Background/Aims: Although proton pump inhibitors (PPIs) remain a mainstay for the suppression of gastric acid secretion, long-term PPI use is associated with side effects. However, the genotoxicity associated with long-term PPI use is unclear. Materials and Methods: This prospective observational pilot study enrolled patients who had been on PPIs for >1 year and healthy controls from July 2015 to August 2016. The subjects completed self-report questionnaires pertaining to their drug and medical history, and only those with no medical history and a ≥2-year wash-out period (for drugs other than PPIs) were included. We collected peripheral-blood lymphocytes from long-term PPI users and healthy controls and analyzed the genotoxicity by using the cytokinesis-block micronucleus cytome assay; we also determined the fasting serum levels of pyridoxine, folate, cobalamin, and homocysteine. Results: Ten long-term PPI users and 40 healthy control subjects were enrolled. The median serum pyridoxine, folate, cobalamin, and homocysteine levels were not significantly different between the groups. The median frequencies of micronuclei (MNi), nucleoplasmic bridges (NPBs), and nuclear buds (Nbuds) per 1,000 binucleated cells, in long-term PPI users and healthy controls, were 30.3 and 16.3 (P<0.005), 2.5 and 1.8 (P<0.005), and 9.3 and 5.0 (P<0.005), respectively. Even after adjustment for confounding factors, the OR of the MNi, NPBs, and Nbuds for long-term PPI users compared with healthy control subjects were 14.1 (P<0.001), 2.0 (P=0.001), and 1.3 (P=0.3), respectively. Conclusions Long-term PPI use was significantly associated with an increased risk of genotoxicity after adjustment for age, sex, body mass index, medical history, drug history, and the serum levels of vitamins.

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Demography ; Eczema/pathology ; Face/pathology ; Female ; Humans ; Lupus Erythematosus, Cutaneous/pathology ; Male ; Middle Aged ; Psoriasis/pathology ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Tinea/*diagnosis/microbiology ; Trichophyton/isolation & purification ; Young Adult

Advanced hepatocellular carcinoma (HCC) has a poor prognosis and few effective therapies. Recently, low-dose antiangiogenic (also called metronomic) chemotherapy has been tested in patients with advanced HCC. Here, we report two patients with advanced HCC who showed a good response after metronomic chemotherapy. The first was a 54-year-old man who was diagnosed with advanced HCC with lung metastasis. After three cycles of metronomic chemotherapy, the size of tumor and pulmonary metastatic lesions had decreased markedly on follow-up computed tomography. The second was a 54-year-old woman who was diagnosed with HCC with portal vein thrombosis. Metronomic therapy was performed. After 9 months, tumor enhancement in the arterial phase had disappeared completely, and the portal vein thrombus was decreased slightly. Metronomic therapy is an interesting treatment option for patients with advanced HCC. More clinical data and studies are needed to confirm this result.
Carcinoma, Hepatocellular ; Female ; Follow-Up Studies ; Hepatic Artery ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Thrombosis

Neurofibromatosis 1 (NF-1) is an inherited neurocutaneous disorder arising from the chromosome 17q with a prevalence of one in 4,000. Neurofibroma, Cafe-au-lait spots, freckles in axilla, Lisch nodule and bony dysplasia are features of NF-1. It is diagnosed preoperatively by history taking, physical examination, CT, MRI and intraoperatively by tissue biopsy. Scalp neurofibroma accompanying pain, motor disturbance, rapid growth, and suspicious of malignancy are indications for surgical removal. We present a case of NF-1 with two giant neurofibromas (15x7x4 cm, 3x5x2 cm) on the left scalp in a patient suffering from a head injury after falling down. The neurofibromas were successfully removed after diagnosed by MRI and histology.
Axilla ; Biopsy ; Cafe-au-Lait Spots ; Craniocerebral Trauma ; Humans ; Melanosis ; Neurocutaneous Syndromes ; Neurofibroma ; Neurofibromatosis 1 ; Physical Examination ; Prevalence ; Scalp ; Stress, Psychological

The coexpression of cortical and medullary features in a single adrenal cortical cell has been recognized, leading to terms such as cortico-medullary cells. Here, we reported a case of adrenocortical adenoma consisting of cortico-medullary cells that clinically mimicked pheochromocytoma. A 52-year-old woman was admitted to our hospital complaining of an 8-month history of paroxysmal palpitation with refractory hypertension. A 24-hour urine study revealed increased norepinephrine and metanephrine levels. Computed tomography of the abdomen revealed a 1.0x0.9-cm mass in the left adrenal gland. The patient subsequently underwent unilateral laparoscopic adrenalectomy for a presumptive pheochromocytoma. Light microscopic findings of the left adrenal mass indicated an adrenocortical adenoma, but electron microscopy identified lipid vacuoles and smooth endoplasmic reticulum, along with dense core neurosecretory granules, so-called cortico-medullary cells. This is the first report of the detection of cortico-medullary cells in adrenocortical adenoma presenting as pheochromocytoma in Korea.
Abdomen ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma ; Endoplasmic Reticulum, Smooth ; Female ; Humans ; Hypertension ; Light ; Metanephrine ; Microscopy, Electron ; Middle Aged ; Norepinephrine ; Pheochromocytoma ; Vacuoles

Chronic expanding hematoma of the thorax is a specific subtype of the chronic empyema. It presents as a slowly expanding intrathoracic mass which result in dyspnea or recurrent hemoptysis. The symptoms develop months or years after tuberculous pleurisy, trauma or surgery. Usually, it shows three common findings: a giant mass lesion in the thorax, some surrounding calcifications, the absence of signs or symptoms of infection. We report a case of chronic expanding hematoma of the thorax, initially presenting as massive hemoptysis through bronchopleural fistula which resulted in radiologic findings of new air-fluid level within the previous pleural lesion filled with unknown materials.
Dyspnea ; Empyema ; Fistula ; Hematoma ; Hemoptysis ; Thorax ; Tuberculosis, Pleural

Schwannoma, also referred to as neurilemmoma, is an encapsulated benign soft tissue tumor arising from the schwann cells of the nerve sheath. Although 25 to 45% of schwannomas arise in the head and neck region, pterygopalatine fossa is the rarest sites of involvement with only 23 cases reported in the medical literature. It is usually seen in the second and fifth decades, but sex or racial predilection has not been noted. Clinical features of this tumor are dependent on the involved anatomical site, nerve of origin, and compression of adjacent structures. The differential diagnosis of masses in pterygopalatine fossa includes angiofibroma, fibrous histiocytoma, malignant melanoma, lymphoma, and low-grade rhabdomyosarcoma. The treatment of choice is that the tumor is completely removed with careful preservation of its nerve. Recently, the authors experienced a case of schwannoma arising in pterygopalatine fossa, which was removed with transantral approach. Hence, we report a rare case with a review of literature.
Angiofibroma ; Diagnosis, Differential ; Head ; Histiocytoma, Malignant Fibrous ; Lymphoma ; Melanoma ; Neck ; Neurilemmoma ; Pterygopalatine Fossa ; Rhabdomyosarcoma ; Schwann Cells

In most cases, sudden deafness results from viral infection, vascular occlusion or cochlear membrane rupture, but occasionally, its central origin can not be excluded. Although a number of signs are theoretically plausible in patients with pontine infarction such as facial weakness, lateral gaze palsy, Horner syndrome, limb dysmetria, crossed sensory loss or vertigo, isolated sudden deafness is a very rare manifestation. When pontine infarction occurs, it is usually identified on T2-weighted and diffusion-weighted magnetic resonance imaging (MRI). Early treatment with anticoagulant and antiplatelet agents leads to a more rapid resolution of symptoms and preservation of existing brain function. Recently, the authors have experienced two cases of sudden hearing loss caused by acute pontine infarction. Hence, we report two cases with a review of literature.
Brain ; Brain Stem Infarctions ; Cerebellar Ataxia ; Extremities ; Hearing Loss, Sudden ; Horner Syndrome ; Humans ; Infarction ; Magnetic Resonance Imaging ; Membranes ; Paralysis ; Platelet Aggregation Inhibitors ; Pons ; Rupture ; Vertigo

BACKGROUND AND OBJECTIVES: Tympanic membrane perforations are usually caused by trauma, infection, surgical procedures such as tympanoplasty or myringoplasty. Because perforations interfere with the transmission and perception of sound, whatever the cause of the perforation, repair of the membrane is desirable. The purpose of this study is to investigate the clinical application and usefulness of allograft amniotic membrane, instead of autograft materials, in the management of tympanic membrane perforation. SUBJECTS AND METHOD: A retrospective study was performed on 14 patients who underwent myringoplasty with allograft amniotic membrane for tympanic membrane perforation from October 2006 to September 2007. Information was collected on sex, age, the cause of perforation, the perforation size, postoperative hearing result, the success rate. RESULTS: Of 14 patients, 13 patients were successfully treated by myringoplasty with allograft amniotic membrane and one patient failed due to infection. So the overall success rate was 93%. The mean air-bone gap was improved from 13.3 dB to 7.1 dB. CONCLUSION: The myringoplasty with allograft amniotic membrane is a successful procedure for the healing of tympanic membrane perforations.
Amnion ; Hearing ; Humans ; Membranes ; Myringoplasty ; Retrospective Studies ; Transplantation, Homologous ; Tympanic Membrane ; Tympanic Membrane Perforation ; Tympanoplasty

Solitary tubulovillous adenoma of the duodenal bulb is a rare tumor, which has not been reported in the Korean literature. Most of duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the duodenal bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.
Adenoma