Donor lymphocyte infusion (DLI) is performed to augment an anti-tumor immune response or ensure donor stem cells remain engrafted following allogeneic stem cell transplantation but may induce graft-versus-host disease (GVHD) involving skin, intestine, and liver. Although hepatic involvement of GVHD can manifest as mild to severe hepatitis, few reports have mentioned acute severe liver dysfunction with encephalopathy. We experienced a case of acute severe liver dysfunction with semicoma after DLI in a patient with relapsed multiple myeloma following allogeneic stem cell transplantation, in whom chronic viral hepatitis B had been suppressed by antiviral treatment. The patient recovered after high-dose glucocorticoid administration based on an assessment of hepatic GVHD.Clinicians should be aware of the possibility of this catastrophic hepatic complication after DLI in hematologic disorders.

Erythema nodosum (EN) is the most common form of panniculitis and may be triggered by a variety of stimuli, including infections, drugs, pregnancy, sarcoidosis, inflammatory bowel disease, and malignancies. Rare cases of vaccination-related EN have been reported, but none due to the coronavirus disease 2019 (COVID-19) vaccine of Pfizer have been documented. We report a case of EN associated with the Pfizer vaccine. A 43-year-old woman presented with acute-onset painful nodular lesions that appeared bilaterally on the extensor surface of the lower legs. These lesions appeared 5 days after the first dose of Pfizer vaccination. The patient reported no recent infectious history other than fever for 3 days after vaccination. Skin biopsy revealed inflammation extending into the subcutaneous fat with a septal distribution. It is important for physicians to be aware of the side effects of the COVID-19 vaccine because more people are bound to be vaccinated.

Objectives: . The impacts of ventilation tube (VT) type and effusion composition on the VT extrusion rate and complications in children with otitis media remain unclear. This part II study evaluated the factors affecting the extrusion rate, recurrence rate, and complications of VT insertion. Methods: . A prospective study was conducted between June 2014 and December 2016 (the EVENT study [analysis of the effectiveness of ventilation tube insertion in pediatric patients with chronic otitis media]), with follow-up data collected until the end of 2017. Patients aged <15 years diagnosed with otitis media with effusion who received VT insertion were recruited at 15 tertiary hospitals. The primary outcomes were time to extrusion of VT, time to effusion recurrence, and complications. Results: . Data from 401 patients were analyzed. After excluding the results of long-lasting tubes (Paparella type II and T-tubes), silicone tubes (Paparella type I) exhibited a significantly longer extended time to extrusion (mean, 400 days) than titanium tubes (collar-button-type 1.0 mm: mean, 312 days; P<0.001). VT material (hazard ratio [HR], 2.117, 95% confidence interval [CI], 1.254–3.572; P=0.005), age (HR, 3.949; 95% CI, 1.239–12.590; P=0.02), and effusion composition (P=0.005) were significantly associated with the time to recurrence of middle ear effusion. Ears with purulent (mean, 567 days) and glue-like (mean, 588 days) effusions exhibited a shorter time to recurrence than ears with serous (mean, 846 days) or mucoid (mean, 925 days) effusions. The revision VT rates during follow-up were 3.5%, 15.5%, 10.4%, and 38.9% in ears with serous, mucoid, glue-like, and purulent effusions, respectively (P<0.001). The revision surgery rates were higher among patients aged <7 years than among those aged ≥7 years. Conclusion . Silicone tubes (Paparella type I) were less prone to early extrusion than titanium 1.0 mm tubes. VT type, patient age, and effusion composition affected the time to recurrence of effusion.

Background: The advancement of treatment with direct-acting antiviral (DAA) agents has improved the cure rate of hepatitis C virus (HCV) infection close to 100%. The aim of our study was to assess the real-world effectiveness and safety of DAA regimens for the treatment of patients with chronic HCV genotype 2. Methods: We retrospectively analyzed the clinical data of patients treated with sofosbuvir plus ribavirin (SOF + RBV) or glecaprevir/pibrentasvir (G/P) for chronic HCV genotype 2 infection at seven university hospitals in the Korean southeast region. Results: SOF + RBV therapy produced an 89% and 98.3% sustained virologic response 12 week (SVR12) after treatment completion in the full analysis set and per-protocol set, respectively, and the corresponding values for G/P therapy were 89.5% and 99.2%, respectively. The difference between the treatments was probably because 6.2% (59/953) of patients in the SOF + RBV group did not complete the treatment and 9.8% (14/143) in the G/P group did not test HCV RNA after treatment completion. Adverse events (A/Es) were reported in 59.7% (569/953) and 25.9% (37/143) of the SOF + RBV and G/P groups, respectively. In the SOF + RBV group, 12 (1.26%) patients discontinued treatment owing to A/Es, whereas no patients discontinued treatment because of A/Es in the G/P group. Conclusion In both treatment groups, SVR was high when treatment was completed.However, there was a high dropout rate in the SOF + RBV group, and the dropout analysis showed that these were patients with liver cirrhosis (LC; 43/285, 15.1%), especially those with decompensated LC (12/32, 37.5%). Therefore, an early initiation of antiviral therapy is recommended for a successful outcome before liver function declines. Furthermore, patients with decompensated LC who are considered candidates for SOF + RBV treatment should be carefully monitored to ensure that their treatment is completed, especially those with low hemoglobin and high alanine transaminase.

Background: The advancement of treatment with direct-acting antiviral (DAA) agents has improved the cure rate of hepatitis C virus (HCV) infection close to 100%. The aim of our study was to assess the real-world effectiveness and safety of DAA regimens for the treatment of patients with chronic HCV genotype 2. Methods: We retrospectively analyzed the clinical data of patients treated with sofosbuvir plus ribavirin (SOF + RBV) or glecaprevir/pibrentasvir (G/P) for chronic HCV genotype 2 infection at seven university hospitals in the Korean southeast region. Results: SOF + RBV therapy produced an 89% and 98.3% sustained virologic response 12 week (SVR12) after treatment completion in the full analysis set and per-protocol set, respectively, and the corresponding values for G/P therapy were 89.5% and 99.2%, respectively. The difference between the treatments was probably because 6.2% (59/953) of patients in the SOF + RBV group did not complete the treatment and 9.8% (14/143) in the G/P group did not test HCV RNA after treatment completion. Adverse events (A/Es) were reported in 59.7% (569/953) and 25.9% (37/143) of the SOF + RBV and G/P groups, respectively. In the SOF + RBV group, 12 (1.26%) patients discontinued treatment owing to A/Es, whereas no patients discontinued treatment because of A/Es in the G/P group. Conclusion In both treatment groups, SVR was high when treatment was completed.However, there was a high dropout rate in the SOF + RBV group, and the dropout analysis showed that these were patients with liver cirrhosis (LC; 43/285, 15.1%), especially those with decompensated LC (12/32, 37.5%). Therefore, an early initiation of antiviral therapy is recommended for a successful outcome before liver function declines. Furthermore, patients with decompensated LC who are considered candidates for SOF + RBV treatment should be carefully monitored to ensure that their treatment is completed, especially those with low hemoglobin and high alanine transaminase.

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.
Anti-Bacterial Agents ; Bacteria ; Child ; Ear ; Ear, Middle* ; Haemophilus influenzae ; Hearing ; Humans ; Influenza, Human ; Korea ; Middle Ear Ventilation ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Prospective Studies ; Staphylococcus ; Tertiary Care Centers ; Tympanic Membrane ; Ventilation*

BACKGROUND/AIMS: Several studies suggest that pyogenic liver abscess (PLA) is associated with colon neoplasm. A colonoscopic exam for cryptogenic PLA might detect a hidden colon neoplasm, through which intestinal flora can be transmitted into the liver. However, there are no prospectively enrolled cross-sectional data for colonic neoplasm in cryptogenic PLA. METHODS: Patients with PLA were prospectively enrolled from two university hospitals. Among them, all the patients with cryptogenic PLA were recommended for colonoscopic exam to check for colonic neoplasm. RESULTS: One hundred eighty-three patients with PLA were enrolled in the study for 22 months. One hundred and one (55.2%) patients did not have a definite cause of liver abscess at initial evaluation. The median diameter of the largest lesion was 5.7 cm (1.0-14.0 cm), and 74.3% of the patients were treated by percutaneous abscess drainage. Ninety-one percent of the patients who had an identified pathogen yielded Klebsiella. Sixty-two patients underwent colonoscopic exams, and no one had a colonic cancer, one had an adenomatous polyp with high grade dysplasia (1.6%), and 27 had adenomatous polyps with low grade dysplasia (43.5%; 41.0% in male and 43.5% in female). Of fifty patients who underwent an esophagogastroduodeno-scopic exam, nine had gastric ulcers, one had an esophageal ulcer, and one had hemorrhagic gastritis. CONCLUSIONS: The prevalence of colonic neoplasm among the patients with cryptogenic PLA was not as high as that in previous studies. Further well-designed, large-scale studies are required to assess the association of the colon neoplasm and cryptogenic PLA.
Abscess ; Adenomatous Polyps ; Colon* ; Colonic Neoplasms* ; Cross-Sectional Studies* ; Drainage ; Gastritis ; Gastrointestinal Microbiome ; Hospitals, University ; Humans ; Klebsiella ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Male ; Prevalence* ; Prospective Studies* ; Stomach Ulcer ; Ulcer

BACKGROUND/AIMS: The aims of this study were to compare the bowel-cleansing efficacy, patient affinity for the preparation solution, and mucosal injury between a split dose of poly-ethylene glycol (SD-PEG) and low-volume PEG plus ascorbic acid (LV-PEG+Asc) in outpatient scheduled colonoscopies. METHODS: Of the 319 patients, 160 were enrolled for SD-PEG, and 159 for LV-PEG+Asc. The bowel-cleansing efficacy was rated according to the Ottawa bowel preparation scale. Patient affinity for the preparation solution was assessed using a questionnaire. All mucosal injuries observed during colonoscopy were biopsied and histopathologically reviewed. RESULTS: There was no significant difference in bowel cleansing between the groups. The LV-PEG+Asc group reported better patient acceptance and preference. There were no significant differences in the incidence or characteristics of the mucosal injuries between the two groups. CONCLUSIONS: Compared with SD-PEG, LV-PEG+Asc exhibited equivalent bowel-cleansing efficacy and resulted in improved patient acceptance and preference. There was no significant difference in mucosal injury between SD-PEG and LV-PEG+Asc. Thus, the LV-PEG+Asc preparation could be used more effectively and easily for routine colonoscopies without risking significant mucosal injury.
Adult ; Ascorbic Acid/administration & dosage/*adverse effects ; Cathartics/administration & dosage/*adverse effects ; Colonoscopy/methods ; Drug Therapy, Combination ; Female ; Humans ; Intestinal Mucosa/drug effects/*injuries ; Male ; Middle Aged ; Patient Compliance ; Patient Satisfaction ; Polyethylene Glycols/administration & dosage/*adverse effects ; Preoperative Care/*adverse effects/methods ; Surveys and Questionnaires ; Vitamins/administration & dosage/adverse effects

BACKGROUND AND OBJECTIVES: The evaluation of subjective outcomes of hearing aid fitting is of paramount importance along with audiometric improvement. The aim of this study was to develop a Korean adaptation of the International Outcome Inventory for Hearing Aids (IOI-HA) and to determine its reliability and validity. SUBJECTS AND METHOD: The translation of IOI-HA into the Korean version (K-IOI-HA) was completed through a process of forward translation, reconciliation, reverse translation and cognitive debriefing. K-IOI-HA was administered to 101 patients using hearing aids and visiting any the 10 referral hospitals. Reliability was evaluated by Cronbach's alpha coefficient and by test-retest analysis. Validity was assessed by confirmatory factor analysis and criterion validity based on the results of pure tone audiometry. RESULTS: K-IOI-HA showed a good internal consistency (Cronbach's alpha=0.83) and a high test-retest reliability (r=0.943, p<0.01). Validity checked by confirmatory factor analysis also showed good construct validity. CONCLUSION: The Korean version of IOI-HA is a reliable and valid tool for evaluating subjective outcomes of hearing aids.
Hearing ; Hearing Aids ; Humans ; Surveys and Questionnaires ; Referral and Consultation ; Reproducibility of Results

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.
Biomarkers, Tumor ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; Mastectomy ; Medical Records ; Mortality ; Neoplasm Metastasis ; Oncogenes ; Paraffin ; Prognosis ; Survival Rate