Objective: : The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation. Methods: : This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018. Results: : There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Posttreatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status. Conclusion : Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.

Background: In the event of an industrial accident, the appropriate choice of hospital is important for worker health and prognosis. This study investigates whether the choice of hospital by the employer in the case of industrial accidents affects the prognosis of injured employees. Methods: Data from the 2018 Panel Study of Workers’ Compensation Insurance in Korea were used in an unmatched case-controlled study. The exposure variable is “hospital selection by an employer,” and the outcome variable is ‘worker’s disability.” Odds ratios (ORs) were estimated by modified Poisson regression and adjusted for age, gender, underlying disease, injury severity, and workplace size and stratified by industrial classification. The group at increased risk was analyzed and stratified by age, gender, and area. Results: In the construction industry, hospital selection by the employer was significantly associated with increased risk of disability (adjusted OR 1.26; 95% confidence interval [CI]: 1.20–1.32) and severe disability (adjusted OR 1.38; 95% CI: 1.08–1.76) among the injured. Female and younger workers not living in the Seoul capital area were more at risk of disability and severe disability than those living in the Seoul capital area. Conclusions Hospital selection by employers affects the prognosis of workers injured in an industrial accident. For protecting workers’ health and safety, workplace emergency medical systems should be improved, and the selection of appropriate hospitals to supply treatment should be reviewed.

We report a case of lateral cavernous sinus wall dural arteriovenous fistula (DAVF) accompanied large venous aneurysm which is presented intracerebral hemorrhage (ICH). A 58-year-old male patient came to emergency department for acute onset of headache and dysarthria. In brain computed tomography scan, large left temporal lobe ICH was noted. In transfemoral cerebral angiography, multiple arteries from external carotid artery and left internal carotid artery (ICA) fed arteriovenous shunt. This shunt was drained through cavernous sinus with enlarged multiple cortical veins. One large venous aneurysm was estimated as bleeding focus for ICH. Considering ICH and high flow shunt, we planned urgent treatment to reduce flow of arteriovenous shunt. However, transvenous embolization was failed due to tortuous venous anatomy. Therefore, we planned craniotomy and microsurgical treatment. There was engorged small vessel in lateral wall of cavernous sinus and vascular trunk which is fistulous connection was noted. Fistula connection was obliterated and disconnected after coagulation. In postoperative image, fistula was completely disappeared and there was no cortical venous reflux, also large venous aneurysm was disappeared. Patient recovered very well without new neurological deficits. We reported successfully treated lateral cavernous sinus wall DAVF by combined endovascular and transcranial-microsurgical treatment.

Background: This study investigates the safety and health status of geographically isolated and confined workers. Methods: This study was conducted in Baekryeong Island in Korea in 2020. The agestandardized prevalence ratios (aSPR) for occupational injury, unmet medical needs, psychological status, and lifestyle were estimated from the available data. Also, we compared the aSPRs of workers in Baekryeong Island with a reference study population who participated in a nationally representative survey in Korea. Results: The study revealed that Baekryeong Island workers had an increased risk of acquiring health and safety problems compared to the general worker population. The island workers showed a significant increase in unmet medical care (aSPR, 5.319; 95% confidence interval [CI], 3.984–6.958) and occupational injury (aSPR, 8.371; 95% CI, 3.820–15.892). Conclusion This study identified the safety and health problems of geographically isolated workers in Baekryeong Island. The risk of occupational injury and unmet medical care are simultaneously highlighted in the region's population, thereby underscoring the importance of prevention.

BACKGROUND: This study examined the long-term preventive effects of a case management service on suicide reattempts, and clarified the factors related to suicide reattempts. METHODS: We reviewed the medical records of suicide attempters who visited the emergency department of Ulsan University Hospital from August 28, 2013 to July 31, 2017. A 4-week case management service was provided to consenting participants, either face-to-face or by telephone. Using survival analysis, we analyzed differences in the time to the next emergency department visit for a suicide attempt according to whether participants completed the case management service. We also assessed which characteristics of participants were associated with suicide reattempts. RESULTS: We found no overall difference in time to suicide reattempt between case-managed participants and controls over the entire observation period (median period: 19 months). However, in the first 24 weeks after the initial suicide attempt, the case-managed group showed a longer time to reattempt than did the control group (log-rank test = 4.243; P = 0.039). A higher risk of reattempt was found among participants with the medical benefit type of health insurance compared to those with national health insurance (hazard ratio [HR], 5.134; P < 0.001) and among participants aged 20–39 compared to those aged ≥ 60 (HR, 3.502; P = 0.05). CONCLUSION: Case management had only short-term benefits (within 24 weeks of initial suicide attempt). Risk factors for suicide reattempts were having a medical benefit health insurance and being aged 20–39 years.
Case Management* ; Emergency Service, Hospital ; Insurance, Health ; Medical Records ; National Health Programs ; Risk Factors ; Socioeconomic Factors ; Suicide* ; Survival Analysis* ; Telephone ; Ulsan

We report a case of lateral cavernous sinus wall dural arteriovenous fistula (DAVF) accompanied large venous aneurysm which is presented intracerebral hemorrhage (ICH). A 58-year-old male patient came to emergency department for acute onset of headache and dysarthria. In brain computed tomography scan, large left temporal lobe ICH was noted. In transfemoral cerebral angiography, multiple arteries from external carotid artery and left internal carotid artery (ICA) fed arteriovenous shunt. This shunt was drained through cavernous sinus with enlarged multiple cortical veins. One large venous aneurysm was estimated as bleeding focus for ICH. Considering ICH and high flow shunt, we planned urgent treatment to reduce flow of arteriovenous shunt. However, transvenous embolization was failed due to tortuous venous anatomy. Therefore, we planned craniotomy and microsurgical treatment. There was engorged small vessel in lateral wall of cavernous sinus and vascular trunk which is fistulous connection was noted. Fistula connection was obliterated and disconnected after coagulation. In postoperative image, fistula was completely disappeared and there was no cortical venous reflux, also large venous aneurysm was disappeared. Patient recovered very well without new neurological deficits. We reported successfully treated lateral cavernous sinus wall DAVF by combined endovascular and transcranial-microsurgical treatment.

Background: This study investigates the safety and health status of geographically isolated and confined workers. Methods: This study was conducted in Baekryeong Island in Korea in 2020. The agestandardized prevalence ratios (aSPR) for occupational injury, unmet medical needs, psychological status, and lifestyle were estimated from the available data. Also, we compared the aSPRs of workers in Baekryeong Island with a reference study population who participated in a nationally representative survey in Korea. Results: The study revealed that Baekryeong Island workers had an increased risk of acquiring health and safety problems compared to the general worker population. The island workers showed a significant increase in unmet medical care (aSPR, 5.319; 95% confidence interval [CI], 3.984–6.958) and occupational injury (aSPR, 8.371; 95% CI, 3.820–15.892). Conclusion This study identified the safety and health problems of geographically isolated workers in Baekryeong Island. The risk of occupational injury and unmet medical care are simultaneously highlighted in the region's population, thereby underscoring the importance of prevention.

Moyamoya disease (MMD) is a rare progressive steno-occlusive cerebrovascular disorder. Currently, revascularization surgery is used as optimal treatment to overcome MMD. However, revascularization for MMD has reported several complications. Also, iatrogenic complications such as pseudoaneurysms formation or dural arteriovenous fistulas (dAVFs) formation—has been identified in rare cases after the surgical intervention for revascularizations.
We describe two cases. In first case, the patency of the anastomosis site was good and saccular type pseudoaneurysm formation was found at parietal branch of posterior middle meningeal artery (MMA) in transfemoral cerebral angiography (TFCA) performed on the twelfth day after surgery. We decided to treat pseudoaneurysm by endovascular embolization the next day, but the patient was shown unconsciousness and anisocoria during sleep at that day. Computed tomography showed massive subdural hemorrhage at the ipsilateral side, thus we performed decompressive craniectomy and hematoma evacuation.
In second case, the patency of the anastomosis site was good and dAVF formation at right MMA was found in TFCA performed on the sixth day after surgery. We performed endovascular obliteration of the arteriovenous fistula under local anesthesia.
Pseudoaneurysm formation or dAVF formation after revascularization surgery is an exceptional case. If patients have such complications, practioner should carefully screen the patients by implementing digital subtraction angiogram to identify anatomic features; as well as consider immediate treatment in any way, including embolization or other surgery

Arteriovenous malformations (AVMs) are congenital anomalies of the cerebrovascular system. AVM harbors 2.2% annual hemorrhage risk in unruptured cases and 4.5% annual hemorrhage risk of previously ruptured cases. Stereotactic radiosurgery (SRS) have been shown excellent treatment outcomes for patients with small- to moderated sized AVM which can be achieved in 80–90% complete obliteration rate with a 2–3 years latency period. The most important factors are associated with obliteration after SRS is the radiation dose to the AVM. In our institutional clinical practice, now 22 Gy (50% isodose line) dose of radiation has been used for treatment of cerebral AVM in single-session radiosurgery. However, dose-volume relationship can be unfavorable for large AVMs when treated in a single-session radiosurgery, resulting high complication rates for effective dose. Thus, various strategies should be considered to treat large AVM. The role of pre-SRS embolization is permanent volume reduction of the nidus and treat high-risk lesion such as AVM-related aneurysm and high-flow arteriovenous shunt. Various staging technique of radiosurgery including volume-staged radiosurgery, hypofractionated radiotherapy and dose-staged radiosurgery are possible option for large AVM. The incidence of post-radiosurgery complication is varied, the incidence rate of radiological post-radiosurgical complication has been reported 30–40% and symptomatic complication rate was reported from 8.1% to 11.8%. In the future, novel therapy which incorporate endovascular treatment using liquid embolic material and new radiosurgical technique such as gene or cytokine-targeted radio-sensitization should be needed.

Background: The cutaneous adverse effects (AEs) of amivantamab, a novel monoclonal bispecific antibody against the epidermal growth factor receptor and mesenchymal-epithelial transcription factor, have not been investigated. Objective: To analyze the type and prevalence of cutaneous AEs in patients with non-small cell lung cancer (NSCLC) treated with amivantamab. Methods: A single-institution retrospective medical record review was conducted on patients with NSCLC who were treated with amivantamab between January 1, 2021, and June 30, 2023. A total of 37 patients receiving amivantamab monotherapy for NSCLC were included in this study. Demographic data (age, sex, body mass index, age at cancer diagnosis, age at amivantamab therapy initiation, and duration of amivantamab use) and the types and severity of cutaneous AEs were evaluated. Results: Cutaneous AEs occurred in 59.5% of the patients. The most common AEs were maculopapular eruptions (37.8%), paronychia (24.3%), pruritus/xerosis (16.2%), acneiform eruptions (13.5%), pustulosis (5.4%), and scalp rashes (5.4%). No Grade 3 cutaneous AE, which led to the discontinuation of amivantamab therapy, was observed. Conclusion Our data describes an extensive review of cutaneous AEs caused by amivantamab. Further research with a larger patient population is necessary to reliably predict and manage cutaneous AEs associated with amivantamab.