A Case of Recurrent Small Bowel Obstruction caused by a Mesodiverticular Band of Meckel Diverticulum / 대한내과학회지

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal system. Although it is commonly asymptomatic in adults, Meckel diverticulum can lead to intussusception, volvulus, inflammatory adhesions, or an internal hernia. However, small bowel obstruction due to a mesodiverticular band of Meckel diverticulum is rare. We report a case of a 24-year-old man who complained of abdominal pain and vomiting caused by recurrent small bowel obstruction. He had undergone no previous abdominal surgery. Abdominal computed tomography revealed a transition point at the mid-to-distal ileum. To identify the cause of the obstruction, we performed single-balloon enteroscopy, which revealed extrinsic compression at the proximal ileum 100 cm from the ileocecal valve. After marking the obstruction site, subsequent laparoscopy revealed a Meckel diverticulum with a mesodiverticular band, which entrapped a bowel loop and caused the recurrent small bowel obstruction. The patient was treated successfully with laparoscopic diverticulectomy.

Metastatic Pulmonary Calcification in a Patient with Adult T-Cell Leukemia/Lymphoma / 대한내과학회지

Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive disease that is geographically clustered, mirroring areas endemic for human T-cell lymphotropic virus type 1 infection. Most patients with ATLL present with aggressive manifestations such as severe hypercalcemia, lymphadenopathy, hepatosplenomegaly, and bone marrow involvement with progressive thrombocytopenia. We herein report a case of a patient with ATLL exhibiting increased uptake in both lungs as shown on a bone scan using 99mTc-methylene diphosphonate. This finding is thought to have been caused by metastatic calcification associated with ectopic parathyroid hormone production.

Overtube-related Delayed Esophageal Perforation with Mediastinitis / 대한소화기학회지

Overtube provides a conduit for the passage of endoscope into the digestive tract. Esophageal perforation with mediastinitis is a rare overtube-related complication. Until now, no reports have been published regarding the esophageal perforation which developed many months after the original procedure using the overtube. A 56-year-old female visited our hospital complaining of chest pain and back pain that began 14 days ago. The patient underwent esophageal variceal ligation using the overtube 12 months earlier. She was diagnosed with esophageal perforation with mediastinitis which extended to intervertebral and epidural space. The cause of this condition was considered to have been related to the use of overtube. Management of delayed perforation remains controversial. Although surgical management might be the preferred mode of treatment, she underwent local N-butyl 2-cyanoacrylate injection therapy and temporary stent therapy with antibiotics due to high operative risk. Herein, we report a case of overtube-related delayed esophageal perforation with mediastinitis that was successfully treated by nonoperative management.

Evaluation of Transnasal Esophagogastroduodenoscopy as a Surveillance Endoscopy in a General Medical Checkup

BACKGROUND/AIMS: Transnasal esophagogastroduodenoscopy (T-EGD) has been reported to be well tolerated and is known to reduce patient discomfort that occurs with conventional EGD (C-EGD) performed via an oral route. We aimed to evaluate factors that influence preferences for T-EGD as a surveillance EGD in a general medical checkup. MATERIALS AND METHODS: A total of 658 subjects (median age, 49 years; 45% men) underwent T-EGD procedures by 8 endoscopists using a 5.2-mm diameter endoscope. All examinees and endoscopists were asked to assess the T-EGD examinations using the post-endoscopy questionnaire. The post-endoscopy questionnaire included a 10-point visual analogue scale, which asked the patient to place a cross on the line according to examinee's or endoscopist's experience of the endoscopy procedure. Zero represented the worst experience and 10 the best experience. RESULTS: T-EGD was feasible in 96.6% of the subjects. Younger age ( or =35 years) or male examines preferred T-EGD as the modality for the next examination. The endoscopist's overall discomfort level was higher in the beginner group than in the expert group. CONCLUSIONS: The T-EGD may be better tolerated than C-EGD and offers a more comfortable surveillance endoscopic procedure to older (> or =35 years), male, or sedated C-EGD-experienced examinees in a general medical checkup. More experience with and education about T-EGD may help to improve the tolerance of the beginner group of endoscopists.

A Case of Organizing Pneumonia Associated with FOLFIRI Chemotherapy / 결핵및호흡기질환

The combination chemotherapy of irinotecan with 5-fluorouracil and leucovorin (FOLFIRI regimen) was recently proven to be beneficial in patients with advanced colorectal cancer. Pulmonary toxicity is very rare in adverse effects of irinotecan. No case of organizing pneumonia (also known as bronchiolitis obliterans organizing pneumonia) associated with FOLFIRI chemotherapy has been reported. We experienced a case of a 62-year-old man who presented persistent dry cough and progressive dyspnea after receiving chemotherapy with FOLFIRI regimen. After surgical lung biopsy, the patient was diagnosed with FOLFIRI chemotherapy-induced organizing pneumonia which was successfully treated with steroid therapy.

Polycythemia Vera Presenting with Generalized Chorea: A Case Report and Review of the Literature / 대한내과학회지

Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by erythrocytosis. Clinical symptoms can range in severity from headache and tinnitus to thrombohemorrhagic complications. Neurologic symptoms are common at the onset of polycythemia; however, chorea due to PV is a rare complication. We present the case of a 77-year-old female who was referred to our hospital because of choreic movement of the limbs, head and face. She was diagnosed with JAK2V617F mutation-positive PV. Her chorea was completely resolved by phlebotomy combined with hydroxyurea and aspirin.

Polycythemia Vera Presenting with Generalized Chorea: A Case Report and Review of the Literature / 대한내과학회지

Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by erythrocytosis. Clinical symptoms can range in severity from headache and tinnitus to thrombohemorrhagic complications. Neurologic symptoms are common at the onset of polycythemia; however, chorea due to PV is a rare complication. We present the case of a 77-year-old female who was referred to our hospital because of choreic movement of the limbs, head and face. She was diagnosed with JAK2V617F mutation-positive PV. Her chorea was completely resolved by phlebotomy combined with hydroxyurea and aspirin.

Lipomyelomeningocele with Thoracic Spinal Cord Tumor in VATER Association: A case report

VATER association represents vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, renal abnormalities and radial limb dysplasia. The probability of the simultaneous occurrence of any three of these defects is so unlikely that it suggests a sporadic non-random association. This non-random association appears to be related to mesodermal defects in early developmental period. We experienced one case of VATER association in 21 months old male child having vertebral anomalies with severe scoliosis, rib defects, imperforated anus, right renal agenesis, lipomyelomeningocele, spinal cord tumor. We reported a case of VATER association with brief review of related literature.

Comparative evaluation of micro-shear bond strength between two different luting methods of resin cement to dentin / 대한치과보존학회지

The purpose of this study was to evaluate the effect of dual bonding technique by comparing microshear bond strength between two different luting methods of resin cement to tooth dentin. Three dentin bonding systems(All-Bond 2, One-Step, Clearfil SE Bond), two temporary cements (Propac, Freegenol) were used in this study. In groups used conventional luting procedure, dentin surfaces were left untreated. In groups used dual bonding technique, three dentin bonding systems were applied to each dentin surface. All specimens were covered with each temporary cement. The temporary cements were removed and each group was treated using one of three different dentin bonding system. A resin cement was applied to the glass cylinder surface and the cylinder was bonded to the dentin surface. Then, micro-shear bond strength test was performed. For the evaluation of the morphology at the resin/dentin interface, SEM examination was also performed. 1. Conventional luting procedure showed higher micro-shear bond strengths than dual boning technique. However, there were no significant differences. 2. Freegenol showed higher micro-shear bond strengths than Propac, but there were no significant differences. 3. In groups used dual bonding technique, SE Bond showed significantly higher micro-shear bond strengths in One-Step and All-Bond 2 (p < 0.05), but there was no significant difference between One-Step and All-Bond 2. 4. In SEM observation, with the use of All-Bond 2 and One-Step, very long and numerous resin tags were observed. This study suggests that there were no findings that the dual bonding technique would be better than the conventional luting procedure.

Temporary Veno-venous Hemofiltration (TVVH) Using Low Flux Hemodialyzers / 대한신장학회잡지

BACKGROUND: Continuous veno-venous hemofiltration (CVVH) is one of the continuous renal replacement therapies for managing patients with refractory edema or oliguric renal failure with unstable vital signs. High-flux hemofilters are usually used for CVVH, but low-flux hemodialyzers are not used for CVVH. We tried temporary veno-venous hemofiltration (TVVH) procedures using low-flux hemodialyzers for 9 patients with acute or chronic renal failure who were on mechanical ventilation with positive end-expiratory pressure (PEEP) in the ICU. METHODS: All of the nine patients with acute or chronic oligo-anuric renal failure could not receive hemodialysis treatment in the hemodialysis room, because they were on mechanical ventilation with PEEP in the ICU due to severe fluid overload with elevated CVP and acute pulmonary edema. Low-flux hemodialyzers with effective membrane area of 1.0- 1.1 m2 and blood pumps on the discarded hemodialysis machines were used for TVVH procedures. RESULTS: Mean duration of TVVH was 17.0+/-16.7 hours and mean ultrafiltration rate was 440+/-203 mL/hour. After finishing the TVVH procedures, CVP decreased from 22.9+/-8.5 cmH2O to 6.4+/-2.4 cmH2O. Of nine patients, 6 patients (67%) were able to be off the mechanical ventilation with clinical improvement. CONCLUSION: Even if CVVH is usually done with expensive high-flux hemofilters and CVVH machines, simplified and cheaper TVVH procedures using low- flux hemodialyzers and discarded hemodialysis machines with functioning blood pumps can be done with good results and cost effectiveness, especially in institutions not equipped with facilities such as CVVH machines or portable water purification systems for hemodialysis in the ICU.

The Effect of Vertebral Endplate Area and Shape in the Patients with Lumbar Herniated Intervertebral Disc

OBJECTIVE: To determine whether the area and the shape of the vertebral body endplate in the magnetic resonance image (MRI) findings were risk factors for the development of symptomatic herniated lumbar intervertebral disc. METHOD: Sixty patients of low back pain with the age below 60 were enrolled. They didn't have spondylolisthesis or the history of spine surgery. MRI films of these patients were reviewed. Anteroposterior and transverse diameter of endplates, height of vertebral body and intervertebral discs were measured. The relation of these data and intervertebral disc herniation, body weight, height, body mass index (BMI) were statistically studied. RESULTS: Patients' weight, BMI, the vertebral body area and the shape of the endplate were related to disc herniations. Furthermore, the larger and circular vertebral body was observed in the patients with disc herniation. In the patients with lower back pain, men were diagnosed disc herniations of the MRI finding more than women. CONCLUSION: In anatomical aspect, the area and the shape of the vertebral body at the endplate level were important factors contributing to the development of disc herniations at L4-L5 and L5-S1.

Effects of Exercise Therapy on Natural Killer Cell Cytotoxic Activity in Breast Cancer Patients after Curative Surgery

OBJECTIVE: Exercise may contribute to alteration in cancer in many ways. The major cell in cellular immunity to defense against cancer cell is natural killer [NK] cell. So this study is aimed to investigate the effects of exercise on NK cell cytotoxic activity (NKCA) in breast cancer patients who underwent mastectomy. METHOD: Thirty-one breast cancer patients who had undergone curative surgery were randomly assigned to an exercise group (n=16) and a non-exercise group (n=15). Exercise therapy was consisted of aerobic activity such as bicycle ergometer for 30 minutes, twice a day, five times each week for 2 weeks. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells. RESULT: The baseline study did not show any statistical difference between exercise group and non-exercise group. Mean NKCA of day 7 decreased in both groups compared with that at postoperative day 1 (p<0.05). At day 14, the difference of the mean NKCA between two groups was not significant, but the mean NKCA of the exercise group without metastasis demonstrated a significant increase compared with that of the non-exercise group without metastasis (p<0.05). CONCLUSION: This study suggested that early moderate exercise had a beneficial effect on the function of NK cells in early stage of breast cancer patients after curative surgery. A further study will be needed to evaluate long-term effect of exercise on NK cell.

A study on the postoperative stability of occlusal plane in Class III orthognathic surgery patients / 대한치과교정학회지

In Patients with severe skeletal discrepancy, surgical orthodontic treatment must be accompanied, and recently two jaw surgery has become a common procedure, resulting in improved esthetics and function. Choosing the position of the occlusal plane in this two jaw surgery is an important factor in postoperative stability. Therefore this must be taken into consideration during the diagnosis and treatment plan. In this study, among patients with skeletal Class III occlusion, 25 patients(8 male, 17 female, average age 23.2+/-3.17) who have undergone two jaw surgery, setting the ideal occlusal plane according to Delaire's architectural and structural cranial analysis. In comparing preoperative(T1). postoperative(T2, average of 15.4 days), and long-term postoperative(T3, average of 32.6 months) lateral cephalometric radiography, the following conclusions have been made. 1. There were no significant changes of the occlusal plane angle after the two jaw surgery, and there were no significant differences between the surgical technique(SSRO and IVRO). 2. The postoperative changes of the occlusal plane had no relationship with the amount of jaw movement, amount of posterior impaction, nor the time relapse after surgery. 3. After two jaw surgery, in the SSRO group there was significant forward movement of the mandible, and in the IVRO group the lower incisors extruded as the mandible moved backward and downward which makes the gonial angle and the mandibular plane angle significantly increased.

Study on the Korean craniofacial skeletal pattern by counterpart analysis / 대한치과교정학회지

Enlow's counterpart analysis explains the complex with anatomic and developmental characteristics where craniofacial aspect of individuals has been developed. The analysis does not compare individual measurement with the normal value from the average of majority but analyzes by comparison of values that each individual has. This study was to clarify the Korean craniofacial skeletal pattern using Enlow's counterpart analysis considering the fact that the craniofacial skeletal pattern has racial and regional variations. This research will be helpful in the future for growth research and research of the orthognathic For this study, the samples were consisted of 100 Korean adult subjects(50 males and 50 females) who had normal occlusion and pleasing face. Measurement points and lines were established using Enlow's counterpart analysis and they were statistically evaluated. The results indicated that: 1. The average angle between PCF and PMV was 38.54 degrees in males and 38.43 degrees in females, and the average Wits' appraisal was -2.51 in males and -2.3 in females. The ramus alignment(R4) was 1.89 in males and 2.36 in females. 2. It shows that females have a longer ramus than the PCF compared to the males, because there was a significant difference in Ramus/PCF horizontal dimensions (Skeletal A3-B3) between female and male subjects 3. It shows that males have a longer mandibular corpus than the maxilla compared to the females, because there was a significant difference in Maxillary/Mandibular arches(Skeletal A4-B4) between male and female subjects 4. In cranial floor+maxilla/ramus+corpus at A and B points(A1-B1), which represents difference in total horizontal length between the maxilla and mandible, there was no significant difference between males and females. In conclusions, compared to Caucasian, Korean have more depressed midface, prognathic mandible, and ramus that rotates inferioposterior. Also, we observe that Korean women have larger ramus posterior cranial base, as compared with Korean men. Consequently, the total length of maxilla and mandible does not show any difference, because man's mandible is longer than maxilla in comparison with woman's one.

Effect of the inhibition of phospholipase A2 in generation of free radicals in intestinal ischemia/reperfusion induced acute lung injury

The role of phospholipase A2 (PLA2) in acute lung leak induced by intestinal ischemia was investigated in association with neutrophilic respiratory burst. To induce lung leak, we generated intestinal ischemia for 60 min prior to the 120 min reperfusion by clamping superior mesenteric artery in Sprague-Dawley rats. Acute lung leak was confirmed by the increased lung leak index and protein content in bronchoalveolar fluid. These changes were inhibited by mepacrine, the non-specific PLA2 inhibitor. The lung myeloperoxidase (MPO) activity denoting the pulmonary recruitment of neutrophils was increased by intestinal I/R, but decreased by mepacrine. Simultaneously, the number of leukocytes in bronchoalveolar fluid was increased by intestinal ischemia/reperfusion (I/R) and decreased by mepacrine. Gamma glutamyl transferase activity, an index of oxidative stress in the lung, was increased after intestinal I/R but decreased by mepacrine, which implicates that PLA2 increases oxidative stresscaused by intestinal I/R. The PLA2 activity was increased after intestinal I/R not only in the intestine but also in the lung. These changes were diminished by mepacrine. In the cytochemical electron microscopy to detect hydrogen peroxide, intestinal I/R increased the generation of the hydrogen peroxide in the lung as well as in the intestine. Expression of interleukin-1 (IL-1) in the lung was investigated through RT-PCR. The expression of IL-1 after intestinal I/R was enhanced, and again, the inhibition of PLA2 suppressed the expression of IL-1 in the lung. Taken together, intestinal I/R seems to induce acute lung leak through the activation of PLA2, the increase of IL-1 expression associated with increased oxidative stress by neutrophilic respiratory burst.

Effect of the inhibition of PLA 2 on oxidative lung injury induced by interleukin-1alpha

In order to understand the pathogenetic mechanism of adult respiratory distress syndrome (ARDS), the role of phospholipase A2 (PLA2) in association with oxidative stress was investigated in rats. Interleukin-1alpha (IL-1, 50 mug/rat) was used to induce acute lung injury by neutrophilic respiratory burst. Five hours after IL-1 insufflation into trachea, microvascular integrity was disrupted, and protein leakage into the alveolar lumen was followed. An infiltration of neutrophils was clearly observed after IL-1 treatment. It was the origin of the generation of oxygen radicals causing oxidative stress in the lung. IL-1 increased tumor necrosis factor (TNF) and cytokine-induced neutrophil chemoattractant (CINC) in the bronchoalveolar lavage fluid, but mepacrine, a PLA2 inhibitor, did not change the levels of these cytokines. Although IL-1 increased PLA2 activity time-dependently, mepacrine inhibited the activity almost completely. Activation of PLA2 elevated leukotriene C4 and B4 (LTC4 and LTB4), and 6-keto-prostaglandin F2alpha (6-keto-PGF2alpha) was consumed completely by respiratory burst induced by IL-1. Mepacrine did not alter these changes in the contents of lipid mediators. To estimate the functional changes of alveolar barrier during the oxidative stress, quantitative changes of pulmonary surfactant, activity of gamma glutamyltransferase (GGT), and ultrastructural changes were examined. IL-1 increased the level of phospholipid in the bronchoalveolar lavage (BAL) fluid, which seemed to be caused by abnormal, pathological release of lamellar bodies into the alveolar lumen. Mepacrine recovered the amount of surfactant up to control level. IL-1 decreased GGT activity, while mepacrine restored it. In ultrastructural study, when treated with IL-1, marked necroses of endothelial cells and type II pneumocytes were observed, while mepacrine inhibited these pathological changes. In histochemical electron microscopy, increased generation of oxidants was identified around neutrophils and in the cytoplasm of type II pneumocytes. Mepacrine reduced the generation of oxidants in the tissue produced by neutrophilic respiratory burst. In immunoelectron microscopic study, PLA2 was identified in the cytoplasm of the type II pneumocytes after IL-1 treatment, but mepacrine diminished PLA2 particles in the cytoplasm of the type II pneumocyte. Based on these experimental results, it is suggested that PLA2 plays a pivotal role in inducing acute lung injury mediated by IL-1 through the oxidative stress by neutrophils. By causing endothelial damage, functional changes of pulmonary surfactant and alveolar type I pneumocyte, oxidative stress disrupts microvascular integrity and alveolar barrier.