We report a case of hepatocellular carcinoma presented with severe hypoglycemia. Computerized tomography and ultrasonography revealed a massive bilateral tumor with portal vein thrombosis. The levels of IGF-I (113 ng/mL) and IGFBP- (815 ng/mL) measured in the plasma, were lower than normal range. There was strong immunoreactivity of IGF- and IGF-I in immunohistochemical stain of tumor cells.
Carcinoma, Hepatocellular* ; Carrier Proteins* ; Fibrinogen* ; Hypoglycemia* ; Insulin-Like Growth Factor Binding Proteins ; Insulin-Like Growth Factor I ; Plasma ; Reference Values ; Ultrasonography ; Venous Thrombosis

No abstract available.
Interleukin-6* ; Rabbits*

No abstract available.

The authors report two cases of successful reconstruction in infected nonunion of the femur involving marked shortening by compression and gradual distraction at the nonunion site using Ilizarov external fixator. At first, infection was controlled by radical excision & the administration of systemic antibiotics for four weeks and we also started compression at the nonunion site 3 days after operation. Autogenous iliac bone graft was added to strengthen the site of new bone formation lastly. In this report, the role of the compression seems to provide a good environment for distraction osteogenesis by focal necrosis and triggering inflammation. Compression and gradual distraction may be one of the treatment mordalities for nonunion of a long bone with massive bone loss or shortening, even infected.
Anti-Bacterial Agents ; External Fixators ; Femur* ; Inflammation ; Necrosis ; Osteogenesis ; Osteogenesis, Distraction ; Transplants

Malignant hyperthermia is a metabolic and genetic disease which present with multiple signs of variable intensity and time course. Most of signs are nonspecific to malignant hyperthermia an4 it is not unusual for malignant hyperthermia-susceptible patients to under- go their first anesthesia uneventfully. Thus,the accurate prediction of preanesthetic susceptibility and early diagnosis of malignant hyperthermis can be lifesaving. Recently, some episodes of signs and symptoms suggestive of malignant hyperthemia after spinal an- esthesia those were suspected to be malignant hyperthermia have been reported. In our hospital, two patients suffered from signs and symptoms suggestive of malignant hyperthermia after spinal anesthesia. One patient showed severe muscle rigidity on the un- blocked upper extremities and thorax, tachycardia (120-160beat/min) and hypertension (180-160/120-100mmHg) and later he showed high fever(38-40degrees C), generalized seizure and severe acidosis. He expired the next day of operation in spite of intensive care. The other patient showed shivering, high fever(39degrees C) and elevated serum CPK level(more than 1,500IU/ L) after spinal anesthesia. Intensive treatment with cooling was immediately initiated. Then, he recovered completely 6 hours later. His mother and a brother showed increased serum CPK level(91,112IU/L, respectively), too. Although we could not performed confirmatory diagnostic test, signs and symptoms were very similar to those of malignant hyperthermia. So, we suspected that it might be malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Spinal* ; Diagnostic Tests, Routine ; Early Diagnosis ; Humans ; Hypertension ; Critical Care ; Malignant Hyperthermia* ; Mothers ; Muscle Rigidity ; Seizures ; Shivering ; Siblings ; Tachycardia ; Thorax ; Upper Extremity

Alcohol withdrawal syndrome (AWS) is the most common and well-known condition occurring after intentional or unintentionalcessation or decreasing heavy drinking. Approximately 5-10% of these people are suffering from serious medical and psychiatricproblems, withdrawal seizures, perceptual disturbances, and delirium tremens. Despite acute medical conditions with the highmortality of severe AWS, proper management could decrease the severity and mortality of AWS. The Clinical Institute withdrawalassessment for alcohol-revised version is a valid, reliable, and sensitive instrument for assessing the clinical course and thetreatment monitoring of alcohol withdrawal. Benzodiazepine is the pharmacotherapy of choice for alcohol withdrawal. Diazepamor lorazepam treatment is best initiated early in the course of alcohol withdrawal to prevent progression to more severewithdrawal. There are three strategies for the pharmacotherapy of AWS. After the treatment of AWS, most patients should bemanaged or treated by the continuing care, including the psychosocial treatments, community-based management, and programsfor preventing recurrence of AWS.

Objectives: The purpose of the study was to investigate the factors affecting unmet dental care needs among elderly living alone. Methods: The study subjects were 19,019 elderly living by themselves, who participated in the Korea Community Health Survey 2018 (KCHS, 2018). The data were analyzed using frequency analysis, Rao-Scott chi-square test, t-test, and binary logistic regression analysis, using the SAS 9.4 software. Results: Results from the multiple logistic regression analysis revealed a higher odds ratio (OR) for unmet dental care needs among those with a monthly household income below KRW 1,000,000 (OR=1.64, 95% confidence interval, 95%CI=1.39-1.92), compared to those with an income of above KRW 2,000,000. With regards to stress levels, unmet dental care needs were more prevalent among participants in the “stress moderate” (OR=1.19, 95% CI=1.06-1.33) and “stress” groups (OR=1.68 95% CI=1.48-1.92), compared to the “no stress” group. Furthermore, the OR for unmet dental care needs was significantly higher among participants in the “depression” group (OR=1.84, 95% CI=1.61-2.11) than the “no depression” group. Conclusions Higher unmet dental care needs were found among participants in the low monthly household income, stress, and depression groups. Further study is needed to analyze the association between factors and needs related to unmet dental care.

Objectives: The purpose of the study was to investigate the factors affecting unmet dental care needs among elderly living alone. Methods: The study subjects were 19,019 elderly living by themselves, who participated in the Korea Community Health Survey 2018 (KCHS, 2018). The data were analyzed using frequency analysis, Rao-Scott chi-square test, t-test, and binary logistic regression analysis, using the SAS 9.4 software. Results: Results from the multiple logistic regression analysis revealed a higher odds ratio (OR) for unmet dental care needs among those with a monthly household income below KRW 1,000,000 (OR=1.64, 95% confidence interval, 95%CI=1.39-1.92), compared to those with an income of above KRW 2,000,000. With regards to stress levels, unmet dental care needs were more prevalent among participants in the “stress moderate” (OR=1.19, 95% CI=1.06-1.33) and “stress” groups (OR=1.68 95% CI=1.48-1.92), compared to the “no stress” group. Furthermore, the OR for unmet dental care needs was significantly higher among participants in the “depression” group (OR=1.84, 95% CI=1.61-2.11) than the “no depression” group. Conclusions Higher unmet dental care needs were found among participants in the low monthly household income, stress, and depression groups. Further study is needed to analyze the association between factors and needs related to unmet dental care.

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.