PURPOSE: The benefit of electroencephalography after sleep deprivation (SDEEG) in the diagnosis of epilepsy is controversial, and it is difficult to apply SDEEG to all pediatric patients in the clinical setting. This study is to figure out the usefulness of SDEEG for the detection of epileptiform discharges (EDs). METHODS: Medical records were reviewed retrospectively. Routine electroencephalography (REEG) was performed in 150 patients, and SDEEG was taken in 69 patients among the study population(n=219). The detection rates of EDs were compared between two groups, and also compared according to the presence of sleep in each group. RESULTS: The detection rate of EDs was higher in SDEEG group than in REEG group [n=69 (59.4%) vs n=150 (43.3%), P=0.03). Whereas there was no significant differences of the detection rate of EDs between REEG with and without sleep recording groups (43.8% vs 38.5%, P=0.777), there was significantly higher detection rate of EDs in SDEEG with sleep than SDEEG without sleep recording groups [n=63 (61.9%) vs n=6 (33.3%), P=0.022]. The detection rate of EDs was not significantly different between each group with and without sleep recording in overall EEGs (49.5% vs 36.8%, P=0.342). However, in overall EEGs with sleep recording, the detection rate of EDs was statistically significantly higher in SDEEG group than REEG group [n=63 (61.9%) vs n=137 (43.8%), P=0.022]. CONCLUSION: SDEEG revealed higher detection rate of EDs than REEG. It is not because of the effect of sleep recording, but of sleep deprivation itself. SDEEG is useful tool to apply for the diagnosis of epilepsy in daily clinical practice in children.
Child* ; Diagnosis* ; Electroencephalography* ; Epilepsy* ; Humans ; Medical Records ; Retrospective Studies ; Sleep Deprivation*

Survival rates of preterm infants have improved in the past few decades, and central venous catheters play an important role in the intensive medical treatment of these neonates. Unfortunately, these indwelling catheters increase the risk of intracardiac thrombosis, and they provide a nidus for microorganisms during the course of septicemia. Herein, we report a case of persistent bacteremia due to methicillin-resistant Staphylococcus aureus in an extremely low birth weight (ELBW) infant, along with vegetation observed on an echocardiogram, the findings which are compatible with a diagnosis of endocarditis. The endocarditis was successfully treated with antibiotic therapy, and the patient recovered without major complications. We suggest a surveillance echocardiogram for ELBW infants within a few days of birth, with regular follow-up studies when clinical signs of sepsis are observed.
Bacteremia ; Catheterization, Central Venous ; Catheters, Indwelling ; Central Venous Catheters ; Diagnosis ; Endocarditis* ; Follow-Up Studies ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Parturition ; Sepsis ; Survival Rate ; Thrombosis

BACKGROUND/AIMS: Sorafenib is the standard treatment for patients with advanced hepatocellular carcinoma (HCC). We aimed to investigate the prognosis predictors and the role of second-line cytotoxic systemic chemotherapy (CSC) in patients with advanced HCC after sorafenib discontinuation in the pre-regorafenib era. METHODS: From 2007 to 2015 in the pre-regorafenib era, the medical records of 166 HCC patients, who had permanently discontinued sorafenib, were retrospectively reviewed. For further analysis of survival factors after sorafenib treatment failure, we compared the survival of patients who had maintained liver function after second-line treatment with the best supportive care (BSC) group and selective BSC (SBSC) group. RESULTS: After discontinuation of sorafenib, median overall survival (OS) was 2.8 (1.9–3.7) months. The OS in patients who discontinued sorafenib due to adverse effect, progression, and poor clinical condition were 5.5 (2.4–8.6), 5.5 (2.2–8.9), and 0.9 (0.5–1.3) months, respectively (P<0.001). The independent predictive factors of survival after sorafenib failure were serum level of bilirubin and albumin, α-fetoprotein, discontinuation cause, and second-line CSC. In comparison with survival between second-line CSC and BSC group, the CSC group showed better survival outcome compared to the BSC group (10.6 vs. 1.6 months, P<0.001) and SBSC group (10.6 vs. 4.2 months, P=0.023). CONCLUSIONS: The survival after sorafenib failure in patients who discontinued sorafenib due to progression and adverse effects was significantly better than in those who discontinued treatment due to clinical deterioration. In the pre-regorafenib era, patients who received second-line CSC showed better survival than those who received only supportive care after sorafenib failure.
Bilirubin ; Carcinoma, Hepatocellular ; Drug Therapy ; Humans ; Liver ; Medical Records ; Prognosis ; Retrospective Studies ; Treatment Failure

Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.
Aged ; Alzheimer Disease ; Anemia, Iron-Deficiency ; Biopsy ; Bronchi ; Bronchoscopy ; Constriction, Pathologic ; Diagnosis ; Foreign Bodies ; Hemoptysis ; Humans ; Inflammation* ; Iron ; Korea ; Necrosis ; Nervous System Diseases ; Parkinsonian Disorders ; Reflex ; Respiratory Aspiration ; Stroke ; Tablets

BACKGROUND: Lung cancer is the leading cause of cancer deaths in Korea and the number of lung cancer deaths is increasing. The higher response rates, decreased toxicity and improved performance status of the first-line treatments have resulted in an increased number of patients becoming candidates for second-line therapy. Several new anti??neoplastic agents, including gemcitabine, docetaxel and paclitaxel, have recently demonstrated second-line activity. This phase II study evaluated the efficacy and toxicity of gemcitabine and vinorelbine as combination chemotherapy for Korean patients with NSCLC as a second-line treatment. METHODS: Sixty response-evaluable patients were enrolled from December 2000 to July 2003. We conducted a phase II study of a combination gemcitabine and vinorelbine chemotherapy for patients with histologically confirmed NSCLC that was stage IIIB and IV disease at the time of diagnosis, and the disease had progressed onward or the patients had relapsed after first-line platinum-based chemotherapy. They were treated with intravenous gemcitabine 1000mg/m2 and intravenous vinorelbine 25mg/m2 on days 1 and 8. This chemotherapy regimen was repeated every 3 weeks. RESULTS: A total of 215 cycles of treatment were given and the mean number of cycles was 3.6 cycles. All the patients were evaluable for the toxicity profile. The response rate was 10% according to the WHO criteria.?The median progression free survival was 3.8 months and the median survival time was 10.1 months. The 1-year survival rate was 32.9%. Grade III and IV neutropenia were seen in 20 (33.3%) and 7 (11.7%) patients, respectively. CONCLUSION: The combination of gemcitabine and vinorelbine is active and well tolerated as a second-line therapy for patients with advanced nonsmall cell lung carcinoma.
Carcinoma, Non-Small-Cell Lung ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Korea ; Lung Neoplasms ; Lung* ; Neutropenia ; Paclitaxel ; Survival Rate

Background/Aims: To prevent the perinatal transmission of hepatitis B virus (HBV) from mother to child, administration of an antiviral agent during pregnancy has been attempted in women who are either hepatitis B e antigen positive or have a high viral load. In this systematic review and meta-analysis with randomized controlled trials, we analyzed the efficacy and safety of tenofovir disoproxil fumarate (TDF) in preventing the perinatal transmission of HBV in pregnant women who have high HBV DNA titers. Methods: Multiple comprehensive databases (PubMed, EMBASE, and Cochrane databases) were searched for studies evaluating the efficacy of TDF for the prevention of perinatal transmission of HBV. Results: Two studies (one open label study and one double blind study) were included and analyzed. Intention-to-treat analysis (527 pregnancies) showed that the preventive effect of TDF was not significant (odds ratio [OR], 0.53; 95% confidence interval[CI], 0.13 to 2.17; p = 0.38, I2 = 81%). However, the per-protocol analysis showed that TDF significantly reduced perinatal transmission (OR, 0.10; 95% CI, 0.01 to 0.77; p = 0.03, I2 = 0%). There was no significant difference between the TDF group and the control group with respect to maternal and fetal safety outcomes. Conclusions In pregnant women who have high HBV DNA titers, TDF can reduce the perinatal transmission from mother to child without significant adverse events.

Objective: To assess the safety and effectiveness of high-density light-emitting diode (LED) irradiation therapy in patients with hand osteoarthritis (OA) and compare the pre- and post-intervention symptoms. Methods: Twenty-three patients with hand OA underwent eight sessions of high-density LED irradiation therapy directed at the five most painful areas in the finger joints. Each session lasted for 18 minutes; and the sessions were conducted twice a week, for 4 weeks. We evaluated the degree of pain using the visual analogue scale, ring size, and passive range of motion (flexion+extension) for two most painful joints from the baseline to post-therapy (weeks 4 and 6). Results: High-density LED irradiation therapy significantly reduced the pain posttreatment compared with that observed at the baseline (p<0.001). Although improvements were observed in ring size and joint range of motion at 4 and 6 weeks, they were not statistically significant (p>0.05). No adverse events were observed. Conclusion We examined the safety and effectiveness of high-density LED irradiation therapy in reducing pain and hand swelling and improving joint mobility in patients with hand OA. These results suggest that high-density LED irradiation therapy has the potential to be an important strategy for managing hand OA.