BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been widely accepted as a method of treatment of early gastric tumor. This study aimed to identify the incidence and characteristics of multiple gastric tumors after ESD. METHODS: Patients with early gastric tumors who were treated by ESD from January 2004 to June 2012 and followed up with endoscopic examination periodically for at least 1 year were enrolled. All multiple gastric lesions were subsequently treated with ESD and the medical records of the patients were retrospectively reviewed. RESULTS: In total, 643 patients were included. The mean duration of endoscopic follow-up was 45.27±27.59 (range, 12–148) months. Overall, 144 patients (22.4%) showed multiple gastric tumors during the follow-up period (44 synchronous [6.8%] and 100 metachronous [15.5%]). The cumulative incidence rate steadily increased during the follow-up period. More than 50% of the tumors that developed at the same longitudinal location of the stomach were of the same macroscopic and histological type as the primary lesions. CONCLUSIONS: Because synchronous and/or metachronous gastric tumors are common, considerable attention should be paid to detect multiple gastric lesions after ESD of early gastric neoplasm.
Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Methods ; Neoplasms, Second Primary ; Retrospective Studies ; Stomach ; Stomach Neoplasms*

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has clinical features of psychiatric symptoms, loss of memory, seizure, dyskinesia and autonomic dysfunction. While Anti-NMDA receptor encephalitis was initially reported in young women with ovarian teratoma, viral infections can trigger anti-NMDA receptor encephalitis as well. Among them, herpes virus is the most common. We report a patient who developed the anti-NMDA receptor encephalitis 47 days after herpes virus encephalitis, which is, to our knowledge, the first case in Korea.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Dyskinesias ; Encephalitis ; Encephalitis, Herpes Simplex ; Female ; Herpes Simplex ; Humans ; Korea ; Memory ; Seizures ; Simplexvirus ; Teratoma

Many kinds of degenerative, psychiatric, and cerebrovascular diseases can mimic behavioral variant frontotemporal dementia. We present a 73-year-old woman who presented with apathy, inappropriate social behavior, and persecutory delusion. A neuropsychological examination revealed frontal/executive dysfunction with relative sparing of episodic memory. Magnetic resonance imaging and F-18 fluorodeoxyglucose positron-emission tomography produced normal findings. However, magnetic resonance angiography revealed severe right internal carotid stenosis. After carotid stenting, her behavioral symptoms disappeared and did not recur during an 18-month follow-up.
Aged ; Apathy ; Behavioral Symptoms ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebrovascular Disorders ; Delusions ; Female ; Follow-Up Studies ; Frontotemporal Dementia* ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Memory, Episodic ; Positron-Emission Tomography ; Social Behavior ; Stents

BACKGROUND/AIMS: Surgeons must be aware of risk factors for strictures before performing endoscopic submucosal dissection (ESD), to enable early interventions to prevent severe strictures. METHODS: This study was a single-center retrospective study. We reviewed the clinical data of patients who has undergone gastric ESD from January 2007 to December 2012. RESULTS: Among the 3,819 patients who had undergone gastric ESD, 11 patients (7.2%) developed pyloric strictures and received successful endoscopic balloon dilation. Significant differences were noted between the patients without and with post-ESD strictures for pretreatment of antral or pyloric deformities (46.4% vs 81.8%), the proportion of extension to the lumen circumference (>3/4, 9.4% vs 54.5%), the longitudinal extent of mucosal defects (27.9±10.1 mm vs 51.5±10.8 mm), and post-ESD bleeding (2.9% vs 27.3%). Multivariate analysis revealed that pretreatment antral or pyloric deformities (odds ratio [OR], 30.53; 95% confidence interval [CI], 1.476 to 631.565; p=0.027), larger longitudinal extent of mucosal defects (OR, 1.20; 95% CI, 1.074 to 1.340; p=0.001), and circumferential extension of 3/4 (OR, 13.69; 95% CI, 1.583 to 118.387; p=0.017) were independent risk factors for post-ESD stricture. CONCLUSIONS: Antral or pyloric deformities, sub-circumferential resection over more than 75% of the circumference and greater longitudinal extent of mucosal defects are independent risk factors for post-ESD stricture.
Congenital Abnormalities* ; Constriction, Pathologic* ; Early Intervention (Education) ; Hemorrhage ; Humans ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Surgeons

BACKGROUND AND OBJECTIVES: ZLow frequency hearing loss is known to be the most common hearing loss form in Meniere's disease (MD) and episodic dizziness with low frequency sensorineural hearing loss is considered a very crucial symptom for the diagnosis of MD. However, flat or high frequency hearing loss is also commonly encountered in the Ear, Nose and Throat clinic. The aim of this study is to investigate the differences in clinical manifestation between episodic dizzy patients with low frequency hearing loss (LFHL) group and non-low frequency hearing loss (non-LFHL) group. SUBJECTS AND METHOD: We reviewed medical records of 78 patients (36 of LFHL group and 42 of non-LFHL group) who had episodic dizziness with unilateral hearing loss and analyzed clinical characteristics according to hearing loss pattern. RESULTS: The clinical features of LFHL include a predominance of female sufferers, high incidence of tinnitus and short duration of dizziness. There was no significant difference in frequency, nature of dizziness, and results of vestibular function test. Although the proportion of patients diagnosed with definite MD was higher in LFHL group at initial and final diagnosis, there were no statistically significant differences between two groups. CONCLUSION: Therefore, when episodic dizziness is accompanied with unilateral hearing loss, not only low frequency but flat or high frequency hearing loss could be considered as a critical sign for possible progression to Meniere's disease and careful observation should be taken.
Diagnosis ; Dizziness* ; Ear ; Female ; Hearing Loss* ; Hearing Loss, Sensorineural ; Hearing Loss, Unilateral* ; Humans ; Incidence ; Medical Records ; Meniere Disease ; Nose ; Pharynx ; Tinnitus ; Vestibular Function Tests

With the wide use of button battery in everyday life, the risk associated with its use is also increasing. Mechanical pressure, chemical and electrical burn caused by button battery in the nasal cavity result in necrosis. Prolonged presence of button battery in the nasal cavity may also incur serious side effects of cosmetic nature, including saddle nose. Thus prompt diagnosis and treatment is important when button battery is detected in the nasal cavity. We present two cases of button battery in the nasal cavity with review of literatures.
Burns ; Diagnosis ; Foreign Bodies ; Nasal Cavity* ; Necrosis ; Nose

Angioleiomyoma is a benign myogenic tumor that may develop wherever smooth muscle is present. It occurs commonly in the uterus, skin, and gastrointestinal tract and is rare within the nasal cavity, but only three of 24 reported cases of sinonasal leiomyoma may have originated from the nasal septum. Treatment of choice for these neoplasms is surgical excision. We present one case of nasal septal angioleiomyoma arising from the nasal septum with symptoms of nasal obstruction and epistaxis, which were successfully removed by endoscopic surgery.
Angiomyoma* ; Epistaxis ; Gastrointestinal Tract ; Leiomyoma ; Muscle, Smooth ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum* ; Skin ; Uterus

BACKGROUND AND OBJECTIVES: Caloric test and rotatory chair test have been adopted in diagnosing bilateral vestibulopathy. However, most of patients who were confirmed by the diagnostic testing not complained typical symptoms of bilateral vestibulopathy such as ossilopsia and ataxia. Patients who do not have typical symptoms of bilateral vestibulopathy, were often diagnosed with bilateral vestibulopathy by caloric test and slow harmonic acceleration test (SHA). The aim of this study is to assess the clinical features between groups classified according to the caloric test and SHA test, and possibly to investigate the representative test in the diagnosis of bilateral vestibulopathy. MATERIALS AND METHODS: Seventy-five patients were divided into three groups: (A) patients diagnosed with the caloric test only, (B) patients diagnosed with SHA test only, (C) patients satisfying the diagnostic criteria of both tests. Clinical characteristics, the results of physical examination, hearing test and vestibular function test (VFT) were compared among three groups. Results: There was no difference in clinical characteristics and results of physical examination among three groups. Regarding VFT results, only in step velocity test, The proportion of patients who showed low gain value on both sides were higher in group C than that of group A and B. No difference was observed in the other VFT results among three groups. RESULTS: There was no difference in clinical characteristics and results of physical examination among three groups. Regarding VFT results, only in step velocity test, The proportion of patients who showed low gain value on both sides were higher in group C than that of group A and B. No difference was observed in the other VFT results among three groups. CONCLUSION: We could not predict the clinical features of bilateral vestibulopathy by the results of VFT, and could not find preferable test in diagnosing bilateral vestibulopathy.
Acceleration ; Ataxia ; Caloric Tests ; Diagnosis ; Diagnostic Tests, Routine ; Hearing Tests ; Humans ; Physical Examination ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the non-dissected anatomic structures and abnormal computed tomographic findings that contribute to the recurrence of chronic rhinosinusitis (CRS) or the trail of revision endoscopic sinus surgery (ESS). SUBJECTS AND METHOD: The medical records of 34 subjects who were diagnosed with recurrent chronic rhinosinusitis, and required to undergo revision endoscopic sinus surgery were collected retrospectively. The subjects' computed tomography results were examined by a radiology specialist. RESULTS: The most common anatomic factors associated with the revision ESS for recurrence of CRS or retained inflammation were residual uncinate process (47.0%) and residual anterior ethmoidal cells followed by undissected posterior ethmoidal cells (38.2%) and obstructed sphenoid sinus ostium (32.3%). In addition, the uncorrected septal deviation, retained agger nasi cells or Haller cells and lateralized middle turbinate were also identified in the patients. CONCLUSION: From these data, we analyzed anatomical structures and CT findings related to the failure of primary ESS. We suggest that careful attention be given to these structures after primary ESS so as to reduce the failure rate and increase successful outcomes.
Humans ; Inflammation ; Medical Records ; Recurrence ; Retrospective Studies ; Sinusitis ; Specialization ; Sphenoid Sinus ; Turbinates

The postmortem examination certificate and death certificate provide proof of death and supply important data used to establish health statistics. However, the format of the form and the accuracy of postmortem examination and death certificates yield errors that must be corrected by comparison with postmortem studies. We reviewed 401 autopsies performed in the Department of Forensic Medicine of Chonnam National University Medical School from January 1, 2009 to December 31, 2011 and compared the reports with their postmortem examination certificates and death certificates. Of the 252 cases submitted with death certifications, 60 cases were concordant with the cause of death on the autopsy report. Eighty-nine cases had clear descriptions of the cause of death. Of these cases, 47 were from postmortem examination, 42 were from death certificates; 17 were natural deaths, 72 were unnatural. Concordance in each group was 59.6% (28/47 cases), 76.2% (32/42 cases), 41.2% (7/17 cases), and 73.6% (53/72 cases). We thus identified various types of errors in postmortem examination and death certificates. This study reveals a high rate of discrepancy between causes of death reported on death certificates and postmortem examination certificates. There are a few useful death certificate and postmortem examination certificates that can be used as a model, based on which we propose several remedies to increase the accuracy of death and postmortem examination certificates.
Autopsy ; Cause of Death ; Certification ; Death Certificates ; Forensic Medicine ; Schools, Medical