Crohn’s disease (CD) is a relapsing and progressive condition characterized by diarrhea, abdominal pain, weight loss, and hematochezia that results in serious complications such as perforations, fistulas, and abscesses. Various medications, interventions, and surgical treatments have been used to treat CD. The Korean guidelines for CD management were distributed in 2012 and revised in 2017 by the Inflammatory Bowel Disease (IBD) Research Group of the Korean Association for the Study of Intestinal Diseases. Substantial progress in mucosal immunologic research has elucidated the pathophysiology of IBD, leading to development of biological agents for treatment of CD. The first developed biologic agent, tumor necrosis factor-α agents, were shown to be efficacious in CD, heralding a new era in management of CD. Subsequently, vedolizumab, a monoclonal antibody against integrin α4β7, and ustekinumab, a human monoclonal antibody that inhibits the common p40 subunit of interleukin-12 and interleukin-23, were both approved for clinical use and are efficacious and safe for both induction and maintenance of remission in moderate-to-severe CD patients. Moreover, a recent study showed the non-inferiority of CT-P13, an infliximab biosimilar, compared with infliximab in CD patients. The third Korean guidelines for CD management provide updated information regarding treatment of moderate-to-severe CD patients with biologic agents.

PURPOSE: Partial nephrectomy has a similar oncologic outcome to radical nephrectomy while reducing cardiac and metabolic morbidity. However, previous studies reported that partial nephrectomy had been underutilized. The purpose of this study is to analyze trends in the use of partial nephrectomy in Korea and evaluate which individual factors and hospital factor influenced the operative approach. MATERIALS AND METHODS: Using URO-PDS database, 11560 patients underwent nephrectomy for renal cell carcinoma between 2006 and 2010 were identified. International Classification of Disease (ICD-9) diagnosis codes were applied to target subject of interest. Logistic regression was applied to identify determinants of partial nephrectomy. RESULTS: Over the study period, the proportion of partial nephrectomies has steadily increased from 9.4% in 2006 to 30.4% in 2010 (p<0.001). Deviation of utilization in partial nephrectomy has been observed based on the area (p<0.001) and type of surgery (p<0.001). Individual of younger age, as well as male, were more likely to be treated with partial nephrectomy (p<0.001 for each). Furthermore, Patient treated at hospitals with higher nephrectomy volume were more prone to be treated with partial nephrectomy (p<0.001 for each). CONCLUSIONS: Partial nephrectomies have been increasingly performed over the study period but are still underutilized.
Carcinoma, Renal Cell* ; Classification ; Diagnosis ; Humans ; Korea* ; Logistic Models ; Male ; Nephrectomy*

This study represents the first epidemiological study based on the national registry of primary immunodeficiencies (PID) in Korea. Patient data were collected from 23 major hospitals. A total of 152 patients with PID (under 19 yr of age), who were observed from 2001 to 2005, have been entered in this registry. The period prevalence of PID in Korea in 2005 is 11.25 per million children. The following frequencies were found: antibody deficiencies, 53.3% (n = 81), phagocytic disorders, 28.9% (n = 44); combined immunodeficiencies, 13.2% (n = 20); and T cell deficiencies, 4.6% (n = 7). Congenital agammaglobulinemia (n = 21) and selective IgA deficiency (n = 21) were the most frequently reported antibody deficiency. Other reported deficiencies were common variable immunodeficiencies (n = 16), X-linked agammaglobulinemia (n = 15), IgG subclass deficiency (n = 4). Phagocytic disorder was mostly chronic granulomatous disease. A small number of patients with Wiskott-Aldrich syndrome, hyper-IgE syndrome, and severe combined immunodeficiency were also registered. Overall, the most common first manifestation was pneumonia. This study provides data that permit a more accurate estimation PID patients in Korea.
Adolescent ; Agammaglobulinemia/congenital/epidemiology ; Age Distribution ; Child ; Child, Preschool ; Common Variable Immunodeficiency/epidemiology ; Female ; Genetic Diseases, X-Linked/epidemiology ; Humans ; IgA Deficiency/epidemiology ; IgG Deficiency/epidemiology ; Immunologic Deficiency Syndromes/*epidemiology ; Infant ; Infant, Newborn ; Job's Syndrome/epidemiology ; Male ; Prevalence ; Questionnaires ; Registries ; Republic of Korea/epidemiology ; Severe Combined Immunodeficiency/epidemiology ; Sex Distribution ; Wiskott-Aldrich Syndrome/epidemiology ; Young Adult

BACKGROUND: Farnesylacetone compounds that dilate blood vessels by blocking calcium channels in sargassum siliquastrum have been reported. And this study was done to demonstrate the effect of YJ-7, a synthetic material derived from these compounds, on vessel dilation and blood pressure control. METHODS: We used vasoconstricted basilar and carotid artery of rabbits. Changes in blood pressure were measured in vivo at 15, 30, 45, and 60 minutes after intravenous injection of YJ-7 3 microM, EC50 value from in vitro experiment, and nimodipine 10 microM through the tail vein of 20 rats. Spontaneous hypertensive rat (SHR) has its blood pressure higher than 190 mmHg. Measurements of blood pressure were done 6 times and the mean values were used for data analysis. RESULTS: Systolic and diastolic blood pressure before the injection of YJ-7 were 194.2 +/- 6.1 mmHg and 140.2 +/- 6.4 mmHg. Blood pressure were decreased with time, 157.2 +/- 2.6 / 120.8 +/- 4.2 mmHg at 15 minutes, 161.8 +/- 18.3 / 123.2 +/- 13.9 mmHg at 30 minutes, and 156.0 +/- 4.1 / 112.4 +/- 1.7 mmHg at 45 minutes. The blood pressure lowering effect lasted until 45 minutes. However, the blood pressure increased to 182.2 +/- 16.4 / 149.0 +/- 20.4 mmHg at 60 minutes reaching similar levels of before the injection (P < 0.05). CONCLUSIONS: We could see YJ-7 has vasorelaxation effect and would be helpful to control blood pressure with short recovery period than nimodipine.
Animals ; Blood Pressure ; Blood Vessels ; Calcium ; Calcium Channels ; Carotid Arteries ; Glycosaminoglycans ; Injections, Intravenous ; Nimodipine ; Rabbits ; Rats ; Sargassum ; Terpenes ; Vasodilation ; Veins

The present case first describes the spontaneous thigh hematoma induced by enoxaparin in a hemodialysis patient. A 64- year-old woman on a hemodialysis therapy was diagnosed with acute coronary syndrome, and treated with enoxaparin. Ten days after enoxaparin administration, diffuse swelling and pain developed suddenly in the right thigh without a history of trauma. There was a weak arterial pulse below the knee with an abrupt decrease of hemoglobin level. There were no significant abnormalities in the coagulation tests including the platelet count, prothrombin time, and activated partial thromboplastin time. Computed tomographic (CT) angiography and lower extremity arteriography were performed, which showed several bleeding foci involving branches of the right deep femoral artery. She was treated successfully by embolization at the bleeding sites, along with a transfusion.
Acute Coronary Syndrome ; Angiography ; Enoxaparin ; Female ; Femoral Artery ; Hematoma ; Hemoglobins ; Hemorrhage ; Humans ; Knee ; Lower Extremity ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Renal Dialysis ; Thigh

In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System (SynchronyTM, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were 11.5+/-3.09 mm for desynchronization and 0.14+/-0.08 mm for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was 0.18+/-0.06 mm. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was 17.39+/-0.14 mm for inactivity and 1.37+/-0.11 mm for activity. The mean difference of absolute dose was 0.68+/-0.38% in static target and 1.31+/-0.81% in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.
Four-Dimensional Computed Tomography ; Prescriptions ; Radiosurgery ; Track and Field

BACKGROUND/AIMS: We performed a prospective study to compare the feasibility, safety and tolerance among ultrathin transnasal (UT-N), thin transnasal (T-N) and ultrathin oral (UT-O) esophagogastroduodenoscopy. METHODS: Two narrow diameter endoscopes (phi=5.2 mm for UT-N and UT-O, phi=6.5 mm for T-N) were used. The operator factors and patient factors were quantified by a visual analogue scale. RESULTS: The procedure was successfully completed in 100 of 100 patients in the UT-O group. The T-N group, when compared with the UT-N group, accounted for a significantly higher portion of failure (14% vs 3%, respectively, p=0.000), more cases of epistaxis (11% vs 3%, respecttively, p=0.013) and more complaints of nasal pain (17% vs 6%, p=0.016). The overall quality of the exam was significantly higher in the UT-N group (UT-N, 8.7; T-N, 8.1; UT-O, 8.2, p=0.04). The frequency of a incurring a gag reflex was significantly lower in the UT-N group (UT-N, 1.26; T-N, 1.48; UT-O, 2.94, p= 0.000). The patients' score for overall general satisfaction was higher in the UT-N group (UT-N, 8.5; T-N, 7.8; UT-O, 7.7, p=0.006). Nausea was significantly reduced the in UT-N group (UT-N, 8.2; T-N, 7.8; UT-O, 7.3, p= 0.003). Patients in the UT-N group were more willing to repeat the same procedure (UT-N, 82%; T-N, 65%; UT-O, 71%, p=0.046). CONCLUSIONS: Ultrathin transnasal endoscopy is more feasible, safe and comfortable compared with the thin transnasal endoscopy or when compared with either instrument that was passed orally.
Endoscopes ; Endoscopy ; Epistaxis ; Humans ; Nausea ; Prospective Studies ; Reflex

Metastatic renal cell carcinoma is renowned for its potency to spread to almost any organ of the body; however metastasis to the gall bladder is very rare. We present a case of a 48 year old man who initially demonstrated renal cell carcinoma, and in who gallbladder metastasis was later detected. A review of the literature revealed only a small number of cases of renal cell carcinoma metastasizing to the gallbladder, and these were primary found upon necropsy. Gall-bladder metastasis in this case was detected clinically.
Carcinoma, Renal Cell/pathology/*secondary ; Gallbladder Neoplasms/pathology/*secondary ; Human ; Kidney Neoplasms/*pathology ; Male ; Middle Aged

The purpose of this study was to estimate the national prevalence of childhood asthma and other allergic diseases in Korea, and to determine potential risk factors for the diseases. Stratified random samples of 42,886 were selected from 34 elementary (6-12 yr olds) and 34 middle schools (12-15 yr olds) nationwide, and 38,955 were in the final analysis. The Korean-translated modified version of the International Study of Asthma and Allergies in Childhood questionnaire was used in this cross-sectional survey. Twelve-month prevalences of the symptoms of asthma, rhinoconjunctivitis, and flexural eczema were 8.7%, 10.5%, 7.3% in 6-12 yr olds, and 8.2%, 10.0%, 3.9% in 12-15 yr olds, respectively. For allergic conjunctivitis, food allergy, and drug allergy, the prevalences in 6-12 yr olds were 11.2%, 6.5%, and 1.5%, respectively. Asthma and flexural eczema decreased significantly with age. Other significant risk factors were also noted. For 6-12 yr-old asthma, adjusted odds ratio (aOR) of body mass index was 1.21 with 95% confidence interval (CI) 1.0-1.48, aOR of passive smoking was 1.37 with 95%CI 1.24-1.51, aOR of carpet use was 1.28 with 95%CI 1.10-1.49. For 6-12 yr-old eczema, aOR of affluence was 1.22 with 95%CI 1.07-1.39. The control of obesity and passive smoking would be the most important preventive measures of allergic diseases.
Adolescence ; Age Distribution ; Asthma/*epidemiology ; Child ; Conjunctivitis, Allergic/*epidemiology ; Drug Hypersensitivity/epidemiology ; Eczema/*epidemiology ; Female ; Food Hypersensitivity/epidemiology ; Human ; Korea/epidemiology ; Male ; Prevalence ; Questionnaires ; Risk Factors ; Sex Distribution

The major clinical advantages of dialyzer reuse are improved biocompatibility and a decrease in the frequency of the first use syndrome. Dialyzer reuse has made it possible to use biocompatible high flux membranes of the high price. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, it is not widely accepted in Korea. At Ajou University Hospital, we have reprocessed dialyzers since March 2000, and here we report our clinical experience for the 1st 8 weeks. We used high flux dialyzers with reprocessing practice in 24 chronic hemodialysis patients. Dialyzer reprocessing was performed by an automated machine(Renatron) using Renalin. We limited reuse upto 20 times, and we were able to reuse dialyzers upto this number in 17 patients. During the study period, no significant complication was observed as a result of the reuse program. Kt/Vurea and urea reduction ratio(URR) were not different between high and low flux dialyzers(1.41+/-0.29 vs 1.61+/-0.41 for Kt/Vurea and 66.70+/- 6.40% vs 65.69+/-5.63% for URR). In contrast, beta2-microglobulin(beta2M) reduction ratio and clearance were greater in high flux dialyzers than low flux dialyzers(p<0.001, -9.52+/-20.28% vs 42.00+/-8.61% for beta2M reduction ratio and 9.54+/-11.71mL/min vs 48.54+/-14.33mL/min for beta2M clearance). Kt/Vurea, URR, beta2M reduction ratio and beta2M clearance did not deteriorate with the increasing number of reuse. The predialysis values of beta2M decreased by 51% after 19 uses(p<0.001, 37.04+/-13.39 to 18.98+/-3.41mg/L). In summary, during the short pilot study period of 8 weeks, no significant clinical complication was encountered as a result of dialyzer reuse, and our results confirmed the effects of high flux dialyzers on removal of beta2M.
Humans ; Kidneys, Artificial* ; Korea ; Membranes ; Pilot Projects ; Renal Dialysis ; United States ; Urea