No abstract available.
Drug Therapy* ; Methotrexate* ; Uterine Cervical Neoplasms*

Liver cancer is more complex to treat compared to cancers in other organs, since liver function should be considered. In addition, only a few patients can be applied curative treatment due to advanced stage at diagnosis. Therefore, early stage detection is important and has been increased through screening and surveillance programs using image modalities recently. However, it is still difficult to diagnose small or hypovascular hepatocellular carcinoma (HCC) even using advanced image modalties. In particular, hypovascular HCCs do not show arterial contrast enhancement which is a typical finding of HCC on computed tomography (CT) and magnetic resonance imaging (MRI). Those also account for a considerable portion of early HCC. We present 54 yearsold man who had recurrent hypervascular and hypovascular nodules on three phase CT and gadoxetic acid-enhanced MRI. The nodules were removed by surgical resection and confirmed as combined hepatocellular-cholangiocarcinoma and well differentiated HCC respectively.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma* ; Diagnosis ; Early Diagnosis ; Humans ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Mass Screening

PURPOSE: With in vitro fertilization (IVF) becoming a common treatment for infertility, there has been an increasing number of studies on perinatal complications related to IVF. This study compares the clinical characteristics of twins at gestational age less than 34 weeks, between IVF and spontaneous conceived. METHODS: We retrospectively reviewed the medical records of 138 preterm twins at gestational age less than 34 weeks, admitted between January 2009 and December 2011 to the neonatal intensive care units of two hospitals. Maternal and preterm infant's clinical characteristics of 58 IVF and 80 spontaneous conceived twins were compared. RESULTS: Maternal age was older in IVF twins (33.3+/-2.8 vs. 31.3+/-4.2, P-value=0.007), and there was no other significant difference between the two maternal groups. Gestational age was lesser in IVF twins (30.6+/-3.2 vs. 31.2+/-2.7, P-value=0.048). Age at the day of full enteral feeding (24.2+/-12.1 vs. 18.2+/-13.2, P-value<0.001) and age at day of full oral feeding (30.1+/-18.5 vs. 25.3+/-19.2, P-value<0.001) were significantly longer in IVF twins as adjusted by gestational age. Retinopathy of prematurity (ROP) showed higher incidence in IVF twins (P-value=0.011), but there was no significant difference between the two groups after adjusting gestational age. CONCLUSION: The clinical characteristics in IVF twins at gestational age less than 34 weeks were not significantly different from those of spontaneously conceived twins except age at the day of full enteral feeding and age at the day of full oral feeding after adjusting by gestational age.
Enteral Nutrition ; Fertilization in Vitro ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infertility ; Intensive Care Units, Neonatal ; Maternal Age ; Medical Records ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors ; Seizures ; Twins

Objective: Despite a high prevalence of dementia in older adults hospitalized with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), or so called COVID-19, research investigating association between preexisting diagnoses of dementia and prognosis of COVID-19 is scarce. We aimed to investigate treatment outcome of patients with dementia after COVID-19. Methods: We explored a nationwide cohort with a total of 2,800 subjects older than 50 years who were diagnosed with COVID-19 between January and April 2020. Among them, 223 patients had underlying dementia (dementia group). We matched 1:1 for each dementia- non-dementia group pair yielding 223 patients without dementia (no dementia group) using propensity score matching. Results: Mortality rate after COVID-19 was higher in dementia group than in no dementia group (33.6% vs. 20.2%, p=0.002). Dementia group had higher proportion of patients requiring invasive ventilatory support than no dementia group (34.1% vs. 22.0%, p=0.006). Multivariable analysis showed that dementia group had a higher risk of mortality than no dementia group (odds ratio=3.05, p<0.001). We also found that patients in dementia group had a higher risk of needing invasive ventilatory support than those in no dementia group. Conclusion Our results suggest that system including strengthen quarantines are required for patients with dementia during the COVID- 19 pandemic.

Objective: Despite a high prevalence of dementia in older adults hospitalized with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), or so called COVID-19, research investigating association between preexisting diagnoses of dementia and prognosis of COVID-19 is scarce. We aimed to investigate treatment outcome of patients with dementia after COVID-19. Methods: We explored a nationwide cohort with a total of 2,800 subjects older than 50 years who were diagnosed with COVID-19 between January and April 2020. Among them, 223 patients had underlying dementia (dementia group). We matched 1:1 for each dementia- non-dementia group pair yielding 223 patients without dementia (no dementia group) using propensity score matching. Results: Mortality rate after COVID-19 was higher in dementia group than in no dementia group (33.6% vs. 20.2%, p=0.002). Dementia group had higher proportion of patients requiring invasive ventilatory support than no dementia group (34.1% vs. 22.0%, p=0.006). Multivariable analysis showed that dementia group had a higher risk of mortality than no dementia group (odds ratio=3.05, p<0.001). We also found that patients in dementia group had a higher risk of needing invasive ventilatory support than those in no dementia group. Conclusion Our results suggest that system including strengthen quarantines are required for patients with dementia during the COVID- 19 pandemic.

OBJECTIVES: The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan. METHODS: We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center. RESULTS: The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient). CONCLUSIONS: Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.
Abscess ; Bacillus ; Candida albicans ; Catheters ; Cellulitis ; Chest Pain ; Drainage ; Female ; Hip ; Humans ; Klebsiella ; Male ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Pulmonary Embolism ; Retrospective Studies ; Sensation ; Sepsis ; Tertiary Healthcare ; Thorax

BACKGROUNDS/AIMS: Standard liver volume (SLV) is an important parameter that has been used as a reference value to estimate the graft matching in living donor liver transplantation (LDLT). This study aimed to determine a reliable SLV formula for Korean adult patients as compared with the 15 SLV formulae from other studies and further estimate SLV formula by gender and body mass index (BMI). METHODS: Computed tomography liver volumetry was performed in 1,000 living donors for LDLT and regression formulae for SLV was calculated. Individual donor data were applied to the 15 previously published SLV formulae, as compared with the SLV formula derived in this study. Analysis for confounding variables of BMI and gender was also performed. RESULTS: Two formulae, "SLV (ml)=908.204xBSA-464.728" with DuBois body surface area (BSA) formula and "SLV (ml)=893.485xBSA-439.169" with Monsteller BSA formula, were derived by using the profiles of the 1,000 living donors included in the study. Comparison with other 15 other formulae, all except for Chouker formula showed the mean volume percentage errors of 4.8-5.4%. The gender showed no significant effect on total liver volume (TLV), but there was a significant increase in TLV as BMI increased. CONCLUSIONS: Our study suggested that most SLV formulae showed a crudely applicable range of SLV estimation for Korean adults. Considering the volume error in estimating SLV, further SLV studies with larger population from multiple centers should be performed to enhance its predictability. Our results suggested that classifying SLV formulae by BMI and gender is unnecessary.
Adult* ; Body Mass Index ; Body Surface Area ; Confounding Factors (Epidemiology)* ; Humans ; Liver Transplantation ; Liver* ; Living Donors ; Reference Values ; Tissue Donors ; Transplants

Liver cancer is the 2nd most common cause of cancer related death in Korea. Especially, patients who present extrahepatic spread of hepatocellular carcinoma (HCC) have a shorter life expectancy (50% survival at 1 year and less than 4 months of median overall survival). Molecular target agent like sorafenib was usually mentioned as a treatment for them, but that was still not firmly established. We present a 75 year-old who had expanding nodular type of HCC. The mass was removed by resection and radiofrequency ablation. However, lung metastasis were revealed shortly after surgery. That lesions were treated with lenvatinib and systemic chemotherapy.
Carcinoma, Hepatocellular* ; Catheter Ablation ; Drug Therapy ; Humans ; Korea ; Life Expectancy ; Liver Neoplasms ; Lung* ; Molecular Targeted Therapy ; Neoplasm Metastasis*

PURPOSE: Distinguishing malaria from severe infection among febrile patients in emergency room is difficult, so we tried to analyze the clinical manifestations of malaria and the results of using devices as a quick way to detect malaria among febrile patients visiting an emergency medical center (EMC). METHODS: We retrospectively reviewed the clinical records of patients visiting a local EMC from January 2001 to December 2004 and confirmed as having vivax malaria by using a peripheral blood smear and Malaria antibody test (Immunochromatographic assay). RESULTS: All of the 108 included patients were infected with Plasmodium vivax and suffered from high fever, but tertian fever was seen in only 41 patients (37.9%). Various symptoms included headache, myalgia, abdominal pain, and so on. Laboratory findings noted thrombocytopenia, anemia, elevated alanin aminotransferase, and coagulopathies. Malaria antibody test was used in all cases for early diagnosis in the EMC. Compared with the peripheral blood smear, malaria antibody test identified 103 cases as positive, and five cases as negative. The diagnostic sensitivity of the malaria antibody test is 95.3%. CONCLUSION: Since south Korea is a malaria endemic area, for patients visiting an emergency room with a high fever, accompanied by thrombocytopenia and anemia, malaria must be included in the differential diagnosis whether the fever is tertian or not. The Malaria antibody test can be done by even an unskilful person, so it is a very helpful screening test and an early detection tool for malaria.
Abdominal Pain ; Anemia ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Fever ; Headache ; Humans ; Korea ; Malaria* ; Malaria, Vivax ; Mass Screening ; Myalgia ; Plasmodium vivax ; Retrospective Studies ; Thrombocytopenia

BACKGROUND: Donors with acitretin medication history are deferred for three years in Korea, because acitretin has teratogenic effect. Authors tried to evaluate the cost-effectiveness of the donor screening measures for acitretin medication. METHODS: From January 2006 to May 2007, the numbers of screened donors and accepted donors were 10,098,868 and 7,867,019, respectively. Although there was no single case of reported congenital malformation due to transfusion of blood donated by donors on acitretin medication, we assumed one case had occurred to contect the cost-effectiveness analysis. Also, the quality of life (QOL) of fetus with congenital malformation was assumed to be 0. The expected life-span of average Korean people was 78.6 years. RESULTS: The cost-effectiveness of electronic inquiry of computer database and blood test for acitretin were calculated to be 173,453,840 won/QALY and 8,780,333,865/QALY, respectively. They equaled $188,537/QALY and $9,543,841/QALY, respectively. CONCLUSION: The cost-effectiveness of electronic inquiry of computer database and blood test for acitretin were 3.8 and 190 times of $50,000/QALY, which is usually accepted to be reasonable in medical field. Electronic inquiry of computer database could be reasonable measure, if we deal with the problem protecting donor privacy, while blood test for acitretin could not be enforced because of unacceptably expensive cost.
Acitretin ; Blood Donors ; Donor Selection ; Electronics ; Electrons ; Fetus ; Hematologic Tests ; Humans ; Korea ; Privacy ; Quality of Life ; Tissue Donors