STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.
Aged ; Carcinoma in Situ/*mortality/*pathology/therapy ; Disease Progression ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*mortality/*pathology ; Prognosis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk ; Urinary Bladder Neoplasms/*mortality/*pathology/therapy

Acute limb ischemia (ALI) is a serious condition requiring prompt intervention due to a sudden decrease in limb perfusion threatening limb viability. Treatment of ALI depends on the clinical status of the affected limb and patient comorbidities. Surgical therapy has been the historical standard of care for restoring limb perfusion; however, percutaneous endovascular intervention has been shown to be a promising treatment option in selected patients of ALI at high surgical risk. We report on a case of a 75-year-old man with ALI caused by thrombotic occlusion of the suprainguinal artery, successfully treated with endovascular therapy including stent insertion and thrombus aspiration and catheter-directed urokinase infusion in view of the clinical findings and imaging studies.
Aged ; Arteries* ; Comorbidity ; Endovascular Procedures ; Extremities* ; Humans ; Ischemia* ; Lower Extremity ; Perfusion ; Standard of Care ; Stents ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

OBJECTIVE: To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. MATERIALS AND METHODS: Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. RESULTS: Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 +/- 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. CONCLUSION: Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.
Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Contrast Media/*adverse effects ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney Diseases/*chemically induced/epidemiology/*radiography ; Male ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Tomography, X-Ray Computed/*methods

Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.
Adult ; Biopsy ; Female ; Giant Cells/pathology ; Granuloma/complications/*diagnosis/therapy ; Headache/etiology ; Hemianopsia/etiology ; Humans ; Hyperprolactinemia/etiology ; Hypopituitarism/etiology ; Inflammation/complications/*diagnosis/therapy ; Magnetic Resonance Imaging ; Optic Chiasm/pathology ; Pituitary Diseases/complications/*diagnosis/therapy ; Pituitary Function Tests ; Pituitary Gland/*pathology/surgery ; Predictive Value of Tests ; Severity of Illness Index ; Treatment Outcome

Coral is a member of the class Anthozoa, which cause injury due to stings from their tentacles containing nematocytes or from their sharp-edged calcified outer skeletons. Sting from their nematocytes may cause coral poisoning and cause a rare type of contact dermatitis. A 24-year-old woman, who had been contacted to coral during skin-scuba diving in the Philippines 7 days before, was presented with multiple brownish plaques and patches with small vesicles on the dorsum of the left hand. Herein, we report a case of contact dermatitis to coral by the nematocyst stings of corals.
Anthozoa ; Bites and Stings ; Dermatitis, Contact ; Diving ; Female ; Hand ; Humans ; Nematocyst ; Philippines ; Skeleton ; Young Adult

Coral is a member of the class Anthozoa, which cause injury due to stings from their tentacles containing nematocytes or from their sharp-edged calcified outer skeletons. Sting from their nematocytes may cause coral poisoning and cause a rare type of contact dermatitis. A 24-year-old woman, who had been contacted to coral during skin-scuba diving in the Philippines 7 days before, was presented with multiple brownish plaques and patches with small vesicles on the dorsum of the left hand. Herein, we report a case of contact dermatitis to coral by the nematocyst stings of corals.
Anthozoa ; Bites and Stings ; Dermatitis, Contact ; Diving ; Female ; Hand ; Humans ; Nematocyst ; Philippines ; Skeleton ; Young Adult

BACKGROUND/AIMS: The Korean Network for Organ Sharing (KONOS) was established in 2000, and the KONOS criteria for expanded-criteria donors (ECD) have since been applied to kidney allocation from deceased donors. The outcome of cadaveric kidney transplantation from ECD according to KONOS criteria has not been investigated. METHODS: Seventy-seven cadaveric kidney transplants from January 2003 to December 2009 were recruited retrospectively. Factors that influence the glomerular filtration rate (GFR) of graft kidneys up to 36 months after transplantation were evaluated. Postoperative renal function and allograft and patient survival in the ECD group (n = 28) were compared with those in the standard-criteria donor (SCD) group (n = 49). RESULTS: The GFR of graft kidneys was different according to donor GFR, age, hypertension history, and cause of brain death. In the ECD group, GFR was lower than that in the SCD group by KONOS criteria. No differences in allograft or patient survival were observed until 3 years after kidney transplantation. CONCLUSIONS: Cadaveric kidney transplantation using the ECD by KONOS criteria is acceptable in term of graft and 3-year patient survival, although the GFR was lower in the ECD than in the SCD group.
Brain Death ; Cadaver ; Glomerular Filtration Rate ; Graft Survival ; Humans ; Hypertension ; Kidney ; Kidney Transplantation ; Retrospective Studies ; Tissue Donors ; Transplantation, Homologous ; Transplants

PURPOSE: We assessed the efficacy of radical prostatectomy (RP) in prostate cancer patients with preoperative prostate-specific antigen (PSA) levels > or = 20 ng/ml and no distant metastases. MATERIALS AND METHODS: The records of 132 prostate cancer patients undergoing RP with preoperative PSA levels > or =20 ng/ml and no distant metastases were reviewed. Sixty-six patients received preoperative neoadjuvant hormonal therapy. Pathologic and clinical outcomes were compared between the groups with PSA of 20-40 ng/ml and > or =40 ng/ml. RESULTS: There were no statistical differences in age, prostate volume, or the frequency of neoadjuvant hormonal therapy between the two groups. The PSA > or =40 ng/ml group had a higher RP Gleason score, tumor stage, and extracapsular extension. After a mean follow-up of 47.0 months, 73 (55.3%) patients had PSA progression with a median time of 37.0 months. Fifty-six patients received adjuvant hormonal therapy, and 19 received salvage external beam radiation therapy. Clinical disease progression developed in 10 patients (7.6%). During follow-up, 8 patients died, 1 of prostate cancer and 7 of other causes. Preoperative PSA was a significant predictor of PSA progression and time to PSA progression after RP, whereas there were no differences in distant metastasis, local recurrence, hormone-refractory prostate cancer progression, and overall or prostate cancer-specific death between the 2 groups. CONCLUSIONS: On the basis of the favorable postoperative outcomes of RP in patients with preoperative PSA > or =20 ng/ml and no distant metastases, we suggest that RP has a role in treating these high-risk prostate cancer patients and that preoperative PSA is a significant predictor of postoperative PSA progression.
Disease Progression ; Follow-Up Studies ; Humans ; Neoplasm Grading ; Neoplasm Metastasis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Treatment Outcome

PURPOSE: To evaluate the feasibility and safety of the extraperitoneal robotic radical prostatectomy (ERP), we compared the results of transperitoneal robotic radical prostatectomy (TRP) with those of ERP performed by a single surgeon. MATERIALS AND METHODS: All operation was performed by a single surgeon, who had the experience of more than 150 transperitoneal cases. Recently, 30 cases were performed through transperitoneal approach, and then extraperitoneal approach was applied to next 30 cases. We compared the clinicopathologic parameters and perioperative outcomes between two groups. RESULTS: There were no significant differences in mean age, body mass index (BMI), preoperative prostate-specific antigen (PSA) level, prostatectomy Gleason scores and pathologic T stage between two groups, whereas positive surgical margin rate was significantly lower in ERP. There was no significant difference in total operation time, whereas console time, and vesicourethral anastomosis time significantly decreased in ERP. There were no significant differences in postoperative normal diet start day, the duration of hospital stay and bladder catheterization. There were no significant differences in the amount of estimated blood loss and the number of resected lymph nodes. In both groups, there were no inadvertent organ injury during trocar placement and conversion to open surgery, whereas 1 case of lymphocele in ERP was recovered with conservative care. CONCLUSIONS: ERP showed similar perioperative outcomes compared to TRP. Considering the potential risk of bowel injury in TRP and reduced peritoneal irritation in ERP, ERP may be alternative in robotic radical prostatectomy.
Body Mass Index ; Catheterization ; Catheters ; Conversion to Open Surgery ; Diet ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Lymphocele ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Robotics ; Surgical Instruments ; Urinary Bladder