BACKGROUND/AIMS: A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) patients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful.METHODS: Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened.RESULTS: Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tumor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment response to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-refractoriness and liver function deterioration.CONCLUSIONS: The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.

BACKGROUND/AIMS: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. METHODS: Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. RESULTS: Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. CONCLUSIONS: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA.
Academic Medical Centers ; Carcinoma, Hepatocellular ; Catheter Ablation ; Follow-Up Studies ; Humans ; Liver Neoplasms ; Liver ; Recurrence ; Survival Rate ; Treatment Outcome

Several autoimmune and chronic inflammatory conditions have been consistently linked with an increased risk of hematologic malignancies. Although ankylosing spondylitis (AS) is a chronic inflammatory disease, previous studies have demonstrated that it is not associated with an increase in risk of malignant lymphomas. Cases of AS accompanied by hematologic malignancies such as multiple myeloma, chronic myelogenous leukemia, and Hodgkin's disease have been reported. In Korea, AS with non-Hodgkin's lymphoma or follicular lymphoma has not been reported. We experienced a 38-year-old male who had been diagnosed with follicular lymphoma with bone metastasis, who achieved complete remission after having been treated with chemotherapy, developed new inflammatory back pain. An MRI of his hip showed an active inflammation of the left sacroiliac joint and a positive HLA-B27. The patient was diagnosed with AS and was treated with naproxen, which improved the pain in his back and buttock.
Adult ; Back Pain ; Buttocks ; Hematologic Neoplasms ; Hip ; HLA-B27 Antigen ; Hodgkin Disease ; Humans ; Inflammation ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Lymphoma ; Lymphoma, Follicular ; Lymphoma, Non-Hodgkin ; Male ; Multiple Myeloma ; Naproxen ; Neoplasm Metastasis ; Sacroiliac Joint ; Spondylitis, Ankylosing

PURPOSE: Any battery impacted in the esophagus must be removed urgently because of the possibility of serious complications such as perforation, fistula, and mediastinitis. The use of endoscopic procedures was compared to find the most rapid, effective, and safe method to remove disk batteries. METHODS: The cases of 24 children (9 males, mean age, 1.5 years) that had accidentally ingested disk batteries were reviewed. The patients had visited the Department of Pediatrics, Kyungpook National University Hospital from July 1997 to June 2007 for the removal of disk batteries. Endoscopic removal was attempted using a retrieval net or a magnetic extractor with a balloon (condom). The procedure times for removing the ingested battery were compared. RESULTS: Children that ingested batteries with a larger diameter (20 mm) had a greater chance to have esophageal impaction with serious injury, such as esophageal mucosal necrosis or ulcers, as compared to the ingestion of smaller diameter batteries (10 mm) (p<0.01). Endoscopic removal of disk batteries was attempted either using a retrieval net in 10 children or by using a magnetic extractor with a balloon in 6 children. Endoscopic removal using a retrieval net was more effective (mean procedure time: 1.5 min) as compared to using a magnetic extractor with a balloon (mean procedure time: 3.3 min) (p<0.05). CONCLUSION: Both procedures, either using a retrieval net or a magnetic extractor with a balloon were effective in removing ingested disk batteries. Based on our experience, an endoscopic procedure using a retrieval net was a more effective method for foreign body removal.
Child* ; Eating ; Endoscopy ; Esophagus ; Fistula ; Foreign Bodies ; Gyeongsangbuk-do ; Humans ; Male ; Mediastinitis ; Necrosis ; Pediatrics ; Ulcer

PURPOSE: Any battery impacted in the esophagus must be removed urgently because of the possibility of serious complications such as perforation, fistula, and mediastinitis. The use of endoscopic procedures was compared to find the most rapid, effective, and safe method to remove disk batteries. METHODS: The cases of 24 children (9 males, mean age, 1.5 years) that had accidentally ingested disk batteries were reviewed. The patients had visited the Department of Pediatrics, Kyungpook National University Hospital from July 1997 to June 2007 for the removal of disk batteries. Endoscopic removal was attempted using a retrieval net or a magnetic extractor with a balloon (condom). The procedure times for removing the ingested battery were compared. RESULTS: Children that ingested batteries with a larger diameter (20 mm) had a greater chance to have esophageal impaction with serious injury, such as esophageal mucosal necrosis or ulcers, as compared to the ingestion of smaller diameter batteries (10 mm) (p<0.01). Endoscopic removal of disk batteries was attempted either using a retrieval net in 10 children or by using a magnetic extractor with a balloon in 6 children. Endoscopic removal using a retrieval net was more effective (mean procedure time: 1.5 min) as compared to using a magnetic extractor with a balloon (mean procedure time: 3.3 min) (p<0.05). CONCLUSION: Both procedures, either using a retrieval net or a magnetic extractor with a balloon were effective in removing ingested disk batteries. Based on our experience, an endoscopic procedure using a retrieval net was a more effective method for foreign body removal.
Child* ; Eating ; Endoscopy ; Esophagus ; Fistula ; Foreign Bodies ; Gyeongsangbuk-do ; Humans ; Male ; Mediastinitis ; Necrosis ; Pediatrics ; Ulcer

Many young women suffer from premenstrual syndrome (PMS). The purpose of this study was to examine the effect of isoflavone on serum sex hormone and PMS during the luteal phase of the menstrual cycle. We investigated the incidence of PMS in 116 Korean female college students. The incidence of PMS was 19.8%. Among them, 9 PMS and 13 control were given 90 mg isoflavone per day during 2 menstrual cycles. The changes in anthropometric measurements, dietary intakes, serum parameters including sex hormones, and PMS symptoms were observed. Isoflavone supplementation did not affect anthropometric measurements. However, SBP and DBP were significantly decreased in control. Dietary intakes were not changed after supplementation of isoflavones. Serum SHBG was lower in PMS group than in control and significantly decreased in control with isoflavone supplementation. PMS symptoms such as backache, sweet, salty, and fatty food craving, coffee/tea drinking, and anxiety were significantly lessened. Based on these results, isoflavone supplementation may benefit young women by reducing some of PMS. Further studies of soy isoflavones effect on sex hormone and PMS may help to prepare for PMS management.
Anxiety ; Back Pain ; Drinking ; Female* ; Gonadal Steroid Hormones ; Humans ; Incidence ; Isoflavones ; Luteal Phase ; Menstrual Cycle ; Premenstrual Syndrome*

OBJECT: To gather information concerning ontogeny, the authors present the results of immunohistochemical stainings of neuronal and glial markers and the reverse transcriptase-prolongation chain reaction (RT-PCR) of nestin for three intraventricular tumors located around the foramen of Monro. METHODS: Seven cases of central neurocytomas(CN), three subependymomas(SE) and eight subependymal giant cell astrocytomas(SEGA), were included in this study. Antihuman monoclonal antibodies of synaptophysin(SNP)(DAKO, 1:20), chromogranin A(ChrA)(DAKO, 1:100), neuron specific enolase (NSE)(DAKO, 1:500) and nerve cell adhesion molecule(NCAM)(Zymed, 1:500) were utilized for neuronal markers and glial fibrillary acidic protein(GFAP)(DAKO, 1:300) functioned as a glial marker in immunohistochemical(IHC) stainings. Reverse transcriptase polymerase chain reaction(RT-PCR) for nestin was performed in all cases. RESULTS: For chromogranin A, positive reaction was found in three of the seven CN cases but none of the SE and SEGA cases. For IHC staining of synaptophysin, positive reaction was revealed in all CN cases but in none of the SE and SEGA cases. For NCAM, positive reaction was demonstrated in five of the eight SEGA cases and in all SE and CN cases. For NSE, positive reaction was exhibited in seven of the eight SEGA cases and in all SE and CN cases. Positive reactions for NSE and NCAM in the SEGA cases were manifested mainly in the cytoplasms of giant cells and their background. For IHC staining of GFAP, positive reaction was demonstrated in one of the seven CN cases, in three of the eight SEGA cases, and in all SE cases. RT-PCR product of nestin was expressed in two of the seven CN cases, in two of the three SE cases, and in one SEGA case. CONCLUSION: Many cells of CN, SE and SEGA, had expressed positive reactions for both neuronal and glial markers in IHC study and nestin in RT-PCR. It is suggested that origin cells of these tumors might express both neuronal and glial differentiation.
Antibodies, Monoclonal ; Astrocytoma* ; Cerebral Ventricles* ; Chromogranin A ; Cytoplasm ; Giant Cells ; Glioma, Subependymal* ; Immunohistochemistry ; Nestin ; Neural Cell Adhesion Molecules ; Neurocytoma* ; Neurons ; Phosphopyruvate Hydratase ; RNA-Directed DNA Polymerase ; Synaptophysin

The purpose of the study was to find the sociopsychological factors predicting the intention of compliance with the dietary regimen in diabetes with a questionnaire. Data were collected from 282 adult noninsulin-dependent diabetics in Seoul, Kyoggida, and Kyongsangbukdo in Korea. Stepwise multiple regression analysis was conducted with predictor variables from theories of the Health Belief Model, Social Cognitive Model, The Theory of Reasoned Action, and Social Support. The behavioral intention of compliance with the prescribed diet was the independent variable. Subjects norm self-efficacy knowledge about diet therapy, outcome expectation, relationship with medical team, threat of deterioration of disease, and social support were the independent variables, The mean score of behavior intention was high ie 35.3 out to 42. Subjective norm and self-efficacy were the significant variables to predict the intention of dietary compliance. These variables comprised 39% of the common variance. To increase dietary compliance by influence of the referents and improve self-efficacy significant referents must be included and concrete and practical methods to follow the dietary regimen must be provided in nutrition education.
Adult ; Compliance* ; Diet ; Diet Therapy ; Education ; Humans ; Intention ; Korea ; Seoul ; Surveys and Questionnaires

The purpose of this study was to find the sociopsychological factors influencing the compliance of dietary regimen in diabetes by using focus group interviews. The data were collected from fifty three diabetes patients in eleven focus groups from September 1997 to March, 1998 in Seoul and Suwon Korea. The interviews were tape-recorded and the contents of the interviews were analysed by researchers. The subjects knew the causes, complications, and therapies of diabetes although they were incorrect at times . Patients had a wide range of outcome expectations from very optimistic to pessimistic. They recognized diabetes as a disease which needs life-time care, and they though that good care could provide a normal life. One the other hand they thought diabetes could lead to death through complications, and cause financial problems as well as social isolation. As for self-efficacy they recognized the importance of compliance to diet regimen but they thought the diet therapy was very difficult and were not very willing to follow it. They felt medical professionals, especially doctors, were influential for the therapies. However they frequently felt counselling provided by doctors was insufficient in time and content and led to attitude problems. They felt support from families and others was often insufficient and inadequate. Nutrition education fostering outcome expectation, social support, and self-efficacy is needed to increased compliance. The most influential referents were medical professional including doctors, nurses, dieticians, so their role in diet therapy should by emphasized.
Compliance* ; Diabetes Mellitus ; Diet ; Diet Therapy ; Education ; Focus Groups* ; Foster Home Care ; Gyeonggi-do ; Hand ; Humans ; Korea ; Nutritionists ; Seoul ; Social Isolation

BACKGROUND AND OBJECTIVES: No existing device for cardiopulmonary resuscitation(CPR)isdesignedto exploit both the "cardiac pump" and the "thoracic pump" simultaneously. This study was designed to assess the hemodynamic effects of simultaneous sterno-thoracic CPR (SST-CPR) vs. standard CPR (S-CPR) using a mechanical resuscitator in a canine model of cardiac arrest. DEVICE DESCRIPTION: We have built a device that depresses the sternum and circumferentially constricts the thorax simultaneously. This device has two components. The first component is a piston, which depresses the sternum. The second is a circumferential strap that constricts the thorax as the piston is pushed down on the sternum. MATERIALS AND METHODS: Twelve domestic dogs were enrolled in this study. After catheterizations to measure pressures from the aorta and the right atrium, ventricular fibrillation was induced by passing AC current to the right ventricle. After 4 minutes of cardiac arrest, S-CPR and SST-CPR were performed alternatively. Aortic pressure, right atrial pressure, cardiac output, and end tidal CO2 were measured while each method of CPR was performing. RESULTS: SST-CPR resulted in significantly higher mean arterial pressure than S-CPR (68.9+/-16.1 vs 30.5+/-10.0 mmHg, p<0.01). SST-CPR could generate higher coronary perfusion pressure than S-CPR (47.0+/-11.4 vs 17.3+/-8.9 mmHg, p<0.01). End tidal CO2 tension was also higher during SST-CPR than S-CPR (11.6+/-6.1 vs 2.17+/-3.3 mmHg, p<0.01). CONCLUSION: Simultaneous sternothoracic cardiopulmonary resuscitation is a new method of cardiopulmonary resuscitation, which can generate better hemodynamic effects than standard cardiopulmonary resuscitation.
Animals ; Aorta ; Arterial Pressure ; Atrial Pressure ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters ; Dogs ; Heart Arrest* ; Heart Atria ; Heart Ventricles ; Hemodynamics* ; Perfusion ; Sternum ; Thorax ; Ventricular Fibrillation