Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
Candidiasis ; Child* ; Cough ; Deglutition Disorders ; Dilatation ; Electric Impedance ; Endoscopy ; Esophageal Achalasia* ; Esophageal pH Monitoring ; Esophagus ; Failure to Thrive ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Lost to Follow-Up ; Male ; Manometry* ; Vomiting

The prognosis of lateral medullary infarction is mostly benign, but unexpected sudden death can occur even when the initial symptoms are benign. An 81-year-old man visited the emergency room with whirling-type dizziness and right-veering tendency. Brain magnatic resonance imaging (MRI) revealed a right lateral medullary infarction accompanied by a right cerebellar infarction. He died suddenly at 1 day after admission with only slight lesion progression on MRI. This case suggests that patients with a lateral medullary infarction should be carefully monitored during the acute period.
Aged, 80 and over ; Brain ; Death, Sudden ; Dizziness ; Emergency Service, Hospital ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Medulla Oblongata ; Prognosis ; Stroke

Background: and Purpose: Choline alfoscerate (CA) is an acetylcholine precursor known for its beneficial effect on cognition in patient with Alzheimer’s disease dementia (ADD).However, there is little evidence of its effects in patients with mild cognitive impairment (MCI). We assessed the influence of CA on the progression from MCI to all-cause dementia or ADD in three observational Korean databases using a Common Data Model (CDM). Methods: Patients who were diagnosed with MCI and were aged over 60 years were included.After propensity score matching, 3,062 matched pairs patients using CA use and those not using CA were included. The Cox regression model was used to analyze the hazard ratio (HR) of CA use for conversion from MCI to all-cause dementia or ADD. Subgroup analyses were performed based on sex, acetylcholine esterase inhibitor (AchEI) use, and donepezil use. Results: A meta-analysis across three hospitals revealed that CA use was not associated with the progression from MCI to all-cause dementia (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.59–1.26) or ADD (HR, 1.05; 95% CI, 0.51–1.59). Subgroup analyses revealed that CA use was not related to progression to all-cause dementia or ADD when stratified by sex, AchEI use, and donepezil use. Conclusions In this multicenter cohort study based on the Observational Medical Outcomes Partnership CDM real-world data, no association was noted between CA use and disease progression from MCI to all-cause dementia or ADD.

Background: and Purpose: Choline alfoscerate (CA) is an acetylcholine precursor known for its beneficial effect on cognition in patient with Alzheimer’s disease dementia (ADD).However, there is little evidence of its effects in patients with mild cognitive impairment (MCI). We assessed the influence of CA on the progression from MCI to all-cause dementia or ADD in three observational Korean databases using a Common Data Model (CDM). Methods: Patients who were diagnosed with MCI and were aged over 60 years were included.After propensity score matching, 3,062 matched pairs patients using CA use and those not using CA were included. The Cox regression model was used to analyze the hazard ratio (HR) of CA use for conversion from MCI to all-cause dementia or ADD. Subgroup analyses were performed based on sex, acetylcholine esterase inhibitor (AchEI) use, and donepezil use. Results: A meta-analysis across three hospitals revealed that CA use was not associated with the progression from MCI to all-cause dementia (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.59–1.26) or ADD (HR, 1.05; 95% CI, 0.51–1.59). Subgroup analyses revealed that CA use was not related to progression to all-cause dementia or ADD when stratified by sex, AchEI use, and donepezil use. Conclusions In this multicenter cohort study based on the Observational Medical Outcomes Partnership CDM real-world data, no association was noted between CA use and disease progression from MCI to all-cause dementia or ADD.

Background: and Purpose: Choline alfoscerate (CA) is an acetylcholine precursor known for its beneficial effect on cognition in patient with Alzheimer’s disease dementia (ADD).However, there is little evidence of its effects in patients with mild cognitive impairment (MCI). We assessed the influence of CA on the progression from MCI to all-cause dementia or ADD in three observational Korean databases using a Common Data Model (CDM). Methods: Patients who were diagnosed with MCI and were aged over 60 years were included.After propensity score matching, 3,062 matched pairs patients using CA use and those not using CA were included. The Cox regression model was used to analyze the hazard ratio (HR) of CA use for conversion from MCI to all-cause dementia or ADD. Subgroup analyses were performed based on sex, acetylcholine esterase inhibitor (AchEI) use, and donepezil use. Results: A meta-analysis across three hospitals revealed that CA use was not associated with the progression from MCI to all-cause dementia (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.59–1.26) or ADD (HR, 1.05; 95% CI, 0.51–1.59). Subgroup analyses revealed that CA use was not related to progression to all-cause dementia or ADD when stratified by sex, AchEI use, and donepezil use. Conclusions In this multicenter cohort study based on the Observational Medical Outcomes Partnership CDM real-world data, no association was noted between CA use and disease progression from MCI to all-cause dementia or ADD.

Background: and Purpose: Choline alfoscerate (CA) is an acetylcholine precursor known for its beneficial effect on cognition in patient with Alzheimer’s disease dementia (ADD).However, there is little evidence of its effects in patients with mild cognitive impairment (MCI). We assessed the influence of CA on the progression from MCI to all-cause dementia or ADD in three observational Korean databases using a Common Data Model (CDM). Methods: Patients who were diagnosed with MCI and were aged over 60 years were included.After propensity score matching, 3,062 matched pairs patients using CA use and those not using CA were included. The Cox regression model was used to analyze the hazard ratio (HR) of CA use for conversion from MCI to all-cause dementia or ADD. Subgroup analyses were performed based on sex, acetylcholine esterase inhibitor (AchEI) use, and donepezil use. Results: A meta-analysis across three hospitals revealed that CA use was not associated with the progression from MCI to all-cause dementia (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.59–1.26) or ADD (HR, 1.05; 95% CI, 0.51–1.59). Subgroup analyses revealed that CA use was not related to progression to all-cause dementia or ADD when stratified by sex, AchEI use, and donepezil use. Conclusions In this multicenter cohort study based on the Observational Medical Outcomes Partnership CDM real-world data, no association was noted between CA use and disease progression from MCI to all-cause dementia or ADD.

PURPOSE: To evaluate the effects of hydrogen peroxide pretreatment and heat activation of silane on the shear bond strength of fiber-reinforced composite posts to resin cement. MATERIALS AND METHODS: The specimens were prepared to evaluate the bond strength of epoxy resin-based fiber posts (D.T. Light-Post) to dual-curing resin cement (RelyX U200). The specimens were divided into four groups (n=18) according to different surface treatments: group 1, no treatment; group 2, silanization; group 3, silanization after hydrogen peroxide etching; group 4, silanization with warm drying at 80℃ after hydrogen peroxide etching. After storage of the specimens in distilled water at 37℃ for 24 hours, the shear bond strength (in MPa) between the fiber post and resin cement was measured using a universal testing machine. The fractured surface of the fiber post was examined using scanning electron microscopy. Data were analyzed using one-way ANOVA and post-hoc analysis with Tukey's HSD test (α=0.05). RESULTS: Silanization of the fiber post (Group 2) significantly increased the bond strength in comparison with the non treated control (Group 1) (P<.05). Heat drying after silanization also significantly increased the bond strength (Group 3 and 4) (P<.05). However, no effect was determined for hydrogen peroxide etching before applying silane agent (Group 2 and 3) (P>.05). CONCLUSION: Fiber post silanization and subsequent heat treatment (80℃) with warm air blower can be beneficial in clinical post cementation. However, hydrogen peroxide etching prior to silanization was not effective in this study.
Cementation ; Hot Temperature* ; Hydrogen Peroxide* ; Hydrogen* ; Microscopy, Electron, Scanning ; Resin Cements* ; Shear Strength ; Water

We describe a 58-year-old woman who was incidentally found to have gastric and colonic polyposis, hypoalbuminemia, cutaneous hyperpigmentation and onychodystrophy (Cronkhite-Canada syndrome). Histology of polyps from the stomach showed features of juvenile or retention type (hamartomatous) polyps with Helicobacter pylori (H. pylori) infection. The large pedunculated colonic polyps showed hamartomatous polyps with adenomatous component and polypectomy was performed. After the treatment with H. pylori eradication and omeprazole, the gastric polyposis, hypoalbuminemia and anemia regressed, and endoscopic polypectomy of gastric polyps were performed. After the continuous use of omeprazole for 14 months, the patient showed complete resolution of clinical features of Cronkhite-Canada syndome. The experience of this case suggests that eradication of H. pylori and proton pump inhibitor treatment might be considered in patients with gastric polyposis combined with Cronkhite-Canada syndome.
Anti-Ulcer Agents/*therapeutic use ; Colonic Polyps/complications/microbiology/pathology ; Female ; Helicobacter Infections/complications/*drug therapy ; *Helicobacter pylori ; Humans ; Hyperpigmentation/pathology ; Middle Aged ; Nails, Malformed/pathology ; Omeprazole/*therapeutic use ; Polyps/*complications/microbiology/pathology ; Proton Pumps/antagonists & inhibitors ; Stomach Neoplasms/*complications/microbiology/pathology ; Syndrome

Inflammatory bowel disease has a potential risk of developing colorectal cancer. However, there is little causal relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is curable disease and has relatively short disease course. But there were a few case reports of intestinal tuberculosis associated with colon cancer. Diffuse infiltrating colon cancer, characterized by tumor cells in the presence of inflammatory changes with much fibrosis, is very rare in the colon. We experienced a 49-year-old woman who had tuberculous colitis combined with diffuse infiltrative colon cancer. She visited our hospital because of chronic diarrhea and abdominal pain. Colonoscopy showed multiple geographic ulcers in the transverse colon and partial intestinal obstruction. Histological examination revealed non-caseating granuloma and Mycobacterium tuberculosis was cultured in biopsied tissue. She took an anti-tuberculosis drug for 2 weeks, but her symptoms were aggravated. Therefore, extended right hemicolectomy was performed and revealed mucin-secreting, diffuse infiltrating adenocarcinoma. Herein, we report a rare case of diffuse infiltrative colon cancer coexisting with colonic tuberculosis with a review of liferatures.
Abdominal Pain ; Adenocarcinoma ; Colitis ; Colon* ; Colon, Transverse ; Colonic Neoplasms* ; Colonoscopy ; Colorectal Neoplasms ; Diarrhea ; Female ; Fibrosis ; Granuloma ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Middle Aged ; Mycobacterium tuberculosis ; Tuberculosis* ; Ulcer

Eosinophilic gastroenteritis is a rare disease characterized by prominent eosinophilic tissue infiltration of the gastrointestinal tract. Here, we report a case of eosinophilic gastroenteritis in an 18-year-old patient with prolonged nephrotic syndrome who presented with abdominal pain and peripheral hypereosinophilia. During the previous 2 years, he had visited local Emergency Department several times because of epigastric pain and nausea. He had been treated with steroid-dependent nephrotic syndrome since 3 years of age. Tests ruled out allergic and parasitic disease etiologies. Gastroduodenoscopy with biopsy revealed marked eosinophilic infiltration in the duodenum. Renal biopsy findings indicated minimal change disease spectrum without eosinophilic infiltration. The oral deflazacort dosage was increased, and the patient was discharged after abdominal pain resolved. To our knowledge, this is the first report of eosinophilic gastroenteritis in a patient with minimal change disease.
Abdominal Pain ; Adolescent* ; Biopsy ; Duodenum ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils* ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Male* ; Nausea ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Parasitic Diseases ; Rare Diseases