Clinical and endoscopic characteristics of sessile serrated lesions with dysplasia/carcinoma

Background/Aims@#Some sessile serrated lesions (SSLs) progress into dysplasia and colorectal cancer, however, the clinical and endoscopic characteristics of SSLs with dysplasia remain to be determined. In this study, we elucidated these characteristics in SSLs with dysplasia/carcinoma, compared with those of SSLs without dysplasia. @*Methods@#We retrospectively collected the clinical, endoscopic, and pathological data of 254 SSLs from 216 patients endoscopically resected between January 2009 and December 2020. @*Results@#All SSLs included 179 without dysplasia and 75 with dysplasia/carcinoma, including 55 with low-grade dysplasia, 10 with high-grade dysplasia, and 10 with submucosal cancer. In clinical characteristics, SSLs with dysplasia/carcinoma were significantly associated with advanced age, metabolic diseases, and high-risk adenomas. In endoscopic characteristics, SSLs with dysplasia/carcinoma were significantly associated with the distal colon, large size, polypoid morphology, surface-changes, no mucus cap, and narrow-band imaging international colorectal endoscopic classification (NICE) type 2/3. In the multivariate analysis, high-risk adenomas (odds ratio [OR], 2.98; p = 0.01), large size (OR, 1.18; p < 0.01), depression (OR, 11.74; p = 0.03), and NICE type 2/3 (OR, 14.97; p < 0.01) were significantly associated with SSLs with dysplasia/carcinoma. @*Conclusions@#SSLs had a higher risk of dysplasia in the distal colon than in the proximal colon. SSLs with large size, depression, and adenomatous surface-patterns, as well as those in patients with high-risk adenomas, increased the risk of dysplasia/ carcinoma. This suggests that the clinical and endoscopic characteristics can aid in the diagnosis and management of SSLs with dysplasia/carcinoma.

Superior Patellar Sleeve Fracture after Serial Knee Injuries / 대한정형외과학회잡지

Sleeve fractures of the superior pole of the patella are rare but usually occurs in adolescents with an immature skeletal system. This paper reports a 15-year-old male who complained of knee pain after a bicycle accident. The initial radiographs and magnetic resonance imaging showed a bony bruise of the patella with signal change on the medial meniscus. After conservative treatment with immobilization for four weeks, he slipped down, and eccentric forced flexion of the knee was applied. This second injury caused a sleeve fracture of the superior pole of the patella. After splint immobilization for five weeks, the patient showed adequate function of the quadriceps and range of motion.Among the cases collected, some patients showed a similar history of sleeve fracture of the superior pole of the patella after serial knee injuries.

A large and pedunculated inflammatory pseudotumor with pseudosarcomatous change of the cecum mimicking a malignant polyp: a case report and literature review

Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown etiology that can occur in almost any organ system. It has neoplastic features such as local recurrence, invasive growth, and vascular invasion, leading to the possibility of malignant sarcomatous changes. The clinical presentations of colonic IPT may include abdominal pain, anemia, a palpable mass, and intestinal obstruction. A few cases of colonic IPT have been reported, but colonic IPT with pedunculated morphology is very rare. Furthermore, since it can mimic malignant polyps, understanding the endoscopic findings of colonic IPT is important for proper treatment. Herein, we present a case of colonic IPT with pseudosarcomatous changes, presenting as a large polyp, mimicking a malignant polyp in the cecum, along with a literature review.

Cadaveric Study of Thread Carpal Tunnel Release Using Newly Developed Thread, With a Histologic Perspective

Objective@#To examine the usefulness and feasibility of modified thread carpal tunnel release (TCTR) by comparing the results of using pre-existing commercial thread with those of a newly developed thread (Smartwire-01). @*Methods@#A total of 17 cadaveric wrists were used in the study. The modified TCTR method was practiced by two different experts. Pre-existing commercial surgical dissecting thread (Loop&ShearTM) was used for five wrists and the newly developed Smartwire-01 was used for twelve wrists. The gross and microanatomy of the specimens were evaluated by a blinded anatomist. @*Results@#Both types of thread were able to cut the TCL similarly. Gross anatomy and histologic findings showed that there was no significant difference between the two types of threads. However, the practitioners felt that it was easier to cut the TCL using the newly-developed thread. @*Conclusion@#TCTR using Smartwire-01 was as effective as pre-existing Loop&ShearTM, with better user experiences.

Olmesartan-associated Enteropathy with Acute Kidney Injury / 대한소화기학회지

Olmesartan, a recently introduced angiotensin II receptor blocker for hypertension, has been reported to cause drug-induced small bowel enteropathy. The diagnosis of olmesartan-associated enteropathy (OAE) needs clinical suspicion and the exclusion of coeliac disease, as it mimics coeliac sprue. Once diagnosed, it can be completely cured with the discontinuation of olmesartan. However, due to the extremely low incidence of OAE in Korea, clinical suspicion and diagnosis may be a challenge. The authors report the first case of OAE presenting with chronic diarrhea and acute kidney injury in Korea.

A Cadaveric Study of Thread Cubital Tunnel Release with Newly Developed Threads

Objective@#: The percutaneous thread transection technique is a surgical dissecting method using a dissecting thread inserted through a needle under ultrasound guidance without skin incision. As the new dissecting threads were developed domestically, this cadaver study was conducted to compare the effectiveness and safety between the new threads (ultra V sswire and smartwire-01) and a pre-existing commercial dissecting thread (loop & shear) by demonstrating a modified looped thread cubital tunnel release. @*Methods@#: The percutaneous cubital tunnel release procedure was performed on 29 fresh cadaveric upper extremities. The preexisting commercial thread was used in 5 upper extremities. The two newly developed threads were used in 24 upper extremities. Two practitioners performed the procedures separately. After the modified looped thread cubital release, anatomical and histological analyses were performed by a blinded anatomist. The presence of the dissected cubital tunnel and damaged adjacent soft tissue was assessed. @*Results@#: Out of the 29 cadaveric upper extremities, 27 specimens showed complete dissection of the Osborne ligament and the proximal fascia of the flexor carpi ulnaris muscle. One specimen was incompletely dissected in each of the ultra V sswire and smartwire-01 groups. There were no injuries of adjacent structures including the ulnar nerve, ulnar artery, medial antebrachial cutaneous nerve, or flexor tendon with either the commercial thread or the newly developed threads. The anatomical analysis revealed clear and sharp incisional margins of the cubital tunnel in the Smartwire-01 and loop & shear groups. All three kinds of threads maintained proper linear elasticity for easy handling during the procedure. The smartwire-01 provided higher visibility in ultrasound than the other threads. @*Conclusion@#: The newly developed threads were effective and safe for use in the thread cubital tunnel release procedure.

Evaluating the effectiveness of gluteal intramuscular injection sites: a cadaveric study / 대한해부학회지

The gluteal region is a frequent target for injecting high volumes. However, the safe intramuscular injection sites have been controversy in this region. This study was aimed to compare the subcutaneous fat and muscle thicknesses at the two gluteal injection sites and to determine the influence of sex and body mass index (BMI) on fat and muscle thicknesses.The ultimate purpose of this study is to suggest the most suitable intramuscular injection site among the ventrogluteal and dorsogluteal regions. Eleven fresh cadavers were injected with colored gelatin using syringes at the two gluteal injection sites.Seven variables were measured at both gluteal injection sites and analyzed relative to sex and the BMI. No variables showed statistically significant differences between the two gluteal injection sites according to sex. In a one-way analysis of variance, total length and muscle thickness had significant difference according to the BMI category. In obese cadavers, the injected gelatin core was located in the subcutaneous layer (average 109.0 percentile), and in the muscle layer (average 78.9 percentile) in the dorsogluteal region. These were found that the success rate of injection in the dorsogluteal region was higher than in the ventrogluteal region, especially when classed as obese. Also, it is suggested that nurses should use the traditional intramuscular injection method. It will also be necessary to consider expanding these findings to other ethnic groups in the Asia–Pacific region and then also education in universities and health providers on selecting the intramuscular gluteal injection site.

Basic Knowledge that Doctors Starting ERCP Should Know / 대한췌담도학회지

The first endoscopic retrograde cholangiopancreatography (ERCP) wad performed in 1968. With tremendous progress in techniques, instruments and devices, ERCP has played an important role in modern medicine for the diagnosis and management of various pancreaticobiliary diseases. ERCP has a potential risk of various complications even in the hands of the experts. The incidence of all ERCP-related complications is known to be about 4–10%, and that of fatal complications to be less than 0.5%. In order to prevent and minimize its side effects, the everyone who performs ERCP needs to fully understand various techniques and also recognize and deal with ERCP-related complications. In this review, we have summarized the must-know points in techniques and complications of ERCP for the beginners.

The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve / 대한해부학회지

Understanding anatomic variations in neurovascular structure inside the femoral triangle is crucial for regional anesthesiologists performing femoral nerve block. During routine dissection of a cadaver, an ascending branch of the lateral circumflex femoral artery with an anomalous course passing through the femoral nerve, specifically the posterior division, was identified inside the femoral triangle on the left thigh. The novel variation identified in this study occurred in an early stage of prenatal development. Recognition of this anatomic variation will be helpful for reducing unexpected complications during the femoral nerve block and the tensor fascia latae flap. Penetration of the posterior division of the femoral nerve by the arterial branch might cause pain or paresthesia of the medial aspect of the leg in the distribution of the saphenous nerve.

Basic Knowledge that Doctors Starting ERCP Should Know / 대한췌담도학회지

The first endoscopic retrograde cholangiopancreatography (ERCP) wad performed in 1968. With tremendous progress in techniques, instruments and devices, ERCP has played an important role in modern medicine for the diagnosis and management of various pancreaticobiliary diseases. ERCP has a potential risk of various complications even in the hands of the experts. The incidence of all ERCP-related complications is known to be about 4–10%, and that of fatal complications to be less than 0.5%. In order to prevent and minimize its side effects, the everyone who performs ERCP needs to fully understand various techniques and also recognize and deal with ERCP-related complications. In this review, we have summarized the must-know points in techniques and complications of ERCP for the beginners.

The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve / 대한해부학회지

Understanding anatomic variations in neurovascular structure inside the femoral triangle is crucial for regional anesthesiologists performing femoral nerve block. During routine dissection of a cadaver, an ascending branch of the lateral circumflex femoral artery with an anomalous course passing through the femoral nerve, specifically the posterior division, was identified inside the femoral triangle on the left thigh. The novel variation identified in this study occurred in an early stage of prenatal development. Recognition of this anatomic variation will be helpful for reducing unexpected complications during the femoral nerve block and the tensor fascia latae flap. Penetration of the posterior division of the femoral nerve by the arterial branch might cause pain or paresthesia of the medial aspect of the leg in the distribution of the saphenous nerve.

Usefulness and Complications of Needle Knife Fistulotomy as a Rescue Procedure in Patients with Pancreaticobiliary Disease / 대한소화기학회지

Background/Aims@#Needle knife fistulotomy (NKF) is a technique to facilitate pancreatic and biliary duct access during ERCP. The double-guidewire technique (DGT) is also used in cases of difficult cannulation, but it can increase the incidence of post-ERCP-pancreatitis (PEP). This study examined the success and complication rates of NKF after unsuccessful standard cannulation or DGT in patients with pancreaticobiliary disease. @*Methods@#The data of 209 patients who received NKF as a rescue procedure between January 2009 and December 2016 were reviewed retrospectively. The cannulation success and complication rates were assessed. @*Results@#The overall cannulation success rate was 90.4%. The success rates of patients who received NKF after standard cannulation or DGT were similar (82.6% [142/172] and 73.0% [27/37], respectively, p=0.179). Furthermore, there was no significant difference in the incidence of procedure-related adverse events between the two groups (10.5% [18/172] and 16.2% [6/37], respectively, p=0.391). Endoscopic retrograde pancreatic drainage (ERPD) insertion decreased the incidence of PEP (0% [0/16] in ERPD and 14.6% [19/130] in non-ERPD, p=0.132) among patients who received PD cannulation. @*Conclusions@#NKF is an effective and safe method that can be considered for rescue management after the initial failure of standard cannulation or DGT. NKF following standard cannulation can be preferred over NKF following DGT because of the higher success rate and the lower rate of pancreatitis, but the difference was not significant. PD stenting in patients at high risk of PEP can be considered to decrease pancreatitis.

Three-Dimensional Morphometric Analysis of Penetrative Depth and Size of Nonarthritic and Degenerative Arthritic Glenoids: Implications for Glenoid Replacement in Shoulder Arthroplasty

Background@#Shoulder arthroplasty is technically demanding and relies heavily on the precision of surgical techniques. Proper glenoid component sizing plays a crucial role in successful shoulder arthroplasty. We measured the size and penetrative depth of the glenoid for peg or screw fixation in nonarthritic and degenerative arthritic shoulders by using three-dimensional computed tomography to determine the reference dimensions of the glenoid in nonarthritic and degenerative arthritic shoulders. @*Methods@#From January 2010 to January 2011, data on two groups of patients were collected and reviewed. Group 1 comprised 38 patients who underwent surgical treatment due to fracture of the proximal humerus and who had no evidence of a pathological glenoid. Group 2 comprised 14 patients who underwent surgical treatment due to osteoarthritis of the glenohumeral joint. The height (maximal superoinferior diameter) of the glenoid was measured, and the width (anteroposterior [AP] diameter) of the glenoid was measured at five different levels (H1–H5). Axial images were taken at H1–H5 levels, the AP glenoid diameter of each was divided into eight areas, and division points were labeled as W1–W7. The penetrative depths between the near cortex and far cortex of the glenoid (thickness) at each point (W1–W7) were measured. @*Results@#The overall mean glenoid height was 37.67 ± 4.09 mm in nonarthritic glenoids and 39.42 ± 3.54 mm in degenerative arthritic glenoids. The nonarthritic glenoid was significantly thicker than the degenerative arthritic glenoid at the H1W3, H1W4, H1W5, H2W7, H3W1, H3W6, H3W7, H4W5, H4W6, H4W7, H5W4, H5W5, H5W6, and H5W7 points. The posteroinferior quadrant had the smallest penetrative depth in both nonarthritic and degenerative arthritic glenoids. Also, the degenerative arthritic glenoids were significantly thinner than the nonarthritic glenoids along the posterior and inferior parts of the glenoid. @*Conclusions@#The posterior and inferior parts of the degenerative arthritic glenoid appears thinner than the nonarthritic glenoid. Thus, caution has to be taken when drilling the screw hole or inserting screws into the posteroinferior parts, where the glenoid is thinner than 15 mm on average, to avoid penetration of the far cortex.

Concurrent Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture: A Case Report

Isolated posterolateral corner (PLC) injury associated with a Schatzker type 2 fracture is a very rare combination of injuries. A male who was driving a motor vehicle was injured after a collision accident. The plain radiographs and computed tomography scans of the knee showed a Schatzker type 2 fracture of the tibial plateau, mostly in the anterolateral portion of tibial plateau, and an avulsion fragment on the fibular tip. Magnetic resonance imaging showed no injury to cruciate ligaments, medial collateral ligament, or any meniscal injury. We performed an open reduction operation and internal fixation for treating the fracture. Six months later, he complained of instability. At 11 months later after initial operation, we performed the second operation for stabilizing the PLC. We present here a rare case of an isolated PLC injury associated with a Schatzker type 2 fracture. We discuss the mechanism of injury and review similar cases.

Endoscopic Removal of Gastric Lipoma with Hemorrhage Using Endoscopic Submucosal Dissection / 대한내과학회지

Most upper gastrointestinal lipomas occur in the duodenal second portion, and gastric lipomas are rare. Most lipomas are usually asymptomatic, but symptoms such as abdominal pain, intussusception, ulceration, and intestinal obstruction may occur depending on the size and location and, rarely, can cause bleeding. Endoscopic polypectomy, endoscopic mucosal resection, and surgical resection are the treatments of choice for lipomas with intestinal obstruction or bleeding. Upper gastrointestinal bleeding from lipoma is mostly of duodenal origin and very rarely from the stomach. Here, we report a case of successful treatment of gastric lipoma with massive bleeding by endoscopic resection.

Comparison of the VMO/VL EMG Activity Ratio According to Resistance Condition in Partial Lunge Exercise

Purpose@#The purpose of this study was to investigate the effects of the resistance conditions on the electromyography (EMG) activity ratio of vastus medialis oblique (VMO) and vastus lateralis (VL) muscle during partial lunge exercise in healthy subjects in order to suggest the basic data of exercise intervention for such as patients with patellofemoral pain syndrome (PFPS). @*Methods@#The participants of this study were healthy twenty two people with no knee pain, limitation of motion and past history of operation at lower extremity. The participants performed three types of lunge 1) no resistance, 2) anterolateral 45° resistance and 3) lateral 90° respectively. The EMG activity of the VMO and VL were recorded by surface EMG and the measured data normalized by the %MVIC value was analyzed by repeated measured ANOVA. @*Results@#The results showed that the VMO/VL EMG activity ratio during lunge with anterolateral 45° resistance was significantly higher than with no resistance and lateral 90° resistance (p0.05). @*Conclusion@#This study suggests that partial lunge exercise with anterolateral 45° resistance can increase the VMO/VL muscle activity in healthy subjects. This result could be used as basic data to develop therapeutic exerc

Endoscopic Removal of Gastric Lipoma with Hemorrhage Using Endoscopic Submucosal Dissection / 대한내과학회지

Most upper gastrointestinal lipomas occur in the duodenal second portion, and gastric lipomas are rare. Most lipomas are usually asymptomatic, but symptoms such as abdominal pain, intussusception, ulceration, and intestinal obstruction may occur depending on the size and location and, rarely, can cause bleeding. Endoscopic polypectomy, endoscopic mucosal resection, and surgical resection are the treatments of choice for lipomas with intestinal obstruction or bleeding. Upper gastrointestinal bleeding from lipoma is mostly of duodenal origin and very rarely from the stomach. Here, we report a case of successful treatment of gastric lipoma with massive bleeding by endoscopic resection.

Comparison of the VMO/VL EMG Activity Ratio According to Resistance Condition in Partial Lunge Exercise

Purpose@#The purpose of this study was to investigate the effects of the resistance conditions on the electromyography (EMG) activity ratio of vastus medialis oblique (VMO) and vastus lateralis (VL) muscle during partial lunge exercise in healthy subjects in order to suggest the basic data of exercise intervention for such as patients with patellofemoral pain syndrome (PFPS). @*Methods@#The participants of this study were healthy twenty two people with no knee pain, limitation of motion and past history of operation at lower extremity. The participants performed three types of lunge 1) no resistance, 2) anterolateral 45° resistance and 3) lateral 90° respectively. The EMG activity of the VMO and VL were recorded by surface EMG and the measured data normalized by the %MVIC value was analyzed by repeated measured ANOVA. @*Results@#The results showed that the VMO/VL EMG activity ratio during lunge with anterolateral 45° resistance was significantly higher than with no resistance and lateral 90° resistance (p0.05). @*Conclusion@#This study suggests that partial lunge exercise with anterolateral 45° resistance can increase the VMO/VL muscle activity in healthy subjects. This result could be used as basic data to develop therapeutic exerc

Effects of Virtual Reality Horse Riding Simulator Training Using a Head-Mounted Display on Balance and Gait Functions in Children with Cerebral Palsy: A Preliminary Pilot Study

PURPOSE: The purpose of this study was to investigate the effects of three-dimensional virtual reality horse riding simulator training using a head-mounted display on gait and balance in children with cerebral palsy.METHODS: Ten children with cerebral palsy were randomly assigned to the horse riding simulator (HRS) group (n=5) or the horse riding simulator with virtual reality (HRSVR) group (n=5). To evaluate balance, center of gravity (COG) sway velocity and total sway distance of each group were assessed using the Wii balance board, and gait speed and stride length of each group were assessed using a gait analysis system.RESULTS: Intra-group comparisons between pre- and post-intervention measures revealed that there were significant changes in all gait and balance variables such as stride length, gait velocity, COG sway velocity and COG sway distance in the HRSVR group (p<0.05). In the HRS group, there were significant changes in all variables except stride length (p<0.05). In addition, inter-group comparisons showed significant differences between the two groups in stride length, gait velocity and COG sway distance except COG sway velocity (p<0.05).CONCLUSION: The findings of this study suggest that horse riding simulator training combined with 3D virtual reality can be a new positive therapeutic approach for improving functional performance in children with cerebral palsy.

A Rare Case of Extrahepatic Left Hepatic Duct Diverticulum: Case Report with Literature Review / 대한췌담도학회지

Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.