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

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.

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

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*

Neurological manifestations of internal carotid aretry (ICA) dissection include amaurosis fugax, cerebral ischemia, oculosympathetic paresis, and various cranial nerve palsies. Isolated hypoglossal nerve palsy is a rare manifestation of ICA dissection. A 55-year-old man developed dysarthria following sudden pain in the left retroauricular area. His tongue was paralysed on the left side. Magnetic resonance image and carotid angiogram showed characteristic features of left ICA dissection, which may be the most plausible cause of hypoglossal nerve palsy in this patient. Expanding hematoma of dissecting aneurysm of ICA seems to have compressed the nutrient artery of the hypoglossal nerve, although the possibility of direct compression of the hypoglossal nerve itself is not completely ruled out.
Amaurosis Fugax ; Aneurysm, Dissecting ; Arteries ; Brain Ischemia ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Cranial Nerve Diseases ; Dysarthria ; Hematoma ; Humans ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Middle Aged ; Neurologic Manifestations ; Paresis ; Tongue

We report a patient diagnosed with neuro-Behcet's disease showing multiple enhancing lesions on a brain MRI that were confined to the cerebral cortex without any involvement of other brain regions. The patient, a 30-year-old man, was admitted because of seizure attacks. He had the symptom triad of recurrent oral ulcer, genital ulcer, and uveitis. Neurologic symptoms included ataxia, dysarthria, and dementia which had progressed over several years. During the hospital course, he underwent a right hemicolectomy due to bowel perforation. A pathological examination showed multiple discrete ulcerations from the cecum to the mid-transverse colon, consistent with Behcet's colitis. A brain MRI revealed multiple small enhancing lesions distributed over wide areas of the cerebral cortex. To our knowledge, this pattern of lesion distribution has not yet been reported in neuro-Behcet's disease.
Adult ; Ataxia ; Brain ; Cecum ; Cerebral Cortex ; Colitis ; Colon ; Dementia ; Dysarthria ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Oral Ulcer ; Seizures ; Ulcer ; Uveitis

Acute pulmonary embolism is a cardiovascular emergency and is a major cause of morbidity and mortality. Endothelial damage secondary to invasion by Orientia tsutsugamushi can lead to focal occlusive endangiitis, causing microinfarcts in various tissues. This localized process can also cause venous thrombosis and peripheral gangrene. However, pulmonary embolism associated with scrub typhus has not been reported in Korea. Here, we report a patient diagnosed with pulmonary embolism associated with scrub typhus, the first report of its kind. The patient had an eschar with detection of anti-tsutsugamushi antibody, fever, dyspnea, and a maculopapular rash over the entire body. He was treated with doxycycline and anticoagulation therapy.
Doxycycline ; Dyspnea ; Emergencies ; Exanthema ; Fever ; Gangrene ; Humans ; Korea ; Mortality ; Orientia tsutsugamushi ; Pulmonary Embolism* ; Scrub Typhus* ; Venous Thrombosis

Since the existence of cell-free fetal DNA (cff-DNA) in maternal circulation was discovered, it has been identified as a promising source of fetal genetic material in the development of reliable methods for non-invasive prenatal diagnosis (NIPD) of fetal trisomy 21 (T21). Currently, a prenatal diagnosis of fetal T21 is achieved through invasive techniques, such as chorionic villus sampling or amniocentesis. However, such invasive diagnostic tests are expensive, require expert technicians, and have a miscarriage risk approximately 1%. Therefore, NIPD using cff-DNA in the detection of fetal T21 is significant in prenatal care. Recently, the application of new techniques using single-molecular counting methods and the development of fetal-specific epigenetic markers has opened up new possibilities in the NIPD of fetal T21 using cff-DNA. These new technologies will facilitate safer, more sensitive and accurate prenatal tests in the near future. In this review, we investigate the recent methods for the NIPD of fetal T21 and discuss their implications in future clinical practice.
Abortion, Spontaneous ; Amniocentesis ; Chorionic Villi Sampling ; Diagnostic Tests, Routine ; DNA ; Down Syndrome ; Epigenomics ; Female ; Humans ; Pregnancy ; Prenatal Care ; Prenatal Diagnosis ; Trisomy

PURPOSE: To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors. MATERIALS AND METHODS: The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed. RESULTS: The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. CONCLUSIONS: Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.
Cholecystectomy ; Cosmetics ; Gastrectomy ; Gastrointestinal Stromal Tumors ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Medical Records ; Neurilemmoma ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Surgical Instruments ; Surgical Procedures, Minimally Invasive