No abstract available.
Aortic Stenosis, Supravalvular*

The Korean law on medicine was amended in 2003 to introduce new provisions for telemedicine, electronic medical record, and electronic prescription. However, this has not satisfied the realities of the increased demand on medical services and related technology development, resulting in calls for a legislative amendment. In this regard, recent active promotion projects and the advance notice proposing a new amendment by the Ministry of Health, Welfare, and Family Affairs have raised the need for active discussions on telemedicine because the current law on medicine and its amendment do not adequately address the individual privacy protection aspect in the telemedicine environment. In this regard, this study examines current domestic and foreign legal systems on telemedicine and privacy protection, drawing and reviewing subjects to be discussed for individual privacy protection in telemedicine, and proposes plans that may improve Korea's legal system. The domestic and foreign literature on telemedicine and privacy protection was reviewed, recent legislations on telemedicine and views of interest groups were considered, and expert opinions were collected. In addition, the main discussions on privacy protection in telemedicine were identified and reviewed, including information ownership, the scope of privacy protection, the right to review and request correction, and privacy protection matters related to foreign patients. The recent amendment to tele medicine contains a provision only on penalties for privacy protection violations. The main discussions in this study on privacy protection are expected to be reflected in future amendments to enforcement rules and sub-ordinances such as the enforcement ordinance.
Electronic Health Records ; Electronic Prescribing ; Expert Testimony ; Humans ; Jurisprudence ; Ownership ; Privacy ; Public Opinion ; Telemedicine

Purpose: To investigate the efficacy of intense pulsed light (IPL) treatment in patients with meibomian gland dysfunction (MGD) associated with Sjögren’s syndrome. Methods: This study included 43 patients with MGD and Sjögren’s syndrome. Patients received either IPL with meibomian gland expression (IPL/MGX) (n = 22) or MGX only (n = 21). Treatments were administered three times at a 3-week interval. Patients were followed up 6 weeks after the end of the treatment. Ocular Surface Disease Index (OSDI), tear film breakup time with fluorescein dye (FBUT), non-invasive tear breakup time, tear meniscus height (TMH), Schirmer test, SICCA ocular surface staining score, meibum quality score (MQS), and meibum expression score (MES) were evaluated at each visit. Meibomian gland dropouts (meiboscore) and tear film lipid layer grade were measured using keratography. Results: OSDI, FBUT, corneal surface staining score, MQS, meiboscore, and tear film lipid layer grade improved after IPL/MGX treatment (p < 0.05). In both treatment groups, MES significantly improved (p < 0.01 and p < 0.05 for IPL/MGX and MGX groups, respectively). The Schirmer test score, conjunctival surface staining score, and TMH after treatment were not significantly different between the groups. After treatment, the IPL/MGX group had significantly lower OSDI, FBUT, corneal staining score, MQS, and MES, but higher FBUT, compared with the MGX group (p < 0.05). Conclusions IPL treatment effectively improved tear film, ocular surface parameters, meibomian gland function, and lipid layer grade in patients with Sjögren’s syndrome and MGD.

Background/Objectives: Pediatric & Adolescent thyroid cancer is a steadily increasing malignancy. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence in pediatric & adolescent patients with differentiated thyroid carcinoma (DTC).Materials & Methods: The data of 42 pediatric & adolescent patients (aged ≤19 years) with DTC who underwent thyroidectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between December 1997 and February 2019 were retrospectively reviewed. Clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews. Results: The mean age was 16.6 years. A total of 6 (14.3%) patients experienced recurrence after initial treatment. The recurrence rate was significantly different between total thyroidectomy (TT) and lobectomy groups (23.1% vs. 0%, p=0.038). However, no statistically significant differences were found in the recurrence rate according to lymph node ratio (LNR) of 0.4 (10.7% vs 21.4%; p=0.383). Multivariate analysis confirmed age (hazard ratio [HR], 0.443; p=0.008) and bilaterality (HR, 11.477; p=0.022) as significant risk factors for DFS. Conclusion Pediatric & Adolescent thyroid cancer is a rare malignancy and TT is recommended as the treatment of choice. However, lobectomy may be considered for Pediatric & Adolescent patients with age >16 years, tumor size <1 cm, and no bilateral disease.

Background/Objectives: Pediatric & Adolescent thyroid cancer is a steadily increasing malignancy. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence in pediatric & adolescent patients with differentiated thyroid carcinoma (DTC).Materials & Methods: The data of 42 pediatric & adolescent patients (aged ≤19 years) with DTC who underwent thyroidectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between December 1997 and February 2019 were retrospectively reviewed. Clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews. Results: The mean age was 16.6 years. A total of 6 (14.3%) patients experienced recurrence after initial treatment. The recurrence rate was significantly different between total thyroidectomy (TT) and lobectomy groups (23.1% vs. 0%, p=0.038). However, no statistically significant differences were found in the recurrence rate according to lymph node ratio (LNR) of 0.4 (10.7% vs 21.4%; p=0.383). Multivariate analysis confirmed age (hazard ratio [HR], 0.443; p=0.008) and bilaterality (HR, 11.477; p=0.022) as significant risk factors for DFS. Conclusion Pediatric & Adolescent thyroid cancer is a rare malignancy and TT is recommended as the treatment of choice. However, lobectomy may be considered for Pediatric & Adolescent patients with age >16 years, tumor size <1 cm, and no bilateral disease.

No abstract available.
Tetracycline* ; Thyroid Gland* ; Thyroid Nodule*

Purpose: We report a case of infectious keratitis caused by Eikenella corrodens in a patient who lost visual function.Case summary: A 65-year-old male with histories of a corneal ulcer, glaucoma, and bullous keratopathy visited our hospital complaining of redness and pain in his right eye for the past 10 days. Slit-lamp examination revealed stromal infiltration, a 2-mm-high hypopyon, and severe inflammation of the anterior chamber. Vitreous opacity was evident on ocular ultrasonography. Culture of corneal scrapings yielded Eikenella corrodens. After 5 days of antibiotic treatment, ceftazidime was injected intravitreally and histoacryl glue applied to treat the corneal perforation and the endophthalmitis. Two months later, the eye was not inflamed. Conclusions Eikenella corrodens should be considered a possible pathogen when a patient with an underlying ocular disease presents with infectious keratitis. A corneal ulcer caused by Eikenella corrodens has not previously been reported in the Republic of Korea.

Purpose: We report a case of infectious keratitis caused by Eikenella corrodens in a patient who lost visual function.Case summary: A 65-year-old male with histories of a corneal ulcer, glaucoma, and bullous keratopathy visited our hospital complaining of redness and pain in his right eye for the past 10 days. Slit-lamp examination revealed stromal infiltration, a 2-mm-high hypopyon, and severe inflammation of the anterior chamber. Vitreous opacity was evident on ocular ultrasonography. Culture of corneal scrapings yielded Eikenella corrodens. After 5 days of antibiotic treatment, ceftazidime was injected intravitreally and histoacryl glue applied to treat the corneal perforation and the endophthalmitis. Two months later, the eye was not inflamed. Conclusions Eikenella corrodens should be considered a possible pathogen when a patient with an underlying ocular disease presents with infectious keratitis. A corneal ulcer caused by Eikenella corrodens has not previously been reported in the Republic of Korea.

Purpose: We investigated the clinical effects of Siccafluid carbomer eye gel on the symptoms, tear film, and ocular surface in dry eye patients. Methods: Fifty-five patients with dry eye syndrome were also treated with carbomer eye gel for 6 months. The Dry Eye Questionnaire (DEQ-5), tear film breakup time (TBUT), Schirmer’s test, and ocular surface staining score were assessed during follow-up. Patients were classified into Sjögren’s syndrome and non-Sjögren’s syndrome groups and the effects of the carbomer eye drops in each group were analyzed. Results: Overall, the dry eye patients showed significant improvement in the total DEQ-5 score, frequency and intensity of dryness, and TBUT 6 months after treatment. In the non-Sjögren’s group, the total DEQ-5 score, intensity of dryness, and TBUT improved, while in the Sjögren’s group, the total DEQ-5 score, frequency and intensity of dryness, and TBUT improved. In both groups, patients with a shorter TBUT showed a significant improvement in the total DEQ-5 score. Conclusions After 6 months of carbomer eye gel use in patients with dry eye syndrome, the symptoms of ocular dryness and tear film breakup time improved. In patients with dry eye syndrome who have a short TBUT, this can be an effective treatment for alleviating dry eye symptoms.

BACKGROUND: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. METHODS: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. RESULTS: The mean ultrafiltration time was 231+/-28min, ultrafiltrated volume was 5.15+/-1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5+/-23.7mg/dL to 25.7+/-20.2mg/dL; serum aldosterone level decreased from 807.3+/-301.1pg/ml to 431.1+/-187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67+/-0.28g/dL to 1.90+/-1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. CONCLUSION: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
Abdomen ; Aldosterone ; Anti-Bacterial Agents ; Ascites* ; Ascitic Fluid ; Blood Pressure ; Blood Urea Nitrogen ; Carcinoma, Hepatocellular ; Chemistry ; Creatinine ; Drainage ; Electrolytes ; Filtration ; Fluid Therapy ; Heart Rate ; Humans ; Hypotension ; Korea ; Liver Cirrhosis* ; Liver* ; Paracentesis ; Patient Rights ; Peritonitis ; Plasma ; Punctures ; Renin ; Ultrafiltration*