Comprehensive Rehabilitation in Patients with Acute Respiratory Distress Syndrome due to Coronavirus Disease 2019 (COVID-19)

We described a case in which symptoms and function improved through rehabilitation in a patient with coronavirus disease 2019 (COVID-2019) accompanied by acute respiratory distress syndrome (ARDS), limb weakness, and peroneal neuropathy. A 71-year-old man was diagnosed with COVID-19 and ARDS. He needed extracorporeal membrane oxygenation (ECMO) treatment in an incentive care unit (ICU). After ICU treatment, both ankle dorsiflexor weakness and foot drop were present. Common peroneal neuropathy was diagnosed and it was presumed to be due to long-term ECMO application. Comprehensive rehabilitation was performed to improve respiratory function and functional level. In addition, electrical stimulation therapy was applied to strengthen the ankle dorsiflexor. Before rehabilitation, he could not maintain a sitting position independently and required oxygen supply through tracheostomy. After 6 months rehabilitation, he was able to walk independently without oxygen.However, the ankle dorsiflexor did not improve sufficiently, so ankle foot orthosis was applied for outdoor gait.

Shoulder Quadruple Dislocation Fracture: Fracture of Glenoid Rim, Coracoid Process, Greater Tuberosity, Surgical Neck of Humerus Associated with Anterior Shoulder Dislocation: A Case Report

Shoulder joint dislocation has the most common incidence rate compare compared to other joints. It is reported that shoulder Shoulder dislocation couldmay be associated with glenoid rim, greater tuberosity of humerus and coracoid process fracture. There were have only been 2 cases of anterior shoulder dislocation simultaneously combined with simultaneous glenoid rim, coracoid process, and humerus greater tuberosity fracture worldwide and no report reports in Korea. We present a case of quadruple fracture (glenoid rim, coracoid process, greater tuberosity, surgical neck of humerus) associated with anterior shoulder dislocation and treated successfully by open reduction. In addition, with we provide the injury mechanism, diagnosis, treatment procedure and discussion.

Mitochondrial Control of Innate Immunity and Inflammation

Mitochondria are key organelles involved in energy production, functioning as the metabolic hubs of cells. Recent findings emphasize the emerging role of the mitochondrion as a key intracellular signaling platform regulating innate immune and inflammatory responses. Several mitochondrial proteins and mitochondrial reactive oxygen species have emerged as central players orchestrating the innate immune responses to pathogens and damaging ligands. This review explores our current understanding of the roles played by mitochondria in regulation of innate immunity and inflammatory responses. Recent advances in our understanding of the relationship between autophagy, mitochondria, and inflammasome activation are also briefly discussed. A comprehensive understanding of mitochondrial role in toll-like receptor-mediated innate immune responses and NLRP3 inflammasome complex activation, will facilitate development of novel therapeutics to treat various infectious, inflammatory, and autoimmune disorders.

Primary intestinal mast cell tumor in a Russian Blue cat: ultrasonographic and histopathological findings

A 11-year-old, female Russian Blue cat was presented with anorexia, vomiting, and diarrhea lasting for 3 days. Abdominal ultrasonography revealed a hypoechoic, non-circumferential, and eccentrically formed intestinal loop with altered wall layering and thickening of the tunica muscularis. After surgical resection, histopathologic examination confirmed an infiltrative, round-cell neoplasm composed of sheets and cords of neoplastic mast cells within a fibrotic, edematous stroma. The cat was alive and healthy 6 months after surgery. To the best of our knowledge, this is the first reported case of an intestinal mast cell tumor in a Russian Blue cat in South Korea.

Acute toxicity assessment of camphor in biopesticides by using Daphnia magna and Danio rerio

OBJECTIVES: An ecofriendly alternative to chemical pesticides is bio-pesticides, which are derived from natural sources. The interest in bio-pesticides is based on the disadvantages associated with chemical pesticides. METHODS: We conducted acute toxicity assessments of camphor, a major component of bio-pesticides, by using Daphnia magna (D. magna) as well as assessed the morphological abnormalities that occurred in Danio rerio (D. rerio) embryos. RESULTS: The median effective concentration of camphor on D. magna after 48 hours was 395.0 muM, and the median lethal concentration on D. rerio embryos after 96 hours was 838.6 muM. The no observed effect concentration and predicted no effect concentration of camphor on D. magna, which was more sensitive than D. rerio, were calculated as 55.2 muM and 3.95 muM, respectively. Morphological abnormalities in D. rerio embryos exposed to camphor increased over time. Coagulation, delayed hatching, yolk sac edema, pericardial edema, and pigmentation of embryos mainly appeared between 24 and 48 hours. Further, symptoms of scoliosis and head edema occurred after 72 hours. In addition, bent tails, ocular defects and collapsed symptoms of fertilized embryonic tissue were observed after 96 hours. CONCLUSIONS: The camphor toxicity results suggest that continuous observations on the ecosystem are necessary to monitor toxicity in areas where biological pesticides containing camphor are sprayed.

Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography / 대한족부족관절학회지

PURPOSE: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography and simple X-ray in intra-articular calcaneal fractures. MATERIALS AND METHODS: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgical treatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation of preoperative and postoperative Gissane angle, Bohler angle, and calcaneal fracture width. Computed tomography scan was performed for evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation of the postoperative clinical outcomes and radiologic findings based on the measurement. RESULTS: The average postoperative AOFAS score and VAS score was 84.1+/-8.5 and 2.2+/-2.2. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average Bohler angle was restored from 11.1degrees to 24.7degrees (p0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, Bohler angle, and width, and there was no significant correlation between the clinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. CONCLUSION: The clinical outcome did not show correlation with Bohler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.

Two Cases of Endoscopic Resection of Submucosal Tumor of the Minor Papilla / 대한소화기내시경학회지

Tumors of the minor papilla are very rare and these tumors have generally been known as neuroendocrine tumors such as carcinoid tumor and somatostatinoma. As these are mostly submucosal tumors, their diagnosis is difficult by just performing endoscopic forceps biopsy, but diagnosis is possible by surgery or endoscopic resection. EUS and ERCP is an essential tool for the diagnosis of these tumors, and abdominal CT or MRI is also useful because there is the possibility of malignant tumors such as carcinoid tumor. For our present two cases, screening endoscopy revealed the polypoid lesion of the minor papilla. EUS disclosed that the submucosal tumor was limited to the submucosal layer and no abnormality was found from the abdominal CT and ERCP. Herein, we performed endoscopic resection for making the diagnosis and treatment. Histologically, these 2 tumors were diagnosed as ectopic pancreas and gangliocytic paraganglioma, respectively.

Long Term Results of the Lensectomy in Children with Ectopia Lentis

PURPOSE: To analyze the clinical features and the long term visual results of children with ectopia lentis after lensectomy. METHODS: Enrolled in this study were 79 eyes of 43 patients who were operated on and followed up for at least 3 years. We performed a retrospective analysis of the patient records. RESULTS: The mean age at diagnosis was 4.6 years, mean age at surgery was 5.7 years and average follow-up was 7.1 years. Of the 43 patients with bilateral ectopia lentis, 7 underwent monocular surgery. The mean age at diagnosis was higher and mean postoperative BCVA was significantly lower in the monocular surgery group than in the binocular surgery group. All eyes showed reduced hyperopia for 5 years postoperatively, but the reduction rate of the monocular operated eyes was significantly lower than that of the binocular operated eyes (P<0.05). No complication occurred during surgery and 1 eye (1.3%) with Marfan syndrome showed retinal detachment 9 years after surgery. CONCLUSIONS: Surgical treatment of ectopia lentis was safe and showed good visual outcomes after 7.1 years of follow-up. Nevertheless, consideration must be given to the possibility of amblyopia due to the difference of the degree of dislocation between the two eyes.

A Case of Rectal Gastrointestinal Stromal Tumor with Bleeding / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GIST), although uncommon mesenchymal tumors of the gastrointestinal tract, are occasionally encountered on endoscopic examination. GIST can be found all gastrointestinal tract, but rare in the rectum. We report a 72-year-old woman presented with intermittent bloody stool for a year. On rectal examination, a firm fixed mass was felt on the anterior wall of the rectum. Computed tomography revealed the 4.8x4.5 cm sized exophytic and centrally depressed mass on the rectum without the evidence of adjacent organ invasion or metastasis. On colonoscopic examination, there was a round elevated lesion having central ulcer with adherent blood clots. Endoscopic deep biopsy examination revealed a submucosal tumor consisting of spindle cells with elongated cigar-shaped nuclei arranged in fascicles and whorls. Mitotic counts were fewer than 5 per 50 high-power fields. The tumor cells were positive for KIT and CD34 immunohistostaining and negative for SMA. Local excision recommended, but the patient discharged against the advice.

Gastric pH and Helicobacter pylori Infection in Patients with Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Data from previous studies on gastric acid secretion and the prevalence of H. pylori in liver cirrhosis patients remain poorly defined. H. pylori is a potential source of NH3, but the possible role of H. pylori in hepatic encephalopathy is not clear. The purpose of this study was to compare gastric acid secretion, the impact of H. pylori infection, and the production of NH3 between cirrhotic patients and healthy, matched controls. METHODS: Twenty-nine patients with liver cirrhosis (HBV, n=12; Alcohol, n=12; HCV, n=5) were matched with 33 healthy persons for age and sex. None of the patients or controls were being treated with antacids, H2-receptor blockers or proton pump inhibitors. The pH and NH3 concentration was measured in gastric juice obtained by endoscopy. H. pylori infection was diagnosed using the rapid urease test. The level of NH3 in venous blood was also measured. RESULTS: The average gastric pH was significantly higher in cirrhosis patients compared to controls (3.91 vs. 2.99, P4) was significantly greater in cirrhosis patients (45 vs. 21%, P<0.05). In contrast, the prevalence of H. pylori infection (62% vs. 58%) and gastric NH3 concentrations (3.4 vs. 3.3 mM/L) were similar between both groups. However, venous NH3 levels were significantly higher in cirrhotics than in controls (63.1 vs. 25.2 micro M/L, P<0.05). The patients with H. pylori infection had significantly higher gastric NH3 concentration (3.8 vs. 1.6 mM/L) and gastric pH (3.87 vs. 2.76, P<0.05) than those without infection, but no significant difference in venous NH3 levels were detected (39.6 vs. 48.1 micro M/L). In patients with cirrhosis, the presence of H. pylori infection was not correlated with either gastric or blood NH3 levels. CONCLUSIONS: The gastric pH of liver cirrhosis patients is higher than that of controls and a larger proportion of cirrhotic patients have hypochlorhydria. The prevalence of H. pylori in liver cirrhosis patients was similar to that in controls and no correlation was found between gastric and blood NH3 levels. Thus, H. pylori infection does not seem to play a major role in generation of elevated NH3 associated with hepatic encephalopathy.

A Case of Nonspecific Ulcer of the Terminal Ileum Associated with Massive Bleeding / 소아과

Nonspecific ulcer of the small bowel is rare in children. Nonspecific ulcer of the colon or small bowel is clinically and pathologically recognized as a disease related to intestinal Behcet's disease. Differentiation of nonspecific ulcers from Behcet's ulcer by pathologic findings is often impossible and the clinical course is similar. A 13-year-old boy was admitted due to massive lower gastrointestinal bleeding with an intractable tongue ulcer. Colonoscopic findings revealed a well demarcated deep ulcer on the terminal ileum. The patient was treated with steroids and sulfasalazine and the response was favorable. We report a case of nonspecific ulcer of terminal ileum with massive rectal bleeding in a 13-year-old boy.

Ultrasound-Guided Fine-Needle Aspiration Biopsy in Nonpalpable Thyroid Nodules: Is It Useful in Infracentimetric Nodules?

The purpose of this study was to evaluate the usefulness of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) for the evaluation and treatment planning of nonpalpable thyroid lesions, including infracentimetric nodules. One hundred and twenty one patients underwent US-FNAB for 149 non-palpable solid nodules. Sixty-five patients underwent surgery, and 84 were followed up for at least 36 months. The results of the US-FNAB correlated with the pathological findings and clinical follow-up results. The nodules ranged from 0.3 to 2 cm in diameter, with a mean of 0.8cm. Among the 149 nodules, 115 were infracentimetric and 34 were centimetric or supracentimetric in size. Of the 149 thyroid nodules, US-FNAB was true positive in 43, true negative in 90, false positive in 7 and false negative in 1. In 8 cases, the lesion was inadequately sampled. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the US-FNAB for the infracentimetric nodules were 96.9, 93.4, 86.1, 98.6 and 94.4%, and for the centimetric or supracentimetric nodules, were 100, 90.5, 85.7, 100 and 93.9%, respectively. There were no significant differences in the results between the infracentimetric and centimetric or supracentimetric nodules. In conclusion, an US-FNAB is a useful tool for determining the treatment plan of non-palpable solid thyroid nodules, even when less than 1 cm in diameter, and shows high sensitivity, specificity and accuracy.

Molecular Relatedness between Isolates Yersinia pseudotuberculosis from a Patient and an Isolate from Mountain Spring Water

A 40-yr-old buddhist monk was admitted to the hospital with abdominal pain, fever, and confusion. He had a history of drinking untreated mountain spring water in his temple, and experienced the above symptoms for several days before admission. In past medical history, he had suffered from hepatic cirrhosis. Yersinia pseudotuberculosis was isolated from his blood and ascitic fluid. The mountain spring water that he had ingested was cultivated and Y. pseudotuberculosis was also isolated. For identification of pathogenic Y. pseudotuberculosis, each isolate from the three sources (blood, ascitic fluid, and drinking water) was also analysed for the inv gene for Y. pseudotuberculosis and the virF gene for virulent plasmid by PCR. All strains were positive for both the virF and the inv genes and also positive for autoagglutination test. For relationship study, each isolate from the three sources was also analysed with serotyping and restriction endonuclease analysis of virulence plasmid DNA (REAP) using BamHI. All belonged to the serotype 4b and REAP pattern D. Thus, all these findings supported that the mountain spring water was the source of the Y. pseudotuberculosis infection in this case.

Effect of Ascorbic Acid on Experimental Retinal Vein Occlusion

The retinal vein occlusion is one of the most common vision-threatening retinal diseases, and both the hemi-central and central retinal vein occlusion might induce severe visual loss. There have been many studies on the role of abnormally produced oxygen free radicals and excitatory amino acids in the mechanism of ischemic retinal injury. Many free radical scavengers, such as superoxide dismutase (SOD), catalase, and EGB 761 were reported to reduce the extent of ischemic retinal injury in animal experiments. Ascorbic acid is also a well-known free radical scavenger, but its in vivo therapeutic effects on retinal ischemia has not been studied, yet. We induced experimental retinal vein occlusion in 48 albino rat eyes; half of major veins in 24 eyes (group A) and total veins in 24 eyes (group B), with rose bengal dye injection followed by argon-green laser photocoagulation. The occlusion of veins was confirmed with fluorescein angiography. We injected ascorbic acid intraperitoneally just after venous occlusion in 12 eyes for each group. Rats were sacrificed after I week (group A) or 2 weeks (group B) following experiment and histological examination was done. In both groups, inner retina was less damaged than outer retina. The density of retinal ganglion cells was reduced to a less degree in eyes of rats treated with ascorbic acid in group A(P=0.0318). These data support the idea that the reactive free adicals are involved in the mechanism of ischemic retinal injury and thus the ascorbic acid may attenuate the ischemic retinal damage.

Experimental Exudative Retinal Detachment in Albino Rats

To establish animal model of exudative retinal detachment in Sprague Dawley albino rats and to elucidate the possible role of retinal vein in the induction of exudative retinal detachments, rose bengal photosensitive dye was injected intravenously and argon laser was applied. In group A(10 eyes), laser was applied on intervascular retinal areas linearly. In group B (12 eyes), laser was applied on major retinal veins. In group C(4 eyes), laser was applied on major retinal arteris. In group D(3 eyes), laser was applied on major retinal veins without rose bengal dye and in group E(26 eyes), only the rose bengal dye was perfused. And in group F(3 eyes), normal eyes were fixed for negative controls. Exudative bullous retinal detachment occurred only in group B and these resutls were confirmed in histological examinations. In control groups (D and E), tissue injuries were not found. In conclusion, exudative retinal detachment could be induced by occlusion of retinal veins in albino rats and the abnormalities of retinal venous blood flow were required for the induction of exudative retinal detachment.

Experimental Retianl Vein Occlusion in Albino Rats

The retinal vein occlusion is one of the most common, vision-threatening retinal diseases, and the establishment of animal model in rats will be of great help for further study. We occluded retinal veins with rose bengal dye injection followed by argon green laser photocoagulation in albino rats and confirmed the occlusion of veins with fluorescein angiography one hour after photocoagulation. We occluded half of an all of major retinal veins in 12 eyes, respectively. After 1-2 weeks of follow-up, histologic examinations were done. Eyes which underwent occlusion of all major retinal veins showed severe retinal atrophy and preretinal neovas-cularization developed in two eyes. Eyes which underwent occlusion of half of retinal veins showed relatively less damage and the number of retinal ganglion cells was significantly reduced in occluded area than that in control area (P=0.0033), which might represent the ischemic damage of inner retina. We expect that it will be possible to establish an animal model of retinal vein occlusion in albino rats using this method.

Experimental Branch Retinal Vein Occlusion in Albino Rats

The retinal vein occlusion is one of the most common retinal diseases, and the establishment of animal model in rats will be a great help for further study. We occluded branch retinal veins with rose bengal dye injection followed by argon-green laser photocoagulation in albino rats. Retinal vein occlusion was maintained over 1 day in 35 eyes out of 47, maximally over 5 days. Retinal tissue damage was confined to the photocoagulated areas in most eyes and the loss of ganglion cells began when the occlusion persisted over 1 day. If the reproducibility is further increased, this will be a good animal model of retinal vein occlusion in albino rats.

Growing pulmonary aspergilloma for 10 years: one case report / 대한흉부외과학회지

No abstract available.