Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP). Diabetic ketoacidosis (DKA) leads to lipolysis and HTG, and can result in AP. Triad of AP, DKA, and HTG is rare and not fully understood. Usually AP is associated with severe HTG with serum triglyceride (TG) level over 1,000 mg/dL. However, we experienced two cases of AP in DKA with mild HTG with TG level less than 200 mg/dL. Herein, we report these unusual cases and provide a review of the literature about the triad of DKA, HTG, and AP.

Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP). Diabetic ketoacidosis (DKA) leads to lipolysis and HTG, and can result in AP. Triad of AP, DKA, and HTG is rare and not fully understood. Usually AP is associated with severe HTG with serum triglyceride (TG) level over 1,000 mg/dL. However, we experienced two cases of AP in DKA with mild HTG with TG level less than 200 mg/dL. Herein, we report these unusual cases and provide a review of the literature about the triad of DKA, HTG, and AP.

Background: The purpose of this study was to identify the differences in the importance of oral pathology learning objectives forinstructors and clinical dental hygienists and provide basic data that can guide learning objectives for acquiring practically necessary basic knowledge in the clinical field. Methods: Through the first-stage expert meeting, 27 items with less than four points out of 129 learning objectives in 15 detailed areas were deleted, 12 additional opinions were reflected, 114 learning objectives were set, and a survey was conducted with 253 people. Results: There were statistically significant differences in 92 items after examining the difference between professors and clinical dental hygienists. Among the areas of inflammation and repair, “Can explain the five symptoms of inflammation” had the highest with a score at 4.76 in the case of the professors. Among the areas of tooth damage, “Can explain abrasion” had the highest with a score at 4.61 in the case of the clinical dental hygienists. Conclusion I would like to propose the existing 15 detail areas and 129 learning objectives as 14 detail areas and 98 learning objectives and strengthen the job competency of dental hygienists in the future. First, you need to develop competencies that are highly relevant to your work. Second, it is necessary to develop related textbooks and educational materials based on revised learning objectives and competencies. Third, based on revised learning objectives, the dental hygienist national examination should be improved. Through these changes in education, the education of oral and maxillofacial disease subjects should strengthen job competencies among dental hygienists with learning objectives that can be applied to actual clinical practice based on basic knowledge rather than knowledge orientation. In addition, it is possible to improve the quality of dental hygiene studies.

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) is challenging to gastrointestinal endoscopists. The aim of this study was to evaluate the impact of scope exchange from a long single balloon enteroscope (SBE) to a gastroscope during SBE-assisted ERCP (SBE-ERCP) in patients with SAA. Methods: Patients who underwent SBE-ERCP between February 2019 and October 2020 were retrospectively identified. Intubation success, scope exchange success, cannulation success, and therapeutic success were analyzed along with complications. Results: Fifty-six patients with various SAAs underwent SBE-ERCP procedures, including Billroth II subtotal gastrectomy (B-II, n=13), pylorus-preserving pancreato-duodenectomy (PPPD, n=6), Roux-en-Y hepaticojejunostomy (REY HJ, n=4), and total gastrectomy with REY anastomosis (TG REY, n=33). Overall intubation, cannulation, and therapeutic success rates were 89.3%, 82.1%, and 82.1%, respectively. Therapeutic success rates did not differ significantly among the type of SAA. Successful scope exchange rate after successful intubation was significantly higher in native papilla (B-II and TG REY, 83.3%, 35/42) compared to bilioenteric anastomosis (PPPD and REY HJ, 0%, 0/8, p<0.001). Intubation success, scope exchange, and cannulation success were associated with therapeutic success (p<0.001). In multivariate analysis, successful scope exchange was the only factor related to cannulation success (p=0.02). The major complication rate was 1.8% (one perforation). Conclusions SBE-ERCP is a safe and effective procedure to treat biliary problems in patients with SAA. Successful scope exchange may lead to higher therapeutic success by way of cannulation success.

Benign fibrous histiocytoma (FH) is a benign tumor composed of fibroblasts and histiocytes in varying proportions. This tumor is usually found in adult extremities but rarely occurs in deep soft tissues of the oral cavity. As it is difficult to diagnose with physical and radiologic exams, deep benign FH can only be diagnosed by histopathology. We report a case of a 36-year-old female patient who came to our department with painless swelling in the right buccal mucosa. This case report reviews the clinical, radiological, and histological aspects of this tumor.
Adult ; Extremities ; Female ; Fibroblasts ; Head and Neck Neoplasms ; Histiocytes ; Histiocytoma ; Histiocytoma, Benign Fibrous* ; Humans ; Mouth Mucosa ; Mouth Neoplasms ; Mouth*

Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.
Adult ; Botulinum Toxins, Type A/administration & dosage/*adverse effects ; Female ; Humans ; Injections ; Migraine Disorders/*drug therapy

OBJECTIVES: The cost of psychiatric service is increasing every year in Korea. The length of inpatient stay (LOS) is an important factor determining in-patient service cost. This study was aimed to find the factors that influence LOS in a psychiatric open ward of a general hospital. METHODS: The study includes 134 inpatients who were consecutively admitted to a psychiatric open ward in a general hospital from January 1st to June 30th in 2001. Demographic data, clinical characteristics on admission and discharge, global functioning, social support levels and life stressors were collected. RESULTS: The mean LOS for the 134 patients was 15.5 days (S.D 9.2). The occupation of housekeeper and those secred high in phobic anxiety subscale on SCL-90-R were statistically significant predictor for longer LOS in the univariate analysis. No significant differences in LOS were found by diagnostic groups and social support. In multiple regression analysis, the scores of phobic anxiety subscale, occupation and presence of physical illness were statistically significant predictor for LOS. CONCLUSION: This study failed to find the significant variables to account for substantial proportion of variance for LOS.
Anxiety ; Diagnosis ; Hospitals, General* ; Humans ; Inpatients ; Korea ; Length of Stay* ; Occupations

PURPOSE: The aim of this study was to determine the force distribution and pattern of mastication after injection of botulinum toxin type A (BTX-A) into both masseter muscles. The hypothesis to be tested was that the difference between right and left balance of occlusal force diminishes over time following BTX-A injection. MATERIALS AND METHODS: Fifteen patients were submitted to BTX-A injection therapy for subjective masseter hypertrophy. A total of 25 U of BTX-A (50 U in total) was injected into two points located 1 cm apart at the center of the lower one-third of both masseter muscles. All patients were examined using the T-Scan occlusion analysis system before and 4, 8, 12, and 24 weeks after BTX-A injection. RESULTS: A significant change in force balance was found between the right and left sides over time and the difference between the two sides decreased with the time post-injection, reaching a minimum at 12 weeks. Comparison of the force balance between the anterior and posterior occlusions revealed no significant difference at any of the time points. The occlusion and disclusion times (right and left sides) did not differ significantly with time since BTX-A injection. CONCLUSION: A decline in the difference in the clenching force between the left and right sides was found with increasing time up to 12 weeks following BTX-A injection.
*Bite Force ; Botulinum Toxins, Type A/administration & dosage/*pharmacology/therapeutic use ; Female ; Humans ; Hypertrophy/drug therapy ; Injections ; Male ; Masseter Muscle/abnormalities/drug effects ; Neuromuscular Agents/administration & dosage/*pharmacology/therapeutic use

Clear cell odontogenic carcinoma (CCOC) is a rare jaw tumor that was classified as a malignant tumor of odontogenic origin in 2005 by the World Health Organization because of its aggressive and destructive growth capacity and metastasis to the lungs and lymph nodes. We report a case of a 66-year-old female who had swelling, incision and drainage history and a well-defined unicystic radiolucent lesion that was comparable to a cystic lesion. At first, the patient received decompression, and the lesion size decreased. Three months after decompression, cyst enucleation was performed. The pathologic result indicated that the lesion was CCOC. In this report we emphasize that patients with painful cystic lesions in addition to jaw enlargement and loosening teeth should be considered for the possibility of malignancy.
Aged ; Decompression ; Diagnostic Errors* ; Drainage ; Female ; Head and Neck Neoplasms ; Humans ; Jaw ; Lung ; Lymph Nodes ; Mouth Neoplasms ; Neoplasm Metastasis ; Tooth ; World Health Organization

Hydatid disease in humans is a parasitic disease typically caused by the larvae of Echinococcus granulosus. Although the disease can occur in any body part, it most frequently affects the liver. Hydatid disease is usually diagnosed incidentally and presents with various types of cystic lesion in the infected anatomical locations. Among the many potential complications of hepatic hydatid cysts, including rupture, infection, biliary communication, and peritoneal seeding, spontaneous rupture of the cyst into the hollow viscera is exceptionally rare and has been reported in less than 0.5% of cases. We report the case of a patient with hepatic hydatid disease complicated by spontaneous rupture into stomach causing gastric ulcer and peritoneal seeding.