Phlegmonous Esophagitis Treated with Internal Drainage and Feeding Jejunostomy

We report the case of a 67-year-old woman presenting with epigastric pain. Computed tomography identified diffuse phlegmonous esophagitis. Esophagogastroduodenoscopy revealed multiple perforations in the mucosal layer of the esophagus. A large amount of pus was drained internally through the gut. The patient was treated with antibiotics and early jejunostomy feeding. Although phlegmonous esophagitis is a potentially fatal disease, the patient was successfully treated medically with only a minor complication (esophageal stricture).

Psychological effects of a disastrous hydrogen fluoride spillage on the local community

BACKGROUND: On September 27, 2012, at 3:43 pm, a hydrogen fluoride spill occurred in a manufacturing plant located at the 4th complex of the Gumi National Industrial Complex in Gumi City, South Korea. The present study aimed to evaluate the psychological effects of the hydrogen fluoride spill on the members of the community and to investigate their relationships with physical symptoms and changes in psychological effects occurring as time passed after the accident. METHODS: The 1st phase involved a survey of 1359 individuals that was conducted 1 month after the spill, and the 2nd phase involved a survey of 711 individuals that was conducted 7 months after the accident. The questionnaires included items for assessing demographic characteristics, hydrogen fluoride exposure level, physical symptoms, and psychological status. Physical symptoms were assessed to determine the persistence of irritations. Psychological status was assessed to investigate the impact of event level using the Impact of Event Scale – Revised Korean version (IES-R-K), and the anxiety level was assessed using the Beck Anxiety Inventory (BAI). RESULTS: As the hydrogen fluoride exposure level increased, the impact of event and anxiety levels increased significantly both 1 and 7 months after the accident (p < 0.05). The mean score of the impact of event levels decreased significantly from 33.33 ± 14.64 at 1 month after the accident to 28.68 ± 11.80 at 7 months after the accident (p < 0.05). The mean score of the anxiety levels increased significantly from 5.16 ± 6.59 at 1 month after the accident to 6.79 ± 8.41 at 7 months after the accident (p < 0.05). The risk of persistent physical symptoms at 7 months after the accident was significantly higher in females. The risk of persistent physical symptoms also increased significantly, with increasing age, hydrogen fluoride exposure, and impact of event levels (p < 0.05). CONCLUSIONS: The present study found that the impact of event level and anxiety level increased with increasing hydrogen fluoride exposure. Anxiety levels persisted even after time passed. The risk of persistent physical symptoms at 7 months after the accident was higher in females, and it increased with increasing age, hydrogen fluoride exposure level, and impact of event levels.

Migration of a contraceptive subdermal device into the lung

A single-rod subdermal contraceptive implant is usually located around the insertion site, has been usually known to migrate within less than 2 cm of the insertion site and the true migration over 2 cm has been rarely reported. We report a case of migrated radiopaque subdermal contraceptive implant into lung in a 37-year-old woman. On conducted chest computed tomography, subdermal contraceptive implant was in subsegmental branch in left posterior basal segment of lung. Removal of subdermal contraceptive implant in left posterior basal segment of lung by mini-thoracotomy was performed by a chest surgeon. Complications with insertion and removal of subdermal contraceptive implant are rare in the hands of medical professionals familiar with the techniques and these procedures should only be undertaken by those with relevant training. The migration over 2 cm should not occur if the correct subdermal insertion procedure is followed and carried out by a properly trained individual.

Expression of Secreted Protein Acidic and Rich in Cysteine in the Stroma of a Colorectal Carcinoma is Associated With Patient Prognosis

PURPOSE: Secreted protein acidic and rich in cysteine (SPARC), also known as osteonectin or basement-membrane-40 (BM-40), is a member of a family of matricellular proteins, whose functions are to modulate cell-matrix interactions, growth and angiogenesis in colorectal cancer. In this study, the expression of SPARC was evaluated and its correlations with clinicopathological parameters were investigated. METHODS: The researchers analyzed the expression patterns of SPARC by using immunohistochemistry in 332 cases of colorectal cancer of tissue microarray. The clinicopathological characteristics were defined by using the TNM criteria of the Union for International Cancer Control. Clinicopathological factors such as age, sex, histologic type of the tumor, pathologic tumor stage, TNM stage, and lymphovascular invasion were evaluated according to the SPARC expression. RESULTS: The hazard ratios expressing SPARC in tumor cells, in the stroma, and in both tumor cells and the stroma were 2.10 (P = 0.036), 3.27 (P = 0.003) and 2.12 (P = 0.038), respectively. Patient survival was decreased in patient expressing SPARC in the stroma, and this result showed statistical significance (P = 0.016). CONCLUSION: These findings suggest that SPARC expression in a tumor and in the stroma correlates with disease progression and may be used as a prognostic marker for colorectal cancer.

Expression of Secreted Protein Acidic and Rich in Cysteine in the Stroma of a Colorectal Carcinoma is Associated With Patient Prognosis

PURPOSE: Secreted protein acidic and rich in cysteine (SPARC), also known as osteonectin or basement-membrane-40 (BM-40), is a member of a family of matricellular proteins, whose functions are to modulate cell-matrix interactions, growth and angiogenesis in colorectal cancer. In this study, the expression of SPARC was evaluated and its correlations with clinicopathological parameters were investigated. METHODS: The researchers analyzed the expression patterns of SPARC by using immunohistochemistry in 332 cases of colorectal cancer of tissue microarray. The clinicopathological characteristics were defined by using the TNM criteria of the Union for International Cancer Control. Clinicopathological factors such as age, sex, histologic type of the tumor, pathologic tumor stage, TNM stage, and lymphovascular invasion were evaluated according to the SPARC expression. RESULTS: The hazard ratios expressing SPARC in tumor cells, in the stroma, and in both tumor cells and the stroma were 2.10 (P = 0.036), 3.27 (P = 0.003) and 2.12 (P = 0.038), respectively. Patient survival was decreased in patient expressing SPARC in the stroma, and this result showed statistical significance (P = 0.016). CONCLUSION: These findings suggest that SPARC expression in a tumor and in the stroma correlates with disease progression and may be used as a prognostic marker for colorectal cancer.

Detection of BRAFV600E Mutations in Papillary Thyroid Carcinomas by Peptide Nucleic Acid Clamp Real-Time PCR: A Comparison with Direct Sequencing

BACKGROUND: Papillary thyroid carcinoma (PTC) of the thyroid is the most common endocrine malignancy. High prevalence of an activating point mutation of BRAF gene, BRAFV600E, has been reported in PTC. We assessed the efficiency of peptide nucleic acid clamp real-time polymerase chain reaction (PNAcqPCR) for the detection of BRAFV600E mutation in PTC in comparison with direct sequencing (DS). METHODS: A total of 265 thyroid lesions including 200 PTCs, 5 follicular carcinomas, 60 benign lesions and 10 normal thyroid tissues were tested for BRAFV600E mutation by PNAcqPCR and DS. RESULTS: The sensitivity and accuracy of the PNAcqPCR method were both higher than those of DS for the detection of the BRAFV600E mutation. In clinical samples, 89% of PTCs harbored the BRAFV600E mutation, whereas 5 follicular carcinomas, 50 benign lesions and 10 normal thyroid tissues lacked the mutation. The mutation was associated with aggressive clinical behaviors as extrathyroid invasion (p=0.015), lymph node metastasis (p=0.002) and multiple tumor numbers (p=0.016) with statistical significance. CONCLUSIONS: The PNAcqPCR method is efficiently applicable for the detection of the BRAFV600E mutation in PTCs in a clinical setting.

Comparative Study of Sensation with or without Preservation of Great Auricular Nerve during Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Whether to sacrifice the posterior branch of great auricular nerve (GAN) during parotidectomy is disputatious. This study was to provide a guideline for decision-making. SUBJECTS AND METHOD: Thirty-two patients who underwent parotidectomy due to parotid mass were randomized into two groups. Three patients who underwent further treatment were excluded. Fourteen patients underwent classic parotidectomy by sacrificing GAN whereas 15 patients underwent surgery that preserved the nerve. A two-point discrimination test, sensation of light touch, sharp instrument, blunt instrument and temperature were evaluated preoperatively, and at 7 days, 1, 3, 6, 12 months and 45 months, postoperatively. Patients' preference for the operation time to preserve the nerve was also evaluated. RESULTS: The mean preservation time was 156 seconds. There was no difference in touch sensation, preoperatively, between the two groups. The two-point discrimination test of the infra-auricular area showed significant differences at 1 week postoperatively (p<0.05). The two-point discrimination test of lobule showed significant differences at 1 month (p<0.05), but these differences disappeared at 1 and 3 months. All measured data had no statistically significant differences at 3 and 6 months. At one year, light touch sensation of lobule and temperature sensation of infra-auricular area showed significant differences (p<0.05). Differences in temperature were found at 45 months of follow-up. Of the patients, 95% wanted to preserve the nerve. CONCLUSION: The authors suggest that the posterior branch of GAN was preserved according to patients' preference for the sensation of temperature in the infra-auricular area.

Mutations in Hepatitis B Virus Precore, Core Promoter, and "a" Determinant in Children with Chronic Hepatitis B Virus Infection / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to determine the prevalence, types of variants, and clinical significance of mutations in precore, core promoter, and "a" determinant mutations in children with chronic hepatitis B virus infection. METHODS: Thirty-one patients with chronic hepatitis B virus infection who visited Seoul National University Children's Hospital in Korea between 2004 and 2005 were enrolled in this study. Serum HBV DNA was amplified by polymerase chain reaction (PCR) and the precore/core promoter and "a" determinant sequences were determined. RESULTS: Precore mutations were found in 11 of 27 patients (40.7%), and appeared more frequently in the HBeAg-negative group (p<0.05) compared to the HBeAg-positive group. G1896A was detected most frequently (81.8%). BCP mutations were found in 15 of 27 patients (55.6%) and the TA mutation (A1762T/G1764A) was the most common (86.7%). Mutations in the "a" determinant region were detected in 8 of 28 patients (28.6%), and amino acid changes were detected in 6 of 28 patients (21.4%). Of these mutations, substitutions at amino acid position 126 were found most frequently. CONCLUSION: In children with chronic hepatitis B virus infection, the most common mutations were G1896A in the precore region and TA mutation(A1762T/G1764A) in the core promoter region. Substitutions at amino acid position 126 was the most common mutation in the "a" determinant. Precore mutants were found to be significantly higher in HBeAg-negative patients. The high prevalence of mutations in the "a" determinant and low frequency of G145R were characteristic features. These mutations were not significantly associated with other clinical features except for high aminotransferase concentration in the core promoter variant group.

Emphysema as a Risk Factor for the Outcome of Surgical Resection of Lung Cancer

It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2+/-3.0 vs. 40.6+/-3.1 months, P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV1/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.

Dissecting Intramural Hematoma of the Esophagus: A case report / 대한흉부외과학회지

Dissection intramural hematoma of the esophagus (DIHO) is a rare, but well-documented condition that is part of the spectrum of acute esophageal injuries; these include the more common Mallory-Weiss tear and Boerhaave's syndrome. This disorder is predominantly seen in women during their sixth or seventh decade and the disease has various etiologies, but the pathogenesis has yet to be clarified. The triad of symptoms for this disorder includes retrosternal pain, hematemesis and odynophagia. It is important to differentiate esophageal submucosal dissection form other disorders that have a similar appearance, such as Mallory-Weiss syndrome and esophageal perforation because the prognosis of DIHO is excellent with conservative therapy and these other diseases require surgical treatment. We report here on a case of a dissecting intramural hematoma of the esophagus that was preoperatively misdiagnosed as the submucosal tumor of the esophagus preoperatively, and it was confirmed by Video-assisted thoracic surgery.

Recurrent Brucellar Meningoencephalitis

Brucellar meningoencephalitis is a rare complication of zoonotic brucellosis. A stockman with a previous diagnosis of brucellar spondylitis presented with recurrent episodes of fever, confusion, and headache. He showed lymphocytic pleocytosis and positive agglutinin test for Brucella spp in the cerebrospinal fluid without lesion in brain MRI. Brucellar meningoencephalitis should be included in the differential diagnosis of meningitis in high-risk patients for brucellosis.

Is the Tuberculosis Case Reporting Rate of Medical Care Institutions in Private Sector low? / 한국역학회지

PURPOSE: To estimate the reporting rate of tuberculosis in one medium-sized city in Korea. METHODS: Data claimed by national health insurance corporationand notification data of KTBS (Korea Tuberculosis Surveillance System) were compared through medical record-linkage method. Regarding the cases that were claimed medical care fee as tuberculosis but not notified to KTBS, we reviewed medical charts of the patients and investigated the reasons of failure to notify. RESULTS: Number of cases claimed health insurance fee as tuberculosis occurrences in Cheonan was 2,331 in 2007, while 956 cases were matched as notified cases to KTBS after electronic record-linkage by personal identifier. Among remaining 1,375 cases that were not matched, real missed cases through medical record review survey were found to be 104. The reasons of failure to notify were because of 'not tuberculosis patients' (500, 36.4%), 'notified in 2006' (421, 30.6%), 'diseases coding error' (341, 24.8%) and 'notified as other diseases' (9, 0.7%). Therefore, the corrected reporting rate was calculated at 93% (95% CI: 91.6% - 94.2%). Notably, reporting rate of clinics (58.1%) was significantly lower than those of hospitals (93.4%) or general hospitals (96.6%). CONCLUSIONS: All cases of tuberculosis diagnosis, which were claimed and not notified, were verified, the reporting rate was not as low as that of the data known through media. However, to reach the goal of tuberculosis elimination (reporting rate over 95%), more effort into improvement of the reporting system is necessary.

Nontraumatic Subperiosteal Orbital Hematoma Associated with Ethmoid Sinusitis: A Case Report

Subperiosteal hematoma of the orbit is a rare disease and most of the cases occur in young adult males as a result of direct facial or orbital trauma. In the absence of direct facial or orbital trauma, nontranmatic subperiosteal orbital hematoma has rarely been reported in association with a sudden elevation of cranial venous pressure or venous congestion, systemic diseases associated with a bleeding diathesis and paranasal sinusitis. We report here on a rare case of subperiosteal orbital hematoma associated with ethmoid sinusitis, as was seen on CT imaging.

A Case of Blue Digit Syndrome after Intraarterial Cerebral Angiography

No abstract available.

Comparison of the Results of Parenchymal Sparing Operation and Pneumonectomy for Non-small Cell Lung Cancer

PURPOSE: Parenchymal sparing lung surgery indicated for central tumors for which the alternative is pneumonectomy. Pneumonectomy has a higher perioperative mortality risk than lobectomy. To increase resection rates and improve outcomes we have implemented a policy of parenchymal sparing operation for tumors involving a main stem bronchus and pulmonary artery. MATERIALS AND METHODS: From January 2000 to May 2004, 30 pneumonectomies and 30 parenchymal sparing procedures were carried out in the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital. Suvival and complications were analyzed and compared. Parenchymal sparing operation was always done when technically possible. Thus pneumonectomy was reserved for lesions that could not be removed by a parenchymal sparing operation. RESULTS: There were no significant inter-group differences in perioperative course or outcome and patient characteristics except postoperative stage. One year survival was 56.7% after pneumonectomy and 86.7% after parenchymal sparing operation. The rate of pneumonectomy decreased significantly with increasing experience of parenchymal sparing operation with 21 of the last 32 patients (66%) avoiding pneumonectomy. CONCLUSION: We suggested that as a curative treatment, parenchymal sparing operation may be a safer procedure than pneumonectomy without adversely affecting outcome. Pneumonectomy can be avoided in a large proportion of patients with non-small cell lung cancer

Granular Cell Tumor Simulating Breast Malignancy: A Case Report

Granular cell tumor is a rare and usually benign tumor that occasionally involves the breast. The physical examination, the mammographic and ultrasonographic findings and the pathologic findings are often suggestive of carcinoma. We report here a rare case of granular cell tumor of the breast that mimicked carcinoma on the mammography, ultrasonography and MR imaging.

Iron Nutritional Status by ALAD Genotype and Intervention Study for Rural Area Residents / 대한지역사회영양학회지

Previous studies have suggested that delta-aminolevulinic acid dehydratase (ALAD) phenotype differently affect mineral metabolism. The objective of this study was to determine the effectiveness of 6-month iron supplementation as syrup of NaFeEDTA in improvement of iron status according to ALAD genotype. One hundred thirty adult women living in rural areas of Asan were provided NaFeEDTA syrup once a week for 6 months at the dose of 64mg Fe/week. Three hundred control subjects were observed during the study period. Fasting blood was obtained for analyzing hemoglobin (Hb) and zinc protophorphyrin (ZPP) and serum was analyzed for ferritin, iron and total iron capacity (TIBC) levels before and after iron supplementation. Ninety percent of ALAD 1-1 (ALAD1) and 10% of ALAD 1-2 (ALAD2) genotype were observed in the control group. However, in the intervention group, 98% showed ALAD1 while only 2% was ALAD2, which is significantly lower proportions of ALAD2 compared to the control group (p<0.01). The iron status of intervention group significantly improved except for ferritin and TIBC regardless of ALAD genotype, while the control group did not show any changes in iron status except for ZPP. ZPP concentration of the control group significantly increased in both ALAD1 and 2 while the intervention group showed significantly decreased ZPP after supplementation in ALAD1. Iron supplementation in the form of NaFeEDTA seems to be effective in reduction of ZPP levels although ALAD2 did not show significant changes due to the small number. However, it is difficult to make a conclusion from these results, and more specified further investigation is needed with more participants.

Factors Affecting Final Adult Height in Patients with Turner Syndrome / 소아과

PURPOSE: Short stature is one of the characteristic features of Turner syndrome. We investigated the factors affecting final adult height(FAH) in patients with Turner syndrome. METHODS: The study group was comprised of 60 patients who were diagnosed with Turner syndrome by chromosomal study and clinical phenotypes and attained FAH. Data were obtained from retrospective review of the medical records. We analyzed the factors influencing FAH in growth hormone(GH) treated and GH untreated groups. RESULTS: Sixty patients were enrolled; 48 patients received GH treatment, and 12 patients did not. Mean duration of GH treatment was 35.8 months(range 4 to 120 months), and mean dosage of GH was 0.8+/-0.2 IU/kg/wk in GH treated group. Mean growth velocity was 5.6+/-2.0 cm/yr, which was significantly higher than that during pretreatment period. In the GH treated group, mean chronological age, bone age, mean height, and height standard deviation(SD) score at GH treatment were 12.2+/-2.7 yr, 10.3+/-2.5 yr, 127.5+/-10.1 cm and -3.1+/-1.1, respectively. In the GH treated group, the mean FAH and SD score of FAH were 146.9+/-5.8 cm and -2.7+/-1.2, respectively, which showed significant differences compared with those of the GH untreated group. Analyzing the factors affecting FAH in GH-treated patients, only the SD score of height at the time of treatment was significantly related to FAH. CONCLUSION: GH treatment leads to an increment in FAH in patients with Turner syndrome. Average FAH gain was as much as 5.8 cm. SD score of height at the time of GH treatment was the only factor influencing FAH.

The Effect of ALAD and VDR Polymorphism on the Hematopoietic Biomarkers in Lead Exposed Workers / 대한산업의학회지

OBJECTIVES: This study was conducted with new workers who entered lead industries from 1992 to 2001 to evaluate the genetic susceptibility of ALAD (delta-aminolevulinic acid dehydratase) and VDR (vitamin D receptor) gene on health effect of lead exposure. METHODS: Among the subjects of the database of lead industries at the Soonchunhyang University Institute of Industrial Medicine, only new workers were selected for this study. The total of eligible workers for this category was 3,540 workers, including non lead exposed workers of same lead industries. From stored blood in specimen bank of Soonchunhyang University, genotype of ALAD and VDR were measured using PCR method. Variables for this study were blood lead as an index of lead exposure, ZPP (zinc protoporphyrin in blood), urine ALA (delta-aminolevulinic acid), and hemoglobin as an index of hematopoietic effect of lead. Information on sex, job duration, and weight were collected for personal information. The data were analyzed using SAS (version 8.2) with descriptive analysis of t-test and multiple regression analysis. RESULTS: Among 3,540 new employed study subjects during period of 1992-2001, 3,204 workers (90.5%) had ALAD genotype 1-1, while 336 workers (9.5%) had variant type of ALAD (1-2 or 2-2). For VDR genotype, 2,903 workers (89.7%) out of total tested 3,238 workers were belonged to type bb and 335 workers (10.5%) were type bB or BB. The distribution of genotype of ALAD and VDR were not different according to the job duration in male workers, but were different in female workers. The effect of ALAD and VDR genotype on blood lead were positively significant in the analysis of all cumulative data of new employed workers for 10 years. The effect of VDR genotype on blood lead were stronger than that of ALAD. While the variant ALAD gene made decrease of mean ZPP and ALA in urine after controlling for blood lead and other covariate, the variant VDR gene made increased the mean ZPP and ALA in urine in all cumulative data analysis and cross sectional analysis by job duration. For hemoglobin, ALAD and VDR genotype did not affect the mean value. CONCLUSIONS: From the above our results, we found that ALAD and VDR genotype exerted significant effect in various way. We confirmed that the finding of a cross sectional study of protective effect of variant ALAD on the effect of blood lead on blood ZPP in our retrospective study design. It was found that VDR did not exert protective effect for lead exposure as the variant ALAD did.

A Case of RUL Bronchopleural Fistula Occluded by Flexible Bronchoscope with Endobronchial Watanabe Spigot (EWS) / 결핵및호흡기질환

An 86 year old woman was admitted complaining of dyspnea and right pleuritic pain with a 5 week durations. A physical examination, chest X-ray, and diagnostic thoracentesis upon admission revealed findings consistent with severe pneumonia and empyema on the right lung. Despite the insertion of a chest tube and negative suction via Emersion pump, the continuous air leakage was sustained, and a bronchopleural fistula (BPF) was found on the chest-CT. A flexible bronchoscopic occlusion with an Endobronchial Watanabe Spigot (EWS) was performed after 56 days of admission. An 5 mm diameter EWS was successfully inserted into the anterior segmental bronchus of the right upper lobe by flexible bronchoscope. There was no aAir leakage detected after this procedure. The patient was discharged 30 days after the EWS occlusion.