BACKGROUND: From our clinical experiences, there are some problems with a paratracheal stellate ganglion block at the 6th cervical level e.g. small changes in blood flow to the upper extremities and more difficulty in differentiating sympathetically-maintained pain from neuropathic pain. This study compared the effectiveness of the classic injection technique and the modified injection technique in paratracheal stellate ganglion block at the 6th cervical level. METHODS: Forty patients were randomly divided into 2 groups. In Group I, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the classic injection technique. In Group II, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the modified injection technique by applying strong pressure to the cephalad portion of the needle entry point. The skin temperature of the first finger was measured before and after the stellate ganglion block, and the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis were examined. RESULTS: The increase in skin temperature of the first finger after the procedure was 0.26 +/- 0.22 degrees C in Group I and 0.84 +/- 0.63 degrees C in Group II, which was statistically significant (P < 0.05). There were no significant differences in the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis between the two groups. CONCLUSIONS: The modified injection technique is more effective in the sympathetic block on the upper extremities than the classic injection technique.
Fingers ; Hoarseness ; Humans ; Mepivacaine ; Needles ; Neuralgia ; Paralysis ; Sensation ; Skin Temperature ; Stellate Ganglion* ; Upper Extremity*

BACKGROUND: If an inhalation agent has an odor that causes airway irritation and cardiovascular instability, it is important that inhalation induction is performed rapidly and smoothly. So, we studied characteristics of inhalational induction in healthy adults using high inspired concentrations of sevoflurane. METHODS: Fifty-three patients, 19 to 59 years old, received 6 vol% sevoflurane in 66 vol%N2O/28 vol%O2 by face mask for five minutes until endotracheal intubation. Participants exhaled to residual volume and took vital capacity breaths of the gas mixture, thereafter ventilation was manually assisted. Subsequently we recorded the number of breaths before apnea, time to loss of consciousness, the loss of lid-lash reflex, eyeball deviation, the time until BIS reduced to 45, degree of jaw relaxation, and vital signs. After endotracheal intubation without muscle relaxant, ease of intubation and vital signs were observed. RESULTS: Apnea developed after an average three time vital capacity breaths, time to unconciousness was less than one minute. The mean times to loss of lid-lash reflex was 69.0 +/- 8.2 seconds, to eyeball deviation 85.7 +/- 22.2 seconds, and to pupil convergenece 239.5 +/- 31.4 seconds. There was no case of increased secretion or laryngospasm during mask ventilation. The BIS score was significantly lowered after inhalational induction, and the time to a BIS < 45 was 132.3 +/- 19.7 seconds. Mean blood pressures before and after intubation were 75.0 mmHg, and 104.6 mmHg, and heart rates before and after intubation were 77.0 beats/min and 109.8 beats/min, respectively. CONCLUSIONS: The speed of the induction of anesthesia to loss of lid lash reflex in healthy adults approaches that of intravenous induction techniques. No untoward airway responses were noted using the vital capacity breath technique. Healthy adults were successfully intubated with sevoflurane without muscle relaxant.
Adult* ; Anesthesia ; Apnea ; Heart Rate ; Humans ; Inhalation ; Intubation ; Intubation, Intratracheal ; Jaw ; Laryngismus ; Masks ; Middle Aged ; Odors ; Pupil ; Reflex ; Relaxation ; Residual Volume ; Unconsciousness ; Ventilation ; Vital Capacity ; Vital Signs

BACKGROUND/AIMS: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. METHODS: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. RESULTS: A total of 16 patients were included. They were 45.4+/-16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. CONCLUSIONS: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.
Asthma ; Bilirubin ; DNA ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Immunosuppressive Agents ; Organ Transplantation ; Prednisolone ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Spondylitis, Ankylosing ; Transplants ; Urticaria

BACKGROUND/AIMS: Pegylated interferon (peginterferon) and ribavirin is the current standard therapy for chronic hepatitis C. The aims of this study were to evaluate the efficacy of peginterferon and ribavirin and to identify predictors of a sustained virological response (SVR) to the retreatment of chronic hepatitis C in Korea. METHODS: The clinical records of 91 patients with chronic hepatitis C who were retreated with peginterferon and ribavirin were retrospectively analyzed. None of the patients had previously attained a SVR, and the patients were categorized according to their previous responses (nonresponder, relapser, or inadequate treatment) to conventional interferon/ribavirin. RESULTS: The overall SVR rate was 54.9%. Independent predictors of a SVR were genotypes 2 and 3, relapse, an adherence to peginterferon of over 80%, and an early virological response (EVR). For genotype 1 patients, an adherence to peginterferon of over 80% was an independent predictor of a SVR. CONCLUSIONS: Peginterferon and ribavirin therapy is effective for the retreatment of Korean chronic hepatitis C patients who have failed interferon/ribavirin, especially in patients with genotypes 2 and 3, relapse, an adherence to peginterferon over 80%, and an EVR. For genotype 1 patients, retreatment was effective in patients with an adherence to peginterferon over 80%.
Genotype ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Recurrence ; Retreatment ; Retrospective Studies ; Ribavirin

The therapeutic effectiveness and safety of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) have been clinically established, and the procedure is now generally accepted as a curative treatment for very early or early stage HCC. Recently, we observed an aggressive recurrence after RFA for HCC in 50 year-old female. RFA was performed for a 2.7 cm sized HCC, which was completely ablated. However, 7 months later, aggressive intrahepatic recurrence was observed. Herein, we report a case with a discussion.
Ablation Techniques ; Carcinoma, Hepatocellular* ; Catheter Ablation* ; Female ; Humans ; Recurrence

BACKGROUND/AIMS: The aim of this study was to elucidate the antiviral efficacy of lamivudine (LMV)-adefovir (ADV) combination therapy in chronic hepatitis B patients who showed resistance to LMV and ADV consecutively. METHODS: A retrospective review was performed in eighteen patients with chronic hepatitis B who developed virologic breakthroughs during LMV-ADV sequential mono-therapy and treated with LMV-ADV combination therapy. RESULTS: The median duration of follow up was 17 months (range, 6-27) after the start of LMV-ADV combination therapy. Mean HBV DNA level in log10 IU/mL was 6.08+/-0.95, 4.05+/-1.66, 3.17+/-1.58, 3.18+/-2.16, and 2.35+/-1.52 at 0, 3, 6, 12, and 24 months, respectively. Sixteen patients (88.9%) showed HBV DNA reduction below detection limit (<20,000 IU/mL). HBeAg seroconversion was observed in one patient (7.1%) after 8 months of combination therapy. Virologic breakthrough occurred in only one patient after 21 months of combination therapy. Viral rebound occurred in two patients at 12 months and 14 months of combination therapy. Normalization of serum ALT was achieved in twelve patients (66.7%). Primary non-response was observed in two cases (11.1%). CONCLUSIONS: LMV-ADV combination treatment was effective in 88.9% of patients with resistance to LMV and ADV in a short-term follow up. It may be applied as a bridge therapy until another effective antiviral regimen becomes available.
Adenine/*analogs & derivatives/therapeutic use ; Adult ; Antiviral Agents/*therapeutic use ; DNA, Viral/analysis ; Drug Resistance, Viral ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis B, Chronic/*drug therapy ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Phosphonic Acids/*therapeutic use ; Time Factors

BACKGROUND: High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT. METHODS: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively. RESULTS: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively. CONCLUSIONS: Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.
Adult ; End Stage Liver Disease ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Living Donors* ; Medical Records ; Mortality* ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survival Rate ; Transplants ; Ventilators, Mechanical

To preserve scientific integrity, Journal of Liver Cancer agreed with the authors that this paper be retracted.

BACKGROUND/AIMS: Noninvasive diagnostic criteria for hepatocellular carcinoma (HCC) differ between guidelines, especially for subcentimeter-sized nodules. This study aimed to analyze clinical and radiological characteristics of subcentimeter-sized HCC, and assess the validity of noninvasive diagnostic criteria of the revised 2014 the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG-NCC) guideline for subcentimeter-sized HCC. METHODS: A total of 33 consecutive patients (median age, 58.6 years; men, 60.6%; hepatitis B virus-infected, 87.9%) who were diagnosed with HCC between January 2009 and December 2013 and had a maximum tumor diameter less than 1 cm were retrospectively included. RESULTS: Among 33 subcentimeter-sized HCC cases, 6 cases were histologically proven and the remaining 27 patients were diagnosed by radiologically and/or serologically. Initial detection modality was dynamic contrast-enhanced computed tomography (CT) (66.7%, 22/33) or dynamic contrast-enhanced magnetic resonance imaging (MRI) (33.3% 11/33). No case was identified by surveillance ultrasonography. Typical radiological feature of HCC, which is arterial enhancement with delayed washout, was present in 51.7% (15/29 patients) in dynamic contrast-enhanced CT, and 90.9% (30/33 patients) in dynamic contrast-enhanced MRI. When these 33 cases were re-assessed by the revised 2014 KLCSG-NCC guideline, no one has fulfilled the noninvasive diagnostic criteria. CONCLUSIONS: None of the cases that were diagnosed as subcentimeter-sized HCC including histologically confirmed cases did not fulfill the noninvasive diagnostic criteria of the revised 2014 KLCSG-NCC guideline. Refinement of the current noninvasive diagnostic criteria for subcentimeter-sized HCC may be required.
Carcinoma, Hepatocellular ; Hepatitis B ; Humans ; Liver Neoplasms ; Liver ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

Background/Aims: We systematically evaluated the clinical characteristics, prevalence of cirrhosis, and mode of detection in virus-unrelated (non-B non-C, NBNC) hepatocellular carcinoma (HCC) patients in Korea. Methods: A total of 447 consecutive treatment-naïve NBNC-HCC adult patients who were registered at the Samsung Medical Center HCC registry in Korea from 2010 to 2013 were analyzed. NBNC was defined as negative hepatitis B surface antigen and negative anti-hepatitis C virus antibody. Presence of cirrhosis was determined based on histological, radiological, endoscopic, and serologic results. Mode of detection was classified as either under surveillance, incidental, or symptomatic. Results: Heavy alcohol use was the most common potential etiology in NBNCHCC (NBNC-A, alcohol) (59.7%). Ten patients had other identifiable causes (NBNC-O, other identifiable cause) such as autoimmune hepatitis. The rest (38.0%) had no-identifiable cause (NBNC-NA-NO, non-alcohol, no-other identifiable cause). In NBNC-NA-NO group, 83.5% (96/115) of patients with available hepatitis B core immunoglobulin G antibody (HBcIgG) showed HBcIgG positivity, and 80.6% (137/170) had metabolic risk factors (diabetes, obesity, hypertension, and/ or dyslipidemia). Cirrhosis was present in 90.0%, 70.4%, and 60.0% of NBNC-O, NBNC-A, and NBNC-NA-NO patients, respectively. The proportion of patients diagnosed under surveillance was 25.5% across all patients, with specific proportions being 80.0%, 27.7%, and 18.8% for NBNC-O, NBNC-A, and NBNC-NA-NO, respectively. Conclusions Among NBNC-HCC patients, heavy alcohol use or any other identifiable cause was not found in 38.0%. These NBNC-NA-NO HCC patients showed a high prevalence of HBcIgG positivity and metabolic risk factors, suggesting that prior hepatitis B virus infection and metabolic risk factors may be major contributing factors in the hepatocarcinogenesis in NBNC-NA-NO patients.