Background and Objective: Anemia is very common in cancer patients with many etiologies. Palliative care patients also have a number of risk factors for iron-deficiency anemia. Prescribers of ironreplacement therapy often overlook that iron-loading can negatively affect the cancer prognosis. Methods and results: A 66-year-old male was diagnosed with hepatitis B virus-related hepatocellular carcinoma (HCC). After resection, he received the transarterial chemo-embolization (TACE) and radiofrequency ablation (RFA) on the recurred HCC. He was also diagnosed with renal cell carcinoma (RCC), and received RFA. Meanwhile, his hemoglobin level was slightly low (11.0 g/dL). After 21 months, his HCC recurred, together with a significant rise in blood hemoglobin level from 11.0 to 15.0 g/dL due to oral iron supplementation. Further TACE was recommended but refused by the patient. Only after discontinuation of the iron supplement, the follow-up MRI scans did prove that the recurrent tumor improved as the hemoglobin level returned to 11.0 g/dL. His disease is currently stable. Conclusion: Iron-replacement therapy should not be indiscriminately prescribed to all cancer patients with anemia. Further studies about the effect of mild iron deprivation on survival in the palliative care population are necessary since mildly low hemoglobin index can be beneficial to the prognosis of HCC in this case.

Background: Blepharoplasty has both aesthetic and functional benefits in patients with pseudoptosis; however, previous studies could not demonstrate its beneficial effects quantitatively and objectively. The authors objectively analyzed the visual field before and after surgery and investigated whether measurements of the visual field can be applied as a suitable predictor of surgical outcomes. Methods: In total, 18 eyelids in nine patients with pseudoptosis who had undergone simple skin excision blepharoplasty were evaluated prospectively from February to May 2016. The visual fields were analyzed preoperatively and 3 months postoperatively using the Goldmann kinetic perimetry test. The visual field test area was assessed using Adobe Photoshop. Results: Blepharoplasty had an average 4.99-fold beneficial effect on the superior visual field. In particular, more improvement was seen in the superior temporal quadrant than in the nasal quadrant. No correlation was found between the preoperative margin-to-reflex distance 1 (MRD1) and the surgical outcome (P=0.119). However, there was a strong correlation between the preoperative superior visual field and the surgical outcome (P=0.001). Conclusions Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.

Objectives: We analyzed theta-band phase synchrony (TBPS) under reduced and ordinary flicker lighting to determine the effect of light flickers on neurocognitive processes. Methods: Nineteen healthy participants (mean age, 30.4±4.5 years; male, 63.2%) performed the Sternberg working memory tasks with event-related potential recording under reduced and control flicker conditions, respectively. We measured the P300 amplitude during memory retrieval, and for TBPS analysis, we calculated the weighted phase lag index within the P300 time window. Furthermore, we used standardized low-resolution brain electromagnetic tomography (sLORETA) to determine differences in functional cortical source connectivity between the two flicker conditions. Results: The hit rate (F1,18=0.862, p=0.365), reaction time (F1,18=0.021, p=0.887), and P300 amplitude (F1,18=3.992, p=0.061) did not differ between the two flicker conditions. However, connectivity analysis at the scalp level showed that TBPS under reduced flicker lighting was significantly higher than that under control flicker lighting at higher memory loads (p=0.002). Cortical source imaging with sLORETA confirmed that reduced flicker lighting significantly increased TBPS between the left prefrontal cortex and right hippocampus compared with control flicker lighting (false discovery rate<0.1). Conclusions Reduced flicker lighting enhanced TBPS during the working memory task compared with control flicker lighting. Reduced flicker light may improve cognitive functioning by facilitating information transfer within the brain network. Flicker conditions should be considered when optimizing lighting, especially in environments demanding high-level cognitive performance.

Objectives: We analyzed theta-band phase synchrony (TBPS) under reduced and ordinary flicker lighting to determine the effect of light flickers on neurocognitive processes. Methods: Nineteen healthy participants (mean age, 30.4±4.5 years; male, 63.2%) performed the Sternberg working memory tasks with event-related potential recording under reduced and control flicker conditions, respectively. We measured the P300 amplitude during memory retrieval, and for TBPS analysis, we calculated the weighted phase lag index within the P300 time window. Furthermore, we used standardized low-resolution brain electromagnetic tomography (sLORETA) to determine differences in functional cortical source connectivity between the two flicker conditions. Results: The hit rate (F1,18=0.862, p=0.365), reaction time (F1,18=0.021, p=0.887), and P300 amplitude (F1,18=3.992, p=0.061) did not differ between the two flicker conditions. However, connectivity analysis at the scalp level showed that TBPS under reduced flicker lighting was significantly higher than that under control flicker lighting at higher memory loads (p=0.002). Cortical source imaging with sLORETA confirmed that reduced flicker lighting significantly increased TBPS between the left prefrontal cortex and right hippocampus compared with control flicker lighting (false discovery rate<0.1). Conclusions Reduced flicker lighting enhanced TBPS during the working memory task compared with control flicker lighting. Reduced flicker light may improve cognitive functioning by facilitating information transfer within the brain network. Flicker conditions should be considered when optimizing lighting, especially in environments demanding high-level cognitive performance.

PURPOSE: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. METHODS: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. RESULTS: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. CONCLUSIONS: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.
Amputation ; Fingers ; Free Tissue Flaps ; Hand ; Hand Injuries ; Hand Strength ; Humans ; Necrosis ; Thigh ; Thumb ; Tissue Donors

Central venous catheterization is common in the emergency department for monitoring of CVP (central venous pressure), fluid administration, and drug infusions. However, the insertion of a central venous catheter is a technically challenging procedure with known risks and complications. A 94-year-old woman was transferred to an emergency department due to difficulties in removing the guidewire during central catheter insertion through the right subclavian vein. A focused bedside ultrasound showed that the guidewire was improperly positioned in the right internal jugular vein. Upon computed tomographic evaluation, the guidewire perforated the right subclavian vein, looped in the mediastinum, reentered the right internal jugular vein toward the right jugular foramen, and was removed by surgery. In conclusion, as catheter and guidewire entrapment are well-known potential complications of central venous catheterization, when resistance is encountered at any stage of central venous catheterization (especially when removing the entrapped catheter or guidewire) the procedure should be stopped and evaluated with imaging assistance. Clinicians should be aware of more complicated sequelae caused by blunt removal of an entrapped catheter and guidewire, despite its low probability.
Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Emergencies ; Female ; Humans ; Jugular Veins ; Mediastinum ; Patient Harm ; Subclavian Vein ; Ultrasonography

OBJECTIVE: This study examined the epidemiological characteristics of bicycle injuries and the wearing of a helmet. METHODS: A cross-sectional observational study was conducted using the emergency department-based Injury In-depth Surveillance data from 2013 to 2016. The study population consisted of patients related to bicycles of all ages. The variables associated with helmet wearing were sex, age, type of location, activity at injury, alcohol use at injury, and time of injury. Multivariable logistic regression analysis was conducted to estimate the risks of nonuse of helmets. RESULTS: Among the 31,923 eligible patients, 3,304 patients (10.3%) were wearing helmets at the time of the injury. The adjusted logistic regression model showed that females (adjusted odds ratio [aOR], 0.675; 95% confidence interval [CI], 0.614–0.742), teenagers (aOR, 0.265; 95% CI, 0.232–0.302), old age (aOR, 0.378; 95% CI, 0.326–0.438), road except for bicycle lanes (aOR, 0.510; 95% CI, 0.467-0.557), leisure (aOR, 0.290; 95% CI, 0.252–0.334) or vital activity (aOR, 0.188; 95% CI, 0.162–0.218) at injury, alcohol use at injury (aOR, 0.329; 95% CI, 0.253–0.427), night time (aOR, 0.609; 95% CI, 0.560–0.663), and winter (aOR 0.734; 95% CI 0.619–0.872) were significantly associated with the nonuse of helmets. CONCLUSION: This study identified the factors associated with helmet use during bicycle riding. Strategies aimed at increasing the use of bicycle helmets targeting the risk population are needed.
Adolescent ; Bicycling ; Emergencies ; Female ; Head Protective Devices ; Humans ; Leisure Activities ; Logistic Models ; Morinda ; Observational Study ; Odds Ratio

OBJECTIVE: The aim of this study was to analyze the effects of total abdominal hysterectomy (TAH) versus supracervical hysterectomy (SCH) on sexual function in patients with non-malignant conditions. METHODS: We choose fifty patients who were operated by SCH and forty-six patients who were operated by TAH. They were interviewed that effects of the two operations on sexual desire, coital frequency, quality and frequency of orgasms, post-op development of dyspareunia and overall sexual satisfaction. RESULTS: 1. The sexual desire significantly decreased in TAH group compared with SCH group (46% vs 8%, P<0.001). And the coital frequency also decreased in TAH group (48% vs 6%, P<0.001). 2. Orgasm frequency and quality decreased in more patients with TAH compared with SCH (22% vs 2%, 33% vs 2%). 3. After SCH and TAH, there was no change in dyspareunia and significantly decreased sexual satisfaction was noted in TAH group (35% vs 4%). CONCLUSION: It suggest that TAH patients experienced worse postoperative sexual function than SCH patients. therefore, it should be considered to conserving the cervix at hysterectomy.
Cervix Uteri ; Coitus ; Dyspareunia ; Female ; Humans ; Hysterectomy* ; Orgasm

Morphea is a subclass of localized scleroderma, and this is a connective tissue disorder that is limited to the skin and subcutaneous tissue. We report here on a case of a 43-year-old woman who presented with a solitary skin colored plaque in the vertex area. The histopathologic findings showed basal hydrophic changes of the basal cells, multiple melanophages in the upper dermis and broadened, compact, eosinophilic collagen fibers in the entire dermis. We finally made the diagnosis of morphea in the vertex, and the vertex is an unusual site for this disease.
Adult ; Collagen ; Connective Tissue ; Dermis ; Eosinophils ; Female ; Humans ; Scleroderma, Localized ; Skin ; Subcutaneous Tissue

PURPOSE: Herpes zoster, or shingles is caused by reactivation of varicella zoster virus lying latent in the ganglion of the dorsal root. It is rare in hand and upper extremities. The aim of this study is to report the shingles occurred in the hand, upper extremity along the various dermatome. MATERIALS AND METHODS: Between October of 2006 and August of 2009, patients with herpes zoster infection in hand and upper extremity were reviewed. The mean age of the patients was 61.4 years, and there were four female patients, one male patient. With the appropriate diagnosis, antiviral agent such as acyclovir(Zovirax(R)), Zovirax(R) cream were applied within 72 hours of skin lesions. Analgesics and wet dressing were commonly applied for relief of acute pain. To prevent the secondary infection and postherpetic neuralgia, tricyclic antidepressants, anticonvulsants and opioids were also prescribed. RESULTS: Herpes zoster infection was occurred along the distribution of ulnar nerve in three cases, radial nerve in one case and medial antebrachial cutaneous nerve in one case. Four patients developed unilateral vesicular eruption with dermatomal rash in addition to severe pain. But, one patient did not show any significant signs on physical exam except dysesthesia along the ulnar nerve distribution in hand and forearm. All of the patients were relieved acute pain, skin rash within 1-2 weeks. There were no recurrence and complications during the one year follow-up period. CONCLUSIONS: It is important that hand surgeons should not misdiagnose the possibility of herpes zoster infection even without developed skin rash. Early diagnosis, appropriate treatment can lower the risk of its complications.
Acute Pain ; Acyclovir ; Analgesics ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents, Tricyclic ; Bandages ; Coinfection ; Deception ; Early Diagnosis ; Exanthema ; Female ; Follow-Up Studies ; Forearm ; Ganglion Cysts ; Hand ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Male ; Neuralgia, Postherpetic ; Paresthesia ; Radial Nerve ; Recurrence ; Skin ; Spinal Nerve Roots ; Ulnar Nerve ; Upper Extremity