Improvement of Severe Colon Stricture after Rituximab Therapy for Concomitant Mucosa-associated Lymphoid Tissue Lymphoma in a Patient with Ulcerative Colitis / 대한소화기학회지

Colorectal strictures are uncommon in patients with ulcerative colitis (UC). An extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is rarely involved in the colon but may be associated with inflammatory bowel diseases. A 41-year-old female with a six-year history of UC presented with a severe stricture of the sigmoid colon that prevented the passage of a colonoscope. A histological examination revealed non-specific inflammation and fibrosis without dysplasia or cancer.Despite conventional treatment, including mesalazine and azathioprine for one year after that visit, the stricture persisted. In addition, diffuse, edematous exudative inflammation and multiple shallow ulcers were observed in the distal rectum, revealing a MALT lymphoma testing positive for CD20, CD43, CD5, and Bcl-2, but negative for CD3, CD10, CD23, and cyclin-D1. Four weekly doses of rituximab were administered. Follow-up colonoscopy performed one month after treatment revealed slight improvement in the rectal lesion without remnant histological evidence of a MALT lymphoma. In addition, the stricture showed marked improvement, and the colonoscope could pass easily through the stricture site. This is the first case report on an improvement of a severe sigmoid colon stricture in a patient with UC after rituximab treatment for a concomitant rectal MALT lymphoma.

Polycystic liver disease: an overview of clinical manifestations, diagnosis, and treatment / 고신대학교의과대학학술지

Polycystic liver disease (PLD) is a hereditary disease characterized by the presence of 20 or more liver cysts. It is classified into three types: isolated autosomal dominant PLD, PLD with autosomal dominant polycystic kidney disease, and PLD with autosomal recessive polycystic kidney disease. Genetic alterations, ciliary dysfunction of the biliary epithelial cells, and aberrant cell signaling pathways are the main factors contributing to the pathophysiology of PLD; however, other complicated mechanisms are also involved. The Gigot and Schnelldorfer classifications are widely used in clinical practice. Most patients with PLD are asymptomatic; however, a few patients with advanced-stage disease may develop symptoms and complications that impair their quality of life and require treatment. The known treatment options for PLD are somatostatin analogues, aspiration with sclerotherapy, fenestration, hepatic resection, and liver transplantation. Although liver transplantation remains the only curative treatment for PLD, medical therapies are gradually being developed with the increasing knowledge of the disease’s pathophysiology. This review focuses on the clinical manifestations and diagnosis of PLD, as well as treatment strategies, to support clinicians regarding the clinical management of the disease.

Standardized Database of 12-Lead Electrocardiograms with a Common Standard for the Promotion of Cardiovascular Research: KURIAS-ECG / 대한의료정보학회지

Objectives@#Electrocardiography (ECG)-based diagnosis by experts cannot maintain uniform quality because individual differences may occur. Previous public databases can be used for clinical studies, but there is no common standard that would allow databases to be combined. For this reason, it is difficult to conduct research that derives results by combining databases. Recent commercial ECG machines offer diagnoses similar to those of a physician. Therefore, the purpose of this study was to construct a standardized ECG database using computerized diagnoses. @*Methods@#The constructed database was standardized using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Observational Medical Outcomes Partnership–common data model (OMOP-CDM), and data were then categorized into 10 groups based on the Minnesota classification. In addition, to extract high-quality waveforms, poor-quality ECGs were removed, and database bias was minimized by extracting at least 2,000 cases for each group. To check database quality, the difference in baseline displacement according to whether poor ECGs were removed was analyzed, and the usefulness of the database was verified with seven classification models using waveforms. @*Results@#The standardized KURIAS-ECG database consists of high-quality ECGs from 13,862 patients, with about 20,000 data points, making it possible to obtain more than 2,000 for each Minnesota classification. An artificial intelligence classification model using the data extracted through SNOMED-CT showed an average accuracy of 88.03%. @*Conclusions@#The KURIAS-ECG database contains standardized ECG data extracted from various machines. The proposed protocol should promote cardiovascular disease research using big data and artificial intelligence.

Effectiveness of Albumin-bilirubin Score as a Predictor of Post-hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma / 대한소화기학회지

Background/Aims@#Post-hepatectomy liver failure (PHLF) is a major concern for patients with hepatocellular carcinoma (HCC) who have undergone liver resection. The albumin-bilirubin (ALBI) score is a novel model for assessing liver function. We aimed to investigate the effectiveness of the ALBI score as a predictor of PHLF in HCC patients who have undergone hepatectomy in South Korea. @*Methods@#Between January 2014 and November 2018, HCC patients who underwent hepatectomy and indocyanine retention rate at 15 min (ICG-R15) test were enrolled in this study. @*Results@#A total of 101 patients diagnosed with HCC underwent hepatectomy. Thirty-two patients (31.7%) experienced PHLF. The ALBI score (OR 2.83; 95% CI 1.22-6.55; p=0.015), ICG-R15 (OR 1.07; 95% CI 1.02-1.12; p=0.007) and ALBI grade (OR 2,86; 95% CI 1.08-7.58; p=0.035) were identified as independent predictors of PHLF by multivariable analysis. The area under the receiver operating characteristic curve of the ALBI score and ICG-R15 were 0.676 (95% CI 0.566-0.785) and 0.632 (95% CI 0.513-0.752), respectively. The optimal cutoff value of the ALBI score in predicting PHLF was -2.62, with a sensitivity of 75.0% and a specificity of 56.5%. @*Conclusions@#The ALBI score is an effective predictor of PHLF in patients with HCC, and its predictive ability is comparable to that of ICG-R15.

Fasciola Hepatica Induced Hepatic Abscess Treated with Triclabendazole / 대한소화기학회지

Fascioliasis is a zoonotic disease caused by Fasciola Hepatica that infects mainly cattle, sheep, and goats. Humans can be infected by water or aquatic plants contaminated with metacercariae. The authors encountered two cases of F. hepatica infection. One patient reported abdominal discomfort with marked eosinophilia. The other patient had chest discomfort with marked eosinophilia. The abdominal CT images revealed hypodense lesions in the liver. The ultrasonography-guided liver biopsy findings in both patients were indicative of parasitic infections. Serological tests confirmed the definite diagnoses. Both patients were treated with a single dose of triclabendazole, which is the treatment of choice for fascioliasis. These findings suggest that a diagnosis of fascioliasis, particularly in the acute phase, should be considered in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT.

Association between Parental Cotinineverified Smoking Status and Childhood Asthma: a Population-based Nationally Representative Analysis

Background@#Environmental tobacco smoke exposure due to parents is a modifiable risk factor for childhood asthma, but many studies have evaluated parental smoking using selfreported data. Therefore, we aimed to analyze the relationship between parental cotinineverified smoking status and asthma in their children. @*Methods@#This population-based cross-sectional study used data from the Korean National Health and Nutrition Examination Survey from 2014 to 2017. Participants aged 0 to 18 years with complete self-reported physician-diagnosed childhood asthma and measurement of their parental urinary cotinine levels were included. Parental urinary cotinine-verified smoking status was defined using both urinary cotinine levels and self-report, as active, passive, and non-smoker. Sample weights were applied to all statistical analyses because of a complex, multistage and clustered survey design. Logistic regression model was used to analyze the relationship between childhood asthma and parental smoking. @*Results@#A total of 5,264 subjects aged < 19 years were included. The prevalence of asthma was 3.4%. The proportions of paternal and maternal urinary cotinine-verified active smokers during the study period were 50.4% and 16.9%, respectively. When parental urinary cotinine level increased, the proportion of parental low household income was increased (P < 0.001).There was no significant association between the parental urinary cotinine-verified smoking group and childhood asthma group. However, the adjusted odds ratios of childhood asthma in the middle and highest tertile of paternal urinary cotinine levels compared with those in lowest tertile were 1.95 (95% confidence interval [CI], 0.98–3.89) and 2.34 (95% CI, 1.21–4.54), respectively. @*Conclusion@#There seems to be a dose-related association between paternal urinary cotinine levels and the risk of childhood asthma. Because of the high rate of paternal smoking, further studies are needed to develop a targeted strategy to reduce parental smoking for childhood asthma.

Association between Parental Cotinineverified Smoking Status and Childhood Asthma: a Population-based Nationally Representative Analysis

Background@#Environmental tobacco smoke exposure due to parents is a modifiable risk factor for childhood asthma, but many studies have evaluated parental smoking using selfreported data. Therefore, we aimed to analyze the relationship between parental cotinineverified smoking status and asthma in their children. @*Methods@#This population-based cross-sectional study used data from the Korean National Health and Nutrition Examination Survey from 2014 to 2017. Participants aged 0 to 18 years with complete self-reported physician-diagnosed childhood asthma and measurement of their parental urinary cotinine levels were included. Parental urinary cotinine-verified smoking status was defined using both urinary cotinine levels and self-report, as active, passive, and non-smoker. Sample weights were applied to all statistical analyses because of a complex, multistage and clustered survey design. Logistic regression model was used to analyze the relationship between childhood asthma and parental smoking. @*Results@#A total of 5,264 subjects aged < 19 years were included. The prevalence of asthma was 3.4%. The proportions of paternal and maternal urinary cotinine-verified active smokers during the study period were 50.4% and 16.9%, respectively. When parental urinary cotinine level increased, the proportion of parental low household income was increased (P < 0.001).There was no significant association between the parental urinary cotinine-verified smoking group and childhood asthma group. However, the adjusted odds ratios of childhood asthma in the middle and highest tertile of paternal urinary cotinine levels compared with those in lowest tertile were 1.95 (95% confidence interval [CI], 0.98–3.89) and 2.34 (95% CI, 1.21–4.54), respectively. @*Conclusion@#There seems to be a dose-related association between paternal urinary cotinine levels and the risk of childhood asthma. Because of the high rate of paternal smoking, further studies are needed to develop a targeted strategy to reduce parental smoking for childhood asthma.

Obesity and Insulin Resistance According to Age in Newly Diagnosed Type 2 Diabetes Patients in Korea / 고신대학교의과대학학술지

OBJECTIVES: With the rapid increase in the prevalence of diabetes, the age groups of diabetic patients are becoming diversified. This study will examine the degree of obesity, insulin resistance, and insulin secretion ability among patients first diagnosed with diabetes according to age and gender. METHODS: The subjects of this study included 616 patients who were first diagnosed with diabetes during a routine physical examination. This sample was obtained from a total of 28,075 adults aged 19 years and older who received the examination among 33,829 participants in the Korea National Health & Nutrition Examination Survey (KNHANES) from 2007–2010. The subjects were categorized by age into young age (age: 19 – 39 years), middle age (age: 40 – 59 years), and old age (age: 60 years and older). The degree of obesity was categorized according to body mass index (BMI) into normal weight (BMI: 18.5 ~ 22.9), overweight (BMI: 23 ~ 24.9), and obesity (BMI: 25 or above). Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: It was found that 14.1% (n = 87) of a total of 616 subjects (324 men, 292 women) were in the young age group, 43.8% (n = 270) were in the middle age group, and 42.1% (n = 259) were in the old age group. In addition, 83.3% of men that were overweight or obesity were in the young age group, while 79.2% and 60.5% were in the middle age and old age groups, respectively. A total of 82.2% of women that were overweight or obesity were in the young age group, while 79.5% and 77% were in the middle age and old age groups, respectively. For men, the more obesity they were in all age groups, the higher their HOMA-IR. For women, the more obesity they were in the young age and middle age groups, the higher their HOMA-IR; however, women in the old age group showed the highest HOMA-IR when they were of normal weight. CONCLUSION: Among diabetic patients first diagnosed with the disease in Korea, the youth population had the highest obesity rate. Insulin resistance increases as an individual's weight increases among those patients who are first diagnosed with diabetes; the only exception noted is for elderly women.

A Case of Improved Leukocytoclastic Vasculitis after Successful Treatment of Hepatocellular Carcinoma and Membranous Obstruction of Inferior Vena Cava

Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature.

Cardiac Involvement in Hypereosinophilia Associated with Toxocariasis

Cardiac involvement in hypereosinophilia is rare; when present, it manifests as ventricular thickening, usually with fibrous tissue and mural thrombosis. We present a case of a 57-year-old man with an abnormal right ventricular apex with eosinophilia, which was caused by Toxocara canis infection.

Plain Abdominal Radiograph as an Evaluation Method of Bowel Dysfunction in Patients With Spinal Cord Injury

OBJECTIVE: To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI). METHODS: Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography. RESULTS: The constipation scores ranged from 1 to 13, and the average was 4.19+/-3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13+/-1.45. CTTs were 19.3+/-16.17, 19.3+/-13.45, 15.32+/-13.15, and 52.42+/-19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4+/-0.7, 1.8+/-0.86, 2.83+/-0.82, 2.14+/-1, and 10.19+/-2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28+/-0.7, 2.8+/-0.8, 2.35+/-0.85, and 8.45+/-1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05). CONCLUSION: Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.

Changes in the Muscarinic Receptors on the Colonic Smooth Muscles of Rats with Spinal Cord Injury

OBJECTIVE: To investigate changes in (1) the colonic response to acetylcholine (Ach), (2) the muscarinic (M) receptors in the colon, and (3) the levels of colonic contraction-related proteins after a spinal cord injury (SCI). METHOD: We divided 16 Sprague-Dawley rats into 2 groups: the control group and the SCI group. A spinal cord transection was performed surgically at the T10 vertebral level. After 1 week, the entire colon was divided into 2 segments, the proximal and distal colon. Each segment was mounted in a longitudinal or circular muscle direction in a 10-ml organ bath. We determined the intergroup differences as percentage changes in contractility after Ach treatment alone, Ach treatment with M2 receptor antagonist (AQ-RA741) pretreatment, and Ach treatment with M3 receptor antagonist (4-DAMP) pretreatment. Western blot analyses were performed to determine the expression level of RhoA, and heat shock protein 27 (HSP27). RESULTS: Compared to the control rats, the SCI rats showed an increased response to Ach along both the directions in the proximal colon (p<0.05). Compared to the control group, in the SCI group, the Ach response was significantly different in the proximal segment under AQ-RA741 pretreatment (p<0.05) and in the distal segment under 4-DAMP pretreatment (p<0.05). Findings of the western blot analyses showed a significant decrease in the level of protein gene product 9.5 in the proximal and distal colon and a significant increase in the level of RhoA and HSP27 in the proximal colon of the SCI rats. CONCLUSION: Our results suggest that changes in colonic contractility after SCI are partly attributable to changes in the M receptor subtypes.

Surgical Treatment of Orbital Tumors at a Single Institution

OBJECTIVE: The authors reviewed the experience of 19 patients with orbital tumors and summarize the clinical features, surgical treatment and outcomes. METHODS: The authors searched the database for all patients who underwent surgery for the treatment of orbital tumors at a single institution between 1999 and 2007. Data from clinical notes, surgical reports, and radiological findings were obtained for the analysis. RESULTS: Orbital tumors constituted a heterogenous array of histopathology. The presenting symptoms were exophthalmos (52.6%), visual disturbance (26.3%) and pain (21.1%). The surgical approaches used were transcranial in 17 patients. Tumors located in the intraconal or perioptic space were surgically excised using a frontoorbital approach (8 cases), while pterional (3 cases), orbital (2 cases) and combined approaches (6 cases) were used for tumors in other sites. Total resection of tumors was achieved in 12 of 19 patients. In 4 patients with glioma and lymphoma only diagnostic biopsy was done. Three patients experienced visual deterioration postoperatively. Two patients had temporary diplopia, and one patient had temporary ptosis. CONCLUSION: Surgical treatment could be the mainstay of therapy for the majority of symptomatic orbital tumors. Many orbital tumors can be treated safely via a transcranial approach. Frontoorbital approach allows the surgeon to reach both the intraorbital and intracranial structures. Knowledge of the microanatomy of the orbit and meticulous surgical skills are necessary to overcome the pitfalls of intraorbital surgery.

The Parameters of the Retinal Nerve Fiber Layer Measured with Confocal Scanning Laser Ophthalmoscope & Nerve Fiber Analyzer

Assessment of the optic nerve head or the retinal nerve fiber layer is essential for the early diagnosis and monitoring of glaucoma. We compared mean retinal nerve fiber layer[RNFL]thickness with Average, and compared RNFL CSA with Integral between Heidelberg Retina Tomograph[HRT] and GDx nerve fiber analyzer[GDx]at global, superior, inferior, nasal and temporal area. Mean RNFL thickness in HRT was significantly greater than Average in GDx at all quadrants[p<0.001], and correlated with Average at global, superior and inferior area[p<0.05]. RNFL CSA in HRT was significantly greater than Integral in GDx at superior, inferior and nasal quadrants[p<0.001], and correlated with Integral at superior and inferior quadrants[p<0.05]. In conclusion, the two parameters related to nerve fiber layer in HRT were measured greater than those in GDx. Correlations of the above parameters between HRT and GDx were mainly present at superior and inferior quadrant. These results may come from regional difference in measurement between HRT and GDx, and uncorrected disc tilting in HRT appears to have adverse effects on the correlations of the above parameters between HRT and GDx at nasal or temporal quadrant.

The Changes of Scanning Laser Polarimeter(GDx) Values in LASIK

No Abstract Available.

Additional Subconjunctival Low Dose 5-fluoro u racil Injection after Mitomycin C Applied Filtering Surgery in Glaucoma Patients

To evaluate the additive efficacy of postoperative low dose 5-FU subconjunctival injection, we analyzed 43 patients[43 eyes]who had undergone trabeculectomy or triple surgery with intraoperative MMC for 2.5~3min.18eyes[case group =MMC 5-FU group]of 43 eyes had postoperative low dose 5-FU injection additionally and 25 eyes[control group =MMC group]of which had only undergone intraoperative MMC. The mean[+/-SD]follow-up periods were 13.6 +/-5.3 months in MMC 5-FU group and 12.1 +/-3.6 months in MMC group.There was no statistically significant difference in preoperative IOP between the two groups[p>0.05].Mean postoperative intraocular pressures were 12.9 +/-4.2 mms of mercury in MMC 5-FU group and 13.3 +/-4.4 mms of mercury in MMC group at 12 months postoperatively[p>0.05]. Kaplan-Meier survival analysis showed that the cumulative success rates at 1.5 year were 82.6%and 87.2%in the case and control groups, respectively[p>0.05].Of the postoperative complications, corneal epithelial defect was more frequent in MMC 5-FU group[p<0.05]. In conclusion, postoperative injection of low dose 5-FU additionally did not have an additive effect on the IOP control in patients undergone MMC applied filtering surgery. We may need additional postoperative injection of higher dose of 5-FU.Or, we may need to individualize the duration of application or the concentration of intraoperative MMC to begin with.

The Quantitative Evaluation of Optic Ne rve Head of Normal Tension Glaucoma

It is known that optic disc morphology is different between high tension glaucoma[HTG]and normal tension glaucoma[NTG]. We quantitatively evaluated optic nerve head by confocal scanning laser ophthalmoscope [CSLO]to determine if substantial morphological differences between the HTG and the NTG could be identified. 21 patients[21 eyes]in the early NTG and 32 patients[32 eyes]in the early HTG were matched for visual field defect[MD>-10dB].The optic nerve head was evaluated by Heidelberg Retina Tomograph[HRT]and 12parameters provided by HRT were compared between NTG and HTG. The mean age of patients was 56.6 +/-13.6 years in NTG and 48.9 +/-14.7 years in HTG, respectively[p>0.05].Mean MD was -5.4 +/-1.9dB in the NTG, -5.0 +/-2.5dB in the HTG, respectively[p>0.05]. Disc area was slightly lager in the NTG than in the HTG, but the difference did not reach statistical significance[p>0.05].The neuroretinal rim area was significantly larger in the NTG than in the HTG[p<0.05], whereas the mean cup depth was significantly smaller in the NTG than in the HTG[p<0.05].Among the 12 parameters, cup area, rim area, cup volume, mean cup depth, and maximum cup depth in the NTG had significant correlations with CPSD in the visual field index.These findings further support the hypothesis that there may be different mechanisms in the glaucomatous optic nerve damage.

A Case of Schwartz's Syndrome

It is known that intraocular pressure (IOP)decreases in two thirds of rheg-matogenous retinal detachment.We experienced a case of Schwartz's syndrome in a thirty-one year old male patient, who had been suffering from open angle glaucoma, anterior uveitis and retinal detachment.His vision fluctuated, improving with high IOP and decreasing with low IOP when the retina was detached.Following the retinal reattachment surgery, IOP increased and was not controlled with maximal tolerated medical therapy.Molteno tube was implanted.To our knowledge, a case of Schwartz's syndrome has not been reported in Korea.

Clinical Usefulness of Central 24-2 Full Th reshold Test-Comparison between Central 24-2 and Central 30-2 Full Threshold Test in Glaucoma Patients

We compared the clinical performance of central 24-2(C-24-2 test) and central 30-2 full threshold test(C-30-2 test) in detecting glaucomatous visual field defect. Thirty glaucoma patients underwent automated perimetry were enrolled. One eye of each patient was examined with both C-24-2 test and C-30-2 test by a simple crossover design. MD, CPSD, SF, test time and number of question asked were compared using two tests. Whether the differences between two tests would be related to the order of test, the duration between two tests, patient's age, and the degree of visual field loss were performed. C-24-2 test showed 24.4% saving in test time(p0.05). The increase in MD in C-24-2 test was not related to patient`s age, order of tests, the duration between two tests and degree of visual field defect(p>0.05). In conclusion, C-24-2 test reduced test time and increased MD compared to C-30-2 test. It is suggested that the conventional C-30-2 test can be replaced with C-24-2 test without compromising the reliability and ability to detect localized defects.

Relationship between Optic Disc Parameters and Myopic Refractive Errors in Myopia

Myopic discs(range: -0.5D) which were taken a confocal scanning laser ophthalmoscope(HRT, Heidelberg Engineering) were analyzed to determine the relationship between optic disc parameters and myopic refractive errors. Regression analysis and coefficient variation were used for a statistic tool. The disc area was not correlated with the myopic refractive error(p=0.21) and showed 16.0% of coefficient of variation. Cup area, cup disc area ratio, rim area, cup volume, rim volume, mean cup depth, maximum cup depth and cup shape measure showed statistically significant correlation with myopic refractive error, respectively(p<0.05). Among these parameters, rim area varied least(within all myopic eyes) with 16.5% of coefficient of variation. As the rim area is the most stable optic disc parameter interindividually in myopic population, it seem to be valuable for follow-up evaluation when a glaucomatous damage is suspected in myopic eyes by calculating its expected normal value with a regression equation.