Cytomegalovirus (CMV) is the most important opportunistic viral pathogen in solid organ transplant (SOT) recipients.The Korean guideline for the prevention of CMV infection in SOT recipients was developed jointly by the Korean Society for Infectious Diseases and the Korean Society of Transplantation. CMV serostatus of both donors and recipients should be screened before transplantation to best assess the risk of CMV infection after SOT. Seronegative recipients receiving organs from seropositive donors face the highest risk, followed by seropositive recipients. Either antiviral prophylaxis or preemptive therapy can be used to prevent CMV infection. While both strategies have been demonstrated to prevent CMV infection post-transplant, each has its own advantages and disadvantages. CMV serostatus, transplant organ, other risk factors, and practical issues should be considered for the selection of preventive measures. There is no universal viral load threshold to guide treatment in preemptive therapy. Each institution should define and validate its own threshold.Valganciclovir is the favored agent for both prophylaxis and preemptive therapy. The evaluation of CMV-specific cellmediated immunity and the monitoring of viral load kinetics are gaining interest, but there was insufficient evidence to issue recommendations. Specific considerations on pediatric transplant recipients are included.

Purpose: We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. Conclusions Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

Purpose: We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. Conclusions Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.

Gynecomastia refers to persistent enlargement of the breast in males caused by enlargement of the breast bud and surrounding stroma. It typically occurs in newborns, during early adolescence, and in late adulthood. There are several pathological causes. If no pathological cause is evident, gynecomastia is considered idiopathic. The reported prevalence of unilateral gynecomastia is approximately 35% to 45%, but most previous reports have focused on distinctive pathologic causes. As such, few previous reports of idiopathic unilateral gynecomastia during early adolescence have been published. Herein, we report a case of idiopathic unilateral gynecomastia in an adolescent male.
Adolescent* ; Breast ; Gynecomastia* ; Humans ; Infant, Newborn ; Male ; Male* ; Prevalence

Gynecomastia refers to persistent enlargement of the breast in males caused by enlargement of the breast bud and surrounding stroma. It typically occurs in newborns, during early adolescence, and in late adulthood. There are several pathological causes. If no pathological cause is evident, gynecomastia is considered idiopathic. The reported prevalence of unilateral gynecomastia is approximately 35% to 45%, but most previous reports have focused on distinctive pathologic causes. As such, few previous reports of idiopathic unilateral gynecomastia during early adolescence have been published. Herein, we report a case of idiopathic unilateral gynecomastia in an adolescent male.
Adolescent* ; Breast ; Gynecomastia* ; Humans ; Infant, Newborn ; Male ; Male* ; Prevalence

PURPOSE: Upper gastrointestinal bleeding (UGIB) is one of the most common causes of emergency department (ED) presentation which can lead to a fatal condition. Many clinical scoring systems intended to predict the prognosis of UGIB patients were developed and validated, including Glasgow-Blatchford score (GBS) and Rockall score (RS). In particular, GBS has shown its superiority in prediction of mortality, the necessity of endoscopic intervention and admission, compared with other scoring systems, in recent studies. However, GBS does not include the age of the patient as its component and has clearly shown its efficacy only in subjects under age 70. Hence, we aimed to assess whether GBS could also be used in old age UGIB patients as a useful risk stratifying method as in younger age. METHODS: UGIB patients who visited our ED for one year were retrospectively enrolled in the analysis. Medical records of the subjects were reviewed, and their GBS and clinical RS were calculated. Receiver-operating characteristics (ROC) curve of each score in prediction of high risk UGIB was drawn and area under curve (AUC) was calculated. Correlation analysis of each score and hospital length of stay was also performed. To assess the validity of each score for use in old age patients, all analyses were also performed in subgroups of age over 60 years, and under that. RESULTS: ROC curves suggest that GBS has significant detecting power for high risk UGIB in overall subjects, subgroups of age over 60 and under (p=<0.001 for all, AUC=0.919, 0.935, 0.901, respectively). Otherwise, clinical RS only showed significant results in overall group and subgroup of age over 60 with lower AUC. CONCLUSION: GBS may also be used safely as an initial risk stratifying method in old age UGIB patients visiting the ED, as in other age groups.
Area Under Curve ; Emergency Service, Hospital* ; Gastrointestinal Hemorrhage ; Geriatric Assessment ; Hemorrhage* ; Humans ; Length of Stay ; Medical Records ; Mortality ; Patient Acuity ; Prognosis ; Retrospective Studies ; ROC Curve

An immunoglobulin G4 (IgG4)-related disease is a recently emerging entity, and a few cases of IgG4-related disease in lung and pleura have been reported. Herein, we report the case of a 74-year-old man with IgG4-related disease of lung and pleura, clinically suspicious of malignant mesothelioma. Chest computed tomography showed diffuse nodular pleural thickening, and microscopic finding disclosed diffuse thickening of visceral pleura with infiltrations of many lymphoplasma cells with increased number of IgG4-positive plasma cells and a few multinucleated giant cells. It is important for pathologists and clinicians to recognize this rare entity and its histologic finding, because it can be confused with malignant tumors on the radiologic examination although it can be treated with steroid therapy.
Aged ; Giant Cells ; Humans ; Immunoglobulin G ; Immunoglobulins ; Lung ; Lung Diseases ; Mesothelioma* ; Plasma Cells ; Pleura ; Pleural Diseases ; Thorax

BACKGROUND/AIMS: Real-time, convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used for the staging of malignant mediastinal lymph nodes. We evaluated the diagnostic efficacy and safety of EBUS-TBNA when used as an initial diagnostic tool. METHODS: We retrospectively studied 56 patients who underwent EBUS-TBNA as an initial diagnostic tool between August 2010 and December 2011. Procedure purpose were classified into four categories: 1) intrathoracic masses adjacent to the central airway; 2) enlarged lymph nodes for concurrent diagnosis and staging in suspected malignancy; 3) enlarged lymph nodes in suspected malignancy cases with inability to perform percutaneous core needle biopsy (PCNB); and 4) solely mediastinal masses/lymph nodes in lieu of mediastinoscopy. RESULTS: The diagnostic accuracy of EBUS-TBNA regardless of procedure purpose was calculated to be 83.9%. Furthermore, the diagnostic accuracy of malignant disease was significantly higher than benign disease (93.9% vs. 70.6%, p < 0.001). The diagnostic accuracy of EBUS-TBNA for each disease is as follows: tuberculosis, 50%; sarcoidosis, 60%; aspergillosis, 100%; lung abscess, 100%; lung cancer, 93%; and lymphoma, 100%. There were minor complications in seven patients during the EBUS-TBNA procedure. The complications included mild hypoxia and bleeding. CONCLUSIONS: In conclusion, EBUS-TBNA is a useful initial diagnostic tool for both benign and malignant diseases. EBUS-TBAN is also a very safe procedure and less invasive compared to mediastinoscopy or PCNB.
Adult ; Aged ; Aged, 80 and over ; Biopsy, Large-Core Needle ; *Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects ; Female ; Humans ; Lung Diseases/*pathology/radiography ; Lung Neoplasms/pathology ; Lymph Nodes/*pathology/radiography ; Lymphatic Metastasis ; Male ; Mediastinoscopy ; Middle Aged ; Neoplasm Staging ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: Measuring grip and pinch strength is an important part of hand injury evaluation. Currently, there are no standardized values of normal grip and pinch strength among the Korean population, and lack of such data prevents objective evaluation of post-surgical recovery in strength. This study was designed to establish the normal values of grip and pinch strength among the healthy Korean population and to identify any dependent variables affecting grip and pinch strength. METHODS: A cross-sectional study was carried out. The inclusion criterion was being a healthy Korean person without a previous history of hand trauma. The grip strength was measured using a Jamar dynamometer. Pulp and key pinch strength were measured with a hydraulic pinch gauge. Intra-individual and inter-individual variations in these variables were analyzed in a standardized statistical manner. RESULTS: There were a total of 336 healthy participants between 13 and 77 years of age. As would be expected in any given population, the mean grip and pinch strength was greater in the right hand than the left. Male participants (137) showed mean strengths greater than female participants (199) when adjusted for age. Among the male participants, anthropometric variables correlated positively with grip strength, but no such correlations were identifiable in female participants in a statistically significant way. CONCLUSIONS: Objective measurements of hand strength are an important component of hand injury evaluation, and population-specific normative data are essential for clinical and research purposes. This study reports updated normative hand strengths of the South Korean population in the 21st century.
Cross-Sectional Studies ; Female ; Hand ; Hand Injuries ; Hand Strength ; Humans ; Male ; Pinch Strength ; Population Dynamics ; Reference Values

BACKGROUND/AIMS: While chemoradiotherapy (CRT) is considered to be a reasonable treatment for locally advanced pancreatic cancer (LAPC), there is little information about the associated risk of gastrointestinal (GI) hemorrhage. We investigated the clinical features of GI toxicity after CRT in patients with LAPC and examined the effect of GI hemorrhage on survival. METHODS: Patients enrolled in this study had received CRT for pathologically proven LAPC. Their medical records were retrospectively reviewed. RESULTS: A total of 156 patients with LAPC (median age, 65 years; range, 39 to 90 years) who received treatment between August 2005 and March 2009 were included in this study. The most common GI toxicities were ulcer formation (25.6%) and hemorrhage (25.6%), and the most common grade 3 to grade 5 GI toxicity was hemorrhage (65%). The origins of GI hemorrhage were gastric ulcer (37.5%), duodenal ulcer (37.5%), and radiation gastritis (15.0%). The independent risk factor for GI hemorrhage was tumor location in the pancreatic body. The median overall survival of the patients with a GI hemorrhage was 13.8 months (range, 2.8 to 50.8 months) and was not significantly different from that of patients without GI hemorrhage. CONCLUSIONS: GI hemorrhage was common in patients with LAPC after CRT. Although GI hemorrhage was controlled with endoscopic hemostasis, preventive measures should be investigated to reduce needless suffering.
Chemoradiotherapy ; Duodenal Ulcer ; Gastritis ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Medical Records ; Pancreatic Neoplasms ; Retrospective Studies ; Risk Factors ; Stomach Ulcer ; Stress, Psychological ; Ulcer