Actinomycosis is an oppoturnistic infection of actinomyces, which are relatively avirulent endogenous oral commensals. After trauma or infection, they breach the normally protective mucosal barriers to invade adjacent soft tissue structures. Lesions routinely contain other bacteria, the normal resident flora at the site of primary infection, which act synergistically with actinomyces species to provoke this unique infection, which range from an acute suppurative process to a chronic fibrotic process. According to epidemic studies about pelvic actinomycosis, it should be significantly related to IUD(intrauterine device). It is accounted that IUD cause chronic intrauterine infection, tissue injury and act as nucleus for parasitic infestation. Here we present a case of pelvic actinomycosis related to IUD with brief review of the concerned literature.
Actinomyces ; Actinomycosis* ; Bacteria

OBJECTIVES: Diabetic autonomic neuropathy is a common complication of long standing diabetes mellitus and is well known to induce the motor dysfunction of cardiovascular system, genitourinary system and diges tive system. Although many studies have done to eval uate the diabetic autonomic neuropathy, gallbladder motor function and biliary dynamic study to evaluate the change of gallbladder function in diabetic patients is relatively rare. This study was performed to measure the gall bladder ejection fraction using Tc- 99m-DISIDA with fatty meal in order to evaluate the gallbladder motor func tion in diabetic patients and to examine the usefulness of it in analyzing diabetic autonomic neuropathy. METHODS: 51 diabetic patients(males 31, females 18, mean age 57yr(39-77yr)) and 18 control subjects(males 14, females 4, mean aged 47yr(31-70yr)) without gall stone and impaired liver function were enrolled in our study. Also the diabetic patients were categorized by age, disease duration, body weight and diabetic complications such as retinopathy, peripheral neuropathy and cardiovas cular autonomic neuropathy accompanying with or not. RESULTS: 1) Median value and interquartile range of gallbladder ejection fraction(%) were 66%(48-79%) in diabetic pa tients group and 75%(64-80%) in control subjects. There was no statistically significant difference between the two groups, but the mean value of diabetic patients was slightly lower than that of control subjects. 2) There was no significant difference between the two groups in mean value of gallbladder ejection fraction in every age group(P>0.05). 3) Median value of gallbladder ejection fraction in diabetic groups with less than 10 years of duration (both under 5 years and 5 to 10 years groups) was similar to that of control subjects. However in patients whose diabetic conditions last more than 10 years, the median range of gallbladder ejection fraction was significantly lower than that of control subjects(p<0.05). 4) Median range of gallbladder ejection fraction in obese diabetic patients group was significant lower than those of control subjects and non-obese diabetic pa tients(p<0.05). 5) Median value of gallbadder was lower in diabetic patients group with complications like retinopathy, periph eral neuropathy or cardiovascular autonomic neuropathy (p<0.05) in comparison with those of control subjects and diabetic patients group without diabetic complication (p>0.05). Also seven diabetic patients whose gallbladder ejection fraction was reduced under 35% have had at least two diabetic complications. CONCLUSION: We observed that gallbladder ejection fraction of diabetic patients was reduced compared with that of control subjects. This is due to the reduced gallbladder muscle contractility resulting from diabetic autonomic dysfunction. These results suggest that the assessment of gallbladder ejection fraction using 99m- Tc-DISIDA would be useful to diagnose diabetic auto nomic neropathy.
Body Weight ; Cardiovascular System ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Neuropathies ; Female ; Gallbladder* ; Gallstones ; Humans ; Liver ; Meals ; Peripheral Nervous System Diseases ; Radionuclide Imaging* ; Urinary Bladder ; Urogenital System

PURPOSE: We wanted to evaluate the efficacy and computed tomography(CT) findings of renal artery embolization with using a mixture of Histoacryl(R) and lipiodol in rabbit depending on the mixture proportions and the temporal course. MATERIALS AND METHODS: Eighteen rabbits were equally divided into two groups: group A received a 1:3 mixture and group B received a 1:5 mixture of Histoacryl(R) and lipiodol. We subdivided each group as follows: the 1-day group, the 10-day group and the 20-day group according to the elapsed days after embolization, respectively. As a result, the experimental groups were composed of six subgroups. Afterright renal artery embolizations, plain abdominal radiographs were obtained from all the rabbits. On the first day, the 10th day and the 20th day after embolization, abdominal CT was performed in each subgroup. RESULTS: On the post-embolization radiographs, the embolic casts were formed only at the main or segmental renal arteries in 7 cases of group A. On the other hand, the embolic casts were formed at the entire arterial trees in two cases of group A and all the cases of group B. On the pre- contrast-enhanced CT scans, there were radiopaque densities of embolic casts, residual lipiodol flecks and calcifications in the embolized kidneys. On the contrast-enhanced CT scans, global perfusion defects of the kidneys were noted in 17 rabbits. The cortical rim signs were noted in all rabbits of the 10-day and 20-day groups, except for one rabbit. CONCLUSIONS: The mixture of Histoacryl(R) and lipiodol is effective for renal artery embolization. The CT findings of the embolized kidneys are characteristic depending on the mixture proportions of the embolic agents and the temporal courses.
Embolization, Therapeutic ; Ethiodized Oil* ; Hand ; Kidney ; Perfusion ; Rabbits ; Renal Artery* ; Tomography, X-Ray Computed

No abstract available.
Craniocerebral Trauma* ; Head* ; Humans ; Tomography, Emission-Computed, Single-Photon*

An ameloblastic carcinoma is a very rare odontogenic malignant tumor, which sometimes have a benign clinical nature, but typically have aggressive features, with large ulcerative lesion and extensive local destruction. These clinical characteristics make the complete surgical removal of a tumor difficult. As a consequence, a poor prognosis may result due to local recurrence and distant metastasis. For this reason, it is important to consider adjuvant therapies for high-risk ameloblastic carcinoma patients. Here, the case of a recurrent ameloblastic carcinoma that occurred in the mandible after primary surgery is reported. The lesion was treated with further local excision, followed by postoperative radiotherapy. Also, a few remarks on the role of postoperative radiotherapy in patient with ameloblastic carcinoma have been made from a review of the current literatures on the treatment of this type of lesion.
Ameloblasts* ; Humans ; Mandible* ; Neoplasm Metastasis ; Prognosis ; Radiotherapy* ; Recurrence ; Ulcer

An ameloblastic carcinoma is a very rare odontogenic malignant tumor, which sometimes have a benign clinical nature, but typically have aggressive features, with large ulcerative lesion and extensive local destruction. These clinical characteristics make the complete surgical removal of a tumor difficult. As a consequence, a poor prognosis may result due to local recurrence and distant metastasis. For this reason, it is important to consider adjuvant therapies for high-risk ameloblastic carcinoma patients. Here, the case of a recurrent ameloblastic carcinoma that occurred in the mandible after primary surgery is reported. The lesion was treated with further local excision, followed by postoperative radiotherapy. Also, a few remarks on the role of postoperative radiotherapy in patient with ameloblastic carcinoma have been made from a review of the current literatures on the treatment of this type of lesion.
Ameloblasts* ; Humans ; Mandible* ; Neoplasm Metastasis ; Prognosis ; Radiotherapy* ; Recurrence ; Ulcer

Objective: To investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent. Materials and Methods: We retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11–92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures. Results: Stent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2–7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6–146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5–124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency. Conclusion Long-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.

Objective: This study was conducted to identify the needs assessment for education and training of emergency medicine (EM) residents. Methods: The results of a national survey of EM residents of the Korean Society of Emergency Medicine in 2019 were used. Education was one of the five categories in the survey. The preferred learning methods and their perceived importance and ability to perform in nine competencies were assessed. The Borich’s needs assessment model was used to analyze their needs. Results: Among 591 EM residents, 382 responded, and 371 responses were finally analyzed. Regarding the learning methods, junior residents preferred in-hospital conferences, staff lectures, internet resources, and textbooks. Overall, medical knowledge and procedural skills were the most important, and research was less important to recognize. Medical knowledge showed the highest rank in the needs assessment in all years, and ethics and professionalism showed the lowest ranks. The needs for procedural skills were higher in junior years but lower in senior years. Conclusion These results will form the basis for the design of training programs to meet the educational needs of EM residents for each grade. Furthermore, an analysis of the educational needs should be done periodically according to the changes and demands of the times.

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.
Aneurysm ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Chest Pain ; Constriction, Pathologic ; Coronary Vasospasm ; Creatinine ; Dilatation ; Dyspnea ; Follow-Up Studies ; Heart Diseases ; Humans ; Japan ; Myocardial Infarction* ; Myocardial Stunning ; Phosphotransferases ; Prospective Studies* ; Pulmonary Edema ; Shock, Cardiogenic ; Stress, Psychological ; Stroke Volume ; Takotsubo Cardiomyopathy ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: Small myocardial infarction (MI) has been reported in 8 - 20% of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). But neither appropriate threshold of cardiac enzyme nor useful biochemical marker for its detection has not yet been fully defined. We examined the cardiac enzyme to define more valuable biochemical marker for the detection of small MI after PTCA and to evaluate factors associated with small MI after PTCA. MATERIALS AND METHODS: This study population consisted of 209 consecutive patients who underwent PTCA. Cardiac enzyme levels were measured before and 8, 24 hours after PTCA for CK-MB, and before and 16 hours after PTCA for troponin T. We defined small MI when CK-MB levels were over 16U/L and/or troponin T levels were over 0.2 ng/ml. RESULTS: Incidence of small MI after PTCA was 28/209 (13.4%) and the most of those were non-Q MI (24/28, 86%). In the detection of small MI after PTCA, the sensitivity of troponin T was higher than CK-MB (92.9% vs 39.3%). Major complications (major dissection, acute coronary occlusion, and side branch occlusion) developed significantly more in patients with small MI than in patients without small MI (p=0.002). Three independent variables, which were significantly associated with small MI after PTCA, were age, total/subtotal occlusion, and acute coronary occlusion as complication (p=0.01, p=0.02, and p=0.04, respectively). CONCLUSIONS: Troponin T is more sensitive biochemical marker than CK-MB in the detection of small MI after PTCA. Major complications of angioplasty are frequently associated with small MI. Especially, age, total occlusion, and acute coronary occlusion as complication are independent factors significantly associated with small MI after PTCA.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Biomarkers ; Coronary Occlusion ; Humans ; Incidence ; Myocardial Infarction ; Troponin T* ; Troponin*