Recently, novel biologics or small molecular drugs have been introduced for overcoming the unmet needs associated with anti-tumor necrosis factor α agents for inflammtory bowel disease (IBD) treatment. Among these novel drugs, anti integrin agents block leukocyte trafficking to the intestine by blocking the interaction between integrin and cell adhesion molecules. Vedolizumab (anti-α4β7) is most widely used anti-integrin approved in both ulcerative colitis and Crohn’s disease .It has been shown to be effective in both induction and maintenance therapy with a favorable safety profile due to gut selectivity. Several models incorporating clinical, genetic, immune and gut microbial markers to predict response to vedolizumab in IBD have been developed. Etrolizumab (anti-β7) blocks leukocyte trafficking via α4β7 and cell adhesion via αEβ7 integrins. In addition, the introduction of subcutaneous vedolizumab showed similar efficacy and safety with improved patients’ convenience. Other investigational anti-integrin therapies include abrilumab (anti-α4β7 IgG2), PN-943 (orally administered and gut-restricted α4β7 antagonist peptide), AJM300 (orally active small molecule inhibitor of α4), and ontamalimab (anti-MAdCAM-1 IgG).

BACKGROUND/AIMS: Mesenteric microvascular thrombosis has been implicated as a contributing factor to the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to assess the possibility of subclinical atherosclerosis in patients with IBD by measuring their carotid intima-media thickness (c-IMT). METHODS: Thirty-eight patients with IBD who were followed-up for at least 3 years participated. Patients with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded. As a control group, 38 healthy patients matched for age and gender without atherosclerosis risk factors were included. Carotid ultrasonography was performed in all patients and controls. Patient baseline characteristics and laboratory parameters were recorded to evaluate atherosclerosis risk factors. RESULTS: The mean age of patients with IBD was 38.5+/-6.62 years. Twenty-three patients with IBD were diagnosed with ulcerative colitis and the other 15 cases were diagnosed with Crohn's disease. The median duration of disease was 52.0 months. Serologic markers such as erythrocyte sedimentation rate, C-reactive protein (CRP), and cholesterol levels differed significantly, however, there was no significant difference in c-IMT between patients with IBD and those in the control group (0.53+/-0.10 mm vs. 0.53+/-0.07; P=0.85). Multivariate analysis revealed that body mass index, CRP, disease duration, and age were significantly correlated with c-IMT in patients with IBD. CONCLUSIONS: The results of the current study did not show an increase in c-IMT in patients with IBD. Further studies that include more subjects and a longer follow-up period will be necessary in order to evaluate the risk of atherosclerosis in Korean patients with IBD.
Atherosclerosis ; Blood Sedimentation ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Intima-Media Thickness* ; Cholesterol ; Colitis, Ulcerative ; Crohn Disease ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases* ; Multivariate Analysis ; Risk Factors ; Thrombosis ; Ultrasonography

Suppressing the verbal expression of anger is related to increased pain severity. We investigated the relationship between the pain and anger using a questionnaire in patients with back or neck pain. From August 2007 to January 2008, 173 patients visited our hospital due to back and/or neck pain. They answered the questionnaire before physical examination by themselves. Visual analog scale(VAS) was used to measure the intensity of the pain. The same method was used to measure the intensity and frequency of the anger. We also asked the degree of sleep disturbance, fatigue, loss of appetite, and mood. Psychological disturbances were relatively common; moderate to severe sleep disturbance in 66%, fatigue in 79%, loss of appetite in 55%, and depressed mood in 86%. More than a half answered their anger was moderate to severe in both frequency and degree. All psychological factors appeared to be strong contributors to the intensity of pain by a linear regression analysis. More than a half of the patients with back or neck pain have significant psychological problems. Proper evaluation and management of those psychological factors are important.
Anger ; Appetite ; Back Pain ; Fatigue ; Humans ; Linear Models ; Neck ; Neck Pain ; Physical Examination ; Surveys and Questionnaires

Intracranial dermoid cyst is a rare congenital benign disease, representing less than 0.5% of primary brain tumors. Nevertheless, if ruptured spontaneously or during surgery, it has a poor prognosis due to chemical meningitis. Therefore, it is essential to perform accurate diagnosis and proper treatment. We report an intracranial subdural dermoid cyst that may be misdiagnosed as extracranial or epidural lesion because of extension into the right foramen ovale, and describe the CT and MR imaging findings.
Brain Neoplasms ; Dermoid Cyst* ; Diagnosis ; Foramen Ovale* ; Magnetic Resonance Imaging* ; Meningitis ; Prognosis

PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.
Alprostadil ; Education ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Humans ; Male ; Papaverine ; Phentolamine

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.
Adult ; Child* ; Critical Illness ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital* ; Humans ; Observational Study* ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Triage*

OBJECTIVES: The purpose of this study was to assess the microbiological quality of unchlorinated drinking water in Korea, 2010. One hundred and eighty unchlorinated drinking water samples were collected from various sites in Seoul and Gyeonggi province. METHODS: To investigate bacterial presence, the pour plate method was used with cultures grown on selective media for total bacteria, total coliforms, and Staphylococcus spp., respectively. RESULTS: In the 180 total bacteria investigation, 72 samples from Seoul and 33 samples from Gyeonggi province were of an unacceptable quality (>10(2) CFU/mL). Of all the samples tested, total coliforms were detected in 28 samples (15.6%) and Staphylococcus spp. in 12 samples (6.7%). Most of the coliform isolates exhibited high-level resistance to cefazolin (88.2%), cefonicid (64.7%) and ceftazidime (20.6%). In addition, Staphylococcus spp. isolates exhibited high-level resistance to mupirocin (42%). Species of Pseudomonas, Acinetobacter, Cupriavidus, Hafnia, Rahnella, Serratia, and Yersinia were isolated from the water samples. CONCLUSIONS: The results of this study suggest that consumption of unchlorinated drinking water could represent a notable risk to the health of consumers. As such, there is need for continuous monitoring of these water sources and to establish standards.
Acinetobacter ; Bacteria ; Cefazolin ; Cefonicid ; Ceftazidime ; Cupriavidus ; Drinking ; Drinking Water ; Hafnia ; Korea ; Mupirocin ; Pseudomonas ; Rahnella ; Serratia ; Staphylococcus ; Water ; Yersinia

BACKGROUND/AIMS: Bowel wall thickening on CT has been reported to reflect colorectal carcinoma and colitis. The aim of this study was to evaluate the clinical significance of the large intestinal wall thickening on CT. METHODS: Between January 2006 and August 2010, medical records of 815 patients who underwent endoscopy after CT scans within 1 month were reviewed retrospectively. RESULTS: A total of 233 patients were included. The wall thickening was actually associated with abnormal endoscopic findings in 81.1% of the cases. The accuracy rate on diagnosis between CT and endoscopy was 63.5%. The discrepancy in diagnosis was higher in cases with left colon abnormality and short segment lesion. Abdominal pain was significantly more common in cases suspected malignancy on CT compared with colitis (p=0.047). Most of the malignancy diagnosed on CT involved the left side colon and most of the colitis involved the entire colon (p<0.001). The length of lesion was below 5 cm in 86.5% of the malignancy. Malignancy was more common in patients aged over 50 years with hemoglobin below 12 g/dL. The CT findings significantly suggestive of malignancy were lymph node enlargement and length of lesion below 5 cm (p=0.027 and p<0.001). CONCLUSIONS: The large intestinal wall thickening on CT was limited in the differential diagnosis of malignancy and colitis. Additional endoscopic evaluation is needed in patients with bowel wall thickening associated with lymph node enlargement and short segment lesion on CT in order to exclude malignancy.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colitis/*diagnosis/radiography ; Colonic Neoplasms/*diagnosis/radiography ; Colonoscopy ; Female ; Hemoglobins/analysis ; Humans ; Intestine, Large/*physiopathology ; Lymph Nodes/physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.
Adult ; Aged ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Sigmoidoscopy ; Tomography, X-Ray Computed

OBJECTIVE: The purpose of this study is to investigate the incidence of new compression and to analyze factors that influence the fractures in adjacent levels after percutaneous vertebroplasty (PVP). METHODS: This retrospective study examined 206 patients who had undergone PVP for single level osteoporotic or osteopenic compression fractures during the last seven years in our department. After PVP, the patients were observed for at least over one year, and 29 patients showed new additional compression fractures in adjacent levels. One hundred seventy seven patients who did not show additional compression fractures were analyzed as the control group. Statistical comparisons were performed between the groups, in terms of age, gender, bone mineral density, whether bisphosphonate (BPP) was treated, preoperative kyphosis, preoperative wedge angle, change in wedge angle, amount of bone cement, existence of intradiscal bone cement leakage, and initial fracture levels. RESULTS: The statistically significant factors that influence new compression fractures in adjacent levels after PVP were as follows: being female, initial thoracolumbar junction fracture, preoperative large kyphotic, preoperative large wedge angle, change in wedge angle, administration of BPP in osteopenia group, and intradiscal cement leakage. CONCLUSION: This study identified many factors that influence newly developed compression fractures in adjacent levels after PVP. Interestingly, the administration of BPP in osteopenia group had positive influence on new fractures in this study. Therefore, we recommend early administration of BPP to patients with osteopenia.
Aged* ; Bone Density ; Bone Diseases, Metabolic ; Diphosphonates ; Female ; Fractures, Compression* ; Humans ; Incidence ; Kyphosis ; Retrospective Studies ; Risk Factors* ; Spinal Fractures ; Vertebroplasty*