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.

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.

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.

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

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*

BACKGROUND AND OBJECTIVES: The local delivery of drugs to the arterial wall represents a strategy for the treatment of fibroproliferative vascular disease. Paclitaxel has been shown to inhibit vascular smooth muscle cell proliferation and migration, which contribute to neointimal formation. This study tested whether the perivascular delivery of paclitaxel can prevent neointimal formation in a rat carotid artery injury model. MATERIALS AND METHODS: The ability of locally-administered paclitaxel to prevent the neointimal hyperplastic response was tested by incorporating 10 microgram paclitaxel into 40% F-127 pluronic gel, which was then applied to the adventitial surface of the rat carotid artery immediately following balloon injury. Fourteen days after angioplasty, the neointimal growth was compared between paclitaxel- (n=12) and pluronic gel only treated (control group, n=11) rats. RESULTS: The paclitaxel-treated group showed significant neointimal formation reductions compared to the control group (0.10+/-0.05 versus 0.21+/-0.05 mm2, p<0.05). The perivascular application of paclitaxel produced a highly localized pattern of neointimal growth inhibition in the arterial cross-section. Although 10 microgram paclitaxel showed no significant cytotoxicity, 20 microgram paclitaxel (n=3) demonstrated cytotoxicity, with medial cell drop out in the region of application. CONCLUSION: We have demonstrated that the local extravascular application of 40% F-127 pluronic gel containing paclitaxel provides an effective mechanism for inhibiting the proliferative response to vascular injury in the rat. The cellular response to paclitaxel is highly focal. Locally sustained delivery of paclitaxel, as little as 10 microgram, was effective in preventing neointimal growth, without destroying medial wall smooth muscle cells.
Angioplasty ; Animals ; Carotid Arteries* ; Carotid Artery Injuries* ; Cell Proliferation ; Hyperplasia* ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Paclitaxel* ; Rats* ; Vascular Diseases ; Vascular System Injuries