No abstract available.
Hypothyroidism* ; Myasthenia Gravis*

“Chronic pain after spinal surgery” (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.

Recently, significant improvements have been made in artificial intelligence. The artificial neural network was introduced in the 1950s. However, because of the low computing power and insufficient datasets available at that time, artificial neural networks suffered from overfitting and vanishing gradient problems for training deep networks. This concept has become more promising owing to the enhanced big data processing capability, improvement in computing power with parallel processing units, and new algorithms for deep neural networks, which are becoming increasingly successful and attracting interest in many domains, including computer vision, speech recognition, and natural language processing. Recent studies in this technology augur well for medical and healthcare applications, especially in endoscopic imaging. This paper provides perspectives on the history, development, applications, and challenges of deep-learning technology.

Background/Aims: Data on the immunoprotective status against measles, mumps, rubella, varicella zoster virus (VZV), hepatitis A virus (HAV), and Epstein-Barr virus (EBV) infection in patients with inflammatory bowel disease (IBD) are still lacking. Therefore, we investigated the seropositivity rates for viral infectious diseases and the associated factors in Korean patients with IBD. Methods: In this retrospective cohort study, serum immunoglobulin G antibody positivity rates against measles virus, mumps virus, rubella virus, VZV, HAV, and EBV viral capsid antigen (VCA) were measured in patients with Crohn’s disease or ulcerative colitis (UC) who first visited the IBD clinic. Seropositivity rates and their associated factors were analyzed. Results: Between January 2016 and December 2018, 263 patients were enrolled (male, 167 [67.3%]; UC, 134 [50.9%]). The median age at serological test was 30 years (interquartile range, 22 to 46). The seropositivity rates were 84.0%, 85.2%, 66.5%, 87.4%, 50.0%, and 93.7% for measles, mumps, rubella, VZV, HAV, and EBV, respectively. Younger age at serological test was associated with seronegative status for measles (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.88 to 0.96), VZV (aOR, 0.83; 95% CI, 0.74 to 0.93), and HAV (aOR, 0.93; 95% CI, 0.91 to 0.95). Furthermore, IBD type-UC was associated with seronegative status against VZV (aOR, 0.33; 95% CI, 0.11 to 0.99). Conclusions Seropositivity rates for common viral infectious diseases in Korean patients with IBD were similar to those of the general population. In the younger age group, protective immunity against measles, VZV, and HAV is required, with proper vaccination, as necessary.

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a favored effect on the Department of Gastroenterology's overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, II, and III criteria. Overall, Manning's criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome II and III yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice.
Blood Cell Count ; Blood Sedimentation ; Breath Tests ; C-Reactive Protein/analysis ; Feces/enzymology/parasitology ; Humans ; Irritable Bowel Syndrome/*diagnosis ; Severity of Illness Index ; Thyroid Function Tests

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a favored effect on the Department of Gastroenterology's overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, II, and III criteria. Overall, Manning's criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome II and III yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice.
Blood Cell Count ; Blood Sedimentation ; Breath Tests ; C-Reactive Protein/analysis ; Feces/enzymology/parasitology ; Humans ; Irritable Bowel Syndrome/*diagnosis ; Severity of Illness Index ; Thyroid Function Tests

There have been many reports about infections in patients with rheumatoid arthritis (RA) being more frequent than general population. Increased susceptability to infections in RA could be related to disease itself, comorbid conditions, and use of immunosuppressive drugs and steroid. Herpes zoster viral infections also have been reported to be more frequent in RA. We describe a case of 60-year-old woman with RA presented with ophthalmoplegia associated with herpes zoster ophthalmicus. Initially she complained of right orbital and periorbital pain. Six days later, she noted a cutaneous herpes zoster eruption involving the right 1st division of trigeminal nerve. Three days after developing skin eruption, she developed a right ptosis with external ophthalmoplegia and pupil dilatation resulting from the 3rd and 6th cranial nerve involvement. She was placed on intravenous acyclovir for 7days. Eight weeks after the onset of ophthalmoplegia, she recovered nearly completely.
Acyclovir ; Arthritis, Rheumatoid* ; Cranial Nerves ; Dilatation ; Female ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Middle Aged ; Ophthalmoplegia* ; Orbit ; Pupil ; Skin ; Trigeminal Nerve

Mucormycosis is a rare opportunistic infection caused by fungi of the nrder Mucorales. It occurs almost exclusively in immunocompromised patients, and the prognosis is grave. Rhinocerebral and pulmonary diseases are the most comrnon forms. Gastric mucormycosis is very rare and the manifestations range from colonization of peptic ulcers to infiltrative disease with vascular invasion and dissemination. Only one case of gastric mucormycosis was reported in Korean literature. We recently experienced a case of gastric mucormycosis in a renal transplant recipient. The 29-year-old male patient received a renal transplant from his rnother seven years ago, and had been on immunosuppressive therapy. He experienced intermittent epigastric pain for one week, and a gastroscopy revealed a huge gastric ulcer covered with black necrotic material. The diagnosis of gastric mucormycosis was confirmed on a histologic examination, and amphctericin B was administered. Despite two weeks of intensive medical therapy he expired due to shock and multiorgan failure. This is the first case of gastric mucormycosis in an organ transplant recipient in Koren.
Adult ; Colon ; Diagnosis ; Fungi ; Gastroscopy ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Lung Diseases ; Male ; Mucorales ; Mucormycosis* ; Opportunistic Infections ; Peptic Ulcer ; Prognosis ; Shock ; Stomach ; Stomach Ulcer ; Transplantation* ; Transplants

Background/Aims: Polyethylene glycol (PEG)-based bowel preparations are effective cleansing agents for colonoscopy. However, they require relatively large volumes to be used even with agents such as 2 L PEG with ascorbate (2LPEG). This phase 3, randomized, single-blinded, multicenter, parallel-group study compared the efficacy of 1 L PEG with high-dose ascorbate, TJP-008, to 2LPEG. Methods: Patients undergoing colonoscopy were randomized (1:1:1) to receive TJP-008 as 1-day split dose (TJP-008-1) or 2-day split dose (TJP-008-2) regimen or to receive 2LPEG as a 2-day split dose regimen. Cleansing efficacy was evaluated using the Harefield Cleansing Scale. The primary endpoint was overall bowel cleansing success. Full analysis set (FAS) and per protocol set (PPS) analyses were performed. Results: Of the 314 screened patients, efficacy was assessed in the following patient numbers (FAS/PPS): total (293/285), TJP-008-1 (98/94), TJP-008-2 (97/95), and 2LPEG (98/96). FAS revealed noninferiority between TJP-008 and 2LPEG with regard to overall success (TJP-008-2, 99.0%; TJP-008-1, 95.9%; 2LPEG, 94.9%; p=0.100 and p=0.733, respectively). PPS also showed noninferiority (p=0.721 and p=0.211, respectively). However, the PPS analyses showed a higher bowel cleansing score for TJP-008-2 for high-quality cleansing in the right colon (TJP-008-2 83.2% vs 2LPEG 62.5%; p=0.005). Conclusions TJP-008 is a new low-volume cleansing agent with a colon cleansing efficacy comparable to that of standard 2LPEG that exhibits significant safety and tolerability

Background/Aims: Guide tube-assisted endoscopy for procedures that require repeated endoscopic access is safer and more effective than conventional endoscopy. However, its effectiveness has not been confirmed in animal studies. We assessed the usefulness of guide tube-assisted endoscopic procedures in an in vivo porcine model. Methods: Five different guide tube-assisted endoscopic procedures were performed by experienced endoscopists on a pig weighing 32 kg. To evaluate the efficacy of these procedures, we compared the endoscopic approach time when a guide tube was used to that when it was not. Additional endoscopic procedures using a guide tube were performed, including multiple foreign body extractions, multiple polypectomies, and multiple submucosal dissections. To evaluate safety, we compared the insertion force into the proximal esophagus between the guide tube and conventional overtube methods. Results: Using the endoscopic approach with a guide tube required a shorter average approach time to reach the three target lesions than when using the endoscopic approach without a guide tube (p<0.001). Compared to the conventional overtube method, the guide tube method produced a lower average resistance during insertion into the upper esophagus (p<0.001). Conclusions Guide tube-assisted endoscopic procedures are effective and safe for repeated endoscopic access in an in vivo porcine model.