A Cross-sectional Epidemiological Study on Trends in the Prevalence of Allergic Diseases among Children and Adolescents in the Jeju Area in 2008 and 2013

PURPOSE: This study was to find epidemiological trends in the prevalence of allergic diseases among children and adolescents in Jeju Province, Korea. METHODS: Two questionnaire surveys of the same method were conducted, respectively, in 2008 and in 2013 with five years' interval with 1,296 participants in 2008 and 878 in 2013 who were elementary and secondary students sampled at random from the same five schools. 'International Study of Asthma and Allergies in Childhood (ISAAC)' was applied to the parents with their written consent to the survey. RESULTS: The results of analysis showed an increasing trend in the prevalence of lifetime asthma (8.6% in 2008 and 10.4% in 2013) and in the prevalence of lifetime allergic rhinitis (25.3% in 2008 and 31.1% in 2013) (p=.003), and a decreasing trend in the prevalence of lifetime atopic dermatitis (32.0% in 2008 and 26.8% in 2013) (p=.011). CONCLUSION: This research showed an increasing trend in the prevalence of asthma and allergic rhinitis among children and adolescents in Jeju Province compared to that 5 years ago, but represented a declining trend in the prevalence of atopic dermatitis.

Japanese Cedar (Cryptomeria japonica) Pollinosis in Jeju, Korea: Is It Increasing?

Jeju is an island in South Korea located in a temperate climate zone. The Japanese cedar tree (JC) has become the dominant tree species while used widely to provide a windbreak for the tangerine orchard industry. An increase in pollen counts precedes atopic sensitization to pollen and pollinosis, but JC pollinosis in Jeju has never been studied. We investigated JC pollen counts, sensitization to JC pollen, and JC pollinosis. Participants were recruited among schoolchildren residing in Jeju City, the northern region (NR) and Seogwipo City, the southern region (SR) of the island. The JC pollen counts were monitored. Sensitization rates to common aeroallergens were evaluated by skin prick tests. Symptoms of pollinosis were surveyed. Among 1,225 schoolchildren (49.6% boys, median age 13 years), 566 (46.2%) were atopic. The rate of sensitization to Dermatophagoides pteronyssinus (35.8%) was highest, followed by D. farinae (26.2%), and JC pollen (17.6%). In the SR, 156 children (23.8%) were sensitized to JC pollen; this rate was significantly higher than that in the NR (59 children, 10.4%, P<0.001). A significant increment in the sensitization rate for JC pollen with increasing school level was observed only in the SR. JC pollen season in the SR started earlier and lasted longer than that in the NR. JC pollen season in Jeju was defined as extending from late January to mid-April. The prevalence of JC pollinosis was estimated to be 8.5%. The prevalence differed significantly between the NR and SR (5.3% vs 11.3%, P<0.001), mainly due to the difference in sensitization rates. JC pollen is the major outdoor allergen for early spring pollinosis in Jeju. JC pollen season is from late January to mid-April. Warmer weather during the flowering season scatters more JC pollen in the atmosphere, resulting in a higher sensitization rate in atopic individuals and, consequently, making JC pollinosis more prevalent.

Association of acute tubular necrosis with gross hematuria in cirrhosis-related immunoglobulin A nephropathy

Immunoglobulin A (IgA) nephropathy associated with cirrhosis is the most common form of secondary IgA nephropathy (IgAN). Cirrhosis-related IgAN is usually clinically silent with a rare occurrence of gross hematuria, unlike in cases of idiopathic IgAN. Especially, acute tubular necrosis (ATN) associated with gross hematuria is very rare in cirrhosis-related IgAN, although acute renal failure is a frequently reported complication in advanced cirrhosis. Herein, we report an unusual case of ATN requiring renal replacement therapy, associated with gross hematuria in a patient with nonalcoholic, hepatitis B virus-associated cirrhosis. Results of a histopathological analysis revealed obstruction of the lumen of renal tubules by red blood cell casts, a marked tubular necrosis, and IgA deposition in the mesangium. The patient's renal function and gross hematuria were clearly improved after lamivudine treatment.

Association of acute tubular necrosis with gross hematuria in cirrhosis-related immunoglobulin A nephropathy

Immunoglobulin A (IgA) nephropathy associated with cirrhosis is the most common form of secondary IgA nephropathy (IgAN). Cirrhosis-related IgAN is usually clinically silent with a rare occurrence of gross hematuria, unlike in cases of idiopathic IgAN. Especially, acute tubular necrosis (ATN) associated with gross hematuria is very rare in cirrhosis-related IgAN, although acute renal failure is a frequently reported complication in advanced cirrhosis. Herein, we report an unusual case of ATN requiring renal replacement therapy, associated with gross hematuria in a patient with nonalcoholic, hepatitis B virus-associated cirrhosis. Results of a histopathological analysis revealed obstruction of the lumen of renal tubules by red blood cell casts, a marked tubular necrosis, and IgA deposition in the mesangium. The patient's renal function and gross hematuria were clearly improved after lamivudine treatment.

Complete enumeration for the prevalence of allergic disease in Udo Isle's inhabitants

PURPOSE: This study is to estimate the prevalence of allergic disease for the entire inhabitants living in Udo Isle, one of the islands of Jeju. METHODS: The complete enumeration using International Study of Asthma and Allergies in Childhood group was applied to the 1,090 people residing in the Isle. This survey was performed for 2 months from June to July, 2012. For children, their parents' responses were collected, and for adults, their self-reports and interview were performed simultaneously. Of the 1,003 questionnaires (92.0%) were collected, 925 questionnaires were finally analyzed, excluding those of insufficient responses for questionnaires and inhabitants residing in Udo Isle less than one year. RESULTS: For asthma, the prevalence of "wheeze, last 12 months" was 6.6%. The prevalence of "allergic rhinitis, last 12 months" was 17.9%. The prevalence of "itchy eczema, last 12 months" was 8.1%. The prevalence of "allergic conjunctivitis, last 12 months" was 8.1%. The prevalence of "food allergy, last 12 months" was 2.3%. The prevalence of "drug allergy, last 12 months" was 0.8%. CONCLUSION: The inhabitants of Udo Isle had lower prevalence of atopic dermatitis than that of in the entire Jeju Island. However, compared with other regions, it showed higher prevalence, and it tended to be decreased with aging. The prevalence of asthma, allergic rhinitis, allergic conjunctivitis, food allergy and drug allergy, presented no difference by age.

Epidemiology of allergic rhinitis in Korean children

PURPOSE: The diagnosis of allergic rhinitis (AR) is based upon the concordance between a history of allergic symptoms and diagnostic tests. This study is to investigate the epidemiology of AR by using data from National Health Insurance Corporation (NHIC) and data according to the AR definition in general students health screening. METHODS: We examined medical insurance claims data of NHIC from 2004 to 2010 according to age, area, and gender. We investigated the results of Korean International Study of Asthma and Allergies in Childhood questionnaires and skin prick tests of 14,133 students participated in health screening from 2010 to 2012. RESULTS: The prevalence of AR according to the NHIC data was elementary school students (24.34%); middle school students (13.75%) and high school students (12.17%). The prevalence of AR was higher in boy than in girl, annually. In health screening, the prevalence of AR was elementary school students (19.50%+/-0.26); middle school students (23.19%+/-0.30) and high school students (24.11%+/-0.31). The prevalence of AR had peaking at the age late teens (P<0.0001) and was higher in boy (26.49%+/-0.38) than in girl (17.43%+/-0.35) (P<0.0001). Sensitization rate of allergen in students with AR was house dust mite (86.71%+/-0.48); pollen (41.26%+/-1.01) and molds (14.80%+/-0.52). CONCLUSION: The prevalence according to the AR definition tended to be increased with aging in Korean children. There are some differences in the prevalence of AR in the data of NHIC and health screening study. Further investigation will be needed to reveal the causes of this difference.

Annual Change of Peak Expiratory Flow Rate in Asthma and COPD / 결핵및호흡기질환

BACKGROUND: Measurement of peak expiratory flow rate (PEFR) in a follow-up examination for a chronic airway disease is useful because it has the advantages of being a simple measurement and can be repeated during examination. The aim of this study was to examine the annual decrease of PEFR in asthma and chronic obstructive pulmonary disease (COPD) patients and to confirm the factors which influence this decrease. METHODS: From May, 2003 to September, 2010, the annual decrease of PEFR was obtained from asthma and COPD patients attending an outpatient pulmonary clinic. PEFR was measured using a Mini-Wright peak flow meter (Clement Clarke International Ltd. UK), and we conducted an analysis of factors that influence the change of PEFR and its average values. RESULTS: The results showed an annual decrease of 1.70+/-12.86 L/min the asthmatic patients and an annual decrease of 10.3+/-7.32 L/min in the COPD patients. Age and FEV1 were the predictive factors influencing change in asthma, and FEV1 and smoking were the predictive factors influencing change in COPD. CONCLUSION: We confirmed the annual decreasing PEFR in patients with chronic airway disease and identified factors that work in conjunction with FEV1 to influence the change.

Sensitization rates of airborne pollen and mold in children / 소아과

PURPOSE: Aeroallergens are important causative factors of allergic diseases. Previous studies on aeroallergen sensitization rates investigated patients groups that had visited pediatric allergy clinics. In contrast, we investigated sensitization rates in a general population group of elementary school to teenage students in Incheon, Jeju, and Ulsan. METHODS: After obtaining parental consent, skin-prick tests were performed on 5,094 students between March and June 2010. Elementary school students were tested for 18 common aeroallergens, whereas middle and high school students were tested for 25 allergens. The 25 allergens included Dermatophagoides pteronyssinus, Dermatophagoides farinae, pollen (birch, alder, oak, Japanese cedar, pine, willow, elm, maple, Bermuda grass, timothy grass, rye grass, orchard grass, meadow grass, vernal grass, mugwort, Japanese hop, fat hen, ragweed, and plantain), and mold (Penicillatum, Aspergillus, Cladosporium, and Alternaria). RESULTS: The sensitization rates in descending order were 25.79% (D. pteronyssinus), 18.66% (D. farinae), 6.20% (mugwort), and 4.07% (willow) in Incheon; 33.35% (D. pteronyssinus), 24.78% (D. farinae), 15.36% (Japanese cedar), and 7.33% (Alternaria) in Jeju; and 32.79% (D. pteronyssinus), 30.27% (D. farinae), 10.13% (alder), and 8.68% (birch) in Ulsan. The dust mite allergen showed the highest sensitization rate among the 3 regions. The sensitization rate of tree pollen was the highest in Ulsan, whereas that of Alternaria was the highest in Jeju. The ragweed sensitization rates were 0.99% in Incheon, 1.07% in Jeju, and 0.81% in Ulsan. CONCLUSION: The differences in sensitization rates were because of different regional environmental conditions and distinct surrounding biological species. Hence, subsequent nationwide studies are required.

A Case of Giant Cell Arteritis Accompanied by Acute Myeloid Leukemia

Giant cell arteritis (GCA), the most common form of systemic vasculitis in adults, preferentially involves large and medium-sized arteries in patients over the age of 50. The classic manifestations are headaches, jaw claudication, polymyalgia rheumatica, and visual symptoms. Acute myeloid leukemia (AML) is a hematopoietic stem cell disorder characterized by a block in the differentiation of hematopoiesis, resulting in the growth of a clonal population of neoplastic cells or blasts. This malignant alteration in hematopoietic stem cells leads to a loss of normal hematopoietic function, which, if left untreated, typically leads to death within weeks to months of its clinical presentation. Although there have been reports of CLL or CML accompanied by several kinds of autoimmune vascular diseases, such as polymyalgia rheumatica, GCA, or necrotizing temporal arteritis, no studies have reported a case of AML with GCA. We experienced an 80-year-old male patient who developed AML 6 years after the diagnosis of GCA. He was under the use of oral glucocorticoid, hydroxychloroquine, and methotrexate at the time of the diagnosis of the AML. This is the first case in Korea to report GCA accompanied by AML.

The Prevalence of Allergic Diseases in Children Living In Jeju / 소아알레르기및호흡기학회지

PURPOSE: We investigated the prevalence of allergic diseases in preschoolers and children attending elementary, middle and high schools in Seogwipo city, Jeju, South Korea. METHODS: A cross-sectional survey in November 2008 was conducted, using questionnaires, translated in Korean, from the International Study of Asthma and Allergies in Childhood group. All the attendees, 29,606, in 136 nurseries and kindergartens, 47 elementary schools, 15 middle schools and 10 high schools in Seogwipo city were surveyed in this study. RESULTS: Of the 25,312 (85.5%) questionnaires retrieved, 25,024 were appropriately completed and analyzed. For asthma, the prevalence of "wheeze, last 12 months" was 15.4% for the preschool children, 6.4% for the elementary school students, 5.3% for the middle school students and 5.8% for the high school students. The prevalence of "allergic rhinitis, last 12 months" was 23.9%, 30.0%, 31.4% and 34.2%, respectively. The prevalence of "atopic dermatitis, last 12 months" was 19.0%, 17.4%, 12.3% and 11.4%, respectively. The prevalence of "allergic conjunctivitis, last 12 months" was 8.5%, 12.3%, 20.3% and 23.4%, respectively. The prevalence of "food allergy, last 12 months" was 5.4%, 4.2%, 4.2% and 5.1%, respectively. The prevalence of "drug allergy, last 12 months" was 0.7%, 0.3%, 0.6%, and 0.8% for each group. CONCLUSION: In Seogwipo city, the prevalence of asthma and atopic dermatitis decreases with age. However, allergic rhinitis and allergic conjunctivitis are increasing by age. The prevalence of food allergy and drug allergy showed no difference by age.

The Influence of the Residential Environment on the Sensitization Rates to Aeroallergens and the Prevalence of Allergic Disorders in the School Children in Jeju / 소아알레르기및호흡기학회지

PURPOSE: This study is to investigate the influence of the residential environment on the sensitization rates to aeroallergens and the prevalences of atopic disorders in the school children. METHODS: Two elementary schools in Jeju, Korea were selected according to their distinctive residential environment, one located in the area surrounded by the tangerine farms and Japanese cedar forests (tangerine farming community) and the other rarely with them (non-tangerine farming community). All the school children (1,550 students) from the two school were enrolled in this study. Under their parents' informed consent, surveys based on International Study of Asthma and Allergies in Childhood questionnaire were answered by the parents and skin prick tests with 16 common aeroallergens were performed. RESULTS: The questionnaire is responded from 1,290 parents (83.2%) and the skin test was done in 1,284 students (82.8%). The sensitization rates to more than one aeroallergen was 41.9%, increasing by age. The children residing in the tangerine farming community showed significantly higher sensitization rates than those from non-farming one (47.5% vs. 38.4%, P=0.004). The former were sensitized more frequently to house dust mite, citrus red mite and Japanese cedar pollen, while the others to outdoor moulds. However, the prevalence of atopic disorders had no difference between the two groups. CONCLUSION: The residential environment might influence the sensitization rates to prevalent aeroallergens in the environment among school children, but there is no difference in the prevalence of the atopic disorders.

Successful Rechallenge with Gefitinib for an Initial Erlotinib-Responder with Advanced Lung Adenocarcinoma / 결핵및호흡기질환

Although failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) is generally believed to be associated with cross-resistance to other EGFR TKI, the benefit of administering erlotinib as a second EGFR TKI after resistance of gefitinib as the first TKI has been well known. However, good response to gefitinib after an initial response to erlotinib has been rare. We report that a 45-year-old woman (never smoked), with lung adenocarcinoma and EGFR mutation, showed an initial response to erlotinib, and then responded to gefitinib again.

A Case of Gastrointestinal Stromal Tumor of the Rectum Presenting as Constipation / 이화의대지

A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and expresses CD117, a c-kit proto-oncogene, which can be detected immunohistochemically. We reported a GIST of the rectum of a 61-year-old-woman who had visited emergency room complaining of constipation over one week. Upon rectal examination, a round hard mass was palpated. Colonoscopy showed a 7x5 cm sized protruded lesion with surface ulceration on a rectum, adjacent the anus. And abdomen computed tomography revealed the soft tissue mass compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST. The patient had been treated with a ultra anorectal anastomosis with loop ileostomy. Immunohistochemical studies on the surgically resected specimen showed c-kit (+) and CD34 (+). The final diagnosis was a GIST of the rectum. She was grouped into high risk and she has been given adjuvant chemotherapy with Imatinib.

Influences of Geometric Configurations of Bypass Grafts on Hemodynamics in End-to-Side Anastomosis

BACKGROUND: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. MATERIALS AND METHODS: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of 45degrees, 60degrees and 90degrees. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. RESULTS: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. CONCLUSION: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.

Cefepime-Induced Nonconvulsive Status Epileticus Presenting as Coma in a Patient with ESRD on Hemodialysis / 대한신장학회지

Cefepime-induced nonconvulsive status epilepticus (NCSE) in end-stage renal disease (ESRD) patients receiving hemodialysis has only rarely been reported. Here we report a case of cefepime-induced NCSE presenting as coma in a patient with ESRD on hemodialysis. A 73-year-old man, who had been receiving maintenance hemodialysis, developed aphasia and coma during cefepime therapy for epidural abscess. Emergent eletroencephalography (EEG) revealed evidence of NCSE. The abnormal EEG findings were resolved and comatose mentality was completely recovered after cessation of cefepime and administration of anticonvulsive drugs. Cefepime-induced NCSE should be considered if neurological symptoms including comatose mentality develops during cefepime therapy in a patient with renal failure.

A Case of Scleredema Associated with Dermatomyositis

Dermatomyositis (DM) is rare systemic inflammatory disease with typical skin manifestations and muscular involvement. Various skin lesions can accompany this disease, such as Gottron's sign, Heliotrope rash, mechanic's hands, V sign and shawl sign. Scleredema is a very rare skin manifestation in DM. We report a case of DM in a 63-year-old woman, who had scleredema on her thighs. A diagnosis of DM was established by clinical manifestation, elevated muscle enzyme levels, electromyogram measures, and muscle biopsy findings. She was successfully treated with the immunosuppressants methotrexate, cyclosporine, and steroids (low dose).

The Significance of Delphian Lymph Node in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The Delphian lymph node (DLN) has long beenregarded as a predictor of thyroid malignancy and indicator of advanced disease; however, there are a few published data in relation to the thyroid. Therefore we are to determine the significance of DLN involvement in differentiated papillary carcinoma. METHODS: We prospectively assessed the discovering rate of DLN and the frequency of DLN metastasis in the consecutive patients undergoing total thyroidectomy with central neck node dissection at Endocrine Surgery Department of our hospital. And we assessed whether DLN involvement may predict extensive cervical lymph node disease and other unfavorable prognostic factors. RESULTS: The DLN was separately removed and identified as such in 42 of 164 patients (25.6%), and 9 of 42 patients (21.4%) had DLN metastases. DLN involvement was not associated with larger tumor size (1.8 vs. 1.1 cm), age (41 vs. 46 years), perithyroidal tissue invasion (66.6 vs. 72.7%) and lymphovascular invasion. DLN involvement was highly predictive of central compartment metastasis (sensitivity 100%, specificity 41%), high proportion of metastatic nodes, and moderately suggestive of further disease in the lateral compartment (sensitivity 44%, specificity 92%). CONCLUSION: Although the clinical appearance of the DLN is not an accurate indicator of the presence of thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for paying greater attention to the central and lateral compartment lymph nodes.

The Study of Risk Factors for Symptomatic Knee Osteoarthritis in Korea / 대한류마티스학회지

OBJECTIVE: To investigate the risk factors for symptomatic knee osteoarthritis (OA) in Koreans METHODS: A total of 1,194 persons consisting of 588 men and 606 women (mean age+/-SD, 48.9+/-14.0 years) were enrolled in rural and urban areas or in a hospital of Korea between september 2000 and august 2001. All participants were interviewed about symptoms of knee OA and possible risk factors including age, sex, occupation, body mass index (BMI), smoking, age of menarche, menopause and hormone replacement therapy and examined. Knee radiograph was obtained in all participants with knee symptoms. Symptomatic knee OA was defined according to clinical criteria or clinical and radiographic criteria for classification of osteoarthritis of the knee by Altman. RESULTS: Of 1,194 participants, symptomatic knee OA was found in 189 persons (15.8%) and multivariate analysis showed that female (OR=5.66, 95% CI 3.42~9.38), aging (OR=1.10, 95% CI 1.08~1.12), living in rural area (OR=3.83, 95% CI 2.27~6.45) and BMI over 25 kg/m(2) (OR=2.26, 95% CI 1.42~3.59) were risk factors. Age (older than 70 years, OR=1.08, 95% CI 1.04~1.12) and living in rural area (OR=5.39, 05% CI 1.94~14.96) were associated with symptomatic knee OA in men and age (older than 40 years, OR=1.11, 95% CI 1.07~1.16), living in rural area (OR=2.46, 95% CI 1.17~5.17), and BMI over 25 kg/m(2) (OR=3.45, 95% CI 1.63~7.29) in women. CONCLUSION: The risk factors for symptomatic knee OA were aging, female, living in rural area and high BMI in Koreans.

The usefulness of immediate implantation using Bio-Oss. and Bio-Gide.in ITI. implant system

Mucoepidermoid carcinoma of palate: report of a case