A Qualitative Study on Reducing Dental Anxiety through Cognitive Behavioral Therapy / 치위생과학회지

Many people in Korea suffer from a fear of dental treatments; however, only a few studies have focused on this population. This study assessed the effectiveness of cognitive behavioral therapy (CBT) and its interventions in reducing dental anxiety, especially when administered by trained dental staff. Using case studies, the authors analyzed the content of each session and examined the process of reducing dental anxiety. First, the authors observed that the results of both dental fear scale and subjective unit of disturbance decreased significantly with changes in cognitive distortions related to dental anxiety and that rapid improvements were noted after two therapy sessions. Second, the study reported that practicing relaxation (deep-breathing) and muscle relaxation techniques; using hand signals to indicate anxiety or discomfort; establishing an empathic relationship with the therapist; making an anxiety list; and graded insensitive and exposure along with rehearsal, were effective in coping with dental anxiety and in changing negative thoughts towards the dentist. Third, a simple cognitive behavioral intervention can be effective in reducing dental anxiety. In summary, a short-term, five-session psychological intervention with CBT produced a sustained decrease in the symptoms of dental anxiety, allowing the patients to receive the required procedures. The authors discussed the study limitations and the implication of their results on future research.

Midgut Volvulus in a 70-year-old Man Due to Intestinal Nonrotation / 대한소화기학회지

Intestinal malrotation is a congenital disorder that results from the failure of normal bowel rotation and fixation during the 5th gestational week. The incidence of intestinal malrotation is <0.2%, but prompt diagnosis is important because this anomaly can cause midgut volvulus and lead to fatalities. Compared to infants presenting with acute symptoms, such as abdominal pain, vomiting, or diarrhea, adult patients complain of intermittent self-limited abdominal pain. We present a case of intestinal malrotation complicated by midgut volvulus improved with conservative care in a 70-year-old man. The diagnosis was suggested on the basis of imaging findings.

Jejunal Perforation Caused by Primary Jejunal Diffuse Large B Cell Lymphoma

Small bowel malignancy accounts for approximately 2% of gastrointestinal malignancies. In particular, malignant lymphoma of the small intestine is so rare that it accounts for less than 1% of gastrointestinal malignancies. Initial symptoms are non-specific and diagnosis may be delayed until the patient presents with complications such as intestinal obstruction, hemorrhage, or perforation. A 79-year-old man visited the emergency room with lower abdominal pain. Segmental resection of the small intestine was done and surgery revealed a 9.5x6 cm sized mass with jejunal perforation at 20 cm inferior to the ligament of Treitz. The mass was diagnosed as diffuse large B cell lymphoma. We experienced a case of diffuse large B cell lymphoma which was diagnosed after emergent surgery for jejunal perforation, and report it with a review of literature.

A Large Hematoma Due to Benign Ulcer Perforation of the Gastric Fundus Resembling Submucosal Tumor / 대한소화기내시경학회지

The gastric fundus is a rare site for benign ulcer and perforation to occur. A 47 year-old male presented to the emergency department with epigastric pain. An endoscopic examination revealed a submucosal tumor-like lesion with friable, superficial ulceration in the high body of the stomach. We performed surgical resection to rule out malignancy because of the lesion's large size and we found chronic gastric ulcer perforation, which was pathologically diagnosed. We presumed that the formation of the large hematoma, which mimicked a submucosal tumor, was a result of repeated bleeding, perforation and healing. We report here on a case of a large hematoma due to a benign gastric ulcer perforation in the fundus, and this all mimicked a submucosal tumor.

A case of ectopic Cushing's syndrome combined with papillary thyroid carcinoma / 대한내과학회지

Locating a corticotropin-releasing hormone (CRH)- or adrenocorticotropic hormone (ACTH)-secreting tumor is challenging. A 69-year-old woman admitted to our hospital for generalized edema was diagnosed with ectopic Cushing's syndrome. We attempted to find an ectopic tumor and could establish no ectopic focus except a retropharyngeal mass in the neck. We diagnosed the retropharyngeal mass as thyroid papillary carcinoma and examined whether the thyroid papillary carcinoma was the ectopic focus. No relationship between thyroid papillary carcinoma and ectopic Cushing's syndrome has been established. We failed to find another ectopic focus, except for the increased uptake of the retropharyngeal mass on fluorodeoxyglucose positron emission tomography (FDG-PET). Ectopic Cushing's syndrome combined with thyroid papillary carcinoma is very rare, so we report this case along with reviews of related literatures.

An Endobronchial Metastasis from Breast Cancer Seven Years after Modified Radical Mastectomy: A Case Report / 한국유방암학회지

A 39-year-old woman was admitted to our hospital because of her chronic cough. She had undergone modified radical mastectomy for breast cancer 7 year before admission. A chest radiograph showed collapse of the left upper lobe (LUL) and computed tomography of the chest revealed a mass in the proximal portion of the LUL bronchus and distal atelectasis. Bronchoscopy showed obstruction of the LUL bronchus. The microscopic examination showed findings consistent with breast cancer with the same immunohistochemical features for the hormone receptors, as compared to those features of the previously resected tumor. Positron emission tomography showed increased fluorodeoxyglucose uptake only in the LUL. Left upper lobectomy was performed and she is now undergoing systemic chemotherapy. We report here on this rare case to emphasize that when a patient with a history of breast cancer complains of respiratory symptoms, and even though the patient was treated curatively a long time ago, we should suspect the possibility of endobronchial metastasis.

A non-functioning pituitary macroadenoma detected incidentally with PET-CT / 대한내과학회지

Whole-body positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (18F-FDG) is a tomographic imaging technique that uses a radiolabeled analog of glucose, 18F-FDG, to image relative glucose uptake rates in various tissues. Since the glucose uptake is increased in many malignancies, 18F-FDG PET is a sensitive method for detecting, staging, and monitoring the effects of therapy on many malignancies. However, it is uncommon to discover an asymptomatic non-functioning pituitary tumor unexpectedly as a hypermetabolic lesion in PET studies. Here, we report a pituitary tumor that was detected incidentally by FDG-PET and ultimately turned out to be a non-functioning pituitary macroadenoma.