ABSTRACT
Substantial progress has been made in peripheral nerve surgery, owing to the advances in pathophysiological understanding, microsurgical techniques and the improvement of synthetic materials. Despite this, large gaps caused by trauma, tumor resection and congenital deformities show unsatisfactory results. While primary direct end-to-end tension-free nerve repair remains as the gold standard for surgical treatment, an autologous nerve graft is recommended for nerve gaps greater than 2 to 3 cm. Studies cite remarkable clinical reports with decellularized nerve allografts after overcoming the previous immune suppression and cost issues with allograft nerve transfers. New light is being shed regarding synthetic nerve conduits that combines various cytokines and growth factors. Stem cell studies applying biomolecular and biological engineering technologies also show good results. Despite this, further assessment are required for clinical application because these results are based primarily on animal studies.
ABSTRACT
Schwannoma is a rare tumor from the peripheral nerve and is mainly found alone. Diagnosis is made by ultrasonography or magnetic resonance imaging, and magnetic resonance imaging is preferred to ultrasonography for differential diagnosis of mass. After diagnosis, treatment is performed through surgical excision. In this case, a very small-sized neuropathy-causing lesion was identified through ultrasonography with electrodiagnostic study, and the other mass in the same nerve was discovered by chance through ultrasonography. Both masses were identified as schwannoma originating from the ulnar nerve and were successfully excised. We confirmed the advantages of ultrasonography in the rare diagnosis and again showed that ultrasonography has a diagnostic value that is not inferior to magnetic resonance imaging. Also, cases of multiple schwannomas confined to the ulnar nerve are rare and have been rarely reported worldwide. Therefore, it is reported together with the previous reports.
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BACKGROUND@#Autologous nerve grafts are the gold standard treatment for peripheral nerve injury treatment. However, this procedure cannot avoid sacrificing other nerves as a major limitation. The aim of the present study was to evaluate the potential of olfactory ensheathing cells (OECs) embedded in a nerve conduit. @*METHODS@#A 10-mm segment of the sciatic nerve was resected in 21 rats, and the nerve injury was repaired with one of the following (n = 7 per group): autologous nerve graft, poly (ε-caprolactone) (PCL) conduit and OECs, and PCL conduit only. The consequent effect on nerve regeneration was measured based on the nerve conduction velocity (NCV), amplitude of the compound muscle action potential (ACMAP), wet muscle weight, histomorphometric analysis, and nerve density quantification. @*RESULTS@#Histomorphometric analysis revealed nerve regeneration and angiogenesis in all groups. However, there were significant differences (p 0.05). No significant results in NCV, wet muscle weight, and nerve density quantification were observed among the 3 groups. @*CONCLUSION@#A PCL conduit with OECs enhances the regeneration of injured peripheral nerves, offering a good alternative to autologous nerve grafts.
ABSTRACT
BACKGROUND@#Autologous nerve grafts are the gold standard treatment for peripheral nerve injury treatment. However, this procedure cannot avoid sacrificing other nerves as a major limitation. The aim of the present study was to evaluate the potential of olfactory ensheathing cells (OECs) embedded in a nerve conduit. @*METHODS@#A 10-mm segment of the sciatic nerve was resected in 21 rats, and the nerve injury was repaired with one of the following (n = 7 per group): autologous nerve graft, poly (ε-caprolactone) (PCL) conduit and OECs, and PCL conduit only. The consequent effect on nerve regeneration was measured based on the nerve conduction velocity (NCV), amplitude of the compound muscle action potential (ACMAP), wet muscle weight, histomorphometric analysis, and nerve density quantification. @*RESULTS@#Histomorphometric analysis revealed nerve regeneration and angiogenesis in all groups. However, there were significant differences (p 0.05). No significant results in NCV, wet muscle weight, and nerve density quantification were observed among the 3 groups. @*CONCLUSION@#A PCL conduit with OECs enhances the regeneration of injured peripheral nerves, offering a good alternative to autologous nerve grafts.
ABSTRACT
Background/Aims@#Post-hepatectomy liver failure (PHLF) is a major concern for patients with hepatocellular carcinoma (HCC) who have undergone liver resection. The albumin-bilirubin (ALBI) score is a novel model for assessing liver function. We aimed to investigate the effectiveness of the ALBI score as a predictor of PHLF in HCC patients who have undergone hepatectomy in South Korea. @*Methods@#Between January 2014 and November 2018, HCC patients who underwent hepatectomy and indocyanine retention rate at 15 min (ICG-R15) test were enrolled in this study. @*Results@#A total of 101 patients diagnosed with HCC underwent hepatectomy. Thirty-two patients (31.7%) experienced PHLF. The ALBI score (OR 2.83; 95% CI 1.22-6.55; p=0.015), ICG-R15 (OR 1.07; 95% CI 1.02-1.12; p=0.007) and ALBI grade (OR 2,86; 95% CI 1.08-7.58; p=0.035) were identified as independent predictors of PHLF by multivariable analysis. The area under the receiver operating characteristic curve of the ALBI score and ICG-R15 were 0.676 (95% CI 0.566-0.785) and 0.632 (95% CI 0.513-0.752), respectively. The optimal cutoff value of the ALBI score in predicting PHLF was -2.62, with a sensitivity of 75.0% and a specificity of 56.5%. @*Conclusions@#The ALBI score is an effective predictor of PHLF in patients with HCC, and its predictive ability is comparable to that of ICG-R15.
ABSTRACT
Fascioliasis is a zoonotic disease caused by Fasciola Hepatica that infects mainly cattle, sheep, and goats. Humans can be infected by water or aquatic plants contaminated with metacercariae. The authors encountered two cases of F. hepatica infection. One patient reported abdominal discomfort with marked eosinophilia. The other patient had chest discomfort with marked eosinophilia. The abdominal CT images revealed hypodense lesions in the liver. The ultrasonography-guided liver biopsy findings in both patients were indicative of parasitic infections. Serological tests confirmed the definite diagnoses. Both patients were treated with a single dose of triclabendazole, which is the treatment of choice for fascioliasis. These findings suggest that a diagnosis of fascioliasis, particularly in the acute phase, should be considered in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT.
ABSTRACT
Transarterial chemoembolization (TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). The most common complications after TACE are non-specific symptoms called post-embolization syndrome, such as abdominal pain or fever. Rare complications, such as liver failure, liver abscess, sepsis, pulmonary embolism, cholecystitis, can also occur. On the other hand, gallbladder perforation is quite rare. This paper reports a case of gallbladder perforation following TACE. A 76-year-old male with a single 9-cm-sized HCC underwent TACE. Five days after TACE, he developed persistent right upper quadrant pain and ileus. An abdomen CT scan confirmed gallbladder perforation with bile in the right paracolic gutter and pelvic cavity. Percutaneous transhepatic gallbladder drainage was performed with the intravenous administration of antibiotics. After 1 month, the patient underwent right hemihepatectomy and cholecystectomy. Physicians should consider the possibility of gallbladder perforation, which is a rare complication after TACE, when unexplained abdominal pain persists.
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Objectives@#ZZThe purpose of this study is to investigate the interest level, perception and attitude of suicide high-risk group towardthe media’s suicide report, and also to provide the fundamental data in order to strengthen both the standard and the recommendationof media coverage in Korea. @*Methods@#ZZWe analyzed the data from the 2013 The Korea National Suicide Survey. The study included 1500 participants aged between19 and 75 years. The participants were selected through the regional multi-layer stratification method using the sampling frameof the 2010 Census. One-on-one face-to-face interviews investigated the interest level, opinions, and attitudes toward suicide reportsand collected data on past suicide history and demographic data. The collected data were evaluated using multiple logistic regressionanalysis. A probability level of p < 0.05 was considered statistically significant. @*Results@#ZZThe suicide high risk groups with histories of suicidal ideations or attempts showed more interest in suicidal reports [suicidalthought odds ratio (OR) = 1.81, 95% confidence interval (CI) = 1.40–2.34 ; suicidal attempt OR = 3.21, 95% Cl = 1.52–6.78]. However,there was no difference among the groups in thought that suicide reports incite suicide (suicidal thought OR = 1.26, 95% Cl = 0.92–1.73 ; suicidal attempt OR = 0.96, 95% Cl = 0.44–2.09). The suicide high risk groups showed a positive attitude toward suicide reports,but it was not statistically significant (suicidal thought OR = 1.10, 95% Cl = 0.41–2.92 ; suicidal attempt OR = 1.10, 95% Cl = 0.76–1.59). @*Conclusions@#ZZWe suggest the need of careful attitude of media suicidal reports not to bring about copycat suicides. and also we offersuicide prevention campaign based on media leverage.
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Objectives@#ZZThe purpose of this study is to investigate the interest level, perception and attitude of suicide high-risk group towardthe media’s suicide report, and also to provide the fundamental data in order to strengthen both the standard and the recommendationof media coverage in Korea. @*Methods@#ZZWe analyzed the data from the 2013 The Korea National Suicide Survey. The study included 1500 participants aged between19 and 75 years. The participants were selected through the regional multi-layer stratification method using the sampling frameof the 2010 Census. One-on-one face-to-face interviews investigated the interest level, opinions, and attitudes toward suicide reportsand collected data on past suicide history and demographic data. The collected data were evaluated using multiple logistic regressionanalysis. A probability level of p < 0.05 was considered statistically significant. @*Results@#ZZThe suicide high risk groups with histories of suicidal ideations or attempts showed more interest in suicidal reports [suicidalthought odds ratio (OR) = 1.81, 95% confidence interval (CI) = 1.40–2.34 ; suicidal attempt OR = 3.21, 95% Cl = 1.52–6.78]. However,there was no difference among the groups in thought that suicide reports incite suicide (suicidal thought OR = 1.26, 95% Cl = 0.92–1.73 ; suicidal attempt OR = 0.96, 95% Cl = 0.44–2.09). The suicide high risk groups showed a positive attitude toward suicide reports,but it was not statistically significant (suicidal thought OR = 1.10, 95% Cl = 0.41–2.92 ; suicidal attempt OR = 1.10, 95% Cl = 0.76–1.59). @*Conclusions@#ZZWe suggest the need of careful attitude of media suicidal reports not to bring about copycat suicides. and also we offersuicide prevention campaign based on media leverage.
ABSTRACT
Suicide is a serious problem worldwide, especially in Korea, but the factors affecting suicide are complex and diverse. Therefore, a medical policy should be developed to help establish an effective national suicide prevention policy in Korea. To reduce suicide rates effectively, some of the current suicide prevention policies need to be improved. This study proposes the following steps to do so: 1) standardizing the suicide attempt management system, 2) strengthening effective counseling programs in the psychiatric field, and 3) strengthening early psychiatric interventions in patients with a physical illness. These improvements should be considered high-priority measures for ensuring successful suicide prevention at the national level.
ABSTRACT
OBJECTIVES: Suicide is a complex phenomenon not only caused by the individual's mental illness and economic situation, but also occurred in sociocultural contexts and relationships around the individual. Therefore, the attitudes, which include collective norms, thoughts and feelings of a population, toward suicide play a fundamental role in the prevention of suicide. Factor structure of Attitudes Toward Suicide (ATTS), developed by Renberg, is also various in different sociocultural contexts. This is the first study to investigate factor structure of ATTS along with nationwide sample of Korean adults.METHODS: This study analyzed the factor structure and reliability of ATTS in 1500 regionally stratified Korean adults. Exploratory factor analysis was performed by using principal axis factoring and varimax rotation.RESULTS: The selection of 33 ATTS items based on internal consistency and communality was conducted. Five factors were analyzed, which were named ‘Good reason,’ ‘Negative gaze,’ ‘Predictability,’ ‘Means of escape,’ and ‘Common secret,’ respectively. Explained total variance was 41.94%, and the internal consistency ranged from 0.516 to 0.740.CONCLUSIONS: Each of the five factors contains different semantic dimensions. Consistent with previous studies, factors containing permissive attitude toward suicide was high in those with history of suicidal thought and of suicide attempt. It is notable that the ‘Good reason’ showed higher score in elderly. This may be related to socioeconomic or physical adversities which have been considered the major cause of suicide in elderly.
Subject(s)
Adult , Aged , Humans , Factor Analysis, Statistical , Korea , Semantics , SuicideABSTRACT
OBJECTIVES: The aim of this study was to explore the prevalence of type 1 diabetes in patients with schizophrenia and their total medical costs and risk of hospitalization. METHODS: This study used Health Insurance Review and Assessment Service data in Korea. To examine total medical costs and risk of hospitalization, we selected 1,510 subjects with schizophrenia (half with and half without type 1 diabetes) that were 1:1 matched via propensity score matching. In health care system perspective, total medical costs included out-of-pocket and insurer's costs. Logistic regression models were used to examine the risk of hospitalization. RESULTS: The prevalence of type 1 diabetes in patients with schizophrenia was 3.87 per 1,000 person year. Among patients with schizophrenia, the amount of total average medical costs and hospitalization costs in patients with type 1 diabetes was 1.49 and 1.59 times higher than those in patients without it, respectively. The odds of hospitalization were higher among patients with type 1 diabetes compared with those without it (odds ratio, OR=1.97 ; 95% CI 1.60–2.43). CONCLUSION: This study showed that medical costs and risk of hospitalization were higher in schizophrenia patients with type 1 diabetes. Therefore, these individuals may require specific care programs.
Subject(s)
Humans , Comorbidity , Delivery of Health Care , Diabetes Mellitus, Type 1 , Hospitalization , Insurance, Health , Korea , Logistic Models , Prevalence , Propensity Score , SchizophreniaABSTRACT
Suicide is a serious problem worldwide, especially in Korea, but the factors affecting suicide are complex and diverse. Therefore, a medical policy should be developed to help establish an effective national suicide prevention policy in Korea. To reduce suicide rates effectively, some of the current suicide prevention policies need to be improved. This study proposes the following steps to do so: 1) standardizing the suicide attempt management system, 2) strengthening effective counseling programs in the psychiatric field, and 3) strengthening early psychiatric interventions in patients with a physical illness. These improvements should be considered high-priority measures for ensuring successful suicide prevention at the national level.
Subject(s)
Humans , Counseling , Korea , SuicideABSTRACT
Carpal tunnel syndrome is rare in children. When it does occur in children, the most common causes reported are mucopolysaccharidosis and mucolipidosis. The median artery is a transitory vessel that develops from the axillary artery in early embryonic life and does not normally survive until postfetal life. In a small percentage of individuals, however, it persists into adulthood and is frequently accompanied by a bifid median nerve. A persistent median artery can be a cause of carpal tunnel syndrome in adults, but it is extremely rare in children and adolescents. This paper reports a case of a carpal tunnel syndrome caused by a persistent median artery and bifid median nerve in a 13-year-old girl.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Arteries , Axillary Artery , Carpal Tunnel Syndrome , Median Nerve , Mucolipidoses , MucopolysaccharidosesABSTRACT
OBJECTIVES: This study tried to explore the prevalence of chronic physical diseases in patients with schizophrenia and its effects on total medical costs. METHODS: The Health Insurance Review and Assessment Service data in 2014–2015 was employed. Only the injuries and diseases, identically diagnosed 3 times or more as a major or minor injury and disease, were classified into chronic physical diseases to improve data accuracy. Total medical costs included out-of-pocket and insurer's costs from health care system perspective. RESULTS: It was shown that 24.5%, 17.3% and 23.4% of schizophrenia patients had one, two and three or more chronic physical diseases, respectively. There was a high prevalence of not only metabolic, but also musculoskeletal, diseases in those patients. The amount of 2015 total medical costs of patients with schizophrenia in 2014 was about 1.08 trillion won. The factors affecting the costs included sex, age, number of chronic physical diseases, and health insurance status. CONCLUSIONS: It is considered that clinical practice guidelines based on personal diseases may not sufficiently solve the problems for comorbidities in schizophrenia patients. Accordingly, it should be required to develop models for new types of medical systems capable of treating and caring varied illnesses at the same time.
Subject(s)
Humans , Comorbidity , Data Accuracy , Delivery of Health Care , Insurance, Health , Prevalence , SchizophreniaABSTRACT
OBJECTIVES: The aim of this study was to analyze research and development projects in mental health services in Korea, using priority evaluation of mental health promotion policies to determine direction of the service. METHODS: An online survey was conducted that targeted experts in the mental health service regarding promotion of mental health in Korea in 2016. The survey was based on 32 policy projects that resulted from 12 strategies according to 4 policy objectives. RESULTS: Analysis of 32 mental health projects were assessed regarding the possibility of technology development success, magnitude of the ripple effect, and necessity of a national response. It was observed that 3 policy projects relevant to suicide, had a high relative priority. This was followed by policies for improvement of health insurance and the medical benefit cost system, and policies for reinforcement of crisis psychological support such as those for disaster victims. CONCLUSION: The prioritization of mental health services should place an emphasis on promotion of a healthy mental lifestyle, rehabilitation support for patients with serious mental illness, and reinforcement of social safety networks for suicide prevention.
Subject(s)
Humans , Disaster Victims , Health Promotion , Industrial Development , Insurance, Health , Korea , Life Style , Mental Health Services , Mental Health , Rehabilitation , Social Change , SuicideABSTRACT
BACKGROUND/AIMS: Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs. METHODS: Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis. RESULTS: A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions. CONCLUSIONS: Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.
Subject(s)
Humans , Antiviral Agents , Hepatitis C , Hepatitis C, Chronic , Interferons , Medical Records , Recurrence , RNAABSTRACT
OBJECTIVE: This study was designed to examine the pattern of benzodiazepine use in a representative sample of patients with schizophrenia in Korea. METHOD: Data generated by the Health Insurance Review Agency of Korea was used to examine the frequency of benzodiazepine use. Demographic and geographic factors, hospital types in which patients received prescriptions, health insurance coverage, and the number of concomitant antipsychotics associated with benzodiazepine use were explored by multivariate logistic regression analysis. RESULTS: Among the 183427 patients with schizophrenia, the frequency of benzodiazepine use was 67.5% (n=122859). Use of benzodiazepines was highly associated with female patients treated in hospitals located in Gyeonggi, Gyeongsang, and Gangwon provinces, medicaid patients, patients treated in mental hospitals and private psychiatric clinics, and patients using concomitant antipsychotic agents. CONCLUSION: The study demonstrated that benzodiazepine use was highly prevalent among patients with schizophrenia. Long-term use of benzodiazepine may be at higher risk of neurocognitive side effects and risk of mortality. Therefore, patients with schizophrenia taking benzodiazepine concomitantly should be closely monitored for benefits and risks of benzodiazepine use. For the medicaid patients, policy change is urgently needed in order for patients to receive equal quality of treatment with that of non-medicaid patents.
Subject(s)
Female , Humans , Antipsychotic Agents , Benzodiazepines , Geography , Hospitals, Psychiatric , Insurance, Health , Korea , Logistic Models , Medicaid , Methods , Mortality , Prescriptions , Risk Assessment , SchizophreniaABSTRACT
Double compression of the ulnar nerve, including Guyon's canal syndrome associated with cubital tunnel syndrome caused by the anconeus epitrochlearis muscle, is a very rare condition. We present a case of double crush syndrome of the ulnar nerve at the wrist and elbow in a 55-year-old man, as well as a brief review of the literature. Although electrodiagnostic findings were consistent with an ulnar nerve lesion only at the elbow, ultrasonography revealed a ganglion compressing the ulnar nerve at the hypothenar area and the anconeus epitrochlearis muscle lying in the cubital tunnel. Careful physical examination and ultrasound assessment of the elbow and wrist confirmed the clinical diagnosis prior to surgery.
Subject(s)
Humans , Middle Aged , Crush Syndrome , Cubital Tunnel Syndrome , Deception , Diagnosis , Elbow , Ganglion Cysts , Physical Examination , Ulnar Nerve , Ultrasonography , WristABSTRACT
PURPOSE: The purpose of this study was to investigate the effects of transplantation of an in vitro-generated, scaffold-free, tissue-engineered cartilage tissue analogue (CTA) using a suspension chondrocyte culture in a rabbit growth-arrest model. MATERIALS AND METHODS: We harvested cartilage cells from the articular cartilage of the joints of white rabbits and made a CTA using a suspension culture of 2x107 cells/mL. An animal growth plate defect model was made on the medial side of the proximal tibial growth plate of both tibias of 6-week-old New Zealand white rabbits (n=10). The allogenic CTA was then transplanted onto the right proximal tibial defect. As a control, no implantation was performed on the left-side defect. Plain radiographs and the medial proximal tibial angle were obtained at 1-week intervals for evaluation of bone bridge formation and the degree of angular deformity until postoperative week 6. We performed a histological evaluation using hematoxylin-eosin and Alcian blue staining at postoperative weeks 4 and 6. RESULTS: Radiologic study revealed a median medial proximal tibial angle of 59.0degrees in the control group and 80.0degrees in the CTA group at 6 weeks. In the control group, statistically significant angular deformities were seen 3 weeks after transplantation (p<0.05). On histological examination, the transplanted CTA was maintained in the CTA group at 4 and 6 weeks postoperative. Bone bridge formation was observed in the control group. CONCLUSION: In this study, CTA transplantation minimized deformity in the rabbit growth plate injury model, probably via the attenuation of bone bridge formation.