Successful Simultaneous Treatment of Benign Stricture and Colonic Neoplasm Arising from Colonic Interposition after Esophagectomy: A Case Report / 대한소화기학회지

Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session.Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.

Clinical Impact of Mixed Respiratory Viral Infection in Children with Adenoviral Infection / 감염과화학요법

BACKGROUND: Although adenovirus (ADV) infection occurs steadily all year round in Korea and the identification of respiratory viral coinfections has been increasing following the introduction of multiplex real-time polymerase chain reaction tests, the clinical impact of viral coinfection in children with ADV infection has rarely been reported. MATERIALS AND METHODS: Medical records of children diagnosed with ADV infection were retrospectively reviewed. The enrolled children were divided into two groups based on the identified respiratory viruses: ADV group and coinfection group. Clinical and laboratory parameters were compared between the two groups. RESULTS: In total, 105 children (60 males and 45 females) with a median age of 29 months (range: 0-131 months) diagnosed with an ADV infection were enrolled. Fever (99.0%) was by far the most frequent symptom, followed by respiratory (82.9%), and gastrointestinal (22.9%) symptoms. Upper and lower respiratory tract infections were diagnosed in 56 (53.3%), and 32 (30.5%) children, respectively. Five (4.8%) children received oxygen therapy, and no child died due to ADV infection. Coinfection was diagnosed in 32 (30.5%) children, with rhinovirus (46.9%), and respiratory syncytial virus (21.9%) being the most frequent. The proportions of children younger than 24 months (P <0.001), with underlying medical conditions (P = 0.020), and diagnosed with lower respiratory tract infection (P = 0.011) were significantly higher in the coinfection group than in the ADV group. In a multivariate analysis, only the younger age was significantly associated with coinfection (P <0.001). Although more children in the coinfection group received oxygen therapy (P = 0.029), the duration of fever and hospitalization was not significantly different between the two groups. CONCLUSION: Respiratory viral coinfection with ADV occurred more frequently in children younger than 24 months of age compared with children aged 24 months or older. Respiratory viral coinfection may increase the severity of ADV infection, however, appropriate therapy prevented prolonged hospitalization and poor prognosis due to coinfection.

A Validation Study for the Scale of the Media Reports Regarding Suicide

OBJECTIVE: This study was conducted to develop the evaluating scale of adherence to guideline 2.0 for suicide reporting declared by Ministry of Health and Welfare and the Korea Suicide Prevention Center. METHODS: Four hundred and fifty one subjects who work in suicide prevention center or mental health center across the country participated in survey. They responded to 20 items after reading media report regarding suicide episode. Two hundred and twenty six cases of recruited data were analyzed. Reliability and validity were assessed by Chronbach-α and exploratory factor analysis. Then, confirmatory factor analysis based on another 225 data was conducted. RESULTS: The Results of exploratory factor analysis shows three factor structures. The validity of previous three factor structure based on confirmatory factor analysis was appropriate and the three factor structure consisted of 10 questionnaires with three subconcepts such as ‘glorification’, ‘lasciviousness’, and ‘providing information’. CONCLUSION: Three factor structures in the scale on media reports regarding as suicide is appropriate and this scale will contribute to evaluating suicide report on media.

Interfraction Prostate Movement in Bone Alignment After Rectal Enema for Radiotherapy

PURPOSE: To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS: We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS: A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12+/-2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14+/-1.73 mm and 1.97+/-1.44 mm, respectively) compared with the right-left direction (0.26+/-0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS: The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.

The Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Erectile Dysfunction After Robot-Assisted Laparoscopic Radical Prostatectomy: 1-Year Follow-up

PURPOSE: To evaluate the efficacy and safety of tadalafil 5 mg once daily use in the treatment of erectile dysfunction (ED) after robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: The study retrospectively evaluated 92 patients who underwent RALP at Dong-A University Hospital. The patients were surveyed by use of the abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire, which was self-administered before surgery and at 6 months and 1 year after surgery. The 92 patients were classified into the tadalafil group (n=47) and the non-tadalafil group (n=45). Each group was then classified depending on the nerve-sparing (NS) procedure used: bilateral NS or unilateral NS. RESULTS: At 6 months, the total IIEF-5 scores of the tadalafil group and the non-tadalafil group were 10.0+/-3.4 and 7.0+/-4.0, respectively. At 1 year, the total IIEF-5 score in the tadalafil group was significantly greater than that in the non-tadalafil group (13.2+/-5.6 vs. 7.7+/-4.8, p<0.0001). Statistically significant improvements (p<0.05) were observed in the tadalafil group for all 5 domains of the IIEF-5 score, whereas in the non-tadalafil group there was no significant improvement in any of the domains at 1 year. The reported side effects were flushing (8.5%, n=4), headache (4.3%, n=2), and dizziness (2.1%, n=1). CONCLUSIONS: In ED patients after NS RALP, a once-daily dose of tadalafil 5 mg was well tolerated and significantly improved EF compared with that in the non-tadalafil group.

Erratum: Acknowledgments. The Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Erectile Dysfunction After Robot-Assisted Laparoscopic Radical Prostatectomy: 1-Year Follow-up

In this paper, acknowledgments section was omitted unintentionally.

Tamsulosin Monotherapy versus Combination Therapy with Antibiotics or Anti-Inflammatory Agents in the Treatment of Chronic Pelvic Pain Syndrome / 대한배뇨장애요실금학회지

PURPOSE: Chronic pelvic pain syndrome (CPPS) is treated by use of various protocols. We compared tamsulosin monotherapy with tamsulosin in combination with antibiotics or anti-inflammatory agents and evaluated the efficacy of these treatments in patients with CPPS. METHODS: Patients (n=107) who were younger than 55 years and diagnosed with CPPS were randomly assigned to treatment with tamsulosin at 0.2 mg (group A), tamsulosin at 0.2 mg plus anti-inflammatory drugs (group B) or tamsulosin at 0.2 mg plus antibiotics (group C) daily. We applied the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostate Symptom Score (IPSS) to evaluate 100 patients who were treated for 12 weeks (7 withdrew). Scores of the three groups were compared by analysis of variance and we also evaluated subscores, which included pain, voiding and quality of life (QoL). RESULTS: All three groups showed statistically significant decreases in NIH-CPSI score, IPSS and subscore scores (P<0.05). There were no statistically significant differences between the groups except for the QoL domain of the IPSS (group A vs. C; P<0.01). CONCLUSIONS: Tamsulosin monotherapy for 12 weeks was effective for treating patients with CPPS, compared with combination therapy with antibiotics or anti-inflammatory drugs.

Risk Factors Associated with the Severity of Delirium / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. METHODS: The participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a 'mild delirium group (MDG)', whose total scores on the K-DRS-R98 were below 16, and a 'severe delirium group (SDG)' with the scores above 16. RESULTS: There was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). CONCLUSION: The present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms.

Iron Status and Anemia of Middle School Girls in Ulsan Metropolitan City / 대한지역사회영양학회지

This study was designed to assess the nutritional iron status and anemia of middle school girls. Three-hundred-fiftythree female subjects in Ulsan metropolitan city were evaluated using a questionnaire, and hematological indices. The average height and weight of the respondents were 157.19 +/- 5.57 cm and 51.06 +/-9.42 kg, respectively. The average Body Mass Index (BMI, Kg/m2) was 20.63 +/-3.23, which was within the normal range. With regard to clinical symptoms, the greatest number of respondents reported that they experienced 'decreased ability to concentrate'. The total caloric intake of each subject was 1743.28 +/- 343.47 kcal (83.01% of the Korean RDA) and the calcium intake was 634.98 +/- 201.43 mg (79.37% of the Korean RDA). The mean daily intake of iron was 14.76 +/- 4.36 mg (92.25% of the Korean RDA) and the heme iron intake was 6.12 +/- 2.30 mg, which was 41.5% of the total iron intake. The average hemoglobin (Hb) concentration of the subjects was 13.24 +/- 1.01 g/dl, and the average hematocrit (Hct) level was 37.79 +/- 4.10%. The transferrin saturation {TS (%)} was 19.41 +/- 9.21%, and the ferritin level was 26.26 +/- 18.60 ng/ml. The iron deficiency anemia among the subjects was estimated at 6.1% by using Hb (< 12 g/dl), 20.5% by using Hct (< 36%), 30.8% by using TS (< 14%), and 23.1% by using ferritin (< 12 ng/ml). The total iron binding capacity (TIBC) showed a negative correlation with the Hb, iron, ferritin and TS. With regard to the correlation between blood biochemistry and clinical symptoms related to anemia, the Hb concentration was negatively correlated with 'pale face' (p < 0.05). In addition, the level of iron was significantly and negatively correlated with 'poor memory' (p < 0.01) and the ferritin concentration was negatively correlated with 'no appetite' (p < 0.05), 'pale face (p < 0.05). These results suggest that the prevalence of iron deficiency among middle school girls is very high; therefore, guidelines on dietary support and nutritional education to improve their dietary iron status should be provided.