We report the CT findings of diffuse esophageal spasm (DES) in a patient with dysphagia. Although an uncommon condition, DES should be included in the differential diagnosis if relatively long and symmetric segmental esophageal wall thickening and an epiphrenic esophageal diverticulum are noted at CT.
Deglutition Disorders ; Diagnosis, Differential ; Diverticulum, Esophageal ; Esophageal Spasm, Diffuse* ; Humans

Despite significant progress in audiology, there is no definitive treatment option for Ménière disease due to its multifactorial etiology.Current Concepts: The primary treatment goal for Ménière disease is first, to decrease the frequency of symptoms and, second, to minimize the severity of vertigo and hearing loss. Concurrently, the preservation of vestibular and auditory functions should be prioritized. The protection of vestibular and auditory functions should also be considered. Treatment options for Ménière disease include lifestyle modifications, medical treatment, and surgical intervention. Recent treatment algorithms aim to gradually escalate the invasiveness of the treatment to assist in developing a more uniform treatment approach.Nanomaterials, including nanoparticles and nanocarriers, offer an array of novel diagnostic and therapeutic applications for achieving effective drug delivery into the inner ear of patients with Ménière disease. New treatment drugs, such as SPI-1005 (Sound Pharmaceuticals) are currently under clinical trial. Furthermore, drugs are also being repurposed and investigated for their potential in treating Ménière disease.Discussion and Conclusion: Developing new drugs and investigating the pathophysiology of Ménière disease for subtyping is emerging. These may direct the future diagnosis and treatment of the disease and facilitate a better understanding of disease mechanisms. Patients with different subtypes of Ménière disease may require different treatment strategies, which can be achieved by personalized therapy, accurate prognosis prediction, and even, disease prevention.

A rhabdoid cholangiocarcinoma is a very rare variant of sarcomatous cholangiocarcinomas. Here, we report a vimentin positive cholangiocarcinoma showing rhabdoid features in the entire tumor, with a very aggressive behavior. A 41-year-old woman was admitted to our hospital due to a huge hepatic mass. The resected liver revealed a 17x15cm sized solid mass with extensive necrosis and an infiltrative border. On microscopic examination, the entire tumor was composed of loosely cohesive round to polygonal cells, with rhabdoid features having abundant eosinophilic glassy cytoplasm and eccentrically located vesicular nuclei. Some tumor cells contained intracytoplasmic mucin vacuoles, but definite areas of glandular differentiation or spindle cell were not found. Immunohistochemical staining showed a diffuse strong positive reaction to pan-cytokeratin and vimentin, and focal positivity for the carcinoembryonic antigen. Other immunohistochemical stainings for cytokeratin 7, cytokeratin 20, S-100 protein, HMB-45, desmin, alpha-smooth muscle actin, c-kit, CD34, alpha-fetoprotein, anti-hepatocyte antigen, chromogranin and synaptophysin were all negative. After two months, the patient developed a local recurrence along the resection margin, and multiple hematogenous metastases to the lung and liver were seen on the follow-up CT scan.
Adult ; Cholangiocarcinoma/chemistry/*pathology ; Female ; Human ; Liver Neoplasms/chemistry/*pathology ; Magnetic Resonance Imaging ; Prognosis ; Rhabdoid Tumor/chemistry/*pathology ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed ; Vimentin/analysis

PURPOSE: The management of cervical lymph node metastases from papillary thyroid cancer ranges from selective removal to a radical neck dissection. A clear understanding of the metastases of nodes at potential risk improves the quality of life (QOL) of patients, and through correct surgical methods, based on previous studies; it has been found that lymph node metastasis correlated with a high risk of recurrence. The purpose of our study was to improve the QOL of patients through an appropriate surgical method at the time of the initial operation, which decreases the risk and incidence of reoperation, by reviewing the relationship of multiple variables with cervical lymph node metastases. METHODS: We retrospectively reviewed 123 consecutive patients with papillary thyroid cancer, who underwent a total thyroidectomy with modified radical neck dissection between January 2000 and December 2001. We analysed the relationship between the metastatic pattern, age, sex, tumor location and tumor size, degree of invasion, multicentricity, duration and postoperative complications, in the patients with cervical lymph node metastases. RESULTS: Of the multiple variables, age, sex and capsular invasion were found to significantly correlate with lymph node metastases. CONCLUSION: In patients presenting with capsular invasion, modified radical neck dissections are recommended for palpable cervical lymph nodes, for the prevention of recurrence and reoperation, even when the statistics indicate significance in male patients, or those of a young age, although, further studies with a larger population are required.
Humans ; Incidence ; Lymph Nodes* ; Male ; Neck Dissection ; Neoplasm Metastasis* ; Postoperative Complications ; Quality of Life ; Recurrence ; Reoperation ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

OBJECTIVE: The purpose of this study was to evaluate the ultrasonographic (US) findings in the shoulder impingement syndrome and to correlate them with the Hawkins and Kennedy's clinical stages. METHOD: 41 patients with suspected shoulder impingement syndrome were evaluated. All patients were divided into 3 clinical groups according to Hawkins and Kennedy and US examination was done in each group. RESULTS: US findings were as follows. In stage I, there were 3 normal findings, 5 tendinitis of the rotator cuff (RC), 2 partial thickness tear of RC, and 0 full thickness tear of RC. In stage II, 6 normal findings, 13 tendinitis of RC, 3 partial thickness tear of RC and 2 full thickness tear of RC. In stage III, 0 normal findings, 1 tendinitids of RC, 1 partial thickness tear of RC, and 5 full thickness tear of RC. The most common findings in the tendinits of RC were tendon thickness, focal hypoechogenicity and calcification. In partial thickness tear of RC, focal hypoechogenicity and impingement in abduction were most common findings. In full thickness tear of RC, the irregular humeral head surface and the biceps tendon effusion were most common findings CONCLUSION: The ultrasonography is a valuable means of evaluating the shoulder impingement syndrome and its findings have good correlation with clinical stages
Humans ; Humeral Head ; Rotator Cuff ; Shoulder Impingement Syndrome* ; Shoulder* ; Tendinopathy ; Tendons ; Ultrasonography*

OBJECTIVE: Stenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients. METHODS: Between June 2009 and October 2010, stent-assisted angioplasty by using a balloon-expandable coronary stent for intracranial severe stenosis (>70%) was performed in 7 patients after TIA and 5 patients after minor stroke (14 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed. RESULTS: Stenting was successful in all 12 patients. The mean time from symptom onset to stenting was 2.1 days (1-8 days). Post-procedural angiography showed restoration to a normal luminal diameter in all patients. In-stent thrombosis occurred in one patient (n=1, 8.3%), and was lysed with abciximab. No device-related complications, such as perforations or dissections at the target arteries or intracranial hemorrhaging, occurred in any patient. The mortality rate was 0%. No patient had an ischemic event over the mean follow-up period of 12.5 months (range, 7-21 months), and follow-up angiography (n=7) revealed no significant in-stent restenosis (>50%). CONCLUSION: Urgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of > or =70%.
Angiography ; Angioplasty ; Antibodies, Monoclonal ; Arteries ; Constriction, Pathologic ; Dissent and Disputes ; Follow-Up Studies ; Humans ; Immunoglobulin Fab Fragments ; Intracranial Arteriosclerosis ; Ischemic Attack, Transient ; Phenobarbital ; Retrospective Studies ; Stents ; Stroke ; Thrombosis

PURPOSE: The Gleason score is an important predictor of outcome that is used in conjunction with clinical stage and prostate-specific antigen to guide clinical decision making. The prostate biopsy Gleason grade frequently differs from the radical prostatectomy grade. The aim of this study was to determine the risk factors of Gleason upgrading in patients with low-risk prostate cancer after radical prostatectomy. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 146 patients who underwent radical prostatectomy between 1998 and 2008 in two hospitals of Jeonbuk province in Korea. Pathological Gleason score upgrading was defined as an increase in the Gleason score from < or =6 to > or =7 between the biopsy and radical prostatectomy specimen. Pretreatment clinical and pathological parameters were used to identify predictors of pathological upgrading. RESULTS: Of the total 146 patients, 51 (34.9%) were upgraded postoperatively. Small prostate volume (p=0.008), abnormality on the digital rectal examination, and positive surgical margin (p=0.001) were significantly and positively associated with upgrading after radical prostatectomy. A total of 17 of 65 patients with low-risk prostate cancer (26.2%) were upgraded postoperatively. Small prostate volume (<30 ml) was significantly (p=0.026) and positively associated with upgrading after radical prostatectomy in patients with low-risk prostate cancer. CONCLUSIONS: Overall, 26% of patients with low-risk disease were upgraded postoperatively. Small prostate volume was associated with an increased risk for pathological upgrading after radical prostatectomy. These conclusions should be kept in mind when making treatment decisions for men with low-risk prostate cancer.
Biopsy ; Decision Making ; Digital Rectal Examination ; Humans ; Korea ; Male ; Medical Records ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Retrospective Studies ; Risk Factors

The purpose of this study was to evaluate the difference of subgingival bacterial compositions between periodontally healthy and diseased sites. Subgingival plaque samples were obtained from 100 sites in 20 untreated adult periodontitis patients(experimental group), and 100 sites in healthy individuals(control group). Before sampling, probing pocket depth(PPD) and clinical level of attachment(CAL), Plaque Index(PI), and Sulcus Bleeding Index(SBI) were recorded for each sampled sites. Microbial samples were collected from the bases of gingival sulci or periodontal pockets with sterile curettes. The samples were examined under darkfield microscope(x400). At least 150 bacteria were evaluated and categorized on the basis of bacterial morphology and motility, i.e. cocci, non-motile rods, motile rods, and spirochetes. In control group, subgingival microbial flora consisted of 73.7% of cocci, 20.0% of non-motile rods, 4.3% of motile rods, and 2.0% of spirochetes. The microbial samples from experimental group consisted of 51.5% of cocci, 19.4% of non-motile rods, 17.6% of motile rods, and 11.6% of spirochetes. The proportion of cocci was higher in control group than in experimental group. Proportions of motile rods and spirochetes were higher in experimental group than in control group. The proportion of nonmotile rods in experimental group and control group was not significantly different. Sulcus Bleeding Index and Plaque Index showed high correlation with the bacterial composition. These findings suggests that examination of subgingival bacterial proportion may serve as more sensitive mirror of the local periodontal status than clinical parameters.
Adult* ; Bacteria ; Chronic Periodontitis* ; Hemorrhage ; Humans ; Periodontal Pocket* ; Spirochaetales

In the operation room, members of the surgical team have the ultimate responsibility of safe guarding the patient from electrical devices. The electrosurgical unit is one instrument commonly used during surgical procedures. We have experienced accidental burning. Sixty-seven years-old patient received burn at the site of the ECG electrode which was caused by an electrocautery used in conjunction with electronic monitoring equipment. Although cutting and coagulation powers were very low, the normal size of the ECG electrodes led to the generation of a high current density. Prevention of interactions of this kind between properly functioning monitoring and surgical units requires good communication among all members of the operating room team and every electrical instruments should inspected, tested regularly.
Burns* ; Electrocardiography* ; Electrocoagulation ; Electrodes* ; Humans ; Operating Rooms

PURPOSE: The purpose of this study was to investigate the degree of compliance with supportive periodontal therapy(SPT), to determine if any significant differences existed in the characteristics of compliant, erratically compliant and non-compliant patients and to identify reasons for poor compliance. MATERIALS AND METHODS: Four hundred five patients who initially visited between July 2003 and December 2004 and were treated until June 2005 were retrospectively evaluated for their compliance with SPT in terms of attendance for a recommended schedule of visits. Patients' compliance was classified as complete compliance(attended more than 80% of the recommended appointments), erratic compliance(attended less than 80% of the recommended appointments or discontinued) and non-compliance(did not return for SPT). Analysis was made for each group to correlate the degree of compliance with gender, age, smoking, distance between their houses and the hospital, disease severity, type of therapy, implant, plaque control instruction and systemic diseases. Tele research of erratically compliant and non-compliant patients was carried out to identify reasons for their poor compliance. RESULTS: Only 24.7% of the patients were in complete compliance. The highest drop-out rate(32.4%) occurred in the first year. A significantly greater percentage of non-smokers and patients who finished plaque control instruction were in complete compliance. A significantly greater percentage of patients without implant and patients who had been treated by only scaling and root planing were in non-compliance. More males were found to be compliant with SPT, although this was marginally significant. There were no significant differences between compliant, erratically compliant and non-compliant patients with regard to age, distance, disease severity and systemic disease. The survey revealed that the main reasons for poor compliance with SPT were inconvenient location and insufficient time. CONCLUSION: Patients' compliance with SPT was poor and the highest drop-out rate(32.4%) occurred in the first year. Significant relationships were found between the degree of compliance and smoking, type of therapy, implant, plaque control instruction and gender.
Appointments and Schedules ; Compliance ; Humans ; Male ; Patient Compliance ; Retrospective Studies ; Root Planing ; Smoke ; Smoking