, Won Kim Understanding the effects of sex and sex differences on liver health and disease is crucial for individualized healthcare and informed decision-making for patients with liver disease. The impact of sex on liver disease varies according to its etiology. Women have a lower prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) than men. However, postmenopausal women face a higher risk of advanced liver fibrosis due to hormonal influences. Sex differences affect the pathogenesis of MASLD, which involves a complex process involving several factors such as hormones, obesity, and the gut microbiome. Furthermore, sex-related differences in the development of MASLDrelated hepatocellular carcinoma have been observed. The sex-specific characteristics of MASLD necessitate an individualized management approach based on scientific evidence. However, research in this area has been lacking. This article reviews the current understanding of sex differences in MASLD.
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, Gwang Ha Kim, Bong Eun Lee, Moon Won Lee, Cheolung Kim Subepithelial tumors in the upper gastrointestinal (GI) tract are often detected during nationwide endoscopic gastric cancer screening in Korea. Most GI lipomas are asymptomatic and do not necessitate further treatment. However, large tumors may lead to complications such as bowel obstruction, intussusception, and bleeding. These GI lipomas require endoscopic or surgical resection. On radiological examination, GI lipomas typically manifest as hypodense lesions with similar density to that of fat tissue. White-light endoscopy generally reveals a yellowish subepithelial tumor exhibiting a positive cushion sign, while endoscopic ultrasonography shows a homogeneous hypoechoic mass within the third layer of the GI tract. We present the case of an 81-year-old woman with symptomatic duodenal lipoma following endoscopic resection.
, Hyeonuk Hwang, Hyungju Kwon Conventional open thyroidectomy is a safe procedure, but it has the disadvantage of leaving noticeable scars on the neck. Bilateral axillo-breast approach (BABA) robotic thyroidectomy was developed as an alternative technique to remove thyroid glands without making incisions in the neck. In traditional BABA robotic thyroidectomy, dividing the isthmus is a routine step to improve the efficiency of the dissection during thyroid surgery. However, there are safety concerns when performing this procedure on patients with thyroid cancer located in the isthmus. We report a case of BABA robotic total thyroidectomy carried out without dividing the isthmus in a patient with isthmic papillary thyroid carcinoma. Our experience suggests that BABA robotic surgery can be a feasible and safe option for selected patients with isthmic papillary thyroid carcinoma.
Graves disease (GD) is the primary cause of hyperthyroidism in children. The standard management options—namely, antithyroid drugs (ATD), radioactive iodine, and surgery—have not changed for many years. Although ATD therapy is often the first-line treatment for pediatric patients, the low likelihood of spontaneous remission means that most children will require a more permanent solution. Recent clinical trials and systematic reviews have shed light on the long-term outcomes of ATD therapy, radioactive iodine, and surgical interventions in managing pediatric GD. Additionally, novel therapies aimed at B-cells or the thyroid-stimulating hormone receptor, both implicated in the pathogenesis of GD, are under investigation. However, their definitive role in treating childhood GD has yet to be established. This review will cover the latest developments in the treatment of childhood GD, including information on emerging targeted therapies.
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, Zahra Salimi, Fatemeh Zarei, Farshad Moradpour, Mohammad Rasool Khazaei, Mozafar Khazaei, Maryam Pourjalili Alzheimer disease (AD) is a common neurodegenerative disorder, characterized by memory impairment, dementia, and diminished cognitive function. This disease affects more than 20 million people worldwide. Amyloid beta (Aβ) plaques and neurofibrillary tangles (NFTs) are important pathological markers of AD. Multiple studies have indicated a potential association between elevated cholesterol levels and increased risk of AD, suggesting that lowering the cholesterol level could be a viable strategy for AD treatment or prevention. Statins, potent inhibitors of cholesterol synthesis, are widely used in clinical practice to decrease the plasma levels of LDL cholesterol in patients with hyperlipidemia. Statins are known to play a neuroprotective role in limiting Aβ pathology through cholesterol-lowering therapies. In addition to Aβ plaques and neurofibrillary tangles, the brains of AD patients exhibit signs of oxidative stress, neuroinflammatory responses, and synaptic disruption. Consequently, compounds with antioxidant, anti-inflammatory, and/or neuroprotective properties could be beneficial components of AD treatment strategies. In addition to lowering LDL cholesterol, statins have demonstrated therapeutic efficacy in various forms, including antioxidant, anti-inflammatory, and neuroprotective effects. These properties of statins are potential mechanisms underlying their beneficial effects in treating neurodegenerative diseases. Therefore, this review was conducted to provide an overview of the protective effects of statins against AD.
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, Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang Differentiating between intestinal tuberculosis (ITB) and Crohn’s disease (CD) remains a challenge for gastroenterologists. In Asia, where the prevalence of tuberculosis is relatively high and the incidence of CD is rapidly increasing, this issue is crucial. Here we report a case that was initially misdiagnosed as CD, subsequently showed no response to empirical first-line anti-tuberculosis medication, and was finally diagnosed with multidrug-resistant ITB. This case reminds physicians that multidrug-resistant ITB may complicate distinguishing between ITB and CD.
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, Hyungju Kwon, Woosung Lim, Byung-In Moon, Nam Sun Paik Active surveillance (AS) of papillary thyroid microcarcinoma was first suggested by Dr. Akira Miyauchi at Kuma Hospital in 1993. Based on several subsequent evidences, AS was approved by the American Thyroid Association in 2015. AS is no longer an experimental treatment but has become an acceptable standard of care for patients with low-risk thyroid cancers. No molecular markers, such as BRAF mutations, have been identified to predict the prognosis of papillary thyroid cancer. However, future molecular studies may reveal the relationship between genetic mutations and thyroid cancer prognosis. AS involves closely monitoring thyroid cancer over time, instead of immediately treating it with surgery. Patients and medical doctors should consider these two options: observation or surgery.
, Nadhum Abdulnabi Awad, Amel Hussein Mohammed We aimed to evaluate the effect of insulin resistance (IR) on serum Intelectin-1 and endocrinological hormones levels in obese and non-obese women with and without polycystic ovary syndrome (PCOS) in Basrah, Iraq.
From 124 women volunteers, 60 patients with primary and 64 patients with secondary, while 56 normal ovulatory women were taken as controls. Their fasting insulin hormone, intelectin-1, anti-Mullerian hormone, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), estradiol (E2) and testosterones (T) were determined by ELISA methods. BMI, glucose and quantitative insulin sensitivity check index as well as IR was determined by the homeostasis model assessment.
A significant changes (P<0.05) were seen in the level of homeostasis model assessment-IR, E2 and T. Levels of anti-Mullerian hormone, LH, LH/FSH ratio and prolactin were significantly (P<0.01) increased and level of intelectin-1 and E2/T ratio were significantly (P<0.01) decreased, while quantitative insulin sensitivity check index level was not significantly different (P>0.05) between the patients (1°PCOS and 2°PCOS) and control groups. On the other hand, our data reported that FSH level was significantly (P<0.05) lower in obese and higher in non-obese patients with PCOS as compared to control group.
Levels of intelectin-1 and endocrinological hormones have significantly associated with body mass index, IR and physical activity in patients and normal groups and the strategies that can modulate levels of these parameters would improve metabolic disarrangements in women with PCOS.
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, Ah Young Kim, Hee Yun Cho, Yun Taek Kim To evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy.
This prospective, comparative case series included 21 patients (28 eyes) with severe diabetic retinopathy. All patients underwent three sessions of PRP. The SFCT and macular thickness were measured using EDI-OCT at baseline and one week after completion of 3 sessions of PRP.
SFCT before PRP was 318.1±96.5 µm and increased to 349.9±108.3 µm; P=0.001 after PRP. Macular thickness significantly increased at one week after PRP from 273.1±23.9 µm at baseline 295.8±25.3 µm at one week; (P<0.001). No significant relationship between the changes in macular thickness and SFCT was observed (r=−0.13, P=0.52).
PRP induced increases in both SFCT and macular thickness. Changes in SFCT did not correlate with changes in macular thickness.
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Microorganisms coexist in the human body and its function is essential to maintain normal physiology and homeostasis. Microbiota refers to the entire population of microorganisms that colonizes a particular location; includes not just bacteria but also other microbes. Gut microbiota is vast and complex. It could be changed dynamically according to the variable factors. Well balanced host-microbial symbiotic state is a harmonious ecosystem in the stable individual. But, dysbiosis is a state of deviation in composition or function from the usual gut microbiota. It has been found that this condition is associated with many gastrointestinal, metabolic, allergic and the other diseases. Dysbiosis plays an important role in the pathophysiology of functional bowel disease, such as irritable bowel syndrome and functional constipation. Probiotics is microorganism which, when administrated in adequate amounts, confer a health benefit on the host. Probiotics have beneficial effects to reduce several symptoms of functional bowel diseases. Currently, complementary and alternative medicine therapies with probiotics is recommended for symptomatic relief from functional bowel disease.
, Min A Park, Myung Jae Park, So Young Park, Seung Hyeun Lee Uremic pleuritis is a fibrinous pleuritis of unknown pathogenesis in patients with chronic kidney disease. Although it responds to regular dialysis or repeated thoracentesis, cases that are refractory to those therapies have been reported. We report a case of uremic pleuritis which showed marked improvement following corticosteroid therapy. The effusion was exudate, and negative in cytology and microbiology. Pleural biopsy revealed chronic inflammation with fibrosis. The pleural effusion did not respond to chest tube drainage and continuance of hemodialysis. With a diagnosis of refractory uremic pleuritis, we started methylprednisolone. The pleural effusion responded to the treatment and resolved without complication.
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, Risshi Kudoh, Masahide Seki, Motohiro Endo, Mirei Shiki A 60-year-old man who had been diagnosed with protein-losing enteropathy (PLE) and vitiligo at age 51 years was admitted with dyspnea, hemoptysis, and lower-limb edema. On the basis of computed tomography findings, the cause of respiratory symptoms was thought to be diffuse alveolar hemorrhage (DAH). The final diagnosis of late-onset systemic lupus erythematosus (SLE) was established on the basis of renal biopsy examinations that revealed evidence of active SLE with lupus nephritis (World Health Organization, class V) and positive results for antinuclear antibody. DAH, as well as PLE and vitiligo were attributed to SLE. The patient was successfully treated with methylprednisolone and then prednisolone in combination with cyclosporin A. Because late-onset SLE is rare and patients tend to show atypical symptoms, close attention should be paid to the preceding symptoms.
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, Jae Myung Cha, Joung Il Lee, Kwang Ro Joo, In Taik Hong, Hye Jin Ki Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract. These tumors are frequently small, asymptomatic and found incidentally. GI bleeding is a common complication of these tumors, but small sized, very low risk GIST rarely complicated with fatal bleeding. In this report, we describe a 42-year-old woman with a jejunal GIST accompanied by severe GI bleeding. She presented with melena and an angiographic embolization was performed for a jejunal mass with bleeding. However, rebleeding was suspected after an angiographic embolization and an emergent segmental resection for the bleeding mass was performed. She was finally diagnosed as a 1.8 cm sized very low risk GIST in jejunum. In conclusion, physician should consider that even very low risk GIST can be the cause of GI bleeding when there is severe bleeding.
The present study investgated if constitutive nitric oxide synthase(cNOS), especially neuronal type, is expressed in gastrointestinal epithelial cells of rat. Expression of cNOS was immunohistochemically determined. Some gastric epithelial cells were found to express cNOS. Although less than that by the gastric epithelial cells, cNOS was also found to be expressed by the intestinal epithelial cells. Thus it is possible that constitutive type of nitric oxide synbthase in gastrointestinal epithelial cells may play a role in normal gastrointestinal function.
, Hee Jin Kim, Yeon Ah Sung, Nan Ho Kyung Thyroid nodule is a common clinical problem and it is important to distinguish benign from malignant nodule. Although features found on history taking, physical examnation and imaging studies help the diagnosis, fine needle aspiration(FNA) has been accepted as an accurate and reliable diagnostic procedure of thyroid nodule. This study was aimed to assess the values of FNA and needle biopsy in the diagnosis of thyroid nodules.
We reviewed the medical records of the 405 patients who underwent FNA and needle biopsy for the diagnosis of thyroid nodule form September 1993 to July 1996.
The 414 fine needle aspiration cytologic specimens were obtained from 405 patients(male : 26, female : 379). 390 cases(94.2%) were adequate for cytologic diagnosis. And the diagnosis showed benign in 357(91.5%), malignancy in 20(5.1%) and suspicious malignancy in 13(3.3%). Among the 357 benign cases, 104 cases were benign cysts, 163 cases were adenomatous goiter and 45 cases were follicular adenoma. 46 patients underwent thyroidectomy after FNA and 21 patients(45.7%) were diagnosed as having carcinoma. The sensitivity and specificity of FNA in diagnosing malignancy were 65% and 82%, respectively, with an accuracy of 74%. Of 46 patients, needle biopsy was done in 41. The sensitivity and specificity of the needle biopsy were 79% and 73%, respectively. And the accuracy was 76%. Hoarseness was developed in one patient after FNA and needle biopsy, and small amount of hemoptysis was developed in another patient after FNA.
Although it had been expected that needle biopsy may increase the diagnostic accuracy, our study didn't show the superiority of needle biopsy as compared with FNA. FNA has limitations in suspicious and nondiagnostic results but it is a safe, simple, reliable and cost-effective means of evaluating thyroid nodules. It is the preferred initial diagnostic method in all patients with thyroid nodule.
, Kyu Man Shin The assessment of the vasoreactivity measured with transcranial doppler(TCD) provides information regarding to the reserve capacity of the cerebral circulation in patients with acute head injuries, which has important therapeutic consequencies because it allows for the diagnosis of impending ischemia and for the control of the effect of initiated corrective measures.
The authors performed TCD study to measure the CO2 reactivity to the entire basal cerebral arteries in 30 cases of control group and 14 cases of head inury group between the 3rd and the 7th day after insult. All patients were examined by single photon emission computed tomography and their results were compared to CO2 reactivities at 8 basal cerebral arteries. All of these results were analyzed by statistical analysis system(SAS).
The increase of MBFV(mean blood flow velocity) and decrease of PI(pulsatility index)were noted in the cerebral arteries with decreased CO2 reactivity. It meant that the arterial walls were dilated. There was no close relationship between region of interest(ROI) index and CO2 index but CO2 reactivity was remarkably decreased in the region which showed abnormal regional cerebral blood flow in SPECT(single photon emission computed tomogram)(P=0.04). In the relationship between the variables, ROI increased as the clinical status worsen(r=0.5, P=0.0008), the prognosis of the patients had positive correlation with CO2 index(r=0.32, P=0.04) or clinical status had negative correlation with ROI index(r=0.40, P=0.0094).
The doppler CO2 test in patients with head injury provides useful information regarding hemodynamic state, prognosis and determination of beneficial effects of specific therapy, especially during subacute stage. In the various TCD parameters CO2 index was correlated well with prognosis.
This paper reports a study on 246 cases of upper gastrointestinal(UGT) hemorrhage thatwere treated in the Department of Internal Medicine of the Ewha Womans University(Mokdong Hospital) over a period of 18 months from September of 1993 to May of 1995.
The results were as follows.
1) The causes of UGI hemorrhage were 156 peptic ulcer cases(63.4%) including 71 gastriculcer,82 duodenal ucler, and 3 marginal ulcer ; 44 esophageal varix cases(17.9%) ; 18 MalloryWeiss syndrome cases(7.3%) : 15 stomach cancer cases(6,1%) ; 7 acute gastric mucosal lesioncases(2.8%) ; 2 unknown causes ; and 4 other causes.
2) There were 204 males and 42 females(4.8 : 1). The age distribution was 51 in fifties(20.7%),49 in forties(19.9%), 44 in thirties(17.9%), 40 in sixties(16.2%), 24 in twenties(9.5%), and 24 in seventies(9.8%) resulting in 58.5% of the total cases from the thirties to fifties. Agedistribution of duodenal ulcer and Mallory-Weiss tear was younger than stomach cancer andgastric ucler(P<0.05).
3) The seasonal distribution showed spring 78 cases(31.7%), summer aS cases(10.1%), autum67 cases(27.2%), and winter 74 cases(30.1%) with peak incidence in spring.
4) The severity of UGI hemorrhage according to Palumbo's criteria was mild bleeding in 71 cases(28.8%), moderate bleeding in 115 cases(46.7%), and massive bleeding in 60 cases(24.4%)
5) The mean amount of transfusion for treatment was 4.2±2.4 unit for peptic ulcer, 3.2±1.8unit for varix, 5.9±3.1 unit for stomach cancer, and 0.3±0.2 unit for Mallory-Weiss tear.
6) Ninety one peptic ulcer was received endoscopic treatment(58.4%). Among them, therewere 13 rebleeding cases(14.3%) and 9 cases required surgical opertaion(9.8%). Thirly fivevarix cases received endoscopic treatment(79.5%) and there were 3 rebleeding cases(8.6%).
7) The motality was 4.1%(10 cases). The main causes of deaths were 1 sepsis case, 3 hepaticcoma cases, and 6 hepatoma intraperitoneal rupture cases.
, Gil Ja Shin, Si Hoon Park, Woo Hyung Lee Hypothyroidism may accompany pericardial may accompany pericardial effusion occasionally, in the patient who complains of any symptom of hypothyroidism and dose not receive treatment. We have experienced two cases of hypothyroidism presenting with the symptoms of dyspnea and chest tightness. The cuase of dyspnea and chest tightness was pericardial effusion and congestive heart failure. So we report two cases of primary hypothyroidism presenting with pericardial effusion and review the literature.
, Jeong Hee Hahm Periorbital hemanogiomas are commonly associated with ocular complications such as amblyopia or strabismus. So early treatment and regular ophthalmologic study are recommended.
We report a case of upper eyelid strawberry hemangioma in a 5-month-old infant. Thehemangioma was treated with intralesional corticosteroid injection, and so a marked involutionof the tumor resulted. There were no local or gystemic complications. So this therapeutic methodis considered to be sueful in the management of strawberry haemangioma.
, Chung Nam Kang, Jin Man Wang, Kwon Jae Rho, Kwang Sug Sim There are many methods for treatment of solitary bone cyst. But the recurrence rate was relatively high and beside, serious complications may be followed. Recently, simple topical of steroid into cyst was contrived and the result was know as same or even better than surgical management. A patient of solitary bone cyst who had been failed two times by surgical intervention was treated with topical steroid injection for several times. Two years following up, the result was good. No evidence of recurrency was seen and was shown good healing process
, Ki-Nam Shim, Chung Hyen Tae, Kyeong Jin Kim, Myung-Eun Song, Ha Eung Song, Hye-Won Yun, Ka-Young Jung, Jung-Wha Chung Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4×2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.
, Ki-Sook Hong The incidence of thyroid cancer has been rapidly increased in Korea. Although fine needle aspiration cytology is recommended for diagnosis of cancer, there are some limitations. Patients with indeterminate or suspicious cytology category in which malignancy cannot be ruled out usually undergone a thyroidectomy, however, only 10~25% of them finally diagnosed as cancer. According to the progress in understanding molecular mechanism, some mutations or other molecular alterations have been studied for the diagnostic and prognostic markers for thyroid cancer. The majority of papillary thyroid cancers have
, Ki Nam Shim, Sun Hee Roh, Min Jin Lee, Hye In Kim, Seung Jung Jun, Da Yeon Oh, Sung Chul Hong, Jae In Ryu, Kwang-Ho Kim A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and expresses CD117, a c-kit proto-oncogene, which can be detected immunohistochemically. We reported a GIST of the rectum of a 61-year-old-woman who had visited emergency room complaining of constipation over one week. Upon rectal examination, a round hard mass was palpated. Colonoscopy showed a 7×5 cm sized protruded lesion with surface ulceration on a rectum, adjacent the anus. And abdomen computed tomography revealed the soft tissue mass compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST. The patient had been treated with a ultra anorectal anastomosis with loop ileostomy. Immunohistochemical studies on the surgically resected specimen showed c-kit (+) and CD34 (+). The final diagnosis was a GIST of the rectum. She was grouped into high risk and she has been given adjuvant chemotherapy with Imatinib.
, Woo Sik Chung, Hana Yoon Androgen plays an important role in female sexual function, and its insufficiency causes a clinically significant sexual dysfunction. This study examines the association between sex hormones and the clinical effect of testosterone replacement therapy in female sexual dysfunction.
This study examined 75 female patients who visited our hospital from March 2002 to June 2008 to treat sexual dysfunction. For the rest of the patients, we performed primary treatment and physiotherapy in accordance with the main cause of their sexual dysfunction. We also performed combination treatment of androgen replacement therapy for the patients who did not make medical progress after two months of primary treatment and for the patients whose free testosterone level is in the bottom group out of three normal range groups.
The mean age of target patients was 39.6±8.7 years (range, 35~66 years) old. 10 patients out of 75 patients were postmenopausal women, and estrogen replacement therapy had been performed without androgen replacement therapy. We performed a combination treatment of androgen replacement therapy for the patients with sexual desire disorder, and 60% of them answered that they had an increased sexual response after they were given combination treatment of androgen replacement therapy.
The results support the concepts that sex hormones significantly affect sexual response in women with sexual dysfunction. Clinically, it is effective and safe to perform a combination treatment of androgen replacement therapy in treating sexual dysfunction if medication is administered properly and carefully.
, Eun Mi Song, Doo Hyun Beak, Hyun Jung Oh, Hyun Kyung Kim, Min Young Choi, Kyung Joo Kwon, Hye Won Kang, Seo Woo Kim, Unjin Shim, Yeon Ah Sung, Young Sun Hong Propylthiouracil(PTU) is a commonly used antithyroid drug in the management of hyperthyroidism. However, it is associated with a variety of side effects. Antineutrophil cytoplasmic antibody( ANCA)-positive vasculitis is an extremely rare side effect of PTU. We report a case of a patient with diffuse pulmonary hemorrhage while being treated with PTU. A 28-year-old woman was admitted due to fever and abdominal pain. She was diagnosed as Graves' disease 4 years before the admission, and was taking PTU intermittently. Thyroid storm was suspected and we treated her with PTU, hydrocortisone, lugol solution and propranolol. However, coughing was aggravated, with chest X-ray and computed tomography revealing diffuse alveolar hemorrhage. Perinuclear-ANCA was positive. After discontinuation of PTU, all symptoms resolved. In conclusion, ANCA-positive diffuse alveolar hemorrhage is a rare but a potential side-effect of PTU. Therefore, early awareness of this complication is important.
, Do Sang Cho, Myung-Hyun Kim The piriformis syndrome appears to be more common because it is often underdiagnosed and undertreated. This syndrome is caused by compression or irritation of the sciatic nerve by the piriformis muscle as it passes through the sciatic notch. This entrapment neuropathy presents as pain, numbness, paresthesias, and associated weakness in the distribution of the sciatic nerve. In this article. we present the clinical symptoms, anatomy of the piriformis muscle, and the technique and result of the injection therapy with local anesthetics and steroid.
A 72-year-old woman presented with 7 days history of severe pain in the right buttock, hip, numbness of the right thigh. Previous management had included non-steroidal anti-inflammatory drug and physical therapy in local orthopedic clinic. Her past medical history was unremarkable. Her right side buttock was tender and discomfort was increased by right hip flexion, adduction and internal rotation with pain radiating to the anterior thigh. The her leg lenghts were equal, the strenght of right hip abductors and abduction was normal. Also low back range of motion and neurological examination were normal. Radiographs of the lumbosacral spine, pelvis and the hip joint were unremarkable. The she didn't respond to conservative treatment including physcal theraphy combined with the use antiimflammatory drugs, analgesics and muscle relaxants.
One week later she received an injection of 0.5% mepibacaine HCI 8cc and methyl-predanisolone(Depomedrol) 40mg into the medal right piriformis muscle. She reported that the 3 days after the injection, her right buttock pain had resolved and 7 days after the injection the pain resolved completely and she resumed normal activities and continued pain free.
We reviewed the literature on piriformis syndrome and its signs, symptoms and treat-ments. In an isolated piriforms syndrome, the major finding include buttock tenderness from the sacrum to the greater trochanter, piriformis tenderness on rectal or vaginal examination. The patient with piriformis syndrome usually does not have neurologic deficits Through complete history, physical and neurologic examinations, the other causes of low back pain and sciatica should be eliminated. Patients who do not respond to conservative therapy are candidates for local anesthetics and steroid injection. We injected methyl prednisolone 40mg and 0.5% mepibacaine HCl 8cc into the medial right piriformis muscle. 3 days after injection, her pains of right buttock and trochanter had resolved and 7 days after the injection, she resumed normal activites and consumed free. In order to improve the reliability of proper needle placement and allow for definite and treatment, EMG-assisted or MRI guidance may utilize.
Pancreatitis is the most common and serious complication of ERCP. On the basis of several reports, corticosteroid, octreotide, or calcium channel blocker might be effective in this regard. The aim of this study was to determine whether the phamacologic agents(steroid, variable amount of octreotide, and verapamil) prevent post-ERCP pancreatitis.
A total of 80 patients were randomized. All patients received intravenously gabexate mesilate(Foy®) before endoscopy. Group 1 has been dose of octreotide (0.2mg blous and 6mg intravenous infusion) in group 3, and verapamil in group 4. Clinical outcomes and risk factors were analysed in each groups. We checked cytokines (IL-1, TNF-α) in group 3 and 4 compared with control and alcohol induced pacreatitis.
The overall frequency of hyperamylasemia and pancreatitis were 35% (28/80) and 13.7% (11/80), respectively. There was no difference among 4 groups with the incidence and severity of pancreatitis. The groups were similar with regard to demographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. There was no risk factors of ERCP-pancreatitis in all groups. In the cytokine data, TNF-α was markedly decreased on right after ERCP in patients with hyperamyasemia and pancreatitis.
Prophylactic administered corticosteroid, octredtid, or verpamil would not be helpful for prevention in post-ERCP pancreatitis. Also IL-1 and TNF-α may not be useful markers in prediction of ERCP-pancretitis. But TNF-α would be useful marker as mild form ERCP-pancreatitis and alcoholic pancreatitis.
, Yong Jae Cho, Do Sang Cho, Myung Hyun Kim, Eui Kyo Seo, Sang Jin Kim Inflammatory response may play role in symptomatic nerve irritation that is associated herniated disc. Steroids decrease neurogenic inflamation, inhibit phospholipase A2 and produce membrane stabilization that result in pain relief. Local anesthetics are believed to break the cycle of pain that exists between local pain and a secondary muscle spasm. Epidural block with steroid combined with local anesthetics(EBSL) are recommended in patients with sign and symptoms of nerve root irritation. The purpose of this study was to asses of ESBL.
A retrospective study undertaken of 20 patients who received ESBL from May 2004 to November 2005 at the pain clinic of Mokdong Hospital Ewha Womans Medical Center. The mean age of the patients was 52, with range from 18-82 years. Nine patients was male, eleven were female. The etiologies of the pain were low back strain(3 patients), bulging disc(9 patients), degenerative disc(4 patients), lumbar stenosis(2 patients) and spondylolisthesis(2 patients). Diagnostic workouts were history, physical and neurologic examinations, and labo-rative studies including simple X-ray and magnetic resonance image. The steroid preparation usedis methylprednisolone and the use of dilute local anesthetics Is mepibacaine. The method of technique of EBSL was median approach with loss of resistance technique. The clinical responsefall into four categories, 6 months follow up after therapy. An excellent response was defined ascomplete resolution of presenting symptoms. A good response was judged to greater than 75%improvement in symptoms with full resumption of the patients life style. A fair response was defined as improvement in the patients condition, whereas a poor response indicated little or noimprovement. The total numbers of blocks were 48 in 20 patients and 2.4/per patient. The duration symptoms within one month were 8 patients and the other 12 patients over one month.
A detailed follow-up of 20 patients with EBSL showed a successful rate(good to excellent) 65%, fair 25%, and poor 10%. The effective responses of EBSL were depend on the etiologies, duration of pains and patients age. All patients of low back strain with one month duration or less have a response rate of very successful excellent. Also all patient with bulging disc who present with pain within one month have a response rate of excellent 3(60%), good 2(40%) and the patient who present with pain of over one month or more have a response rate excellent 1(25%), fair 2(50%) and poor 1(25%). All patients of degenerative disc present with pain of over one month have 50% relative success rate and good 2 patients. The response rate of two patients of spinal stenosis and two patients of spondylolisthesis present pain of long time(2-6 months) and response rate showed fair 3, poor 1, and 0% of successful rate.
EBSL can safely performed and its efficacy has been established in patients with low back strain and bulging disc. The success of this therapeutic procedure depends on attention to selected of patient etiologies and concomitant therapies. In addition, well controlled studics are needed to evaluate any effectivness of EBSL on back pain and radiculopathy.
, Kyung Eun Lee Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. On the basis of several reports, corticostroid or octreotide might be effective in this regard. The aim of this study was to determine whether the pharmacologic agents(stroid and octreotide) prevent post-ERCP pancreatitis.
Patients received an intravenous infusion of hydrcortisone(100mg) and octreotide (0.2mg bolus) in treated group Tmmediately before endoscopy. A total of 140 patients(73men and 67 women, with an average age of 61.5 yr) who were scheduled to undergo diagnostic or therapeutic ERCP. Nine patients were excluded from the final evaluation for incomplete records. The remaining 131 patients, 61 in the treated group and 70 in the control group, were analyzed.
The overall frequency of hyperamylasmia and pancreatitis were 33.6%(44/131) and 7.6%(10/131), respectively. The all pancreatitis were mild. There was no difference between the groups with the incidence and severity of pancreatitis. The procedure-induced pancreatitis occured in 5 of 61(8.2%) patients treated with hydrocortisone and octreotide and 5 of 70(7.2%) patients in the control group(p=ns). the groups were similar with regard to desmographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. The only risk factor of ERCP-pancreatitis is the visualization of pancreatic duct in both groups.
Prophylactic administered corticosteroid and octreotide did not prevent of post-ERCP pancreatitis. Pancreatic injury may be only related to maneuver of pancreatic duct.
, Chun Dong Kim To establish new
Four SCCHN cell lines were used for MTS and raft culture.
All cell lines formed MTS, but only Tu-138 showed a good stratification at the airliquid interface in the raft culture system.
MTS and raft culture system were established successfully from the SCCHN cell lines.
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