No abstract available.
Knee Joint* ; Knee*

Blood-injury phobia may present as a vasovagal syncope in response to the sight of blood or after receiving venipuncture. A 26-year-old man presented with a history of syncope induced by venipuncture. A transcranial Doppler (TCD) scan with monitoring of both heart rate and blood pressure reproduced the syncope and showed it to be vasovagal in nature. Treatment by practicing physical maneuvers, such as leg crossing and muscle tensing, improved the condition of the patient. This case suggests that physical maneuvering is effective in the treatment of blood-injury phobia.
Adult ; Blood Pressure ; Heart Rate ; Humans ; Leg ; Phlebotomy ; Phobic Disorders* ; Syncope ; Syncope, Vasovagal* ; Transcutaneous Electric Nerve Stimulation

Familial adenomatous polyposis (FAP) is a precancerous clinical entity, which is characterized by the development of numerous adenomatous polyps throughout the colon and rectum. The majority of FAP are associated with mutations of the adenomatous polyposis coli (APC) gene. Until now, more than 1,000 different APC mutations have been reported and some mutations express attenuated phenotypes which are milder forms with 10~100 colorectal polyps. We identified a novel mutation of APC gene which expressed an attenuated FAP but caused large gastroduodenal tubular adenomas requiring repeated endoscopic resections. A 16-year-old girl was referred to Incheon St. Mary's Hospital for evaluation of gastric polyposis. Initial esophagogastroduodenoscopy (EGD) showed numerous gastric polyps in the fundus and upper body and a few polyps in the duodenum. Pathologic examination confirmed gastric polyps as fundic gland polyps and duodenal polyps as tubular adenomas. Only a few colonic polyps of 2 to 5 mm in size were found on colonoscopy. Genetic analysis using polymerase chain reaction and direct sequencing revealed a novel stop codon mutation at codon 1522 in exon 16 of APC gene. At 12-month, 18-month, and 35-month follow-up EGD, large duodenal polyp and gastric polyps were removed endoscopically.
Adenoma ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Adolescent ; Codon ; Codon, Terminator ; Colon ; Colonic Polyps ; Colonoscopy ; Duodenum ; Endoscopy, Digestive System ; Exons ; Female ; Follow-Up Studies ; Genes, APC* ; Germ-Line Mutation* ; Humans ; Incheon ; Phenotype ; Polymerase Chain Reaction ; Polyps* ; Rectum

No abstract available.
Humans ; Intubation

In the management of advanced maxillary sinus cancer, sometimes it requires an extensive ablation and orbital exenteration that results in large and full defects of the cheek and orbital regions. Reconstruction of large orbital-maxillary defects can be accomplished in one stage by microsurgical free transfer of rectus abdominis myocutaneous flap. The muscle component is suitable to fill the orbital and maxillary cavities, and the skin components are used for cheek, palate and lateral nasal cavity wall reconstruction as a three-dimentional folded free flap. Major problems with this flap are the bulkiness, the possibility of abdominal hernia and muscle weakness following the removal of the rectus abdominis muscle. Free deep inferior epigastric artery skin flap without rectus abdominis muscle is available in the reconstruction of large orbital-maxillary defect without the problems of the rectus abdominis myocutaneous free flap. We experienced one case of rectus abdominis myocutaneous free flap, and one other case of inferior rectus abdominis free flap for the reconstruction of huge surgical defects due to radical maxillectomy with orbital excenteration. Both of the patients were satisfied and there have been no severe complication associated with these technique.
Cheek ; Epigastric Arteries ; Free Tissue Flaps* ; Hernia, Abdominal ; Humans ; Maxillary Sinus Neoplasms* ; Maxillary Sinus* ; Muscle Weakness ; Myocutaneous Flap ; Nasal Cavity ; Orbit ; Palate ; Rectus Abdominis* ; Skin

BACKGROUND/AIMS: Levofloxacin resistance is increasing rapidly, and widely limits its application in Helicobacter pylori eradication. This study aimed to evaluate the efficacy of a clarithromycin- versus gemifloxacin-containing triple therapy regimen in first-line eradication of H. pylori infection. MATERIALS AND METHODS: This was an open-label, prospective, non-randomized two-armed pilot study in which treatment-naïve subjects with active H. pylori infection received a seven-day triple therapy with rabeprazole 20 mg bid (twice daily), gemifloxacin 320 mg qd (once daily), and amoxicillin 500 mg bid (n=70) or seven-day triple therapy with rabeprazole 20 mg bid (twice daily), clarithromycin 500 mg bid (twice daily), and amoxicillin 500 mg bid (n=83). H. pylori infection status was checked in all patients at enrollment and at least 8 weeks after the end of therapy by the urea breath test. RESULTS: Intention-to-treat eradication rates were 71.1% and 74.3% for clarithromycin-containing triple therapy and gemifloxacin- containing triple therapy, respectively (P=0.398). The corresponding per-protocol eradication rates were 76.6% and 76.1% (P=0.624). The gemifloxacin-containing triple therapy was associated with a lower incidence of adverse events (2.9% vs. 18.5%, P=0.003). CONCLUSIONS: Although the seven-day gemifloxacin-containing triple therapy regimen showed a more favorable safety profile, there was no significant difference in eradication rates between the gemifloxacin-containing and clarithromycin-containing triple regimens, and both regimens had eradication rates slightly lower than acceptable efficacy for the Korean population. Therefore, the gemifloxacin-containing regimen might be useful as an alternative regimen for patients showing severe side effects of clarithromycin due to poor tolerance. Further studies on the efficacy of gemifloxacin in the Korean population are warranted.
Amoxicillin ; Breath Tests ; Clarithromycin ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Levofloxacin ; Pilot Projects* ; Prospective Studies ; Rabeprazole ; Treatment Outcome* ; Urea

Background/Aims: Few studies have investigated the long-term outcomes of endoscopic resection for early gastric cancer (EGC) in very elderly patients. The aim of this study was to determine the appropriate treatment strategy and identify the risk factors for mortality in these patients. Methods: Patients with EGC who underwent endoscopic resection from 2006 to 2017 were iden-tified using National Health Insurance Data and divided into three age groups: very elderly (≥85 years), elderly (65 to 84 years), and non-elderly (≤64 years). Their long- and short-term outcomes were compared in the three age groups, and the survival in the groups was compared with that in the control group, matched by age and sex. We also evaluated the risk factors for long- and short-term outcomes. Results: A total of 8,426 patients were included in our study: 118 very elderly, 4,583 elderly, and 3,725 non-elderly. The overall survival and cancer-specific survival rates were significantly lower in the very elderly group than in the elderly and the non-elderly groups. Congestive heart failure was negatively associated with cancer-specific survival. A significantly decreased risk for mortality was observed in all groups (p<0.001). The very elderly group had significantly higher readmission and mortality rates within 3 months of endoscopic resection than the non-elderly and elderly groups. Furthermore, the cerebrovascular disease was associated with mortality within 3 months after endoscopic resection. Conclusions Endoscopic resection for EGC can be helpful for very elderly patients, and it may play a role in achieving overall survival comparable to that of the control group.

PURPOSE: This study was designed to assess the clinical manifestations and the effect on prognosis of seizures in children with acute lymphoblastic leukemia(ALL). METHODS: The study group consisted of 20 patients(10 males and 10 females) who experienced seizures out of the 198 pediatric ALL patients(117 males and 81 females) who were diagnosed and treated at the Department of Pediatrics, St. Mary's Hospital, the Catholic University of Korea. RESULTS: The overall incidence of seizure developing after the diagnosis of ALL was 10.1% and in 11 patients(5.6%), seizure recurred one or more times. An average of 6.5+/-3.6 months(range 0-42 months) elapsed between the beginning of treatment and the new onset of seizures. In 13 patients(65%), the first seizure occurred during the induction or re-induction chemotherapy phase. Seizure type was partial seizure in 11 patients(55%), and generalized seizure in 9 patients(45%). In 15 patients(88.2%), brain imaging study showed abnormal findings and in 18 patients(90%), EEG revealed abnormal findings. 11 patients were diagnosed with epilepsy and were treated with long-term anticonvulsants. In these patients, 4 patients(36.4%) had no seizure recurrence, but 2 patients(18.2%) showed no response to anticonvulsants. The 5-year survival rate of the patients experiencing seizures was 47%, while the rate was 78% for those did not experience seizures (P<0.001). CONCLUSION: Seizures in pediatric patients with ALL was closely related to the 5-year survival rate. Therefore, these patients require early careful observation, evaluation and intensive care. Also, further studies such as ways to diminish the side effects of antileukemic agents are necessary to reduce the risk of seizure.
Anticonvulsants ; Child ; Electroencephalography ; Epilepsy ; Humans ; Incidence ; Critical Care ; Leukemia ; Male ; Neuroimaging ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Recurrence ; Seizures ; Survival Rate

No abstract available.

BACKGROUND/AIMS: The aim of this study was to compare the clinical effects of preoperative and postoperative dexamethasone on pain after endoscopic submucosal dissection (ESD) for early gastric neoplasm. METHODS: Forty patients with early gastric neoplasm who were scheduled for ESD were randomized into two groups according to the timing of steroid administration: preoperative ("pre", n=20) and postoperative ("post", n=20) steroid administration. The pre group received 0.15 mg/kg dexamethasone before ESD and placebo after, and the post group received pre-ESD placebo and post-ESD dexamethasone. The present pain intensity (PPI) index and the short-form McGill pain (SF-MP) questionnaire were evaluated. RESULTS: The primary outcome was PPI score at 6 hours after ESD. There was a greater reduction in 6-hour PPI in the pre group than in the post group (2.1±0.8 vs 3.0±1.1, respectively; p=0.006). The immediate PPI was also significantly lower in the pre group than in the post group (1.6±0.6 vs 2.9±0.6, respectively; p<0.001), and the total SF-MP scores were significantly lower in the pre group than in the post group both immediately and at 6 hours after the operation. CONCLUSIONS: Preoperative administration of dexamethasone may produce a superior analgesic effect in patients who undergo ESD compared with the postoperative administration of dexamethasone.
Dexamethasone* ; Humans ; Stomach Neoplasms*