A 63-year-old male experienced sudden diplopia after 9 weeks of administration of pegylated interferon (IFN) alpha-2b and ribavirin for chronic hepatitis C (CHC). Ophthalmologic examinations showed ptosis on the right upper lid and restricted right eye movement without any other neurological signs. A brain imaging study and repetitive nerve stimulation test indicated no abnormality. The acetylcholine receptor antibody titer and response to acetylcholinesterase inhibitors were negative, and the results of thyroid function tests were normal. The patient's ophthalmological symptoms improved rapidly 3 weeks after discontinuation of pegylated IFN alpha-2b and ribavirin. The ocular myasthenia associated with combination therapy of pegylated IFN alpha-2b and ribavirin for CHC is very rarely reported; therefore, we present this case with a review of the various eye complications of IFN therapy.
Antiviral Agents/*adverse effects/therapeutic use ; Drug Therapy, Combination ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon Alfa-2b/*adverse effects/therapeutic use ; Male ; Middle Aged ; Myasthenia Gravis/*chemically induced/*diagnosis ; Polyethylene Glycols/*adverse effects/therapeutic use ; Ribavirin/*adverse effects/therapeutic use

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.
Abdominal Pain ; Adult ; Anticoagulants ; Early Diagnosis ; Female ; Gastrointestinal Hemorrhage ; Humans ; Infarction ; Mesenteric Ischemia ; Mesenteric Vascular Occlusion ; Mortality ; Prevalence ; Pulmonary Embolism ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.

BACKGROUND: Although abnormal serum alanine aminotranferase(ALT) and aspartate aminotransferase (AST) clearly indicates certain disease in the liver, normal reversion of serum ALT and AST during the disease process, after the histologic diagnosis of chronic hepatitis, does not ensure that the patients liver would be normal. We considered a partial remission of chronic hepatitis as the levels of serum ALT and AST were persistently normal over 6 months or more, and studied how the histologic findings in the partial-remitted patients of chronic hepatitis would change. MATERIALS: Twenty-three agreed to rebiopsy in the patients of chronic hepatitis with normal level of serum ALT and AST over 6 months. The histologic findings between the first and second liver-biopsied specimens were compared, and the classification of their morpholgy was translated with Batts and Ludwigs new scoring system of chronic hepatitis divided into grade and stage. RESULTS: The grading scores of the first and second biopsy were 2.70 +/- 0.16 and 1.48 +/- 0.14, respectively, and the grading scores of the second biopsy decreased significantly than of the first biopsy (p=0.000); 18 cases(78.1%) were improved, but none was aggravated. The staging scores of the first and second biopsy were 1.870.19 and 1.430.22, respectively, and the staging scores of the secand biapsy also decreased significantly than of the first biopsy (p=0,020); 14 cases (61.2%) were unchanged, 8 cases (34.5%) were improved, but 1 case (4.3%) was aggravated. The stage-improved cases were 7 in the patients of chronic viral hepatitis B, and 1 in the patient of chronic viral hepatitis C, and viral loads of them disappeared. Three cases (13.0%) of them changed into no fibrosis, and 2 cases of them (8.7%) with severe fibrosis improved to mild fibrosis. But, although the levels of serum ALT and AST were persistently normal over average 16 months, grading and staging scores decreased over 2 points in 21.0% and 13.0%, respectively, and the case of which both grading and staging scores improved to normal was only 4.3%. CONCLUSION: Serum ALT and AST level were well correlated with grading. However, the correlation between serum ALT and AST level and staging was poor, even though the triggering factors of chronic hepatitis had been disappeared. Then, we recommand close follow-up and treatment to lessen the fibrogenic reaction of the liver in them.
Alanine* ; Aspartate Aminotransferases ; Aspartic Acid* ; Biopsy ; Classification ; Diagnosis ; Fibrosis ; Follow-Up Studies ; Hepatitis B ; Hepatitis C ; Hepatitis, Chronic ; Humans ; Liver Diseases* ; Liver* ; Viral Load

Abdominal pregnancy is a rare variation of ectopic pregnancy, which has been classified as primary or secondary. The clinical characteristics of abdominal pregnancy are extremely variable, so early diagnosis is very difficult. Because of high maternal morbidity and mortality, the prompt surgical intervention is required. Omental pregnancy is a very rare form of abdominal pregnancy, which is hard to detect early. The diagnosis of omental pregnancy is hardly ever made prior to laparotomy. We have experienced a case of omental pregnancy in a 36-year-old woman and report this case with brief review of literature.
Adult ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Laparotomy ; Mortality ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.
Carcinoma, Squamous Cell ; Diet ; Humans ; Hypopharyngeal Neoplasms ; Pharyngectomy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.
Carcinoma, Squamous Cell ; Diet ; Humans ; Hypopharyngeal Neoplasms ; Pharyngectomy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: The aims of our study are to assess the frequency of peripheral blood mononuclear cell (PBMC) proliferation and cytokine profiles to hepatitis C virus (HCV) core protein and NS3 protein to search the potential immunosuppressive effect of HCV core in chronically HCV-infected patients. Subjects and METHODS: Thirty two anti-HCV-positive patients with chronic liver diseases, eight HBsAg-positive patients with chronic liver diseases, and six healthy adults were the subjects of our study. Using recombinant HCV core and NS3, proliferative response of PBMC and cytokine production were determined. RESULTS: Fifty nine percent and thirteen percent of patients with HCV-related chronic liver diseases showed positive PBMC proliferation to HCV core and NS3, respectively. Thirty four percent and fifty nine percent of patients with HCV-related chronic liver diseases showed significant production of interferon-gamma to HCV core and NS3, respectively. IL-4 production was negligible. When the PBMC were treated with HCV core and NS3 concurrently, or HCV core and phytohemagglutinin concurrently, the stimulation indices were significantly decreased compared to those treated either with NS3 or PHA without core. CONCLUSIONS: Although about two thirds of chronically HCV-infected patients with liver diseases showed the PBMC proliferation and Th 1 type cytokine profile, they could not eradicate the viral infection. This ineffective immune response seems to play a role in the pathogenesis of chronic inflammatory liver disease resulting in liver cirrhosis and hepatocellular carcinoma. HCV core showed a potential immunosuppressive effect, which has important meaning for the mechanism of HCV persistence.
Adult ; Carcinoma, Hepatocellular ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Immunosuppression ; Interferon-gamma ; Interleukin-4 ; Liver Cirrhosis ; Liver Diseases

PURPOSE: The purpose of this study was to develop evidence-based nursing practice guidelines for the care of febrile children in the emergency room and to evaluate the guidelines by applying them to practice. METHODS: This study was conducted using a methodological design. referring to the Scottish intercollegiate guideline network, draft of guidelines were developed based on the recommendations found from the critical literature analysis. Then, the draft was modified by an expert group and a pilot application. The final draft was evaluated by the expert group using appraisal of guidelines for research and evaluation. Finally, the final guideline and algorithm were completed. RESULTS: The guideline includes 39 recommendations for the care of febrile children in the emergency room. CONCLUSION: The clinical guidelines developed through this research can be utilized as systematic and scientific guidelines for the care of febrile children in the emergency room. In addition, the research results will contribute to improving care services.
Child ; Emergencies ; Evidence-Based Nursing ; Fever ; Humans ; Child Health