Big Data-Driven Approach for Health Inequalities in Foreign Patients with Injuries Visiting Emergency Rooms / 대한의료정보학회지

Insulin resistance is an independent predictor of erectile dysfunction in patients with gout

BACKGROUND/AIMS: Gout is associated with metabolic disorders that are important risk factors for cardiovascular disease and erectile dysfunction (ED). We aimed to identify independent predictors of ED in patients with gout. METHODS: From August 2014 to August 2015, male outpatients who were being treated for gout in our rheumatology clinic and healthy males without any history of inflammatory disease (control group) were studied. ED was assessed in participants using the five-item version of the International Index of Erectile Function questionnaire. Insulin resistance (IR) was estimated using the homeostatic model assessment (HOMA-IR). Logistic regression analysis was performed to determine the effect of variables on ED risk in all of the study subjects and in patients with gout. RESULTS: We analyzed 80 patients with gout and 70 healthy controls. The median age of patients with gout was 52 years and median disease duration was 120 months. Gout patients were more likely to have ED than controls (55.3% vs. 41.4%, p < 0.047). After adjustment for confounding factors, only HOMA-IR was significantly associated with ED (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.05 to 3.15). Gout patients with ED were more likely to be older (p < 0.001), have higher HOMA-IR (p = 0.048), and have lower glomerular filtration rate (p = 0.038) than those without ED. Multivariate logistic regression analysis showed that HOMA-IR was an independent predictor for ED (OR, 1.62; 95% CI, 1.03 to 2.82) in gout patients. CONCLUSIONS: IR is an independent predictor of ED in patients with gout.

Focal Eosinophilic Myositis Associated with Behçet's Disease

Behçet's disease (BD) is a systemic vasculitis commonly accompanied by recurrent mucosal ulceration and other systemic manifestations, but rarely by myositis. Focal eosinophilic myositis is the most limited idiopathic eosinophilic myopathy characterized by peripheral blood eosinophilia and/or eosinophilic muscle infiltration. Clinical manifestations include myalgia, muscle weakness, and cutaneous lesions, such as subcutaneous induration and erythema. Given that BD can mimic deep vein thrombosis or pseudotumor, muscle biopsy should be performed to enhance the accuracy of diagnosis. Microscopic examination reveals extensive infiltration of eosinophils and mononuclear cells into muscle, myofiber necrosis, and regeneration. To the best of our knowledge, there have not been any published reports on MEDLINE regarding focal eosinophilic myositis associated with BD. Here, we presented a case of focal eosinophilic myositis associated with intestinal BD in a 23-year-old man who suffered from a large ulcer in the terminal ileum.

Relationship Between Mobility and Self-Care Activity in Children With Cerebral Palsy

OBJECTIVE: To investigate the factors influencing the development of self-care activity, and the association between mobility and self-care activity in children with cerebral palsy (CP). METHODS: A total of 63 CP children aged ≥4 years, were studied retrospectively. Children with severe intellectual disability or behavioral problems were excluded. The relationship between the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Pediatric Evaluation of Disability Inventory (PEDI) was analyzed. Simple and multiple linear regression analyses were conducted for continuous variables, such as verbal intelligence quotient (IQ) and PEDI subscales. RESULTS: Final evaluation was done for 25 children, ranging from 4 to 11 years of age. According to GMFCS levels, the differences in PEDI-self-care scores, showed statistically borderline significance (p=0.051). Conversely, differences in PEDI-self-care scores according to CP types and MACS levels were not statistically significant. Simple linear regression analysis showed that PEDI mobility and PEDI social function significantly influence the PEDI self-care. Multiple linear regression analysis showed that PEDI mobility was the only factor significantly influencing PEDI self-care in children aged ≥7 years (R²=0.875, p=0.03). CONCLUSION: Mobility is important for the acquisition of self-care abilities in children with CP aged ≥7 years.

The Effects of Bolus Volume and Texture on Pharyngeal Pressure Events Using High-resolution Manometry and Its Comparison with Videofluoroscopic Swallowing Study

BACKGROUND/AIMS: The purpose of this study was to develop new parameters of high-resolution manometry (HRM) and to applicate these to quantify the effect of bolus volume and texture on pharyngeal swallowing. METHODS: Ten healthy subjects prospectively swallowed dry, thin fluid 2 mL, thin fluid 5 mL, thin fluid 10 mL, and drinking twice to compare effects of bolus volume. To compare effect of texture, subjects swallowed thin fluid 5 mL, yogurt 5 mL, and bread twice. A 32-sensor HRM catheter and BioVIEW ANALYSIS software were used for data collection and analysis. HRM data were synchronized with kinematic analysis of videofluoroscopic swallowing study (VFSS) using epiglottis tilting. RESULTS: Linear correlation analysis for volume showed significant correlation for area of velopharynx, duration of velopharynx, pre-upper esophageal sphincter (UES) maximal pressure, minimal UES pressure, UES activity time, and nadir UES duration. In the correlation with texture, all parameters were not significantly different. The contraction of the velopharynx was faster than laryngeal elevation. The durations of UES relaxation was shorter in the kinematic analysis than HRM. CONCLUSIONS: The bolus volume was shown to have significant effect on pharyngeal pressure and timing, but the texture did not show any effect on pharyngeal swallowing. The parameters of HRM were more sensitive than those of kinematic analysis. As the parameters of HRM are based on precise anatomic structure and the kinematic analysis reflects the actions of multiple anatomic structures, HRM and VFSS should be used according to their purposes.

Application and Interpretation of High-resolution Manometry for Pharyngeal Dysphagia

The pharyngeal phase of swallowing is a complex event consisted with subsequent muscular contractions and pressure generation to move a bolus from the mouth to the esophagus. Recently, high-resolution impedance manometry (HRIM) was developed and used for the evaluation of pharyngeal dysphagia. Although HRIM provides precise pharyngeal pressure information, it has yet to be used as part of routine clinical practice for the assessment of dysphagia. The main reasons are thought to be that the test method and result interpretation are not easily applicable and standardized. The anatomical landmarks for HRIM parameters are velopharynx, tongue base, epiglottis, low pharynx, and upper esophageal sphincter. With HRIM, the pressure and timing data could be obtained at a precise anatomical structure. In the present review, we will review how to apply HRIM for the evaluation of pharyngeal dysphagia, including the interpretation of its parameters.

A Case of Tuberculous Peritonitis in a Patient with Ankylosing Spondylitis during Infliximab Therapy / 대한내과학회지

Infliximab is a chimeric monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha) that is used to treat chronic inflammatory diseases such as ankylosing spondylitis (AS). Side effects include greater susceptibility to severe infections, such as tuberculosis. Positive diagnosis of tuberculous infections, such as tuberculous peritonitis, are often difficult due to the nonspecific nature of symptoms and the rarity of the infection, with definitive diagnoses requiring either a positive culture or histological biopsy. Here, we describe a case of tuberculous peritonitis during infliximab therapy in a 71-year-old man with AS; the disease was confirmed via histopathological examination.

Inter-rater Reliability of Videofluoroscopic Dysphagia Scale

OBJECTIVE: To investigate the inter-rater agreement using the Videofluoroscopic Dysphagia Scale (VDS). METHOD: The present study was designed as a multicenter, single-blind trial. A Videofluoroscopic Swallowing Study (VFSS) was performed using the protocol described by J.A Logemann. Thick-fluid, pureed food, mechanically altered food, regularly textured food, and thin-fluid boluses were sequentially swallowed. Each participant received a 3 ml bolus followed by a 5 ml bolus of each food material, in the order mentioned above. All study procedures were video recorded. Discs containing these video recordings in random order were distributed to interpreters who were blinded to the participant information. The video recordings were evaluated using a standardized VDS sheet and the inter-rater reliability was calculated. RESULTS: In total, 100 patients participated in this study and 10 interpreters analyzed the findings. Inter-rater reliability was fair in terms of lip closure (kappa: 0.325), oral transit time (0.253), delayed triggering of pharyngeal swallowing (0.300), vallecular residue (0.275), laryngeal elevation (0.345), pyriform sinus residue (0.310), coating of the pharyngeal wall (0.310), and aspiration (0.393). However, other parameters of the oral phase were lower than those of the pharyngeal phase (0.06-0.153). Moreover, the summation of VDS reliability (intraclass correlation coefficient: 0.556) showed moderate agreement. CONCLUSION: VDS shows a moderate rate of agreement for evaluating the swallowing function. However, many of the parameters demonstrated a lower rate of agreement, particularly the oral phase parameters.

A Case of a False-Positive Anti-Myeloperoxidase Antibody ELISA in a Patient with Hypothyroidism / 전남의대학술지

We present a case of a false-positive anti-myeloperoxidase (MPO) antibody result on an ELISA in a patient with anti-thyroid microsomal antibody (TMA)-positive hypothyroidism. A 41-year-old woman presented with dyspnea on exertion. The initial evaluation revealed pericardial effusion associated with hypothyroidism. In addition, microscopic hematuria with normal renal function and positive cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) on immunofluorescent assay were found. In further evaluation, elevated anti-TMA and MPO antibodies by ELISA. While no definite signs of vasculitis were present, the clinical state improved with thyroid hormone replacement and diuretics. Anti-MPO antibody was still positive in the follow-up tests, and microscopic hematuria persisted. On the basis of previous reports that thyroid peroxidase and MPO molecules contain cross-reactive epitopes that are exposed in denaturated molecules, we suggest that in a patient with anti-TMA-positive hypothyroidism, anti-MPO antibody might also be positive on ELISA without clinical signs of vasculitis.

A large paraovarian cyst torsion in a 73-year-old patient: case report and review of the literature / 대한산부인과내시경학회지

Although paraovarian cysts rarely cause symptoms, they may be complicated due to massive size, torsion or internal hemorrhage from rupture. Moreover, benign or malignant neoplasms may occasionally develop in paraovarian cysts. We present a case of a 73-year-old patient who suffered from a twisted large left paraovarian cyst. The patient visited emergency room with a chief complaint of acute abdominal pain. The patient was treated with good result by laparoscopic surgery. The maximum diameter of the mass was 10cm which was twisted 3 1/2 times clockwise. In conclusion, paraovarian cysts, even in elderly patients, can reach large sizes requiring awareness of the possible complications caused by large cyst which could be treated successfully by laparoscopy.

Systemic Lupus Erythematosus Preceded by Distal Renal Tubular Acidosis / 대한내과학회지

Distal renal tubular acidosis (RTA) is characterized by a decreased net H+ secretion in the collecting tubules, which results in a failure of urine acidification and results in metabolic acidosis, hypokalemia, and nephrocalcinosis. The acquired form of distal RTA is associated with tubulointerstitial involvement of immune-mediated disorders such as Sjogren's syndrome and systemic lupus erythematosus (SLE). Only a few case reports have indicated that distal RTA precedes SLE by months to years. We present a 39-year-old woman who had manifestations of distal RTA for 21 years before the development of overt symptoms of SLE.

Association between Cross-sectional Areas of Lumbar Muscles on Magnetic Resonance Imaging and Chronicity of Low Back Pain

OBJECTIVE: To investigate the prognostic value of cross-sectional areas (CSA) of paraspinal (multifidus and erector spinae) and psoas muscles on magnetic resonance imaging (MRI) in chronicity of low back pain. METHOD: Thirty-eight subjects who visited our hospital for acute low back pain were enrolled. Review of their medical records and telephone interviews were done. Subjects were divided into two groups; chronic back pain group (CBP) and a group showing improvement within 6 months after onset of pain (IBP). The CSA of paraspinal and psoas muscles were obtained at the level of the lower margin of L3 and L5 vertebrae using MRI. RESULTS: CSA of erector spinae muscle and the proportion of the area to lumbar muscles (paraspinal and psoas muscles) at L5 level in the CBP group were significantly smaller than that of the IBP group (p0.05). CSA of psoas muscle at L5 level and all values measured at L3 level were not significantly different between the groups (p>0.05). CONCLUSION: CSA of erector spinae muscle at the lower lumbar level and the proportion of the area to the lumbar muscles at the L5 level can be considered to be prognostic factors of chronicity of low back pain.

A Case of a False-Positive Anti-Myeloperoxidase Antibody ELISA in a Patient with Hypothyroidism / 전남의대학술지

We present a case of a false-positive anti-myeloperoxidase (MPO) antibody result on an ELISA in a patient with anti-thyroid microsomal antibody (TMA)-positive hypothyroidism. A 41-year-old woman presented with dyspnea on exertion. The initial evaluation revealed pericardial effusion associated with hypothyroidism. In addition, microscopic hematuria with normal renal function and positive cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) on immunofluorescent assay were found. In further evaluation, elevated anti-TMA and MPO antibodies by ELISA. While no definite signs of vasculitis were present, the clinical state improved with thyroid hormone replacement and diuretics. Anti-MPO antibody was still positive in the follow-up tests, and microscopic hematuria persisted. On the basis of previous reports that thyroid peroxidase and MPO molecules contain cross-reactive epitopes that are exposed in denaturated molecules, we suggest that in a patient with anti-TMA-positive hypothyroidism, anti-MPO antibody might also be positive on ELISA without clinical signs of vasculitis.

Secondary Achalasia due to Injury of Vagus Nerve after Chest Trauma: A case report

Achalasia is rare disorder with an estimated prevalence of 0.5~1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma.

Successful treatment of refractory livedoid vasculitis with rituximab and cyclophosphamide / 대한내과학회지

Livedoid vasculitis (LV) is a chronic recurrent cutaneous disease that is characterized by a netlike vascular pattern of purpuric lesions that progress to ulcers and atrophic white scars. The etiology of LV is unknown. Various therapies have been used for LV with inconsistent results, including antiplatelet agents, fibrinolytics, anticoagulants, prostaglandin E1, and immunosuppressive agents, such as systemic corticosteroids, azathioprine, methotrexate, cyclosporine, and mycophenolate mofetil. We present a patient with idiopathic LV refractory to immunosuppressive therapy who had a good response to treatment with rituximab and cyclophosphamide.

Comparison of morbidity by uterine weight in total laparoscopic hysterectomy / 대한산부인과학회지

OBJECTIVE: To evaluate the effect of uterine weight on short-term outcome of total laparoscopic hysterectomy (TLH) for benign gynecological conditions. METHODS: A retrospective medical records review of 265 cases of patients with TLH was performed. Patients included in this study underwent TLH as benign uterine disorders at Kangnam Sacred Heart Hostpital, Hallym University from January 2008 through June 2009. These patients were stratified into three groups; Group 1 patients with uterus weighing less than 180 g (n=60), Group2 patients with uterus weighing 180 g to 350 g (n=141), Group 3 patients with uterus weighing more than 350 g (n=64). The groups were compared as regard postoperative stay, operative time, estimated blood loss, hemoglobin change, conversion to open surgery, and postoperative complications. RESULTS: There was no significant difference in age, gravidity, body mass index, previous pelvic surgery and past medical history. The overall complication rates were not significantly different. But operative time prolonged as uterine weight increased. CONCLUSION: The TLH can be performed successfully in case of enlarged uterus. Therefore the enlarged uterus is not an absolute contraindication for TLH.

A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disorder associated with oral aphthous ulcer, genital ulcer and uveitis. Vascular lesions in BD can affect all types and sizes of vessels. The venous thrombosis, which is uncommon feature of other vasculitis, is relatively common clinical manifestation of BD. Sometimes the cardiovascular involvement in BD results in serious complications as the leading cause of morbidity and mortality. We report a 41-year-old male patient who suffered BD and presented massive chylopericardium due to the superior vena cava (SVC) syndrome. After thrombectomy of SVC, the highly productive left-sided chylothorax and restenosis of anastomosis site at SVC had occurred, which were successfully treated by the ligation of the thoracic duct and balloon-stent angioplasty. We discussed the mechanism and treatment of chylopericardium in SVC syndrome, and the possible complications after the surgical management.

The Effects of Arm Ergometry Exercise in Acute Stroke Patients

OBJECTIVE: To evaluate the effect of arm ergometry exercise training on the cardiovascular system and sensorimotor function in the early stroke patients. METHOD: 19 stroke patients without cardiac disease were randomly assigned to exercise training group (9 patients) and control group (10 patients). The time interval between the onset of stroke and exercise training was 20 days. The training group subjects were trained three times a week for 30 minuts by arm ergometry and conventional rehabilitation during 4 weeks. Exercise intensity was prescribed at 30% to 60% of heart rate reserve. Control group were trained only conventional rehabilitation. Exercise test with arm ergometry was performed before and after 4 weeks training period. To evaluate sensorimotor function, Fugl-Meyer score of upper extremities was measured before and after 4 weeks training period. RESULTS: In training group, heart rate at rest decreased after 4 weeks training significantly. However, improvement of peak oxygen uptake was not significant. After 4 weeks, the difference of Fugl-Meyer score are correlate the difference of peak oxygen uptake. CONCLUSION: Early aerobic exercise training in stroke patients may improve resting heart rate and sensorimotor function.

Effects of Resting Hand Splint in Early Stroke Patients

OBJECTIVE: To assess effectiveness of resting hand splints to prevent contracture, maintain functional position and minimize spasticity in early stroke patients. METHOD: Subjects were hemiplegic patients with stroke less than one month. Both splint and control groups participated in individual motor training and upper limb stretching exercise. The subjects of the splint group wore resting hand splints for maximum of 12 hours each night for 4 weeks. Measurements of edema by measuring circumference of the third phalanx, pain at hemiplegic upper extremity using visual analog scale, spasticity at the wrist graded by the modified Ashworth scale, passive range of motion at the wrist with goniometer, and functional hand use with the manual function test (MFT) were made. All measurements were taken during standard rehabilitation at the beginning and end of a 4-week treatment period. RESULTS: Before treatment, the circumferences of the splint and control groups were 6.7+/-0.5 cm and 6.7+/-0.8 cm, respectively. After 4 weeks, both were 6.8+/-0.6 cm and 6.8+/-0.8 cm, which showed no significant differences between the groups. The effects of splinting were statistically nonsignificant between control and splint groups for all measurements. CONCLUSION: An overnight splint-wearing regimen for early stroke patients may not produce clinically beneficial effects.

The Effects of Integrative Art Therapy on Social Competence and Hand Function of Children with Cerebral Palsy

OBJECTIVE: To determine the effects of integrative art therapy on social competence and hand function in children with cerebral palsy. METHOD: Nine children with cerebral palsy were given integrative art therapy and conventional occupational therapy for 50 minutes, once a week over 6 months. Ten children were selected as a control group and were given only conventional occupational therapy. To estimate the effectiveness of integrative art therapy, both groups were evaluated by Denver Developmental Screening Test (DDST-II), Box and Block test and Walker-McConnell scale before and after therapy. RESULTS: Children of integrative art therapy showed significant improvement in 'personal and social' category of DDST-II and 'adaptive behavior' and 'adjustment to social relationships with peers' of Walker-McConnell scale. They also showed improvement of Box and Block test. CONCLUSION: This study revealed that integrative art therapy was effective on social competence as well as hand function in children with cerebral palsy. So, integrative art therapy is expected to be an adjuvant therapy for children with cerebral palsy.