Clinical Experiences and Selection of Accessory Devices for Pediatric Endoscopic Foreign Body Removal: A Retrospective Multicenter Study in Korea

Background@#Swallowing of foreign bodies (FBs) is the most common indication of therapeutic endoscopy in children. Endoscopic removal may be necessary depending on the type of FB, age of the child, and location of the FB. We attempted to analyze the characteristics of each device used for the endoscopic removal of FBs in children. @*Methods@#Medical records of the patient’s age, sex, weight, type, location, size, shape, type of device used for endoscopic removal, and endoscopic time were retrospectively collected. @*Results@#A total of 424 FB removal procedures were analyzed. The average age of the patients at the time of FB removal was 4.1 ± 3.7 years. Coins were the most common FBs (192, 45.3%). The most common locations of the FBs were the esophagus (45.7%) and the stomach (48.3%), respectively. For a total of 371 cases, forceps were used in 96 cases (25.9%) for esophageal FBs and in 25 cases for gastric FBs (6.7%), while nets were used in 250 cases (67.4%) for gastric FBs retrieval; the average durations of the procedures were 7.2 ± 7.4 minutes, 8.5 ± 7.2 minutes, and 5.7 ± 7.3 minutes, respectively (P = 0.003). The procedure time was significantly shorter, in the group of patients with low body weights, when nets were used than when forceps were used to remove gastric FBs (P = 0.001). @*Conclusion@#The endoscopic procedure duration, in low-weight children, was shorter when retrieval nets were used than that with forceps.

A Case of Endoscopically Treated Laryngopharyngitis Resulting from Clinostomum complanatum Infection / 대한소화기학회지

A 46-year-old woman visited our hospital presenting throat pain and globus sensation. The symptoms occurred seven days after eating raw perch and mullet. An endoscopy under sedation showed a fluke―with an approximate length of 4.8 mm and width of 1.5 mm―on the left aryepiglottic fold, with active motility on the mucosa. It was extracted from the larynx using biopsy forceps and was identified as Clinostomum complanatum. To the best of our knowledge, this is the second reported case of human infection with Clinostomum complanatum diagnosed and treated by an endoscopy in Korea. Endoscopy is a useful tool in the diagnosis and treatment of patients at risk for parasitic infections complaining of throat pain.

A Case of Acute Endophthalmitis After 23-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To report a case of acute endophthalmitis associated with 23-gauge transconjunctival sutureless vitrectomy and gas tamponade for macular hole surgery. CASE SUMMARY: A 66-year-old female patient who presented with a macular hole in the left eye was treated with 23-gauge transconjunctival sutureless vitrectomy. On postoperative day 2, the patient developed acute endophthalmitis and was treated with gas-fluid exchange, lensectomy and intravitreal antibiotic injection. Staphylococcus epidermidis was detected in the vitreous fluid of the operated eye. Intraoperative fundus findings showed severe retinal hemorrhage, vascular occlusion and fibrous membranes due to inflammatory response. After treatment, the patient's fundus findings markedly improved and the inflammatory response was controlled. CONCLUSIONS: Acute endophthalmitis after sutureless vitrectomy performed via intraocular gas injection may quickly result in inflammation and disease due to infection. Immediate reoperation and intravitreal antibiotic injections are recommended in such cases.

A Case of Acute Eosinophilic Myopericarditis Presenting with Cardiogenic Shock and Normal Peripheral Eosinophil Count

Eosinophilic myocarditis usually results from myocardial damage as a result of drugs or parasites, and is generally associated with increased peripheral eosinophil count. This form of myocarditis is difficult to diagnose clinically. A 25 year-old previously healthy woman was transferred from a local clinic because of hypotension and dyspnea with sudden cardiogenic shock after a three day history of gastrointestinal illness. Echocardiography revealed concentric left ventricular wall thickening with moderate pericardial effusion. Biopsy of endomyocardial tissue from the right ventricle showed diffuse infiltration of inflammatory cells, mostly eosinophils, even though the patient had a peripheral eosinophil count that was normal at the time of biopsy. The patient was treated with corticosteroids for the symptoms of pericarditis, and she recovered without cardiac sequelae, clinically and echocardiographically. We here report a case of acute eosinophilic myopericarditis, with cardiogenic shock, diagnosed by endomyocardial biopsy with normal peripheral eosinophil count at the time of biopsy, and complete recovery without sequelae.

Thyroid Papillary Carcinoma with Exuberant Nodular Fasciitis-like Stroma: A Case Report

Thyroid papillary carcinoma (TPC) with exuberant nodular fasciitis-like stroma is one of the rare variants of TPC. To date, only 19 cases have been reported in the English medical literature. We report here on the the first Korean case of TPC that contained a prominent nodular fasciitis-like stroma. A 40-year-old female presented with a hard painless right neck mass that had been present for two months. Total thyroidectomy disclosed a solitary nodule in the mid portion of the right lobe that measured 25 x 20 mm. The tumor was well delineated, but it was not encapsulated. Microscopically, the tumor was a typical papillary carcinoma except that large areas of the tumor were occupied by a stroma composed of irregular fascicular spindle cells. The stromal component accounted for 60% of the tumor mass. The spindle cells exhibited neither atypism nor mitosis, and the tumor's extensive stromal cell proliferation resembled the appearance of nodular fasciitis of the soft tissues. Immunohistochemically, the spindle cells were positive for vimentin and alpha-smooth muscle actin, but they were negative for thyroglobulin, thyroid transcription factor-1, S-100 protein, CD34 and desmin, and this represents myofibroblastic features.

Polymorphism and Mutation of C-Stretch of the D-loop of Mitochondrial DNA / 대한법의학회지

To investigate the polymorphism and mutation of the C-stretch of the D-loop in mitochondrial DNA in the maternal lineages in Koreans, Amp-FLP (amplified fragment length polymorphism), cloning and sequencing, and analysis of overlapped signals of the end of C-stretch after enlargement of Y axis of electropherogram were performed in 104 random objects and 63 families which are confirmed by STR analysis of autosome, Y chromosome, X chromosome and D-loop of mitochondrial DNA. Analysis of Amp-FLP and enlargement of Y axis of electropherogram are better than sequencing after cloning in the analysis of C-stretch. C- stretch 16183 has 15 genotypes, C-stretch 303 has 14 genotypes, C-stretch 568 has 6 genotypes, These results are useful for individual identification. However, mutation of C-stretch 16183, C-stretch 303, and C-stretch 568 were observed in 5 (7.9%), 7 (11.1%), and 1 (1.6%) cases among the 63 families. It means the C-stretch cannot be applied to analyze the genetic pattern in the maternal lineages. Conclusively, Amp-FLP and enelargement of Y axis of electropherogram are enough for analysis of C-stretch. Analysis of C-stretch is useful for individual identification and not in the study of maternal lineages.

An Autopsy Case of Postpartum Acute Myocardial Infarction Associated with Postpartum Ergot Alkaloids Administration in Old-Aged Pregnant Women

Cases of acute myocardial infarction (AMI) that occur during pregnancy or postpartum are rarely reported. Ergot derivatives are known to induce the spasmodic contraction of coronary arteries. Administration of ergot derivatives can cause AMI, even in normal healthy people. In several reported cases, ergot derivatives triggered severe AMI during the postpartum period. Here, we report the case of a forty-year-old woman who was successfully impregnated by artificial fertilization and died after treatment with ergot derivatives. The autopsy revealed AMI with severe coronary atherosclerosis. This is the first case that reports aggravation of pre-existent severe coronary atherosclerosis after postpartum infusion of ergot derivtives.

Acute Appendicitis in Henoch-Schonlein Purpura: A Case Report

Common complications of Henoch-Schonlein purpura (HSP) that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Acute appendicitis is rarely seen as a complication of HSP. A sevenyear-old boy was admitted for arthralgia, abdominal pain, hematochezia, melena, and purpuric rash on the lower extremities. On admission day abdominal ultrasonography was normal, but on day 5, he became pyrexial and developed right iliac fossa pain and tenderness with guarding. Ultrasonography showed distended appendix surrounded by hyperechoic inflamed fat. On exploration an acutely inflamed, necrotic appendix was removed and grossly there was an appendiceal perforation in the appendiceal tip. Microscopically some of the small blood vessels in the submucosa showed fibrinoid necrosis with neutrophilic infiltrations. The authors report the case of a child who developed acute perforative appendicitis requiring appendectomy while on treatment for HSP.

The Evaluation of HRTII in Screening of Glaucoma with Different Discrimiant Formulas in Koreans

PURPOSE: To find the optimal discrimiant formula of HRTII program in detection of glaucoma in Korean patients. METHODS: The objects of this study were 421 eyes of 225 patients at Kangnam St. Mary's Hospital from December in 2002 to February in 2003. Humphery automated perimetry, program C24-2 testing, and HRTII (Software: IP1-V1.6) were performed. The results were analyzed with Moorfields discrimiant formula, Mikelberg discrimiant formula and Park discrimiant formula. RESULTS: In 421 eyes, the number of glaucomatous eyes was 214. The accuracy of Moorfields discrimiant formula was 71.25%, its sensitivity was 72.42%, and its specificity was 70.04%, The accuracy of Mikelberg discrimiant formula was 71.49%, its sensitivity was 71.96%, and its specificity was 71.01%, The accuracy of Park discrimiant formula was 72.92%, its sensitivity was 73.31%, and its specificity was 72.46%. CONCLUSIONS: Park discrimiant formula was expected to be useful in the screenning of glaucoma in Korean patients.

Comparison of Decentration and Tilt of Sensar(R) with Acrysof

PURPOSE: To compare the change in the decentration and the tilt of Sensar(R) with Acrysof(R). The optic and haptic portions of the two had a similar composition, but the difference between the two intraocular lens groups was the shape. METHODS: The objects of this study were 59 patients (69 eyes) with Sensar(R) and 44 patients (49 eyes) with Acrysof(R). Each posterior chamber intraocular lens (PCL) was inserted into the capsular bag after continuous curvilinear capsulorhexis and phacoemulsification. The decentration and the tilt of Sensar(R) and Acrysof(R) were measured 1 day, 30 days and 60 days postoperatively using anterior eye segment analysis system (EAS 1000, Nidek, Japan). RESULTS: The decentration of Sensar(R) was significantly lower than that of Acrysof(R) on the 1st and 30th postoperative day but showed no difference on the 60th day. Decentration of Sensar(R) and Acrysof(R) showed no difference on 1st, 30th and 60th postoperative day. CONCLUSIONS: If Sensar(R) and Acrysof(R) are both inserted into the capsular bag adequately, the decentration and the tilt of the two IOLs show no difference on the 60th postoperative day.

Mesoblastic Nephroma of Adulthood

Mesoblastic nephroma is a benign neoplasm of the kidney, which is usually diagnosed during the first six months of life. Incidence in adults is exceedingly rare. We report herein a case of mesoblastic nephroma that occurred in the upper pole of the right kidney of a 39-year-old woman. It was a round mass measuring 3X3X2 cm in dimension. Microscopically, it consisted of uniform spindle cells with foci of hyalinization and dystrophic calcification. Tubular structures were entrapped in the tumor. Upon immunohistochemical staining, the spindle cells were found to be positive for smooth muscle actin, desmin, and vimentin. The epithelial cells of the entrapped tubules were positive for cytokeratin. On electron microscopic examination, the spindle cells demonstrated smooth muscle differentiation identified by indented nuclei, microfilaments beneath the cell membrane, dense bodies, and basal lamina-like materials.

Malignant Granular Cell Tumor of the Shoulder: A case report

A malignant granular cell tumor (MGCT) occurred in the left shoulder of a 62-year-old man. The patient underwent wide marginal excision followed by chemotherapy and radiotherapy. A metastatic tumor was identified in the axillary lymph node 22 months after the excision of the shoulder mass. The primary tumor was a poorly circumscribed mass measuring 5 5 4 cm. On cut section, it was a solid mass with yellowish tan color. Histologically, both primary and metastatic tumor consisted of polygonal cells with abundant granular cytoplasm and a vesicular nucleus with a prominent nucleolus. Two to three mitotic figures per ten high power fields at 200 were counted. Tumor cells were weakly stained with periodic acid-Schiff (PAS) preparation both before and after diastase digestion, and were positive for S-100 protein, neuron-specific enolase (NSE), and vimentin. By electron microscopy, the cytoplasm was filled with numerous autophagolysosomes containing myelin figures, mitochondria, and fragmented rough endoplasmic reticula. Basal laminae and angulated bodies were also noted. These findings suggest schwannian differentiation of this tumor.

Cytoskeletal Changes in Cortical Dysplasia

Cortical dysplasia is a cause of intractable epilepsy and a candidate for surgical resection to control epileptic attacks. The neuronal cytomegaly and balloon cell change are the diagnostic hallmarks of cortical dysplasia. Little research has been performed about the normal-sized dysplastic neuron which has complex arborizing dendrites and lacks in its polarity. The aim of this study was to define the histopathologic characteristics of the neurons in cortical dysplasia. Twelve cases of cortical dysplasia who underwent partial lobectomy for intractable seizures were selected and immunohistochemical staining for NF-M/H, MAP2, tau, and ubiquitin was performed. The perikarya and dendrite of dysplastic neurons were more intensely labeled with antibodies for the high and medium molecular weight neurofilament proteins (NF-M/H) than normal neurons. Immunoreactivity with the MAP2 antibody expressed mainly within the somatodendritic regions was present in the dysplastic or normal neurons without any significant difference in intensity. The complex arborizing dendrites of dysplastic neurons were easily identified due to pronounced immunoreactivity within the somatodendritic regions. Immunoreactivity with the primary antibody against tau and ubiquitin was present in the normal-looking neurons as well as the dysplastic neurons. This study suggests that the dysplastic neurons in cortical dysplasia are accompanied by changes of cytoskeletal neurofilaments, and the immunohistochemical stains for NF-M/H, MAP2, tau, and ubiquigin are useful to detect them.

Significance of rectosigmoid polyp as a predictor of proximal colonic polyp

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.