The Effect of Continuous Positive Pressure Therapy for Obstructive Sleep Apnea on Quality of Life : A Single-Institution Study / 수면정신생리

Objectives@#In this study, the clinical characteristics of OSA patients and the quality of life before and after CPAP use were compared to determine the degree of improvement in quality of life according to CPAP use. @*Methods@#Age, sex, height, weight, body mass index, Epworth Sleepiness Scale, Modified Mallampatti Score, Montreal Cognitive Assessment-Korean, and Pittsburgh Sleep Quality Index were compared between men and women through medical records. To understand the degree of improvement in quality of life resulting from use of CPAP, a personal telephone call was made to compare the VAS scores for quality of life before and after CPAP use. @*Results@#In height (HT) (Z = -4.525, p 0.05). The difference between AHI before and after CPAP was 36.48 ± 21.54 (t = 11.609, p < 0.001) and the difference between QOL before and after CPAP was –25.43 ± 22.06 (t = -7.901,p < 0.001), both of which were significant (p < 0.001). @*Conclusion@#Among OSA patients, there were differences in height (HT), weight (BW), sleep quality (PSQI), arousal index (AI), and severity of OSA between men and women, but the quality of life before and after CPAP was different. However, there was no difference between men and women in quality of life before and after CPAP. In addition, quality of life in OSA patients improved after using CPAP

The Effect of Continuous Positive Pressure Therapy for Obstructive Sleep Apnea on Quality of Life : A Single-Institution Study / 수면정신생리

Objectives@#In this study, the clinical characteristics of OSA patients and the quality of life before and after CPAP use were compared to determine the degree of improvement in quality of life according to CPAP use. @*Methods@#Age, sex, height, weight, body mass index, Epworth Sleepiness Scale, Modified Mallampatti Score, Montreal Cognitive Assessment-Korean, and Pittsburgh Sleep Quality Index were compared between men and women through medical records. To understand the degree of improvement in quality of life resulting from use of CPAP, a personal telephone call was made to compare the VAS scores for quality of life before and after CPAP use. @*Results@#In height (HT) (Z = -4.525, p 0.05). The difference between AHI before and after CPAP was 36.48 ± 21.54 (t = 11.609, p < 0.001) and the difference between QOL before and after CPAP was –25.43 ± 22.06 (t = -7.901,p < 0.001), both of which were significant (p < 0.001). @*Conclusion@#Among OSA patients, there were differences in height (HT), weight (BW), sleep quality (PSQI), arousal index (AI), and severity of OSA between men and women, but the quality of life before and after CPAP was different. However, there was no difference between men and women in quality of life before and after CPAP. In addition, quality of life in OSA patients improved after using CPAP

Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.

A Case of Disseminated Extranodal Interdigitating Dendritic Cell Sarcoma Arising from Parotid Gland / 고신대학교의과대학학술지

Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare tumor derived from professional antigen presenting cell and primarily found in lymph nodes, with rarer case report about extranodal presentation of IDCS. A 71-yr-old man was admitted with progressively enlarging and painless mass in the right parotid area for 2 months. Computed tomography of the neck and chest revealed enhancing mass in right parotid gland, multiple lymphadenopathies around neck and mediastinum, and an osteolytic metastasis at thoracic spine. Morphological and immunohistochemical analysis of an excisional biopsy specimen from parotid mass were consistent with a diagnosis of IDCS. Palliative chemotherapy with 6 cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) regimen and 2 cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) regimen plus radiotherapy on parotid mass failed in tumor reduction. We describe a rare case of disseminated extranodal IDCS arising from parotid gland.

Metformin-Associated Lactic Acidosis: Predisposing Factors and Outcome

BACKGROUND: Metformin is considered the first choice oral treatment for type 2 diabetes patients in the absence of contraindications. Rarely, life-threatening complications associated with metformin treatment are seen in some patients with underlying diseases. The aim of this study was to further investigate the clinical profiles and risk factors for metformin-associated lactic acidosis (MALA) and the treatment modalities according to survival. METHODS: To identify MALA, we performed a retrospective study in seven diabetic patients who were taking metformin and had been diagnosed with lactic acidosis at Inha University Hospital between 1995 and 2012. For each patient, we recorded the age, sex, daily metformin dosage, laboratory test results, admission diagnosis, and risk factors. Also, concurrent conditions, treatment modalities, and outcomes were evaluated. RESULTS: Six patients had risk factors for lactic acidosis before admission. All patients had renal impairment on admission as a precipitating risk factor. Five patients survived and two patients died despite early renal replacement therapy. Older patients tended to have a poorer prognosis. CONCLUSION: Renal function must be monitored in elderly type 2 diabetes mellitus patients with underlying diseases and conditions causing renal impairment who begin metformin treatment. Accurate recognition of MALA and initiation of renal replacement are essential for treatment.

Two Cases of Phlegmonous Esophagogastritis in New Onset Type 2 Diabetes / 임상당뇨병

Phlegmonous esophagogastritis is a rare bacterial infection that has been reported to result in mortality. The pathophysiology of phlegmonous gastrointestinal infection is unclear, but some predisposing factors are reported. Those include immunocompromised status, alcohol abuse, malignancy and uncontrolled diabetes mellitus. We report two cases of phlegmonous esophagogastritis with newly diagnosed diabetes mellitus. A 26-year-old woman and a 56-year-old woman individually visited our hospital for sore throat, neck pain and fever. The laboratory findings of both patients demonstrated leukocytosis, and elevated serum glucose levels. HbA1c of both patients was above 11%. Enhanced computed tomography of young woman showed submucosal edema with intramural abscess along the esophagus and stomach, and that of older woman showed the same defined to esophagus. In both cases, empirical antibiotic therapy with intravenous third generation cephalosporin and metronidazole were started. Later, we identified Klebsiella pneumonia through pus culture in both cases. The symptoms of case 1 improved with conservative management with antibiotics only. However, case 2 required surgical drainage and esophagectomy. Early radiologic diagnosis of this disease and accurate identification of pathogens are important factors for good prognosis. Therefore, we emphasize suspicion of such a rare disease is needed, especially when the patient has risk factors such as diabetes mellitus.

A Case of Egg-Shell Calcification of Renal Cell Carcinoma in Continuous Ambulatory Peritoneal Dialysis Patient with Sclerosing Encasulating Peritonitis

Acquired cystic kidney disease (ACKD), a common complication in patients with end-stage renal disease, is characterized by more than three kidney cysts and normal or decreased sizes of both kidneys without any familial history of cystic kidney disease. In autosomal dominant polycystic kidney disease (ADPKD), however, both kidneys are usually enlarged. Extrarenal manifestations are common in ADPKD, including hepatic cysts, seminal vesicle cysts, mitral valve prolapse. A 40-year-old man presented to the emergency clinic at Inha University Hospital with severe abdominal pain, nausea, and vomiting for 3 days. He had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 15 years, but it was recently changed to hemodialysis owing to sclerosing encapsulating peritonitis (SEP). Radiologic imaging studies revealed bilateral enlarged kidneys with multiple eggshell calcified cysts and some hepatic cysts, which suggested ADPKD. He underwent left nephrectomy, and pathological tests revealed ACKD-associated renal cell carcinoma (RCC) confined to the resected kidney. He was treated with steroids for SEP, and the symptoms resolved. We herein report a case of ACKD-resembling ADPKD-that progressed to RCC in a patient with concurrent SEP who had been undergoing CAPD for 15 years.

Post-Hepatitic Aplastic Anemia Associated with Hepatitis A Virus

Hepatitis-associated aplastic anemia is a rare disease, but can be fatal if it is diagnosed late or untreated. Despite the previous case report of severe aplastic anemia following hepatitis, hepatitis A virus (HAV)-associated aplastic anemia is very rare, and a case with bone marrow transplantation (BMT) has not been reported in the literature. Here, we report the case of a 13-year-old boy, who developed severe aplastic anemia after full recovery of acute HAV infection, and eventually received BMT for aplastic anemia following HAV infection. It is a very rare case and the first case that recovered after BMT. The aim of this case report is to highlight the potential of progression to aplastic anemia after acute HAV infection and the importance of suspicion when pancytopenia is developed.

Rosai-Dorfman Disease Combined with Aortic Vasculitis, Arrhythmia, and Valvular Heart Disease

Rosai-Dorfman disease (RDD) is a rare and benign self-limited disorder with pathologic feature of the lymph node sinuses expanded by a proliferation of distinctive histiocytes. The most often involving site is bilateral cervical lymphadenopathy, followed by the skin and soft tissue. Treatment options, including steroid, chemotherapy, radiotherapy and debulking surgery depend on the symptoms or the extent and localization of the lesions. We encountered a very rare case of RDD at the skin lesions, particularly combined with aortic vasculitis, arrhythmia, and valvular heart disease.

Endoscopic Treatment of a Case of Post-cholecystectomy Mirizzi Syndrome / 대한췌담도학회지

Mirizzi's syndrome (MS) caused by the retention of a stone in the cystic duct stump after cholecystectomy is rare. Most cases of MS are treated by surgical intervention. However, developments of endoscopic accessories and techniques have resulted in the recent introduction of endoscopic treatments for MS. Furthermore, in view of the postoperative morbidity caused by post-operative scarring, the endoscopic approach should be preferred to the surgical approach. In the described case, the authors were able to remove a remnant cystic duct stone endoscopically because the cystic duct stump was wide and non-tortuous. This case shows endoscopic retrograde cholangiopancreatography with mechanical lithotripsy can be utilized in suitable cases of type I MS development after cholecystectomy.

Anticarcinogenic Effect of Panax ginseng C.A. Meyer and Identification of Active Compounds

The failure to improve the five-year survival rate of cancer patients, from one in three in the 1960s to one in two in the 1970s, stimulated awareness of the importance of primary prevention of cancer. Korean investigators carried out extensive long-term anticarcinogenicity experiments with 2000 newborn mice to investigate whether Panax ginseng C.A. Meyer inhibited carcinogenesis induced by several chemical carcinogens in 1978. There was a 22% decrease (p<0.05) in the incidence of urethane induced lung adenoma by the combined use of red ginseng extract. In the group sacrificed at 56 weeks after the treatment with aflatoxin B1, the incidence of hepatoma significantly decreased to 75% by the addition of red ginseng extract (p<0.05). The result showed that natural products can provide hope for human cancer prevention. By the newly established '9 week medium-term anticarcinogenicity test model of lung tumors in mice' (Yun's model), we confirmed significant anticarcinogenic effects of powders and extracts of the 6- yr-old dried fresh ginseng, 5- and 6-yr old white ginsengs, and 4-, 5-, and 6-yr old red ginseng. We also demonstrated that the anticarcinogencity of ginseng was more prominent in aged or heat treated extracts of ginseng and red ginseng made by steaming. To investigate the active components for cancer prevention, several fractions of 6-yr old fresh ginseng and red ginseng, four semi-synthetic ginsenoside Rh1, Rh2, Rg3 and Rg5, major saponin components in red ginseng, were prepared. Among the ginsenosides, Rg3 and Rg5 showed statistically significant reduction of lung tumor incidence and Rh2 had a tendency of decreasing the incidence. Ginsenoside Rg3, Rg5 and Rh2 were found to be active anticarcinogenic compounds. Rg3, Rg5 and Rh2 are active components in red ginseng, and they prevent cancer either singularly or synergistically.

Isolation of cytotoxicity-potentiating substances from red ginseng / 대한암학회지

No abstract available.