Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*

BACKGROUND: The incidence of early colorectal epithelial neoplasm (ECEN) is increasing, and its pathologic diagnosis is important for patient care. We investigated the incidence of ECEN and the current status of its pathologic diagnosis. METHODS: We collected datasheets from 25 institutes in Korea for the incidence of colorectal adenoma with high grade dysplasia (HGD) and low grade dysplasia in years 2005, 2007, and 2009; and early colorectal carcinoma in the year 2009. We also surveyed the diagnostic terminology of ECEN currently used by the participating pathologists. RESULTS: The average percentage of diagnoses of adenoma HGD was 7.0%, 5.0%, and 3.4% in years 2005, 2007, and 2009, respectively. The range of incidence rates of adenoma HGD across the participating institutes has gradually narrowed over the years 2005 to 2009. The incidence rate of early colorectal carcinoma in the year 2009 was 21.2%. The participants did not share a single criterion or terminology for the diagnosis of adenoma HGD. The majority accepted the diagnostic terms that distinguished noninvasive, mucosal confined, and submucosal invasive carcinoma. CONCLUSIONS: Further research requirements suggested are a diagnostic consensus for the histopathologic diagnosis of ECEN; and standardization of diagnostic terminology critical for determining the disease code.
Academies and Institutes ; Adenoma ; Colorectal Neoplasms ; Consensus ; Incidence ; Korea ; Neoplasms, Glandular and Epithelial ; Pathology, Surgical ; Patient Care

PURPOSE: To report 2 different cases of postoperative endophthalmitis caused by Stenotrophomonas maltophilia after cataract surgery. CASE SUMMARY: A 73-year-old male with diabetes mellitus developed severe pain in the right eye 2 weeks after cataract surgery. The patient was hospitalized with a diagnosis of infectious endophthalmitis, and vitrectomy was performed. Cultures of aqueous humor and vitreous aspirate revealed S. maltophilia. On day 30 after vitrectomy, his visual acuity had improved to 20/20 and there were no recurrences. A 61-year-old female with no significant past medical history was referred for uveitis or delayed onset endophthalmitis 30 days after cataract surgery. An anterior chamber tapping and cultures were performed. S. maltophilia and Aspergillus fumigatus were isolated. The patient received antibiotics and antifungal agents and her visual acuity improved to 20/25. CONCLUSIONS: S. maltophilia has been considered a life-threatening systemic opportunistic infection; however, the organism has recently been reported as an exogenous pathogen of endophthalmitis following cataract surgery. Herein, 2 different cases of S. maltophilia endophthalmitis after cataract surgery are presented and compared with previous case reports.
Aged ; Anterior Chamber ; Anti-Bacterial Agents ; Antifungal Agents ; Aqueous Humor ; Aspergillus fumigatus ; Cataract ; Coinfection ; Diabetes Mellitus ; Endophthalmitis ; Eye ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Stenotrophomonas ; Stenotrophomonas maltophilia ; Uveitis ; Visual Acuity ; Vitrectomy

Parosteal lipoma is a rare kind of lipoma that occurring adipous tissue around the periosteum. It has been reported most commonly in the femur, the radius, the tibia and the fibular. Treatment consists of resecting the lipomatous tumor with further exeresis of the bone and periosteal excrescence in cases with hyperostosis. The authors report a rare case of parosteal lipoma occurring at the medial portion of the femur shaft with a review of the relevant literatures.
Femur ; Hyperostosis ; Lipoma ; Periosteum ; Radius ; Tibia

We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, "giant" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.
Laparoscopy

BACKGROUND/AIMS: Gastric glomus tumors are extremely rare, and presurgical confirmation is often impossible. The identification of clinical and radiologic characteristics of this tumor type is important for preoperative diagnosis and treatment planning. METHODS: In this study, we analyzed 10 cases of gastric glomus tumors resected at a single institute over 9 years. RESULTS: Eight of the patients were men and 2 were women, with a mean age of 49 years. Five patients presented with abdominal discomfort or pain, 1 presented with anemia, and the remaining 4 cases were found incidentally during endoscopic examinations. The most common location of the tumor was the antrum (n=7), followed by the low (n=2) and high body (n=1). Although the endoscopic ultrasonography findings were variable, contrast-enhanced computed tomography generally showed a strong homogeneous enhancement. The resected tumors were well-demarcated solid masses with sizes ranging from 1.0 to 3.6 cm. Microscopically, the masses were composed of abundant vascular channels with clusters of uniform and round glomus cells. There was no evidence of recurrence after complete surgical resection. CONCLUSIONS: Gastric glomus tumors are unusual, distinct lesions that should be considered in the differential diagnosis of a gastric submucosal mass. Unlike their deep soft tissue counterparts, most glomus tumors in the stomach are benign.
Anemia ; Diagnosis, Differential ; Endoscopy ; Endosonography ; Female ; Glomus Tumor ; Humans ; Male ; Recurrence ; Stomach

Inflammatory bowel disease (IBD) is considered as a dysregulated immune mediated disease. Pericarditis in IBD is a very rare disease both as an extra-intestinal manifestation of IBD and an adverse reaction of therapeutic drug for IBD such as mesalazine or sulfasalazine. A 26-year-old IBD male patient who had been taking mesalazine regularly for about 1 month was referred to our hospital because of fever, chest discomfort, and abnormal electrocardiographic findings. The patients was diagnosed as acute myopericarditis, and recovered after cessation of mesalazine using steroid and aspirin. When mesalazine was re-medicated some days after discharge, he suffered from myopericarditis again. Subsequently, myopericarditis was resolved just after cessation of mesalazine again. These findings suggest that the development of myopericarditis is caused by mesalazine.
Adult ; Aspirin ; Colitis, Ulcerative ; Electrocardiography ; Fever ; Humans ; Inflammatory Bowel Diseases ; Male ; Mesalamine ; Pericarditis ; Rare Diseases ; Sulfasalazine ; Thorax ; Ulcer

PURPOSE: A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease. METHODS: We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009. RESULTS: All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months). CONCLUSION: In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.
Abscess ; Adult ; Dermoid Cyst ; Drainage ; Epidermal Cyst ; Female ; Follow-Up Studies ; Humans ; Odors ; Physical Examination ; Rare Diseases ; Rectal Fistula ; Retrospective Studies ; Suppuration ; Teratoma

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and cystic changes are commonly observed. However, there have been few reports of cases of exophytic pedunculated GIST with cystic changes. Here, we report a 45-year-old man who presented with a palpable mass in the left upper quadrant of the abdomen. The mucosal folds were endoscopically abnormal, but there was no mucosal lesion. Computed tomography demonstrated a large, low-density cystic lesion surrounding an enhanced nodule in the greater curvature of the gastric body, and there was no tumor infiltration to other organs. The patient underwent hemigastrectomy and the lesion was shown to be an exophytic pedunculated cystic tumor. Histopathological examination showed epithelioid cells with marked hemorrhaging. Immunohistochemical examination indicated that most of the tumor cell cytoplasm was positive for the c-kit protein (CD117) and CD34. The tumor was diagnosed as an exophytic pedunculated GIST of the stomach with cystic changes.
Abdomen ; Cytoplasm ; Epithelioid Cells ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Middle Aged ; Proto-Oncogene Proteins c-kit ; Stomach