were assessed. We also checked side effects, and hemodynamic variables. RESULTS: Anesthesia was successful in 57%, 80%, and 93.3% of groups I (14 mg), II (16 mg), and III (18 mg) respectively and there was no significant difference between the three groups. The time to max. sensory and motor block and level of maximum sensory block were not significantly different between the three groups. All groups showed complete motor block, and muscle relaxation was equally excellent in the three groups. Sensory and motor recovery time were not significantly different. The incidence of hypotension was more frequent in group 3 compared with group 1. The incidence of nausea was more frequent in group 3 compared with group 1, and 2. CONCLUSIONS: An intrathecal injection of 16 mg of isobaric 0.75% ropivacaine with fentanyl 20microgram during spinal anesthesia is suitable for an elective cesarean section.

Calcium and phosphorous distributions in the alveolar bone of orthodontically treated cats / 대한치과교정학회지

This experiment was performed to investigate the response of inorganic substances in alveolar bone in relation to the experimental tooth movement. Right canine in maxillary jaw was tipped in cats by coil springs generating 80 gm. force, in mandibular jaw, the force was 100 gm. force. Cats were divided into five groups and orthodontically treated for one hour, 1, 7, 14 and 28 days, respectively. Alveolar bone samples were obtained from tension and compression sites as well as from contralateral control sites. The level of calcium of alveolar bone was determined by atomic absorption spectrophotometry and inorganic phosphorus was measured by spectrophotometry. The results obtained were-as follows: 1. In tension and compression site of maxillary alveolar bone, calcium levels were decreased at 1, 7 and 14 days, but recovered at 28 days. 2. The levels of inorganic phosphorus in compression site of maxillary alveolar bone had little change but in tension site of maxillary alveolar bone,, phosphorous levels were decreased. 3. Calcium levels in tension and compression site of mandibular alveolar bone were decreased, especially at 28 days. 4. In tension and compression site of mandibular alveolar bone, inorganic phosphorus were slightly decreased from I day.