Single random measurement of urinary gonadotropin concentration for screening and monitoring girls with central precocious puberty

Purpose@#The gold standard for assessing pubertal activation is the gonadotropinreleasing hormone (GnRH) stimulation test (GnRHST), which is invasive, timeconsuming, and inconvenient. This study evaluated whether a single random measurement of urinary luteinizing hormone (LH) concentration could substitute for the GnRHST in diagnosing and monitoring central precocious puberty (CPP) in girls. @*Methods@#Fifty-five girls with breast buds before 8 years of age were assessed by both the GnRHST and urinary gonadotropin assays. Based on the GnRHST results, 29 girls were assigned to the CPP group (peak LH≥5 IU/L), and 26 were placed in the premature thelarche (PT) group (peak LH<5 IU/L). Auxological data and urine and serum samples were collected at baseline and after treatment with a GnRH agonist for 12 and 24 weeks. @*Results@#Although the auxological data did not differ between the 2 groups, the serum levels of insulin-like growth factor-1, basal LH, follicle-stimulating hormone (FSH), estradiol, and peak LH; urinary LH; and peak serum LH/FSH and urinary LH/FSH ratios were higher in the CPP group than in the PT group. Pearson correlation analysis showed a positive correlation between the urinary and serum LH concentrations (r=0.660, P<0.001). Receiver-operating characteristic curve analyses showed that a urinary LH concentration of 0.725 IU/L was a cutoff that significantly predicted positivity on the GnRHST. Urinary LH and FSH concentrations declined significantly during GnRH agonist treatment. @*Conclusion@#A single, random measurement of urinary gonadotropin concentration could be a reliable tool for initial screening and therapeutic monitoring of CPP in girls.

Single random measurement of urinary gonadotropin concentration for screening and monitoring girls with central precocious puberty

Purpose@#The gold standard for assessing pubertal activation is the gonadotropinreleasing hormone (GnRH) stimulation test (GnRHST), which is invasive, timeconsuming, and inconvenient. This study evaluated whether a single random measurement of urinary luteinizing hormone (LH) concentration could substitute for the GnRHST in diagnosing and monitoring central precocious puberty (CPP) in girls. @*Methods@#Fifty-five girls with breast buds before 8 years of age were assessed by both the GnRHST and urinary gonadotropin assays. Based on the GnRHST results, 29 girls were assigned to the CPP group (peak LH≥5 IU/L), and 26 were placed in the premature thelarche (PT) group (peak LH<5 IU/L). Auxological data and urine and serum samples were collected at baseline and after treatment with a GnRH agonist for 12 and 24 weeks. @*Results@#Although the auxological data did not differ between the 2 groups, the serum levels of insulin-like growth factor-1, basal LH, follicle-stimulating hormone (FSH), estradiol, and peak LH; urinary LH; and peak serum LH/FSH and urinary LH/FSH ratios were higher in the CPP group than in the PT group. Pearson correlation analysis showed a positive correlation between the urinary and serum LH concentrations (r=0.660, P<0.001). Receiver-operating characteristic curve analyses showed that a urinary LH concentration of 0.725 IU/L was a cutoff that significantly predicted positivity on the GnRHST. Urinary LH and FSH concentrations declined significantly during GnRH agonist treatment. @*Conclusion@#A single, random measurement of urinary gonadotropin concentration could be a reliable tool for initial screening and therapeutic monitoring of CPP in girls.

Interpersonal Relations, Hope, Professional Self-concept and Turnover Intention according to Adult Attachment Styles in Early Stage Nurses / 간호행정학회지

PURPOSE: This study was done to examine interpersonal relations, hope, professional self-concept and turnover intention according to adult attachment styles in early stage nurses. METHODS: A survey using a structured questionnaire was conducted with 245 nurses who work in one of six general hospitals. Additionally, a qualitative method was used to obtain data on experiences in interpersonal relations. Data were analyzed using SPSS/WINdows 14.0 and qualitative data from open question in the survey questionnaire were analyzed using content analysis. RESULTS: There was a significant difference in interpersonal relations, hope, and professional self-concept according to adult attachment styles. In the interpersonal relation of early stage nurses, 8 themes were identified, of which the most frequent were: a comfortable relationship with my co-workers (43%) and stress from the relationship (34%). CONCLUSION: Findings from this study should be useful in the development of programs to promote adult attachment and professional self-concept for early stage nurses.

Pseudo-Vestibular Neuritis Caused by a Vascular Tumor Involving the Anterior Inferior Cerebellum / 대한평형의학회지

Acute vestibular syndrome (AVS) is characterized by the rapid onset of dizziness/vertigo accompanied by nausea/vomiting, gait unsteadiness, and nystagmus lasting a day or more. Some patients with AVS have potentially dangerous central etiologies. AVS caused by central etiologies without significant other neurologic deficit, so called pseudo-vestibular neuritis (pseudo-VN), could be difficult to be differentiated from acute vestibular neuritis. In addition to imaging studies, bedside oculomotor examination-head impulse test, nystagmus and test of skew)-is essential to identify patients with pseudo-VN. Among several central causes of AVS, brain tumor is extremely rare. We report a case of vascular tumor involving the anterior inferior cerebellum with AVS presentations.

The Effects of Foot Reflexology on Peripheral Neuropathy, Symptom Distress, Anxiety and Depression in Cancer Patients Treated with Oxaliplatin

PURPOSE: This study was done to clarify the effects of foot reflexology on peripheral neuropathy, symptom distress, anxiety and depression in cancer patients treated with oxaliplatin. METHODS: A quasi-experimental design was employed. Changes in the variables were evaluated to test the effects of foot reflexology. Participants were cancer patients treated with oxaliplatin (experimental group 14 and control group 17). Peripheral neuropathy, symptom distress, anxiety and depression were measured before and after reflexology. Data were collected from October, 2010 to April, 2011. chi2-test, Fisher's exact test, t-test, Wilcoxon signed rank test and the Mann-Whitney U test were used to analyze the data. RESULTS: The experimental group who received foot reflexology experienced less peripheral neuropathy and symptom distress than the control group. There was no difference in anxiety and depression between the experimental and control group. CONCLUSION: The foot reflexology program adopted in this study was found to be an effective method to reduce peripheral neuropathy and symptom distress. We recommend foot reflexology for patients with chemotherapy induced peripheral neuropathy.

Hyperintense Vessel Signs on FLAIR MRI as a Predictor of Early Neurological Deterioration in Patients with Acute Posterior Circulation Infarction

BACKGROUND: Hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery imaging (FLAIR) is an indicator of slow flow and early ischemia. This study tested the hypothesis that HVS in the posterior circulation is associated with a worse outcome. METHODS: We retrospectively included 64 stroke patients with posterior circulation steno-occlusion within 6 hours of symptom onset and reviewed early neurological deterioration (END). END was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score of 4 or more from baseline during the first week. We analyzed demographic and laboratory information followed by an assessment of the magnetic resonance images. In addition, we assessed the posterior circulation Albert Stroke Program Early CT Score (pc-ASPECTS) on diffusion-weighted imaging (DWI). RESULTS: Among the 64 patients who met the inclusion criteria, END was seen in 17 patients. On univariate analysis, these END patients had higher baseline NIHSS scores and elevated initial systolic blood pressure (iSBP). Multiple logistic regression analysis revealed pc-ASPECTS (p=0.007), HVS on FLAIR (p=0.011), and iSBP (p=0.016) as independent predictors of END. CONCLUSIONS: The presence of HVS on FLAIR in the posterior circulation might indicate the presence of more severe ischemic penumbrae and END. pc-ASPECTS may also be an independent predictor of functional outcome.

The Psychometric Properties of Night Eating Questionnaire in Schizophrenic Outpatients / 신경정신의학

OBJECTIVES: The purpose of this study was to evaluate the psychometric properties of the Night Eating Questionnaire (NEQ) as a measure of the night eating syndrome (NES) in a sample of outpatients with schizophrenia. METHODS: The behavioral and psychological symptoms of NES were assessed with the 14-item self-report questionnaire (NEQ). Body weight and height were measured to calculate the body mass index (BMI). Subjective estimates of depression, binge eating patterns, sleep quality and weight-related quality of life were evaluated using Beck's Depression Inventory (BDI), the Binge Eating Scale (BES), the Pittsburgh Sleep Quality Index (PSQI) and the Korean version of Obesity-related Quality of Life (KOQoL) Scale. RESULTS: Among 165 schizophrenic outpatients who completed the NEQ, 15 (9.1%) patients screened as having NES (total NEQ > or =25). The NEQ demonstrated high internal consistency (Cronbach's alpha=0.72), and the item-total correlations (r=0.29-0.75 ; p<0.001, respectively) were acceptable, except for morning anorexia. A principal components analysis revealed five factors (nocturnal ingestions, evening hyperphagia, mood/sleep, morning anorexia, and delayed morning meal), which explained 65.7% of the total variance. Although the NEQ total score was not correlated with BMI, age at onset, duration of illness, or use of atypical antipsychotics, it was significantly correlated with total scores on the BDI, BES, PSQI and KOQoL. Test-retest reliability was also good (r=0.74, p<0.001). CONCLUSION: Our results showed that the NEQ appears to be an efficient, valid measure of NES in outpatients with schizophrenia.

Comparative study on the aflatoxin B1 degradation ability of rumen fluid from Holstein steers and Korean native goats

The aflatoxin B1 degrading abilities of two different ruminants were compared in this study. One set of experiments evaluated the aflatoxin B1 degradation ability of different rumen fluid donors (steers vs. goats) as well as the rumen fluid filtration method (cheese cloth filtered vs. 0.45 microm Millipore) in a 2 x 2 factorial arrangement. Additional studies examined aflatoxin B1 degradation by collecting rumen fluid at different times (0, 3, 6, 9 and 12 h) after feeding. Cannulated Holstein steers (740 +/- 10 kg bw) and Korean native goats (26 +/- 3 kg bw) were fed a 60% timothy and 40% commercial diet with free access to water. Rumen fluid from Korean native goats demonstrated higher (p < 0.01) aflatoxin B1 degradability than Holstein steers. However, filtration method had no significant influence on degradability. In addition, aflatoxin degradation did not depend upon rumen fluid collection time after feeding, as no significant differences were observed. Finally, a comparison of two types of diet high in roughage found aflatoxin degradability in goats was higher with timothy hay opposed to rice straw, although individual variation existed. Thus, our findings showed the aflatoxin degradability is comparatively higher in goats compared to steers.

A case of omental infarction successfully managed with conservative treatment / 대한내과학회지

Infarction of the greater omentum is an uncommon cause of acute abdominal pain, usually diagnosed during surgery for suspected appendicitis. However, during the last decade, preoperatively diagnosed omental infarctions successfully managed with conservative treatments have been increasingly identified with expanded utilization and technical advancements of sonography and computed tomography (CT). We report a case of omental infarction in a middle aged woman. Diagnosis was confirmed by abdominal CT, and she was successfully managed with conservative treatments including analgesics and prophylactic antibiotics. Follow-up CT performed 14 days after discharge revealed a decrease of infarct area without any intra-abdominal complications. This report emphasizes that nonoperative management of omental infarction may be safe and effective in most cases.

Microscopic colitis in a single center study: clinical feature & characteristics / 대한내과학회지

BACKGROUND/AIMS: Collagenous colitis (CC) and lymphocytic colitis (LC) are characterized by chronic diarrhea and normal radiologic and endoscopic findings. These are currently not uncommon entities whose incidence in increasing as more clinicians take biopsies from macroscopically normal colons. The purpose of this study was to examine the clinical features and characteristics in microscopic colitis. METHODS: From January 2003 to December 2006, medical records were reviewed from 80 patients with chronic diarrhea, who had normal colonoscopic findings but underwent biopsy. Patients with microscopic colitis were identified by reviewing the pathology databases and by reviewing biopsies. RESULTS: Microscopic colitis was diagnosed in 12 patients (15%). Six patients with CC (Male:Female=2:4, mean age 54+/-20.1 years) and 6 patients with LC (Male:Female=5:1, mean age 51.2+/-21.4 years) were identified. Autoimmune disease was diagnosed in 4 patients (33%). Drug-induced disease was suspected in 3 patients (25%). The inciting drugs were NSAIDs, ticlopidine, ranitidine, and acarbose. Complete or partial resolution of diarrhea was achieved in all patients, including spontaneous resolution in 2 patients. Antidiarrheal drugs, mesalazine, and cholestylamine were highly effective in both diseases. Recurrence of symptoms occurred in 2 patients (17%). They are taking medicine at present. CONCLUSIONS: Microscopic colitis is a relatively common cause of chronic diarrhea that appears to be increasing in incidence. We reported clinical features, characteristics, treatment, and response of microscopic colitis in our experience.

Two Cases of Cytomegalovirus Pneumonia after CD34 Selected Autologous Stem Cell Transplantation / 대한혈액학회지

Cytomegalovirus (CMV) pneumonia is an important cause of treatment related mortality after allogeneic stem cell transplantation (SCT) and autologous SCT, particularly in a CD34 selected setting. There is little known about the immune reconstitution pertaining to the CMV after CD34 selected SCT. However, several studies have suggested there is more profound immunodeficiency early in the CD34 selected population compared with the unselected population. We encountered two fatal cases of CMV pneumonia at the CD34 selected SCT for T-cell lymphoblastic lymphoma and high-risk breast cancer that was confirmed through a lung biopsy and bronchoalveolar lavage. In conclusion, autologous CD34 selected CMV seropositive recipients need to be monitored in a similar manner to allogeneic recipients.

A Case of Protein Losing Enteropathy Caused by Primary Intestinal Lymphangiectasia / 대한소화기내시경학회지

Primary intestinal lymphangiectasia is a rare congenital cause of protein losing enteropathy that is characterized by chronic diarrhea, generalized edema, ascites, hypoproteinemia, hypoalbuminemia, and lymphopenia. We encountered an 18-year-old woman who suffered from longstanding diarrhea and progressive leg edema. The laboratory findings showed the typical features of this disorder. The presence of enteric protein loss was documented with the 24 hour fecal clearance of alpha(1)-antitrypsin and (99m)Tc human serum albumin scintigraphy. A duodenoscopy and biopsy showed scattered white spots and markedly dilated lymphatics in the tips of the villi, respectively. The patient's clinical symptoms improved after placing her on a high protein and low fat diet with medium chain triglyceride supplements.

A Case of Condyloma Acuminatum Treated by Argon Plasma Coagulation / 대한소화기내시경학회지

Condyloma acuminatum (CA) is a common sexually transmitted disease caused by the human papillomavirus. In gastrointestinal practice, we generally encounter this disease in the anal canal but rarely in the rectum during a colonoscopy. There are many therapeutic options for CA including chemical or physical destruction, immunological therapy, or a surgical excision. All these procedures have some degree of limitations such as limited clearance rate, high recurrence rate, long duration of therapy, bleeding, release of potentially infectious aerosols, scarring etc. With argon plasma coagulation (APC), which is more available than lasers in gastrointestinal practice, a high frequency current flows through the argon plasma to the tissue, allowing well-controlled superficial tissue destruction without any direct contact between the probe and the tissue. We present a case of anal CA that was treated successfully with APC during a colonoscopy with no recurrence during the follow up.

Two Cases of Gastric Mucosal Calcinosis / 대한소화기내시경학회지

Gastric mucosal calcinosis (GMC) is a very rare condition that is characterized by the nodular deposition of calcium salts in the gastric mucosa. It has been associated with renal failure, gastric cancer, ingestion of aluminum- containing antacids and the use of sucralfate in organ transplant patients. The etiology of this condition is uncertain, but several theories have been proposed; the condition is due secondarily to hyperparathyroidism in renal failure and to the alkalinization of the gastric mucosa. We report here on two patients who had long-term use of bismuth and/or aluminum-containing antacids to treat their gastro-esophageal reflux symptoms. The esophagogastroduodenoscopy revealed acute gastritis patterns, and GMC was confirmed histologically with biopsy. When one patient stopped ingesting bismuth-containing antacid solution, the follow-up esophagogastroduodenoscopy and the biopsy revealed a completely improved state. We report here on these interesting cases and we include a brief review of the literature.

Increased Rate of Palmitate Oxidation in Adults Female: Comparison with Peri-pubertal Young Female Rats

Although estrogen is known to play a role in fatty acid metabolism, it remains unclear whether fatty acid oxidation in mature female rats differs from fatty acid oxidation in peri-pubertal young rats. In this study, we measured fatty acid metabolism in the skeletal muscles and livers of 5 and 50 weeks old male and female rats. The rate of palmitate oxidation in the liver and gastrocnemius red in the 50-week-old female rats were elevated as compared to the 5-week-old females, whereas there were no differences in the male rats. The rate of palmitate oxidation in the gastrocnemius red was correlated inversely with intra-abdominal fat mass in the 5-week-old male and female rats, whereas the palmitate oxidation rate was positively correlated with fat mass in the liver and gastrocnemius red in the 50-week-old rats. HOMA-IR and plasma insulin levels were positively correlated with intra-abdominal fat mass in the pooled 50-week-old male and female rats, but this correlation was not apparent in 5-week-old rats. In summary, the rate of fatty acid oxidation measured in the middle-aged adult female rats was significantly higher than those measured in the peri-pubertal young female rats. This difference may be attributed to the influence of ovarian hormones.

The Relationship between Intake of Vegetables and Fruits and Colorectal Adenoma-Carcinoma Sequence / 대한소화기학회지

BACKGROUND/AIMS: Evidence for the effect of dietary factors on colorectal carcinogenesis is yet inconsistent. Few studies have been conducted to investigate whether dietary factors were associated with the developement of colorectal adenoma-carcinoma sequence in Korea. We evaluated the relationship between the intake of vegetables and fruits and the degree of dysplasia of the colorectal adenoma and cancer. METHODS: For this study, 539 cases with histopathologically confirmed incidental colorectal adenoma, 162 cases with colorectal cancer and 2,576 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea during 1994-1999. Informations on demographic characteristics, life style habits and dietary intake were obtained by interviewed questionnaire before the colonoscopy. Adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by using polytomous logistic regression model. RESULTS: In female, the high intake of raw green and yellow vegetables were found to be negatively associated with the risk of colorectal cancer (adjusted OR: 0.54, 95% CI=0.32-0.93) and the high intake of persimmon, mandarin and strawberry among fruits were negatively associated with the risk of adenoma with mild dysplasia (adjusted OR: 0.43, 95% CI=0.20-0.94). In male, the high intake of banana, pear, apple and watermelon among fruits were negatively associated with the risk of colorectal cancer (adjusted OR: 0.36, 95% CI=0.16-0.84). CONCLUSIONS: These findings suggest that the intake of vegetables and fruits may act differently in developmental steps of colorectal adenoma-carcinoma sequence.

Treatment Results of Twist-drill Craniostomy with Closed-system Drainage for the Symptomatic Chronic Subdural Hematoma Patients

OBJECTIVE: Symptomatic chronic subdural hematoma(CSDH) is a well-known neurosurgical entity and most of the lesion is managed by surgical treatment. The authors analyze the surgical indication and the treatment results of twist drill craniostomy with closed-system drainage(TDD) for the symptomatic CSDH. METHODS: From March 2001 through December 2003, 31patients who were treated with TDD for the symptomatic CSDH and followed more than 6months were included. The radiologic criteria of TDD in this study were 1) homogeneous density of hematoma on computed tomography(CT), 2) no septation of hematoma on magnetic resonance imaging(MRI), and 3) thicker hematoma more than twice thickness of skull. Surgical procedures were performed on the maximum thickness of hematoma on CT/MRI. Short and long Steinman pins were used to penetrate the skull and hematoma membrane. As the 5L catheter was inserted through the drill hole, it was kept for 1-7days for the drainage of CSDH. The patients of CSDH were followed with clinical symptoms and CT studies. RESULTS: Most of all the 31 patients were improved. However, one patient was suffered from postoperative epidural hematoma and the other patients have received the secondary operation because of the recurrence of CSDH on 3 months after initial surgery. CONCLUSION: TDD is safe procedure for the symptomatic CSDH if the patients are selected appropriately.

The Clinical Evaluation of Anomalous Bronchi Arising From The Trachea and Main Bronchi / 결핵및호흡기질환

OBJECTIVES: To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. METHODS: 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. RESULTS: Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. CONCLUSION: Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.

Results of Arthroscopic All-Inside Sutures in Medial Meniscus with Concomitant Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic all-inside suture using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears by second-look arthroscopy in patients received concurrent anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: From May 1997 to June 2001, 78 MMPH tears were treated with arthroscopic all-inside sutures with concurrent anterior cruciate ligament (ACL) reconstruction. Among these 39 patients were availablefor follow-up evaluation by second-look arthroscopy. All MMPH tears were repaired using the arthroscopic all-inside suture technique using 2 posteromedial portals. Second-look arthroscopy was performed on average 19 months (range 6 to 40 month) after the ACL reconstruction and meniscal repair. Meniscus healing status was defined and classified. According to the Henning classification, they were divided into complete healing, incomplete healing, and failure. Tear size, type and location were analyzed and compared with healing category. We determined clinical criterias for success in meniscal status as; (1) no positive among 4 clinical objective parameters: joint line pain and tenderness, locking or catching, recurrent effusions, and positive McMurry test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. RESULTS: Of 39 knees assessed by second-look arthroscopy, 32 (82.1%) showed complete healing, 6 (15.4%) incomplete healing without any positive findings of clinical symptoms. Furthermore, all in the incompletely healed group showed complete healing of the posterior horn, which was sutured by allinside suture, whereas incomplete healing was observed at the junctional areas between all-inside and inside-out sutures, mainly at the posteromedial corner. So the overall success rate was 97.4% (38/39) for all-inside suture healing. The one (2.6%) patient with clinical failure revealed a retear of the repaired site, and subsequent subtotal menisectomy was performed. KT-2000 arthrometry showed that sagittal knee laxity was less than 2 mm (Average 1.5 mm, SD 0.72) in all reconstructed knees. The average knee scores, Lysholm knee score and HSS score, at final follow up were 95.5 and 96.5, respectively. As expected, small, longitudinal, and more peripheral (red-red zone) tears resulted in a higher healing outcome. CONCLUSION: Accurate repair with arthroscopic all-inside vertical suture using a suture hook, resulted in a high healing rate even in large and complex vertical tears. Arthroscopic all-inside meniscal suturing may be an optimal treatment for medial meniscus posterior horn tear greater than 1 cm during concurrent anterior cruciate ligament reconstruction.

Peripheral nerve repair using sural nerve graft