A colonic intussusception caused by an intraluminal lipoma is a rare disease in adults, in whom it usually has a definite organic cause. In fact, it is either caused by a benign or a malignant condition, both of which occur at similar rates. However, little literature is available on laparoscopic procedures for use in cases of adult colonic intussusceptions. Recently, a 52-year-old woman was admitted to our hospital with abdominal pain of one-month duration. Abdominal computed tomography showed an intussusception with a fat-containing mass in the right hepatic area. Colonoscopy showed a colon lumen occupied by the mass. A right hemicolectomy was performed laparoscopically, and the cause of the intussusception was found to be a lipoma. Before obtaining histological confirmation, we carefully perform a laparoscopic procedure, which required consideration of the relations between the involved colonic segment and other conditions such as the location of main vessels, the anatomical exposure with respect to colonic mobilization and the location of specimen retrieval.
Abdominal Pain ; Adult ; Colon ; Colon, Ascending ; Colonoscopy ; Female ; Humans ; Intussusception ; Laparoscopy ; Lipoma ; Rare Diseases

PURPOSE: Conventional laparoscopic appendectomy (LA) is a widely used treatment for appendicitis. Nowadays, single incision laparoscopic appendectomy (SILA) is increasingly used as an alternative treatment for appendicitis. The purpose of this study is to evaluate the clinical significance and differences between LA and SILA. METHODS: A total of 519 patients undergoing LA or SILA between January 2011 and December 2012 were identified in a retrospectively collected database. Patients' characteristics and peri-operative variables were analyzed. RESULTS: LA was performed in 485 patients and SILA was performed in 34 patients. Mean operation time for the LA group was 62.7 minutes (range 23.3~68.1) and that for the SILA group was 62.7 minutes (range 50.9~74.5). This difference of operation time was statistically significant. In the learning curve of SILA, operation time was gradually decreased. No significant differences in hospital stay and peri-operative complications were observed between groups. CONCLUSION: Although operation time for SILA was longer than that for LA, SILA was safe. Therefore, a prospective study should be conducted in order to confirm the possibility of application to most appendicitis patients.
Appendectomy ; Appendicitis ; Humans ; Laparoscopy ; Learning Curve ; Length of Stay ; Retrospective Studies

We experienced a case of lumbar epidural lipomatosis patient who had been treated with several epidural steroid injection for the management of lower back pain. This 67-years-old man, complained of lower back pain and radiating paresthetic pain to the dorsum of left foot. Epidural lipomatosis is a rare condition of focal or multiple deposition of excessive adipose tissue in epidural space. Since excessive deposited adipose tissue compresses the spinal cord or spinal root, patients complaint the atypical low back pain and low extremity radiculopathy which mimics the symptoms of spinal stenosis or herniated nucleus pulposus. In managing of lower back pain patient, especially who had been treated with steroid previously, we should consider that epidural lipomatois would be one of the cause.
Adipose Tissue ; Epidural Space ; Extremities ; Foot ; Humans ; Lipomatosis* ; Low Back Pain* ; Radiculopathy ; Spinal Cord ; Spinal Nerve Roots ; Spinal Stenosis

Small bowel obstruction due to congenital band is not only rare in children, but also difficult to diagnose, because common symptoms such as vomiting and abdominal pain are observed in patients. In order to prevent a fatal result, an anomalous congenital band should be considered in the discriminative diagnosis of intestinal obstruction in children who have no previous experience of operation or intraperitoneal inflammation. This report presents a 4-year-old boy who was admitted with abdominal pain and nonbilious vomiting for a day. The initial suspicion was for acute gastroenteritis. However, after further investigation and performance of surgery, the intestinal obstruction associated with a congenital band was confirmed. No recurrence was observed during the 8-month follow-up period. Thus early confirmation based on radiologic study is a crucial factor for the diagnosis of small bowel obstruction caused by a congenital band.
Abdominal Pain ; Child ; Follow-Up Studies ; Gastroenteritis ; Humans ; Inflammation ; Intestinal Obstruction ; Preschool Child ; Recurrence ; Vomiting

PURPOSE: Central venous catheterization is widely used to supply substantial amounts of fluids, total parenteral nutrition and hemodialysis in renal failure patients, as well as for measuring the central venous pressure. The most common complications encountered during central venous catheterization include catheter-related infections and subsequent sepsis. Therefore, when fever exists in patients with a central venous catheter, an immediate blood culture should be performed, and if the fever persists, an infection must be suspected and the catheter immediately removed; a culture of the catheter tip should also be performed. To date, no definite clinical details relating to this matter have been reported. METHODS: Between December 2002 and March 2005, a retrospective study was undertaken using the medical records of 85 patients. In those patients where a fever lasted for more than 8 hours, or when catheterization was no longer needed, the catheter tip cultures were sent to the microbiology laboratory. Blood cultures were also performed on 49 patients with a fever. The Chi-square method using the PC SPSS program, with P value less than 0.05 as statically significant. RESULTS: Of the 85 patients where the catheters were removed, significant microorganisms were detected 20 of the 49 with a fever. Only 5 of the remaining 36 patients had their catheters spontaneously removed. Moreover, 14 of the 20 patients with significant microorganisms were found to have kept their catheter in place for more than 14 days. Of the 49 patients with a fever, in who blood cultures were undertaken, 13 showed specific microorganisms, with 6 of these showing the same results for both their blood and catheter tip cultures, which enabled the definite diagnosis of the catheter-related infection and underlying sepsis. Various microorganisms were detected from the catheter tip cultures, including Staphylococcus species the CNS, with S. aureus being the most common, at 61.6%. CONCLUSION: A central venous catheter should be removed immediately when an infection is suspected, but early broad-spectrum antibiotics therapy should be commenced due to the time required to obtain the culture results. Moreover, even if a fever does not exist in patients with a catheter inserted for more than 14 days, infection and sepsis from the catheter should be of concern, with a more cautious approach being mandatory.
Anti-Bacterial Agents ; Catheter-Related Infections ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Diagnosis ; Fever ; Humans ; Medical Records ; Parenteral Nutrition, Total ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Sepsis ; Staphylococcus

Hepatitis B virus (HBV) reactivation has previously occurred in hepatitis B surface antigen-negative patients with malignant lymphoma who received rituximab-based combination chemotherapy. However, few reports have described cases of HBV reactivation in patients with multiple myeloma thus far. We report a case of HBV reactivation in a patient with multiple myeloma treated with chemotherapy, autologous hematopoietic stem cell transplantation, and maintenance steroid therapy. For the HBV reactivation, the patient was treated with the antiviral agent entecavir. The clinical symptoms and laboratory findings improved after 3 months. Further studies should target the identification of patients at high risk of HBV reactivation in multiple myeloma treated with autologous hematopoietic stem cell transplantation and steroid therapy for maintenance and establish viral prophylaxis strategies, especially in Korea, in which HBV infection is endemic.
Drug Therapy ; Drug Therapy, Combination ; Hematopoietic Stem Cell Transplantation ; Hepatitis B ; Hepatitis B virus ; Humans ; Korea ; Lymphoma ; Multiple Myeloma* ; Prednisolone* ; Transplantation

PURPOSE: The frequency of performing laparoscopic appendectomy (LA) has increased compared to that of open appendectomy because of its advantages such as decreased postoperative pain, shorter hospitalization and quicker recovery. The advantages of minimally invasive surgery are well known to the general public, so we recognized the importance of a laparoscopic training course. We analyzed the results of LA performed by one resident and we determined the learning curve and the safety. METHODS: We retrospectively studied 50 consecutive patients with a preoperative diagnosis of acute appendectomy and who underwent LA by one surgical resident. We used the medical and video records and compared the patients' age, gender, BMI, the location of the appendix tip, the pathologic findings, the state of drainage insertion, intraoperative bleeding, conversion to open surgery, the operation time and the complicating factor affecting the operating time. RESULTS: The mean operation time was 79.9 minutes and the operation time was effectively shortened when the surgeon had many experiences, the patients had a low BMI and there was no perforation, periappendiceal abscess or insertion of drains. After 25 cases of surgery experience (LA), the surgeon had enough expertise for the operations. Two cases of wound infection around the umbilical area and 1 case of intraperitoneal fluid collection occurred after the surgery. Yet this was all soon cured by wound dressing and the use of antibiotics. CONCLUSION: Fifty cases of LA were safely performed by one surgical resident. Thus, LA is a suitable procedure for surgical residents and it helpful for learning the basic technique of other advanced laparoscopic surgeries.
Abscess ; Appendectomy ; Appendix ; Bandages ; Conversion to Open Surgery ; Drainage ; Hemorrhage ; Hospitalization ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Pain, Postoperative ; Retrospective Studies ; Wound Infection

Nitrous oxide (N2O) is a chemical used as a medical anesthetic supplement, industrial semiconductor cleaning agent, and food additive in the manufacture of whipping cream. Nitrous oxide causes hypoxemia and suffocation during repeated inhalation. In severe cases, it causes coma and death. Some of those who are not aware of the dangers still illegally obtain and abuse nitrous oxide even with the law enforcing its use, and some people seem to have abused nitrous oxide after purchasing large amounts in small containers before the law has taken effect. Deaths from misuse of nitrous oxide are extremely rare in South Korea compared to those from other addictions such as carbon monoxide poisoning. No autopsy or follow-up blood tests were performed in this case.However, this is a unique and rare case in which carbon monoxide inhalation due to the combustion of lightning coal at the last moment overlaps with continuous inhalation of large amounts of nitrous oxide for several days beyond simple hallucination use, and is included in this report with a simple literature review.

Background: An excess of thyroid hormones in Graves’ disease (GD) has profound effects on systemic energy metabolism that are currently partially understood. In this study, we aimed to provide a comprehensive understanding of the metabolite changes that occur when patients with GD transition from hyperthyroidism to euthyroidism with methimazole treatment. Methods: Eighteen patients (mean age, 38.6±14.7 years; 66.7% female) with newly diagnosed or relapsed GD attending the endocrinology outpatient clinics in a single institution were recruited between January 2019 and July 2020. All subjects were treated with methimazole to achieve euthyroidism. We explored metabolomics by performing liquid chromatography-mass spectrometry analysis of plasma samples of these patients and then performed multivariate statistical analysis of the metabolomics data. Results: Two hundred metabolites were measured before and after 12 weeks of methimazole treatment in patients with GD. The levels of 61 metabolites, including palmitic acid (C16:0) and oleic acid (C18:1), were elevated in methimazole-naïve patients with GD, and these levels were decreased by methimazole treatment. The levels of another 15 metabolites, including glycine and creatinine, were increased after recovery of euthyroidism upon methimazole treatment in patients with GD. Pathway analysis of metabolomics data showed that hyperthyroidism was closely related to aminoacyl-transfer ribonucleic acid biosynthesis and branched-chain amino acid biosynthesis pathways. Conclusion In this study, significant variations of plasma metabolomic patterns that occur during the transition from hyperthyroidism to euthyroidism were detected in patients with GD via untargeted metabolomics analysis.

PURPOSE: Fibroblast growth factor (FGF) signals are important in carcinogenesis and progression of prostate cancer. Dovitinib is an oral, pan-class inhibitor of vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor, and fibroblast growth factor receptor (FGFR). We evaluated the efficacy and toxicity of dovitinib in men with metastatic castration resistant prostate cancer (mCRPC). MATERIALS AND METHODS: This study was a single-arm, phase II, open-label, multicenter trial of dovitinib 500 mg/day (5-days-on/2-days-off schedule). The primary endpoint was 16-week progression-free survival (PFS). Secondary endpoints were overall survival (OS), toxicity and prostate-specific antigen (PSA) response rate. Biomarker analyses for VEGFR2, FGF23, and FGFR2 using multiplex enzyme-linked immunosorbent assay was performed. RESULTS: Forty-four men were accrued from 11 hospitals. Eighty percent were post-docetaxel. Median PSA was 100 ng/dL, median age was 69, 82% had bone metastases, and 23% had liver metastases. Median cycles of dovitinib was 2 (range, 0 to 33). Median PFS was 3.67 months (95% confidence interval [CI], 1.36 to 5.98) and median OS was 13.70 months (95% CI, 0 to 27.41). Chemotherapy-naïve patients had longer PFS (17.90 months; 95% CI, 9.23 to 28.57) compared with docetaxel-treated patients (2.07 months; 95% CI, 1.73 to 2.41; p=0.001) and the patients with high serum VEGFR2 level over median level (7,800 pg/mL) showed longer PFS compared with others (6.03 months [95% CI, 4.26 to 7.80] vs. 1.97 months [95% CI, 1.79 to 2.15], p=0.023). Grade 3 related adverse events were seen in 40.9% of patients. Grade 1-2 nausea, diarrhea, fatigue, anorexia, and all grade thrombocytopenia are common. CONCLUSION: Dovitinib showed modest antitumor activity with manageable toxicities in men with mCRPC. Especially, patients who were chemo-naïve benefitted from dovitinib.
Anorexia ; Biomarkers ; Carcinogenesis ; Castration ; Diarrhea ; Disease-Free Survival ; Enzyme-Linked Immunosorbent Assay ; Fatigue ; Fibroblast Growth Factors ; Humans ; Liver ; Male ; Multicenter Studies as Topic ; Nausea ; Neoplasm Metastasis ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Prostatic Neoplasms, Castration-Resistant ; Receptors, Fibroblast Growth Factor ; Receptors, Platelet-Derived Growth Factor ; Receptors, Vascular Endothelial Growth Factor ; Thrombocytopenia