Klebsiella pneumoniae has been recognized to cause an invasive syndrome characterized by liver abscess and its metastatic infection. The characteristics of metastatic infection involving the central nervous system in this invasive syndrome are poorly understood. The authors report an 84-year-old woman with diabetes mellitus who developed liver abscess caused by K. pneumoniae, complicated with ventriculitis. The patient died despite the antibiotic treatment. Ventriculitis is a rare CNS complication of K. pneumoniae invasive syndrome and requires prompt diagnosis for the appropriate treatment.

Purpose: The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage. Methods: This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe. Results: There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm2 vs. 14.95±2.60 cm2, P<0.001). In addition, both MLH and LAD scores tended to increase at each stage. Conclusion There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.

Background: Toe symphalangism is characterized by a fusion of the interphalangeal joint between the middle and distal phalanges. While typical lesser toe fractures heal well with conservative treatment, in our clinical experience, we encountered patients with symphalangeal toe fractures who experienced long-lasting pain and delayed radiographic union. Therefore, this study aimed to report radiographic outcomes following conservative treatment of symphalangeal fractures of the lesser toes. Methods: We retrospectively reviewed 14 patients with symphalangeal lesser toe fractures who were treated conservatively. We investigated the mechanism of injury and measured the time from the initial injury date to the complete radiographic union. The fracture gap distance was measured on an initial lateral radiograph. Results: Symphalangeal fractures involved the fourth toe in 4 patients (28.5%) and the fifth toe in 10 patients (71.4%). Regarding the mechanism of injury, 6 patients (42.9%) were injured by stubbing or bumping into the door, 5 patients (35.7%) were injured by tripping, 2 patients (14.3%) were injured by heavy objects falling directly on their toes, and 1 patient (2.3%) complained of pain after wearing pointed shoes for half a day. The mean time to complete union was 9.1 months, and the median period was 5.5 months (range, 0.8–29 months). The initial gap of the fracture was 0.60 mm (range, 0.30–1.04 mm). Conclusions The results of our case series may help counsel patients in the outpatient clinic that prolonged healing time may be required for the union of symphalangeal toe fractures.

OBJECTIVE: To analyze the clinical characteristics of total laparoscopic hysterectomy. METHODS: Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated. RESULTS: The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or other pulmonary complications. CONCLUSIONS: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.
Adenomyosis ; Cervical Intraepithelial Neoplasia ; Colpotomy ; Endometriosis ; Female ; Fistula ; Humans ; Hysterectomy* ; Ileus ; Leiomyoma ; Length of Stay ; Sutures ; Thrombophlebitis ; Ureter ; Urinary Bladder

The objective of this study is to evaluate short-term results of total laparoscopic hysterectomy with those of total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy in a retrospective study. We compared patient's age, mean uterine weight, total operating time, length of hospital stay and perioperative hemoglobin concentration change between total laparoscopic hysterectomy (300 patients) and total abdominal hysterectomy (100 patients) and laparoscopically assisted vaginal hysterectomy (52 patients). There were no differences in terms of patient's age, parity between the three groups. There were 7 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 9 minor complications in the abdominal hysterectomy group and 14 minor complications in the total laparoscopic hysterectomy group (P not significant). The length of hospital stay was significantly shorter for total laparoscopic hysterectomy than laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy (p<.001). This study demonstrates that laparoscopic-assisted vaginal hysterectomy and total laparoscopic hysterectomy appears to be as safe as laparotomy and may replace abdominal hysterectomy in most patients and generally has the advantage of shorter hospital stay and earlier return to normal activities.
Female ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Laparotomy ; Length of Stay ; Parity ; Retrospective Studies

Crotamiton is an anti-scabies drug, but it was recently found that crotamiton also suppresses non-scabietic itching in mice. However, the underlying mechanism is largely unclear. Therefore, aim of the study is to investigate mechanisms of the anti-pruritic effect of crotamiton for non-scabietic itching. Histamine and chloroquine are used as non-scabietic pruritogens. The effect of crotamiton was identified using fluorometric intracellular calcium assays in HEK293T cells and primary cultured dorsal root ganglion (DRG) neurons. Further in vivo effect was evaluated by scratching behavior tests. Crotamiton strongly inhibited histamine-induced calcium influx in HEK293T cells, expressing both histamine receptor 1 (H1R) and transient receptor potential vanilloid 1 (TRPV1), as a model of histamine-induced itching. Similarly, it also blocked chloroquine-induced calcium influx in HEK293T cells, expressing both Mas-related G-protein-coupled receptor A3 (MRGPRA3) and transient receptor potential A1 (TRPA1), as a model of histamine-independent itching. Furthermore, crotamiton also suppressed both histamine- and chloroquine-induced calcium influx in primary cultures of mouse DRG. Additionally, crotamiton strongly suppressed histamine- and chloroquine-induced scratching in mice. Overall, it was found that crotamiton has an anti-pruritic effect against non-scabietic itching by histamine and chloroquine.Therefore, crotamiton may be used as a general anti-pruritic agent, irrespective of the presence of scabies.

Objectives: Although the characteristics of different aggression subtypes provide important information in establishing treatment and prevention strategies in schizophrenia patients, limited information is available about the characteristics of the aggressive subtype in schizophrenia patients in South Korea. The present study was designed to compare the demographic and psychological characteristics across the impulsive and premeditated aggression subtypes in schizophrenia patients in South Korea who had committed a crime. Methods: We enrolled 116 schizophrenia spectrum disorder patients who were admitted to the National Forensic Psychiatric Hospital. Using the criminal and interview records, the study subjects were divided into 83 impulsive and 33 premeditated aggression groups. The subjects’ demographic and psychological characteristics were summarized and compared across aggression subtypes. Results: Compared to the premeditated aggression group, the impulsive aggression group had a higher intelligent quotient and a lower rate of physical and sexual abuse experience. Conclusion To our knowledge, this is the first study to describe the characteristics of aggression subtypes in schizophrenia patients in South Korea who had committed a crime. Our results suggest that different treatment and prevention strategies should be considered for each aggression subtype.

Objective: This study aims to empirically determine if indirect exposure to client violence has significant negative effects on social workers’ posttraumatic stress disorder (PTSD) the same way direct victimization does. Methods: Using a sample of 1,359 social workers drawn from the data collected by the Seoul Association of Social Workers, this study employs descriptive statistics to examine the prevalence of indirect experiences with client violence, and utilizes a series of hierarchical regression analyses to demonstrate the potential impact of indirect exposure to client violence on PTSD. To assess the severity of PTSD symptoms in participants, the Korean version of the Impact of Events Scale-Revised (IES-R-K) was employed. Results: A descriptive analysis shows that 12.4% of the sample indirectly experienced client violence by witnessing it or hearing about a violent incident, whereas 6.0% were directly victimized. Hierarchical regression analyses indicate that direct experience (B=4.548, p<0.05) and indirect experience (B=7.297, p<0.001) of client violence have a significant association with the scores on IES-R-K. An investigation of the interaction terms between experiences of client violence and violence-prevention training illustrates that such training significantly moderates the influence on the scores on IES-R-K from indirect exposure to client violence (B=-8.639, p<0.01). Conclusion Social workers who are indirectly exposed to client violence experience PTSD symptoms comparable to their colleagues who were directly victimized. Further, violence-prevention training has greater ameliorative effects with regard to indirect experience of client violence than for direct victimization.

Objectives: Although the characteristics of different aggression subtypes provide important information in establishing treatment and prevention strategies in schizophrenia patients, limited information is available about the characteristics of the aggressive subtype in schizophrenia patients in South Korea. The present study was designed to compare the demographic and psychological characteristics across the impulsive and premeditated aggression subtypes in schizophrenia patients in South Korea who had committed a crime. Methods: We enrolled 116 schizophrenia spectrum disorder patients who were admitted to the National Forensic Psychiatric Hospital. Using the criminal and interview records, the study subjects were divided into 83 impulsive and 33 premeditated aggression groups. The subjects’ demographic and psychological characteristics were summarized and compared across aggression subtypes. Results: Compared to the premeditated aggression group, the impulsive aggression group had a higher intelligent quotient and a lower rate of physical and sexual abuse experience. Conclusion To our knowledge, this is the first study to describe the characteristics of aggression subtypes in schizophrenia patients in South Korea who had committed a crime. Our results suggest that different treatment and prevention strategies should be considered for each aggression subtype.

Background: Evidence is lacking on whether the resection of lung parenchymal cancer improves the survival of patients with unexpected pleural metastasis encountered during surgery. We conducted a single-center retrospective study to determine the role of lung resection in the long-term survival of these patients. Methods: Among 4683 patients who underwent lung surgery between 1995 and 2014, 132 (2.8%) had pleural metastasis. After excluding 2 patients who had incomplete medical records, 130 patients’ data were collected. Only a diagnostic pleural and/or lung biopsy was performed in 90 patients, while the lung parenchymal mass was resected in 40 patients. Results: The mean follow-up duration was 29.8 months. The 5-year survival rate of the resection group (34.7%±9.4%) was superior to that of the biopsy group (15.9%±4.3%, p=0.016). Multivariate Cox regression analysis demonstrated that primary tumor resection (p=0.041), systemic treatment (p<0.001), lower clinical N stage (p=0.018), and adenocarcinoma histology (p=0.009) were significant predictors of a favorable outcome. Interestingly, primary tumor resection only played a significant prognostic role in patients who received systemic treatment. Conclusion When pleural metastasis is unexpectedly encountered during surgical exploration, resection in conjunction with systemic treatment may improve long-term survival, especially in adenocarcinoma patients without lymph node metastasis.