A Case of Thymic Carcinoma with Behcet's Disease Combined with Immunoglobulin A Nephropathy

Behcet's disease is a systemic inflammatory disorder of unknown etiology, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Renal involvement is rare in patients with Behcet's disease particularly immunoglobulin A (IgA) nephropathy. Other autoimmune diseases have been associated with increased risk of malignancy, but not Behcet's disease. Some cases of Behcet's disease accompanied by bladder cancer, thyroid cancer, stomach cancer, or hematologic malignancies have been reported. However, to the best of our knowledge, co-occurrence of Behcet's diseases with thymic carcinoma has not yet been reported. We experienced a 49-year-old male patient who had been treated for Behcet disease and IgA nephropathy, who presented with a large mediastinal mass on chest x-ray. After thymectomy, he was diagnosed with thymic carcinoma with complete resection.

A Case of Acute Esophageal Necrosis in a Patient with Diabetic Ketoacidosis / 대한내과학회지

Acute esophageal necrosis is a rare clinical entity characterized by the endoscopic finding of extensive black discoloration of the esophageal mucosa. Acute esophageal necrosis in a patient with diabetic ketoacidosis has rarely been reported. We report a case of acute esophageal necrosis in a patient with diabetic ketoacidosis. The patient had coffee ground emesis and, after an esophagogastroduodenoscopy with mucosal biopsy, acute esophageal necrosis was diagnosed. The patient was treated conservatively with an intravenous proton pump inhibitor and oral sucralfate without any complications.

The Utility of HbA1c as a Diagnostic Criterion of Diabetes / 가정의학회지

BACKGROUND: Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves. METHODS: This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria. RESULTS: The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05). CONCLUSION: For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.

Epidemiology of Patients Using the Resuscitation Room in an Emergency Department

PURPOSE: The resuscitation room is the hub of intensive care and focused management within the emergency department (ED). For patients with life-threatening conditions, immediate triage and proper treatment using the resuscitation room is important. This study was conducted to assess the epidemiology of patients using the resuscitation room in an emergency department. METHODS:This was a retrospective observational study. Eligible subjects were enrolled through the National Emergency Department Information System from July 2007 to September 2008. All subjects came through a single regional emergency center that logs more than 45,000 patients annually. Pediatric patients less than 15 years of age and those who were dead on arrival at the ED were excluded. The Emergency Severity Index (ESI) version IV was used as a triage tool, and characteristics and ESI levels of patients using or not using resuscitation rooms were compared. RESULTS: The total number of eligible subjects was 40,926 and the male-female ratio was 1:0.92. The numbers of patients using the resuscitation room was 1,050 (2.99%). Patients using the resuscitation room were older than the patients not using the resuscitation room, were more likely to have used an ambulance to visit the ED, and had a higher mortality rate and a higher admission rate. A majority of staff members had the authority to put patients in the resuscitation room. Among them were professors 18.19%, emergency residents 11.43%, certified emergency nurses 40.57%, emergency nurses 19.43%, emergency medical technicians 2.86%, and paramedics 6.19%. Critical care was done in the resuscitation room for cardiopulmonary resuscitation 11.66%, intubation 26.33%, ventilation 1.71%, defibrillation 5.73%, and other 54.57%. The most frequent ESI levels of patients using the resuscitation room was 1 (57.89%); an ESI score of 3 (72.01%) was the most frequent value for patients not using the resuscitation room. CONCLUSION: Patient using the resuscitation room were older, more likely to have used an ambulance, and had a higher mortality rate, admission rate and ESI level.

Plasma Adiponectin and Insulin Resistance in Korean Type 2 Diabetes Mellitus

Insulin resistance, which implies impairment of insulin signaling in the target tissues, is a common cause of type 2 diabetes. Adipose tissue plays an important role in insulin resistance through the dysregulated production and secretion of adipose-derived proteins, including tumor necrosis factor-alpha, plasminogen activator inhibitor-1, leptin, resistin, angiotensinogen, and adiponectin. Adiponectin was estimated to be a protective adipocytokine against atherosclerosis, and also to have an anti-inflammatory effect. In this study, the relationship between fasting plasma adiponectin concentration and adiposity, body composition, insulin sensitivity (ITT, HOMAIR, QUICK), lipid profile, fasting insulin concentration were examined in Korean type 2 diabetes. The difference in the adiponectin concentrations was also examined in diabetic and non-diabetic subjects, with adjustment for gender, age and body mass index. 102 type 2 diabetics and 50 controls were examined. After a 12-h overnight fast, all subjects underwent a 75gram oral glucose tolerance test. Baseline blood samples were drawn for the determinations of fasting plasma glucose, insulin, adiponectin, total cholesterol, triglyceride, LDL-cholesterol, and HDL-cholesterol. The body composition was estimated using a bioelectric impedance analyzer (Inbody 2.0). The insulin sensitivity was estimated using the insulin tolerance test (ITT), HOMAIR and QUICK methods. In the diabetic group, the fasting adiponectin concentrations were significantly lower in men than in women. They were negatively correlated with BMI (r=-0.453), hip circumference (r=-0.341), fasting glucose concentrations (r=-0.277) and HOMAIR (r=-0.233). In addition, they were positively correlated with systolic blood pressure (r=0.321) and HDL-cholesterol (r= 0.291). The systolic blood pressure and HDL-cholesterol were found to be independent variables, from a multiple logistic regression analysis, which influenced the adiponectin concentration. Compared with the non-diabetic group, the adiponectin concentrations were significantly lower in the diabetic group, with the exception of obese males. In conclusion, the plasma adiponectin concentrations were closely related to the insulin resistance parameters in Korean type 2 diabetic patients.

Replantation of Nose Amputation by Use of Medical Leech

In the microsurgical era, replantation with microvascular anastomosis is considered as the most superior method in aspects of texture, color, shape in case of nose amputation. There are some reported cases of replantation in nose amputation historically, but most of them are composite graft cases rather than microvascular anastomosis. Only a few cases of successful nasal replantation with microvascular anastomosis have been reported due to the reason that the size of vessels is usually very small and identifying suitable vessels for anastomosis is difficult. Microanastomosis of artery and microanastomosis of vein are ideal in replantation, but identifying suitable veins is often difficult. Without venous anastomosis, resolving the venous congestion remains to be a problem. We can carry out arteriovenous shunt if we can find two arteries in amputee. However, the smaller the size of amputee is, the more difficult it is to find two arteries. Instead of arteriovenous shunt, we can try external venous drainage(frequently swab, pin-prick, stab incision, IV or local heparin injection, dropping, apply of heparin-soaked gauze, use of medical leech). Here, we present three cases of replantation with microscopical arterial anastomosis (one angular artery, two dorsal nasal arteries) and external venous drainage (stab incision, application of medical leech and heparin-soaked gauze) even though the size of amputee may be as small as 1.5x1.0 cm. In all cases, surgical outcomes were excellent in cosmetic and functional aspects. This report describes successful replantation by microvasular anastomosis in case that suitable veins are not found.

Comparison of Sleep Disturbance in Patients Treated with Hemodialysis, Peritoneal Dialysis and Renal Transplantation / 대한신장학회잡지

BACKGROUND: We investigated a group of patients with chronic renal failure to evaluate the prevalence and the risk factor related to sleep disturbance. We also studied to explore relationship between sleep disturbance and renal replacement therapy of chronic renal failure such as hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (RT). METHODS: The patients with 43 HD patients, 52 PD patients, and 32 RT patients completed a self- administered questionnaire package, which included Weekly Sleep Questionnaire (WSQ) and Beck's Depression Inventory (BDI). RESULTS: About 75% of chronic renal failure patients have sleep disturbance. There was difference of morning dissatisfaction feeling item score between HD and RT (pRT) groups and of daytime sedation item score among PD, HD and RT (pRT, PDRT) groups. The BDI (beta= 0.546) and the serum creatinine (beta=0.221) were significantly positive correlated with WSQ total score, but other factors (modalities of renal replacement therapy, duration of illness, duration of dialysis, Bood urea nitrogen, hematocrit, Body mass index) were not correlated with WSQ total score. CONCLUSION: Sleep disturbance is common in chronic renal failure patients. There was significant difference of daytime sleep disturbance among renal replacement therapy groups. It was caused by difference of emotional state and physical states.

A Study on the Relationship of Internet Addiction and Depression in College students / 한국역학회지

OBJECTIVES: To investigate the relationship of internet addiction and depression, and evaluate other possible related factors. METHODS: Data was based on the questionnaires from 300 college students in Seoul. Gender, age, major, family income, academic performance, people they live with, location, and main use of internet were included. We used Young`s Internet Addiction Test and Beck Depression Inventory(BDI) to measure the depression and addiction degree. RESULTS: In logistic regression analysis, it was found that gender, depression degree and main use of internet were significant variables. There were 136 males, 144 females in this study, and the risk of being addicted to internet were 10.9 times(CI:2.67~44.68) higher in male than female. People with moderate depression (Beck`s Depression Inventory(BDI) Score>20) also had higher risk(11.4 times, CI:2.03~63.95) to be addicted in internet than normal group. Lastly, in case of internet use, people who use internet for games and chatting were 6.38(CI:1.38~29.63) and 4.84 times(CI:1.30~18.06) risky compare to the group with web surfing. CONCLUSION: The result of this study suggests that there is noticeable relationship of internet addiction and depression. However we do not have evidence of exact relation between them, therefore more studies should be done.

Conservative Treatment with Silicone Gel Sheet of Aplasia Cutis Congenita: Case Reports

Aplasia cutis congenita represents a congenital absence of all skin layers, and it may occasionally extend through the bone and dura of the skull. Since the first report by Cordon in 1767, over 500 cases have been reported. Eighty percents of all cases are found in the scalp, and 20 percents of these cases involve extremities and trunk and are often bilaterally symmetrical. Histologic examination demonstrates a layer of thin dermal collagen without overlying epithelium or adnexal structures. It has several clinical groups classified by the location and pattern of the skin defect, associated anomalies and the mode of inheritance. Its management is controversial and may be conservative treatment or the surgical option to provide definite skin cover. In 1990, Wexler suggested that conservative treatment using Silvadene was the preferred option. We would like to present 2 cases in which silicone gel sheet as a conservative treatment modality led to favorable outcomes. It was invented for the treatment of hypertrophic scar but has been used and studied for the open wounds in recent years. The use of silicone gel sheet on congenital skin defect has many advantages: the danger of infection is minimized due to frequent washing; prolonged hospitalization is prevented; pain or bleeding is minimized for dressing changes because it doesn't adhere to the wound; and it can be used after the epithelization for the prevention of hypertrophic scar.

A Case Report: Fibrous Hamartoma of Infancy in the Buttock

Fibrous hamartoma of infancy is an uncommon, benign, subcutaneous fibrous proliferation and usually found during the first 2 years of life, presenting non- tender, hard and movable soft-tissue mass. This tumor can cause much concern about malignancy because it may be fixed in the underlying tissue and is composed of poorly differentiated mesenchymal cells. The diagnosis is made easily by the characteristic histologic features, treatment is local excision and the prognosis is excellent. Because misdiagnosis of malignancy can lead to unnecessary radical therapy, both surgeon and pathologist must be aware of this entity. We experienced and report a case of a 11 month-old male patient who had a 10x15 cm sized hard, fixed and non-tender mass on the right buttock that manifested characteristic pathology of this disease. We excised the mass widely with safety margin of 1 cm and no recurrence was reported in 12 months.

Meckel-Gruber syndrome

Meckel-Gruber syndrome is a multiple malformation syndrome featuring occipital meningoencephalocele, multicystic dysplasia of kidney, cystic and fibrotic change of liver, polydactyly, and other characteristics inherited by the autosomal recessive trait. We exprienced a case of Meckel-Gruber syndrome in a newborn male diagnosed clinically and confirmed pathologically. Abnormalities of the fetus were found prenataly by ultrasonogram, and subsequently the baby was terminated by cesarean section delivery at 32 weeks of gestational age. We report this case with brief review of literature.

The effect of GnRH analogue on epidermal growth factor receptor in uterine myoma / 대한산부인과학회잡지

No abstract available.