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1.
Article in English | WPRIM | ID: wpr-874809

ABSTRACT

Objective@#: The low-profile Neuroform Atlas stent can be deployed directly without an exchange maneuver by navigating into the Gateway balloon. This retrospective study assessed the safety and efficacy of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombetomy (MT) for large artery occlusion. @*Methods@#: Between June 2018 and December 2019, a total of 31 patients underwent Neuroform Atlas stenting with prior Gateway balloon angioplasty after failure of conventional MT caused by residual intracranial atherosclerotic stenosis (ICAS). Primary outcomes were successful recanalization and patency of the vessel 24 hours after intervention. Secondary outcomes were vessel patency after 14 days and 3-month modified Rankin Scale. Peri-procedural complications, intracerebral hemorrhage (ICH), and 3-month mortality were reviewed. @*Results@#: With a 100% of successful recanalization, median value of stenosis was reduced from 79.0% to 23.5%. Twenty-eight patients (90.3%) showed tolerable vessel patency after 14 days. New infarctions occurred in three patients (9.7%) over a period of 14 days; two patient (6.5%) underwent stent occlusion at 24 hours, and the other patient (3.2%) with delayed stent occlusion had a non-symptomatic dot infarct. There were no peri-procedural complications. Two patients (6.5%) developed an ICH immediately after the procedure with one of them is symptomatic. @*Conclusion@#: Neuroform Atlas stenting seems to be an effective and safe rescue treatment modality for failed MT with residual ICAS, by its high successful recanalization rate with tolerable patency, and low peri-procedural complication rate. Further multicenter and randomized controlled trials are needed to confirm our findings.

2.
Article in English | WPRIM | ID: wpr-874800

ABSTRACT

Objective@#: The Solitaire Platinum 4×40 mm stent retriever contains radiopaque markers with a long length. We evaluated the effect of Solitaire Platinum 4×40 mm stent retriever in Solumbra technique thrombectomy, and compared it with shorter Solitaire stent retrievers. @*Methods@#: A total of 70 patients who underwent Solumbra technique thrombectomy with equal diameter (4 mm) and different length (40 vs. 20 mm) Solitaire stent retrievers were divided into two groups : the Solitaire Platinum 4×40 mm stent (4×40) group and the Solitaire FR 4×20 mm stent or Solitaire Platinum 4×20 mm stent (4×20) group. The clinical outcomes, Thrombolysis in Cerebral Infarction score, the first pass reperfusion status, and complications were evaluated and compared between the two groups. Multivariate analysis was performed to evaluate the predictive factors for reperfusion and complete reperfusion from the first pass. @*Results@#: Higher first-pass reperfusion and complete reperfusion were achieved in the 4×40 group (68.0% and 48.0%) than in the 4×20 group (46.7% and 33.3%; p=0.004 and 0.007, respectively). In multivariate analysis, radiopaque device and longer stent retriever were correlated with first-pass reperfusion (p=0.014 and 0.008, respectively) and first-pass complete reperfusion (p=0.022 and 0.012, respectively). @*Conclusion@#: Our study demonstrated the usefulness of the Solitaire Platinum 4×40 mm stent retriever, which led to higher firstpass reperfusion and complete reperfusion rates than the Solitaire FR 4×20 mm stent or the Solitaire Platinum 4×20 mm stent, especially in Solumbra technique thrombectomy.

3.
Chonnam Medical Journal ; : 58-61, 2021.
Article in English | WPRIM | ID: wpr-874392

ABSTRACT

The purpose of this study was to evaluate clinical characteristics and treatment outcome of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP), treated according to the method of our hospital. Six patients with histopathologically and radiologically confirmed HNSCCUP January 2010-December 2016 were enrolled in this study. All patients underwent radical neck dissection involving level I-V, bilateral tonsillectomy, and diagnostic esophagoscopy and postoperative radiotherapy (RT), with or without concurrent chemotherapy. There were no major complications resulting from surgical intervention. Duration of follow-up was 56.3±20.2 months (range, 28-82 months). There was no recurrence or late detection of primary site of HNSCCUP. All patients with HNSCCUP except one were alive, at the time of the last follow-up. The other patient had no recurrence of HNSCCUP, but died of colon cancer at 58 months postoperatively. We have successfully treated patients with HNSCCUP by performing radical neck dissection, bilateral tonsillectomy, and diagnostic esophagoscopy and postoperative RT with concurrent chemotherapy, and recommend using this method as the main treatment method.

4.
Article in English | WPRIM | ID: wpr-875405

ABSTRACT

The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir.

5.
Article in English | WPRIM | ID: wpr-903452

ABSTRACT

Objectives@#The aim of this study was to examine the clinical presentation, treatment delivery, and cisplatin eligibility of Korean patients with urothelial carcinoma (UC) in a real-world setting. @*Methods@#We performed a retrospective cohort study of patients initially diagnosed with UC from March 2013 to June 2018. Creatinine clearance >60 mL/min and Eastern Cooperative Oncology Group performance status (0–1) were adopted as cisplatin eligibility criteria. @*Results@#This study included 557 eligible patients. Median age was 71.0 years (range, 33–94 years), and males were dominant (80%). Primary tumor sites were: upper genitourinary tract, 18%; bladder, 81%; and urethra, 0.4%. Initial disease status was non-muscle invasive bladder cancer (313, 56%), diffuse infiltrating non-muscle invasive bladder cancer (19, 3%), cTanyN0 upper tract UC (75, 13%), cT2-4N0 bladder UC (82, 15%), TanyN1-3 UC (36, 7%), or initially metastatic UC (32, 6%). At the time of analysis (June 2019), following treatments were delivered to 134 patients with localized UC: radical operation with or without perioperative treatment (89, 67%), definitive chemoradiation (7, 5%), and palliative surgery or supportive care only (36, 28%). In total, 89 patients had metastatic UC, including those with recurrent disease (n=57), and 34 (38%) of the 89 were eligible for cisplatin. @*Conclusion@#Clinical presentations in East Asian UC patients were consistent with those of previous studies in other countries, except for a relatively high incidence of upper genitourinary tract. Our results can serve as a benchmark for further advances and future research for treatments of UC in East Asian patients.

6.
Annals of Dermatology ; : 351-361, 2021.
Article in English | WPRIM | ID: wpr-896785

ABSTRACT

Background@#Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients’ quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. @*Objective@#These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. @*Methods@#A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. @*Results@#Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. @*Conclusion@#These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.

7.
Article in English | WPRIM | ID: wpr-895748

ABSTRACT

Objectives@#The aim of this study was to examine the clinical presentation, treatment delivery, and cisplatin eligibility of Korean patients with urothelial carcinoma (UC) in a real-world setting. @*Methods@#We performed a retrospective cohort study of patients initially diagnosed with UC from March 2013 to June 2018. Creatinine clearance >60 mL/min and Eastern Cooperative Oncology Group performance status (0–1) were adopted as cisplatin eligibility criteria. @*Results@#This study included 557 eligible patients. Median age was 71.0 years (range, 33–94 years), and males were dominant (80%). Primary tumor sites were: upper genitourinary tract, 18%; bladder, 81%; and urethra, 0.4%. Initial disease status was non-muscle invasive bladder cancer (313, 56%), diffuse infiltrating non-muscle invasive bladder cancer (19, 3%), cTanyN0 upper tract UC (75, 13%), cT2-4N0 bladder UC (82, 15%), TanyN1-3 UC (36, 7%), or initially metastatic UC (32, 6%). At the time of analysis (June 2019), following treatments were delivered to 134 patients with localized UC: radical operation with or without perioperative treatment (89, 67%), definitive chemoradiation (7, 5%), and palliative surgery or supportive care only (36, 28%). In total, 89 patients had metastatic UC, including those with recurrent disease (n=57), and 34 (38%) of the 89 were eligible for cisplatin. @*Conclusion@#Clinical presentations in East Asian UC patients were consistent with those of previous studies in other countries, except for a relatively high incidence of upper genitourinary tract. Our results can serve as a benchmark for further advances and future research for treatments of UC in East Asian patients.

8.
Article in English | WPRIM | ID: wpr-913765

ABSTRACT

Background@#Modified orbitozygomatic craniotomy is characterized by simplicity and wide exposure. The purpose of the present study was to describe a modified orbitozygomatic approach without resecting the zygomatic arch for large parasellar tumor surgeries. @*Methods@#Between April 2016 and December 2019, seven patients with parasellar tumor underwent surgiest with a modified orbitozygomatic approach. Surgical procedures, clinical outcomes, and complications were analyzed. @*Results@#This study included 3 meningiomas, 2 pituitary adenomas, 1 chondrosarcoma, and 1 schwannoma. Modified orbitozygomatic craniotomy provides a wider surgical freedom in the opticocarotid and prechiasmatic cistern than frontotemporal craniotomy without orbitotomy, Total, subtotal, and partial resections were achieved for 3, 2, and 2 patients, respectively. Reasons for partial resections were tight adhesion to the carotid artery and encasing of the carotid artery. Permanent morbidities developed in one patient with 3rd nerve palsy and one patient with hemiparesis. @*Conclusion@#Modified orbitozygomatic approach can provide the shortest access to the interpeduncular cistern with a minimum brain retraction. Surgeons who experience surgical challenge during the conventional approach for parasellar tumor resection are recommended to learn the modified orbitozygomatic approach.

9.
Annals of Dermatology ; : 351-361, 2021.
Article in English | WPRIM | ID: wpr-889081

ABSTRACT

Background@#Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients’ quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. @*Objective@#These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. @*Methods@#A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. @*Results@#Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. @*Conclusion@#These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.

10.
Article in English | WPRIM | ID: wpr-889820

ABSTRACT

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.

11.
Article | WPRIM | ID: wpr-837203

ABSTRACT

PURPOSE@#. The purpose of this in vitro study was to examine the reliability of the Anycheck device and the effect of the healing abutment diameter on the Anycheck values (implant stability test, IST). @*MATERIALS AND METHODS@#. Thirty implants were placed into three artificial bone blocks with 10 Ncm, 15 Ncm, and 35 Ncm insertion torque value (ITV), respectively (n = 10). (1) The implant stability was measured with three different kinds of devices (Periotest M, Osstell ISQ Mentor, and Anycheck). (2) Five different diameters (4.0, 4.5, 4.8, 5.5, and 6.0 mm) of healing abutments of the same height were connected to the implants and the implant stability was measured four times in different directions with Anycheck. The measured mean values were statistically analyzed. @*RESULTS@#. The correlation coefficient between the mean implant stability quotient (ISQ) and IST value was 0.981 (P<.01) and the correlation coefficient between the meant periotest value (PTV) and IST value was -0.931 (P<.01). There were no statistically significant differences among the IST values with different healing abutment diameters. @*CONCLUSION@#. There was a strong correlation between the Periotest M and Anycheck values and between the ISQ and IST. The diameter of the healing abutment had no effect on the Anycheck values.

12.
Journal of Liver Cancer ; : 173-176, 2020.
Article | WPRIM | ID: wpr-836099

ABSTRACT

Cholangiocarcinoma is a biliary carcinoma with a wide spectrum of imaging, histological, and clinical features. In immunocompromised patients, pyogenic abscesses are relatively common and an echinococcal hepatic cysts are very rare. The authors experienced a very rare case of cholangiocarcinoma showing multiple hypodense masses with wall enhancement mimicking pyogenic liver abscess, echinococcal hepatic cyst, and cystic metastases. An 83-year-old man, complaining of fatigue and poor oral intake, presented to our outpatient clinic. Abdominal computed tomography (CT) revealed multiple, variable-sized hypodense masses with peripheral rim enhancement throughout the liver. Dynamic liver magnetic resonance images also showed findings similar to those of a CT scan. We performed ultrasound-guided biopsy of the mass which revealed cholangiocarcinoma.

13.
Article | WPRIM | ID: wpr-831517

ABSTRACT

Background@#Characteristics of coronary vasospasm-related sudden cardiac death are not well understood. We aimed to compare the characteristics and clinical outcomes between coronary vasospasm and stenosis, in out-of-hospital cardiac arrest (OHCA) survivors, who underwent coronary angiogram (CAG). @*Methods@#We conducted a multicenter retrospective observational registry-based study at 8 Korean tertiary care centers. Data of OHCA survivors undergoing CAG between 2010 and 2015 were extracted. Patients were divided into vasospasm and stenosis (stenosis > 50%) groups based on CAG findings. The primary and the secondary outcomes were survival and a good neurologic outcome at 30 days after OHCA. Patients in the vasospasm and stenosis groups were propensity score matched. @*Results@#Of the 413 included patients, vasospasm and stenosis groups comprised 87 and 326 patients, respectively. There were 279 (66.7%) survivors and 206 (49.3%) patients with good neurologic outcomes. The vasospasm group had better clinical characteristics for outcome (younger age, less diabetes and hypertension, more prehospital restoration of spontaneous circulation, higher Glasgow Coma Scale, less ST segment elevation, and less requirement of circulatory support). The vasospasm group had better survival (75/87 vs. 204/326, P < 0.001) and good neurologic outcomes (62/87 vs. 144/326, P < 0.001). However, vasospasm was not independently associated with survival (odds ratio [OR], 0.980; 95% confidence interval [CI], 0.400–2.406) or neurologic outcomes (OR, 0.870; 95% CI, 0.359–2.108) after adjustment and vasospasm was not associated with survival and neurologic outcome in propensity score-matched cohorts. @*Conclusion@#Our analysis of propensity score-matched cohorts finds that vasospasm OHCA survivors have survival and neurologic outcomes comparable with those of stenotic OHCA survivors.

14.
Article | WPRIM | ID: wpr-831302

ABSTRACT

Objectives@#. To investigate the prognostic factors and treatment outcomes of primary parotid carcinoma treated with surgery and postoperative radiotherapy (PORT). @*Methods@#. We reviewed retrospectively 57 patients with primary parotid carcinoma who were treated with surgery and PORT between 2005 and 2014. Superficial parotidectomy was performed in 19 patients, total parotidectomy in 10 patients, and total parotidectomy with lymph node dissection in 28 patients PORT on the tumor bed was performed in 41 patients, while PORT on tumor bed and ipsilateral cervical lymph nodes was performed in 16 patients. @*Results@#. With a median follow-up of 66 months, the 5-year overall survival, disease-free survival, locoregional control, and distant control rates were 77.0%, 60.2%, 77.6%, and 72.8%, respectively. The 5-year overall survival by stage was 100%, 100%, 80.0%, and 46.4% in stage I, II, III, and IV, respectively. Recurrences at primary lesions were found in seven patients, while at cervical nodes in six patients. Distant recurrences were developed in 12 patients. No patient with the low and intermediate histologic grade developed distant failure. As prognostic factors, the histologic grade for overall survival (P=0.005), pathological T-stage (P=0.009) and differentiation grade (P=0.009) for disease-free survival, pathological T-stage for locoregional control (P=0.007), and lympho-vascular invasion (P=0.023) for distant recurrence were significant on multivariate analysis. @*Conclusion@#. This study revealed that differentiation grade, histologic grade, pathological T-stage, and lympho-vascular invasion were significant independent prognostic factors on clinical outcomes.

15.
Article in Korean | WPRIM | ID: wpr-902110

ABSTRACT

Paraganglioma is a rare benign neuroendocrine tumor arising from the paraganglia of the autonomic nervous system. Paraganglioma occurs mainly in the carotid body, jugular foramen, and vagus nerve in the head and neck region. Herein, we report a case of paraganglioma of the submandibular region that has not been reported. This case highlights paraganglioma as a rare differential diagnosis for submandibular region tumors.

16.
Article in English | WPRIM | ID: wpr-897524

ABSTRACT

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.

17.
Article in Korean | WPRIM | ID: wpr-894406

ABSTRACT

Paraganglioma is a rare benign neuroendocrine tumor arising from the paraganglia of the autonomic nervous system. Paraganglioma occurs mainly in the carotid body, jugular foramen, and vagus nerve in the head and neck region. Herein, we report a case of paraganglioma of the submandibular region that has not been reported. This case highlights paraganglioma as a rare differential diagnosis for submandibular region tumors.

18.
Article in Korean | WPRIM | ID: wpr-920130

ABSTRACT

Low-grade fibromyxoid sarcoma (LGFS) is a soft tissue tumor that rarely occurs in the head and neck region. It occurs mainly in the proximal extremities and the trunk and is prevalent in the young and middle-aged adults. In the present case, LGFS was present at an atypical location and at an unusual age. The treatment of choice for LGFS is radical wide surgical excision with a clear margin. Long-term follow-up is essential for all patients with LGFS, as it has the potential for late recurrence or metastasis.

19.
Article in Korean | WPRIM | ID: wpr-764841

ABSTRACT

OBJECTIVE: The aim of this study is to investigate the effects of cognitive training and cognitive trainer on cognitive function in persons with mild cognitive impairment (MCI). METHODS: A randomized controlled single blind trial with 2 treatment groups was designed and 40 participants were included in this study. They received cognitive training intervention by cognitive professional and non-professional. The cognitive training focused on memory strategies. This cognitive intervention consisted of 8 sessions training and once a week. The effect of program was examined in performance-based measures of cognitive abilities; memory, language, constructional praxis, attention, and working memory. The comparison of effect of trainer was examined by repeated measure analysis of variance. RESULTS: Thirty-six MCI completed the cognitive intervention and was assessed neurocognitive test on pre- and post-intervention. Attention, language inhibition and semantic language were significantly improved compared with baseline in total group. The memory (p=0.003) was significantly improved in Professional Program Group and attention (p=0.007) was significantly improved in Non-Professional Program Group (NPG). Distinctively, Korean version of Short form of Geriatric Depression Scale mean score in NPG was statistically improved from 4.24 to 3.29 (p=0.018) after intervention, but the comparison between groups was not significant. CONCLUSION: This study shows that the cognitive intervention program may improve on memory, attention and language in cognitive functions of MCI. But there is difference in improvement of the domains of cognitive abilities depending on the trainer.


Subject(s)
Cognition , Depression , Humans , Memory , Memory, Short-Term , Cognitive Dysfunction , Semantics
20.
Article in English | WPRIM | ID: wpr-830010

ABSTRACT

BACKGROUND AND OBJECTIVES@#The purpose of this study was to review the clinical characteristics and treatment outcomes of benign and malignant nasal septal tumors.@*SUBJECTS AND METHODS@#A total of 34 patients who underwent the treatment for nasal septal tumor between 2004 and 2015 were included in this study. Demographic characteristics, sinonasal chief complaints, size and localization of nasal septal tumor, imaging findings, surgical method, histopathologic results, treatment outcomes, and postoperative complications were reviewed.@*RESULTS@#Of the 34 patients with nasal septal tumor used in this study, 22 (64.7%) had benign tumors and 12 (35.3%) had malignant tumors. The most common sinonasal complaint of both benign and malignant nasal septal tumors was nasal obstruction. The most common benign tumor was inverted papilloma (n=7), whereas the most common malignant tumors were malignant melanoma (n=2), plasmacytoma (n=2), and metastatic carcinoma (n=2). All patients except two cases underwent endoscopic tumor removal. There were 4 recurrences in malignant nasal septal tumors. There was no recurrence in benign tumors. No major complications resulting from surgical intervention were found.@*CONCLUSION@#Endoscopic surgery with complete excision is a safe and effective procedure for benign nasal septal tumors. Recurrence is more common in malignant nasal septal tumor. Therefore, long term follow-ups with regular radiologic and endoscopic examinations are necessary for patients with malignant nasal septal tumor.

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