The Functional Dysphagia Scale Is a Useful Tool for Predicting Aspiration Pneumonia in Patients With Parkinson Disease

OBJECTIVE: To describe the correlation between the functional dysphagia scale and aspiration pneumonia and which characteristics influence the occurrence of aspiration pneumonia in patients with idiopathic Parkinson disease. METHODS: Fifty-three patients with idiopathic Parkinson disease were prospectively evaluated in this study. Disease severity and functional status were measured by modified Hoehn and Yahr (H&Y) staging, Schwab and England activities of daily living (S-E ADL) scale and Korean version of Mini-Mental State Examination (K-MMSE). Swallowing function was evaluated by the functional dysphagia scale (FDS) and the penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study. The patients were followed up for 3 months and divided into two groups according to the occurrence of aspiration pneumonia. The correlation between the variables and aspiration pneumonia was analyzed. RESULTS: Eight patients of the 53 patients were allocated to the aspiration pneumonia group and 45 patients to the non-aspiration pneumonia group. The patients in the aspiration pneumonia group had significantly higher H&Y staging, and scored lower on S-E ADL scale and K-MMSE. The patients in the aspiration pneumonia group had significantly higher scores on FDS and PAS. A multiple logistic regression analysis showed that the S-E ADL scale and the FDS were associated with the occurrence of aspiration pneumonia in the patients with Parkinson disease. CONCLUSION: Given that the FDS can quantitatively assess the functional problems associated with dysphagia, it can be clinically effective in predicting the occurrence of aspiration pneumonia, and the FDS and the S-E ADL scale could be predictive variables for aspiration pneumonia in patients with Parkinson disease.

The Outcome of Endoscopic Biliary Drainage with Plastic Stents for Irretrievable Common Bile Duct Stones / 대한소화기내시경학회지

Background/Aims: Endoscopic biliary drainage (EBD) using a plastic stent has been proposed for the management of choledocholithiasis when there is difficulty with stone extraction. We investigated the long-term effects and complications of EBD with using a plastic stent in the elderly or high risk patients with common bile duct (CBD) stones. METHODS: From January 2000 to June 2004, thirty-one patients with CBD stones underwent EBD with using plastic stents (17 women and 14 men, mean age: 75.2 years). RESULTS: Biliary drainage was successful in all patients. As for the early complications, only minor hemorrhage with no requirement of transfusion occurred in 2 patients. Twelve patients (38.7%) had late complications of EBD. Six of them had cholangitis, five had biliary colics and one had nausea. Of the six patients with cholangitis, three were managed with stent exchange and one was managed by removal of the stent. The remaining two patients died from stent-related sepsis. The mean symptom-free duration was 39.9 months. CONCLUSIONS: For the elderly or high risk patients who undergo an operation, EBD proved to be a safe and effective alternative for the treatment of patients with irretrievable bile duct stones.

Population Pharmacokinetic and Pharmacodynamic Modeling in Beagle Dogs Sedated by Propofol Microemulsion / 대한마취과학회지

BACKGROUND: Aquafol(R) is a microemulsion formulation of propofol. This study was designed to investigate the population pharmacokinetic and pharmacodynamic modeling in beagle dogs sedated by Aquafol(R). METHODS: Electroencephalogram was recorded and venous blood was sampled at preset times in 15 beagle dogs during 3 hours of infusion of Aquafol(R) and subsequently during 3 hours of recovery. Venous blood was sampled at 0, 2, 10, 30, 60, 120, 180, 190, 240 and 360 minutes after infusion. We evaluated the effect of propofol on electroencephalogram by calculating SEF(90). In the preliminary analysis, two compartment model best described all data from all subjects. The pharmacodynamics were best described using an effect compartment model and k(e0), a first-order elimination rate constant characterizing the effect-site equivalent to estimate the apparent effect-site concentrations. The relationship between propofol effect-site concentration and SEF90 was analyzed using an inhibitory sigmoid E(max) model. RESULTS: The final pharmacokinetic model was best described with the followings: V(1) = 18.5e(0.114*BWT), k(10) = 1.86 min(-1), k(12) = 0.6 min(-1), k(21) = 0.684 min(-1). The final pharmacodynamic model was best described with the followings: t(1/2)k(e0) = 0.62 min, C(e50) = 32.2 ng/ml, E(o) = 31.3 Hz, E(max) = 20.9 Hz, gamma = 1.28. CONCLUSIONS: The propofol microemulsion shows different pharmacokinetics and pharmacodynamics compared with the propofol lipid emulsion.

A Case of Clonorchiasis Presenting as Common Hepatic Duct Mass / 대한소화기내시경학회지

The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year-old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures.

Acute Gastric Volvulus due to Diaphragmatic Hernia / 대한소화기학회지

Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. It designates abnormal rotation of the stomach along its longitudinal (organoaxial) or transverse (mesenteroaxial) axis. When the rotation exceeds 180 degrees, gastric obstruction or strangulation may occur. The classical presentation of acute gastric volvulus is the triad of severe epigastric pain, vomiting followed by retching without the ability to vomit, and difficulty or inability to pass a nasogastric tube. Delay in diagnosis and treatment of gastric volvulus can lead to fatal complications such as gastric ischemia, perforation, and hemorrhage. Gastric volvulus is a true emergency which should be treated immediately either surgically or by upper endoscopy. We report a case of an acute incarcerated gastric volvulus due to a left-sided diaphragmatic hernia in an adult male patient, which was treated successfully by operation.

A Case of Psoas Muscle Abscess in Crohn's Disease / 대한소화기내시경학회지

Psoas abscess, complicating Crohn's disease, is a rare condition. Typical symptoms and signs are fever, abdominal tenderness and limb pain. Our patient had fever and abdominal tenderness. The diagnosis is made by abdominopelvic CT scan. Medical therapy with antibiotics, surgical resection of the affected bowel segment with end to end anastomosis and surgical drainage of focus are treatment of choice. We have experienced one case of psoas abscess with Crohn's disease in 28-year-old male patient. He visited our hospital due to diarrhea and lower abdominal pain. The colonoscopy revealed active stage of Crohn's disease. Then he has taken methyl prednisolone and mesalazine. During the hospitalization, we detected anal fistula and psoas abscess on abdominal CT. He was managed with antibiotics and surgical drainage after colectomy. We present the case with brief review of the articles.

Retrospective Analysis of Treatment Outcome and Prognostic Factors in Multiple Myeloma / 대한혈액학회지

BACKGROUND: The prognostic outlook for multiple myeloma has markedly improved in recent decades, which is probably related to the introduction of chemotherapy and the development of supportive care for various complications. In the present work we analysed retrospectively the therapeutic outcomes of newly diagnosed patients with multiple myeloma treated at Korea Cancer Center Hospital (KCCH). And we studied to identify prognostic factors influencing the therapeutic outcome of the disease. METHODS: Between January 1987 and December 1998, eighty three patients were diagnosed as multiple myeloma by the criteria of Southwestern Oncology Group at KCCH. Of these patients, clinical analysis was performed retrospectively for sixty-one patients who were treated with combination chemotherapy. RESULTS: The median age at diagnosis was 55 years of age, which was lower than that of western countries and 48% of patients were in their 4th decade. Male to female ratio was 1: 1.1. The main chief complaint at diagnosis was bone pain. Ninety-one percent of the patients were clinical stage III. Serum immuno-electrophoresis revealed M-protein as IgG in 41%. The ratio of micro to lambda light chain was 1.5:1. The response rate to initial chemotherapy was 75% (95% C. I.=63.4~86.6%) and median progression free interval was 20.9 months. The median overall survival of total 61 patients was 28.5 months. The patients' age at diagnosis and the response to initial chemotherapy were statistically significant prognostic factors influencing the overall survival of patients. CONCLUSION: This study showed that we could get relatively high response rate with conventional chemotherapy for the patients with multiple myeloma, but, that most patients eventually progressed and the cure was nearly impossible. To obtain cure or to have much longer survival time, we need more delicate strategies including more intensive chemotherapy with stem cell transplantation for the treatment of multiple myeloma patients.

Implications of Serum Levels of Basic Fibroblast Growth Factor and Vascular Endothelial Growth Factor in Chronic Liver Diseases and Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Angiogenesis occurs in response to tissue damage, and is of vital importance for tumor growth and metastasis. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are potent angiogenic factors, and have been suggested to be useful diagnostic markers in certain hypervascular tumors. However, little is known of serum bFGF and VEGF in patients with hepatocellular carcinoma (HCC). We attempted to measure serum bFGF and VEGF in patients with chronic liver diseases (CLD) and HCC to assess their pathogenetic role and usability as tumor markers. METHODS: Serum bFGF and VEGF were measured in 8 patients with chronic hepatitis (CH), 15 patients with liver cirrhosis (LC), and 49 patients with HCC. bFGF was measured in 33, and VEGF was measured in 50, healthy blood donors. RESULTS: Serum bFGF was 3.8+/-1.9, 2.0+/-1.4, 4.2+/-6.0, 17.4+/-30.0 pg/mL in normal control, CH, LC, HCC, respectively. The serum bFGF level was significantly increased in patients with HCC when compared with normal control or patients with CLD. No difference, however, was observed in serum VEGF levels among the four groups. The serum levels of bFGF and VEGF were not significantly different in patients with HCC according to tumor type, size and stage. Serum bFGF showed good sensitivity (90%), specificity (87%), and positive predictive value (94%) in differentiating patients with HCC from those with CLD at the cut-off value of 4.6 pg/mL. CONCLUSIONS: bFGF might play a role in the growth of HCC and its serum level might be used as a tumor marker. On the other hand, serum VEGF does not seem to be an adequate tumor marker.

Clinical Characteristics of Female Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: The incidence of hepatocellular carcinoma has been universally lower in female than in male. The aims of our study are to define whether there are any difference between female and male patients with hepatocellular carcinoma in terms of clinical characteristics and results of treatment. METHODS: Retrospective analyses of medical history, physical findings, laboratory results, etiological factors, characteristics of tumor, and therapeutic results were performed in 80 female patients with hepatocellular carcinoma compared to 160 male patients. RESULTS: Asymptomatic presentation and family history of liver disease were found more frequently in female patients than in male patients. A history of smoking and alcohol drinking were found less frequently in female patients than in male patients. The detection rate of spider angioma was significantly lower in female patients than in male patients. There was no difference in laboratory results, characteristics of tumor, and therapeutic results between female and male patients. CONCLUSIONS: Environmental factors such as smoking and alcohol drinking could contribute the sexual difference of hepatocarcinogenesis. However, clinical characteristics at the time of diagnosis and therapeutic results were not significantly different between female and male patients with hepatocellular carcinoma.

Necessity and Safety of Fine-needle Aspiration Cytology for Diagnosis of Hepatocellular Carcinoma / 대한간학회지

BACKGROUNDS/AIMS: The fine-needle aspiration (FNA) is a useful method for diagnosis of hepatocellular carcinoma (HCC). The aims of our study are to assess diagnostic accuracy of FNA, to define proper indications of FNA for diagnosis of HCC, and to evaluate the complications of FNA. SUBJECTS AND METHODS: To assess diagnostic accuracy we compared the results of preoperative FNA with postoperative pathology in 38 resected cases with primary liver cancer. To define proper indications and complications of FNA, we prospectively followed 138 patients received FNA for their liver tumors which were suspicious of primary liver tumor. RESULTS: The sensitivity, specificity, positive and negative predictive values of FNA were 100%, 97%, 100% and 66% respectively. All patients with serum alpha-fetoprotein (AFP) level over 1000 ng/ml were having HCC on FNA result. Among 36 patients with AFP level ranged 15-1000 ng/ml and hypervascular mass on angiography, 96% were having HCC. Among 50 patients with normal AFP level and hypervascular mass on angiography, 92% were having HCC. The major complications after FNA such as hemoperitoneum, pneumothorax, and iatrogenic arterioportal shunt developed in 2%, 2%, and 7% of subjects, respectively. We did not find any case of needle-tract seeding of cancer during a mean 4.7 months of follow-up. CONCLUSIONS: Although the FNA is an accurate method for diagnosis of HCC, FNA was usually not indicated for patients with serum AFP level over 1000 ng/ml or patients with hypervascular mass on angiography when they were suspected of having primary liver cancer. Major complications were hemoperitoneum, pneumothorax and iatrogenic arterioportal shunt. Iatrogenic arterioportal shunt may influence the efficacy of subsequent transcatheter arterial embolization.

Primary Sjogren's syndrome manifested as multiple sclerosis and cutaneous erythematous lesions: a case report

Sjogren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the lacrimal and salivary glands, leading to dryness of eyes (kerato-conjunctivitis sicca) and mouth (xerostomia). The skin lesions in Sjogren's syndrome are usually manifested as xeroderma, but sometimes appear as annular erythema or vasculitis. Central nervous system symptoms may be presented as one of extraglandular manifestations, though rare in incidence, and need differential diagnosis from multiple sclerosis. We report a case of a 45-year-old woman diagnosed as multiple sclerosis at first but later as neurologic manifestation of primary Sjogren's syndrome, showing signs of multiple sclerosis and cutaneous erythematous lesions.

Median Raphe Cyst of the Glans Penis / 대한피부과학회지

Median raphe cyst of the penis is an uncommon entity that usually presents as a cystic lesion on the ventral aspect of the penis, and which has a broad spectrum of histopathological appearances. It occurs most commonly near the glans penis, but may occur anywhere from the urethral meatus to the anus. It is solitary and measures only a few millimeters in diameter. Surgical excision is the treatment of choice. Recently we observed an 18-year-old male patient who had had a median raphe cyst since 5 years ago near the urethral orifice of the glans penis.

A Case of Actinic Reticuloid

Actinic reticuloid as a manifestation of chronic actinic dermatitis (CAD) is a rare dermatosis whose clinical and histologic features resemble other types of pseudolymphomas including mycosis fungoides and Jessner's lymphocytic infiltration, and it is regarded as an eventual stage of various photodermatoses like photosensitive eczema or persistent light reaction or chronic photoallergic contact dermatitis and so on. Phototests in the patients with actinic reticuloid usually reveal hypersensitivity to UVB, UVA, and sometimes to visible light. We present a case of actinic reticuloid in a 65-year-old male, whose skin lesions developed as erythematous lichenified infiltrating plaques on the face at first, and then spread themselves onto the upper trunk later. Histologically those skin lesions showed the aggregation of atypical lymphocytes and photobiologically the results of phototests revealed photosensitivity to UVB and UVA.

A Study of Microscopic Interpretation of Feozen Sections in Mohs Micrographic Surgery for Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Mohs micrographic surgery (MMS) achieves higher cure rates for cutaneous squamous cell and basal cell carcinomas than any other therapeutic modality. For a unifocal tumor, a 100% cure rate after MMS should theoretically be possible, however for primary basal cell carcinoma, 98-99% 5-year disease-free rates have been achieved. OBJECTIVE: Our purpose was to investigate the pitfalls in microscopic Interpretation of frozen sections in Mohs micrographic surgery for basal cell carcinoma which decrease the cure rate after surgery. METHODS: From March 1991 to February 1998, fifty-nine patients were diagnosed with basal cell carcinoma at our department. All the tumors were removed with Mohs micrographic surgery and frozen section specimens were stained with hematoxylin-eosin. The microscopic evaluation was done by Mohs surgeon and pathologist. RESULTS: We can summarize the matters that demand special attention during microscopic Interpretation of frozen sections in Mohs surgery as two groups. First, as false negative interpretation, there are 1) small nests of tumor scattered within areas of heavy inflammation 2) tumor present along the hair follicle, 3) tumor present along a cut edge, 4) empty space in a tissue section, 5) hair follicle-like structure of the tumor, 6) gland-like structure of the tumor, and 7) infiltrative BCC-like inflammatory cells. Second, as a false positive interpretation, there are 1) foreign body reactions or scar containing trapped pilosebaceous structures, 2) horizontal and tangential cuts through the pilosebaceous apparatus, 3) some epidermal neoplasms including solar lentigines, seborrheic keratoses, and acantholytic actinic keratoses, and 4) contamination of the tumor tissue. CONCLUSION: With careful attention to the examples which can affect the interpretation as mentioned above, it may be possible to detect complete removal of tumor mass and achieve higher cure rate. We could achieve a 100% of cure rate for primary basal cell carcinoma and 95 % of cure rate for recurrent basal cell carcinoma after Mohs Micrographic surgery in our hospital from March 1991 to February 1998.

A Case of Radiation-Induced Pemphigus

Radiation induced pemphigus, as an example of induced pemphigus, is a rare disease which occurs in patients receiving radiotherapy. A 56-year-old male patient with nasopharyngeal cancer received 3 cycles of chemotherapy and radiotherapy on the neck and anterior chest areas. One month after completion of radio-therapy, eroded and crusted areas developed within the irradiation site. In spite of systemic antibiotic treatment, the skin lesions persisted and spread further to the trunk and upper extremities with new crops of bullae. He was treated with a high dose of prednisolone and the skin lesions cleared. We discuss the suggestive pathogenesis of radiation-induced pemphigus with the comparative results of immunoblotting in various variants of pemphigus.

Comparative Effects of Isoflurane and Enflurane on Respiratory Mechanics with Methacholine-induced Bronchoconstriction in Cats / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the effects of isoflurane and enflurane on respiratory resistance using flow-interruption technique. METHODS: Twenty one cats were divided into 3 groups according to the agents administered; Control(control), Isoflurane(1 MAC of isoflurane) and Enflurane(1 MAC of enflurane) groups. Tracheal pressure was measured at 2 cm beyond the distal end of the tube. After measuring the baseline value, methacholine chloride(25 microgram/kg/min) was infused to induce bronchoconstriction which was continued throughout the experiment. Anesthetics were administered for each group 15 minutes after methacholine infusion (control value) via low pressure inlet of the ventilator. Measurements were made every 15 minutes. Intermittent mandatory ventilation was applied with Servo 900C ventilator. Inspiratory flow rate and tidal volume were fixed throughout the experiment for each subject. Pressure, volume and flow were monitored with Bicore CP100 pulmonary monitor. The data were transferred to a personal computer and analyzed by a processing software. Respiratory system, airway and tissue resistances, and dynamic and static compliances were calculated. RESULTS: Methacholine infusion increased both airway and tissue resistances. Fifteen minutes after administering inhalation anesthetics(M30), airway resistances for isoflurane and enflurane decreased to 50.8+/-4.7% and 62.5+/-4.9% of the control value(p<0.05). And the values of tissue resistances for isoflurane and enflurane decreased to 54.7+/-6.2% and 68.0+/-4.4% of the control value respectively (p<0.05). There were significant differences between the isoflurane and enflurane in the values of airway and tissue resistances at M30(p<0.05). But there were no significant differences between the two agents in the values of airway and tissue resistances at M45. CONCLUSION: For isoflurane and enflurane, both airway and tissue resistances are reduced. Isoflurane is more potent than enflurane in reversing methacholine-induced bronchoconstriction in this animal model.

Comedonal Darier's Disease

Darier's disease is a well-known genodermatosis characterized by recurrent waxy, hyperkeratotic papules usually occurring over the seborrheic area. The major histopathological changes are characteristic acantholysis and dyskeratosis which are diagnostic of the disease with typical clinical features. There are less common variants including the hypertrophic, vesicobullous and linear type. However, comedonal lesions are very rare. We report an unusual case of Darier's disease, which showed prominent comedonal papules and plaques over the face, scalp and upper trunk with the typical findings of Darier's disease.