Osteochondroma, also known as osteocartilaginous exostosis, or just exostosis, is the most common benign bone tumor. Most of osteochondromas are solitary lesions and affect long bones; however, about 12% of osteochondromas are multiple lesions with the autosomal dominant inheritance. Only 1~4% of solitary osteochondromas originate in the spine. Symptoms vary depending on its location. We experienced a case of osteochondroma of the atlas presenting as an oropharyngeal mass. We report the case with a review of literatures.
Exostoses ; Osteochondroma* ; Spine ; Wills

Purpose: We aimed to identify risk factors for transurethral coagulation (TUC) using bipolar electrocautery for hemostasis during holmium laser enucleation of the prostate (HoLEP) surgery for benign prostatic hyperplasia (BPH). Methods: We analyzed the clinical outcomes of HoLEP surgery performed by a single surgeon between January 2010 and April 2020 at the Seoul National University Hospital. Patient characteristics and perioperative parameters were used to identify the risk factors for TUC. The TUC group was defined as a case of conversion to hemostasis using electrocautery during the hemostasis step after enucleation. Results: Of 1,563 patients, 357 underwent TUC (TUC group; 22.8%) as an adjuvant (n=299, 19.1%) or salvage (n=58, 3.7%) therapy. Patients in the TUC group were older (mean±standard deviation, 70.6±7.3 years vs. 69.3±7.0 years; P=0.002), had more 5-alpha reductase inhibitor (5-ARI) use (35.6% vs. 25.9%, P<0.001), higher serum prostate-specific antigen (PSA) (5.4 ±4.8 ng/mL vs. 3.8 ±4.5 ng/mL, P <0.001), larger total prostate volume (TPV) (89.5 ±44.7 mL vs. 66.0 ±32.6 mL, P<0.001), and larger transitional zone volume (TZV) (57.3±34.9 mL vs. 37.7±24.2 mL, P<0.001) than those who did not undergo TUC (non-TUC group). In univariate logistic regression analysis, age, 5-ARI use, PSA, TPV, and TZV correlated with TUC, whereas in multivariate logistic regression analysis, only TZV was associated with TUC. The odds ratios (ORs) of TUC were analyzed per TZV quartile. Compared to TZV<22.3 mL, the OR was 2.42 in 34.1 mL≤TZV<53.5 mL (95% confidence interval [CI], 1.58–3.72; P<0.001), 5.17 in ≥53.5 mL (95% CI, 3.44–7.77; P<0.001). Conclusions The risk of TUC during HoLEP surgery increases in patients with TZV >35 mL. Therefore, TUC may be potentially necessary in patients with a large transition zone volume in patients with BPH.

OBJECTIVE: We investigated the characteristics of cellular phone use and its association with psychological problems among adolescents. METHODS: A total of 332 adolescent students were recruited for this study. The participants' self-reported characteristics of cellular phone use and the psychological problems caused by this were tested by using the Excessive Cellular Phone Use Survey (ECPUS), the Children's Depression Inventory (CDI), Spielberger's State-Trait Anxiety Inventory for Children (STAIC) and the Korea-Youth Self Report (K-YSR). RESULTS: The excessive user group made more use of text messages and they spent more time and paid higher fees than the comparison group. They expressed severer depression and anxiety and they had more behavior problems and lower school performance than the comparison group. The ECPUS score was positively correlated with score of the CDI, STAIC and the behavior problem scales of the K-YSR, and the ECPUS score was negatively correlated with the school performance scale of the K-YSR. CONCLUSION: Our findings suggest that excessive cellular phone use by adolescents may be related to psychological problems. Careful education about the use of cellular phones and intervention are recommended for adolescents who excessively use cellular phones.
Adolescent ; Anxiety ; Cellular Phone ; Child ; Depression ; Fees and Charges ; Humans ; Self Report ; Text Messaging ; Weights and Measures

A 23 years old single nulligravida woman underwent laparoscopic removal of a huge cystic adnexal mass that occupied her entire abdomen, giving the appearance of a full term pregnancy. After anesthesia, a vertical infra-umbilical incision, 1 cm long, was made and a telescope was introduced through the port to determine the status of the intra-abdomen and the surface contour of the mass. A needle tipped with a laparoscopic suction apparatus was inserted into the cyst through the infra-umbilical port, directly under the mass. Subsequently, 3, 200 ml of cystic fluid was aspirated without spillage. A huge cyst, reaching to the level of the xyphoid process was effectively excised through the operative laparoscopy after prelaparoscopic drainage. Operation time was 140 minutes and hospital stay was 2 days. There were no complications during hospital stay and after discharge. It seems the size of the cyst is not a criteria for the contraindication of laparoscopic surgery.
Abdomen ; Anesthesia ; Drainage ; Female ; Humans ; Laparoscopy ; Length of Stay ; Needles ; Ovarian Cysts* ; Pregnancy ; Suction ; Telescopes ; Young Adult

BACKGROUND: Pulmonary complications following bonemarrow transplantation(BMT) are common and associated with a high mortality rate, We investigated the yield, safety, and impact of fiberoptic bronchoscopy(FOB) for diagnosis of postBMT pneumoniae. METHODS: From May 1997 to April 2000, 56 FOBs were performed in 52 post BMT patients for clinical pneumoniae. BMT patients with repiratory symptoms and/or pulmonary infiltrates had a thoracic HRCT(high resolution computed tomography) and bronchoscopic examination including BAL(bronchoalveolar lavage), TBLB(transbronchial lung biopsy), PSB(protected specimen brush). RESULTS: The characteristics of the subjects were as follows:37 males, 15 females, mean age of 31.3 years(17-45), 35 sibling donor allogenic BMTs, 15 nonrelated donor allogenic BMTs, and 2 autologous BMTs. Fiftynine percent of FOBs (33 FOBs, 31 patients) were diagnostic. Isolated pathogens included the following:12 cytomegalovirus(CMV) (21.4%), 7 pneumocystis carinii(PC) (12.5%), 11 CMV with PC (19.6%), 2 Mycobacaterium tuberculosis (3.6%), and 1 streptococcus (1.8%). Most of the radiographic findings were diffuse interstitial lesions. CMV pneumoniae had mainly diffuse interstitial nodular lesion, and PC pneumoniae had diffuse, interstitial ground glass opacity(GGO). When CMV was accompanied by PC, a combined pattern of nodular and GGO was present. Of the 56 cases(23.2%), 13 died of CMV pneumoniae(n=2), PCP(n=2), mixed infection with CMV and PC(n=3), underlying GVHD(n=1), underlying leukemia progression(n=1), or respiratory failure of unknown origin(n=4). There was no major complication by bronchoscopy. Only 3 cases developed minor bleedig and 1 episode temporary hypoxemia. CONCLUSION: Based on our findings, CMV and PC are the major causes of postBMT pneumoniae. In addition, BAL can be considered a safe and accurate procedure for the evaluation of pulmonary complications after BMT.
Anoxia ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchoscopy* ; Coinfection ; Diagnosis* ; Female ; Glass ; Humans ; Leukemia ; Lung ; Male ; Mortality ; Pneumocystis ; Pneumonia* ; Respiratory Insufficiency ; Siblings ; Streptococcus ; Tissue Donors ; Tuberculosis

Many antipsychotics have the potential to increase plasma prolactin levels, leading to a range of short-term and long-term adverse effects. In addition to short-term adverse effects such as galactorrhea, gynecomastia, menstrual irregularities, and sexual dysfunction, a number of important and potentially serious long-term adverse effects have been reported, including loss of bone mineral density, weight gain, pituitary tumor, breast cancer, and prostate cancer. Short-term adverse effects may negatively impact medication compliance, and long-term effects have the potential for serious health consequences. However, to a large degree, hyperprolactinemia has been neglected in clinical practice and research, compared with other potential adverse effects. Balancing the benefits of treatment with antipsychotics against their potential adverse effects is clinically important. Effective management of hyperprolactinemia begins with taking a careful patient history to determine the presence of any relevant signs and symptoms. If a mild elevation of plasma prolactin levels is detected (< 0 ng/mL), then it may be reasonable to continue to monitor the levels. If the elevation is persistent and > 0 ng/mL, then the clinician should consider switching to a drug with a lower potential to elevate prolactin. In any patient with a prolactin elevation greater than 150 ng/mL, a prolactinoma should be considered
Antipsychotic Agents ; Bone Density ; Breast Neoplasms ; Female ; Galactorrhea ; Gynecomastia ; Humans ; Hyperprolactinemia ; Male ; Medication Adherence ; Organothiophosphorus Compounds ; Pituitary Neoplasms ; Plasma ; Pregnancy ; Prolactin ; Prolactinoma ; Prostatic Neoplasms ; Weight Gain

No abstract available.
Humans

PURPOSE OF REVIEW: This journal introduces a overview in depth about the evolution of transoral robotic thyroidectomy, which has been encountering major confrontations in expanding its indications. RECENT FINDINGS: Transoral robotic thyroidectomy (TORT) is one of the newest approaches and draws attention because of its cosmetic excellence. The major advantage of TORT is comparatively smaller flap dissection area than other remote-access methods. The other advantage of TORT is that the wounds of lips fades out over time, and leaves concealed scar near axilla. SUMMARY: TORT can be done safely to the appropriately selected patients by surgeon expertise in robotic thyroidectomy. It might be a potential alternative surgical approach for thyroidectomy to surgeons who are experienced in remote-access robotic surgery.
Axilla ; Cicatrix ; Humans ; Liability, Legal ; Lip ; Mouth ; Robotic Surgical Procedures ; Surgeons ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Wounds and Injuries

Purpose: Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively. Methods: Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups. Results: Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056). Conclusion Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.

PURPOSE: We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. METHODS: Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. RESULTS: A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. CONCLUSIONS: External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.
Calibration ; Cohort Studies ; Dataset ; Decision Support Systems, Clinical ; Discrimination (Psychology) ; Humans ; Mobile Applications ; Nomograms ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Seoul ; Smartphone* ; Tertiary Care Centers ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Tract*