PURPOSE: The purpose of this study was to identify factors influencing psychosocial well-being in family caregivers of patients with amyotrophic lateral sclerosis (ALS). METHODS: A descriptive correlational design was used. The transactional model of stress and coping was used to investigate the psychosocial well-being of 137 family caregivers of patients with ALS. Data were collected through self-reported questionnaires from January to November 2016. Data were analyzed using an independent t-test, one-way ANOVA, Pearson's correlation, and hierarchical multiple regression analysis with the SPSS WIN 21.0 program. RESULTS: The regression model had an adjusted R2 of .49, which indicated that meaning-focused coping, social support, ALS patient-family caregiver relationship (especially a spousal relationship), and tracheostomy were significant predictors of caregivers' psychosocial well-being. CONCLUSION: Meaning-focused coping and social support significantly influenced caregivers' psychosocial well-being. Therefore, interventions to improve caregivers' psychosocial well-being must focus on increasing meaning-focused coping and social support resources.
Adaptation, Psychological ; Amyotrophic Lateral Sclerosis* ; Caregivers* ; Humans ; Social Adjustment ; Tracheostomy

PURPOSE: The purpose of this study is to report real life experiences of sorafenib therapy for hepatocellular carcinoma (HCC) in Korea, using a subset of data from GIDEON (Global Investigation of Therapeutic Decisions in HCC and of Its Treatment with Sorafenib; a large, prospective, observational study). MATERIALS AND METHODS: Between January 2009 and April 2012, a total of 497 patients were enrolled from 11 sites in Korea. Of these, 482 patients were evaluable for safety analyses. Case report forms of paper or electronic version were used to record safety and efficacy data from all patients. RESULTS: More patients of Child-Pugh A received sorafenib for > 8 weeks than did patients of Child-Pugh B (55.5% vs. 34.3%). Child-Pugh score did not appear to influence the starting dose of sorafenib, and approximately 70% of patients both in Child-Pugh A and B groups received the recommended initial daily dose of 800 mg (69.0% and 69.5%, respectively). The median overall survival (OS) and time to progression (TTP) were 8.5 months and 2.5 months. In Child-Pugh A patients, the median OS and TTP were 10.2 months and 2.5 months. The most frequent treatment-emergent drug-related adverse event was hand-foot skin reaction (31.7%), followed by diarrhea (18.0%). The incidence of treatment-emergent adverse events was similar in both Child-Pugh A (85.4%) and Child-Pugh B (84.8%) patients. CONCLUSION: Sorafenib was well tolerated by Korean HCC patients in clinical settings, and the safety profile did not appear to differ by Child-Pugh status. Survival benefit in Korean patients was in line with that of a previous pivotal phase III trial (SHARP).
Carcinoma, Hepatocellular* ; Diarrhea ; Humans ; Incidence ; Korea* ; Life Change Events ; Prospective Studies ; Skin

Teeth wear and extrusion of antagonist are commonly observed in deep bite patient having severe vertical and horizontal overlap. These problems cause collapse of occlusal plane and abnormal anterior guidance. Without restoring harmonious occlusion, loss of multiple teeth and decreased masticatory function could not be prevented. To resolve problems associated with deep bite, multidisciplinary treatment including oral surgical, orthodontic and prosthetic treatment should be performed. This clinical report describes the results of increasing occlusal vertical dimension with a full-mouth restoration procedure. The treatment procedures include extraoral and intraoral examination, diagnosis, treatment planning, diagnostic wax-up, segmental osteotomy, orthodontic intrusion and prosthodontic rehabilitation. Full mouth rehabilitation with increasing occlusal vertical dimension can solve esthetic and functional problems.
Dental Occlusion ; Diagnosis ; Humans ; Methods ; Mouth Rehabilitation* ; Osteotomy* ; Overbite* ; Prosthodontics ; Rehabilitation ; Tooth ; Vertical Dimension

BACKGROUND/AIMS: Identifying the impact of a patient's ethnicity on treatment responses in clinical practice may assist in providing individualized treatment regimens for chronic hepatitis C (CHC). The effectiveness of standard peginterferon plus ribavirin therapy and the need for triple combination therapy with protease inhibitors in Koreans remain matters of debate. These issues were investigated in the present study. METHODS: The clinical data of 272 treatment-naive Korean CHC patients who were treated in a community-based clinical trial (Clinical Trial group; n=51) and in clinical practice (Cohort group; n=221), were analyzed and compared. All were treated with standard protocols of peginterferon alfa-2a plus ribavirin therapy. RESULTS: For patients with hepatitis C virus (HCV) genotype 1, the sustained virological response (SVR) rates in the Clinical Trial and Cohort groups were 81% (21/26) and 55% (58/106), respectively, by intention-to-treat (ITT) analysis (P=0.02), and 100% (13/13) and 80% (32/40), respectively, in treatment-adherent patients (P=0.18). For patients with HCV genotype 2, the SVR rates in these two groups were 96% (24/25) and 88% (101/115), respectively, by ITT analysis (P=0.31). Adherence and treatment duration were independent predictors of SVR for genotypes 1 and 2, respectively (P<0.01 for each). Korean patients with CHC achieved high SVR rates with peginterferon alfa-2a plus ribavirin in both the clinical trial and clinical practice settings. CONCLUSIONS: Measures to raise adherence to standard therapy in clinical practice may improve the SVR rates in these patients as effectively as adding protease inhibitors, thus obviating the need for the latter.
Adolescent ; Adult ; Aged ; Antiviral Agents/*therapeutic use ; Asian Continental Ancestry Group ; Cohort Studies ; Drug Therapy, Combination ; Female ; Genotype ; Hepacivirus/genetics ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon-alpha/*therapeutic use ; Male ; Middle Aged ; Odds Ratio ; Polyethylene Glycols/*therapeutic use ; Predictive Value of Tests ; RNA, Viral/genetics ; Recombinant Proteins/therapeutic use ; Republic of Korea ; Ribavirin/*therapeutic use ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: The virologic response of Koreans to combination therapy for chronic hepatitis C is similar to westerns; however, dose modification occurs more frequently in Koreans. We evaluated the rates of peginterferon alpha-2a and ribavirin dose modifications and their effect on the virologic response in Koreans. METHODS: Patients with detectable HCV RNA and enrolled from multicenters were treated with peginterferon alpha-2a (180 microgram/week) and ribavirin (800 mg/day) for 24 weeks (genotype non-1, n=37) or peginterferon alpha-2a (180 microgram/week) and ribavirin (1,000-1,200 mg/day) for 48 weeks (genotype 1, n=55). RESULTS: Early virologic response (EVR) and sustained virologic response (SVR) were 77.2% (genotype 1, 75%; non-1, 81%) and 66.3% (genotype 1, 56%; non-1, 81%), respectively. The frequency of dose modification was 32.6% within the first 12 weeks and 52.2% during the entire treatment period. No difference was found in SVR regardless of dose modification. However, the SVR for patients using > or =80% of the peginterferon dose was significantly higher than for those using <80% (81.3 vs. 50.0%, p=0.007), despite varying ribavirin doses. No difference was found in SVR regardless of whether the ribavirin dose was <80% or not. These results did not change based on genotype. CONCLUSIONS: We suggest that using at least 80% of the peginterferon alpha-2a dose in Koreans not only maintains SVR but also reduces drug side effects during the entire treatment period. A lower dose of ribavirin may be as efficacious as a standard dose.
Adult ; Aged ; Antiviral Agents/*administration & dosage ; Drug Therapy, Combination ; Female ; Hepatitis C, Chronic/*drug therapy/virology ; Humans ; Interferon Alfa-2a/*administration & dosage/adverse effects ; Male ; Middle Aged ; Polyethylene Glycols/*administration & dosage/adverse effects ; RNA, Viral/blood ; Ribavirin/*administration & dosage/adverse effects

The aims of the study were to evaluate the effect of epinephrine-containing local anesthetics on pulpal blood flow (PBF) and to investigate its effect on cavity preparation-induced PBF change. PBF was recorded using a laser Doppler flowmeter (Perimed Co., Sweden) from canines of nine cats under general anesthesia before and after injection of local anesthetics and after cavity preparation. 2% lidocaine hydrochloride with 1 : 100,000 epinephrine was administered by local infiltration given apical to the mandibular canine at the vestibular area and the same volume of isotonic saline was injected on the contralateral tooth as a control. A round carbide bur was operated at slow speed with isotonic saline flushing to grind spherical cavities with increasing depth through the enamel and into the dentin on both teeth. The obtained data was analyzed with paired t-test. Cavity preparation caused significant increase of PBF (n = 9, p < 0.05). Local infiltration of lidocaine with epinephrine resulted in decreases of PBF (n = 9, p < 0.05), whereas there was no significant change of PBF with the physiologic saline as a control. Cavity preparation on tooth anesthetized with lidocaine with epinephrine caused significantly less increase of PBF than in control tooth (p < 0.05). Therefore, the result of the present study demonstrates that local infiltration of 2% lidocaine with 1 : 100,000 epinephrine effectively reduces PBF increase caused by cavity preparation.
Anesthesia, General ; Anesthesia, Local* ; Anesthetics, Local ; Animals ; Cats ; Dental Enamel ; Dentin ; Epinephrine ; Flowmeters ; Flushing ; Lidocaine ; Neurogenic Inflammation ; Tooth*

A 58-years-old man came to the hospital because of progressive intellectual deterioration, gait disturbance and postural instability for 6 months. Neuropsychological tests showed severe impairment of memory and executive functions, and dural arteriovenous fistula of the superior sagittal sinus (dAVF of SSS) was found on brain MRI and angiography. The symptoms were markedly improved after selective transvascular embolization treatments. Even though the dAVF of SSS is a rare cause of dementia, we suggest that it can be one of the treatable causes of dementia.
Angiography ; Brain ; Central Nervous System Vascular Malformations* ; Dementia* ; Executive Function ; Gait ; Magnetic Resonance Imaging ; Memory ; Neuropsychological Tests ; Superior Sagittal Sinus*

Pregnancy is rarely encountered in women with liver cirrhosis, but can occur in all forms of liver cirrhosis. The amount of data regarding pregnancy in cirrhotic patients is not great and thus no clear-cut guidelines for management can be outlined. Another interesting point of pregnancy in liver cirrhosis would be how pregnancy affects liver function in cirrhotic patients. In Korea, only 6 pregnancies in 5 patients have been reported. Recently, we experienced a case of pregnancy in a patient with liver cirrhosis. A 36 year-old, primigravida woman presented at 23 weeks of gestation. B-viral liver cirrhosis was diagnosed 2 months earlier when she had developed generalized edema and ascites. We observed a recovery of hyperbilirubinemia and hypoalbuminemia after a therapeutic termination of pregnancy. This case may illustrate that pregnancy can deteriorate liver function in some patients with liver cirrhosis. We report this case with an analysis of the reported cases in Korea.
Adult ; Ascites ; Edema ; Female ; Humans ; Hyperbilirubinemia ; Hypoalbuminemia ; Korea* ; Liver Cirrhosis* ; Liver* ; Pregnancy*

Pancreatic trauma is uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. The principal cause of pancreas specific complication and pancreas specific mortality is the presence of an injury to the pancreatic ductal system. It has been suggested that the main pancreatic duct injury is an indication of surgery or endoscopic therapy depending on the extent of leakage. Recently, we experienced a 53-year-old man who had an injury to the main pancreatic duct due to blunt abdominal trauma by a handlebar. Endoscopic retrograde pancreatography correctly diagnosed a leak at the main pancreatic duct, but his stable clinical condition and narrow main pancreatic duct precluded surgery or endoscopic therapy. Interestingly, this case was successfully treated by conservative management including octreotide administration.
Diagnosis ; Humans ; Middle Aged ; Mortality ; Octreotide* ; Pancreas ; Pancreatic Ducts*

Cytomegalovirus (CMV) infections are commonly reported in severely immunocompromised hosts and ulcers of the alimentary tract are frequently observed in systemic CMV infections. However, invasive and ulcerative disease of the gastrointestinal (GI) tract caused by CMV has also been reported in healthy adults. Many reports show that a CMV infection can produce localized ulcerations in the esophagus, stomach, small intestine, and colon in nonimmunocompromised individuals. The most common site of involvement by CMV infection in the GI tract is the colon followed by the upper GI tract and the least common site is the small intestine. Although GI bleeding is one of the major presenting symptoms of patients with CMV infections of the GI tract, lower GI bleeding due to CMV ileal ulcers in immunocompetent patients, to our knowledge, has not been reported in the English literature. Recently, we experienced a case of lower GI bleeding due to CMV ileal ulcers in a 57-year-old man who had no evidence of immunocompromise. This case suggests that small intestinal ulcers due to CMV infection should be included in the differential diagnosis of lower GI bleeding even in immunocompetent hosts.
Case Report ; Cytomegalovirus Infections/complications* ; Gastrointestinal Hemorrhage/etiology* ; Human ; Ileal Diseases/complications* ; Male ; Middle Age ; Ulcer/complications*