Subgaleal hematoma (SGH) is a rare condition in adults, typically resulting from trauma. It has primarily been treated with traditional methods, such as aspiration and needle puncture. However, Conventional treatments, such as simple compression dressings and needle aspiration, have been found inadequate in addressing refractory SGH. To overcome these challenges, we performed endovascular treatment (EVT), involving selective coil embolization of the vessels feeding the hematoma, followed by percutaneous hematoma aspiration and compression dressing. In this case report, a 37-year-old female patient with head trauma developed a recurrent subgaleal hematoma despite conservative treatments. Endovascular treatment was performed, resulting in significant improvement and no recurrence. This case suggests that EVT provides a viable and effective treatment alternative for adult patients with refractory SGH, offering a less invasive approach compared to surgical incision and drainage, with promising long-term outcomes.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Background: s: Alcohol-related liver disease (ALD) is currently a major indication for liver transplantation (LT) in South Korea. Alcoholic recidivism is a primary concern after LT for ALD. However, it is unclear how patients who have received LT for ALD are managed regarding medical and psychological issues. Furthermore, management approaches vary across centers. This study aims to investigate how these management approaches differ among centers. Methods: We conducted a survey of 19 liver transplant centers in South Korea to gather detailed information on the management protocols and related issues of ALD in LT patients. Results: All 19 centers that responded to the survey had been performing LT for patients with ALD for more than 5 years. Nine out of the 19 centers (47%) stated that a minimum abstinence period of 1–6 months from alcohol was required before evaluating LT and enrolling on the transplant waiting list. Only 2 (10%) and 5 (26%) centers had protocols for assessing alcohol consumption while awaiting LT or for treating alcohol consumption after transplantation, respectively. Monitoring abstinence from drinking before and after LT mostly relied on direct interviews, and alcohol biomarkers were not used. Conclusion Our findings emphasize the importance of consistent patient management guidelines for ALD-LTs in South Korea.

Objective: : To analyze the outcomes of coil embolization (CE) for unruptured intracranial aneurysm (UIA) according to region and hospital size based on National Health Insurance Service data in South Korea. Methods: : The incidence of complications, including intracranial hemorrhage (ICRH) and cerebral infarction (CI), occurring within 3 months and the 1-year mortality rates in UIA patients who underwent CE in 2018 were analyzed. Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs) or semigeneral hospitals (sGHs) according to their size, and the administrative districts of South Korea were divided into 15 regions. Results: : In 2018, 8425 (TRGHs, 4438; GHs, 3617; sGHs, 370) CEs were performed for UIAs. Complications occurred in 5.69% of patients seen at TRGHs, 13.48% at GHs, and 20.45% at sGHs. The complication rate in TRGHs was significantly lower than that in GHs (p=0.039) or sGHs (p=0.005), and that in GHs was significantly lower than that in sGHs (p=0.030). The mortality rates in TRGHs, GHs, and sGHs were 0.81%, 2.16%, and 3.92%, respectively, with no significant difference. Despite no significant difference in the mortality rates, the complication rate significantly increased as the number of CE procedures per hospital decreased (p=0.001; rho=-0.635). Among the hospitals where more than 30 CEs were performed for UIAs, the incidence of CIs (p=0.096, rho=-0.205) and the mortality rates (3 months, p=0.048, rho=-0.243; 1 year, p=0.009, rho=-0.315) significantly decreased as the number of CEs that were performed increased and no significant difference in the incidence of post-CE ICRH was observed. Conclusion : The complication rate in patients who underwent CE for UIA increased as the hospital size and physicians’ experience in conducting CEs decreased. We recommend nationwide quality control policies CEs for UIAs.

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.
Acne Vulgaris ; Adenocarcinoma* ; Appetite ; Clinical Study ; Diarrhea ; Drug Resistance ; Erlotinib Hydrochloride ; Exanthema ; Humans ; Lung* ; Nausea ; Pneumonia* ; Protein-Tyrosine Kinases ; Pruritus ; Receptor, Epidermal Growth Factor ; Receptors, Vascular Endothelial Growth Factor ; Stomatitis ; Treatment Outcome

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.
Acne Vulgaris ; Adenocarcinoma* ; Appetite ; Clinical Study ; Diarrhea ; Drug Resistance ; Erlotinib Hydrochloride ; Exanthema ; Humans ; Lung* ; Nausea ; Pneumonia* ; Protein-Tyrosine Kinases ; Pruritus ; Receptor, Epidermal Growth Factor ; Receptors, Vascular Endothelial Growth Factor ; Stomatitis ; Treatment Outcome

PURPOSE: The purpose of this study is to analyze the treatment strategies of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. This is a retrospective study. METHODS: We experienced 13 perforations associated with ERCP. We reviewed the medical recordsand classified ERCP-related perforations according to mechanism of injury in terms of perforating device. Injury by endoscopic tip or insertion tube was classified as type I, injury by cannulation catheter or sphincterotomy knife as type II, and injury by guidewire as type III. RESULTS: Of four type I injuries, one case was managed by conservative management after primary closure with a hemoclip during ERCP. The other three patients underwent surgical treatments such as primary closure orpancreatico-duodenectomy. Of five type II injuries, two patients underwent conservative management and the other three cases were managed by surgical treatment such as duodenojejunostomy, duodenal diverticulization and pancreatico-duodenectomy. Of four type III injuries, three patients were managed conservatively and the remaining patient was managed by T-tube choledochostomy. CONCLUSION: Type I injuries require immediate surgical management after EPCP or immediate endoscopic closure during ERCP whenever possible. Type II injuries require surgical or conservative treatment according to intra- and retro-peritoneal dirty fluid collection findings following radiologic evaluation. Type III injuries almost always improve after conservative treatment with endoscopic nasobilliary drainage.
Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Humans ; Retrospective Studies

OBJECTIVE: To determine the clinical utility of flexor carpi radialis (FCR) H-reflex with and without facilitation in the diagnosis of 7th cervical radiculopathy. METHOD: Thirty-four subjects (27 men, 7 women) participated in this study showed symptoms and signs suggesitive of cervical radiculopathy and every subject had single herniated cervical disc on MRI study. All participants underwent electrophysiologic study including routine nerve conduction study (NCS), electromyography (EMG), FCR H-reflexes with and without facilitation in both arms. Abnormal parameters for FCR H-reflex were 1) side to side latency difference more than 1.0 msec, 2) absence of FCR H-reflex in one side, 3) side to side amplitude ratio below 33% for without facilitation and 22% for facilitation. If the subjects had at least one of the three abnormal parameters, we concluded as having abnormal FCR H-reflex. RESULTS: In the FCR H-reflex without facilitation group, we were not able to elicit FCR H-reflex in both arms in 17 subjects. Among the 17 subjects with elicited FCR H-reflex, 7 had abnormal FCR H-reflex (C7 root; 4, other roots; 3). In the FCR H-reflex with facilitation group, FCR H-reflex was obtained in 32 subjects, 13 out of the 32 showed abnormal FCR H-reflex (C7 root; 6, other roots; 7). The sensitivity and specificity of FCR H-reflex without facilitation in the diagnosis of 7th cervical radiculopathy were 67%, 73%, with facilitation it were 50%, 65%. CONCLUSION: Even though FCR H-reflex without facilitation is superior in its sensitivity and specificity, low elicitabiliy is the factor that limits its clinical utility. FCR H-reflex with facilitation with its good elicitability, seems to be a useful adjunctive method to routine NCS and EMG examination in the diagnosis of 7th cervical radiculopathy.
Arm ; Diagnosis ; Electromyography ; H-Reflex* ; Humans ; Magnetic Resonance Imaging ; Male ; Neural Conduction ; Radiculopathy* ; Sensitivity and Specificity

OBJECTIVE: To verify the efficacy of 6cm segmental nerve conduction study in ulnar neuropathy at the elbow (UNE). METHOD: Ulnar nerve conduction studies were performed unilaterally in twenty five asymptomatic healthy adult volunteers and twenty five symptomatic patients with UNE. Twenty five symptomatic patients with UNE were diagnosed by standard ulnar nerve conduction studies, and needle EMG study. In the same healthy controls and patients groups, 6 cm and 10 cm segmental study were then performed at the elbow. The sensitivity and specificity of 6 cm segmental study were compared with those of 10 cm segmental study in these patients. RESULTS: The sensitivity and specificity came out to be 76% and 92% for the 6 cm segmental study and, 52% and 96% for the 10 cm segmental study. CONCLUSION: The sensitivity of 6 cm segmental NCS was much higher compared with 10 cm segmental NCS, whereas the specificity was similar in both tests. For screening of the UNE, 6 cm segmental NCS seems to be a more efficacious test.
Adult ; Elbow* ; Electromyography ; Humans ; Mass Screening ; Needles ; Neural Conduction ; Sensitivity and Specificity ; Ulnar Nerve ; Ulnar Neuropathies* ; United Nations ; Volunteers

OBJECTIVE: To determine the normal values of flexor carpi radialis (FCR) H-reflex without facilitation, with facilitation and with facilitation & averaging. And to compare the three methods. METHOD: The FCR H-reflex was tested in 60 healthy people. 1) H-reflexes was recorded in the FCR muscle without facilitation. 2) H-reflexes was recorded in the FCR muscle with facilitation and facilitation was carried out by contracting the FCR muscle with 1 kg of weight. 3) FCR H-reflex was tested by repetitive stimulation with facilitation and the multiple responses were averaged. RESULTS: Without facilitation, FCR H-reflexes were elicited only in 24 people out of 60 people and with facilitation, FCR H-reflexes were elicited in all 60 people. The mean latencies and amplitudes of the three methods were measured and normal limits of latency difference and amplitude ratio were calculated. In the FCR H-reflex without facilitation, with facilitation and with facilitation & averaging, the normal limits of latency difference were 1.0 msec, 1.0 msec, 1.1 msec and normal limits of amplitude ration were 0.37, 0.22, 0.57. CONCLUSION: FCR H-reflex with facilitation and with facilitation & averaging might be useful in the clinical diagnosis.
Diagnosis ; H-Reflex* ; Reference Values