Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson’s Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30–3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

Purpose: The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. Materials and Methods: A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. Results: AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001).Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). Conclusion AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.

Objective: Data pertaining to the prognostic value of the combination of high neutrophilto-lymphocyte ratio (NLR) and anemia on admission in patients with ST-segment elevation myocardial infarction (STEMI) are limited. The objective of this study was to investigate the clinical value of baseline NLR in combination with anemia in predicting clinical outcomes after STEMI. Methods: A total of 5,194 consecutive patients with STEMI within 12 hours of symptom onset from the Korea Acute Myocardial Infarction Registry-National Institute of Health database between 2011 and 2015 were categorized into 4 groups according to their NLR and hemoglobin levels: low NLR (<4) without anemia (n=2,722; reference group); high NLR (≥4) without anemia (n=1,527); low NLR with anemia (n=508); and high NLR with anemia (n=437). The co-primary outcomes were 180-day and 3-year all-cause mortality. Results: Mortality rates significantly increased at the 3-year follow-up across the groups (3.3% vs. 5.4% vs. 16.5% vs. 21.7% for 180-day mortality and 5.3% vs. 9.0% vs. 23.8% vs. 33.4% for 3-year mortality; all p-trends <0.001). After adjusting for baseline covariates, the combination of high NLR and anemia was a significant predictor of 180-day mortality after STEMI with low NLR and no anemia as the reference (adjusted hazard ratio, 2.16; 95% confidence interval, 1.58–2.95; p<0.001). Similar findings were observed for the 3-year mortality. Conclusions This nationwide prospective cohort study showed that the combination of high NLR (≥4) and anemia is a strong predictor of all-cause mortality after STEMI.

Background: From only frequency rate of industrial accidents, it is difficult to define the industry composition of accident statistics in a nation. This study aims to propose and develop a new index for measuring the degree of concentration of industrial accidents using the concept of the Herfindahl-Hirschman index in the case of European countries. Methods: Using the concept of the Herfindahl-Hirschman index, the concentration index of accidents in the country is developed, and the conditions of European countries are compared using indexes of frequency rate and concentration ratio. Results: The frequency rate and concentration ratio of fatal and nonfatal accidents in European countries are compared. According to the economic condition and geographical position, different patterns of accidents concentration are presented in terms of frequency rate and concentration ratio. Conclusion We develop the concentration index of industrial and occupational accidents that identifies the industrial ratio of accident occurrence, and the differentiated strategy can be formulated such as approaches to reducing frequency and prioritizing target industries.

OBJECTIVE: To evaluate the effectiveness and efficacy of delayed burr hole surgery in relation to the reduction of postoperative subdural hematoma (SDH) volume in patients with acute SDH. METHODS: We retrospectively analyzed patients with acute SDH who received delayed burr hole surgery at our institute. Age, sex, Glasgow coma scale, maximal SDH thickness, volume of SDH, midline shifts, hounsfield unit (HU), and medical history of anticoagulant agent usage were recorded. Outcome measures were delayed operation day, reduction of SDH volume after operation, and the Glasgow outcome scale (GOS) score at discharge. The patients were divided two groups according to the post-operative reduction of volume of SDH (≥50%, group A; <50%, group B). We also analyzed variables and differences between two groups. RESULTS: Eighteen patients were available for this analysis. The mean delayed of surgery was 13.9±7.5 days. Maximal thickness of SDH was changed from 10.0±3.5 mm to 12.2±3.7 mm. Volume of SDH was changed from 38.7±28.0 mL to 42.6±29.6 mL. Midline shifts were changed from 5.8±3.3 mm to 6.6±3.3 mm. HU were changed from 66.4±11.2 to 53.2±20.6. Post-operative reduction of SDH volume was 52.1±21.1%. Eleven patients (61%) had a discharge GOS score of 1 (good recovery). Ten patients (56%) were enrolled in group A. Midline shifting was greater in group A than in group B (7.4±3.3 vs. 3.0±2.4 mm; p<0.02). The delay of surgery was shorter for group A than group B (9.2±2.3 vs. 19.8±7.7 days; p<0.0008). CONCLUSION: Among well selected patients, delayed burr hole surgery in patients with acute SDH may be effective for reduction of SDH volume. Further studies will be necessary to establish the effectiveness and safety of delayed burr hole surgery in patients with acute SDH.
Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma, Subdural ; Hematoma, Subdural, Acute* ; Humans ; Outcome Assessment (Health Care) ; Retrospective Studies

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.
Aluminum ; Esophageal Neoplasms ; Esophagus ; Hemangioma ; Humans ; Laser Therapy ; Potassium ; Thyroid Gland ; Thyroid Neoplasms

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.
Aluminum ; Esophageal Neoplasms ; Esophagus ; Hemangioma ; Humans ; Laser Therapy ; Potassium ; Thyroid Gland ; Thyroid Neoplasms

Orbital apex syndrome (OAS) has been described previously as a syndrome involving damage to the oculomotor nerve, trochlear nerve, abducens nerve, and ophthalmic branch of the trigeminal nerve in association with optic nerve dysfunction. The conditions and symptoms of OAS are characterized by blindness, fixed dilated pupils, proptosis, ptosis of the eye and ophthalmoplegia. Infectious diseases involving the central nervous system, paranasal sinuses, and periorbital structures may lead to an OAS. We recently experienced a rare case of sphenoidal aspergillosis, which damaged the adjacent cavernous sinus structures and led to the definite symptom of OAS in a 75 year-old female. We present this rare case with a brief review of these disease's entities.
Abducens Nerve ; Aspergillosis ; Blindness ; Cavernous Sinus ; Central Nervous System ; Communicable Diseases ; Exophthalmos ; Eye ; Female ; Humans ; Oculomotor Nerve ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Paranasal Sinuses ; Pupil ; Sinusitis ; Sphenoid Sinusitis ; Trigeminal Nerve ; Trochlear Nerve

BACKGROUND: Pyogenic liver abscess is an acute infectious disease caused by bacteria and can become severe and potentially life-threatening, with a mortality rate of 6-18%. The purpose of this study is to provide the basic informations for the management of liver abscess and the choice of the most effective and economic antibiotics. MATERIALS AND METHODS: We investigated clinical, laboratory, radiologic findings and the results of bacteriological studies retrospectively by reviewing the medical records of 141 cases of pyogenic liver abscess patients, admitted to Catholic University St Vincent's Hospital from January 1998 to December 2007. RESULTS: Patients demographics revealed a mean age of 57.1, (age: 18 to 87), and 71 of the 141 patients were male (50.4%). Cure was achieved in 51 (98.1%) of the 52 patients who were treated with the combination of percutaneous drainage and antibiotics, and in 80 (90.0%) of 89 patients who were treated only with antibiotics. However, there were no significant differences in mortality (P=0.092) and the time to defervescence between both groups. The mean duration of percutaneous drainage was 15.8+/-9.7 days. Sixty-four of 141 patients showed positive culture results, and K. pneumoniae (70.3%) was the most common organism. Among 45 K. pneumoniae, the rates of resistance were 73.3% to ampicillin, 66.7% to piperacillin, 8.9% to cefazolin, 2.2% to cefuroxime, 0% to ceftriaxone, and 0% to ciprofloxacin. CONCLUSIONS: Combination treatment of intravenous antibiotics and percutaneous drainage was effective for the treatment of pyogenic liver abscess. Initial broad spectrum antibiotic coverage and then switch to first or second cephalosporin according to the susceptibility results, could be recommended especially in patients with monomicrobial K. pneumoniae liver abscess.
Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Cefazolin ; Ceftriaxone ; Cefuroxime ; Ciprofloxacin ; Communicable Diseases ; Demography ; Drainage ; Humans ; Liver Abscess ; Liver Abscess, Pyogenic ; Male ; Medical Records ; Piperacillin ; Pneumonia ; Retrospective Studies

BACKGROUND: Pyogenic liver abscess is an acute infectious disease caused by bacteria and can become severe and potentially life-threatening, with a mortality rate of 6-18%. The purpose of this study is to provide the basic informations for the management of liver abscess and the choice of the most effective and economic antibiotics. MATERIALS AND METHODS: We investigated clinical, laboratory, radiologic findings and the results of bacteriological studies retrospectively by reviewing the medical records of 141 cases of pyogenic liver abscess patients, admitted to Catholic University St Vincent's Hospital from January 1998 to December 2007. RESULTS: Patients demographics revealed a mean age of 57.1, (age: 18 to 87), and 71 of the 141 patients were male (50.4%). Cure was achieved in 51 (98.1%) of the 52 patients who were treated with the combination of percutaneous drainage and antibiotics, and in 80 (90.0%) of 89 patients who were treated only with antibiotics. However, there were no significant differences in mortality (P=0.092) and the time to defervescence between both groups. The mean duration of percutaneous drainage was 15.8+/-9.7 days. Sixty-four of 141 patients showed positive culture results, and K. pneumoniae (70.3%) was the most common organism. Among 45 K. pneumoniae, the rates of resistance were 73.3% to ampicillin, 66.7% to piperacillin, 8.9% to cefazolin, 2.2% to cefuroxime, 0% to ceftriaxone, and 0% to ciprofloxacin. CONCLUSIONS: Combination treatment of intravenous antibiotics and percutaneous drainage was effective for the treatment of pyogenic liver abscess. Initial broad spectrum antibiotic coverage and then switch to first or second cephalosporin according to the susceptibility results, could be recommended especially in patients with monomicrobial K. pneumoniae liver abscess.
Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Cefazolin ; Ceftriaxone ; Cefuroxime ; Ciprofloxacin ; Communicable Diseases ; Demography ; Drainage ; Humans ; Liver Abscess ; Liver Abscess, Pyogenic ; Male ; Medical Records ; Piperacillin ; Pneumonia ; Retrospective Studies