An inguinal hernia shows that the protruding viscus exits from the endoabdominal fascial sac through the internal inguinal ring. Because an inguinal hernia is usually associated with incarceration, obstruction and even strangulation, it must be quickly treated whenever observed. Although there are several predisposing factors of the development of inguinal hernia, relatively little is a case report of the inguinal hernia developed by the increased intra-abdominal pressure during general anesthesia. In this case, we report a patient who developed the unexpected recurrence of left inguinal hernia following lumbar spinal surgery in prone position by increasing intra-abdominal pressure. After manual reduction was performed promptly by general surgeon, the patient was discharged without any complication on the eighth postoperative day.
Anesthesia, General ; Causality ; Hernia, Inguinal* ; Humans ; Inguinal Canal ; Prone Position* ; Recurrence

BACKGROUND/AIMS: The aim of this study was to evaluate the seroconversion rate of a hepatitis A virus (HAV) vaccination in patients with hepatitis B virus (HBV)-related chronic liver disease (CLD). METHODS: Analyses were conducted using clinical records from 94 patients with chronic HBV infection who were seronegative for IgG anti-HAV antibodies between September 2008 and June 2009. Two doses of an HAV vaccine were administered 24 weeks apart. A third vaccine dose was administered only for patients seronegative for anti-HAV antibodies at week 48. RESULTS: The seroconversion rate of anti-HAV following the two-dose vaccination was 86.17%. The seroconversion rate of anti-HAV was not significantly different according to age or status of liver disease. The rate was higher in female than in male patients. A third HAV vaccine dose was administered to 13 patients seronegative for anti-HAV after the two-dose regimen, and 84.62% of these patients showed seroconversion at week 72. CONCLUSIONS: HAV vaccination is effective in most Korean patients with HBV-related CLD, and it might be necessary to evaluate three-dose vaccination approach for non-responders to the conventional regimen to maximize the success of an HAV vaccination program.
Antibodies ; Female ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Immunoglobulin G ; Korea ; Liver ; Liver Diseases ; Male ; Vaccination

BACKGROUND: The differentiation of mesial temporal lobe epilepsy (MTLE) from neocortical temporal lobe epilepsy (NTLE) is important in surgical planning of temporal lobe epilepsy (TLE). We tried to find clinical semiology separating one from the other. METHODS: We reviewed 136 seizures of 28 patients who had epilepsy surgery and good clinical outcome (Engel class I or II). We compared the following clinical features between MTLE and NTLE; the history of febrile convulsion, staring, automatism, head version, contralateral dystonic (CLD) and tonic (CLT) posturing, secondarily generalized tonic-clonic seizure (SGTC) frequency, the duration of partial seizures (excluding SGTC part) and time to SGTC and the type of aura (abdominl aura, vertiginous aura, visual aura, gustatory aura, and psychic aura etc.). RESULTS: Eighteen men and ten women were included. Mean age was 29.1+ 8.8 years (11-45). Abdominal aura (p = 0.04), oroalimentary (p < 0.01) and gestural automatism (p < 0.01), CLD (p < 0.01), and CLT posturing (p < 0.01) were seen significantly more often in MTLE and the duration of partial seizure (excluding SGTC) (p < 0.01) was longer in MTLE than NTLE. In NTLE, head version (p < 0.01) and SGTC (p < 0.01) occurred more frequently and the evolution time to SGTC (p = 0.04) was shorter. Duration of automatism and staring and occurrence of unilateral blinking were not different between two groups. CONCLUSION: Abdominal aura, oroalimentary and gestural automatism, CLD and CLT posturing, longer partial seizure duration were more suggesting MTLE, while rapid generalization, frequent SGTC and head version were seen more often in NTLE.
Automatism ; Blinking ; Epilepsy ; Epilepsy, Temporal Lobe* ; Female ; Generalization (Psychology) ; Head ; Humans ; Male ; Seizures ; Seizures, Febrile ; Temporal Lobe*

BACKGROUND/AIMS: Pegylated interferon (peginterferon) and ribavirin is the current standard therapy for chronic hepatitis C. The aims of this study were to evaluate the efficacy of peginterferon and ribavirin and to identify predictors of a sustained virological response (SVR) to the retreatment of chronic hepatitis C in Korea. METHODS: The clinical records of 91 patients with chronic hepatitis C who were retreated with peginterferon and ribavirin were retrospectively analyzed. None of the patients had previously attained a SVR, and the patients were categorized according to their previous responses (nonresponder, relapser, or inadequate treatment) to conventional interferon/ribavirin. RESULTS: The overall SVR rate was 54.9%. Independent predictors of a SVR were genotypes 2 and 3, relapse, an adherence to peginterferon of over 80%, and an early virological response (EVR). For genotype 1 patients, an adherence to peginterferon of over 80% was an independent predictor of a SVR. CONCLUSIONS: Peginterferon and ribavirin therapy is effective for the retreatment of Korean chronic hepatitis C patients who have failed interferon/ribavirin, especially in patients with genotypes 2 and 3, relapse, an adherence to peginterferon over 80%, and an EVR. For genotype 1 patients, retreatment was effective in patients with an adherence to peginterferon over 80%.
Genotype ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Recurrence ; Retreatment ; Retrospective Studies ; Ribavirin

BACKGROUND AND OBJECTIVES: It is known that both hypercholesterolemia and aging cause endothelial dysfunction, but which has the greater effect is less well known. A useful, non-invasive method for the evaluation of endothelial function is flow-mediated dilation (FMD) of the brachial artery (BA) employing high-resolution ultrasound. This study was performed to evaluate the effect of serum cholesterol and age on endothelial function in women utilising the above method. SUBJECTS AND METHODS: 21 of the 37 women in this study (mean age 46+/-15 years, range 24-72), had hypercholesterolemia (>or=200 mg/dL) and 16 had normocholesterolemia (<200 mg/dL). None of the subjects suffered classic risk factors associated with atherosclerosis other than hypercholesterolemia. The inner diameter of the right BA was measured at the peak of ECG R wave, from a longitudinal section taken by an 8.0-MHz B-mode linear-array ultrasonic transducer. Scans were taken at rest, during reactive hyperaemia (endothelium-dependent dilation;EDD), again at rest, and following sublingual nitroglycerin (endothelium-independent dilation;EID). RESULTS: From simple linear regression analyses, the serum cholesterol levels were found to be negatively related to the EDD of the BA at an age <50 years (r=-0.63, p<0.01), and also >or=50 years (r=-0.54, p<0.05). Serum cholesterol levels were not significantly related to the EID, regardless of age. In contrast, age was not related to EDD or EID in either normocholesterolemic or hypercholesterolemic subjects. CONCLUSION: These results suggest hypercholesterolemia has a greater effect than age in impairing the endothelial function in women.
Age Factors ; Aging ; Atherosclerosis ; Brachial Artery ; Cholesterol ; Electrocardiography ; Endothelium ; Female ; Humans ; Hypercholesterolemia* ; Linear Models ; Nitroglycerin ; Risk Factors ; Transducers ; Ultrasonics ; Ultrasonography ; Vasodilation

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.
Acromegaly ; Consensus ; Expert Testimony ; Insurance Coverage ; Insurance, Health ; Octreotide ; Somatostatin

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.
Acromegaly ; Expert Testimony ; Growth Hormone ; Humans ; Octreotide ; Pituitary Neoplasms ; Somatostatin

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure