Adult ; Aneurysm ; Arteries ; Carotid Artery, Internal ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography ; Parents ; Prospective Studies ; Recurrence ; Retinal Artery ; Retreatment ; Stents ; Stroke, Lacunar ; Thromboembolism

BACKGROUND/AIMS: To investigate the predictive factors for complete response (CR) and recurrence after CR in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). METHODS: Among 691 newly diagnosed HCC patients, 287 were treated with TACE as a first therapy. We analyzed the predictive factors for CR, recurrence after CR, and overall survival (OS). RESULTS: Eighty-one patients (28.2%) achieved CR after TACE, and recurrence after CR was detected in 35 patients (43.2%). In multivariate analyses, tumor size (≤5 cm) and single nodularity were predictive factors for CR, with hazard ratios (HRs) of 0.35 (p=0.002) and 0.41 (p<0.001), respectively. Elevated serum α-fetoprotein (AFP) (>20 ng/mL) level and multinodularity exhibited significant relationships with recurrence after CR, with HRs of 2.220 (p=0.026) and 3.887 (p<0.001), respectively. Tumor size (>5 cm), multinodularity, elevated serum AFP (>20 ng/mL) level, Child-Turcotte-Pugh score (B and C), and portal vein thrombosis were significant factors for OS. CONCLUSIONS: In patients treated with TACE as a first therapy, tumor size (≤5 cm) and single nodularity were predictive factors for CR, and multinodularity and elevated serum AFP (>20 ng/mL) levels were predictive factors for recurrence after CR. These factors were also significant for OS.
Carcinoma, Hepatocellular* ; Chemoembolization, Therapeutic ; Humans ; Multivariate Analysis ; Recurrence* ; Venous Thrombosis

BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. RESULTS: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). CONCLUSIONS: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
Ambulances ; Cerebral Infarction ; Humans ; Intracranial Hemorrhages ; Mortality ; Stroke* ; Thrombectomy ; Thrombolytic Therapy ; Tissue Plasminogen Activator

No abstract available.
Hematopoietic Stem Cell Mobilization ; Heterocyclic Compounds ; Korea ; Stem Cells

BACKGROUND/AIMS: During endoscopic retrograde cholangiopancreatography (ERCP), all efforts should be made to be aware of radiation hazards and to reduce radiation exposure. The aim of this study was to investigate the status of radiation protective equipment and the awareness of radiation exposure in health care providers performing ERCP in Korean hospitals. METHODS: A survey with a total of 42 questions was sent to each respondent via mail or e-mail between October 2010 and March 2011. The survey targeted nurses and radiation technicians who participated in ERCP in secondary or tertiary referral centers. RESULTS: A total of 78 providers from 38 hospitals responded to the surveys (response rate, 52%). The preparation and actual utilization rates of protective equipment were 55.3% and 61.9% for lead shields, 100% and 98.7% for lead aprons, 47.4% and 37.8% for lead glasses, 97.4% and 94.7% for thyroid shields, and 57.7% and 68.9% for radiation dosimeters, respectively. The common reason for not wearing protective equipment was that the equipment was bothersome, according to 45.7% of the respondents. CONCLUSIONS: More protective equipment, such as lead shields and lead glasses, should be provided to health care providers involved in ERCP. In particular, the actual utilization rate for lead glasses was very low.
Cholangiopancreatography, Endoscopic Retrograde ; Data Collection ; Delivery of Health Care ; Electronic Mail ; Eyeglasses ; Glass ; Health Personnel ; Humans ; Korea ; Postal Service ; Referral and Consultation ; Thyroid Gland

PURPOSE: To report a case of central retinal vein occlusion caused by iron deficiency anemia in a healthy young adult. CASE SUMMARY: A 23-year-old female was referred to the department of ophthalmology after 4 days of acute onset of decreased vision in her left eye. The best corrected visual acuity was 20/20 in the right eye and 10/20 in the left eye. There was no ocular pain, afferent pupillary defect or other ocular symptoms. Results of the anterior segment examination were normal. Fundus examination showed mild optic disc swelling, flame-shaped retinal hemorrhages around the optic disc, and vascular tortuosity with dilatation. The fluorescein angiography showed tortuous peripapillary veins, multiple blocked fluorescences due to retinal hemorrhages, and delayed arteriovenous transit time. All medical examinations and laboratory tests for the risk factors of central retinal vein occlusion were within normal limits, except for iron deficiency anemia. The patient was subsequently treated with oral iron. Three months after the first visit, the best corrected visual acuity was 20/20 in the patient's left eye with nearly normal fundus appearances and no iron deficiency anemia detected in laboratory tests. CONCLUSIONS: In cases of CRVO in young adults without other systemic diseases and risk factors, evaluation of the hematologic state may be necessary.
Anemia, Iron-Deficiency ; Dilatation ; Eye ; Female ; Fluorescein Angiography ; Humans ; Iron ; Ophthalmology ; Pupil Disorders ; Retinal Hemorrhage ; Retinal Vein ; Risk Factors ; Veins ; Vision, Ocular ; Visual Acuity ; Young Adult

PURPOSE: To obtain the average values of anterior segment structures of adult Koreans using Visante OCT in relation to age and sex, and to compare the central corneal thickness values with these measurements using an A-scan ultrasonic pachymeter. METHODS: Anterior segment images were obtained in 185 Korean (298 eyes) using Visante OCT. Four different parameters (central corneal thickness, anterior chamber depth, anterior chamber angle, and internal anterior chamber diameter) were measured at four meridians (vertical, horizontal, 45 degrees, and 135 degrees). Afterwards, the same examiner performed A-scan ultrasonic pachymetry to measure central corneal thickness. RESULTS: Central corneal thickness values measured using Visante OCT were significantly less than those obtained using an A-scan ultrasonic pachymeter (p=0.000). Central corneal thickness, anterior chamber angle, and internal anterior chamber diameters were all smaller in females than in males (p<0.05). Anterior chamber depth, anterior chamber angle, and internal anterior chamber diameter showed a significant decrease according to increasing age in both sexes (p<0.05). CONCLUSIONS: Average values and changes of anterior segment structures in relation to age and sex were established using Visante OCT in Korean adults. These results may be useful as standard values in anterior segment surgeries as well as in the diagnosis and follow-up of certain anterior segment diseases.
Adult ; Anterior Chamber ; Female ; Follow-Up Studies ; Humans ; Male ; Meridians ; Ultrasonics

PURPOSE: To report the results of managing dislocated posterior chamber intraocular lenses (PC IOLs) by externalizing both haptics alternately through a single clear corneal incision. METHODS: The study included 10 eyes of 10 patients in which a dislocated PC IOL was managed with pars plana vitrectomy. With our modified method, both haptics were alternately externalized through a single clear corneal incision for suture knot placement and then reinserted. RESULTS: The dislocated PC IOLs were repositioned successfully in all 10 eyes, and the corrected visual acuity improved postoperatively in 9 eyes at a minimum follow-up of six months. Abnormal IOL position, IOL capture by the iris, or posterior synechia was not observed. Hypotony maculopathy occurred in one eye, but the macular folding disappeared and the visual acuity improved after adding one-bite suture. CONCLUSIONS: The technique we describe in this study is a simple and effective procedure for repositioning posteriorly dislocated PC IOLs with minimal intraocular manipulations and complications.
Dislocations ; Eye ; Follow-Up Studies ; Humans ; Iris ; Lenses, Intraocular ; Sutures ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of inflammatory granuloma in the right medial canthal area which occurred seven years after a cosmetic collagen-containing dermal filler injection in the forehead. CASE SUMMARY: A-47-year-old female, who had been treated with collagen-containing filler 7 years earlier, presented with a mass in the right medial canthal area discovered 20 days previously. There was mild tenderness and the mass was firm and not fixed. The patient reported that the size of the mass was slowly increasing. Orbital computed tomography and magnetic resonance imaging showed an approximate 1 cm-sized, poorly defined, enhancing nodular thickening without evidence of bony erosion. The mass was removed through a skin incision and unidentified foreign bodies were found around the mass. On histopathologic examination, it was diagnosed as inflammatory granuloma caused by foreign substances. CONCLUSIONS: Collagen-containing fillers are widely used in cosmetic surgery for their lasting effect and few complications. However some complications such as inflammatory granuloma may occur at the injection site or other sites, even several years after operation.
Collagen ; Cosmetics ; Female ; Foreign Bodies ; Granuloma ; Humans ; Magnetic Resonance Imaging ; Orbit ; Skin ; Surgery, Plastic

Mycotic aneurysms of the hepatic artery are usually caused by mycotic infection in patients suffering with bacterial endocarditis. Mycotic aneurysms have become very rare recently due to early intensive antibiotic treatment for infective endocarditis. Despite of the non-specific symptoms, these aneurysms show a high possibility of sudden death if thye ruptured. Therefore, early detection and surgical repair of aneurysms are very important. We report here on a case of hepatic artery mycotic aneurysm that presented as sudden shock and rupture.
Aneurysm* ; Aneurysm, Infected ; Death, Sudden ; Endocarditis ; Endocarditis, Bacterial ; Hepatic Artery* ; Humans ; Korea* ; Rupture* ; Shock