Functional dyspepsia is a condition with chronic indigestion symptoms such as epigastric pain or discomfort, early satiety, and bloating without an alternative organic disease. The symptoms are similar to those of functional dyspepsia, but abnormal retention of food in the stomach should be identified in gastroparesis. In this case, botulinum toxin injection was performed for treatment in a patient who complained of symptoms such as nausea, early satiety, abdominal distension, and poor appetite without no abnormal findings in gastric emptying scan. Through this case, a possibility was found that antral and pyloric dysfunction may cause symptoms of functional dyspepsia, without gastric emptying abnormalities.
Objective: We investigated the diagnostic accuracy of high-resolution magnetic resonance angiography (HR-MRA) with volume rendering (VR) post-processing techniques for the detection of cerebral aneurysms compared with conventional MRA (C-MRA) using digital subtraction angiography (DSA) as the gold standard.Methods: HR-MRA was performed for 51 possible aneurysms of 38 patients on C-MRA. For each possible aneurysm, readers recorded their level of confidence on a 5-point scale. All patients underwent DSA, which was used as the standard of reference. Receiver-operating characteristic (ROC) analysis and the area under the ROC curves (AUC) were used to determine the effectiveness of C-MRA and HR-MRA in detecting cerebral aneurysm with and without VR algorithm. The increased discriminative value was examined by calculation of Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) index.Results: DSA revealed 37 aneurysms in 26 patients. In aneurysm-based analysis, HR-MRA showed higher diagnostic accuracy than C-MRA, and increased diagnostic accuracy on adding VR (C-MRA vs. HR-MRA, P< 0.01; C-MRA with VR vs. HR-MRA with VR, P< 0.01, respectively). The differences in AUC, IDI (19.38%, Z= 3.18, P< 0.01) and NRI (46.3%, Z= 6.32, P< 0.01), on adding VR to the HR-MRA, were also statistically significant. The application of HR-MRA with VR increased the detection rate of aneurysms less than 3 mm.Conclusion: The application of HR-MRA with VR algorithm improves diagnostic performance for the detection of intracranial aneurysms, especially when the aneurysm is less than 3 mm. Clinically, HR-MRA with VR algorithm could facilitate the accurate differentiation of aneurysms from infundibula and prevent unnecessary, invasive procedure before aneurysmal rupture.
Objective: Despite Korea’s low birth rate, pediatric emergency medical centers (PEMCs) are grappling with overcrowding. This study evaluates the use of PEMCs in Korea amid a declining birth rate and increased overcrowding.Methods: Data from 176 emergency medical centers (EMCs, 2018–2021) was analyzed using the National Emergency Department Information System, focusing on demographics, Korean Triage and Acuity Scale (KTAS) scores, and pediatric patient outcomes. The most common complaints and diagnoses were identified by the EMC level. This study also examined the characteristics of patients visiting PEMCs.Results: There was a 48% drop in pediatric visits to EMCs during the coronavirus disease 2019 (COVID-19) pandemic. The majority of patients were boys aged 1–4, primarily visiting in the evenings and weekends. The breakdown of cases included 66% disease-related and 34% injury-related. Notably, 8.5% of these visits were via ambulance, 36% were high-acuity according to KTAS, 88% resulted in discharge, and 11% in hospitalization. The median stay was 85 minutes, with 83% utilizing local emergency services. Fever, abdominal pain, and vomiting were the most common complaints, comprising 40% of all visits.Conclusion: Despite a decrease in birth rates, PEMC usage in Korea saw an initial rise followed by a significant decrease during the COVID-19 pandemic. Children aged 1–4 were the most frequent users. The majority of cases were medical rather than trauma-related, and resulted in patient discharge. Strategic redirection of non-urgent cases may help alleviate overcrowding in emergency departments.
Objective: Osteomyelitis in patients with diabetic foot has been diagnosed clinically, radiologically, and histologically. However, the accuracy of these diagnostic modalities is not well established. In this study, we histologically reviewed patients who underwent surgical procedures for diabetic foot osteomyelitis and correlated these histological features with radiological findings.Methods: Eighty patients who were clinically diagnosed with diabetic foot osteomyelitis, who underwent surgical treatment between November 2017 and February 2022, were enrolled. Hematoxylin and eosin-stained slides and radiological findings were reviewed.Results: Eighty patients were radiologically examined by magnetic resonance imaging (MRI) (49 cases) and/or 99mTc-hexamethyl-propylene amine oxime-labeled white blood cells single-photon emission computed tomography (SPECT)/computed tomography (CT) (65 cases). MRI findings were suggestive of osteomyelitis in 35 cases (71.4%) and soft tissue inflammation in 46 cases (93.8%). In SPECE/CT, 60 cases (92.3%) and 64 cases (98.4%) showed signs of osteomyelitis and soft tissue inflammation, respectively. Histologically, both bone and soft tissue lesions were found in 32 cases (40%), only bone tissue lesions in seven cases (8.8%), and only soft tissue lesions in 40 cases (50%). The sensitivity and specificity of MRI for osteomyelitis were 83.3% (10/12) and 28.6% (4/14), and that of SPECT/CT was 100.0% (12/12) and 12.5% (2/16), respectively. Moreover, those of by MRI findings for soft tissue inflammation were 90.6% (29/32) and 0% (0/12), while that of SPECT/CT was 97.4% (38/39) and 0% (0/18), respectively.Conclusion: For accurate histological diagnosis of diabetic foot osteomyelitis, sufficient specimens should be obtained. White blood cell SPECT/CT seems to be a more sensitive modality than MRI for the detection of osteomyelitis.
Jamu sticks are used in some Southeast Asian cultures especially Indonesia for vaginal health and tightening. However, there is no scientific evidence supporting the safety or effectiveness of Jamu sticks for vaginal tightening or health. Chemical reactions caused by these foreign substances can lead chemical vaginitis, increasing the risk of secondary infection through the disrupted vaginal wall. I report a case of a patient successfully treated for vaginal stenosis due to chemical vaginitis caused by Jamu sticks experienced in our hospital and advise caution against indiscriminate folk remedies.
