Purpose: In the present study, we determined the prevalence of obstructive meibomian gland dysfunction (MGD), hyposecretory MGD, grossly normal MG, and hypersecretory MGD in patients with dry eye syndrome using lipid layer thickness (LLT) and MG dropout. Methods: Eighty-eight patients with dry eye syndrome were included in the study. Patients were categorized into four groups according to the LLT and weighted total meiboscore. The proportion of patients in each group was calculated. The age, sex, Ocular Surface Disease Index, LLT, Schirmer, tear film breakup time, cornea stain, weighted total meiboscore, expressibility, and quality of meibum were compared between the four groups. Results: Fifteen eyes (17.0%) had obstructive MGD, two eyes (2.3%) had hyposecretory MGD, 40 eyes (45.5%) had grossly normal MG, and 17 eyes (19.3%) had hypersecretory MGD. The obstructive MGD group was younger than the grossly normal MG group. In obstructive MGD, the ratio of men to women was higher than that of the other groups. However, Ocular Surface Disease Index, Schirmer, tear film breakup time, and corneal stain did not show statistically significant differences between the four groups. The meibum expressibility of the hyposecretoy MGD group was worse than those of the other groups. The meibum expressibility of the hyposecretoy MGD group was poor than those of the obstructive and hypersecretory MGD group. Conclusions This categorization was expected to help determine the best treatment method for dry eye syndrome, according to the MG status.

Poly(ADP-ribose) polymerase inhibitors have been shown dramatic responses in patients with BRCAness. However, clinical studies have been limited to breast cancer patients with germline mutations. Here, we describe a patient with metastatic breast cancer who had a rare BRCA1 somatic mutation (BRCA1 c.4336G>T (p.E1446*)) detected by cell-free DNA analysis after failing standard therapies. This tier III variant of unknown significance was predicted to be a pathogenic variant in our assessment, leading us to consider off-label treatment with olaparib. The patient responded well to olaparib for several months, with a decrease in allele frequency of this BRCA1 somatic mutation in cell-free DNA. Olaparib resistance subsequently developed with an increase in the allele frequency and new BRCA1 reversion mutations. To our knowledge, this is the first report confirming BRCA1 c.4336G>T (p.E1446*) as a mutation sensitive to olaparib in breast cancer and describing the dynamic changes in the associated mutations using liquid biopsy.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

BACKGROUND: The prevalence and incidence of Parkinson's disease (PD) are important for supporting the better comprehension of disease aspects and helping public health planning. Our aim is to evaluate the prevalence and incidence in South Korea between 2004 and 2013. METHODS: This retrospective, nationwide, longitudinal population-based study used National Health Insurance Service-National Sample Cohort Database to define patients with PD from 2004 to 2013 based on having Korean Classification of Diseases code G20, which were assigned by neurologists, and being prescribed PD medication. Annual prevalence and incidence were calculated. RESULTS: The prevalence of PD per 100,000 of population was 41.4 in 2004 and 142.5 in 2013, and there was 13.2% yearly increase over the 10 years. However, the incidence of PD per 100,000 of population increased steadily from 20.2 in 2004 to 53.1 in 2013. The prevalence and incidence were higher in women than in men. CONCLUSIONS: Our data show that there was an increasing trend in the prevalence and incidence of PD from 2004 to 2013, particularly in 70 years and older.
Classification ; Cohort Studies ; Comprehension ; Female ; Humans ; Incidence* ; Korea* ; Male ; National Health Programs ; Parkinson Disease* ; Prevalence* ; Public Health ; Retrospective Studies

Patients with inflammatory bowel disease (IBD) have an elevated risk of venous thromboembolism compared with the general population. The most common sites of venous thromboembolism in IBD patients are the deep veins of the legs, the pulmonary system, and portal and mesenteric veins. However, cerebral venous thrombosis is rarely associated with IBD. This report describes a case of cerebral venous thrombosis in a patient with Crohn's disease. A 17-year-old girl, diagnosed 4 years earlier with Crohn's disease, presented with headache and vomiting. Magnetic resonance imaging of the brain with venography showed venous thrombosis in the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. The patient immediately started anticoagulation therapy with intravenous heparin infusion followed by daily oral rivaroxaban 10 mg. Follow-up imaging after 2 weeks showed resolution of the thrombosis, with recanalization of the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. She continued rivaroxaban therapy for 6 months, and remained well, without neurologic sequelae. A high level of concern for cerebral venous thrombosis may be important when treating active IBD patients, because anticoagulation treatment can prevent fatal complications.
Adolescent ; Brain ; Crohn Disease* ; Female ; Follow-Up Studies ; Headache ; Heparin ; Humans ; Inflammatory Bowel Diseases ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Mesenteric Veins ; Phlebography ; Rivaroxaban ; Superior Sagittal Sinus ; Thrombosis ; Veins ; Venous Thromboembolism ; Venous Thrombosis* ; Vomiting

Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.
Adult ; Aneurysm/*diagnosis/etiology ; Arteries ; Embolization, Therapeutic ; Gastroscopy ; Head and Neck Neoplasms/complications/*diagnosis ; Hepatic Artery/diagnostic imaging ; Humans ; Male ; Neurofibromatosis 1/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*etiology ; Radiography

PURPOSE: This study was conducted to compare in vivo biofilm formation on titanium surface and zirconia surface. MATERIALS AND METHODS: For biofilm formation on titanium and zirconia in oral cavity, after producing oral appliances using acrylic resin and orthodontic wire tailored to 9 subjects, we made titanium and zirconia specimens (6 mm x 6 mm x 2 mm), fixed them on oral appliances and maintained them in oral cavity of test subjects for 24 and 72 hours. Test subjects who have equipped two pairs of specimens maintained oral hygiene not by using toothpaste but only by tooth brushing. After 24 and 72 hours, we removed and observed specimens through scanning electron microscopy (SEM). RESULTS: Biofilm formation showed large deviation depending on individuals. For formation comparison between titanium and zirconia for 24 hours, zirconia showed less biofilm formation than titanium. Biofilm formation showed large deviation depending on individuals. As for formation comparison between zirconia and titanium, the degree of biofilm formation in zirconia was less than it was in titanium after a lapse of 24 hours. The result of biofilm formation in 72 hours trial show that zirconia has an inclination to formate less biofilm than it was in titanium. CONCLUSION: Based on the above results, we can conclude that early biofilm formation in oral cavity was influenced by difference of abutment materials.
Biofilms* ; Microscopy, Electron, Scanning ; Mouth ; Oral Hygiene ; Orthodontic Wires ; Titanium* ; Tooth ; Toothpastes ; Zirconium

A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard.
Adult ; Angioplasty ; Anti-Bacterial Agents ; Arteries ; Electrocardiography ; Emergencies ; Friction ; Humans ; Ibuprofen ; Mediastinitis ; Myocardial Infarction ; Shoulder ; Stents ; Thorax

Esophageal schwannoma is a very rare neoplasm. The differentiation of schwannoma from the other submucosal tumors such as GISTs or leiomyoma is very difficult to do on the preoperative examination with performing esophagoscopy and computed tomography. The diagnosis is generally not confirmed until the histologic and immunohistochemical tests of the tumor are performed. A 38- year-old man presented to us with neck discomfort. The endoscopy showed a middle esophageal submucosal tumor that measured 12 mm in size and there were no mucosal changes. The endoscopic ultrasonography showed a tumor in the muscluaris mucosa layer without lymphadenopathy. After band ligation of the lower part of the tumor, it was removed by performing endoscopic mucosal resection and using a snare. A definitive diagnosis of esophageal benign schwannoma was made from the pathologic findings, which included positive immunohistochemical staining for S-100 protein and negative staining for C-kit, CD34 and actin. We report here on an esophageal benign schwannoma that was removed by endoscopic mucosal resection.
Actins ; Endoscopy ; Endosonography ; Esophagoscopy ; Leiomyoma ; Ligation ; Lymphatic Diseases ; Mucous Membrane ; Neck ; Negative Staining ; Neurilemmoma ; S100 Proteins ; SNARE Proteins

BACKGROUND/AIMS: Although the initial rate of hemostasis achieved by endoscopic treatment for acute non-variceal gastrointestinal bleeding (NVGIB) is high, recurrent or persistent bleeding occurs in 10% to 25% of the patients. The aim of this study was to assess the efficacy and safety of transcatheter arterial embolization (TAE) in patients with acute upper and lower NVGIB who could not be managed by endoscopic treatment. METHODS: A retrospective analysis of the clinical data was done in 43 patients (M/F: 26/17, mean age: 60 years) whom underwent angiography or TAE for acute upper and lower NVGIB between January 1998 and December 2003. Among 43 patients, 18 had upper NVGIB, 19 had lower NVGIB, and 6 had obscure gastrointestinal bleeding. Demographic characteristics and outcome parameters including the rates of hemostasis, in-hospital death, and complications were analyzed. RESULTS: Thirty-four patients underwent TAE while 9 patients underwent angiography. TAE was used as the first line treatment in 17 patients and as the second line treatment in others. Hemostasis was achieved in 29 of 34 patients (85.3%) by TAE. According to the site of bleeding, hemostasis was achieved in 14 of 17 patients (82.4%) with upper NVGIB and in 15 of 17 patients (88.2%) with lower NVGIB. There was no significant angiography or TAE-related complications such as bowel ischemia or infarction except a hematoma on the angiography site in one patient. CONCLUSIONS: TAE is effective and safe in patients with acute upper or lower NVGIB who cannot be managed by endoscopic treatment.
Adult ; Aged ; Aged, 80 and over ; Catheterization ; *Embolization, Therapeutic/methods ; English Abstract ; Female ; Gastrointestinal Hemorrhage/*therapy ; *Hemostatic Techniques ; Humans ; Male ; Middle Aged