Background/Aims: The optimal treatment (Tx) for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains to be determined. Methods: A retrospective review was conducted on 77 NSCLC patients with synchronous BM who underwent first-line EGFR-tyrosine kinase inhibitor (TKI) Tx. The outcomes of patients were analyzed according to the clinicopathological characteristics including local Tx modalities. Results: Fifty-nine patients underwent local Tx for BM (gamma knife surgery [GKS], 37; whole brain radiotherapy [WBRT], 18; others, four) concurrently or sequentially with EGFR-TKI. Patients treated with TKI alone showed significantly lower incidence of central nervous system (CNS) symptoms. The median progression-free survival (PFS) and overall survival (OS) after the initiation of EGFR-TKI for all patients were 9 and 19 months, respectively. In 60 patients with follow-up brain imaging, the median time to CNS progression was 15 months. Patients with EGFR exon 19 deletion had a significantly longer median OS than those with other mutations including L858R (23 months vs. 17 months). Other clinical characteristics, including CNS symptoms, number of BM, and the use of local Tx were not associated with OS, as well as PFS. In terms of the local optimal Tx modality, no difference was found between GKS and WBRT in the OS and PFS. Conclusions This study suggests that EGFR-TKI may result in a favorable outcome in NSCLC patients with synchronous BM, especially in deletion 19 mutant, regardless of the extent of BM lesions or local Tx modalities. Patients with asymptomatic BM can be treated with EGFR-TKI and careful surveillance.

Objective: This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning. Methods: This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used ‘severe poisoning’ as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis. Results: Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83). Conclusion Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.

Objective: This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning. Methods: This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used ‘severe poisoning’ as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis. Results: Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83). Conclusion Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.

BACKGROUND AND PURPOSE: The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown. METHODS: This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/e′ ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/e′ ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. RESULTS: This study finally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42–2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58–9.69] and all-cause death (HR, 1.95; 95% CI, 1.23–3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. CONCLUSIONS: Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
Atrial Fibrillation ; Cohort Studies ; Diastole ; Echocardiography ; Follow-Up Studies ; Heart Atria ; Hospitalization ; Humans ; Prospective Studies ; Registries ; Stroke ; Survivors

PURPOSE: Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. METHODS: We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. RESULTS: Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. CONCLUSION: PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.
Abscess ; Busan ; Constriction, Pathologic ; Female ; Hemorrhage ; Hemorrhoids* ; Humans ; Length of Stay ; Male ; Medical Records ; Mucous Membrane ; Rectovaginal Fistula ; Recurrence ; Retrospective Studies ; Sepsis ; Skin ; Surgeons ; Sutures ; Urinary Retention

In 2008, the Korean Centers for Disease Control and Prevention (KCDC) initiated Korean Community Health Survey (KCHS), the first nationwide survey to provide data that could be used to plan, implement, monitor and evaluate community health promotion and disease prevention program. This community-based cross-sectional survey has been conducted by 253 community health centers, 36 community universities and 1,500 interviewers. The KCHS standardized questionnaire is developed jointly by KCDC staff, a working group of health indicators standardization subcommittee and 16 metropolitan cities and provinces with 253 regional sites. The KCHS was administered by trained interviewers and the quality control of KCHS was improved by introduction of computer-assisted personal interview in 2010. The questionnaire was reviewed annually so that revised and/or new questions could be added based on public health policy. The additional questions included the fixed and rotating cores, emerging issues and optional modules. The standardized questionnaire of KCHS covered a wide variety of health topics, which could be used to assess the prevalence of personal health behaviors related to causes of disease. The KCHS data allows that the differences of health issues among provinces can be directly compared. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention.
Centers for Disease Control and Prevention (U.S.) ; Community Health Centers ; Cross-Sectional Studies ; Health Behavior ; Health Promotion ; Health Surveys ; Humans ; Organothiophosphorus Compounds ; Prevalence ; Public Health ; Quality Control ; Surveys and Questionnaires

We review the effect of methylphenidate, focusing on Osmotic-controlled Release Oral delivery System (OROS) methylphenidate, on cardiovascular system, appetite and growth, sleep, tic, epilepsy, psychiatric and rare adverse events. Although OROS methylphenidate has side effects including increased heart rate or blood pressure, decreased appetite, delayed sleep onset, emergence or aggravation of tics, withdrawal or changes in mood, these effects appeared to be minimal in impact or difficult to distinguish from risk to untreated population and tended to be improved by dose adjustment or drug discontinuation. However, in subjects with underlying cardiac problems, uncontrolled epilepsy, previous psychotic episode, clinicians should pay attention and balance the risk and benefit.
Appetite ; Blood Pressure ; Cardiovascular System ; Epilepsy ; Heart Rate ; Methylphenidate ; Tics

We review the effect of methylphenidate, focusing on Osmotic-controlled Release Oral delivery System (OROS) methylphenidate, on cardiovascular system, appetite and growth, sleep, tic, epilepsy, psychiatric and rare adverse events. Although OROS methylphenidate has side effects including increased heart rate or blood pressure, decreased appetite, delayed sleep onset, emergence or aggravation of tics, withdrawal or changes in mood, these effects appeared to be minimal in impact or difficult to distinguish from risk to untreated population and tended to be improved by dose adjustment or drug discontinuation. However, in subjects with underlying cardiac problems, uncontrolled epilepsy, previous psychotic episode, clinicians should pay attention and balance the risk and benefit.
Appetite ; Blood Pressure ; Cardiovascular System ; Epilepsy ; Heart Rate ; Methylphenidate ; Tics

No abstract available.
Humans ; Retinal Artery ; Retinal Artery Occlusion ; Risk Factors ; Stroke

PURPOSE: The aim of this study is to evaluate the value of preoperative MRCP prior to laparoscopic cholecystectomy by analysis of postoperative outcomes. METHODS: Between 2009.12~2010.12, 283 patients underwent laparoscopic cholecystectomy for treatment of benign biliary disease. Among these patients, 125 underwent preoperative MRCP and were classified as the MRCP group. The remaining 158 patients who did not undergo MRCP were classified as the non MRCP group. We compared perioperative data, including the rate of bile duct injury, operative complication, conversion rate, hospital stay, and hospital cost between the two groups. In addition, we analyzed preoperative MRCP findings, including common bile duct (CBD) stones and bile duct anomaly. RESULTS: Findings on pre-operative MRCP scan revealed silent CBD stones in five patients (4.0%) and bile duct anomalies were identified in 17 patients (13.6%). Three cases of bile duct injury occurred in the non MRCP group, whereas, no bile duct injury occurred in the MRCP group. No significant statistical difference in postoperative complication was observed in either group. Mean duration of operation was 50.5 (+/-30.4) minutes in the MRCP group, and 52.2 (+/-29.9) minutes in the non MRCP group (p=0.630). Post operative hospital stay was 2.1 (+/-1.4) days (mean) in the MRCP group, and 2.5 (+/-2.5) days in the non MRCP group. No statistical difference was observed between the two groups (p=0.110). CONCLUSION: MRCP may be useful for evaluation of bile duct anomaly and identification of hidden bile duct stones. However, this modality did not show statistical benefits for postoperative outcomes in patients who underwent laparoscopic cholecystectomy.
Bile Ducts ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Gallbladder ; Hospital Costs ; Humans ; Length of Stay ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Postoperative Complications