Tuberculosis is an adverse event in patients with Crohn’s disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn’s disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient’s condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

Background: This study investigated the recognition of employees and blood donors regarding the spread of COVID-19 and the response of the Korean Red Cross Blood Service. Methods: An online survey was conducted through internal groupware targeting employees of the Korean Red Cross Blood Center and Blood Laboratory Center. For the blood donor survey, a text message containing the survey URL was sent to 20,000 blood donors on July 31, 2020, and the responses were analyzed. Results: Of those who received text messages, 63.7% of staff and 8.6% of blood donors participated. Of the employees surveyed, the greatest urgency was the need to prepare after COVID-19; strengthening safety and protection measures of employees showed the highest result. In the concern on future blood services, the highest result was the deterioration of blood supply due to decreasing number of blood donors. In a survey of blood donors, 16.0% answered that the spread of COVID-19 had a very negative or somewhat negative effect on the recognition of blood donation, and 80.4% responded positively to sending an ‘emergency disaster message requesting blood donation’ when blood stocks dropped sharply. Conclusion It is necessary to expand blood donation promotion and prepare systematic blood donor management measures for a stable blood supply during a pandemic, such as COVID-19. The emergency disaster message requesting blood donation helped solve the blood shortage, but it appears that an effective use plan will be needed in the future.

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

PURPOSE: Current clinical data support a safe warm ischemia time (WIT) limit of 30 minutes during laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). We evaluated independent factors predicting prolonged WIT (more than 30 minutes) after LPN or RPN. MATERIALS AND METHODS: A retrospective data review was performed for 317 consecutive patients who underwent LPN or RPN performed by the same surgeon from October 2007 to May 2013. Patients were divided into two groups: group A was defined as prolonged WIT (> or =30 minutes) and group B as short WIT (<30 minutes). We compared clinical factors between the two groups to evaluate predictors of prolonged WIT. RESULTS: Among 317 consecutive patients, 80 were in the prolonged WIT group. Baseline characteristics were not significantly different between the groups. In the univariable analysis, PADUA (preoperative aspects and dimensions used for an anatomical) score (p=0.001), approach method (transperitoneal or retroperitoneal approach; p<0.001), and surgeon experience (p<0.001) were significantly associated with prolonged WIT. In the multivariable analysis, PADUA score (p=0.032), tumor size (> or =25 mm; odds ratio, 2.98; 95% confidence interval, 1.48-5.96; p=0.002), and surgeon experience (p<0.001) were independent predictors of prolonged WIT. CONCLUSIONS: Surgeon experience, tumor size, and PADUA score predicted prolonged WIT after RPN or LPN. Among these factors, increasing surgical experience with LPN or RPN is the most important factor for preventing prolonged WIT.
Adult ; Aged ; Carcinoma, Renal Cell/pathology/*surgery ; Clinical Competence ; Female ; Humans ; Intraoperative Period ; Kidney Neoplasms/pathology/*surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Nephrectomy/*methods ; Pneumoperitoneum, Artificial/*methods ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/methods ; Warm Ischemia/*methods

OBJECTIVE: To evaluate the effects of physical properties of foods on the changes of viscosity and mass as well as the particle size distribution after mastication. METHOD: Twenty subjects with no masticatory disorders were recruited. Six grams of four solid foods of different textures (banana, tofu, cooked-rice, cookie) were provided, and the viscosity and mass after 10, 20, and 30 cycles of mastication and just before swallowing were measured. The physical properties of foods, such as hardness, cohesiveness, and adhesiveness, were measured with a texture analyzer. Wet sieving and laser diffraction were used to determine the distribution of food particle size. RESULTS: When we measured the physical characteristics of foods, the cookie was the hardest food, and the banana exhibited marked adhesiveness. Tofu and cooked-rice exhibited a highly cohesive nature. As the number of mastication cycles increased, the masses of all foods were significantly increased (p<0.05), and the viscosity was significantly decreased in the case of banana, tofu, and cooked-rice (p<0.05). The mass and viscosity of all foods were significantly different between the foods after mastication (p<0.05). Analyzing the distribution of the particle size, that of the bolus was different between foods. However, the curves representing the particle size distribution for each food were superimposable for most subjects. CONCLUSION: The viscosity and particle size distribution of the bolus were different between solid foods that have different physical properties. Based on this result, the mastication process and food bolus formation were affected by the physical properties of the food.
Adhesiveness ; Deglutition ; Hardness ; Mastication ; Musa ; Particle Size ; Rheology ; Soy Foods ; Viscosity

BACKGROUND/AIMS: Double balloon enteroscopy (DBE) is an effective modality for making the diagnosis and managing suspected small bowel bleeding. However, there is limited data on the follow-up results after DBE. The aim of this study was to evaluate the long-term clinical outcome after DBE in patients with suspected small bowel bleeding. METHODS: We retrospectively analyzed the rebleeding rate of 60 consecutive patients (M:F=39:21, age: 13~85 years) who underwent DBE because of suspected small bowel bleeding at Asan Medical Center during a 3 year period. RESULTS: The median follow-up period was 552 days. Bleeding sources were detected by DBE in 41 patients. The cumulative rebleeding rate at 6, 12 and 24 months was 22%, 27% and 30%, respectively. There was no significant difference in the cumulative rebleeding rate between the patients with bleeding sources detected by the initial DBE and those without bleeding sources detected by the initial DBE. The cumulative rebleeding rate at 6 and 12 months was significantly higher for the patients with vascular or superficial mucosal lesions than for the patients with tumors or other lesions (p=0.013). CONCLUSIONS: The rebleeding risk after DBE is not low for patients with suspected small bowel bleeding. The rebleeding risk is especially high for patients with vascular or superficial mucosal lesions, and this may necessitate careful follow-up.
Double-Balloon Enteroscopy ; Follow-Up Studies ; Hemorrhage ; Humans ; Retrospective Studies

BACKGROUND/AIMS: Small intestinal polyps in patients with Peutz-Jeghers (PJ) syndrome cause therapeutic difficulties because of the necessity for repeated laparotomy. We evaluated the short-term outcomes and long-term usefulness of double balloon enteroscopy (DBE) polypectomy for treating small intestinal PJ polyps. METHODS: We retrospectively reviewed 10 patients with PJ syndrome (M:F=7:3, mean age 22.7 years) and whose small intestinal polyps were resected with DBE between January 2005 and July 2008. We analyzed their clinical, endoscopic and pathologic features, the short-term outcomes and the long-term follow-up results. RESULTS: Among 10 patients, 2 complained hematochezia and 2 presented with intussusceptions. DBE polypectomy was performed by the oral route in 4 patients, by the anal route in 1 and by both routes in 5 without significant complications, except for only one perforation. The polyps were 0.5~6 cm in size and most of them were pedunculated. The histopathology revealed hamartomatous polyps in most cases. Follow-up small bowel series was performed in 6 of 10 patients, and 3 showed remnant polyps. Two of them underwent repeated DBE polypectomy without significant complications. CONCLUSIONS: We suggest that DBE polypectomy is a useful treatment for PJ small intestinal polyps because of the good short-term outcome and the effectiveness of repeated polypectomy for the remnant or recurrent polyps.
Double-Balloon Enteroscopy ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Polyps ; Intestine, Small ; Intussusception ; Laparotomy ; Peutz-Jeghers Syndrome ; Polyps ; Retrospective Studies

No abstract available.
Cell Line* ; Cytokines* ; Nitric Oxide*

No abstract available.
Panniculitis*

The adult trematodes, Fasciola hepatica, Eurytrema pancreaticum and Paramphistomum cervi, employed in this experiment were obtained from the cattle slaughtered at the local abbatoir. The worms selected and washed several times in normal sterilized saline solution. Each about ten of intact F. hepatica, fourty of E. pancreaticum, and twenty of P. cervi were incubated in 50 cc volume of special incubation flasks with incubation medium consisting of 10 cc. of Krebs-Ringer phosphate buffer(pH 7.4) The incubation medium was added C(14)-1-acetate and non-radioactive carrier Na-acetate so as to contain acetate concentration of 50 mg per cent . The worms were allowed to incubate for 5 hours in the Dubnoff metabolic shaking incubator at 38 C. After incubation period, respiratory CO(2) samples from central well of incubation flask were analysed for total CO(2) production rate and their specific activity of respiratory CO(2). The lactate and pyruvate appearance rates were determined by analyzing the lactate and pyruvate concentration in a medium after incubation. The glycogen samples isolated from worms were analyzed for the tissue concentration and their radioactivities in order to determine the turnover rate of glycogen pool. Radioactivities of these series of experiments were counted by an endwindow Geiger-Muller counter as an infinitely thin samples. The quantitative analysis of C(14)-acetate utilized by F. hepatica, E. pancreaticum and P. cervi were compared and discussed in this report. According to these data of the experiment, it is suggested that the fatty acid such as acetate may play a part of their oxidative process into the respiratory CO2 and the synthetic process into glycogen in the above species of trematodes.
parasitology ; helminth ; trematoda ; Fasciola hepatica ; Eurytrema pancreaticum ; Paramphistomum cervi ; acetate ; metabolism ; biochemistry ; CO(2) ; glycogen ; Krebs-Ringer phosphate buffer