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Diagnostic Approach to Refractory Constipation.

Tae Hee LEE

Korean Journal of Medicine.2017;92(6):514-520. doi:10.3904/kjm.2017.92.6.514

No abstract available.
Constipation*

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Misunderstandings and Truth about Chronic Cough.

Seung Hun JANG

Korean Journal of Medicine.2017;92(6):506-513. doi:10.3904/kjm.2017.92.6.506

There seem to be several pitfalls in an anatomic, diagnostic protocol for the evaluation of chronic cough. Instead, it is reasonable to propose that non-asthmatic chronic cough depends on the combined effects of an underlying, abnormally enhanced cough reflex and aggravating factors. Unexplained chronic cough is distressingly common despite a systematic diagnostic approach. It is often related to bronchial hypersensitivity and nonspecific bronchial inflammation. Inhaled corticosteroid (ICS) is effective for asthmatic cough. ICS is less effective in non-asthmatic cough than in asthma but not ineffective. It can be modestly effective in a significant portion of patients with non-asthmatic cough. Cough itself can induce upper airway mucosal inflammation, which could enhance the cough reflex and viciously aggravate cough. Therefore, an antitussive agent is not a just symptom controller but can play a major role in successful cough control. Cough can be more effectively controlled by behavioral interventions, with psychological counseling in addition to a pharmacological approach. ICS and antihistamines can reduce cough regardless of its cause, so therapeutic diagnosis is a misconception in the diagnosis of cough.
Asthma ; Cough* ; Counseling ; Diagnosis ; Histamine Antagonists ; Humans ; Hypersensitivity ; Inflammation ; Reflex

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New Classification Criteria for Primary Sjögren's Syndrome and Salivary Gland Ultrasonography.

Kyung Ann LEE ; Hae Rim KIM ; Sang Heon LEE

Korean Journal of Medicine.2017;92(6):499-505. doi:10.3904/kjm.2017.92.6.499

Primary Sjögren's syndrome (pSS) is a chronic autoimmune inflammatory disorder characterized by lymphocytic infiltration of exocrine organs. Since 1965, several sets of classification criteria for pSS have been proposed by single experts or groups of multidisciplinary specialists. In 2002, the American-European Consensus Group proposed new classification criteria, which have been widely used in both clinical trials and routine clinical practice. In 2012, updated classification criteria were approved by the American College of Rheumatology (ACR). The existence of two different sets of criteria emphasized the need for an international consensus. Using methods consistent with those employed to develop recent ACR/European League Against Rheumatism (EULAR)-approved criteria, new ACR/EULAR classification criteria for pSS were developed and endorsed in 2016. Salivary gland ultrasonography (SGUS) is a new imaging tool used to detect salivary gland abnormalities in pSS patients. Several reports on the utility of SGUS for pSS diagnosis have appeared. This review focuses on the new 2016 ACR/EULAR classification criteria for pSS and the clinical application of SGUS in patients with pSS.
Classification* ; Consensus ; Diagnosis ; Humans ; Rheumatic Diseases ; Rheumatology ; Salivary Glands* ; Specialization ; Ultrasonography*

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Influenza.

Seong Yeol RYU

Korean Journal of Medicine.2017;92(6):494-498. doi:10.3904/kjm.2017.92.6.494

Influenza causes variable epidemics annually and imposes public health problems and socioeconomic burden. They cause epidemic acute respiratory disease, characterized by fever, cough and systemic symptoms. The annual epidemics of seasonal influenza can affect any age group and result in serious illness or death, particularly in high risk populations such as adults > 65 years old, children < 2 years old and those with chronic medical condition at any age. Three types (A, B, and C) are recognized as well as many subtypes within the type A. New influenza A virus subtypes sporadically emerge in humans to cause widespread disease or pandemics. Antiviral therapy with oseltamivir or zanamivir is available and shorten the duration of illness and reduce the rate of complications. Influenza vaccines are effective in the prevention of influenza illness, although improved vaccines are needed.
Adult ; Child ; Cough ; Fever ; Humans ; Influenza A virus ; Influenza Vaccines ; Influenza, Human* ; Oseltamivir ; Pandemics ; Public Health ; Seasons ; Vaccines ; Zanamivir

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Hospice-Palliative Care and Law.

Do Kyong KIM

Korean Journal of Medicine.2017;92(6):489-493. doi:10.3904/kjm.2017.92.6.489

No abstract available.
Jurisprudence*

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Acute renal infarction : Clinical features in 23 cases.

Jung Sup KIM ; Sung Yik LEE ; Jung Hee KIM ; Eun Hoe KWON ; Sang Heon SONG ; Dong Won LEE ; Soo Bong LEE ; Ihm Soo KWAK

Korean Journal of Medicine.2006;70(5):543-550.

BACKGROUND: Acute renal infarction is an uncommon disease which is often delyed or missed due to its rarity and unspecific clinical presentation. METHODS: In order to evaluate the clinical features and to elucidate diagnostic or therapeutic options, we analyzed the medical records of 23 patients who were admitted to Pusan National University Hospital from January, 1995 to July, 2004 and diagnosed as renal infarction. RESULTS: The mean age of the patients was 57.3 18.4 years and male to female ratio was 0.91:1. Underlying diseases were cardiovascular disease (n=18), tumor embolism (n=1), vasculitis (n=1), post kidney transplantation thrombosis (n=1), and trauma(n=1). One patient did not have any underlying disease. Initial symptoms were abdominal or flank pain (61%), fever (35%), anorexia (35%), nausea (26%), vomiting (17%), gross hematuria (9%), and oliguria (4%). On physical examination, costovertebral angle tenderness (43%), abdominal tenderness (9%), and hypertension (35%) were noted. Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (87%), ALT (83%), CK (22%), and creatinine (>1.4 mg/dL, 17%). Imaging diagnosis of renal infarction included renal angiography, isotope renal scan, computed tomography or ultrasonography. CT was done in 17/23 cases and useful in diagnosis of renal infarction. Nine patients were treated with heparin or warfarin. Thrombolysis was done in 3 patients. Others were treated conservatively. CONCLUSIONS: In a patients with an increased risk of thromboembolism, flank or abdominal pain, microscopic hematuria, and an elevated serum LDH are strongly supportive of diagnosis of renal infarction. Under such circumstances, enhanced CT is essential for the early diagnosis of renal infarction.
Abdominal Pain ; Angiography ; Anorexia ; Busan ; Cardiovascular Diseases ; Creatinine ; Diagnosis ; Early Diagnosis ; Female ; Fever ; Flank Pain ; Hematuria ; Heparin ; Humans ; Hypertension ; Infarction* ; Kidney Transplantation ; Male ; Medical Records ; Nausea ; Neoplastic Cells, Circulating ; Oliguria ; Physical Examination ; Renal Insufficiency ; Thromboembolism ; Thrombosis ; Ultrasonography ; Vasculitis ; Vomiting ; Warfarin

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Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules.

Hyun Jung TAE ; Ki Hyun BAEK ; Ho Sang LEE ; Byoung Ha JUNG ; Eui Hyung KIM ; Dae Sung KIM ; Hong Kun BIN ; Jeong Hoon KIM ; Jung Eun CHOI ; Jong Min LEE ; Moo Il KANG ; Bong Yun CHA ; Ho Young SON ; Sung Koo KANG ; Kwang Woo LEE

Korean Journal of Medicine.2006;70(5):535-542.

BACKGROUND: Thyroid ultrasonography can accurately detect nonpalpable nodules, estimate the size of the nodule during follow-up, and discriminate between solid nodules and simple cysts. Many studies have recently been done to detect malignant thyroid nodules by high-resolution ultrasonography. However, the exact role of high-resolution ultrasonography in distinguishing benign from malignant nodules is still unresolved. We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography. METHODS: We retrospectively analyzed the sonographic feature of thyroid nodules in patients who had been examined with fine-needle aspiration cytology or had surgery for a thyroid nodule at St. Mary's Hospital, Korea from January 2003 to January 2005. Sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as category 3 (malignant). If a nodule had none of the features described, it was classified as category 2 (benign). Anechogenic cystic nodule was classified as category 1 (benign). RESULTS: Of 124 lesions classified as category 3, 60 were malignant. Of 418 lesions classified as category 1 or 2, 409 was benign. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy based on sonographic classification method were 90%, 86.5%, 48.4%, 97.8%, 86.5%, respectively. CONCLUSIONS: Our results identified sonographic classification with calcification, margin, echogenicity and shape as useful tool in the differentiation of malignant from benign nodule. In view of the high value of negative predictive value of sonographic classification, a more aggressive approach is recommended only for nodules with category 3.
Biopsy, Fine-Needle ; Classification ; Humans ; Korea ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

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Clinical characteristics of constipation associated with diabetes mellitus.

Taeg Soo KIM ; Jeong Sik BYEON ; Seung Jae MYUNG ; Suk Kyun YANG ; Jung Eun KO ; Oh Ryoun KWON ; In Ja YOON ; Jeong Min KANG ; Hyun Woo KIM ; Jung Min AHN ; Soon Joo KIM ; Ji Yun JO ; Kee Don CHOI ; Gin Hyug LEE ; Hwoon Yong JUNG ; Weon Seon HONG ; Jin Ho KIM

Korean Journal of Medicine.2006;70(5):527-534.

BACKGROUND: Constipation occurs frequently in diabetes mellitus (DM). However, there are few reports that investigated the characteristics of constipation associated with DM. The purpose of this study was to evaluate the clinical features of constipation associated with DM. METHODS: Among constipated patients who visited Asan Medical Center from January 2000 to December 2004, 45 patients with DM (DM group) and 104 patients without DM (non-DM group) were included in this study. We reviewed the clinical presentation, results of anorectal manometry, colon transit time study, and defecogram. We also analyzed the response to biofeedback therapy. RESULTS: The severity of constipation symptoms before treatment was not different between DM and non-DM group. Patients with colon transit time over 56 hours were more frequent in DM group than in non-DM group (21/45, 46.7% vs. 31/104, 29.8% ; p=0.047). Among DM group, colon transit time and the duration of DM showed positive correlation (r=0.431, p=0.003). The resting anal sphincter pressure was significantly lower in DM group than in non-DM group (43.5+/-21.5 mmHg vs. 51.7+/-22.6 mmHg ; p=0.048). The results of defecography were similar between DM and non-DM group. Successful responses to biofeedback therapy were not different between DM and non-DM group (19/34, 55.9% vs. 43/79, 54.4% ; p=0.887). CONCLUSIONS: Slow transit constipation was more frequent in DM group than in non-DM group. The successful responses to biofeedback therapy appear to be similar between DM and non-DM group.
Anal Canal ; Biofeedback, Psychology ; Chungcheongnam-do ; Colon ; Constipation* ; Defecography ; Diabetes Mellitus* ; Humans ; Manometry ; Time and Motion Studies

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Clinical features and imaging findings of portal biliopathy.

Tae Oh KIM ; Gwang Ha KIM ; Sang Yeon HWANG ; Sang Yong LEE ; Jeong HEO ; Dae Hwan KANG ; Geun Am SONG ; Mong CHO ; Suk KIM ; Jun Woo LEE

Korean Journal of Medicine.2006;70(5):518-526.

BACKGROUND: The term 'portal biliopathy' has been used to describe abnormalities of the extrahepatic and intrahepatic bile ducts in patients with portal hypertension, especially those with extrahepatic portal vein obstruction. The aim of this study was to delineate the clinical features and imaging findings of portal biliopathy. METHODS: Clinical and imaging data of 15 patients who had portal biliopathy from April 2001 to March 2005 were reviewed. Two radiologists working in concensus analyzed the imaging finings and each radiologist and gastroenterologist made a comparison between MRCP and ERCP. RESULTS: Of the 15 patients with portal biliopathy, there were 7 men and 8 women and their mean age was 56.4 years (range, 24 to 78 years). Most of them were unknown origin (11/15, 73%) and 4 patients combined with recurrent pyogenic cholangitis. 4 patients presented with obscure right abdominal pain, 3 had mild fever with chilling and others had no symptoms. Extrahepatic portal vein obstruction was replaced by cavernous transformation in all patients. 3 different types of biliary abnormalities were 3 pseudocholangiocarcinoma type, 8 varicoid type and 4 mixed type. Choledocholithiasis occuring 4 patients (2 CBD stone, 1 GB stone and 1 CBD with IHD stone). Correlation betwen MRCP and ERCP (or PTC) was identical and exact diagnosis was possible. During EST or cholecystectomy, no significant bleeding was found. CONCLUSIONS: On portal hypertension combined with biliary obstruction, portal biliopathy should be suspected as a possible diagnosis. Knowledge of these clinical features and imaging findings should facilitate accurate diagnosis of portal biliopathy.
Abdominal Pain ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledocholithiasis ; Diagnosis ; Female ; Fever ; Hemorrhage ; Humans ; Hypertension, Portal ; Male ; Portal Vein

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Decrease in serum concentration of nitric oxide (NO) metabolites after lamivudine therapy in patients with chronic hepatitis B.

Sung Keun PARK ; Yong Kyun CHO ; Sang Jun HWANG ; Young Lyul KOH ; Hyun Jong LEE ; Hyo Sun CHOI ; Ji Cheul PAE ; Jung Ho PARK ; Hong Joo KIM ; Dong Il PARK ; Chong Il SOHN ; Woo Kyu JEON ; Byung Ik KIM ; Ji Won MO ; Chang Shin PARK

Korean Journal of Medicine.2006;70(5):511-517.

BACKGROUND: It is known that the hepatic nitric oxide (NO) production is induced by various pathologic inflammatory response such as viral hepatitis and mediated by various cytokines from hepatic immune or non-immune cells. We have investigated nitric oxide metabolites (NOx) concentration to know the effect of lamivudine treatment on NOx in chronic hepatitis B patients, and the association between NO metabolic concentration and other clinical factors. METHODS: The study subjects comprised 70 candidates for antiviral treatment for chronic viral hepatitis B. We observed the concentration of NOx in patients group before and after antiviral treatment with lamivudine 100 mg for 24 weeks and compared them with controls. We also examined clinical factors which can affect the concentration of NOx. RESULTS: The mean concentration of NOx in chronic viral hepatitis B patients was significantly higher than that of control group. (patient group: 78.2+/-12.7 micrometer and healthy control group: 31.8+/-11.3 micrometer, p=0.014). The mean concentration of NOx significantly decreased after lamivudine treatment (after treatment: 44.2+/-17.9 micrometer and before treatment: 78.2+/-12.7 micrometer, p=0.027). HBV DNA titer and ALT level were significantly correlated with the concentration of NOx (HBV DNA titer: r=0.697, p=0.038 and ALT level: r=0.402, p=0.012). CONCLUSIONS: The fact that serum NO concentration increased proportionally to the amount of ALT and HBV DNA and decreased after the treatment with lamivudine suggests that serum concentration of NO have correlation with course of HBV infection.
Cytokines ; DNA ; Hepatitis ; Hepatitis B ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Nitric Oxide*

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