Purpose: The aim of this study was to assess the effects of tyrosine kinase inhibitors (TKIs) following metastasectomy in patients with metastatic renal cell carcinoma (mRCC). Materials and Methods: A systematic search of multiple electronic databases was conducted. The inclusion criteria encompassed randomized clinical trials evaluating the use of TKIs after metastasectomy in mRCC patients. Study outcomes were relapse-free survival (RFS)/disease-free survival (DFS), overall survival (OS), and adverse events of TKIs. Results: Two studies with 197 randomized participants that compared TKIs following metastasectomy versus metastasectomy alone were identified. According to these studies, TKIs following metastasectomy may result in little to no difference in RFS/DFS (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.65–1.57; I2=29%; low-certainty evidence). TKIs after metastasectomy may slightly increase OS, but the CI crossed the line of no effect (HR, 0.80; 95% CI, 0.06–9.87; I2=86%; low-certainty evidence). TKIs after metastasectomy likely resulted in a large increase in adverse events (risk ratio, 2.76; 95% CI: 1.65–4.62; I2=not applicable; moderatecertainty evidence). Conclusions TKIs following metastasectomy did not improve RFS/DFS, but slightly improved OS. It is likely that TKIs following metastasectomy increase adverse events compared to surgery only. The certainty of evidence ranged from moderate (signaling confidence that the reported effect size is likely close to the true effect) to low (indicating that the true effect may be substantially different from the effect estimate). The findings of this study should help to inform future guidelines and clinical decision-making at the point of care.

Background/Aims: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver func-tion, ascites, hepatic encephalopathy, and especially esopha-geal varix (EV) after PARTO. Methods: From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. Results: The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score: change from 11.46±4.35 to 10.33±2.96, p=0.021).Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure mea-sured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post: odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). Conclusions The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pres-sure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient’s clinical outcome.

PURPOSE: To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. MATERIALS AND METHODS: The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. RESULTS: Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). CONCLUSIONS: Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibiotic Prophylaxis/*methods ; Biopsy, Needle/adverse effects/methods ; Ceftriaxone/*therapeutic use ; Cross Infection/epidemiology/etiology/*prevention & control ; Drug Evaluation/methods ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Escherichia coli/drug effects ; Escherichia coli Infections/epidemiology/prevention & control ; Fluoroquinolones/*therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Prostatic Neoplasms/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Ultrasonography, Interventional ; Young Adult

Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.
Colon ; Colonic Neoplasms ; Colonoscopy ; Developed Countries ; Diverticulitis ; Diverticulum ; Follow-Up Studies ; Humans ; Prevalence

PURPOSE: The purpose of this study was to investigate the relationship between patients with a neuropsychiatric history and features of their suicide attempt, in order to analyze the risk associated with psychiatrist prescribed drugs. METHODS: We retrospectively investigated cases of intentional overdose drug ingestion in patients greater than 14 years of age who visited OO emergency medical center between January 1, 2008 and July 31, 2010. We evaluated patient medical records to ascertain their age, sex, neuropsychiatric history, and components of ingested intoxicant. Information regarding any suicide reattempt was obtained after discharge through follow up telephone survey. SPSS version 13.0 was used for statistical analysis. Fisher's exact test was performed with p<0.05 considered statistically significant. RESULTS: Ninety-six of 209 patients (46%) had a past history of psychological problems. Among those 96 patients with a history of psychological problems, 46(48%) used an overdose of the medicine prescribed by their psychologist in order to attempt suicide. However, for patients without a history of psychological problems, intoxication by neuropsychiatric drugs was insignificant. Neuropsychiatric patients required greater follow up care after discharge and exhibited significantly more suicide reattempts. CONCLUSION: This study revealed that patients sometimes use the medicine prescribed by their psychologist to attempt suicide. Therefore, an exhaustive plan to control the medicines prescribed to psychiatric patients should be established.
Eating ; Emergencies ; Follow-Up Studies ; Humans ; Medical Records ; Psychiatry ; Retrospective Studies ; Suicide ; Telephone

Foreign bodies that migrate outside the esophagus into the mediastinum or soft tissues usually cause respiratory symptoms. Also, esophageal foreign body granulomas that cause tracheal stenosis, lobar atelectasis, and bronchoesophageal fistulas are reported as complications. Foreign bodies can become lodged above esophageal strictures, and chronically-embedded esophageal foreign bodies can induce stricture formation, although these are less common. This is rare case report that the trachea was directly compressed due to impacted esophagus by foreign body.
Constriction, Pathologic ; Dyspnea ; Esophagus ; Fistula ; Foreign Bodies ; Granuloma, Foreign-Body ; Mediastinum ; Pulmonary Atelectasis ; Trachea ; Tracheal Stenosis

PURPOSE: To study tissue adhesive effectiveness in with laceration at various body sites. METHODS: From January 2007 to December 2009, we collected the data of laceration patients treated using tissue adhesive in the emergency department of a university hospital. Data concerning treatment satisfaction were collected twice and analyzed. RESULTS: Of the 8665 patients with laceration, 196 (mean age 23 years, 106 males) were treated using tissue adhesive. Many of the 196 patients were <15-years-of-age. Involved body sites mainly comprised head/neck, followed by the upper extremities. The procedure was the most rapid of all treatments. CONCLUSION: Emergency physicians can reliably use tissue adhesive treatment for various lacerations in the emergency setting.
Emergencies ; Humans ; Lacerations ; Tissue Adhesives ; Upper Extremity

PURPOSE: The purpose of this study was to compare the rate of bloodstream infections associated with use of central venous catheters (CVCs) by an emergency department (ED) versus an intensive care unit (ICU). METHODS: Using the hospital administrative and billing database, we identified patients who received CVCs between January 1, 2006, and December 31, 2009 in the ED and ICU at an academic, urban hospital with an annual census of 55,000. We performed a structured, explicit chart review to determine durations of catheterization and rates of bloodstream infections. RESULTS: We screened 4,088 charts and identified 1,480 patients with CVCs that were administered in the ED, (total of 12,888 catheter-days with 47 bloodstream infections), and 982 patients with CVCs that were administered in the ICU (13,326 catheter-days with 52 bloodstream infections). The rate of bloodstream infections associated with CVCs placed in the ED was 3.65 per 1,000 catheter-days (95% confidence interval 2.68 to 4.85), and the rate of bloodstream infections in the ICU was 3.75 per 1,000 catheter-days (95% confidence interval 2.91 to 5.12). The median duration of catheterization was 6.0 days in the ED, and 10.0 days in the ICU. Among the infected CVCs, the median duration of catheterization was 12.0 days in the ED, and 14.0 days in the ICU. Of 1480 total CVCs administered in the ED, 897 were placed in the subclavian veins (61%), 554 in the internal jugular (37%), and 29 were placed in femoral veins (2%). Of the total 982 CVCs administered in the ICU, 779 were placed in the subclavian veins (79%), 158 in the internal jugular veins (16%), and 45 in femoral veins (4.3%). CONCLUSION: The rate of bloodstream infections in the ED is comparable to those in the ICU. The duration of catheterization was found to be a more important factor than the CVC insertion location.
Catheter-Related Infections ; Catheterization ; Catheterization, Central Venous ; Catheters ; Censuses ; Central Venous Catheters ; Emergencies ; Femoral Vein ; Hospitals, Urban ; Humans ; Critical Care ; Intensive Care Units ; Jugular Veins ; Subclavian Vein

PURPOSE: The purpose of this study was to determine whether continuous capnography monitoring detects adverse respiratory and airway events earlier than pulse oximetry and the clinical exam can during intramuscular ketamine for procedural sedation in children. METHODS: This study was a prospective observational study conducted from April 2009 to March 2010 in an urban Korean teaching hospital. Pediatric patients who needed procedural sedation for primary closure were enrolled. After patients received intramuscular ketamine, they were monitored using clinical ventilation assessment, pulse oximetry and capnography. Adverse respiratory and airway events were recorded RESULTS: A total of 91 patients were enrolled. Of the 91 patients, 16 (17%) had adverse respiratory events; 5 had hypoxia. Capnography was 100% sensitive for predicting hypoxia and apnea. CONCLUSION: When intramuscular ketamine is administered for procedural sedation in children, capnography allows early detection of adverse respiratory events.
Anoxia ; Apnea ; Capnography ; Child ; Conscious Sedation ; Hospitals, Teaching ; Humans ; Ketamine ; Oximetry ; Prospective Studies ; Ventilation

PURPOSE: To evaluate and analyze the clinical characteristics and history of patients with hemoperitoneum due to ovarian rupture. METHODS: Subjects were fertile females who visited the emergency department between January 2006 and December 2008. We did retrospective chart reviews only for patients diagnosed with hemoperitoneum. We investigated the characteristics and history of enrolled patients. RESULTS: A total of 76 females (mean age = 28 years) were enrolled. Of the 76, 32 (41.8%) were initially checked for coitus history by emergency physicians (EP). Of the 76, 52 (68.4%) were operated on and the remaining 24 (31.6%) were only observed. Only 4 patients had knowledge of a history of ovarian cysts. CONCLUSION: Coitus history and ovarian cyst history should be done by EPs during the initial examination of fertile females who complain of lower abdominal pain.
Abdominal Pain ; Coitus ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Medical History Taking ; Ovarian Cysts ; Retrospective Studies ; Rupture