Mycophenolate mofetil (MMF) is usually prescribed with a reduced fixed dose in Asian kidney transplant recipients (KTRs). However, the clinical efficacy and safety of the fixed dose have not yet been investigated via therapeutic drug monitoring. We evaluated whether reduced fixed-dose MMF is an optimal dosing strategy to achieve the therapeutic target of mycophenolic acid (MPA) exposure in Korean KTRs. Methods: This open-label, prospective study enrolled 50 de novo KTRs prescribed with tacrolimus, corticosteroid, and fixed-dose MMF (1.0–1.5 g/day). The trough level (C0) and area under the curve (AUC0–12 hr) of MPA were measured at 1 and 24 weeks after kidney transplantation (KT). The relationship of body weight (BW)-adjusted MMF dose with MPA C0 and MPA AUC0–12 hr was assessed using linear regression analysis. Results: The initial fixed dose of MMF of 1.44 ± 0.16 g/day was adjusted in 24 patients (48.0%) and then reduced to a mean dose of 1.19 ± 0.31 g/day at 24 weeks after KT. Most patients (≥84.0%) attained the minimum required MPA C0 of 1.0 μg/mL and MPA AUC0–12 hr of 30 μg × hr/mL at 1 and 24 weeks. The BW-adjusted MMF dose demonstrated significant positive correlations with MPA C0 and MPA AUC0– 12 hr at 1 and 24 weeks after KT. Moreover, 14 patients (28.0%) reported MPA-related adverse events that were predictable based on MPA AUC0–12 hr (cutoff level, 46.4 μg × hr/mL). Conclusion: The current reduced fixed-dose MMF strategy can help achieve the therapeutic target of MPA exposure in tacrolimus- treated Korean KTRs during the early posttransplant period.

BACKGROUND: As the number of big-cohort studies increases, validation becomes increasingly more important. We aimed to validate administrative database categorized as colorectal cancer (CRC) by the International Classification of Disease (ICD) 10th code. METHODS: Big-cohort was collected from Clinical Data Warehouse using ICD 10th codes from May 1, 2003 to November 30, 2016 at Seoul National University Bundang Hospital. The patients in the study group had been diagnosed with cancer and were recorded in the ICD 10th code of CRC by the National Health Insurance Service. Subjects with codes of inflammatory bowel disease or tuberculosis colitis were selected for the control group. For the accuracy of registered CRC codes (C18–21), the chart, imaging results, and pathologic findings were examined by two reviewers. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CRC were calculated. RESULTS: A total of 6,780 subjects with CRC and 1,899 control subjects were enrolled. Of these patients, 22 subjects did not have evidence of CRC by colonoscopy, computed tomography, magnetic resonance imaging, or positron emission tomography. The sensitivity and specificity of hospitalization data for identifying CRC were 100.00% and 98.86%, respectively. PPV and NPV were 99.68% and 100.00%, respectively. CONCLUSIONS: The big-cohort database using the ICD 10th code for CRC appears to be accurate.
Classification ; Colitis ; Colonoscopy ; Colorectal Neoplasms ; Hospitalization ; Humans ; Inflammatory Bowel Diseases ; Magnetic Resonance Imaging ; National Health Programs ; Positron-Emission Tomography ; Retrospective Studies ; Sensitivity and Specificity ; Seoul ; Tuberculosis

BACKGROUND: The radial forearm flap is a versatile, widely used flap. However, the possibility of donor site complications has led to concern over its use. Some surgeons prefer using other flaps whose donor sites can be closed primarily with less morbidity, including avoiding unpleasant scarring. However, in our experience, donor site stability of the radial forearm flap can be reliably achieved by using well-implemented specific procedures. Here, we present a collection of donor site cases of the radial forearm flap and investigate factors that affect the aesthetic results as the basis for a reference for selecting a radial forearm flap. METHODS: In this retrospective study, we reviewed 171 cases in which a radial forearm flap was used for free tissue transfer after resecting head and neck cancer. We focused on donor site morbidity rates. Each operation involved a detailed procedure designed to minimize donor site morbidity. Moreover, statistical investigations were conducted for 22 cases to determine factors affecting the scar appearance. RESULTS: Only one case developed total skin graft necrosis as a major complication. Scar-related aesthetic results were acceptable, and the body-mass index, body weight, diabetes, and cardiac problems were significant factors related to the appearance of scars. CONCLUSIONS: Performing the radial forearm flap using a well-implemented detailed technique helps achieve acceptable donor site morbidity results. The aesthetic results were more promising for patients without excess body weight, diabetes, or cardiac problems. Therefore, anxiety about donor site morbidity should not be a reason to avoid selecting the radial forearm flap in suitable patients.
Anxiety ; Body Weight ; Cicatrix ; Esthetics ; Forearm* ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Humans ; Necrosis ; Retrospective Studies ; Skin ; Skin Transplantation ; Tissue Donors* ; Transplants

PURPOSE: In recent, years, an increase of syphilis infections has become an issue in Korea as well as globally. Herein, we report a recent clinical manifestation of syphilitic uveitis in a Korean population. METHODS: Over a 5-year period (2007-2012), we collected and analyzed the medical records of 16 patients with syphilitic uveitis in three tertiary eye clinics in Pusan. Sixteen patients were confirmed to have syphilis based on serological tests. Retrospective chart review was performed to determine the best corrected visual acuity, anterior and posterior segments, and treatment regimen, as well as ancillary test results including fluorescein angiogram (FAG). RESULTS: Of the 16 patients, 12 were males and four were females. The mean age of the patients was 51.16 years. Non-granulomatous anterior uveitis was observed in nine eyes (47.4%). Vitritis was the most frequently observed posterior segment finding (16 eyes, 84.2%). Retinal vasculitis and chorioretinitis were found in 11 (57.9%) and five eyes (26.3%), respectively. All patients had negative results in the serum HIV antibody test. Of the 16 patients, 15 were treated with penicillin or ceftriaxone due to neurosyphilis. Mean visual acuity improved from 1.33 +/- 1.1 to 0.58 +/- 0.68 after treatment. CONCLUSIONS: Clinical manifestation of syphilitic uveitis in Korean patients is different from occurrences in Western countries. Ophthalmological findings of syphilitic uveitis are diverse; thus, serological testing for syphilis is recommended for all uveitis patients. Further research regarding long-term treatment, relapse of syphilitic uveitis, and complications is necessary.
Busan ; Ceftriaxone ; Chorioretinitis ; Female ; Fluorescein ; HIV ; Humans ; Korea ; Male ; Medical Records ; Neurosyphilis ; Penicillins ; Recurrence ; Retinal Vasculitis ; Retrospective Studies ; Serologic Tests ; Syphilis ; Uveitis* ; Uveitis, Anterior ; Visual Acuity

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD. METHODS: Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(-), anti-HCV(-), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups. RESULTS: Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70+/-11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56+/-7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs. 27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m2 vs. 24.1 kg/m2, p=0.042) than those in the HBV-HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007). CONCLUSIONS: Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.
Age Factors ; Aged ; Body Mass Index ; Carcinoma, Hepatocellular/*diagnosis/etiology/pathology ; Diabetes Complications ; Diabetes Mellitus/pathology ; Female ; Hepatitis B/complications ; Humans ; Hypertension/complications ; Lipids/blood ; Liver Neoplasms/*diagnosis/etiology/pathology ; Male ; Metabolic Syndrome X/complications ; Middle Aged ; Neoplasm Staging ; Non-alcoholic Fatty Liver Disease/*diagnosis/pathology ; Risk Factors ; Severity of Illness Index ; Sex Factors

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. CASE SUMMARY: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. CONCLUSIONS: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.
Anterior Chamber ; Eye ; Female ; Follow-Up Studies ; Headache ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Inflammation ; Ophthalmic Solutions ; Prednisolone ; Pregnancy ; Pregnant Women ; Retinal Detachment ; Tinnitus ; Triamcinolone* ; Uveomeningoencephalitic Syndrome* ; Vision, Ocular ; Visual Acuity ; Young Adult

OBJECTIVE: To investigate the effects of different pilot-drilling methods on the biomechanical stability of self-tapping mini-implant systems at the time of placement in and removal from artificial bone blocks. METHODS: Two types of artificial bone blocks (2-mm and 4-mm, 102-pounds per cubic foot [102-PCF] polyurethane foam layered over 100-mm, 40-PCF polyurethane foam) were custom-fabricated. Eight mini-implants were placed using the conventional motor-driven pilot-drilling method and another 8 mini-implants were placed using a novel manual pilot-drilling method (using a manual drill) within each of the 2-mm and 4-mm layered blocks. The maximum torque values at insertion and removal of the mini-implants were measured, and the total energy was calculated. The data were statistically analyzed using linear regression analysis. RESULTS: The maximum insertion torque was similar regardless of block thickness or pilot-drilling method. Regardless of the pilot-drilling method, the maximum removal torque for the 4-mm block was statistically higher than that for the 2-mm block. For a given block, the total energy at both insertion and removal of the mini-implant for the manual pilot-drilling method were statistically higher than those for the motor-driven pilot-drilling method. Further, the total energies at removal for the 2-mm block was higher than that for the 4-mm block, but the energies at insertion were not influenced by the type of bone blocks. CONCLUSIONS: During the insertion and removal of mini-implants in artificial bone blocks, the effect of the manual pilot-drilling method on energy usage was similar to that of the conventional, motor-driven pilot-drilling method.
Foot ; Linear Models ; Polyurethanes ; Torque

BACKGROUND/AIMS: Most patients with acute viral hepatitis A have a favorable course, but a few of them suffer from severe forms of hepatitis such as fulminant hepatitis. This study was carried out to identify the factors influencing the severity of acute viral hepatitis A. METHODS: We retrospectively reviewed the medical records of 713 patients with acute hepatitis A, who were divided into two groups: severe hepatitis A (N=87) and non-severe hepatitis A (N=626). Severe hepatitis was defined as fulminant hepatitis or prolongation of prothrombin time (INR> or =1.5). Clinical variables were compared between the two groups. RESULTS: The incidence of fulminant hepatitis was 1.4 % (10/713) in patients with acute hepatitis A. Thirty-three (4.6 %) cases exhibited HBsAg positivity. In multivariate analyses, significant alcohol intake and the presence of HBsAg were significant predictive factors of fulminant hepatitis A, and significant alcohol intake and age were significant predictive factors of severe hepatitis A. HBeAg and HBV-DNA status did not affect the clinical course of hepatitis A in chronic hepatitis B carriers. CONCLUSIONS: While most patients with acute hepatitis A have an uncomplicated clinical course, our data suggest that a more-severe clinical course is correlated with being older, significant alcohol intake, and chronic hepatitis-B-virus infection. (
Acute Disease ; Adult ; Age Factors ; Alcohol Drinking ; Female ; Hepatitis A/complications/*diagnosis ; Hepatitis B Surface Antigens/blood ; Hepatitis B, Chronic/complications ; Humans ; Liver Failure, Acute/epidemiology/etiology ; Male ; Middle Aged ; Predictive Value of Tests ; Prothrombin Time ; Retrospective Studies ; Severity of Illness Index

Despite remarkable progress in understanding and treating gastrointestinal stromal tumors (GISTs) during the past two decades, the pathological characteristics of GISTs have not been made clear yet. Furthermore, concrete diagnostic criteria of malignant GISTs are still uncertain. We collected pathology reports of 1,227 GISTs from 38 hospitals in Korea between 2003 and 2004 and evaluated the efficacy of the NIH and AFIP classification schemes as well as the prognostic factors among pathologic findings. The incidence of GISTs in Korea is about 1.6 to 2.2 patients per 100,000. Extra-gastrointestinal GISTs (10.1%) are more common in Korea than in Western countries. In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival. However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis. The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

BACKGROUND/AIMS: Alcohol may be a cocarcinogen in patients with chronic viral hepatitis. We investigated the effect of alcohol on the development of hepatocellular carcinoma (HCC) in liver cirrhosis (LC) caused by hepatitis B virus (HBV). METHODS: All patients with LC or HCC associated with HBV or alcohol, admitted between March 2001 and June 2005, were included. Patients were divided into three groups according to the etiology of LC: Alcohol (AL), HBV, or HBV+alcohol (HBV+AL). Age and laboratory data at the enrollment of study were analyzed. The logistic regression coefficiency for the prevalence of HCC was calculated by using variables such as age, gender, serologic markers, and etiology of LC. RESULTS: In LC patients (n=342), the proportions of AL, HBV, and HBV+AL groups were 44%, 39%, and 17%, respectively. The proportions of HCC in AL, HBV and HBV+AL groups were 17%, 55%, and 76%, respectively. Age at the diagnosis of HCC was younger in HBV+AL than in AL group (p=0.036). In logistic regression analysis for the risk factor of HCC, odds ratio of age was 1.056 (p<0.001). Odds ratios of HBV and HBV+AL group comparing AL were 8.449 (p<0.001) and 17.609 (p<0.001), respectively. Therefore, old age and chronic alcohol intake in patients with HBsAg were the risk factors of HCC. CONCLUSIONS: Chronic alcohol intake may be an additive factor for the development of HCC in patient with LC caused by HBV. However, a prospective cohort study is needed to confirm these findings.
Adult ; Aged ; Carcinoma, Hepatocellular/*epidemiology/etiology ; Cross-Sectional Studies ; Female ; Hepatitis B, Chronic/*complications/epidemiology ; Hepatitis, Alcoholic/complications/epidemiology ; Humans ; Liver Cirrhosis/*complications/virology ; Liver Cirrhosis, Alcoholic/*complications/epidemiology/virology ; Liver Neoplasms/*epidemiology/etiology ; Male ; Middle Aged ; Odds Ratio ; Regression Analysis ; Retrospective Studies ; Risk Factors