Clinco-pathologic Features of Alopecia in a Patient of Cronkhite-Canada Syndrome / 대한피부과학회지

Although hair loss in Cronkhite-Canada syndrome (CCS) developed frequently, its exact mechanism has not been elucidated. Thus, we attempted to investigate the histopathologic features of hair loss with scalp biopsy in one case of CSS. The patient complained of persistent diarrhea and diffuse hair loss of the scalp 1 month prior to the hospital visit. CCS has been already diagnosed through colonoscopy and medical examination. Scalp biopsy was performed to evaluate hair loss of the patient, and pathologic examination showed increased telogen hairs (anagen to telogen is 7:8) without specific dermal inflammation and miniaturization of hair follicles. The patient was treated with topical and systemic steroids, and hair loss has almost completely recovered in 5 months. In this case, we investigated the clinical and pathological features of hair loss through scalp biopsy in one case of CCS and reported them with a review of the literature.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to reveal the effects of POPs on the endocrine and nervous system and on cancer, few studies focus on the relationship between low-dose POPs and public health. We attempted to find a relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Hospital for a health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls and 23 types of organochlorine pesticides. Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Our results showed that abdominal discomfort had an inverse relationship with several polychlorinated biphenyls. Moreover, an inverted U-shaped relationship was observed between abdominal discomfort and several other organochlorine pesticides including p,p'-dichlorodiphenyldichloroethane and p,p'-dichlorodiphenyltrichloroethane, and the effects of these pesticides on abdominal discomfort were similar to that of organochlorine pesticides on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear cause could be related to POPs levels.

A patient presenting with recurrent post-prandial abdominal discomfort and vomiting.

Duodenal diverticulum is the second most common diverticulum of gastrointestinal tract. Among duodenal diverticulum, incidence of intramural duodenal diverticulum is 100 as per report till date. It is usually asymptomatic, but in middle or adult age, it may present with postprandial abdominal discomfort, often complicates in the form of bleeding, perforation or rarely neoplasm. So, this congenital duodenal deformity requires urgent definitive treatment. Here we presented a case presenting with postprandial abdominal discomfort with occasional vomiting. He was advised upper gastrointestinal endoscopy. It showed evidence of duodenal septa at the junction of 1st and 2nd part. Scope was negotiated through one channel. He was advised barium meal of stomach, duodenum and follow through, which ultimate demonstrated presence of a rare abnormality, duodenal intramural diverticulum, which if not treated, can produce severe complication in future.

Review of patients with Strongyloides stercoralis infestation in a tertiary teaching hospital, Kelantan

Strongyloides stercoralis is an intestinal nematode infecting humans. The actual prevalence of infestation with this parasite in our setting is not well established. Thus, this study was conducted to determine the age, sex and co-morbid conditions among patients with S. stercoralis infestation as well as to study the common manifestations of strongyloidiasis in our patients. Records of patients with positive S. stercoralis larvae from January 2000 to December 2012 in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan were reviewed. Ten patients were male and two were female. Their ages ranged from 19 to 78 years old. The majority (92%) of cases, presented with intestinal symptoms and 50% with moderate to severe anaemia. Thirty percent of cases had extraintestinal manifestations such as cough, sepsis and pleural effusion. Ninety-two percent of the patients had a comorbid illness. Most patients were immunocompromised, with underlying diabetes mellitus, retroviral disease, lymphoma and steroid therapy contributing to about 58% of cases. Only 58% were treated with anti-helminthic drugs. Strongyloidiasis is present in our local setting, though the prevalence could be underestimated.

Retroperitoneal Spinal Extradural Arachnoid Cyst Combined with Congenital Hemivertebrae

Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery.

Characteristics of Adverse Effects When Using High Dose Short Term Steroid Regimen

BACKGROUND AND OBJECTIVES: Although the adverse effect of long term steroid usage is well known, the adverse effect of short term high dose steroid usage has not been studied thoroughly. The purpose of this study was to identify the characteristics of the adverse effects when using a high dose steroid for a short term. We also compared the adverse effect of steroid between in- and out-patients. SUBJECTS AND METHODS: The medical record of 500 patients, who were treated with methylprednisolone 48 mg/day for 1-2 weeks, was retrospectively reviewed. Steroid was prescribed due to SSNHL, Bell's palsy, Ramsay-Hunt syndrome and herpes zoster oticus. The incidence of each adverse effect was analyzed, and also the time point of detection was analyzed. The 500 patients were composed of 250 in-patients and 250 out-patients. The adverse effect was compared between these two groups, as well. RESULTS: Adverse effect of steroid was found in 33.0% of the patients. Among these adverse effects, abdominal discomfort (26.8%) was most common, followed by skin rash (14.7%), swelling (13.4%), and hot flush (6.9%). Abdominal discomfort and hot flush was mostly detected on the first week. Meanwhile, the skin rash was usually detected on the third week. The incidence of adverse effect was significantly higher in the out-patient group. CONCLUSIONS: The incidence of high dose short term steroid treatment may be very high. The patients should be warned about these adverse effects. Monitoring should be performed until 3-4 week, since some adverse effects may not be detected until this time point.

Four Hemodialysed Patients with Upper Abdominal Discomfort Successfully Treated with Heiisa / 日本東洋医学雑誌

In this report, we describe four hemodialysed patients with upper abdominal discomfort successfully treated with Heiisan, one of the known traditional oriental herbal medicine.Case 1 was a 61-year-old man suffering from upper abdominal discomfort after each meal even though daily taking some medicine for gastritis. Case 2 was a 45-year-old man, who has also been suffering from upper abdominal discomfort after breakfast and supper despite daily taking H₂-blocker. Case 3 was a 61-year-old man complaining of upper abdominal discomfort. He has had loss of appetite despite being treated with H₂-blocker and gastroprokinetic medication. Case 4 was a 69-year-old woman complaining of upper abdominal discomfort with dull pain before eating. She was diagnosed as chronic gastritis and healing stage of duodenal ulcer and prescribed H₂-blocker. However, this medicine did not work.We diagnosed that upper abdominal discomfort in all the patients came from shitsu-jya (pathogenic dampness) in hii (Spleen-Stomach functional unit), and treated them with Heiisan, which was popular to remove shitsu-jya in Hii. Their symptom disappeared soon after taking this medicine.It is also difficult for hemodialysed patients to control their weight due to anuria and they tend to easily gain the weight due to inappropriate eating and drinking, leading to shitsu-jya in such patients. Therefore, our reports suggested that Heiisan was good for hemodialysed patients to control various upper abdominal symptoms that might be caused by shitsu-jya in Hii.

Patients With Irritable Bowel Syndrome Exhale More Hydrogen Than Healthy Subjects in Fasting State

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a common disorder with significant morbidity and impairment of quality of life. Most patients (26%-83%) with IBS from Asia reported bloating. Bloating may result from increased amount or distribution of gas in the gut or exaggerated perception of distension. To evaluate whether patients with IBS produce more hydrogen even in fasting state, we conducted a study with the following aims: (1) to estimate fasting breath hydrogen levels among patients with IBS as compared with healthy controls (HC) and (2) to study relationship between symptoms of IBS and stool frequency and fasting breath hydrogen levels. METHODS: Eighty-one patients with IBS (Rome III criteria) and 123 HC were included. Hydrogen breath test was performed using a gas analyzer after an overnight (12 hours) fast. Both patients with IBS and HC had similar preparation before breath hydrogen estimation. RESULTS: Of 93 patients with symptoms of functional gastrointestinal disorders, 81 (87.1%) met Rome III criteria and 12 (12.9%) were negative and hence, excluded from the study. Patients with IBS were comparable in age (35 +/- 11.8 years vs 37.5 +/- 13.1 years, p = NS) and gender (male 61/81 [75.3%] vs 77/123 [62.6%], p=0.67) with HC. Average fasting breath hydrogen was higher in patients with IBS as compared to HC (mean 10.1 +/- 6.5 ppm vs 5.5 +/- 6.2 ppm, p < 0.0001). Number of stools per week correlated with average fasting breath hydrogen excretion in patients with IBS (r = 0.26, p = 0.02). CONCLUSIONS: Inspite of similar preparation for the test, fasting breath hydrogen was higher in patients with IBS as compared to HC. Number of stools per week correlated with fasting breath hydrogen levels among patients with IBS.

Equine Monocytic Ehrlichiosis (EME) in Rio de Janeiro State, Brazil / Ehrliquiose Monocítica Eqüina (EME) no estado do Rio de Janeiro, Brasil

Realizaram-se testes de imunofluorescência indireta (IFI) para Ehrliquiose Monocítica Eqüina (EME) em soros de 27 eqüinos, provenientes de duas propriedades do estado do Rio de Janeiro (regiões Metropolitana e Serrana) onde ocorreram manifestações clínicas sugestivas de EME. Coletaram-se duas amostras de sangue de cada animal. Os intervalos entre as coletas variaram entre 30 e 180 dias. Vinte e um animais (77,8 por cento) foram reagentes à IFI com título 1:50, nos testes realizados nas duas amostras coletadas. Os demais (22,2 por cento) - animais 1 a 6 - foram reagentes à IFI, com títulos sorológicos de 1:100, 1:200, 1:400, 1:400, 1:400 e 1:800 na primeira coleta e 1:200, 1:800, 1:200, 1:400, 1:800 e 1:800 na segunda coleta, respectivamente. Três animais (1, 4 e 5) apresentaram manifestações subclínicas. Um animal (2) recuperou-se após o tratamento. Dois animais (3 e 6) evoluíram para óbito. Títulos sorológicos maiores que 1:320 são conclusivos para o diagnóstico específico. Este é o primeiro relato de EME no estado do Rio de Janeiro, Brasil