Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Purpose: The positions of the mandibular foramen (MnF) and the lingula affect the success rate of inferior alveolar nerve block. The objective of this study was to investigate aspects of the MnF and the lingula relevant for mandibular block anesthesia using cone-beam computed tomography (CBCT). Materials and Methods: Fifty CBCT scans were collected from a picture archiving and communications system. All scans were taken using an Alphard Vega 3030 (Asahi Roentgen Co. Ltd., Kyoto, Japan). Fifty-eight MnFs of 30 subjects were included in the study. The position of the MnF, the size of the MnF, the position of the lingula, the size of the lingula, and the shape of the lingula were measured and recorded. All data were statistically analyzed at a significance level of p<0.05. Results: The position of MnF was 0.1 mm and 0.8 mm below the occlusal plane in males and females, respectively. The horizontal position of the MnF was slightly anterior to the center of the ramus in males and in the center in females (p<0.05). The vertical position of the MnF was lower in females than in males (p<0.05). The MnF was an oval shape with a longer anteroposterior dimension. The height of the lingula was 9.3 mm in males and 8.2 mm in females. The nodular type was the most common shape of the lingula, followed by the triangular, truncated, and assimilated types. Conclusion CBCT provided useful information about the MnF and lingula. This information could improve the success rate of mandibular blocks.

Purpose: We aimed to investigate the clinicopathologic factors associated with distant metastasis (DM) and post-recurrence overall survival (OS) after salvage treatments for isolated locoregional recurrence (ILRR) of breast cancer and identify long-term surviving patients for providing a more personalized therapy. Methods: We analyzed 125 patients who underwent salvage local treatments for ILRR after initial curative breast surgery. Results: Fifty-two (41.6%) patients experienced secondary recurrence or disease progression, of which 20 (38.5%) experienced a secondary locoregional recurrence and 40 (76.9%) experienced DM as the first site of failure. In multivariate analysis of distant metastasis free survival (DMFS) and post-recurrence OS, the initial pN2-3 stage, a disease-free interval of < 36 months, and non-curative resection for recurrent disease were independently poor prognosticators. The score for patients stratified according to the number of risk factors increased from 0 to 3; the corresponding 5-year DMFS rates were 91.4%, 53.0%, 35.9%, and 0% and the 5-year OS rates were 97.3%, 70.4%, 32.7%, and 25.0%, respectively (p < 0.001).Systemic chemotherapy reduced DM in patients with a score of 2–3, but it did not in those with a score of 0-1. Conclusion Our collective stratification can help with prognosis prediction for ILRR of breast cancer. Depending on the DM risk of patients, the potential combination of systemic therapy should be discussed further.

PURPOSE: This report presents a procedure for performing power Doppler ultrasound-guided sialography using the phenomenon of increased blood flow and illustrates its application to practical patient cases.MATERIALS AND METHODS: The salivary gland was scanned using ultrasound equipment (GE LOGIQ5 Expert® device; GE Medical Systems, Milwaukee, WI, USA) to identify pathological findings related to the patient's chief complaint. To identify the orifice of the main duct, it should be cannulated using a lacrimal dilator. After inserting the catheter into the cannulated main duct, the position of the catheter within the duct was confirmed by ultrasound. A contrast agent was injected until the patient felt fullness, and ultrasound (B-mode) was used to confirm whether the contrast agent filled the main canal and secondary and tertiary ducts. Then, power Doppler ultrasound was performed to determine whether the salivary gland had increased blood flow.RESULTS: In 2 cases in this report, a power Doppler ultrasound scan showed a significant increase in blood flow after contrast medium injection, which was not observed on a preoperative scan.CONCLUSION: Power Doppler ultrasound was found to be a simple, safe, and effective tool for real-time sialography monitoring.
Catheters ; Humans ; Salivary Glands ; Sialography ; Ultrasonography ; Vasodilation

PURPOSE: This study was performed to investigate the influence of object shape and distance from the center of the image on the volumetric accuracy of cone-beam computed tomography (CBCT) scans, according to different parameters of tube voltage and current. MATERIALS AND METHODS: Four geometric objects (cylinder, cube, pyramid, and hexagon) with predefined dimensions were fabricated. The objects consisted of Teflon-perfluoroalkoxy embedded in a hydrocolloid matrix (Dupli-Coe-Loid TM; GC America Inc., Alsip, IL, USA), encased in an acrylic resin cylinder assembly. An Alphard Vega Dental CT system (Asahi Roentgen Ind. Co., Ltd, Kyoto, Japan) was used to acquire CBCT images. OnDemand 3D (CyberMed Inc., Seoul, Korea) software was used for object segmentation and image analysis. The accuracy was expressed by the volume error (VE). The VE was calculated under 3 different exposure settings. The measured volumes of the objects were compared to the true volumes for statistical analysis. RESULTS: The mean VE ranged from −4.47% to 2.35%. There was no significant relationship between an object's shape and the VE. A significant correlation was found between the distance of the object to the center of the image and the VE. Tube voltage affected the volume measurements and the VE, but tube current did not. CONCLUSION: The evaluated CBCT device provided satisfactory volume measurements. To assess volume measurements, it might be sufficient to use serial scans with a high resolution, but a low dose. This information may provide useful guidance for assessing volume measurements.
Americas ; Colloids ; Cone-Beam Computed Tomography* ; Imaging, Three-Dimensional ; Seoul

PURPOSE: To assess the prevalence and the risk factors of dry eye disease after refractive surgery. METHODS: A retrospective study was performed on 180 eyes of 98 patients based on medical records. Those who had tear break-up time less of than 5 seconds or had an Oxford stain scale equal to or greater than 2 were defined to have dry eye disease. We analyzed the prevalence of dry eye, compared demographic and clinical features of the dry eye group and normal group, and found risk factors of dry eye after refractive surgery. RESULTS: The prevalence of postoperative dry eye was 62.2%. Compared to the normal eye group, the dry eye group had a significantly higher proportion of women (p = 0.016), older age (p = 0.001), and thin cornea (p = 0.002). The most significant risk factor of dry eye after refractive surgery was presence of dry eye before refractive surgery (odds ratio [OR] = 9.02, confidence interval [CI] = 3.8-21.4). Old age was also found to be an independent risk factor of dry eye after refractive surgery (OR = 1.06, CI = 1.01-1.11). CONCLUSIONS: The risk of dry eye after refractive surgery was increased in older age and preoperative dry eye disease. In order to prevent post-refractive surgery dry eye, caution should be exercised in middle aged patients with preoperative dry eye disease.
Cornea ; Eye Diseases* ; Female ; Humans ; Medical Records ; Middle Aged ; Prevalence* ; Refractive Surgical Procedures* ; Retrospective Studies ; Risk Factors* ; Tears

PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

OBJECTIVE: Acute myocardial infarction is a major cause of out-of-hospital cardiac arrest (OHCA). Coronary angiography (CAG) enables diagnostic confirmation of coronary artery disease and subsequent revascularization, which might improve the prognosis of OHCA survivors. Non-randomized data has shown a favorable impact of CAG on prognosis for this population. However, the optimal timing of CAG has been debated. METHODS: The clinical outcomes of 607 OHCA patients registered in CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance), a nationwide multicenter registry performed in 27 hospitals, were analyzed. Early CAG was defined as CAG performed within 24 hours of emergency department admission. The primary outcome was survival to discharge, with neurologically favorable status defined by cerebral performance category scores ≤2. RESULTS: Compared to patients without CAG (n=469), patients who underwent early CAG (n=138) were younger, more likely to be male, and more likely to have received bystander cardiopulmonary resuscitation, pre-hospital defibrillation, and revascularization (P<0.01 for all). Analysis of 115 propensity score-matched pairs showed that early CAG is associated with a 2.3-fold increase in survival to discharge with neurologically favorable status (P<0.001, all). Survival to discharge increased consistently according to the time interval between emergency department visit and CAG (P<0.05). CONCLUSION: Early CAG of OHCA patients was associated with better survival and favorable neurologic outcomes at discharge. However, there was no clear time threshold for CAG that predicted survival to discharge.
Cardiopulmonary Resuscitation ; Coronary Angiography* ; Coronary Artery Disease ; Emergency Service, Hospital ; Humans ; Male ; Myocardial Infarction ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Survival Rate ; Survivors

PURPOSE: The population of senior citizens is rapidly growing in Korea, and this would inevitably result in the increase of elder abuse. This study was designed to survey healthcare providers in the emergency department, who may have a high probability of coming into contact with abused senior citizens, on the awareness of elder abuse, and to evaluate the level of legal knowledge and standard of education amongst these care providers. METHODS: This study was a descriptive, cross-sectional survey research and was made for doctors and nurses with at least a one-year experience working in an emergency department at a university hospital in Seoul. A total of 142 participants were included for analysis. RESULTS: Approximately 69.7% (n=99) of participants were relatively well aware of the obligation to report an elder abuse case. However, only 17.6% (n=25) of participants were aware of the method to file a report. Moreover, only 8.0% (n=11) of participants knew the provisions on punishing for not reporting. Only 15% (n=22) of participants received proper education relating to elder abuse after getting hired. Participants who received the education after getting hired have a better knowledge about elder abuse than those who did not receive the education (p=0.001). Participants who watch press reports about elder abuse showed to have better legal knowledge than those who do not watch such reports (p=0.012). CONCLUSION: With regard to participants' level of awareness of the severity according to the type of abuse, physical abuse was seen as the most serious (4.22), followed by neglect (3.52), abandonment (3.18), emotional abuse (2.66), sexual abuse (2.61), and financial abuse (2.27).
Aged ; Cross-Sectional Studies ; Delivery of Health Care* ; Education ; Elder Abuse* ; Emergencies* ; Emergency Service, Hospital* ; Health Personnel* ; Humans ; Korea ; Methods ; Physical Abuse ; Seoul ; Sex Offenses

PURPOSE: Middle East respiratory syndrome (MERS) outbreaks occurred in Korea during the year 2015, with the involvement of 186 patients in a relatively short period of time. The epidemiological pattern in South Korea was hospital-associated. Infection control plans for all hospitals were implemented to stop the spread of and to protect the healthcare workers from MERS infection. Such enhanced guidelines for infection control measures might affect healthcare workers. The purpose of this study was to determine the changes of tertiary emergency department healthcare workers' perception and compliance to hand hygiene and personal protective equipment (PPE) before and after the MERS outbreak. METHODS: A written questionnaire was administered to members in the emergency department at Samsung Medical Center. Participants were asked to rate the combined overall effectiveness of hand hygiene and PPE and to report their compliance on a 5-point scale. This survey was conducted between 11th and 26th of September 2015. RESULTS: The total number of participants was 123. Perception of effectiveness before and after the MERS outbreak was improved on hand hygiene, N-95 masks, gowns, eye protection, and gloves, except surgical masks (3.65 vs. 3.68, p=0.714). Respondents showed a statistically higher compliance with hand washing and PPE. Compliance with hand hygiene and PPE showed a dependency on their patients' symptoms; symptoms of fever or fever with upper respiratory symptoms were reported with statistically increased compliance, with the exception of surgical masks. CONCLUSION: Infection control measures except surgical masks were perceived to be more effective post the MERS outbreaks. The emergency department's workers reported increased compliance on hand hygiene and PPE, except surgical masks.
Compliance* ; Coronavirus Infections* ; Delivery of Health Care ; Disease Outbreaks ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Hand Disinfection ; Hand Hygiene ; Humans ; Infection Control* ; Korea ; Masks ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Personal Protective Equipment ; Surveys and Questionnaires