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Ahead-of print article

Articles in the epub version are posted online ahead of regular online publication.

Original article

[English]
Effect of ultrasound-guided bilateral rectus sheath block on postoperative pain control after robotic single-site gynecologic surgery: a randomized study
Sunyoung Moon, Sooyoung Cho, Youn Jin Kim, Seunghee Yoo, Jong Wha Lee, Hye-Won Oh, Eunbi Cho
Received May 18, 2026  Accepted June 10, 2026  Published online June 22, 2026  
DOI: https://doi.org/10.12771/emj.2026.01396    [Epub ahead of print]
Purpose
Rectus sheath block (RSB) is a simple abdominal wall block that can be readily applied. This study evaluated the postoperative analgesic efficacy of ultrasound-guided bilateral RSB in robotic single-site gynecologic surgery.
Methods
Sixty patients were randomly assigned to the RSB group (n=30) or the control group (n=30). After induction of general anesthesia, patients in the RSB group received ultrasound-guided bilateral RSB with 30 mL of 0.25% ropivacaine. Pain intensity was assessed using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, and 48 hours postoperatively. Intravenous patient-controlled analgesia was provided to all patients, and fentanyl was administered as rescue analgesia on request.
Results
VNRS scores at 0, 1, and 6 hours were significantly lower in the RSB group than in the control group (all P<0.05). Rescue fentanyl use in the post-anesthesia care unit was also significantly lower in the RSB group than in the control group (19.8±21.0 µg vs. 46.3±27.6 µg, P<0.001). Subgroup analysis showed that RSB was associated with lower VNRS scores in patients undergoing ovarian surgery or myomectomy, whereas no significant difference was observed in patients undergoing hysterectomy.
Conclusion
Ultrasound-guided bilateral RSB reduced early postoperative pain and rescue analgesic requirements after robotic single-site gynecologic surgery.
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Case report

[English]
Metastatic appendiceal mucinous adenocarcinoma presenting as bilateral ovarian masses mimicking advanced ovarian cancer: a case report
Naina Kumar, Gunvanti Rathod, Annapurna Srirambhatla, Mishu Mangla, Nireesha Bukke, Pooja T. Rathod
Received February 21, 2026  Accepted June 5, 2026  Published online June 22, 2026  
DOI: https://doi.org/10.12771/emj.2026.01347    [Epub ahead of print]
Appendiceal mucinous adenocarcinoma is a rare gastrointestinal malignancy that may metastasize to the ovaries and closely mimic advanced primary ovarian cancer, creating diagnostic and therapeutic challenges. A 61-year-old postmenopausal woman presented with postmenopausal bleeding, abdominal distension, abdominal pain, and weight loss. Imaging demonstrated bilateral adnexal masses with omental caking and ascites, suggestive of advanced ovarian malignancy. Cancer antigen 125 was elevated, and carcinoembryonic antigen (CEA) levels were markedly increased. She had a history of acute appendicitis 1 year earlier. Biopsy revealed mucinous adenocarcinoma with signet-ring cells. Endoscopic evaluation was unremarkable. Despite neoadjuvant chemotherapy for presumed ovarian cancer, the disease progressed, necessitating cytoreductive surgery. Histopathological examination demonstrated bilateral mucinous adenocarcinoma with peritoneal spread. Immunohistochemistry showed positivity for cytokeratin 20, caudal-type homeobox 2, and special AT-rich sequence-binding protein 2 and negativity for cytokeratin 7 and paired-box gene 8, confirming metastatic appendiceal origin. She was started on fluorouracil, leucovorin, and oxaliplatin chemotherapy. Metastatic appendiceal carcinoma can closely resemble primary ovarian malignancy. Bilateral mucinous ovarian tumors with elevated CEA levels and poor chemotherapy response should prompt evaluation for a gastrointestinal primary tumor.
  • 97 View
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Review article

[English]
Clinical phenotypes and clustering patterns of human toxocariasis in PubMed-indexed case reports: an Antigravity-assisted systematic scoping review
Eun Hee Ha
Received February 28, 2026  Accepted June 10, 2026  Published online June 22, 2026  
DOI: https://doi.org/10.12771/emj.2026.01221    [Epub ahead of print]
Purpose
This study aimed to characterize co-occurrence patterns, statistical associations, and phenotypic clusters of clinical manifestations reported in human toxocariasis case reports indexed in PubMed from 2005 through 2025, inclusive.
Methods
PubMed-indexed case reports from 2005 through 2025 were identified using the query (“Toxocariasis” OR “Toxocara”) AND “Case Reports” [Publication Type] AND 2005:2025[dp] AND ffrft[Filter]. Free full-text articles were retrieved through PubMed Central and other links indexed in PubMed using the ffrft filter. After 7 nonhuman reports and 5 reports without objective diagnostic confirmation were excluded, 139 case reports were included. Antigravity was used to support data extraction, standardization, statistical analysis, and figure generation. Clinical features were mapped to standardized symptom and organ-involvement variables. Pairwise co-occurrence was assessed using 2×2 contingency tables and Fisher’s exact test; association strength was measured using Pearson correlation coefficients; and k-means clustering was used to identify distinct clinical phenotypes.
Results
Four principal clusters were identified: subclinical disease, ocular larva migrans, visceral larva migrans, and neurotoxocariasis/multisystemic disease. The ocular larva migrans and visceral larva migrans clusters were largely distinct, whereas ocular features were frequently co-reported in the neurotoxocariasis/multisystemic cluster. Eosinophilia was strongly associated with systemic manifestations, including fever, dyspnea, cough, pruritus, hepatomegaly, headache, and meningitis, but was not statistically significantly associated with ocular features. Neurotoxocariasis-related features, including headache, meningitis, and seizures, clustered closely.
Conclusion
This artificial intelligence-assisted scoping review identified exploratory clinical association and clustering patterns in human toxocariasis case reports. These findings may support clinical awareness, but they require validation in curated clinical datasets before they are used for diagnosis, risk stratification, or practice guidance.
  • 114 View
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Opinion

[English]
SKYVaricella (a live attenuated varicella vaccine) safety issues revisited
Joowon Lee
Received March 27, 2026  Accepted April 20, 2026  Published online June 15, 2026  
DOI: https://doi.org/10.12771/emj.2026.01263    [Epub ahead of print]

Citations

Citations to this article as recorded by  
  • Letter regarding a herpes zoster outbreak in Korean children: insights from an additional 14 months of data
    Joowon Lee
    Infectious Diseases.2026; 58(7): 738.     CrossRef
  • 163 View
  • 19 Download
  • 1 Crossref

Case report

[English]
Primary breast leiomyosarcoma—pathological challenges and immunohistochemical insights in diagnosing a rare tumor: a case report
Ashwini Pitambra, Ashutosh Rath, Immanuel Pradeep, Krishna Ramavath, Chandramouli Ramalingam
Received March 5, 2026  Accepted April 24, 2026  Published online June 15, 2026  
DOI: https://doi.org/10.12771/emj.2026.01249    [Epub ahead of print]
Primary leiomyosarcoma of the breast is an extremely rare malignancy, accounting for less than 1% of all breast tumors. Diagnosis is challenging because its morphology overlaps with that of other spindle cell lesions, and standardized treatment guidelines are currently unavailable. A 44-year-old woman presented with a rapidly enlarging, firm, 14.8 cm mass in the left breast. She had previously undergone surgery elsewhere, with diagnoses of leiomyoma and desmoid-type fibromatosis. Imaging demonstrated a lobulated mass without evidence of metastasis. Excision revealed pleomorphic spindle cells arranged in intersecting fascicles, with necrosis and dermal invasion. Primary breast leiomyosarcoma was confirmed by immunohistochemistry, which demonstrated smooth muscle actin and desmin positivity and negative staining for pancytokeratin, p63, S100, CD34, and BCL2. The patient underwent modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Primary breast leiomyosarcoma is a rare entity that remains diagnostically challenging. Immunohistochemistry is essential for accurate diagnosis, and optimal management requires a dedicated multidisciplinary approach.
  • 162 View
  • 12 Download
Correspondence
[English]
Artificial intelligence as a pragmatic adjunct to molecular classification in endometrial cancer
Gunvanti Rathod, Pragnesh Parmar
Received February 5, 2026  Accepted April 24, 2026  Published online June 15, 2026  
DOI: https://doi.org/10.12771/emj.2026.01158    [Epub ahead of print]
  • 121 View
  • 8 Download
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