Depression, Anxiety, Related Risk Factors and Cognitive Distortion in Korean Patients with Inflammatory Bowel Disease

Objective@#To evaluate the severity of depression, anxiety, associated risk factors, and cognitive distortion in Korean patients with ulcerative colitis (UC) and Crohn’s disease (CD). @*Methods@#This study included 369 patients with inflammatory bowel disease. The severity of depression and anxiety was examined using Patient Health Questionnaire-9 and Hospital Anxiety and Depression Scale. The Anxious Thoughts and Tendencies scale was used to measure catastrophizing tendency. Multivariate regression analyses were performed. @*Results@#The predictors of depression were marital status, anti-tumor necrosis factor-α (TNF-α) agent use, age, and body mass index in UC patients and marital status, disease activity, alcohol use, and employment status in CD patients. For anxiety, sex and marital status were the associated factors in UC patients, whereas steroid use was the only significant predictor in CD patients. Comparing the cognitive distortion level, there were no significant differences between UC and CD patients although there was an increasing tendency according to the severity of depression or anxiety. @*Conclusion@#If patients are accompanied by high levels of depression or anxiety and their associated risk factors including TNF-α agent or steroid use, it is recommended that not only symptoms are treated but also cognitive approach and evaluation be performed.

Clinical and radiological findings of incidental Rathke's cleft cysts in children and adolescents

PURPOSE: In the pediatric population, Rathke's cleft cysts (RCCs) are known to be an infrequent cause of headaches, visual disturbances, and pituitary dysfunction. We investigated the clinical characteristics of children in whom RCCs were incidentally discovered and evaluated whether RCCs influence the treatment response of patients with proven endocrinopathy. METHODS: A retrospective analysis was conducted in 34 patients with RCCs who were diagnosed between 2006 and 2013 at Hallym University Medical Center. Their clinical, hormonal, and imaging findings were reviewed. We evaluated the clinical outcomes of the patients with concomitant RCCs and endocrinopathy compared to matched controls. RESULTS: Twenty-six of 34 patients with radiologically proven RCCs had endocrine disorders. They were 9 boys and 17 girls, with ages ranging from 4.8 to 17.4 years at the time of the diagnosis. Of these, 7 (27%) had idiopathic short stature, 7 (27%) had growth hormone deficiency (GHD), and 12 (46%) had central precocious puberty (CPP). Nineteen of 26 patients (73.1%) showed low signal intensities on T1-weighted images (T1WI) and high signal intensities on T2-weighted images. The incidence of hypointensity on T1WI was higher in the patients with RCCs accompanied by endocrinopathy than in those without endocrinopathy (P=0.033). The treatment outcomes of the patients with CPP and GHD with and without RCCs were similar. CONCLUSION: CPP and GHD patients with a small RCC (less than 20 mm) expressing cystic magnetic resonance intensity can be managed with medical treatment, although the RCCs need to be closely monitored in radiological studies to observe their growth.

Eagle's Syndrome Presenting With Transient Ischemic Attack

Eagle's syndrome is a condition due to elongation of styloid process or calcification of the stylohyoid ligament. The styloid process can cause compression of the cervical carotid arteries leading to flow reduction in these arteries. We report a 49 year-old man who experienced transient right-sided weakness and monocular blindness within 10 seconds of turning his head to the left. Three-dimensional computed tomography revealed compression of left carotid artery by elongated styloid process during symptom provocation.

T1 Slope and Cervical Sagittal Alignment on Cervical CT Radiographs of Asymptomatic Persons

OBJECTIVE: We performed a retrospective analysis of medical records and radiographic images of patients who never underwent spinal treatment including diagnosis. The objective of this study is to explain the biomechanical and physiologic characteristics of cervical alignment related to thoracic inlet angle including T1 slope changes in each individual. METHODS: We reviewed the cervical CT radiographs of 80 patients who visited ENT outpatient clinic without any symptom, diagnosis and treatment of cervical spine from January 2011 to September 2012. All targeted people were randomized without any prejudice. We assessed the data-T1 slope, Cobb's angle C2-7, neck tilt, sagittal vertical axis (SVA) C2-7 and thoracic inlet angle by the CT radiographs. RESULTS: The relationships between each value were analyzed and we concluded that Cobb's angle C2-7 gets higher as the T1 slope gets higher, while the SVA C2-7 value decreases. CONCLUSION: We propose that the T1 slope is background information in deciding how much angle can be made in the cervical spinal angle of surgical lordotic curvature, especially severe cervical deformity.

Endoscopic Characteristics of Upper Gastrointestinal Mesenchymal Tumors Originating from Muscularis Mucosa or Muscularis Propria / 대한소화기학회지

BACKGROUND/AIMS: Subepithelial tumors are occasionally found during upper gastrointestinal endoscopy. The purpose of this study was to evaluate endoscopic characteristics of mesenchymal tumors originating from muscularis mucosa or muscularis propria. METHODS: A total of 307 mesenchymal tumors of the upper gastrointestinal tract were diagnosed between March 2006 and February 2012 at Yeouido St. Mary's Hospital (Seoul, Korea). Data on endoscopic and endoscopic ultrasonographic findings were collected and analyzed by retrospectively reviewing the medical records. RESULTS: The mean size of the mesenchymal tumors originating from muscularis mucosa was significantly smaller than those originating from muscularis propria (10.5+/-6.9 mm vs. 14.3+/-13.9 mm, p=0.035). The most common locations of the mesenchymal tumors originating from muscularis mucosa and muscularis propria were esophagus (69.1%) and body of the stomach (43.3%), respectively (p<0.001). Rolling sign was more commonly observed with mesenchymal tumors originating from muscularis mucosa (80.4%, p=0.001), and cushion sign was more frequently absent with those originating from muscularis propria (72.4%, p<0.001). Internal echo was homogenous in 89.7% and 81.9% of mesenchymal tumors originating from muscularis mucosa and muscularis propria, respectively (p=0.092). CONCLUSIONS: The size, location, and movability of mesenchymal tumors originating from muscularis mucosa were different from those of mesenchymal tumor originating from muscularis propria.propria.

A Case of Phlebosclerotic Colitis in a Hemodialysis Patient / 대한소화기학회지

Phlebosclerotic colitis is a rare disease of intestinal ischemia caused by calcified peripheral mesenteric veins and a thickened colonic wall, differentiating it from the typical ischemic colitis. A 68-year-old man who was undergoing hemodialysis presented with hematochezia and abdominal pain. Colonoscopic findings showed typical dark purple-colored edematous mucosa. Linear calcifications in the colon were noted on both a plain abdominal radiolography and abdominal computer tomography. These findings suggested that the patient suffered from phlebosclerotic colitis. Following bowel rest and fluid therapy, there was full recovery. We herein report a rare case of phlebosclerotic colitis in a hemodialysis patient and include a review of the relevant literature.

Dura Mater Graft-Associated Creutzfeldt-Jakob Disease: The First Case in Korea

Since 1987, dura mater graft-associated iatrogenic Creutzfeldt-Jakob disease (dCJD) has been reported in many countries. We report the first case of dCJD in Korea. A 54-yr-old woman, who underwent resection of the meningioma in the left frontal region and received a dura mater graft 23 yr ago presented with dysesthesia followed by psychiatric symptoms and ataxia. Her neurological symptoms rapidly progressed to such an extent that she exhibited myoclonus, dementia, and pyramidal and extrapyramidal signs within 8 weeks. The 14-3-3 protein was detected in her cerebrospinal fluid; however, an electroencephalogram did not reveal characteristic positive sharp wave complexes. Diffusion-weighted magnetic resonance images, obtained serially over 64 days, revealed the rapid progression of areas of high signal intensity in the caudate nucleus and cingulate gyrus to widespread areas of high signal intensity in the cortex and basal ganglia. Pathological examination of brain biopsy specimens confirmed the presence of spongiform changes and deposition of prion protein in the neurons and neuropils.

Colonoscopic Perforation During a Diagnostic Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopy is a useful method for detecting colorectal disease, but complications are on the rise due to the increasing number of colonoscopies. The aim of this study was to analyze colon perforations following diagnostic colonoscopies. METHODS: We performed retrospective reviews of all patients with colonoscopic perforations between January 2000 and June 2010. RESULTS: Of 25,883 diagnostic colonoscopies performed, seven cases of colon perforations were reported. Among those, five cases had an abdominal operation history; the site of perforation was the sigmoid colon in three cases and the rectum in four cases. The manipulation type was forward viewing in three cases and retroflexion in four cases. The time to diagnosis was immediate in six cases and delayed in one case, and treatment was conservative management in three cases and surgical management in four cases. CONCLUSIONS: Special attention is required for patients with a previous abdominal operation and retroflexion. Even after perforations occur, favorable outcomes can be obtained by conservative treatment if the patient's condition is stable, the bowel preparation is proper, and there are no signs of peritonitis.

Local Recurrence of EGC after ESD / 대한소화기내시경학회지

Endoscopic mucosal resection is not accepted as an alternative to surgery for treating EGC of the undifferentiated histologic type because of the relatively higher probability of lymph node metastasis with the endoscopic procedure. The recently developed endoscopic submucosal dissection (ESD) techniques have made en-bloc resection of large intramucosal or ulcerated lesions feasible, but the procedure's therapeutic indications are limited to EGC without lymph node metastasis. If we could define a subgroup of patients who have undifferentiated EGC with a low-risk of lymph node metastasis, then the application of ESD would be possible instead of surgery. ESD also allows precise histologic assessment of resected specimens and it may prevent residual disease and local recurrence. We report on a case that poorly differentiated adenocarcinoma was curatively removed by ESD, but cancer recurrence was detected in the lamina propria of the post ESD scar without lymph node metastasis or intraluminal lesions three years after the ESD.

EFFECT OF SHORT ADMINISTRATION BISPHOSPHONATE TO PERIOSTEUM AND SINUS MEMBRANE AFTER ILIAC BONE GRAFT INTO MAXILLARY SINUS IN RABBIT

SOLITARY PLASMA CELL MYELOMA ON ANTERIOR MAXILLA: A CASE REPORT

Diagnosis of Acute Appendicitis Using Scoring System: Compared with the Alvarado Score

PURPOSE: This study evaluated the usefulness of a new scoring system in diagnosing acute appendicitis which expresses the patient's symptoms, physical examination, and laboratory findings more clearly and objectively. METHODS: A prospective study was conducted with 314 patients who were hospitalized with suspicion of acute appendicitis. After analyzing the symptoms, physical examination, and laboratory findings, 10 meaningful variables were selected, each of which were scored separately. The diagnostic value of the new scoring system was evaluated, and analyzed in comparison to the preexisting Alvarado score. RESULTS: Ten variables including vomiting, migration pain, fever, Dunphy's sign, Rovsing's sign, tenderness, rebound tenderness, increased white blood cell counts, increased neutrophil proportion, and increased CRP levels were associated with acute appendicitis. The new scoring system is developed by applying 1 point for each variable, with a total score of 10 points. In the new scoring system, a score above 5 points had sensitivity of 0.75, specificity of 0.73, positive predictive value of 0.92, and diagnostic accuracy of 0.71. The area under the receiver operating characteristic curve was 0.80, which is larger than 0.72 of the preexisting Alvarado score, and thus has a higher diagnostic accuracy. As acute appendicitis progresses, the average score tends to become significantly higher (P=0.001). CONCLUSION: The new scoring system, which objectively reflects the clinical variables of the patient's symptoms, physical examination and laboratory findings, will be useful in accurately diagnosing acute appendicitis and in quickly deciding a therapeutic policy in patients with right lower abdominal pain.

Case Report of Treatment of Multiple Odontogenic Keratocysts with Basal Cell Nevus Syndrome Using Preoperative Marsupialization andOrthodontic Extrusion

Preliminary study on "ridge splitting technique in horizontally deficient alveolar ridge"

A Case of Systemic Lupus Erythematosus and Abdominal Aorta Thrombosis Associated with Protein C and S Deficiency / 대한류마티스학회지

Thrombosis is a well known manifestation in patients with systemic lupus erythematosus, along with lupus anticoagulant, anticardiolipin antibody and anti beta2-glycoprotein I. We describe here a 44-year-old female with an abdominal aorta thrombosis of SLE and the patient had no antiphospholipid antibodies. She had this unusual site of thrombosis and this was associated with protein C and S deficiency. She had no other cause of thrombosis. After anticoagulant treatment, her thrombosis of the abdominal aorta resolved.

Effect of platelet-rich plasma on autogenous bone graft for bone formation in rabbit

Membranous glomerulonephritis associated with pancreatic tuberculosis / 대한내과학회지

A 51-year old man presented with generalized edema for 10 days. He was admitted to the hospital for a renal biopsy, and a pancreatic mass was incidentally detected by ultrasonography. The renal biopsy was consistent with membranous glomerulonephritis and the pancreas biopsy revealed chronic granulomatous inflammation with multinucleated giant cells, which was suggestive of tuberculosis of the pancreas. The patient was initially treated with a steroid and anti-tuberculosis drugs, but the proteinuria in the nephrotic range persisted throughout the 3-month follow-up. With the presumed diagnosis of tuberculosis-induced membranous nephropathy, immunosuppressant therapy was stopped and anti-tuberculosis drugs were administered for 31 months. With anti-tuberculous treatment, the proteinuria was reduced from 22 g/day to 0.57 g/day. A follow-up abdominal CT revealed a marked reduction in the size of the pancreatic mass. This finding suggests that the membranous nephropathy in our case was related to the pancreatic tuberculosis rather than it being related to primary nephrotic syndrome.

Effect of Platelet-Rich Plasma on Osteogenesis of Marrow-derived Osteoblasts in the Mandible of Rabbit: Histomorphometric Analysis

Retrieval of a Retained Capsule due to Isolated Crohn's Enteritis by Means of Double Balloon Enteroscopy / 대한소화기내시경학회지

Capsule endoscopy is being increasingly used for investigating GI bleeding of an obscure origin and also the bleeding that's due to Crohn's disease. Capsule endoscopy is a safe procedure with few complications. Complications of capsule endoscopy are capsule retention, incomplete small bowel examination, swallowing disorders and technical complications. However, capsule retention still remains a major concern. Crohn's disease may rarely show its first manifestation as GI bleeding. We present here a case of obscure GI bleeding in which the diagnosis of isolated Crohn's enteritis was made by using wireless CE. The retained capsule at the jejunal stricture of Crohn's disease was successfully retrieved by performing double balloon enteroscopy.

Clinical Analysis between the Endoscopic Thyroidectomy and the Open Thyroidectomy during the Same Period

PURPOSE: We peformed endoscopic thyroidectomy and open thyroidectomy during the same period. In this study, we analyzed the result (merits and demerits) between endoscopic procedure and open procedure. METHODS: From Aug. 2003 to Aug. 2004, each procedure was performed in 92 patients. Conventional open thyroidectomy was underwent in 50 patients and endoscopic thyroidectomy was underwent in 42 patients. We performed the endoscopic thyroidectomy using breast approach. The 2 incisions, which could use 12 mm ports were placed on the areolar area of the breast as a circumferential fashion. The remaining 1 incision, which could use 5 mm port was placed on the right subclavicular area, 3~4 cm below right clavicle. We used 25 degree, a rigid laparoscope with 5 mm Hg of CO2 insufflation pressure. We also compared the results of mean ages and sex ratio, pathologic diagnosis, extent of operation, mean hospital day, mean operation time between open surgery group and endoscopic thyroidectomy group. RESULTS: We found that the mean age in the endoscopic group was younger, inversely the operation time was longer than in the open surgery group significantly (P0.05). The endoscopic group in the aspect of cosmetic was satisfactory. CONCLUSION: We could perform the endoscopic thyroidectomy safely and feasibly. The endoscopic surgery was cosmetically satisfactory. We expect it can increase the extent of surgery.