A Yellowish Granular Lesion in the Esophagus

No abstract available.

A Case of Medullary Thyroid Carcinoma with de novo V804M RET Germline Mutation

Many cases of RET proto-oncogene mutations of hereditary medullary thyroid carcinoma (MTC) have been reported in Korea. However, MTC with V804M RET proto-oncogene germline mutations have not been reported in Korea. A 33-yr-old man was diagnosed with a 0.7-cm sized thyroid nodule. Laboratory testing revealed serum calcitonin was elevated. The patient underwent total thyroidectomy with central compartment neck dissection for the thyroid tumor. RET gene analysis was performed in both the index patient and his family. There were no V804M RET mutation and abnormal laboratory findings within his family except the index patient. Therefore, this patient was a de novo V804M RET germline mutation.

Co-Occurrence of Papillary Thyroid Carcinoma and Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient with Long-Standing Hashimoto Thyroiditis

Papillary thyroid carcinoma (PTC) is a common affliction of the thyroid gland, accounting for 70% to 80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland is uncommon. The simultaneous occurrence of both malignancies is extremely rare. We report the case of a patient with both PTC and MALT lymphoma in the setting of Hashimoto thyroiditis. An 81-year-old female patient was first admitted with goiter and hoarseness, which was attributed to an ultrasonographic thyroid nodule. Subsequent fine-needle aspirate, interpreted as suspicious of papillary thyroid cancer, prompted total thyroidectomy. MALT lymphoma was an incidental postsurgical finding, coexisting with PTC in the setting of Hashimoto thyroiditis. Although the development of MALT lymphoma is very rare, patients with longstanding Hashimoto thyroiditis should undergo careful surveillance for both malignancies.

Factors Influencing Drinking Behavior during Pregnancy in Korean Women / 신경정신의학

OBJECTIVES: Drinking alcohol during pregnancy can result in various negative consequences. Nevertheless, few studies have been conducted in Korea to investigate alcohol consumption and factors influencing drinking behavior during pregnancy in Korean women. A survey was therefore conducted on pregnant women to investigate whether they drank alcohol and to identify factors predictive of drinking behavior during pregnancy. METHODS: Pregnant women at less than 30 days before expected delivery were asked to complete a self-report questionnaire. Demographic and obstetric characteristics and smoking history were investigated in addition to their history of alcohol use. RESULTS: Six hundred and sixty five subjects of average age 30.8+/-3.8 years were enrolled. Five hundred fifty five (83.5%) and 163 subjects (24.5%), respectively, consumed alcohol before becoming pregnant and after they were aware of being pregnant. Ninety six (14.4% of 665 subjects) and 20 subjects (3.0% of 665 subjects), respectively, smoked before becoming pregnant and after they were aware of being pregnant. Those who had consumed alcohol before becoming pregnant (OR=12.13, p<0.001), those who smoked before becoming pregnant (OR=2.24, p=0.001) and those with a family history of smoking (OR=1.59, p< or =0.05) were found to be more likely to drink alcohol when pregnant. CONCLUSION: Three factors, alcohol drinking before becoming pregnant, cigarette smoking before becoming pregnant and a family history of cigarette smoking, are predictive of alcohol consumption during pregnancy. These results strongly suggest that an anti-drinking educational program should be devised to target women of child bearing potential and, in particular, those at high risk.

Korean Adult Growth Hormone Deficiency Treatment Registry / 대한내분비학회지

BACKGROUND: Adult growth hormone (GH) deficiency is related with decreased lean body mass, increased body fat, and poor quality of life. In western countries, adult GH deficiency treatment registriesy provide a database of the effects and safety of GH deficiency treatment. The Korean Adult Growth Hormone Study Group of the Korean Society of Endocrinology register adult GH deficiency since 1996. METHEODS: Subjects were aged over 15 years, had organic hypothalamo-pituitary disease, and GH deficiency as documented by GH stimulation test or serum insulin-like growth factor-I (IGF-I) level. The underlying etiology for GH deficiency, serum IGF-I level, starting and maintenance dose, and adult GH deficiency assessment (AGHDA) score were investigated. RESULTS: From January 1996 to May 2001. 115 patients were enrolled. Mean age was 43.7 13.8 years and 60% were female. Thirteen medical institutions were involved in the registry. The most common underlying diseases were Sheehan's syndrome and pituitary adenomas. GH starting dose was from 0.4 to 1.0 units. Maintenance dose was between 0.5 and 1.2 units. Serum IGF-I levels were increased after GH treatment (0-week, 93.7 69.7 ng/mL; 2-weeks, 184.9 89.0 ng/mL; 6-weeks, 188.4 94.8 ng/mL; 10-weeks, 207.6 111.1 ng/mL; 6 months, 281.9 95.5 ng/mL). AGHDA scores slightly improved from 10.25 6.70 to 8.58 5.47 after 6 months of GH deficiency treatment. CONCLUSION: The GH Treatment Registry will be beneficial in monitoring the effects of GH deficiency treatment on Korean adult GH deficient subjects

A Case of Gastric Mucormycosis, Vascular Invasive Type Associated with a Severe Malnutrition in a Non-diabetic Hemodialysis Patient / 대한신장학회잡지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.

A Case of Gastric Mucormycosis, Vascular Invasive Type Associated with a Severe Malnutrition in a Non-diabetic Hemodialysis Patient / 대한신장학회잡지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.

A Case of Myocarditis in Patient with Korean Hemorrhagic Fever / 대한신장학회잡지

Korean hemorrhage fever(KHF) is an acute febrile disease with high fever, hypotension, gastrointestinal symptom, hemorrhagic symptom and renal failure. An adult patient with KHF presented with normal EKG on admission and no hypotensive period, subsequently developed dypnea on 10 th hospital days. Pulmonary edema pattern of the chest x-ray, T inversion of EKG and diffuse ventricular dyskinesia of echocardiography apperaed on 10th hospital days, and then disappered on 2 month. We experienced a rare case of KHF associtaed with myocarditis. This case suggests that the Myocarditis can be associated with KHF.

Antibiotic cement-coated Unreamed nailing for Treatment of Infected Nonunion of Long bone / 대한정형외과학회잡지

PURPOSE: Our study was aim to evaluate the results of treatment by antibiotic cement-coated unreamed nailing for infected nonunion of long bone shaft. MATERIALS AND METHODS: Ten cases of nonunion, 6 femurs and 4 tibias were included in this study. Average age of patients was 38.5 and men were eight. Average follow-up period was 16.4 months (12-35) . Etiologies of infection were open fractures (6 cases) and iatrogenic (4 cases) . Eight cases which had positive antimicrobial sensitivity test preoperatively were used a sensitive, heatstable, and powderform antibiotics. Primary autogenous bone grafting with nailing was perfomed in five cases. Delayed bone grafting after curettage and nailing was done in another five cases in infected by S. aures organism. RESULTS: All of ten cases had bony union. Union time was average 31.5 in femur and 26.4 in tibia. Early weight bearing ambulation and motion of adjacent joint were beneficial. But average 8 mm of shortening was developed and angulation more than 5 degrees occured in one case. CONCLUSION: Antibiotic cement coated-unreamed intramedullay nailing is the recommended treatment of method in infected nonunion of long bone shaft with minimal shortening.

A Case of Microscopic Polyangiitis / 대한신장학회잡지

Microscopic polyangiitis is a systemic small vessel vasculitis, which, although primarily associated with necrotizing and crescentic glomerulonephritis and pulmonary capillaritis, often has cutaneous and muscul-oskelectal features. Microscopic polyangiitis is strongly associated with antineutrophil cytoplamic autoantibody that are a useful diagnostic serologic marker for the most common form of necrotizing vasculitis, and that have two patterns(C-ANCA and P-ANCA). We have experienced a case of microscopic polyangiitis with purpurae on both lower extrimities, C-ANCA positive and cresent formation on renal biopsy, which had no history of asthma and no pathologic evidence of granuloma. In our case, deterioration of renal function was recovered after steroid pulse therapy.

A Case of Wernicke's Encephalopathy with Hyponatremia / 대한신장학회잡지

Thiamine deficiency is known to lead to certain neurologic sequales including Wernicke-Korsakoff syndrome. Wernicke's encephalapathy is charac-terized by ataxia, ophthalmoplegia, nystagmus, and mental change. Although classically associated with chronic alcoholism, a number of other predisposing conditions exist such as hyperemesis gravidarum, thyrotoxicosis, starvation, anorexia nervosa, prolonged total parenteral nutrition, gastric plication and renal dialysis. We have experienced a case of Wernicke's encephalopathy associated with prolonged starvation which was misdiagnosed by hyponatremic ence-phalopathy at first, and which seemed to be developed by thiamine-free dextrose infusion in 39-year-old male patient. We report the case with review of the literature and emphasize the need for thiamine supplementation with slow correction of hyponatremia before the infusion of dextrose solution in the prolonged starved hyponatremic patient.

Clinical Efficacy of Diagnostic Approach of Diabetic Neuropathy in Korean NIDDM(Preliminary report): with Feldman's Approach to Diabetic Neuropathy / 대한내과학회지

OBJECTIVES: It is important to consider the symptoms of diabetic neuropathy in determining a diagnostic approach. To evaluate diabetic neuropathy, an appropriate questionnaire for Korean diabetic patients is required. In 1994, Feldman et al. proposed the two-step diagnostic approach which included a questionnaire. To adapt a diagnostic approach and questionnaire for Korean diabetics, we initially diagnosed diabetic neuropathy by using Feldman's method and by assessing the efficiency of their method for Korean diabetics as a preliminary study. METHODS: We diagnosed diabetic neuropathy with Feldman's method in 99 NIDDM patients who visited Ajou university hospital from October 1, 1996 to April 30, 1997. The sensitivity and specificity of Feldman's 4 diagnostic procedures were ebaluated. To include the highly specific symptoms in the diagnostic approach, we applied a different scoring system(from 5 to 1) to the questionnaire accroding to specificity and then evaluated the sensitivity and specificity with this new system. If the sensitivity and specificity were 60% or more, the new scoring system was regarded as clinically useful. RESULTS: Using Feldman's method, the sensitivity of MNSIQ and MNSIC was 12.8% and the specificity was 88.3% and 98.3%, respectively. The sensitivity of MDNS and NCV was 100% and the specificity was 68.3% and 61.6%, respectively. The new scoring system consisted of 13 of 15 questions with sensitivity of 46.2% and specificity of 71.7%, omitting 2 questions due to possible relation to vascular symptoms. Among the 4 diagnostic procedures, the strongest correlation existed between MDNS and NCV. None of the procedures had a significant correlatiion with MNSIQ. MNSIC, which shares similar characteristics with MDNS, had significant correlation with MDNS and NCV, but its sensitivity was very low. CONCLUSON: MNSIQ and MNSIC were not useful as screening instruments in the diagnostic approach to diabetic neuropathy using Feldman's method. Thus, a new questionnaire composed of symptoms common in Korean diabetic patients should be designed, and MNSIC could be omitted from the diagnostic approach.

Postoperative Change in Mood and Cognition of the Elderly Patients

OBJECTIVES: Surgery is being offered to an increasing proportion of the over 60s and postpoerative cognitive dysfunction may occur in the elderly. We investigated that age could be a risk factor. The confounding effects, such as learning effect due to repeated testing and the effect of distress on the test performance, were controlled for by control group. METHOD: Twenty patients aged at least 60 years completed neuropsychological test 1 day before and 1 week after surgery. We measured Mini-Mental Status Examination (MMSE), digit span, 'A' test, similarity test, Digit Symbol Substitution Test (DSST), Beck Depression Inventory (BDI), Montgomery-Asberg Depression Rating Scale (MADRS) and State Anxiety Inventory (SAI). The authors compared postoperative cognitive dysfunction by neuropsychological test in the elderly patients with those in the control group. RESULTS: One week after operation, there was no cognitive impairment compared with before operation. Advanced age might not contribute to cognitive impairment except DSST. And there was an improvement in the scores for BDI and SAI in the control group only. We did not find a significant relation between early postoperative cognitive dysfunction and mood state before operation. Because the elderly patients had lower educational level and more depressive than control group before operation, we thought that the deterioration of DSST did not happened with operation, but by insufficiency of learning effect in the elderly patients. CONCLUSION: Cognition in the elderly patients was not impaired significantly after operation when attention was paid to the known perioperative influences on mental function.

Depressive Symptoms in Elderly Patients with Physical Illness

OBJECTIVES: This study aimed to evaluate the effects of severity of functional disability, caused by physical illness, on the depressive symptoms and depressive disorders of the elderly patients (above 65 year-old) with physical illness. METHOD: Complete medical and psychiatric evaluations were achieved on 138 patients, except the 12 patients, who were severely cognitively impaired (MMSE-K score;below 19), of the 150 elderly patients (above 65 year-old) with physical illness. Sociodemographic data and health characteristic data were systematically collected, and the severity of functional disability caused by physical illness was evaluated. Depression scales (KGDS, GDS, MADRS) on 138 elderly patients were executed. In addition, based on the 61 patients of the 65 elderly patients (above 65 years old) with physical illness, except 4 patients who were severely cognitively impaired (MMSE-K score;below 19), sociodemographic data and health characteristic data were collected. The clinical diagnosis by DSM-IV diagnostic criteria and KGDS on 61 elderly patients were performed, and their functional disability caused by physical illness was evaluated. RESULTS: The frequency of depressive symptoms showed 50.0%, 36.2%, and 35.5%, respectively in KGDS, GDS, and MADRS. The patients with severe functional disability caused by physical illness-compared with those with mild functional disability-had significantly higher score on the depression scales (KGDS, GDS, MADRS). The correlation between severity of functional disability caused by physical illness and depression scales was highly positive. Severity of functional disability caused by physical illness was the strongest contributor to the depression scales. In the additional study, 19.7% of patients were diagnosed as major depressive disorder, 18% of them as dysthymic disorder, and depressive disorder (major depressive disorder & dysthymic disorder) group-compared with nondepressive disorder group-showed significantly higher score on the FDRPT and KGDS. CONCLUSION: The frequency of depressive symptoms and depressive disorder in elderly patients with physical illness was higher, compared with those in general elderly people. Functional disability caused by physical illness most highly influenced on depressive symptoms. Thus, it is important to discriminate whether the elderly patients with physical illness have depressive symptoms or not. In addition, we assumed that KGDS was not only highly correlated with other depression scales (GDS, MADRS), but also had the high diagnostic power of dis-crimination for depressive symptoms and depressive disorder. This study suggested that KGDS was available in screening depression in the elderly patients with physical illness. It was necessary to study systematically the availability of KGDS in the future.

Prebanked Autologous Transfusion using Recombinant Human Erythropoietin: Report of one case / 대한정형외과학회잡지

In the orthopaedic field, some elective surgery such such as joint replacement, spinal surgery and limb sparing procedures for musculoskeletal tumors frequently need various amounts of blood trans- fusion. But homologous transfusion occasionally result in various side effect including allergic reaction, febrile reaction, coagulopathies due to reduced platelets and coagulating factors, graft versus host disease(GVHD) and transmission of infectious diseases such as malaria, syphilis, hepatitis and AIDS. Recently these complications especially in elective surgery might result in medicolegal and social problem. Risks of transfusion could be minimized with autologous blood. So many authors are interested in prebanked autologous transfusion in elective orthopaedic surgery to prevent these problems. But there might be need of additional homologous blood transfusion because of the time limited and low yield of autologous blood. Recombinant human erythropoietin(4-HuEPO) has been shown to increase erythropoiesis. The authors could yield 5 units during 14 days using r-HuEPO without any adverse reactions. Therefore we could performed decompression, posterolateral fusion with pedicular screw fixation in spondylolisthesis without additional homologous transfusion.