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.

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.

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

OBJECTIVE: To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV). MATERIALS AND METHODS: Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical & clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits. RESULTS: The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups. CONCLUSION: The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter.
Ankle ; Extremities ; Follow-Up Studies ; Humans ; Laser Therapy* ; Paresthesia ; Punctures ; Saphenous Vein* ; Ultrasonography ; Veins

PURPOSE: Triage tags help prioritize the treatment for disaster patients based on the severity of the illness and help distribute limited resources during a time of disaster. In this study, we developed a novel triage tag and evaluated its feasibility during a hospital-based disaster drill. METHODS: For the first stage, we developed a new triage tag. The most commonly used triage tags (Medical Emergency Triage-TAG and SMART tag) were analyzed. We reassembled their advantages and invented a novel triage tag (NT tag). The second stage involved an evaluation of the quality of NT tag. The NT tag was used in a hospital-based disaster drill held in a single center with 22 mock patients. After the drill, hospital staffs were asked to complete a questionnaire which included visibility, comprehensibility, and ease of use with respect to the new NT tag. A five-category Likert scale was used to quantify the answer. RESULTS: The NT tag was successfully developed considering 6 quality indexes: visibility, expandability, flexibility, solidity, space, and fixity. Forty-two out of ninety (46.7%) subjects answered the questionnaire. Approximately 21% of participants had previous disaster drill experience and 33% had previous education of the SMART triage system. The visibility scale of the severity category was on average 3.3 (standard deviation (SD): 1.0), the comprehensiveness of the severity category was 3.6 (SD:0.9), the ease to understand patient information was 2.2-4.2, the ease to follow up symptoms and vital signs was 2.3-4.1. Eighty and percent of participants preferred to use the NT tag in a future disaster situation or disaster drill. CONCLUSION: We successfully developed a novel triage tag. The NT tag showed moderate feasibility.
Disasters ; Education ; Emergencies ; Follow-Up Studies ; Humans ; Pliability ; Triage* ; Vital Signs

A 59-year-old man presented to the emergency department with a chief complaint of sore throat after swallowing sodium picosulfate/magnesium citrate powder for bowel preparation, without first dissolving it in water. The initial evaluation showed significant mucosal injury involving the oral cavity, pharynx, and epiglottis. Endotracheal intubation was performed for airway protection in the emergency department, because the mucosal swelling resulted in upper airway compromise. After conservative treatment in the intensive care unit, he underwent tracheostomy because stenosis of the supraglottic and subglottic areas was not relieved. The tracheostomy tube was successfully removed after confirming recovery, and he was discharged 3 weeks after admission.
Airway Obstruction* ; Cathartics ; Caustics ; Citric Acid* ; Colonoscopy ; Constriction, Pathologic ; Deglutition ; Eating* ; Emergency Service, Hospital ; Epiglottis ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Middle Aged ; Mouth ; Pharyngitis ; Pharynx ; Sodium* ; Tracheostomy ; Water

OBJECTIVE: To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries. MATERIALS AND METHODS: From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits. RESULTS: A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found. CONCLUSION: Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.
Catheters/adverse effects ; Femoral Vein ; Fluoroscopy/methods ; Humans ; Laser Therapy/methods ; Radiography, Interventional/methods ; *Saphenous Vein/radiography/surgery ; Sclerosing Solutions/*administration & dosage/chemistry ; Sclerotherapy/adverse effects/instrumentation/*methods ; Treatment Outcome ; Varicose Veins/radiography/*therapy ; Venous Insufficiency/surgery

Synthetic cannabinoids (CBs) such as the JWH series have caused social problems concerning their abuse liability. Because the JWH series produces euphoric and hallucinogenic effects, they have been distributed illegally under street names such as "Spice" and "Smoke". Many countries including Korea have started to schedule some of the JWH series compounds as controlled substances, but there are a number of JWH series chemicals that remain uncontrolled by law. In this study, three synthetic CBs with different binding affinities to the CB1 receptor (JWH-073, 081, and 210) and Delta9-tetrahydrocannabinol (Delta9-THC) were evaluated for their potential for psychological dependence. The conditioned place preference test (unbiased method) and self-administration test (fixed ratio of 1) using rodents were conducted. Ki values of the three synthetic cannabinoids were calculated as supplementary data using a receptor binding assay and overexpressed CB1 protein membranes to compare dependence potential with CB1 receptor binding affinity. All mice administered JWH-073, 081, or 210 showed significantly increased time spent at unpreferred space in a dose-dependence manner in the conditioned place preference test. In contrast, all tested substances except Delta9-THC showed aversion phenomenon at high doses in the conditioned place preference test. The order of affinity to the CB1 receptor in the receptor binding assay was JWH-210 > JWH-081 >> JWH-073, which was in agreement with the results from the conditioned place preference test. However, no change in self-administration was observed. These findings suggest the possibility to predict dependence potential of synthetic CBs through a receptor binding assay at the screening level.
Animals ; Appointments and Schedules ; Cannabinoids* ; Controlled Substances ; Jurisprudence ; Korea ; Mass Screening ; Membranes ; Mice ; Receptor, Cannabinoid, CB1 ; Rodentia ; Social Problems