With the recent development of information and communication technology, social interest in virtual reality (VR) is increasing rapidly. VR technology is expanding into applications such as games, movies, entertainment, healthcare, education/media, manufacturing, and construction. In the healthcare, VR is used for surgical training, medical education, rehabilitation medicine, pain control, and treatment for psychiatric disorder, but the market size of VR in healthcare is not big compared to VR application in other industries. However, as the demand for high-quality medical care increases and the training time of the resident physicians is reduced, the demand for VR in the healthcare is expected to increase rapidly. Especially, the nose and paranasal sinus are composed of complicated osseous structures, which makes it difficult to understand the exact anatomy and requires highly skilled techniques to perform accurate and safe surgery. For this reason, nose and sinus are a suitable field to apply VR technology. In this review article, we describe the overview of VR technology used in healthcare, the status and prospects of VR in endoscopic sinus surgery and facial plastic surgery.
Delivery of Health Care ; Education ; Education, Medical ; Motion Pictures as Topic ; Nose ; Paranasal Sinuses ; Plastics* ; Rehabilitation ; Simulation Training ; Surgery, Plastic

PURPOSE: To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. MATERIALS AND METHODS: A total of 289 apparently healthy personnel at Yonsei University (male: 170, female: 119, age: mean(SD=54.9 +/-7.1 years) underwent EBT (electron bean tomography). The risk factors for atherosclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58 % ) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. RESULTS: The prevalence of CAC was 40% in men and 18.5% in women (mean score: 29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141, 41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6% ) , respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity (p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score (p=0.118). CONCLUSION: This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans.
Arteries ; Atherosclerosis ; Calcium* ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Obesity ; Prevalence ; Risk Factors ; Smoke ; Smoking

Otolaryngologic symptoms and findings are often the first manifestations of post-transplant lymphoproliferative disorder (PTLD) in children. We report a case of lymphoproliferative disorder which occurring in the epiglottis and aryepiglottic fold of a post-liver transplant, 28-month-old girl. Inspiratory stridor and mild respiratory distress were presented 7 months after the transplantation. Bronchoscopy revealed swelling of the epiglottis, multiple nodular lesions in the arytenoid and the pharyngeal wall, and collapse of the false vocal cord due to a redundant nodular mass during inspiration. Microscopic examination showed polymorphic, polyclonal small lymphoid aggregates, which were dominantly stained by monoclonal antibody to CD20. In this case, PTLD was associated with Epstein-Barr virus (EBV) infection. The patient was treated successfully by the surgical excision of the obstructing redundant mass in the arytenoids, dose reduction of immunosuppressive drugs and the administration of an antiviral agent. A diagnosis of PTLD should be considered in transplanted children who later develop upper airway obstruction.
Airway Obstruction ; Bronchoscopy ; Child* ; Child, Preschool ; Diagnosis ; Epiglottis ; Female ; Herpesvirus 4, Human ; Humans ; Liver Transplantation ; Lymphoproliferative Disorders* ; Respiratory Sounds* ; Vocal Cords

Ochrobactrum anthropi is an aerobic, gram-negative, motile, non-lactose-fermenting, oxidase-producing, and urease-positive bacillus. We reported a case of aortic valve endocarditis due to O. anthropi in a hemodialysis patient. To our knowledge, this is the first case of O. anthropi endocarditis in a hemodialysis patient in Korea. The organism was resistant to beta-lactam antibiotics and susceptible to ciprofloxacin, amikacin, trimethoprim-sulfamethoxazole, gentamicin and carbapenem. We treated O. anthropi endocarditis with meropenem for 6 weeks and the patient recovered completely.
Amikacin ; Anti-Bacterial Agents ; Aortic Valve ; Bacillus ; Ciprofloxacin ; Endocarditis ; Gentamicins ; Humans ; Korea ; Ochrobactrum ; Ochrobactrum anthropi ; Renal Dialysis ; Thienamycins ; Trimethoprim, Sulfamethoxazole Drug Combination

Alimentary tract duplications are uncommon congenital abnormalities that usually have an anatomical connection with some part of the gastrointestinal tract and have a common blood supply with the adjacent segment of intestine. A completely isolated duplication cyst (CIDC) is a very rare type of gastrointestinal duplication that does not communicate with the normal bowel segment and possesses its own exclusive blood supply. Only 5 CIDC cases in adults have been reported in the English medical literature. Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported. This report describes a 52-year-old male patient with a peritoneal CIDC, which upon curative excision was found to have given rise to an adenocarcinoma. The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue. We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.
Adenocarcinoma* ; Adult* ; Congenital Abnormalities ; Cystadenoma, Mucinous ; Gastrointestinal Tract ; Humans ; Ileum ; Intestines ; Male ; Mesentery* ; Middle Aged

A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.
Adult ; Aorta, Thoracic ; Echocardiography ; Esophagus ; Follow-Up Studies ; Humans ; Male ; Multidetector Computed Tomography ; Respiratory Function Tests ; Thorax ; Trachea

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection. Rhino-cerebral and pulmonary involvement are the most common forms and usually occur in immunecompromised patients. Gastrointestinal involvement is extremely rare, the stomach being the most frequently involved site among them. We report a case of gastric mucormycosis in a 37 year old male alcoholic with gastric ulcer. On histological examination, characteristic findings of hyphae with irregular width and right angle branchings were observed in the gastric mucosa and ulcer debris. The diagnosis of gastric mucormycosis was made by the characteristic histological nature. The patient was treated aggressively with antibiotics and antiulcer regimen for 6 weeks, and then no fungus was present on follow up biopsy of gastric mucosa.
Adult ; Alcoholics ; Anti-Bacterial Agents ; Biopsy ; Diagnosis ; Follow-Up Studies ; Fungi ; Gastric Mucosa ; Humans ; Hyphae ; Male ; Mucormycosis* ; Stomach ; Stomach Ulcer* ; Ulcer

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.
Acute Disease ; Aged ; Aneurysm, Dissecting/complications/*therapy ; *Angioplasty, Balloon ; Female ; Humans ; Ischemia/etiology ; *Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/etiology ; *Stents

BACKGROUND: Molecular techniques are fundamental for establishing an accurate diagnosis and therapeutic approach of glycogen storage diseases (GSDs). We aimed to evaluate SLC37A4 mutation spectrum in Korean GSD Ib patients. METHODS: Nine Korean patients from eight unrelated families with GSD Ib were included. SLC37A4 mutations were detected in all patients with direct sequencing using a PCR method and/or whole-exome sequencing. A comprehensive review of previously reported SLC37A4 mutations was also conducted. RESULTS: Nine different pathogenic SLC37A4 mutations were identified in the nine patients with GSD Ib. Among them, four novel mutations were identified: c.148G>A (pGly50Arg), c.320G>A (p.Trp107*), c.412T>C (p.Trp138Arg), and c.818G>A (p.Gly273Asp). The most common mutation type was missense mutations (66.7%, 6/9), followed by nonsense mutations (22.2%, 2/9) and small deletion mutations (11.1%, 1/9). The most common mutation identified in the Korean population was c.443C>T (p.Ala148Val), which comprised 39.9% (7/18) of all tested alleles. This mutation has not been reported in GSD Ib patients in other ethnic populations. CONCLUSIONS: This study expands knowledge of the SLC37A4 mutation spectrum in Korean patients with GSD Ib.
Alleles ; Codon, Nonsense ; Diagnosis ; Glycogen Storage Disease* ; Glycogen* ; Humans ; Methods ; Mutation, Missense ; Polymerase Chain Reaction ; Sequence Deletion

Activated phosphoinositide 3-kinase δ syndrome (APDS)1 is caused by gain-of-function mutations in PIK3CD, which encodes the catalytic p110δ subunit of phosphoinositide 3 kinase. We describe three patients with APDS1, the first thereof in Korea. Therein, we investigated clinical manifestations of APDS1 and collected data on the efficacy and safety profile of sirolimus, a mammalian target of rapamycin inhibitor and pathway-specific targeted medicine. The same heterozygous PIK3CD mutation was detected in all three patients (E1021K). After genetic diagnosis, all patients received sirolimus and experienced an excellent response, including amelioration of lymphoproliferation and improvement of nodular mucosal lymphoid hyperplasia in the gastrointestinal tract. The median trough level of sirolimus was 5.5 ng/mL (range, 2.8–7.5) at a dose of 2.6–3.6 mg/m2. Two patients who needed highdose, short-interval, immunoglobulin-replacement treatment (IGRT) had a reduced requirement for IGRT after initiating sirolimus, and the dosing interval was extended from 2 and 3 weeks to 4 weeks. The IgG trough level after sirolimus treatment (median, 594 mg/dL; range, 332–799 mg/dL) was significantly higher than that before sirolimus treatment (median, 290 mg/dL; range, 163–346 mg/dL) (p<0.001). One episode of elevated serum creatinine with a surge of sirolimus (Patient 2) and episodes of neutropenia and oral stomatitis (Patient 1) were observed. We diagnosed the first three patients with APDS1 in Korea. Low-dose sirolimus may alleviate clinical manifestations thereof, including hypogammaglobulinemia.