Odontogenic keratocyst (OKC) accounts for 3-11% of all odontogenic cysts. OKC is a benign intra-osseous odontogenic tumor, but what makes this cyst special is its aggressive behavior and high recurrence rate. OKC is relatively aggressive compared to other odontogenic cysts, but its malignant transformation is considered extremely rare. Squamous cell carcinoma associated with odontogenic keratocysts have rarely been reported in the medical literature. We recently experienced a case of a 63-year-old man finally confirmed with squamous cell carcinoma of the mandible, which was initially diagnosed as a benign odontogenic keratocyst. Surgical resection was performed as definitive treatment. Therefore, we present this unique case with a review of the literature.

Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

Background: The effect of fluid balance on outcomes in elderly patients with acute kidney injury (AKI) requiring continuous renal-replacement therapy (CRRT) is not explained well. We investigated outcomes according to cumulative fluid balance (CFB) in elderly patients with AKI undergoing CRRT. Methods: A total of 607 patients aged 65 years or older who started CRRT due to AKI were enrolled and stratified into two groups (fluid overload [FO] vs. no fluid overload [NFO]) based on the median CFB value for 72 hours before CRRT initiation. Propensity score-matching analysis was performed. Results: The median age of included patients was 73.0 years and 60.0% of the population was male. The median 72-hour CFB value was 2,839.0 mL. The overall cumulative survival and 28-day survival rates were lower in the FO group than in the NFO group (P < 0.001 for both) and remained so after propensity score-matching. Furthermore, patients in the FO group demonstrated a higher overall mortality risk after adjustment for age, sex, systolic blood pressure, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II score, serum albumin, creatinine, diuretic use, and mechanical ventilation status (hazard ratio, 1.38; 95% confidence interval, 1.13 to 1.89; P < 0.001). Among survivors, both the duration of CRRT and the total duration of hospitalization from CRRT initiation showed no difference between the FO and NFO groups. Conclusion A higher CFB value is associated with an increased risk of mortality in elderly patients with AKI requiring CRRT.

Background: The effect of fluid balance on outcomes in elderly patients with acute kidney injury (AKI) requiring continuous renal-replacement therapy (CRRT) is not explained well. We investigated outcomes according to cumulative fluid balance (CFB) in elderly patients with AKI undergoing CRRT. Methods: A total of 607 patients aged 65 years or older who started CRRT due to AKI were enrolled and stratified into two groups (fluid overload [FO] vs. no fluid overload [NFO]) based on the median CFB value for 72 hours before CRRT initiation. Propensity score-matching analysis was performed. Results: The median age of included patients was 73.0 years and 60.0% of the population was male. The median 72-hour CFB value was 2,839.0 mL. The overall cumulative survival and 28-day survival rates were lower in the FO group than in the NFO group (P < 0.001 for both) and remained so after propensity score-matching. Furthermore, patients in the FO group demonstrated a higher overall mortality risk after adjustment for age, sex, systolic blood pressure, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II score, serum albumin, creatinine, diuretic use, and mechanical ventilation status (hazard ratio, 1.38; 95% confidence interval, 1.13 to 1.89; P < 0.001). Among survivors, both the duration of CRRT and the total duration of hospitalization from CRRT initiation showed no difference between the FO and NFO groups. Conclusion A higher CFB value is associated with an increased risk of mortality in elderly patients with AKI requiring CRRT.

Background: Although appropriate dietary adjustments in hemodialysis (HD) patients are important, most HD patients have difficulty adhering to dietary therapy due to the stress of a restricted-food diet or loss of appetite, which eventually leads to malnutrition and other complications. The dietary intake of HD patients stratified by nutritional status has not yet been studied. Methods: In total, 111 HD patients from five dialysis centers were stratified into 2 groups based on the Subjective Global Assessment: the well-nourished group and the poorly nourished group. The 7-day dietary intake and food behaviors of the two groups were compared. Logistic regression analysis was performed to reveal the factors associated with poorly nourished status. Results The 7-day dietary survey showed a lower intake of total calories and protein and a higher intake of sodium and potassium than in the standard recommendations, but there were no differences between groups. The poorly nourished group ate fried food significantly more frequently than the well-nourished group. Moreover, higher hip and waist circumferences were significantly associated with poorly nourished status.

PURPOSE: The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. MATERIALS AND METHODS: This study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate discharged ICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses. RESULTS: After propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higher in MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meir estimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011). CONCLUSION: This study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coverage was provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policy for ICU survivors with low economic status.
Cohort Studies ; Critical Care ; Financing, Government ; Humans ; Insurance ; Intensive Care Units ; Korea ; Mortality ; National Health Programs ; Propensity Score ; Retrospective Studies ; Survivors ; Tertiary Care Centers

PURPOSE: Despite new treatment strategies, anemia remains the most prevalent complication in patients with end-stage renal disease (ESRD). We investigated whether 25-hydroxyvitamin D [25(OH)D3] deficiency was associated with anemia in ESRD patients. MATERIALS AND METHODS: We reviewed the medical records of 410 ESRD patients who had undergone renal transplantation (RTx) at Yonsei University Health System and who had 25(OH)D3 levels measured at the time of RTx. Patients were divided into two groups based on baseline 25(OH)D3 concentrations: group 1, 25(OH)D3 levels <10 ng/mL; and group 2, 25(OH)D3 levels ≥10 ng/mL. RESULTS: Using multivariate regression models, 25(OH)D3, age, and erythrocyte-stimulating agent (ESA) dose were found to be significantly associated with hemoglobin (Hb) levels [25(OH)D3: β=0.263, p<0.001; age: β=0.122, p=0.010; ESA dose: β=-0.069, p=0.005]. In addition, logistic regression analysis revealed that patients in group 1 had a significantly higher risk for developing anemia (Hb level <10 g/dL) compared to group 2 patients, even after adjusting for potential risk factors for anemia (odds ratio=3.857; confidence interval=1.091-13.632; p=0.036). CONCLUSION: 25(OH)D3 deficiency was significantly associated with anemia in patients with ESRD. Randomized controlled trials are needed to determine whether vitamin D supplementation can improve anemia in these patients.
Adult ; Aged ; Anemia/blood/*etiology ; Calcifediol ; Cross-Sectional Studies ; Female ; Hemoglobin A/analysis ; Humans ; Kidney Failure, Chronic/*complications ; Kidney Transplantation ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Regression Analysis ; Risk Factors ; Vitamin D/analogs & derivatives/blood ; Vitamin D Deficiency/blood/*complications

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.
Aneurysm* ; Embolization, Therapeutic ; Emergencies ; Emergency Service, Hospital ; Endovascular Procedures ; Gyeongsangbuk-do ; Hemothorax ; Humans ; Mammary Arteries* ; Middle Aged ; Neurofibromatosis 1 ; Resuscitation ; Rupture ; Thoracic Surgery, Video-Assisted

Primary amyloidosis has unfavorable prognosis, particularly with organ involvement. Here, we report a case of clinical remission of renal amyloidosis after autologous hematopoietic cell transplantation. A 51-year-old female patient visited our hospital due to generalized edema. Initial evaluation showed hyperlipidemia, hypoalbuminemia, and heavy proteinuria, which were consistent with nephrotic syndrome. However, IgM lamda type monoclonal gammopathy was detected in serum and urine electrophoresis studies. Renal biopsy showed Congo red-positive amyloid deposition in mesangial area, glomerular capillary walls, and arterioles and amyloid fibers were confirmed by electron microscopy. Immunohistochemial study of the biopsy tissue demonstrated systemic light-chain amyloidosis (AL amyloidosis). Multiple myeloma was not evident on bone marrow examination. She received autologous hematopoietic cell transplantation after high dose melphalan treatment. Complete remissions were achieved after the treatment, respectively. Our findings suggest the potential role of autologous peripheral blood stem cell transplantation in treatment of AL amyloidosis.
Amyloid ; Amyloidosis* ; Arterioles ; Biopsy ; Bone Marrow Examination ; Capillaries ; Cell Transplantation ; Congo ; Edema ; Electrophoresis ; Female ; Humans ; Hyperlipidemias ; Hypoalbuminemia ; Immunoglobulin M ; Melphalan ; Microscopy, Electron ; Middle Aged ; Multiple Myeloma ; Nephrotic Syndrome ; Paraproteinemias ; Peripheral Blood Stem Cell Transplantation* ; Plaque, Amyloid ; Prognosis ; Proteinuria ; Transplants

Primary amyloidosis has unfavorable prognosis, particularly with organ involvement. Here, we report a case of clinical remission of renal amyloidosis after autologous hematopoietic cell transplantation. A 51-year-old female patient visited our hospital due to generalized edema. Initial evaluation showed hyperlipidemia, hypoalbuminemia, and heavy proteinuria, which were consistent with nephrotic syndrome. However, IgM lamda type monoclonal gammopathy was detected in serum and urine electrophoresis studies. Renal biopsy showed Congo red-positive amyloid deposition in mesangial area, glomerular capillary walls, and arterioles and amyloid fibers were confirmed by electron microscopy. Immunohistochemial study of the biopsy tissue demonstrated systemic light-chain amyloidosis (AL amyloidosis). Multiple myeloma was not evident on bone marrow examination. She received autologous hematopoietic cell transplantation after high dose melphalan treatment. Complete remissions were achieved after the treatment, respectively. Our findings suggest the potential role of autologous peripheral blood stem cell transplantation in treatment of AL amyloidosis.
Amyloid ; Amyloidosis* ; Arterioles ; Biopsy ; Bone Marrow Examination ; Capillaries ; Cell Transplantation ; Congo ; Edema ; Electrophoresis ; Female ; Humans ; Hyperlipidemias ; Hypoalbuminemia ; Immunoglobulin M ; Melphalan ; Microscopy, Electron ; Middle Aged ; Multiple Myeloma ; Nephrotic Syndrome ; Paraproteinemias ; Peripheral Blood Stem Cell Transplantation* ; Plaque, Amyloid ; Prognosis ; Proteinuria ; Transplants