Posttraumatic pseudoaneurysms of the sphenopalatine artery are rare. Only a few cases have been reported. We report two cases of hemorrhage due to pseudoaneurysm of the sphenopalatine artery. The hemorrhage was uncontrollable. It required embolization. Two patients visited our hospital for treatment of zygomaticomaxillary complex fracture. At the emergency room, patients presented with massive nasal bleeding which ceased shortly. After reduction of the fracture, patients presented persistent nasopharyngeal bleeding. Under suspicion of intracranial vessel injury, we performed angiography. Angiograms revealed pseudoaneurysms of the sphenopalatine artery. Endovascular embolization was performed, leading to successful hemostasis in both patients. Due to close proximity to pterygoid plates, zygomaticomaxillary complex fracture involving pterygoid plates may cause injury of the sphenopalatine artery. The only presentation of sphenopalatine artery injury is nasopharyngeal bleeding which is common. Based on our clinical experience, although pseudoaneurysm of maxillary artery branch after maxillofacial trauma has a low incidence, suspicion of injury involving deeply located arteries and early imaging via angiogram are recommended to manage recurrent bleeding after facial trauma or surgery.
Aneurysm, False ; Angiography ; Arteries ; Embolization, Therapeutic ; Emergency Service, Hospital ; Epistaxis ; Hemorrhage ; Hemostasis ; Humans ; Incidence ; Maxillary Artery

PURPOSE: To evaluate the clinical outcome of an operation with early rehabilitation from ankle fracture in accordance with the injury type. MATERIALS AND METHODS: A total of 136 patients (70 males and 66 females) who underwent surgery and early rehabilitation for ankle fractures between December 2008 and December 2013 were retrospectively reviewed. The average age was 47.9 years, with a range of 18~79 years. The mean follow-up period was 28.7 months, with a range of 24~102 months. All patients were classified in accordance with the Lauge Hansen classification and anatomic fracture site. Moreover, the presence of ligament injuries were documented. A short-leg cast was applied postoperatively for two weeks; thereafter, patients began the range-of-motion exercises after cast removal. Full weightbearing was allowed at 2 weeks postoperatively. Each patient was assessed radiologically and clinically based on the Olerud-Molander score, visual analogue scale (VAS) for pain, joint stiffness, and capability of single heel raising. RESULTS: Seventeen patients (12.5%) complained of postoperative pain (VAS score 1~3), and the incidence was higher in patients with trimalleolar fractures or associated ligament injuries. Twenty-three patients (16.9%) complained of postoperative ankle stiffness. The mean Olerud-Molander score was 75.4/80 (range, 55~80). Olerud-Molander scores were lower in patients with ligament injuries than in those with fracture alone. There was no nonunion or fracture displacement even after early weightbearing walking. CONCLUSION: In this retrospective series, early rehabilitation after surgical restoration of ankle mortise by anatomical reduction and stabilization was shown to be successful. Earlier motion exercise and weightbearing walking can minimize fracture complications like joint stiffness or weakness in ankle fracture.
Ankle Fractures* ; Ankle* ; Arthralgia ; Classification ; Exercise ; Follow-Up Studies ; Heel ; Humans ; Incidence ; Joints ; Ligaments ; Male ; Pain, Postoperative ; Rehabilitation* ; Retrospective Studies ; Walking ; Weight-Bearing

OBJECTIVE: The aim of this study was to investigate the anti-proliferative effect of the salinomycin in cell proliferation and apoptosis in primary cultured human uterine leiomyoma cells. METHODS: Cell viability was measured by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Caspase-3 activity assay and DNA fragmentation assay were performed to determine the effect of apoptosis. The expression of apoptosis regulatory-related proteins was evaluated by western blot. RESULTS: The cell viability and proliferation of uterine leiomyoma cells were significantly reduced by salinomycin treatment in a dose-dependent manner. DNA fragmentation assay results showed apoptotic cell death after salinomycin incubation. Salinomycin activated caspase-3, -8, and -9, causing apoptosis in uterine leiomyoma cells. Down-regulation of Bcl-2, XIAP, and FLIP with a concomitant increase in Bax, Fas, and DR5 were observed. CONCLUSION: These results provided the first evidence that salinomycin induce both intrinsic and extrinsic apoptosis. Therefore, salinomycin may be a promising chemopreventive and therapeutic agent against human uterine leiomyoma.
Apoptosis* ; Blotting, Western ; Caspase 3 ; Cell Death ; Cell Proliferation* ; Cell Survival ; DNA Fragmentation ; Down-Regulation ; Humans ; Leiomyoma*

BACKGROUND: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. METHODS: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. RESULTS: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. CONCLUSIONS: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
Antifungal Agents/*pharmacology ; Candida/*drug effects/isolation & purification ; Candidiasis/epidemiology/microbiology ; Drug Resistance, Fungal/drug effects ; Fluconazole/*pharmacology ; Humans ; Microbial Sensitivity Tests ; Pyrimidines/*pharmacology ; Republic of Korea ; Triazoles/*pharmacology

BACKGROUND: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. METHODS: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. RESULTS: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. CONCLUSIONS: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
Antifungal Agents/*pharmacology ; Candida/*drug effects/isolation & purification ; Candidiasis/epidemiology/microbiology ; Drug Resistance, Fungal/drug effects ; Fluconazole/*pharmacology ; Humans ; Microbial Sensitivity Tests ; Pyrimidines/*pharmacology ; Republic of Korea ; Triazoles/*pharmacology

The Beijing family of Mycobacterium tuberculosis has been emerging in the world. However, there are few nationwide data of genotypic distribution in Korea. This study aimed to identify the genotypic diversity of clinical isolates of M. tuberculosis and to demonstrate the population of Beijing family in Korea. We collected 96 clinical M. tuberculosis isolates from 11 university hospitals nationwide in Korea from 2008 to 2009. We observed 24 clusters in IS6110-RFLP analysis and 19 patterns in spoligotyping. Seventy-five isolates were confirmed to be Beijing family. Two isolates of the K strain and 12 isolates of the K family strain were also found. We found that drug resistance phenotypes were more strongly associated with Beijing family than non-Beijing family (P=0.003). This study gives an overview of the distribution of genotypes of M. tuberculosis in Korea. These findings indicate that we have to pay more attention to control of M. tuberculosis strains associated with the Beijing family.
Drug Resistance, Bacterial ; Genotype ; Humans ; Microbial Sensitivity Tests ; Mycobacterium tuberculosis/*classification/genetics/isolation & purification ; Phenotype ; Polymorphism, Restriction Fragment Length ; Republic of Korea ; Tuberculosis/*epidemiology/genetics/microbiology

OBJECTIVE: Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. METHODS: Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. RESULTS: Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. CONCLUSION: The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.
Arthritis, Rheumatoid ; Asian Continental Ancestry Group ; Axis, Cervical Vertebra ; Decompression ; Follow-Up Studies ; Foramen Magnum ; Humans ; Male ; Occipital Bone ; Orthopedics ; Pneumonia ; Retrospective Studies ; Sepsis ; Spinal Cord Diseases ; Spine

Mucin-producing tumors of the pancreas were first reported by Ohhashi and Takagi in 1980. Since then, many cases of intraductal papillary mucinous tumor (IPMT) of the pancreas, which is almost homonymous to mucin-producing tumors of the pancreas, have been reported. IPMTs are generally regarded as tumors with a favorable prognosis. Some IPMTs have invasiveness and this is always associated with a poor prognosis. Most IPMTs arise from the main pancreatic duct and IPMTs arising from the accessory pancreatic duct are relatively rare. Only 6 cases have been reported in the literature so far. Our patient was a 43-year old man who was admitted to the hospital due to recurrent pancreatitis. An endoscopic retrograde pancreatography revealed a patulous minor papilla orifice extruding mucin and a cystic lesion in a branch of the accessory duct. A pancreaticoduodenectomy was performed and a pathologic examination of the resected specimen showed intraductal papaillary mucinous neoplasm, low grade malignancy, in the accessory pancreatic duct and its branch. We herein report this interesting case with a review of the literature.
Adult ; Humans ; Mucins* ; Pancreas ; Pancreatic Ducts* ; Pancreaticoduodenectomy ; Pancreatitis ; Prognosis

We report a case of mucinous adenocarcinoma in the ascending colon. A 55-year-old woman was admitted to Asan Medical Center due to right lower quadrant abdominal pain. On physical examination, an approximately 5X5 cm sized tender mass was palpated in the right lower quadrant. Colonoscopy revealed a fungating mass covered with gelatinous, yellow-whitish mucoid material in the ascending colon. Abdominal computed tomography showed irregular wall thickening from ileocecal valve to mid ascending colon with pericolic fat thickening. She underwent right hemicolectomy and surgical specimen revealed well differentiated tubulopapillary adenocarcinoma with mucinous background consistent with mucinous adenocarcinoma.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Chungcheongnam-do ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Female ; Gelatin ; Humans ; Ileocecal Valve ; Middle Aged ; Mucins* ; Physical Examination

BACKGROUND AND OBJECTIVES: To evaluate the association between chronic infection with Chlamydia pneumoniae, as measured by Immunoglobulin G and A, and acute myocardial infarction (AMI) in Korea. MATERIALS AND METHODS: A total of 136 patients [normal control 65 cases (male:female 27:8, mean age 55.1+/-11.7 years), AMI 71 cases (male:female 54:17, mean age 58.9+/-12.7 years)] had immunoglobulin G, A, and M antibody titers measured against Chlamydia pneumoniae by microimmunoflorescence assay and had coronary angiography performed. We investigated the incidence of major adverse cardiac events (MACE) at 6 month follow-up. Controls were defined as patients with no significant stenosis on coronary angiography. RESULTS: 1) AMI patients were more likely to be male (76.1: 41.5%) and smokers (67.6: 16.9%) compared with the controls. >2) In AMI patients, there was a weak correlation with IgG and IgA antibody titers (r=0.39, p=0.001).> 3) After adjusting for gender and smoking status, IgG and IgA antibody titers were similar between two groups.> 4) Increased IgG and IgA titers did not affect the MACE during follow-up. CONCLUSION: Chronic Chlamydia pneumoniae infection detected by immunoglobulin assay is not significantly associated with AMI. Further studies, such as polymerase chain reaction, immunocytochemistry, or culture of the atheromatous plaques, are needed to better define the association.
Chlamydia* ; Chlamydophila pneumoniae* ; Constriction, Pathologic ; Coronary Angiography ; Follow-Up Studies ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulins ; Immunohistochemistry ; Incidence ; Korea* ; Male ; Myocardial Infarction* ; Plaque, Atherosclerotic ; Polymerase Chain Reaction ; Risk Factors* ; Smoke ; Smoking