Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Objective: : This retrospective study investigated the clinical and angiographic characteristics of ruptured true posterior communicating artery (PCoA) aneurysms in comparison with junctional PCoA aneurysms presenting with a subarachnoid hemorrhage. Methods: : The medical records and radiological data of 93 consecutive patients who underwent three-dimensional rotational angiography and surgical or endovascular treatment for a ruptured junctional or true PCoA aneurysm over an 8-year period were examined. Results: : The maximum diameter of the ruptured true PCoA aneurysm (n=13, 14.0%) was significantly smaller than that of the ruptured junctional PCoA aneurysms (n=80, 4.45±1.44 vs. 7.68±3.36 mm, p=0.001). In particular, the incidence of very small aneurysms <4 mm was 46.2% (six of 13 patients) in the ruptured true PCoA aneurysm group, yet only 2.5% (two of 80 patients) in the ruptured junctional PCoA aneurysm group. Meanwhile, the diameter of the PCoA was significantly larger in the true PCoA aneurysm group than that in the junctional PCoA aneurysm group (1.90±0.57 vs. 1.15±0.49 mm, p<0.001). In addition, the ipsilateral PCoA/P1 ratio was significantly larger in the true PCoA aneurysm group than that in the group of a junctional PCoA aneurysm (mean PCoA/P1 ratio±standard deviation, 2.67±1.22 vs. 1.14±0.88; p<0.001). No between-group difference was identified for the modified Fisher grade, clinical grade at admission, and 3-month modified Rankin Scale score. Conclusion : A true PCoA aneurysm was found to be associated with a larger PCoA and ruptured at a smaller diameter than a junctional PCoA aneurysm. In particular, the incidence of a ruptured aneurysm with a very small diameter <4 mm was significantly higher among the patients with a true PCoA aneurysm.

Background and Objectives: Factors associated with low heart failure (HF) awareness have not been well-evaluated. This study was conducted to find out which demographic features would be associated with low HF awareness in the general population of Korea. Methods: A telephone interview was conducted with 1,032 adults (58 years and 50.6% were male) across the country. Based on answer to 15 questions about HF, we scored from 0 to 15 points (mean, 7.53±2.75; median, 8; interquartile range, 6–9). A score of <8 was defined as low HF awareness, and a score of ≥8 was defined as high HF awareness. Results: A total of 478 subjects (46.3%) had low HF awareness. HF awareness scores were 5.18±1.85 and 9.55±1.50 in subjects of low and high HF awareness groups, respectively. Subjects with low HF awareness were older, more female-dominant, more diabetic, lower educational and house hold income levels, and more frequently living in rural areas, compared to those with high HF awareness (p<0.05 for each). In multivariable logistic regression analyses, older age (≥67 years: odds ratio [OR], 1.61; 95% confidence interval [CI], 1.16–2.19; p=0.004), female sex (OR, 1.33; 95% CI, 1.02–1.73; p=0.034) and low educational level (high school graduate or less vs. college graduate: OR, 2.38; 95% CI, 1.75–3.22; p<0.001) were significantly associated with low HF awareness even after controlling for potential confounders. Conclusions Older age, female sex, and lower level of education were independently associated with low HF awareness in the general Korean population. More attention and education are needed for these vulnerable groups to improve HF awareness.

Objective: ：Older adults are at greater risk for malnutrition than younger adults, and malnutrition can be associated with a variety of mental problems. This study was undertaken to investigate differences in mental health indicators according to nutritional risk administered to elderly people living in the community. Methods: ：Nutritional risk score was assessed using the ‘Determine Your Nutrition Health’ checklist, developed by the Nutritional Screening Initiative. The study enrolled 400 elderly people living in the community. Study subjects were divided into 3 groups based on their nutritional risk score: good nutrition (score ≤2; n=275), moderate nutritional risk (score 3-5; n=63), and high nutritional risk (score ≥6; n=62). The General Health Questionnaire-12 (GHQ-12), suicide risk screening tool, memory decline awareness, sleep disorder questionnaire, and health-related quality of life (EuroQoL-5 dimension, EQ-5D) were used to assess mental health problems. Statistical analyses were performed using chi-square test, analysis of variance, and Pearson correlation analysis. Results: ：In the high nutrition risk group, GHQ-12 score was highest. In the good nutrition group, subjective memory impairment score and sleep difficulty were lowest, and EQ-5D index was highest. The risk of suicide tended to increase with increasing nutritional risk. Nutritional risk score was significantly correlated with GHQ-12, subjective memory impairment, sleep latency time, total sleep duration, sleep difficulty, and EQ-5D index. Conclusion ：This study confirms that nutritional risk in the elderly is related to various psychological symptoms and low quality of life. High nutritional risk in the elderly warrants clinical attention to mental health and quality of life.

Authors requested to change the name of the hospital to proper name.

OBJECTIVE: To identify the center of extensor indicis (EI) muscle through cadaver dissection and compare the accuracy of different techniques for needle electromyography (EMG) electrode insertion. METHODS: Eighteen upper limbs of 10 adult cadavers were dissected. The center of trigonal EI muscle was defined as the point where the three medians of the triangle intersect. Three different needle electrode insertion techniques were introduced: M1, 2.5 cm above the lower border of ulnar styloid process (USP), lateral aspect of the ulna; M2, 2 finger breadths (FB) proximal to USP, lateral aspect of the ulna; and M3, distal fourth of the forearm, lateral aspect of the ulna. The distance from USP to the center (X) parallel to the line between radial head to USP, and from medial border of ulna to the center (Y) were measured. The distances between 3 different points (M1– M3) and the center were measured (marked as D1, D2, and D3, respectively). RESULTS: The median value of X was 48.3 mm and that of Y was 7.2 mm. The median values of D1, D2 and D3 were 23.3 mm, 13.3 mm and 9.0 mm, respectively. CONCLUSION: The center of EI muscle is located approximately 4.8 cm proximal to USP level and 7.2 mm lateral to the medial border of the ulna. Among the three methods, the technique placing the needle electrode at distal fourth of the forearm and lateral to the radial side of the ulna bone (M3) is the most accurate and closest to the center of the EI muscle.
Adult ; Cadaver* ; Electrodes ; Electrodiagnosis ; Electromyography* ; Fingers ; Forearm ; Head ; Humans ; Needles* ; Ulna ; Upper Extremity

Eccrine poroma is a common benign cutaneous tumor that originates in an intraepidermal eccrine duct. This tumor exhibits acral distribution (sole, palm), and is rarely encountered in the head and neck area. In fact eccrine poroma in the postauricular area has only been rarely reported. A 55-year-old female visited our hospital with a main complaint of a mass that first developed in the left postauricular area about a year previously. The mass was painless, soft, protruding, domed, and dark red in color, and had slowly enlarged (at presentation it measured 1×1 cm). Excisional biopsy was performed. Histological examination showed distinct features, and eccrine poroma was diagnosed. Follow-up at 6 months postoperatively showed no recurrence. The frequency of eccrine poroma is dependent on eccrine sweat glands density, and thus, usually occurs on the palms or soles. For eccrine poroma in the head and neck region, the differential diagnosis must rule out other masses, such as nevus, skin tag, pyogenic granuloma, cyst, basal cell carcinoma, and seborrheic keratosis. Importantly, 18% of poromas show malignant transformation, and can develop into porocarcinoma. For these reasons, an eccrine poroma in the facial area requires histological examination, complete excision, and follow-up.
Biopsy ; Carcinoma, Basal Cell ; Diagnosis, Differential ; Ear ; Female ; Follow-Up Studies ; Granuloma, Pyogenic ; Head ; Humans ; Keratosis, Seborrheic ; Middle Aged ; Neck ; Nevus ; Poroma* ; Recurrence ; Skin ; Sweat Glands

PURPOSE: Periappendiceal abscess (PAA) is a severe complicated appendicitis with high morbidity. Non-surgical treatment followed by interval appendectomy (IA) is associated with lower complication rate compared with emergency surgery (ES) and minimally invasive surgery (MIS) can be done more often. The purpose of this study is to assess the incidence and factors predictive of complications of surgery for PAA and to evaluate the clinical effectiveness of IA as a treatment policy to increase MIS. METHODS: Retrospectively, we reviewed 171 patients undergoing surgery for PAA between 2011 and 2016 at Ulsan University Hospital. The incidence and influence of different factors were assessed by univariate and multivariate analyses. RESULTS: In 171 patients, 28 (16.4%) developed postoperative complications, which included; wound complications (7.6%), intra-abdominal abscess (4.1%) and ileus (2.9%). In both analyses, only ES was independently associated with postoperative complications; (Relative risk, 15.0; 95% Confidence interval, 2.4~92.5). Comparing the IA and ES groups revealed that operative time, complication rate, laparoscopic approach, postoperative hospitalization, postoperative antibiotic use and bowel resection rate were significantly different. The postoperative complication rate of patients with PAA in ES group was 28.7%, which was statistically higher than that of IA group (3.6%). Especially, MIS rate was more than 9-times greater in the IA group (98.8% vs. 10.3%, p<0.001). Although the IA group required additional hospitalization, there was no statistical difference between the two groups in total length of hospital stay. CONCLUSION: Morbidity was high for patients who had emergency surgery for PAA. ES was the only factor associated with postoperative morbidity. IA can reduce the postoperative complication rate and allowed MIS to be used more often as a useful treatment policy for PAA.
Abdominal Abscess ; Abscess* ; Appendectomy* ; Appendicitis ; Emergencies ; Hospitalization ; Humans ; Ileus ; Incidence ; Length of Stay ; Minimally Invasive Surgical Procedures ; Multivariate Analysis ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Ulsan ; Wounds and Injuries

A giant cutaneous horn (GCH) is a morphological description of huge, conical, dense, hyperkeratotic protrusion. Because of its bizarre shape and associated risk of malignancy, GCH requires proper treatment. A 48-year-old male patient visited our department with a GCH on a burn scar of his right hand. It had started to develop about 8 months previously. At initial physical examination, the lesion presented as a hard, dark brown mass of basal area 4×3.5 cm², and height 3.5 cm. Preoperative biopsy confirmed the absence of malignancy. We performed excision of the entire GCH, and biopsy and repaired the resulting defect with full-thickness skin graft. Histopathologic results revealed that all surgical margin were negative for malignancy. Microscopically, the lesion exhibited marked regular acanthosis, parakeratosis and hyperkeratosis with granular layer loss. At 3 months postoperatively, no complication was observed. According to Mantese et al., 58.56% of GCHs originate from malignant or premalignant lesions. And thus, a histopathologic examination is mandatory, and if an accompanying malignant lesion is found, additional resection should be undertaken. In another study, it was concluded the risk of premalignancy or malignancy depends on development time. In our case, the GCH had grown from a burn scar, this has not been previously reported in Korea. Surgeons need to be aware cutaneous horn harbors risks of premalignancy or malignancy, and that histopathological evaluation is indispensable for treatment decision making.
Animals ; Biopsy ; Burns* ; Cicatrix* ; Decision Making ; Hand ; Horns* ; Humans ; Korea ; Male ; Middle Aged ; Parakeratosis ; Physical Examination ; Skin ; Surgeons ; Transplants

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.
Appointments and Schedules ; Atmosphere ; Clinical Clerkship ; Clinical Competence ; Family Practice ; Focus Groups ; Humans ; Methods ; Physical Examination ; Self-Evaluation Programs ; Surveys and Questionnaires