The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived.
Decompression ; Duodenum ; Esophageal and Gastric Varices ; Esophagus ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mucous Membrane ; Sclerotherapy ; Ulcer ; Varicose Veins*

The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission.(continue...)
Cholangiopancreatography, Endoscopic Retrograde* ; Gallstones ; Humans ; Incidence ; Pancreatitis*

PURPOSE: The purpose of this study was to compare the accuracy of the implant master cast according to the type (pick-up, transfer) and the length (long, short) of the impression copings. MATERIALS AND METHODS: The metal master cast was fabricated with three internal connection type implant analogs (Osstem GS III analog), embedded parallel and with 10degrees of mesial angulation to the center analog. Four types of impression coping were prepared with different combinations of types (transfer, pick-up) and lengths (long, short) of the coping. The impressions were made using vinyl polysiloxane (one step, heavy + light body) with an individual tray, and 10 impressions were made for each group. Eventually, 40 experimental casts were produced. Then, the difference in the distance between the master cast and the experimental cast were measured, and the error rate was determined. The analysis of variance was performed using the SPSS (v 12.0) program (alpha = .05), and the statistical significance was set at P < .05. RESULTS: The ANOVA showed that the pick-up type impression coping exhibited a significantly lower error rate than the transfer type. However, no significant difference was observed with respect to the length of the impression coping. Additionally, no significant difference was observed between the parallel and mesial angulated groups. CONCLUSION: Within the limitations of this study, the pick-up type impression coping exhibited a more accurate implant master cast than the transfer type in parallel group. The accuracy of the implant master cast did not differ for different lengths of impression coping of at least 11 mm. Additionally, the accuracy of the implant cast was not different for the parallel and 10degrees mesial angulated groups.
Light ; Polyvinyls ; Siloxanes

Although very rare, the incidence of tricuspid valve regurgitation after blunt chest trauma has risen in line with the increasing rate of car accidents and steering wheel trauma. It is easy to miss the diagnosis of tricuspid valve regurgitation following blunt chest trauma because most patients feel no symptoms at trauma, and the condition is sometimes overlooked for a long period of time due to its mild symptoms. A 49-year-old man suffered dyspnea on exertion for 1 month due to right heart failure 8 years after accidentally falling from a third floor. Preoperative echocardiography revealed severe tricuspid valve regurgitation resulting from prolapse of the anterior leaflet with annular dilatation. The patient underwent tricuspid valvuloplasty with a 36-mm Carpentier tricuspid ring. Intraoperative transesophageal echocardiography showed mild tricuspid valve regurgitation. We report a case of successful native valve salvage of ruptured tricuspid valve after blunt chest trauma, and present a review of the relevant literature.
Diagnosis ; Dilatation ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Heart Failure ; Humans ; Incidence ; Middle Aged ; Prolapse ; Thorax* ; Tricuspid Valve Insufficiency ; Tricuspid Valve* ; Wounds, Nonpenetrating

Although very rare, the incidence of tricuspid valve regurgitation after blunt chest trauma has risen in line with the increasing rate of car accidents and steering wheel trauma. It is easy to miss the diagnosis of tricuspid valve regurgitation following blunt chest trauma because most patients feel no symptoms at trauma, and the condition is sometimes overlooked for a long period of time due to its mild symptoms. A 49-year-old man suffered dyspnea on exertion for 1 month due to right heart failure 8 years after accidentally falling from a third floor. Preoperative echocardiography revealed severe tricuspid valve regurgitation resulting from prolapse of the anterior leaflet with annular dilatation. The patient underwent tricuspid valvuloplasty with a 36-mm Carpentier tricuspid ring. Intraoperative transesophageal echocardiography showed mild tricuspid valve regurgitation. We report a case of successful native valve salvage of ruptured tricuspid valve after blunt chest trauma, and present a review of the relevant literature.
Diagnosis ; Dilatation ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Heart Failure ; Humans ; Incidence ; Middle Aged ; Prolapse ; Thorax* ; Tricuspid Valve Insufficiency ; Tricuspid Valve* ; Wounds, Nonpenetrating

Background: The aim of this study was to investigate the surgical trends of primary total ankle arthroplasty (TAA) and revision procedure in Korea from 2007 to 2017 using national population-based data. Methods: We reviewed the National Health Insurance data of Korea from 2007 to 2017. The data included diagnosis codes, procedure codes, prescriptions, medical costs, and other demographic data. Trends of primary diagnosis for primary TAA were evaluated. Annual trends and incidences per 100,000 person-years of primary TAA and revision procedures as well as compound annual growth rate (CAGR) during the study period were analysed. Surgical trends according to patients' age, hospital grades, and insurance systems were also evaluated. Results: Primary diagnosis for primary TAA was mostly degenerative arthritis (6,501 cases; 90.5%). From 2007 to 2017, the total number of cases of primary TAA and revision procedures was 7,183 and 585, respectively. The number of cases in 2007 of primary TAA was 313; there were no cases of revision. The number of cases in 2017 of primary TAA were 986 and of revision were 108. The CAGR during this period was 28.6% for primary TAA and 44.6% for revision procedures. Incidences per 100,000 person-years in 2017 were 1.91 for primary TAA and 0.21 for revision procedures. The average cost paid by patients themselves was USD 813 (19%) and by the National Health Insurance Service was USD 3,480 (81%). Conclusion The incidence of primary TAA and revision procedures steadily increases in Korea during the 11-year study period.

BACKGROUND: Cyclin-dependent kinase (CDK) inhibitors are family of molecules that regulate the cell cycle. The CDKN2, a CDK4 inhibitor, also called p16, has been implicated in human tumorigenesis. The CDKN2 inhibits the cyclin/CDK complexes which regulate the transition from G1 to S phase of cell cycle. There is a previous report that homozygous deletion of CDKN2 region on chromosome 9p21 was detected frequently in astrocytoma, glioma and osteosarcoma, less frequently in lung cancer, leukemia and ovarian cancer, but not detected in colon cancer and neuroblastoma. However, little is known about the relationship between CDKN2 and laryngeal cancer. Therefore this study was initiated to investigate the role of CDKN2 in human laryngeal squamous cell carcinoma development. MATERIALS AND METHODS: We used 5 human laryngeal carcinoma cell lines whether they have deletions or losses of CDKN2 gene expression by DNA-PCR or RT-PCR, respectively. We examined 8 fresh frozen human laryngeal cancer tissues to detect the loss of heterozygosity (LOH) of CDKN2. PCR was performed by using microsatellite markers of short arm of human chromosome 9 (D9S126, D9S144, D9S156, D9S161, D9S162, D9S166, D9S171, D9S200 and D9SIFNA). For informative cases, allelic loss was scored if the signal of one allele was significantly decreased in tumor DNA when compared to the same allele in normal DNA. RESULTS: The CDKN2 DNA deletion was observed in 3 cell lines. The CDKN2 mRNA expression was observed in only one cell line, which was very weak. LOH was detected in 7 cases (87.5%). CONCLUSION: These results suggest that CDKN2 plays a role in the carcinogenesis of human laryngeal squamous cell carcinoma.
Alleles ; Arm ; Astrocytoma ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Cell Cycle* ; Cell Line* ; Chromosomes, Human ; Colonic Neoplasms ; DNA ; Genes, p16* ; Glioma ; Head* ; Humans ; Laryngeal Neoplasms ; Leukemia ; Loss of Heterozygosity ; Lung Neoplasms ; Microsatellite Repeats ; Neck* ; Neuroblastoma ; Osteosarcoma ; Ovarian Neoplasms ; Phosphotransferases ; Polymerase Chain Reaction ; RNA, Messenger ; S Phase

A microdebrider is increasingly used in endoscopic sinus surgery. Although it has many advantages over conventional instruments, it has been associated with severe complications. We treated a case of rupture of the left medial rectus muscle after use of a microdebrider during endoscopic sinus surgery in a 50 year-old female patient who complained of binocular diplopia and exotropia. The patient showed marked limitation on adduction and about 40 prism diopters of left exodeviation. The orbital computed tomography showed a bony defect at the left medial orbital wall, and injury of the medial rectus muscle. The exodeviation was corrected after ophthalmologic surgery. We report a case of the rupture of the medial rectus muscle after use of a microdebrider during endoscopic sinus surgery and review the medical literature.
Diplopia ; Exotropia ; Female ; Humans ; Middle Aged ; Orbit ; Rupture ; Telescopes

BACKGROUND: Saccade test, smooth pursuit test, and optokinetic nystagmus test are clinically useful tests to accurately diagnose vertigo. However, there have only been a few studies regarding a correlation between the anatomical site of the lesion and the abnormality of eyeball movement in patients with vertigo. METHODS: The medical records of 97 patients with vertigo between January 2006 and June 2008 were reviewed retrospectively. We classified many kinds of abnormalities regarding the saccade test, smooth pursuit test and optokinetic nystagmus test into several categories and analyzed the localizing lesion of vertigo. RESULTS: According to the saccade test, both total saccade abnormality (S-total) and slow velocity of saccade (S-type 3) were shown to be significantly higher in the central lesion of vertigo. According to the smooth pursuit test, symmetrical unidirectional smooth pursuit abnormality (SP-type 2) was observed to be significantly higher in the peripheral lesion over vertigo. Moreover, according to the optokinetic nystagmus test, total optokinetic nystagmus abnormalities (OKN-total) were shown to be significantly useful findings in the diagnosis of the central lesion of vertigo. The coexisting abnormalities of all three tests (S+SP+OKN abnormalities) were shown to be significantly higher in the central lesion of vertigo. CONCLUSION: These results suggest that all these tests, saccade test, smooth pursuit test, and optokinetic nystagmus test, are very useful to distinguish between the central lesion and the peripheral lesion of vertigo. However, these tests are not beneficial in localizing the central lesion of vertigo.
Diagnosis ; Humans ; Medical Records ; Nystagmus, Optokinetic* ; Pursuit, Smooth* ; Retrospective Studies ; Saccades* ; Vertigo

Dermoid cysts can be found anywhere in the body, particularly in areas where embryonic elements fuse together. Dermoid cysts arising in the head and neck lesion are relatively common, but that of nasolabial area has not been reported. Recently, we experienced a case of epidermoid cyst mimicking nasolabial cyst. The patient was a 49 year-old man with an anterior nasolabial swelling that has been presented for 1 year. After cyst excision, a histologic examination revealed that it was an epidermoid cyst. We report this case with the literature review.
Dermoid Cyst ; Epidermal Cyst ; Head ; Humans ; Neck