Objective: To evaluate the outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) according to the size of the beads for the treatment of small hepatocellular carcinoma (HCC). Materials and Methods: This retrospective study included 212 patients with a single HCC ≤5 cm from five tertiary institutions. One hundred and nine patients were treated with 70–150-µm doxorubicin DEBs (group A), and 103 patients received 100–300-µm doxorubicin DEBs (group B). The initial tumor response (assessed between 3 weeks and 2 months after DEB-TACE), time to local tumor progression (TTLTP), restricted mean duration of complete response (RMDCR), rate of complications, incidence of post-embolization syndrome, and length of hospital stay were compared between the two groups.Logistic regression was used to analyze prognostic factors for initial tumor response. Results: The initial objective response rates were 91.7% (100/109) and 84.5% (87/103) for groups A and B, respectively (P = 0.101). In the subgroup analysis of tumors ≤3 cm, the initial objective response rates were 94.6% (53/56) and 78.0% (39/50) for groups A and B, respectively (P = 0.012). There was no significant difference in the TTLTP (median, 23.7 months for group A vs. 19.0 months for group B; P = 0.278 [log-rank], 0.190 [multivariable Cox regression]) or RMDCR at 24 months (11.4 months vs. 8.5 months, respectively; P = 0.088). In the subgroup analysis of tumors >3-cm, the RMDCR at 24 months was significantly longer in group A than in group B (11.8 months vs. 5.7 months, P = 0.024). The incidence of mild bile duct dilatation after DEB-TACE was significantly higher in group B than in group A (5.5% [6/109] vs. 18.4% [19/103], P = 0.003). Conclusion DEB-TACE using 70–150-µm microspheres demonstrated a higher initial objective response rate in ≤3-cm HCCs and a longer RMDCR at 24 months in 3.1–5-cm HCCs compared to larger DEBs (100–300-μm).

Objective: To assess the two-year treatment outcomes of chemoembolization with drug-eluting embolics (DEE) for nodular hepatocellular carcinoma (HCC). Materials and Methods: This study was a prospective, multicenter, registry-based, single-arm trial conducted at five university hospitals in Korea. Patients were recruited between May 2011 and April 2013, with a target population of 200. A DC Bead loaded with doxorubicin was used as the DEE agent. Patients were followed up for two years. Per-patient and perlesion tumor response analysis, per-patient overall survival (OS) and progression-free survival (PFS) analysis, and per-lesion tumor control analysis were performed. Results: The final study population included 152 patients, with 207 target lesions for the per-lesion analysis. At one-month, six-month, one-year, and two-year per-patient assessments, complete response (CR) rates were 40.1%, 43.0%, 33.3%, and 19.6%, respectively. The objective response (OR) rates were 91.4%, 55.4%, 35.1%, and 19.6%, respectively. The cumulative two-year OS rate was 79.7%. The cumulative two-year PFS rate was 22.4% and the median survival was 9.3 months. In multivariable analysis, the Child-Pugh score (p = 0.019) was an independent predictor of OS, and tumor multiplicity (p < 0.001), tumor size (p = 0.020), and Child-Pugh score (p = 0.006) were independent predictors of PFS. In per-lesion analysis, one-month, six-month, one-year and two-year CR rates were 57.5%, 58.5%, 45.2%, and 33.3%, respectively, and the OR rates were 84.1%, 65.2%, 46.6%, and 33.3%, respectively. The cumulative two-year per-lesion tumor control rate was 36.2%, and the median time was 14.1 months. The Child-Pugh score (p < 0.001) was the only independent predictor of tumor control. Serious adverse events were reported in 11 patients (7.2%). Conclusion DEE chemoembolization for nodular HCCs in the Korean population showed acceptable survival, tumor response, and safety profiles after a two-year follow-up. Good liver function (Child-Pugh score A5) was a key predictor of per-patient OS, PFS, and per-lesion tumor control.

Objective: To assess the two-year treatment outcomes of chemoembolization with drug-eluting embolics (DEE) for nodular hepatocellular carcinoma (HCC). Materials and Methods: This study was a prospective, multicenter, registry-based, single-arm trial conducted at five university hospitals in Korea. Patients were recruited between May 2011 and April 2013, with a target population of 200. A DC Bead loaded with doxorubicin was used as the DEE agent. Patients were followed up for two years. Per-patient and perlesion tumor response analysis, per-patient overall survival (OS) and progression-free survival (PFS) analysis, and per-lesion tumor control analysis were performed. Results: The final study population included 152 patients, with 207 target lesions for the per-lesion analysis. At one-month, six-month, one-year, and two-year per-patient assessments, complete response (CR) rates were 40.1%, 43.0%, 33.3%, and 19.6%, respectively. The objective response (OR) rates were 91.4%, 55.4%, 35.1%, and 19.6%, respectively. The cumulative two-year OS rate was 79.7%. The cumulative two-year PFS rate was 22.4% and the median survival was 9.3 months. In multivariable analysis, the Child-Pugh score (p = 0.019) was an independent predictor of OS, and tumor multiplicity (p < 0.001), tumor size (p = 0.020), and Child-Pugh score (p = 0.006) were independent predictors of PFS. In per-lesion analysis, one-month, six-month, one-year and two-year CR rates were 57.5%, 58.5%, 45.2%, and 33.3%, respectively, and the OR rates were 84.1%, 65.2%, 46.6%, and 33.3%, respectively. The cumulative two-year per-lesion tumor control rate was 36.2%, and the median time was 14.1 months. The Child-Pugh score (p < 0.001) was the only independent predictor of tumor control. Serious adverse events were reported in 11 patients (7.2%). Conclusion DEE chemoembolization for nodular HCCs in the Korean population showed acceptable survival, tumor response, and safety profiles after a two-year follow-up. Good liver function (Child-Pugh score A5) was a key predictor of per-patient OS, PFS, and per-lesion tumor control.

BACKGROUND/AIMS: Dyslipidemia and obesity are risk factors for the development of acute myocardial infarction (AMI) that affect the clinical outcomes in patients. METHODS: We analyzed 2,751 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) (mean age, 63.7 +/- 12.1 years). The patients were divided into four groups based on serum triglyceride levels and central obesity [Group Ia: triglycerides < 200 mg/dL and (-) central obesity; Group Ib: triglyceride < 200 mg/dL and (+) central obesity; Group IIa: triglyceride > or = 200 mg/dL and (-) central obesity; Group IIb: triglyceride > or = 200 mg/dL and (+) central obesity]. In-hospital outcome was defined as in-hospital mortality and complications. One-year clinical outcome was compared and defined as the composite of 1-year major adverse cardiac events (MACE), including death, recurrent MI, and target vessel revascularization. RESULTS: Total MACE developed in 502 patients (18.2%), while 303 patients (11.0%) died prior to the 1-year follow-up visit. In-hospital complications and in-hospital mortality were not different among the four groups. One-year clinical outcomes based on triglyceride levels (Group I vs. Group II) were not different. In addition, there were no differences in clinical outcomes in patients with a triglyceride level < 200 mg/dL, regardless of central obesity. One-year MACE rates were not significantly different among the four groups. CONCLUSIONS: There was no significant difference in the 1-year MACE rate based on the triglyceride level and presence of central obesity in patients with AMI who underwent PCI.
Dyslipidemias ; Follow-Up Studies ; Hospital Mortality ; Humans ; Mortality ; Myocardial Infarction* ; Obesity ; Obesity, Abdominal* ; Percutaneous Coronary Intervention* ; Risk Factors ; Triglycerides*

BACKGROUND/AIMS: Dyslipidemia and obesity are risk factors for the development of acute myocardial infarction (AMI) that affect the clinical outcomes in patients. METHODS: We analyzed 2,751 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) (mean age, 63.7 +/- 12.1 years). The patients were divided into four groups based on serum triglyceride levels and central obesity [Group Ia: triglycerides < 200 mg/dL and (-) central obesity; Group Ib: triglyceride < 200 mg/dL and (+) central obesity; Group IIa: triglyceride > or = 200 mg/dL and (-) central obesity; Group IIb: triglyceride > or = 200 mg/dL and (+) central obesity]. In-hospital outcome was defined as in-hospital mortality and complications. One-year clinical outcome was compared and defined as the composite of 1-year major adverse cardiac events (MACE), including death, recurrent MI, and target vessel revascularization. RESULTS: Total MACE developed in 502 patients (18.2%), while 303 patients (11.0%) died prior to the 1-year follow-up visit. In-hospital complications and in-hospital mortality were not different among the four groups. One-year clinical outcomes based on triglyceride levels (Group I vs. Group II) were not different. In addition, there were no differences in clinical outcomes in patients with a triglyceride level < 200 mg/dL, regardless of central obesity. One-year MACE rates were not significantly different among the four groups. CONCLUSIONS: There was no significant difference in the 1-year MACE rate based on the triglyceride level and presence of central obesity in patients with AMI who underwent PCI.
Dyslipidemias ; Follow-Up Studies ; Hospital Mortality ; Humans ; Mortality ; Myocardial Infarction* ; Obesity ; Obesity, Abdominal* ; Percutaneous Coronary Intervention* ; Risk Factors ; Triglycerides*

Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea in the year of 1985. However, it deserve to say that the invaluable data from fertility centers may serve as a useful source to find out which factors affect successful IVF outcome and to offer applicable information to infertile patients and fertility clinics. This article intended to report the status of ART in 2009 Korean Society of Obstetrics and Gynecology surveyed. The current survey was performed to assess the status and success rate of ART performed in Korea, between January 1 and December 31, 2009. Reporting forms had been sent out to IVF centers via e-mail, and collected by e-mail as well in 2012. With International Committee Monitoring Assisted Reproductive Technologies recommendation, intracytoplasmic sperm injection (ICSI) and non-ICSI cases have been categorized and also IVF-ET cases involving frozen embryo replacement have been surveyed separately. Seventy-four centers have reported the treatment cycles initiated in the year of 2009, and had performed a total of 27,947 cycles of ART treatments. Among a total of 27,947 treatment cycles, IVF and ICSI cases added up to 22,049 (78.9%), with 45.3% IVF without ICSI and 54.7% IVF with ICSI, respectively. Among the IVF and ICSI patients, patients confirmed to have achieved clinical pregnancy was 28.8% per cycle with oocyte retrieval, and 30.9% per cycle with embryo transfer. The most common number of embryos transferred in 2009 is three embryos (40.4%), followed by 2 embryos (28.4%) and a single embryo transferred (13.6%). Among IVF and ICSI cycles that resulted in multiple live births, twin pregnancy rate was 45.3% and triple pregnancy rate was 1.1%. A total of 191 cases of oocyte donation had been performed to result in 25.0% of live birth rate. Meanwhile, a total of 5,619 cases of frozen embryo replacement had been performed with 33.7% of clinical pregnancy rate per cycle with embryo transfer. When comparing with international registry data, clinical pregnancy rate per transfer from fresh IVF cycles including ICSI (34.1%,) was comparable to clinical pregnancy rate per transfer in European Society for Human Reproduction and Embryology report was 32.5% though lower than 45.0% for USA data. There was no remarkable difference in status of assisted reproductive technology in Korea between the current report and the data reported in 2008. The age of women trying to get pregnant was reconfirmed to be the most important factor that may have impact on success of ART treatment.
Electronic Mail ; Embryo Transfer ; Female ; Fertility ; Fertilization in Vitro ; Humans ; Korea* ; Live Birth ; Oocyte Donation ; Oocyte Retrieval ; Pregnancy ; Pregnancy Rate ; Pregnancy, Twin ; Reproduction ; Reproductive Techniques ; Reproductive Techniques, Assisted* ; Sperm Injections, Intracytoplasmic

BACKGROUND: Pelvic inflammatory disease (PID) is a common genital tract infection in reproductive women. This study aimed to determine the frequency of Neisseria gonorrheae, Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis in Pelvic inflammatory disease (PID), and to further sub-analyze the clinical characteristics in patients diagnosed with Fitz-Hugh-Curtis syndrome (FHCS). MATERIAL AND METHODS: Sixty-six patients diagnosed clinically as PID were recruited from April, 2007 to February, 2011. Retrospective chart review was performed for investigating the characteristics of the clinical manifestation, laboratory findings, and image findings. And then all subjects were classified into two groups, the PID-only group and the FHCS group, depending on whether or not computed tomography showed increased perihepatic enhancement. Samples obtained in endocervical swabs were tested using Roche COBAS Amplicor Polymerase-chain reaction (PCR) for N. gonorrheae, C. trachomatis, U. urealyticum, and M. hominis. RESULTS: The 66 PID patients ranged in age from 19 to 49 years. Thirty nine patients were diagnosed as having an inflammation localized only in the lower abdomen (PID only), and 27 patients were diagnosed as FHCS. According to results of PCR, U. urealyticum was found most commonly in both the PID-only group and the FHCS group (66.7% and 59.3%, respectively). CONCLUSIONS: Organisms other than C. trachomatis and N. gonorrheae, particularly U. urealyticum, may be detected more frequently in PID patients in Korea. In addition, identification of M. hominis may be of importance in female health problems such as FHCS.
Abdomen ; Chlamydia Infections ; Chlamydia trachomatis ; Female ; Gonorrhea ; Hepatitis ; Humans ; Inflammation ; Korea ; Mycoplasma hominis ; Neisseria ; Pelvic Inflammatory Disease ; Peritonitis ; Polymerase Chain Reaction ; Reproductive Tract Infections ; Retrospective Studies ; Ureaplasma urealyticum

PURPOSE: A restorative proctocolectomy has been accepted as the operation of choice for ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the postoperative complications and functional outcomes following a total proctocolectomy with a J ileal pouch-anal anastomosis. METHODS: The medical records of 12 patients who had undergone a total proctocolectomy, with a J ileal pouch-anal anastomosis, between January 1997 and June 2002, were retrospectively reviewed according to sex, age, underlying disease and postoperative complications. We evaluated the functional outcomes using medical record reviews and patients and telephone interviews. RESULTS: Total proctocolectomy, with a J ileal pouch-anal anastomosis, were done for ulcerative colitis (n=2) and familial adenomatous polyposis (n=10). A diverting ileostomy was performed in 8 patients. Postoperative complications occurred in 7 patients (58%), intestinal obstructions in 4 and complications related with anastomosis in 3, i.e. J ileal pouch leakage (n=2) and ileal pouch-vaginal fistula (n=1). Re-operations, due to postoperative complications, were performed in 4 patients, i.e. small bowel segmental resection (n=1), adhesiolysis (n=1), diverting ileostomy (n=1) and ileal pouch resection & reconstruction (n=1). The daily median defecation frequencies were 7.7 (range 4~20) a month after the operation, 5.4 (3~12) at 2~3 months, 4.5 (3~7) at 6 months and 4.1 (3~5) at 12 months, following the operation. Two patients had gas incontinence, 1 had fluid incontinence, 4 had night soiling and 3 needed pads, but these incontinences, the need for anti-diarrhea medication and the use of pads, all improved within 6 months of the operation. Fluid incontinence and the use of pads improved within 3 months of the operation, gas incontinence and night soiling improved within 6 months of the operation. The mean length of follow-up was 30.6 months. CONCLUSIONS: The postoperative complication rate was 58%. Thirty-three percent of patients had fecal incontinence, but all these improved within 6 months. The long- term functional outcomes, after a total proctocolectomy with J ileal pouch-anal anastomosis, were satisfactory, and the postoperative complications acceptable. The postoperative complication rates were no different between the protective diverting ileostomy and non-ileostomy .
Adenomatous Polyposis Coli ; Colitis, Ulcerative ; Defecation ; Fecal Incontinence ; Fistula ; Follow-Up Studies ; Humans ; Ileostomy ; Interviews as Topic ; Intestinal Obstruction ; Medical Records ; Postoperative Complications ; Proctocolectomy, Restorative ; Retrospective Studies ; Soil

Protothecosis is an unusual cutaneous soft tissue infection caused by the Prototheca, which is a genus of the unicelluar, achloric algae. We report a case of cutaneous protothecosis in a 66-year-old female, who showed erythematous, purulent patches and plaques with ulcerations on the right forearm for 2 months. Biopsy specimen revealed the characteristic thick-walled morulalike sporangia in the dermis. Prototheca wickerhamii was isolated in the culture and the biochemical study. Electron microscopic examination showed the thick-walled spores containing dark dense bodies and amyloplasts. After two months of oral itraconazole 200mg/day, skin lesions were improved.
Aged ; Biopsy ; Dermis ; Female ; Forearm ; Humans ; Itraconazole ; Plastids ; Prototheca ; Skin ; Soft Tissue Infections ; Sporangia ; Spores ; Ulcer

Idiopathic hypereosinophilic syndrome(HES) is a multisystem disease characterized by unexplained prolonged eosinophilia and evidence of specific organ damage, including skin. Cutaneous involvement occurs in more than 50 percent of patients but cutaneous nodule as the only manifestation of HES is rare. We report a case of hypereosinophilic syndrome in a 39-year-old male, who showed a solitary tender coin-sized erythematous nodule on his right lower abdomen for 2.5 months without evidence of systemic involvement.
Abdomen ; Adult ; Eosinophilia ; Humans ; Hypereosinophilic Syndrome* ; Male ; Skin