Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

Granular cell tumor is a rare disease, and it is even rarer in the male breast. Although it is typically a benign tumor, due to its features and image findings, it can be easily misdiagnosed and managed as a malignant tumor. Therefore, the extent of the surgery can inappropriately be expanded. To avoid misdiagnosis and overtreatment, surgeons must perform a careful evaluation. We describe a case of a granular cell tumor of the male breast treated with mastectomy.

Purpose: In this study, polymerase chain reaction (PCR)-based microsatellite instability (MSI) testing was comprehensively analyzed and compared with immunohistochemistry (IHC) for mismatch repair (MMR) protein expression in patients with gastric cancer (GC). Materials and Methods: In 5,676 GC cases, PCR-based MSI testing using five microsatellites (BAT-26, BAT-25, D5S346, D2S123, and D17S250) and IHC for MLH1 were performed. Reevaluation of MSI testing/MLH1 IHC and additional IHC for MSH2, MSH6, and PMS2 were performed in discordant/indeterminate cases. Results: Of the 5,676 cases, microsatellite stable (MSS)/MSI-low and intact MLH1 were observed in 5,082 cases (89.5%), whereas MSI-high (MSI-H) and loss of MLH1 expression were observed in 502 cases (8.8%). We re-evaluated the remaining 92 cases (1.6%) with a discordant/ indeterminate status. Re-evaluation showed 1) 37 concordant cases (0.7%) (18 and 19 cases of MSI-H/MMR-deficient (dMMR) and MSS/MMR-proficient (pMMR), respectively), 2) 6 discordant cases (0.1%) (3 cases each of MSI-H/pMMR and MSS/dMMR), 3) 14 MSI indeterminate cases (0.2%) (1 case of dMMR and 13 cases of pMMR), and 4) 35 IHC indeterminate cases (0.6%) (22 and 13 cases of MSI-H and MSS, respectively). Finally, MSI-H or dMMR was observed in 549 cases (9.7%), of which 47 (0.8%) were additionally confirmed as MSI-H or dMMR by reevaluation. Sensitivity was 99.3% for MSI testing and 95.4% for MMR IHC. Conclusions Considering the low incidence of MSI-H or dMMR, discordant/indeterminate results were occasionally identified in GCs, in which case complementary testing is required.These findings could help improve the accuracy of MSI/MMR testing in daily practice.

Purpose: The purpose of study was to compare oncologic outcomes (recurrence-free survival [RFS], cancer-specific survival [CSS], and overall survival [OS]) and early complication (within 30 days) after radical cystectomy (RC) between old patients (70–79 aged) and oldest-old patients (above 80). Materials and Methods: This retrospective study reviewed total 340 patients with urothelial carcinoma of bladder who received RC between November 1996 and December 2018. The patients were divided into 2 groups by age, 307 patients aged 70–79 and 33 patients aged above 80. Baseline characteristics, perioperative outcomes and early complication were compared between the 2 groups. Kaplan–Meier (K-M) survival analysis was used to estimate RFS, CSS, OS, and multivariable Cox proportional hazard models were used to identify factors predicting RFS, CSS, OS. Results: The results of both groups did not statistically differ from each other in most clinicopathologic baseline characteristics and perioperative information. Both groups showed similar 30-day complication rates (59.3% vs. 60.3%, p=0.210). K-M showed 3-year survival rate, RFS was shorter in oldest-old group (41.4% vs. 56.7%) but not statistically different (p=0.063). Oldest-old group showed similar 3-year CSS (78.1% vs. 74.6%, p=0.779) but worse OS (51% vs. 58%, p=0.047) compared with the old group. Common factor affecting RFS, CSS, and OS were T stage and N stage (all p<0.05). Age is not factor affecting RFS, CSS, and OS. Conclusions Oldest-old who received RC had similar perioperative, oncologic outcome and complication compared with the seventies. RC could be considered treatment option for selected oldest-old patients.

Fungi are a major cause of human infections with diverse clinical manifestations. The incidence of fungal infections has increased over time, particularly in patients who have risk factors such as neutropenia, immune suppression, an intravascular catheter, parenteral nutrition, a prosthetic device, and prior broad spectrum antibiotic therapy. Here, we present an unusual case of co-infection by 2 distinct fungi, Candida parapsilosis and Trichosporon asahii, isolated from a patient who did not have any known risk factors initially, except active pulmonary tuberculosis. Despite the negative conversion of sputum acid-fast bacilli (AFB) culture test after treatment, clinical symptoms were refractory to therapy. The patient developed symptoms suggesting septic shock, and 2 distinct colonies were isolated from a blood specimen, which were identified as C. parapsilosis and T. asahii by MALDI-TOF and rRNA sequencing. Fever and hypotension were relieved after anti-fungal agent injection, and pulmonary lesions identified by imaging also improved.
Candida ; Catheters ; Coinfection ; Fever ; Fungemia ; Fungi ; Humans ; Hypotension ; Incidence ; Neutropenia ; Parenteral Nutrition ; Risk Factors ; Shock, Septic ; Sputum ; Trichosporon ; Tuberculosis, Pulmonary

BACKGROUND: Systemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet. OBJECTIVE: To establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy. METHODS: The Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey. RESULTS: KADA approved that AD with 16≤eczema area and severity index (EASI)<23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient's daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD. CONCLUSION: KADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need.
Advisory Committees ; Classification ; Consensus ; Dermatitis, Atopic ; Dermatology ; Diagnosis ; Humans ; Pruritus ; Quality of Life ; Recurrence ; Treatment Failure ; Withholding Treatment

While radioactive isotope analysis has proved to be a useful method in disciplines such as archaeology and forensic anthropology, more recently, radiocarbon dating has allowed for a more nuanced biological profile of human skeletal remains. Radiocarbon dating has been made possible by the above ground nuclear bomb test conducted in 1963, which raised the level of atmospheric radiocarbon concentration to almost twice the natural level. Because the annually measured tropospheric ¹⁴C concentrations are integrated into the bomb peak curve, the time of birth and death of an individual can be estimated by comparing the radiocarbon content of a skeletal sample to the bomb-curve value. In July 2017, about 1,000 skeletal remains were excavated at the construction site of Sokcho. For medico-legal purposes, we conducted anthropological and odontological examinations of all the human remains. We then conducted the radiocarbon analysis on seven femora (head and body portions), five mandibular teeth, and soil from the site through a request to the Korea Institute of Geoscience and Mineral Resources. The results demonstrated that the estimated year of birth or death was prior to the 1950s. Due to the diverse distribution of results, we deduced that the human remains were from the local mass grave. This study supports and suggests the use of radiocarbon dating more frequently in the analysis of human skeletal remains.
Archaeology ; Bombs ; Earth Sciences ; Forensic Anthropology ; Gangwon-do ; Humans ; Korea ; Methods ; Miners ; Parturition ; Radiometric Dating ; Soil ; Tooth

There have been many radiographic studies on age estimation that evaluate reduction in size of dental pulp cavity with secondary dentin formation. The Paewinsky method reported high accuracy in estimating ages by measuring the width of the pulp cavity in panoramic radiographs. The aim of this study was to evaluate the application of the Paewinsky method to digital periapical radiographs. This study was conducted on 103 cases that reported to the Section of Human Identification of the National Forensic Service. The age was calculated by applying the Paewinsky method that measures the root and pulp canal width at three points in a tooth. The estimation results were compared with those calculated by the Johanson method. When the Paewinsky models were applied to digital periapical radiographs, the errors were significantly greater as compared to the original study. The errors of the maxillary second premolar and mandibular lateral incisor were greater than those of the maxillary central incisor, lateral incisor, mandibular canine, and first premolar. Furthermore, errors of the age estimation models in level C were greater than those in levels A and B. This study could be a reference for the application of the Paewinsky method to digital periapical radiographs.
Age Determination by Teeth ; Bicuspid ; Dental Pulp Cavity ; Dentin, Secondary ; Forensic Anthropology ; Incisor ; Methods ; Radiography, Dental ; Tooth