Purpose: We aimed to evaluate the precision of preoperative colonoscopic tattooing and intraoperative colonoscopic tumor localization in determining distal surgical margins for leftsided colorectal cancer surgery. Methods: This retrospective study included 30 patients who underwent laparoscopic colorectal surgery, preoperative colonoscopic tattooing, and intraoperative colonoscopic localization for colorectal cancer at our center between July 2020 and March 2024. Clinical data were collected, and the precision of these methods was assessed by measuring the differences between the target resection margin and the actual pathological resection margin. Results: In four patient cases, the indocyanine green tattoo was not visible in the laparoscopic surgical field. The average stained length of the tattoo was 2.89 cm, with a mean distance of 1.18 cm between the low margin of the tattoo and the cancer. The difference between the target distal resection margin by intraoperative colonoscopic localization and the actual pathological resection margin was 0.88 cm. No complications related to the intraoperative colonoscopy were observed. Conclusion Preoperative tattooing showed limitations, such as spreading and occasional invisibility. Intraoperative colonoscopic localization proved to be an effective method for achieving more precise distal surgical margins in left-sided colorectal cancer surgery.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.

Background and Objectives: Cigarette smoking is a major risk factor for atherosclerosis.Nicotine, a crucial constituent of tobacco, contributes to atherosclerosis development and progression. However, evidence of the association between nicotine and neointima formation is limited. We aimed to evaluate whether nicotine enhances neointimal hyperplasia in the native epicardial coronary arteries of pigs after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods: After coronary angiography (CAG) and quantitative coronary angiography (QCA), we implanted 20 DES into 20 pigs allocated to 2 groups: no-nicotine (n=10) and nicotine (n=10) groups. Post-PCI CAG and QCA were performed immediately. Follow-up CAG, QCA, optical coherence tomography (OCT), and histopathological analyses were performed 2 months post-PCI. Results: Despite intergroup similarities in the baseline QCA findings, OCT analysis showed that the nicotine group had a smaller mean stent and lumen areas, a larger mean neointimal area, greater percent area stenosis, and higher peri-strut fibrin and inflammation scores than the no-nicotine group. In immunofluorescence analysis, the nicotine group displayed higher expression of CD68 and α-smooth muscle actin but lower CD31 expression than the no-nicotine group. Conclusions Nicotine inhibited re-endothelialization and promoted inflammation and NIH after PCI with DES in a porcine model.

ABO/RhD-mismatch transfusions are frequently encountered in clinical practice, so a systematic and thorough understanding of these events is necessary. In the case of ABO minor-incompatible transfusions, it is important to consider the possibility of hemolytic transfusion reactions because of the reaction between the ABO antibodies in the blood product and the patient’s red blood cells. For platelet products, the risk is approximately 1 in 9,000.In ABO major-incompatible transfusions, red blood cell products are contraindicated, but plasma or platelet products may be allowed in situations such as blood product shortages. In RhD major-incompatible transfusions, the use of Rh immunoglobulin to prevent alloimmunization may be considered depending on the patient’s clinical status and the availability of blood products. In the case of RhD major-incompatible red blood cell transfusions, however, such prevention is difficult to apply in Korea. ABO/RhD-mismatch transfusion may also affect the long-term outcomes of patients, in addition to immediate hemolytic transfusion reactions. Therefore, decisions must be made based on the patient’s clinical situation considering the benefits and potential risks.

Hemicrania continua (HC) is an indomethacin-responsive headache, characterized by unilateral and continuous headaches with cranial autonomic symptoms. Various pathologies, including sinus-related conditions, are associated with HC. Here, we report the case of a 62-year-old man with HC and rhinosinusitis. The patient complained of a unilateral continuous headache with ipsilateral cranial autonomic symptoms, conjunctival injection, and eyelid edema for 20 months. HC was identified as a potential diagnosis based on the symptom criteria, and a response to indomethacin confirmed the diagnosis. Trigeminal autonomic cephalalgia should be considered in patients with unilateral headaches and cranial autonomic symptoms.

Primary care services improve healthcare outcomes and limit unnecessary specialty care. Thus, it is essential to monitor primary care physician demand and supply projections to suggest evidence-based healthcare reforms and promote better healthcare delivery. This study evaluates 28 demand variables, 50 supply variables, and 26 additional variables associated with the demand and supply projections of physicians by reviewing scenarios from other countries, including Taiwan, Singapore, Japan, and the United States of America. The results indicate that Korea uses less diverse demand and supply indicators and suggest the need to implement variables used in the other four countries to improve projection modeling.

Purpose: We aimed to investigate the causes and clinical features of compressive optic neuropathy in Koreans. Methods: We analyzed the medical records of patients diagnosed with compressive optic neuropathy from March 2014 to December 2023 to determine the cause of optic nerve compression, symptoms and symptom patterns at first visit, accompanying symptoms, types of visual field defects, and visual prognosis after surgery. In addition, the results of visual field tests and optical coherence tomography were analyzed to determine the positivity rate of each test and factors affecting test results. Results: A total of 73 patients were diagnosed with compressive optic neuropathy, and the most common cause was pituitary tumor (37 patients, 50.7%) followed by meningioma (16 patients, 21.9%), hemangioma (4 patients, 5.5%), thyroid ophthalmopathy (4 patients, 5.5%), and paranal sinus tumor tumor (2 patients, 2.7%). In terms of symptom pattern, half of the patients had vision and visual field defects that appeared gradually (41 patients, 56.2%), but there were also quite a few patients whose symptoms appeared suddenly (17 patients, 23.3%). The positivity rate of the diagnostic test was highest for visual field testing (89.0%). In pituitary tumors, tumor size affected diagnostic test results (p = 0.01). Conclusions The most common cause of compressive optic neuropathy in South Koreans was a pituitary tumor. Deterioration of visual function can also occur acutely, and visual field testing was useful for diagnosis.

Background and Objectives: The Valsalva test, although commonly utilized to assess the Eustachian tube function, is limited by drawbacks such as inconsistent pressure increases in the nasal cavity. Thus we introduced the “Popper test,” a tympanic membrane inflation test using the automatic middle ear inflation device known as middle ear inflation device (MEID), to explore its viability as an alternative to the Valsalva test.Subjects and Method We sampled 80 ears from patients between June 1, 2023, and August 1, 2023. Each patient underwent both the Valsalva and Popper tests using the MEID. Participants were divided into three categories: the “unable” group (patients who could not follow the Valsalva maneuver) and the “successful” and “unsuccessful” groups (patients whose attempts at the Valsalva or Popper tests either successed or failed). Success or failure was determined using an otoscope to assess the bulging of the tympanic membrane. Results: Of the 68 ears with normal middle ear pressure, 30.9% (21 ears) showed an inability to perform the Valsalva test, 45.6% (31 ears) successfully inflated the tympanic membrane via the Valsalva test, and 23.5% (16 ears) failed. Conversely, the Popper test resulted in an 88.2% (60 ears) success rate for inflating the tympanic membrane, with only 11.8% (8 ears) failing. Conclusion Variability observed in the Valsalva test outcomes may be attributed to individual differences and the instructor’s technique. MEID, as utilized in the Popper test, offers a promising alternative to the Valsalva test, potentially enhancing the reliability by minimizing individual variation. However, the diagnostic performance may be dependent on the properties of the MEID.

This report provides a summary of the 2024 survey results on the external quality assessment (EQA) scheme for the general transfusion medicine test and the general transfusion antibody test programs in Korea. Proficiency testing materials were prepared at the Asan Medical Center for bi-annual distribution to participating laboratories. The accuracy rates and number of participating laboratories for the bi-annual EQAs were: ABO typing, 99.6%–99.9% (n=944, n=945); RhD typing, 99.9%–100.0% (n=929, n=930);crossmatching, 95.0%–99.2% (n=825, n=825); unexpected antibody scre ening, 99.5%–100.0% (n=363, n=367); direct antiglobulin test (DAT) using a polyspecific reagent, 99.3%–100.0% (n=296, n=299); DAT using an antiimmunoglobulin G monospecific reagent, 100.0% (n=74, n=72); and DAT using an anti-C3d monospecific reagent, 98.6%–100.0% (n=72, n=71). The 2024 EQA scheme for the transfusion medicine program has improved and maintained the standards of the participating laboratories.