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

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.
Breast ; Breast Diseases ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Prospective Studies ; Recurrence

PURPOSE: A relationship between thyroid disease and primary breast cancer remains controversial. Several studies have demonstrated there is an increased risk of breast cancer in patients with thyroid dysfunction and thyroid cancer. The purpose of this study was to evaluate the incidence, relationship and clinical characteristics of thyroid nodules and cancer in patients with breast cancer. METHODS: Two hundred sixty one women with primary breast cancer had an ultrasonogram of the thyroid prospectively performed at the Department of General Surgery of the Soonchunhyang University Hospital from April 1995 to December 1999. The thyroid nodules were identified by high- resolution ultrasonography before all patients had undergone breast cancer surgery. RESULTS: Among the 261 patients with breast cancer, thyroid nodules were found in 57 (21.8%). The most prevalent age group of the 57 thyroid nodules was the 5th decade. Twenty- one out of 57 patients with thyroid nodules had undergone thyroid surgery and 14 benign nodules and 7 thyroid cancers (5 papillary carcinoma & 2 follicular carcinoma) were discovered. The incidence of thyroid cancer in the patients with breast cancer was 2.7%. CONCLUSION: Although the factors associated with thyroid nodules and cancer in the patients with breast cancer were not demonstrated, these results were suggested that there may be a relationship between them. Therefore, ultrasonography of the thyroid in patients with breast cancer priorto breast cancer surgery operations is recommended.
Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Female ; Humans ; Incidence* ; Prospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

PURPOSE: A relationship between thyroid disease and primary breast cancer remains controversial. Several studies have demonstrated there is an increased risk of breast cancer in patients with thyroid dysfunction and thyroid cancer. The purpose of this study was to evaluate the incidence, relationship and clinical characteristics of thyroid nodules and cancer in patients with breast cancer. METHODS: Two hundred sixty one women with primary breast cancer had an ultrasonogram of the thyroid prospectively performed at the Department of General Surgery of the Soonchunhyang University Hospital from April 1995 to December 1999. The thyroid nodules were identified by high- resolution ultrasonography before all patients had undergone breast cancer surgery. RESULTS: Among the 261 patients with breast cancer, thyroid nodules were found in 57 (21.8%). The most prevalent age group of the 57 thyroid nodules was the 5th decade. Twenty- one out of 57 patients with thyroid nodules had undergone thyroid surgery and 14 benign nodules and 7 thyroid cancers (5 papillary carcinoma & 2 follicular carcinoma) were discovered. The incidence of thyroid cancer in the patients with breast cancer was 2.7%. CONCLUSION: Although the factors associated with thyroid nodules and cancer in the patients with breast cancer were not demonstrated, these results were suggested that there may be a relationship between them. Therefore, ultrasonography of the thyroid in patients with breast cancer priorto breast cancer surgery operations is recommended.
Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Female ; Humans ; Incidence* ; Prospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

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

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

PURPOSE: A relationship between thyroid disease and primary breast cancer remains controversial. Several studies have demonstrated there is an increased risk of breast cancer in patients with thyroid dysfunction and thyroid cancer. The purpose of this study was to evaluate the incidence, relationship and clinical characteristics of thyroid nodules and cancer in patients with breast cancer. METHODS: Two hundred sixty one women ith primary breast cancer had an ultrasonogram of the thyroid prospectively performed at the Department of General Surgery of the Soonchunhyang University Hospital from April 1995 to December 1999. The thyroid nodules were identified by high-resolution ultrasonography before all patients had undergone breast cancer surgery. RESULTS: Among the 261 patients with breast cancer, thyroid nodules were found in 57 (21.8%). The most prevalent age group of the 57 thyroid nodules was the 5th decade. Twenty-one out of 57 patients with thyroid nodules had undergone thyroid surgery and 14 benign nodules and 7 thyroid cancers (5 papillary carcinoma & 2 follicular carcinoma) were discovered. The incidence of thyroid cancer in the patients with breast cancer was 2.7%. CONCLUSION: Although the factors associated with thyroid nodules and cancer in the patients with breast cancer were not demonstrated, these results were suggested that there may be a relationship between them. Therefore, ultrasonography of the thyroid in patients with breast cancer priorto breast cancer surgery operations is recommended.
Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Female ; Humans ; Incidence* ; Prospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

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