Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session.Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.

Orchids live with mycorrhizal fungi in mutualism. This symbiotic relationship plays an essential role in the overall life cycle of orchids from germination, growth, settlement, and reproduction. Among the 1000 species of the orchid, the Korean lady’s slipper, Cypripedium japonicum, is known as an endangered species. Currently, only five natural habitats of the Korean lady’s slipper remain in South Korea, and the population of Korean lady’s slipper in their natural habitat is not increasing. To prevent extinction, this study was designed to understand the fungal community interacting in the rhizosphere of the Korean lady’s slipper living in the native and artificial habitats. In-depth analyses were performed to discover the vital mycorrhizal fungi contributing to habitat expansion and cultivation of the endangered orchid species. Our results suggested that Lycoperdon nigrescens contributed most to the increase in natural habitats and Russula violeipes as a characteristic of successful cultivation. And the fungi that helped L. nigrescens and R. violeipes to fit into the rhizosphere community in Korean lady’s slipper native place were Paraboeremia selaginellae and Metarhizium anisopliae, respectively. The findings will contribute to restoring and maintaining the endangered orchid population in natural habitats.

PURPOSE: Anaphylaxis is an acute, life-threatening systemic reaction which should be treated by epinephrine, and patients should be prescribed epinephrine auto-injector after the event. The purpose of this study was to investigate the clinical features of pediatric anaphylaxis, including the rate of using epinephrine at hospital and prescribing epinephrine auto-injector. METHODS: We performed a retrospective study of 68 anaphylactic patients at in-hospital, out-hospital, and Emergency Department of Soonchunhyang University Cheonan Hospital, Cheonan, Korea, who were under 15 years of age, from January 2013 through December 2014. We reviewed their clinical features, doctor's treatment methods, rate of follow-up and prescribing epinephrine auto-injectors. RESULTS: Causes of anaphylaxis were food (76.5%), drug (10.3%), and idiopathic (13.2%). The involved organs were the skin (86.8%), respiratory tract (80.9%), cardiovascular system (23.5%), and gastrointestinal tract (17.7%). Patients were treated with systemic steroids (91.2%), antihistamines (88.2%), and epinephrine (75.0%). Fifty-three patients (77.9%) revisited our pediatric allergy clinic and epinephrine auto-injectors were prescribed for 25 patients (36.8%). CONCLUSION: Physicians should make an effort to use epinephrine as an initial treatment of anaphylaxis, to prescribe epinephrine auto-injectors, and to give proper information about disease.
Anaphylaxis* ; Cardiovascular System ; Child ; Chungcheongnam-do ; Emergency Service, Hospital ; Epinephrine* ; Follow-Up Studies ; Gastrointestinal Tract ; Histamine Antagonists ; Humans ; Hypersensitivity ; Korea ; Respiratory System ; Retrospective Studies ; Skin ; Steroids

Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.
Aloe* ; Bezoars* ; Causality ; Diagnosis, Differential ; Hernia ; Humans ; Intestinal Obstruction ; Intestinal Volvulus ; Intestine, Small ; Intussusception ; Methods ; Tomography, X-Ray Computed

Skin hyperpigmentation is one of the most common skin disorders caused by abnormal melanogenesis. The mechanism and key factors at play are not fully understood. Previous reports have indicated that cystamine (CTM) inhibits melanin synthesis, though its molecular mechanism in melanogenesis remains unclear. In the present study, we investigated the effect of CTM on melanin production using ELISA reader and the expression of proteins involved in melanogenesis by Western blotting, and examined the involvement of transglutaminase-2 (Tgase-2) in SK-MEL-2 human melanoma cells by gene silencing. In the results, CTM dose-dependently suppressed melanin production and dendrite extension in alpha-MSH-induced melanogenesis of SK-MEL-2 human melanoma cells. CTM also suppressed alpha-MSH-induced chemotactic migration as well as the expressions of melanogenesis factors TRP-1, TRP-2 and MITF in alpha-MSH-treated SK-MEL-2 cells. Meanwhile, gene silencing of Tgase-2 suppressed dendrite extension and the expressions of TRP-1 and TRP-2 in alpha-MSH-treated SK-MEL-2 cells. Overall, these findings suggested that CTM suppresses alpha-MSH-induced melanogenesis via Tgase-2 inhibition and that therefore, Tgase-2 might be a new target in hyperpigmentation disorder therapy.
Blotting, Western ; Cystamine ; Dendrites ; Enzyme-Linked Immunosorbent Assay ; Gene Silencing ; Humans ; Hyperpigmentation ; Melanins ; Melanoma* ; Skin

BACKGROUND/AIMS: The recent introduction of computerized surveillance systems has promoted the monitoring of adverse drug reactions (ADRs), a feature that facilitates voluntary reports and enables prompt feedback. To investigate the causative agents and severity of ADRs that occurred in a single hospital, we analyzed the features of 980 ADRs that occurred over 14 months after developing a computerized ADR reporting system in Hallym Sacred Heart Hospital. METHODS: ADR data collected prospectively from September 2007 to October 2008 by a computerized reporting system were analyzed. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria were used to determinate causality for each ADR. RESULTS: The number of ADR cases reported voluntarily increased rapidly since the introduction of the computerized ADR reporting system. Of the 980 cases, antibiotics (34.5%) were the most common causative drugs, followed by analgesics such as tramadol and its compound (15.2%), radiocontrast media (7.0%), narcotics (5.9%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (5.5%). Fifty-nine (6.0%) and 206 (21.0%) cases were classified as severe and moderate reactions, respectively. The mean age was older in patients with severe ADRs than in patients with non-severe ADRs. The most common clinical features were skin manifestations, such as pruritus, skin eruptions, and urticaria. Gastrointestinal symptoms including nausea, vomiting, and diarrhea were the second most frequently reported ADRs. Among antibiotics, first-generation cephalosporins were the most frequently reported causative drugs, followed by second-generation cephalosporins, penicillin/beta-lactamase inhibitors, and third-generation cephalosporins. While 11.6% of ADRs related to penicillin/beta-lactamase inhibitors were classified as severe, there was only one severe ADR (1.1%) for first-generation cephalosporins. Most ADRs were reported equally in men and women, although female cases constituted about two thirds of ADRs associated with tramadol and NSAIDs. CONCLUSIONS: We believe that a computerized reporting and replying system promoted the monitoring of ADRs. Antibiotics were reported most frequently as the causative agent of ADRs. Elderly patients seemed to be more susceptible to severe ADRs. With the voluntary reporting system, skin manifestations and gastrointestinal symptoms were detected successfully, while laboratory abnormalities without prominent symptoms seemed to be overlooked. Further efforts to screen for automated ADR signals are required.
Aged ; Analgesics ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Cephalosporins ; Contrast Media ; Diarrhea ; Drug Toxicity ; Electronics ; Electrons ; Female ; Heart ; Humans ; Male ; Narcotics ; Nausea ; Prospective Studies ; Pruritus ; Skin ; Skin Manifestations ; Tramadol ; Urticaria ; Vomiting ; World Health ; World Health Organization

PURPOSE: The aim of this project is to report the successful removal of a free - floating pigmented iris cyst in a patient ' s anterior chamber, which was causing visual disturbance. CASE SUMMARY: A 27 - year - old man visited our hospital because of an intermittent visual disturbance in his right eye developed two months prior to admission. There was no history of ocular trauma, surgery, inflammation, or a general medical problem. On slit lamp examination, we found a free - floating translucent pigmented iris cyst, which was ovoid in shape and about 3 mm in size in the right eye near the pupil margin. Moving in the anterior chamber, the cyst caused visual disturbance because it partly covered the pupil. It was also near the endothelium. Through the clear cornea incision, the iris cyst was removed successfully. From histopathologic investigation of the cyst, the tissue was found to consist of mature pigment epithelium, including pigment granules CONCLUSIONS: A free - floating pigmented iris cyst in the anterior chamber generally does not result in any complications and maintains its condition stably without changing in size. Hence, as long as it does not cause complications, no treatment is necessary. However, if it causes visual disturbance or it damages endothelial cells or causes glaucoma or any other intraocular complication, it needs to be treated. In the case of our patient, visual disturbance did occur and we removed the iris cyst through an operation. Such a case has not been reported before in South Korea.
Anterior Chamber ; Cornea ; Endothelial Cells ; Endothelium ; Epithelium ; Eye ; Glaucoma ; Humans ; Inflammation ; Iris ; Pupil ; Republic of Korea

PURPOSE: We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. MATERIALS AND METHODS: We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. RESULTS: At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. CONCLUSION: 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US.
Arthrography* ; Arthroscopy ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Rotator Cuff* ; Sensitivity and Specificity ; Shoulder Joint ; Shoulder* ; Tendons

Cervical spondylolysis is a rare condition, and less than 100 cases have been reported in the world literature. Cervical spondylolysis is defined as a well corticated defect in the posterior element of a cervical vertebra. Although the etiology of cervical spondylolysis is unknown, its association with dysplastic changes and spina bifida occulta suggest that the lesion is congenital. Here, we describe the radiographs and CT images of cervical spondylolysis involving four levels in a 9 year old boy.
Child* ; Humans ; Male ; Spina Bifida Occulta ; Spine ; Spondylolysis*

Cryptococcus is an important opportunistic pathogen of fungal infection after organ transplantation. And, tuberculosis is also a major cause of infection in immunocompromised patients. We experienced a case of asymptomatic cryptococcal pulmonary infection detected by routine chest X-ray in a renal transplant patient, and a subsequent development of symptomatic multi-drug resistant pulmonary tuberculosis during oral fluconazole treatment. For the appropriate infection control, we should make the thorough evaluation in immunocompromised organ-transplant patients.
Cryptococcus* ; Fluconazole ; Humans ; Immunocompromised Host ; Infection Control ; Kidney Transplantation ; Organ Transplantation ; Thorax ; Transplants ; Tuberculosis* ; Tuberculosis, Pulmonary