Rhabdomyolysis is defined as necrosis of the skeletal muscle fibers with release of the intracellular muscle constituents, including myoglobins,into the blood and urine. Severe myoglobinemia causes obstruction and necrosis of the renal tubule, resulting in acute renal failure (ARF). In this case, a patient with rhabdomyolysis-induced ARF was in recovery phase after treatment with fluid replacement and continuous renal replacement therapy (CRRT). However, a sudden relapse of severe myoglobinemia occurred during CRRT. To remove myoglobinas rapidly as possible, we applied two sessions of plasmapheresis (total plasma exchange, TPE) in addition to CRRT for two days. The myoglobin level of the patient successfully decreased by 91%, and clinical symptoms and laboratory-measuredabnormalities subsequently improved. If severe myoglobinemia is persistent, or if relapse in spite of CRRT occurs, it would be reasonable to consider TPEas an additional therapy.
Acute Kidney Injury ; Humans ; Muscle Fibers, Skeletal ; Myoglobin* ; Necrosis ; Plasma Exchange ; Plasmapheresis* ; Recurrence ; Renal Replacement Therapy ; Rhabdomyolysis*

A 16-year-old male presented with pain in the right posterior mandible on chewing that had lasted for several months. The radiographic features of the lesion included a radiolucent-radiopaque mixed-density mass with a radiolucent rim attached to the root of the mandibular right first molar. The preliminary radiographic diagnosis was benign cementoblastoma, which was confirmed by histopathological examination following surgical excision. The lesion recurred 3 years after treatment; radiographically, it consisted of 3 round foci with mixed radiopacity, each with a radiolucent rim near the root of the mandibular right second premolar and the edentulous postoperative region. The lesion was diagnosed as recurrent benign cementoblastoma and a second surgery was scheduled. This report presented an unusual case of recurrent benign cementoblastoma following surgical excision and extraction of the involved tooth, along with a literature review on reported cases of recurrent benign cementoblastoma with a focus on its clinical features and the best treatment options.

PURPOSE: Although laparoscopic surgery is widely accepted in the treatment of colorectal cancer, conversion to open surgery is associated with the rate of unfavorable outcomes. The aim of this study was to determine the factors associated with open conversion from laparoscopic surgery for colorectal cancer.METHODS: A total of 3,002 patients who underwent laparoscopic colectomy as an initial plan for the treatment of colorectal cancer located from the sigmoid colon to the rectum were retrospectively evaluated between January 2009 and December 2018 at Samsung Medical Center in Korea. Risk factors significantly associated with open conversion were determined using univariate and multivariate regression models.RESULTS: Among the 3,002 patients, open conversion was performed in 120 patients (4%). Age >60 years (adjusted odds ratio [AOR], 2.370), preoperative bowel obstruction (AOR, 2.348), clinical T4 stage (AOR, 2.201), and serum carcinoembryonic antigen level >5 ng/mL (AOR, 2.289) were significantly associated with open conversion. Moreover, mucinous carcinoma was a significantly more frequent histopathologic type than adenocarcinoma (10.0% vs. 3.2%, P<0.001) in the open conversion group with an AOR of 2.549 (confidence interval, 1.259–5.159; P=0.009).CONCLUSION: The present study presented a novel finding, i.e. mucinous carcinoma as the histopathologic type could be an independent predictive factor for conversion from laparoscopic colectomy to open surgery. Identifying patients with mucinous carcinoma will help stratify the risk of open conversion preoperatively.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoembryonic Antigen ; Colectomy ; Colon, Sigmoid ; Colorectal Neoplasms ; Conversion to Open Surgery ; Humans ; Korea ; Laparoscopy ; Mucins ; Odds Ratio ; Rectum ; Retrospective Studies ; Risk Factors

This report presents the case of a 49-year-old man who presented with giant masses that had recently grown on the bilateral sides of the tongue. A clinical examination revealed rubbery yellowish lesions protruding from the tongue.A panoramic radiograph showed an enlarged soft tissue shadow of the tongue. Computed tomography showed well-defined circumscribed mass exhibiting a homogeneous low density on the bilateral sides of the tongue. On magnetic resonance images, the masses showed a high signal intensity on T1-weighted images and iso-signal intensity with partially hyperintense margin on fat-suppressed T2-weighted images. Surgical excision was performed, and a histopathologic examination confirmed the diagnosis of lipoma. The patient recovered well with no sign ofrecurrence. A giant lipoma is defined as a lipoma larger than 5 cm in diameter. A literature review of giant lipomas of the tongue is also presented herein.

Agenesis of the dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas and can manifest as diabetes. A 24-year-old man, who had been treated with insulin for 7 years, presented with epigastric pain, vomiting, and watery diarrhea. Abdominal computed tomography showed only the head of the pancreas without visualization of the pancreatic body and tail. Left renal agenesis and absence of the left vertebral pedicle in T12 were also observed. The duct of Santorini and the duct in the body and tail were not visible in magnetic resonance cholangiopancreatography. The associated anomalies reported here are very rare globally. We report a case of complete agenesis of the dorsal pancreas with multiple congenital abnormalities and diabetes mellitus.
Cholangiopancreatography, Magnetic Resonance ; Congenital Abnormalities ; Diabetes Mellitus ; Diarrhea ; Endoderm ; Head ; Humans ; Insulin ; Kidney ; Kidney Diseases ; Pancreas ; Pancreatic Ducts ; Vomiting ; Young Adult

The demand for medical care and welfare for patients with disabilities is expanding, and healthcare professionals are also increasingly interested in the need for medical care for patients with disabilities. The purpose of this study was to evaluate the competency of disabled patients' management and the education experience of dental hygiene students, who are the main players of oral health care for disabled patients. A total of 196 students in the dental hygiene department and 3rd and 4th grade students were surveyed using questionnaires. As a result, most of the students had a positive awareness of disabled patients; 84.7% answered with the need to train dental hygienists in specializing in handicapped patients, 76.5% were willing to attend seminars related to disabled patients after graduation, and 71.4% of the students provided dental treatment for patients with disabilities in curriculum and comparative curriculum. The students who provided treatment for disabled patients showed that their competence in most areas of knowledge of disabled patients, oral health education, and oral disease prevention was highly evaluated as significant. The competence of respondents who answered that the theoretical education was sufficient was significantly higher. Based on this, institutional support for the education of dentistry for disabled patients is needed, and sufficient theoretical education and practical training should be offered to foster personnel capable of contributing to the improvement in the oral health of patients with disabilities. In addition, in-depth discussions on the training of dental hygienists specialized in handicapped patients should be conducted.
Clinical Competence* ; Curriculum ; Delivery of Health Care ; Dental Care for Disabled ; Dental Hygienists ; Disabled Persons ; Education ; Humans ; Mental Competency ; Oral Health ; Oral Hygiene* ; Surveys and Questionnaires

PURPOSE: We aimed to determine whether Autism Spectrum Disorder (ASD) would show neural abnormality of the social reward system using functional MRI (fMRI). MATERIALS AND METHODS: 27 ASDs and 12 typically developing controls (TDCs) participated in this study. The social reward task was developed, and all participants performed the task during fMRI scanning. RESULTS: ASDs and TDCs with a social reward learning effect were selected on the basis of behavior data. We found significant differences in brain activation between the ASDs and TDCs showing a social reward learning effect. Compared with the TDCs, the ASDs showed reduced activity in the right dorsolateral prefrontal cortex, right orbitofrontal cortex, right parietal lobe, and occipital lobe; however, they showed increased activity in the right parahippocampal gyrus and superior temporal gyrus. CONCLUSION: These findings suggest that there might be neural abnormality of the social reward learning system of ASDs. Although this study has several potential limitations, it presents novel findings in the different neural mechanisms of social reward learning in children with ASD and a possible useful biomarker of high-functioning ASDs.
Brain/*physiopathology ; Brain Mapping ; Case-Control Studies ; Child ; Child Development Disorders, Pervasive/*physiopathology ; Female ; Functional Neuroimaging/*methods ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Neural Pathways/*physiopathology ; Psychiatric Status Rating Scales ; Republic of Korea ; *Reward ; *Social Behavior

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS: Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS: The changes in the McGill pain questionnaire were 38.8+/-9.0 prior to treatment and 11.8+/-3.1 following the treatment. The corresponding values for the control group were 37.2+/-7.7 and 28.5+/-10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0+/-1.5 and 2.8+/-0.8 in the ESWT group, respectively, and 7.2+/-1.4 and 5.8+/-2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm2) were not significantly different between groups (p>0.05). CONCLUSION: The study findings imply that ESWT for stump neuroma is superior to conventional therapy.
Amputation ; Amputation Stumps ; Humans ; Neuroma* ; Pain Measurement ; Shock* ; Transcutaneous Electric Nerve Stimulation ; Ultrasonography ; Visual Analog Scale

BACKGROUND: Thoracic paravertebral blockade (TPVB) can be effective in many clinical settings. However, many clinicians are reluctant to use this technique due to its adverse effects such as pneumothorax. The aim of this study was estimate the appropriate depth and width for safe needle positioning. METHODS: The depth from skin to the paravertebral space (PVS) and the width from the spinous process (SP) to the PVS and the lateral tip of the transverse process (LTTP) were measured in all available sections from 84 patients examined by chest computed tomography (CT). The correlation between age, gender, body mass index (BMI) and each measured value was analyzed. RESULTS: All 828 sections from the 84 patients aged between 19 and 65 years old were evaluated. The minimum and maximum values of the mean depth from the skin to PVS were 40.3-52.4 mm in men and 41.2-55.9 mm in women. The minimum and maximum values of the mean width from the SP to LTTP were 29.2-34.6 mm in men and 23.7-31.0 mm in women. At every thoracic level, the depth to PVS was similar in both genders but the width from the SP to the NEP in men was significantly higher than in women. Weight significantly influenced the width from the SP to LTTP in men but height and BMI did not. Also weight and BMI significantly influenced the depth from skin to PVS in almost all of the thoracic region at both sex, but height did not influence the depth from skin to PVS in both sex. CONCLUSIONS: We report clinically useful estimates that may be used to help avoid side effects such as pneumothorax and achieve a successful thoracic paravertebral blockade.
Aged ; Body Mass Index ; Female ; Humans ; Male ; Needles* ; Pneumothorax ; Skin ; Thorax

BACKGROUND AND AIMS: Gastric candidiasis is an uncommon disorder. But in recent years this diagnosis has increased as a result of the greater use of broad-spectrum antibiotics, immunosuppressive and chemotherapeutic agents or of the use of drugs that reduce the gastric acid production, such as H2 receptor antagonists. Our aim of the present study was to investigate clinical characteristics of gastric candidiasis including endoscopic findings and histopathology. METHODS: We reviewed 28 cases of gastric candidiasis who have under-went endoscopic biopsy at Wonkwang University Hospital from January 1995 to eptember 1996. RESULTS: 1) The prevalence rate of gastric candidiasis was 0.8% (28/3400). 2) In benign and malignant gastric ulcer patients, occurrence of other clinical findings were cardio-vascular disease in 5 cases, diabetes mellitus in 3 cases, hepatobiliary disease in 5 cases, bronchopulmonary disease in 10 cases, renal disease in 1 case, immunosuppressive therapy in 1 case, peptic ulcer therapy in 4 cases, and nongastric neoplasm in 1 case. 3) Locations of benign and malignant gastric ulcers in patients with candidial infection were prepyloric area in 8 cases, angle in 7 cases, body in 11 cases, cardia and fundus in 2 cases. 4) Sizes of ulcer cases were almost > or =2 cm in benign ulcer (76.5%), all cases were > or =3 cm in malignant ulcer. 5) According to endoscopic criteria, thrush type were in 22 cases, ulcerated type in 6 cases and depth of candidial infection in ulcer base were suppurative type in 18 cases, fibrinoid type in 10 cases. 6) After 6 weeks of therapy, endoscopic and clinical cure occurred in 60% (3/5) of patients treated by H2 blocker, antacid, and occurred in 100% (5/5) of patients treated by H2 blocker, antacid and antifungal agent. CONCLUSIONS: These results suggest that gastric candidiasis has a large and dirty ulcer base, white or green-white membrane and spread over inflammed area.
Anti-Bacterial Agents ; Biopsy ; Candidiasis* ; Candidiasis, Oral ; Cardia ; Diabetes Mellitus ; Diagnosis ; Endoscopy ; Gastric Acid ; Humans ; Membranes ; Peptic Ulcer ; Prevalence ; Stomach Ulcer ; Ulcer