The Frequency and Risk Factors of Colorectal Adenoma in Health-Check-up Subjects in South Korea: Relationship to Abdominal Obesity and Age

BACKGROUND/AIMS: Obesity is associated with the risk of colorectal cancer. However, there is a lack of information about the relationship between obesity and colorectal adenoma. We investigated whether general and abdominal obesity are risk factors for colorectal adenoma. METHODS: Subjects who received health check-ups, including colonoscopy, from April 2006 to September 2007 in Chung-Ang University Hospital were included (n=1,316). The frequency and characteristics of colorectal adenomas were analyzed according to demographic features, past history, blood tests, body mass index, and components of metabolic syndrome. Abdominal obesity was defined as a waist circumference of > or =80 cm in women and > or =90 cm in men. RESULTS: The sex ratio of the subjects was 1.9:1 (male:female) and their age was 47.7+/-10.0 years (mean+/-SD). In univariate analysis, abdominal obesity was significantly associated with the frequency of colorectal adenoma (26.5% "yes" vs 16.9% "no"; p or =100 mg/dL) or fatty liver (p or =60 years; OR, 6.7; 95% CI, 3.5-12.5), and abdominal obesity (OR, 1.5; 95% CI, 1.0-2.2) were independent risk factors for colorectal adenoma (p<0.05). The frequency of multiple adenomas (more than two sites) was also significantly higher in subjects with abdominal obesity. However, the effect of abdominal obesity on the development of colorectal adenoma decreased in elderly people. CONCLUSIONS: Abdominal obesity is an independent risk factor for colorectal adenoma and its multiplicity, especially in younger people in South Korea.

A Case of Amblyomma testudinarium Tick Bite in a Korean Woman

A case of tick bite was found in the inguinal region of a 74-year-old Korean woman. She was attacked by the tick while working in her vegetable garden in the vicinity of mountain located in Suncheon City, the southern coastal area of the Korean Peninsula. On admission she complained of mild discomfort and itching around the bite area. The causative tick was 23 mm long and had slender pedipalps. The scutum was quite ornate and had eyes at the edge. The genital aperture was located anterior to the level of the coxa II. The spiracular plate was comma-shaped and the anus was surrounded posteriorly by the anal groove. The coxa I had subequal 2 spurs; the external one slightly larger. The spur of coxa IV was slightly longer than those of coxae II and III. The tarsus IV had 2 distinct subapical ventral spurs. It was identified as the fully engorged adult female of Amblyomma testudinarium. This is the first human case of Amblyomma bite in Korea.

Clinical Analysis of Cerebral Aneurysms of Posterior Circulation / 대한뇌혈관외과학회지

OBJECTIVES: We sought to examine the diverse factors associated with aneurysms of the posterior circulation. In addition, the results of conventional craniotomy were compared with those of endovascular treatment. METHODS: One hundred and one patients with posterior circulation aneurysms were selected for study inclusion. The factors that might affect the clinical outcomes were studied , such as the initial Hunt-Hess (H-H) grade, aneurysm location, size of the aneurysm, and therapeutic modalities. In addition, the morbidity and mortality rates were analyzed. The treatment outcomes were evaluated using the Glasgow Outcome Scale (GOS) 6 months after the initial insult. RESULTS: The patient population consisted of 67 women and 34 men, with a mean age of 52 (range 28-81 years). The overall morbidity and mortality rates at 6 months were 13.9% (14/101) and 17.8% (18/101), respectively. Sixty-one operations (60.3%) were performed, and 32 patients were treated with endovascular therapy. Forty-two (85.7%) of the 49 patients that had initial H-H grades of I and II had a better prognosis (GOS more than 4) than those with poor H-H grades (P<0.001). Patients that underwent endovascular treatment had better outcomes than those that had clipping (P=0.032). There was no significant difference in outcome according to the size of the aneurysm, location of the aneurysm, or the age of the patients. CONCLUSIONS: The results of this study showed that the factors affecting the prognosis were the initial HH grade and treatment modality. Considering the very high mortality rate in patients with rebleeding, early management may help improve the prognosis of patients with posterior circulation aneurysms. Endovascular therapy should be considered the primary treatment modality in patients with posterior circulation aneurysms.

The Changes in Prevalence and the Related Factors of Helicobacter pylori Infection in Korean Health Check-up Subjects during 8 Years / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the changes in prevalence and the related factors of Helicobacter pylori (H. pylori) infection in Korean health check-up subjects during the period of 8 years. METHODS: Among 89,231 subjects who visited the Health Promotion Centers of Severance hospital or Chung-Ang University hospital from Jan. 1998 through Dec. 2005, a total of 10,553 subjects who received esophagogastroduodenoscopy (EGD) and H. pylori test were enrolled. H. pylori infection was assessed by histologic examination. Changes of the prevalence of H. pylori infection during 8 years, and infection-related factors such as demographic characteristics, body mass index, ABO blood types, endoscopic findings (presence of peptic ulcer diseases), educational level, economic status, smoking habits, and alcohol intake in year 2005 were analyzed. RESULTS: The mean age of 10,553 subjects (7,329 men, 3,224 women) was 49.7+/-10.4 years (range from 17 to 92 years). The prevalence of H. pylori infection at the first, second, third, fourth, fifth, sixth, seventh, and eighth year were 64.7%, 58.1%, 54.2%, 50.4%, 48.9%, 49.5%, 39.6%, and 40.0%, respectively, and these serial decreases in prevalence over 8 years were statistically significant (p<0.001). Regardless of sex, age or EGD findings, the prevalence of H. pylori infection was significantly decreased. In the analysis of the H. pylori infection-related factors in 2005, only age and EGD findings (peptic ulcer diseases) were significant factors. CONCLUSIONS: The prevalence of H. pylori infection was significantly decreased during 8-year period in Korean health check-up subjects. Age and peptic ulcer diseases were the two significant factors related to H. pylori infection in Korea.

Diabetes Mellitus and the Risk of Colorectal Adenoma

BACKGROUND/AIMS: Diabetes mellitus (DM) is associated with an increased incidence of colon cancer. However, the relationship between DM and colorectal adenoma is not definite. In this study, we sought to determine the association between DM and the prevalence of colorectal adenoma. METHODS: We enrolled 606 patients with DM and 606 asymptomatic adults who underwent colonoscopy for routine health evaluations from June 2003 to June 2007. The frequency and characteristics of the colorectal adenomas were analyzed and compared between the two groups. RESULTS: The sex ratio and mean age were 1.67:1 (M:F) and 58.1+/-10.6 years, respectively, in patients with DM, and 1.68:1 and 57.6+/-8.9 years, respectively, in patients without DM, and these values were similar. The frequency of colorectal adenoma was 33.2% for the patients with DM and 32.3% for the patients without DM. The frequency, location, number, size and histopathologic findings of the colorectal adenomas were not different between the two groups. Among the patients with DM, the frequency of colorectal adenoma was 35.7% in the patients treated with oral hypoglycemic agents and 31.4% in the patients treated with insulin. Also, the other characteristics of the colorectal adenomas were not different according to the treatment method. CONCLUSIONS: The frequency and characteristics of colorectal adenomas were not different between the patients with and without DM.

The etiology of acute viral hepatitis for the last 3 years at a single institution in Seoul / 대한내과학회지

BACKGROUND/AIMS: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. METHODS: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. RESULTS: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. CONCLUSIONS: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.

A case of septic embolism after fever, sore throat, and myalgia / 대한내과학회지

Lemierre syndrome or postanginal septicemia (necrobacillosis) is caused by an acute oropharygeal infection with secondary septic internal jugular vein thrombophlebitis and frequent metastatic infections. 17-aged girl visted emergency room with dyspnea. She had the symptoms of fever, sore throat and myalgia before 3 or 4 days. She had multiple septic emboli in both lung fields and septic thrombophlebitis of right internal jugular vein. Although Fusobacterium necrophorum is the most common pathogen isolated from the patients, The pathogen can not be confirmed. We experienced a case of Lemierre syndrome with septic embolism after fever, sore throat and myalgia. We present the case with the review of literature.

Risk Factors of Deep Vein Thrombosis and Pulmonary Embolism in Korean

BACKGROUND AND OBJECTIVES: Deep vein thrombosis and pulmonary embolism are both associated with a high mortality. However, in Korea, they are known as relatively rare diseases and are not sufficiently evaluated, so there is limitations in the proper approach toward their diagnosis and management. SUBJECTS AND METHODS: The risk factors, accompanying illness and family history of patients with deep vein thrombosis and pulmonary embolism, treated at Hallym University Sacred Heart Hospital, between January 1999 and July 2002, were analyzed. RESULTS: There were 113 patients with deep vein thrombosis and pulmonary embolism, comprised of 45 men and 68 women, 31 being older than 70 years of age (the largest portion). Of the 113 patients, 101 had identified causal illness causative diseases, but the other was no obvious risk factors. Overweight and obese turned out to be the most frequent risk factor. While there were 35% with one risk factor, 51.3, 10 and 3.7% had two, three or four risk factors, respectably. The recurrence rate was 20.3%, and that of women was 1.2 fold that of men, irrespectively of the risk factor. There were also two patients with a positive family history. CONCLUSION: The freguent risk factors and underlying diseases for deep vein thrombosis and pulmonary embolism were over-weight/obesity, antiphospholipid syndrome, cancer and a bed ridden state, in that order of frequency. As the individual risk factors of the patients overlapped in 61.5% cases, attention should be paid to overlapping risk factors. In order to reduce the complications of these diseases, each patient's risk factors should be carefully evaluated, and some patients should be advised to take life-long care.

A Case of Hashimoto's Thyroiditis with Transient T3-Thyrotoxicosis Induced by Hydatidiform Mole / 대한내분비학회지

Human chorionic gonadotropin(HCG) is a member of the glycoproteins family synthesized by the placenta, which consists of 2 noncovalently joined subunits(alpha(alpha) and beta(beta)). The alpha- and beta-subunits have a structural homology with the alpha- and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic disease (GTD), such as a hydatidiform mole or a choriocarcinoma, but the clinical symptoms of hyperthyroidism are rarely observed. We experienced a case of Hashimoto's thyroiditis, where the patient was diagnosed with T3-thyrotoxicosis, which had initially been induced by excess beta-HCG due to an H-mole; after evacuation of the H-mole, the condition was diagnosed as hypothyroidism. It has been speculated that a patient with Hashimoto's thyroiditis could have hyperthyroidism, induced by beta-HCG, due to an H-mole

A Case of Spontaneous Perforation of the Common Bile Duct Associated with Cholangitis / 대한소화기학회지

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.