PURPOSE: The aim of this study was to compare synchronous and metachronous hepatic metastases in patients with gastric cancer to determine clinicopathologic features and differences in prognosis as a function of the timing of the metastasis and the treatment modality rendered. MATERIALS AND METHODS: Sixty-seven patients who were diagnosed with gastric cancer metastatic to the liver and treated at the Hanyang University Hospital between June 1992 and December 2006 were retrospectively analyzed to study the pertinent clinicopathologic features and effect of treatment methods. RESULTS: There was a significant difference with respect to lymphatic (P=0.041) and vascular invasion (P=0.036) in comparing the clinicopathologic features between the patients with synchronous and metachronous hepatic metastases. The 1-year survival rate and median survival time of patients with gastric cancer and liver metastases were 38.9% and 9.2 months in the entire patient cohort, 30.9% and 9.2 months in the synchronous group, and 44.5% and 9.7 months in the metachronus group, respectively (P=0.436). The group of patients undergoing local treatment (such as surgery and radiologic intervention) followed by systemic chemotherapy, the group of patients receiving systemic chemotherapy only, and the untreated group of patients were compared, and there was no difference between the synchronous and metachronous groups. The synchronous and metachronous groups had high survival rates with local treatment. CONCLUSION: In patients with gastric cancer and liver metastases, there was no difference in prognosis based on the timing of the hepatic metastases. Independent of the timing of hepatic metastasis, aggressive treatment, such as surgery and radiologic intervention, may help improve the prognosis.
Cohort Studies ; Humans ; Liver ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

Objective: Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disease. Both tralokinumab and dupilumab have been recommended in the European Guideline for the treatment of adult patients with severe AD. In Korea, dupilumab has been approved for patients with moderate to severe AD, and reimbursed for those with severe AD. Since there is no clinical trial directly comparing tralokinumab and dupilumab, we conducted indirect comparison to assess the clinical usefulness in patients with AD. Methods: We selected clinical trials for indirect comparison through a systematic literature review. Individual patient data were available for the tralokinumab clinical trial, and aggregated data were available for the dupilumab clinical trial. Therefore, we employed the Matching-Adjusted Indirect Comparison (MAIC) method. The treatment efficacy was assessed based on whether patients achieved a 75% reduction on the Eczema Area and Severity Index (EASI 75) after drug administration. Results: The difference in the proportion of patients achieving EASI 75 between tralokinumab and dupilumab was 4.7% (95% CI: −7.9 to 17.3). Considering the non-inferiority margin for the EASI 75 achievement rate is −10%, tralokinumab is deemed non-inferior to dupilumab as the lower bound of the CI for the difference in the EASI 75 achievement rate between tralokinumab and dupilumab was within −10%. Conclusion We conducted a MAIC analysis comparing tralokinumab and dupilumab based on EASI 75 achievement. The findings of this study show that tralokinumab is non-inferior to dupilumab and can be implemented in Korean clinical settings with a therapeutic position comparable to dupilumab.

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma and its surrounding tissues that results in the accumulation of gas in the renal parenchyma, collecting system or perinephric tissue. EPN is a potentially life-threatening condition, which is most commonly associated with poorly controlled diabetes. We describe a case of emphysematous pyelonephritis associated with emphysematous ureteritis and cystitis in a 68-year-old diabetic woman, who was cured with medical treatment and surgical intervention.
Aged ; Cystitis ; Female ; Humans ; Pyelonephritis ; Ureter

Acute generalized exanthematous pustulosis is a rare, drug-induced disease that is occasionally accompanied by acute renal failure. It is characterized by the abrupt onset of widespread pustules on an erythematous base and rapid spontaneous healing. We report a case involving a 47-year-old male who presented with exanthematous pustules after taking medication. Azotemia was found in the resulting blood test. We were able to achieve the final diagnosis by skin biopsy. After instructing the patient not to take the previous medication, oral steroids were prescribed. He recovered within 2 weeks with just desquamations remaining.
Acute Generalized Exanthematous Pustulosis ; Acute Kidney Injury ; Azotemia ; Biopsy ; Hematologic Tests ; Humans ; Male ; Middle Aged ; Skin ; Steroids

Internal iliac artery aneurysm (IIAA) is a type of abdominal aneurysm that is a rare cause of lower urinary tract symptoms because of its anatomic location. If diagnosed after rupture, it can be lethal and surgery is mandatory. A 57-year-old male presented with acute urinary retention and syncope. An intra-abdominal mass initially thought to be an aneurysm was apparent by ultrasound. A computed tomography scan of the abdomen confirmed an internal iliac artery aneurysm accompanied by rupture. The patient was discharged without any complications within 20 days after receiving a vascular graft and resection of the aneurysm.
Abdomen ; Aneurysm ; Humans ; Iliac Aneurysm ; Iliac Artery ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Rupture ; Syncope ; Transplants ; Urinary Retention

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.
Accidental Falls ; Aneurysm, False/etiology/*radiography/ultrasonography ; Cardiac-Gated Imaging Techniques/methods ; Echocardiography/methods ; Female ; Follow-Up Studies ; Heart Aneurysm/etiology/*radiography/ultrasonography ; Heart Ventricles/injuries/radiography/ultrasonography ; Humans ; Middle Aged ; Multidetector Computed Tomography/*methods ; Remission, Spontaneous ; Thoracic Injuries/*complications ; Wounds, Nonpenetrating/*complications

Objective: Troponin I is a cardiac biomarker to diagnose acute myocardial infarction and is known to be elevated in sepsis patients as well. Recent studies have shown a correlation between troponin I results the prognosis of sepsis patients. We attempted to correlate the serial measurements of high-sensitivity troponin I (Hs-TnI) results with the prognosis of sepsis patients visiting the emergency room (ER). Methods: We conducted a retrospective study of patients who visited the ER from December 2019 to May 2021 with a diagnosis of infectious disease and a quick Sequential Organ Failure Assessment (qSOFA) score of over two. Those who had been administered the 3-hour interval Hs-TnI test were selected and the difference between two Hs-TnI (delta Hs-TnI) results were correlated with the prognosis of the patient. Results: A total of 76 patients were included in the study, including 56 28-day survivors and 20 28-day non-survivors. The delta Hs-TnI was higher in the non-survivor group and associated with a poorer prognosis (P=0.004). Multivariate logistic regression was used, and log(delta Hs-TnI) showed an odds ratio (OR) of 2.227 (95% confidence interval [CI], 1.171-5.818), (P=0.023) while the Sequential Organ Failure Assessment (SOFA) score showed an OR of 1.478 (95% CI, 1.229-1.777) (P<0.001). The area under the curve (AUC) was calculated using the receiver operating characteristic curve and the AUC for the SOFA score was 0.893 and that from the log(delta Hs-TnI) was 0.724. Conclusion An increase in delta Hs-TnI is correlated with the poorer prognosis of sepsis patients. Hence, it would be useful to check the serial Hs-TnI to predict the 28-day outcome of sepsis patients visiting the ER.