Anaphylaxis to polyethylene glycol (PEG) is rare and mainly occurs with the use of laxatives containing PEG. Recently, an increasing number of PEG allergies have been reported, particularly those related to coronavirus disease 2019 (COVID-19) vaccines. mRNA COVID-19 vaccines, such as the BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna) vaccines, contain PEG2000 as an excipient and are contraindicated when allergy to a vaccine component exist. We report a 55-year-old woman’s history as a case of successful mRNA COVID-19 vaccination and colonoscopy after oral desensitization to PEG in a patient with PEG allergy who required both COVID-19 vaccination and colon evaluation. Allergy to PEG was diagnosed based on clinical history, skin test results, and basophil histamine release testing. Oral desensitization effectively suppressed histamine release from basophils in response to PEG stimulation, suggesting that oral desensitization using PEG-based laxatives may be an effective treatment option for patients with allergy to the substance.

Upper gastrointestinal symptoms such as epigastric fullness, nausea, and vomiting are often observed in CAPD patients. Intraabdominal pressure depends on the amount of dialysate and the body positions. It is not clear whether upper gastrointestinal symptoms are manifestations of raised intraperitoneal pressure produced by dialysate. To investigate the changes of LESP according to the amount of dialysate and the body position and the relationship between LESP and parameters of 24-h esophageal pH monitoring, esophageal manometry and 24-h esophageal pH monitoring were performed in 12 CAPD patients. The sex ratio was 1:2. The duration of CAPD of patients except one was less than 1 month. The mean age was 47.5 15.5(SD) years old. There were no changes in supine LESPs according to the infused volume of dialysate. Sitting LESPs at 500, 1500, and 2000ml were elevated significantly compared to basal sitting LESP(27.1 5.5, 27.0 6.0, and 28.5 7.0 vs. 23.9 5.7mmHg, p<0.05). Supine LESPs at basal and 500ml of dialysate significantly higher than sitting LESPs(30.2 9.1 and 31.2 8.5 vs. 23. 9 5.7 and 27.1 5.5mmHg, p<0.05). There were no differences in LESP by age, sex, and diabetic status. Supine LESP at 2000ml strongly correlated with total reflux episodes(r=-0.92, p<0.01), fraction time of pH<4.0(r=-0.85, p<0.01), and total reflux score(DeMeester)(r=-0.88, p<0.01), but other LESPs did not. When the patients were divided into group I(<30mmHg) and group II(330mmHg) by supine LESP at 2000ml, group I had more total reflux episodes(73.7 27.0 vs. 14.0 10.3, p<0.05), fraction time of pH<4.0(4.0 3.7 vs. 0.5 0.4%, p<0.05), and total reflux score(15.2 10.5 vs. 2.8 1.5, p<0.05). In conclusion, CAPD patients seem to have a risk of gastroesophageal reflux due to elevated intraperitoneal pressure by dialysate, especially if supine LESP at 2000ml was lower than 30mmHg.
Esophageal pH Monitoring* ; Esophageal Sphincter, Lower* ; Gastroesophageal Reflux ; Humans ; Manometry ; Nausea ; Peritoneal Dialysis, Continuous Ambulatory ; Sex Ratio ; Vomiting

Primary small cell neuroendocrine carcinoma in stomach is known to be very rare and only the twelve cases have been reported in the English literature. This tumor appears to be analogous to small cell carcinoma and carcinoid tumors of the lung, and is characterized by a very aggressive clinical course. Recently, we have experienced a 68-year-old man with primary small cell neuroendocrine carcinoma in the stomach, which had liver metastasis and peritoneal seeding. A positive Grimelius stain was present and immunohistochemical studies revealed positivity for neuron-specific enolase in the tumor. For its rarity, we report this case with review of literatures.
Aged ; Carcinoid Tumor ; Carcinoma, Neuroendocrine* ; Carcinoma, Small Cell ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Phosphopyruvate Hydratase ; Stomach*

BACKGROUND: Enterococcus faecium has emerged as an important nosocomial pathogen worldwide, and this trend has been associated with the dissemination of a genetic lineage designated clonal complex 17 (CC17). In the present study, characterization of the glycopeptide resistance mechanism, genetic relatedness, and pathogenicity in isolates of vancomycin-resistant E. faecium in the Chungcheong area were investigated. METHODS: A total of 37 consecutive, non-duplicate, vancomycin-resistant E. faecium were isolated at three university hospitals in the Chungcheong area. The mechanism of glycopeptide resistance and pathogenicity factors were studied using PCR, and the genetic relatedness was determined via multilocus sequence type and esp repeat profile analysis. Additionally, the quinolone resistance-determining regions of parC and gyrA were sequenced to identify mutations involved in ciprofloxacin resistance. RESULTS: Two genotypes of VRE were confirmed: VanA-phenotype vanA genotype VRE (25 isolates) and VanB-phenotype vanA genotype VRE (12 isolates). MLST analysis revealed five sequence types. A significant result was that ST414 and CNS4 (4-1-1-1-1-1-1) were considered as belonging to CC17. The esp and hyl genes were found in 100% and 86.4% of the isolates, respectively. A total of 37 isolates showed genetic mutations in parC and gyrA. CONCLUSION: All isolated strains in the present study belonged to one of the CC17 genotypes including ST414 and CNS4 (4-1-1-1-1-1-1), which were not previously detected in Korea. The combination of MLST and the esp gene repeat profiles can be useful for genetic characterization of VREF isolates with regard to the evolutionary process and epidemiology of the clones.
Ciprofloxacin ; Clone Cells ; Enterococcus ; Enterococcus faecium ; Genotype ; Hospitals, University ; Korea ; Multilocus Sequence Typing ; Polymerase Chain Reaction ; Virulence Factors

According to Moertel's classification, synchronous multiple gastric cancer is eonsidered to be a sort of multiple primary cancer, The clinical signifieance of multiplicity in gastric cancer was its location relative to the resection line. Compared with patients with single gastric cancer, multiple gastric cancer were more frequently found among the older men, and they were more commonly found in early gastric cancer. The frequency of multifocality in gastric cancer is 2.2-9% in the world literature reports and is increasing recently, with advance in the diagnostic method of gastric cancer. However, synchronous multiple gastric cancer which has more than four foci is rare. In Korea, there has been only one case reported about quadruple gaatric cancer. Recently, we experienced a case of a 58-year-old male patient with synchronously developed-quadruple gastric cancer on the body of stomach, for whom radical total gastrectomy and esophagojejunostomy was done. All of them were moderately differentiated adenocarcinoma. The mapping about four lesions showed that Borrmanin type III AGC extending to the serosa was placed on the posterior wall of higher body; EGC IIc invading the submucosa, the anterior wall of mid body, EGC III confined to the mucosa, the lesser curvature side of mid to lower body; EGC III localizing to the mucosa, the posterior wall of lower body. So we reported this case with a review of literatures.
Adenocarcinoma ; Classification ; Gastrectomy ; Humans ; Korea ; Male ; Middle Aged ; Mucous Membrane ; Serous Membrane ; Stomach ; Stomach Neoplasms*

Toothpicks are not uncommonly swallowed, and subsequently, may be impacted into gastrointestinal wall and cause morbidities, and even mortality. Therefore, the early diagnosis and immediate retrieval of an ingested toothpick is important. In many cases, endoscopic removal is attempted initially, but if this fails or a complication is encountered, surgery should be considered. The authors experienced a case of ingested toothpick penetrating the gastric wall. A 51-year-old woman visited our hospital with epigastric pain of one-week duration. Upper endoscopy revealed that the sharp end of a toothpick had been impacted into the distal antrum. Endoscopic removal using an alligator jaw forceps failed because the toothpick broke during removal and our continued attempts to extract the remnant resulted in it becoming more embedded in the stomach wall. In such circumstances, surgical treatment should be considered. However, we incised the mucosa to expose the remnant toothpick, and fortunately, we were then able to grasp and remove the toothpick using an alligator jaw forceps. We report this unusual case of a toothpick impacted in the gastric wall that was resolved endoscopically by mucosal incision.
Alligators and Crocodiles ; Early Diagnosis ; Endoscopy ; Female ; Foreign Bodies ; Hand Strength ; Humans ; Jaw ; Middle Aged ; Mucous Membrane ; Stomach ; Surgical Instruments

Toothpicks are not uncommonly swallowed, and subsequently, may be impacted into gastrointestinal wall and cause morbidities, and even mortality. Therefore, the early diagnosis and immediate retrieval of an ingested toothpick is important. In many cases, endoscopic removal is attempted initially, but if this fails or a complication is encountered, surgery should be considered. The authors experienced a case of ingested toothpick penetrating the gastric wall. A 51-year-old woman visited our hospital with epigastric pain of one-week duration. Upper endoscopy revealed that the sharp end of a toothpick had been impacted into the distal antrum. Endoscopic removal using an alligator jaw forceps failed because the toothpick broke during removal and our continued attempts to extract the remnant resulted in it becoming more embedded in the stomach wall. In such circumstances, surgical treatment should be considered. However, we incised the mucosa to expose the remnant toothpick, and fortunately, we were then able to grasp and remove the toothpick using an alligator jaw forceps. We report this unusual case of a toothpick impacted in the gastric wall that was resolved endoscopically by mucosal incision.
Alligators and Crocodiles ; Early Diagnosis ; Endoscopy ; Female ; Foreign Bodies ; Hand Strength ; Humans ; Jaw ; Middle Aged ; Mucous Membrane ; Stomach ; Surgical Instruments

A 38-year-old woman was admitted for evaluation of cyst-like lesion of the pancreas, which was incidentally found on physical check up. She has been well until the lesion was found except epigastric pain. On endoscopic retrograde pancreatogram, pancreatic head portion revealed a 2 x 2 cm sized cystic mass with marginal calcification. There was no definitive communication between pancreatic duct and cyatic mass, but amylase level of cystic content was increased. Surgical excision was performed, Microspically, the cystic wall showed flat lining epithelium with dense fibrosis and dysplastic calcification accompanied by chronic pancreatitis of adjacent pancreatic tissue.
Adult ; Amylases ; Epithelium ; Female ; Fibrosis ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic

A 38-year-old woman was admitted for evaluation of cyst-like lesion of the pancreas, which was incidentally found on physical check up. She has been well until the lesion was found except epigastric pain. On endoscopic retrograde pancreatogram, pancreatic head portion revealed a 2 x 2 cm sized cystic mass with marginal calcification. There was no definitive communication between pancreatic duct and cyatic mass, but amylase level of cystic content was increased. Surgical excision was performed, Microspically, the cystic wall showed flat lining epithelium with dense fibrosis and dysplastic calcification accompanied by chronic pancreatitis of adjacent pancreatic tissue.
Adult ; Amylases ; Epithelium ; Female ; Fibrosis ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic

To understand the early cellular differentiation of neurons, we studied the differentiation of ventral spinal cord (VSC) neurons in culture. Immunofluorescence techniques with myelin associated protein 2 (MAP2) and phosphorylated neurofilament heavy chain were used with phase contrast microscopy. VSC neurons were best grown and differentiated on the coverslips coated with polyethylenimine or poly-L-Lysine. During 3 days of culture, VSC neurons changed from a round cell with no neurites to multipolar neurons with an axon and dendrites. The differentiating VSC neurons could be classified into 4 types based on the shape and length of processes. The process with axonal character, that is MAP2 negative and phosphorylated neurofilament positive, was first identified at the tip of dendritic process when one or more processes grew out. Our results suggest that the formation of an axon in VSC neurons may follow the formation of dendrites.
Animals ; Axons* ; Cell Culture Techniques ; Dendrites ; Fluorescent Antibody Technique ; Microscopy, Electron, Scanning ; Microscopy, Phase-Contrast ; Myelin Sheath ; Neurites ; Neurons* ; Polyethyleneimine ; Rats* ; Spinal Cord*