Plexiform neurofibroma (PN) is an uncommon benign tumor, usually associated with neurofibromatosis type 1. As most PNs involve the craniomaxillofacial region, PN of the colon is very rare. Here we present a case of PN involving the sigmoid colon. A 43-year-old male patient presented to the outpatient clinic for the evaluation of an incidentally discovered sigmoid colon mass. A colonoscopic biopsy was performed for the mass, and the result revealed neuronal proliferation. The patient visited the outpatient clinic a year later with symptoms of abdominal pain and stool caliber change. Biopsy was repeated for the sigmoid colon mass, and the results showed mucosal Schwann cell proliferation and S-100 immunostaining positivity. Computed tomography and magnetic resonance imaging were performed for further evaluation, and neurofibroma or schwannoma was suspected based on the imaging studies. For an accurate diagnosis, the patient underwent surgery to remove the sigmoid colon mass. The final diagnosis of the mass was confirmed as PN. We hereby report a rare case of PN involving the sigmoid colon that could not be diagnosed before surgery.

Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL-NT) is the most common subtype of Epstein-Barr virus-associated NK/T-cell lymphomas. ENKTCL-NT occurs infrequently in the gastrointestinal tract. In particular, reports of ENKTCL-on NT arising from the stomach are extremely rare. Several clusters of differentiation (CDs) have been useful in recognizing NK-cells, T-cells, and tumor cells of NK/T-cell lymphomas. Among them, the CD56 antigen is considered the most sensitive marker for ENKTCL-NT and is expressed in almost all cases of ENKTCL-NT. Thus, the development of CD56-negative ENKTCL-NT is highly atypical. This paper reports a case of a young Asian female who presented with gastric ulcer bleeding. The patient was histologically diagnosed with ENKTCL-NT. No tumor cells for CD56 were observed, whereas no monoclonality of the T-cell receptor gamma gene rearrangement was detected in the tumor cells. The patient was scheduled for systemic chemotherapy six times and achieved complete remission. Peripheral blood-hematopoietic stem cell transplantation was performed later.

Background: Benign esophageal strictures are treated endoscopically, often with balloon dilatation (BD) or bougie dilators. However, recurrent esophageal strictures have been reported after BD, and severe complications sometimes occur. The aim of this study was to compare the efficacy and complications of endoscopic incisional therapy (EIT) and BD for benign esophageal strictures. Methods: We retrospectively reviewed patients who underwent BD or EIT as primary treatment for benign esophageal strictures between July 2014 and June 2021. Technical success was defined as restoration of the lumen diameter with <30% residual stenosis. Clinical success was defined as no recurrence of dysphagia within 1 month after BD or EIT and an increase of 1 grade or more on the Functional Oral Intake Scale. Results: Thirty patients with benign esophageal stricture were enrolled. There were 16 patients in the BD group and 14 patients in the EIT group. No significant differences in technical and clinical success rates were found between the two groups. Furthermore, no significant differences in the re-stricture rate were observed between the groups. There was one complication in the EIT group and three complications in the BD group. Three patients who underwent BD had re-stricture and underwent EIT thereafter, and we regrouped patients who underwent EIT at least once. The clinical success rate was significantly higher in patients regrouped to the EIT group than in patients who underwent BD only. Conclusions EIT is not inferior to BD as the primary treatment for benign esophageal strictures, especially for recurrent cases.

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.

PURPOSE: The aim of this study was to investigate the effect of epidural dexamethasone on analgesia and cytosolic phospholipase A2 (cPLA2) expression in the spinal cord in a rat formalin test. MATERIALS AND METHODS: Epidural dexamethasone injection was performed to Sprague-Dawley rats with a 25 gauge needle under fluoroscopy. Following the epidural injection, a formalin induced pain behavior test was performed. Next, the spinal cords corresponding to L4 dorsal root ganglion was extracted to observe the cPLA2 expression. RESULTS: There were no differences in pain response during phase I among the groups. The phase II pain response in 300 microg of epidural dexamethasone group decreased as compared to control, 30 microg of epidural dexamethasone, 100 microg of epidural dexamethasone, and 300 microg of systemic dexamethasone groups. The expression of cPLA2 decreased in Rexed laminae I-II in 300 microg of the epidural dexamethasone group compared with the ones in the control group. CONCLUSION: Taken together, these results suggest that 300 microg of epidural dexamethasone has an attenuating effect on the peripheral inflammatory tissue injury induced hyperalgesia and this effect is mediated through the inhibition of intraspinal cPLA2 expression and the primary site of action is the laminae I-II of the spinal cord.
Animals ; Anti-Inflammatory Agents/*pharmacology ; Dexamethasone/*pharmacology ; Formaldehyde/*adverse effects ; Group IV Phospholipases A2/*metabolism ; Hyperalgesia/*drug therapy ; Injections, Epidural ; Male ; Pain/chemically induced/*metabolism ; Pain Measurement ; Rats ; Rats, Sprague-Dawley ; Spinal Cord/*metabolism

BACKGROUND: To investigate the influence of the initial readings of blood pressure (BP) components on functional outcome in acute ischemic stroke patients stratified by age. METHODS: We reviewed the medical records of 54 first-ever hemiplegic MCA ischemic stroke patients (age 61.6+/-9.6 years; 37men, 17 women). Subjects were stratified by age, and BP was measured six times within the initial 24 hours after stroke onset. The maximal systolic BP (MSBP), minimal diastolic BP (mDBP), and maximal pulse pressure (MPP) were selected for analysis. Functional outcomes were evaluated with the korean-modified Barthel index (K-MBI) and functional independence measure (FIM) at 3 months after stroke onset in all subjects. RESULTS: The amount of MSBP and MPP elevation was significantly higher in patients with diabetes mellitus and smoking history, respectively (p<0.05). In regards to age groups, MPP was inversely correlated with FIM (r= -0.727, p=0.027) in subjects in their 40s. Each of MSBP and MPP were inversely correlated with FIM in the 50s age group (r= -0.666, -0.761; p=0.013, 0.002). MPP was inversely correlated with each of K-MBI and FIM in the 60s age group (r= -0.659, -0.786; p=0.002, 0.000). MPP was inversely correlated with K-MBI, and MSBP was inversely correlated with FIM in the 70s age group (r= -0.787, -0.651; p=0.002, 0.022). CONCLUSION: In elderly patients with ischemic stroke, MPP was significantly correlated with functional outcome. Therefore, the tight control and management of pulse pressure from the acute stage of stroke should be seriously considered.
Aged ; Blood Pressure ; Diabetes Mellitus ; Humans ; Medical Records ; Reading ; Smoke ; Smoking ; Stroke

OBJECTIVE: To investigate the correlation between the pulse pressure (PP) and functional outcome in acute middle cerebral arterial (MCA) ischemic stroke. METHOD: We reviewed the medical records of 52 first-ever hemiplegic MCA ischemic stroke patients (age 61.5+/-9.7 years; 35 men, 17 women). Functional outcomes were evaluated with Korean-modified Barthel index (K-MBI), functional independence measure (FIM), Korean-national institutes of health stroke scale (K-NIHSS), and Korean-mini mental state examination (K-MMSE) on 3 days and 3 months after the onset of stroke in all the subjects. The PP was measured six times within initial 24 hours after stroke onset and then the highest PP was selected for the analysis. RESULTS: The degree of PP elevation revealed the significant correlations with male gender, over the age of 55 years, diabetes mellitus, and current smoking history, respectively (p<0.05). In TOAST (Trial Org 10172 in Acute Stroke Treatment) classification, the large artery atherosclerosis group showed significantly the higher PP rather than the other groups (p<0.05). There were inverse correlations between the PP and each of FIM and K-MBI scores on 3 months after stroke onset (p=0.000, 0.009; r=- 0.479, -0.358). There was an inverse correlation between the PP and the change of FIM (p=0.000, r=-0.532). CONCLUSION: The PP within initial 24 hours after stroke onset revealed significant correlation with functional outcome. The management for the proper PP gives the favorable effect on the functional outcome in acute MCA territory ischemic stroke.
Academies and Institutes ; Arteries ; Atherosclerosis ; Blood Pressure ; Chondroitin Sulfates ; Dermatan Sulfate ; Diabetes Mellitus ; Hemiplegia ; Heparitin Sulfate ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Smoke ; Smoking ; Stroke

OBJECTIVE: To investigate the correlation between functional evaluation scales and cognitive evoked potentials (CEPs) in chronic stroke patients. METHOD: Ten chronic stroke patients with middle cerebral arterial infarction (age 53.6+/-15.7 years, 5 men, 5 women, duration 210.5+/-143.2 days) were recruited. Korean mini-mental status examination (K-MMSE) scores of the subjects were ranked between 15~24 points and the grades of Rancho Los Amigos level of cognitive function of the subjects were VI or VII. They received physical therapy using neuro-developmental technique and cognitive rehabilitation twice a day, 5 times a week, for total 4 weeks. Before and after the treatment, cognitive function tests including K-MMSE, Loewenstein occupational therapy cognitive assessment (LOTCA) and motor-free visual perception test (MVPT) and functional ability tests including functional independence measure (FIM) and Korean version of National Institutes of Health stroke scale (K-NIHSS) were done and CEPs were recorded. RESULTS: The scores of K-MMSE, LOTCA, MVPT, FIM and K-NIHSS showed significant improvement, respectively (p<0.05). The P300 latencies significantly decreased from 420.2+/-34.8 msec to 391.5+/-36.4 msec (p<0.05). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of K-MMSE, LOTCA and MVPT (r=0.863, p=0.001; r=0.745, p=0.013; r=0.806, p=0.005). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of FIM and K-NIHSS (r=0.758, p=0.011; r=0.743, p=0.014). CONCLUSION: The CEPs would be a useful method for reflecting the effect of neuro-cognitive rehabilitation treatment and predicting the functional recovery in chronic stroke patients.
Evoked Potentials ; Female ; Humans ; Infarction ; Male ; National Institutes of Health (U.S.) ; Occupational Therapy ; Stroke ; Visual Perception ; Weights and Measures

OBJECTIVE: To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). METHOD: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6+/-5.6 months, age 28.5+/-3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1+/-6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. RESULTS: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p<0.05, p< 0.05). The AI of the patient group significantly decreased after treatment (p<0.05, p<0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p<0.05). CONCLUSION: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS.
Chin ; Cryotherapy ; Electrodes ; Electromyography* ; Female ; Forehead ; Humans ; Hyperthermia, Induced ; Male ; Masseter Muscle ; Relaxation ; Temporomandibular Joint ; Tooth ; Trigger Points ; Ultrasonography ; Visual Analog Scale