A 76-year-old male presented with dizziness and disequilibrium. Magnetic resonance imaging revealed an acute ischemic stroke in the left anterior inferior cerebellar artery (AICA) territory. Three days after admission the patient developed peripheral facial palsy with no radiological exacerbation of the infarction. He was managed with antiplatelet therapy and supportive care. Both the facial palsy and initial cerebellar symptoms resolved within 1 month. This case highlights delayed facial palsy as a rare presentation of AICA infarction.

Purpose: To propose improvements for promoting eyeball donation and managing donated corneas, this study analyzed the current system in Korea and reviewed relevant Korean laws, international standards, and foreign practices. Methods: To understand the current situation in Korea, annual reports published by the Korean Network for Organ Sharing and existing Korean laws were examined. For the international context, references were made to the National Organ Transplant Act, 21 CFR Part 1271 (Code of Federal Regulations Title 21 Part 1271), Current Good Tissue Practice guidelines of the Food and Drug Administration, and the Medical Standards of the Eye Bank Association of America in the United States. Opinions on promoting eyeball donation, improving the monitoring system for donated corneas and revising laws related to cornea management were gathered. The perspectives of 31 experts affiliated with the Korea Cornea Society were collected through a survey. Results: Currently, there are no laws or regulations that can be appropriately applied to the cornea which has properties of both organs and tissue. Additionally, there is no law regulating imported corneas. Therefore, there is a need to legislate or revise the current law; all experts who conducted the survey agreed on this. Furthermore, the current system faces limitations in the efficient procurement, stable supply, and management of donor corneas, as well as in donation promotion. To address these issues, the establishment of independent legislation for managing donated corneas and a National Central Eye Bank was proposed. This central body would oversee continuous personnel training, education, and monitoring, along with ensuring stable procurement, processing, and supply of corneas within a structured management system. Sixty-eight percent of the surveyed experts agreed with this proposal. Conclusions To establish a safe and efficient Korean corneal supply and demand system, it is imperative to enact cornea-specific laws, including the establishment of a National Central Eye Bank.

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.

Purpose: Persistent hypercalcemia after parathyroidectomy (PTx) remains a significant concern in patients with tertiary hyperparathyroidism (THPT) following kidney transplant (KT). Complete resection of hyperfunctioning glands is challenging due to ectopic or intrathyroidal glands. This study evaluated whether intraoperative parathyroid hormone (ioPTH) monitoring during PTx in KT patients with THPT reduces the surgical failure rate. Methods: We retrospectively analyzed 111 patients with THPT who underwent PTx at a single tertiary center. Patients were divided into 2 groups: those without ioPTH monitoring (n=98) and those with ioPTH monitoring (n=13). Surgical procedures included less than subtotal, subtotal, or total PTx with autotransplantation. Surgical failure was defined as persistent hypercalcemia (serum calcium ≥10.3 mg/dL and intact parathyroid hormone [PTH] >65 pg/mL) on postoperative day 1 (POD1) or at ≥6 months postoperatively. Results: The ioPTH group demonstrated a significantly lower mean PTH level on POD1 (21±15.3 pg/mL vs. 39±39 pg/mL; P=0.006). Although not statistically significant, the ioPTH group showed a higher biochemical cure rate at 3 months (53.8% vs. 30.6%) and no cases of persistent hyperparathyroidism, compared to 15.3% in the non-ioPTH group.Despite adequate intraoperative PTH reduction, some patients in both groups exhibited isolated PTH elevation without hypercalcemia. Conclusion Although ioPTH monitoring did not significantly reduce the surgical failure rate in PTx for THPT, the use of ioPTH may meaningfully improve surgical completeness and reduce the risk of persistent or recurrent hyperparathyroidism, suggesting its substantial potential value as an intraoperative.

Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Medial opening wedge supramalleolar osteotomy (SMO) is a representative joint-preserving surgical procedure for varus ankle osteoarthritis, based on the principle of load redistribution, with favorable radiologic and clinical outcomes. This procedure is indicated for patients with Takakura stage 2 or 3A arthritis, whereas severe vascular or neurological impairment and osteomyelitis are considered absolute contraindications. Although SMO is generally limited to patients younger than 70 years because of the risk of delayed or nonunion in elderly individuals, few reports on the outcomes in elderly patients have been published. This paper reports two cases of varus ankle osteoarthritis in patients over 75 years of age who underwent SMO after failed conservative treatment, with a follow-up exceeding 2 years, along with a review of the relevant literature. Both cases achieved successful bone union without delayed healing. At the final follow-up, the foot and ankle ability measure (FAAM)–activities of daily living and FAAM-sport scores showed marked improvement compared with the preoperative values. In conclusion, SMO may be a viable joint-preserving treatment option, even in elderly patients, provided that their general health is favorable.

This study aimed to investigate sleep quality and the fear of falling among community- dwelling older women living alone and to identify the factors influencing the fear of falling. Methods: This descriptive correlational study included 178 community-dwelling older women living alone. Data were collected from December 10, 2023, to February 29, 2024. The collected data were analyzed using t-tests, analysis of variance, Pearson’s correlation coefficients, and hierarchical multiple linear regression. Results: The results of this study showed that age (β=.29, p<.001), community activity (β= -.23, p<.001), depression (β=.29, p<.001), social participation (β=-.18, p=.004), and sleep quality (β=.37, p<.001) were significantly associated with the fear of falling. Conclusion: Identifying the factors influencing the fear of falling, including sleep quality, among community-dwelling older women living alone highlights the need to develop preventive programs tailored to the characteristics of this population.

This study aimed to describe a facet-preserving modified transpedicular unilateral biportal endoscopic (UBE) approach for upwardly migrated thoracic disc herniation that allows safe decompression without spinal cord retraction or postoperative instability. Thoracic disc herniation is rare but often symptomatic, producing myelopathy that typically necessitates surgical intervention. Because of the spinal cord’s close proximity, traditional discectomy approaches carry a high risk of neural injury, and achieving complete disc removal without cord manipulation remains a significant surgical challenge. Although several techniques have been proposed, many are limited by the potential for incomplete decompression or iatrogenic instability. A facet-preserving modified transpedicular UBE approach may overcome these limitations by offering a minimally invasive surgical corridor while maintaining spinal stability. A 76-year-old woman presented with progressive bilateral lower extremity weakness and numbness over 6 months, with rapid deterioration during the past month. Magnetic resonance imaging (MRI) revealed an upwardly migrated thoracic disc herniation at T10–11 compressing the spinal cord. A UBE discectomy using a facet-preserving modified transpedicular approach was performed. The herniated fragment was completely removed without spinal cord retraction. Postoperatively, the patient demonstrated neurological improvement without complications. MRI confirmed complete decompression of the cord, and computed tomography verified preservation of the facet joint. This video article introduces the modified transpedicular UBE approach as a safe and precise minimally invasive technique for thoracic ventral pathologies. By enabling direct ventral decompression while preserving spinal stability, it broadens the scope of endoscopic spine surgery and warrants further clinical validation.

Probiotics have gained increasing clinical attention as adjunctive treatment for lower gastrointestinal disorders. However, evidence supporting their therapeutic efficacy remains limited, particularly with regard to sex-related differences. This expert review provides evidence-based insights and practical recommendations for the use of probiotics in patients with irritable bowel syndrome (IBS), functional constipation (FC), and Clostridioides difficile infection (CDI), considering possible sex-related differences. Evidence from randomized controlled trials and meta-analyses indicates that probiotics can modestly improve global symptoms, abdominal pain, and bloating in IBS and enhance bowel movement frequency and stool consistency in FC. However, these effects are strain-specific and heterogeneous. Although clinical studies on probiotics in IBS have not confirmed significant sex-related differences, experimental animal studies using stress-induced IBS models have demonstrated sex-dependent responses to specific probiotic strains, supporting the biological plausibility of such differences. For CDI, the efficacy of probiotics in preventing primary or recurrent infections remains inconsistent across large trials, and current guidelines usually do not recommend their routine use. However, sex and age difference of immunology supports the clinical differences of CDI. Probiotics are generally considered safe for healthy individuals, although caution is advised in patients who are immunocompromised or critically ill. Clinicians should select probiotic products based on strain-specific clinical evidence, adequate viable doses, patient's characteristics, or patient’s sex. In conclusion, probiotics might play a role as adjunctive therapy for IBS and FC, with variability in responses influenced by microbial, host, and potential sex-related factors. Further research is needed to establish optimized personalized probiotic strategies.