It is important to consider the fetal, uteroplacental, and maternal issues when choosing anesthetic technique for fetal surgery. The twin reversed arterial perfusion (TRAP) sequence, or the acardiac anomaly, occurs in 1:100 monozygous multiple pregnancies and in 1:35,000 births. The TRAP sequence is characterized by placental vascular arterio-arterial anastomosis between twin fetuses, one an acardiac/acephalic twin that receives its blood flow from the normal pumping twin, thereby endangering the normal twin by high output cardiac failure. The acardiac twin is nonviable, and perinatal mortality in the pump cotwin exceeds 50% because of cardiac failure and prematurity. This can be managed by fetal surgery. We report on a patient with a 26-wk gestation complicated by an acardiac/acephalic fetus anesthetized for surgical umbilical cord ligation.
Anesthesia* ; Female ; Fetus ; Heart Failure ; Humans ; Ligation ; Parturition ; Perfusion* ; Perinatal Mortality ; Pregnancy ; Pregnancy, Multiple ; Umbilical Cord

In this article, Table 1's data was given incorrectly. Metodopramide should be corrected as Metoclopramide.

Background: South Korea has one of the world’s fastest aging populations and is witnessing increased age-related hearing impairment cases as well as an increase in the number of hearing aid users. The aim of this study was to analyze complications caused by hearing aid mold materials. In addition, we hope to raise awareness of the harm and danger that inexperienced hearing aid providers can cause to patients. Methods: We retrospectively reviewed the medical records of 11 patients who were diagnosed with hearing aid mold material as a foreign body in the ear at a tertiary center between 2016 and 2020. The following data were analyzed: symptoms, endoscopic findings, audiometry, temporal bone CT images, treatment methods, and complications after removal. The currently available literature was also reviewed to develop clinical guidelines, to identify the systematic weaknesses in the South Korean hearing aid market, and to identify policies that warrant better quality control. Results: Among the 11 cases, 9 were restricted to the external auditory canal, all of which were successfully removed under endoscopy with minor complications. Two cases with middle ear involvement resulted in infection and thus required surgical removal with mastoidectomy. The average age of these patients was 76.4, and all patients received their molding procedure at private hearing aid shops without an otolaryngologist’s examination. Conclusion Thorough patient history-taking and otologic examination must be performed to identify patients at higher risk of complications. Such patients should be referred to an otolaryngologist. If a patient exhibits alarming symptoms, early referral is critical since prompt surgery can minimize complications. A CT scan is highly recommended to determine an optimal approach for foreign body removal. Systematic and regulatory changes in hearing aid dispensers, such as requiring apprenticeship, raising the required level of education, and legally mandating referrals, can help reduce these complications.

BACKGROUND: The automation system for blood typing and antibody screening has been developed and is now used widely. In this study, we evaluated the economic effectiveness between automation system QWALYS-3 (DIAGAST, Loos Cedex, France) and manual testing. METHODS: Clinical samples from March 2012 were used for comparison of the costs and TAT for ABO-RhD blood typing and antibody screening. The costs included those of materials (reagents and consumables), labor, and equipment depreciation. TAT was analyzed for either blood typing only for one, 16, and 32 samples or blood typing and antibody screening for the same number of samples. RESULTS: The blood typing TAT for one, 16, and 32 samples was 4.5, 35.1, and 70.1 minutes by manual and 24.0, 36.0, and 38.1 minutes by automated system. Both blood typing and antibody screening TAT for one, 16, and 32 samples was 27.5, 75.0, and 129.9 minutes by manual and 45.0, 52.0, and 54.0 minutes by automation. CONCLUSION: The blood automation system reduced TAT only for the batch test, therefore, when using the automation system, blood bank test size and emergency situation should be considered.
Automation* ; Blood Banks* ; Blood Grouping and Crossmatching* ; Depreciation ; Emergencies ; Mass Screening*

BACKGROUND: Therapeutic indications for stellate ganglion block range from head and upper arm disease to general disease including psychosomatic disorders. The aim of this study was to evaluate the effects of superior cervical ganglionectomy on anxiety using the elevated plus maze test. METHODS: Male Sprague-Dawley rats (150-250 g) were used. Each rat was put into the elevated plus maze 5 minutes per day for 10 days. We checked the number of entries into each arm (open arm and closed arm) and the duration of time staying in each arm. Rats were then divided into two groups: a group that received bilateral superior cervical ganglionectomy, and a control group that received a sham operation. The elevated plus maze test was then repeated and we evaluated the effect of superior cervical ganglionectomy on anxiety. RESULTS: Although there was an increased tendency of ganglionectomized rats to enter each arm, there were no significant differences in number of entries or in duration of stay between experimental and control groups. CONCLUSIONS: Bilateral superior cervical ganglionectomy in rats does not reduce anxiety. However, further studies are needed, ones combined with neuroendocrine and clinical studies, to determine the effect of superior cervical ganglionectomy on behavioral responses.
Animals ; Anxiety ; Arm ; Ganglionectomy ; Head ; Humans ; Male ; Psychophysiologic Disorders ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Stellate Ganglion ; Sympathectomy

Background/Aims: Intrahepatic cholangiocarcinoma (iCCA) with a ductal plate malformation (DPM) pattern is a recently recognized rare variant. The genomic profile of iCCA with DPM pattern needs to be elucidated. Methods: Cases of iCCA with DPM pattern were retrospectively reviewed based on the medical records, pathology slides, and magnetic resonance imaging (MRI) reports collected between 2010 to 2019 at a single center. Massive parallel sequencing was performed for >500 cancerrelated genes. Results: From a total of 175 iCCAs, five (2.9%) cases of iCCA with DPM pattern were identified. All cases were of the small duct type, and background liver revealed chronic B viral or alcoholic hepatitis. Three iCCAs with DPM pattern harbored MRI features favoring the diagnosis of hepatocellular carcinoma, whereas nonspecific imaging features were observed in two cases. All patients were alive without recurrence during an average follow-up period of 57 months. Sequencing data revealed 64 mutated genes in the five cases, among which FGFR2 and PTPRT were most frequently mutated (three cases each) including an FGFR2-TNC fusion in one case. Mutations in ARID1A and CDKN2A were found in two cases, and mutations in TP53, BAP1, ATM, NF1, and STK11 were observed in one case each. No IDH1, KRAS, or PBRM1 mutations were found. Conclusions iCCAs with DPM pattern have different clinico-radio-pathologic and genetic characteristics compared to conventional iCCAs. Moreover, FGFR2 and FGFR2 variants were identified. Altogether, these findings further suggest that iCCA with DPM pattern represents a specific subtype of small duct type iCCA.

Purpose: We investigated the clinical impact of genomic and pathway alterations in stage I epidermal growth factor receptor (EGFR)–mutant lung adenocarcinomas, which have a high recurrence rate despite complete surgical resection. Materials and Methods: Out of the initial cohort of 257 patients with completely resected stage I EGFR-mutant lung adenocarcinoma, tumor samples from 105 patients were subjected to analysis using large-panel next-generation sequencing. We analyzed 11 canonical oncogenic pathways and determined the number of pathway alterations (NPA). Survival analyses were performed based on co-occurring alterations and NPA in three patient groups: all patients, patients with International Association for the Study of Lung Cancer (IASLC) pathology grade 2, and patients with recurrent tumors treated with EGFR–tyrosine kinase inhibitor (TKI). Results: In the univariate analysis, pathological stage, IASLC grade, TP53 mutation, NPA, phosphoinositide 3-kinase pathway, p53 pathway, and cell cycle pathway exhibited significant associations with worse recurrence-free survival (RFS). Moreover, RPS6KB1 or EGFR amplifications were linked to a poorer RFS. Multivariate analysis revealed that pathologic stage, IASLC grade, and cell cycle pathway alteration were independent poor prognostic factors for RFS (p=0.002, p < 0.001, and p=0.006, respectively). In the grade 2 subgroup, higher NPA was independently associated with worse RFS (p=0.003). Additionally, in patients with recurrence treated with EGFR-TKIs, co-occurring TP53 mutations were linked to shorter progression-free survival (p=0.025). Conclusion Genomic and pathway alterations, particularly cell cycle alterations, high NPA, and TP53 mutations, were associated with worse clinical outcomes in stage I EGFR-mutant lung adenocarcinoma. These findings may have implications for risk stratification and the development of new therapeutic strategies in early-stage EGFR-mutant lung cancer patients.

BACKGROUND: Plasminogen activator inhibitor type 1 (PAI-1), an important regulator of plasminogen activator system which controls degradation of extracellular membrane and progression of tumor cells, and PAI-1 gene polymorphic variants have been known as the prognostic biomarkers of non-small cell lung cancer patients. Recently, experimental in vitro study revealed that transforming growth factor-beta1 initiated PAI-1 transcription through epithelial growth factor receptor (EGFR) signaling pathway. However, there is little clinical evidence on the association between PAI-1 A15T gene polymorphism and prognosis of Korean population with pulmonary adenocarcinoma and the influence of activating mutation of EGFR kinase domain. METHODS: We retrospectively reviewed the medical records of 171 patients who were diagnosed with pulmonary adenocarcinoma and undergone EGFR mutation analysis from 1995 through 2009. RESULTS: In all patients with pulmonary adenocarcinoma, there was no significant association between PAI-1 A15T polymorphic variants and prognosis for overall survival. However, further subgroup analysis showed that the group with AG/AA genotype had a shorter 3-year survival time than the group with GG genotype in patients with EGFR mutant-type pulmonary adenocarcinoma (mean survival time, 24.9 months vs. 32.5 months, respectively; p=0.015). In multivariate analysis of 3-year survival for patients with pulmonary adenocarcinoma harboring mutant-type EGFR, the AG/AA genotype carriers had poorer prognosis than the GG genotype carriers (hazard ratio, 7.729; 95% confidence interval, 1.414-42.250; p=0.018). CONCLUSION: According to our study of Korean population with pulmonary adenocarcinoma, AG/AA genotype of PAI-1 A15T would be a significant predictor of poor short-term survival in patients with pulmonary adenocarcinoma harboring mutant-type EGFR.
Adenocarcinoma* ; Biomarkers ; Carcinoma, Non-Small-Cell Lung ; Genotype ; Humans ; Medical Records ; Membranes ; Multivariate Analysis ; Phosphotransferases ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Polymorphism, Single Nucleotide ; Prognosis* ; Receptor, Epidermal Growth Factor ; Retrospective Studies

OBJECTIVE: This study aimed to confirm effectiveness of psychoeducation program on insight and treatment attitudes in patients with schizophrenia, schizophreniform disorder and schizoaffective disorder. METHODS: Seventy eight psychotic patients who were diagnosed as schizophrenia, schizophreniform disorder, and schizoaffective disorder by Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV TR) were included. Subjects who decline more than 30% compared with baseline in Positive and Negative Syndrome Scale (PANSS) scores participated in psychoeducation program. Insight and Treatment Attitudes Questionnaire (ITAQ) and Drug Attitude Inventory (DAI) were assessed at pre-psychoeducation, post-psychoeducation and 2 months after discharge to estimate insight and treatment attitudes. RESULTS:There were significant improvement in ITAQ and DAI scores at post-psychoeducation and 2 months after discharge. Increase in DAI scores related with high ITAQ scores at post-psychoeducation. Small changes in PANSS scores and ITAQ scores at post-psychoeducation had positive relationship. Subjects of late onset of illness and female took better ITAQ and DAI scores after psychoeducation. CONCLUSION: This study showed that psychoeducation program would be effective for insight and treatment attitudes in patients with schizophrenia, schizophreniform disorder, and schizoaffective disorder.
Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Psychotic Disorders ; Surveys and Questionnaires ; Schizophrenia

BACKGROUND: Polycythemia vera (PV) is a myeloproliferative neoplasm that can cause complications such as thrombosis and organ damage. To prevent complications of PV, therapy for maintenance of a hematocrit target of less than 45% has been recommended and phlebotomy is a simple therapy. However, the effects of phlebotomy have not been well evaluated in Korea. Therefore, we evaluated the effects of phlebotomy performed in patients with PV and secondary polycythemia. METHODS: The clinical data and phlebotomy records of 15 patients diagnosed with PV and secondary polycythemia from May 2005 to March 2013 at the National Cancer Center were reviewed retrospectively. RESULTS: Patients included 10 males and five females. The median age of patients was 63 years (range, 50~72 years). There were six PV patients (40%) and nine secondary polycythemia patients (60%). The mean number of phlebotomy attempts per patient was 6 (range, 1~22), with an interval between phlebotomy attempts of 16 weeks (range, 1~96 weeks). The mean phlebotomy volume was 458 mL, which was 10.3% of the total blood volume. After phlebotomy, the mean hematocrit showed a decline, from 50.4 (+/-4.35)% to 46.5 (+/-4.85)%, and symptoms improved. After phlebotomies, 10 patients achieved a hematocrit of less than 45% and this hematocrit level was obtained after an average of six phlebotomies. CONCLUSION: Phlebotomy is an effective treatment modality for lowering the hematocrit value in patients with PV and secondary polycythemia. However, target hematocrit was not achieved after a single phlebotomy. Therefore, adjustment of visit intervals and changes in phlebotomy volume were needed.
Blood Volume ; Female ; Hematocrit ; Humans ; Korea ; Male ; Phlebotomy* ; Polycythemia Vera* ; Polycythemia* ; Retrospective Studies ; Thrombosis