The widespread application of coronary angiography and poen heart surgery have resulted in more frequent detection of patients with coronary artery anomaly. In 0.6 to 1.2 percent of individials, the coronary arteries arise aberrantly from the aorta. Anomalous origin of the left coronary artery from the fight coronary sinus with subsequent coursing between the aorta and pulmonary artery is a rare and sometimes fatal coronary amonaly. This anomaly has been reported in young and healthy men who died suddenly during or immediately forllowing vigorous physical exercise. The exact mechanism of sudden death is unclear. It is believed to be related to either extrinsic compression of the left coronary artery or distorsion of the vessel orifice, with resultant global ischemia and ventricular fibrllation. A 13-years old healthy boy, who was completely asymptomatic until he had sudden chest pain after running, arrived at hospital with typical clinical picture of acute myocardial infarction. The electrocardiography taken on admission demonstrated pathologic Q wave changes on lead I, aVL, V2, V3 and V4. Cardiac enzymes were elevated. The selective coronary angiography demonstrated that left coronary artery arose from the right coronary sinus. The anomalous left coronary artery passed posterioly around aortic root to reach its normal position in the interventricular groove. We report the patient with anomalous origined left coronary artery which causes the acute myocardial infarction.
Adolescent ; Aorta ; Chest Pain ; Coronary Angiography ; Coronary Sinus* ; Coronary Vessels* ; Death, Sudden ; Electrocardiography ; Exercise ; Humans ; Ischemia ; Male ; Myocardial Infarction* ; Pulmonary Artery ; Running ; Thoracic Surgery

PURPOSE: A case study and literature review of alveolar rhabdomyosarcoma (RMS) in an adult. METHODS: A 48-year-old male patient presented at our clinic complaining of proptosis that had persisted for 2 weeks in his left eye. A computed tomography (CT) scan revealed a destructive soft-tissue mass in the left ethmoid sinus with invasion of the left orbit and compression of the medial rectus muscle. Endoscopic intranasal biopsy revealed alveolar RMS. Conservative debulking and orbital wall decompression were performed. RESULTS: Immunohistochemical testing was positive for desmin, S-100, and smooth muscle actin (SMA), supporting the diagnosis of RMS. Since ipsilateral cervical and spinal metastasis was detected, systemic treatment was administered simultaneously. CONCLUSIONS: Although rarely found in adults, RMS should be considered in the differential diagnosis of orbital tumors. Immunohistochemical analysis plays an important role in the definitive diagnosis of RMS.
Tomography, X-Ray Computed ; Rhabdomyosarcoma, Alveolar/*pathology/radiography ; Paranasal Sinus Neoplasms/*pathology/radiography ; Orbital Neoplasms/*pathology/radiography ; Neoplasm Invasiveness ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Humans ; *Ethmoid Sinus ; Diagnosis, Differential ; Biopsy

BACKGROUND/AIMS: Quantitation of hepatitis B surface antigen (HBsAg) is an increasingly popular method to determine the treatment response in chronic hepatitis B (CHB) patients. The clinical value of HBsAg level measurement during rescue therapy for lamivudine (LMV)-resistant CHB patients have not been evaluated to date. Therefore, this study investigated the correlation between HBsAg level and treatment response in LMV-resistant CHB patients treated with adefovir (ADV) add-on therapy. METHODS: LMV-resistant CHB patients treated with LMV-ADV combination therapy for over 2 years were included. HBsAg levels were measured at 6 month intervals until 1 year, and annually thereafter. Treatment response was assessed by determining the virological response (VR, undetectable HBV DNA levels) during treatment. RESULTS: Fifty patients were included, of which 40 showed a VR. HBsAg levels were not different significantly at baseline (4.0 vs. 3.6 Log10 IU/mL, P=0.072). However, the HBsAg level decreased after 6 months of treatment in patients with a VR and became different significantly between the groups thereafter (3.9 vs. 3.3 at 6 months, P=0.002; 3.8 vs. 3.2 at 1 year, P=0.004; 3.9 vs. 3.2 at 2 years, P=0.008; 3.7 vs. 3.1 at 3 years, P =0.020). CONCLUSIONS: The HBsAg level at 6 months after treatment can help predict treatment response.
Adenine/*therapeutic use ; Adult ; Antiviral Agents/*therapeutic use ; Area Under Curve ; DNA, Viral/blood ; Drug Resistance, Viral ; Female ; Hepatitis B Surface Antigens/*blood ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/*drug therapy/virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Organophosphates/*therapeutic use ; ROC Curve ; Treatment Outcome

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height2) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.
Absorptiometry, Photon ; Accidental Falls ; Aging ; Body Composition ; Bone Density ; Case-Control Studies* ; Female ; Hip Fractures ; Hip* ; Humans ; Korea ; Leg ; Male ; Multivariate Analysis ; Muscle, Skeletal ; Nutrition Surveys ; Osteoporosis ; Prevalence* ; Sarcopenia*

PURPOSE: The purpose of this study is to identify nature of regenerated articular cartilage after microfracture surgery. MATERIALS AND METHODS: From Oct. 1997 to Nov. 1998, 40 knees were treated for osteoarthritis by arthroscopic microfracture technique. In the 18 knees, during the second arthroscopic procedure, biopsy specimens extending to the subchondral bone were taken and immunohistochemical staining was done to identify type of collagen. One patient was man and 17 patients were women. Average age of the patients were 58 years (range, 40-75 years). RESULTS: Type II collagen in articular cartilage appeared to be brown color with this staining. Degree of staining were +3 in 4 knees(22%), +2 in 2 knees(11%), +1 in 7 knees(39%) and trace in 5 knees(28%). CONCLUSION: Microfracture surgery restores the function of the joint by forming predominantly hyaline-like cartilage containing type II collagen. As analyzing amounts of type II collagen with an immunohistochemical staining in regenerated cartilage, we can presume the prognosis of regenerated cartilage tissue after microfracture surgery.
Biopsy ; Cartilage* ; Cartilage, Articular ; Collagen ; Collagen Type II* ; Female ; Humans ; Joints ; Knee ; Osteoarthritis ; Prognosis

The coronavirus disease (COVID-19) by severe acute syndrome coronavirus-2 (SARS-CoV-2) occurs the unprecedented pandemic during recent two years and the WHO declared a global pandemic of COVID-19 in March 2020. The most common sampling sites in COVID-19 test are the oropharynx and nasopharynx. We recently encountered a total laryngectomee who had a positivity COVID-19 diagnostic test from the tracheostoma, on the other hand, false negativity from the nasal cavity. The meaning of this case is that accurate screening test could be achieved by performing a test through the tracheostoma as well as nasal cavity or oropharynx. We also would like to discuss the accurate testing methods of patients whose airflow has distorted due to surgery, the management method of these patients, and the need of further research in the COVID-19 pandemic period with relevant literature reviews.

A paranasal sinus mucocele is an epithelial-lined, mucus-containing sac that completely fills the sinus and forms an expandable cystic structure. It most commonly affects the frontal and ethmoidal sinuses, and rarely the maxillary and sphenoid sinuses. Orbital displacement or external disfigurement resulting from the expansion of the frontal or ethmoid sinuses is common; however, facial asymmetry caused by maxillary bone remodeling is rare. We describe a case of large maxillary sinus mucocele that destroyed the maxillary sinus bony wall, resulting in notable left cheek swelling and disfigurement, and review the relevant literature.

Objectives: Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%–70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods: The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results: Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRSrelated conditions.

Neoplasm from the accessory parotid glands (APG) rarely occurs, and its malignancy rate is higher than other salivary glands. The B-cell lymphoma from APG is rare, with less than 2% of all malignancy in APG. The mucosa-associated lymphoid tissue (MALT) lymphoma, a subtype of B-cell lymphoma, tends to be a localized disease with an indolent clinical course. It is very rare for MALT lymphoma to develop bilaterally in the APG and the parotid glands without an autoimmune disease. A 43-year-old male presented with superficial masses in the bilateral infra-zygomatic regions, and was pathologically confirmed as MALT lymphoma by excisional biopsy. We report this very rare and interesting case with a brief literature review.

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.
Anti-Bacterial Agents/therapeutic use ; Ceftriaxone/therapeutic use ; Drainage ; Endophthalmitis/diagnosis/drug therapy ; Humans ; Injections, Intravenous ; Klebsiella Infections/complications/*diagnosis/drug therapy ; Klebsiella pneumoniae/isolation & purification ; Liver Abscess/*diagnosis/etiology ; Male ; Middle Aged ; Psoas Abscess/diagnosis/etiology ; Spondylitis/diagnosis/drug therapy ; Tomography, X-Ray Computed