Combined Effects of Focused Ultrasound and Photodynamic Treatment for Malignant Brain Tumors Using C6 Glioma Rat Model

Purpose@#Glioblastoma (GBM) is an intractable disease for which various treatments have been attempted, but with little effect.This study aimed to measure the effect of photodynamic therapy (PDT) and sonodynamic therapy (SDT), which are currently being used to treat brain tumors, as well as sono-photodynamic therapy (SPDT), which is the combination of these two. @*Materials and Methods@#Four groups of Sprague-Dawley rats were injected with C6 glioma cells in a cortical region and treated with PDT, SDT, and SPDT. Gd-MRI was monitored weekly and 18F-FDG-PET the day before and 1 week after the treatment. The acoustic power used during sonication was 5.5 W/cm2 using a 0.5-MHz single-element transducer. The 633-nm laser was illuminated at 100 J/cm2 . Oxidative stress and apoptosis markers were evaluated 3 days after treatment using immunohistochemistry (IHC): 4-HNE, 8-OhdG, and Caspase-3. @*Results@#A decrease in tumor volume was observed in MRI imaging 12 days after the treatment in the PDT group (p<0.05), but the SDT group showed a slight increase compared to the 5-Ala group. The high expression rates of reactive oxygen species-related factors, such as 8-OhdG (p<0.001) and Caspase-3 (p<0.001), were observed in the SPDT group compared to other groups in IHC. @*Conclusion@#Our findings show that light with sensitizers can inhibit GBM growth, but not ultrasound. Although SPDT did not show the combined effect in MRI, high oxidative stress was observed in IHC. Further studies are needed to investigate the safety parameters to apply ultrasound in GBM.

Bertolotti’s Syndrome Misdiagnosed as Juvenile Idiopathic Arthritis in an Adolescent Girl with Low Back Pain

Bertolotti’s syndrome is a congenital abnormality in which the expanded lower lumbar transverse process articulates with the ilium or sacrum. It is an important cause of low back pain in children and adolescents that is frequently misdiagnosed. We describe the case of a 17-year-old girl with low back pain who had a 4-year history of juvenile idiopathic arthritis. She subsequently underwent plain radiography and magnetic resonance imaging and was eventually diagnosed with Bertolotti’s syndrome. She was managed conservatively with 6 weeks of physical therapy and an exercise program, and her pain subsided.This case demonstrates the importance of considering anatomical and structural variants when evaluating low back pain in adolescents.

Bertolotti’s Syndrome Misdiagnosed as Juvenile Idiopathic Arthritis in an Adolescent Girl with Low Back Pain

Bertolotti’s syndrome is a congenital abnormality in which the expanded lower lumbar transverse process articulates with the ilium or sacrum. It is an important cause of low back pain in children and adolescents that is frequently misdiagnosed. We describe the case of a 17-year-old girl with low back pain who had a 4-year history of juvenile idiopathic arthritis. She subsequently underwent plain radiography and magnetic resonance imaging and was eventually diagnosed with Bertolotti’s syndrome. She was managed conservatively with 6 weeks of physical therapy and an exercise program, and her pain subsided.This case demonstrates the importance of considering anatomical and structural variants when evaluating low back pain in adolescents.

Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis

OBJECTIVE: To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. METHODS: PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria.

Imaging and Pathologic Characterization of the Skin Thickening or Enhancement under the Breast MRI

The purpose of this paper is to show the radiologic features of various lesions appearing as skin thickening or enhancement under the breast MRI. And histopathologic results of the skin lesions were correlated. Radiologist must be familiar with normal appearance of the breast skin under the MRI and a wide variety of conditions may affect the skin of the breast.

A Case of Aortitis with Systemic Lupus Erythematosus

A 21-year-old woman with a history of systemic lupus erythematosus (SLE) was admitted with dyspnea on exertion for a year. A transesophageal echocardiogram showed dilated aortic root with intimal thickening. A positron emission tomography/computed tomography demonstrated increase in glucose hypermetabolic along the walls of the aortic valve, ascending aorta, aortic arch, and aorta, vasculitis was observed. She underwent the Bentall operation due to inflammation at sinus of right coronary cusp. She started high dose glucocorticoid after the operation. Currently she is able to sustain with low dose steroid after gradually tapered. Her symptoms were disappeared, and inflammatory markers decreased to within the normal range. Aortitis and aortic aneurysms are an uncommon manifestation of SLE. Furthermore, almost of lupus patients with medium and large vessel vasculitis are not biopsied or studied histologically. We present first case in Korea that was a 21-year-old woman who diagnosed with lupus aortitis by pathology after aortic valve replacement operation.

Splenic Rupture following Colon Polypectomy: A Case Report and Review of Literature / 대한소화기학회지

Colonoscopy is a safe procedure performed routinely worldwide. Splenic rupture is a rare complication of colonoscopy with several reported cases since 1974. We report the first case of a complication in the Republic of Korea. The literature on this rare complication is also reviewed here, with focus on the analysis of risk, diagnosis, and treatment. A 77-year-old patient receiving oral aspirin underwent colonoscopy with polypectomy. After 24 hours, the patient experienced dizziness and hypotension. Colonoscopy was performed to exclude intestinal bleeding, which could be diagnosed with hemoperitoneum. A computed tomography scan showed copious abdominal free blood and a splenic rupture. An urgent splenectomy was performed, which was the recognized procedure of choice. Physicians should have greater awareness of the possibility of splenic rupture following colonoscopy in order to avoid delay of diagnosis and treatment for this life-threatening complication.

Eosinophilic Gastritis Presenting as Tissue Necrosis

Eosinophilic gastroenteritis is very rare disorder that is characterized by eosinophilic infiltration of the gastrointestinal tract in the absence of any definite causes of eosinophilia. It is associated with various clinical gastrointestinal manifestations, and depends on the involved layer and site. We report a case of eosinophilic gastritis presenting with severe necrosis. The symptoms disappeared immediately after beginning steroid treatment, and the eosinophil count decreased to the reference range. The patient showed eosinophilic gastritis characterized by necrotic change such as necrotizing gastritis. It is a unique presentation of eosinophilic gastritis. To the best of our knowledge, no case of eosinophilic gastritis characterized by necrotic change such as necrotizing gastritis has been previously reported in Korea.

A Case of Small Bowel Diffuse Large B-cell Lymphoma Mimicking Crohn's Disease / 대한소화기학회지

A 66-year-old male with dyspepsia and weight loss was referred to our hospital for evaluation. On laboratory examination, anti-saccharomyces cerevisiae (ASCA)-IgA was positive and iron deficiency anemia was present. PET/CT and abdominal CT scan images showed multiple small bowel segmental wall thickening and inflammation. Capsule endoscopy images showed multiple small bowel ulcerative lesions with exudates. Based on laboratory test results and imaging studies, the patient was diagnosed with Crohn's disease and treated with prednisolone and 5-aminosalicylic acid (5-ASA). However, the patient underwent second operation due to small bowel perforation within 2 month after initiation of treatment. Pathology report of the resected specimen was compatible to primary small bowel diffuse large B cell lymphoma and pertinent treatment was given to the patient after recovery. Herein, we describe a case of primary small bowel diffuse large B cell lymphoma that was mistaken for Crohn's disease.

Solitary Fibrous Tumor of the Pancreas: A Case Report and Review of the Literature / 대한내과학회지

Solitary fibrous tumors (SFTs) are histologically characterized as mesenchymal tumors of probable fibroblastic origin that can arise at pleural and extrapleural sites. SFTs originating in the pancreas are extremely rare. Here, we report a case of pancreatic SFT in a 77-year-old female who presented with jaundice. A malignant neuroendocrine tumor (NET) was suspected based on radiologic findings. However, it is difficult to differentiate SFTs from a NET from radiographs and in this report, we summarize magnetic resonance imaging findings and discuss how to distinguish between SFT and NET using immunohistochemistry. Radical excision is the treatment of choice for SFT; however, in the present case, excision was not possible and close observation showed no changes 10 months after the diagnosis.

A Case of IgG4-Related Pancreas and Kidney Disease Mimicking a Renal Pelvic Malignancy / 대한내과학회지

IgG4-related sclerosing disease is a disease entity that has recently attracted attention, manifesting as a multiorgan disease characterized by high serum IgG4 levels, extensive IgG4-positive plasma cells and lymphocyte infiltration of the affected organs, with the pancreas (autoimmune pancreatitis) and kidney as representative targets. In cases of renal involvement, parenchymal lesions are predominant, such as renal cortical lesions or diffuse renal enlargement. However, mass-like lesions involving the renal pelvis are very rare, and mass forming or pelvic involvement types should be distinguished from lymphomas, metastatic cancers and other genitourinary malignancies to avoid unnecessary surgery. Herein, we report a case of IgG4-related sclerosing disease involving the kidney as an unusual involvement pattern presenting as a mass-like lesion with pelvic and perirenal involvement.

Colonic Stent-Related Complications and Their Management

Since its introduction in the early 1990s, the self-expandable metal stent (SEMS) has been increasingly used for the management of malignant colorectal obstruction, not only as a palliative method but also as a preoperative treatment in surgical candidates. However, more recently, concerns have been raised over stent complication rates. Early complications include pain, perforation, and rectal bleeding, and late complications include stent migration and stent obstruction. With the increasing use of SEMS for treatment, physicians need to be more aware of complications occurring after the placement of these stents. This review covers the technical considerations and management of complications after colonic stenting.

Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon / 고신대학교의과대학학술지

Stent dislodgement is a rare complication of complex percutaneous coronary artery intervention and is often associated with significant morbidity. We report a case of stent dislodgement complicated by coronary artery dissection and acute total occlusion of left circumflex coronary artery. Direct expansion of the dislodged stent was performed using parallel wire technique and small balloon. An overlapping stent was implanted for remained coronary artery dissection. Coronary artery flow was restored and ST segment elevation was normalized after successful intervention.

Delayed-Onset Complete Atrioventricular Block in a Patient with Murine Typhus Myocarditis / 대한내과학회지

Murine typhus is a flea-borne infectious disease caused by Rickettsia typhi, of which myocarditis is a rare complication in the acute disseminating phase. A 62-year-old female presented with a fever and was diagnosed with murine typhus. She was treated with doxycycline and discharged after complete resolution of the fever. However, recurrent presyncope and exertional dyspnea developed 6-8 weeks later. Complete atrioventricular (AV) block with a wide QRS escape rhythm and a left bundle branch block configuration was documented. Subacute myocarditis was diagnosed based on persistent cardiac troponin-I elevation and typical cardiac magnetic resonance imaging findings. A permanent pacemaker was implanted for symptomatic complete AV block. Few reports of myocarditis in murine typhus have been published. We report a case of murine typhus myocarditis complicated by complete AV block in the late convalescence phase.

A Case of Sjogren's Syndrome Associated with Neuromyelitis Optica

Neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating disease, characterized by optic neuritis and myelitis. NMO is a very uncommon and serious neurologic manifestation of Sjogren's syndrome. We report on a 32-year-old female with NMO as central nerve system involvement of Sjogren's syndrome. She had a transverse myelitis ten years ago and did not have symptoms for a long period of time. She visited the emergency center because of worsening weakness of both limbs. She had an appendectomy three days ago before hospitalization. Cervical spinal magnetic resonance imaging showed increased signal intensity in T2-weighted images from the cervical (C2) to the upper thoracic (T4) spinal cord. As serum NMO-IgG was positive, we diagnosed neuromyelitis optica and treated with high dose steroid, but failed. Therefore, we treated with plasmapheresis and the patient was discharged without any neurological deficits.

Effects of low-dose niacin on dyslipidemia and serum phosphorus in patients with chronic kidney disease

BACKGROUND: Niacin supplementation improves dyslipidemia and lowers serum phosphorus levels in patients with chronic kidney disease (CKD). We evaluated whether low-dose niacin supplementation can improve dyslipidemia, lower serum phosphorus levels, and be administered with a low frequency of adverse effects in patients with CKD. METHODS: We retrospectively analyzed the clinical records of patients with CKD who had taken niacin from January 2009 to June 2011. We excluded patients with CKD stage 1 and 5. We then enrolled 31 patients with CKD who had taken niacin at a fixed dose of 500mg/day for 6 months. We also randomly selected 30 patients with CKD who had been taking statin for 9 months as a control group. RESULTS: Among the 34 patients with CKD who were prescribed niacin, five (14%) complained of adverse effects, and three (8%) discontinued niacin. The proportion of patients in the niacin group who had been taking a statin or omega-3 fatty acids was 67.7% and 48.8%, respectively. In the niacin group, high-density lipoprotein cholesterol level was significantly increased and triglyceride level was significantly decreased at 12 and 24 weeks compared with baseline levels (P < 0.05). In the niacin group, phosphorous level (P < 0.05) was significantly decreased, and glomerular filtration rate (GFR) was significantly increased (P < 0.05) at 24 weeks compared with baseline values. CONCLUSION: Low-dose niacin had a low frequency of adverse effects and also improved dyslipidemia, lowered serum phosphorus level, and increased GFR in patients with CKD. Further studies are needed to evaluate the long-term effects of low-dose niacin for renal progression of CKD.

Effects of low-dose niacin on dyslipidemia and serum phosphorus in patients with chronic kidney disease

BACKGROUND: Niacin supplementation improves dyslipidemia and lowers serum phosphorus levels in patients with chronic kidney disease (CKD). We evaluated whether low-dose niacin supplementation can improve dyslipidemia, lower serum phosphorus levels, and be administered with a low frequency of adverse effects in patients with CKD. METHODS: We retrospectively analyzed the clinical records of patients with CKD who had taken niacin from January 2009 to June 2011. We excluded patients with CKD stage 1 and 5. We then enrolled 31 patients with CKD who had taken niacin at a fixed dose of 500mg/day for 6 months. We also randomly selected 30 patients with CKD who had been taking statin for 9 months as a control group. RESULTS: Among the 34 patients with CKD who were prescribed niacin, five (14%) complained of adverse effects, and three (8%) discontinued niacin. The proportion of patients in the niacin group who had been taking a statin or omega-3 fatty acids was 67.7% and 48.8%, respectively. In the niacin group, high-density lipoprotein cholesterol level was significantly increased and triglyceride level was significantly decreased at 12 and 24 weeks compared with baseline levels (P < 0.05). In the niacin group, phosphorous level (P < 0.05) was significantly decreased, and glomerular filtration rate (GFR) was significantly increased (P < 0.05) at 24 weeks compared with baseline values. CONCLUSION: Low-dose niacin had a low frequency of adverse effects and also improved dyslipidemia, lowered serum phosphorus level, and increased GFR in patients with CKD. Further studies are needed to evaluate the long-term effects of low-dose niacin for renal progression of CKD.

Clinical use of a ceramide-based moisturizer for treating dogs with atopic dermatitis

In humans, skin barrier dysfunction is thought to be responsible for enhanced penetration of allergens. Similar to conditions seen in humans, canine atopic dermatitis (CAD) is characterized by derangement of corneocytes and disorganization of intercellular lipids in the stratum corenum (SC) with decreased ceramide levels. This study was designed to evaluate the effects of a moisturizer containing ceramide on dogs with CAD. Dogs (n = 20, 3~8 years old) with mild to moderate clinical signs were recruited and applied a moisturizer containing ceramide for 4 weeks. Transepidermal water loss (TEWL), skin hydration, pruritus index for canine atopic dermatitis (PICAD) scores, and canine atopic dermatitis extent and severity index (CADESI) scores of all dogs were evaluated. Skin samples from five dogs were also examined with transmission electron microscopy (TEM) using ruthenium tetroxide. TEWL, PICAD, and CADESI values decreased (p < 0.05) and skin hydration increased dramatically over time (p < 0.05). Electron micrographs showed that the skin barrier of all five dogs was partially restored (p < 0.05). In conclusion, these results demonstrated that moisturizer containing ceramide was effective for treating skin barrier dysfunction and CAD symptoms.

Severe Scrub Typhus with Enterocolitis by the Ikeda Strain of Orientia tsutsugamushi

Scrub typhus is a mite-borne bacterial infection of humans that is caused by Orientia tsutsugamushi, which causes generalized vasculitis. The disease may involve the tissues of any organ system but no case with involvement of the lower gastrointestinal tract has been reported. We report a case of a 39-year old Korean male with enterocolitis of severe scrub typhus, of which the serotype was Ikeda strain. The patient was admitted to hospital with fever, abdominal pain and shock. He developed multi organ failure and frequent watery diarrhea. Abdominal computed tomography revealed diffuse edematous thickening of the entire small and colon with inflammation. Three days after admission, the antibody to O. tsutsugamushi was reported to be 1:320. He improved with doxycycline and azithromycin, and the persistent watery diarrhea stopped at 24 hours. This study shows that scrub typhus should be considered when the small and large intestine are affected. For the genotype of O. tsutsugamushi in Korea, additional studies of the impact of changes in the vector distribution on the genotype distribution will be needed.

Evaluation of the effect of a 0.0584% hydrocortisone aceponate spray on clinical signs and skin barrier function in dogs with atopic dermatitis

The purpose of this study was to evaluate the effects of a topical spray containing 0.0584% hydrocortisone aceponate (HCA) on canine atopic dermatitis (CAD) and to evaluate the skin barrier function during the treatment of CAD. Twenty-one dogs that fulfilled the diagnostic criteria for CAD were included in this study. The HCA spray was applied once a day to the lesions of all dogs for 7 or 14 days. Clinical assessment was performed before (day 0) and after treatment (day 14), and clinical responses were correlated with changes in skin barrier function. CAD severity significantly decreased after 14 days of HCA treatment based on the lesion scores (p < 0.0001), which were determined using the CAD extent and severity index (CADESI-03) and pruritus scores (p < 0.0001) calculated using a pruritus visual analog scale. Transepidermal water loss, a biomarker of skin barrier function, was significantly reduced compared to baseline (day 0) measurements (p = 0.0011). HCA spray was shown to be effective for significantly improving the condition of dogs suffering from CAD. This treatment also significantly improved cutaneous hydration and skin barrier function in the animals.