Background: s/Aims: The treatment landscape for hepatocellular carcinoma (HCC) has significantly evolved over the past decade. We aimed to analyze trends in treatment patterns for HCC using a nationwide claims database from the Korean Health Insurance Review and Assessment Service. Methods: This retrospective population-based cohort study analyzed 171,002 newly diagnosed HCC patients between 2008 and 2022. Etiologies and treatment modalities were categorized based on the ICD-10 codes and insurance data. Results: The annual incidence decreased from 11,814 in 2008 to 10,443 in 2022. However, patients aged ≥70 increased noticeably, with those aged ≥80 rising from 3.8% in 2008 to 13.1% in 2022. From 2008 to 2022, the predominant cause of hepatitis B virus decreased from 68.9% to 59.7%, whereas nonalcoholic fatty liver disease increased from 8.9% to 15.8%. The initial treatment trends shifted: surgical resection and systemic therapy increased from 12.2% to 21.3% and from 0.2% to 9.6%, whereas transarterial therapy decreased from 49.9% to 36.6%. Best supportive care decreased from 31.7% to 21.3%. In the subgroup analysis, laparoscopic resection rate increased from 10.6% to 60.6% among the surgical resections. Sorafenib initially accounted for 100%, lenvatinib peaked at 36.5% in 2021, and atezolizumab-bevacizumab became the most widely used (63.1%) by 2022 among the systemic therapies. Conclusions This study demonstrates the temporal changes in the treatment patterns of Korean HCC patients. Surgical resection, particularly laparoscopic liver resection, and systemic therapy has increased significantly. These changes may have been influenced by reimbursement policies and advances in clinical research.

Xanthogranulomatous cystitis is a rare, benign chronic inflammatory disease of unknown etiology. Herein we report a case of a 41-year-old man who presented with painless hematuria and a bladder mass on imaging studies.
Adult ; Cystitis ; Hematuria ; Humans ; Urinary Bladder ; Xanthomatosis

OBJECTIVES: To investigate the outcome of preterm infants and the prevalence of cerebral palsy and to examine the relevance between clinical risk factors, ultrasonographic abnormalities and the development of cerebral palsy. METHODS: From January, 1993, to December, 1994, we selected and followed up 437 cases of survived preterm infants born in Seoul National University Hospital. Clinical risk factors such as gestational age, birth weight, maternal complications, birth asphyxia, and neonatal sepsis were evaluated. Sequential ultrasonographic observations were done at the interval of 7 or 10 days. Ultrasonographic abnormalities could be classified into periventricular echodensity, periventricular leukomalacia (PVL) including cystic PVL, intraventricular hemorrhage, ventriculomegaly and brain atrophy. Diagnosis of the cerebral palsy was confirmed after the follow up more than 2 years after birth, and the correlations of ultrasongraphic abnormalities with clinical types and severities of cerebral palsy were analyzed. RESULTS: Twenty one cases (4.8%) among survived infants were diagnosed as a cerebral palsy. The prevalence of cerebral palsy was 20% in infants with less than 32 weeks of gestation, and 1.4% after 34 weeks. The prevalence of cerebral palsy was 12% in infants with less than 2000 g of birth weight, while, 0.4% in more than 2000 g of birth weight. Mother's age, primiparaty, and history of abortion did not influence the prevalence of cerebral palsy, but preterm labor, preterm rupture of membrane, severe birth asphyxia, neonatal sepsis, and respiratory distress syndrome were significantly relevant to the increased prevalence of cerebral palsy. Fifty six percents (18/32) of PVL (100% of cystic PVL) and 53% (7/13) of third grade IVH progressed to a cerebral palsy. Without PVL, third grade IVH had no explicit correlation with a cerebral palsy. Multiple logistic regression analysis of clinical risk factors and ultrasonographic abnormalities revealed that PVL is a determinant and independent risk to the cerebral palsy. Most cases turned out a spastic diplegia. The cases with cystic lesions especially showed the worse clinical outcomes. CONCLUSION: Four point eight percents of survived preterm infants developed a cerebral palsy. The existence of PVL was the most important risk factor among the perinatal problems and ultrasonographic abnormalities.
Asphyxia ; Atrophy ; Birth Weight ; Brain ; Cerebral Palsy* ; Diagnosis ; Female ; Follow-Up Studies ; Gestational Age ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Leukomalacia, Periventricular ; Logistic Models ; Membranes ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Prevalence ; Risk Factors* ; Rupture ; Seoul ; Sepsis ; Ultrasonography

As the survival rate of preterm infants increasing, much perinatologic concern has been paid to the possibility of their getting into cerebral palsy. The purpose of this study is to determine the relationship between the early periventricular abnormalities and the incidence of cerebral palsy among preterm infants, and then to estimate the value of periventricular leukomalacia(PVL) as the prognostic factor by verifying the clinicopathological correlation of it with cerebral palsy. We have selected 174 cases with periventricular abnormality in early ultrasonographic findings among the survival preterm infants. 163 of them were followed up successfully to verify the incidence of cerebral palsy. Sequential ultrasonographic observations had been made at the interval of 7 or 10 days. Periventricular abnormalities could be classified into three types, which consist of the PVL(including cystic PVL), suspicious PVL, and periventricular echodensity without tissue loss. Associated lesions such as intraventricular hemorrhage, ventriculomegaly, brain atrophy were evaluated. Diagnosis of cerebral palsy was confirmed after following up more than 2 years of age, and the correlations of periventricular abnormalities with the clinical type and severity of cerebral palsy were analyzed. The 24.5% (40/163) of our samples revealed periventricular leukomalacia and the 17.8% (29/163) of them were diagnosed as cerebral palsy. The 65% (26/40) of preterm infants with definite PVL were cerebral palsy and their relative risk ratio for cerebral palsy is 26.7. Without PVL, there were no explicit correlations between cerebral palsy and associated abnormalities. Most cases with cerebral palsy turned out to be the spastic diplegia. In the cases with cystic lesions especially, the clinical outcome appear to be more severe. We've reached the point that the presence of PVL in preterm infants had a strong correlation with the development of cerebral palsy. Moreover, the association with cystic lesions is not only a strong correlation with cerebral palsy, but also a poor prognostic value for functional outcome.
Atrophy ; Brain ; Cerebral Palsy* ; Diagnosis ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Leukomalacia, Periventricular* ; Odds Ratio ; Survival Rate ; Ultrasonography

Background: /Aim: Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established. Methods: Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC. Results: Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05). Conclusions Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.

Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as a polymorphic eruption of pregnancy, is the most common dermatosis of pregnancy. Typically, PUPPP starts with erythema and urticarial papular eruption in the abdominal striae and may extend to the buttocks and thighs. It usually evolves in the third trimester and resolves rapidly in the postpartum. It is not usually recurrent in subsequent pregnancies. We report herein two patients with postpartum PUPPP.
Buttocks ; Erythema ; Female ; Humans ; Postpartum Period ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Pruritus ; Skin Diseases ; Thigh

Calcium channel blockers are widely used antihypertensive drugs, which are uncommonly associated with cutaneous reactions, such as pruritus, urticaria, or alopecia. Photosensitivity presenting with telangiectasia has rarely been described. We present here a case of photodistributed telangiectasia induced clinically by amlodipine and histologically by enlarged capillaries in the upper dermis without signs of vasculitis.
Alopecia ; Amlodipine ; Antihypertensive Agents ; Calcium Channel Blockers ; Capillaries ; Dermis ; Pruritus ; Telangiectasis ; Urticaria ; Vasculitis

Apert syndrome is a rare genetic craniofacial disorder associated with premature fusion of multiple cranial sutures and syndactyly. It is caused by mutation in the fibroblast growth factor receptor 2 genes. The clinical findings are characterized by the typical dysmorphic facial features, including hypertelorism, proptosis and cleft palate. Most of these patients have widespread, severe acne involving the face, chest, back and forearms during puberty and the acne is unresponsive to conventional treatments. We report here on a patient with the recalcitrant acne of Apert syndrome and the patient had failed to respond to conventional acne treatment, but the acne was successfully treated with isotretinoin
Acne Vulgaris ; Acrocephalosyndactylia ; Cleft Palate ; Cranial Sutures ; Exophthalmos ; Forearm ; Humans ; Hypertelorism ; Isotretinoin ; Puberty ; Receptor, Fibroblast Growth Factor, Type 2 ; Syndactyly ; Thorax

PURPOSE: Fractional exhaled nitric oxide (FeNO) is a maker of airway inflammation, and impedance of low frequency in the impulse oscillometry system (IOS) reflects small-airway obstruction. We investigated the association of the FeNO level with IOS parameters and spirometry results in asthma patients. METHODS: Fifty-eight children with asthma (60.3%, male), mean age 8.3 years (range, 4.5-16.0 years), were enrolled in the study. Reactance and resistance at 5 Hz with IOS, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced expiratory flow 25%-75% of the vital capacity (FEF25%-75%) with spirometry and FeNO were measured in all patients. The Z-score of spirometry and IOS parameters and the mean level of FeNO were used for correlation and regression analysis. RESULTS: FeNO was not significantly associated with height, age, or other demographic parameters. There was a statistically significant correlation between spirometry results and IOS measurements. The FeNO level was not significantly correlated with IOS variables. After adjusting for height, sex, atopic status, and the use of inhaled corticosteroid, the FeNO level showed significant correlations with Z-score of FEV1/FVC (P=0.037, adjusted R 2=0.234). CONCLUSION: FeNO was significantly correlated with Z-scores of FEV1/FVC, but not with IOS variables. Therefore, FeNO may be used to detect whole airway obstruction, but not small-airway obstruction.
Airway Obstruction ; Asthma* ; Child* ; Electric Impedance ; Forced Expiratory Volume ; Humans ; Inflammation ; Nitric Oxide* ; Oscillometry* ; Regression Analysis ; Respiratory Function Tests ; Spirometry* ; Vital Capacity

Among hematologic diseases, structural abnormalities of autosomal chromosomes are well-known, but cases involving the sex chromosomes are uncommon. Duplications of the long arm of chromosome 1 have been reported in several hematologic diseases including myelodysplastic syndrome, myeloproliferative neoplasms, acute myeloid leukemia, acute lymphoblastic leukemia, and Burkitt lymphoma. However, dup(1q) as a der(Y)t(Y;1)(q12;q12) is very rare. Here, we report a case of essential thrombocythemia harboring der(Y)t(Y;1)(q12;q12) with literature review.
Arm ; Burkitt Lymphoma ; Chromosome Aberrations ; Chromosomes, Human, Pair 1 ; Hematologic Diseases ; Humans ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Sex Chromosomes ; Thrombocythemia, Essential*