A 75-year-old male with recurrent pancreatic adenocarcinoma after a previous Whipple's procedure presented with jaundice. The local advancement of the tumor caused obstructions of the common bile duct, intrahepatic bile duct hilum, and small bowel. Endoscopic stent insertion was precluded by the Roux-en-Y reconstruction. A successful transhepatic percutaneous single-access stenting of the whole biliary tree and intestine was achieved by H-configured triple stenting by combining T-configured dual stent placement in the biliary system with a duodenal stent insertion across the bottom of the anastomosis after looping a wire in the afferent limb. The ‘H-configured’ stents remained patent for 10 months without major or minor complications. This technique adds a new minimal-invasive and effective palliative option for patients with obstruction of a bilio-enteric anastomosis inaccessible to endoscopy.
Adenocarcinoma ; Aged ; Bile Ducts, Intrahepatic ; Biliary Tract ; Cholestasis ; Common Bile Duct ; Endoscopy ; Extremities ; Gastric Outlet Obstruction ; Humans ; Intestines ; Jaundice ; Male ; Stents

This review focused on the research published to date on the treatment of phalangeal fractures according to the anatomical location of the finger bones, excluding the thumb. In many finger fracture cases, conservative treatment should be prioritized over surgical treatment. The three determinants of surgical treatment are the presence of an intra-articular fracture, the stability of the fracture itself, and the degree of damage to the surrounding soft tissues. Surgical treatment is recommended when bone fragments of 3 mm or more and distal phalanx subluxation are present in the bony mallet finger, and the main surgical treatment is closed reduction and extension block pin fixation. It is essential to pay attention to rotational deformation asf ractures occur proximally. Since intra-articular fractures can cause stiffness and arthritis in the future, a computed tomography scan is recommended to confirm the fracture pattern. These fractures require anatomical reduction of the bone fragments within the joint, and the instability of the joint itself must be corrected. There are no superior surgical treatment methods. It is therefore advantageous for the surgeon to select a surgical method that he is familiar with and confident of performing, considering the fracture itself and various patient-related clinical factors. Nonunion is rare as a complication of a finger fracture, and finger stiffness is the most common complication. Ensuring rapid joint movement as soon as possible can reduce finger stiffness.

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

Background: We aimed to investigate the current trend of joint replacement surgery incidence in patients with rheumatoid arthritis (RA) in South Korea and to compare the incidence of joint replacement surgery in each affected joint. Methods: We performed this big data analysis to investigate the current trend of joint replacement surgery incidence in patients with RA in South Korea and to compare the incidence of joint replacement surgery in each affected joint. This retrospective study was based on data from the Korea National Health Insurance claims database. Results: The prevalence of RA increased every year (0.13% in 2008, 0.25% in 2016). The number of newly diagnosed patients increased from 29,184 in 2010 to 38,347 in 2016. The incidence rate of joint replacement surgery in patients with RA increased from 0.72% in 2010 to 4.03% in 2016. The knee (68.3%) was the most commonly replaced joint. The relative risk (RR) of additional joint replacement surgery was highest for the shoulder joint (RR,1.454; 95% confidence interval, 0.763–2.771). The median time from diagnosis to surgery was the shortest in the elbow joint (379 days) and the longest in the shoulder joint (955 days). The median time for each joint was short in order of the elbows, ankles, hips, knees, and shoulders (p < 0.01). Conclusions The most frequently and initially replaced joints were different, but the prevalence and incidence of RA, as well as those of joint replacement surgery, have recently increased in South Korea. Joint replacement surgery in RA was the highest for the knee joint. The median time from diagnosis to surgery was shortest for the elbow, followed by the ankle, hip, knee, and shoulder. Regardless of whether patients are symptomatic, evaluation of large joints such as the knee, elbow, ankle, and hip should be considered from an early stage.

BACKGROUND: An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models. METHODS: The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12-18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES. RESULTS: After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease. CONCLUSION: Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.
Adolescent* ; Education ; Female ; Humans ; Korea* ; Obesity* ; Odds Ratio ; Parents ; Pediatric Obesity ; Residence Characteristics* ; Risk-Taking* ; Social Class* ; Social Problems ; Socioeconomic Factors

Background and Objectives: O-cyclic phytosphingosine-1-phosphate (cP1P) is a synthetic chemical and has a structure like sphingosine-1-phosphate (S1P). S1P is known to promote cell migration, invasion, proliferation, and anti-apoptosis through hippocampal signals. However, S1P mediated cellular-, molecular mechanism is still remained in the lung.Acute lung injury (ALI) and its severe form acute respiratory distress syndrome (ARDS) are characterized by excessive immune response, increased vascular permeability, alveolar-peritoneal barrier collapse, and edema. In this study, we determined whether cP1P primed human dermal derived mesenchymal stem cells (hdMSCs) ameliorate lung injury and its therapeutic pathway in ALI mice. Methods: and Results: cP1P treatment significantly stimulated MSC migration and invasion ability. In cytokine array, secretion of vascular-related factors was increased in cP1P primed hdMSCs (hdMSCcP1P ), and cP1P treatment induced inhibition of Lats while increased phosphorylation of Yap. We next determined whether hdMSCcP1P reduce inflammatory response in LPS exposed mice. hdMSCcP1P further decreased infiltration of macrophage and neutrophil, and release of TNF-α, IL-1β, and IL-6 were reduced rather than naïve hdMSC treatment. In addition, phosphorylation of STAT1 and expression of iNOS were significantly decreased in the lungs of MSCcP1P treated mice. Conclusions Taken together, these data suggest that cP1P treatment enhances hdMSC migration in regulation of Hippo signaling and MSCcP1P provide a therapeutic potential for ALI/ARDS treatment.

We report the first Korean patient with familial hemiplegic migraine type 1, with clinical and multimodal imaging findings. A 43-yr-old man was admitted for right hemianopia and aphasia, followed by coma. MRI showed only cerebellar atrophy. CT angiography showed mild vasodilation of intracranial blood vessels and increased vascularity in the left hemisphere and perfusion-weighted imaging showed elevated cerebral blood flow. Gene analysis of the patient and his mother led to the identification of a heterozygous point mutation (1997C-->T, T666M) in exon 16 of the CACNA1A gene. Familial hemiplegic migraine should be considered in patients with episodic neurological dysfunction with cerebellar atrophy.
Asian Continental Ancestry Group/*genetics ; Atrophy/genetics/metabolism ; Calcium Channels/*genetics ; Cerebellum/blood supply/*pathology ; Cerebral Angiography ; Coma/*diagnosis ; Exons ; Heterozygote ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine with Aura/*diagnosis/genetics ; Point Mutation ; Republic of Korea ; Tomography, X-Ray Computed