Factors Influencing the Miss Rate of Polyps in a Tandem Colonoscopy Study / 대한소화기학회지

BACKGROUND/AIMS: The miss rate of colon polyps and its related factors have not been clearly identified yet. This study aims to review the miss rate of polyps both on the patient-level and on the polyp-level and to analyze the factors affecting the miss rate such as those related to the endoscopist, procedure, patient, and polyp. METHODS: From August 2011 to August 2013, patients who underwent elective second colonoscopy for resection of polyps, the sizes of which were not small enough to be resected by biopsy forceps alone at first colonoscopy, were enrolled retrospectively. RESULTS: The miss rate on the patient-level was 59.2% (234/395) and on the polyp-level was 27.9% (578/2,068). There was no significant difference in the miss rate depending on the experience of the endoscopists or characteristics of the patients. In terms of the procedure, the miss rate was higher when the colonoscopy was performed in the afternoon (OR 1.632, p=0.046). It was found that the miss rate of polyps increased when the polyps were small (OR 4.595, p<0.001 in <5 mm/OR 3.447, p<0.001 in 5-10 mm), flat or sessile (OR 2.406, p<0.001 in flat/OR 1.768, p=0.002 in sessile), and located in the left colon (OR 1.391, p=0.007). CONCLUSIONS: The experience of endoscopists did not have influence on the accuracy of polyp detection. However, the fatigue of endoscopists in the afternoon is considered to render polyp detection less accurate. Also, the large curves and folds of the sigmoid colon are regarded as a reason for the higher miss rate of polyps in the left colon.

Comparison of Blood Leptin Concentration and Colonic Mucosa Leptin Expression in Colon Adenoma Patients and Healthy Control / 대한소화기학회지

BACKGROUND/AIMS: Obesity increases the risk of colorectal cancer and adenomatous polyp, and one of the underlying mechanisms of this increase is considered to be due to the growth promoting effects of adipokines, such as leptin. In order to investigate this finding, leptin expression in the colonic tissue and blood leptin concentration of the colonic adenoma patients were compared to those of the control group. METHODS: Colonic adenoma tissues were obtained by polypectomy (n=60). In these patients, normal colonic mucosa at remote areas from the polyp was also obtained and blood samples were collected as well. Age and sex matched control subjects were selected among those who showed normal colonic mucosa in health screening colonoscopy (n=60). RESULTS: There was no significant difference in serum leptin concentration between the colonic adenoma patients and control subjects. Leptin expression was noted in 43.3% of the colonic adenomas, but only in 6.7% of normal colonic mucosa from the control subjects (p<0.01). There were ten cases of concurrent adenocarcinoma in situ in adenoma patients, eight cases of which expressed leptin (p=0.01). In adenoma group, leptin expression rate was significantly high in larger adenomas and in obese patients (p<0.05). However, there was no statistically significant relationship between leptin expression in colonic mucosa and serum leptin level. CONCLUSIONS: Leptin expression was more frequently observed in colonic adenomas, especially in larger adenomas associated with adenocarcinoma in situ, but blood leptin level was not related to tissue leptin expression. Leptin expression was more frequently observed in obese patients from the adenoma group. Therefore, leptin may play an important role in colonic tumorigenesis and progression, especially in obese patient.

Comparison of Blood Leptin Concentration and Colonic Mucosa Leptin Expression in Colon Adenoma Patients and Healthy Control / 대한소화기학회지

BACKGROUND/AIMS: Obesity increases the risk of colorectal cancer and adenomatous polyp, and one of the underlying mechanisms of this increase is considered to be due to the growth promoting effects of adipokines, such as leptin. In order to investigate this finding, leptin expression in the colonic tissue and blood leptin concentration of the colonic adenoma patients were compared to those of the control group. METHODS: Colonic adenoma tissues were obtained by polypectomy (n=60). In these patients, normal colonic mucosa at remote areas from the polyp was also obtained and blood samples were collected as well. Age and sex matched control subjects were selected among those who showed normal colonic mucosa in health screening colonoscopy (n=60). RESULTS: There was no significant difference in serum leptin concentration between the colonic adenoma patients and control subjects. Leptin expression was noted in 43.3% of the colonic adenomas, but only in 6.7% of normal colonic mucosa from the control subjects (p<0.01). There were ten cases of concurrent adenocarcinoma in situ in adenoma patients, eight cases of which expressed leptin (p=0.01). In adenoma group, leptin expression rate was significantly high in larger adenomas and in obese patients (p<0.05). However, there was no statistically significant relationship between leptin expression in colonic mucosa and serum leptin level. CONCLUSIONS: Leptin expression was more frequently observed in colonic adenomas, especially in larger adenomas associated with adenocarcinoma in situ, but blood leptin level was not related to tissue leptin expression. Leptin expression was more frequently observed in obese patients from the adenoma group. Therefore, leptin may play an important role in colonic tumorigenesis and progression, especially in obese patient.

A Case of Adrenal Tuberculosis with Atypical Clinical Manifestation / 고신대학교의과대학학술지

Addison's disease is a rare disorder that causes fatigue, genral weakness, weight loss, pigmentation due to adrenal hypofunction and it's underlying causes are various. We report a case of 42-year-old man with fatigue, generalized cutaneous pigmentation. Computed tomography showed bilateral adrenal enlargement, but no calcification. Adrenal tuberculosis was established by ultrasound-guided fine needle aspiration biopsy.

Candida Arthritis Presenting as a Huge Popliteal Cyst in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature / 대한내과학회지

Candida arthritis is an uncommon cause of infectious arthritis that can occur in immunocompromised patients, such as those with rheumatoid arthritis. Candida arthritis arises in two ways: from direct inoculation or hematogenous dissemination. Direct inoculation is common in immunocompromised hosts during intra-articular injection or surgical procedures. The affected joints are generally swollen, tender, and mildly warm, with no evidence of disseminated candidiasis. Reported treatments include intravenous amphotericin B administration and drainage, or the use of 5-fluocytosine or ketoconazole to decrease amphotericin B toxicity. Surgical treatment has been necessary in some cases to eradicate candidal infection. Here, we report a case of candida arthritis combined with a huge popliteal cyst in a patient with rheumatoid arthritis and present a review of the relevant literature.

Candida Arthritis Presenting as a Huge Popliteal Cyst in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature / 대한내과학회지

Candida arthritis is an uncommon cause of infectious arthritis that can occur in immunocompromised patients, such as those with rheumatoid arthritis. Candida arthritis arises in two ways: from direct inoculation or hematogenous dissemination. Direct inoculation is common in immunocompromised hosts during intra-articular injection or surgical procedures. The affected joints are generally swollen, tender, and mildly warm, with no evidence of disseminated candidiasis. Reported treatments include intravenous amphotericin B administration and drainage, or the use of 5-fluocytosine or ketoconazole to decrease amphotericin B toxicity. Surgical treatment has been necessary in some cases to eradicate candidal infection. Here, we report a case of candida arthritis combined with a huge popliteal cyst in a patient with rheumatoid arthritis and present a review of the relevant literature.

A Case of Primary Aldosteronism Accompanied by Hypokalemic Rhabdomyolysis / 영남의대학술지

Primary aldosteronism is characterized by hypertension, hypokalemia, and metabolic alkalosis, associated with excessive aldosterone production and suppressed plasma renin activity. Hypokalemia-induced rhabdomyolysis has been rarely reported in primary aldosteronism patients. This paper reports a case of primary aldosteronism presented with rhabdomyolysis due to severe hypokalemia. A 48-year-old male with a three-year history of hypertension presented himself at the authors' hospital with generalized weakness and myalgia in both legs over a period of several days. His laboratory findings showed hypokalemia (1.8 mEq/L) with elevations of his serum creatine phosphokinase and serum myoglobin. His plasma aldosterone level was also elevated, and his plasma renin activity was reduced. An abdominal computed tomography revealed a 2.0 cm hypodense mass in the left adrenal gland, which suggested adrenal adenoma. The accordingly underwent laparoscopic adrenalectomy. Three months later, his plasma potassium level and blood pressure became normal without the use of medications.

A Case of Left Adrenal Gland Metastatic Cancer Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration

With widespread use of imaging techniques, the discovery of adrenal incidentalomas is increasing recently. Benign tumors are more frequent than malignant tumors in adrenal incidentalomas. Among malignant adrenal incidentalomas, metastatic neoplasms are the most common etiology. Traditional techniques to obtain tissue of adrenal gland include percutaneous approach under computed tomography or abdominal ultrasound guidance as well as open or laparoscopic adrenalectomies. They are invasive and associated with considerable complications such as pneumothorax, pancreatitis, adrenal abscesses, bacteremia, needle-tract metastases, and hemorrhage. Currently, endo scopic ultrasound-guided fine needle aspiration (EUS-FNA) is increasingly used to obtain tissue for diagnosis if the lesion is located in close proximity to the gut lumen. Compared with the traditional percutaneous techniques of tissue acquisition, EUS-FNA has many advantages including less invasiveness and lower complication rate. Here, we report a case of metastatic non-small cell carcinoma of left adrenal gland diagnosed by EUS-FNA with a review of literature.

Modality of malocclusion according to regional difference using HLD(handicapping labiolingual deviation), TPI(treatment priority index) and HMAR(handicapped malocclusion assessing record) / 대한치과교정학회지

We tried to evaluate frequencies and severities of malocclusion of various socioeconomic areas according to growth and development. To obtain objective validity, we used Handicapping Labiolingual Deviation (HLD) suggested by Draker, Treatment Priority Index (TPI) by Grainger, Handicapped Malocclusion Assessing Record (HMAR) by American Dental Association and American Association of Orthodontist. Seoul and Kwangju were selected as an urban group, Ahnyang as an middle socioeconomic group and Hwasun near the Kwangju area as an rural group. 140 (male 63, female 73) of 5th grade in 'E' elementary school students in Seoul, 202 (male 101, female 101) of 'S' elementary school students in Kwangju, 207(male 105, female 102) of 'H' elementary school students in Hwasun, and 100(male 49, female 51) of 'M' elementary school students of in Ahnyang of all the same grade were analyzed and we obtained the results as follows; 1. TPI, HLD, and HMAR showed high coincidence and reproducibility between different observer. (p<0.01) 2. In comparison of TPI, HLD, and HMAR according to clinical decision, there was statistically difference between each other. (p<0.01) 3. As the severity of malocclusion increases there was high correlation between TPI and HLD, and between HLD and HMAR (p<0.05) 4. With respect to differences between areas in TPI and HLD, there was statistically difference between Ahnyang and other areas. 5. In Seoul as an urban group there was a high incidence of periodic checkup and history of orthodontic treatment than other area. 6. Mode of feeding and posture during sleeping did not affect the severity of malocclusion. As a conclusion, TPI, HLD and HMAR are so reproducible and coincident that they can be used as a guide on evaluating the frequency and severity of malocclusion and determining the priority of orthodontic treatment to determine the need and supply of orthodontic treatment. Furthermore these indices can provide objectively valid data for establishing public health problem solution.