Purpose: This study evaluated the treatment outcomes of benign and malignant tumors of the foot to establish the treatment guidelines for foot tumors. Materials and Methods: Eighty-three (41 male and 42 female) cases were included in the study. All patients were treated in a single institution from January 2006 to December 2022. The mean age was 43 years (range, 12–92). The mean follow-up period was 91 months (range, 5–208 months). The location of the tumor, recurrence following surgery, histologic diagnosis, overall five-year survival rate, and disease-specific five-year survival rate were evaluated. The oncologic results were analyzed at the final follow-up. Results: Benign tumors were found in 60 cases and malignant tumors were found in 23 cases. The 41 male cases composed 25 cases of benign tumors and 16 cases of malignant tumors. The 42 female cases composed 35 cases of benign tumors and seven cases of malignant tumors. The tumor locations were 61 cases in the forefoot, five in the midfoot, and 17 in the hindfoot. Reoperation was performed in two cases due to recurrence. An un-planned excision was done in two cases, which led to secondary wide resections. The overall five-year survival rate was 65.9% (58.3% in males and 85.7% in females). The disease-specific five-year survival rate was 62.3% (62.5% in males and 66.7% in females). The oncologic outcomes of 23 malignant cases were continuous disease-free in 16 cases and died of disease in seven cases at the final follow-up. Conclusion Benign foot tumors were dominant (72%) in this study. The preferred location was the forefoot, with statistical significance (p<0.05). There were no statistical significant differences between males and females (p>0.05). This study provides the guidelines for treating benign and malignant foot tumors by analyzing the treatment and oncologic outcomes.

Purpose: This study evaluated the treatment outcomes of benign and malignant tumors of the foot to establish the treatment guidelines for foot tumors. Materials and Methods: Eighty-three (41 male and 42 female) cases were included in the study. All patients were treated in a single institution from January 2006 to December 2022. The mean age was 43 years (range, 12–92). The mean follow-up period was 91 months (range, 5–208 months). The location of the tumor, recurrence following surgery, histologic diagnosis, overall five-year survival rate, and disease-specific five-year survival rate were evaluated. The oncologic results were analyzed at the final follow-up. Results: Benign tumors were found in 60 cases and malignant tumors were found in 23 cases. The 41 male cases composed 25 cases of benign tumors and 16 cases of malignant tumors. The 42 female cases composed 35 cases of benign tumors and seven cases of malignant tumors. The tumor locations were 61 cases in the forefoot, five in the midfoot, and 17 in the hindfoot. Reoperation was performed in two cases due to recurrence. An un-planned excision was done in two cases, which led to secondary wide resections. The overall five-year survival rate was 65.9% (58.3% in males and 85.7% in females). The disease-specific five-year survival rate was 62.3% (62.5% in males and 66.7% in females). The oncologic outcomes of 23 malignant cases were continuous disease-free in 16 cases and died of disease in seven cases at the final follow-up. Conclusion Benign foot tumors were dominant (72%) in this study. The preferred location was the forefoot, with statistical significance (p<0.05). There were no statistical significant differences between males and females (p>0.05). This study provides the guidelines for treating benign and malignant foot tumors by analyzing the treatment and oncologic outcomes.

Purpose: This study evaluated the treatment outcomes of benign and malignant tumors of the foot to establish the treatment guidelines for foot tumors. Materials and Methods: Eighty-three (41 male and 42 female) cases were included in the study. All patients were treated in a single institution from January 2006 to December 2022. The mean age was 43 years (range, 12–92). The mean follow-up period was 91 months (range, 5–208 months). The location of the tumor, recurrence following surgery, histologic diagnosis, overall five-year survival rate, and disease-specific five-year survival rate were evaluated. The oncologic results were analyzed at the final follow-up. Results: Benign tumors were found in 60 cases and malignant tumors were found in 23 cases. The 41 male cases composed 25 cases of benign tumors and 16 cases of malignant tumors. The 42 female cases composed 35 cases of benign tumors and seven cases of malignant tumors. The tumor locations were 61 cases in the forefoot, five in the midfoot, and 17 in the hindfoot. Reoperation was performed in two cases due to recurrence. An un-planned excision was done in two cases, which led to secondary wide resections. The overall five-year survival rate was 65.9% (58.3% in males and 85.7% in females). The disease-specific five-year survival rate was 62.3% (62.5% in males and 66.7% in females). The oncologic outcomes of 23 malignant cases were continuous disease-free in 16 cases and died of disease in seven cases at the final follow-up. Conclusion Benign foot tumors were dominant (72%) in this study. The preferred location was the forefoot, with statistical significance (p<0.05). There were no statistical significant differences between males and females (p>0.05). This study provides the guidelines for treating benign and malignant foot tumors by analyzing the treatment and oncologic outcomes.

Background: and Purpose The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0–5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. Results: In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03–1.71) and stroke (aHR=1.32, 95% CI=1.00–1.75). Conclusions The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.

Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers. In this consensus statement, Korean Society of Interventional Neuroradiology and Korean Stroke Society Joint Task Force Team propose a standard workflow to reduce door-to-reperfusion time for stroke patients eligible for EVT. This includes early stroke identification and pre-hospital notification to stroke team of receiving hospital in pre-hospital phase, the transfer of stroke patients from door of the emergency department to computed tomography (CT) room, warming call to neurointervention team for EVT candidate prior to imaging, neurointervention team preparation in parallel with thrombolysis, direct transportation from CT room to angiography suite following immediate decision of EVT and standardized procedure for rapid reperfusion. Implementation of optimized workflow will improve stroke time process metrics and clinical outcome of the patient treated with EVT.
Advisory Committees ; Angiography ; Benchmarking ; Consensus* ; Emergency Service, Hospital ; Humans ; Joints ; Reperfusion ; Stroke* ; Transportation

Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers. In this consensus statement, Korean Society of Interventional Neuroradiology and Korean Stroke Society Joint Task Force Team propose a standard workflow to reduce door-to-reperfusion time for stroke patients eligible for EVT. This includes early stroke identification and pre-hospital notification to stroke team of receiving hospital in pre-hospital phase, the transfer of stroke patients from door of the emergency department to computed tomography (CT) room, warming call to neurointervention (NI) team for EVT candidate prior to imaging, NI team preparation in parallel with thrombolysis, direct transportation from CT room to angiography suite following immediate decision of EVT and standardized procedure for rapid reperfusion. Implementation of optimized workflow will improve stroke time process metrics and clinical outcome of the patient treated with EVT.
Advisory Committees ; Angiography ; Benchmarking ; Consensus* ; Emergency Service, Hospital ; Humans ; Joints ; Reperfusion ; Stroke* ; Transportation

PURPOSE: The purpose of this study was to assess the safety and early outcomes of the Pipeline device for large/giant or fusiform aneurysms. MATERIALS AND METHODS: The Pipeline was implanted in a total of 45 patients (mean age, 58 years; M:F=10:35) with 47 large/giant or fusiform aneurysms. We retrospectively evaluated the characteristics of the treated aneurysms, the periprocedural events, morbidity and mortality, and the early outcomes after Pipeline implantation. RESULTS: The aneurysms were located in the internal carotid artery (ICA) cavernous segment (n=25), ICA intradural segment (n=11), vertebrobasilar trunk (n=8), and middle cerebral artery (n=3). Procedure-related events occurred in 18 cases, consisting of incomplete expansion (n=8), shortening-migration (n=5), transient occlusion of a jailed branch (n=3), and in-stent thrombosis (n=2). Treatment-related morbidity occurred in two patients, but without mortality. Both patients had modified Rankin scale (mRS) scores of 2, but had an improved mRS score of 0 at 1-month follow-up. Of the 19 patients presenting with mass effect, 16 improved but three showed no changes in their presenting symptoms. All patients had excellent outcomes (mRS, 0 or 1) during the follow-up period (median, 6 months; range, 2-30 months). Vascular imaging follow-up (n=31, 65.9%; median, 3 months, range, 1-25 months) showed complete or near occlusion of the aneurysm in 24 patients (77.4%) and decreased sac size in seven patients (22.6%). CONCLUSION: In this initial multicenter study in Korea, the Pipeline seemed to be safe and effective for large/giant or fusiform aneurysms. However, a learning period may be required to alleviate device-related events.
Aneurysm* ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Korea* ; Learning ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Thrombosis

PURPOSE: To assess gastric pH and its relationship with urease-test positivity and histological findings in children with Helicobacter pylori infection. METHODS: Fasting gastric juices and endoscopic antral biopsy specimens were collected from 562 children and subjected to the urease test and histopathological examination. The subjects were divided into 3 age groups: 0-4, 5-9, and 10-15 years. The histopathological grade was assessed using the Updated Sydney System, while the gastric juice pH was determined using a pH meter. RESULTS: The median gastric juice pH did not differ significantly among the age groups (p=0.655). The proportion of individuals with gastric pH >4.0 was 1.3% in the 0-4 years group, 6.1% in the 5-9 years group, and 8.2% in 10-15 years (p=0.101). The proportions of moderate and severe chronic gastritis, active gastritis, and H. pylori infiltration increased with age (p<0.005). Urease-test positivity was higher in children with hypochlorhydria (77.8%) than in those with normal gastric pH (31.7%) (p<0.001). Chronic and active gastritis were more severe in the former than the latter (p<0.001), but the degree of H. pylori infiltration did not differ (20.9% vs. 38.9%; p=0.186). CONCLUSION: Gastric pH while fasting is normal in most children regardless of age. Urease-test positivity may be related to hypochlorhydria in children, and hypochlorhydria is in turn related to H. pylori infection.
Achlorhydria ; Biopsy ; Child* ; Fasting ; Gastric Juice ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hydrogen-Ion Concentration* ; Urease

BACKGROUND/AIMS: There is increasing need for third-line therapy of Helicobacter pylori due to increasing level of antibiotics resistance. The aim of this study was to compare rifabutin and levofloxacin rescue regimens in patients with first- and second-line Helicobacter pylori eradication failures. METHODS: Patients, in whom a first treatment with proton pump inhibitor-clarithromycin-amoxicillin and a second trial with proton pump inhibitor-bismuth-tetracycline-metronidazole had failed, received treatment with either rifabutin or levofloxacin, plus amoxicillin (1 g twice daily) and standard dose proton pump inhibitor. Eradication rates were confirmed with 13C-urea breath test or rapid urease test 4 weeks after the cessation of therapy. RESULTS: Eradication rates were 71.4% in the rifabutin group, and 57.1% in the levofloxacin group, respectively. Although there was no significant difference in Helicobacter pylori eradication rates between two groups (p=0.656), rifabutin based regimen showed relatively higher eradication rate. CONCLUSIONS: Helicobacter pylori eradication rates of rifabutin- or levofloxacin-based triple therapy could not achieve enough eradication rate. Further studies would be needed on combination of levofloxacin and rifabutin-based regimen or culture based treatment.
Adult ; Aged ; Aged, 80 and over ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/*therapeutic use ; Breath Tests ; Drug Resistance, Bacterial/drug effects ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Ofloxacin/*therapeutic use ; Proton Pump Inhibitors/therapeutic use ; Rifabutin/*therapeutic use ; Salvage Therapy

BACKGROUND/AIMS: Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy. METHODS: A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients. RESULTS: The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury. CONCLUSIONS: When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.
Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Endoscopes ; Female ; Gastrectomy ; Gastroenterostomy ; Humans ; Male ; Sphincterotomy, Endoscopic