A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

Behavioral and psychological symptoms of dementia are major components of Alzheimer’s disease. In this study, we aimed at investigating the prevalence and severity of behavioral and psychological symptoms of dementia in very mild to mild Alzheimer’s disease. Forty-four patients with Alzheimer’s disease who visited the neurology outpatient clinic of Seoul Medical Center were included. A trained neurologist or a supervised test technician administered the neuropsychological test, the Seoul Neuropsychological Screening Battery including Mini Mental State Examination and Clinical Dementia Rating. The instrument used for assessing behavioral and psychological symptoms of dementia was Neuropsychiatric Inventory-Questionnaire. In order of prevalence, apathy, depression, irritability, anxiety, and agitation were the most common symptoms occurring in very mild-to-mild Alzheimer’s disease group. The prevalence and severity of behavioral and psychological symptoms of dementia were found to be in positive correlation with the Clinical Dementia Rating scores. Behavioral and psychological symptoms of dementia are found even in the very early stage of Alzheimer’s disease, apathy and depression being the most common symptoms. Physicians should be aware of this when managing dementia patients.

Lumbar puncture is a simple bedside procedure that is essential for the diagnosis and treatment of several neurologic diseases. Known complications include headache, backache, infection, and hemorrhage, with the most common being postpuncture headache. We report a case of postpuncture spinal subdural hematoma-which is extremely rare-in a 29-year-old female. Although most cases of postpuncture spinal hematomas are associated with coagulation abnormalities, this case shows that it can occur in the absence of predisposing factors.
Back Pain ; Female ; Headache ; Hematoma ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Spinal Puncture

Purpose: We investigated the satisfaction of physical therapy course according to teaching ways after COVID-19. Methods: 336 students in major of physical therapy were recruited in this study. Based on the classification of subjects in the national examination, the questionnaire was divided into 6 subjects in the basic field of physical therapy, 2 subjects in the field of physical therapy diagnostic evaluation, 8 subjects in the field of physical therapy intervention, and 3 subjects in other fields. The Likert scale was used. Results: In the basic field of physical therapy, all subjects were shown the high score of the satisfactory in face-to-face classes except for the public health and medical law compared to the non-face-to-face classes and mixed classes. Regarding the field of physical therapy diagnostic evaluation, the principle of diagnostic evaluation was shown the high score of the satisfactory in face-to-face classes compared to the non-face-to-face classes and mixed classes. In the field of physical therapy intervention, all subjects were shown the high score of the satisfactory in face-to-face classes compared to the non-face-to-face classes and mixed classes. Conclusion We found that the face-to-face classes in most of subjects was shown the high score of satisfactory. We believed that our results can be used as basic data for physical therapy major learning methods.

Purpose: To determine the clinical manifestations and maternal and perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). Methods: We conducted a retrospective observational study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to National Health Insurance Service (NHIS) Ilsan Hospital between August 2020 and October 2021. The maternal and perinatal outcomes were investigated. Results: Among 184 pregnant women infected with SARS-CoV-2, 79 women delivered. Of the women who delivered, with 36 women giving birth during the quarantine period. At delivery, 45 women were positive for SARS-CoV-2 by polymerase chain reaction (PCR), whereas 34 women were negative. The most common clinical manifestations were cough (65.2%), fever (38.0%), and myalgia (33.2%). Regarding perinatal outcomes, none of the babies had an Apgar score <7 at 5 minutes, and none were intubated following the delivery. The preterm birth rate and small-for-gestational-age (SGA) rate were 15.2% and 16.5%, respectively. All babies who was delivered at NHIS Ilsan Hospital were negative for SARS-CoV-2 infection by PCR, which was evaluated using amniotic fluid, cord blood, neonatal nasopharyngeal and oropharyngeal swabs in the 1st and 2nd days following delivery, although 45 women were positive for SARS-CoV-2 infection by PCR at the time of delivery. Conclusion Most pregnant women with COVID-19 in South Korea were unlikely to manifest symptoms or present with a severe disease progression. The observed preterm birth rate and SGA rate were higher in women with COVID-19 than in those without COVID-19. However, there was no evidence of vertical transmission, and all babies were negative for SARS-CoV-2 infection during pregnancy.

Inflammatory bowel disease (IBD) is a chronic condition characterized by continuous inflam-mation of the gastrointestinal tract that varies in intensity over time. IBD is caused by several factors including aberrant gut flora, immunological dysregulation, altered environmental con-ditions, and genetic variations. However, the pathogenesis of IBD remains unclear. Studies have indicated that an imbalance between T helper 17 (Th17) and regulatory T (Treg) cells contributes significantly to the development of IBD. Intestinal Tregs suppress inflammation and are critical for maintaining tissue homeostasis. Th17 cells are known to play an import-ant role in the development and pathogenesis of IBD and provide non-inflammatory support for the integrity of the intestinal barrier against bacterial and fungal infections. Therefore, the Th17/Treg cell balance is crucial in the pathogenesis of IBD and gut integrity. The micro-environment of the intestinal mucosal immunity is regulated by the secretion of cytokines associated with Th17 cells and Tregs. Several studies have indicated that the gut bacteria contribute to the control of the immune milieu and play a key role in the regulation of Th17 cell development. Intestinal bacteria and cytokines control Th17 cell development. Th17 cells secrete cytokines that regulate the immune microenvironment in the gut mucosa. This review provides an overview of Th17 cells and examines the strategies for treating patients with IBD using Th17 cell-targeted drugs.

Mature cystic teratomas of the ovary are one of the most common ovarian neoplasms found in reproductive age women. Malignant transformation is an uncommon complication in a mature cystic teratoma of the ovary, usually being reported in about 1-3% of cases. Of malignant transformations, squamous cell carcimona is the most common type and sarcomatous transformation is rare, its prognosis is poor. Adenocarcinoma occurs with less frequency. We experienced a case of squamous cell carcinoma and adenocarcinoma arising in mature cystic teratoma of the ovary, so we present this case with brief review of the literature.
Adenocarcinoma* ; Carcinoma, Squamous Cell* ; Female ; Humans ; Ovarian Neoplasms ; Ovary* ; Prognosis ; Teratoma*

BACKGROUND: With the ageing population, number of dementia patients is on the rise, as well as the public interest. The population who would visit memory disorder clinic will also grow. The diagnostic significance of brain MRI in dementia lies in idetifying hippocampal atrophy or ischemic lesions. However, patients visiting memory disorder clinic are mostly old-aged with multiple vascular risk factors, raising the risk of cerebrovascular abnormalities. The authors set out to evaluate the need for cerebrevascular imaging in patients who visited memory disorder clinic. METHODS: The study recruited patients who visited the memory clinic in Seoul medical center between July 2011 and June 2012. Among those, patients who had taken the neuropsychiatric test and had both brain MRI and MRA taken were included for analysis. In brain MRI, severities of white matter hyperintensities and presence of cerebral infarction were assessed. In brain MRA, intra- and extra-cranial arterial stenosis and presence of aneurysm were noted. RESULTS: A total of 173 patients was included, and 64 were men. The mean age was 71+/-9.4 years, and the mean education period was 7+/-5.2 years. In brain MRI, white matter hyperintensities were observed in 113 patients (65.3%), and cerebral infarction was present in 57 patients (32.9%). In brain MRA, 88 (50.9%) patients showed more than one stenotic segment in intracranial vessel or proximal ICA and 6 patients (3.5%) were diagnosed with unruptured aneurysm. CONCLUSIONS: The incidence of white matter hyperintensities or stenosis of cerebral vessels on magnetic resonance imaging is very high. Therefore, brain MRI and MRA should be included in diagnostic work up for dementia in patients who are old aged and have multiple vascular risk factors. It would provide clinicians with valuable information in making treatment decisions and prevention of future cerebrovascular accident.
Aged ; Aneurysm ; Atrophy ; Brain ; Cerebral Infarction ; Constriction, Pathologic ; Dementia ; Glycosaminoglycans ; Hospitals, General ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Memory ; Memory Disorders ; Risk Factors ; Stroke

PURPOSE: To evaluate the HRCT findings and to correlate the findings with the results of a pulmonary function test (PFT) in patients with reactive airway dysfunction syndrome (RADS). MATERIALS AND METHODS: On March 2003, a fire at a boarding house of primary school soccer players caused a multiple casualty disaster. After 8 months, nine boys that presented with chronic cough and dyspnea were treated, and were subjected to follow-up evaluations. Eight patients underwent a chest radiograph, HRCT, and a PFT. Two patients with severe symptoms received extended follow-up after 1 year. Two radiologists retrospectively reviewed the chest radiographs and the follow-up HRCT scans. We correlated the HRCT findings with the results of the PFT. RESULTS: Six patients with an inhalation injury were diagnosed with RADS. On the chest radiographs, eight patients showed no abnormal findings. On an HRCT scan, four patients showed abnormal findings. The abnormal findings were mosaic air trapping (n = 4), bronchial wall thickening (n = 1), and parenchymal consolidation (n = 1). In all four patients that showed abnormal findings in the HRCT scan, abnormal results of the PFT were also seen. The two patients that received extended follow-up showed an improvement of the clinical symptoms, as seen by the PFT, and had a decreased extent and degree of mosaic air trapping, as seen on HRCT. CONCLUSION: An HRCT scan is an essential modality for the diagnosis and follow-up of patients with RADS. Both a full expiratory and inspiratory HRCT scan must be performed for an accurate diagnosis.
Bronchial Hyperreactivity ; Cough ; Diagnosis ; Disasters ; Dyspnea ; Fires ; Follow-Up Studies ; Humans ; Inhalation* ; Lung ; Radiography, Thoracic ; Respiratory Function Tests* ; Retrospective Studies ; Smoke Inhalation Injury ; Soccer ; Thorax*

Background and Objectives: Toxoplasmosis is a disease caused by an intracellular parasite, Toxoplasma gondii. There has been only a few studies done on cervical toxoplasma lymphadenitis, and this study was performed to evaluate its clinical characteristics and outcomes.Subjects and Method We retrospectively reviewed the patients diagnosed with cervical toxoplasma lymphadenitis from January 2010 to December 2019. We investigated clinical pathologic findings, treatment and clinical outcomes. Results: Enrolled in the study were 21 patients who were confirmed with typical pathologic findings in an excisional biopsy (16/21) and core needle biopsy (5/21). Nine patients were male and 12 patients were female, with the mean age of 46.1±13.59 (19-70). All patients complained of neck masses and 5 (23.8%) patients showed pain or tenderness. Only one (4.8%) patient had mild fever. Fine needle aspiration cytology was performed in 5 patients, with no resulting pathognomonic outcomes in any one of the patients. CT scan was performed in 15 patients, with 8 (53.3%) patients showing multiple nodal enlargements but 7 (46.6%) patients showing a single enlarged lymph node. The most frequently involved location was level I (53.3%), followed by level II (46.6%), level V (46.6%), level III (40.0%), and level IV (20.0%). The serologic test for toxoplasma revealed positive IgG (100%) and IgM (85.7%). Treatments were excision only (61.9%) and excision with pharmacologic treatment using sulfonamide or pyrimethamine (38.1%). There was no case of recurrence after treatment. Conclusion Cervical toxoplasma lymphadenitis can be diagnosed by biopsy but needle aspiration has little role. It shows favorable clinical outcomes after treatment.