Association of Vitamin D Deficiency with Diabetic Nephropathy

Background@#Low 25-hydroxyvitamin D (25OHD) levels are associated with the incidence of type 2 diabetes mellitus (T2DM). However, the association between 25OHD and metabolic health status or diabetic complications is inconclusive. We evaluated this relationship between vitamin D status and metabolic parameters and complications of T2DM. @*Methods@#This study included 1,392 patients with T2DM who visited Eulji and Ewha Diabetes Center between January 2011 and August 2016. Anthropometric parameters and laboratory tests including glycated hemoglobin (HbA1c), lipid profile, liver and kidney function, and urinary albumin-to-creatinine ratio (UACR) were evaluated. Diabetic macro- and microvascular complications were determined through a medical record review. Serum 25OHD concentrations were measured by chemiluminescent immunoassay. @*Results@#The mean 25OHD level was 16.8±9.6 ng/mL. Vitamin D deficiency (<20 ng/mL) and severe deficiency (<10 ng/mL) were observed in 990 (71.1%) and 351 (25.2%) participants, respectively. 25OHD level was positively correlated with age and highdensity lipoprotein cholesterol (HDL-C) level and negatively correlated with HbA1c, triglyceride level, and UACR. HDL-C and UACR were significantly associated with 25OHD after adjusting for other variables. Vitamin D deficiency was independently related to nephropathy after adjusting for confounding variables. @*Conclusion@#Vitamin D deficiency was common among Korean T2DM patients; it was independently associated with microalbuminuria and HDL level, and positively related to diabetic nephropathy.

Early Retinal Hemorrhage Absorption Rate and Long Term Clinical Outcomes in Branch Retinal Vein Occlusion

Purpose@#We report the relationship between early retinal hemorrhage absorption rate (RHAR) and long-term clinical outcomes associated with branch retinal vein occlusion (BRVO). @*Methods@#This retrospective study included 66 eyes with BRVO. We used a grid as a quantitative measurement unit for measuring the amount of hemorrhage, and calculated the RHAR by measuring variance between sums of the grids. We investigated the relationship of best corrected visual acuity (BCVA), central foveal thickness (CFT), and other long term clinical outcomes with RHAR. @*Results@#The RHAR in BRVO patients measured 16.46 ± 21.48 ∑grid/time (month). Improvement of BCVA (logMAR) was 0.28 ± 0.28 at 12 months, showing statistical significance with the RHAR (p < 0.01). We divided RHAR into two groups by 7.5 ∑ grid/month; slow and fast RHAR groups. Improvement of BCVA (logMAR) was 0.16 ± 0.23 in the slow RHAR group, and 0.38 ± 0.28 in the fast RHAR group, with statistical significance (p = 0.01). Regression of CFT was 133.12 ± 142.93 μm in the slow RHAR group, and 236.62 ± 131.55 μm in the fast RHAR group, with statistical significance (p < 0.01). @*Conclusions@#RHAR may be a prognostic factor during follow-up in BRVO patients.

Early Retinal Hemorrhage Absorption Rate and Long Term Clinical Outcomes in Branch Retinal Vein Occlusion

Purpose@#We report the relationship between early retinal hemorrhage absorption rate (RHAR) and long-term clinical outcomes associated with branch retinal vein occlusion (BRVO). @*Methods@#This retrospective study included 66 eyes with BRVO. We used a grid as a quantitative measurement unit for measuring the amount of hemorrhage, and calculated the RHAR by measuring variance between sums of the grids. We investigated the relationship of best corrected visual acuity (BCVA), central foveal thickness (CFT), and other long term clinical outcomes with RHAR. @*Results@#The RHAR in BRVO patients measured 16.46 ± 21.48 ∑grid/time (month). Improvement of BCVA (logMAR) was 0.28 ± 0.28 at 12 months, showing statistical significance with the RHAR (p < 0.01). We divided RHAR into two groups by 7.5 ∑ grid/month; slow and fast RHAR groups. Improvement of BCVA (logMAR) was 0.16 ± 0.23 in the slow RHAR group, and 0.38 ± 0.28 in the fast RHAR group, with statistical significance (p = 0.01). Regression of CFT was 133.12 ± 142.93 μm in the slow RHAR group, and 236.62 ± 131.55 μm in the fast RHAR group, with statistical significance (p < 0.01). @*Conclusions@#RHAR may be a prognostic factor during follow-up in BRVO patients.

Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma

PURPOSE: To evaluate a new gonioscopy score and preoperative factors as a potential predictor for intraocular pressure (IOP) reduction after phacoemulsification. METHODS: This is a retrospective review of 182 eyes with glaucoma of either open or narrow angles that underwent phacoemulsification. Preoperative variables such as age, IOP, refractive errors, anterior chamber depth (ACD), axial length, and lens position were evaluated at 6 months after surgery. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants. To determine variables associated with IOP change at 6 months, univariate and multivariate linear regression analysis was performed. RESULTS: The mean age of the patients was 72.8 ± 9.5 years and the average preoperative IOP was 16.4 ± 3.7 mmHg with 1.2 glaucoma medications. The mean IOP reduction after phacoemulsification was 2.7 ± 2.2 mmHg at postoperative 6 months. Preoperative IOP (β = 0.55, p < 0.001), gonioscopy score (β = −0.29, p < 0.001), ACD (β = −0.67, p = 0.02), and IOP/ACD ratio (β = 0.58, p = 0.01) were associated with IOP reduction at 6 months. CONCLUSIONS: Preoperative predictors for IOP reduction after phacoemulsification were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio in patients with glaucoma. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.

Prognostic Significance of Immunohistochemical MSH2 Expression in Prostate Cancer

PURPOSE: There are numerous prostate cancer-related genes that involve in carcinogenesis and tumor progression. Among the genes, DNA mismatch repair genes recognize and repair misincorporated nucleotides during DNA replication. In this analysis, we evaluated the association of hMSH2 which is one of the mismatch repair genes, with risk of aggressive prostate cancer and prostate cancer recurrence. MATERIALS AND METHODS: Immunohistochemistry was performed in 46 patients who diagnosed prostate cancer and underwent radical prostatectomy between January 2006 and December 2012 at Kyung Hee University Hospital at Gangdong. We evaluated an association between the degree of hMSH2 immunohistochemical staining and various clinical variables including prostate-specific antigen (PSA), Gleason score, pathological stage, and biochemical recurrence. The intensity of immunostaining for hMSH2 was divided into 2 groups: low expression group (immunostaining score < 2) and high expression group (immunostaining score ≥2). RESULTS: Although seminal vesicle invasion was marginally associated with the degree of hMSH2 immunohistochemical staining, PSA, Gleason score, lymph node metastasis, presence of lymphatic, perineural, vascular invasion, and extracapsular extension were not associated with the degree of hMSH2 immunohistochemical staining. Furthermore, the association of biochemical recurrence free survival with hMSH2 expression was not statistically significant. CONCLUSIONS: The hMSH2 expression was marginally associated with risk of aggressive prostate cancer such as seminal vesicle invasion. Further evaluation with a larger number of cases is needed to verify these results.

Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment / 영남의대학술지

BACKGROUND: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). METHODS: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. RESULTS: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p < 0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317–1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. CONCLUSION: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.

Acute upper limb ischemia in a patient with newly diagnosed paroxysmal atrial fibrillation / 영남의대학술지

Acute limb ischemia (ALI) due to an embolism is associated with high mortality rate and poor prognosis, and early diagnosis with prompt revascularization is required to reduce the risk of limb amputation or even death. The etiologies of ALI are diverse, and it includes an embolism from the heart and thrombotic occlusion of the atherosclerotic native vessels, stents, or grafts. An uncommon cause of ALI is acute arterial thromboembolism, and atrial fibrillation (AF) is the single most important risk factors for systemic thromboembolism. It is important to correctly identify the source of ALI for secondary prevention, as it depends on the underlying cause. Percutaneous transluminal angioplasty (PTA) has been proven to be a safe and effective treatment for focal atherosclerotic and thrombotic occlusive diseases of the aorta and its major extremity branches. Herein, we report on a 77-year-old female patient with acute upper limb ischemia, treated by PTA using a catheter-guided thrombectomy. He was newly diagnosed with paroxysmal AF (PAF) while evaluation the cause of his acute arterial thromboembolism. We recommend that cardiologists always consider PAF as a possible diagnosis even in patients without any history of AF under ALI because it is possible to develop thromboembolism in clinical practice.

Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment / 영남의대학술지

BACKGROUND: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI).METHODS: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared.RESULTS: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p < 0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317–1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes.CONCLUSION: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.

Acute upper limb ischemia in a patient with newly diagnosed paroxysmal atrial fibrillation / 영남의대학술지

Acute limb ischemia (ALI) due to an embolism is associated with high mortality rate and poor prognosis, and early diagnosis with prompt revascularization is required to reduce the risk of limb amputation or even death. The etiologies of ALI are diverse, and it includes an embolism from the heart and thrombotic occlusion of the atherosclerotic native vessels, stents, or grafts. An uncommon cause of ALI is acute arterial thromboembolism, and atrial fibrillation (AF) is the single most important risk factors for systemic thromboembolism. It is important to correctly identify the source of ALI for secondary prevention, as it depends on the underlying cause. Percutaneous transluminal angioplasty (PTA) has been proven to be a safe and effective treatment for focal atherosclerotic and thrombotic occlusive diseases of the aorta and its major extremity branches. Herein, we report on a 77-year-old female patient with acute upper limb ischemia, treated by PTA using a catheter-guided thrombectomy. He was newly diagnosed with paroxysmal AF (PAF) while evaluation the cause of his acute arterial thromboembolism. We recommend that cardiologists always consider PAF as a possible diagnosis even in patients without any history of AF under ALI because it is possible to develop thromboembolism in clinical practice.

Lower limb ischemia after bee sting / 영남의대학술지

Bee sting causes mild symptoms such as urticaria and localized pain, and severe symptoms including anaphylaxis, cardiovascular collapse, and death. We reported on a patient with arterial thrombotic occlusion and severe ischemia in the lower limb after multiple bee stings. The patient was stung 5 times and complained of pallor, pain, and coldness in the left toe, and did not have dorsalis pedis pulsation. Computed tomography angiography showed multiple thrombotic occlusion of the anterior and posterial tibial artery below the knee. Local thrombolytic therapy using urokinase was administered and the occluded arteries were successfully recanalized.

Choroidal Metastasis from Prostate Cancer

Metastasis of choroid from prostate cancer is not common and has not been reported before in Korea. We report a case of decreased vision in a patient with prostate cancer. After external beam radiotherapy, patient had complete response in the choroidal metastasis. Metastasis of choroid secondary to prostate is not common. There have been only 8 cases reported. In this case, we demonstrated that external beam radiotherapy showed a therapeutic effect.

Epithelial Cyst of the Uvula with Unilateral Complete Cleft Lip and Palate

Suture technique for successful guided bone regeneration; Preliminary report of double layered suture technique with subgingival suture

Electoroglottograph in Normal Adult; Preliminary Study for Electroglottographic Study of Swalloing Disorder

Analysis of Speech Pathologic Evaluation for Children With Ankyloglossia

A Case of Focal Segmental Membranoproliferative Glomerulonephritis in a 5 Years Old Girl

=Abstract= Membranoproliferative glomerulonephritis (MPGN) is a progressive primary glomerulonephritis characterized by mesangial proliferation with increased mesangial matrix, subendothelial immune deposits, mesangial interposition and a double contour feature of the glomerular basement membrane. The glomerular involvement in MPGN is usually diffuse; however, cases of focal or segmental MPGN have been reported by several authors. We report a case of focal segmental MPGN with prolonged hypocomplementemia for 3 years in a 5 years old girl.

Complementary and Alternative Medical Therapies in Children and Adolescent with Chronic Disease: Utilizations and Patterns / 소아과

PURPOSE: This study describes how often complementary and alternative medical (CAM) therapies, what patterns of CAM therapies utilization, what types of CAM therapies and why CAM therapies are used in children and adolescent with chronic disease. METHODS: We interviewed and filled out questionnaires with parents of patients suffering from asthma, atopic dermatitis, congenital myopathy, epilepsy and so on from Mar 2004 to Aug 2004. RESULTS: Two hundred fifty two parents answered questionnaires; 160 cases (63.5 percent) had used CAM therapies. Utilization of CAM therapies according to each chronic disease was as follows: congenital myopathy (100 percent), atopic dermatitis (91.1 percent), asthma (72.5 percent), chronic diarrhea (50.0 percent), epilepsy (17.1 percent) etc. Types of CAM therapy were as follows: dietary supplement (31.1 percent), herb medicine (23.4 percent), massage (14.2 percent), acupuncture (4.6 percent) etc. Sixty four (40.0 percent) case underwent more than two types of CAM therapies simultaneously. One hundred thirty three (83.1 percent) case were asked through non-medical prescription. Ninety nine (61.9 percent) case were recognized positive effect of CAM therapies. Parents' and childrens' ages were influential factors in CAM therapies utilization: the older the parents and the younger the children, the higher the utilization. CONCLUSION: Although patients receive treatment with western medicine, many of them not only undergo CAM therapies, especially more than two types, but also recognize the positive effects of CAM therapies. As a result, we suggest that it is easy to use of CAM therapies, and the positive effects of CAM therapies are prominent, domestically. Therefore, medical approach and study about the effectiveness and side effects of CAM therapies is necessary to avoid the imprudent use of such therapies.

A Case of Nutcracker Syndrome Presenting with Orthostatic Proteinuria

Orthostatic proteinuria is documented as a benign condition and the most common cause of isolated proteinuria. The etiology and pathogenesis of orthostatic proteinuria is not clear yet. Recently there were a few report that nutcracker syndrome seemed to cause orthostatic proteinuria. We experienced a case of a twelve-year-old female patient with incidently discovered orthostatic proteinuria who was suspected to have nutcracker phenomenon by doppler sonography. We confirmed this patient as nutcracker syndrome by renal venography.

INFILTRATING LIPOMA OF THE NECK: A CASE REPORT