Seong Cheol Jeong

What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children

PURPOSE Recurrence is the most common complication after an initial episode of primary spontaneous pneumothorax (PSP). However, preventive surgery in children remains a controversial issue. The purpose of this study was to determine predictive factors of recurrence to better inform early surgical referrals. METHODS We retrospectively reviewed all consecutive patients under 18 years of age who conservatively treated for an initial episode of PSP between March 2005 and September 2011. RESULTS One hundred fourteen patients were included in this study. The mean follow-up period was 43.1 months. Ipsilateral and contralateral recurrence developed in 47.3% and 14.0% of patients. The risk of ipsilateral recurrence for patients with or without air-containing lesions according to high-resolution computed tomography (HRCT) was 60.3% and 31.4%. In the multivariate analysis, the presence of air-containing lesions on HRCT scans and bullae on chest X-rays were independent risk factors for ipsilateral recurrence. CONCLUSION The presence of bleb or bullae on HRCT scans or chest X-rays after an initial episode of PSP was significantly related to the ipsilateral recurrence in children. If the risk factors are clarified in further studies, hospital stays and the recurrence of PSP after the first episode could be reduced with early video-assisted thoracoscopic surgery.

Prevalence and risk factors of periodontitis among adults with or without diabetes mellitus

Background/Aims: This study examined prevalence and risk factors of periodontitis in representative samples of Korean adults, with and without diabetes mellitus (DM). Methods: Data from the 2012 Korean National Health and Nutritional Examination Survey were analyzed. A total of 4,477 adults (≥ 30 years old) were selected from 8,057 individuals who completed a nutrition survey, a self-reported general health behavior questionnaire, an oral examination, an oral hygiene behaviors survey, and laboratory tests. DM was defined as a fasting plasma glucose ≥ 126 mg/dL, or self-reported diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. The community periodontal index was used to assess periodontitis status and comparisons between the periodontitis and the non-periodontitis group, were performed, according to the presence of DM. Risk factors for periodontitis in adults with DM and without DM were evaluated by multiple logistic regression analysis. Results: The prevalence of periodontitis was significantly higher in adults with DM (43.7%) than in those without DM (25%, p < 0.001). In adults without DM, risk factors for periodontitis were older age, male, urban habitation, waist circumference, smoking, oral pain, and less frequent tooth brushing. Significant risk factors for periodontitis in adults with DM were the smoking, oral pain, and not-using an oral hygiene product. Conclusions: Adults with DM have an increased risk of periodontitis than those without DM. Current smoking and oral pain increase this risk. Using an oral hygiene product can reduce risk of periodontal disease in adults with DM.

Anemia resolved by thoracoscopic resection of a mediastinal mass: a case report of unicentric Castleman’s disease

Castlemans disease (CD) is an uncommon benign lymphoproliferative disorder that usually presents as a single or multiple mediastinal mass. In unicentric CD, constitutional symptoms are rare, but are curable with surgical resection. However, serious intraoperative bleeding often requires conversion to thoracotomy. We present a case of unicentric CD in a 25-year-old woman with anemia, who was successfully treated by thoracoscopic resection. We describe the clinical course from the initial presentation to diagnosis and surgical cure.

Increased urinary albumin/creatinine ratio is associated with atopic dermatitis in Korean males: The 2011-2013 Korea National Health and Nutrition Examination Survey

academic institution (Table I). Improved rates of alcohol and tobacco screening and of alcohol, tobacco, and obesity counseling were observed compared to the study published in 2014. Academicians averaged higher rates of screening based on guidelines. Although alcohol and tobacco screening rates were moderately high, less than half of both academicians and nonacademicians screened for hypertension, dyslipidemia, and diabetes mellitus. Approximately one-fifth of dermatologists reported never screening patients with psoriasis or referring them for management of cardiovascular risks, with worse screening rates in nonacademic (15.2%) versus academic (6.8%) dermatologists. A larger proportion of academic (16.9%) versus nonacademic (10.3%) dermatologists determined disease severity as the stimulating factor for screening, while more nonacademicians relied on history. A majority of respondents (61.6%) refer screening to PCPs. No respondents reported always handling the screening themselves and never referring out for screening. Despite geographically wide distribution, it is uncertain whether the subjects surveyed are truly representative of the entire dermatologic community. As with all surveys, ours was subject to response bias, which we attempted to mitigate by piloting and incorporating feedback from 20 initial respondents. Our results suggest that screening and counseling for modifiable lifestyle factors are the most commonly completed preventive efforts; however, more effort should be made to refer patients to PCPs or cardiologists to screen and manage hypertension, dyslipidemia, obesity, and diabetes mellitus. A possible explanation is the easier nature of verbally screening for the earlier factors; whereas, hypertension, dyslipidemia, diabetes mellitus, and obesity all require more time-consuming quantified measurements. Furthermore, dermatologists may be the primary/ exclusive providers for many patients with psoriasis, emphasizing our need to advise them to see their PCPs or order lab tests ourselves. Our results reinforce the benefit for both academic and nonacademic dermatologists’ involvement in Performance Improvement activities to maintain proper preventive practices for better patient outcomes.

Excision of epicardial cyst originating from the left ventricle using video-assisted thoracoscopic surgery without cardiopulmonary bypass

Pericardial cysts are occasionally encountered and successfully excised using video-assisted thoracoscopic surgery (VATS). However, cardiac cysts originating from the epicardium are extremely rare. Herein, we report an epicardial cyst that was completely excised using VATS. The epicardial cyst had a feeding vessel from the left ventricle and was considered to originate from the left ventricle. To the best of our knowledge, this case is the first to report excision of an epicardial cyst using VATS.

Flexible bronchoscopic excision of a tracheal mass under extracorporeal membrane oxygenation

Tracheal tumor is a rare but life-threatening condition that can cause obstruction of the airway. Management of tracheal tumors is very challenging and includes surgical resection, radiotherapy, and therapeutic bronchoscopy. Herein, we present a very rare case of an 88-year-old female patient with a tracheal mass due to direct invasion of a mediastinal teratoma. We devised a new method for resection of the tracheal mass because management of her airway and the tracheal mass by conventional methods was impossible. We successfully resected the tracheal mass with flexible bronchoscopic electrocautery under extracorporeal membrane oxygenation (ECMO) without any complications. When management of a patients airway and tracheal mass are impossible by conventional methods, this technique may be very useful.

Complete excision of acute necrotic regression of thymoma mimicking an infected mediastinal cyst with mediastinitis using video-assisted thoracoscopic technique

Thymomas are rare and demonstrate indolent growth (1). Because all thymoma are considered malignant due to local invasion or dissemination, wide surgical excision, such as total thymectomy without biopsy is the treatment of choice for both diagnosis and therapy (1-3).

Successful surgical treatment of massive spontaneous hemothorax due to intrathoracic secondary degeneration of a neurofibroma from mediastinal involvement of type 1 neurofibromatosis

Massive hemothorax caused by a mediastinal mass is extremely rare. Herein, we present a case of successful surgery for a massive hemothorax caused by intrathoracic cystic hemorrhagic degeneration of a neurofibroma in a patient with neurofibromatosis type 1 (NF1). A 44-year-old man with NF1 was admitted to our emergency department for chest pain and dyspnea. Image studies revealed a massive hemothorax caused by a posterior mediastinal mass adjacent to the descending aorta and the spinal canal. The tumor, located at the fourth to the sixth thoracic vertebra, had diffusely and extensively infiltrated around proliferative vessels. It was successfully excised via thoracostomy after aortic cross-clamping preparation. Final pathology revealed that the tumor was cystic hemorrhagic degeneration of a neurofibroma from mediastinal involvement of NF1. The patient had an uneventful postoperative course and was discharged on the 10th postoperative day. There was no recurrence of tumor or hemothorax six months after surgery.

Prevalence and risk factors for reduced pulmonary function in diabetic patients: The Korea National Health and Nutrition Examination Survey

Background/Aims An association between reduced pulmonary function and diabetes has been observed. Our aim was to evaluate the prevalence and risk factors associated with reduced pulmonary function in diabetic patients. Methods We analyzed data from the Korea National Health and Nutrition Examination Survey 2011 to 2013. The study population included data from 8,784 participants (including 1,431 diabetics) aged ≥ 40 years. Reduced pulmonary function was defined as patients with restrictive (forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] ≥ 0.7 and FVC < 80% of predicted value) or obstructive (FEV1/FVC < 0.7) patterns. Results Subjects with diabetes had a higher prevalence of restrictive (18.4% vs. 9.4%, p < 0.001) and obstructive impairments (20% vs. 12.6%, p < 0.001) than those without diabetes. The adjusted odds ratios (aORs) (95% confidence interval [CI]) for obstructive and restrictive pulmonary impairment were 0.91 (0.75 to 1.11) and 1.57 (1.30 to 1.89), respectively. In the diabetes population, age (aOR, 1.04; 95% CI, 1.02 to 1.06), male sex (aOR, 1.40; 95% CI, 1.04 to 1.88), and body mass index (aOR, 1.15; 95% CI, 1.10 to 1.21) were independently associated with restrictive pulmonary impairment. Age (aOR, 1.12; 95% CI, 1.09 to 1.14), male sex (aOR, 4.24; 95% CI, 2.42 to 7.44), and smoking at any point (ever-smoker: aOR, 1.96; 95% CI, 1.16 to 3.33) were independent risk factors for obstructive pulmonary impairment in diabetics. Diabetes duration or glycated hemoglobin had no association with pulmonary impairment in diabetes. Conclusions Subjects with diabetes had a higher risk of restrictive pulmonary impairment than those without diabetes after adjusting for confounding factors. Older age, male sex, body mass index, and smoking were associated with reduced lung function in diabetes.

Association between Cockroach-specific Immunoglobulin E and periodontitis in Korean male adults Based on Korean National Health and Nutrition Examination Survey

Periodontitis is an inflammatory disease affecting the tooth supporting tissues (periodontium) and associated with chronic diseases such as cardiovascular disease and insulin resistance. However, there has been no nation-wide population based epidemiologic study regarding any association between periodontitis and serum IgE. Among the 8,958 participants in the 2010 Korean National Health and Nutrition Examination Survey (KNHANES V-1), 1,731 adults aged 19 to 64 who had measured serum IgE were included in the analysis. Dentists examined the periodontal status of the participants. Multiple logistic regression analyses were used to evaluate the odds ratio of periodontitis in association with total IgE and specific IgE to cockroach and house dust mite. In males, total IgE showed a positive correlation with the presence of periodontitis. The participants in the highest tertile of cockroach specific IgE (T3, >31.6 kU/L) had a significantly increased risk of periodontitis (OR = 2.108; 95% CI, 1.233–3.606). In females, the inverse association occurred between total IgE and periodontitis (OR = 0.409; 95% CI, 0.200–0.839). The present study firstly demonstrated the association between periodontitis and serum IgE, using the Korean nationwide, population-based, cross-sectional health examination and survey. This study suggested a positive correlation between periodontitis and cockroach-specific IgE in Korean male adults.