PURPOSE: To elucidate the mechanism of neoangiogenesis in human retinal pigment epithelium under oxidative stress. METHODS: Paraquat was added to cultured human retinal pigment epithelium (HRPE) for 72 hours to induce oxidative stress milieu. Expression and production of angiogenic factors, including vascular endothelial growth factor (VEGF) and pigment epithelial derived factor (PEDF), was checked by RT-PCR and Western blot, respectively. The induction of neoangiogenesis was monitored by both tube formation in ECV 304 cell and migration assay of human fetal dermal microvascular endothelial cells. RESULTS: Competitive RT-PCR showed that PEDF gene in paraquat-treated HRPE was expressed at a significantly lower level than in non-treated HRPE. However, Western blot showed a significant increase of VEGF production (p<0.05) and a decrease of PEDF production (p<0.05). Moreover, angiogenesis was dose-dependently increased when the various concentrations of paraquat were added to HRPE. CONCLUSIONS: Taken together, oxidative stress by addition of paraquat caused HRPE to produce more VEGF and less PEDF, thereby leading to neoangiogenesis, and suggesting that the neovascularization in age-related macular degeneration (AMD) is caused by destroying the balance of angiogenic factors in HRPE such as VEGF and PEDF; that is, in oxidative stressed HRPE, more VEGF is released and less PEDF, as compared to normal HRPE.
Angiogenesis Inducing Agents ; Blotting, Western ; Endothelial Cells ; Humans* ; Macular Degeneration ; Oxidative Stress* ; Paraquat ; Retinal Pigment Epithelium ; Vascular Endothelial Growth Factor A

Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.
Adolescent ; *Appendix ; Cecal Diseases/*diagnosis ; *Colonoscopy ; Female ; Humans ; Intussusception/*diagnosis

Neurogenic neoplasms of the facial nerve are uncommon. These neoplasms are usually classified into two types: schwannoma and neurofibroma. Although intraparotid facial nerve schwannomas have been documented sporadically throughout the medical literature, neurofibromas from intraparotid facial nerve are extremely rare. Neurogenic neoplasms of the intraparotid facial nerve are usually diagnosed intraoperatively by tissue biopsy. The management of neurogenic tumors associated with normal facial function is a particularly difficult problem. These benign tumors of neurogenic origin should be considered in the differential diagnosis of parotid masses. This is a case report of a solitary neurofibroma involving the main trunk of the facial nerve in the parotid gland.
Biopsy ; Diagnosis, Differential ; Facial Nerve* ; Neurilemmoma ; Neurofibroma* ; Parotid Gland

Arteriovenous malformation is a part of the spectrum of vascular malformations that involve shunting of blood from the arterial vessel directly into the venous system. The most frequent locations, in order of incidence, are the extremities, the lungs, and the head and neck. However, arteriovenous malformation of the parotid gland is rare, The "turkey wattle" sign describes the enlargement of a facial mass in dependency of the head, and when present, it is pathognomonic of hemangioma or vascular malformation. The treatment of choice is to complete removal of the mass by surgery to stop their progress. We report a recent encounter with a case of arteriovenous malformation of the parotid gland in a 43-year-old female patient. This disorder was successfully removed by total parotidectomy with the preservation of the facial nerve.
Adult ; Arteriovenous Malformations* ; Extremities ; Facial Nerve ; Female ; Head ; Hemangioma ; Humans ; Incidence ; Lung ; Neck ; Parotid Gland* ; Vascular Malformations

The fundic gland type (GA-FG) of gastric adenocarcinoma is a rare variant of gastric cancer recently included in the 5th edition of the World Health Organization’s classification of digestive system tumors. Five patients with GA-FG underwent an endoscopic resection at our institution. None of the patients had a Helicobacter pylori infection. Four lesions were located in the upper third of the stomach, and one was in the lower third. Three lesions had a IIa shape, while two resembled a subepithelial tumor. An endoscopic submucosal dissection was performed in four patients and endoscopic mucosal resection in one. Tumor cells were composed of well-differentiated columnar cells mimicking fundic gland cells, and the median tumor size was 10 mm. Three lesions exhibited submucosal invasion. No lymphatic or venous invasion was observed. Tumor cells were positive for MUC6 in all five cases; one case was focally positive for MUC5AC. No recurrence was observed during a median follow-up period of 13 months. An endoscopic resection can be a safe treatment modality for GA-FG, considering its small size and low risk of recurrence or metastasis. (Korean J Gastroenterol 2023;81:259-264)

Background/Aims: This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives. Methods: A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40–65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40–65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated. Results: The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective. Conclusions One-time universal HCV screening in the Korean population aged 40–65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives.

Carnobacterium is a genus of gram-positive bacilli belonging to the family Lactobacillaceae.Generally, Carnobacterium species are considered nonpathogenic to humans and are mostly found in the natural environment, food, and food packaging. Furthermore, some Carnobacterium species play a bioprotective role in the food industry. Isolation of Carnobacterium from human blood or other sites, such as skin or abscess, has rarely been reported—there are only four published case reports worldwide, and none of them is from Korea. In all the reported cases, the patients reported contact with an aqueous environment or were administered nutrition via a parenteral route. Herein, we report the detection of Carnobacterium divergens bacteremia in an immunocompromised patient by using mass spectrometry in Korea.

The majority of cardiac myxoma occur sporadically as isolated lesions in the left atrium of middle-aged women. However, a familial form and a syndrome form of this lesion have also been identified. The syndrome myxoma can present itself with pigmented skin lesions and peripheral or endocrine neoplasms. The familial and syndrome forms of cardiac myxomas can usually be distinguished from the sporadic form by their occurrences at younger ages, their unusual locations, the multicentricity of the lesions, and the presence of rare pathological conditions. In addition, a higher rate of recurrent lesions is usually associated with the familial and syndrome forms of this disease. We present a case of complex cardiac myxoma with pigmented skin lesions and breast myxoma and report it with a review of literature.
Breast ; Female ; Heart Atria ; Humans ; Myxoma* ; Nipples* ; Skin

Background/Aims: Endoscopic submucosal dissection (ESD) is a curative treatment modality for early gastric neoplasms; however, ESD can be a time-consuming process. To overcome this pitfall, we developed the one-step knife (OSK) approach, which combines an endoscopic knife and injection needle on a single sheath. We aimed to evaluate whether this approach could reduce the ESD procedure time. Methods: This single-blinded randomized multicenter trial at four tertiary hospitals from June 2019 to June 2020 included patients aged 19 to 85 years undergoing ESD. Patients were randomly assigned to two groups (OSK or conventional knife [CK]). The injection time, total procedure time, resected specimen size, submucosal fluid amount, degree of device satisfaction, and adverse events were evaluated and compared between groups. Results: Fifty-one patients were analyzed (OSK: 25 patients and CK: 26 patients). No baseline differences were observed between groups, with the exception of a higher portion of males in the OSK group. The mean injection time was significantly reduced in the OSK group (39.0 seconds) compared to that in the CK group (87.5 seconds, p<0.001). A decrease of more than 10 minutes in the total procedure time (18.0 minutes vs 28.1 minutes, p=0.055) in the OSK group compared to the CK group was observed. Second-look esophagogastroduodenoscopy revealed two delayed bleeding cases in the OSK group that were easily controlled by endoscopic hemostasis. Conclusions OSK reduced the injection time and showed a decrease in total procedure time compared with the CK approach. OSK can be a feasible tool for ESD, especially in difficult cases.

PURPOSE: We wanted to evaluate the MR imaging findings of portal biliopathy. MATERIALS AND METHODS: We retrospectively reviewed the MR imaging of twelve patients having biliary abnormalities and portal cavernoma. Two radiologists working in consensus analyzed the presence of extrahepatic portal vein obstruction, cavernous transformation, portosystemic collaterals and bile ducts abnormalities that included irregular contour, stricture, ductal dilatation, wall thickening and enhancement of the ductal wall. RESULTS: Extrahepatic portal vein obstruction was replaced by cavernous transformations in all patients. The cavernous transformations depicted on the MR scans were paracholedochal veins in 12 patients and epicholedochal veins in 6 patients. Three different types of biliary abnormalities were present: 1) the pseudocholangiocarcinoma type (3 patients) that resembled extrahepatic cholangiocarcinoma, 2) the varicoid type (6 patients) that was mainly distinguished by the multiple smooth extrinsic impressions along the common bile duct and 3) the mixed type (3 patients). The highly specific findings for the pseudocholangiocarcinoma type disease were thickening and delayed enhancement of the biliary ductal wall. CONCLUSION: The MR findings of portal biliopathy include cavernous transformation of the portal vein and morphological alterations of the biliary tracts such as irregular contour, biliary stricture with proximal ductal dilatation and thickening of the ductal wall with delayed enhancement. Recognition of these MR findings should facilitate the accurate diagnosis of portal biliopathy and prevent the misinterpretation or inappropriate management of this disease as malignancy or sclerosing chloangitis.
Bile Ducts ; Biliary Tract ; Cholangiocarcinoma ; Common Bile Duct ; Consensus ; Constriction, Pathologic ; Diagnosis ; Dilatation ; Humans ; Magnetic Resonance Imaging* ; Portal Vein ; Retrospective Studies ; Veins