Gastric subepithelial tumors (SETs) are usually asymptomatic and are often detected incidentally during screening endoscopy. A gastric inverted hyperplastic polyp (IHP) is characterized by downward growth of hyperplastic mucosa into the submucosal layer. Owing to these characteristics, a gastric IHP is frequently misdiagnosed as a SET. Gastric IHPs are asymptomatic in most cases and are discovered incidentally. Notably, IHPs may be accompanied by an adenocarcinoma or anemia owing to chronic bleeding associated with this lesion; therefore, endoscopic submucosal dissection is recommended for complete excision of IHPs measuring > 2 cm. We report a case of gastric IHP that was diagnosed during screening endoscopy in an asymptomatic patient. We observed a whitish purulent exudate expressed from the SET, and endoscopic ultrasonography revealed a SET originating from the muscularis mucosa. Endoscopic submucosal dissection was performed to remove the SET, and final histopathological findings revealed a gastric IHP. This case report highlights that IHPs should be suspected in patients with a SET associated with whitish exudates.

OBJECTIVE: Ubiquitin-specific peptidase 46 gene (USP46) polymorphisms is part of ubiquitin-proteasome system, which is responsible for dynamic cellular processes such as the regulation of cell cycle. USP46 has been reported to be associated with major depressive disorder. The objective of the present study was to investigate the association of USP46 polymorphisms with affective temperamental traits in healthy subjects. METHODS: A total of 557 Korean healthy volunteers were recruited, and 545 subjects (328 male, 217 female) were included in the final analysis. The DNA of the subjects was isolated from saliva samples. Two single-nucleotide polymorphisms (SNPs) rs346005, rs2244291 in USP46 were genotyped. Affective temperaments were assessed using the Korean version of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). RESULTS: A significant association was found between rs346005 genotypes and TEMPS-A only in male subjects. In particular, subjects with the CC genotype of rs346005 showed a more depressive temperament than subjects with AA or CA genotypes in males. For rs2244291, there were no associations between the rs2244291 genotypes and TEMPS-A scores. CONCLUSION: Some affective temperaments may serve as a genetic predisposing factors for affective disorders, such as depressive disorder, via vulnerability genes related to the ubiquitin-proteasome system.
Causality ; Cell Cycle ; Depressive Disorder ; Depressive Disorder, Major ; DNA ; Genetic Association Studies ; Genotype ; Healthy Volunteers ; Humans ; Male ; Mood Disorders ; Saliva ; Temperament ; Volunteers

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
Surveys and Questionnaires ; Delivery of Health Care ; Dizziness ; Electronic Mail ; Korea ; Otolaryngology ; Otolithic Membrane ; Public Opinion ; Vertigo

PURPOSE: To evaluate the possibility of lowering tourniquet pressure to 200 mmHg during total knee arthroplasty (TKA) by pressing the femoral artery. Lowering the toniquette pressure can attribute to minimize the soft tissue damage and pain after the operation. MATERIALS AND METHODS: We analyzed patients who had TKA from Sep 16th, 2010 to Mar 3rd, 2011. Among them, 35 patients (test I) had operations on both knees, and 50 patients (test II) underwent operation on one knee. We excluded the patients who had a previous operation, infection, or bleeding tendency. We put a cotton roll at the antero-medial side of the thigh just under the tourniquet in order to apply more pressure on the femoral artery that is scanned by ultrasonography. We scored 0 on non-bleeding, 1 on bleeding that did not affect the operation, and 2 on bleeding which disturbed the operation. RESULTS: In test I, the group which applied 200 mmHg with local pressure, 24 patients (68.6%) scored 0, 9 patients (25.7%) scored 1, and two patients (5.7%) scored 2. In the other group used pressure 250 mmHg, however, 31 patients (88.6%) scored 0, 4 patients (11.4%) scored 1, and no one scored 2 (p=0.039). Totally, in the 200 mmHg group with local pressure, 33 patients had no problem in surgery, and only for 2 patients (5.7%), we had to increase pressure. For the patients with 250 mmHg, however, we had to increase pressure on nobody (0%). In test II, in the group which had operation on one knee with 200 mmHg with local pressure, 14 patients scored 0, 8 patients scored 1, and one patient scored 2. Also in the 250 mmHg group, 24 patients scored 0, 2 patients scored 1, and one patient scored 2. (p=1.000). Overall results demonstrate no differences in bleeding that disturb operations statistically. CONCLUSION: Even with a little more bleeding compared to the 250 mmHg group, 94.8% of patients can have operation with no bleeding problems by using a cotton roll and the pressure 200 mmHg. For successful operations, there is no difference between groups using 250 mmHg and 200 mmHg with local pressure on femoral artery.
Arthroplasty ; Femoral Artery ; Hemorrhage ; Humans ; Knee ; Thigh ; Tourniquets

PURPOSE: Depression is associated with increased inflammation and cardiovascular disease. And in patients with end stage renal disease (ESRD), depression is a common problem and cardiovascular disease is the main cause of death. The aim of this study is to investigate the association of depression with various inflammatory markers and with some cardiovascular risk factors in ESRD patients on hemodialysis METHODS: 53 patients with ESRD on maintenance hemodialysis were divided into depressive symptom (BDI> or =11) group and control (BDI < 11) group by the 21-items Becks depression inventory (BDI). We collected patients characteristics and laboratory measurements by medical records. And then, we measured the levels of IL-10 and TNF-alpha a and analyzed the genotype of IL-10 and TNF-alpha a promoter area. RESULTS: The levels of TNF-alpha, CRP and ferritin were significantly higher in depressive symptom group (p=0.001, 0.04, 0.02) and IL-10 concentration tended to be lower in depressive symptom group (p= 0.05). The prevalence of left ventricular hypertrophy was higher in depressive symptom group than in the control group (44% vs 9%, p=0.01). GG genotype known as high IL-10 producer was less common in depressive symptom group than in control group (8% vs 36%, p=0.039). CONCLUSION: Increased inflammation, high left ventricular hypertrophy prevalence and low ejection fraction were observed in depressive hemodialysis patients. Further prospective study is needed to clarify the role of depression in the development of inflammation and cardiovascular disease in ESRD patients.
Cardiovascular Diseases ; Cause of Death ; Depression ; Ferritins ; Genotype ; Humans ; Hypertrophy, Left Ventricular ; Inflammation ; Interleukin-10 ; Kidney Failure, Chronic ; Medical Records ; Prevalence ; Renal Dialysis ; Risk Factors ; Tumor Necrosis Factor-alpha

PURPOSE: CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels. METHODS: Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-alpha and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured. RESULTS: After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-alpha levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF. CONCLUSION: In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.
Arterial Pressure ; Cytokines ; Dialysis ; Echocardiography ; Heart Failure ; Heart Ventricles ; Humans ; Imidazoles ; Inflammation ; Interleukin-10 ; Kidney Failure, Chronic ; Nitro Compounds ; Prospective Studies ; Pulmonary Edema ; Renal Dialysis ; Stroke Volume ; Tumor Necrosis Factor-alpha

PURPOSE: inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. METHODS: 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-alpha, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-alpha and IL-10 were measured for the evaluation of immune response by external stimuli. RESULTS: As uremia was reduced by initiating dialysis, serum level of TNF-alpha was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. CONCLUSION: Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.
Adiponectin ; Atherosclerosis ; C-Reactive Protein ; Cytokines ; Dialysis* ; Humans ; Inflammation ; Interleukin-10 ; Interleukins ; Kidney Failure, Chronic* ; Malnutrition ; Mortality ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Insufficiency, Chronic ; Serum Albumin ; Tumor Necrosis Factor-alpha ; Uremia

Heat stroke is a potentially fatal disorder that's caused by an extreme elevation in body temperature. We report here an unusual case of multiple organ failure that was caused by classical, nonexertional heat stroke due to taking a warm bath at home. A 68 year old diabetic man was hospitalized for loss of consciousness. He was presumed to have been in a warm bath for 3 hrs and his body temperature was 41 degrees C. Despite cooling and supportive care, he developed acute renal failure, disseminated intravascular coagulation (DIC) and fulminant liver failure. Continuous venovenous hemofiltration was started on day 3 because of the progressive oligouria and severe metabolic acidosis. On day 15, septic ascites was developed and Acinetobacter baumanii and Enterococcus faecium were isolated on the blood cultures. In spite of the best supportive care, the hepatic failure and DIC combined with septic peritonitis progressed; the patient succumbed on day 25.
Multiple Organ Failure/*etiology ; Male ; Liver Failure/*etiology ; Kidney Failure/*etiology ; Humans ; Heat Stroke/*complications/etiology ; Fatal Outcome ; Baths/*adverse effects ; Aged

Murine typhus is an infectious disease caused by Rickettsia typhi, an intracellular parasite that lives in the cytoplasm of host cells. Rickettsia typhi infection can induce lymphohistiocytic vasculitis leading to pulmonary, cardiovascular, central nervous system and renal complications. We experienced a case of acute renal failure resulting from acute tubulointerstitial nephritis associated with murine typhus infection. A 67 year old man was transferred from local hospital due to fever, confusion, oliguria with renal failure. Laboratory finding showed elevated liver enzyme with hypoalbuminemia and progressive azotemia. Despite supportive care, his azotemia progressed with anuria and acute hemodialysis was started. Kidney biopsy showed acute tubulointerstitial nephritis with vasculitis and indirect immunofluorecent antibody to murine typhus was 1: 3, 200. Doxycyclin was started and his renal function recovered. We report a case of acute renal failure resulting from murine typhus infection induced acute tubulointerstitial nephritis.
Acute Kidney Injury* ; Aged ; Anuria ; Azotemia ; Biopsy ; Central Nervous System ; Communicable Diseases ; Cytoplasm ; Fever ; Humans ; Hypoalbuminemia ; Kidney ; Liver ; Nephritis, Interstitial* ; Oliguria ; Parasites ; Renal Dialysis ; Renal Insufficiency ; Rickettsia typhi ; Typhus, Endemic Flea-Borne* ; Vasculitis