Mucormycosis is a rare, fulminating, opportunistic fungal infection that occurs almost exclusively in immunocompromised hosts such as patients with diabetes, leukemia, lymphoma. These fungi are ubiquitous in nature, and can be found on decaying vegetation and in the soil. So they are relatively frequent contaminants in the clinical microbiology laboratory. Recently the incidence of mucormycosis is rising associated with the increasing use of immunosuppressive agents, antibiotics. Though mucormycosis is frequently fatal, there has been a significant improvement in the outcome by early diagnosis and aggressive treatment. Mucormycosis can be categorized as rhinocerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated and miscellaneous; gastro-intestinal involvement is extremely rare. We report a patient with gastric mucormycosis who had diabetes mellitus and alcoholic hepatitis. His chief complaint was an epigastric pain, and the gastroscopy showed huge multiple ulcers, coated with exudates. The histologic examination revealed multiple broad, nonseptate hyphae with right angle branchings, diagnosed as mucormycosis.
Alcoholics* ; Anti-Bacterial Agents ; Diabetes Mellitus* ; Early Diagnosis ; Exudates and Transudates ; Fungi ; Gastroscopy ; Hepatitis, Alcoholic* ; Humans ; Hyphae ; Immunocompromised Host ; Immunosuppressive Agents ; Incidence ; Leukemia ; Lymphoma ; Mucormycosis* ; Soil ; Ulcer

Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but significant spinal condition. Urgent surgical evacuation of a hematoma is generally indicated to prevent serious permanent neurological deficits. We encountered three cases of spontaneous spinal epidural hematomas associated with motor weakness that were treated successfully by surgical intervention.
Hematoma ; Hematoma, Epidural, Spinal ; Laminectomy

BACKGROUND/AIMS: Polyethylene glycol (PEG) solution is the most widely used bowel preparation agent for colonoscopy because of its safety and efficacy in colon cleansing. It has been hypothesized that the timing of colon preparation may influence the quality of colon cleansing, and therefore affect the diagnostic yield of colonoscopy. The aim of this study was to determine the optimal interval of time between complete ingestion of PEG and performing colonoscopy. METHODS: We prospectively enrolled 1,355 patients who had undergone a PEG-based bowel preparation on the day of colonoscopy in 11 tertiary hospitals in Korea between March 2008 and February 2009. All colonoscopies were performed in the afternoon. The start time of PEG ingestion, completion time of PEG ingestion, dose of PEG ingested, start time of colonoscopy, and the quality of bowel cleansing were recorded. RESULTS: There was no difference of cleansing quality of bowel preparation between three groups of less than 7 hours of elapsed time (2< or = and <3 hours, 3< or = and <5 hours, 5< or = and <7 hours). However, group of more than 7 hours of elapsed time presented poor cleansing quality than others (P<0.01). CONCLUSIONS: If>7 hours elapses after ingestion of PEG, the quality of bowel preparation is poor. Therefore, depending on the time colonoscopy is scheduled, the start time of PEG ingestion may need to be adjusted.
Colon ; Colonoscopy ; Eating ; Humans ; Korea ; Polyethylene ; Polyethylene Glycols ; Prospective Studies ; Tertiary Care Centers

BACKGROUND/AIMS: Polyethylene glycol (PEG) solution is the most widely used bowel preparation agent for colonoscopy because of its safety and efficacy in colon cleansing. It has been hypothesized that the timing of colon preparation may influence the quality of colon cleansing, and therefore affect the diagnostic yield of colonoscopy. The aim of this study was to determine the optimal interval of time between complete ingestion of PEG and performing colonoscopy. METHODS: We prospectively enrolled 1,355 patients who had undergone a PEG-based bowel preparation on the day of colonoscopy in 11 tertiary hospitals in Korea between March 2008 and February 2009. All colonoscopies were performed in the afternoon. The start time of PEG ingestion, completion time of PEG ingestion, dose of PEG ingested, start time of colonoscopy, and the quality of bowel cleansing were recorded. RESULTS: There was no difference of cleansing quality of bowel preparation between three groups of less than 7 hours of elapsed time (2< or = and <3 hours, 3< or = and <5 hours, 5< or = and <7 hours). However, group of more than 7 hours of elapsed time presented poor cleansing quality than others (P<0.01). CONCLUSIONS: If>7 hours elapses after ingestion of PEG, the quality of bowel preparation is poor. Therefore, depending on the time colonoscopy is scheduled, the start time of PEG ingestion may need to be adjusted.
Colon ; Colonoscopy ; Eating ; Humans ; Korea ; Polyethylene ; Polyethylene Glycols ; Prospective Studies ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: In this paper, rehabilitation of voice after total laryngectomy has been suggested through the correct estimation and simulation of patients' vocal tract. Material and Methods: The author studied the shape of vocal tract during the phonation of five Korean vowels /u, o, a, e, i/ in tracheoesophageal shunt patients by magnetic resonance images (MRI). The same vocal tract was determined in each vowels from MRI. First, speech data produced by them were analyzed and also checked for speech intelligibility. Then the author tried to synthesize vowels from the vocal tract area of each vowels and from the expanded pharyngeal section of the vocal tract. RESULTS: The obtained results were as follows: 1) The sounds of /a/, /e/, /i/ were similar to natural sounds in actual patients' speech. The sound of /o/ was heard as /sigma/. The sound of /u/ was heard as strained /u/. 2) The synthesized vowels of /a/, /e/ from MRI were heard as natural sounds. The sounds of /u/, /o/, /i/ were heard as other sounds. 3) The synthesized vowel by the expanded pharyngeal section of 3 times in vowel /o/ was more naturally heard than that of 2 times. The synthesized vowel from Formfrek was more naturally heard than that from AreatoFormant. CONCLUSION: In conclusion, some of the synthesized sounds from MRI disagrees with the actual sounds produced by the subjects. This could be best identified by the synthesis from the area data. Future MRI studies should consider this problem for more accurate measurements. Also, pharyngeal areas with varied sizes should be experimented to secure better speech output because the correct shapes of vocal tract ensures correct vowel pronunciation.
Humans ; Laryngectomy* ; Magnetic Resonance Imaging ; Phonation ; Rehabilitation ; Speech Intelligibility* ; Voice

BACKGROUND/AIMS: Carnitine and vitamin complex (Godex(R)) is widely used in patients with chronic liver disease who show elevated liver enzyme in South Korea. The purpose of this study is to identify the efficacy and safety of carnitine from entecavir combination therapy in Alanine aminotransferase (ALT) elevated Chronic Hepatitis B (CHB) patients. METHODS: 130 treatment-naive patients with CHB were enrolled from 13 sites. The patients were randomly selected to the entecavir and the complex of entecavir and carnitine. The primary endpoint of the study is ALT normalization level after 12 months. RESULTS: Among the 130 patients, 119 patients completed the study treatment. The ALT normalization at 3 months was 58.9% for the monotherapy and 95.2% for the combination therapy (P<0.0001). ALT normalization rate at 12 months was 85.7% for the monotherapy and 100% for the combination group (P=0.0019). The rate of less than HBV DNA 300 copies/mL at 12 months was not statistically significant (P=0.5318) 75.9% for the monotherapy, 70.7% for the combination and it was. Quantification of HBsAg level was not different from the monotherapy to combination at 12 months. Changes of ELISPOT value to evaluate the INF-gamma secretion by HBsAg showed the increasing trend of combination therapy compare to mono-treatment. CONCLUSIONS: ALT normalization rate was higher in carnitine complex combination group than entecavir group in CHB. Combination group was faster than entecavir mono-treatment group on ALT normalization rate. HBV DNA normalization rate and the serum HBV-DNA level were not changed by carnitine complex treatment.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; Carnitine/*therapeutic use ; DNA, Viral/analysis ; Drug Therapy, Combination ; Enzyme-Linked Immunospot Assay ; Female ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B Surface Antigens/blood ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/*drug therapy ; Humans ; Interferon-gamma/metabolism ; Male ; Middle Aged ; Mitochondria/physiology ; Treatment Outcome ; Vitamin B Complex/*therapeutic use