Long-term survival after CCRT and HAIC followed by ALPPS for hepatocellular carcinoma with portal vein invasion: a case report

There are various methods for treating advanced hepatocellular carcinoma with portal vein invasion, such as systemic chemotherapy, transarterial chemoembolization, transarterial radioembolization, and concurrent chemoradiotherapy. These methods have similar clinical efficacy but are designed with a palliative aim. Herein, we report a case that experienced complete remission through “associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)” after concurrent chemoradiotherapy and hepatic artery infusion chemotherapy. In this patient, concurrent chemoradiotherapy and hepatic artery infusion chemotherapy induced substantial tumor shrinkage, and hypertrophy of the nontumor liver was sufficiently induced by portal vein ligation (stage 1 surgery) followed by curative resection (stage 2 surgery). Using this approach, long-term survival with no evidence of recurrence was achieved at 16 months. Therefore, the optimal use of ALPPS requires sufficient consideration in cases of significant hepatocellular carcinoma shrinkage for curative purposes.

Diagnosis and treatment of nerve injury following venipuncture - A report of two cases -

Background@#Venipuncture is one of the one of the most commonly performed, minimally-invasive procedures; however, it may lead to peripheral nerve injury. Here, we describe the diagnosis, treatment, and prognosis of two self-reported cases of nerve injury during venipuncture with the aim of drawing attention to possible needle-related nerve injuries.Case: Two anesthesiologists in our hospital experienced an injury of the lateral antebrachial cutaneous branch of the musculocutaneous nerve during venipuncture. Immediately, they underwent ultrasound examinations and nerve blocks with oral medication, resulting in full recovery. @*Conclusions@#Ultrasonography is important for the early and confirmative diagnosis of a nerve injury during venipuncture, and for immediate treatment with a nerve block. Moreover, it is imperative for both the practitioner and the patient to be aware of the possible complication of nerve injury after venipuncture.

Incidence of Febrile Neutropenia in Korean Female Breast Cancer Patients Receiving Preoperative or Postoperative Doxorubicin/Cyclophosphamide Followed by Docetaxel Chemotherapy / 한국유방암학회지

PURPOSE: Doxorubicin/cyclophosphamide followed by docetaxel chemotherapy (AC-D) is an intermediate risk factor (incidence of 10%–20%) for febrile neutropenia (FN) in breast cancer. However, the reported incidence of FN while using this regimen was obtained mostly from Western breast cancer patients, with little data available from Asian patients. This study aimed to assess the incidence of FN in Korean breast cancer patients and to describe clinical variables related to FN. METHODS: From September 2010 to February 2013, data from the Yonsei Cancer Center registry of breast cancer patients who received neoadjuvant or adjuvant chemotherapy with four cycles of AC-D (60 mg/m2 doxorubicin, 600 mg/m2 cyclophosphamide every 3 weeks for four cycles followed by 75 mg/m2 or 100 mg/m2 docetaxel every 3 weeks for four cycles) were analyzed. The incidence of FN, FN associated complications, dose reduction/delays, and relative dose intensity (RDI) were investigated. RESULTS: Among the 254 patients reported to the registry, the FN incidence after AC-D chemotherapy was 29.5% (75/254), consisting of 25.2% (64/254) events during AC and 4.7% (12/254) during docetaxel chemotherapy. Dose reductions, delays, and RDI less than 85.0% during AC were observed in 16.5% (42/254), 19.5% (47/254), and 11.0% (28/254) of patients, respectively. Patients with FN events frequently experienced dose reduction/delays, which eventually led to a decreased RDI. CONCLUSION: The incidence of FN during AC-D neoadjuvant or adjuvant chemotherapy was higher than expected in Korean breast cancer patients. Whether these patients should be classified as a high-risk group for FN warrants future prospective studies.

The Housewives' Purchase Behaviors on Environment-friendly Agricultural Products in Daejeon Area / 대한지역사회영양학회지

This study was to investigate the housewives' purchase behaviors on the environment-friendly agricultural products (EFAP) by survey in Daejeon area housewives. 390 questionnaires were used and analysed. Most of the subjects were female (92.6%) distributed evenly in their 40's (55.4%), and graduated from high school (43.6%) or college (36.4%). Subjects' occupation was most housewives (64.1%) and 77.4% of the subjects had monthly family income of 2 million won or more. 76.9% of the subjects had purchased EFAP already. The reason of purchasing EFAP was mainly "good for health" (80.3%), and reason for non-purchasing was "high prices" (28%) or "not so trustworthy" (25.6%). The most purchasing frequency was "once a week" (29%). 46.7% of the subjects spent 20% of their agricultural product cost for EFAP and 38.7% of them spent less than 30,000 won per month for EFAP. On checking of EFAP labeling, the housewives scored 3.59 for the validate date, 3.25 for the place of origin, 2.8 for the quality certification mark by 4-point Likert scale. 65.1% of the subject had intention to increase purchasing of EFAP in future. To promote the consumption of EFAP, the improvement factors were price-cutting (47.9%), trust on producers (18.2%) and quality betterment (17.7%). Accordingly, the consumers prefer EFAP for wellbeing health of families; however, they hesitate to buy due to their high price and the low reliability on producers of EFAP. Thus the producers and the related organization of EFAP should contrive proper countermeasures to increase consumer's satisfaction level on their credibility and price of EFAP.

Effects of Repeated Ozone Exposure on Airway Remodeling in Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To investigate whether repeated long-term exposure of ozone has an effect on airway remodeling and whether ozone exposure has an aggravating effect on airway remodeling during allergen challenge in previously sensitized mice. MATERIALS AND METHOD: Forty female BALB/c mice were divided into four groups as follows: Group I as the control group, Group II the ovalbumin aerosol exposure group, Group III the ozone exposure group, and Group IV the ovalbumin aerosol and ozone exposure group. Twenty-four hours after the last OVA challenge, the concentration of IFN-gamma, IL-5, IL-13 and TGF-beta and the count of eosinophil and lymphocyte were measured in nasal lavage fluid (NLF) and bronchoalvelolar lavage fluid (BALF). Immunohistochemical staining for MMP-9 and TIMP-1 were performed. Trichrome staining was also conducted to evaluate subepithelial fibrosis. RESULTS: Group II and III exhibited increased IL-5, IL-13, and TGF-beta in NLF and BALF, compared to Group I;Group IV showed more increased pattern for these cytokines, compared to Group II and III. Group II, III, and IV also showed increased expression of MMP-9 and TIMP-1, compared to Group I in lung;Group II and IV showed more compared to Group I and III in nasal cavity mucosa. Subepithelial fibrosis was prominent in Group II, III, and IV, compared with group I. In group IV, subepithelial fibrosis was more increased than Group II and III. CONCLUSION: These results suggest that ozone exposure induces remodeling in upper and lower airway and also enhances allergen-mediated airway remodeling in previously sensitized animals.

Intracranial Ictal EEG Patterns Predicting the Surgical Outcome and the Yield of Intracranial Electrodes in Patients with Temporal Lobectomy

BACKGROUND: Analysis of intracranial ictal patterns may help to predict surgical outcomes. We investigated intracranial EEG patterns to correlate with surgical outcomes and compared the yield of 'subdural electrodes alone (SE)' versus 'combined depth and subdural electrodes (CDSE)' for ictal lateralization in temporal lobe epilepsy (TLE). METHODS: We reviewed a total of 95 seizures recorded by bilateral temporal depth and subdural electrodes in 25 TLE patients who underwent surgery. We classified surgical outcomes as 'seizure-free' or 'not-seizure-free'. Each seizure was analyzed based on the presence or absence of peri-ictal discharges, ictal distribution, waveform patterns, onset frequency and involved number of electrodes, and interhemispheric propagation time (IHPT). The accuracy of lateralizing seizure foci by CDSE was compared to that by SE. RESULTS: 20 patients (80.0%) were 'seizure-free' and 5 (20.0%) were 'not-seizure-free'. The presence of peri-ictal discharges (p<0.001), distribution of depth only or depth and medial electrodes (p<0.001) and higher onset frequency (p=0.021) were associated with 'seizure-free' outcomes. Ictal onset pattern with fast spike trains was common in 'seizure-free', whereas pattern with rhythmic activity was common in 'not-seizure-free' (p=0.005). SE correctly lateralized in 18 of 20 patients, and incorrectly lateralized in the remaining 2 patients, but CDSE correctly lateralized in all 20 patients. CONCLUSIONS: Some intracranial ictal patterns were significantly correlated with good surgical outcomes. These findings suggest that the analysis of ictal EEG patterns help to predict surgical outcomes. CDSE is more accurate for the lateralization of seizure foci compared to SE.

The Related Factors to Atypical Language Dominance in Patients with Epileptic Foci in the Left Hemisphere

BACKGROUND: Several studies have revealed the increased incidence of atypical language dominance in patients with left hemisphere epileptic foci. We retrospectively investigated the incidence and related factors for language dominance shift determined by intracarotid amobarbital procedure (IAP) in patients with left hemispheric epilepsies. METHODS: We included 222 epileptic patients with epileptic foci in left hemisphere whose language dominance was determined by IAP at Asan Medical Center from 1994 to 2004. The items on the language test in IAP included spontaneous speech (6 items), understanding (2 items), and repetition (2 items). Language lateralization index (LI) was computed according to the formula L=(Score IAP right-Score IAP left)/(Score IAP right+Score IAP left). Clinical information was obtained from medical records including age, gender, age at onset of epilepsy, duration of epilepsy, frequency of seizures, risk factors, onset age of risk factors, and lateralization of MRI or EEG. RESULTS: Of the 222 patients (male 110 patients, 49.5%), complete left language dominance was 142 patients (64.0%), and complete right hemispheric language dominance was 29 patients (13.1%). Seizure onset age, onset age of risk factors, handedness and MRI lesions (hippocampal atrophy or left extensive lesion) had statistically significant association with atypical language dominance. On a linear regression analysis, the significant predictors of the atypical language dominancy were handedness and left extensive lesion (R2=.64). CONCLUSIONS: Atypical language dominancy in patients with left epileptic foci was highly correlated with non-right handedness and extensive lesion on the left hemisphere.

The Contributing Factors to Utilize Complementary and Alternative Medicine in People with Epilepsy / 대한간질학회지

PURPOSE: To determine which factors are influential in complementary and alternative medicine (CAM) utilization in people with epilepsy (PWE). METHOD: The 246 adult PWE (53.7% male, mean age 33.6 years) were recruited from out-patient clinic of a tertiary care hospital. Data about CAM utilization in the last five years and willingness of CAM use in the future were collected via a face-to-face semi-structured interview. RESULTS: 1) The utilization rate of CAM among PWE was 31.3% for the last 5 years. On univariate analyses, it was significantly associated with several variables such as men, younger age, shorter epilepsy duration, higher educational level, higher economic status, and the belief in safety of CAM use. Multivariate analyses identified men (p=.021 OR=2.3 [95% CI=1.1 to 4.9]), higher economic status (p=.010, OR=2.5 [95% CI=1.2 to 5.0]), and the belief in safety of CAM use (p=.001, OR=1.9 [95% CI=1.3 to 2.9]). 2) Out of our participants, 30.5% reported that they were willing to utilize CAM for their epilepsy in the future. Univariate analyses showed that it was related to experience of CAM use in the past, higher economic status, and the belief in safety of CAM use. Multivariate analyses identified experience of CAM use in the past (p=.000, OR=8.4 [95% CI=4.0 to 17.7]) and the belief in safety of CAM use (p=.002, OR=1.7 [95% CI=1.2 to 2.6]). CONCLUSION: One third of PWE reported to have use the CAM in the past or to have willingness of the CAM use in the future. The important factors contributing to the CAM use were gender, economic status, experience of the CAM use in the past, and the belief in safety of the CAM use.

Interpretation of Traumatic Lumbar Puncture in Aseptic Meningitis / 소아과

PURPOSE: This study was undertaken to find out a useful method that can predict the true leukocytosis in blood-contaminated cerebrospinal fluid(CSF) due to traumatic lumbar puncture(LP), using white and red cell counts of sanguineous CSF and peripheral blood. METHODS: From May 2001 to December 2002, among 1,247 patients presenting symptoms of meningitis who had received LP at Chonnam Hospital, 126 patients were included in this study who had undergone a second LP due to a traumatic first one. According to the final results of second LP, they were devided into two groups, aseptic meningitis group; and normal CSF group. Medical records were reviewed retrospectively, the proportions of white blood cells to red blood cells were obtained in the peripheral blood(WBC:RBCBlood) and CSF(WBC:RBCCSF), based on the results of the traumatic first LP and simultaneously performed peripheral blood count. The WBC:RBCCSF/WBC:RBCBlood ratio was calculated in each patient. RESULTS: The WBC:RBCCSF/WBC:RBCBlood of the normal CSF group was 13.5+/-7.3(standard deviation), significantly lower than 47.3+/-39.5 of the aseptic meningitis group. CONCLUSION: The WBC:RBCCSF/WBC:RBCBlood is a useful value to predict frank leukocytosis in the blood-contaminated CSF due to traumatic LP, but all clinical and laboratory informations must be considered before deciding on a treatment strategy to minimize the risk of misdiagnosis.

A Case of Verruca Vulgaris Assocaited with Nevus Sebaceus of Jadassohn / 대한피부과학회지

Nevus sebaceus of Jadassohn is organoid nevus that tends to develop secondary tumors on the lesion in adulthood. We report a case of verruca vulgaris associated with nevus sebaceus in a 8-year-old girl. Histologic findings showed typical findings of verruca vulgaris such as papillomatosis, hyperkeratosis, and acanthosis with vaculoated cells as well as the findings of nevus sebaceus. To our knowledge, this is the first case report of verruca vulgaris associated with nevus sebaceus in the Korean dermatologic literatures.

The Usefulness of Nasal Bone CT in Diagnosis of the Nasal Bones Fractures of Children

The incidence of nasal bone fracture in children is relatively uncommon compared with that in adults. But nasal injuries in children merit special attention, because the disturbance of the growth centers essential to the normal development may cause significant cosmetic or functional disabilities, the patients should be carefully examined and properly treated. Because the injured nose swells more quickly and more diffusely in children than in adults, the diagnosis is more difficult. The pediatric patient does not permit even the most gentle examination at times and x-ray examination is often inconclusive. Because of these reasons, the diagnosis of nasal fractures in children is often difficult. The authors have performed facial bone CT in accurate diagnosis of the nasal bones fractures in such children. Conclusively, facial bone CT is useful in early accurate evaluation of the nasal bones fractures in children.

Airway Obstruction Immediately after Endotracheal Intubation for Removal of Cervico-Mediastinal Cystic Hygroma: A case report / 대한마취과학회지

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.

The Level of Tuffier's Line in Korean Adults / 대한마취과학회지

BACKGROUND: Tuffier's line, which connect the two iliac crests, is the often used landmark in determining the level for the needle insertion into lumbar intervertebral space for the spinal and/or epidural blocks. However, the level of Tuffier's line varies depending on the observer. METHODS: Two methods were used to measure the level of Tuffier's line was measured on a simple abdominal X-ray taken in the supine position (study 1). Second, the level of Tuffier's line was also measured on fluroscopy of students in the sitting position (study 2). RESULTS: Overall, the level of Tuffier's line was most frequently observed along the L4-5 intervertebral space and second most frequently observed along the lower one-third of L4. In study 1 using abdominal X-ray, the level of Tuffiers line was most frequently observed along the L4-5 intervertebral space, however, the second most frequently observed level varied depending on the ages of the volunteers. In study 2 using fluoroscopy, the level of Tuffier's line was most frequently observed along the L4-5 intervertebral space and second most frequently observed along the upper one-third of L5. CONCLUSIONS: The level of Tuffier's line was most frequently observed along the L4-5 intervertebral space both in the supine and sitting positions. Further, the level of Tuffier's line went higher with age for women but stayed constant independent of age for men in the supine position.

Pneumomediastinum, Subcutaneous Emphysema, Pneumoperitoneum and Pneumoretroperitoneum after Nephrectomy: A case report / 대한마취과학회지

Pneumomediastinum, air within the planes of the mediastinum, occurs in a wide variety of clinical settings. In the perioperative period, pneumomediastinum is caused by various anesthetic and surgical complications, but may appear spontaneously. When pneumomediastinum occurs with no apparent cause, it is referred to as a spontaneous pneumomediastinum. The suggested mechanism of spontaneous pneumomediastinum is rupture of marginal alveoli due to increased intraalveolar pressure and dissection of air along the bronchovascular sheath into the mediastinum. Predisposing factors include raised intrathoracic pressure, as with coughing, vomiting, and Valsalva maneuvers. The auther's case is presented of pneumomediastinum, with subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum, occurring one day postoperatively, in a 26-year-old female patient who underwent nephrectomy under general anesthesia. The patient was treated conservatively with oxygen and had an uneventful recovery. The authors discuss the possible causes and its management with a review of the relevant literature.

Pneumomediastinum, Subcutaneous Emphysema, Pneumoperitoneum and Pneumoretroperitoneum after Nephrectomy: A case report / 대한마취과학회지

Pneumomediastinum, air within the planes of the mediastinum, occurs in a wide variety of clinical settings. In the perioperative period, pneumomediastinum is caused by various anesthetic and surgical complications, but may appear spontaneously. When pneumomediastinum occurs with no apparent cause, it is referred to as a spontaneous pneumomediastinum. The suggested mechanism of spontaneous pneumomediastinum is rupture of marginal alveoli due to increased intraalveolar pressure and dissection of air along the bronchovascular sheath into the mediastinum. Predisposing factors include raised intrathoracic pressure, as with coughing, vomiting, and Valsalva maneuvers. The auther's case is presented of pneumomediastinum, with subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum, occurring one day postoperatively, in a 26-year-old female patient who underwent nephrectomy under general anesthesia. The patient was treated conservatively with oxygen and had an uneventful recovery. The authors discuss the possible causes and its management with a review of the relevant literature.