Deep cervical space abscess may cause life-threatening complications despite the advent of antibiotics, so early detection and localization of the abscess are essential for management decision. To evaluate the efficacy of utilizing CT scanning in deep cervical space abscess, we retrospectively revieweed CT of 17 patients confirmed by surgery. CT was found tobe very accurate in defining the presence, location, and extent of the abscess along with the demonstration of life-threatening complications such as airway compression and mediastinal extension. In conclusion, CT can play and essential role in guiding surgical approach to deep cervical space abscess.
Abscess* ; Anti-Bacterial Agents ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

A primary tumor of mesenteric origin is rare. We encountered a malignant gastrointestinal stromal tumor (GIST) of mesenteric origin that demonstrated severe necrosis, and report the CT findings and review the literature.
Gastrointestinal Stromal Tumors* ; Mesentery* ; Necrosis

An infraoptic anterior cerebral artery (ACA) arising at a low bifurcation of the internal carotid artery is a rare anomaly, of which about 33 cases have been reported to date, often in association with cerebral aneurysms. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. Angiography revealed the presence of an abnormal solitary ACA, arising from the intracranial proximal internal carotid artery near the origin of the ophthalmic artery, and a contralateral middle cerebral artery aneurysm. Magnetic resonance imaging showed that the ACA passed below the ipsilateral optic nerve, anterior to the optic chiasm, to join the normally positioned anterior communicating artery above the optic chiasm.
Angiography ; Anterior Cerebral Artery* ; Arteries ; Carotid Artery, Internal ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Ophthalmic Artery ; Optic Chiasm ; Optic Nerve

For evaluating the reproductive performances of GTD patients, we found 115 cases of GTD patients, 77 HM and 38 GTT, who became pregnant after the completion of treatments and follow-up period. The results of this study suggest subsequent pregnancies after the completion of treatments may promise normal reproductive outcomes regardless of the chemotherapy.
Drug Therapy ; Follow-Up Studies ; Gestational Trophoblastic Disease* ; Humans ; Pregnancy

PURPOSE: Dental CT software program can provide reformatted cross-sectional and panoramic images that cannot be obtained with conventional axial & direct coronal CT scan. The purpose of this study is to describe the method of the technique and to identify the precise anatomy of jaw. MATERIALS AND METHODS:We evaluated 13 mandibles & 7 maxillae of 15 subjects without bony disease who were being considered for endosseous dental implants. Reformatted images obtained by the use of bone algorithm performed on GE HiSpeed Advantage CT scanner were retrospectively reviewed for detailed anatomy of RESULTS: Anatomy related to neurovascular bundle(mandibular foramen, inferior alveolar canal, mental foramen, canal for incisive artery, nutrient canal, lingual foramen and mylohyoid groove), muscular insertion(mylohyoid line, superior & inferior genial tubercle and digastric fossa) and other anatomy(submandibular fossa, sublingual fossa, contour of alveolar process, oblique line, retromolar fossa, temporal crest & retromolar triangle) were well delineated in mandible. In maxilla, anatomy related to neurovascular bundle(greater palatine foramen & groove, nasopalatine canal and incisive foramen) and other anatomy(alveolar process, maxillary sinus & nasal fossa) were also well delineated. CONCLUSION: Reformatted images using dental CT software program provided excellent delineation of the jaw anatomy. Therefore, dental CT noftware program can play an important role in the preoperative assessment of mandible and maxilla for dental implants and other surgical conditions.
Alveolar Process ; Arteries ; Dental Implants ; Haversian System ; Jaw* ; Mandible ; Maxilla ; Maxillary Sinus ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. MATERIALS AND METHODS: We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. RESULTS: We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). CONCLUSION: In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.
Diagnosis ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Propensity Score ; Uterine Cervical Neoplasms

Parathyroid carcinoma is an uncommon cause of PTH-related hypercalcemia with a reported incidence of 0.4% to 5% of all cases of primary hyperparathyroidism. Even though the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma than in those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma preoperatively. Parathyroid carcinomas are usually larger and firmer than parathyroid adenomas and patients with parathyroid carcinoma have a higher incidence of renal dysfunction, bone disease and gastrointestinal symptoms. Anemia is an uncommon clinical feature of parathyroid carcinoma. There have been no prior cases of ectopic parathyroid carcinomas reported to date. In this article, we report the case of a 26-year-old man who developed severe anemia and acute renal failure due to an ectopic parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. His serum calcium levels returned to normal and the anemia resolved postoperatively.
Acute Kidney Injury ; Adenoma ; Adult ; Anemia* ; Bone Diseases ; Calcium ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Incidence ; Parathyroid Neoplasms* ; Renal Insufficiency*

OBJECTIVE: Clozapine is the treatment of choice for refractory schizophrenia. The aim of this study was to compare the pharmacokinetics of the brand name (Clozaril) formulation and a generic formulation (Clzapine) of clozapine in Korean schizophrenic patients. METHODS: A prospective, randomized, crossover study was conducted to evaluate the steady-state pharmacokinetic profiles of Clozaril and Clzapine. Schizophrenic patients were randomized to receive either the brand name or generic formulation (100 mg twice daily) for 10 days, followed by the other formulation for 10 days. Plasma samples were collected on the last day of each treatment period. RESULTS: Twenty-two of 28 patients (78.6%) completed the study. The mean C(max,ss) values for Clzapine and Clozaril were 524.62 and 551.18 ng/mL, and the mean AUC(0-12) values were 4479.90 hr.ng/mL and 4724.56 hr.ng/mL, respectively. The 90% CI values for the natural logarithmically transformed C(max,ss) and AUC(0-12) ratios (Clzapine to Clozaril) after a single oral dose (100 mg) were 0.934 (0.849-1.028) and 0.936 (0.869-1.008), respectively. Five patients (20.8%) among 24 patients who took Clzapine reported 11 adverse events and six adverse events were reported by four patients (15.4%) among 26 who took Clozaril; there were no significant differences on physical examination or in vital signs, ECG, and laboratory tests between groups. CONCLUSION: Generic clozapine (Clzapine) appears to be bioequivalent to brand name clozapine (Clozaril).
Clozapine* ; Cross-Over Studies* ; Electrocardiography ; Humans ; Pharmacokinetics ; Physical Examination ; Plasma ; Prospective Studies ; Schizophrenia ; Therapeutic Equivalency* ; Vital Signs

VACTERL association is a disease with multiple congenital anomalies of the vertebrae, anus, cardia, tracheoesophageal(TE) fistula, renal and limb. This disease is derived from VATER anomaly, accompanied by cardiac and limb anomalies. We experienced a case of a 1-day-old boy with anal atresia, who represented multiple anomalies during hospital course. The multiple anomalies were hemivertebra, anal atresia, complex heart disease(coarctation of aorta, secundum aterial septal defect, patent ductus arteriosus), horseshoe kidney, tracheal stenosis, tracheal bronchus and left upper lung agenesis. Because both trachea and esophagus arise from fetal foregut, tracheal or pulmonary anomalies may be developed in VACTERL association instead of TE fistula. VACTERL association with tracheal anomalies, such as tracheal stenosis and tracheal bronchus or pulmonary agenesis, have been reported in foreign scientific society reports. But a case of VACTERL association with both tracheal bronchus and pulmonary agenesis has not reported yet. So we report this case with a brief review of related literature and suggest the consideration of possibility of tracheal or pulmonary anomaly in VACTERL association without TE fistula.
Anal Canal ; Anus, Imperforate ; Aorta ; Bronchi* ; Cardia ; Esophagus ; Extremities ; Fistula ; Heart ; Humans ; Kidney ; Lung ; Male ; Societies, Scientific ; Spine ; Trachea ; Tracheal Stenosis* ; Tracheoesophageal Fistula*

OBJECTIVE: In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS: AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION: The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
Adult ; Aged ; Antipsychotic Agents ; Biological Therapy ; Consensus ; Depression ; Depression, Postpartum ; Depressive Disorder ; Depressive Disorder, Major ; Drug Therapy ; Electroconvulsive Therapy ; Female ; Humans ; Mood Disorders ; Pregnant Women ; Premenstrual Dysphoric Disorder ; Transcranial Magnetic Stimulation