BACKGROUND: The primitive reflexes such as palmomental, glabella, snout, nuchocephalic reflexes may appear in a variety of diseases of the central nervous system. In this study, we investigated the frequencies of these primitive reflexes in the healthy elderly Korean population that have never been studied before. METHODS: Randomly selected 103 vol-unteers aged older than 60 years were examined by neurologists with a systemic neurological examination which included primitive reflexes and by radiologists with neuroimaging. Seven subjects were excluded from the study due to abnormal findings in the MRI of one subject and unusual neurological signs in 6 subjects. RESULTS: The overall mean age of the subjects was 66.5 years. One or more of the primitive reflexes were seen in 26 (24.9%) subjects. Eighteen (17.2%) subjects showed the palmomental reflex; eleven (10.5%) subjects showed the glabella reflex; five (4.8%) sub-jects showed the snout reflex; and one (1.0%) subject showed the nuchocephalic reflex. One subject had palmomental, glabella as well as snout reflexes, and five subjects had two primitive reflexes at the same time. CONCLUSIONS: Despite the normal findings from the neurological examinations and neuroimaging, 24.9% of healthy aged people had one or more primitive reflexes. The presence of these primitive reflexes as an isolated phenomenon may not imply brain lesions. (J Korean Neurol Assoc 19(4):380~383, 2001)
Aged* ; Brain ; Central Nervous System ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Examination ; Reflex*

Objectives: We aimed to collect and report data from all patients who have been diagnosed with mucosal malignant melanoma to obtain the epidemiology and principles of current treatments. Materials and Methods: Between January 2008 and December 2018, 20 patients underwent surgery or follow-up observations at Yonsei University Dental Hospital. The patients’ clinical information was reviewed retrospectively. Results: Seventeen of 20 patients had undergone definitive surgery, while only 6 patients received adjuvant radiotherapy or systemic therapy. Eight of 20 patients, including those that had recurrent lesions, were provided immunotherapy. The 3-year survival for all stages was 50%, with a local recurrence rate of 75% and a metastasis rate of 65%. Conclusion The overall survival of patients receiving surgical treatment was longer than that of patients who did not undergo surgical resection.Eight of 20 patients received immunotherapy as the first-line regimen at our clinic, and those patients exhibited longer overall survival compared to patients in reported keynote studies.

PURPOSE: We aimed to evaluate objective ultrasonography (US) findings for diagnosis of liver cirrhosis and to correlate the utility between the use of the low frequency and high frequency probes for images analyzed on the picture archiving and communications system (PACS). MATERIALS AND METHODS: A total of 87 patients participated in the study; 19 patients that had a clinically proven normal liver and 68 patients that had biopsy-proven chronic liver disease were evaluated with the use of US for the status of the liver. Multiple variables such as a 'smooth surface,' 'irregular nodular surface,' 'homogeneous echotexture,' 'heterogeneous appearance mixed with hypoechoic and hyperechoic echotexture' and 'hypoechoic honeycomb like echotexture' were evaluated based on images obtained with the use of both low frequency and high frequency probes by two observers. The diagnoses obtained after US were correlated with the histological results using assess agreement as statistical method. The concordance rate was calculated to correlate the utility between the use of the low frequency and high frequency probes. RESULTS: An 'irregular nodular surface' showed high interobserver agreement for the diagnosis of liver cirrhosis on images obtained with the low frequency probe (kappa= 0.61). In addition, 'hypoechoic honeycomb' showed high interobserver agreement on images obtained with the high frequency probe (kappa= 0.60). The use of the low frequency probe was associated with more accuracy for the diagnosis of liver cirrhosis (73%). CONCLUSION: Objective US findings for the diagnosis of liver cirrhosis are an 'irregular nodular surface' on images obtained with use of a low frequency probe and a 'hypoechoic honeycomb' on images with use of a high frequency probe.
Humans ; Liver ; Liver Cirrhosis ; Liver Diseases

Objectives: We aimed to collect and report data from all patients who have been diagnosed with mucosal malignant melanoma to obtain the epidemiology and principles of current treatments. Materials and Methods: Between January 2008 and December 2018, 20 patients underwent surgery or follow-up observations at Yonsei University Dental Hospital. The patients’ clinical information was reviewed retrospectively. Results: Seventeen of 20 patients had undergone definitive surgery, while only 6 patients received adjuvant radiotherapy or systemic therapy. Eight of 20 patients, including those that had recurrent lesions, were provided immunotherapy. The 3-year survival for all stages was 50%, with a local recurrence rate of 75% and a metastasis rate of 65%. Conclusion The overall survival of patients receiving surgical treatment was longer than that of patients who did not undergo surgical resection.Eight of 20 patients received immunotherapy as the first-line regimen at our clinic, and those patients exhibited longer overall survival compared to patients in reported keynote studies.

Objectives: . The transcutaneous approach is a good option for office-based vocal fold injection (VFI). However, precise localization requires extensive experience because the needle tip is invisible in small and complex laryngeal spaces. Recently, real-time light-guided VFI (RL-VFI) was proposed as a new technique that allows simultaneous injection under precise needle localization by light guidance. Herein, we aimed to verify the feasibility of RL-VFI in an in vivo canine model and explored its clinical usefulness. Methods: . The device for RL-VFI comprised a light source (light-emitting diode modules [10 W] of red color [650 nm]) and injectors (1.5 inches, 23 gauge). An adult male beagle was used for the experiment. After tracheostomy, a rigid laryngoscope was inserted and suspended to expose the larynx. A flexible naso-laryngoscopy system was used to visualize the vocal folds. Results: . RL-VFI was performed using various transcutaneous approaches, including the cricothyroid, transthyroid, and transhyoid approaches. Light guidance helped identify the path of the needle and prevent inadvertent penetration. The location of the needle tip was accurately indicated by the light. The illuminated needle could be easily placed at the intended points in the vocal fold with real-time visual-motor feedback. Hyaluronic acid could be simultaneously injected lateral to the vocal process under light guidance without manipulation of the device. Conclusion . RL-VFI was found to be safe and feasible in an in vivo canine model, providing precise localization and visualmotor feedback. The clinical application of RL-VFI is expected to improve the safety and precision of VFI.

Objectives: . The transcutaneous approach is a good option for office-based vocal fold injection (VFI). However, precise localization requires extensive experience because the needle tip is invisible in small and complex laryngeal spaces. Recently, real-time light-guided VFI (RL-VFI) was proposed as a new technique that allows simultaneous injection under precise needle localization by light guidance. Herein, we aimed to verify the feasibility of RL-VFI in an in vivo canine model and explored its clinical usefulness. Methods: . The device for RL-VFI comprised a light source (light-emitting diode modules [10 W] of red color [650 nm]) and injectors (1.5 inches, 23 gauge). An adult male beagle was used for the experiment. After tracheostomy, a rigid laryngoscope was inserted and suspended to expose the larynx. A flexible naso-laryngoscopy system was used to visualize the vocal folds. Results: . RL-VFI was performed using various transcutaneous approaches, including the cricothyroid, transthyroid, and transhyoid approaches. Light guidance helped identify the path of the needle and prevent inadvertent penetration. The location of the needle tip was accurately indicated by the light. The illuminated needle could be easily placed at the intended points in the vocal fold with real-time visual-motor feedback. Hyaluronic acid could be simultaneously injected lateral to the vocal process under light guidance without manipulation of the device. Conclusion . RL-VFI was found to be safe and feasible in an in vivo canine model, providing precise localization and visualmotor feedback. The clinical application of RL-VFI is expected to improve the safety and precision of VFI.

Purpose: Since 2020, atezolizumab plus bevacizumab (Ate/Bev) has been the standard first-line therapy for unresectable hepatocellular carcinoma (HCC), but long-term treatment studies are limited. This study evaluated the clinical characteristics and effects of Ate/Bev for over 1 year. Materials and Methods: This study included patients with unresectable HCC treated with first-line Ate/Bev between May 2020 and April 2022. Those receiving Ate/Bev for 1 year or more were classified as the long-term treatment group. Results: Of 246 patients, 69 (28.0%) were in the long-term treatment group, which comprised more proportions of intrahepatic tumor burden < 25%, Eastern Cooperative Oncology Group 0, and a lower proportion of portal vein tumor thrombosis than the short-term treatment group. The long-term treatment group had a higher incidence of atezolizumab-related thyroid dysfunction (31.9% vs. 10.7%, p < 0.001; median time to onset [mTTO], 2.8 months), dermatologic toxicity (29.0% vs. 14.7%, p=0.017; mTTO, 3.3 months), bevacizumab-related hypertension (44.9% vs. 22.0%, p=0.001; mTTO, 4.2 months), and proteinuria (69.6% vs. 38.4%, p < 0.001; mTTO, 6.8 months), compared to the short-term treatment group. Regarding liver function in the long-term treatment group, patients initially classified as Child-Pugh class A decreased from 87.0% to 75.4%, and albumin-bilirubin grade 1 decreased from 68.1% to 50.7% after 1 year of treatment. Conclusion The Ate/Bev long-term treatment group had a lower intrahepatic tumor burden, less portal vein tumor thrombosis, and better performance status and liver function at baseline. Atezolizumab-related immunological adverse events emerged relatively early in treatment compared to the bevacizumab-related. Additionally, some patients demonstrated liver function deterioration during long-term Ate/Bev treatment.

Purpose: Since 2020, atezolizumab plus bevacizumab (Ate/Bev) has been the standard first-line therapy for unresectable hepatocellular carcinoma (HCC), but long-term treatment studies are limited. This study evaluated the clinical characteristics and effects of Ate/Bev for over 1 year. Materials and Methods: This study included patients with unresectable HCC treated with first-line Ate/Bev between May 2020 and April 2022. Those receiving Ate/Bev for 1 year or more were classified as the long-term treatment group. Results: Of 246 patients, 69 (28.0%) were in the long-term treatment group, which comprised more proportions of intrahepatic tumor burden < 25%, Eastern Cooperative Oncology Group 0, and a lower proportion of portal vein tumor thrombosis than the short-term treatment group. The long-term treatment group had a higher incidence of atezolizumab-related thyroid dysfunction (31.9% vs. 10.7%, p < 0.001; median time to onset [mTTO], 2.8 months), dermatologic toxicity (29.0% vs. 14.7%, p=0.017; mTTO, 3.3 months), bevacizumab-related hypertension (44.9% vs. 22.0%, p=0.001; mTTO, 4.2 months), and proteinuria (69.6% vs. 38.4%, p < 0.001; mTTO, 6.8 months), compared to the short-term treatment group. Regarding liver function in the long-term treatment group, patients initially classified as Child-Pugh class A decreased from 87.0% to 75.4%, and albumin-bilirubin grade 1 decreased from 68.1% to 50.7% after 1 year of treatment. Conclusion The Ate/Bev long-term treatment group had a lower intrahepatic tumor burden, less portal vein tumor thrombosis, and better performance status and liver function at baseline. Atezolizumab-related immunological adverse events emerged relatively early in treatment compared to the bevacizumab-related. Additionally, some patients demonstrated liver function deterioration during long-term Ate/Bev treatment.

Objective: Boost radiation using brachytherapy (BT) is a standard treatment for local disease control in concomitant chemoradiation therapy (CCRT) for advanced cervical cancer.However, it is associated with gastrointestinal and genitourinary complications. Hence, this study investigates the feasibility of helical tomotherapy (HT) as an alternative to BT. Methods: Medical records of patients who underwent CCRT between 2000 and 2017 at a single institution were retrospectively reviewed. Patients with stage IIB–IVA cancers were selected based on the 2009 criteria of The International Federation of Gynaecology and Obstetrics.External beam radiation combined with chemotherapy was followed by either BT or HT. The propensity score matching of both groups was calculated using logistic regression analysis.Disease outcomes and treatment-related adverse events were compared between the 2 groups. Results: The matched population included 70 BT patients and 35 HT patients. The 5-year progression-free survival rates for BT and HT were 72.6% and 72.5%, respectively (p=0.721).There was no difference in the overall survival rate between the two groups (p=0.203). The presence of acute and chronic gastrointestinal complications was also similar between the groups (p=0.460 and p=0.563, respectively). The chronic genitourinary toxicities were also comparable (p=0.105). Conclusions HT boost treatment showed comparable disease outcomes with those observed with conventional BT in patients with advanced cervical cancer. HT could be a complementary boost protocol as a single modality or hybrid with BT in selected patients.Further studies with longer follow-up periods are warranted to confirm long-term outcomes.

Purpose: Since 2020, atezolizumab plus bevacizumab (Ate/Bev) has been the standard first-line therapy for unresectable hepatocellular carcinoma (HCC), but long-term treatment studies are limited. This study evaluated the clinical characteristics and effects of Ate/Bev for over 1 year. Materials and Methods: This study included patients with unresectable HCC treated with first-line Ate/Bev between May 2020 and April 2022. Those receiving Ate/Bev for 1 year or more were classified as the long-term treatment group. Results: Of 246 patients, 69 (28.0%) were in the long-term treatment group, which comprised more proportions of intrahepatic tumor burden < 25%, Eastern Cooperative Oncology Group 0, and a lower proportion of portal vein tumor thrombosis than the short-term treatment group. The long-term treatment group had a higher incidence of atezolizumab-related thyroid dysfunction (31.9% vs. 10.7%, p < 0.001; median time to onset [mTTO], 2.8 months), dermatologic toxicity (29.0% vs. 14.7%, p=0.017; mTTO, 3.3 months), bevacizumab-related hypertension (44.9% vs. 22.0%, p=0.001; mTTO, 4.2 months), and proteinuria (69.6% vs. 38.4%, p < 0.001; mTTO, 6.8 months), compared to the short-term treatment group. Regarding liver function in the long-term treatment group, patients initially classified as Child-Pugh class A decreased from 87.0% to 75.4%, and albumin-bilirubin grade 1 decreased from 68.1% to 50.7% after 1 year of treatment. Conclusion The Ate/Bev long-term treatment group had a lower intrahepatic tumor burden, less portal vein tumor thrombosis, and better performance status and liver function at baseline. Atezolizumab-related immunological adverse events emerged relatively early in treatment compared to the bevacizumab-related. Additionally, some patients demonstrated liver function deterioration during long-term Ate/Bev treatment.