Association Between Vitamin D Deficiency and Suspected Nonalcoholic Fatty Liver Disease in an Adolescent Population / 대한소아소화기영양학회지

PURPOSE: Vitamin D deficiency is a condition widespread throughout the world. Recent studies have suggested that vitamin D deficiency was associated with obesity and metabolic syndrome. The purpose of the study was to examine the relationship between vitamin D deficiency and nonalcoholic fatty liver disease (NAFLD) in adolescents. METHODS: The data were obtained from the Korean National Health and Nutrition Examination Survey from 2008–2014. A total of 3,878 adolescents were included in the study. Vitamin D deficiency was defined as a 25-hydroxyvitamin D concentration 30 U/L. RESULTS: Vitamin D deficiency was noted in 78.9% of the studied population. Age, body mass index, waist circumference, and blood pressure, glucose, cholesterol, and triglyceride levels were significantly higher in adolescents with suspected NAFLD than in adolescents without suspected NAFLD, while the mean vitamin D level was significantly lower in adolescents with suspected NAFLD. The multivariate-adjusted odds of suspected NAFLD were higher with increased age, male gender, obesity, and metabolic syndrome. Individuals with vitamin D deficiency were at higher risk of suspected NAFLD (odds ratio, 1.77; 95% confidence interval, 1.07–2.95) after adjusting for age, gender, obesity, and metabolic syndrome. CONCLUSION: Vitamin D deficiency was associated with suspected NAFLD, independent of obesity and metabolic syndrome, in adolescents.

Association of Chest CT-Based Quantitative Measures of Muscle and Fat with Post-Lung Transplant Survival and Morbidity: A Single Institutional Retrospective Cohort Study in Korean Population

OBJECTIVE: Abnormal body composition is an important modifiable risk factor in lung transplantation. Therefore, precise quantification of different body components, including muscle and fat, may play an important role in optimizing outcomes in lung transplant patients. The purpose of the study was to investigate the prognostic significance of muscle and subcutaneous fat mass measured on chest CT with regard to lung transplantation survival and other post-transplant outcomes. MATERIALS AND METHODS: The study population included 45 consecutive adult lung transplant recipients (mean age of 47.9 ± 12.1 years; 31 males and 14 females) between 2011 and 2017. Preoperative cross-sectional areas of muscle and subcutaneous fat were semi-automatically measured on axial CT images at the level of the 12th thoracic vertebra (T12). Additional normalized indexed parameters, adjusted for either height or weight, were obtained. Associations of quantitative parameters with survival and various other post-transplant outcomes were evaluated. RESULTS: Of the 45 patients included in the present study, 10 mortalities were observed during the follow-up period. Patients with relative sarcopenia (RS) classified based on height-adjusted muscle area with a cut-off value of 28.07 cm²/m² demonstrated worse postoperative survival (log-rank test, p = 0.007; hazard ratio [HR], 6.39:1) despite being adjusted for age, sex, and body mass index (HR, 8.58:1; p = 0.022). Weight-adjusted parameters of muscle area were negatively correlated with duration of ventilator support (R = −0.54, p < 0.001) and intensive care unit (ICU) stay (R = −0.33, p = 0.021). CONCLUSION: Patients with RS demonstrate worse survival after lung transplantation that those without RS. Additionally, quantitative parameters of muscles measured at the T12 level on chest CT were associated with the duration of post-lung transplant ventilator support and duration of stay in the ICU.

Use of Anti-TNF Alpha Blockers Can Reduce Operation Rate and Lead to Growth Gain in Pediatric Crohn's Disease / 대한소아소화기영양학회지

PURPOSE: Pediatric Crohn's disease (CD) is directly related to growth and has a high probability of requiring surgical intervention(s); therefore, more active treatment for CD is required for children. This study investigated the impact of biologics on growth and disease course associated with surgery. METHODS: This was a retrospective cohort study involving patients diagnosed with CD at the Seoul National University Children's Hospital (Seoul, Korea) between January 2006 and October 2017. The aim was to determine the characteristics of pediatric patients with CD and whether biologics affected growth and the surgical disease course. RESULTS: Among patients who underwent surgery for CD, the mean number of operations per patient was 1.89. The mean time from initial diagnosis to surgery was 19.3 months. The most common procedure was fistulectomy (34%), followed by incision and drainage (25%). In all patients, the use of biologics increased the height (p=0.002) and body mass index (BMI) (p=0.005). Among patients who underwent surgery, height (p=0.004) and BMI (p=0.048) were increased in the group using biologics. Patients who used biologics exhibited a low operation rate only within 2 years after diagnosis, with no differences thereafter (p=0.027). CONCLUSION: Although biologics could not mitigate the operation rate in pediatric patients who underwent surgery for CD, biological therapy delayed disease progression within 2 years of disease onset. Additionally, biologics conferred growth and BMI benefits in this window period. Therefore, it may be helpful to use biologics for optimal growth in pediatric patients with a high probability of undergoing future surgery.

Quantitative CT Imaging in Chronic Obstructive Pulmonary Disease: Review of Current Status and Future Challenges

Chronic Obstructive Pulmonary Disease (COPD) is a complex heterogeneous condition with various clinical and pathologic features. In recent years, technical advances in quantitative CT imaging have generated considerable interest because they can provide a more precise and objective assessment of COPD. Emphysema and small-airway disease, the two major components of COPD, and other comorbidities, including pulmonary vessel alterations, atherosclerosis, cachexia, and osteoporosis, can all be assessed by means of quantitative imaging parameters. Increasing numbers of studies provide promising reports indicating that such parameters are associated with clinical measures of disease severity, respiratory symptoms, COPD exacerbations, and mortality. Despite such optimistic results, there are still many obstacles to using this quantitative technology in everyday practice to manage COPD patients. In this article, we review the current technical status of quantitative CT assessment, emphasizing its clinical implications and limitations. We also discuss present challenges and the potential future role of quantitative CT imaging in assessing COPD.

Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis

PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system has not yet been validated by an immunological study and needs to provide treatment guidelines based on underlying immunologic profiles. We investigated the immunologic profile of each CRS subgroup according to the JESREC classification and suggest its clinical application. METHODS: A total of 140 CRS patients and 20 control subjects were enrolled. All patients were classified into 4 groups according to the JESREC (non-, mild, moderate and severe ECRS). Nasal tissues were analyzed for mRNA expression of major cytokines (IL-5, IL-10, IL-13, IL-17A, IL-22, IL-23p19, IFN-γ, periostin, thymic stromal lymphopoietin [TSLP] and ST2), major chemokines (CCL11, CCL24, CXCL1 and CXCL2), transcription factors (T-bet, GATA3, RORC and FOXP3) and COL1A1 for type I collagen. Protein levels of 3 major cytokines (IL-5, IL-17A and IFN-γ) were also measured by multiplex immunoassay. Principal component analysis (PCA) was conducted to investigate the overall profile of multiple mediators. RESULTS: The moderate/severe ECRS showed up-regulation of type 2-related mediators (IL-5, IL-13, periostin, TSLP and ST-2), whereas INF-γ (type 1 cytokine) and CXCL1 (neutrophil chemokine) expressions were increased in non-/mild ECRS compared with moderate/severe ECRS. The JESREC classification reflected an immunological endotype. In PCA data, PCA1 indicates a relative type 2 profile, whereas PCA2 represents a type 1/type 17-related profile. In this analysis, mild ECRS was indistinguishable from non-ECRS, whereas moderate to severe ECRS showed a distinct distribution compared with non-ECRS. The JESREC classification could be divided into 2 categories, non-/mild vs. moderate/severe ECRS based on underlying immunological analyses. CONCLUSIONS: The CRS clinical scoring system from the JESREC study reflects an inflammatory endotype. However, the immunologic profile of mild ECRS was similar to that of non-ECRS. Therefore, we propose type 2-targeted medical treatment for moderate to severe ECRS and type 1/type 17-targeted for non-ECRS and mild ECRS as the first treatment option.

Idiopathic Cervicosyringomyelia in 2 year-old Boy

Syringomyelia is a disorder in which a cavity has formed within the spinal cord. Idiopathic syringomyelia is not associated with identifiable causes such as Chari type 1 malformation, spinal cord tumor, vascular malformation, tethered cord, arachnoiditis, hydrocephalus, or previous spinal surgery. The main neurologic symptoms of idiopathic syringomyelia are toe-walking, constipation, incontinence, abnormal reflexes, and lower extremity weakness. Patients may present with various symptoms such as scoliosis, cutaneous markers, pain in the lower extremities or back, or may be asymptomatic. Herein, we report a young child with idiopathic syringomyelia presenting with subtle neck pain. A 23-month-old boy visited the neurologic clinic after 3 months of right occipital area neck pain. He had no history of trauma or central nervous system infection, and neurologic examination results were normal except for right posterior neck hyperesthesia. Brain and spinal magnetic resonance imaging showed an ovoid intramedullary cystic lesion (9.7×5.0×4.7 mm) at C6/7 of the spinal cord. There was no evidence of Chiari malformation or other lesions that can be primary pathologies of syringomyelia. Electromyogram/nerve conduction velocity results were normal. The subject was diagnosed as idiopathic syringomyelia. His symptoms and neurologic/radiologic indications showed no change at a 1-year follow-up. Idiopathic syringomyelia symptoms are varied and may be overlooked by physicians. Pediatricians may consider syringomyelia if patients complain about persistent sensory abnormality. All patients who present with syringomyelia should undergo detailed neuroimaging of the entire neuraxis to elucidate the proximate cause of the lesion.

Primary Malt Lymphoma of the Common Bile Duct

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings.

Laparoscopic Resection of a 12 cm Sized Retroperitoneal Schwannoma Adjacent to Retroperitoneal Vital Vessels: Are Large Retroperitoneal Schwannomas Not Suitable for the Laparoscopic Approach?

There are a lot of advantages to laparoscopic surgery, including early recovery, less postoperative pain, better cosmesis, shorter hospital stay and an early return to normal activities because of its minimal invasiveness. So, most surgeons have agreed on these points and have accepted the various indications for laparoscopic surgery. Despite these advantages and the recent advances in laparoscopic surgery, there are few cases using the laparoscopic approach for treating retroperitoneal schwannomas. Laparoscopic resection of a large retroperitoneal schwannoma has some difficulties for tumor retraction, dissecting around the large vessels, and removal of the resected tumor. Sometimes these difficulties may cause complications and a lengthened hospital stay. However, if appropriate methods are used, long hospital stay and complication can be prevented while maintaining the advantages of laparoscopic surgery.

Osteoma cutis in Albright's Hereditary Osteodystrophy / 대한피부과학회지

Albright's hereditary osteodystrophy is an inherited syndrome that encompasses endocrinologic anomaly of pseudohypoparathyroidim or less commonly, pseudo-pseudohypoparathyroidism and various physical stigmata such as mental retardation, short stature, skeletal anomaly of the hands, abnormal dentition, round facies, and osteoma cutis. Primary osteoma cutis in this syndrome presents at birth or in early infancy, preceding most of the other manifestations. This case is a typical presentation with osteoma cutis as the sole initial manifestation. Rather unfamiliar to dermatologists, Albright's hereditary osteodystrophy still deserves to be included in the differentials when an isolated case of osteoma cutis presents in a young child.

Comparison of Small Dose Bupivacaine-Fentanyl with Conventional Dose Bupivacaine during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.

Effects of Clonidine Added to Ropivacaine in Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.

Comparison of Small Dose Bupivacaine-Fentanyl with Conventional Dose Bupivacaine during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.

Effects of Clonidine Added to Ropivacaine in Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.

The Distribution and Concentration of Ofloxacin Contained in Sustained Releasing Microsphere after Intraprostatic Injection / 대한비뇨기과학회지

PURPOSE: Sporadic excellent treatment results of intra-prostatic antibiotic injections against resistant chronic prostatitis were reported without sufficient background. So, for the scientific base of this effective treatment modality, we studied the tissue distribution and concentration of the ofloxacin after intraprostatic injection of formula which is designed for sustained release ofloxacin at least for four weeks. MATERIAL AND METHODS: 28 male dogs aged over 2 and ofloxacin designed to release over four weeks were used. The ofloxacin 12mg and poly(D,L-lactic) acid 28mg were prepared for sustained releasing formula and resolved in 1ml of 1.5% sodium carboxymethyl cellulose solution. Dogs were grouped into two, 8 control and 16 experiments for open injection. For control, oral ofloxacin 100mg was given twice a day for two and four weeks and for experimental groups, the new formula were injected at right lobe of prostate directly. The ofloxacin concentration was measured by high performance liquid chromatography(HPLC). RESULTS: Oral ofloxacin 2,800(2 weeks) and 5,600(4 weeks) were given for control and tissue concentration of ofloxacin were relatively even at all partitions of the prostate, 7.4+/-1.4(2 weeks) and 9.2+/-1.3mg/ml(4 weeks) and the blood level were 3.6-5.1mg/ml. In experimental groups, the only 12mg of ofloxacin was given and tissue concentration were 10.5+/-3.0(1 weeks), 13.8+/-4.5(2 weeks), 7.1+/-0.9(3 weeks) and 7.7+/-3.0mg/ml(4 weeks) in rights and 8.0+/-1.1(1 weeks), 10.2+/-4.2(2 weeks), 5.1+/-1.4(3 weeks) and 7.6+/-0.8(4 weeks)mg/ml in left lobes suggesting communication of blood between two lobes, and blood concentration were 0.16-0.59mg/ml. In histologic examination, the formula were localized between stroma and their size were reduced with time. CONCLUSIONS: Authors conclude that there are free communication of blood between two lobes of prostate and one direct injection of this sustained releasing formula ofloxacin into prostate can be a substitute with local effects without disturbing prostatic tissue level which reducing number or medication in future.

Clinical Recovery after Surgical Treatment of Lumbar HIVD / 대한척추외과학회지

STUDY DESIGN: The authors retrospectively analysed the recovery of clinical symptoms after surgical treatment of lumbar HIVD. OBJECTIVES: To investigate the incidence of clinical symptoms, the recovery rate and time after surgical treatment and the difference between L4-5 and L5-S1 lesion. SUMMARY OF LITERATURE REVIEW: There are many reports concerning the clinical result of surgical treatment for the HIVD. They usually describe the result as excellent, good, fair and poor. We can't get any information about the recovery rate and recovery time of each clinical symptom from the reports . MATERIALS AND METHODS: Thirty-eight patients were treated by one level open discectomy from march 1991 to december 1995, The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: In preoperative examination, SLR was positive in 82%, motor deficit in 76%, sensory deficit in 74%, DTR change in 50%, and radiating pain in 100%. The recovery rate of SLR was 96.8%, motor deficit ; 93.6%, sensory deficit ,78.6%, DTR change ; 21% and radiating pain ,84.2%. The average recovery time of SLR was 3.4 months, motor deficit ; 1.9 months, sensory deficit ; 5.3 months, DTR change ; 4.1 months and radiating pain ; 3.2 months. Motor and sensory deficit was more frequent in L4-5 lesion but DTR change was usually noted in L5-S1 lesion. The recovery rate and time showed no great difference between the two level. CONCLUSIONS: The recovery rate was higher in SLR, motor deficit and radiating pain rather than sensory deficit and DTR change. The recovery time was fastest in radiating pain but variable nature was noted in sensory deficit. Above results may be helpful to explain the prognosis of the lumbar HIVD.