Comparison of Foot Structure, Function, Plantar Pressure and Balance Ability According to the Body Mass Index of Young Adults

OBJECTIVES: This study compared foot arch height, plantar fascia thickness, a range of motion assessments of the ankle joint, strength of the ankle joint, plantar pressure, and balance between obese and normal weight young adults. METHODS: Fifty-two participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. The participants were categorized to normal weight or obese groups based on BMI (≤ 24 kg/m2 and ≥ 25 kg/m2, respectively). The foot and ankle disability index and Sport survey were completed by the participants before the measurements. Foot arch height was measured using the navicular drop test, and plantar fascia thickness was measured using ultrasound. Plantar pressure and balance tests were also conducted, followed by ankle joint range of motion and strength tests. RESULTS: Foot arch height and plantar fascia thickness was significantly higher in the obese group compared with the normal weight group (p < 0.01). There were significant differences in eversion of ankle strength, plantar pressure in the big toe and heel and anterior-posterior balance between normal and obese weight groups (p < 0.05). CONCLUSION: Obese young adults had more abnormalities in the medial longitudinal arch, plantar fascia, and plantar pressure as well as weakened ankle eversion strength and balance problems compared with the normal weight group.

A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy / 대한췌담도학회지

Direct peroral cholangioscopy (POC) which permits direct visualization of the biliary tree has recently gained widespread clinical use for diagnosis and treatment of various pancreatobiliary diseases. But, there is currently little reliable data on evaluating the complications of POC. POC is associated with complications such as pancreatitis, cholangitis, hemorrhage, rarely air embolism, and ductal perforation. The incidence of complication during POC is 2.9-12%. However, pneumoperitoneum due to intrahepatic bile duct perforation after POC has not yet been reported in Korea. We report a case of pneumoperitoneum after POC which has been successfully managed with endoscopic nasobiliary drainage and antibiotics.

A Case of Endoscopic Removal of a Giant Appendicolith Combined with Stump Appendicitis

Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.

A Case of Enteritis Cystica Profunda in the Ampulla of Vater Mimicking Choledochocele

Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.

Adrenal Metastasis from Hepatocellular Carcinoma without Intrahepatic Recurrence after Hepatic Resection / 대한소화기학회지

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.

A Case of B-Lymphoblastic Leukemia/Lymphoma Detected as a Laterally Spreading Tumor / 대한소화기내시경학회지

Acute lymphoblastic leukemia is a cancer of blood cells. It is known as lymphoblastic lymphoma when it involves lymph nodes rather than the blood and bone marrow. The gastrointestinal tract is a predominant site for extra-nodal lymphomas. But, B-lymphoblastic leukemia/lymphoma more frequently presents in the leukemic form than in the lymphomatous form. We herein report a case of B-lymphoblastic leukemia/lymphoma detected as a laterally spreading tumor in the colon. A 54-year-old man was referred to our hospital for removal of multiple colonic polyps. A colonoscopy revealed multiple colonic polyps and several colonic laterally spreading tumors. An esophagogastroduodenoscopy revealed several raised erosive lesions on the fundus and several variable sized sessile polypoid lesions on the duodenum. We diagnosed B-lymphoblastic leukemia/lymphoma following biopsies of the lesions.

Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Subclinical apoplexy of pituitary functional adenoma can cause spontaneous remission of hormone hypersecretion. The typical presence of pituitary growth hormone (GH) adenoma is gigantism and/or acromegaly. We investigated the clinical characteristics of patients with spontaneous partial remission of acromegaly or gigantism due to subclinical apoplexy of GH adenoma.</p><p><b>METHODS</b>Six patients with spontaneous remission of acromegaly or gigantism were enrolled. The clinical characteristics, endocrinological evaluation and imageological characteristics were retrospectively analyzed.</p><p><b>RESULTS</b>In these cases, the initial clinical presences were diabetes mellitus or hypogonadism. No abrupt headache, vomiting, visual function impairment, or conscious disturbance had ever been complained of. The base levels of GH and insulin growth factor-1 (IGF-1) were normal or higher, but nadir GH levels were all still > 1 µg/L in 75 g oral glucose tolerance test. Magnetic resonance imaging detected enlarged sella, partial empty sella and compressed pituitary. The transsphenoidal surgery was performed in 2 cases, and the other patients were conservatively managed. All the patients were in clinical remission.</p><p><b>CONCLUSIONS</b>When the clinical presences, endocrine evaluation, biochemical examination and imageology indicate spontaneous remission of GH hypersecretion in patients with gigantism or acromegaly, the diagnosis of subclinical apoplexy of pituitary GH adenoma should be presumed. To these patients, conservative therapy may be appropriate.</p>

The Adequate Induction Dose of Propofol for Conscious Sedation During Esophagogastroduodenoscopy in Persons 60 Years or Older / 대한소화기내시경학회지

BACKGROUND/AIMS: Propofol is an effective sedative drug in endoscopic procedures, but it has potentially serious adverse effects, so close monitoring of the vital signs should be performed during endoscopy. This study was undertaken to determine the adequate induction dose of propofol for safe and effective sedation during esophagogastrodudenoscopy (EGD) in persons 60 years or older. METHODS: Three hundred patients who visited our hospital for EGD were randomly assigned to three groups (A,B and C). An initial induction dose of 0.5 mg/kg, 0.75 mg/kg and 1.0 mg/kg of propofol was allocated to groups A, B and C, respectively. RESULTS: The 0.5 mg/kg, 0.75 mg/kg and, 1 mg/kg dose of propofol were all safe as an initial dose of propofol for achieving sedation during EGD in persons 60 years or older. There was no difference in the total amount of propofol among the three groups. Group C had a significantly shorter induction time and a lower dose was required for an additional injection of propofol without increasing adverse events, as compared to the two other groups. CONCLUSIONS: We suggest that 1 mg/kg of propofol is an effective induction dose for sedation during EGD in persons 60 years or older.

A Case of Primary Endometrioid Adenocarcinoma of the Vagina / 대한산부인과학회지

Primary cancer of the vagina is very rare, accounting for 1-2% of gynecologic malignancies. Vaginal cancers are composed of primary and metastatic one. Of them, metastatic cancers constitute the majority of vaginal cancers, as 80-90%. Differentiating as type of cancer cell, the squamous cell carcinoma is the most common, as 80-90%, but, the adenocarcinoma is rare, as 9% of primary vaginal cancer. Same as other disease, if there is a symptom, the 5 year-survival rate of the vaginal cancer is 37%, but, if not in early stage, that becomes higher, as 61%. So, the early diagnosis and treatment are very important for patients' prognosis. A woman who had underwent both ovarian cystectomy due to both ovarian endometriomas 2 years ago visit us complaining of vaginal spotting, mild lower abdominal discomfort and pelvic pain for 2 months. She underwent operation at the impression of primary vaginal cancer and was irradiated. We report a case of primary endometrioid adenocarcinoma of the vagina with review of literatures.

Two Cases of Linear Scleroderma 'En Coup de Sabre' Treated with Polymethylmethacrylate Microspheres (PMMA-NewPlastic(R)) / 대한피부과학회지

Localized scleroderma is a disease of unknown origin and is characterized by circumscribed sclerotic skin changes. When occurring in a linear pattern, it is called linear scleroderma. 'En coup de sabre' is a subtype of linear scleroderma which is characterized by band-like, ivory-colored depressions on the frontoparietal scalp region. Several treatment modalities have been used. However, they have not been effective or safe. We report our experience of two patients with 'en coup de sabre' on the forehead, who were treated successfully with polymethylmethacrylate microspheres (PMMA-NewPlastic(R)).

Transverse Vaginal Septum: Difficult Management Concerning Postoperative Stricture: Report of 2 Cases / 대한산부인과학회잡지

Two cases of incomplete transverse vaginal septum with a small opening in the upper third of vagina were presented. One case was a patient presenting at 31 years of age for evaluation of primary infertility and oligomenorrhea. Diagnosis was made by hysterosalpingography, tranvaginal ultrasonography, MRI, and diagnostic pelviscopy for evaluation of abnormality of endopelvic organs. The patient was treated with surgical resection of septum (simple septectomy). Examination 3 months later demonstrated narrowing of the vaginal lumen. Another case was a patient presenting intrauterine pregnancy at 8 weeks and 2 days accompanying transverse vaginal septum with small opening. She had previous septotomy history and presented postoperative scarring. She had septectomy and anastomosis of the mucosa, and presented postoperative narrowing again about a month postoperatively. In this report we describe the two cases of transverse vaginal septum. We also reviewed the literature including diagnostic and treatment guidelines. Prevention of postoperative scarring is the most important factor in management of transverse vaginal septum. For that, first of all, initial septectomy should be done with approximation of the mucosa and postoperative dilatation is necessary. Importance of the initial accurate septectomy is too important to be over-emphasized.

The Effects of Dexamethasone and MK-801 on Edema Formation in Middle Cerebral Artery Occlusion Model of the Rat / 대한마취과학회지

BACKGROUND: This study was conducted to determine the effects of dexamethasone and MK-801 on the formation of brain edema resulting from a focal ischemic injury by middle cerebral artery occlusion in rats. METHODS: Fifteen Sprague-Dawley rats (220 280 g) were freely allowed to drink and eat until just before surgery. Anesthesia was induced with 4% isoflurane in oxygen and then maintained with 2% isoflurane in oxygen. Ischemic injury was induced by an intraluminal suture with a blunted tip inserted into the internal carotid artery and occlusion of the middle cerebral artery. All rats were divided randomly into three groups. In group I (n = 5), normal saline 1 ml was injected intravenously 10 minutes before MCA occlusion. In group II (n = 5), dexamethasone 3 mg/kg was administered 10 minutes before injury. In group III (n = 5), a N-methyl-D-aspartate receptor antagonist, MK-801 1 mg/kg was injected 30 minutes before injury. Rectal temperatures were monitored during the experiment. After 60 minutes of MCA occlusion, the intraluminal sutures were removed and all the rats were returned to their cages. Their brain were quickly removed and the cerebral hemispheres were sepaerated into ischemic cores and penumbra zones after 1 hour of reperfusion. The separated cerebral hemispheres were dried 7 days at 60oC dry oven. The cerebral water content was assessed by the dry-weight method. RESULTS: In the dexamethasone group, there were no significant changes in cerebral edema formation in both ischemic core and the penumbra. In the MK-801 group, there were significant reductions in the brain edema formation in the penumbra (P< 0.05), but not in the core. CONCLUSIONS: Dexamethasone has no effect on ischemic brain edema; however, MK-801 is effective in the ischemic penumbra zone by reducing of edema formation.