No abstract available.
Lymphoma, Non-Hodgkin*

STUDY DESIGN. This is a retrospective study. OBJECTIVES. To verify the advantage of segmental pedicle screw fixation in restoration of thoracic kyphosis in hypokyphotic patients. SUMMARY OF BACKGROUND DATA. Restoration of thoracic kyphosis is essential for a satisfactory three dimensional correction in thoracic AIS. However, with significant preoperative hypokyphosis, the result of multiple hook fixation was often unsatisfactory. METHODS. Fifty-one patients with thoracic AIS treated by posterior instrumentation and followed up for more than 2 years were divided into 3 groups each comprising 17 patients. Hypokyphosis- Hook(HH) group comprised patients with thoracic kyphosis less than 15degrees treated by multiple hooks. Hypokyphosis-Screw(HS) group comprised hypokyphotic patients treated by segmental pedicle screws. Normal kyphosis-Screw(NS) group comprised patients with kyphosis greater than 15degrees treated by segmental pedicle screws. Preoperative thoracic kyphosis was 4.1+/-8.6degrees, 8.1+/-5.6degrees and 27.3+/-9.8degrees in the HH, HS and NS group respectively. There was no significant difference between the HH and HS groups(p=0.39). Three groups were compared for restoration of thoracic kyphosis. Results. At the final follow up, the thoracic kyphosis was 14.5+/-10.2degrees, 27.3+/-11.3degrees and 28.3+/-3.7degrees in the HH, HS group and NS group showing correction of 10.0+/-10.0degrees, 19.2+/-14.0degrees and 0.4+/-12.3degreesrespectively. There was a significant difference between HH and HS group(p=0.0008). However there were no difference between tile HS and the NS group(p=0.8). CONCLUSIONS. Segmental pedicle screw fixation was more effective than multiple hooks in restoring the thoracic kyphosis in AIS patients with hypokyphosis. The restored kyphosis was similar to that obtained in patients without hypokyphosis.
Adolescent* ; Follow-Up Studies ; Humans ; Kyphosis* ; Retrospective Studies

PURPOSE: This study aims to figure out the changes of the prevalence and management of carotid arterial occlusive diseases (CAOD), abdominal aortic diseases (AAA), and arterial diseases of the lower extremities (LAOD) in Korea over the past 5 years. METHODS: Data were extracted from the Health Insurance Review and Assessment Service during the period from 2008 to 2012. RESULTS: The number of patients with CAOD increased by about 30% every year. From the year 2008, the number of open surgeries (OS) and endovascular treatments (ET) increased by more than 20% during each of the first 2 years and by 10% every year for 3 years thereafter for CAOD. ET was preferred to OS and occupied 77%-79% of the total number of procedures. The number of patients with AAA increased by 11%-17% every year. ET for AAA occupied 52% of the total number of procedures in 2008 and gradually increased to 70% in 2012. The number of patients who were diagnosed with LAOD fluctuated over the five years. The total number of procedures to treat LAOD increased each year by 20%-25%. ET for LAOD constantly increased by 18%-24% each year and occupied 80%-95% of the total number of procedures. CONCLUSION: It is evident that the incidence of vascular diseases will be increasing as our society ages, not to mention its care costs. The need for long-range plans and guidelines are urgent.
Aortic Aneurysm ; Aortic Diseases ; Arterial Occlusive Diseases ; Carotid Stenosis ; Endovascular Procedures ; Humans ; Incidence ; Insurance, Health* ; Korea* ; Lower Extremity ; Peripheral Arterial Disease ; Prevalence ; Vascular Diseases

The necessity of embracing selective courses in medical curriculum is increasing due to the expansion of medical knowledge and changes in the health care environment. In contrast to the abundant evidence regarding elective or selective courses during the clinical phase, articles focusing on the preclinical period are relatively scarce. This study aims to explore the development, implementation, and evaluation of newly-adopted selective courses in the first-year medical curriculum in a medical school which recently underwent a major curricular revision. First of all, the Curriculum Committee established goals and operating principles of the courses, and then the committee encouraged all participating professors to attend a related faculty development workshop after finalizing the list of courses. A survey was conducted at the end of each course for evaluation. Of the 36 courses opened in 2016, the overall satisfaction of students was 4.98±1.06 (out of 6) and showed a strong correlation with students' previous expectations, reasoning- and participation-oriented teaching, and outcome of the courses including increased motivation. In the open-ended responses, students and professors described not only intended outcomes such as acquisition of medical knowledge and increased interest in new topics, but also unintended outcomes including positive impression for selective courses and even high satisfaction and rewarding experiences, especially from the teachers' perspective. Although long-term outcomes remain to be seen, the results of this study show the feasibility and impact of selective courses and will contribute to effective implementation in other medical schools.
Curriculum ; Delivery of Health Care ; Education ; Humans ; Motivation ; Reward ; Schools, Medical

PURPOSE: It is well known that a terminal cancer condition affects not only patient themselves but their family members because the patients experience a variety of symptoms. This study was aimed to investigate modifiable factors that influence family caregivers' quality of life, depression, and anxiety. METHODS: From January 2015 through May 2015, a survey was conducted with 61 family caregivers of hospice patients who were hospitalized in two university hospitals and one municipal hospital in Busan. The questionnaire was consisted of characteristics of family caregivers and patients, the Korean version of the Caregiver Quality of Life Index-Cancer (CQOLC-K), Beck's Depression Inventory II (BDI-II), Beck's Anxiety Inventory (BAI), and patient's symptom controlling scores rated by family caregivers. RESULTS: Family caregivers' depression was associated with religion. Quality of life and depression of family caregivers were also influenced by monthly household income. Patient age was inversely related to family caregiver's quality of life (rs=-0.259, P=0.043). Family caregivers' quality of life was associated with patient's anxiety (r=0.443, P=0.001). Family caregivers' depression was affected by patient's constipation (r=0.276, P=0.046), anxiety (r=0.508, P<0.001), and daytime drowsiness (r=0.377, P=0.005). And family caregivers' anxiety was influenced by patients' sleep disturbance (r=0.276, P=0.046), depression (r=0.297, P=0.031), and anxiety (r=0.357, P=0.009). CONCLUSION: According to our findings, family caregivers had higher quality of life and less depression and anxiety when symptoms in hospice patients were well controlled.
Anxiety* ; Busan ; Caregivers ; Constipation ; Depression* ; Family Characteristics ; Hospices* ; Hospitals, Municipal ; Hospitals, University ; Humans ; Quality of Life* ; Sleep Stages

BACKGROUND: AND PURPOSE: The US Food and Drug Administration approval for perampanel has only recently been expanded to patients as young as 4 years, and so there have been few real-life studies of the effects of perampanel in pediatric patients. The aim of this study was to determine the long-term efficacy, factors affecting treatment response, and tolerability of perampanel as an add-on therapy in pediatric patients aged 4 years or older with epilepsy. METHODS: This multicenter retrospective observational study collected data from pediatric epilepsy centers of four Korean national universities. Changes in the seizure frequency from baseline, adverse events, and retention rates were obtained at 3, 6, and 12 months. Adverse events and discontinuation profiles were obtained to assess tolerability. RESULTS: This study included 220 children and adolescents (117 males and 103 females) aged 4 to 20 years. The overall response rate was 43.6%, and the seizure-freedom rate was 17.7%. Factors affecting a good treatment response were the absence of intellectual disability, small number of concomitant antiepileptic drugs, and low baseline seizure frequency. Eighty-eight patients (40%) experienced adverse events, but they mostly were of mild severity and resolved after the dose reduction or discontinuation of perampanel. The retention rates at 3, 6, and 12 months were 85.0%, 71.8%, and 50.5%, respectively. CONCLUSIONS Adjunctive treatment with perampanel was efficacious and tolerated in pediatric patients aged 4 years or older with epilepsy. Early perampanel treatment may help to reduce the burden of their seizures and improve their quality of life.

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.
Adenocarcinoma* ; Biopsy ; Diagnosis ; Duodenal Neoplasms ; Duodenum* ; Early Diagnosis ; Endoscopy, Digestive System ; Hemorrhage ; Humans ; Incidence ; Lymph Node Excision ; Methods ; Mortality ; Pancreaticoduodenectomy ; Quality of Life ; Recurrence ; Treatment Outcome

Primary adenocarcinoma of duodenum is an uncommon neoplasm. Besides its rarity, vague symptoms and signs with the lack of physical findings can delay diagnosis and result in poor treatment outcome. Aggressive surgical managements including pancreaticoduodenectomy was generally recommended for localized cancers despite high operational mortality. However, if early stage cancer is detected, wedge resection can be a therapeutic option. The authors encountered a 2.5x1.5 cm sized subepithelial tumor like mass with spontaneous bleeding and central dimpling located in the third portion of duodenum on esophagogastroduodenoscopy. After repeated deep biopsy, the patient underwent wedge resection and regional lymph node dissection of the duodenum. Finally, the mass was proven as adenocarcinoma and the patient remains in good condition without recurrence for over 2 years. Due to it's low incidence and high mortality, meticulous endoscopic examination of duodenum is essential for early diagnosis and limited operational methods may improve survival and quality of life of patients.
Adenocarcinoma* ; Biopsy ; Diagnosis ; Duodenal Neoplasms ; Duodenum* ; Early Diagnosis ; Endoscopy, Digestive System ; Hemorrhage ; Humans ; Incidence ; Lymph Node Excision ; Methods ; Mortality ; Pancreaticoduodenectomy ; Quality of Life ; Recurrence ; Treatment Outcome

BACKGROUND: Anti-tuberculosis drugs used in combination cause adverse drug reactions, but the prevalence of the reactions and risk factors have not been determined. This study aims to identify the prevalence and risk factors of adverse drug reactions (ADR) to the use of first line anti-tuberculosis drugs. METHODS: A total of 435 newly diagnosed patients with tuberculosis (44.1 years+/-19.0 years) were eligible for this study. All patients received daily oral isoniazid (300 or 400 mg), rifampicin (450 or 600 mg) and ethambutol (800 mg) for 6 months, and pyrazinamide (20 mg/kg) for 2 months. Blood tests were performed regularly (before treatment, 2 weeks after treatment, and bimonthly there after). Patients were interviewed 2 months and 6 months after treatment. A serious ADR was defined as any ADR that resulted in the discontinuation of one or more of the drugs. RESULTS: An ADR was noted in 52.6% of all patients. Gastrointestinal (19.3%), cutaneous (17.7%), hepatic (13.8%), renal (12.6%), and neurological (10.3%) ADRs were frequent and hematological (4.4%), musculoskeletal (3.0%) ADRs were less frequent. A skin ADR was associated with an elevated baseline of liver enzymes (odds ratio, 3.48; 95% CI, 1.2 to 9.9), whereas a hepatic ADR was associated with a history of chronic liver disease (odds ratio, 4.82; 95% CI, 1.7 to 13.2). The prevalence of any serious ADR was 9.7%. Occurrence of any serious ADR was associated with a history of chronic liver disease (odds ratio, 4.29; 95% CI, 1.4 to 13.6). CONCLUSIONS: Anti-tuberculosis drugs given in combination frequently caused a ADR and the findings suggest that a patient receiving anti-tuberculosis treatment should be closely monitored.
Drug-Related Side Effects and Adverse Reactions* ; Ethambutol ; Hematologic Tests ; Hepatitis ; Humans ; Isoniazid ; Liver ; Liver Diseases ; Prevalence* ; Pyrazinamide ; Rifampin ; Risk Factors ; Skin ; Tuberculosis