Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.
Acinetobacter/isolation & purification ; Acute Disease ; Aged ; Anti-Bacterial Agents/*therapeutic use ; Anti-Infective Agents/therapeutic use ; Cefotaxime/therapeutic use ; Ceftriaxone/therapeutic use ; Ciprofloxacin/therapeutic use ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Gastritis/*diagnosis/drug therapy/microbiology ; Gastroparesis/*diagnosis/microbiology ; Gastroscopy ; Humans ; Imipenem/therapeutic use ; Klebsiella oxytoca/isolation & purification ; Male ; Ofloxacin/therapeutic use ; Pneumonia/diagnosis/drug therapy ; Tomography, X-Ray Computed

PURPOSE: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. MATERIALS AND METHODS: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. RESULTS: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). CONCLUSION: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.
Congenital Abnormalities ; Follow-Up Studies ; Genu Valgum* ; Knee ; Osteotomy* ; Patellar Dislocation* ; Weight-Bearing

Botryomycosis is a rare, chronic and suppurative di- sease that is often mistaken clinically and histologically for a fungal infection, because the histologic feature shows a cluster of bacteria found within an eosinophilic matrix or capsule, giving the appearance of granules mimicking the sulfur granules of actinomycosis. Staphy- lococcus aureus is the most common organism cultured from lesions of botryomycosis, but other bacteria have also been isolated and implicated, including Psudomonas aeruginosa, E. coli, Proteus spp., Bacillus spp.. In some case, multiple pathogenic bacteria were found on cul ture. This disease has two patterns of organ involve ment. The more common type is cutaneous type, which involves the skin, subcutaneous soft tissue, muscle and bone. The other is visceral type which involves the lungs, liver, tongue, orbit, bowel, brain, kidney or pros tate. We report a case of brain and pulmonary botry omycosis in a 60 year-old man, who have early lung cancer. Botryomycosis was diagnosed by brain mass removal, PCNA and bronchoscopy, and lung cancer was detected incidentally by bronchoscope. The patient was treated with the Penicillin G after operation of brain mass, and right pneumonectomy was done.
Actinomycosis ; Bacillus ; Bacteria ; Brain ; Bronchoscopes ; Bronchoscopy ; Eosinophils ; Humans ; Kidney ; Liver ; Lung Neoplasms* ; Lung* ; Middle Aged ; Oceans and Seas ; Orbit ; Penicillin G ; Pneumonectomy ; Proliferating Cell Nuclear Antigen ; Proteus ; Skin ; Sulfur ; Tongue

BACKGROUND/AIMS: Combination treatment consisting of hepatic arterial infusion chemotherapy with epirubicin and cisplatin (HAIC-EC) and systemic infusion of low-dose 5-fluorouracil (5-FU) are sometimes effective against advanced hepatocellular carcinoma (HCC). However, there is no effective treatment for advanced HCCs with arterioportal shunts (APS) or arteriovenous shunts (AVS). METHODS: We investigated a response and adverse events of a new combination protocol of repeated HAIC-EC and percutaneous intratumoral injection chemotherapy with a mixture of recombinant interferon-gamma (IFN-gamma) and 5-FU (PIC-IF) in patients with far-advanced HCCs with large APSs or AVSs. RESULTS: There was a complete response (CR) for the large vascular shunts in all three patients and for all tumor burdens in two patients. Significant side effects were flu-like symptoms (grade 2) and bone marrow suppression (grade 2 or 3) after each cycle, but these were well-tolerated. CONCLUSIONS: These results suggest that the combination of HAIC-EC and PIC-IF is a new and promising approach for advanced HCC accompanied by a large APS or AVS.
Aged ; Angiography ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy/pathology/radiography ; Cisplatin/administration & dosage ; Epirubicin/administration & dosage ; Fluorouracil/administration & dosage ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Injections, Intramuscular ; Interferon-gamma, Recombinant/administration & dosage ; Liver Neoplasms/*drug therapy/pathology/radiography ; Male ; Tomography, X-Ray Computed ; Tumor Burden

Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38 year old man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease.
Acute Kidney Injury ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Liver Diseases ; Multiple Organ Failure ; Pancreatitis ; Prevalence ; Renal Replacement Therapy ; Superinfection ; Young Adult

In acute myocardial infarction, mural thrombi occur in approximately 20 per cent of patients who do not receive anticoagulant therapy and about 10 percent of thrombi result in systemic embolization. Threrfore, in acute phase of myocardial infarction, heparinization is considered as essential therapeutic regimen which afterwards acute phase, might have no clinical significance. We experienced a patient with recurrent LV apical thrombi inspite of an sufficient anticoagulation. This patient was treated with primary balloon PTCA and optimal duration of anticoa-gulation with IV heparin was maintained. At predischarge follow-up, TTE revealed huge LV apical thrombi and warfarinization was started. Three episodes of appearance and disappearance of thrombi have been noted and we report this patient as thrombophilia associated with acute myocardial infarction.
Follow-Up Studies ; Heparin ; Humans ; Myocardial Infarction* ; Thrombophilia* ; Warfarin

PURPOSE: The effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG). MATERIALS AND METHODS: Ninety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge. RESULTS: The TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm. CONCLUSIONS: This study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Female ; Humans ; Knee

PURPOSE: To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy. METHODS: PubMed/MEDLINE, EMBASE, KoreaMed, and Cochrane Library were searched from the earliest available date of indexing through August 2016. The methodological quality of all articles was assessed according to the Coleman methodology score (CMS). Studies were grouped according to the surgical method, and a meta-analysis was conducted to identify the unsuccessful clinical outcome and complication rates. RESULTS: Nine studies were included; the mean CMS was 67.33 (standard deviation, 8.75 points). Cystectomy was reported in five studies; cystectomy was not performed in four studies. The odds ratio of unsuccessful clinical outcomes evaluated by Rauschning and Lindgren score was 122.05 (p<0.001) with cystectomy and 58.12 (p<0.001) without cystectomy. The effect size of complications was 0.16 (p<0.001) with cystectomy and 0.03 (p<0.001) without cystectomy. The recurrence rate was 0% with cystectomy and 6.4% without cystectomy. CONCLUSIONS: All the currently available studies showed satisfactory outcomes in both with and without cystectomy groups. However, arthroscopic cystectomy concurrently performed with management of intra-articular lesions was associated with a relatively low recurrence rate and a relatively high incidence of complications.
Abstracting and Indexing as Topic ; Arthroscopy ; Cystectomy ; Incidence ; Knee ; Methods ; Odds Ratio ; Popliteal Cyst ; Recurrence

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.
Catheters, Indwelling ; Echocardiography ; Endocarditis ; Female ; Fever ; Heart Septal Defects, Ventricular ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Periodontal Diseases ; Pharyngitis ; Pulmonary Artery ; Pulmonary Embolism ; Thorax ; Thrombophlebitis ; Thrombosis ; Tricuspid Valve ; Young Adult

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a recently understood unique clinicopathologic disease entity comprising approximately 1% of all exocrine pancreatic tumors and 11% of cystic neoplasms of pancreas. It has been reported worldwide, mostly in Japan. It is generally characterized by recurrent pancreatitis, mucin oozing from the papilla of Vater, and dilated pancreatic duct with intraductal filling defects. Microscopically, the mucin-producing columnar epithelium forms papillary proliferation into the dilated pancreatic duct and this feature differentiates IPMT of the pancreas from the more common mucinous cystic neoplasms of the pancreas which usually do not communicate with the pancreatic duct. On the other hand, mucin-hypersecreting bile duct tumors have been rarely reported in the English literature. We herein present the first case of mucin-hypersecreting bile duct tumor combied with IPMT of the pancreas with a review of the related literature.
Bile Ducts ; Bile Ducts, Intrahepatic* ; Epithelium ; Hand ; Japan ; Mucins* ; Pancreas ; Pancreatic Ducts ; Pancreatitis