Association of Nutritional Status with Cognitive Stage in the Elderly Korean Population: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease

BACKGROUND AND PURPOSE: Epidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished. METHODS: Baseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated. RESULTS: After adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/malnutrition group was observed in the left temporal area. CONCLUSIONS: Dementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.

A Case of Acute Colonic Pseudo-obstruction Treated by Percutaneous Endoscopic Colostomy / 대한소화기내시경학회지

Acute colonic pseudo-obstruction (Ogilvie's syndrome) results in massive colonic dilation without mechanical obstruction. In most cases, a conservative treatment with or without endoscopic decompression is efficient. Rarely, surgery has to be performed. A surgical treatment is associated with high morbidity and mortality. However, a percutaneous endoscopic colostomy could be an interesting alternative treatment. We report the case of a 88-year-old female with colonic pseudo-obstruction for which both the conservative and the colonoscopic treatments were unsuccessful. A percutaneous endoscopic colostomy was performed, and symptomatic improvement was observed. We have shown that percutaneous endoscopic colostomy is a safe and effective treatment for acute colonic pseudo- obstruct

Two Cases of Endoscopic Resection of Submucosal Tumor of the Minor Papilla / 대한소화기내시경학회지

Tumors of the minor papilla are very rare and these tumors have generally been known as neuroendocrine tumors such as carcinoid tumor and somatostatinoma. As these are mostly submucosal tumors, their diagnosis is difficult by just performing endoscopic forceps biopsy, but diagnosis is possible by surgery or endoscopic resection. EUS and ERCP is an essential tool for the diagnosis of these tumors, and abdominal CT or MRI is also useful because there is the possibility of malignant tumors such as carcinoid tumor. For our present two cases, screening endoscopy revealed the polypoid lesion of the minor papilla. EUS disclosed that the submucosal tumor was limited to the submucosal layer and no abnormality was found from the abdominal CT and ERCP. Herein, we performed endoscopic resection for making the diagnosis and treatment. Histologically, these 2 tumors were diagnosed as ectopic pancreas and gangliocytic paraganglioma, respectively.

Chronic Granulomatous Mastitis

PURPOSE: Granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology. Clinically and radiologically, it can mimic a breast carcinoma. Therefore, surgeons, pathologists, radiologists need to be aware of this condition in order to avoid unnecessary mastectomies. This study examined the modalities that are important for diagnosing and treating of the granulomatous mastitis. METHODS: The data regarding 14 patients with histologically confirmed granulomatous mastitis and treated at our hospital were analyzed. Age, associated disease, parity, past history of breast feeding and oral contraceptives, radiology findings were retrospectively evaluated. RESULTS: Among the 14 patients, the mean age was 41 years with 5 being in their thirties. Breast pain was the most common presentation. Of the 14 patients, 11 patients had breast-fed and none had previously used oral contraceptives. No patient suffered from pulmonary tuberculosis. Preoperative mammography and ultrasonography was not helpful in identifying granulomatous mastitis. After ultrasonography, 7 patients were found to have mastitis with an abscess and a benign or malignant tumor was found in 3 patients. Two of the 14 patients were diagnosed using pre-operative fine-needle aspiration, which that showed an epithelial histiocyte or multinucleated giant cell. Three cases completely recovered after an excision. In 11 cases, incision and drainage were performed but there was a recurrence in 4 of these, which needed to be treated more than twice by an incision and drainage and steroid. The average treatment period was 5 months and a recurrence was encountered in 4 patients within a 30-month follow-up period. CONCLUSION: Granulomatous mastitis is rare, but it is important to make a histological diagnosis at the early stages. It is believed that a complete excision of the lesion will help prevent a recurrence, and patients with a frequent recurrence can be treated with steroid after stopping unnecessary antibiotic treatment.

Concurrent Severe Alopecia Areata in Dizygotic Twins / 대한피부과학회지

A recent genetic study of alopecia areata shows that the patients with early onset, severe, familial group could be separated from the patients with later onset, milder severity with good prognosis in their genetic background. We have experienced an intractable clinical course of alopecia areata in dizygotic twin brothers and have come to sympathise with the genetic influence of the disease. The alopecia areata of the two brothers began for both at about 10 years of age and became severe and persistent over the twenties up to the present times. All treatments failed. The patients were thought to be an example showing the importance of genetic influences in the treatment of alopecia areata.

Localized Giant Pseudopolyposis of the Cecum Associated with Crohn's Disease / 대한소화기내시경학회지

Pseudopolyposis occurs twice as often in ulcerative colitis as in Crohn's disease. Pseudopolypsis is divided into the followings: localized multiple pseudopolyposis, localized giant pseudopolyposis, generalized pseudopolyposis and long finger-like pseudopolyps. The most serious problem is confusion with carcinoma. Indications for operation are intussusception or obstruction, radiological simulation of carcinoma. The pseudopolyp could be managed by careful follow-up with colonoscopy and multiple biopsies. We report a case of localized giant pseudopolyposis of the cecum associated with Crohn's disease, with review of relevant literature.

A Case of Angiosarcoma on the Scalp in a Teenage Girl / 대한피부과학회지

Angiosarcoma is a rare and highly malignant vascular tumor of endothelial cell origin. Cutaneous angiosarcoma usually occurs on the scalp and face of the elderly person, frequently in the sixth and seventh decade. Unusually, we experienced a case of angiosarcoma of the scalp in a 12-year-old girl. The patient had a solitary, well-demarcated 0.7X0.7cm sized, non-tender, blue-violaceous to gray-black colored, crusted papule on the vertex for 2 months. She was treated by wide surgical excision only but no recurrence in the last eight years after excision.

A Case of Cutaneous Manifestations Associated With Hydroxyurea Therapy / 대한피부과학회지

Hydroxyurea is an antitumor agent that has attained an important role in the management of myeloproliferative syndromes. Its mechanism of action is not fully understood, but it appears to affect DNA synthesis and genetic control of cell replication by inhibiting the conversion of ribonucleotides in deoxyribonucleotides. Cutaneous side effects such as xerosis, hyperpigmentation, nail changes, skin ulceration, alopecia, and palmoplantar keratoderma may occur, especially with long-term treatment. We report a case of 65-year-old chronic myelogenous leukemia(CML) patient showing various cutaneous manifestations after receiving long-term hydroxyurea therapy.

A Case of Phakomatosis Pigmentovascularis Type I a With Multiple Pyogenic Granulomas Developed in Pregnancy / 대한피부과학회지

Phakomatosis pigmentovascularis(PPV) was first described in 1947 as a distinctive association of vascular and pigmentary nevi by Ota et al. Hasegawa et al subclassified the disorder into eight types and type I a is characterized by the coexistence of nevus flammeus and nevus pigmentosus et verrucous, which is not associated with systemic organ involvement. PPV type I a is relatively rare and a case with multiple pyogenic granulomas developed in pregnancy, is not reported yet. We present a case of PPV type I a with multiple pyogenic granulomas developed in pregnancy within nevus flammeus in a 29-year-old female.

Comparative Histopathologic Study of Drug eruption and Rubella / 대한피부과학회지

BACKGROUND: Dermatologists frequently see morbilliform rash in the clinic, drug eruptions and viral eruptions. Due to close clinical similarities, it is difficult to differentiate them. OBJECTIVE: The purpose of this study was to review the histopathologic differences between drug eruption and viral eruption. METHOD: In this study, 13 patients diagnosed as rubella and 13 patients diagnosed as drug eruption in Department of Dermatology, Presbyterian Medical Center from 1995 to 1997 were included. We reviewed the epidermal changes such as vacuolopathy, dyskeratotic cells, spongiosis and exocytosis and dermal changes by light microscopy. RESULTS: 1. Vacuolopathy of basal layer was observed in 92.3% of patients in both diseases. 2. Dyskeratotic cells, spongiosis and exocytosis were observed significantly highly in drug eruption. 3. Perivascular lymphohistiocytic infiltration was mild in both diseases, but eosinophilic infiltration was significantly higher in drug eruption(84.6%) than viral eruption(15.4%). 4. Atypical lymphocytes were observed in both diseases. 5. Red blood cell extravasation was observed only in viral eruption. 6. Perivascular edema was significantly higher in drug eruption(76.9%) than viral eruption(38.4%) CONCLUSION: There were statistically significant differences in dyskeratotic cells, spongiosis, dermal eosinophilic infiltration and Red blood cell extravasation. Considering these observation, histopathologic findings may be helpful in differentiating between drug eruption and viral eruption.

Screening for Antifungal Endophytic Fungi Against Six Plant Pathogenic Fungi

A total of 187 endophytic fungi were isolated from 11 plant species, which were collected from 11 locations in Korea. Their antifungal activities were screened in vivo by antifungal bioassays after they were cultured in potato dextrose broth and rice solid media. Antifungal activity against plant pathogenic fungi such as Magnaporthe grisea (rice blast), Corticium sasaki (rice sheath blight), Botrytis cinerea (tomato gray mold), Phytophthora infestans (tomato late blight), Puccinia recondita (wheat leaf rust), and Blumeria graminis f. sp. hordei (barley powdery mildew) was determined in vivo by observing the inhibition of plant disease development. Twenty (11.7%) endophytic fungi fermentation broths were able to control, by more than 90%, at least one of the six plant diseases tested. Among 187 liquid broths, the F0010 strain isolated from Abies holophylla had the most potent disease control activity; it showed control values of more than 90% against five plant diseases, except for tomato late blight. On the other hand, fourteen (7.5%) solid culture extracts exhibited potent disease control values of more than 90% against one of six plant diseases. The screening results of this study strongly suggested that metabolites of plant endophytic fungi could be good potential sources for screening programs of bioactive natural products.

A Case of Nonsurgical Treatment in Boerhaave's Syndrome Concomitantly Developed with Acute Pancreatitis / 대한소화기내시경학회지

Spontaneous rupture of the esophagus is an uncommon disease which was first reported by Boerhaave in 1724. This esophageal rupture usually occurs during nausea or vomiting, with incoordinate esophageal contraction. Early diagnosis and prompt surgical repair are critical for survival; however late recognition of esophageal rupture is not unusual. In recent years, a variety of nonsurgical approaches have been proposed, particularily in the case of delayed diagnosis. We have experienced one case of Boerhaave's syndrome concomitantly developed with acute pancreatitis which was successfully treated by nonsurgical measures including endoscopic clipping, antibiotics and hyperalimentation. We review the choice of treatment method in delayed diagnosed Boerhaave's syndrome.

A Case of Acute Tetrachloroethylene Poisoning Complicated by Acute Renal Failure / 대한신장학회잡지

Tetrachloroethylene is widely used as a solvent for degreasing operations and for dry cleaning. Accidental overexposure of tetrachloroethylene produces central nervous system depression which may be followed by hepatic and renal damage. Renal changes are usually mild and reversible with removal of the offending agent. The relationship between exposure to tetrachloroethylene and chronic renal failure remains controversial. Acute or subacute tetrachloroethylene poisoning has been occasionally observed in dry cleaners and fatal cases have been rarely reported. We experienced a case of acute tetrachloroethylene poisoning complicated by acute renal failure. After ingestion of 200 mL tetrachloroethylene, a 32- year-old man was admitted to the clinic in semicoma. Under the conservative treatment, the clinical condition of the patient improved consideravely, but acute renal failure developed. After 5 times hemodialysis during the admission, he recovered completely from acute renal failure.

A case successfully treated with percutaneous drainage of infected hepatic cyst in a patient with adult polycystic kidney disease / 대한내과학회지

Even though it is a rare complication to have hepatic cyst infection in adult polycystic kidney disease, the patient is expected to be complicated with sepsis or acute cholangitis and die if not treated properly. The typical clinical manifestations of hepatic cyst infection are fever and right upper quadrant abdominal pain. Liver enzyme and serum bilirubin levels may be elevated. The clinical outcome of hepatic cyst infection is better when antibiotic and drainage are performed simultaneously than only antibiotic is used. We experienced a case of infected hepatic cyst from a 58-year-old male patient receiving hemodialysis with autosomal dominant polycystic kidney disease. Due to his persistent fever and leukocytosis during intravenous antibiotic therapy, we performed percutaneous drainage of hepatic cyst. Because the drainage fluid presented leukocytosis and deep yellow color, we diagnosed the case as a hepatic cyst infection. We applied both percutaneous drainage of infected liver cyst and antibiotic and we observed clinical improvement.

A Case of Giant Cavernous Hemangioma of Transverse Colon Associated with Hematochezia / 대한소화기내시경학회지

Gastrointestinal hemangiomas are not common and congenital lesion. Intestinal bleeding is the most common symptom of it. Hemangiomas were classified with capillary, cavernous and mixed type. Cavernous hemangioma is most common. Colonic cavernous hemangioma is rare and are usually arising in the sigmoid colon or/and rectum. Transverse colonic cavernous hemangioma are very rare. Gastrointestinal hemangioma is commonly developed in childhood and in young adults. Fifty eight-year-old man who complained of hematochezia was admitted. Physical examination was unremarkable. Stool occult blood was positive. Abdominal computerized tomography show normal finding. Colonoscopic examination showed giant and bluish-purple colored vascular malformation, 15 cm in length with tough bleeding, on the transverse colon. The patient underwent segmental resection of transverse colon for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resection lesion was cavernous hemangioma of the transverse colon. We report a case of giant hemangioma of the transverse colon associated with hematochezia, with review of relevant literature.

A Case of Multiple Verruciform Xanthoma of Oral Cavity and Gastrointestinal tract / 대한피부과학회지

Verruciform Xanthoma(VX) is a rare disease of unknown etiology that is typically solitary and predominantly located within the oral cavity. It is usually not associated with other lesions or metabolic abnormalities. Histologic features include acanthosis with uniform elongation of the rete ridges and xanthomatous cells that lie in are and typically confined to the papillary dermis. We report a rare case of multiple verruciform xanthoma that occurs in oral cavity and gastrointestinal tract simultaneously.

Primary Gastric Small Cell Carcinoma-Pure Type 1 Case / 대한소화기내시경학회지

Primary gastric small cell carcinoma is very rare, so that its incidence is about 0.1% of all gastric cancer and it was first reported in 1976. The morphologic and biologic features of primary gastric small cell carcinoma are similar to those of small cell carcinoma of the lung. Gastric small cell carcinomas are pathologically classified as a pure type and a composite type combined with adenocarcinoma and/or squamous cell carcinoma. Because the behavior of this cancer is very aggressive and exclusive, it invade lymphatic and/or vascular lumen, and dose distant metastasis easily. We report the case of a 55-yr-old man who developed pure type primary gastric small cell carcinoma. The patient underwent Billroth-II subtotal gastrectomy and recieved a multiagent chemotherapy. He remains free from tumor recurrence 12 months after surgery.

A Case of Non-Hodgkin's Lymphoma with Massive Involvement of the Right Atrium

Primary cardiac lymphoma is an uncommon malignancy, accounting for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. But, secondary involvement of the heart is seen in 8.7-27.2% of the documented clinical cases of lymphoma. A 66-year-old man was referred to our ER for evaluation of dyspnea. We incidentally detected the huge intracavitary mass of the right atrium using transthoracic and transesophageal echocardiography. Emergently, the mass was surgically resected due to the possibility of sudden death because the mass was at the risk of obstruction of the right ventricular outflow tract. The mass was confirmed with malignant lymphoma (diffuse large B cell type). We report a case of intracavitary cardiac involved huge non-Hodgkin's lymphoma detected using transthoracic echocardiography in a patient complained of dyspnea.

Subepidermal Calcified Nodule Arising in theLesion Of Clear Cell Syringoma / 대한피부과학회지

The subepidermal calcified nodule, also known as a form of calcinosis cutis, is characterized by solitary circumscribed deposits of insoluble calcium within the subepidermis. The disease is not associated with any systemic or cutaneous diseases, or any biochemical abnormalities. The pathogenesis is still unknown. A 55-year-old female presented with a 4-month history of solitary skin-colored, hyperkeratotic papule on the left upper eyelid. The lesion was asymptomatic and had increased slowly in size. It is interesting that excisional biopsy showed typical histopathologic features of the subepidermal calcified nodule and the clear cell syringoma.

A Case of Immune Hemolytic Anemia after Renal Transplantation / 대한이식학회지

Several cases of immune hemolytic anemia have been reported after renal transplantation of ABO-minor-mismatch. We present a case of anti-B immune hemolytic anemia which developed on 11th day after renal transplantation. 48-year-old man, blood group Rh(+) AB, had a successful renal transplantation from his distant family, blood group Rh(+) A. He was maintained under immunosuppression with cyclosporine and prednisolone. On 11th day after renal transplantation he had a hemolytic episode. His hemoglobin dropped from 9.2 g/dl to 7.3 g/dl and corrected reticulocyte count increased to 3.7%. The peripheral blood morphology showed polychromatophilia, spherocytosis, and anisocytosis. Direct antiglobulin tests were positive with anti-IgG and anti-C3d. The antibody that caused hemolytic anemia was confirmed as anti-B IgG. The anti-B antibodies might be originated from passenger's donor B lymphocyte.