Flaviviruses have been important human pathogens after emerging and resurging flavivirus diseases over the past decades. Although effective therapeutic agents are not yet commercially available for use in humans, significant progress has been made toward developing effective therapeutics and treatments. Several studies have shown that antibodies against the flaviviral E and NS1 proteins play a central role in prophylaxis and/or treatment of flavivirus infection through passive immunization. In addition, many anti-flavivirals, including interferons, oligonucleotide-based platforms, and small compounds, have been developed and evaluated for their antiviral effects. This review provides an overview of various approaches to the development of anti-flaviviral candidates and new insights that could improve our strategies for designing effective therapeutics against flaviviruses.
Antibodies ; Flavivirus ; Flavivirus Infections ; Humans ; Immunization, Passive ; Interferons ; Proteins

PURPOSE: To evaluate the application of MRI to the ILAE classification of epilepsies and epileptic syndromes in the setting of epilepsy clinic. METHODS: We reviewed epilepsy registry forms, EEG, and MRI of 300 patients who were consecutively registered to the Yonsei Epilepsy Clinic. The algorhithm of syndromic classification consisted of 3 steps ; 1) clinical diagnosis based on the clinical informations described in the registry form, 2) clinical-EEG correlations, and 3) clinical-EEG-MRI correlations. The interictal epileptiform discharges (IEDs) in EEG were divided into focal, multilobar/multifocal, and generalized. MRI-lesions were divided into focal and non-focal (multilobar/multifocal, and diffuse) lesions. The clinical-EEG, EEG-MRI, and MRI-clinical correlations were categorized as concordant, not discordant, and discordant. RESULTS: Among 300 patients evaluated, 249 patients were found to have epilepsies and both EEG and MRI. By clinical analysis, 190 of 249 patients were diagnosed as localization-related epilepsies (LRE), 24 patients were generalized epilepsies (GE), 34 patients were undetermined epilepsies (UDE), and one patient had alcohol related epilepsy. EEG revealed IEDs in 124 patients and altered the clinical diagnosis in 79 patients. MRI lesions were found in 106 patients with focal lesions in 65 patients and non-focal lesions in 41 patients. MRI lesions were found in 47 of 125 patients with negative EEG. Concordance rates of clinical-EEG, EEG-MRI, and MRI-clinical correlations in 54 patients with lobar epilepsies, who had positive EEG and MRI, were 39%, 54%, and 52%, respectively, and discordant rates were 17%, 11% and 7%, respectively. The complete concordance of all 3 correlations was found in only 33% of them. In 20 patients diagnosed as GE by clinical-EEG correlations, MRI lesions were found in only 3 patients and none of them changed the diagnostic categories due to MRI lesions. CONCLUSION: In lobar epilepsies, the sensitivity of MRI was quite comparable with EEG and the clinical-MRI correlation was superior to the clinical-EEG correlations. MRI provided additional and complimentary informations and should be incorporated to the ILAE-classification system as the category of 'lesional epilepsy'.
Classification ; Diagnosis* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Generalized ; Humans ; Magnetic Resonance Imaging*

BACKGOUND: The number of ICU beds related to the number of general acute care beds provides a broad measure of intensive care, but it has obvious limitations and underestimates extreme regional differences. As a first step, we evaluated the number of ICU beds or the ratio of ICU beds to hospital beds in university and non-university hospitals in Korea. METHODS: The number of ICU beds and hospital beds, the ratio of the number of ICU beds to hospital beds, and the types of ICU in each range of ICU beds and hospital beds in the university and non-university hospital were analyzed as well. RESULTS: Thirty university hospitals had 1,824 ICU beds out of 25,966 hospital beds, an average of 7.0%. The number of ICU beds ranged from 17 to 159 beds and hospital beds ranged from 400 to 2,000 beds in university hospitals. Fourteen non-university hospitals had 377 ICU beds out of 6,121 hospital beds, an average of 6.2%. In non-university hospitals, the number of ICU beds ranged from 6 to 67 beds with 50 to 700 hospital beds. If there was only one ICU, e.g. multidisciplinary, or more than one, the director of a multidisciplinary and surgical ICU was usually filled by an anesthesiologist, while the directors of other ICUs were usually specialists according to each specific ICU. CONCLUSIONS: There was a large disparity in the number of ICU beds and in the ratio of ICU beds to hospital beds between university and non-university hosptials, and even between university hospitals.
Hospitals, University ; Intensive Care Units* ; Critical Care* ; Korea* ; Specialization

Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis.
Abdominal Cavity ; Aged ; Appendectomy ; Appendicitis ; Biopsy ; Chimera ; Cholecystectomy ; Endoscopy ; Female ; Humans ; Liver ; Natural Orifice Endoscopic Surgery ; Resin Cements ; Splenectomy ; Ultrasonics

BACKGROUND: Hepatobiliary and vascular structure anatomy must be understood to ensure donor safety during living donor liver transplantation (LDLT). The purpose of this study was to determine the role of pretransplant magnetic resonance cholangiography (MRC) for understanding the anatomy. METHODS: Eighteen LDLT were analyzed retrospectively through medical records and radiological images. Pretransplant MRC and intraoperative cholangiography (IOC) were reviewed to evaluate the accuracy of pretransplant MRC. RESULTS: The MRC results of 13 donors were acceptable for a living donor operation. However, 5 donor MRC results required further evaluation to identify the biliary anatomy by IOC. In 2 cases, the use of an intravenous low-dose morphine injection helped to obtain a more qualified MRC image. CONCLUSIONS: Despite the small study size, the results showed that MRC can help provide information on donor biliary anatomy to ensure a safe donor operation.
Cholangiography ; Dietary Sucrose ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Medical Records ; Morphine ; Retrospective Studies ; Tissue Donors

Somatostatinoma is a rare form of neuroendocrine tumor that was first described in 1977. Most tumors have involved the pancreas, and gastrointestinal tract involvement is rare. Somatostatinomas of the ampulla of Vater are extremely rare and present distinct clinical and pathologic differences. Pancreatic somatostatinoma has been associated with a clinical syndrome of dyspepsia, mild diabetes, cholelithiasis, steatorrhea, and hypochlorhydria, but duodenal somatostatinoma, in general, has been clinically silent. A further contrast is that duodenal carcinoid tumors, mainly gastrinoma, tended to be benign, whereas ampullary carcinoid tumors, mainly somatostatinoma, exhibited malignant behavior. Therefore, definite diagnosis is important for treatment and prognosis, and is performed by image study, immunohistochemistry and electron microscopic examination. We report a case of somatostatinoma of the ampulla of Vater in a 51-year-old male. He complained of generalized abdominal pain for a few days. Gastrofiberscopically, a 1.2 cm sized bulging mass was observed on the ampulla of Vater. Radiologically, on abdomen CT, a protruding enhancing mass was revealed in the duodenum. In octreoscan, there was an abnormal focus off increased radiouptake in the infrahepatic area. He underwent a pancreatoduodenectomy. Grossly, the mass was an intraluminary protruding polypoid submucosal mass with focal ulceration in the ampulla of Vater. Histologically, it showed well-differentiated nonpleomorphic tubular cell nest and psammoma bodies. Immunohistochemically, the tumor cells showed a neuroendocrine nature with synaptophysin immunostain and intense staining only for somatostatin.
Abdomen ; Abdominal Pain ; Achlorhydria ; Ampulla of Vater* ; Carcinoid Tumor ; Cholelithiasis ; Diagnosis ; Duodenum ; Dyspepsia ; Gastrinoma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neuroendocrine Tumors ; Pancreas ; Pancreaticoduodenectomy ; Prognosis ; Somatostatin ; Somatostatinoma* ; Steatorrhea ; Synaptophysin ; Ulcer

Inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, has a potential risk of developing into colorectal cancer. However, there is little relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is a curable disease and has a relatively short disease course. Nevertheless, there have been a few case reports of intestinal tuberculosis associated with colon cancer. There was a case report in which the carcinoma facilitated entry of tubercle bacilli with development of a secondary infection, and ulcerative lesions of tuberculosis may be precursors of carcinomas. We experienced a 77-year-old woman who had intestinal tuberculosis combined with ascending colon cancer. She visited our hospital because of abdominal pain and constipation. Colonoscopy showed a luminal obstruction mass in the ascending colon. Histologic examination revealed an adenocarcinoma. After surgery, the surgical specimen disclosed an adenocarcinoma in the cecum and ascending colon and intestinal tuberculosis around the cancer site of the cecum. Herein, we report a rare case of colon cancer co-existing with colonic tuberculosis with a review of the literature.
Female ; Humans ; Adenocarcinoma

PURPOSE: The reported incidence of early gastric cancer located in the upper portion of the stomach has been increasing with the recent advances in its diagnosis and screening. Recently, we have successfully performed laparoscopic assisted proximal gastrectomy and gastric tube reconstruction, without pyloroplasty, on six patients with an early gastric carcinoma located in the upper third of the stomach. Herein, we describe our modification of this procedure. METHODS: After creating a surgical pneumoperitoneum, the stomach was mobilized using laparoscopic coagulating shears. The upper half of the greater curvature and three- quarters of the lesser curvature were then dissected in conjunction with a regional D2 lymphadenectomy. This was followed by a 5 cm, longitudinal mini-laparotomy in the upper abdomen, with the construction of the exterior stomach using a 20 cm long and 4 cm wide gastric tube. Reconstruction, with an esophagogastrostomy, was performed using a circular stapler. RESULTS: No post-operative morbidity or mortality was observed in this small series of patients. The average operative time and blood loss were 230 minutes, ranging from 190~290 minutes, and 150 ml, ranging from 90-180 ml, respectively. The mean number of lymph nodes harvested during these laparoscopic proximal gastrectomies was 22.8 nodes, ranging from 19~30 lymph nodes. The average postoperative hospital stays was 8.3 days, ranging from 7~10 days. CONCLUSION: Our technique of laparoscopic assisted proximal gastrectomy and gastric tube reconstruction, without pyloroplasty, offers a minimally invasive technique, with the potential of improving the post-operative quality of life of patients with early-stage proximal gastric cancer.
Abdomen ; Diagnosis ; Gastrectomy* ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Mass Screening ; Mortality ; Operative Time ; Pneumoperitoneum ; Quality of Life ; Stomach ; Stomach Neoplasms*

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
Dyspnea ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intubation ; Lung ; Male ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Plasminogen ; Respiration, Artificial ; Respiratory Sounds ; Spouses ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Warfarin

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
Dyspnea ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intubation ; Lung ; Male ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Plasminogen ; Respiration, Artificial ; Respiratory Sounds ; Spouses ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Warfarin