No abstract available.
Upper Extremity Deep Vein Thrombosis

We observed clinically 27 cases of MCLS at this pediatric department from Jan. 1980 to Jun. 1984 and following result were obtained. 1) The peak incidence of these cases was from 1 year to 4 year of age(74%) and male children were affected more frequently than female children at a ratio of 2.4:1. 2) Clinical manifestation of MCLS were high fever, conjunctioval injection, changes of oral cavity and lips, erythematous rash, cervical lymphadenopathy, changes of the extremities. 3) The abnormal laboratory findings include leukocytosis, slight anemia, raised ESR, positive CRP, mild proteinuria or pyeuria, and slight increase of serum transaminase and LDH. 4) The abnormal cardiovascular findings were as follow : heart murmur in 15% cardiomegaly in 19% by chest roentgenogram, electrocardiographic abnormalities in 59%, suspicious aneurysmal dilatation and coronary aneurysm by 2-D echocardiogram in 11%. 5) Aspirin was given in acute febrile stage as antiinflammatory dose(100mg/kg/day), in non-febrile convalescent stage to maintain low dose of aspirin(20-30mg/kg/day) as antiplatelet effect, and completely recovered in all cases without andy complication.
Anemia ; Aneurysm ; Aspirin ; Cardiomegaly ; Child ; Coronary Aneurysm ; Dilatation ; Electrocardiography ; Exanthema ; Extremities ; Female ; Fever ; Heart Murmurs ; Humans ; Incidence ; Leukocytosis ; Lip ; Lymphatic Diseases ; Male ; Mouth ; Mucocutaneous Lymph Node Syndrome* ; Proteinuria ; Thorax

OBJECTIVE: To determine the utility of perfusion MR imaging in the differential diagnosis of brain tumors. MATERIALS AND METHODS: Fifty-seven patients with pathologically proven brain tumors (21 high-grade gliomas, 8 low-grade gliomas, 8 lymphomas, 6 hemangioblastomas, 7 metastases, and 7 various other tumors) were included in this study. Relative cerebral blood volume (rCBV) and time-to-peak (TTP) ratios were quantitatively analyzed and the rCBV grade of each tumor was also visually assessed on an rCBV map. RESULTS: The highest rCBV ratios were seen in hemangioblastomas, followed by high-grade gliomas, metastases, low-grade gliomas, and lymphomas. There was no significant difference in TTP ratios between each tumor group (p<0.05). At visual assessment, rCBV was high in 17 (81%) of 21 high-grade gliomas and in 4 (50%) of 8 low-grade gliomas. Hemangioblastomas showed the highest rCBV and lymphomas the lowest. CONCLUSION: Perfusion MR imaging may be helpful in the differentiation of thevarious solid tumors found in the brain, and in assessing the grade of the various glial tumors occurring there.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Blood Volume/physiology ; Brain/*pathology/physiopathology ; Brain Neoplasms/*pathology/physiopathology/secondary ; Diagnosis, Differential ; Female ; Human ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Age ; Time Factors

PURPOSE: To evaluate the effect of heat wave on emergency department (ED) visits due to heat related illness, we developed an ED based active surveillance system. We want to identify epidemiology of ED visits due to heat related illness and determine the effect of heat index on daily ED visits due to heat related illness. METHODS: We developed an ED based active surveillance system for adults who visited the ED due to heat stroke, heat exhaustion, heat syncope, heat edema, and heat cramp. We collected demographic and clinical variables, risk factors, and heat index by standardized registry on the webpage. We operated the surveillance into 16 emergency departments in Daegu City from June to September 2011. We analyzed epidemiologic variables descriptively and assessed the effect of heat index on the number of daily ED visits by multivariate Poisson regression analysis. RESULTS: During the study period, 34 cases were registered and nine cases were heat stroke. Heat stroke patients were older, and had more unemployment status than those with other heat related illness (p<0.05). More ED visits due to heat related illness were observed during the danger period than during the cool period, classified by heat index severity (Adjusted odds ratio: 1.72, 95% CI: 1.33-2.23). Increasing heat index by one degree caused more ED visits due to heat related illness (Adjusted incident rate ratio: 1.13, 95% CI: 1.07-1.19). CONCLUSION: We developed an ED based active surveillance system and observed more elderly persons and lower educational level in patients with heat stroke. In addition, increase in heat index significantly affected more daily ED visits due to heat related illness.
Adult ; Aged ; Daegu ; Edema ; Emergency Service, Hospital* ; Epidemiology ; Extreme Heat ; Heat Exhaustion ; Heat Stress Disorders ; Heat Stroke ; Hot Temperature* ; Humans ; Infrared Rays ; Odds Ratio ; Public Health Surveillance ; Risk Factors ; Syncope ; Unemployment

Objective: A regional pandemic may result in a crisis in providing emergency care to the community and disrupt emergency medical services. This study examined how the recent coronavirus disease 2019 pandemic impacted emergency department (ED) preparedness nationwide by describing the current ED operations. Methods: A cross-sectional survey was developed and distributed nationwide to emergency physicians. All 57 severe emergency care centers and 35 selected local emergency medical institutions nationwide were invited to participate. The survey consisted of basic ED information, infection guidelines, and operations for ED, preemptive pretriage area details, ED quarantine area details, cohort isolation and preemptive quarantine area, and difficulties or problems in treating infectious patients. Results: Forty-nine severe emergency care centers (86%) and 24 (68.6%) local emergency medical institutions answered the survey. Most EDs (95.9% and 91.7% of severe emergency care centers and local emergency medical institutions, respectively) operated under infection guidelines. In addition, 51% and 72.3% of preemptive pretriage areas in severe emergency care centers and local emergency medical institutions, respectively, placed doctors. Both negative and normal pressurized ED quarantine areas were more placed in severe emergency care centers (3 and 3 vs. 0.5 and 1 of severe emergency care centers and local emergency medical institutions, respectively). In severe emergency care centers, the preemptive quarantine areas were operated more than the cohort isolation areas (63.3% vs. 40.8%). Common difficulties expressed by EDs were delayed polymerase chain reaction test results (4.5 and 4.1 of severe emergency care centers and local emergency medical institutions, respectively) and a fear of infection with ED shutdown (4.4 and 4.1 of severe emergency care centers and local emergency medical institutions, respectively). Conclusion This study surveyed how ED care was changed by the pandemic and how current resources are redeployed nationwide. These results may be used as a basis for future ED pandemic preparedness.

Purpose: The clinical implications of tumor-infiltrating T cell subsets and their spatial distribution in biliary tract cancer (BTC) patients treated with gemcitabine plus cisplatin were investigated. Materials and Methods: A total of 52 BTC patients treated with palliative gemcitabine plus cisplatin were included. Multiplexed immunohistochemistry was performed on tumor tissues, and immune infiltrates were separately analyzed for the stroma, tumor margin, and tumor core. Results: The density of CD8+ T cells, FoxP3- CD4+ helper T cells, and FoxP3+ CD4+ regulatory T cells was significantly higher in the tumor margin than in the stroma and tumor core. The density of LAG3- or TIM3-expressing CD8+ T cell and FoxP3- CD4+ helper T cell infiltrates was also higher in the tumor margin. In extrahepatic cholangiocarcinoma, there was a higher density of T cell subsets in the tumor core and regulatory T cells in all regions. A high density of FoxP3- CD4+ helper T cells in the tumor margin showed a trend toward better progression-free survival (PFS) (p=0.092) and significantly better overall survival (OS) (p=0.012). In multivariate analyses, a high density of FoxP3- CD4+ helper T cells in the tumor margin was independently associated with favorable PFS and OS. Conclusion The tumor margin is the major site for the active infiltration of T cell subsets with higher levels of LAG3 and TIM3 expression in BTC. The density of tumor margin-infiltrating FoxP3- CD4+ helper T cells may be associated with clinical outcomes in BTC patients treated with gemcitabine plus cisplatin.

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused health problems and distress among healthcare workers (HCWs), so supportive measures to promote their health and relieve distress are needed. Materials and Methods: We conducted two rounds of Delphi surveys with 20 COVID-19-related frontline healthcare professionals and public officials. The surveys evaluated means of supporting HCWs’ health by improving health care systems and working environments in terms of effectiveness and urgency. The validity of the measures was assessed by calculating the content validity ratio. Results: The top-priority measures to support HCWs were “secure isolation units capable of treating severe cases” in the facility infrastructure category, “secure nursing staff dedicated for patients in the intensive care units” in the personnel infrastructure category, “improve communication between central office and frontline field” in the cooperation system category, “support personal protective equipment and infection control supplies” in the aid supplies category, and “realization of hazard pay” in the physical/mental health and compensation category. Conclusion There was consensus among the experts on the validity and priorities of policies in the facility, personnel, cooperation, supplies, and compensation categories regarding measures to promote COVID-19 related HCWs’ health.

Purpose: The current standard chemotherapy for advanced biliary tract cancer (BTC) has limited benefit,and novel therapies need to be investigated. Materials and Methods: In this prospective cohort study, programmed death ligand-1 (PD-L1)–positive BTC patientswho progressed on first-line gemcitabine plus cisplatin were enrolled. Pembrolizumab 200mg was administered intravenously every 3 weeks. Results: Between May 2018 and February 2019, 40 patients were enrolled. Pembrolizumab wasgiven as second-line (47.5%) or  third-line therapy (52.5%). The objective response ratewas 10% and 12.5% by Response Evaluation Criteria in Solid Tumor (RECIST) v1.1 andimmune-modified RECIST (imRECIST) and median duration of response was 6.3 months.Among patients with progressive disease as best response, one patient (1/20, 5.0%)achieved complete response subsequently. The median progression-free survival (PFS) andoverall survival (OS) were 1.5 months (95% confidence interval [CI], 0.0 to 3.0) and 4.3months (95% CI, 3.5 to 5.1), respectively, and objective response per imRECIST was significantlyassociated with PFS (p < 0.001) and OS (p=0.001). Tumor proportion score  50%was significantly associated with higher response rates including the response after pseudoprogression(vs. < 50%; 37.5% vs. 6.5%; p=0.049). Conclusion Pembrolizumab showed modest anti-tumor activity in heavily pretreated PD-L1–positiveBTC patients. In patients who showed objective response, durable response could beachieved.

Many countries have published clinical practice guidelines for appropriate clinical decisions, optimal treatment, and improved clinical outcomes in patients with acute coronary syndrome. Developing guidelines that are specifically tailored to the Korean environment is crucial, considering the treatment system, available medications and medical devices, racial differences, and level of language communication. In 2017, the Korean Society of Myocardial Infarction established a guideline development committee. However, at that time, it was not feasible to develop guidelines, owing to the lack of knowledge and experience in guideline development and the absence of methodology experts. In 2022, the National EvidenceBased Healthcare Collaborating Agency collaborated with a relevant academic association to develop internationally reliable guidelines, with strict adherence to the methodology for evidence-based guideline development. The first Korean acute coronary syndrome guideline starts from the 9 key questions for pharmacotherapy.

Many countries have published clinical practice guidelines for appropriate clinical decisions, optimal treatment, and improved clinical outcomes in patients with acute coronary syndrome. Developing guidelines that are specifically tailored to the Korean environment is crucial, considering the treatment system, available medications and medical devices, racial differences, and level of language communication. In 2017, the Korean Society of Myocardial Infarction established a guideline development committee. However, at that time, it was not feasible to develop guidelines, owing to the lack of knowledge and experience in guideline development and the absence of methodology experts. In 2022, the National EvidenceBased Healthcare Collaborating Agency collaborated with a relevant academic association to develop internationally reliable guidelines, with strict adherence to the methodology for evidence-based guideline development. The first Korean acute coronary syndrome guideline starts from the 9 key questions for pharmacotherapy.