The use of neoadjuvant chemotherapy in older patients is increasing. However, chemotherapy should be administered considering the medical comorbidities of the patients and the toxicity of chemotherapeutic agents. Here, we present a case of abdominal wall hematoma with spontaneous inferior epigastric artery injury caused by coughing in a 70-year-old woman who was treated with neoadjuvant chemotherapy. Abdominal computed tomography demonstrated an abdominal wall hematoma with active bleeding. However, angiography with selective embolization of the right inferior epigastric artery and the right internal mammary artery was performed successfully. Scheduled chemotherapy was discontinued over concerns of rebleeding and breast-conserving surgery was performed. When deciding on chemotherapy for older patients, attention should be paid to the various complications.

Background/Aims: Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. Methods: Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. Results: Median extent of proteinuria reduction was –2.1, –0.9, and –0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: –2.03, –2.44, and –4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. Conclusions This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.

Background/Aims: Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. Methods: Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. Results: Median extent of proteinuria reduction was –2.1, –0.9, and –0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: –2.03, –2.44, and –4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. Conclusions This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.

Purpose: Pneumococcal vaccination (13-valent pneumococcal conjugate vaccine [PCV13]) is recommended to cancer patients undergoing systemic chemotherapy. However, the optimal time interval between vaccine administration and initiation of chemotherapy has been little studied in adult patients with solid malignancies. Materials and Methods: We conducted a prospective randomized controlled trial to evaluate whether administering PCV13 on the first day of chemotherapy is non-inferior to vaccinating 2 weeks prior to chemotherapy initiation. Patients were randomly assigned to two study arms, and serum samples were collected at baseline and 4 weeks after vaccination to analyze the serologic response against Streptococcus pneumoniae using a multiplexed opsonophagocytic killingassay. Results: Of the 92 patients who underwent randomization, 43 patients in arm A (vaccination 2 weeks before chemotherapy) and 44 patients in arm B (vaccination on the first day of chemotherapy) were analyzed. Immunogenicity was assessed by geometric mean and fold-increase of post-vaccination titers, seroprotection rates (percentage of patients with post-vaccination titers > 1:64), and seroconversion rates (percentage of patients with > 4-fold increase in post-vaccination titers). Serologic responses to PCV13 did not differ significantly between the two study arms according to all three types of assessments. Conclusion The overall antibody response to PCV13 is adequate in patients with gastric and colorectal cancer during adjuvant chemotherapy, and no significant difference was found when patients were vaccinated two weeks before or on the day of chemotherapy initiation.

PURPOSE: As the Korean population ages, an increasing number of elderly patients with gastric cancer are undergoing surgical resection. The aim of this study was to analyze the surgical outcomes and prognostic factors after gastric cancer surgery for patients 80 years of age or older.METHODS: We analyzed the medical records of 720 patients with gastric cancer who underwent gastrectomy from March 2010 to December 2014 retrospectively. Patients were divided into two groups: octogenarians (age ≥80 years, n=46) and non-octogenarians (age <80 years, n=674). We evaluated clinicopathologic data including postoperative morbidity, mortality, and 5-year survival rate.RESULTS: The rate of curative resection was not different between the two groups. The American Society of Anesthesiology score was significantly higher in the octogenarians (P<0.05). Octogenarians exhibited poorer performance scale scores, higher comorbidities, and more advanced TNM stages than non-octogenarians. There was no difference in surgical resection margins between the two groups. In addition, octogenarians suffered from more postoperative morbidity and mortality than non-octogenarians. In the analysis of risk factors of survival after gastrectomy for octogenarians, advanced TNM stage and dose of transfusion were independent risk factors. Overall survival was significantly lower in octogenarians than non-octogenarians. There was no difference in the disease-specific survival for each stage of cancer after adjustment for tumor stage.CONCLUSION: Octogenarians had more preoperative risk factors and postoperative morbidity and mortality, but cancer-specific survival was comparable with non-octogenarians. Careful preoperative evaluation, thorough resection, and attentive postoperative care can improve the overall survival of octogenarians with gastric cancer.
Aged ; Aged, 80 and over ; Anesthesiology ; Comorbidity ; Gastrectomy ; Humans ; Medical Records ; Mortality ; Postoperative Care ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate ; Treatment Outcome

OBJECTIVE: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. METHODS: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. RESULTS: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4–9 vs. 6; IQR, 4–8; P < 0.001). Mechanical ventilator (29% vs. 21%, P < 0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78–1.28; P=0.999) for the transferred group compared with the non-transferred group. CONCLUSION: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Logistic Models ; Mortality ; Observational Study* ; Odds Ratio ; Prognosis ; Prospective Studies ; Renal Replacement Therapy ; Retrospective Studies* ; Sepsis ; Shock ; Shock, Septic* ; Tertiary Care Centers* ; Ventilators, Mechanical

PURPOSE: To evaluate 0.025% brilliant blue G (BBG) for staining the internal limiting membrane (ILM) during vitrectomy. METHODS: In a retrospective, non-comparative clinical case series, we analyzed consecutive 111 patients who underwent pars plana vitrectomy and removal of the ILM after staining using BBG solution. BBG was dissolved and diluted with balanced salt solution at a concentration of 0.025% and then sterilized by filtering through a 0.22 microm millipore filter. The prepared BBG solution was injected into the vitreous cavity over the macula after removal of the vitreous and excessive solution was removed immediately. RESULTS: The ILM was successfully removed without use of additional adjuvant in all cases. Mean best corrected visual acuity (log MAR) was significantly improved from 0.80 +/- 0.44 at baseline to 0.40 +/- 0.39 at 6 months postoperatively (p < 0.001). One case each of endophthalmitis and diabetic papillopathy developed. The relationship when using BBG solution was not identified as complications were not observed in the other patients who underwent vitrectomy using the same BBG solution on the same day. One idiopathic epiretinal membrane patient had visual acuity loss more than 2 lines. During the follow-up period, other complications suspected to be associated with the use of BBG solution were not observed. CONCLUSIONS: A BBG solution (0.025%) was effective in staining the ILM for removal. Complications associated with the use of BBG solution were not observed.
Endophthalmitis ; Epiretinal Membrane ; Follow-Up Studies ; Humans ; Membranes* ; Micropore Filters ; Retrospective Studies ; Visual Acuity ; Vitrectomy*

PURPOSE: To evaluate 0.025% brilliant blue G (BBG) for staining the internal limiting membrane (ILM) during vitrectomy. METHODS: In a retrospective, non-comparative clinical case series, we analyzed consecutive 111 patients who underwent pars plana vitrectomy and removal of the ILM after staining using BBG solution. BBG was dissolved and diluted with balanced salt solution at a concentration of 0.025% and then sterilized by filtering through a 0.22 microm millipore filter. The prepared BBG solution was injected into the vitreous cavity over the macula after removal of the vitreous and excessive solution was removed immediately. RESULTS: The ILM was successfully removed without use of additional adjuvant in all cases. Mean best corrected visual acuity (log MAR) was significantly improved from 0.80 +/- 0.44 at baseline to 0.40 +/- 0.39 at 6 months postoperatively (p < 0.001). One case each of endophthalmitis and diabetic papillopathy developed. The relationship when using BBG solution was not identified as complications were not observed in the other patients who underwent vitrectomy using the same BBG solution on the same day. One idiopathic epiretinal membrane patient had visual acuity loss more than 2 lines. During the follow-up period, other complications suspected to be associated with the use of BBG solution were not observed. CONCLUSIONS: A BBG solution (0.025%) was effective in staining the ILM for removal. Complications associated with the use of BBG solution were not observed.
Endophthalmitis ; Epiretinal Membrane ; Follow-Up Studies ; Humans ; Membranes* ; Micropore Filters ; Retrospective Studies ; Visual Acuity ; Vitrectomy*

BACKGROUND/AIMS: Adenoma detection rate (ADR) is widely used as an index of colonoscopy quality management. Although advanced adenomas can be found less frequently than non-advanced adenomas, advanced adenomas have a higher clinical significance during screening for colorectal cancer. The aim of this study was to investigate the correlation between advanced and non-advanced ADR among colonoscopists. METHODS: This study is an observational study of a cohort of patients undergoing screening colonoscopy between 2009 and 2010. We collected the data on patients' characteristics and colonoscopic findings. The detection rates of adenoma and advanced adenoma were calculated. Logistic regression was used to determine the effects of variables on advanced adenoma detection, and spearman's rank-order correlation was used to evaluate the relationship between advanced ADR and ADR. RESULTS: A total of 561 patients underwent screening colonoscopy by 18 experienced colonoscopists. Most colonoscopists had adequate (>20%) ADRs. Logistic regression showed that increased patient age (OR 1.07 per 1 year increase, 95% CI 1.009-1.133, p=0.023) and male gender (OR 1.860, 95% CI 0.764-4.529, p=0.171) were associated with advanced ADR. When colonoscopists were divided into two groups on the basis of advanced ADR of 5%, ADR was also significantly higher in the group having higher level of advanced ADR. However, there was no correlation between advanced ADR and ADR among colonoscopists as an individual. CONCLUSIONS: Colonoscopists' advanced ADRs were independent of their ADRs, indicating that advanced ADR could be quite low even among colonoscopists with acceptable ADRs. Thus, there seems to be a limitation in using ADR as an adequate index of colonoscopy quality management.
Adenoma/*diagnosis ; Adult ; Aged ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Early Detection of Cancer ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio

BACKGROUND AND PURPOSE: Charcot-Marie-Tooth disease (CMT) type 1A (CMT1A) is the demyelinating form of CMT that is significantly associated with PMP22 duplication. Some studies have found that the disease-related disabilities of these patients are correlated with their compound muscle action potentials (CMAPs), while others have suggested that they are related to the nerve conduction velocities. In the present study, we investigated the correlations between the disease-related disabilities and the electrophysiological values in a large cohort of Korean CMT1A patients. METHODS: We analyzed 167 CMT1A patients of Korean origin with PMP22 duplication using clinical and electrophysiological assessments, including the CMT neuropathy score and the functional disability scale. RESULTS: Clinical motor disabilities were significantly correlated with the CMAPs but not the motor nerve conduction velocities (MNCVs). Moreover, the observed sensory impairments matched the corresponding reductions in the sensory nerve action potentials (SNAPs) but not with slowing of the sensory nerve conduction velocities (SNCVs). In addition, CMAPs were strongly correlated with the disease duration but not with the age at onset. The terminal latency index did not differ between CMT1A patients and healthy controls. CONCLUSIONS: In CMT1A patients, disease-related disabilities such as muscle wasting and sensory impairment were strongly correlated with CMAPs and SNAPs but not with the MNCVs or SNCVs. Therefore, we suggest that the clinical disabilities of CMT patients are determined by the extent of axonal dysfunction.
Action Potentials ; Axons ; Charcot-Marie-Tooth Disease ; Cohort Studies ; Humans ; Muscles ; Neural Conduction