Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature.
Ear, Inner ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hemorrhage* ; Magnetic Resonance Imaging ; Neuroma, Acoustic ; Prognosis

BACKGROUND: To evaluate the clinical and functional outcomes of arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension, and investigate the radiologic and clinical benefits from the results. METHODS: We evaluated patients treated with arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension from November 2008 to September 2015. Fractures with displacement exceeding one-fourth of the anterior-articular surface or more than one-third of the posterior-articular surface in radiographic images were treated by surgery. Clinical assessment was conducted based on range of motion, Rowe score, and Constant score of injured arm and uninjured arm at last follow-up. RESULTS: Fifteen patients with Ideberg classification grade III, IV, and V glenoid fracture who underwent arthroscopic-assisted reduction using percutaneous screw fixation were retrospectively enrolled. There were no differences in clinical outcomes at final follow-up compared to uninjured arm. Bone union was seen in all cases within five months, and the average time to bone union was 15.2 weeks. Ankylosis in one case was observed as a postoperative complication, but the symptoms improved in response to physical therapy for six months. There was no failure of fixation and neurovascular complication. CONCLUSIONS: We identified acceptable results upon radiological and clinical assessment for the arthroscopic-assisted reduction and percutaneous fixation. For this reason, we believe the method is favorable for the treatment of Ideberg type III, IV, and V glenoid fractures. Restoration of the articular surface is considered to be more important than reduction of fractures reduction of the scapula body.
Ankylosis ; Arm ; Arthroscopy ; Classification ; Follow-Up Studies ; Fracture Fixation ; Glenoid Cavity ; Humans ; Methods ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Scapula

BACKGROUND: It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. MATERIALS AND METHODS: We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. RESULTS: In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were 0.058+/-0.121 and 0.148+/-0.187, and it was 0.081+/-0.150 and 0.174 +/-0.226 in patients without organic brain lesions. There were significant increases in the spike index (P<0.05) during NREM sleep in both groups (n=36), but no significant difference in the percent increase of spike index (P>0.05). CONCLUSION: The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.
Anticonvulsants ; Brain ; Electroencephalography* ; Epilepsy ; Humans ; Seizures ; Sleep Deprivation

No abstract available.
Ulcer*

STUDY DESIGN: Authors experienced three cases of malignant schwannoma arising from multiple neurofibromatosis and invading the vertebrae. OBJECTIVE: To report treatment results and preventive idea in three cases of malignant schwannoma transformed from neurofibromatosis within the retroperifoneal area and invading the vertebrae. SUMMARY OF BACKGROUND DATA: The patients with neurofibromatosis are clearly at increased risk to develop the malignant schwannoma. A review of Korean literature revealed no such cases. RESULTS: The first case presented in the L4 body and was treated by surgical excision and chemotherapy, but she expired due to secondary metastasis in six months after diagnosis. The second case was treated by diagnostic biopsy and chemotherapy with adriamycin, ifosfamide, DTIC, mesna. He eventually lived for 14 months. After a diagnostic biopsy, the third case died due to lung metastasis before we could begin the treatment. CONCLUSION: We recommend that neurofibromatsis patients be regularly followed-up and if necessary, CT examination of spine or abdomen should be done. If a malignant schwannoma is detected, then early treatment can be started.
Abdomen ; Biopsy ; Dacarbazine ; Diagnosis ; Doxorubicin ; Drug Therapy ; Humans ; Ifosfamide ; Lung ; Mesna ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibromatoses ; Spine*

Early gastric cancer (EGC) is a "curable" disease with a high cure rate made possible through proper surgical treatment; nonetheless, some patients sustain a disease recurrence after curative resection. The aim of this study was to identify the clinicopathological characteristics of recurrent EGC and determine predictable immunohistochemical markers for recurrence. We investigated the clinicopathological features of 1,786 EGC cases, and using tissue microarray, the expression of c-erbB-2, EGFR, MLH1, MSH2, p53, and AQP1 was examined in group with recurrence and control group without recerrence. In the clinical analysis, 32 of 1,786 (1.79%) patients showed recurrence, with a 2.04% five-year cumulative recurrence rate. Age, submucosal invasion, and lymph node metastasis significantly correlated with tumor recurrence (P=0.044, 0.019, and <0.001, respectively). Multivariate analysis showed lymph node status and old age (> or =57 yr) as independent risk factors of recurrence. In a case-control study, immunopositivity for c-erbB-2 was significantly associated with disease recurrence (P=0.024). There is the probability that EGC patients with old age (> or =57 yr), lymph node metastasis, submucosal invasion, and c-erbB-2 immunopositivity will experience recurrence; therefore, it is critical that patients with these risk factors be followed-up closely and considered candidates for adjuvant treatment.
Adult ; Aged ; Animals ; Female ; Genes, erbB-2 ; Humans ; Immunohistochemistry/methods ; Male ; Microarray Analysis/methods ; Middle Aged ; Multivariate Analysis ; *Neoplasm Recurrence, Local/metabolism/pathology ; Prognosis ; Risk Factors ; *Stomach Neoplasms/metabolism/pathology ; Tumor Markers, Biological/*metabolism

No abstract available.
Chondrosarcoma* ; Sternum*

The purpose of this study was to investigate the factors affecting dentists' attitudes and dental hygienists' services on dental anxiety in adults. The subjects were 300 adults older than 20 years of age living in Seoul, Gyeonggi, Daejeon, and Daegu. Data were collected using structured questionnaires. Among the distributed questionnaires, 225 respondents were selected as subjects, excluding 74 people who did not answer and 1 person who was not faithful. Data were analyzed using statistical software with a t-test, one-way ANOVA, and multiple regression. As a result, the gender was slightly higher in women (54.7%) than in men, and the last dental visit was less than one year in 59.6% of respondents. Most of the respondents' educational level was higher than college level (79.1%), and the monthly income was less than 2 million won in 53.8 of respondents. This study showed that distrust of dentists affected dental anxiety and anxiety stimulation. Higher reliability of the dentist was correlated with less dental anxiety in patients. Dental anxiety showed statistically significant results in dentist subcategories of patient slight and dentists' trust (p < 0.01). Additionally, the factors affecting dental anxiety and anxiety stimulus were knowledge of dental hygienist and distrust of dentist (p < 0.01). According to this study, dentists' and dental hygienists' trust of dental staff show the importance of oral health professionals' role in reducing dental anxiety in patients. It is also suggested that efforts should be made to improve public awareness of oral health experts. It is believed that dentists, and dental hygienists need to promoted to become professionals. In addition, a variety of programs have been developed to reduce dental anxiety, so patients need to be comfortable to receive dental treatment.
Adult ; Anxiety ; Daegu ; Dental Anxiety* ; Dental Hygienists ; Dental Staff ; Dentists ; Female ; Gyeonggi-do ; Humans ; Male ; Oral Health ; Seoul ; Surveys and Questionnaires

BACKGROUND: In 1997 the Korean Association of Medical Journal Editors (KAMJE) instituted a program to evaluate member journals. Journals that passed the initial evaluation were indexed in the KoreaMed. Here, we report changes in measures of quality of the KAMJE member journals during the last 20 years. METHODS: Quality measures used in the study comprised 3 assessment categories; self-assessment by journal editors, assessment of the journals by KAMJE reviewers, and by Korean health science librarians. Each used detailed criteria to score the journals on a scale of 0 to 5 or 6 in multiple dimensions. We compared scores at baseline evaluation and those after 7 years for 129 journals and compared improvements in journals indexed vs. not-indexed by the Web of Science (Science Citation Index Expanded; SCIE). RESULTS: Among 251 KAMJE member journals at the end of 2015, 227 passed evaluation criteria and 129 (56%) had both baseline and 7-year follow-up assessment data. The journals showed improvement overall (increase in median [interquartile range; IQR] score from baseline, 0.47 [0.64]; 95% confidence interval [CI], 0.44–0.61; P < 0.001) and within each category (median [IQR] increase by editor's assessment, 0.17 [0.83]; 95% CI, 0.04–0.26; P = 0.007; by reviewer's, 0.45 [1.00]; 95% CI, 0.29–0.57; P < 0.001; by librarian's, 1.75 [1.08]; 95% CI, 1.77–2.18, P < 0.001). Before the foundation of KAMJE in 1996, there were only 5 Korean medical journals indexed in the MEDLINE and none in SCIE, but 24 journals in the MEDLINE and 34 journals in SCIE were indexed by 2016. CONCLUSION: The KAMJE journal evaluation program successfully contributes improving the quality of the member journals.
Follow-Up Studies ; Humans ; Librarians ; Self-Assessment