BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, few studies refer to the cardiac effects of this procedure, despite the fact that the T2 ganglia are in the direct pathway of the sympathetic innervation of the heart. An imbalance of right and left sympathetic efferent activity has been proposed as a mechanism for arrhythmia in patients with long QT syndrome. The aim of this study was to compare hemodynamic effect as well as ECG changes after right and left side sympathicotomy. METHODS: 42 patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathicotomy were randomly divided into two groups: left side first operation group (group L, n = 22) and right side first operation group (group R, n = 20). Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/Kg) and maintained with enflurane. During the procedure, we recorded blood pressure at both forearms and heart rate and ECG were recorded after anesthetic induction as baseline values, immediately after one side resectioned of sympathetic trunk, and after complete resectioning of both side. All operations were done with usual methods by experienced surgeons. All the records were coded and analysed singl blind by one author. RESULTS: After sympathicotomy, there was a significant decrease in heart rate but not in blood pressure. However, statistically there were no significant changes in QT interval during sympathicotomy either right side first operation or left side first operation. CONCLUSIONS: The main result of this study was that there were no significant changes in QT interval during sympathicotomy of either right or left side first operations. However, This does not mean that there was no possibility of prolongation of QT interval during thoracoscopic sympathicotomy. Careful observation of QT interval changes is needed during sympathicotomy.
Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Electrocardiography ; Enflurane ; Forearm ; Ganglia ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Long QT Syndrome ; Pancuronium ; Thiopental

Myoepithelioma is histologically composed exclusively of myoepithelial cells. Myoepithelial cells are present in the major and minor salivary glands. Salivary gland neoplasms that frequently contain myoepithelial cells are the pleomorphic adenoma, adenoid-cystic carcinoma, and epithelial myoepithelial carcinoma of intercalated duct origin. Neoplasms composed exclusively of myoepithelial cells are rare. Myoepitheliomas may be composed of spindle-shaped cells, plasmacytoid(hyaline) cells, or combination of both in varying proportions. A case is reported of plasmacytoid myoepithelioma with ultrastructural confirmation, together with reviews of the English literature.
Adenoma, Pleomorphic ; Immunohistochemistry ; Myoepithelioma* ; Palate* ; Salivary Gland Neoplasms ; Salivary Glands, Minor

Background/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated. Methods: Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary’s Hospital. Results: A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years-old and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan–Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53–11.40) The histological types of MGN were not related to the primary histology types. Conclusions MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

Alveolar Process ; Dental Implants ; Humans ; Lifting ; Mandibular Nerve ; Maxillary Sinus ; Nose ; Rehabilitation

Alopecia ; Bone Transplantation ; Burns ; Cicatrix ; Congenital Abnormalities ; Mandibular Reconstruction ; Tissue Expansion Devices ; Tissue Expansion ; Transplants

Background/Aims: This study evaluated the incidence of iatrogenic colonic perforation (ICP) in a high-volume center and analyzed the clinical outcomes and associated factors. Methods: As a retrospective study of the electronic medical records, the whole data of patients who underwent colonoscopy from June 2004 to May 2020 were reviewed. Results: During 16 years, 69,458 procedures were performed, of which 60,288 were diagnostic and 9,170 were therapeutic. ICP occurred in 0.027% (16/60,288) for diagnostic colonoscopies and in 0.076% (7/9,170) for therapeutic purposes (p=0.015; hazard ratio 2.878; 95% CI, 1.184-6.997). Fifty-two percent (12 cases) were managed with endoscopic clip closure, and 43.5% (10 cases) required surgery. The reasons for the procedure and the procedure timing appeared to affect the treatment decision. Perforations during therapeutic colonoscopy were treated with surgery more often than those for diagnostic purposes (66.7% [4/6] vs. 37.5% [6/16], p=0.221). Regarding the timing of the procedure, ICP that occurred in the afternoon session was more likely treated surgically (56.3% [9/16] vs. 0/5, p=0.027). Mortality occurred in two patients (2/23, 8.7%). Both were aged (mean age 84.0±1.4 vs. 65.7±10.5, p<0.001) and lately recognized (mean elapsed time [hours], 43.8±52.5 vs. 1.5±3.0, p<0.001) than the surviving patients. Conclusions ICP occurs in less than 0.1% of cases. The events that occurred during the morning session were more likely managed endoscopically. Age over 80 years and a longer time before perforation recognition were associated with mortality.

We report the case of a 57-year-old woman with abdominal discomfort. The patient had anemia and hypoalbuminemia. Esophagogastroduodenoscopy and colonoscopy revealed diffuse infiltrative lesions at the stomach, duodenum, and ascending colon. Multiple biopsies were taken and histological examination of the biopsies from the stomach, duodenum and colon showed amyloid deposits stained positively with Congo red. Immunohistochemistry study showed positive sign of kappa and lambda chain at light chain stain. In addition, monoclonal components at serum electrophoresis confirmed the diagnosis of amyloid light-chain amyloidosis. The patient was treated with thalidomide and dexamethasone.
Amyloid ; Amyloidosis* ; Anemia ; Biopsy ; Colon* ; Colon, Ascending ; Colonoscopy ; Congo Red ; Dexamethasone ; Diagnosis ; Duodenum* ; Electrophoresis ; Endoscopy ; Endoscopy, Digestive System ; Female ; Humans ; Hypoalbuminemia ; Immunohistochemistry ; Middle Aged ; Plaque, Amyloid ; Stomach* ; Thalidomide

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. PCI may idiopathic or secondary to various disorders. The etiology and pathogenesis of PCI are unclear. Treatment is usually conservative, and includes oxygen and antibiotics therapy. Surgery is reserved for cases of suspected inconvertible intestinal obstruction or perforation. Eleven patients who were diagnosed with PI between 2005 and 2015 were reviewed. We report three cases of PCI and describe causes and complications. The most important point in the treatment of PCI is to determine whether the patient needs surgery. Conservative care should be considered first if the patient is stable. If any complication is observed, such as ischemia in the intestine, surgery is needed. It is important to choose the best treatment based on prognostic factors and CT findings.
Anti-Bacterial Agents ; Gastrointestinal Tract ; Humans ; Intestinal Obstruction ; Intestines ; Ischemia ; Oxygen ; Pneumatosis Cystoides Intestinalis ; Prognosis

Crohn's disease and ulcerative colitis are well known risk factors of intestinal cancer in relation to the extent and duration of disease. Rarely, small bowel cancer can develop after a longstanding inflammation of Crohn's disease with a relatively higher incidence than the general population. Signet ring cell carcinoma is a rare condition among intestinal cancers, and the diagnosis or detection is more difficult if the cancer originates from the small bowel. We report a case of a 30-year old female in whom signet ring cell carcinoma of ileum was diagnosed after a 15-year history of Crohn's disease.
Adult ; Carcinoma, Signet Ring Cell/*diagnosis/etiology/pathology ; Colonoscopy ; Crohn Disease/*complications/diagnosis/pathology ; Female ; Humans ; Ileal Neoplasms/*diagnosis/etiology/pathology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Though the gastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of Lugano stage IE and IIE1 can often be turned into complete remission with antibiotics treatment, other treatment modalities including surgery and chemotherapy are employed in some cases. The purpose of this study was to evaluate the determining factors for treatment modality and the result of the different treatment modalities. MATERIALS AND METHODS: We reviewed the medical records of patients diagnosed with gastric MALT lymphoma in Yeoido St. Mary's Hospital from March 2002 to Feb 2010. RESULTS: All 16 patients were diagnosed with gastric MALT lymphoma at stage IE and IIE1. Three patients received chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisolone (CHOP) regimen, 3 patients underwent surgery and the other 10 patients received antibiotics only. All patients achieved complete remission within 5.1+/-5.1 months and remained stable for 34.8+/-17.6 months. There were no difference in oncologic outcome between the treatment modalities. The positivity of Helicobacter pylori (H. pylori) infection and the gastroenterology specialty of physician in charge lead to antibiotics treatment rather than other modalities (P<0.05). CONCLUSIONS: The H. pylori infection status and the specialty of the physician in charge were the meaningful determining factors for treatment modalities.
Anti-Bacterial Agents ; Antineoplastic Agents ; B-Lymphocytes ; Cyclophosphamide ; Doxorubicin ; Fees and Charges ; Gastrectomy ; Gastroenterology ; Helicobacter pylori ; Humans ; Lymphoid Tissue ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Medical Records ; Prednisolone ; Stomach ; Vincristine