Syncope is a common symptom, with 15% to 25% of children and adolescents experiencing at least one syncopal episode by young adulthood. In most cases, syncope is a symptom of benign diseases however may be a symptom of severe cardiac disease that results in sudden death. The purpose of this study is to analyze the etiologies and clinical characteristics of syncope in children and adolescents. We retroprospectively analyzed 51 patients with syncope. A total of 51 patients were included in the study and the ratio of males to female was 1: 1.04. The mean patient age was 12.7±3.1 years. Abrupt standing was the most common state of patients with syncopal attack. The etiologies of syncope were noncardiac syncope (60.7%), cardiac syncope (2%), neuropsychiatric syncope (25.5%), and unknown (11.8%). Abnormality of the head-up tilt test was more common in noncardiac syncope than the others [38.7% (12/31) vs 5% (1/20) (p=0.007)]. Further, EEG is a useful diagnostic test for neuropychiatric syncope [41.6% (5/12) vs 2.7% (1/36) (p=0.002)]. Therefore, detailed history taking and physical examinations were useful tools to diagnose the etiology of sycope. The head-up tilt test is an effective diagnostic test in noncardiac syncope and EEG is a valuable test in neuropychiatric syncope, especially in seizure.

We compared the results of early follow-up of F-18 FDG PET/CT and MRI performed within one month after radiation therapy for cervix cancer patients. We conducted a retrospective review of the clinical data of cervix cancer patients whose PET/CT and pelvic MRI performed at staging and within one month from the end of RTx. SUVmax on PET/CT and size on MRI of the primary tumor were analyzed. We compared %change of SUVmax and size between staging and follow-up. A total of 27 patients were enrolled. At staging, larger tumor showed high SUVmax. At follow-up, no significant correlation was observed between size and SUVmax. In 77.8% of patients, changes in SUVmax were well correlated with changes in size. No correlation was observed between % change and value at staging in both SUVmax and size. Except for six patients who showed significant FDG uptake without evidence of a mass on MRI, % changes of size and SUVmax were well correlated. Metabolic change can be accessible on early follow-up PET/CT at±1 month from the end of the RTx of cervix cancer. However, careful interpretation of PET/CT is needed due to possible radiation-induced hypermetabolism even without a definite mass on MRI.

Laparoscopic appendectomy using three trocars has been widely performed. Recently, a single incision laparoscopic surgical procedure has become popular because it is less invasive. We report on our early experience in performance of single incision laparoscopic appendectomy (SIL-A). Data on the operating time, the duration to make the pneumoperitoneum, body mass index (BMI), rate of conversion to another operation, complication, hospital stay, dosage of analgesics, and pain score were collected prospectively at two centers. Twenty seven patients underwent SIL-A. The mean BMI was 23.3±3.1 kg/m2 (17.6-30.5). The mean time required to make a pneumoperitoneum was 9.9±5.0 minutes (5.0-28.0). The mean operating time was 37.6±26.7 minutes (10.0-100.0). The rate of intra-operative complication was 3.7% (1/27), and the rate of post-operative complication was 22.2% (6/27). The mean hospital stay was 4.1±1.2 days (2-6). The immediately postoperative pain score was 5.4±1.5 (3-8), however, the pain score at discharge was 0.4±0.7 (0-2). The mean dosage of analgesics was 1.5±1.3(0-4), however, none of the patients took analgesics after postoperative three days. SIL-A is feasible but requires improved instrumentation and experience.

The principle of treatment of type 2, 3 odontoid process fracture is controversial. The debate is in regard to which is effective between conservative treatment and surgery. We enrolled 41 patients with type 2, 3 odontoid process fracture from January 2007 to December 2011 at Chosun University Hospital. Patients in Group I (GI) received a halo vest and those in Group II (GII) underwent surgery by ant. screw fixation. The bone fusion was classified according to stable bone union, fibrous union, and unstable non-union. Patients in GI received halo vest for a mean period of 4.9 months and those in GII received a neck collar for a mean period of 3.8 months. Tweleve patients in GI and 17 patients in GII had stable bone union. Three patients in GI and two patients in GII had fibrous union. Five patients in GI and two patients in GII had non-union. The halo vest was a good conservative treatment for type 2, 3 odontoid process fracture : however, low bone fusion rate is a problem in particularly old age. However, ant. screw fixation is a better treatment in regard to short surgical time, short fusion time, and high bone fusion rate.

We report a double primary gastric cancer of different types seen on an endoscopy at the same time. At the first gastroscopy, Lymphoepithelioma-like carcinoma (LELC) appeared to be a benign submucosal tumor (SMT) and gastric adenocarcinoma was limited to the mucosa. Adenocarcinoma was removed by endoscopic submucosal dissection (ESD). However, a followup gastroscopy revealed an enlarged SMT, and another ESD was performed. The patient was additionally diagnosed with gastric LELC. This is the only case that LELC and gastric adenocarcinoma were found at the same time in Korea; therefore, the authors report this case with literature review.

Capecitabine is a prodrug of a 5-fluorouracil (5-FU) that is converted to 5-FU inside the tumor cells. Here, we report a case of 5-FU induced encephalopathy which was subsequently treated with capecitabine without any neurologic complication. A 76-year-old man with rectal adenocarcinoma received chemotherapy, which consisted of 5-FU, leucovorin and oxaliplatin after resection of the primary and metastatic masses. Confusion and agitation were observed during the 2nd cycle of chemotherapy and reappeared during 4th cycle. Both events were completely disappeared within a few days. Capecitabine was administered for 4 cycles without any neurologic toxicity. Capecitabine could be an alternative in patients experiencing 5-FU induced encephalopathy.

It has been known that adenomyoma is a rare non-neoplastic lesion of the biliary tract. In literature, adenomyoma was managed by extensive surgical procedures for its diagnosis and treatment because adenomyoma showed symptoms like obstructive jaundice and epigastric pain, which made the decision for the lesion difficult to distinguish from malignant neoplasm.We successfully treated a patient who had 12 mm sized adenomyoma of the major papilla with incomplete pancreas divisum by using an endoscopic papillectomy in the asymptomatic stage. The final diagnosis with an immunohistochemical stain revealed a lesion for adenomyoma of the major papilla.