Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. Among the major and minor complications, migration and erosion of the internal bumper into or through the abdominal wall, so called buried bumper syndrome has been described more recently. We describe a patient in whom internal bumper eroded into stomach wall and was completely covered by gastric epithelium 45 days after gastrostomy placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach. But, endoscopy was failed to remove the gastrostomy tube and surgical exploration was required in our case. We experienced a case of buried bumper syndrome after percutaneous endoscopic gastrostomy and report with a review of literatures.
Abdominal Wall ; Cytochrome P-450 CYP1A1 ; Endoscopy ; Epithelium ; Gastrostomy ; Humans ; Nutritional Support ; Stomach

OBJECTIVES : Impaired autonomic function in patients with chronic renal failure has been well documented in a number of studies to assess the degree of cardiovascular autonomic dysfunction and to assess the relationship with plasma catecholamines. The purpose of the present study was to evaluate the prevalence of autonomic dysfunction and to determine the effect of autonomic dysfunction on the increment of plasma catecholamine, dialysis-induced hypotension and hypotension during chronic dialysis. METHODS: We measured the degree of autonomic damage and the concentration of plasma catecholamines in 20 patients on maintenance hemodialysis, 12 pre- dialysis patients with chronic renal failure and 20 normal controls using a standardized battery of five cardiovascular reflex tests. RESULTS: 1) In normal controls, 70% of cases had a normal or early parasympathetic abnormalities however in patients with chronic renal failure, 45.2% of patients had severe abnormalities. The prevalence of autonomic dysfunction was 62.5% and there was significant correlation between sympathetic and parasympathetic score in patients with chronic renal failure. 2) Although overall autonomic function was not different in two chronic renal failure groups, the magnitude of heart rate response to Valsalva maneuver was increased and the magnitude of fall of blood pressure in response to standing-up was reduced in dialyzed patients compared with nondialyzed patients. 3) Patients with autonomic dysfunction was older and had higher postdialysis concentration of plasma norepinephrine than those with normal autonomic function. 4) In dialyzed patients, predialysis concentration of plasma norepinephrine at rest varied widely and was significantly related to the duration of dialysis. Postdialysis concentration of norepinephrine was significantly correlated with the degree of parasympathetic damage. 5) There were no significant differences in autonomic damage or plasma catecholamines whether dialysis- induced hypotension and hypotension in chronic hemodialysis or not. CONCLUSION : Disturbances of autonomic nerve system are common in chronic renal failure with distinct abnormalities of parasympathetic function and additional sympathetic dysfunction. Elevated plasma norepinephrine seems to be related to the compensatory response of sympathetic nerve system to parasympathetic damage. Impairment of autonomic function does not appear specifically related to dialysis-induced hypotension or hypotension in chronic dialysis.
Autonomic Pathways ; Blood Pressure ; Catecholamines ; Dialysis ; Heart Rate ; Humans ; Hypotension ; Kidney Failure, Chronic* ; Norepinephrine ; Plasma ; Prevalence ; Reflex ; Renal Dialysis ; Valsalva Maneuver

Mycobacterium chelonae is a rapidly growing organism that has been found in water, soil, and dust. Although it can colonize healthy persons without sequelae, it can also cause skin and soft tissue infections, pulmonary infections and other sequelaes and rarely, disseminated disease in immunocompromised patients. But, infections due to rapidly growing mycobacteria are probably markedly underdiagnosed and these organisms are capable of causing a wide spectrum of clinical disease. We experienced a case of wound infection with M. chelonae after percutaneous endoscopic gastrostomy and report with review of literatures.
Colon ; Dust ; Gastrostomy* ; Humans ; Immunocompromised Host ; Mycobacterium chelonae* ; Mycobacterium* ; Skin ; Soft Tissue Infections ; Soil ; Wound Infection* ; Wounds and Injuries*

OBJECTIVE: Left ventricular hypertrophy is common and major complication in patients with end stage renal disease (ESRD), but pathogenesis is not clear. We have used echocardiography to evaluate influential factors and contractile performance according to the geometry of left ventricle. METHODS: We measured left ventricular mass, the extent of pericardial effusion and systolic function of left ventricle with M-mode and two dimensional echocardiography in 99 cases of ESRD from March 1993 to March 1996. RESULTS: 1) Body surface area and systolic blood pressure was higher in men than those in women. But, there was no difference in LV mass index or systolic function between the sex. 2) Among the 99 patients with ESRD, 89 cases (90%) had increased ventricular mass and 10 cases had normal ventricular mass. In the left ventricular hypertrophy groups, 60 cases had concentric hypertrophy, 29 cases had eccentric hypertrophy. 3) In patients with normal ventricular mass, hypertension and pericardial effusion were less frequent than in those with left ventricular hypertrophy. In patients with concentric hypertrophy, systolic blood pressure and body surface area were increased and serum albumin was decreased as compared to patients with eccentric hypertrophy. In patients with eccentric hypertrophy, duration of dialysis was increased. But, the result of Logistic analysis showed that systolic blood pressure and serum albumin were reliable factors for the geometry of left ventricle. 4) In patients with eccentric hypertrophy, LV mass index was significantly correlated with the concentration of serum alkaline phosphatase and phosphate. But, in patients with concentric hypertrophy, any factors were not correlated with LV mass index. 5) Systolic performances such as ejection fraction and fractional shortening were decreased in patients with eccentric hypertrophy. 6) The pattern of left ventricular hypertrophy was not different among non-dialysis group, hemodialysis group and CAPD group. CONCLUSION: In patients with ESRD, left ventricular hypertrophy is a common complication and most common hypertrophic type is concentric hypertrophy. The geometry of left ventricular hypertrophy may be influenced by various factors such as systolic blood pressure and serum albumin concentration and influence on the systolic performance of left ventricle. Further study for the geometry of left ventricle and the prognosis may be necessary for the improvement of cardiovascular complications in patients with ESRD.
Alkaline Phosphatase ; Blood Pressure ; Body Surface Area ; Dialysis ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular* ; Kidney Failure, Chronic* ; Male ; Pericardial Effusion ; Peritoneal Dialysis, Continuous Ambulatory ; Prognosis ; Renal Dialysis ; Serum Albumin

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

PURPOSE: This study aimed to explore the association between increased level of ambient particulate matter and emergency room visits for chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: A retrospective study was conducted. We enrolled patients who lived in Seoul, Korea and were diagnosed with COPD in the emergency room between January 2012 and December 2014. Meteorological factors [daily highest temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine and particulate matter less than 10 µm (PM 10)] between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. We used a multiple Poisson regression model with daily patient's number of COPD as a response variable and meteorological factors as explanatory variable. Variable selection was done via an Elastic net. RESULTS: There was a total of 1,179 emergency visits for acute exacerbations of COPD patients. PM10 (before 4, 10, 11, 15, 16, 17, 22, 24, 27, 28 day), rainfall (before 1, 6, 8, 16, 18 day), relative humidity (before 2, 8), and daily temperature difference (5, 10, 15 day) had a relationship and a lag effect with COPD exacerbations. CONCLUSION: This study showed that an increased concentration of PM10 was associated with COPD exacerbations. A future study that reinforces the limitation of this study is necessary to get a helpful index for an adequate response of medical institution and efficient placement of medical personnel.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Humidity ; Korea ; Lung Diseases ; Meteorological Concepts ; Particulate Matter* ; Pulmonary Disease, Chronic Obstructive* ; Regression Analysis ; Retrospective Studies ; Seoul ; Sunlight

PURPOSE: This study shows the change in emergency room use behavior by homeless patients after implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’ in July 2015. METHODS: A retrospective study was conducted in a public hospital between January 2014 and December 2014 and January 2016 and December 2016. Homeless patients who visited the emergency room in 2014 and 2016 were compared based on age, gender, mode of insurance, admission, revisit within 48 hours, length of stay (LOS) in the emergency department (ED), total cost, and major diagnostic category. RESULTS: A total of 3,642 homeless patients were enrolled during the study period, of which 1,876 visited in 2014 and 1,766 in 2016. Fewer homeless patients in 2016 revisited within 48 hours (p=0.046). Homeless in 2016 had a shorter ED LOS (p < 0.001) and lower total cost (p=0.040). More homeless patients who visited due to alcohol revisited within 48 hours in 2016 (p=0.036). Moreover, these patients did not have a different ED LOS (p=0.060) or total cost (p=0.475). Medicaid homeless patients were less connected compared health insurance by screening, brief intervention, referral to treatment program. CONCLUSION: Comparison of homeless patients who visited the emergency room in 2014 and 2016 revealed fewer total homeless patients in 2016, as well as less revisits within 48 hours, shorter ED LOS and lower total cost. These findings indicate that the ‘Seoul Type Citizen Sympathy Emergency Room Project’ was effective in the emergency room, but improvements for alcohol and medicaid homeless patients are needed.
Alcoholics ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Health Policy ; Homeless Persons ; Hospitals, Public ; Humans ; Insurance ; Insurance, Health ; Length of Stay ; Mass Screening ; Medicaid ; Referral and Consultation ; Retrospective Studies

PURPOSE: This study aimed to evaluate the clinical performance of implant-assisted removable partial dentures (IARPD) with surveyed crowns, also known as implant-crown-retained removable partial dentures (ICRPDs). MATERIALS AND METHODS: Electronic searches of MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials, the Web of Science, and the Korea Citation Index were performed according to the established search terms for ICRPD. A literature search was conducted for studies published in English or Korean until September 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. RESULTS: A total of 216 journals were searched, and 31 eligible studies were selected based on the inclusion and exclusion criteria. One systematic review included five case reports of ICRPD. Nine retrospective studies evaluated implant survival/success rate, implant failure cases, marginal bone loss, periodontal status, clinical complications, and patient satisfaction. Twenty-one case reports published in Korea showed good prognoses. CONCLUSION According to the findings of this systematic review, ICRPD has a reasonable survival/success rate, minimal bone loss, and high patient satisfaction.

PURPOSE: This study aimed to evaluate the clinical performance of implant-assisted removable partial dentures (IARPD) with surveyed crowns, also known as implant-crown-retained removable partial dentures (ICRPDs). MATERIALS AND METHODS: Electronic searches of MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials, the Web of Science, and the Korea Citation Index were performed according to the established search terms for ICRPD. A literature search was conducted for studies published in English or Korean until September 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. RESULTS: A total of 216 journals were searched, and 31 eligible studies were selected based on the inclusion and exclusion criteria. One systematic review included five case reports of ICRPD. Nine retrospective studies evaluated implant survival/success rate, implant failure cases, marginal bone loss, periodontal status, clinical complications, and patient satisfaction. Twenty-one case reports published in Korea showed good prognoses. CONCLUSION According to the findings of this systematic review, ICRPD has a reasonable survival/success rate, minimal bone loss, and high patient satisfaction.