No abstract available.
Child* ; Humans ; Leukemia*

No abstract available.
Ultrasonics*

The rapid spontaneous resolution of an acute epidural hematoma (EDH) has rarely been reported. A possible mechanism of spontaneous resolution is egress of the hematoma into the subgaleal space through a skull fracture. We report a case of rapid redistribution of an acute EDH in a 37-year-old man who had a malignant peripheral nerve sheath tumor of the skull and who slipped and fell when going to the bathroom. A huge EDH without a skull fracture developed in the left parieto-occipital area. The acute EDH was completely alleviated and a newly developed intracerebral hematoma was found on a brain computed tomography scan that was acquired the day after the trauma. Given these findings, a fractured skull and increased pressure in the intradural area may have been the mechanisms underlying the redistribution of the hematoma.
Adult ; Brain ; Hematoma* ; Humans ; Neurofibromatoses ; Peripheral Nerves ; Skull Fractures ; Skull*

Objective: This study aimed to investigate the impact of coronavirus disease-2019 (COVID-19) on suicide attempts and suicide deaths in South Korea, focusing on age and sex differences. Methods: We analyzed the monthly number of suicide attempts and suicide deaths during pre-pandemic (January 2016–February 2020) and pandemic (March–December 2020) periods using nationally representative databases. We conducted an interrupted time series analysis and calculated the relative risk (RR) with a 95% confidence interval (CI), categorizing subjects into adolescents (<18), young adults (18–29), middle-aged (30–59), and older adults (≥60). Results: During the pandemic, the number of suicide attempts abruptly declined in adolescents (RR [95% CI] level change: 0.58 [0.45–0.75]) and older adults (RR [95% CI] level change: 0.74 [0.66–0.84]). In older males, there was a significant rebound in the suicide attempt trend (RR [95% CI] slope change: 1.03 [1.01–1.05]). The number of suicide deaths did not change among age/sex strata significantly except for older males. There was a brief decline in suicide deaths in older males, while the trend showed a following increase with marginal significance (RR [95% CI] level change: 0.76 [0.66–0.88], slope change: 1.02 [1.00–1.04]). Conclusion This study suggests the heterogeneous impact of the COVID-19 pandemic on suicide attempts and suicide deaths across age and sex strata in South Korea. These findings highlight the need for more targeted mental health interventions, given the observed trends in suicide attempts and suicide deaths during the pandemic.

Biliary-enteric fistula is in 0.5% to 5% of patients undergoing biliary tract surgery. The most common cause of biliary-enteric fistula is gallstones and their complications, Much less common causes are complieation of peptic ulcer, malignancy, trauma, and rarely, Crohns, disease. The most common type of biliary-enteric fistula is cholecysto-duadenal. Cholecysto-colic, cholecysto-gastric, and choledocho-duodenal fistula are reported much less frequently. The combination of cholecysto-duodenal fistula with cholecysto-colic fistula is a very rare. Symptoms are generally nonspecific, so diagnosis has depended on plain film of abdomen and barium studies. Recently, endoscopic examination and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. A 78-year-old man was admitted our hospital because of epigastric discomfort, indigestion, nausea and vomiting for 10 days. He was confirmed as cholecysto-duodeno-colic fistula by gastroduodenoscopy, colonoscopy, and endoscopic cholangio-graphic techniques. So, we report a case of cholecysto-duodeno-colic fistula of the patient with a review of relevant literatures.
Abdomen ; Aged ; Barium ; Biliary Tract ; Catheterization ; Colic* ; Colonoscopy ; Diagnosis ; Dyspepsia ; Fistula* ; Gallstones ; Humans ; Nausea ; Peptic Ulcer ; Vomiting

Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Malloly-Weise tears stop spontaneously without specific therapy in 80-90% of patient, but rebleeding occurs in 2 to 5% of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We performed endoscopic mucosal ligation using intraluminal negative pressure with band ligation for uncontrolled Mallory-Weiss syndrome. In conclusion, Endoscopic O-ring band ligation in uncontrolled intractable Mallory-Weiss syndrome is safe and effective method, but its important that accurate endoscopic O-ring band ligation an bleeding site in laceration area. We experienced endoscopic O-ring band ligation in 6 cases of Mallory-Weiss syndrome.
Alcoholics ; Cough ; Esophagogastric Junction ; Hematemesis ; Hemorrhage ; Humans ; Lacerations ; Ligation* ; Mallory-Weiss Syndrome ; Vomiting

Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Mallory-Weiss tears stop spontaneously without specific therapy in 80-90 percent of patient, but rebleeding is uncommonly occurring in 2 to 5 percent of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We conducted an uncontrolled study to evaluate an improved metallic clip(Olympus hemoclip) for the endoscopic treatment of Mallory-Weiss syndrome. Initial hemostasis was achieved in all patients with active bleeding. No complications resulted from this treatment. Clips did not impair healing of teared mucosa. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating uncontrolled Mallory-Weis syndrome.
Alcoholics ; Cough ; Esophagogastric Junction ; Hematemesis ; Hemorrhage ; Hemostasis ; Humans ; Lacerations ; Mallory-Weiss Syndrome ; Mucous Membrane ; Vomiting

Endoscopic esophageal variceal ligation(EVL) was first introduced by Stiegmann and colleagues in 1986, and it has since grown to he became an extremely popular modality throughout the world as well as Korea. Endoseopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic O-rings, has been recently developed as a non-operative alternative to endapic injection sclerotherapy(EIS). EVL is minimally operator-dependent and is also associated with fewer local and systemic complications than sclerotherapy. However, the conventional device has only one O ring, and thus the inner cylinder has to be exchanged after each ligation, So, it is a time-consurning procedure that requires the use of an overtube which has somtimes caused tearing of the esophageal mucosa. To save time and control variceal bleeding, multi-band ligation(MBL) was developed. These ligators have five or six O rings, and serial ligation is now possible without exchanging the cylinder or withdrawing the endoscope.(continue...)
Esophageal and Gastric Varices* ; Korea ; Ligation* ; Mucous Membrane ; Sclerotherapy ; Thrombosis ; Varicose Veins

Although ERCP has been widely used to diagnose and occasionally treat chronic pancreatitis, it is not always easy to differentiate between malignancy and benign disease by ERCP alone. So peroral pancreatoscopy(PPS) using mother and baby type scopes was developed and several types of peroral pancreatoscopes with various diameters have been used at several institutes. To assess the clinical usefulness of ultrathin-caliber pancreatoscopy on diagnosis of various pancreatic diseases, we performed peroral pancreatoscopy with PF 8P (Olympus, external diameter: 0.8 mm) in 12 cases(6 cases of chronic pancreatitis, 5 cases of pancreatic tumor, and 1 case of mucinous ductal ectasia) of pancreatic diseases. The pancreatoscope was successfully inserted into main pancreatic duct in 11 cases and permitted satisfactory endoscopic observation. The endoscopic findings of chronic pancreatitis were smooth stenosis, protein plug, and stones in pancreatic duct. Peroral pancreatoscopic findings of pancreatic cancer were characteristically seen as stenosis with irregular mucosal protrusion. In the mucin-producing tumor cases, the lesions were generally not clearly visualized due to the presence of copious amount of mucin. We conclude that pancreatoscopy is a valuable alternative or supplementary procedure to diagnostic imaging method of arriving at a more definite diagnosis in difficult cases. But several limitations, such as poor visual field, absence of biopsy channel and controllable tip, and poor durability of endoscope will be overcomed to serve as essential diagnosic tool for pancratic diseases.
Academies and Institutes ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Diagnosis* ; Diagnostic Imaging ; Endoscopes ; Humans ; Mothers ; Mucins ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Visual Fields

PURPOSE: Little is known about the clinical features of advanced gastric cancer (AGC) combined with disseminated intravascular coagulation (DIC). The main objective of this study was to determine the clinical outcome of patients with AGC complicated by DIC. MATERIALS AND METHODS: We conducted a retrospective review of 68 AGC patients diagnosed with DIC at four tertiary medical centers between January 1995 and June 2010. RESULTS: Sixty eight patients were included. The median age was 55 years (range, 25 to 78 years). Nineteen patients received chemotherapy, whereas 49 patients received only best supportive care (BSC). The median overall survival (OS) of the 68 patients was 16 days (95% confidence interval [CI], 11 to 21 days). Significantly prolonged OS was observed in the chemotherapy group, with a median survival of 61 days compared to 9 days in the BSC group (p<0.001, log-rank test). Age and previous chemotherapy were another significant factors that were associated with OS in univariate analysis. In multivariate analysis, age (> or =65 vs. <65; hazard ratio [HR], 0.38; 95% CI, 0.18 to 0.78; p<0.001), chemotherapy (BSC vs. chemotherapy; HR 0.31; 95% CI, 0.15 to 0.63; p<0.001), and previous chemotherapy (yes or no; HR, 0.49; 95% CI, 0.25 to 0.98; p<0.045) were consistently independent prognostic factors that impacted OS. CONCLUSION: Our study showed that patients with AGC complicated by DIC had very poor OS, and suggested that chemotherapy might improve OS of these patients.
Dacarbazine ; Disseminated Intravascular Coagulation* ; Drug Therapy* ; Humans ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms*