A 49-year-old woman was referred to our hospital for further treatment due to the suspicion of a submucosal tumor in a routine screening colonoscopy. On colonoscopy, a 1-cm sized subepithelial mass with normal overlying mucosa in the hepatic flexure was found. Endoscopic ultrasonography (EUS) showed a homogenous hypoechoic lesion arising from the second and third layer. We were unable to make a final diagnosis because the lesion showed a small tumor with atypical macroscopic morphology including EUS findings. Therefore, endoscopic submucosal dissection was performed for the diagnostic treatment of the tumor. Submucosal dissection was performed just above the muscle layer, and the tumor was removed completely and reliably without any acute complications such as perforation. Based on histopathological findings, we diagnosed a benign, calcifying fibrous tumor (CFT). The present case is the first report of successful endoscopic diagnosis and treatment of colonic CFT mimicking a submucosal tumor.

Bone Regeneration ; Bone Transplantation ; Humans ; Lifting ; Mandible ; Maxilla ; Survival Rate ; Transplants

Objective: Severe acute cholecystitis is an infectious disease that requires immediate gallbladder drainage. Although percutaneous transhepatic gallbladder drainage (PTGBD) is the most common method of gallbladder drainage, the optimal timing remains unclear. Methods: This study is a retrospective analysis of patients diagnosed with severe acute cholecystitis who underwent PTGBD between July 2018 to June 2021. This study investigated the effect of time from emergency department arrival to PTGBD (tPTGBD) on patient prognosis. Results: Totally, 48 patients were included in this study. Based on the cutoff value calculated using the Youden index, the group with tPTGBD of <5.93 hours had a shorter hospital stay (10 vs. 13.5 days, P=0.021), lower portion of progression (27:5 [15.6%] vs. 7:9 [56.3%], P=0.004), even they had a higher initial SOFA score (6 vs. 4.6, P=0.049). However, no statistical difference was obtained for the length of ICU stay between both groups (1 vs. 2, P=0.617). Conclusion Executing PTGBD to severe acute cholecystitis patients within 5.93 hours after presenting at the emergency department is associated with reduced progression and hospital stay.

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered.
Antibodies ; Blood Platelets ; Bone Marrow ; Disseminated Intravascular Coagulation ; Facial Paralysis ; Gastrointestinal Hemorrhage ; Guillain-Barre Syndrome ; Humans ; Hypersplenism ; Korea ; Leg ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Scrub Typhus* ; Thrombocytopenia

Dengue fever is an acute febrile disease that is caused by a mosquito-borne flavivirus. It has become a major infectious disease threat in tropical and subtropical areas. In Korea, travel-associated dengue fever is increasing. Thirty-five Koreans went to Sri Lanka to do volunteer activities. Eight of the volunteers developed fever, myalgia, and rash; they were diagnosed with dengue fever. Two patients had macular hemorrhages and edema with no ophthalmic symptoms. The maculopathy caused by the dengue fever improved without specific treatment.
Communicable Diseases ; Dengue* ; Edema ; Exanthema ; Eye Manifestations ; Fever ; Flavivirus ; Hemorrhage ; Humans ; Korea ; Myalgia ; Sri Lanka* ; Volunteers*

BACKGROUND: Hypopituitarism is associated with osteoporosis and osteopenia especially when hypogonadotropic hypogonadism is present. Despite hypopituitarism being an important cause of secondary osteoporosis, osteoporosis in patients receiving surgery for pituitary tumors in Korea has not been studied. In this study, we evaluated the effects of testosterone replacement therapy (TRT) on bone mineral density (BMD) in postoperative hypogonadal patients with pituitary tumors. METHODS: To examine the effect of TRT on BMD, we performed a retrospective observational study in 21 postoperative male patients who underwent pituitary tumor surgery between 2003 and 2012 at the Ajou University Hospital. Testosterone was replaced in postoperative hypogonadal patients by regular intramuscular injection, daily oral medication, or application of transdermal gel. BMD (g/cm2) measurements of central skeletal sites (lumbar spine, femoral neck, and total femur) were obtained using dual-energy X-ray absorptiometry (GE Lunar). For lumbar spine BMD, L1 to L4 values were chosen for analysis. Femur neck and total femur were also analyzed. RESULTS: During the follow-up period (mean, 56 months; range, 12 to 99 months) serum testosterone levels increased with the administration of TRT (P=0.007). There was significant improvement (4.56%+/-9.81%) in the lumbar spine BMD compared to baseline BMD. There were no significant changes in the femur neck BMD or total femur BMD. We did not find any statistically significant relationships between changes in testosterone levels and BMD using Spearman correlation analysis. CONCLUSION: Our results indicated that TRT used in the postoperative period for hypogonadal pituitary tumor surgery patients may have beneficial effects on the BMD of the spine.
Absorptiometry, Photon ; Bone Density* ; Bone Diseases, Metabolic ; Femur ; Femur Neck ; Follow-Up Studies ; Humans ; Hypogonadism ; Hypopituitarism ; Injections, Intramuscular ; Korea ; Male* ; Observational Study ; Osteoporosis ; Pituitary Neoplasms* ; Postoperative Period ; Retrospective Studies ; Spine ; Testosterone*

Vibrio cholerae (V. cholerae) serotype O1 or O139 is the etiological agents of cholera. These bacteria are responsible for gastrointestinal infections or more rarely bacteremia in patients with an underlying disease, leading to life-threatening complications. A 73-year-old man presented to the hospital with fever and vomiting. Blood cultures grew non-O1/non-O139 V. cholerae. In this case, clinical improvement and microbiological eradication were achieved due to early appropriate antibiotic therapy. These results suggest that early antibiotic therapy allowed a good outcome in diabetic patient infected with V. cholerae . To our knowledge, this is the first case of primary bacteremia caused by non-O1/non-O139 Vibrio cholera in Korea.
Aged ; Bacteremia* ; Bacteria ; Cholera ; Fever ; Humans ; Korea ; Serogroup ; Vibrio cholerae* ; Vibrio* ; Vomiting

The incidence of bacteremia in human immunodeficiency virus (HIV)-infected patients is significantly decreased by highly active antiretroviral therapy (HAART). However, bacteremia remains a major cause of morbidity and mortality in HIV-infected patients. A 43-year-old male who had fever and cough for 1 week presented to the emergency room. He was diagnosed with acquired immunodeficiency syndrome combined with atypical pneumonia and started on antibiotics plus HAART. After 3 days, Streptococcus pneumoniae was grown in blood cultures. Three weeks later, acid-fast bacilli cultures of blood and bronchoalveolar lavage fluid grew Mycobacterium avium complex (MAC); hence, the patient was treated with antimycobacterial drugs. HIV-infected patients with persistent fever despite administration of appropriate antibiotics should be examined for simultaneous infection by other organisms, such as nontuberculous mycobacteria. We report a case of simultaneous detection of MAC and S. pneumoniae in the blood of a treatment-naïve HIV-infected patient.
Acquired Immunodeficiency Syndrome* ; Adult ; Anti-Bacterial Agents ; Antiretroviral Therapy, Highly Active ; Bacteremia ; Bronchoalveolar Lavage Fluid ; Cough ; Diagnosis* ; Emergency Service, Hospital ; Fever ; HIV ; Humans ; Incidence ; Male ; Mortality ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Pneumonia ; Sepsis* ; Streptococcus pneumoniae

No abstract available.
Antibodies* ; Fetus* ; Heart Block* ; Heart*

Background: Data on the relationship between Parkinson's disease (PD) and stroke have been conflicting, some studies showing a reduced risk of stroke during life because of low prevalence of vascular risk factors, and others indicating an increased risk of strokerelated death. The objective of this study is to determine the frequency of vascular risk factors in PD in relation to an unaffected control group and ischemic stroke patient group. Methods: We performed a case-control study on 206 consecutive PD patients, 207 ischemic strokes patients (served as "Disease" controls) and 138 age and sex matched normal subjects (served as controls), calculating multivariate risk estimates (odd ratio) for a series of established risk factors for vascular disease. Results: We found that (1) cigarette smoking (smoker, 0.078, CI=0.034-0.178; ex-smoker, 0.031, CI=0.011-0.088), and diabetes mellitus (0.340, CI=0.169-0.682) were significant less frequent in PD patients than controls, (2) cigarette smoking (smoker, 0.230, CI= 0.094-0.561; ex-smoker, 0.132, CI=0.050-0.348), hypertension (0.283, CI=0.175-0.459), diabetes mellitus (0.257, CI=0.136-0.486), previous stroke (0.063, CI=0.020-0.191), heart disease (0.344, CI=0.176-0.673) than ischemic stroke patients, respectively. Conclusion: We found the significant negative association of a series of vascular factors with PD, indicating a protective effect of PD against ischemic stroke.
Case-Control Studies ; Diabetes Mellitus ; Heart Diseases ; Humans ; Hypertension ; Parkinson Disease* ; Prevalence* ; Risk Factors* ; Smoking ; Stroke ; Vascular Diseases*