The incidence of adverse toxic reactions to immunotherapy using immune checkpoint inhibitors is 2-10% in the respiratory system and 3.9% to 12% in the neurologic system. The severity of adverse effects increases when combined immunotherapeutic agents are administered.Current Concepts: In cases of high-grade toxicity, it is important to discontinue immunotherapy immediately. In cases of grade 3 to 4 toxicity, immunosuppressive corticosteroid therapy is the first-line treatment. Short-term steroid treatment does not affect anti-tumor efficacy. It is thus necessary to use steroids for an appropriate period then carefully taper the steroid dose to prevent recurrence. If no improvement is achieved within 48-72 hours after the administration of steroids, it is essential to initiate multidisciplinary treatment involving related departments and add immunosuppressive drugs. If the patient is administrated immunotherapy again, it may be necessary to permanently discontinue the immunotherapy depending on the toxicity grade that first occurred.Discussion and Conclusion: The primary goals for effective management of immunotherapy-related adverse events are early recognition of symptoms and immediate treatment.

Background/Aims: The Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria have been used to assess treatment responses for hepatocellular carcinoma (HCC) patients. We investigated which criteria provides better survival predictions in HCC patients treated with transarterial radioembolization (TARE). Methods: In total, 102 patients with unresectable intrahe-patic HCC, who were treated with TARE between 2012 and 2017, were reviewed retrospectively. The treatment response after TARE was evaluated at 1, 3, and 6 months by the mRE-CIST and RECIST 1.1. Responders were defined as patients with complete or partial responses by each criterion. Results: The median age of 83 men and 19 women was 64.3 years.The median alpha-fetoprotein and des-gamma-carboxy pro-thrombin levels were 37.1 ng/mL and 1,780.0 mAU/mL, re-spectively. The median maximal tumor size was 8.3 cm, and multiple tumors were observed in 36 patients (35.3%). Dur-ing the follow-up period (median, 20.7 months), 21 patients (20.6%) died, with a mean survival time of 55.5 months. The cumulative survival rate was 96.1% at 6 months and 89.3% at 12 months. Responders, defined by the mRECIST at 1, 3, and 6 months after TARE, showed better survival outcomes than nonresponders (hazard ratio [HR]=5.736, p=0.008 at 1 month; HR=3.145, p=0.022 at 3 months, and HR=2.887, p=0.061 at 6 months). The survival rates of responders and nonresponders defined by the RECIST 1.1 were similar (all p>0.05). Conclusions Response evaluations that use the mRECIST provide more accurate prognoses than those that use the RECIST 1.1 in HCC patients treated with TARE.

PURPOSE: This study was conducted to evaluate the relationship between epidermal growth factor receptor (EGFR) mutation and clinical outcomes in patients with stage III non-squamous cell lung cancer treated with definitive concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: From January 2008 to December 2013, the medical records of 197 patients with stage III non- squamous non-small cell lung cancer treated with definitive CCRT were analyzed to determine progression-free survival (PFS) and overall survival (OS) according to EGFR mutation status. RESULTS: Among 197 eligible patients, 81 patients were EGFR wild type, 36 patients had an EGFR mutation (exon 19 Del, n=18; L858R, n=9, uncommon [G719X, L868, T790M], n=9), and 80 patients had unknown EGFR status. The median age was 59 years (range, 28 to 80 years) and 136 patients (69.0%) were male. The median follow-up duration was 66.5 months (range, 1.9 to 114.5 months). One hundred sixty-four patients (83.2%) experienced disease progression. Median PFS was 8.9 months for the EGFR mutation group, 11.8 months for EGFR wild type, and 10.5 months for the unknown EGFR group (p=0.013 and p=0.042, respectively). The most common site of metastasis in the EGFR mutant group was the brain. However, there was no significant difference in OS among the three groups (34.6 months for EGFR mutant group vs. 31.9 months for EGFR wild type vs. 22.6 months for EGFR unknown group; p=0.792 and p=0.284). A total of 29 patients (80.6%) with EGFR mutation were treated with EGFR tyrosine kinase inhibitor (gefitinib, n=24; erlotinib, n=3; afatinib, n=2) upon progression. CONCLUSION: EGFR mutation is associatedwith short PFS and the brain is the most common site of distant metastasis in patients with stage III non- squamous cell lung cancer treated with CCRT.
Brain ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease Progression ; Disease-Free Survival ; Epithelial Cells ; Erlotinib Hydrochloride ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Lung ; Male ; Medical Records ; Neoplasm Metastasis ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor

Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.
Abdomen/ultrasonography ; Fasciitis, Necrotizing/etiology ; Hematoma/etiology ; Humans ; Lipectomy/*adverse effects ; Postoperative Complications/*etiology ; Pulmonary Embolism/etiology ; Tomography, X-Ray Computed ; Venous Thrombosis/etiology

BACKGROUND: Colon cancer affects largely elderly populations. Elderly patients treated with adjuvant chemotherapy is lower than younger patients in colon cancer. We aim to evaluate the survival and prognostic factors in accordance with adjuvant chemotherapy in elderly colon cancer patients undergoing curative resection. METHODS: We retrospectively reviewed 86 patients 70 years of age or older with stage II, III colon cancer who were underwent surgical resection between 2005 and 2013 at single-center. We examined demographic factors, comorbidities at the time of diagnosis, factors associated with colon cancer, and factors associated with treatment, and analyzed associations survival and these factors divided into adjuvant chemotherapy group (chemotherapy group) and the conservative treatment group (observation group). RESULTS: Among 86 patients 70 years of age or older, 58 patients (67.4%) administered adjuvant chemotherapy and 28 patients (32%) underwent conservative treatment. There are significant differences in respect to the age of 75 in order to select conservative treatment or adjuvant chemotherapy for patients with surgery (p=0.008). There was no significant difference of median overall survival between both groups (chemotherapy group versus observation group: 20 months vs. 24 months, p=0.000). Poor ECOG PS score was independent prognostic factor for overall survival (95% confidential interval 0.016-0.205; hazard ratio, 0.58; p<0.001). CONCLUSION: Adjuvant chemotherapy did not affect the overall survival in stage II, III elderly colon cancer after surgical resection. There was the tendency to determine whether undergoing adjuvant chemotherapy according to chronologic age. It is thought to be necessary to perform a comprehensive geriatric assessment for decision of adjuvant chemotherapy in elderly patients.
Aged* ; Chemotherapy, Adjuvant ; Colon* ; Colonic Neoplasms* ; Comorbidity ; Demography ; Diagnosis ; Fluorouracil ; Geriatric Assessment ; Humans ; Retrospective Studies ; Risk Factors*

PURPOSE: The Korean Intern Resident Association and Korean Society of Emergency Medicine announced the 'Hospital violence response system' to secure patient safety and provide a health care provider countermeasures against hospital violence. The aim of this study is to investigate the response to hospital violence in the ER and which measures could improve the current status. METHODS: Emergency medicine residents in the Seoul, Incheon, Kyung-gi area participated in the survey. The questionnaire included 4 categories (1. Awareness of protocol, 2. Experience and countermeasure for hospital violence, 3. Understanding of protocol, 4. Suggestions to improve against hospital violence) RESULTS: Among 362 candidates, 236 (65.2%) participated in the survey. Only 7.6% of residents have not experienced hospital violence. In the group of people who were aware of the protocol, participants tended to be more familiar with processes of the hospital violence response protocol, and willing to deal with violence using a better systematic support. People did not counteract to hospital violence because the process was thought to be too complicated. Only 63 participants were actively involved in an official course for countermeasure. Participants suggested that police should deal more appropriately with hospital violence. CONCLUSION: The hospital violence response protocol is thought to have a positive effect on appropriate management of hospital violence. However, a multi-disciplinary approach to hospital violence from the hospital, police, and judicial authority should be developed.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Gyeonggi-do ; Health Personnel ; Humans ; Incheon ; Internship and Residency ; Patient Safety ; Police ; Seoul ; Violence*

In amebic liver abscess, communication between liver abscess and intrahepatic bile ducts is an uncommon cause of bile leak. This condition can be treated surgically or endoscopically. However, these treatment modalities are related with high morbidity and mortality. A 49-year-old man was diagnosed with amebic liver abscess. Percutaneous drainage was performed due to poor medical response and for the purpose of preventing abscess rupture. Liver abscess-biliary communication was found at follow-up imaging study. He was treated successfully with medical therapy and supportive care without further interventions.
Abscess ; Bile ; Bile Ducts, Intrahepatic ; Biliary Fistula* ; Drainage ; Follow-Up Studies ; Humans ; Liver ; Liver Abscess ; Liver Abscess, Amebic* ; Middle Aged ; Mortality ; Rupture

PURPOSE: Dermatofibrosarcoma protuberans (DFSP) carries a translocation resulting in the collagen type I alpha 1 (COL1A1)-platelet-derived growth factor beta (PDGFB) fusion gene, which is responsible for PDGFB activation. The purpose of this study is to evaluate the clinicopathological, genetic, and therapeutic features of DFSP in Korean patients. MATERIALS AND METHODS: Clinicopathological features of 37 patients with DFSP were reviewed. Multiplex reverse transcriptase-polymerase chain reaction (PCR) was carried out in 16 patients using formalin-fixed, paraffin-embedded tissues and specific primers for COL1A1 and PDGFB. RESULTS: The mean age of 37 patients was 37.4 years old. The most common tumor location was the trunk. All patients were treated primarily with surgery: 34 (91.7%) cases with Mohs micrographic surgery (MMS) and 3 (8.3%) cases with wide local excision. The median follow-up time was 33.7 months. Two patients, one in each treatment group, demonstrated local recurrence during the follow-up period. The COL1A1-PDGFB fusion gene was expressed in 14 (87.5%) cases, demonstrated by reverse transcriptase PCR analysis. No association was found among the different COL1A1-PDGFB fusion transcripts, the various histological subtypes and clinical features. CONCLUSION: Our results support the effectiveness of MMS in treating DFSP. The COL1A1-PDGFB fusion transcript was observed in 87.5% of patients. Therefore, COL1A1-PDGFB is a useful and accurate tool in diagnosing DFSP in Koreans.
Adolescent ; Adult ; Asian Continental Ancestry Group/*genetics ; Collagen Type I/*genetics ; DNA Primers ; Dermatofibrosarcoma/ethnology/*genetics/*pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Mohs Surgery ; Multiplex Polymerase Chain Reaction ; Neoplasm Recurrence, Local ; Oncogene Proteins, Fusion/*genetics ; Proto-Oncogene Proteins c-sis/*genetics ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Skin Neoplasms/ethnology/*genetics/*pathology/surgery ; Treatment Outcome

PURPOSE: Dermatofibrosarcoma protuberans (DFSP) carries a translocation resulting in the collagen type I alpha 1 (COL1A1)-platelet-derived growth factor beta (PDGFB) fusion gene, which is responsible for PDGFB activation. The purpose of this study is to evaluate the clinicopathological, genetic, and therapeutic features of DFSP in Korean patients. MATERIALS AND METHODS: Clinicopathological features of 37 patients with DFSP were reviewed. Multiplex reverse transcriptase-polymerase chain reaction (PCR) was carried out in 16 patients using formalin-fixed, paraffin-embedded tissues and specific primers for COL1A1 and PDGFB. RESULTS: The mean age of 37 patients was 37.4 years old. The most common tumor location was the trunk. All patients were treated primarily with surgery: 34 (91.7%) cases with Mohs micrographic surgery (MMS) and 3 (8.3%) cases with wide local excision. The median follow-up time was 33.7 months. Two patients, one in each treatment group, demonstrated local recurrence during the follow-up period. The COL1A1-PDGFB fusion gene was expressed in 14 (87.5%) cases, demonstrated by reverse transcriptase PCR analysis. No association was found among the different COL1A1-PDGFB fusion transcripts, the various histological subtypes and clinical features. CONCLUSION: Our results support the effectiveness of MMS in treating DFSP. The COL1A1-PDGFB fusion transcript was observed in 87.5% of patients. Therefore, COL1A1-PDGFB is a useful and accurate tool in diagnosing DFSP in Koreans.
Adolescent ; Adult ; Asian Continental Ancestry Group/*genetics ; Collagen Type I/*genetics ; DNA Primers ; Dermatofibrosarcoma/ethnology/*genetics/*pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Mohs Surgery ; Multiplex Polymerase Chain Reaction ; Neoplasm Recurrence, Local ; Oncogene Proteins, Fusion/*genetics ; Proto-Oncogene Proteins c-sis/*genetics ; Republic of Korea ; Reverse Transcriptase Polymerase Chain Reaction ; Skin Neoplasms/ethnology/*genetics/*pathology/surgery ; Treatment Outcome

PURPOSE: To report the three-year outcomes of macular laser photocoagulation following intravitreal injection of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME). METHODS: A prospective, randomized controlled study was completed. Eighty-six eyes of 74 patients with diffuse DME were randomized into two groups. Eyes assigned to the combination group (n = 48) were subjected to macular laser photocoagulation three weeks after IVTA. Eyes in the IVTA group (n = 38) underwent IVTA alone. Central macular thickness was measured by optical coherence tomography, and the number of additional treatments and mean time to recurrence were assessed. RESULTS: Thirty-seven eyes in the combination group and 26 eyes in the IVTA group completed the three-year follow-up. Recurrence of DME after initial treatment was not observed for nine of the 37 (24.3%) eyes in the combination group or for one of the 26 (3.9$) eyes in the IVTA group (p = 0.028). DME was absent for 19.9 months after treatment in the combination group compared to 10.3 months in the IVTA group (p = 0.027). The mean number of additional treatments was 0.92 in the combination group and 1.88 in the IVTA group (p = 0.001). CONCLUSIONS: Results in the subset of subjects who completed the three-year follow-up demonstrated that laser photocoagulation following IVTA is more effective than IVTA monotherapy for diffuse DME. Combination therapy required fewer additional treatments and resulted in a lower recurrence rate than IVTA monotherapy.
Combined Modality Therapy ; Diabetic Retinopathy/*therapy ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Glucocorticoids/administration & dosage/*therapeutic use ; Humans ; Intravitreal Injections ; Laser Coagulation/*methods ; Macular Edema/*therapy ; Male ; Middle Aged ; Prospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/administration & dosage/*therapeutic use ; Visual Acuity