Objective: To evaluate the safety and efficacy of coil embolization of venous segments in patients with Type IIa pelvic arteriovenous malformations (AVMs). Materials and Methods: A retrospective study was performed on 13 patients (median age, 43 years, range 20–62 years, 7 males) who underwent transvenous coil embolization for Type IIa pelvic AVM (characterized by multiple arterioles shunting to focal venous segments of a single draining vein) without the use of additional liquid embolic agents from March 2017 to February 2023. Treatment outcomes were analyzed based on clinical evaluations, post angiography findings, and follow-up CT. Results: Fourteen procedures were performed on 13 patients. Except in one patient, all treatments were completed in a single session. Transvenous access was employed in 10 procedures, whereas direct puncture was used in four sessions. The embolization procedures used an average of 55.7 ± 58.5 coils (range, 7–238) and lasted an average of 127.3 ± 39.5 minutes.The technical success rate was 92.9% (of 13/14). All patients reported symptom improvement. Follow-up CT scans showed complete occlusion of the AVM without recurrence in ten of the 13 patients. There was one minor adverse event: a small retroperitoneal hemorrhage, likely related to direct puncture, which resolved spontaneously. No other adverse events were observed. Conclusion Coil embolization of the draining vein segment, without the use of additional liquid embolic agents is a safe and effective method for managing Type IIa pelvic AVM.

Objective: To evaluate the safety and efficacy of coil embolization of venous segments in patients with Type IIa pelvic arteriovenous malformations (AVMs). Materials and Methods: A retrospective study was performed on 13 patients (median age, 43 years, range 20–62 years, 7 males) who underwent transvenous coil embolization for Type IIa pelvic AVM (characterized by multiple arterioles shunting to focal venous segments of a single draining vein) without the use of additional liquid embolic agents from March 2017 to February 2023. Treatment outcomes were analyzed based on clinical evaluations, post angiography findings, and follow-up CT. Results: Fourteen procedures were performed on 13 patients. Except in one patient, all treatments were completed in a single session. Transvenous access was employed in 10 procedures, whereas direct puncture was used in four sessions. The embolization procedures used an average of 55.7 ± 58.5 coils (range, 7–238) and lasted an average of 127.3 ± 39.5 minutes.The technical success rate was 92.9% (of 13/14). All patients reported symptom improvement. Follow-up CT scans showed complete occlusion of the AVM without recurrence in ten of the 13 patients. There was one minor adverse event: a small retroperitoneal hemorrhage, likely related to direct puncture, which resolved spontaneously. No other adverse events were observed. Conclusion Coil embolization of the draining vein segment, without the use of additional liquid embolic agents is a safe and effective method for managing Type IIa pelvic AVM.

Objective: To evaluate the safety and efficacy of coil embolization of venous segments in patients with Type IIa pelvic arteriovenous malformations (AVMs). Materials and Methods: A retrospective study was performed on 13 patients (median age, 43 years, range 20–62 years, 7 males) who underwent transvenous coil embolization for Type IIa pelvic AVM (characterized by multiple arterioles shunting to focal venous segments of a single draining vein) without the use of additional liquid embolic agents from March 2017 to February 2023. Treatment outcomes were analyzed based on clinical evaluations, post angiography findings, and follow-up CT. Results: Fourteen procedures were performed on 13 patients. Except in one patient, all treatments were completed in a single session. Transvenous access was employed in 10 procedures, whereas direct puncture was used in four sessions. The embolization procedures used an average of 55.7 ± 58.5 coils (range, 7–238) and lasted an average of 127.3 ± 39.5 minutes.The technical success rate was 92.9% (of 13/14). All patients reported symptom improvement. Follow-up CT scans showed complete occlusion of the AVM without recurrence in ten of the 13 patients. There was one minor adverse event: a small retroperitoneal hemorrhage, likely related to direct puncture, which resolved spontaneously. No other adverse events were observed. Conclusion Coil embolization of the draining vein segment, without the use of additional liquid embolic agents is a safe and effective method for managing Type IIa pelvic AVM.

Objective: To evaluate the safety and efficacy of coil embolization of venous segments in patients with Type IIa pelvic arteriovenous malformations (AVMs). Materials and Methods: A retrospective study was performed on 13 patients (median age, 43 years, range 20–62 years, 7 males) who underwent transvenous coil embolization for Type IIa pelvic AVM (characterized by multiple arterioles shunting to focal venous segments of a single draining vein) without the use of additional liquid embolic agents from March 2017 to February 2023. Treatment outcomes were analyzed based on clinical evaluations, post angiography findings, and follow-up CT. Results: Fourteen procedures were performed on 13 patients. Except in one patient, all treatments were completed in a single session. Transvenous access was employed in 10 procedures, whereas direct puncture was used in four sessions. The embolization procedures used an average of 55.7 ± 58.5 coils (range, 7–238) and lasted an average of 127.3 ± 39.5 minutes.The technical success rate was 92.9% (of 13/14). All patients reported symptom improvement. Follow-up CT scans showed complete occlusion of the AVM without recurrence in ten of the 13 patients. There was one minor adverse event: a small retroperitoneal hemorrhage, likely related to direct puncture, which resolved spontaneously. No other adverse events were observed. Conclusion Coil embolization of the draining vein segment, without the use of additional liquid embolic agents is a safe and effective method for managing Type IIa pelvic AVM.

Objective: To evaluate the safety and efficacy of coil embolization of venous segments in patients with Type IIa pelvic arteriovenous malformations (AVMs). Materials and Methods: A retrospective study was performed on 13 patients (median age, 43 years, range 20–62 years, 7 males) who underwent transvenous coil embolization for Type IIa pelvic AVM (characterized by multiple arterioles shunting to focal venous segments of a single draining vein) without the use of additional liquid embolic agents from March 2017 to February 2023. Treatment outcomes were analyzed based on clinical evaluations, post angiography findings, and follow-up CT. Results: Fourteen procedures were performed on 13 patients. Except in one patient, all treatments were completed in a single session. Transvenous access was employed in 10 procedures, whereas direct puncture was used in four sessions. The embolization procedures used an average of 55.7 ± 58.5 coils (range, 7–238) and lasted an average of 127.3 ± 39.5 minutes.The technical success rate was 92.9% (of 13/14). All patients reported symptom improvement. Follow-up CT scans showed complete occlusion of the AVM without recurrence in ten of the 13 patients. There was one minor adverse event: a small retroperitoneal hemorrhage, likely related to direct puncture, which resolved spontaneously. No other adverse events were observed. Conclusion Coil embolization of the draining vein segment, without the use of additional liquid embolic agents is a safe and effective method for managing Type IIa pelvic AVM.

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: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. Methods The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuumassisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years.Discussion: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients.

Background: Although patients with psoriasis have an increased risk of cancers, little is known about the risk of psoriasis in cancer patients. Objective: We aimed to comparatively analyze the incidence and risk factors of psoriasis in gastric cancer patients who underwent gastrectomy and in the general population. Methods: A nationwide retrospective cohort of 52,608 gastric cancer survivors (2007~2015) was compared to 123,438 matched controls from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. We also calculated the HRs for psoriasis according to adjuvant cancer treatment, obesity, and vitamin B12 supplementation in gastric cancer survivors. Results: During a mean follow-up of 6.85 years, 645 of the 52,608 gastric cancer patients developed psoriasis, while 1,806 in the 123,438 matched control group developed psoriasis. Gastric cancer patients had a decreased risk of psoriasis (HR, 0.86; 95% confidence interval, 0.79~0.94), especially those who underwent subtotal gastrectomy. We found that vitamin B12 supplementation for more than 3 years had an additive effect on decreasing the risk of psoriasis in gastric cancer patients who underwent subtotal gastrectomy. Total gastrectomy, radio/chemotherapy, and obesity did not affect the risk of psoriasis in gastric cancer survivors. Conclusion The incidence of psoriasis is slightly lower in gastric cancer survivors than in the general population. Our results suggest that the development of psoriasis may be reduced by removing the source of systemic inflammation caused by Helicobacter pylori infection through subtotal gastrectomy in gastric cancer survivors.

Background: Non-palpable splenomegaly in patients with polycythemia vera (PV) has seldom been addressed. In this retrospective study, we evaluated non-palpable, volumetric splenomegaly defined based on age- and body surface area (BSA)–matched criteria in patients with PV diagnosed according to the 2016 World Health Organization diagnostic criteria. Methods: Patients with PV who underwent abdominal computed tomography (CT) and who had palpable splenomegaly at diagnosis from January 1991 to December 2020 at Chungnam National University Hospital were enrolled. The spleen volume of each patient was determined by volumetric analysis of abdominal CT and adjusted for the patient’s age and BSA. Then the degree of splenomegaly was classified as no splenomegaly, borderline volumetric splenomegaly, overt volumetric splenomegaly, or palpable splenomegaly. Results: Of the 87 PV patients enrolled, 15 (17.2%) had no splenomegaly, whereas 17 (19.5%), 45 (51.7%), and 10 (11.5%) had borderline volumetric, overt volumetric, and palpable splenomegaly, respectively. The degree of splenomegaly did not affect the cumulative incidence of thrombotic vascular events (10-year incidence: 7.7%, 0%, 22.3%, and 50.7%, respectively, P = 0.414). By contrast, splenomegaly tended to adversely affect myelofibrotic transformation (10-year cumulative incidence: 0%, 0%, 7.1%, and 30.3%, respectively, P = 0.062). Moreover, the cumulative incidence of myelofibrotic transformation was significantly higher in patients with overt volumetric or palpable splenomegaly than those with no or borderline volumetric splenomegaly (10-year incidence: 0% vs. 10.3%, respectively; 15-year incidence: 0% vs. 26.3%, respectively, P = 0.020). Overall survival (OS) differed among patients with different degrees of splenomegaly (15-year OS: 100%, 78.6%, 71.7%, and 51.9%, respectively, P = 0.021). Conclusion The degree of splenomegaly, including volumetric splenomegaly, based on ageand BSA-matched reference spleen volumes at diagnosis reflects disease progression in PV patients. Therefore, volumetric splenomegaly should be evaluated at the time of diagnosis and taken into consideration when predicting the prognosis of patients with PV.

Background: To evaluate workload in emergency rooms (ERs) among clinical specialties including neurology and investigate characteristics of neurological consultations in ER. Methods: A nationwide survey was conducted to evaluate the number of specialists, resident physicians/surgeons, and emergency consultations of each clinical specialty in Korean tertiary referral hospitals from 2018 to 2019. Characteristics of neurological emergency consultations during the same period were investigated in one of the hospitals that participated. Results: A total of 23 hospitals were included. Four irrelevant clinical specialties were excluded. The number of neurology specialists and resident physicians were 12.5/hospital (4.1% of all specialists) and 6.4/hospital (3.4% of all resident physicians/surgeons), respectively, while the mean numbers of specialists and resident physicians or surgeons per clinical specialty were 13.7/hospital and 8.6/hospital, respectively. Neurological consultations accounted for 11.0% of all ER consultations for severe patients (Korean Triage and Acuity Scale level 1-3). Annual ER consultations for severe patients per neurology specialist was 274.1, which was only second to pediatrics (290.0). Annual ER consultations for severe patients per resident physician was 406.6 which was 1.6 times higher than the second highest (internal medicine, 247.0). Frequent conditions for neurological ER consultation were dizziness (24.8%), motor weakness (23.9%), headache (10.6%), dysarthria (9.9%), and seizures (7.7%). Frequent primary diagnoses were cerebrovascular diseases (29.0%) and episodic and paroxysmal disorders (24.9%). Conclusions Workloads of neurology specialists for ER consultation were significantly heavy, and the workload of neurology resident physicians was the heaviest among all specialties. This should be considered in health care policies.