Carbon monoxide (CO) poisoning typically results in bilateral globus pallidus and subcortical white matter injuries, sometimes followed by delayed encephalopathy with white matter changes. This report describes a patient with CO poisoning who initially presented with isolated cerebellar lesions on imaging. Following recovery from the acute phase, the patient developed delayed encephalopathy, manifesting as Parkinsonism and akinetic mutism. This case highlights that isolated cerebellar involvement may represent an atypical radiological finding in CO poisoning.

Purpose: We compared patient characteristics and surgical outcomes of primary trabeculectomy procedures performed a decade apart to evaluate the long-term efficacy and safety profile of trabeculectomy. Methods: This retrospective comparative study analyzed two cohorts of patients who underwent primary trabeculectomy augmented with mitomycin C. Cohort 1 included 86 eyes of 71 patients operated on between 2007 and 2009, whereas Cohort 2 comprised 88 eyes of 76 patients treated between 2017 and 2019. Data included patient demographics, preoperative intraocular pressure (IOP), visual field mean deviation (MD), mitomycin C usage details, and postoperative surgical outcomes. Results: The interval between glaucoma diagnosis and surgery was significantly longer in Cohort 2 (7.7 ± 4.1 years) compared with Cohort 1 (3.5 ± 3.8 years) (p < 0.001). Preoperative IOP was significantly lower in Cohort 2 (p = 0.009). Visual field MD at diagnosis indicated less advanced visual field loss in Cohort 2 (p < 0.001). No statistically significant differences were observed between the two cohorts in terms of surgical success rates or complication rates. Among patients who did not undergo cataract surgery, visual field progression was slower in Cohort 2 than in Cohort 1 (˗0.78 vs. ˗0.04 dB/year, p = 0.009). Conclusions Although the two cohorts differed in preoperative IOP and the interval from diagnosis to surgery, trabeculectomy with mitomycin C demonstrated comparable success rates and a consistent safety profile over time.

Chronic lung diseases, including asthma, chronic obstructive pulmonary disease, and interstitial lung disease, contribute significantly to morbidity and mortality worldwide. Telemedicine has emerged as a promising approach for addressing these challenges by enabling remote patient monitoring, virtual consultations, and digital health interventions. Advances in home spirometry, wearable devices, and mobile health applications have improved early detection of disease exacerbations, medication adherence, and patient self-management of chronic lung diseases. Telerehabilitation programs have demonstrated their efficacy in enhancing exercise capacity and quality of life in patients with chronic lung diseases. Despite these advancements, challenges such as disparities in digital access, patient engagement, costs, and regulatory frameworks limit widespread adoption. As telemedicine has become an integral component of respiratory care, further research is required to optimize its implementation, evaluate long-term clinical outcomes, and ensure equitable access to all patients. This review explores the current state of telemedicine in chronic lung disease management, highlights technological innovations, and discusses future directions for enhancing its role in improving patient outcomes.

Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background: s/Aims: This study evaluated the feasibility and outcomes of surgical treatment for metachronous periampullary carcinoma following curative resection of primary extrahepatic bile duct cancer. Methods: A retrospective review was conducted of seven patients who underwent pancreaticoduodenectomy (PD) for metachronous periampullary cancer after prior curative surgery for extrahepatic bile duct cancer. Results: The mean age at the second surgery was 66.7 years (range, 43–81 years). Initial malignancies included three hilar cholangiocarcinomas, one middle bile duct cancer, and three gallbladder cancers. Subsequent primary tumors consisted of three distal bile duct cancers, three pancreatic head cancers, and one duodenal cancer. The mean interval between the first and second cancers was 47 months (range, 13–121 months). No perioperative deaths occurred. Postoperative complications developed in three patients (42.9%):chyle leakage (Clavien–Dindo grade II) in two (28.6%) and a grade C postoperative pancreatic fistula requiring reoperation (grade IIIb) in one (14.3%). Both chyle leaks were managed conservatively. During follow-up, four patients died of recurrence at 5, 12, 19, and 24 months postoperatively. One patient underwent video-assisted thoracoscopic surgery for pulmonary metastasis 2 months after PD and remains alive 22 months later without recurrence. Two patients are disease-free at 38 and 92 months of follow-up. Conclusions PD for second primary periampullary cancer after resection of extrahepatic bile duct cancer appears feasible and potentially effective. Although no perioperative mortality occurred, major complications were observed. Larger studies are needed to confirm these preliminary findings.

Purpose: We aimed to compare the final adult height (FAH) of male patients with central precocious puberty (CPP) after treatment with a gonadotropin-releasing hormone agonist (GnRHa). Specifically, we compared FAH with the target height (TH) and the predicted adult height (PAH) before and after GnRHa treatment to quantify height gain and identify predictive factors. Methods: We retrospectively reviewed the medical records of 92 male patients with CPP and known FAH after GnRHa treatment at the Department of Pediatrics of Severance Children’s Hospital between January 2000 and June 2024. Results: The mean duration of GnRHa treatment was 2.7±1.3 years. A significant 1.1±0.9 years narrowing was observed in the difference between bone age (BA) and chronological age (CA) during treatment (P<0.001). TH was 172.4±3.4 cm. FAH was 173.6±6.4 cm. FAH was greater than TH by 1.2±5.9 cm (P=0.047). PAH before and after treatment was 179.9±8.1 and 181.2±7.4 cm, respectively. PAH was increased by 1.3±4.9 cm (P=0.012) after treatment. As the PAH standard deviation score (SDS) before GnRHa treatment increased, FAH tended to exceed TH. In contrast, higher testosterone levels before treatment are associated with FAH falling below TH. A longer duration of treatment and taller TH are associated with an FAH SDS greater than height SDS before treatment. Conversely, a greater weight SDS, BA–CA difference, and testis size before treatment are associated with FAH SDS being less than height SDS before GnRHa treatment. Conclusion GnRHa treatment improved FAH and inhibited bone maturation in male patients with CPP.

The gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the gastrointestinal tract. Between the 1990s and early 2000s, GIST was identified as a tumor characterized by KIT or PDGFRA mutations, resulting in imatinib being established as an effective targeted therapy. However, with advances in molecular diagnostics, approximately 10%–15% of GISTs have been reported to harbor alternative mutations, such as those in the succinate dehydrogenase subunit genes and BRAF, leading to the development of additional targeted therapies. GISTs exhibit a wide spectrum of clinical behaviors, ranging from indolent to highly aggressive, prompting the development of diverse risk classification systems. However, multiple systems remain in use, leading to inconsistent pathologic reports. Moreover, the mitotic counting method—a key factor in risk stratification—has become a major source of confusion among pathologists owing to the adoption of digital pathology and discrepancies between updated international guidelines and outdated reimbursement requirements. These inconsistencies have hindered pathologic reporting and communication between pathologists and clinicians. This review comprehensively overviews the historical background, molecular subtypes, and risk classification systems of GIST, focusing on evolving issues in mitotic rate evaluation and the application of risk classification systems in clinical practice.

Purpose: This study aimed to conduct a systematic review and meta-analysis to identify variables associated with standard precautions compliance among hospital nurses and to comprehensively examine their effect sizes. Methods: A systematic review and meta-analysis were reported in accordance with the PRISMA and MOOSE guidelines. Studies published in English or Korean were retrieved from KMbase, KoreaMed, KISS, ScienceON, RISS, Nanet, DBpia, PubMed, Embase, CINAHL, and CENTRAL. Data collection was conducted from July 6 to July 16, 2024. To ensure a comprehensive search, no restrictions were placed on the publication period, and studies published up to June 2024 were included in the literature search. Analyses were performed using R ver. 4.4.1. Results: Of the 2,321 studies screened, 50 were included in the systematic review and 41 were included in the meta-analysis. Variables were categorized according to the ecological model. Among individual-level factors, variables with medium correlation effect sizes (ESr ≥.30) included self-efficacy (ESr=.41; 95% confidence interval [CI], 0.24 to 0.56), perceived barriers (ESr=−.35; 95% CI, −0.59 to −0.05), cues to action (ESr=.34; 95% CI, 0.07 to 0.57), and perceived benefits (ESr=.30; 95% CI, 0.13 to 0.46). Among organizational factors, organizational culture for infection control (ESr=.47; 95% CI, 0.39 to 0.54) and patient safety culture (ESr=.44; 95% CI, 0.35 to 0.53) demonstrated medium effect sizes. Other statistically significant variables with small effect sizes were also identified. No variables were identified within the interpersonal, community, or public policy domains. Conclusion This study identified self-efficacy and organizational culture for infection control as key determinants of compliance with standard precautions. Strengthening these factors may reduce healthcare-associated infections and promote safer nursing care (PROSPERO registration number: CRD42024566518).

Osteoid osteoma is a benign bone-forming tumor that rarely occurs in the cervical spine. Surgical removal is indicated when symptoms persist despite conservative management. Although open excision or radiofrequency ablation has traditionally been performed, these approaches may be associated with extensive tissue disruption or postoperative spinal instability. Recently, minimally invasive techniques, including unilateral biportal endoscopy (UBE), have been introduced for spinal tumor resection. We report the case of a 50-year-old man with persistent left-sided neck pain lasting 6 months. Imaging studies revealed a 15-mm nidus in the left lamina of C3, consistent with osteoid osteoma. The lesion was completely excised using the UBE technique, with preservation of the facet joint and surrounding structures. Histopathologic examination confirmed the diagnosis of osteoid osteoma. The patient’s symptoms improved immediately after surgery, and no perioperative complications occurred. Follow-up computed tomography and magnetic resonance imaging demonstrated complete lesion removal, with no evidence of recurrence at the 7-month follow-up. UBE-assisted resection represents an effective and minimally invasive surgical option for cervical osteoid osteoma. This approach enables adequate visualization, precise lesion excision, and preservation of spinal stability, resulting in favorable clinical and radiologic outcomes.

Purpose: This study aimed to compare perioperative and postoperative outcomes of single-port laparoscopic articulated instrument-assisted versus da Vinci SP-assisted totally extraperitoneal (TEP) inguinal hernia repair using a propensity score-matched multi-institutional cohort. Methods: Between April 2022 and July 2025, 221 patients underwent TEP unilateral inguinal hernia repair at four institutions. Among them, 33 patients underwent da Vinci SP-assisted repair (Intuitive Surgical) and 188 underwent single-port laparoscopy using the articulated instrument, ArtiSential (LivsMed). Propensity score matching was performed in a 1:1 ratio based on demographic and clinical variables, resulting in 30 matched patients in each group. Perioperative outcomes and postoperative complications were analyzed. Results: After matching, baseline characteristics were well balanced between the groups.Operative time was significantly longer in the da Vinci SP group than in the ArtiSential group (median [interquartile range], 82.0 [67.5–105.0] vs. 35.0 [28.5–47.5] minutes; p < 0.001). No open conversions occurred, and conversions to transabdominal preperitoneal repair were rare and comparable. Mesh size selection differed significantly, with smaller meshes more frequently used in the da Vinci SP group (p < 0.001). Postoperative outcomes, including length of hospital stay, overall complication rates, chronic pain, and recurrence, were similar between the groups. No major complications, readmissions, or reoperations were observed. Conclusion Articulated instrument-assisted TEP inguinal hernia repair demonstrated a significantly shorter operative time than da Vinci SP-assisted repair, while perioperative safety and postoperative outcomes were comparable.