Risk and Protection Factors for Suicidality in Korean Military Officers / 신경정신의학

Objectives@#The aim of this study was to identify risk and protective factors of suicidality among Korean military officers. @*Methods@#This study was conducted on 3162 military officers. Data were collected by online survey after obtaining informed consent. Demographic characteristics, depression, anxiety, suicidality, social support, stress, and attitude toward suicide were evaluated using structured instruments and self-report questionnaires. Suicidality was defined as having a suicidal idea, a suicide plan, or attempting suicide. Statistical analysis was performed using logistic regression to investigate associations between potential risk and protective factors and suicidality. @*Results@#Depression (odds ratio [OR]=16.313, 95% confidence interval [CI]=10.028–26.539), anxiety (OR=14.377, 95% CI=8.680–23.812), and stress (OR=8.116, 95% CI=4.637–14.207) were positively associated with suicidality. On the other hand, good social networks and an unaccepting attitude toward suicide were negatively associated with suicidality (OR=0.131, 95% CI=0.072–0.240). No significant correlation was observed between living status and suicidality (OR=0.991, 95% CI=0.598–1.642). @*Conclusion@#Depression, anxiety, and stress were found to be risk factors of suicidality among Korean military officers. In contrast, good social networks and unaccepting attitudes toward suicide acted as protective factors. Hence, preventive interventions that place focus on risk and protective factors should be developed and implemented to mitigate suicidality.

Change of Pyogenic and Tuberculous Spondylitis between 2007 and 2016 Year : A Nationwide Study

Objective@#: We attempted to compare the incidence of pyogenic spondylitis (PS) and tuberculous spondylitis (TS) between 2007 and 2016. Furthermore, we investigated the patients who underwent surgery in 2016 compared to that in 2007. @*Methods@#: We used a nationwide database managed by the Korean National Health Insurance Service (NHIS) in 2007 and 2016. Total 9655 patients with a newly diagnosis of PS or TS were enrolled in PS or TS group. Among them, 1721 patients underwent either fusion or decompression surgery. We analyzed demographic distribution of patients according to gender and age and year of diagnosis. @*Results@#: Comparing between 2007 and 2016, the incidence of PS has increased in 2016 than in 2007 (4874 vs. 2431, p<0.0001). Conversely, declination of incidence of TS was discovered in 2016 compared to 2007 (594 vs. 1756, p<0.0001). Females showed predominance over males regarding both PS and TS (5228 vs. 4427, p<0.0001). Among them, the number of PS patients who underwent surgery increased significantly in 2016 relative to that in 2007 (979 vs. 592, p<0.0001). @*Conclusion@#: This nationwide study suggests that PS may increase and TS may decrease in Korea. In addition, demand for surgery regarding PS may increase.

Association of Congestive Heart Failure and Death with Ankylosing Spondylitis : A Nationwide Longitudinal Cohort Study in Korea

OBJECTIVE: We attempted to discover that Ankylosing spondylitis (AS) has a comprehensive relationship with congestive heart failure and death.METHODS: We used a nationwide database managed by the Korean National Health Insurance Service from 2010 to 2014. Twelve thousand nine hundred eighty-eight patients with a diagnosis of AS and 64940 age- and sex- stratified matching subjects without AS were enrolled in the AS and control groups. Incidence probabilities of 6 years congestive heart failure and death in each group were calculated. The Cox proportional hazard regression analysis was used to estimate the hazard ratio. We divided the AS and control groups into subgroups according to sex, age, income, and comorbidities.RESULTS: During the follow-up period, 102 patients (0.79%) in the AS group and 201 patients (0.32%) in the control group developed congestive heart failure (p < ;0.0001). In addition, 211 (1.62%) subjects in the AS group died during the follow-up period compared to 639 (0.98%) subjects in the control group (p < ;0.0001). The adjusted hazard ratio of congestive heart failure and death in the AS group was 2.28 (95% confidence interval [CI], 1.80–2.89) and 1.66 (95% CI, 1.42–1.95), respectively. The hazard ratios of congestive heart failure and death were significantly increased in all of the subgroups.CONCLUSION: The incidence rates of congestive heart failure and death were increased in AS patients.

Association of Congestive Heart Failure and Death with Ankylosing Spondylitis : A Nationwide Longitudinal Cohort Study in Korea

OBJECTIVE: We attempted to discover that Ankylosing spondylitis (AS) has a comprehensive relationship with congestive heart failure and death. METHODS: We used a nationwide database managed by the Korean National Health Insurance Service from 2010 to 2014. Twelve thousand nine hundred eighty-eight patients with a diagnosis of AS and 64940 age- and sex- stratified matching subjects without AS were enrolled in the AS and control groups. Incidence probabilities of 6 years congestive heart failure and death in each group were calculated. The Cox proportional hazard regression analysis was used to estimate the hazard ratio. We divided the AS and control groups into subgroups according to sex, age, income, and comorbidities. RESULTS: During the follow-up period, 102 patients (0.79%) in the AS group and 201 patients (0.32%) in the control group developed congestive heart failure (p < ;0.0001). In addition, 211 (1.62%) subjects in the AS group died during the follow-up period compared to 639 (0.98%) subjects in the control group (p < ;0.0001). The adjusted hazard ratio of congestive heart failure and death in the AS group was 2.28 (95% confidence interval [CI], 1.80–2.89) and 1.66 (95% CI, 1.42–1.95), respectively. The hazard ratios of congestive heart failure and death were significantly increased in all of the subgroups. CONCLUSION: The incidence rates of congestive heart failure and death were increased in AS patients.

Non-umbilical Cutaneous Metastasis of Pancreatic Adenocarcinoma as the First Clinical Manifestation: A Case Report / 대한소화기학회지

Non-umbilical cutaneous metastases from pancreatic adenocarcinomas are extremely rare. Only a few cases have been reported in the literature. An 83-year-old Korean woman, with no previous medical history, presented with a painful nodule on her scalp. Histologic examination of the nodule revealed a metastatic adenocarcinoma, and immunohistochemical staining was positive for cytokeratin (CK) 7 and CK 19. These findings were consistent with a metastatic carcinoma of pancreatic origin. An abdominal computed tomography scan identified a mass on the pancreatic head and multiple enlarged lymph nodes. Pathological examination of an endoscopic ultrasound-guided fine needle biopsy of the pancreatic mass determined that it was a poorly differentiated carcinoma. The patient refused any treatment owing to her old age and short life expectancy. Four months later, the disease progressed rapidly, and the patient died.

Two Cases of Autoimmune Hepatitis Accompanied by Connective Tissue Diseases / 대한내과학회지

Autoimmune hepatitis is a generally progressive chronic hepatitis of unknown etiology. Systemic lupus erythematosus (SLE) and Sjogren's syndrome are chronic, multifaceted inflammatory diseases that can affect every organ system, although hepatic involvement is rare. Here, we report two rare cases: autoimmune hepatitis associated with SLE and with primary Sjogren's syndrome. A 52-year-old woman and a 60-year-old woman were admitted our hospital with jaundice and pruritus. They had no history of viral hepatitis, alcohol consumption, or drug use. The pathological findings, clinical manifestations, and laboratory findings satisfied each of the diagnostic criteria for autoimmune hepatitis as well as for SLE and Sjogren's syndrome in the first and second cases, respectively. These patients were treated with prednisolone, and then followed regularly.

Comparison of Forcep-biopsy and Cryo-biopsy by a Flexible Bronchoscopy / 결핵및호흡기질환

BACKGROUND: A forceps-biopsy is performed to acquire tissue from patients with an endobronchial carcinoma using a flexible bronchoscope. Recently, a cryo-biopsy has also been used to acquire tissue samples. Cryo-biopsy is the diagnostic application of extreme cold for the local destruction of abnormal living tissue. This technique is safe, with no radiation danger, no risk of electrical accidents, and a little risk of bleeding. This study compared a forceps-biopsy with a cryo-biopsy using a flexible bronchoscope, and examined the chemosensitivity and level of VEGF (vascular endothelial growth factor) in the specimens obtained from the cryo-biopsy. METHODS: We present a prospective study of 30 consecutive patients who underwent a forceps-biopsy between January 2007 and October 2007 with a mean age of 62.1 years and a male:female ratio of 5 : 1. A flexible bronchoscope was inserted to the area of the abnormal lesions, and a cryo-probe was then applied through the working channel of the flexible bronchoscope. A temperature of approximately -80 was delivered to the tumor site for 8 seconds. The cryo-biopsy was performed after destroying the tumor mass. RESULTS: The mean size of the tissue from the forceps-biopsy and cryo-biopsy were 2.0+/-1.2 mm and 6.0+/-3.0 mm. A chemosensitivity test was performed on 5 specimens obtained using cryo-biopsy and the level of VEGF was examined in 2 specimens obtained from a cryo-biopsy. There were no side effects in either group. CONCLUSION: Cryo-biopsy using a flexible bronchoscope is a safe and effective technique for acquiring tissue samples.

Knowledge, Perception & Practice of Eye Care Nursing among Nurses in Intensive Care Units / 기본간호학회지

PURPOSE: The purpose of this study was to identify levels of knowledge, perception, and practice of eye care as part of nursing care in the ICU. METHOD: A descriptive, cross-sectional study design was used. The participants in this study were 269 registered nurses working in the ICUs of five university hospitals in Seoul, Korea. Between November 2005 and December 2005, data were collected using a semi-structured questionnaire developed by the researchers, and analyzed using the SPSS Program. RESULTS: In general, levels of knowledge of nursing care for the eyes were moderate among ICU nurses, but levels of perception of nursing care for the eyes were very high. Of the respondents, 61.7% reported that they would consult a doctor whenever they found an eye problem. Only 42.4% nurses answered that they provide eye care as part of the daily routine and 43.9% nurses responded that they cleanse the eye lids with wet saline gauze. In regression analysis, the practice of eye care as part of nursing was significantly influenced by perception of nursing care for the eyes, and knowledge of interventions for nursing care for the eyes. CONCLUSION: These results suggest that education on care of the eyes for ICU nurses and the development of a standardized eye care protocol should be done to improve quality of nursing care in the ICU.

Efficacy of Translaminar Epidural Steroid Injection versus Combined Translaminar Epidural Steroid Injection with Selective Nerve Root Injection in Spinal Stenosis

OBJECTIVE: To compare treatment effects of translaminar epidural steroid injections (TLESIs) only and selective nerve root injections (SNRIs) with TLESIs in lumbosacral spinal stenosis. METHOD: Thirty-four patients diagnosed with magnetic resonance imaging (MRI), somatosensory evoked potential (SEP) and electromyography (EMG) were included. 16 patients who had somatosensory pathway dysfunction or abnormal spontaneous activity received combined SNRIs with TLESIs and 20 patients received only TLESIs. The visual analogue scale (VAS) and functional rating index (FRI) were measured before injection, 1 week and 3 months after 3 times injection. RESULTS: The mean values of VAS before injection, 1 week and 3 months after 3 times injection were 7.55, 3.22, 3.61 in only TLESIs and 7.37, 2.06, 2.31 in SNRIs with TLESIs. The mean values of FRI before injection, 1 week and 3 months after 3 times injection were 25.16, 16.00, 15.83 in only TLESIs and 22.50, 8.37, 8.31 in SNRIs with TLESIs. In the mean values of VAS and FRI were significantly lower SNRIs with TLESIs than only TLESIs (p<0.05). CONCLUSION: Combined SNRIs with TLESIs were more effective treatment for reduction of pain and improvement of function than only TLESIs in lumbosacral spinal stenosis.

A case of nizatidine induced cholestatic hepatitis / 대한내과학회지

Histamine H2-receptor antagonists are commonly used in many clinical conditions, and their hepatotoxicity has been reported occasionally.However, cholestatic hepatitis induced by nizatidine is very rare. Here, we report a young female patient with severe cholestatic hepatitis associated with nizatidine use. She had taken nizatidine to manage asymptomatic reflux laryngitis by an otonasolaryngology doctorfor about 20 days. After about 15 days of nizatidine administration, jaundice developed and continued for more than2 months withmaximal serum total bilirubin reaching 17.5 mg/dL, in spite of the discontinuation of medication. Liver specimen obtained by needle biopsy revealed severe centrilobular cholestatic hepatitis. Her liver function improved slowly and serum total bilirubin decreased down to 1.7 mg/dL after months later from the development of jaundice. As far as our knowledge, this is the second case of nizatidine- induced cholestatic hepatitis reported in the literature.

The etiology of acute viral hepatitis for the last 3 years / 대한내과학회지

BACKGROUND: In Korea, the most common cause of acute viral hepatitis used to be the hepatitis B virus, but now the etiology of acute viral hepatitis seems to be changing. We investigated the etiology of newly developed acute viral hepatitis for the last 3 years. METHODS: We retrospectively reviewed the medical records of patients, who visited Asan Medical Center for jaundice during recent 3 years. Among them, one hundred eighty six patients were diagnosed as acute viral hepatitis by typical clinical feature and positive results in any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV PCR, and IgM anti-HEV. RESULTS: The proportion of acute viral hepatitis A, B, C, and E were 49.5% (n=92), 45.2% (n=84), 3.8% (n=7), and 1.6% (n=3), respectively. The patients' age of acute hepatitis A (29.1 +/- 1.75 years) was significantly younger than that of acute hepatitis B (38.2 +/- 3.07 years) (p<0.001). There were 10 cases of fulminant hepatic failure, all of which were caused by hepatitis B virus. Of seven patients diagnosed as acute hepatitis C, three patients were treated with interferon-alpha and ribavirin, and all achieved sustained virologic response. Three patients, who were diagnosed as acute hepatitis E, recovered spontaneously. CONCLUSION: Nowadays, the most common causes of acute viral hepatitis in Korea are in the order of the hepatitis A virus and the hepatitis B virus. The most prevalent age of acute hepatitis A is the 20th, while acute hepatitis B is most common in the 30th. Although the acute hepatitis C and E seems to be rare, they do occur sporadically in Korea.

Efficacy of Percutaneous Cholangioscopic Ethanol Injection in Hepatocellular Carcinoma Invading the Bile Duct / 대한소화기내시경학회지

BACKGROUND/AIMS: To evaluate the clinical outcomes of the percutaneous cholangioscopic ethanol injection in the hepatocellular carcinoma (HCC) invading the bile duct, we conducted a retrospective study. METHODS: Ten patients who received the percutaneous cholangioscopic ethanol injection were selected patients were diagnosed as HCC invading the bile duct between January 1998 and February 2004. Treatment response, complications, survival or death and survival time were analyzed. RESULTS: Ten patients received mean of 5.3 sessions (range 2~19) of cholangioscopic ethanol injection. Eight patients had decreased tumor mass, and the rest 2 patients had no response. Complications were pain (n=10), hemobilia (n=6: bleeding was minimal), cholangitis (n=2), bile duct rupture (n=1), and bile duct stricture (n=1). Nine patients died from severe hepatic failure and sepsis, one patient has survived for 19 months as of now. Median survival time was 5 months (range 2~19 months). Percutaneous transhepatic biliary drainage (PTBD) could be removed in two patients. CONCLUSIONS: Percutaneous cholangioscopic ethanol injection in HCC invading the bile duct showed size reduction of mass. PTBD could be no longer needed in some patients. However, supportive cares such as PTBD may be appropriate considering their short survival period and risk of procedure.

A Case of Juxtaglomerular Cell Tumor / 대한신장학회잡지

The juxtaglomerular cell tumor is a rare benign tumor which causes surgically correctable hypertension. We report a case of hypertension caused by juxtaglomerular cell tumor in a 17-year old man. He presented with hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism. Renal angiography showed no evidence of renal artery stenosis. Though no mass was suspected in renal angiography, CT scan showed a well demarcated mass, 3 cm in diameter, in the upper portion of left kidney, which was resected and diagnosed to be a juxtaglomerular cell tumor. After resection of the tumor, blood pressure was normalized with resolution of hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism.

A Case of Idiopathic Chylothorax and Chyluria / 결핵및호흡기질환

We report a rare case of idiopathic chylothorax and chyluria. A 31 year-old woman was referred to our hospital with a right-sided pleural effusion. Cream-colored pleural fluid and urine were confirmed as chylothorax and chyluria, respectively, by a lipoprotein electrophoresis. Even though she had previously underwent surgery for pelvic fibrosarcoma and experienced its recurrence, there has been no change of mass size and no evidence of thoracic duct or urinary tract obstruction as of the moment. Hence, idiopathic chylothorax and chyluira was diagnosed. Because she responded poorly to conservative treatment, thoracic duct ligation and pleurodesis were performend ; wherease chyluria was resolved spontaneously.

The Correlation of Electrodiagnostic Severity, Severity of Symptom, Functional Status, and Clinical Severity in Patients with Carpal Tunnel Syndrome

OBJECTIVE: To evaluate the correlation of electrodiagnostic severity, severity of symptom, and clinical severity in carpal tunnel syndrome (CTS). METHOD: The sixty eight patients with documented CTS in outpatient clinic from January, 2000 to June, 2001 were included (9 male, 59 female, averaged age 50.0+/-8.8 years). We evaluated the severity of symptom, functional status of ADL with the Levine' questionnaire, and clinical severity with 3 kinds of examination (thenar atrophy, sensory change, and Phalen's test). The electrodiagnostic severity was classified according to Stevens' classification and compared with the severity of symptom, functional status, and clinical severity. RESULTS: The electrodiagnostic severity was classified into three degrees. Five patients (7.4%) were classified into mild degree, 32 patients (47.1%) moderate degree, 31 patients (45.6%) severe degree. The average of severity of symptom scores were 28.4+/-8.5, 31.8+/-7.4, and 31.8+/-9.1 respectively, and there was no significant difference (p>0.05) between the groups. Functional status scales were 14.2+/-6.7, 15.6+/-5.4 and 18.9+/-7.0 respectively and no significant difference (p=0.07) but there was a tendency that the severer was electrodiagnostic severity, the more decreased functional status scale. The clinical severity showed a significant correlation with the electrodiagnostic severity (p<0.05). CONCLUSION: The electrodiagnostic severity has a significant correlation with the clinical severity, but not with the severity of symptom, the functional status in CTS.

Plantar Nerve Injuries Related to Calcaneal Fractures

OBJECTIVE: We investigated plantar nerve injuries associated with calcaneal fracture and severity of disability. METHOD: From July, 2001 to June, 2002, twelve patients who had calcaneal fractures with persistent foot pain and paresthesia were included in our study. We examined electromyography for medial and lateral plantar nerve, inferior calcaneal nerve, also evaluated types of calcaneal fracture and severity of pain and disability with nerve injury. RESULTS: The intraarticular types were 13 cases, extraarticular type was 1 case and communited types were 2 cases. In the electromyographic findings, the 9 cases were diagnosed asneuropathy. In a cases with neuropathy, 8 persons complained over moderate degree of pain and all persons complained over moderate degree of walking disability. However one of three persons without neuropathy complained over moderate degree of walking disability. So disability tended to be more severe in cases with neuropathy. CONCLUSION: We think that neuropathy associated with calcaneal fracture is a cause of aggravation of pain and walking disability, and electromyography for nerves of foot will be needed in the calcaneal fracture.

A Case of Chylous Ascites Associated with Non-Hodgkin's Lymphoma and Liver Cirrhosis / 대한혈액학회지

Chylous effusion is an unusual complication of malignant neoplasm, usually lymphoma. In cases with cancer, the tumor was usually extensive, and the prognosis was invariably poor with a one year mortality rate of 80%. It was also reported that chylous effusion could also result from liver cirrhosis. The incidence of this complication was reported to be 0.5% in patients with liver cirrhosis and ascites. Here we report a case of 62 year old male with chronic alcoholism history who presented with abdom-inal distension and right cervical mass. He was subsequently diagnosed as non-Hodgkin's lymphoma and chylous ascites with liver cirrhosis and treated with chemotherapy. In spite of treatment, lymphoma progressed and the patient expired.

Lipoid Proteinosis / 대한피부과학회지

Lipoid proteinosis is a rare autosomal recessively inherited disorder that is characterized by the deposition of hyaline-like material in the skin, oral cavity, and other organs. Microscopically, there is extensive deposition of amorphous eosinophilic material surrounding capillaries, sweat glands and in papillary dermis. Although the pathogenesis of this disease is not well understood, it is believed that it may result from the defect of collagen metabolism leading to abnormal accumulation of noncollagenous glycoprotein. We report a case of lipoid proteinosis in a 20-year-old female that demonstrates the characteristic clinical, histopathological, and ultramicroscopic features of this disease.

A Case of Vulvar Lymphangiectasia secondary to Primary Lymphedema / 대한피부과학회지

Lymphangiectasia (acquired lymphangioma) is a rare disease that resembles congenital lymphangioma clinically and histopathologically. It usually occurs as a result of acquired lymphatic obstruction secondary to surgery, irradiation, recurrent infection, primary or secondary lymphedema, pressure, and scar due to chronic inflammation, etc. We herein report a case of vulvar lymphangiectasia of a 15-year-old female. She has suffered from swelling on both legs since the age of 5. She was presented because of multiple grouped vesicles and papules containing clear fluid, which resembled frog's spawn and has developed on the vulvar area since the age of 9.

A Case of Congenitally Developed Alopecia Areata / 대한피부과학회지

Alopecia areata is a common cause of acquired circumscribed alopecia in childhood. In infancy alopecia areata is exceptional. No case of congenital alopecia areata has been documented yet. Thus, it is generally assumed that alopecia areata is acquired only postnatally, and it is believed that the presence of an alopecia at birth virtually excludes the diagnosis of alopecia areata. In this report, we document a case of congenitally developed alopecia areata that shows typical clinical and histological features of alopecia areata.