Neurocognitive Function Differentiation from the Effect of Psychopathologic Symptoms in the Disability Evaluation of Patients with Mild Traumatic Brain Injury

OBJECTIVE: We determined whether the relationship between the neuropsychological performance of patients with mild traumatic brain injury (TBI) and their psychopathological characteristics measured by disability evaluation are interrelated. In addition, we assessed which psychopathological variable was most influential on neuropsychological performance via statistical clustering of the same characteristics of mild TBI. METHODS: A total of 219 disability evaluation participants with mild brain injury were selected. All participants were classified into three groups, based on their psychopathological characteristics, via a two-step cluster analysis using validity and clinical scales from the Minnesota Multiphasic Personality Inventory (MMPI) and Symptom Checklist-90-revised (SCL-90-R). The Korean Wechsler Adult Intelligence Scale (K-WAIS), Korean Memory Assessment Scale (K-MAS) and the Korean Boston Naming Test (K-BNT) were used to evaluate the neurocognitive functions of mild TBI patients. RESULTS: Over a quarter (26.9%) experienced severe psychopathological symptoms and 43.4% experienced mild or moderate psychopathological symptoms, and all of the mild TBI patients showed a significant relationship between neurocognitive functions and subjective and/or objective psychopathic symptoms, but the degree of this relationship was moderate. Variances of neurocognitive function were explained by neurotic and psychotic symptoms, but the role of these factors were different to each other and participants did not show intelligence and other cognitive domain decrement except for global memory abilities compared to the non-psychopathology group. CONCLUSION: Certain patients with mild TBI showed psychopathological symptoms, but these were not directly related to cognitive decrement. Psychopathology and cognitive decrement are discrete aspects in patients with mild TBI. Furthermore, the neurotic symptoms of mild TBI patients made positive complements to decrements or impairments of neurocognitive functions, but the psychotic symptoms had a negative effect on neurocognitive functions.

A Case of Gastric Adenocarcinoma Presenting as a Submucosal Tumor / 대한소화기내시경학회지

Neoplasms of the stomach can originate from both epithelial and subepithelial cells. These two types of tumors have different morphological characteristics according to their origin including the mucosal surface texture and contour of the mass in endoscopic examination. However, on rare occasions, neoplasms of an epithelial origin manifest the features of a submucosal tumor on a gross examination, and require additional and more invasive approaches, such as a strip biopsy, computed tomography, and endosonography, to define their nature. We encountered a case of a gastric adenocarcinoma in a 44 year-old woman, which was initially considered to be submucosal tumor by the endoscopic examination and was finally diagnosed after resecting the tumor.

A Case of Hepatoid Carcinoma of the Pancreas / 대한소화기학회지

Hepatoid carcinoma is a primary extrahepatic neoplasm exhibiting features of hepatocellular carcinoma (HCC) in terms of morphology, immunohistochemistry, and behavior. In many cases, tumor cytoplasm is positive for alpha- fetoprotein (alpha-FP) with elevated serum alpha-FP level. Because not all hepatoid carcinomas are associated with alpha- FP overproduction, diagnosis should be made essentially by histological features of the tumor. We present a case of hepatoid carcinoma of the pancreas in a 21-year-old male patient. Abdominal computed tomography and magnetic resonance imaging revealed an inhomogeneously enhanced pancreatic head mass. Serum alpha-FP level was markedly elevated. He underwent pylorus-preserving Whipple's operation. The tumor showed hepatoid and neuroendocrine components simultaneously. The histopathological diagnosis was hepatoid carcinoma associated with neuroendocrine tumor of the pancreas. Seven months after the surgery, the patient is healthy without evidence of recurrence. To date, only 7 cases of hepatoid carcinoma of the pancreas have been reported in the literature, and this is the first case report in Korea.

A Case of Transmesocolic Hernia in Elderly Person without a History of Operation / 대한소화기학회지

Internal hernia is defined as the herniation of viscera through an anatomic or pathologic opening within the boundaries of peritoneal cavity. Transmesocolic hernia, a subtype of internal hernia, has a herniated sac through the transverse mesocolon. Transmesocolic hernia has been rarely described in the literature, and most of reported cases were associated with a history of operation or congenital anormaly. A 72-year-old female with chronic intermittent abdominal pain and bloating was admitted. Small bowel series showed multiple jejunal loops confined to the left upper quadrant of abdomen. Abdomen spiral computed tomography (CT) showed a cluster of mildly dilated small bowel loops with mesenteries on the same area. On the three-dimensional reconstruction CT scan, a herniated sac through the transverse mesocolon was identified. She was diagnosed as transmesocolic hernia by using the three-dimensional reconstruction CT and small bowel series, without surgical exploration. The symptoms were managed with conservative measures.

A Case of Acute Myocardial Infarction in a Patient with Hemorrhagic Fever with Renal Syndrome / 대한신장학회잡지

Hemorrhagic fever with renal syndrome (HFRS) causes arrythmia, myocarditis, atrial hemorrhage, and heart failure as a cardiac complication. But, acute myocardial infarction has not been reported yet in patient with HFRS. We here report a case of acute myocardial infarction in a young adult with HFRS. A 43-year-old man was admitted with high fever and petechiae in the trunk and extremities. He had no history of hypertension, heart disease, and diabetes mellitus. Initial electrocardiographic finding was normal. On the 4th hospital days, sudden cardiac arrest developed and he recovered promptly with cardioversion. After recovery, electrocardiography revealed ST segment elevation in II, III, and aVF. Cardiac enzymes (CPK, LDH, CK-MB, and troponin-I) were also elevated. Echocardiography showed akinesia of inferior wall of heart. He was treated with continuous veno-venous hemodiafiltraion but he expired due to multiorgan failure on the 12th hospital days.

A Case of Asymptomatic Pseudoaneurysm of Thoracic Aorta in a Hemodialysis Patient with Sepsis / 대한신장학회잡지

Pseudoaneurysm of thoracic aorta is very rare but potentially fatal in hemodialysis patients. It results from blunt trauma, cardiovascular surgery, infection, and severe atherosclerosis. Here, we report a case of asymptomatic pseudoaneurysm of thoracic aorta in a hemodialysis patient with sepsis. A 58-year-old man was admitted with a week history of low grade fever and general weakness. He had experienced staphylococcus aureus sepsis with graft infection 6 month ago. Chest X-ray showed severe wall calcification of thoracic aorta and a newly developing round opacity in retrocardiac region. Blood culture demonstrated staphylococcus aureus. Chest computed tomography revealed a large pseudoaneurysm of descending thoracic aorta with disrupted wall calcification.

A Case of Acute Hepatitis E with the Travel History to an Endemic Area / 대한소화기학회지

Hepatitis E is a self-limited and enterically transmitted acute viral hepatitis that occurs from epidemic outbreaks of developing countries and sporadic hepatitis in non-endemic areas. In endemic areas, hepatitis E virus (HEV) is one of the most common causes of acute hepatitis and hepatic failure in pregnancy. Its mortality rate has been reported up to 20%. In non-endemic areas, HEV infection without any travel history is very rare. In Korea, only one case of simple hepatitis E without any travel history to endemic areas was reported. Recently, we experienced a case of acute hepatitis. The patient who had a travel history to India, showed watery diarrhea and high fever. Transaminase level and total bilirubin were increased, and prothrombin time was prolonged. It was positive for IgM anti-HEV and IgG anti-HEV, and showed no evidence of other viral infections or drug ingestion history. In spite of absence of useful test such as seroconversion of IgM anti-HEV and HEV RNA PCR, we diagnosed the case as an acute hepatitis E from his symptom, travel history and initial serologic marker. We report this as a case of hepatitis E infected from endemic areas.

Elevated monocyte chemoattractant protein-1 in patients with Behcet's disease / 대한내과학회지

BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1) belongs to C-C subfamily of chemokines, which stimulates the migration of monocytes. MCP-1 exerts various effects on the monocytes, including the induction of integrin and tissue factor, and synthesis of proinflammatory cytokines and arachidonic acid. In this study, we measured the MCP-1 levels in patients with Behcet's disease and evaluated the associations between the levels of MCP-1 and the level of other chemokines and various clinical features of Behcet's disease. METHODS: Serum samples were obtained from 67 patients with Behcet's disease and 30 healthy controls. Simultaneously, whole blood was isolated from patients (n=25) with Behcet's disease and healthy controls (n=11) and cultured in 24 well plates for 48 hours in the absence or presence of lipopolysaccharide (LPS) 5 microgram/mL, phytohaemagglutinin (PHA) 5 microgram/mL, phorbol 12-myristate 13-acetate (PMA) 50 ng/mL + ionomycin 5 microgram/mL. The MCP-1 concentrations were measured in the sera and culture supernatants by enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of serum MCP-1 were 2.5 times higher in patients with Behcet's disease than healthy controls. The patients with Behcet's disease had also higher levels of MCP-1 in the culture supernatants of whole blood cells, stimulated with LPS, but not with either PHA or PMA plus ionomycin, compared to healthy controls. Serum MCP-1 levels (n=67) were strongly correlated with serum RANTES, MIP-1alpha, IL-8 levels in Behcet's disease. In addition, the production of MCP-1 by whole blood culture from Behcet's disease patients (n=25) were also correlated well with those of RANTES, MIP-1alpha, and IL-8, when stimulated with LPS. However, MCP-1 levels in the sera and culture supernatants did not show any association with various clinical features of Behcet's disease including oral ulcer, genital ulcer, erythema nodosum, arthritis, uveitis, intestinal involvement, central nervous system involvement, and vascular thrombosis. CONCLUSION: In the sera and culture supernatants of whole blood stimulated with LPS, MCP-1 levels were higher in patients with Behcet's disease than controls and correlated well with RANTES, MIP-1alpha, IL-8 levels. These results suggest that the activation and migration of monocytes triggered by the increased production of MCP-1 may play a role in the pathogenesis of Behcet's disease.

A Case of Colonic Diverticular Bleeding Treated with Endoscopic Hemoclip / 대한소화기내시경학회지

Diverticular bleeding is a common cause of lower gastrointestinal bleeding in adults. Most of colonic diverticular bleeding stop spontaneously without any treatment. But diverticular bleeding develops at arterial vessel, which results in massive bleeding in a short period of time and may shows recurrence. Acute lower intestinal bleeding has been treated with heater probe coagulation, injection therapy, bipolar coagulation and endoscopic hemoclips. We experienced a 67-year-old woman presented hematochezia. Emergency colonoscopy was performed and showed a diverticulum with a visible vessel at the cecum. Hemostasis with hemoclip was successfully done. We herein report a case of hemostasis by capping a diverticulum of the colon with hemoclips.

Right Common Iliac Artery Thrombosis and Aortic Artery Thrombosis Associated with Renal Infarction in Adult Minimal Change Nephrotic Syndrome / 대한신장학회잡지

The nephrotic syndrome frequently causes a hypercoagulable state, leading to thromboembolic complications in veins, but arterial thrombosis is relatively rare, and is usually associated with a poor prognosis. We report 50-year-old female patient who presented with minimal change disease complicated with aortic and right iliac arterial thrombosis. She was admitted to our hospital with severe pain in her right leg and left flank. No pulse was palpable in her right femoral artery. Aortography demonstrated a focal eccentric thrombus attached to the left wall of aorta, in which the left renal artery was occluded, and another thrombus obstructing the right common iliac artery. An emergency thrombectomy was performed. Although the patient had satisfactory reperfusion of right common iliac artery, her left renal function was not recovered. A renal biopsy revealed histologic evidence of minimal change of glomerulonephritis. After 8 weeks of steroid therapy, cytoxan was started. After 3 weeks, she developed pneumonitis and died with sepsis.

Pleural Effusion Caused by Central Catheter-Related Infection in a Hemodialysis Patient / 대한신장학회잡지

Central catheterization for temporary vascular access in hemodialysis patients may cause serious catheter-related infection such as bacteremia, osteomyelitis, and septic shock. We here report a case of unusual complication of catheter-related infection in a hemodialysis patient with internal jugular catheter. A 44-year old man was admitted due to intermittent fever and right chest discomfort. Five weeks ago, right internal jugular catheter was inserted for hemodialysis. Three weeks ago, He stopped hemodialysis treatment and exit site skin care of the catheter by himself. Chest X-ray showed massive right pleural effusion. But the catherter was normally positioned in superior vena cava. Both blood and pleural fluid cultures demonstrated Staphylococcus aureus. After prompt removal of the catheter and drainage of the pleural fluid, and adequate antibiotic treatment, catheter-related bacteremia and pleural effusion improved.