Venous leg ulcers (VLUs) represent the most advanced manifestation of chronic venous disease and arise from sustained ambulatory venous hypertension due to superficial reflux, deep venous obstruction, or both. Accurate etiologic assessment is essential, with duplex ultrasound serving as the primary tool to identify axial reflux, perforator incompetence, and signs of proximal outflow obstruction in accordance with contemporary ESVS and SVS/AVF guidelines. Compression therapy remains the foundation of treatment, with inelastic or adjustable compression systems providing the most effective pressure reduction and edema control. Optimal wound care—including moisturebalancing dressings, debridement, and judicious use of antimicrobials—supports timely epithelialization. Adjunctive pharmacologic agents such as micronized purified flavonoid fraction, pentoxifylline, and sulodexide may further enhance healing. Early correction of superficial reflux accelerates healing and reduces recurrence, as demonstrated in the Early Venous Reflux Ablation trial. Iliac venous obstruction should be considered in nonhealing or recurrent ulcers, with IVUS-guided stenting appropriate when significant stenosis is confirmed. Integrating guideline-directed venous intervention, optimized compression, and structured wound care is central to improving long-term outcomes in VLU management.

Purpose: Cannulation of the major papilla is the most challenging part of endoscopic retrograde cholangiopancreatography (ERCP) for which physician-controlled wire-guided cannulation (PCWGC) and assistant-controlled wire-guided cannulation (ACWGC) are used as the cannulation techniques. PCWGC can reportedly save up to about 30% of the labor cost by reducing the number of assistants. This study aims to compare the safety and efficacy of PCWGC and ACWGC. Materials and Methods: Of the 2151 patients aged >20 years (4193 cases) who underwent ERCP at Yonsei University Medical Center between January 2015 and December 2016, 989 were included in this study. Results: Among efficacy outcomes, cannulation success rate, rate of precut sphincterotomy (PCWGC vs. ACWGC: 21.3% vs.25.9%), bile duct cannulation time (PCWGC vs. ACWGC: median 3.0 minutes vs. 3.6 minutes), and total procedure time (PCWGC vs. ACWGC: median 13.6 minutes vs. 13.1 minutes) were not significantly different. Among safety outcomes, lower rates of postERCP pancreatitis were observed with PCWGC than with ACWGC (PCWGC vs. ACWGC: 5.8% vs. 8.8%, p=0.128). Among other post-ERCP adverse events (bleeding, perforation, and cholangitis), the difference was not significant between the groups. Radiation exposure (total dose area product, PCWGC vs. ACWGC: median 1979.9 µGym2 vs. 2062.0 µGym2 , p=0.194) and ERCP cost excluding labor cost (PCWGC vs. ACWGC: $1576 vs. $1547, p=0.606) were not significantly different. Conclusion Requiring less assistants, PCWGC showed comparable efficacy and safety to ACWGC. PCWGC can be considered as an alternative option, especially in facilities lacking manpower and resources.

Objective: As the population of the elderly increases, the prevalence of dementia and other mental diseases of the elderly is also increasing. Dementia is a typical elderly mental illness. Some people with dementia may cause a crime due to symptoms of mental behavior. The purpose of this study is to examine the characteristics of criminal behavior of various elderly mental patients. Methods: From January 1, 2010 to December 31, 2019, the court selected 65 years of age or older from among the criminal psychiatric appraisal cases commissioned by the court. A total of 205 medical records and mental assessments were reviewed retrospectively. All records were prepared through psychiatric interviews, clinical psychological examinations, and other examinations, and the information compiled was viewed in several aspects, including demographic factors, crime characteristics, and psychiatric opinions, at the level of technical analysis. Results: There was a statistically significant difference in the judgment of criminal liability according to the degree of cogni-tive impairment (p<0.001) in the elderly mentally ill, and a significant difference in criminal behavior depending on the type ofmental illness (p<0.001). Conclusion Not only dementia but also other elderly mental illnesses are related to violent crime. In particular, paranoid symptoms and alcohol abuse in older adults’ mental illness are related to the type of criminal behavior. In an aging society, appropriate therapeutic intervention is needed to prevent criminal behavior of the elderly mentally ill.

Objective: As the population of the elderly increases, the prevalence of dementia and other mental diseases of the elderly is also increasing. Dementia is a typical elderly mental illness. Some people with dementia may cause a crime due to symptoms of mental behavior. The purpose of this study is to examine the characteristics of criminal behavior of various elderly mental patients. Methods: From January 1, 2010 to December 31, 2019, the court selected 65 years of age or older from among the criminal psychiatric appraisal cases commissioned by the court. A total of 205 medical records and mental assessments were reviewed retrospectively. All records were prepared through psychiatric interviews, clinical psychological examinations, and other examinations, and the information compiled was viewed in several aspects, including demographic factors, crime characteristics, and psychiatric opinions, at the level of technical analysis. Results: There was a statistically significant difference in the judgment of criminal liability according to the degree of cogni-tive impairment (p<0.001) in the elderly mentally ill, and a significant difference in criminal behavior depending on the type ofmental illness (p<0.001). Conclusion Not only dementia but also other elderly mental illnesses are related to violent crime. In particular, paranoid symptoms and alcohol abuse in older adults’ mental illness are related to the type of criminal behavior. In an aging society, appropriate therapeutic intervention is needed to prevent criminal behavior of the elderly mentally ill.