Purpose: With the revision of the Organ and Transplantation Act in 2018, the hand has become legal as an area of transplantable organs in Korea. In January 2021, the first hand allotransplantation since legalization was successfully performed, and we have performed a total of three successful hand transplantation since then. By comparing and incorporating our experiences, this study aimed to provide a comprehensive reconstructive solution for hand amputation in Korea. Materials and Methods: Recipients were selected through a structured preoperative evaluation, and hand transplantations were performed at the distal forearm level. Postoperatively, patients were treated with three-drug immunosuppressive regimen, and functional outcomes were monitored. Results: The hand transplantations were performed without intraoperative complications. All patients had partial skin necrosis and underwent additional surgical procedures in 2 months after transplantation. After additional operations, no further severe complications were observed. Also, patients developed acute rejection within 3 months of surgery, but all resolved within 2 weeks after steroid pulse therapy. Motor and sensory function improved dramatically, and patients were very satisfied with the appearance and function of their transplanted hands. Conclusion Hand transplantation is a viable reconstructive option, and patients have shown positive functional and psychological outcomes. Although this study has limitations, such as the small number of patients and short follow-up period, we should focus on continued recovery of hand function, and be careful not to develop side effects from immunosuppressive drugs. Through the present study, we will continue to strive for a bright future regarding hand transplantation in Korea.

Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

BACKGROUND/OBJECTIVES: Despite multiple approaches of treatments for salivary duct carcinoma, there has been a need for more successful treatment methods because of its poor prognosis. Treatment options like immunotherapy using new technologies have been attempted. Based on recent study results indicating that targeting programmed death receptors are effective in treating various cancers, this study aimed to identify the frequency of PD-L1 expression and its impact on survival rate in salivary duct carcinoma.MATERIALS #SPCHAR_X0026; METHODS: We studied 33 patients with salivary gland cancer who were available for histologic specimens. We examined the expression of PD-L1 in the tissues and analyzed the association with the survival rate and the association with various clinical parameters.RESULTS: According to this study and review of similar studies, we discovered that the expression of PD-L1 in salivary duct carcinoma was lower than other types of cancers. The impact of PD-L1 on survival rate also showed inconsistency in salivary duct carcinoma.CONCLUSION: Immunotherapy by PD-1/PD-L1 checkpoint blockade in salivary duct carcinoma needs further evaluation for clinical application.
Humans ; Immunotherapy ; Prognosis ; Receptors, Death Domain ; Salivary Ducts ; Salivary Gland Neoplasms ; Survival Rate

No abstract available.
Adenocarcinoma in Situ ; Adenocarcinoma ; Neoplasm Metastasis ; Phenotype

Malignant gastrointestinal neuroectodermal tumor (GNET) is a very rare disease entity, especially in the esophagus. The diagnosis of GNET is based on histologic, immunohistochemical, and genetic findings. The choice of treatment is complete resection, and further treatment options can be considered. Herein, we describe a case of successful surgical treatment of a 23-year-old man with recurrent malignant esophageal GNET.
Diagnosis ; Esophagus ; Humans ; Neural Plate* ; Neuroectodermal Tumors* ; Rare Diseases ; Young Adult

Pheochromocytoma (PCC) is a neuroendocrine tumor that mainly arises from the medulla of the adrenal gland. Some PCCs become malignant and metastasize to other organs. For example, it typically involves skeletal system, liver, lung, and regional lymph nodes. However, only a few cases of PCC with brain metastasis have been reported worldwide. We report a case of metastatic brain tumor from PCC in South Korea in 2016. A 52-year-old man presented with headache, dizziness and motor aphasia. He had a medical history of PCC with multi-organ metastasis, previously underwent several operations, and was treated with chemotherapy and radiotherapy. Brain MRIs showed a brain tumor on the left parietal lobe. Postoperative pathology confirmed that the metastatic brain tumor derived from malignant PCC. This is the first report PCC with brain metastasis in South Korea.
Adrenal Glands ; Aphasia, Broca ; Brain Neoplasms ; Brain* ; Dizziness ; Drug Therapy ; Headache ; Humans ; Korea ; Liver ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Neuroendocrine Tumors ; Parietal Lobe ; Pathology ; Pheochromocytoma* ; Radiotherapy

Esophageal squamous cell carcinoma (ESCC) presenting as subepithelial tumor-like growth is a very rare form of the disease. We report a case of primary ESCC with intramural growth, covered with normal esophageal epithelium. The patient was initially referred due to a subepithelial tumor at the mid-esophagus, butendoscopic ultrasonography revealed a heterogeneously hypoechoic mass, which disrupted the structure of the muscularis propria. An endoscopic submucosal dissection was performed for accurate diagnosis, and the lesion was diagnosed histopathologically as moderately differentiated squamous cell carcinoma. Computed tomography revealed an enlarged left upper paratracheal lymph node, which showed increased uptake on positron emission tomography. The patient underwent subtotal esophagectomy with total mediastinal lymphadenectomy and adjuvant chemotherapy. Primary ESCC with intramural growth is extremely rare. For accurate diagnosis, when there is a high index of suspicion, additional investigations such as endoscopic ultrasonography or diagnostic endoscopic submucosal dissection might be needed.
Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Diagnosis ; Endoscopy ; Endosonography ; Epithelial Cells* ; Epithelium ; Esophagectomy ; Esophagus ; Humans ; Lymph Node Excision ; Lymph Nodes ; Positron-Emission Tomography ; Ultrasonography

Acute renal failure in Immunoglobulin A nephropathy (IgAN), a rare event, is associated with acute tubular necrosis mainly induced by intratubular erythrocytic cast and crescentic glomerulonephropathy (rapidly progressive glomerulonephritis) and the severity paralleled to the degree of glomerular damage. The changes are regarded as those of secondary atrophic response to the glomerular lesions. In that case, renal progression correlates more closely with the severity of tubulointerstitial lesions than with the degree of glomerular lesions in IgAN. Rarely, acute tubulointerstitial nephritis (TIN) could develop independently in primary glomerulonephritis. In this case, the severity of tubulointerstitial lesion was out of proportion with damage of glomerular lesion. To the best of our knowledge, we report the first case of a patient with independently developed severe acute TIN complicating IgAN in Korea. A 38-year-old man was admitted with recurrent hematuria. Proteinuria (<1 g) and severe renal failure were noted and hemodialysis was started. In renal biopsy, IgAN associated with acute TIN was diagnosed. He showed good response to steroid therapy and maintained normal renal function after discontinuation of medication.
Acute Kidney Injury ; Adult ; Biopsy ; Glomerulonephritis ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Korea ; Necrosis ; Nephritis, Interstitial ; Proteinuria ; Renal Dialysis ; Renal Insufficiency ; Tin

BACKGROUND: Conservative management for the trigger fingers includes splinting, steroid injection and other adjuvant methods. If conservative treatment fails, a surgical release of the A1 pulley is offered. Although the success rate of the surgical intervention is high, the complications, for example, a digital nerve injury, bowstringing, infection and continued triggering, have been reported. Percutaneous release with an 18 guage needle has been reported as a safe and effective procedure for the trigger fingers. This study evaluates the safety and efficacy of the percutaneous release. METHODS: 33 patients received the percutaneous release of the A1 pulley with an 18 guage needle and steroid injection (Group A) and 36 patients did the only administration of steroid as a control group (Group B). Patients were examined with a clinical staging for the Watanabe stage (W stage) and 0-10 points verbal numerical rating scale (VNRS) score at 1 week, 3 months, 1 year after the initial treatment. RESULTS: After 1 year of the follow-up, 93.5% in the group A and 57.6% in the group B had complete release of the trigger fingers in the W stage. VNRS after the initial treatment demonstrated that the decrement of the pain score was more significant in the group A. CONCLUSIONS: We need to consider the percutaneous release with steroid injection at an early stage of the trigger fingers because of the more effective resolution of the symptoms and the better long-term prognosis than a steroid injection alone.
Fingers ; Follow-Up Studies ; Humans ; Needles ; Prognosis ; Splints