Heterotopic mesenteric ossification is a very uncommon disorder that is characterized by new bone formation in the mesentery, which does not normally undergo ossification. A 52-year-old female experienced a small bowel obstruction 12 days after a segmental resection of the small bowel following a trauma. A laparotomy was performed 16 days after the initial operation, and a 2 cm hard mass was detected in the small bowel mesentery, with severe fibrous adhesions around the mass, involving the jejunum, which required resection. Postoperatively, the patient developed an intraabdominal abscess, followed by intestinal fistulation. The patient gradually recovered by conservative management, and left hospital 70 days after the first operation. Microscopic examination of the mass showed well oriented trabeculae of the osseous tissue, osteoid formation, with fine calcification and osteoblastic activity, but there was no formation of mature lamellar bone or clear evidence of the "zone phenomenon" that is classically described in heterotopic ossification. These findings appeared consistent with an early stage of heterotopic ossification. The etiology and pathogenesis are unknown; the heterotopic mesenteric ossification was thought to be associated with the trauma (intraabdominal surgery). The previous literature on heterotopic mesenteric ossification is reviewed, and a new case reported.
Abscess ; Female ; Humans ; Intestinal Obstruction ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged ; Ossification, Heterotopic ; Osteoblasts ; Osteogenesis

Heterotopic mesenteric ossification is a very uncommon disorder that is characterized by new bone formation in the mesentery, which does not normally undergo ossification. A 52-year-old female experienced a small bowel obstruction 12 days after a segmental resection of the small bowel following a trauma. A laparotomy was performed 16 days after the initial operation, and a 2 cm hard mass was detected in the small bowel mesentery, with severe fibrous adhesions around the mass, involving the jejunum, which required resection. Postoperatively, the patient developed an intraabdominal abscess, followed by intestinal fistulation. The patient gradually recovered by conservative management, and left hospital 70 days after the first operation. Microscopic examination of the mass showed well oriented trabeculae of the osseous tissue, osteoid formation, with fine calcification and osteoblastic activity, but there was no formation of mature lamellar bone or clear evidence of the "zone phenomenon" that is classically described in heterotopic ossification. These findings appeared consistent with an early stage of heterotopic ossification. The etiology and pathogenesis are unknown; the heterotopic mesenteric ossification was thought to be associated with the trauma (intraabdominal surgery). The previous literature on heterotopic mesenteric ossification is reviewed, and a new case reported.
Abscess ; Female ; Humans ; Intestinal Obstruction ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged ; Ossification, Heterotopic ; Osteoblasts ; Osteogenesis

The objective of this study is to determine the effectiveness of 16-month milk consumption as a part of the health promotion community program for women in Asan. Subjects included 313 women belonging to the milk group (mean age = 69.1, range 47~89 y) and 66 women to the control (mean age = 43.6, range 20~69 y) group. For those in the milk group, one cup (200ml) of partially lactose-digested low-fat milk was provided everyday for 16 months. Each subject was interviewed to assess calcium intake by a 24-h recall after fasting blood was obtained for analyzing bone turnover markers, and calcaneus broadband ultrasound attenuation (BUA) was measured by quantitative ultrasound (QUS) on the left heel before and after the milk supplementation. After 16 months, the calcium intake levels changed from 55% of recommended dietary allowance (RDA) to 85% RDA in the milk group and from 73% RDA to 84% RDA in the control group. BUA were reduced from 67.9+/-8.1 to 64.7+/-17.5 dB/MHz for milk and from 90.4+/-13.0 to 87.2+/-15.2 dB/MHz for control groups. Paired ttest showed the changes of BUA for both groups (-3.24 and -3.15 dB/MHz for milk and control groups, respectively) were significant, but the two groups did not show any differences in absolute changes. When post-BUA was analyzed after age, initial BUA and menopausal status were controlled as covariates in ANCOVA model, the milk group showed significantly (p < 0.05) smaller changes than the control group (-3.50 vs -6.71 dB/MHz, respectively). According to a multiple regression analysis, milk consumption and initial BUA showed significant interaction meaning that those with lower initial BUA showed higher milk effects. We conclude that one-cup a day milk consumption for 16 month can prevent further bone loss and significantly improve calcium intake.
Calcaneus ; Calcium ; Chungcheongnam-do* ; Fasting ; Female ; Health Promotion ; Heel ; Humans ; Milk* ; Osteocalcin ; Recommended Dietary Allowances ; Ultrasonography*

BACKGROUND: This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. METHODS: We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. RESULTS: Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. CONCLUSIONS: The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.
Cardiopulmonary Resuscitation ; Catheterization ; Emergencies* ; Extracorporeal Membrane Oxygenation ; Extremities ; Heart Arrest ; Humans ; Ischemia ; Myocardial Infarction ; Retrospective Studies ; Treatment Outcome

PURPOSE: We investigated the effects of restricted fluid in the first 7 days of life on the risk of bronchopulmonary dysplasia (BPD) or patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants. METHODS: Eighty three VLBW infants who lived more than 28 days were selected. The amount of daily maintenance fluid was determined by calculation of insensible water loss (IWL) and urine output (UO). Seventy to 80 percent of calculated amount was given to the ventilated infants. Subjects were grouped into low (<25th%), moderate (25-75th%), and high (>75th%) fluid groups for the first 24 hours, 3 days and 7 days. Chi square tests analyzed proportions of subjects with or without morbidities across fluid groups. Multivariate logistic regression was used to analyze the effect of fluid intake on BPD or PDA, controlling for factors that are significantly associated with BPD or PDA by univariate analysis. RESULTS: Rates of BPD and PDA were not significantly associated with fluid groups on each time period. The result was the same after controlling for factors that are significantly associated with BPD or PDA by univariate analysis. For the first 3 and 7 days, fluid intakes were positively related with maximal weight loss, urine output and mechanical ventilation duration. CONCLUSION: In VLBW infants, when given based on needs reflected from IWL and UO versus intake, relatively low fluid intakes in the first week of life do not decrease the risk of BPD or PDA, and vice versa. We suggest that calculation of daily fluid based on IWL and UO is appropriate for VLBW infants.
Bronchopulmonary Dysplasia* ; Ductus Arteriosus, Patent* ; Fluid Therapy ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Logistic Models ; Respiration, Artificial ; Water Loss, Insensible ; Weight Loss

Facial injury by firework is not rare, but there are few reports on oral firework explosion injury. The authors of this article present a case of an 18-year-old male with intraoral injury from a firework explosion with literature review.
Adolescent ; Burns* ; Explosions* ; Facial Injuries ; Humans ; Male ; Mouth*

PURPOSE: Multifactorial in pathogenesis, bronchopulmonary dysplasia is difficult to predict based on any single factor, especially early in life. We evaluated clinical and ventilatory parameters in the first week of life, and their combinations were tested for early prediction of BPD. METHODS: Eighty-one very low birth weight (VLBW) infants born at gestational ages<32 weeks and mechanically ventilated for at least first 7 days were selected and classified into BPD (n=48, radiological findings and oxygen dependency at postconceptional age of 36 weeks) and non-BPD (n=33) groups. Clinical and ventilatory parameters on days 1, 4 and 7 were analyzed. Chi-square and t-test were used to compare individual variables between two groups. Multiple logistic regression analysis was done to identify risk factors for BPD. RESULTS: The mean gestational age and birth weight were lower in BPD group. In multivariate analysis, significant risk factors that predict BPD were gestational age<30 weeks (OR 0.112, 95% CI 0.016-0.767), maximum MAP > or =4.5 on day 7 (OR 3.982, 95% CI 1.046-15.162) and maximum FiO2> or =0.3 on day 7 (OR 7.626, 95% CI 1.570-37.054). The combination of these factors for prediction of BPD had a 79% positive predictive value with an 85% sensitivity. CONCLUSION: A number of clinical and ventilatory parameters in combination (gestation, maximum MAP and FiO2 on day 7) can predict BPD in VLBW infants early in life with a relatively high sensitivity and positive predictiveness. With early identification of infants prone to BPD, the clinicians may resort to more active measures to minimize lung injury and to prevent BPD.
Birth Weight ; Bronchopulmonary Dysplasia* ; Gestational Age ; Health Resorts ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Logistic Models ; Lung Injury ; Multivariate Analysis ; Oxygen ; Respiration, Artificial* ; Risk Factors

A submental artery perforator flap was applied to the defect site after surgical excision of basal cell carcinoma on the right lower face. Three points were beneficial: it was perfect for assuring the safe margin of the mandibular branch of the facial nerve as well as intact platysma muscle, functionally; harvesting the flap was much easier than that of submental artery flap, surgically; and the color and contour were well matched aesthetically.
Arteries* ; Carcinoma, Basal Cell ; Facial Nerve ; Perforator Flap*

BACKGROUNDS/AIMS: Complete elimination of intrahepatic duct (IHD) stones is difficult and IHD stone disease is frequently associated with various complications, recurrence and sometimes cholangiocarcinoma. Therefore, we analyzed the long-term surgical results and evaluated the management currently considered appropriate. METHODS: Overall 110 patients who had been diagnosed with benign IHD stone disease and who underwent surgical treatment were enrolled in this study. The patients were categorized into three groups according to the type of surgery performed; liver resection (LR) group, intrahepatic duct exploration (IHDE) group and hepaticoenterostomy (HE) group. We compared and analyzed the results of these three groups. RESULTS: The number of cases in the LR group, IHDE group and HE group were 77, 25 and 8 respectively. The LR group required a longer operation time (p=0.000), more frequent transfusion (p=0.028) and had higher morbidity (p=0.049). However, the LR group had a higher clearance rate (90.9%) (p=0.000) than the other groups. In addition, there were a total of 22 cases of IHD stone recurrence during the follow-up, but there was no statistically significant difference among the three groups. The location of IHD stones was related to a risk factor for incomplete stone removal, but not for recurrence. CONCLUSION: The fundamental principle for the treatment of IHD stone disease should be liver resection. However, it can lead to a longer operative time and higher rate of complications than the other procedures. There is also no difference in the IHD stone recurrence rate among the procedures. Therefore, these alternative and minor procedures could also be taken into account for patients with poor preoperative condition.
Cholangiocarcinoma ; Follow-Up Studies ; Humans ; Liver ; Operative Time ; Recurrence ; Risk Factors

Overactive bladder (OAB) is defined as urgency, usually with frequency and nocturia, and with or without urge incontinence. Duloxetine, an antidepressant that inhibits reuptake of serotonin and norepinephrine, is indicated for the treatment of stress urinary incontinence in Europe. In this paper, we present a case of a 17-year-old female patient with OAB and depressive symptoms who was successfully treated with duloxetine. This case suggests duloxetine can be an option for patient with OAB, and it also highlights the need for further studies of duloxetine's use in the treatment of OAB.
Adolescent* ; Depression ; Europe ; Female* ; Humans ; Nocturia ; Norepinephrine ; Serotonin ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urinary Incontinence, Urge ; Duloxetine Hydrochloride