Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs.

Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient’s physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation.

Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs.

Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient’s physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation.

After failed removal of common bile duct or intrahepatic bile duct (IHD) stones by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous lithotripsy is well-known as an effective procedure. However, it is time-consuming because multiple sessions of transhepatic tract dilatation are required. Endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) has been recently used to approach IHD to remove difficult bile duct stones. We recently experienced EUS-guided CDS performed with metal stent. Common bile duct or IHD stones were removed by retrieval accessories after initial failed or inadequate ERCP in three patients. Serious complications including bleeding, infection, and perforation were not noted. The duration of hospital stay from EUS-guided procedure to discharge ranged from 10 to 14 days. Although this result is interim and ongoing, it suggests that EUS-guided CDS might be an effective and safe procedure after failed ERCP to remove difficult bile duct stones through the tract.

Background and Objectives: This case series is aimed to introduce a new term, antrovestibular polyp (AVP), for an antral polyp herniating anteriorly toward the nasal vestibule and to describe an antral polyp direction of growth through the anterior and posterior fontanelles.Materials and Method: This is a retrospective study involving review of patients who underwent surgery due to maxillary sinus polyp herniating anteriorly toward the nasal vestibular area or posteriorly toward the choana at a tertiary training hospital from January 2007 through July 2016. Their demographic data, computed tomography scan findings, and endoscopic evaluations were analyzed. Results This study included 49 subjects; 8 (16.33%, 6 males) with AVP and 41 (83.67%, 24 males) with antrochoanal polyps (ACP). The mean ages of AVP and ACP patients were 9 and 14.4 years, respectively (p=0.006). The subjects were identified as AVP when computed tomography scan showed an antral polyp directed anteriorly toward the nasal vestibular area, while polyps growing toward the choana were identified as ACP. Endoscopic review showed that AVP grew out through an accessory ostium located anterior to the uncinate process at the area of the anterior fontanelle, while ACP started from an accessory ostium of the posterior fontanelle or a widened maxillary natural ostium.

OBJECTIVES: To develop a simple algorithm for prescreening of obstructive sleep apnea (OSA) on the basis of respiratorysounds recorded during polysomnography during all sleep stages between sleep onset and offset. METHODS: Patients who underwent attended, in-laboratory, full-night polysomnography were included. For all patients, audiorecordings were performed with an air-conduction microphone during polysomnography. Analyses included allsleep stages (i.e., N1, N2, N3, rapid eye movement, and waking). After noise reduction preprocessing, data were segmentedinto 5-s windows and sound features were extracted. Prediction models were established and validated with10-fold cross-validation by using simple logistic regression. Binary classifications were separately conducted for threedifferent threshold criteria at apnea hypopnea index (AHI) of 5, 15, or 30. Prediction model characteristics, includingaccuracy, sensitivity, specificity, positive predictive value (precision), negative predictive value, and area under thecurve (AUC) of the receiver operating characteristic were computed. RESULTS: A total of 116 subjects were included; their mean age, body mass index, and AHI were 50.4 years, 25.5 kg/m2, and23.0/hr, respectively. A total of 508 sound features were extracted from respiratory sounds recorded throughoutsleep. Accuracies of binary classifiers at AHIs of 5, 15, and 30 were 82.7%, 84.4%, and 85.3%, respectively. Predictionperformances for the classifiers at AHIs of 5, 15, and 30 were AUC, 0.83, 0.901, and 0.91; sensitivity, 87.5%,81.6%, and 60%; and specificity, 67.8%, 87.5%, and 94.1%. Respective precision values of the classifiers were89.5%, 87.5%, and 78.2% for AHIs of 5, 15, and 30. CONCLUSION: This study showed that our binary classifier predicted patients with AHI of ≥15 with sensitivity and specificityof >80% by using respiratory sounds during sleep. Since our prediction model included all sleep stage data, algorithmsbased on respiratory sounds may have a high value for prescreening OSA with mobile devices.
Apnea ; Area Under Curve ; Body Mass Index ; Classification ; Humans ; Logistic Models ; Machine Learning ; Noise ; Polysomnography ; Respiratory Sounds ; ROC Curve ; Sensitivity and Specificity ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs. SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION: Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.
Diagnosis ; Humans ; Korea ; Mass Screening ; Medical Records ; Methods ; Motor Vehicles ; Polysomnography ; Prevalence ; Retrospective Studies ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Sleep Apnea, Obstructive ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs.SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.

PURPOSE: This study aimed to investigate the clinical and socioenvironmental characteristics of sudden cardiorespiratory arrest after venipuncture in children. METHODS: We conducted a retrospective email-based survey of all members of the Korean Pediatric Society. The questionnaire included items on patient demographics, socioenvironmental circumstances of the venipuncture, type of cardiorespiratory arrest, symptoms and signs, treatment, prognosis, and presumed cause of the arrest. RESULTS: Fourteen patients were identified. Of these, 13 were young children (< 2 years old), and 1 was 14 years old. All patients had been previously healthy and had no specific risk factors for sudden cardiorespiratory arrest. Most cases (n=11, 79%) were defined as cardiac or cardiorespiratory arrest, while the remaining cases (n=3, 21%) were defined as respiratory arrest. Aspiration (n=3), acute myocarditis (n=2), and laryngeal chemoreflex (n=1) were presumed as the causes; however, the exact causes were unclear. The overall prognosis was poor (death, n=7; morbidity, n=5; full recovery, n=2). The medical institutions faced severe backlash because of these incidents (out-of-court settlement, n=5; medical lawsuit, n=5; continuous harassment, n=3). CONCLUSION: Cardiorespiratory arrest after venipuncture is unpredictable and the probable cause of most cases is a vasovagal reaction. Medical personnel must be aware of the risk of unexpected cardiorespiratory arrest during routine intravenous procedures.
Cardiopulmonary Resuscitation ; Child* ; Demography ; Heart Arrest ; Humans ; Myocarditis ; Phlebotomy* ; Prognosis ; Retrospective Studies ; Risk Factors