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Background/Aims: The controlled attenuation parameter (CAP), based on tran sient elastography, is widely used for noninvasive assessment of the degree of hepatic steatosis (HS). We investigated the correlation of the degree HS between CAP and ultrasound (US) in patients with HS. Methods: In total, 986 patients with US-based HS who underwent transient elas tography within 1 month were evaluated. The US-based grade of HS was catego rized as mild (grade 1), moderate (grade 2), or severe (grade 3). Results: The CAP was significantly correlated with the US-based grade of HS (r = 0.458, p < 0.001). The median CAP value of each US-based HS grade showed a pos itive correlation with grade (271.1, 303.7, and 326.7 dB/m for grades 1, 2, and 3). In a multivariate analysis, the US-based HS grade, body mass index, serum albumin, alanine aminotransferase, and total cholesterol, and liver stiffness were all sig nificantly correlated with the CAP value (all p < 0.05). The areas under the receiver operating characteristic curves for grade 2 to 3 and grade 3 HS were 0.749 (95% confidence interval [CI], 0.714 to 0.784) and 0.738 (95% CI, 0.704 to 0.772). The opti mal cut-off CAP values to maximize the sum of the sensitivity and specificity for grade 2 to 3 and grade 3 HS were 284.5 dB/m (sensitivity 78.6%, specificity 61.7%) and 298.5 dB/m (sensitivity 84.6%, specificity 55.6%). Conclusions: The correlation of the degree of HS between CAP and US was sig nificantly high in patients with HS, and the optimal cut-off CAP values for grade 2 to 3 and grade 3 HS were 284.5 and 298.5 dB/m.

식이(r=.24, p=.011), 약물(r=.43, p

Gastrointestinal stromal tumors (GISTs) and non-GIST subepithelial tumors (SETs) account for about 75 and 25 % of gastric hypoechoic SETs ≥2 cm, respectively. Therefore, identifying preoperative predictive factors for GISTs are required to refine surgical indications. We performed a retrospective review of 375 surgically resected gastric hypoechoic SETs ≥2 cm. Demographic data and tumor characteristics based on upper endoscopy and CT findings were compared between GIST and non-GIST SETs originating from muscularis propria layer (leiomyomas, Schwannomas, glomus tumors, and ectopic pancreas). In cardia, leiomyomas were found twice more frequently than GISTs (63.6 versus 31.8 %). Perilesional lymph node enlargement (PLNE) was found only in patients with GIST or Schwannomas. Patients with GIST showed a significantly lower rate of PLNE than those with Schwannomas (3.5 versus 29.0 %). In multivariate analysis, tumor site outside cardia (odds ratio, 9.157), absence of PLNE (odds ratio, 11.519), old age, large tumor size, exophytic growth pattern, and ulceration or dimpling were identified as independent preoperative predictive factors for GISTs versus non-GIST SETs. The effort for preoperative pathologic diagnosis such as endosonography-guided tissue sampling might be positively considered for SETs at cardia and SETs with PLNE where the possibility of GIST is low.

Purpose: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the χ 2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p⁄0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p¤0.05). Conclusion: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain. (Imaging Sci Dent 2014; 44: 293-9)

The fasciocutaneous flap transplanted into the oral cavity often acquires a gross appearance resembling that of intraoral mucosa. The purpose of this study was to analyze the histologic and morphological changes of the fasciocutaneous free flap in oropharyngeal reconstruction and attempt to determine the related causes. A study was done from January 2006 to February 2010. Study subjects included 67 of 239 patients who had undergone reconstructive surgery after oropharyngeal tumor resection. Histologic evaluation of biopsy specimens was also performed in 20 patients. The correlation of the morphological changes with various factors was analyzed. The histologic examination revealed that numerous histologic changes occurred although the overall structure of the skin was maintained. Analysis of the associated factors showed that the primary defect site was highly correlated with this morphological change in the intraoral flaps.Analysis of the associated factors showed that the primary defect site was highly correlated with this morphological change in the intraoral flaps. Histologic analysis reveals that fasciocutaneous free flaps maintain their feature as cutaneous skin yet undergo changes because of the characteristic oral cavity environment, which resulted in an intermediate-stage morphology.

We assessed the association among ultrasonographically detected non-alcoholic fatty liver disease (US-NAFLD), metabolic syndrome (MetS), and insulin resistance (IR) in non-obese, non-diabetic middle-aged adults, to find out whether US-NAFLD is independently associated with IR in this population.A total of 5,878 non-obese (body mass index, ≥ 18.5 and25), non-diabetic individuals were analyzed. IR was estimated with the homeostasis model assessment index (HOMA2-IR) and defined when HOMA2-IR ≥ 1.5. MetS was defined by the Adult Treatment Panel III (ATP III) criteria.MetS was present in 381 (6.5%) participants, IR was present in 801 (13.6%) participants, and US-NAFLD was present in 1,611 (27.4%) participants. The increase in the prevalence of US-NAFLD closely followed the increase in the number of metabolic components diagnosed according to the ATP III criteria (15.2%, 28.5%, 48.0%, 65.7%, 71.4%, and 100% for 0, 1, 2, 3, 4, and 5 metabolic components, respectively, P0.001). US-NAFLD showed a significantly higher odds ratio (OR) for IR, regardless of the number of metabolic components (OR (95% confidence interval) of 3.48 (2.45-4.94), 3.63 (2.74-4.82), 3.19 (2.29-4.44), and 2.43 (1.43-3.81) for 0, 1, 2, and ≥ 3 metabolic components, respectively, P0.001 for all values). MetS showed a low sensitivity (0.22) for the identification of individuals with IR, and either US-NAFLD alone (0.60) or US-NAFLD with MetS (0.66) improved sensitivity with acceptable trade-off in specificity.US-NAFLD was an independent predictor for IR, irrespective of the number of metabolic components of MetS in the non-obese, non-diabetic middle-aged Asian adults. US-NAFLD could identify individuals with IR that cannot be identified by MetS in this population.

Gardner syndrome is known as a variant of familial adenomatous polyposis. This syndrome is characterized by multiple intestinal polyposes, osteomas, and epidermoid cysts. In addition, dental abnormalities include an increased frequency of multiple odontomas, as well as supernumerary and impacted teeth. The authors report the case of a 7-year-old male patient with Gardner syndrome. Radiographic findings revealed multiple osteomas in both sides of the maxilla, multiple diffuse enostoses in both jaws, and a complex odontoma in the left mandibular body. Two years later, multiple epidermoid cysts on the scalp were found. Since this patient was suspected to have Gardner syndrome, the authors recommended gastrointestinal endoscopy to check for intestinal polyposis. Gastrointestinal endoscopic examination revealed multiple polyposes in the upper gastrointestinal tract and fundus of the stomach. As a result, the final diagnosis was Gardner syndrome.

Entecavir (BaracludeⓇ) is an oral antiviral drug used for the treatment of HBV. Entecavir is a reverse transcriptase inhibitor which prevents the HBV from multiplying. Most common adverse reactions caused by entecavir are headache, fatigue, dizziness, and nausea. Until now, there has been no report of peripheral neuropathy as a side effect associated with entecavir treatment. Herein, we report a case of peripheral neuropathy which probably occurred after treatment with entecavir in a hepatitis B patient. The possibility of the occurrence of this side effect should be carefully taken into consideration when a patient takes a high dose of entecavir for a long period of time or has risk factors for neuropathy at the time of initiating entecavir therapy. (Korean J Gastroenterol 2016;67:216-219)

Background/Aims Serum alanine aminotransferase (ALT) is an easily available, low-cost screening tool for detecting silent chronic liver disease. Recent studies have suggested that the currently accepted healthy ALT thresholds be lowered. Methods In this retrospective cross-sectional study, we determined upper thresholds for ALT values in a nationally representative healthy cohort (n = 3337) from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Sensitivity and specificity of the currently used ALT threshold (40 IU/L, regardless of gender) was compared against study-derived, gender-specific ALT thresholds for detecting individuals at risk for chronic liver disease in 27 913 health check-up participants. Results The 95th percentile levels for ALT in healthy weight, metabolically normal, liver disease-free KNHANES participants were 34 IU/L for men and 25 IU/L for women. The prevalence of ALT elevation among health check-up participants was 11.0% in currently used thresholds, and increased to 22.6% with study-derived, gender-specific thresholds. Of the population who were additionally defined to have elevated ALT levels under new ALT threshold, 65.7% were at risk for chronic liver disease. Sensitivity for detecting individuals at risk for chronic liver disease improved from 18 to 33% with new thresholds whereas a trade-off in specificity (from 96 to 88%) was observed. Conclusions It is recommendable to lower the current ALT thresholds to better identify individuals at risk for chronic liver disease.

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.

Black esophagus is a rare condition of the esophagus that manifests as endoscopic findings of black-colored esophageal mucosa, which is usually caused by acute esophageal necrosis. We report a case of alcoholic patient who developed black esophagus. The 85-year-old man was admitted to Severance Hospital due to copious hematemesis over 2 days. Upper gastrointestinal endoscopy showed black-colored mucosa in the distal esophagus. Endoscopic biopsies of the esophagus revealed necrotic tissue, without any viable cells. Follow-up upper gastrointestinal endoscopy performed after supportive care with a proton-pump inhibitor, sucralfate, and total parenteral nutrition resulted in the remarkable healing of the esophageal wall with no complications.

Purpose: This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). Materials and Methods: The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher’s exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side. Conclusion: Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P¤0.05). (Imaging Sci Dent 2013; 43 : 245-51)

골육종의 위장관 전이는 매우 드물다. 그러나 보조적 항암치료의 도입 이후 골육종의 위장관 전이가 보고되고 있는데 그 중에서도 위전이는 전 세계적으로 3예만 보고되었고 국내에서는 보고된 바가 없다. 또한 수술과 함께 보조적 항암치료를 받은 골육종 환자에서 치료 종료 후 오랜 기간이지난 후에 발생한 지연성 재발이 보고되고 있다. 따라서 오래 전에 항암치료를 포함한 골육종 치료를 받은 환자에서 혈변이나 흑변과 같은 위장관 증상이 새로이 발생했을 때, 치료 후 장기간 동안 재발이 없었다 하더라도 골육종의 위장관 전이 가능성을 고려해야 할 것이다. 저자들은 대퇴부 골육종을 진단받고 수술 및 항암치료 후 11년간 재발이 없었던 환자에서 발생한 위전이 재발의 증례를 문헌고찰과 함께 보고하는 바이다.

Malignant melanoma has a very high propensity to metastasize to the heart. However, melanoma may sometimes present as a metastatic lesion in the absence of a primary lesion, which are called melanomas of unknown primary origin. We report a case in which a patient presented with a metastatic maligant melanoma in the right atrium with pericardial effusion and without a primary origin.

Most ingested foreign bodies pass through the gastrointestinal tract uneventfully within 1 week of ingestion, and so gastrointestinal tract perforation is rare, occurring in less than 1% of patients. The occurrence of a pancreas penetration secondary to foreign-body perforation is even rarer. Here we report two cases of foreign-body penetration of the gastrointestinal tract extending into the pancreas and retroperitoneum. The findings of these cases serve to remind all clinicians that the diagnosis of a foreign-body perforation should always be kept in mind in a patient with abdominal symptoms, and physicians should endeavor to determine the history of ingestion and be aware of foreign bodies in CT scans. (Korean J Med 2012;82:718-723)