Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session.Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.

We performed a point seroprevalence survey of measles among healthcare workers (HCWs) at two Korean teaching hospitals in 2019. A total of 2,830 HCWs underwent an antibody test.The overall seropositivity of measles was 93.1%. The seroprevalence of measles was lowest in HCWs aged 20 - 24 years (81.2%), followed by those aged 25 - 29 years (90.1%). The rates of anti-measles IgG positivity were significantly different between the two hospitals (97.0% vs.89.4%, P <0.001). These results suggest that the seropositivity of measles in HCWs may differ depending on the hospital's vaccination policy.

OBJECTIVE: To compare a high acceleration three-dimensional (3D) T1-weighted gradient-recalled-echo (GRE) sequence using the combined compressed sensing (CS)-sensitivity encoding (SENSE) method with a conventional 3D GRE sequence using SENSE, with respect to image quality and detectability of solid focal liver lesions (FLLs) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced liver MRI. MATERIALS AND METHODS: A total of 217 patients with gadoxetic acid-enhanced liver MRI at 3T (54 in the preliminary study and 163 in the main study) were retrospectively included. In the main study, HBP imaging was done twice using the standard mDixon-3D-GRE technique with SENSE (acceleration factor [AF]: 2.8, standard mDixon-GRE) and the high acceleration mDixon-3D GRE technique using the combined CS-SENSE technique (CS-SENSE mDixon-GRE). Two abdominal radiologists assessed the two MRI data sets for image quality in consensus. Three other abdominal radiologists independently assessed the diagnostic performance of each data set and its ability to detect solid FLLs in 117 patients with 193 solid nodules and compared them using jackknife alternative free-response receiver operating characteristics (JAFROC). RESULTS: There was no significant difference in the overall image quality. CS-SENSE mDixon-GRE showed higher image noise, but lesser motion artifact levels compared with the standard mDixon-GRE (all p < 0.05). In terms of lesion detection, reader-averaged figures-of-merit estimated with JAFROC was 0.918 for standard mDixon-GRE, and 0.953 for CS-SENSE mDixon-GRE (p = 0.142). The non-inferiority of CS-SENSE mDixon-GRE over standard mDixon-GRE was confirmed (difference: 0.064 [−0.012, 0.081]). CONCLUSION: The CS-SENSE mDixon-GRE HBP sequence provided comparable overall image quality and non-inferior solid FFL detectability compared with the standard mDixon-GRE sequence, with reduced acquisition time.
Acceleration ; Artifacts ; Consensus ; Dataset ; Humans ; Liver ; Magnetic Resonance Imaging ; Methods ; Noise ; Retrospective Studies ; ROC Curve

Gastric cancer is one of the most common cancers in the world. The aims of this study were to evaluate the association between polymorphisms in TFF gene family, TFF1, TFF2, and TFF3 and the risk of gastric cancer (GC) and GC subgroups in a Korean population via a case-control study. The eight polymorphisms in TFF gene family were identified by sequencing and genotyped with 377 GC patients and 396 controls by using TaqMan genotyping assay. The rs184432 TT genotype of TFF1 was significantly associated with a reduced risk of GC (odds ratio, [OR) = 0.45; 95% confidence interval, [CI] = 0.25-0.82; P = 0.009), more protective against diffuse-type GC (OR = 0.20; 95% CI = 0.05-0.89; P = 0.035) than GC (OR = 0.34; 95% CI = 0.14-0.82; P = 0.017) in subjects aged < 60 yr, and correlated with lymph node metastasis negative GC and diffuse-type GC (OR = 0.44; 95% CI = 0.23-0.86; P = 0.016 and OR = 0.20; 95% CI = 0.05-0.87; P = 0.031, respectively). In addition, a decreased risk of lymph node metastasis negative GC and diffuse-type GC was observed for rs225359 TT genotype of TFF1 (OR = 0.46, 95% CI = 0.24-0.88; P = 0.020 and OR = 0.21, 95% CI = 0.05-0.88; P = 0.033, respectively). These findings suggest that the rs184432 and rs225359 polymorphisms in TFF1 have protective effects for GC and contribute to the development of GC in Korean individuals.
Adult ; Aged ; Biomarkers, Tumor/*genetics ; Female ; Genetic Markers/genetics ; Genetic Predisposition to Disease/epidemiology/genetics ; Humans ; Incidence ; Male ; Middle Aged ; Peptides/*genetics ; Polymorphism, Single Nucleotide/genetics ; Promoter Regions, Genetic/genetics ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment/methods ; Sensitivity and Specificity ; Stomach Neoplasms/*epidemiology/*genetics ; Tumor Suppressor Proteins/*genetics

IgG4-related disease (IgG4-RD) is a group of fibro-inflammatory diseases affecting multiple organ systems, pathologically characterized by tissue infiltration with abundant IgG4-positive cells. We here report a case of IgG4-RD that was successfully controlled by mycophenolic acid (MPA). A 62-year-old male visited complaining of dizziness and loss of appetite. He had a clinical history of autoimmune pancreatitis treated with steroids and cyclophosphamide 5 years prior, and had also been diagnosed with Hashimoto's thyroiditis at the age of 55 years. We initially prescribed prednisolone (1 mg/kg), tapered to 5 mg/day over 8 months. However, his eosinophilia gradually deteriorated, and we added cyclophosphamide (1 mg/kg daily) for the next 7 months. His laboratory data fluctuated when he was on low-dose predinisolone and cyclophosphamide, and we thus changed his medication to prednisolone combined with MPA for the following 63 months. Currently, his laboratory findings are stable.
Appetite ; Cyclophosphamide ; Dizziness ; Eosinophilia ; Humans ; Immunoglobulin G ; Male ; Middle Aged ; Mycophenolic Acid* ; Pancreatitis ; Prednisolone ; Steroids ; Thyroid Gland ; Thyroiditis

Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE), which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.
Acute Kidney Injury* ; Amputation ; Biopsy ; Blue Toe Syndrome* ; Cholesterol* ; Embolism, Cholesterol ; Gangrene ; Humans ; Ischemia ; Lower Extremity ; Narcotics ; Risk Factors ; Sympathectomy* ; Toes

PURPOSE: This study was conducted to evaluate the prevalence, clinical characteristics and laboratory findings of lobar pneumonia in children caused by Mycoplasma pneumonia and to find a diagnostic tool for identifying M. pneumoniae infection in children. METHODS: We analyzed medical records of 78 children between March 2010 and December 2011, who were admitted to our hospital and diagnosed with lobar pneumonia on the basis of chest X-rays. White blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), specific antibodies to M. pneuomoniae, and cold agglutinin (CA) were measured at the time of admission. Children were divided into 2 groups: those with M. pneuomoniae infection (group A) and those without infection (group B). Group A children were also subdivided into 2 categories: those with increased CA (group 1) and those without (group 2). RESULTS: The prevalence of lobar pneumonia was higher in the year 2011 than in 2010. M. pneuomoniae infection usually occurs in summer and autumn. Group A children accounted for 75.6% (59/78) of all the cases. The onset ages was higher in group A than in group B (P=0.016). WBC counts and PCT values were higher in group B than in group A.(P=0.015 and P=0.011, respectively) Radiologic findings showed that the lower lobe was most commonly involved without predilection for either side and pleural effusion was present in 13.6% of all the cases. The duration of fever before admission was longer in group 1 than in group 2.(P=0.019) CONCLUSION: It is concluded that lobar pneumonia caused by M. pneuomoniae can be more accurately diagnosed using serum PCT values than using CRP values.
Antibodies ; C-Reactive Protein ; Calcitonin ; Child ; Cold Temperature ; Fever ; Humans ; Leukocytes ; Medical Records ; Mycoplasma ; Mycoplasma pneumoniae ; Pleural Effusion ; Pneumonia ; Pneumonia, Mycoplasma ; Prevalence ; Protein Precursors ; Thorax

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition in which submucosal or subserosal gas cysts are present within the bowel wall. We report a case of a 37-year-old man with no medical history. He underwent a colonoscopy for screening purposes, which revealed multiple and variably sized submucosal tumors in the ascending colon. Endoscopic ultrasonographic (EUS) finding showed multiple hyperechogenic regions with distal acoustic shadowing within the submucosa of the ascending colon. A computed tomography scan showed multiple air-filled cystic masses in the ascending colon. EUS appears to be effective for the diagnosis of PCI.
Acoustics ; Adult ; Colon, Ascending ; Colonoscopy ; Endosonography ; Humans ; Mass Screening ; Pneumatosis Cystoides Intestinalis ; Shadowing (Histology)

BACKGROUND/AIMS: Peritonitis is the most frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Prompt recognition and treatment of peritonitis is important. The purpose of this study was to compare the effectiveness of isolation of the microorganisms causing CAPD peritonitis by the BACTEC blood culture and conventional methods. METHODS: We retrospectively reviewed 38 episodes of peritonitis in 34 CAPD patients between September 2007 and February 2010. Two methods of processing dialysate from patients on CAPD were used. Blood culture was performed using two 10-mL effluents, which were inoculated into a pair of BACTEC culture bottles. The conventional method was performed using 50 mL of centrifuged dialysate. The sedimented dialysate was inoculated onto blood agar and MacConkey agar plates or into thioglycollate broth. To evaluate effectiveness, we compared the rate of positive culture results and the time to identify the causative organism of the two culture methods. RESULTS: Use of the BACTEC bottle method resulted in more positive culture results than did conventional culture (86.8 vs. 57.9% p = 0.003). The time taken to identify the causative organism from culture-positive peritonitis was more rapid using the blood culture compared with the conventional culture method (90 vs. 109 hr, p = 0.03). CONCLUSIONS: Blood culture using the BACTEC bottle is more effective than the conventional culture technique for detection of causative microorganisms in CAPD peritonitis.
Agar ; Culture Techniques ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Retrospective Studies

A 59-year-old man treated with pneumococcal meningitis 4 months ago was hospitalized for acute heart failure and performed aortic valve replacement by rupture of aortic valve. The frequent association of pneumococcal meningitis and endocarditis is known as Austrian syndrome. Though Austrian syndrome is a clinically rare disease, the evolution of pneumococcal endocarditis is very aggressive and associated with high mortality, and early recognition for evidence of endocardial lesion in patients with pneumococcal meningitis is important to reduce the complications and mortality rate.
Aortic Valve ; Endocarditis ; Heart ; Heart Failure ; Humans ; Meningitis ; Meningitis, Pneumococcal ; Middle Aged ; Rare Diseases ; Rupture ; Streptococcus pneumoniae