Purpose: To report a case of unilateral incipient syphilitic papillitis.Case summary: A 53-year-old female visited for a routine ocular examination. Best-corrected visual acuities were 20/20 in both eyes and there was no abnormality in the anterior segment, pupillary response, ocular motility examination, color vision test, and there were no inflammatory cells in the anterior chamber and vitreous cavity of both eyes. However, optic disc edema and corresponding retinal nerve fiber layer (RNFL) thickening in her left eye were observed in a fundoscopic examination and by optical coherence tomography. In orbital magnetic resonance imaging, there was no abnormal enhancement of the optic nerve or optic nerve sheath in both eyes. Serological tests were positive for fluorescent treponemal antibody absorbance (FTA-ABS) immunoglobulin M (IgM) and IgG, the treponema pallidum hemagglutination test, venereal disease research laboratory (VDRL) testing, and a rapid plasma reagin test, but there was no abnormal finding in cerebrospinal fluid analyses including the VDRL and FTA-ABS tests. With the diagnosis of unilateral incipient syphilitic papillitis in her left eye, she was treated with intravenous penicillin for 14 days and high dose systemic steroids for 3 days with complete resolution of the optic disc edema and RNFL thickening. Conclusions Syphilis can present as a unilateral incipient papillitis. Therefore, in case with unilateral papillitis, serological test for syphilis, appropriate antibiotics and steroid treatment should be considered.

Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease that is caused by the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 has become pandemic since December 2019, when the first case developed in Wuhan, China. Patients receiving hemodialysis are more vulnerable to viral transmission because their immune functions are impaired and they receive treatment within a narrow space. Calling on previous experience with Middle East Respiratory Syndrome during the 2015 outbreak, the joint committee of the Korean Society of Nephrology and the Korean Society of Dialysis Therapy quickly formed a COVID-19 task force team to develop a manual before the first index case was diagnosed in the hemodialysis unit. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within hemodialysis facilities, which were developed to protect patients, healthcare workers, and caregivers from this highly transmissible virus. The areas of infection control covered by these guidelines include standard precautions, performing dialysis therapy for confirmed or suspected cases, performing cohort isolation for contact patients, and disease monitoring and contact surveillance. We hope these guidelines help healthcare workers and hemodialysis patients around the world cope with the COVID-19 pandemic.

This nationwide, prospective cohort study evaluated pulmonary function and radiological sequelae according to infection severity in 73 survivors from the 2015 Middle East respiratory syndrome (MERS) outbreak in Korea. Patients with severe pneumonia in MERS-coronavirus infection had more impaired pulmonary function than those with no or mild pneumonia at the 1-year follow-up, which was compatible with the radiological sequelae. Severe pneumonia significantly impairs pulmonary function and makes long radiological sequelae in MERS.
Cohort Studies ; Coronavirus ; Coronavirus Infections* ; Follow-Up Studies ; Humans ; Korea ; Middle East* ; Pneumonia* ; Prospective Studies ; Survivors

OBJECTIVE: This study aims to develop a new screening dysphagia questionnaire for elderly people. METHOD: Initial questionnaire for mastication and swallowing function of elderly people were composed of 20 questions. Total of 30 experts were invited to participate in the Delphi survey, including physiatrists, occupational therapists and dietitians. Modified Delphi method was performed into two rounds. Twenty young adults and twenty elderly volunteers were tested with these items and were compared with other pre-existing tests. Also, validity of selected evaluating items was tested using VFSS. RESULT: For the first round of surveys, a consensus was reached on 72.5% of the questionnaire. Final agreement was reached on 98% of the questionnaire. The results of the first round survey with the 20 evaluation items and second round showed that the content validity ratio (CVR) and stability were high enough and met the criteria of consistent agreement from a group of specialists. The final round survey following the 1st and 2nd round survey was implemented, which finally reduced to 14 items from initial 20 items. The researcher allocated the items into the 3 categories. The score of the developed item were highly correlated with that of the pre-existing screening questionnaire and time parameters of the VFSS showing a significant difference according to the score. CONCLUSION: We developed a screening tool for evaluation of chewing nad swallowing function for the elderly people. Though it is necessary to be verified through large scale clinical studies, it may be simply applicable to the elderly people with mastication and swallowing dysfunction or could be evaluated by caregivers.
Aged* ; Caregivers ; Consensus ; Deglutition Disorders ; Deglutition* ; Humans ; Mass Screening ; Mastication* ; Methods ; NAD ; Nutritionists ; Specialization ; Volunteers ; Young Adult

"Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" is a 2nd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 1st edition published in 2009. After 1st stroke rehabilitation CPG, many studies concerning stroke rehabilitation have been published and the necessity for update has been raised. The Korea Centers for Disease Control and Prevention supported the project "Development of Clinical Practice Guideline for Stroke Rehabilitation" in 2012. Thirty-two specialists in stroke rehabilitation from 18 universities and 3 rehabilitation hospitals and 10 consultants participated in this project. The scope of this CPG included both ischemic and hemorrhagic stroke from the acute to chronic stages. The purpose of this CPG is to provide guidelines for doctors and therapists to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. "Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" consists of 'Chapter 1; Introduction of Stroke Rehabilitation', 'Chapter 2; Rehabilitation for Stroke Syndrome, 'Chapter 3; Rehabilitation for Return to the Society', and 'Chapter 4; Advanced Technique for Stroke Rehabilitation'. Both the adaptation and de novo development methods were used to develop this 2nd edition of CPG. The appraisal of foreign CPGs was performed using 'Korean appraisal of guidelines for research and evaluation II' (K-AGREE II); moreover, four CPGs from Scotland (2010), Austrailia (2010), USA (2010), Canada (2010) were chosen for adaptation. For de novo development, articles that were published following the latest foreign CPGs were searched from the database system, PubMed, Embase, and Cochrane library. Literatures were assessed in the aspect of subjects, study design, study results' consistency, language and application possibility in the Korean society. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. GPP (Good Practice Point) was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised.
Canada ; Centers for Disease Control and Prevention (U.S.) ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

A 60-year-old man visited the outpatient clinic complaining of spasmodic abdominal pain. The symptoms had started 4 days previously, within 1 hour of eating sliced raw flatfish (sashimi) and a piece of flatfish gut. Gastroscopy revealed generalized mucosal edema, erythema, multiple erosions, and numerous worms penetrating the gastric mucosa at the greater and lesser curvatures of the middle and lower corpora. Fifty-one worms, 0.5-3 cm in length, were successfully removed with biopsy forceps. Three weeks later, a normal mucosa-covered, 3.5-cm round submucosal tumor (SMT) was found on the greater curvature of the lower corpus and four yellowish, 1-cm SMTs were found on the hepatic flexure of the colon. Histopathological examination revealed marked eosinophilic infiltration in the gastric and colonic mucosa and an eosinophilic abscess in the submucosa. Here, we report a case of eosinophilic granuloma manifesting as SMTs in the stomach and colon after the endoscopic removal of a large number of anisakids.
Abdominal Pain ; Abscess ; Ambulatory Care Facilities ; Anisakiasis ; Anisakis ; Biopsy ; Colon ; Eating ; Edema ; Eosinophilic Granuloma ; Eosinophils ; Erythema ; Gastric Mucosa ; Gastroscopy ; Humans ; Larva ; Middle Aged ; Mucous Membrane ; Stomach ; Surgical Instruments

OBJECTIVE: Patients with severe spontaneous cerebellar hemorrhage typically undergo treatment with suboccipital craniectomy and hematoma evacuation. However, this is a stressful procedure for patients due to the long operating time and operation-induced tissue damage. In addition, the durotomy can result in pseudomeningocele. We investigated the efficacy of stereotactic or navigation-guided burr hole aspiration surgery as a treatment for spontaneous hypertensive cerebellar hemorrhage (SHCH). METHODS: Between January 2002 and December 2011, 26 patients with SHCH underwent surgery using the stereotactic or navigation-guided burr hole aspiration and catheter insertion technique in our institution. RESULTS: Mean hematoma volume was 21.8 +/- 5.8 cc at admission and 13.1 +/- 5.4 cc immediately following surgery. Preoperative Glasgow Coma Scale (GCS) score was 12.5 +/- 1.3 and postoperative GCS score was 13.1 +/- 1.2. Seven days after surgery, the mean hematoma volume was 4.3 +/- 5.6 cc, and there was no occurrence of surgery-related complications during the six-month follow-up period. The mean operation time for catheter insertion was 43.1 +/- 8.9 min, and a mean 31.3 +/- 6.0 min was also added for extra-ventricular drainage. The mean Glasgow Outcome Scale (GOS) score after six months was 4.6 +/- 1.0. CONCLUSION: Stereotactic burr hole aspiration surgery for treatment of SHCH is less time-consuming and invasive than other interventions, and resulted in no surgery-related complications. Therefore, we suggest that this surgical method could be a safe and effective treatment option for selected patients with SHCH.
Catheters ; Drainage ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans

OBJECTIVE: The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent. METHODS: We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011. RESULTS: Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9-19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging. CONCLUSION: Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.
Angioplasty ; Angioplasty, Balloon ; Arteries ; Caves ; Constriction, Pathologic ; Endovascular Procedures ; Fistula ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Stents ; Stroke ; Subarachnoid Hemorrhage

Cytomegalovirus (CMV) is a potentially important pathogen in an immunocompromised host. CMV infection usually occurs in patients with severe immune deficiency, such as acquired immunodeficiency syndrome, organ transplantation, malignant disease, or immunosuppressive therapy. CMV can cause ulcerations anywhere in the GI tract ranging from the esophagus to the rectum, but the colon is the most susceptible organ in the GI tract. CMV infection rarely occurs but generally causes an asymptomatic or mildly symptomatic acute illness in immunocompetent patients. Some patients with gastrointestinal CMV disease do not require antiviral treatment such as ganciclovir and frequently recover with supportive therapy. Although in immunocompetent patients, antiviral therapy may be needed based on age, chronic illness, or treatment response. We experienced a case of CMV-induced multiple gastric ulcers with severe epigastric pain in an immunocompetent patient who fully recovered with supportive therapy including a proton pump inhibitor.
Acquired Immunodeficiency Syndrome ; Chronic Disease ; Colon ; Cytomegalovirus ; Esophagus ; Ganciclovir ; Gastrointestinal Tract ; Humans ; Immunocompromised Host ; Organ Transplantation ; Proton Pumps ; Rectum ; Stomach Ulcer ; Transplants ; Ulcer

BACKGROUND/AIMS: Stercoral colitis is an inflammatory condition related to increased intraluminal pressure, itself caused by impacted fecal material. Stercoral colitis is a rare condition and has a generally poor prognosis. The aims of this study were to investigate the clinical characteristics and outcomes of stercoral colitis according to management strategy. METHODS: From January 2004 to August 2009, 11 patients were diagnosed with stercoral colitis at our center. The medical records of these individuals were reviewed retrospectively with regard to the clinical characteristics, management strategy, and clinical outcomes. We defined severe stercoral colitis as stercoral colitis complicated by systemic inflammatory response syndrome, sepsis, or septic shock. RESULTS: Eleven patients (three men and eight women) with a mean age of 70+/-8 years were included. Ten patients were elderly with constipation as a predisposing factor. Nine patients had severe stercoral colitis according to out criteria. Of these, five patients underwent surgery, and the other four were treated with a conservative management strategy. One patient (20%) in the surgical group and all patients in the conservative management group (n=4) died. CONCLUSIONS: Stercoral colitis should be considered in elderly patients with predisposing factors and presents as fecal impaction with colonic wall thickening or pericolic fat stranding on CT scan. In patients with severe stercoral colitis, early surgery may be effective in reducing mortality.
Aged ; Colitis ; Colon ; Constipation ; Fecal Impaction ; Humans ; Intestinal Perforation ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Sepsis ; Systemic Inflammatory Response Syndrome