Risk for metabolic syndrome in the population with visceral fat area measured by bioelectrical impedance analysis

Background/Aims@#To investigate whether visceral fat area (VFA) measured by bioelectric impedance analysis (BIA) was associated with metabolic syndrome in subjects with and without obesity. @*Methods@#A total 23,202 participants who underwent medical check-ups were assessed. Participants were stratified by body mass index (BMI) and VFA. We evaluated six different groups for metabolic syndrome: Group 1 (normal weight and low VFA), Group 2 (normal weight and high VFA), Group 3 (overweight and low VFA), Group 4 (overweight and high VFA), Group 5 (obesity and low VFA), and Group 6 (obesity and high VFA). @*Results@#Metabolic syndrome traits and metabolic syndrome were significantly more prevalent in the high-VFA (≥ 100 cm2 ) subgroup in each BMI group. Adjusted logistic regression analyses revealed that the odds ratio for metabolic syndrome compared with Group 1 was the highest in Group 6 (24.53; 95% confidence interval [CI], 21.77 to 27.64). Notably, the odds ratio of Group 2 was higher than that of Group 3 (2.92; 95% CI, 2.30 to 3.69 vs. 2.57; 95% CI, 2.23 to 2.97). @*Conclusions@#Our study demonstrates that the combination of BMI assessment and VFA determination by BIA may be a useful method for predicting the risk of metabolic syndrome. The VFA by BIA may be a useful target for interventions to improve metabolic syndrome.

Postoperative Clinical Outcomes of Colonic Stent Placement as Bridge-to-surgery vs. Emergency Surgery in Left-sided Malignant Colonic Obstruction / 대한소화기암학회지

Background/Aims@#Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction. However, since its benefits are uncertain, we aimed to establish whether it has better clinical outcomes. @*Methods@#The patients with acute malignant left-sided colon obstruction enrolled from January 2009 to December 2018 in National Health Insurance Service Ilsan Hospital. The patients were enrolled to undergo colonic stenting as a bridge to elective surgery or emergency surgery. The following oncological outcomes were assessed: incidence of complete remission, disease progression, local recurrence, and systemic recurrence. @*Results@#Out of 40 patients, 33 received self-expanding metallic stent (SEMS) as a bridge-tosurgery, and 7 underwent emergency surgery. More stoma was made in case of emergency surgery with statistical significance (p < 0.001). There were no significant differences in complete remission rate in curable left-sided malignant colonic obstruction between SEMS as a bridgeto-surgery and emergency surgery. Complete remission was achieved for 3 patients (42.9%) in the non-stent group and 27 patients (81.8%) in the stent group. There was no statistically significant difference in oncologic outcomes between the two groups (p = 0.069). According to multi-variate analysis, advanced TNM stage, Adjuvant chemotherapy, and SEMS bridge-tosurgery were significantly associated with disease-free survival. Disease-free survival rate differed significantly between the two groups (p = 0.024). @*Conclusions@#SEMS as a bridge-to-surgery might be an effective strategy and reduce stoma formation in acute malignant left-sided colon obstruction.

Epidemiology of urticaria including physical urticaria and angioedema in Korea

BACKGROUND/AIMS@#Despite the high burden and frequency of urticaria, its epidemiology is not well known. We investigated the epidemiology of various type of urticaria in Korea and changes in its annual prevalence over 5 years.@*METHODS@#We used data from the 2010 to 2014 Health Insurance Review and Assessment database, which covers the claims of 97.0% of the South Korean population. Patients aged > 10 years old were included in this study. The presence of urticaria was identified on physician-certified diagnoses using the International Classification of Diseases 10th Revision (ICD-10) codes that include various type of urticaria (L500–L509) and angioedema (T783). Epidemiology of all type of urticaria, physical urticaria and angioedema were investigated.@*RESULTS@#The prevalence of all-type urticaria over the 5 years was 4.5% with a peak in individuals, especially females, aged 30 to 59 years. The age-specific prevalence of all-type urticaria increased with age from the 10- to 19-year age group to the 70- to 79-year age group. The prevalence of dermographism, cholinergic urticaria, and angioedema were 0.12%, 0.025%, and 0.027%, respectively. Cholinergic urticaria was most prevalent in those aged 10 to 29 years with male predominance. The annual prevalence of all-type urticaria, dermographism, and angioedema increased over the 5 years.@*CONCLUSIONS@#The prevalence of urticaria has increased annually in Korea. Cholinergic urticaria showed unique distribution in its age and gender, and angioedema showed remarkable increases in annual prevalence, although the prevalence estimation is still exploratory and diagnosis of urticaria based on ICD-10 codes need to be validated.

Real World Experience of Telbivudine Versus Entecavir in Patients with Chronic Hepatitis B, Including Long-Term Outcomes after Treatment Modification

PURPOSE: To estimate long-term outcomes after treatment modification in patients with chronic hepatitis B (CHB) treated with entecavir (ETV) and telbivudine (LdT). MATERIALS AND METHODS: The study enrolled 131 nucleos(t)ide analogue (NA)-naïve CHB patients treated with ETV or LdT. During the 3-year study, NA treatment history including the incidence, the type of treatment modification, reasons for the modification, and overall complete virologic response (CVR) rate were retrospectively evaluated using the patients' medical records. RESULTS: Among the 131 patients, 84 and 47 were initially treated with ETV and LdT, respectively. During the course of 3-year study, 82 patients in the ETV group (97.6%) maintained initial treatment whereas only 19 in the LdT group (40.4%). In the LdT group, 26 patients (92.9%) switched to another NA and another NA was added in 2 (7.1%) patients. An assessment of the CVR rate at 3 years, including treatment modification, showed that 89.3% and 95.7% of patients in the ETV and LdT groups, respectively, had undetectable serum hepatitis B virus DNA levels (p=0.329). Among LdT patients with treatment modification, the cumulative incidence rate of a CVR for rescue therapy was significantly higher in the tenofovir than in the ETV group (p=0.009). CONCLUSION: During the 3-year study, there were no significant differences in the CVR between the ETV and LdT groups if appropriate rescue therapy was considered.

Entecavir to Telbivudine Switch Therapy in Entecavir-Treated Patients with Undetectable Hepatitis B Viral DNA

PURPOSE: This study examined 2-year outcome of consecutive therapy using entecavir (ETV) followed by telbivudine (LdT) in subjects with undetectable hepatitis B virus (HBV) DNA level and normal alanine aminotransferase level after the initial 6 months of ETV treatment. MATERIALS AND METHODS: Sixty subjects were randomized to continue with ETV or switch to LdT. Significant difference in baseline characteristics was not found between the two groups. Persistent HBV DNA level of 20–60 IU/mL in three consecutive samples collected three months apart or singly measured HBV DNA level of >60 IU/mL was defined as virological rebound. RESULTS: During 96 weeks of follow-up, all subjects of the ETV-only group (n=30) resulted in undetectable HBV DNA level. On the other hand, 83.3% (n=25) of the LdT-switched group showed treatment success. Virological rebound time varied from week 24 to 84 after switching to LdT. HBV DNA level was 180 to 2940 IU/mL at rebound time. All subjects with virological rebound (n=5) showed drug-resistant mutation: three had mutation rtM204I, and two had mutation rtM204V. Consecutive treatment using ETV followed by LdT showed virological rebound in 16.7% of subjects during 96 weeks of follow-up. HBV DNA negativity during initial ETV therapy could not be achieved in patients who switched to LdT. CONCLUSION: Consecutive treatment using ETV followed by lamivudine was ineffective for treating chronic hepatitis B. LdT was found as a more potent antiviral agent than lamivudine. However, this conclusion requires larger-scale, long-term prospective reviews of the treatment effects of ETV-LdT switch therapy.

The Comparison of Surgical Results Between Non-accommodative and Partially Accommodative Esotropia

PURPOSE: To examine the differences in surgical results between non-accommodative esotropia (NAE) and partially accommodative esotropia (PAE). METHODS: This retrospective study included 47 patients undergoing surgery for pediatric esotropia, defined as esotropia with a decrease in the deviated angle of greater than ten prism diopters (PD) upon administration of hyperopic spectacles. On the other hand, NAE was defined as esotropia with a decrease in the deviated angle of less than 10PD. We compared age at surgery, deviated angle at surgery, frequency of amblyopia, and deviated angle at each postoperative period in two groups. RESULTS: Twenty-nine patients belonged to the PAE group, and 18 patients belonged to the NAE group. The age at surgery in the PAE group was higher than that of the NAE group, and the deviated angle for surgical correction was smaller in the PAE group than in the NAE group. No statistically significant difference in the frequency of amblyopia presentation was found between the two groups. The surgical success rates were much higher in the PAE group at postoperative two years and at the final visit compared to those of the NAE group. CONCLUSIONS: In esotropic children who underwent surgery, the long-term surgical success rate was highest in the cases in which the esotropic angle was decreased by hyperopic correction.

The Effects of Sutureless Faden Operation With Several Materials in Rabbit Models

PURPOSE: To investigate the effects of sutureless faden operation to eliminate suture-related perioperative risks in a rabbit model. METHODS: Twenty-eighty superior recti muscles of 14 rabbits were subjected to faden operation, at a distance of 6 mm from the insertion of the muscle. They were divided into four groups of 7 muscles each: group A, Beriplast-P; group B, Bard(R) mesh (12x2 mm); group C, Surgipro(R) mesh (6x2 mm); group D, Surgipro(R) mesh (6x6 mm). Rabbits were sacrificed and the eyes were enucleated. The operative field was examined upon dissection, 4 weeks after the surgery. Histopathologic sections were examined for the degree (grade 0 to 4) of inflammation, fibrosis, atrophy and/or degeneration of muscle fiber. RESULTS: Grossly, there was a mild adhesion at the myopexy site in group A, while there was greater adhesion at the myopexy site in groups B, C and D. Group B produced a pronounced adhesion, and the mesh firmly adhered to the sclera as well as to adjacent tissue. Upon histologic examination, group A showed a mild inflammatory reaction and fibrosis, whereas groups B and D showed a moderate inflammatory reaction and fibrosis. The degree of fibrosis in group D was more severe than that in group A (p0.05). There was atrophy and degeneration in the muscle fiber in all groups, with the exception of group D. CONCLUSIONS: In the rabbit model, 6x6 mm sized Surgipro(R) mesh may be the best material in sutureless faden operation.

The Clinical Outcomes of Lens Exchange in Patients with Opacified Posterior Chamber Lens

PURPOSE: To evaluate the outcomes of posterior chamber lens (PCL) exchange in patients with opacified foldable PCLs. METHODS: This study consisted of 31 patients (35 eyes) who had received phacoemulsification and implantation of foldable intraocular lenses in the bag or sulcus and developed late opacification of the PCL. All patients reported a reduction of visual acuity and deterioration in vision. The PCLs were explanted and replaced with new PMMA lenses. The perioperative complications and the best corrected visual acuities (BCVAs) before and after surgery were evaluated. RESULTS: The mean visual acuities (logMAR value) before and after IOL exchange were 0.59+/-0.80 and 0.21+/-0.27, respectively. The difference was statistically significant (p=0.005, paired t-test). Intraoperative complications included posterior capsule rupture in six patients, zonular dehiscence in three patients, and both in one patient. Postoperative complications included intraocular pressure elevation in five patients and cystoid macular edema in two patients. One patient showed hypopyon at 6 days postoperatively, which lasted for 3 months, but she showed good visual acuity. CONCLUSIONS: Intraocular lens exchange was a safe and effective treatment for patients whose PCLs were opacified.

The Surgical Outcomes of Exotropia in Children with a Short Preoperative Work-Up

PURPOSE: We performed this study to evaluate the surgical outcome of exotropia in children younger than 10 years with a short, preoperative work-up. METHODS: The study subjects included 18 children who had received surgery for exotropia with preoperative work-ups less than 3 months. They were followed for more than 3 months after surgery. The age, symptoms, visual acuity, refractive errors, binocularity at surgery, and surgical results were analyzed. RESULTS: The average age of the subjects was 9.6 years old, and the preoperative angle of deviation was 25 prism diopters (PD). Most of them (89%) showed intermittent exotropia and myopia. None of them had amblyopia or anisometropia. Of the 18 patients, 16 (89%) were able to fuse at near and distance, and 14 patients showed good stereopsis equal to or less than 200 sec of arc by the Titmus test. The surgery was performed on the basis of the maximum angle, and inferior oblique myectomy was simultaneously performed in three patients. At the postoperative 15 months, 13 (72%) of the 18 patients showed a deviated angle less than 10PD, and exotropia recurred in 5 (28%) patients. CONCLUSIONS: The preoperative visual acuity and binocularity were relatively good, and the surgical outcome was also good in exotropic children younger than 10 years with a short preoperative work-up.

The Surgical Outcome of Partially Accommodative Esotropia with a Large Angle of Deviation

PURPOSE: To investigate the surgical outcome of patients with partially accommodative esotropia with a large angle of deviation. METHODS: Twenty-one patients with partially accommodative esotropia that had angles of deviation of at least 40 prism diopters without correction, were retrospectively studied. They underwent standard surgery, for which the amount of recession was based on the average of the distance and near deviation with correction. The angle of deviation were evaluated at postoperative 3 months and at the last follow-up, and the Titmus test and Worth 4-dot test were performed after surgery. RESULTS: The mean angle of deviation without correction at the first examination was 57.0PD, and the mean age of correction with glasses was 2.6 years. The mean angle of deviation with correction was 31.4PD. The mean age at surgery was 4.4 years. The mean follow-up period was 5.4 years. At 3 months postoperatively, 66.7%, 28.6%, and 4.8% of patients showed acceptable correction, undercorrection, and overcorrection, respectively. At the last visit, undercorrection decreased while overcorrection increased (66.7%, 23.8%, 9.5%). Titmus stereotest showed in positive results with more than 800 seconds of arc in 9 of 16 patients. A Worth 4-dot test resulted in a fusion response at far or at near in 4 of 17 patients. CONCLUSIONS: In partially accommodative esotropia with a large angle of deviation (at least 40PD without correction), the results of conventional surgery were relatively fair, while the prognosis of sensory function was poor.

Tracheobronchopathia Osteochondroplastica detected during Difficult EndotrachealIntubation : A case report

Tracheobronchopathia osteochondroplastica is a rare and usually benign disorder characterized by cartilaginous and/or osseous submucosal nodules projecting into the laryngotracheobronchial lumen. It has been an incidental finding at autopsy but nowadays it is discovered during fiberoptic bronchoscopy or chest computed tomography. We describe a case of 61-year-old man who was diagnosed to have tracheobronchopathia osteochondroplastica due to unpredicted difficult intubation.

Central Retinal Vein Occlusion Associated with Thyroid Ophthalmopathy

PURPOSE: To report the first case of central retinal vein occlusion (CRVO) in association with thyroid ophthalmopathy. METHODS: A 40-year-old woman was came to the ophthalmologic clinic due to conjunctival injection, lid swelling and decreased visual acuity in the left eye. She was ill with hyperthyroidism and was recovered completely. At the first visit, best corrected visual acuity of her left eye was 0.3. The left eye showed proptosis, episcleral vessel dilation, and moderate limitation of ocular movement. Orbit MRI revealed the enlargement of extraocular muscles. Fundus examination showed diffuse retinal hemorrhages with macular edema and retinal veins were dilated and tortuous. Fluorescein angiogram showed the diffuse leakage from the retinal vessels on the posterior pole, but nonperfusion area was not seen. RESULTS: One month after the first visit, best corrected visual acuity of her left eye was improved to 0.6. Proptosis and limitation of ocular movement was improved, and retinal hemorrhages with macular edema were decreased remarkably. CONCLUSIONS: Possible retinal vascular complications such as CRVO may occur in patients with thyroid ophthalmopathy. Therefore, in these cases, fundus examination along with other ophthalmologic examinations are necessary.

Effect of Cromolyn on S100P Interactions with RAGE and Pancreatic Cancer Growth and Invasion in Mouse Models. J Natl Cancer Inst 2006;98:1806-1818 / 대한소화기학회지

No abstract availble.

A Case of Peripheral Neuropathy as the Initial Manifestation of Systemic Sclerosis / 대한류마티스학회지

No abstract available.

The usefulness of Phadiatop R test for screening atopy in asthmatic subjects / 천식및알레르기

BACKGROUND: Phadiatop test has been introduced as a single test for screening the atopics who were sensitized to common inhalant allergens. MATERIAL AND METHOD: We compared the clinical efficiency of Phadiatop test and total IgE level for defining presence of atopy in 136 asthmatic subjects. The presence of atopy was defined by skin prick test done with 10 common inhalant allergens. More than 2+ skin reactivity was defined as having atopy. Phadiatop test and total IgE level in serum were measured using Pharmacia CAP systems. RESULT: 109 out of 136 subjects had more than 2+ skin reactivity to at least one allergen and another 27 subjects had 1+ or negative skin reactivity to allergens. The performance characteristics of Phadiatop test for screening atopy was superior than total IgE level, with sensitivity(91.7% vs. 82.6%), positive predictive value(94.3% vs. 86.5%) and concordance rate(89.0 % vs. 75.7% ). Specificity and negative predictive value of the Phadistop test were acceptable and higher than that of total IgE level. CONCLUSION: These results suggested that Ph adiatop may be simple and useful for screening atopic status in Korean asthmatic subjects.

Brain Metastasis and Leptomeningeal Carcinomatosis in Breast Cancer / 대한암학회지

PURPOSE: Brain metastasis is estimated to occur in 20 to 40% of cancer patients, and meningeal involvement has been reported in 5% to 8% of cancer patients. Even if the prognosis is grave, standard treatment modality of brain metastasis or leptomeningeal carcinomatosis has not been established. We evaluated the prognosis and the clinical features of the brain and leptomeningeal metastasis of the breast cancer. MATERIALS AND METHODS: The 43 patients who was diagnosed as brain parenchymal metastasis or leptomeningeal carcinomatosis clinically, radiologically and/or cytologically were included in this study. The median age was 44(range: 27-61) years. RESULTS: The median duration from brain metastasis to death was 181 days(range: 8~1599), and the median duration from leptomeningeal carcinomatosis to death was 39 days(range: 25~152). Age(p=0.7174) and number of brain metastatic lesion(p=0.4097) did not influence the survival, but the presence of other systemic metastatic lesion affected the survival(p 0.0224). When we compared the survival rates of patients according to treatment modality, the patients with systemic chemotherapy versus patients without systemic chemotherapy showed differences(p= 0.0009). Patients treated with whole brain radiation only versus patients with whole brain radiation and other systemic management also showed different survival rate(p=0.0009). But intrathecal chemotherapy had no effect on survival. Well differentiated, solitary lesions were treated by operation and/or gamma-knife surgery, and their effects were good. CONCLUSION: Prolongation of survival was suggested with whole brain radiotherapy combined with systemic treatment in brain or leptomeningeal metastasis. Further study is expected to confirm this finding.

A Case of Hereditary Sensory Neuropathy Type II with Acroosteolysis / 대한류마티스학회지

The hereditary sensory neuropathy is a very rare disease characterized by prominent sensory loss without corresponding motor involvement, but may be associated with autonomic features. Currently, the disease is divided into five main types and most frequent are Type I and Type II. The type II hereditary sensory neuropathy is characterized by autosomal recessive inheritance, onset in utero or in infancy, loss of touch-pressure sense more than paintemperature sense, and almost total absence of myelinated nerve fibers. In this case, we describe a 23 years old female patient with acroosteolysis and heel ulcer who was diagnosed as hereditary sensory neuropathy type II.