Chronic granulomatous disease (CGD) is an inherited immunodeficient disease characterized by recurrent infections and granuloma formation. Granulomatous obstruction of esophagus is one of the rare complications of CGD. The use of steroids and antimicrobials for esophageal obstruction by granuloma in CGD patients has been controversial due to the possibility of concomitant inapparent infection. We report a case of esophageal obstruction in an 8-year-old CGD patient showing the poor response to antibiotics therapy. However, dramatic improvement of symptoms and radiologic findings of esophageal obstruction were achieved after steroid therapy. One month after discontinuation of steroid, esophageal obstruction recurred and the patient was re-treated with steroid. After that time, he experienced one more recurrence of esophageal obstruction. This symptom subsided after antibiotics therapy without steroid and he has been followed up to the present without further relapse.
Anti-Bacterial Agents ; Child ; Esophageal Stenosis ; Esophagus ; Granuloma ; Granulomatous Disease, Chronic* ; Humans ; Recurrence ; Steroids

Here we present a rare case of an adolescent with hypertension, concurrently diagnosed with fibromuscular dysplasia of the renal artery and Graves’ disease. Although fibromuscular dysplasia and Graves’ disease have distinct pathogenic mechanisms, it is possible to infer the potential correlation between the two from the perspective of vascular involvement. It is believed that transforming growth factor-β, as the shared element of both diseases, may contribute to their development and progression. The overactivation of the sympathetic nervous system in Graves’ disease may induce hyperplasia of vascular smooth muscle cells, similar to that observed in fibromuscular dysplasia. In Graves’ disease, the excessive synthesis and secretion of angiotensin II due to the overactivation of the renin-angiotensin system, along with the up-regulation of angiotensin II receptors, may also induce pathological changes in the vasculature throughout the body. In this regard, exploring the correlation between fibromuscular dysplasia and Graves’ disease is of significant clinical importance.

Transcranial direct current stimulation (tDCS) is a non-invasive and effective neuromodulatory technique to modulate cortical activities by applying 1 to 2 milliamps electric current. The use of tDCS to enhance cognitive function such as executive function and memory has attracted much attention in recent years, and a lot of studies have been carried out to identify neural mechanisms underlying cognitive enhancement effects of tDCS. In this review, we discussed the previous neuroimaging studies on applications of tDCS for cognitive enhancement using functional magnetic resonance imaging (fMRI). Previous tDCS studies for neurological or psychiatric conditions and elderly individuals suggested that cognitive enhancement effects of tDCS were associated with normalizing aberrant brain networks and activities related to pathophysiology. Moreover, tDCS-induced cognitive enhancement in healthy individuals was associated with functional changes in brain activations and network connectivity. Furthermore, cognitive enhancement effects of tDCS were varied depending on the neurological structure and functional characteristics between individuals. The current review may provide critical insights into functional activity and connectivity of the brain regarding cognitive enhancement effects of tDCS, which could give direction for further studies on identifying the specific neural mechanisms and clinical strategies of tDCS.

Background: and Objective: With the advancement of cancer treatments and increased life expectancy, managing breakthrough cancer pain (BTcP) is essential to improve the quality of life for cancer patients. This study aimed to compare the major rapid onset opioids in Korea based on their characteristics and costs to determine the best option for each patient. Methods: Based on sales information from IQVIA-MIDAS, sublingual fentanyl tablet (SLF), fentanyl buccal tablet (FBT), and oral transmucosal fentanyl citrate (OTFC) were selected as the top three drugs for the treatment of BTcP in Korea, considering them the most comparable drugs. The cost and cost-pain relief ratio of the drugs for short-term (1 month) and long-term (1 year) treatment were compared and the ease of administration based on various factors, including pharmacokinetics, onset of action, and administration procedures were evaluated. Results: SLF was evaluated as the best overall in terms of rapid onset of action, ease of administration, and drug cost and also had the highest market share. SLF had the lowest cost pain relief ratio for both the initial and supplemental treatment for the 1-month pain intensity difference 15 (PID15) ratio. However, for the 1-month PID30 ratio, SLF was not superior to OTFC or FBT. The longer the breakthrough cancer pain duration, the more cost-effective the other rapid onset opioids. Conclusion The rapid onset opioids that fit the patient’s breakthrough cancer pain pattern have the best cost-effectiveness.

OBJECTIVE: Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. MATERIALS AND METHODS: Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. RESULTS: Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. CONCLUSION: Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.
Aneurysm, Dissecting* ; Angiography, Digital Subtraction ; Diagnosis ; Endovascular Procedures ; Humans ; Prognosis ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery*

PURPOSE: We evaluate respiratory morbidities in infants beyond 35 weeks of gestation born via elective cesarean section by gestational age. METHODS: This is a retrospective study of 443 infants who were born at Seoul National University Hospital by elective cesarean section beyond 35 weeks of gestation from January 2011 to December 2012. We compared respiratory morbidities in four groups classified by gestational age (35(+0)-36(+6) weeks, 37(+0)-37(+6) weeks, 38(+0)-38(+6) weeks, 39(+0)-40(+6) weeks). RESULTS: There were significantly lower Apgar scores in the late-preterm infant group (35-36 weeks) compared to other term infant groups and the proportion of infants born from mothers with preeclampsia gradually decreased as gestational age increased. There were significant differences in O2 supplement, duration of O2 (>24 hours), checked chest radiography, transient tachypnea of newborn (TTN), transfer to neonatal intensive care unit (NICU), endotracheal intubation, and ventilator uses including nasal continuous positive airway pressure in four groups (P<0.05). By logistic regression analysis, compared to births at 38 weeks, births at 35-36 weeks and at 37 weeks were associated with an increased risk of respiratory morbidities [odds ratios (OR) and 95% confidence intervals (CI) for births at 35-36 weeks, 122.5 (17.4-863.4) for TTN; 54.0 (10.1-289.4) for transfer to NICU; 99.5 (14.9-666.2) for ventilator apply; OR and 95% CI for births at 37 weeks, 8.8 (1.6-50.1) for TTN; 5.3 (1.1-24.7) for transfer to NICU; 8.4 (1.5-47.7) for ventilator apply; P<0.05]. There were no significant differences in respiratory morbidities between births at 38 weeks and births at 39-40 weeks. CONCLUSION: Postponing the timing of elective cesarean section to beyond 38 weeks of gestation would be helpful in reducing the neonatal respiratory morbidities.
Cesarean Section* ; Continuous Positive Airway Pressure ; Female ; Gestational Age* ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Logistic Models ; Mothers ; Parturition ; Pre-Eclampsia ; Pregnancy ; Pregnancy* ; Radiography ; Respiration Disorders ; Retrospective Studies ; Seoul ; Term Birth ; Thorax ; Transient Tachypnea of the Newborn ; Ventilators, Mechanical

Pure subdural hematomas caused by a ruptured intracranial aneurysm are extremely rare. We describe the case of a 42-year-old woman who presented with headache without evidence of head trauma. Magnetic resonance angiography and conventional cerebral angiography revealed a ruptured aneurysm at the right middle cerebral artery bifurcation. The patient underwent surgical treatment and had a good outcome without any neurological deficit. The mechanisms and clinical characteristics of this condition are discussed.
Adult ; Aneurysm, Ruptured ; Cerebral Angiography ; Craniocerebral Trauma ; Female ; Headache ; Hematoma, Subdural* ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Angiography ; Middle Cerebral Artery* ; Rupture* ; Subarachnoid Hemorrhage*

PURPOSE: We aimed to verify whether the formal clinical index derived from infants and toddlers have a good association with the disease severity when we confine subjects to only infants, who undergo profound changes physically and immunologically. METHODS: We retrospectively reviewed the medical records of hospitalized infants with acute bronchiolitis caused by respiratory syncytial virus between January 1, 2010 and December 31, 2011 in three hospitals. The age, respiratory rate, presentation of chest retraction, and percutaneous oxygen saturation upon admission; presentation of fever, use of oxygen therapy and inhaled corticosteroid within 24 hours after admission were investigated. We then examined the effect of clinical index on severity of acute bronchiolitis; the mean length of stay, mean duration of fever and oxygen therapy. RESULTS: A total of 172 infants were studied. The mean length of stay was longer in patients younger than 3 months (P=0.015), in those with fever (P=0.028) and chest retraction (P=0.014), and in those who needed oxygen supplement (P=0.000). In the patients with fever, the mean duration of fever was longer in those who needed the oxygen supplement than those who did not (P=0.046). CONCLUSION: Younger than 3 months of age, chest retraction upon admission; fever, need of oxygen supplement within 24 hours after admission may predict the severe course of infants with acute bronchiolitis.
Bronchiolitis* ; Fever ; Humans ; Infant* ; Length of Stay ; Medical Records ; Oxygen ; Respiratory Rate ; Respiratory Syncytial Viruses ; Retrospective Studies ; Thorax

PURPOSE: The present study aimed to evaluate atypical lymph node metastasis rates according to tumor depth, size, and location in patients with gastric cancer.METHODS: A total of 727 gastric adenocarcinoma patients, with metastasis to 1 or 2 lymph nodes, who underwent radical gastrectomy with curative intent from May 2003 to May 2017, were enrolled in this study. The characteristics of atypical (skip or transversal) metastases were evaluated according to the following risk factors: longitudinal versus circumferential location, size, and T stage of the tumor.RESULTS: The rates of skip and transversal metastases were 8.4% and 15.5%, respectively. Skip metastases were present throughout, regardless of the primary tumor location. On the contrary, transversal metastases of gastric cancer were most frequently observed in the lower third region (19.5%, P=0.002). When the size of the tumor is large (>4 cm), transversal metastasis was found to be significantly more common (P=0.035), compared with skip metastasis, which was less common (P=0.011). There was no significant correlation between atypical metastases and tumor depth.CONCLUSION: Lower and larger tumors were more likely to have transversal metastases compared with others; however, skip metastases were less common in large tumors.
Adenocarcinoma ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Risk Factors ; Stomach Neoplasms