Intestinal malrotation is a constellation of a wide spectrum of embryologic failures of rotation and fixation of the gut, resulting in a narrow-based attachment of the mesentery and the presence of abnormal peritoneal (Ladd's) band. These abnormalities predispose to midgut volvulus, intestinal obstruction and internal herniation. We experienced a case of intestinal malrotation complicated by midgut volvulus in a 4-year-old girl who presente with abdominal pain, abdominal distension and melena. The diagnosis was made by abdominal CT scan, which showed "whirl sign." The diagnosis was confirmed by surgery. A brief review of literature ensues.
Abdominal Pain ; Acidosis ; Acidosis, Renal Tubular* ; Adolescent ; Alkalies ; Anemia, Hemolytic ; Atrophy ; Biopsy ; Chest Pain ; Child, Preschool ; Diagnosis* ; Exanthema ; Female ; Fever ; Fibrosis ; Hospitalization ; Humans ; Hypergammaglobulinemia ; Hypokalemia ; Intestinal Volvulus* ; Leukopenia ; Liver Diseases ; Lupus Erythematosus, Systemic* ; Lymphopenia ; Melena ; Mesentery ; Molecular Weight ; Multiple Myeloma ; Nephrotic Syndrome ; Neutrophils ; Potassium ; Prednisolone ; Proteinuria ; Thyroid Diseases ; Tomography, X-Ray Computed*

Intestinal malrotation is a constellation of a wide spectrum of embryologic failures of rotation and fixation of the gut, resulting in a narrow-based attachment of the mesentery and the presence of abnormal peritoneal (Ladd's) band. These abnormalities predispose to midgut volvulus, intestinal obstruction and internal herniation. We experienced a case of intestinal malrotation complicated by midgut volvulus in a 4-year-old girl who presente with abdominal pain, abdominal distension and melena. The diagnosis was made by abdominal CT scan, which showed "whirl sign." The diagnosis was confirmed by surgery. A brief review of literature ensues.
Abdominal Pain ; Acidosis ; Acidosis, Renal Tubular* ; Adolescent ; Alkalies ; Anemia, Hemolytic ; Atrophy ; Biopsy ; Chest Pain ; Child, Preschool ; Diagnosis* ; Exanthema ; Female ; Fever ; Fibrosis ; Hospitalization ; Humans ; Hypergammaglobulinemia ; Hypokalemia ; Intestinal Volvulus* ; Leukopenia ; Liver Diseases ; Lupus Erythematosus, Systemic* ; Lymphopenia ; Melena ; Mesentery ; Molecular Weight ; Multiple Myeloma ; Nephrotic Syndrome ; Neutrophils ; Potassium ; Prednisolone ; Proteinuria ; Thyroid Diseases ; Tomography, X-Ray Computed*

Since the first description of the trisomy 9p in 1970, over one hundred cases have been described with the advanced chromosomal banding technique. Clinical findings include growth and mental retardation and facial dysmorphism. Crucial determinants of the classical features of this syndrome lie within the distal half of the chromosome 9 short arm. But this syndrome has not been reported in Korea, we are reporting a boy diagnosed by clinical features and chromosomal study that is trisomic for a partial short arm of a chromosome 9. A brief review of the literature is included.
Arm ; Chromosomes, Human, Pair 9 ; Humans ; Intellectual Disability ; Korea ; Male ; Trisomy

Low-grade endometrial stromal sarcoma (LGESS) with intravascular extension is very rare, with only 26 cases having been reported. We experienced a case of LGESS with inferior vena cava (IVC) extension. A 60-year-old female presented with left leg edema. She had a history of total hysterectomy, and was diagnosed of leiomyoma at that time. On imaging study, tumor masses were located around both common iliac veins (CIV), and within the CIV and IVC. The pelvic masses on both side and IVC mass were resected, and then the patient received adjuvant hormonal therapy and radiotherapy over the remnant pelvic masses. LGESS with IVC extension is difficult to distinguish from intravascular leiomyomatosis. LGESS is a malignant disease and commonly recurs, even in early stages. Accurate diagnosis, complete resection, proper adjuvant therapy and close follow-up are very important.
Diagnosis ; Edema ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Iliac Vein ; Korea ; Leg ; Leiomyoma ; Leiomyomatosis ; Middle Aged ; Radiotherapy ; Sarcoma, Endometrial Stromal* ; Vena Cava, Inferior*

In orthodontic field, it is very important to understand the normal growth, Such an understanding can be derived from observation of normal growth in various samples from childhood to adulthood, and this builds a foundation from which growth abnormality or variation can be defined. Thus, a broad data collection of normal children, as well as basic study reviewing such data become necessary. The relationship between the mean values of cephalometric measurements in Growth and Development was studied among the group(boys and Girls) of Korean children from the ages 6-years to 16-years. 220 boys 170 girls were chosen as subjects : cephalometric X-ray were taken for 3 years and hard tissue analysis on McNamara and Riketts Analysis which was divided into measurements of 5 parts(Cranial base, Cranial base and Maxilla & Mandible, Maxilla and Mandible, Mandible. Dental measurements). The relationship of craniofacial growth was studied. The following conclusions were obtained: 1. There was statistically significant differences in anterior cranial base between the two sexes of 14 and 15-year groups. 2. In comparison of growth amounts among different age group, statistically singnificant difference in Posterior facial height exhisted among 10~11, 12~13 and 14~15year-old interval groups. This pattern increased with aging. 3. Na perpendicular to A showed earlier growth peak in females(11-12years) than males (12-13years). When horizontal measurements of point A and Pogonion are compared, mandibular growth appeared to be greater. 4. Maximum growth peak of cranial base and mandible was earlier in females (11-12 years) than males(13-14years). 5. Upper central incisor flared out with aging, and there were increases in lower incisor to A-Pg, and lower incisor inclination. There was significant difference between the two sexes in 10-years-old group.
Aging ; Child* ; Data Collection ; Female ; Growth and Development ; Humans ; Incisor ; Male ; Mandible ; Maxilla ; Skull Base

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

Purpose: The purpose of this study was to compare fatigue, depression, and psychosocial well-being according to level of care dependency in stroke patients. Methods: 140 stroke patients participated in this descriptive correlation study. Data were collected from July 12, 2019, to March 25, 2020. The data collected using a structured questionnaire on care dependency, fatigue, depression, psychosocial well-being. To analyze the data, mean, standard deviation, x2 test, ANCOVA, and Pearson's correlation coefficients were used. Results: Stroke patients with moderate to high level of care dependency showed higher fatigue compared to patients with low care dependency. The patients with high care dependency presented significantly higher depression than the patients with low and the moderate care dependency patients did. Low care dependency group had higher psychosocial well-being scores compared to moderate care dependency group, while moderate care dependency group had higher psychosocial well-being scores compared to high care dependency group. Conclusion The results of this study showed that stroke patients with high care dependency presented high fatigue and depression in addition to low well-being. Therefore, it is necessary to develop and apply nursing interventions to reduce fatigue and depression and to promote psychosocial well-being for the patients with high level of care dependency.

Purpose: This study aimed to identify the early sedation depth in the first 48 hours of mechanical ventilation and its relationship to clinical outcomes to promote the transition to light sedation. Methods: This retrospective single-center cohort study was conducted in two medical intensive care units (MICUs) at a general tertiary hospital, using a standardized sedation protocol. To investigate the early sedation depth, the Sedation Index was used, which can indicate changes over the first 48 hours. Patients were divided into three groups based on tertiles of Sedation Index. The primary outcome was mortality at 30, 90, and 180 days. The secondary outcomes included length of stay in the ICU and ventilator-free days. Kaplan-Meier analysis and multivariable Cox regression were conducted to compare factors influencing mortality. Results: This study included 394 patients. The deepest sedation group showed more severe illness, delirium, and deeper sedation at admission (p < .001). The survival curve decreased as sedation increased, even within the light sedation levels. In the deepest sedation group, 30-day mortality (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.33–3.34), 90-day mortality (HR 2.00, 95% CI 1.31–3.06), and 180-day mortality (HR 1.77, 95% CI 1.17–2.67) increased. The length of stay in the ICU and ventilator-free days did not show statistical differences. Conclusions These results indicate that early deep sedation is a modifiable factor that can potentially affect mortality. The protocol for inducing the transition into light sedation must comply with recommendations to improve clinical outcomes.

V. parahaemolyticus was isolated from blood culture of a 34-year old female patient with HCV viral hepatitis and liver cirrhosis. V. parahaemolyticus is one of the frequent causative agents of gastrointestinal infection, but rarely causes septicemia. This case is thought to be the 3rd report of V. parahaemolyticus septicemia in Korea.
Adult ; Female ; Hepatitis ; Humans ; Korea ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio parahaemolyticus* ; Vibrio*

Purpose: Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes. Methods: In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment. Results: In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure. Conclusion We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.