Solid pseudopapillary tumors of the pancreas (SPTPs) are rare tumors with limited malignant potential; they are mainly diagnosed in young women. Complete surgical resection of the tumor is usually possible and patients have an excellent prognosis. However, local invasion and distant metastases have been reported in about 10-20% of patients with SPTPs; these patients require supplementary management for long-term survival. Here, we report a pediatric patient with inoperable SPTP unresponsive to neoadjuvant chemotherapy using cisplatin, ifosfamide, and etoposide which had spread to other organs. Subtotal resection of the primary tumor, radiofrequency ablation, radiotherapy, and adjuvant chemotherapy using gemcitabine were done to control this progressive SPTP.
Chemotherapy, Adjuvant ; Cisplatin ; Deoxycytidine ; Etoposide ; Female ; Humans ; Ifosfamide ; Neoplasm Metastasis ; Pancreas ; Prognosis

Background and Objectives: Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically. Results: For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results. Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

To analyze the infectious causes and clinical symptoms of febrile infants aged less than 3 months presenting to a Pediatric Emergency Medical Center (PEMC) and to propose more efficient, evidence-based management and treatment. We conducted a retrospective study of 462 febrile infants aged less than 3 months who visited PEMC at Keimyung University Dongsan Medical Center from January 2015 to June 2016. Infants' sex, age, fever duration, and laboratory findings, including bacterial or viral pathogens, were recorded. To evaluate clinical signs, one point per sign was given for grunting, decreased activity, and the presence of cyanosis; total scores were compared between the bacterial infection (BI) and non-bacterial infection (NBI) groups. BI was diagnosed in 118 (25.5%) infants, and no BI was diagnosed in 344 (74.5%) infants. Escherichia coli was the most frequently isolated pathogen, accounting for 80.5% (n = 95) of all infections (n = 118). Statistically significant differences in sex, the duration of fever, sign scores, white blood cell count, neutrophil count, lymphocyte count, and C-reactive protein (CRP) level were found between the BI and NBI groups. The cut-off value for CRP was 1.445 mg/dL, with sensitivity and specificity values of 76.3% and 75.9%, respectively, in BI patients, as determined by the receiver operating characteristic curve. As more PEMCs are being built in Korea, hospital accessibility is better; thus, it may be possible to perform outpatient management of young, febrile infants aged younger than 3 months without antibiotics and lumbar puncture using individual sign scores and laboratory findings.
Anti-Bacterial Agents ; Bacterial Infections ; C-Reactive Protein ; Cyanosis ; Emergencies ; Escherichia coli ; Fever ; Humans ; Infant* ; Korea ; Leukocyte Count ; Lymphocyte Count ; Neutrophils ; Outpatients ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spinal Puncture

BACKGROUND AND OBJECTIVES: Cardiac resynchronization therapy (CRT) has been known to improve the outcome of advanced heart failure (HF) but is still underutilized in clinical practice. We investigated the prognosis of patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We also developed a risk model to predict mortality to improve the facilitation of CRT. SUBJECTS AND METHODS: Patients with symptomatic HF with left ventricular ejection fraction < or =35% and QRS interval >120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy, 239 patients (160 males, mean 67+/-11 years) were eventually recruited. RESULTS: During a follow-up of 308+/-236 days, 56 (23%) patients died. Prior stroke, heart rate >90 bpm, serum Na < or =135 mEq/L, and serum creatinine > or =1.5 mg/dL were identified as independent factors using Cox proportional hazards regression. Based on the risk model, points were assigned to each of the risk factors proportional to the regression coefficient, and patients were stratified into three risk groups: low- (0), intermediate-(1-5), and high-risk (>5 points). The 2-year mortality rates of each risk group were 5, 31, and 64 percent, respectively. The C statistic of the risk model was 0.78, and the model was validated in a cohort from a different institution where the C statistic was 0.80. CONCLUSION: The mortality of patients with advanced HF who were managed conventionally was effectively stratified using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis.
Cardiac Resynchronization Therapy ; Cohort Studies ; Creatinine ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Rate ; Humans ; Male ; Mustard Compounds ; Prognosis ; Risk Factors ; Stroke ; Stroke Volume

OBJECTIVES.: Sodium salicylate (SS) is well known for its ototoxic properties that induce functional and morphological changes in the cochlea and brain. Ginkgo biloba extract (GBE) has been widely used for treatment of various neurodegenerative diseases; however, its effects on salicylate-induced ototoxicity remain unclear. Herein, we examined the effects of EGb 761 (EGb), a standard form of GBE, on the plasticity of the N-methyl-D-aspartate receptor subunit 2B (GluN2B) in the inferior colliculus (IC) following SS administration. METHODS.: Seven-week-old Sprague Dawley rats (n=24) were randomly allocated to control, SS, EGb, and EGb+SS groups. The SS group received a single intraperitoneal SS injection (350 mg/kg), the EGb group received EGb orally for 5 consecutive days (40 mg/kg), and the EGb+SS group received EGb for 5 consecutive days, followed by an SS injection. The auditory brainstem responses (ABRs) were assessed at baseline and 2 hours after SS administration. GluN2B expression was examined by Western blot and immunohistochemistry. RESULTS.: There were no significant differences in ABR threshold shifts among the groups. The expression of the GluN2B protein normalized by which of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was significantly lower in the EGb+SS group, as compared to the SS group (P=0.012). Weak and diffused GluN2B immunoreactivity was detected in the IC neural cells of the EGb+SS group, while those of the SS group exhibited strong and diffused GluN2B positivity. CONCLUSION.: EGb may play a role in regulating the GluN2B expression in the IC of salicylate-induced ototoxicity model.
Blotting, Western ; Brain ; Cochlea ; Evoked Potentials, Auditory, Brain Stem ; Ginkgo biloba ; Glyceraldehyde 3-Phosphate ; Immunohistochemistry ; Inferior Colliculi ; N-Methylaspartate ; Neurodegenerative Diseases ; Oxidoreductases ; Plastics ; Rats, Sprague-Dawley ; Sodium Salicylate

The incidence of type 1 diabetes is increasing worldwide, and the greatest increase has been observed in very young children under 4 years of age. A case of infantile diabetic ketoacidosis in a 10-month-old male infant was encountered by these authors. The infant's fasting glucose level was 490 mg/dL, his PH was 7.13, his pCO₂ was 15 mmHg, and his bicarbonate level was 5.0 mmol/L. The glycosylated hemoglobin level had increased to 9.4%. Ketonuria and glucosuria were detected in the urinalysis. The fasting C-peptide and insulin levels had decreased. The infant was positive for anti-insulin and antiglutamic acid decarboxylase antibodies. Immediately after the infant's admission, fluid therapy and intravenous insulin infusion therapy were started. On the second day of the infant's hospitalization and after fluid therapy, he recovered from his lethargic condition, and his general condition improved. Feeding was started on the third day, and he was fed a formula 5 to 7 times a day and ate rice, vegetables, and lean meat. Due to the frequent feeding, the frequency of rapid-acting insulin injection was increased from 3 times before feeding to 5 times, adjusted according to the feeding frequency. The total dose of insulin that was injected was 0.8-1.1 IU/kg/day, and the infant was discharged on the 12th day of his hospitalization. The case is presented herein with a brief review of the relevant literature.
Antibodies ; C-Peptide ; Child ; Diabetes Mellitus, Type 1* ; Diabetic Ketoacidosis* ; Fasting ; Fluid Therapy ; Glucose ; Hemoglobin A, Glycosylated ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant* ; Insulin* ; Insulin, Short-Acting ; Ketosis ; Male ; Meat ; Urinalysis ; Vegetables

The incidence of type 1 diabetes is increasing worldwide, and the greatest increase has been observed in very young children under 4 years of age. A case of infantile diabetic ketoacidosis in a 10-month-old male infant was encountered by these authors. The infant's fasting glucose level was 490 mg/dL, his PH was 7.13, his pCO₂ was 15 mmHg, and his bicarbonate level was 5.0 mmol/L. The glycosylated hemoglobin level had increased to 9.4%. Ketonuria and glucosuria were detected in the urinalysis. The fasting C-peptide and insulin levels had decreased. The infant was positive for anti-insulin and antiglutamic acid decarboxylase antibodies. Immediately after the infant's admission, fluid therapy and intravenous insulin infusion therapy were started. On the second day of the infant's hospitalization and after fluid therapy, he recovered from his lethargic condition, and his general condition improved. Feeding was started on the third day, and he was fed a formula 5 to 7 times a day and ate rice, vegetables, and lean meat. Due to the frequent feeding, the frequency of rapid-acting insulin injection was increased from 3 times before feeding to 5 times, adjusted according to the feeding frequency. The total dose of insulin that was injected was 0.8-1.1 IU/kg/day, and the infant was discharged on the 12th day of his hospitalization. The case is presented herein with a brief review of the relevant literature.
Antibodies ; C-Peptide ; Child ; Diabetes Mellitus, Type 1* ; Diabetic Ketoacidosis* ; Fasting ; Fluid Therapy ; Glucose ; Hemoglobin A, Glycosylated ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant* ; Insulin* ; Insulin, Short-Acting ; Ketosis ; Male ; Meat ; Urinalysis ; Vegetables

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.
Age Factors ; Aged ; Aged, 80 and over ; Comorbidity ; Head and Neck Neoplasms/mortality/*radiotherapy/*surgery ; Humans ; Retrospective Studies ; Survival Rate ; Treatment Outcome