Pseudoaneurysmal Rupture Associated with Pancreatitis Treated with Transarterial Embolization: A Case Series / 대한췌담도학회지

Pancreatic pseudoaneurysm is a potentially life-threatening complication often associated with pancreatitis or pancreatic surgery. As the rupture of pancreatic pseudoaneurysms can lead to catastrophic bleeding and is associated with high mortality rates, clinical suspicion and early diagnosis are essential to improve patient outcomes. In the management of pseudoaneurysms, transarterial embolization (TAE) could be effective; however, there have been limited local studies on the outcomes of TAE for patients with pseudoaneurysm rupture associated with pancreatitis. Here, we describe patients who were diagnosed with pseudoaneruysm rupture associated with pancreatitis and treated with TAE.

The Relationship between Insomnia and Somatization According to Types of Work of Firefighters / 정신신체의학

Objectives@#：Firefighters are always under stress due to their job environment, and they are likely to become psychologically vulnerable due to continuous exposure to traumatic events, which is a stressful situation that requires emergency standby at all times. The aims of this study were to examine mental health factors for each division of firefighters and to see the relationship between sleep and somatization symptoms among them. @*Methods@#：General characteristics and related inspections were conducted through self-reporting questionnaires for 1,264 firefighters working at Chungbuk fire stations. Several mental health factors were investigated by the Insomnia Severity Index, Severity of somatic symptoms, Impact of Event Scale, Perceived Stress Scale, Resilience Scale, Alcohol Dependent Screening Scale, and the Center for Epidemiologic Studies Depression Scale Depression Scale and Mini-International Neuropsychiatric Interview. @*Results@#：Among the mental health variables, the relationship between insomnia and somatization varies significantly depending on types of work. It was reported that the first aid team was significantly higher than the fire suppression and rescue team. Post-traumatic stress, depression and drinking also differ significantly depending on types of work. The first aid team reported more posttraumatic stress than the fire suppression team and more depressed mood than the rescue team. The administration part had more alcohol consumption than the fire suppression or first aid team. Resilience was significantly higher in the rescue team than the first aid team. No significant differences between the types of work about stress and suicide risks. Insomnia, stress, and post-traumatic stress were significant predictors of somatization among firefighters. Above all, insomnia was significant mental health variable affecting somatization. @*Conclusions@#：Various mental health factors were different according to the types of work in firefighters. The First aid team was more vulnerable to mental health variables such as insomnia and somatization than other divisions. Insomnia is the most important cause of somatization in firefighters, so it is recommended that they be treated for insomnia and to prepare institutional policies.

Comparison of Disc Degeneration between the Cervical and Lumbar Spine

Objectives@#To compare disc degeneration between the cervical and lumbar spine and to elucidate the patterns of degeneration according to the corresponding disc levels in the cervical and lumbar spine.Summary of Literature Review: Disc degeneration results from the aging process in the spine. However, the incidence of disc degeneration in the cervical and lumbar spine might differ due to anatomical differences @*Materials and Methods@#We randomly selected 280 patients by age and sex among 6,168 patients who underwent cervical or lumbar spine magnetic resonance imaging combined with whole-spine T2 sagittal images from June 2006 to March 2012. We classified disc degeneration by the modified Matsumoto grading system and the Pfirrmann classification at 11 intervertebral disc levels from C2 to T1 and from L1 to S1. @*Results@#There was no significant difference in disc degeneration between the cervical and lumbar spine in either grading system. No significant difference was found in the degree of disc degeneration between the lower two disc levels of the cervical spine and the lower two disc levels of the lumbar spine in either system (C5-C6, C6-C7, L4-L5, L5-S1). However, both grading systems showed more severe degeneration in upper two disc levels of the cervical spine than in the upper two disc levels of the lumbar spine (C2-C3, C3-C4, L1-L2, L2- L3). @*Conclusions@#There was a significant difference in disc degeneration between the upper two disc levels of the cervical and lumbar spine. Adjacent segmental degeneration after fusion surgery might reflect the natural history of the condition, not adjacent segmental problems.

Production of Recombinant Anti-Cancer Vaccines in Plants

Plant expression systems have been developed to produce anti-cancer vaccines. Plants have several advantages as bioreactors for the production of subunit vaccines: they are considered safe, and may be used to produce recombinant proteins at low production cost. However, several technical issues hinder large-scale production of anti-cancer vaccines in plants. The present review covers design strategies to enhance the immunogenicity and therapeutic potency of anti-cancer vaccines, methods to increase vaccine-expressing plant biomass, and challenges facing the production of anti-cancer vaccines in plants. Specifically, the issues such as low expression levels and plant-specific glycosylation are described, along with their potential solutions.

Production of Recombinant Anti-Cancer Vaccines in Plants

Plant expression systems have been developed to produce anti-cancer vaccines. Plants have several advantages as bioreactors for the production of subunit vaccines: they are considered safe, and may be used to produce recombinant proteins at low production cost. However, several technical issues hinder large-scale production of anti-cancer vaccines in plants. The present review covers design strategies to enhance the immunogenicity and therapeutic potency of anti-cancer vaccines, methods to increase vaccine-expressing plant biomass, and challenges facing the production of anti-cancer vaccines in plants. Specifically, the issues such as low expression levels and plant-specific glycosylation are described, along with their potential solutions.

Forehead Osteoma Excision by Anterior Hairline Incision with Subcutaneous Dissection

Forehead osteomas are benign but can pose aesthetic and functional problems. These osteomas are resected via bicoronal or endoscopic approach. However, large osteomas cannot be removed via endoscopic approach, and bicoronal approach can result in damage to the supraorbital nerve with resultant numbness in the forehead. We present a new approach to resection of forehead osteomas, with access provided by an anterior hairline incision and subcutaneous dissection. Three patients underwent resection of the forehead osteoma through an anterior hairline incision. The dissection was carried in the subcutaneous plane, and the frontalis muscle and periosteum were divided parallel to the course of supraorbital nerve. The resulting bony defect was re-contoured using Medpor®. All three patients recovered without any postoperative infection or complication and symptoms. Scalp sensory was preserved. Aesthetic outcomes were satisfactory. Patients remain free of recurrence for 12 months of follow up. The anterior hair line approach with subcutaneous dissection is an effective method for removal of forehead osteoma, since it offers broad visualization and hides the scar in the hairline. In addition, the dissection in the subcutaneous plane avoids inadvertent injury to the deep nerve branches and helps to maintains scalp sensation.

Right iliac arterial aneurysm in a 4-year-old girl who does not have a right external iliac artery

Pediatric arterial aneurysm is rare disease. Among them, idiopathic-congenital arterial aneurysm is extremely rare. This is a case report of right common iliac artery idiopathic aneurysm with absence of right external iliac artery. A 4-year-old girl who had been complaining of intermittent abdominal pain since 2 years prior presented with a right lower abdominal mass that had been palpable since 6 months prior. Abdominal CT revealed a 5.2 cm × 4.5 cm × 5.1 cm, right-sided, partially thrombosed, saccular, iliac artery aneurysm. She underwent to operation, aneurismal resection. A pathological examination confirmed that it was a true aneurysm, considering that all layers of the vascular wall were stretched with no deficit. The patient was discharged 3 days after the surgery without any complication. Five months passed since the surgery, and the patient is doing well without any abdominal or leg pain.

Postoperative Quality of Life after Total Gastrectomy Compared with Partial Gastrectomy: Longitudinal Evaluation by European Organization for Research and Treatment of Cancer-OG25 and STO22

PURPOSE: The European Organization for Research and Treatment of Cancer quality-of-life questionnaire-OG25 was developed to evaluate the quality of life in patients with stomach and esophageal cancer. The following are included in the OG25 but not in the STO22: odynophagia, choked when swallowing, weight loss, trouble eating with others, trouble swallowing saliva, trouble talking, and trouble with coughing. In this study, we evaluated the quality of life of gastrectomized patients using both, the OG25 and the STO22. MATERIALS AND METHODS: A total of 138 patients with partial gastrectomy (PG) (distal gastrectomy=91; pylorus-preserving gastrectomy= 47) and 44 patients with total gastrectomy (TG) were prospectively evaluated. Body weight and scores from the OG25 and STO22 were evaluated preoperatively and at 3 weeks, 3 months, and 6 months after surgery. RESULTS: Patients with TG had significant weight loss compared to patients with PG. At 3 months, TG was associated with worse scores for dysphagia, eating, odynophagia, trouble eating with others, trouble with taste, and weight loss on the OG25. TG was also associated with dysphagia, eating restrictions, and anxiety on the STO22. The OG25 helped differentiate between the groups with respect to weight loss, odynophagia, choked when swallowing, and trouble eating with others. The OG25 scores changed over time and were significantly different. CONCLUSIONS: The OG25 is a more sensitive and useful scale than the STO22 for evaluating the quality of life of gastrectomized patients, especially those with total gastrectomy.

Primary Necrotizing Fasciitis of the Breast in an Untreated Patient with Diabetes

No abstract available.

Malignant Peripheral Nerve Sheath Tumor in Frontal Sinus, Orbital Cavity and Ethmoid Cavity

Malignant peripheral nerve sheath tumors are extremely rare soft tissue sarcomas. Among various locations, the trunk and extremities are the most commonly involved sites, with only 15% of such lesions occuring in head and neck region. Here, we report a case of a 74-year-old male who presented with forehead swelling and right eye deviation. Computed tomography images revealed a tumor involving the frontal sinus, ethmoid sinus, and the orbital cavity. The patient underwent a surgical excision of the lesion, which histopathological examination revealed to be a malignant peripheral nerve sheath tumor.

High Dose Vitamin D3 Attenuates the Hypocalciuric Effect of Thiazide in Hypercalciuric Rats

Thiazide is known to decrease urinary calcium excretion. We hypothesized that thiazide shows different hypocalciuric effects depending on the stimuli causing hypercalciuria. The hypocalciuric effect of hydrochlorothiazide (HCTZ) and the expression of transient receptor potential vanilloid 5 (TRPV5), calbindin-D(28K), and several sodium transporters were assessed in hypercalciuric rats induced by high calcium diet and vitamin D3. Urine calcium excretion and the expression of transporters were measured from 4 groups of Sprague-Dawley rats; control, HCTZ, high calcium-vitamin D, and high calcium-vitamin D with HCTZ groups. HCTZ decreased urinary calcium excretion by 51.4% in the HCTZ group and only 15% in the high calcium-vitamin D with HCTZ group. TRPV5 protein abundance was not changed by HCTZ in the high calcium-vitamin D with HCTZ group compared to the high calcium-vitamin D group. Protein abundance of NHE3, SGLT1, and NKCC2 decreased in the hypercalciuric rats, and only SGLT1 protein abundance was increased by HCTZ in the hypercalciuric rats. The hypocalciuric effect of HCTZ is attenuated in high calcium and vitamin D-induced hypercalciuric rats. This attenuation seems to have resulted from the lack of HCTZ's effect on protein abundance of TRPV5 in severe hypercalciuric condition induced by high calcium and vitamin D.

Effects of Thiazide on the Expression of TRPV5, Calbindin-D28K, and Sodium Transporters in Hypercalciuric Rats

TRPV5 is believed to play an important role in the regulation of urinary calcium excretion. We assessed the effects of hydrochlorothiazide (HCTZ) on the expression of TRPV5, calbindin-D28K, and several sodium transporters in hypercalciuric rats. Sprague- Dawley rats were divided into 4 groups; control, HCTZ, high salt, and high salt with HCTZ group in experiment 1; control, HCTZ, high calcium (Ca), and high Ca with HCTZ group in experiment 2. To quantitate the expression of TRPV5, calbindin- D28K, and sodium transporters, western blotting was performed. In both experiments, HCTZ significantly decreased urinary calcium excretion. TRPV5 protein abundance decreased in all hypercalciuric rats, and restored by HCTZ in both high salt with HCTZ and high Ca with HCTZ group. Calbindin-D28K protein abundance increased in the high salt and high salt with HCTZ groups, but did not differ among groups in experiment 2. Protein abundance of NHE3 and NKCC2 decreased in all hypercalciuric rats, and were restored by HCTZ in only high Ca-induced hypercalciuric rats. In summary, protein abundance of TRPV5, NHE3, and NKCC2 decreased in all hypercalciuric rats. The hypocalciuric effect of HCTZ is associated with increased protein abundance of TRPV5 in high salt or calcium diet-induced hypercalciuric rats.

A Case Report of Successful Treatment with Plasmapheresis and Intravenous Immunoglobulin in a Renal Transplant Recipient with Acute Humoral Rejection / 대한신장학회잡지

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.

Tuberculous Pyomyositis in a Renal Transplant Patient / 대한신장학회잡지

Tuberculosis infection of skeletal muscle is rare, even in countries where tuberculosis is relatively prevalent. Because tuberculosis of muscle is usually secondary to underlying tuberculosis of the bone or adjacent joint, isolated tuberculosis of skeletal muscle is very rare. Moreover, tuberculosis pyomysitis shows nonspecific symptoms even in immuno-compromised hosts. Recently we experienced an isolated tuberculosis pyomysitis in renal allograft recipient and report here. A 57-year-old woman presented with pain and edema on right calf area. Sonographic imaging of right calf muscle showed large elongated fluid collection. Operative debridement was done and the histopathology of calf muscle showed granulomas surrounded by Langhans' giant cells. We diagnosed her as tuberculous polymyositis combining the data of histology and positive result of polymerase chain reaction for mycobacterium tuberculosis. We treated her with the anti-tuberculosis medication. After surgical debridement and medical management, calf muscle tuberculous polymyositis showed fair improvement.

Absence of intact thiazide-sensitive sodium-chloride cotransporter in the renal tissue of a Gitelman's syndrome patient / 대한내과학회지

BACKGROUND: Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. It is known to be caused by a mutation of SLC12A3 gene coding the sodium-chloride cotransporter (NCCT) in the distal tubule. The defect of NCCT in human renal tissues has not been investigated, and we tested whether the defect of NCCT can be detected in renal tissue of a patient with Gitelman's syndrome by using immunohistochemistry. METHODS: In an adult patient with Gitelman's syndrome, blood and urine samples were collected for measurement of biochemical parameters. Renal clearance study and gene analysis were performed. Immunohistochemistry was performed on the renal tissue of the patient using a rabbit polyclonal antibody directed against a synthetic peptide corresponding to a portion in the amino terminal tail for human NCCT. Normal human renal tissues from surgical nephrectomy due to renal cell carcinoma and renal biopsy tissues from patients with glomerulonephritis but without any electrolyte disturbance were used as controls. RESULTS: The patient had hypokalemic metabolic alkalosis, hypocalciuria and hypomagnesemia. Renal clearance study revealed a decrease in distal fractional chloride reabsorption after the administration of furosemide. SLC12A3 gene mutation (S967F) was found by direct sequencing method. Immunohistochemistry showed the absence of NCCT staining in the renal tissue of the patient. On the other hand, the immunostaining of other transporters was all positive in renal tissues from both Gitelman's syndrome patients and controls. CONCLUSIONS: We report the absence of intact NCCT in the renal tissue of a Gitelman's syndrome patient.

Application of 2-Octylcyanoacrylate (Dermabond(R) for Laceration Repair in Emergency Department

A retrospective, randomized controlled clinical trial to assess the effectiveness of Dermabond(r) for repair of traumatic laceration in 86 patients, who signed the informed consent, was studied. Patient selection was limited to facial laceration, less than 2cm in length, non-contaminated, non-bitten, and non-crushed lacerations. All of 86 patients were available for the primary follow-up within 7 to 10 days after Dermabond(r) application and the survey was carried out for outcomes of cosmesis, pain, complications and cost. 76 patients (88%) were satisfied and 10 patients(12%) were dissatisfied with Dermabond(r) application. All of 10 unsatisfied patients had complication, such as wound dehiscence in 6 patients, depressed scar in 2 patients, skin necrosis in 1 patient and wound infection in 1 patient. Among 86 patients, 80 patients(93%) pointed the painlessness as the best advantage of Dermabond(r). The cost was compared between Dermabond(r) and standard suture technique on similar facial laceration, resulted in 69,720 won vs. 43,747 won, which difference was not significant to most of the patients. Second follow-up evaluation was done 5 months after Dermabond(r) application. At this time, the quality of scar was compared by patients and two plastic surgeons. Among 63 patients included in second evaluation, 58 cases (92%) satisfied the scar qualities. Dermabond(r) is highly effective and satisfactory material for facial wound repair if the wound is properly selected.

Performance Evaluation of 'Dong-A Syphilis' EIA kit / 대한수혈학회지

BACKGROUND: 'Dong-A Syphilis' enzyme immunoassay(EIA) kit for detecting antibodies against T. pallidum was recently introduced. The performance of 'Dong-A Syphilis' in precision, sensitivity and specificity was evaluated to know the adequacy in substituting for VDRL as a primary screening test. METHODS: Intra and inter-run precision were evaluated by positive and negative controls and 4 other concentrations which were made by mixing positive controls with negative controls. Sensitivity and specificity were evaluated using 120 samples positive in both VDRL and FTA-ABS and using 487 samples negative in VDRL, respectively. Positive rates of EIA and VDRL among 342 persons who visited health promotion center in Asan Medical Center were compared. RESLUTS: Intra-run precision was between 2.2% and 5.5%, and inter-run precision between 9.9% and 15.6%. Sensitivity and specificity were 99.2% and 99.7%, respectively. EIA showed higher positive rate (5.8%) than VDRL (3.5%). 11 samples (3.2%) were reactive only in both EIA and FTA-ABS. CONCLUSION: The performance of 'Dong-A syphilis' EIA was so good in precision, sensitivity and specificty that the EIA kit could substitute for VDRL as a primary screening test for syphilis. EIA screening for syphilis would be more appropriate for a person to promote his own health in that it could detect untreated past infection.

A Study of Sailor Psychiatric Inpatients: Focusing on the Transition in a General Hospital / 신경정신의학

OBJECTIVES: The object of this study was to help the clinicians understand the characteristics of the sailors who were admitted to the psychiatric ward through elucidating the transition in the psychiatric aspect of them. METHODS: The results obtained from psychiatric records of 98 sailors who were admitted to department of psychiatry in a general hospital, from March 1, 1985 to Feb. 28, 1994 were compared with the results obtained from 34 sailor inpatients in the same hospital from March 1, 1982 to Feb. 28, 1985. RESULTS: 1) The number of sailor inpatients showed declining tendency and the age of them showed increasing tendency. 2) The number of patients of somatoform disorder, posttraumatic stress disorder, and organic mental disorder was increased. The number of patients of schizophrenia and mood disorder was decreased. 3) The proportion of inpatients from overseas fishing ship was increased markedly. We must ave a countplan and careful consideration f3r them. 4) We could infer that the groups of low education, crew, overseas fishing ship and below S year of employment duration had high admitted patient occurrence rate. The proportion of psychosis in the groups that were primitive school graduated and 1-5 year of employment duration was high relatively to neurosis(statistically not significant). 5) According to psychological test, the majority of sailor inpatients had constricted thought content, emphasis of responsibility for the family, submissive attitude to an authoritive figure and paranoid tendency. The MMFI profile of neurotic patients showed the tendency of finking bad.

Surgical treatment of the bilateral facial nerve paralysis combined with temporal bone fracture / 대한이비인후과학회지

No abstract available.

Three cases of neurilemmoma of the nasal cavity / 대한이비인후과학회지

No abstract available.