본 사례 보고는 소아 뇌 자기공명영상(MRI) 검사에서 협조가 원활하지 않아 움직임에 의한 인공물이 발생하고, 이로 인해 시간차 자기공명혈관촬영(TOF MRA) 영상의 획득이 어려운 상황에서, 삼차원 구조화 자기공명영상(3D MPRAGE)을 수평면(axial) 방향으로 획득한 후 최대강도투사(MIP) 기법을 적용하여 혈관 형태를 성공적으로 시각 화한 사례를 소개하고, 그 임상적 유용성을 평가하고자 한다. 영상 획득 시, TOF MRA는 약 7분, 3D MPRAGE는 약 4~5분의 검사 시간이 소요되었으며, 3D MPRAGE는 짧은 촬영 시간과 인코딩 방향 변경으로 인한 움직임 감소 효과를 보였다. 수평면 3D MPRAGE 영상은 주요 뇌혈관을 효과적으로 시각화하였고, 진단 해상도 면에서도 TOF 영상과 비교해 손색이 없었다. 본 사례 보고는 특히 협조가 어려운 1세에서 7세 사이의 소아 환자에서 3D MPRAGE 기반 MIP 영상이 TOF 영상의 효과적인 대안이 될 수 있음을 시사한다. 또한 혈류 흐름 방향에 맞추어 MPRAGE의 획득 단면을 조정하고 수평면 영상에 MIP 기법을 적용함으로써 뇌혈관 구조 시각화를 최적화할 수 있었다. 비록 미세혈관 표현에는 TOF 영상 대비 한계가 있었으나, 주요 대혈관 영상은 충분한 진단 정보를 제공하였다. TOF 영상 이 혈관에 특화된 반면, 3D MPRAGE는 뇌 실질 영상과 함께 뇌혈관 형태 영상까지 제공할 수 있어, 진정이 필요한 소아 환자에게 보다 유리한 대안이 될 수 있다. 이러한 접근은 검사 시간을 단축시키고, 뇌혈관 질환과 관련된 부가 적인 임상 정보를 함께 제공함으로써 영상의 진단적 가치를 향상시킬 것으로 기대된다.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a rare gingival lesion predominantly affecting individuals aged <20 years. Although it has a distinct clinical presentation, its underlying pathogenesis remains poorly understood and standardized treatment guidelines are yet to be established. Surgical excision is the most common treatment; however, concerns regarding recurrence, aesthetic impact, and patient cooperation, particularly in pediatric cases, highlight the need for alternative approaches. Although spontaneous regression of LJSGH has been suggested, well-documented cases are rare. This report presents a case of LJSGH demonstrating spontaneous resolution without surgical intervention. A lesion on the mandibular anterior facial gingiva fully resolved over a 32-month period, further supporting the potential for natural resolution, and emphasizing the need for a conservative management approach.

A 48-year-old woman visited the oral and maxillofacial surgery department complaining of swelling under the left mandible. The patient said that the size of the small lump had not changed much since it was first discovered, but it seemed to have grown slightly recently after 5 years. She visited another hospital 1 week ago and had a CT scan, but no specific findings were found. A firm and mobile mass was palpated in the submandibular gland area during clinical examination. Ultrasound imaging and contrast-enhanced CT were performed, and the patient was diagnosed with pleomorphic adenoma. Submandibular gland resection was performed, and the mass was confirmed as pleomorphic adenoma by histopathological examination. There has been no recurrence to date, 8 years later. In this study, we will examine the diagnostic process of a rare submandibular gland pleomorphic adenoma and review the literature.

Intraductal papilloma is a rare benign epithelial neoplasm of the salivary duct system, characterized by papillary proliferation of ductal epithelium into a cystic lumen. It predominantly occurs in minor salivary glands, particularly in the lips and buccal mucosa, and is rarely found in the mandibular region. We report a case of intraductal papilloma in the left retromolar trigone of a 46-year-old woman. Clinically, the lesion presented as a painless, well-circumscribed bluish submucosal mass. Radiographic findings were nonspecific, and a provisional diagnosis of hemangioma was made. The lesion was surgically excised under general anesthesia. Histopathological examination revealed a cystic cavity lined by cuboidal to columnar epithelial cells with intraluminal papillary projections, consistent with intraductal papilloma. Scattered mucous-producing cells were also noted. No evidence of recurrence was noted at the 24-month follow-up. This case highlights the importance of histopathological confirmation in diagnosing intraoral submucosal lesions.

담관 협착 및 확장은 그 원인을 정확히 알기 어려운 경우가 많다. 호산구성 담관염은 담관 협착 및 확장을 일으킬 수 있는 양성 질환으로, 발생빈도는 드문 것으로 알려져 있다. 조직병리학, 방사선 사진, 내시경 및 혈액학적 소견을 종합하여 진단할 수 있으며, 스테로이드 투여를 통해 호전을 기대할 수 있다. 드물지만 담관 협착 및 확장의 감별진단 시 고려해야 하는 질환으로, 이 증례를 통해 호산구성 담관염을 알아보고자 한다.

Ectopic ureter refers to a congenital anomaly in which one or both ureters do not connect to the urinary bladder at the correct anatomical site. This case report discusses the case of a 6-year-old female mixed-breed dog diagnosed with chronic urinary incontinence, systemic hypertension, pancreatitis, and sepsis resulting from an ectopic ureter. Treatment involved an initial nephro-ureterectomy to address severe pyonephrosis, followed by ureteroneocystostomy for the remaining functional kidney. Post-surgical outcomes showed notable improvements in clinical symptoms, laboratory findings, and blood pressure. This report emphasizes the need for early diagnosis and appropriate surgical treatment in cases of ectopic ureter. Additionally, it aims to present the clinical symptoms and conditions resulting from prolonged disease progression, as well as the corresponding treatment methods and prognosis.

Acneiform eruptions are skin diseases that mimic acne vulgaris but lacking typical follicular blockage features. Acne vulgaris and some granulomatous variants of acneiform eruptions can involve Cutibacterium acnes, an anaerobic opportunistic bacterium; however, some cases remain resistant to standard antibiotics treatments. We report a 56-year-old male with facial acneiform granulomas unresponsive to long-term antibiotic and steroid treatments. The patient had no history of additional medications or other diseases, except symptomatic apical periodontitis in a molar toot. Both facial skin and dental lesions shared a key finding, intracellular infection of C. acnes within macrophages, despite differing histopathological features. The facial acneiform eruptions did not respond to initial minocycline treatment. However, following extraction of the infected tooth, the facial granuloma responded to the antibiotics and resolved without complications. PCR analysis confirmed C. acnes DNA in both the dental and skin biopsies. This case indicates the C. acnes-associated oral-skin-microbiome axis although a direct causal link between the distinct lesions could not be fully established. Odontogenic infection may act as reservoirs, impairing efficacy of antibiotic treatment. We recommend dental evaluation for case of facial acneiform granulomas that do not respond to antibiotics alone.

A 34-year-old male patient presented with a gradual facial asymmetry and occasional discomfort in the right temporomandibular joint (TMJ). Initial evaluation, including panoramic radiography, suggested facial asymmetry secondary to condylar elongation. However, computerized tomography and magnetic resonance imaging demonstrated the existence of a condylar mass and multiple calcified lesions within the right TMJ. The patient did not recognize any occlusal changes, but it was suspected that the occlusion had changed based on the cast analysis. The patient underwent a condylectomy and mass excision, which confirmed the diagnosis of osteochondroma with concurrent synovial chondromatosis. Approximately three weeks of postoperative physical therapy were required to achieve stable occlusion. This case is notable for two reasons. First, the simultaneous occurrence of osteochondroma and synovial chondromatosis is extremely rare. Second, the gradual occlusal changes associated with TMJ lesions can go undetected, increasing the chance of misdiagnosis.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is an exceedingly rare gingival disease. Most LJSGH occur in children, predominantly on the labial gingiva of the maxilla, and exhibit clinical manifestations similar to pyogenic granuloma or puberty gingivitis. This report presents a case of LJSGH. A 15-year-old male referred for evaluation of red lesions on the labial gingiva of the maxillary anterior teeth. Clinical examination revealed redness and swelling of the labial marginal gingiva, with no associated pain. After an incisional biopsy, the lesion was histopathologically diagnosed as LJSGH. We present this case to suggest that LJSGH should be considered in the differential diagnosis of patients presenting with painless gingival redness and swelling. We also report that we have obtained satisfactory aesthetic results by applying CO2 laser to LJSGH.

Paradental cysts characteristically develop adjacent to the cervical margin on the lateral aspect of a tooth root and result from inflammatory processes within the periodontal pocket. Standard management usually involves cyst enucleation while striving to retain the affected tooth. Recurrence rates are infrequent following complete removal of the lesion. However, intentional replantation becomes necessary in cases with anatomical constraints or accessibility issues. We present the case of a 13-year-old female patient exhibiting delayed eruption of the mandibular left second molar, attributed to a cystic lesion located on the lingual-coronal aspect of the tooth.

Parotid gland ancient schwannoma is an extremely rare entity, with only 6 cases reported to date. Ancient schwannoma present degenerative alteration, including cystic changes, hyalinizing stroma, hemorrhages, infiltration of macrophages, and cellular atypia with hyperchromatic nuclei. These factors have the potential to mimic malignant tumors, resulting in an overestimation of diagnosis and subsequent inappropriate management. In the present case, we report a case of parotid gland ancient schwannoma, which developed relatively fast degenerative alteration without a large-sized mass. We reviewed all the cases of parotid ancient schwannoma, and suggest that the character of parotid gland tissue can deceive the change of tumor growth size. We also suspect that pre-surgical manipulation, such as FNAB or CNB, can cause degenerative changes in a relative short period. It is important to consider reactive degenerative alteration of schwannoma, and not to misinterpret as a malignant entities, notably when needle biopsy history is present.

The purpose of this study was to introduce and evaluate a nursing ethics seminar course designed for senior nursing students at a university to address the ethical challenges they faced during clinical practice. The course was offered as an elective and 22 students who had completed various clinical practicums over four semesters participated. The participants led discussions on ethical issues they encountered during their clinical practice. To evaluate the effectiveness of the course, an open-ended survey was conducted at the end of the course. The findings were categorized into three main themes: Individual Growth, Collaborative Opportunities, Suggestions for Improvement. The first category is comprised of ‘Experienced emotional acceptance and relaxation’, ‘Felt comforted and encouraged’, ‘Gained clarity’, and ‘Experienced personal growth’. The second category consists of ‘Self-reflection within a group’, ‘Diverse learning opportunities’, ‘Pleasures of discussion-based learning.’ Third category is comprised of ‘Modifying the lesson structure’ and ‘Optimizing the learning space.’

자가면역췌장염은 혈중 IgG4의 증가와 췌장 조직에서 IgG4 양성 플라즈마세포의 침윤을 보이는 질환이다. 제1형 자가면역췌장염의 경우 담관, 타액선, 신장, 후 복강 등을 포함한 다른 장기의 침범도 가능하다. 췌장 종괴 형태로 발현한 자가면역췌장염은 췌장얌과 감별하기 쉽지 않을 수 있다. 60세 남자 환자가 상복부 불편감으로 본원을 방문하였다. 복부전산화단층촬영 및 자기공명영상에서 4.8 cm 크기의 췌장두부 종괴가 있었고 이는 총담관를 침범하고 있었다. 내시경초음파 유도하 세침조직검사 및 내시경역행담 췌관조영술 유도하 담관내조직검사에서 악성세포는 보이지 않았다. 그러나 IgG4 양성 세포가 고배율시야에서 20개 이상 관찰되었다. 총 3주 동안의 스테로이드 치료 후 환자의 증상이 호전되었고 추적 영상검사에서 췌장두부 종괴의 크기가 3 cm로 감소하였다. 이상으로 췌장암과 감별이 어려웠던 췌장 종괴 형태로 발현한 자가면역췌장염 1예를 보고한다.

악성 간문부 담관 폐쇄(malignant hilar biliary obstruction, MHBO) 치료를 위해 시행되는 내시경 담관배액술은 후속 치료, 생존율 및 환자 삶의 질 향상에 필수적이다. 그러나 간문부 담관의 복잡한 해부학적 특징으로 인해 시술의 난이도가 높고 시술 관련 우발증의 위험이 있다. 본 고에서는 완전 피막형 자가팽창성 금속 스텐트(fully covered self-expandable metal stent, fcSEMS)를 이용한 나란한 양측 삽입 담관배액술을 시행 후 근위부 담관내 이탈(proximal stent migration)이 발생한 증례를 보고한다. 현재까지 MHBO에 대해서는 어떤 종류의 스텐트를 어떠한 방법으로 시술할지에 대하여 충분한 근거가 정립되어 있지는 않다. 그렇지만 본 증례와 같이 fcSEMS를 사용할 경우 스텐트 이탈 위험성이 ucSEMS보다 높다는 것은 인지하고 있어야 하겠으며, 환자 진료 시 이러한 사항을 고려하여 적절한 대비가 필요하겠다. 향후 이러한 스텐트 이탈을 줄일 수 있는 다양한 예방법이 고안된다면 많은 도움이 될 것으로 기대 된다.

고주파 흡수제(Accusorb MRI)를 이용한 자기공명영상 검사 중 화재가 발생했다. 다행히 환자는 화상을 입지는 않았 지만 스트랩과 4채널 코일의 케이블, Accusorb MRI가 녹아서 탄 흔적이 발견되었다. 자기공명영상 검사에 사용되 는 도구의 안전 지침을 준수해야 하지만 이를 지키지 않으면 화상, 열상, 장비 손상의 위험이 있다. 사고를 방지하기 위해서는 철저한 사전 점검을 해야 하고 모든 기기, 물품들이 자기공명영상 검사 시 사용 가능한 제품인지 확인하고 사용법을 정확하게 숙지하여야 한다.

Orthokeratinized odontogenic cysts are developmental cysts that occur in the jaw that account for approximately 7%–17% of all cysts in the jaws. Studies have shown that malignant transformation of odontogenic cysts most often occurs in inflammatory cysts, such as periapical cysts, but malignant transformation of orthokeratinized odontogenic cysts has also been reported. In this report, we present an uncommon case of squamous cell carcinoma arising from an orthokeratinized odontogenic cyst.

Purpose: This case report aimed to provide basic data to improve instrumental activities of daily living and quality of care for elderly with dementia. Methods: A total of ten sessions were organized and operated once a week for 16 elderly with dementia. Data analysis was conducted through observational evaluation of participation, concentration, and satisfaction, and pre and post test for each individual. In-depth interviews were performed at the end of each session. Results: Participants were 16.0% in their 70s, 68.7% in their 80s, and 6.3% in their 90s. Their average instrumental activities daily living (I-ADL) score was 20.12±4.93. Post test scores increased in 78% of the elderly. Participation, concentration, and satisfaction were the highest in the 8th session, which was operated under the theme of ‘A good day to go to the hospital,’ and the lowest participation, concentration, and satisfaction were in the 5th session, which was operated under the theme of ‘A good day to go out.’ Conclusion: In the case of elderly with mild or early dementia, performance of instrumental activities of daily living can be improved through repetitive learning. Thus, there is a need to continuously provide such program as a regular program for elderly people in the early stages of dementia.