Acute gastric anisakiasis with multiple anisakid larvae infection is reported. A 68-year-old woman residing in Busan, Korea, had epigastric pain with severe vomiting about 5 hours after eating raw anchovies. Four nematode larvae penetrating the gastric mucosae in the great curvature of the middle body and fundus were found and removed during gasteroendoscopic examination. Another one thread-like moving larva was found in the great curvature of upper body on the following day. On the basis of their morphology, the worms were identified as the 3rd stage larvae of Anisakis simplex. This case is acute gastric anisakiasis provoking severe clinical problems by the multiple infection and the greatest number of anisakid larvae found in a patient in Korea.
Acute Disease ; Aged ; Animals ; Anisakiasis/*parasitology/surgery ; Anisakis/*growth & development ; Female ; Gastric Mucosa/parasitology/pathology/surgery ; Gastroscopy ; Human ; Stomach Diseases/*parasitology/pathology/surgery

Background/Aims: Although localized lymphoid hyperplasia (LLH) of the rectum is occasionally observed, its clinical implications are unclear. This study aimed to investigate the clinical course and significance of LLH of the rectum. Methods: We identified 65 patients diagnosed with LLH of the rectum using a histopathologic examination and who received follow-up endoscopies between January 2009 and June 2015. Patients with a history of inflammatory bowel disease, lymphoma, familial adenomatous polyposis, or uncontrolled malignancy and patients who underwent scar biopsy after endoscopic resection or surgery were excluded. Endoscopic findings and clinical courses were analyzed. Results: During the median follow-up of 31 months (interquartile range, 19 to 40 months), 81.5% (53/65) of LLHs of the rectum were resolved. Clinically significant diseases, including ulcerative colitis (UC, n=5) and mucosa-associated lymphoid tissue (MALT) lymphoma (n=1), were diagnosed in 9.2% of patients (6/65). The other six patients showed no significant changes in the lesion (n=3) or a waxing and waning appearance (n=3). According to endoscopic findings, all of the 47 polypoid types showed resolution or waxing and waning patterns. Five of the 11 nodular types (45.5%) developed into UC. One of the seven submucosal tumor (SMT)-like types (14.3%) developed into MALT lymphoma. Conclusions LLH of the rectum with persistent symptoms or the endoscopic appearance of the nodular or SMT-like type may lead to clinically significant disease. Risk stratification according to endoscopic findings and careful surveillance are required for these lesions.

Ceramide induces cell death in a dose- and time-dependent manner in neuroblastoma SK-N-SH cells. To investigate the mechanism of SK-N-SH cell death by C2-ceramide, morphological features and Hoechst 33258 staining were analyzed. In these morphlogic study the cell death by ceramide showed typical apoptotic features, nuclear condensation, fragmentation, and membrane blebbing. Ceramide-induced apoptosis was accompanied by nuclear accumulation of p53. Inhibition of p53 expression with p53 antisense oligonucleotides inhibited apoptosis evoked by ceramide. Also, ceramide induced mitochondrial event, collapse of mitochondrial membrane potential (delta psi m) and interestingly, inhibition of p53 attenuated collapse of mitochondrial membrane potential, suggests that ceramide induces mitochondrial dysfunction through upregulation of p53 expression. These results suggest that ceramide-induced apoptosis is dependent upon increase in cellular p53 levels which play a critical role in the regulation of apoptotic cell death and p53 modulates mitochondrial function such as mitochondrial membrane potential level.
Apoptosis ; Bisbenzimidazole ; Blister ; Cell Death* ; Membrane Potential, Mitochondrial ; Membranes ; Neuroblastoma ; Neurons* ; Oligonucleotides, Antisense ; Up-Regulation

Splenic artery pseudoaneurysm (SAP) is a very rare case, postoperatively. SAP originates from many causes such as complication of chronic pancreatitis in adults and blunt abdominal trauma in children. SAP related to surgery may result from direct tissue injury during operation. Urgent angiography is helpful in diagnoses and life-saving procedures as the endovascular embolization simultaneously. However, endovascular management is not a definite treatment modality in patients previously operated on because the blood supply of remaining organs will be insufficient after embolization. In this paper, we report a rare case that is proximal splenic artery pseudoaneurysm after radical subtotal gastrectomy in a 63-year-old male patient with early gastric cancer, as well as a brief review.
Adult ; Aneurysm, False ; Angiography ; Child ; Gastrectomy ; Humans ; Male ; Middle Aged ; Pancreatitis, Chronic ; Splenic Artery ; Stomach Neoplasms

OBJECTIVES: The purpose of this study was to examine the associations of childbirth, breastfeeding, and their interaction with breast cancer (BC) risk reduction, and to evaluate the heterogeneity in the BC risk reduction effects of these factors by menopause, hormone receptor (HR) status, and pathological subtype. METHODS: BC patients aged 40+ from the Korean Breast Cancer Registry in 2004-2012 and controls from the Health Examinee cohort participants were included in this study after 1:1 matching (12 889 pairs) by age and enrollment year. BC risk according to childbirth, breastfeeding, and their interaction was calculated in logistic regression models using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: BC risk decreased with childbirth (3+ childbirths relative to 1 childbirth: OR, 0.66; 95% CI, 0.56 to 0.78 and OR, 0.80; 95% CI, 0.68 to 0.95 in postmenopausal and premenopausal women, respectively); and the degree of risk reduction by the number of children was heterogeneous according to menopausal status (p-heterogeneity=0.04), HR status (p-heterogeneity < 0.001), and pathological subtype (p-heterogeneity < 0.001); whereas breastfeeding for 1-12 months showed a heterogeneous association with BC risk according to menopausal status, with risk reduction only in premenopausal women (p-heterogeneity < 0.05). The combination of 2 more childbirths and breastfeeding for ≥13 months had a much stronger BC risk reduction of 49% (OR, 0.51; 95% CI, 0.45 to 0.58). CONCLUSIONS: This study suggests that the combination of longer breastfeeding and more childbirths reduces BC risk more strongly, and that women who experience both 2 or more childbirths and breastfeed for ≥13 months can reduce their BC risk by about 50%.
Breast Feeding* ; Breast Neoplasms* ; Breast* ; Child ; Cohort Studies ; Female ; Humans ; Logistic Models ; Menopause ; Odds Ratio ; Parturition* ; Population Characteristics ; Risk Reduction Behavior*

In Korea, scrub typhus usually occurs in October and November. Hemophagocytic lymphohistiocytosis (HLH) is a distinct clinical entity characterized by a high fever, pancytopenia, hepatosplenomegaly, histiocyte proliferation, and hemophagocytosis. We encountered a summertime case of severe scrub typhus presenting as HLH. A 49-year-old female complained of abdominal pain and fever 3 days in duration. On hospital day 3 she was transferred to the intensive care unit because of clinical deterioration accompanied by severe sepsis. As an eschar was evident on the right shoulder, we commenced doxycycline. Her condition improved dramatically and she was discharged on day 14. Although the indirect immunofluorescence antibody test (IFA) for Orientia tsutsugamushi was negative on admission, a repeat IFA test was positive; the antibody titer was 1:5,120 on hospital day 10. Scrub typhus should be considered during differential diagnosis in a patient with severe sepsis in any season except the fall.
Abdominal Pain ; Diagnosis, Differential ; Doxycycline ; Female ; Fever ; Fluorescent Antibody Technique, Indirect ; Histiocytes ; Humans ; Intensive Care Units ; Korea ; Lymphohistiocytosis, Hemophagocytic* ; Middle Aged ; Orientia tsutsugamushi ; Pancytopenia ; Scrub Typhus* ; Seasons ; Sepsis ; Shoulder

PURPOSE: To report a case of acyclovir-induced acute renal failure (ARF) suspected as acute retinal necrosis syndrome. CASE SUMMARY: The authors report a 55-year-old male patient who presented with left eye visual disturbance due to suspected acute retinal necrosis syndrome. Non-oliguric ARF developed after the infusion of intravenous acyclovir (850 mg every 8 hours). The patient did not show any uremic symptoms or signs. The crystal was not discovered in the urine. After stopping the acyclovir infusion and hydration, acyclovir-induced ARF was reversed. CONCLUSIONS: Although possessing critical nephrotoxicity, acyclovir is a useful antiviral drug. Therefore, when using acyclovir, the importance of hydration and preventing acyclovir-induced ARF should be considered.
Acute Kidney Injury ; Acyclovir ; Eye ; Humans ; Male ; Middle Aged ; Retinal Necrosis Syndrome, Acute

PURPOSE: The aim of this study was to evaluate the usefulness of a method for positioning the femoral stem in neutral position refer to the measured value of "lateral distance" in pre-operative templating and the femoral stem position post-operatively. MATERIALS AND METHODS: A total of 81 hips in 76 patients underwent cementless total hip arthroplasty between March 2008 and April 2012 using the C2 stem (Lima Corporate S.P.A, Udine, Italy). We measured the perpendicular distance from the lateral outermost part of the greater trochanter to the lateral outermost part of the femoral stem (lateral distance, LD) in pre-operative templating. We aimed to insert the femoral stem in neutral position by comparing LD measured intra-operatively. We evaluated the position of the femoral stem on post-operative plain radiography. We compared the result of post-operative re-measurement of the LD with that of pre-operative measurement. RESULTS: In all of the 81 cases, the femoral stem was inserted in neutral position, defined as the femoral stem position within 3degreesvalgus or varus. The average angle of the inserted femoral stem was 1.20degrees(0.003-2.85degrees). LD measured in preoperative templating was 15.6 mm(10-21.5 mm), and it showed no correlation ratio with LD; LD re-measured post-operatively was 15.9 mm(10.3-23.5 mm) (P=0.781). CONCLUSION: Measuring LD pre-operatively and using the value intra-operatively is an effective method for insertion of the femoral stem in neutral position.
Arthroplasty ; Femur ; Hip ; Humans

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is prevalent in general population. This study investigates the prevalence of IBS in medical college students in Korea as well as the influence of dietary habits and nutritional intake on IBS. METHODS: This study is a cross-sectional study of 319 students (239 males and 80 females, age 22.3 +/- 2.5 years) from the 6 grade levels of the Medical College in Korea. All students filled out a self-reported questionnaire for ROME III criteria. They also completed a questionnaire to validate dietary habits and food frequency in Korean. RESULTS: The overall prevalence of IBS was 29.2% without correlation to age, body mass index and grade level in Medical School. However, the prevalence was significantly higher in females than males (33/80 vs 60/239, P = 0.007). There were no significant differences between the IBS-group and the non-IBS group in aspect of nutrition. Not only the diet habits, but also the daily nutritional intake, and even the breakdown into the 12 micronutrients, yielded no significant differences between the 2 groups. CONCLUSIONS: Twenty-nine percent of the medical college students have IBS with a greater prevalence in females. The dietary habits and nutritional intake of the students might not be associated with IBS.
Body Mass Index ; Cross-Sectional Studies ; Female ; Food Habits ; Humans ; Irritable Bowel Syndrome ; Korea ; Male ; Micronutrients ; Prevalence ; Surveys and Questionnaires ; Rome ; Schools, Medical ; Students, Medical

BACKGROUND/AIMS: It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. METHODS: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. RESULTS: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. CONCLUSIONS: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD.
Abortion, Spontaneous ; Family Planning Services ; Female ; Humans ; Inflammatory Bowel Diseases ; Internet ; Korea ; Live Birth ; Male ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Unplanned ; Pregnant Women ; Spouses