Purpose: Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes;however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations. Methods: Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea. Results: Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8–222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer. Conclusion As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2.A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

Purpose: Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes;however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations. Methods: Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea. Results: Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8–222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer. Conclusion As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2.A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

Objective: Serious bacterial infection (SBI) is a common disease among infants, and it is associated with high morbidity and mortality. Making the diagnosis of SBI is challenging and measurement of various biomarkers is useful. This study examined the utility of lactate at an emergency department for diagnosing SBI patients. Methods: This was a retrospective, observational study of febrile infants less than 90 days old presenting to the emergency department of a tertiary hospital between September 2014 and August 2017. The demographic and laboratory data was collected through a chart review. Results: Laboratory tests such as the white blood cell count, C-reactive protein (CRP), procalcitonin, and lactate showed significant differences on the Student-T test and the Mann Whitney-U test. Multivariabe logistic regression test was done using the variables with significant differences. CRP (P=0.037; odds ratio, 1.01), procalcitonin (P=0.011; odds ratio, 1.02) and lactate (P=0.001; odds ratio, 2.38) shows significant correlation. Conclusion For febrile infants at the emergency department, the measurement of lactate is expected to be a useful tool to diagnose serious bacterial infection.

Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

We report the case of 60-yr-old female in which therapeutic hypothermia (TH) was successfully induced maintaining the target temperature of 34degrees C for 12 hr despite a risk of hypothermia-induced coagulation abnormalities following an emergent coronary artery bypass grafting (CABG) due to failed percutaneous coronary intervention, who suffered a cardiac arrest. Emergent CABG may be a relative contraindication for TH in post-cardiac arrest patients because hypothermia may increase the risk of infection and bleeding. However, the possibility of an improved neurologic outcome outweighs the risk of bleeding, although major surgery may be a relative contraindication for TH.
Body Temperature ; Coma/complications ; *Coronary Artery Bypass ; Electrocardiography ; Female ; Heart Arrest/complications/*diagnosis/therapy ; Humans ; *Hypothermia, Induced ; Intensive Care Units ; Middle Aged ; Percutaneous Coronary Intervention ; Treatment Outcome

PURPOSE: The purpose of this study is to investigate the clinical characteristics of patients admitted to emergency rooms with ocular chemical injuries, the substances responsible for such injuries, in order to improve their prevention and treatment. METHODS: The subjects of this study were 73 patients admitted to the hospital with ocular chemical injuries from January 1, 2009 to December 31, 2010. The subjects were divided into groups based on the PSS (poisoning severity score) grade of their injuries, where grades 0 and 1 were classified as the low group (low PSS) and grades 2 and 3 were classified as the high group (high PSS). There were 28 subjects in the low PSS group (38.3%) and 45 subjects in the high PSS group (61.6%). The results were retrospectively reviewed by examining the medical records of the patients. RESULTS: Upon their arrival to the hospital, the most common symptoms were red eye (50.7%), pain (39.7%), and eye irritation (39.7%). Red eyes were more frequently observed from 27 persons (60%) in the high PSS group (p=0.04). The most common causative substances were chemicals and adhesives/glues for both groups (21 cases each). Among the 15 patients exposed to acids or alkalis, 13 patients belonged to the high PSS group. Only two patients visited the hospital after having washed their eyes. CONCLUSION: Worse damage was observed from work-related exposure (including alkali or acid exposure), causing red eye and ocular chemical injuries. Onsite first aid was lacking.
Alkalies ; Burns, Chemical ; Emergency Service, Hospital ; Eye Injuries* ; First Aid ; Humans ; Medical Records ; Occupational Exposure ; Poisoning ; Retrospective Studies ; Therapeutic Irrigation

PURPOSE: Scoring systems such as the Modified Alvarado Score (MAS), Eskelinen score (ES), Lintula score (LS), nd Ohmann score (OS) can be helpful in the early diagnosis of acute appendicitis (AA). We analyze and compare the diagnostic value of each scoring system and investigate the optimal cut off point. METHODS: A total of 62 adult patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Each scoring system was calculated at admission and compared to the final diagnosis. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of scoring systems. The sensitivity and specificity, and area under the ROC curve were calculated. RESULTS: The area under curve of the Ohmann score was higher than those of the other scoring systems (OS: 0.79, MAS: 0.73, ES: 0.65, LS: 0.67). In pairwise comparison of the ROC curve of two scoring systems, OS was found to have significantly higher predictive power than ES and LS. However, no difference was observed between MAS and OS. CONCLUSION: No single score may be used alone to dictate or decline surgery. However, the scoring system may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation may provide helpful information for use by primary or emergency physicians in determination of whether the patient should undergo surgical consultation.
Adult ; Appendicitis ; Area Under Curve ; Early Diagnosis ; Emergencies ; Humans ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tertiary Care Centers

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

PURPOSE OF STUDY: Peripheral nerve regeneration depends on neurotrophism of distal nerve stump, recovery potential of neuron, supporting cell like Schwann cell and neurotrophic factors such as BDNF. Peripheral nerve regeneration can be enhanced by the conduit which connects the both sides of transected nerve. The conduit maintains the effects of neurotrophism and BDNF produced by Schwann cells which can be made by gene therapy. In this study, we tried to enhance the peripheral nerve regeneration by using calcium phosphate coated porous conduit and BDNF-Adenovirus infected Schwann cells in sciatic nerve of rats. MATERIALS AND METHODS: Microporous filter which permits the tissue fluid essential for nerve regeneration and does not permit infiltration of fibroblasts, was made into 2mm diameter and 17mm length conduit. Then it was coated with calcium phosphate to improve the Schwann cell adhesion and survival. The coated filter was evaluated by SEM examination and MTT assay. For effective allogenic Schwann cell culture, dorsal root ganglia of 1-day old rat were extracted and treated with enzyme and antimitotic Ara-C. Human BDNF cDNA was obtained from cDNA library and amplified using PCR. BDNF gene was inserted into adenovirus shuttle vector pAACCMVpARS in which E1 was deleted. We infected the BDNF-Ad into 293 human mammary kidney cell-line and obtained the virus plaque 2 days later. RT-PCR was performed to evaluate the secretion of BDNF in infected Schwann cells. To determine the most optimal m.o.i of BDNF-Ad, we infected the Schwann cells with LacZ adenovirus in 1, 20, 50, 75, 100, 250 m.o.i for 2 hours and stained with beta-galactosidase. Rats(n=24) weighing around 300g were used. Total 14mm sciatic nerve defect was made and connected with calcium phosphate coated conduits. Schwann cells(1x10(6)) or BDNF-Ad infected Schwann cells(1x10(6)) were injected in conduit and only media(MEM) was injected in control group. Twelve weeks after surgery, degree of nerve regeneration was evaluated with gait analysis, electrophysiologic measurements and histomorphometric analysis. RESULTS: 1. Microporous Millipore filter was effective conduit which permitted the adhesion of Schwann cells and inhibited the adhesion of fibroblast. We could enhance the Schwann cell adhesion and survival by coating Millipore filter with calcium phosphate. 2. Schwann cell culture technique using repeated treatment of Ara-C and GDNF was established. The mean number of Schwann cells obtained 1 and 2 weeks after the culture were 1.54+/-4.0*10(6) and 9.66+/-9.6*10(6). 3. The mRNA of BDNF in BDNF-Ad infected Schwann cells was detected using RT-PCR. In Schwann cell 0.69 microgram/microliter of DNA was detected and in BDNF-Adenovirus transfected Schwann cell 0.795 microgram/microliter of DNA was detected. The most effective infection concentration was determined by LacZ Adenovirus and 75 m.o.i was found the most optimal. CONCLUSION: BDNF-Ad transfected Schwann cells successfully regenerated the 14mm nerve gap which was connected with calcium phosphate coated Millipore filter. The BDNF-Ad group showed better results compared with Schwann cells only group and control group in aspect to sciatic function index, electrophysiologic measurements and histomorphometric analysis.
Adenoviridae ; Animals ; beta-Galactosidase ; Brain-Derived Neurotrophic Factor* ; Calcium* ; Cell Adhesion ; Cell Culture Techniques ; Cytarabine ; DNA ; DNA, Complementary ; Fibroblasts ; Gait ; Ganglia, Spinal ; Gene Library ; Genetic Therapy ; Genetic Vectors ; Glial Cell Line-Derived Neurotrophic Factor ; Humans ; Kidney ; Micropore Filters ; Nerve Growth Factors ; Nerve Regeneration ; Neurons ; Peripheral Nerves ; Polymerase Chain Reaction ; Rats* ; Regeneration* ; RNA, Messenger ; Schwann Cells ; Sciatic Nerve*

PURPOSE: Until recently, three variants of benign paroxysmal positional vertigo (BPPV) have been recognized: the first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. However, the last two types of BPPV have not been introduced into the textbook of Emergency Medicine yet. The otolith repositioning maneuvers are effective treatments for BPPV, but in emergency medicine, there has been little interest in and research on them. Our goals were to determine the efficacies of these treatments and to examine the clinical features of each types of BPPV. METHODS: We performed a 6-month prospective study on forty-one patients (47 cases) who presented with a history and physical examination consistent with active BPPV to the emergency departments of a secondary hospital and a tertiary hospital (Dec. 2001-May. 2002). The patients were treated with a modified Epley canalith repositioning maneuver for posterior-canal BPPV, a modified Barbecue rotation for horizontal-canal canalolithiasis, and the maneuver of Jo et al. for horizontal-canal cupulolithiasis. RESULTS: A resolution attributable to the first intervention was obtained in 71.4% of the posterior-canal BPPV cases by using the modified Epley maneuver and in 73.1% of the horizontal-canal BPPV cases by using a modified Barbecue rotation and the maneuver of Jo et al. CONCLUSION: The otolith repositioning maneuvers result in a resolution of vertigo in the majority of patients (84.8% of the cases) immediately after treatment. They are safe and require no special equipment or investigations. They should be established as the treatments of choice for BPPV in emergency department.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Otolithic Membrane* ; Physical Examination ; Prospective Studies ; Tertiary Care Centers ; Vertigo*