A Man Presenting with Sudden Weakness and Pain of the Right Hand, by Non-Small Cell Lung Cancer with Brain Metastases

Unexplained pain and weakness, i.e., without obvious predisposing factors, are often encountered by physiatrists and efforts should be made to determine the cause. A 63-year-old male presented with radiating pain in his right arm and mild weakness of the right hand. An electrodiagnostic examination revealed distal symmetric sensory polyneuropathy in the upper and lower extremities, and denervation potentials in the forearm muscles, which were inconsistent with the cervical spine MRI images and symptoms. A predisposing undiscovered disease was revealed, i.e., squamous cell carcinoma in the lung; brain metastasis affecting the left primary motor cortex was also detected. Therefore, we concluded that the pain and weakness were related to paraneoplastic syndrome and brain metastases of the hand knob. The observed denervation potentials were characterized as trans-synaptic changes in the brain metastasis. This case highlights the importance of unexplainable focal pain and weakness in the increasing prevalence of cancer.

A Man with Dysphagia after Cervical Esophagogastrostomy: A Case Report / 대한연하장애학회지

Dysphagia caused by a functional gastric outlet obstruction is rare and the natural course of a functional gastric outlet obstruction is unclear. This paper reports a patient with dysphagia and a functional gastric outlet obstruction after a cervical esophagogastrostomy. A 62-year-old man with a history of esophageal cancer and cervical esophagogastrostomy presented with dysphagia and discomfort during meals. A videofluoroscopic swallowing study (VFSS) with barium revealed a mild increase in the post-swallow remnants and delayed emptying of the gastric outlet, reflecting a functional gastric outlet obstruction at the diaphragm. One month later, VFSS revealed a worsened functional gastric outlet obstruction at the diaphragm. A delayed chest X-ray showed worsened delayed emptying of the gastric outlet. A cervical esophagogastrostomy for early esophageal cancer can cause functional gastric outlet obstruction, presenting as dysphagia and discomfort during meals. Physicians should be concerned about dysphagia and the functional changes in the esophagus in patients with a cervical esophagogastrostomy.

Delayed Extensive White Matter Injury Caused by a Subdural Hemorrhage and Role of Corticospinal Tract Integrity

A subdural hemorrhage (SDH) is a common disorder with usually good prognosis. Most SDHs resolve with or without with minimal sequelae. We present a case report of a patient with SDH, who had delayed extensive white matter injury with disruptions of corticospinal tracts (CSTs) by diffusion tensor imaging (DTI) and showed abysmal prognosis, despite long-term rehabilitation. A 62-year-old man with an SDH underwent burr hole trephination for hematoma removal. Within 7 days, the hemorrhage diminished. At 12 weeks after the onset, the patient's weakness did not improve, and a follow-up magnetic resonance imaging revealed extensive leukomalacia, especially in the white matter. The DTI for CST revealed severe injury of CST integrity. He did not re-gain muscle strength and functional independence, despite 3 months of inpatient rehabilitation. This case describes SDH with delayed extensive white matter injury and exceptional poor prognosis and urges caution in that the SDH may induce very variable functional recovery. Besides, DTI for CST would be useful in predicting the long-term functional prognosis in extensive white matter injury.

Edible Coating Using a Chitosan-Based Colloid Incorporating Grapefruit Seed Extract for Cherry Tomato Safety and Preservation.

Grapefruit seed extract (GSE)-containing chitosan-based coating was developed and applied to cherry tomatoes to protect them from Salmonella invasion and improve their storability. The coating colloids were produced by mixing a chitosan colloid (1% [w/w] chitosan) with GSE at various concentrations (0.5%, 0.7%, 1.0%, and 1.2% [w/w]) using high-shear mixing (10000 rpm, 2 min). Coatings with chitosan colloids containing GSE at 0.0%, 0.5%, 0.7%, and 1.0% (w/w) inactivated Salmonella on cherry tomatoes by 1.0 ± 0.3, 1.2 ± 0.3, 1.6 ± 0.1, and 2.0 ± 0.3 log CFU/cherry tomato, respectively. Coatings both with and without GSE (1.0%) effectively inhibited the growth of Salmonella and total mesophilic aerobes, reduced CO2 generation, and retarded titratable acidity decrease during storage at 10 and 25 °C. The advantage of incorporating GSE in the formulation was demonstrated by delayed microorganism growth and reduced weight loss at 25 °C. The chitosan-GSE coating did not affect lycopene concentration, color, and sensory properties (P > 0.05). Chitosan-GSE coating shows potential for improving the microbiological safety and storability of cherry tomatoes, with stronger efficacy at 25 °C than that of chitosan coating without GSE. PRACTICAL APPLICATION: A novel chitosan coating containing grape fruit seed extract (GSE) improved the microbiological safety against Salmonella and storability of cherry tomatoes without altering their flavor, demonstrating its strong potential as an effective postharvest technology. Chitosan coating containing GSE might be preferable over chitosan coating without GSE for application to tomatoes that are stored at room temperature in that it more effectively inhibits microbial growth and weight loss than the coating without GSE at 25 °C.

A Case of Rhinocerebral Mucormycosis Presenting with Facial Palsy / 대한피부과학회지

Mucormycosis is an opportunistic fungal infection affecting patients with diabetes or immune-compromised status, caused by species of the Mucoraceae family. Rhinocerebral mucormycosis, the most frequent form of mucormycosis, is characterized by a rapidly progressive and usually fatal course. Common initial symptoms of rhinocerebral mucormycosis include facial pain, facial swelling, headache, fever and blood-tinged rhinorrhea, however, facial palsy is relatively rare. We describe a diabetic female considered rhinocerebral mucormycosis presenting with facial palsy.