A Case of Aspiration Pneumonia after Upper Gastrointestinal Endoscopy

In upper gastrointestinal endoscopy, intravenous anesthesia is commonly used due to its safety and improvement in patient's satisfaction and comfort. The aim of this approach is to improve the condition for endoscopy. Although the risks of sedation are reported to be very low with sufficient monitoring, we still have few risks that cannot be overlooked including aspiration pneumonia. There have been two reported cases of aspiration pneumonia after endoscopic submucosal dissection. However, to our knowledge, there has been no reports about aspiration pneumonia developing after endoscopy for a young healthy female. So, we report a first case of unexpected aspiration pneumonia after endoscopy.

Subjectivity on Childbearing in High School Students

PURPOSE: This study was to explore subjectivity on childbearing in high school students. METHODS: A Q-methodology which provides a method of analyzing the subjectivity of each type was used. Forty-three high school students classified 40 selected Q-statements into 9 points standard. The obtained data were analyzed by using the pc-QUANL program. RESULTS: High school students' subjectivity on childbearing were analyzed into two types: Type 1 turned out to be 'FOLS (family oriented life style)' and Type 2 'CINK (couple important no kid)'. CONCLUSION: In order to resolve such problems as low birth rate and the advanced age of the population, effective youth and adult programs, policy and institution are required. The current demographic, economic and other factors such as personal values and policies may lower birth rate. In particular, youths' need for children and birth rate tend to be lower. There are positive and negative patterns in high school students' subjectivity on childbearing. Thus, national and social efforts are needed to change negative factors into positive ones. In order to maintain positive subjectivity on childbearing in high school students, it is necessary to apply family-centered educational programs and to implement birth-friendly and realistic programs for promoting child birth.

A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

BACKGROUND/AIMS: The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. METHODS: Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). RESULTS: The accuracy of BISAP (> or = 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (> or = 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. CONCLUSIONS: BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

Factors Influencing Run Away Impulse in Early Adolescents

PURPOSE: This study carried out a preliminary analysis of available literature and used the ecological approach to define a research hypothesis with focus on individual, family, and school variables related to early adolescents' urge to run away. This study also aimed to examine the influence of each of these variables in order to build a forecast model showing which variables have more influential on early adolescents' urge to run away. METHODS: Materials were collected from 433 male and female fifth- and sixth-grade students at two schools in Gyeonggi Province. Analysis was carried out using SPSS/WIN 18.0. Frequency analysis, chi2-test, t-test, correlation analysis and logistic regression analysis were conducted. RESULTS: The results indicate that personal factors related to runaway impulse are gender and previous runaway attempts, family-related factor family functionality, and school-related factor the area of stress from study. CONCLUSION: Based on the study results as above, individual, family, and school interventions need to be developed.

A Case of Graves' Disease Presented as Generalized Seizure Attack

Hyperthyroidism is diagnosed when a patient is presented with typical symptoms, such as weight loss, palpitation, and hand tremor. However, early diagnosis is difficult in elders, because they have no typical symptoms, but only cardiovascular or muscular symptoms. In hyperthyroidism, there are often with neurologic changes, leading to various neurologic symptoms. Generalized or focal seizures are rarely reported in thyrotoxicosis and thyrotoxic crisis. Further, cases of hyperthyroidism presented as generalized seizure attack are extremely rare. We report a case of hyperthyroidism. A patient is presented at the hospital with mental change, as well as generalized seizure, who was finally diagnosed to have Graves' disease. A 56-year-old male was admitted to the hospital because of mental change with generalized seizure attack. Initial neurologic evaluations, including a brain magnetic resonance imaging and electroencephalogram proved to be normal. But, thyroid function test showed abnormal results. We diagnosed him as Graves' disease and prescribed anti-thyroid drug. Thereafter, there has been no recurrence of neurologic symptoms for 12 months.

A Case of Synchronous Esophagus and Stomach Cancer Successfully Treated by Combined Chemotherapy / 대한소화기학회지

Although cases of simultaneous esophagus and stomach cancer have been reported sporadically, there are rare reports of successful treatment using chemotherapy. We report a case of synchronous esophageal and gastric cancer successfully treated using docetaxel and cis-diammineedichloro-platinum (CDDP) combination chemotherapy instead of surgery. A 82-years-old man with anorexia and progressive weight loss was diagnosed with synchronous esophageal and gastric cancer by endoscopy. Both cancers were diagnosed as resectable by the preoperative clinical staging. However, surgery was contraindicated because of severe lung dysfunction. Moreover, he actively refused radiotherapy and endoscopic management. Therefore, the patient was given combined chemotherapy with docetaxel (65 mg/m2) and CDDP (60 mg/m2). The esophageal and gastric lesion completely disappeared on endoscopy, and there were no residual tumor cells on endoscopic biopsy after three cycles of chemotherapy. Metastatic lymph nodes also completely disappeared on the CT scan. The patient received a total of ten cycles of chemotherapy, without severe adverse effects. The patient remained asymptomatic for 18 months after discontinuation of the chemotherapy, without evidence of local recurrence or distant metastasis. Surgery or endoscopic treatment of both esophageal and gastric cancers is desirable, but, if medically inoperable, chemotherapy can be alternative treatment option.

Comparison of Vascular Calcification Scores on Plain Radiographs to Predict Coronary Artery Disease According to Dialysis Modality / 대한신장학회지

PURPOSE: Vascular calcification (VC) scores on simple plain radiographic films are known to be associated with coronary artery disease (CAD) in hemodialysis (HD) patients. However, there is no report comparing VC scores on plain radiographic films according to dialysis modality. We hypothesized that there are some differences of VC scores on plain radiographs for the assessment of CAD according to dialysis modality. METHODS: We recruited 78 peritoneal dialysis (PD) patients and compared to 61 HD patients. We defined significant VC as any one finding among the abdominal aortic calcification (AAC) score > or =5, VC score of the hands and pelvis > or =3, or medial artery calcification of the feet on plain radiographs. RESULTS: The prevalence of CAD and significant VC were not different according to dialysis modality. Every VC score on the plain radiographs was highly correlated with each other, but VC evaluation on plain radiographs by single method overlooked nearly 30% of other significant VC sites in PD and HD patients. AAC score was most useful method for the prediction of CAD as a single VC scoring method. There was no association between VC of the feet and CAD in PD patients. Lower high density lipoprotein cholesterol was associated with significant VC on plain radiograph in PD patients. CONCLUSION: Significant VC formation on plain radiographs was not different according to dialysis modality. It is helpful to check several plain radiographs for the decision of CAD evaluation and not overlooking significant VC in both HD and PD patients.

Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers. METHODS: Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission. RESULTS: Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021). CONCLUSIONS: Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis.

A Case of Acute Cholecystitis with a Perforation Complicating Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

The incidence of acute cholecystitis complicating endoscopic retrograde Cholangiopancreatography (ERCP) is rarely reported at 0.2% but is usually associated with a cystic duct obstruction caused by gallstones, gallbladder polyps, or cancer. However, acute cholecystitis with a gallbladder perforation after ERCP without a history of cystic duct obstruction can develop very rarely and has not yet been reported in Korea. We report a case of acute cholecystitis with gallbladder perforation and aggravation of a pancreatic pseudocyst after diagnostic ERCP in a man with a pancreatic cystic lesion. He has been successfully cured using only percutaneous transhepatic gallbladder drainage and antibiotics with no surgery.

Establishment of a Radiation-Induced Fibrosis Model in BALB/c Mice / 대한방사선종양학회지

PURPOSE: Although radiation-induced fibrosis is one of the common sequelae occurring after irradiation of skin and soft tissues, the treatment methods are not well standardized. This study aimed to establish the skin fibrosis mouse model by fractionated radiation for the further mechanism studies or testing the efficacy of therapeutic candidates. MATERIALS AND METHODS: The right hind limbs of BALB/c mice received two fractions of 20 Gy using a therapeutic linear accelerator. Early skin damages were scored and tissue fibrosis was assessed by the measurement of a leg extension. Morphological changes were assessed by H&E staining and by Masson's Trichrome staining. TGF-beta1 expression from soft tissues was also detected by immunohistochemistry and PCR. RESULTS: Two fractions of 20 Gy irradiation were demonstrated as being enough to induce early skin damage effects such as erythema, mild skin dryness, dry and wet desquamation within several weeks of radiation. After 13 weeks of irradiation, the average radiation-induced leg contraction was 11.1+/-6.2 mm. Morphologic changes in irradiated skin biopsies exhibited disorganized collagen and extracellular matrix fibers, as well as the accumulation of myofibroblasts compared to the non-irradiated skin. Moreover, TGF-beta1 expression in tissue was increased by radiation. CONCLUSION: These results show that two fractions of 20 Gy irradiation can induce skin fibrosis in BALB/c mice accompanied by other common characteristics of skin damages. This animal model can be a useful tool for studying skin fibrosis induced by radiation.

Establishment of a Single Dose Radiation Model of Oral Mucositis in Mice / 대한방사선종양학회지

PURPOSE: Oral mucositis induced by radiotherapy to the head and neck area, is a common acute complication and is considered as the most severe symptom for cancer patients in the early stages of treatment. This study was proposed to establish the oral mucositis mouse model induced by a single dose of radiation for the facility of testing therapeutic candidates which can be used for the oral mucositis treatments. MATERIALS AND METHODS: Fifty-five BALB/c mice were divided into four groups: control, 16 Gy, 18 Gy, and 20 Gy. Oral mucositis was induced by a single dose of radiation to the head and neck using 6 MV x-Ray from linear accelerator. After irradiation, body weight and physical abnormalities were checked daily. Tongue tissues from all groups were taken on days 1, 2, 3, 5, 7, 9, and 14, respectively and H&E staining was conducted to examine morphological changes. RESULTS: Body weight dramatically decreased after day 5 in all irradiated mice. In the 16 Gy treatment group, body weight was recovered on day 14. The histology data showed that the thickness of the epithelial cell layer was decreased by the accumulated time after radiation treatment, up to day 9. Severe ulceration was revealed on day 9. CONCLUSION: A single dose of 16 Gy is sufficient dose to induce oral mucositis in Balb/C mice. Significant changes were observed in the Balb/C mice on days 7 and 9 after radiation. It is suggested that this mouse model might be a useful standard tool for studying oral mucositis induced by radiation.

Huge pleomorphic adenoma of the parotid gland: report of a case

Clinical review of midtrimester amniocentesis / 대한산부인과학회지

OBJECTIVE: To compare the usefulness of prenatal screening tests for chromosomal abnormalities by analyzing the cytogenetic results of midtrimester amniocentesis METHODS: We reviewed a total of 1264 cases of midtrimester prenatal genetic amniocentesis performed from February 1997 to September 2003, of which accorded to indications of cytogenetic studies. Cytogenetic results were analyzed with the distribution of maternal age, indications of amniocentesis. RESULTS: The most common age of total subjects was in between 35-39 years (37.1%). The indications of amniocentesis were abnormal maternal serum marker (60.0%), advanced maternal age (34.8%), abnormal ultrasonographic findings (3.2%), in order. The overall incidence of chromosomal aberration was 3.9% (49/1264). No significant difference was found between the mean maternal age with and without abnormal fetal karyotype. According to indications, there was 12.5% (5/49) of chromosomal abnormalities in abnormal sonographic finding group, 5.2% (36/688) in abnormal maternal serum screening group and 2.4% (12/498) in advanced maternal age group. There was statistical significance (P=0.004) only in abnormal ultrasonographic finding group. CONCLUSION: Ultrasonography was become to be more important due to development of high resolution ultrasonography, skillful technique and awareness of sonographic markers. Ultrasonographic abnormality could be the most predictive marker for abnormal fetal karyotypes.

Cephalic tetanus: A case report

Cephalic tetanus is a rare subtype of tetanus in which trismus is a charateristic symptom. The paralysis of one or more cranial nerves can occur. The 7th cranial nerve is most frequently involved. It account for 1 to 3% of the tetanus and has a mortality of 15 to 30%. The incubation period is 1 to 14 days, and approximately two thirds of tetanus cases progress to generalized tetanus. Generally, the symptoms of cephalic tetanus can include : facial pain, trismus, dysphagia, muscle twitching spasms of the face and jaw (risus sardonicus), neck stiffness and malaise. We present a case of cephalic tetanus who 54-year male patient had trismus and dysphagia. There was no history of trauma. As there was a delay in diagnosis of cephalic tetanus, respiratory disorder and intermittent general spasm occurred. The patient was treated by injection of antibiotics, muscle relaxant, and human anti-tetanus immunoglobulin. His symptoms were disappeared, and he was discharged ambulatory.

A CLINICOBACTERIOLOGICAL STUDY ON WOUND INFECTION IN PATIENTS WITH ORAL AND MAXILLOFACIAL TRAUMA

A clinicobacteriological study on wound infection in patients with oral and maxillofacial trauma

Effects of local irrigation and intravenous administration of human tissue-type plasminogen activator on microvascular thrombosis