PURPOSE: To report a case of spontaneous separation of idiopathic epiretinal membrane in an elderly patient. CASE SUMMARY: A 61-year-old male presented with decreased visual acuity in the right eye. He was diagnosed with idiopathic epiretinal membrane (ERM) in the right eye and posterior vitreous detachment (PVD) in both eyes. The patient underwent pars plana vitrectomy and ERM removal in the right eye. At postoperative 1 year, his vision in the right eye had improved, but idiopathic ERM developed in the left eye and visual acuity in the left eye decreased. Three years later, the ERM in the left eye resolved spontaneously and his vision increased. CONCLUSIONS: Herein we present a rare case of spontaneous separation of idiopathic ERM associated with a pre-existing PVD in an elderly patient and reviewed the available literatures regarding the possible mechanisms for the spontaneous separation of ERM in the presence of a pre-existing PVD.
Aged* ; Epiretinal Membrane* ; Humans ; Male ; Middle Aged ; Visual Acuity ; Vitrectomy ; Vitreous Detachment

BACKGROUND/AIMS: The use of self-expandable metallic stents (SEMS) is an established palliative treatment for malignant stenosis in the gastrointestinal tract; therefore, its application to benign stenosis is expected to be beneficial because of the more gradual and sustained dilatation in the stenotic portion. We aimed in this prospective observational study to evaluate the efficacy and safety of temporary SEMS placement in benign pyloric stenosis. METHODS: Twenty-two patients with benign stenosis of the prepylorus, pylorus, and duodenal bulb were enrolled and underwent SEMS placement. We assessed symptom improvement, defined as an increase of at least 1 degree in the gastric-outlet-obstruction scoring system after stent insertion. RESULTS: No major complications were observed during the procedures. After stent placement, early symptom improvement was achieved in 18 of 22 patients (81.8%). During the follow-up period (mean 10.2 months), the stents remained in place successfully for 6 to 8 weeks in seven patients (31.8%). Among the 15 patients (62.5%) with stent migration, seven (46.6%) showed continued symptomatic improvement without recurrence of obstructive symptoms. CONCLUSIONS: Despite the symptomatic improvement, temporary SEMS placement is premature as an effective therapeutic tool for benign pyloric stenosis unless a novel stent is developed to prevent migration.
Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Palliative Care ; Prospective Studies ; Pyloric Stenosis ; Pylorus ; Recurrence ; Stents

There has been a mistake, claimed and confirmed by all the authors of Vol 50(1), 2012, p. 1-9 issue, that first author should have been Il-Han Kim instead of Kwan-Tae Noh.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been widely performed. However, procedure related-complications and the risk of tumor recurrence are limitations. We analyzed the clinicopathological characteristics of patients who underwent curative additional gastrectomy (gastrectomy) after ESD. METHODS: The clinical characteristics of cases underwent gastrectomy after ESD were retrospectively analyzed. RESULTS: Between January 2002 and August 2010, 1,512 cases underwent ESD for early gastric cancer (n=511) or adenoma (n=1,001). Thirty-two cases (2.1%) underwent gastrectomy after ESD. Thirty cases (2.0%) were EGC and 2 cases (0.1%) were adenoma. Extended indication, larger tumor size and piecemeal resection were risk factors for gastrectomy after ESD. According to the causes of gastrectomy, 13 cases underwent gastrectomy due to complications (40.6%; bleeding in 9, perforation in 4), and 19 cases based on pathological results (incomplete resection in 13, lymphatic invasion in 6). In cases with incomplete resection, the rate of residual tumor and lymph node metastasis after gastrectomy was 69.2% (75% lateral margin, 60% deep and 75% both) and 7.7%, respectively. Three (50%) of the 6 cases with lymphatic invasion had lymph node metatstasis. CONCLUSIONS: The causes of gastrectomy after ESD were the procedure-related complications, the incomplete resection and lymphatic invasion. For complete and curative ESD, endoscopists should try to minimize complications and determine the depth of invasion accurately before ESD.
Adenoma/*pathology/surgery ; Aged ; Female ; Gastrectomy ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasm, Residual ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/*pathology/surgery

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is accepted as a standard treatment of early gastric cancer (EGC) and gastric adenoma. Occasionally, tumorous lesion is not found and pathologic discrepancies can occur after ESD. The aim of this study was to analyze the factors affecting the negative pathologic results after ESD. METHODS: We retrospectively reviewed the data from all patients with gastric neoplasm (276 EGC and 516 gastric adenomas) who were treated with ESD during past 3 years and enrolled the patients who had negative pathologic results. RESULTS: Out of 792 patients treated with ESD, 27 patients (3.4%) were eligible for inclusion. Among the 27 patients, factors affecting the negative pathologic results were, most commonly, the focal lesion (n=13, 48.2%) which was small enough to be removed completely during pre-ESD biopsy, followed by pathologic discrepancies (n=11, 40.7%) between pathologists and lastly the operator factor (n=3, 11.1%) dissecting incorrect lesions. Of the focal lesions, the initial pathologic diagnoses were adenocarcinoma in 11 cases (84.6%). In cases with pathologic discrepancies, all the pretreatment diagnoses were adenoma with low grade dysplasia. In cases caused by operator factors, intestinal metaplasia was accompanied by elevated adenoma in all cases. CONCLUSIONS: To decrease negative pathologic results after ESD, an endoscopist should perform ESD after sufficient communication with pathologists, especially for adenoma with low grade dysplasia, and choose correct lesion, especially located at the antrum and associated with intestinal metaplasia. The possibility of total removal of small lesions even by forcep biopsy should be considered.
Adenocarcinoma/*diagnosis/pathology/surgery ; Aged ; Dissection ; Female ; Gastric Mucosa/pathology ; Gastroscopy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/*diagnosis/pathology/surgery

PURPOSE: The purpose of this study was to investigate the effects of a mouthguard on stress distribution under mandibular impact. MATERIALS AND METHODS: The FEM model of head consisted of skull, maxilla, mandible, articular disc, teeth, and mouthguard. The impact locations on mandible were gnathion, the center of inferior border, and the anterior edge of gonial angle. And the impact directions were vertical, oblique (45degrees), and horizontal. The impact load was 800 N for 0.1 sec. RESULTS: When vertical impact was applied, the similar stress and the distribution pattern was occurred without the relation of the mouthguard use (P>.05). The model with mouthguard was dispersed the stress to the teeth, the facial bone and the skull when the oblique (45degrees) impacts were happened. However, the stress was centralized on the teeth in the model without mouthguard (P<.05). The model with mouthguard was dispersed the stress to the teeth, the facial bone and the skull when the horizontal impacts was occurred. However, the stress was centralized on the teeth without mouthguard (P<.05). For all impact loads, stress concentrated on maxillary anterior teeth in model without mouthguard, on the contrary, the stress was low in the model with mouthguard and distributed broadly on maxillary anterior teeth, facial bone, and skull. CONCLUSION: The mouthguard was less effective at shock absorbing when vertical impact was added. However, it was approved that mouthguard absorbed the shock regarded to the oblique (45degrees) and horizontal impact by dispersing the shock to the broader areas and decreasing the stress.
Facial Bones ; Finite Element Analysis ; Head ; Mandible ; Maxilla ; Shock ; Skull ; Tooth

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of a colorectal tumor is technically difficult. This study aimed to analyze the clinical outcomes of superficial large rectosigmoid tumors after ESD. METHODS: Medical records of 15 patients with large rectosigmoid tumors (more than 30 mm), in which ESD performed, were reviewed retrospectively. RESULTS: The mean tumor size was 42.5+/-14.3 mm (range, 30~78 mm). A histological examination revealed a well-differentiated adenocarcinoma in five cases (33.3%), adenoma with high-grade dysplasia in six cases (40%), and low-grade dysplasia in four cases (26.7%). The mean procedural time was 90.5+/-60.7 min (range, 22~246 min). The en bloc resection rate was 86.7%, and the complete resection rate 100%. The lateral resection margin was positive in four cases (26.6%), but no cases with a positive vertical margin were observed. Bleeding occurred in three cases (20%), and all were treated successfully using endoscopic measures. Perforations occurred in three cases (20%); two cases were treated by clipping and the other by a laparotomy. CONCLUSIONS: ESD is a treatment option for superficial large rectosigmoid tumors. Further studies with larger cases and a longer term follow-up are needed to establish the efficacy and safety of ESD for colorectal tumors.
Adenocarcinoma ; Adenoma ; Colon ; Colorectal Neoplasms ; Follow-Up Studies ; Hemorrhage ; Humans ; Medical Records

BACKGROUND/AIMS: Fabry disease is an X-linked recessive and progressive disease caused by alpha-galactosidase A (alpha-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS: Twenty-nine patients had elevated serum GL3 levels. The alpha-GaL A activity was determined for the 26 patients with high GL3 levels. The mean alpha-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased alpha-GaL A activity. Among the group with high GL3 levels, 15 women had a alpha-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and alpha-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.
Adult ; Aged ; Fabry Disease/blood/*diagnosis ; Female ; Humans ; Kidney Failure, Chronic/blood/*therapy ; Male ; Middle Aged ; *Renal Dialysis ; Trihexosylceramides/*blood ; alpha-Galactosidase/genetics/metabolism

BACKGROUND: Clinical trials that utilize imaging findings as surrogate endpoints are considered to be cost-effective. However, unlike numeric data, magnetic resonance imaging (MRI) findings are not quantifiable. Thus, we have begun to develop a software package that is able to convert qualitative MRI findings into quantifiable data. METHODS: Computer software (DUIH_Image) was created with which every patient's MRI data can be registered on a standard brain template. Interuser and intrauser reliabilities for the registration were measured, and then a proof-of-principle experiment was conducted to determine whether the system could identify factors that were associated with a greater National Institutes of Health Stroke Scale (NIHSS) score at admission. We studied 40 consecutive patients [65.1+/-14.2 years old (mean+/-SD); 22 males and 18 females] with first-ever acute lacunar infarction of the corona radiata, who were divided into two groups according to their NIHSS score (i.e., low: 0-2; high: > or =3). The following parameters were compared between these two groups: (1) data retrieved from clinical profiles, including demographic and risk factor variables; and (2) accumulated diffusion MRI lesions mapped on a standard template. RESULTS: Modest levels of interuser and intrauser reliability were observed (p<0.05, R(2)=0.63-0.84, Pearson correlations). Regarding the clinical profiles, no significant difference was found for the numeric data sets or infarct size between the two groups. However, on the accumulated lesion map image, the lesion area that overlapped the most was located more posterolaterally in the high NIHSS score group than in the low NIHSS score group. CONCLUSIONS: In this pilot study we have demonstrated the potential usefulness of the DUIH_Image software. We plan to update this software to enable its utilization in actual clinical trials.
Biomarkers ; Brain ; Computer Systems ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging ; Male ; National Institutes of Health (U.S.) ; Pilot Projects ; Risk Factors ; Software ; Stroke ; Stroke, Lacunar

OBJECTIVE: To investigate the clinical effect of stellate ganglion block in patients with secondary lymphedema after breast cancer treatment. METHOD: In a prospective clinical trial, the consecutive stellate ganglion block (SGB) was performed every two weeks to 10 patients (Mean age 46.0+/-9.4 (yr)) who was diagnosed as of secondary lymphedema after breast cancer treatment. The parameters were the circumstance of arm and the thickness of skin and subcutaneous tissue of the affected arm measured by ultrasonography. We measured these parameters with baseline value before SGB treatment and repeated the evaluation after each SGB treatment. And the subjective data of satisfaction, softness and improvement were obtained by questionnaires. RESULTS: 10 patients were treated with stellate ganglion block. The mean circumferences of upper arm and forearm after three consecutive SGB treatments reduced significantly: upper arm from 31.39 cm to 29.72, forearm from 25.14 cm to 23.64 cm (p <0.05). And the thickness of subcutaneous tissue of upper arm significantly decreased under no- compression measuring technique after three SGB treatments (p <0.05). The compliance of superficial tissue showed significant change with serial procedure. Almost all of the patients had a satisfaction and feeling of softness in their affected arm after treatments. CONCLUSION: The cervical stellate-ganglion block reduced the circumstance and the thickness of arm with lymphedema and satisfied almost lymphedema patients. So this treatment presents a favorable outcome to the breast cancer-related lymphedema patient clinically.
Arm ; Breast ; Breast Neoplasms ; Compliance ; Forearm ; Humans ; Lymphedema ; Pilot Projects ; Prospective Studies ; Skin ; Stellate Ganglion ; Subcutaneous Tissue