Do we need colonoscopy verification in patients with fundic gland polyp?

BACKGROUND/AIMS: The aim of this study was to evaluate the prevalence of colorectal neoplasia in subjects with fundic gland polyps (FGPs) and the relationship between FGPs and colorectal neoplasia in Korea. METHODS: We analyzed 128 consecutive patients with FPGs who underwent colonoscopy between January 2009 and December 2013. For each case, age- (±5 years) and sex-matched controls were identified from among patients with hyperplastic polyps, gastric neoplasms, and healthy controls. Clinical characteristics were reviewed from medical records, colonoscopic findings, pathologic findings, and computed tomography images. The outcome was evaluated by comparison of advanced colonic neoplasia detection rates. RESULTS: Of the 128 patients, seven (5.1%) had colon cancers and seven (5.1%) had advanced adenomas. A case-control study revealed that the odds of detecting a colorectal cancer was 3.8 times greater in patients with FGPs than in the age- and sex-matched healthy controls (odds ratio [OR], 3.80; 95% confidence interval [CI], 1.09-13.24; P =0.04) and 4.1 times greater in patients with FGPs than in healthy controls over 50 years of age (OR, 4.10; 95% CI, 1.16-14.45; P =0.04). Among patients with FGPs over 50 years old, male sex (OR, 4.83; 95% CI, 1.23-18.94; P =0.02), and age (OR, 9.90; 95% CI, 1.21-81.08; P =0.03) were associated with an increased prevalence of advanced colorectal neoplasms. CONCLUSIONS: The yield of colonoscopy in colorectal cancer patients with FGPs was substantially higher than that in average-risk subjects. Colonoscopy verification is warranted in patients with FGPs, especially in those 50 years of age or older.

Moderating Effect of Stress Coping Strategies on the Relationship between a National Statistics Office Workers' Occupational Stress and Mental Health / 신경정신의학

OBJECTIVES: This study examined the moderating effects of stress coping strategies on the relationship between occupational stress of national statistical office workers and mental health. METHODS: Subjects were 133 workers at a regional statistics office. Occupational stress, stress coping strategies, and mental health were examined using the Korean Occupational Stress Scale (KOSS), Ways of Coping Checklist, and The Symptom Check-List-90-R. Stress coping strategies were composed of problem-focused coping, social support coping, emotion-focused coping, and wishful thinking coping. RESULTS: Moderated regression indicated that the social support coping and emotion-focused coping style positively moderated the relationship between occupational stress and mental health in national statistical office workers. The social support coping style positively moderated the relationship between interpersonal conflict (KOSS subscale) and mental health in national statistical office workers. The emotion-focused coping style positively moderated the relationship between job insecurity (KOSS subscale) and mental health in national statistical office workers. The emotion-focused coping style negatively moderated the relationship between job demand (KOSS subscale) and mental health in national statistical office workers. CONCLUSION: The implications of this study included that negative results due to high occupational stress can be varied by use of suitable stress coping strategies.

Circulating Ghrelin Levels and Obestatin/Ghrelin Ratio as a Marker of Activity in Ulcerative Colitis

BACKGROUND/AIMS: Ghrelin levels are known to increase in patients with ulcerative colitis (UC), but serum obestatin levels in UC patients are not well elucidated. The aim of this study was to examine the relationship between serum ghrelin and obestatin levels and disease activity in UC patients. METHODS: The serum ghrelin and obestatin levels were measured in 21 UC patients (12 with active disease and 9 in remission) using enzyme-linked immunosorbent assay. The relationship between the circulating levels of these 2 hormones and disease activity was analyzed. The colonic mucosal mRNA expression of ghrelin and obestatin was measured by quantitative reverse transcription polymerase chain reaction. RESULTS: The mean serum ghrelin values were significantly higher in patients with active disease than in patients with remission (1370.6+/-404.3 vs. 783.5+/-235.3 pg/mL, P=0.001). Colonic mucosal mRNA expression of ghrelin was also significantly higher in patients with active disease than in patients in remission (0.805+/-0.214 vs. 0.481+/-0.356, P=0.018). However, the mean serum obestatin levels and colonic mucosal mRNA expression of obestatin were not significantly different between both groups. The circulating obestatin/ghrelin ratio was significantly lower in patients with active UC than in patients in remission (0.32+/-0.08 vs. 0.58+/-0.20, P=0.001). CONCLUSIONS: The serum ghrelin levels and the obestatin/ghrelin ratio were related to the activity of UC, but serum obestatin was not related to activity of UC. The ghrelin levels and the obestatin/ghrelin ratio could serve as activity markers in patients with UC.

Job Stress and Stress Coping Strategy among Workers in A Regional Statistics Office : A Preliminary Study / 정신신체의학

OBJECTIVES: The purpose of this preliminary study was to investigate job stress and stress coping strategy among workers in a regional statistics office. METHODS: A total of 133 workers in regional statistics office participated in this study and they were divided into two groups, survey group(n=109) and support group(n=24) depending on relation to statistical survey task. They were asked to respond to Short Form of Korean Occupational Stress Scale(KOSS-SF) and Stress Coping Strategy(SCS) to investigate sociodemographic characteristics, job stress, and stress coping strategy. RESULTS: The proportion of the 133 participants in the sample was 59(44.4%) of men, 74(55.6%) of women. There were no significant differences in KOSS-SF scores in relation to age, sex, education, and marital status, while the KOSS-SF scores were significantly different between the two groups. In regard to the subscales of KOSS-SF, the two groups had significant differences in insufficient job control, interpersonal conflict, job insecurity, and organization system. In addition, the total score of KOSS-SF had a negative correlation with problem-focused coping strategy and social support coping strategy of SCS. CONCLUSIONS: Our results suggest that workers of survey group had more job stress compared to those who works in support group in regional statistical office. In addition, in comparison with workers of support group, both men and women of survey group get stressed when they were confronted with interpersonal conflicts. Our results suggest that using problem-focused coping and social support coping strategy lowers job stress.

Case of Acute Methemoglobinemia Caused by Nitrobenzene Ingestion / 대한내과학회지

Nitrobenzene is a poisonous agent, not commonly encountered in clinical practice, which belongs to the aniline dyes. Ingestion of nitrobenzene may cause methemoglobinemia, a condition in which the iron in hemoglobin is oxidized from the ferrous state to the ferric state, resulting in the inability to transport oxygen. A 41-year-old man presented with the clinical features of methemoglobinemia after drinking nitrobenzene. The patient was treated conservatively with intravenous methylene blue. We report a case of acute methemoglobinemia due to ingestion of nitrobenzene.

Preoperative B-type Natriuretic Peptide as a Predictor of Postoperative Cardiac Events Following Orthopedic Elderly Patients

BACKGROUND: The aim of this study was to evaluate the value of preoperative plasma B-type natriuretic peptide (BNP) level in predicting postoperative in-hospital major adverse cardiac events (MACE, defined as atrial fibrillation, congestive heart failure, nonfatal myocardial infarction and cardiac death) in elderly patients undergoing orthopedic surgery. METHODS: Between March 2010 and September 2011, data from 156 patients (aged 65 years or older) who underwent scheduled or emergent orthopedic surgery, were investigated. Screening for postoperative in-hospital MACE was performed using clinical criteria. RESULTS: MACE occurred in 12 patients (7.7%). The BNP level was significantly higher in patients with MACE than in those without (median, 152.0; interquartile range [36.3 to 352.8] pg/mL vs. median, 36.8; interquartile range [15.5 to 98.1] pg/mL, p=0.005). The BNP level was positively correlated with the revised cardiac risk index score (r=0.300, p=0.001). In a receiver operating characteristic (ROC) analysis for MACE, the ROC for BNP was 0.746 (95% confidence interval, 0.602 to 0.891). At the optimal cut-off point (BNP=110 pg/mL), the sensitivity, specificity and positive and negative predictive values were 66.7, 81.2, 22.0% and 96.6%, respectively. On multivariate analysis, preoperative BNP was an independent predictor for MACE (odds ratio, 5.091; p=0.018) after adjusting for baseline confounding factors such as diabetes mellitus and history of cerebrovascular accident. CONCLUSION: The preoperative BNP level may be a useful tool in stratifying the risk for MACE in elderly patients undergoing orthopedic surgery.

A Case of Mycobacterium kansasii Lymphadenitis in HIV-infected Patient / 감염과화학요법

Nontuberculous mycobacteria (NTM) are widely present in the environment, although they rarely cause infection in humans. However, infection by NTM has been increasingly recognized worldwide in the context of the human immunodeficiency virus (HIV) epidemic and therapeutic immunosuppression. Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium, which mainly causes pulmonary infection in patients with predisposing lung diseases, and, occasionally, disseminated infection with poor outcomes in immunocompromised patients. We report on the first case of lymphadenitis caused by infection with M.kansasii in an HIV-infected patient in Korea. The patient showed significant improvement after receiving antituberculous therapy (isoniazid, rifabutin) in combination with surgical drainage and highly active antiretroviral therapy (abacavir, lamivudine, and lopinavir/ritonavir).

A Case of Asymptomatic, Localized, and Idiopathic Diffuse Alveolar Damage / 결핵및호흡기질환

Diffuse alveolar damage (DAD) is a histological change in lung tissue, and is generally caused by an acute lung injury, which is characterized by bilateral and widespread damages. Localized DAD occurs very rarely. The causes for DAD are numerous, but the chief cause is acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia, in cases of idiopathic manifestation. The 82-year-old patient, in this case study, showed a DAD lesion in only 1 lobe. The patient was otherwise healthy, with no previous symptoms of DAD. He was admitted to our medical center owing to localized infiltration, observed on his chest radiograph. Laboratory studies showed no signs of infections. DAD was confirmed by a surgical lung biopsy. The patient received corticosteroid treatment and had gradually improved. We report the case of a patient with localized, idiopathic DAD that cannot be classified as acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia.

Disseminated Penicilliosis in a Korean Human Immunodeficiency Virus Infected Patient from Laos

Penicillium marneffei may cause life-threatening systemic fungal infection in immune-compromised patients and it is endemic in Southeast Asia. A 39-yr-old HIV-infected male, living in Laos, presented with fever, cough, and facial vesiculopapular lesions, which had been apparent for two weeks. CT scans showed bilateral micronodules on both lungs; Pneumocystis jirovecii was identified by bronchoscopic biopsy. Despite trimethoprim-sulfamethoxazole and anti-tuberculosis medications, the lung lesions progressed and the facial lesions revealed central umbilications. Biopsy of the skin lesions confirmed disseminated penicilliosis, with the culture showing P. marneffei hyphae and spores. The P. marneffei was identified by rRNA PCR. A review of the bronchoscopic biopsy indicated penicilliosis. The patient completely recovered after being prescribed amphotericin-B and receiving antiretroviral therapy. This is the first case of penicilliosis in a Korean HIV-infected patient. It is necessary to consider P. marneffei when immunocompromised patients, with a history of visits to endemic areas, reveal respiratory disease.

Lymphobronchial Fistula of Tuberculous Lymphadenitis in Acquired Immunodeficiency Syndrome / 감염과화학요법

Bronchial invasion of tuberculous lymphadenitis in children has been reported in areas of high tuberculosis (TB) prevalence as a complication due to primary pulmonary tuberculosis. However, it is rare in immunocompetent adults. When it appears, it often presents as a consequence of the reactivation of TB in the lung parenchyma. Primary TB occurs more frequently in patients with human immunodeficiency virus (HIV), with a history of organ transplants, or undergoing immunosuppressive treatments such as steroids. Furthermore, bronchial invasion of the bronchus by tuberculous lymphadenitis is considered to be very rare even among immunocompromised adults with primary TB, and has never before been reported in Korea. The authors report a case of bronchial invasion of the bronchus by tuberculous lymphadenitis, confirmed by bronchoscopy, in an Acquired Immunodeficiency Syndrome (AIDS) patient.

Delayed Suprachoroidal Hemorrhage After Ahmed Valve Implantation for Neovascular Glaucoma

PURPOSE: To report the case of delayed suprachoroidal hemorrhage after Ahmed valve implantation in a neovascular glaucoma (NVG) patient. CASE SUMMARY: A 74-years-old male visited the hospital with ocular pain in the left eye. He had a history of vitrectomy and Intraocular lens (IOL) scleral fixation due to trauma in the left eye. NVG was diagnosed and Ahmed valve was implanted in his left eye. Three days later, hypotony occurred with all quadrant choroidal detachment. Next day, raised intraocular pressure (IOP) was checked and anterior chamber was flat on slit lamp examination. Vitreous hemorrhage and suprachoroidal hemorrhage were suspected. We performed anterior chamber formation with viscoelastics. The anterior chamber became deeper and hemorrhage gradually decreased. A month later, the patient visited us with severe ocular pain. Raised IOP and shallow anterior chamber due to moderate hyphema and anteriorly placed IOL were found. Retinal detachment was suspected on B-scan. Vitrectomy, IOL removal, silicone oil insertion, and Ahmed valve removal were performed. CONCLUSIONS: We report we experienced one patient of delayed suprachoroidal hemorrhage after Ahmed valve implantation and he had poor prognosis.

Factors Associated with a Poor Visual Result in Acute Endophthalmitis After Cataract Surgery

PURPOSE: To determine the factors related to the clinical outcome of acute endophthalmitis after cataract surgery. METHODS: Authors performed a retrospective study of 65 eyes of 65 patients who had been treated for endophthalmitis from 2001 to 2006 at our hospital. We analyzed the relationship between final visual outcomes and prognostic factors. RESULTS: Final visual acuities were 0.5 or better in 49.2% of all eyes. Of 57 eyes, 29 eyes (50.8%) were culture positive. Staphylococcus epidermidis and Streptococcus pneumoniae were the most common organisms isolated. Cases with baseline acuity of counting fingers or better, cases with culture-negative or gram-positive infection, and cases not requiring vitrectomy had better prognoses. CONCLUSIONS: Baseline visual acuity, type of cultured organism, and method of treatment are significantly related to visual prognosis.

Vitrectomy and Silicone Oil Tamponade to Prevent Retinal Detachment in Severe Acute Retinal Necrosis Syndrome

PURPOSE: We report the results in two patients received prophylactic surgery to prevent retinal detachment in the severe acute retinal necrosis. CASE SUMMARY: Two patients in whom the presumptive diagnosis of the severe acute retinal necrosis were concomitantly treated with antiviral agents, systemic steroids and anti platelet therapy. We performed vitrectomy and silicone oil tamponade as the prophylactic surgical procedure for retinal detachments. The retinas remained attached in all patients over a follow up periods. CONCLUSIONS: Retinal detachment secondary to acute retinal necrosis has a complex nature and usually results in severe visual loss. A combination of vitrectomy and silicone oil tamponade may be effective prophylaxes against retinal detachment in acute retinal necrosis.

Photodynamic Therapy for Choroidal Neovascularization in Angioid Streaks

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin in the management of choroidal neovascularization (CNV) associated with angioid streaks. CASE SUMMARY: Six eyes of four patients with CNV due to angioid streaks were treated with photodynamic therapy with verteporfin. Visual acuity testing, ophthalmologic examinations, photographs, and fluorescein angiograms were used to evaluate the results of PDT. Two of six eyes had subfoveal lesions, while four eyes had juxtafoveal lesions on initial examination. Conversion from a CNV to a fibrous scar lesion following PDT was observed in four eyes. Enlargement of the CNV was documented in two eyes at the final follow-up. Of a total of 6 eyes, the final best-corrected visual acuity decreased in 4 eyes and stabilized in 2 eyes. CONCLUSIONS: Photodynamic therapy can achieve short-term cessation or decrease of fluorescein leakage from chroidal neovascularization associated with angioid streaks. However, it does not alter the course of this disease, and multiple sessions are needed. Visual prognosis is poor.

Development of the Basic DLS Communication Model in Emergency Medical System(EMS) / 대한의료정보학회지

The dispatch life support(DLS) copes with the emergent situations with the pre-arrival instructions. The instructions are made based on the logical branch which simulates and reflects the knowledge and decision processes of the emergency medical dispatcher. The present practice of the emergency fire-fighting offices in our country is such that the identification of the emergency caller and other administrative affairs are principal, and there is not any systematic standard medical instruction by use of communications system. The emergency medical system(EMS) is defined as the integrated system which can provide the emergency patients with the proper supports with a timely manner and it is essential to construct the emergency medical communication system which connects the patient with all the people involved in the situation. This study focuses on development of the basic DLS model in the emergency communication model. The model comprises of the systematic and standard instructions which can be used for the recovery of the emergency patient. 32 AMPDS, one items of the Heart! Respiratory Arrest are selected, and the communication treatment protocols are prepared for development of DSL model for this items. The DSL will help the communications between the patients and emergency medical dispatchers, and will make the medical dispatcher control the situation by providing a patient with medical instructions before his arrival.