Prognostic impact of hepatitis B or C on intrahepatic cholangiocarcinoma

Background/Aims@#Intrahepatic cholangiocarcinoma (ICC) is the second-most common primary liver malignancy, arising from the peripheral intrahepatic bile duct epithelium. Hepatitis B virus (HBV) or hepatitis C virus (HCV) may be involved in the development of ICC. We explored the prognostic value of hepatitis virus infection, as well as other prognostic factors affecting survival in patients with ICC. @*Methods@#A retrospective chart review was performed for patients diagnosed with ICC between August 2005 and December 2018 at Konkuk University Medical Center. We identified a total of 131 patients with ICC. Overall survival rates of patients with and without hepatitis were determined. Univariate and multivariate analyses were used to estimate factors influencing survival outcomes. @*Results@#A total of 17.6% (23/131) of patients were positive for HBV or HCV. Hepatitis B positive ICC patients were significantly younger with higher albumin and higher α-fetoprotein than those without hepatitis viral infections. The median survival of hepatitis-positive and hepatitis-negative groups was 280 and 213 days, respectively. Survival rates were not significantly different between the two groups (p = 0.279). Multivariate analyses indicated that lower serum carbohydrate antigen 19-9 (CA 19-9) (p < 0.001), lower T stage (p = 0.042), the absence of lymph-node metastasis (p = 0.043), and receiving curative surgery (p = 0.033) were independent predictors of better outcomes. @*Conclusions@#While hepatitis influenced a number of clinical features in ICC patients, it did not affect survival rate. Prognostic factors influencing survival outcomes with ICC were CA 19-9 level, T stage, the presence of lymph node metastasis, and curative surgery.

"Push Hard and Fast" Voice Prompt from AED Can Improve Quality of Chest Compression Performed by Untrained Lay People

PURPOSE: We conducted this study in order to evaluate the question of whether a simple voice prompt, "push hard and fast", could improve the quality of chest compression performed by lay people. METHODS: Non-medical college students with no experience of cardiopulmonary resuscitation (CPR) education participated in this study. They were randomly divided into two groups-metronome prompt automated external defibrillator (AED) (M) group and metronome with intermittent "push hard and fast" voice prompt AED (V) group and performed two cycles of chest compression-only CPR. "Push hard and fast" voice was prompted every 10 seconds. The rate of metronome was fixed to 100/min in two groups. We measured compression depth, compression rate, and total compression frequency using ResusciAnne(R)SkillReporter(TM) (Laerdal, Korea). RESULTS: A total of 208 volunteers were enrolled. There were 120 (57.7%) females, and mean age was 21+/-2 years old. The compression depth was deeper in the V group (40.0+/-12 mm) than in the M group (35.9+/-13 mm) (p=0.02). The mean rate of chest compression was faster in the V group (98+/-20 cpm) than in the M group (88+/-31 cpm) (p=0.07) (*cpm: compressions per minute). Total frequency of chest compression during 2-cycle CPR was also higher in the V group (392+/-80) than in the M group (341+/-117) (p<0.001). CONCLUSION: A simple voice prompt, "push hard and fast", can improve the quality of chest compression performed by untrained lay people.

Listeria Sepsis and Pneumonia in a Premature Neonate

Listeria monocytogenes (L. monocytogenes) is a foodborne anaerobic gram-positive rod and the third most common pathogen for neonatal meningitis. Although the mortality and morbidity of L. monocytogenes infections are high, thus causing serious problems in Western populations, neonatal listeriosis is relatively rare in Eastern countries, including Korea. Possible routes for intrauterine infection or vertical transmission of L. monocytogenes include infected placentas and the reproductive tract. Intrauterine infections may cause chorioamnionitis, preterm labor, spontaneous abortion, stillbirth, or neonatal infection. A high index of suspicion and early empirical antibiotic treatment are critical to achieve a favorable prognosis for neonatal listeriosis. We managed a case of L. monocytogenes sepsis and pneumonia in a premature neonate born at 26 weeks of gestational age from an asymptomatic mother with culture-proven placental infection. The neonate was successively treated with ampicillin and gentamicin.

The Efficacy of ADHD Rating Scale and Continuous Performance Tests in Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder / 대한소아신경학회지

PURPOSE:Attention deficit hyperactivity disorder(ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, impulsivity and/or hyperactivity with an onset during childhood. There are no specific diagnostic and evaluated tools. The aim of this study was to determine clinical availability of adjunctive tests for diagnosis and measure of the efficacy of treatment in ADHD patients. METHODS:The study group consisted of 41 patients under 15 years of age who visited Kangnam Sacred Heart Hospital and Kangdong Sacred Heart Hospital between January 2007 and June 2008 for evaluation of ADHD. Diagnosis was made according to the diagnostic and statistical manual for mental disorder-IV(DSM-IV) with history, physical examination, ADHD rating scale, and attention deficit hyperactivity disorder diagnostic system(ADS). After psychostimulant treatment, patients were reevaluated by previous diagnostic tools and their results were analysed by SPSS version 16.0. RESULTS:The mean age was 8.44+/-2.49 years old, male to female ratio 4.13:1(33:8). Forty one ADHD patients were subdivided into predominantly inattentive type 17(41.5%), predominantly hyperactive-impulsive type 3(7.3%) and combined type 21(51.2%). In patients, concordance rates of adjunctive tests with DSM-IV diagnostic criteria were 74.29% in Korean ADHD Rating scale(K-ARS), 59.09% in abbreviated Conners' rating scale(ACRS) and 92.68 % in ADS with DSM-IV diagnostic criteria. There were significant differences in the ADS results between before and after psychostimulant treatment. CONCLUSION:Because the concordance rates and efficacy of ADS were higher than K- ARS and ACRS in ADHD patients, it suggests that ADS is a useful method to ADHD diagnosis and treatment.

Characteristics of Sleep Disorders in Childhood and Adolescence / 대한소아신경학회지

PURPOSE: Sleep disorders are common diseases in childhood and adolescence. Daytime sleepiness, fatigue, headache, etc caused by sleep disorders may affect daily activities and school performance. Authors conducted this study to understand the clinical characteristics of sleep disorders in pediatric patients. METHODS: The subjects consisted of 88 patients under 16 years of age who visited Kangnam Sacred Heart Hospital and Kangdong Sacred Heart Hospital with sleep disorders for one and half years. Diagnosis was made according to the international classification of sleep disorders-2(ICSD-2) with sleep questionnaire, sleep diaries, night-time video recordings and performed electroencephalogram or polysomnography when needed. RESULTS: The mean age was 7.5 years old, and the male to female ratio was 1.1:1(46: 42). A total of 88 patients consisted of parasomnia of 31(35.2%), insomnia of 27(30.7%), circadian-rhythm sleep disorders of 15(17.0%), sleep-related breathing disorders of 11 (12.5%), and hypersomnia of 4(4.5%). While sleep-onset associated disorders were most common in patients under 3 years old, parasomnia, insomnia, and obstructive sleep apnea syndrome(OSAS) were common in a descending order of frequency in 3-8 years old. Furthermore, school-age patients had circadian-rhythm sleep disorders, insomnia, and hypersomnia in order of frequency. 38 patients(43.2%) complained of headache, 15 patients(17%) fatigue, and others difficulty in waking up in the morning, abdominal pain, attention deficit, hyperactivity, and learning difficulty. CONCLUSION: Pediatric sleep disorders, which variably decrease the quality of life in childhood and adolescence, frequently overlooked by their parents or physicians. Therefore it is important for pediatricians have more interest and better understanding of sleep disorders.

Clinical Significance of C4d-Positivity in Renal Transplant Recipients with Acute Rejection / 대한이식학회지

PURPOSE: C4d detection in peritubular capillaries in acute allograft rejection has been regarded as a poor prognostic factor for graft kidney survival. We investigated the clinical importance of C4d positivity in renal transplant recipients with acute rejection. METHODS: Forty eight renal allograft biopsies were selected, which were available for immunofluorescence study. The samples were divided into two groups, one which was diagnosed as acute rejection clinically (n=30), the other which underwent protocol biopsy 2 weeks after transplantation (n=18). Among the acute rejection group, C4d staining was positive in 50% of acute rejection cases (C4d (+), n=15) and negative in the others. (C4d (-), n=15). We compared the C4d (+) group and the C4d (-) group in terms of clinical parameters and graft survival duration. RESULTS: Renal function was reduced in the C4d (+) group compared to the C4d (-) group. In the C4d (+) group, 8 of 15 cases resulted in graft loss, but only one graft loss developed in the C4d (-) group. Graft survival duration after kidney biopsy was reduced in the C4d (+) group compared to the C4d (-) group. CONCLUSION: Renal transplant recipient with C4d-positive acute rejection shows inferior graft survival duration. So tight management in addition to steroid pulse therapy should be considered for these patients.

Clinical Benefits of On-Line Hemodiafiltration in ESRD Patients / 대한신장학회잡지

BACKGROUND: On-line hemodiafiltration (HDF) is a novel extracorporeal renal replacement therapy to increase the removal of middle molecules by convection and diffusion. This study was aimed to investigate the clinical benefit of on-line HDF. METHODS: Fifteen stable chronic renal failure patients who were maintaining on low-flux hemodialysis (HD) were switched to on-line HDF for 4 months. Blood pressure, solute clearance rate, anemia, nutrition, cardiac function, inflammatory markers, brain natriuretic peptide and subjective symptoms were compared. RESULTS: In the patients treated with HDF swiching from HD, the episode of intradialytic symptomatic hypotension was significantly decreased. In addition, KT/Vurea and urea reduction ratio as well as beta2-microglobulin clearance rate and reduction ratio were significantly increased, HDF treatment also decreased the pre-dialysis phosphorus levels and daily requirement of calcium carbonate. Furthermore, HDF treatment contributed to the reduction of erythropoietin dose to maintain similar hematocrit levels. Patients' dry weight was increased during HDF treatment without any change of serum albumin and nPCR levels. HDF treatment increased brain natriuretic peptide reduction ratio and improved subjective symptoms such as itching, headache, cramp and insomnia. Inflammatory markers such as hsCRP, IL-1beta, IL-6 and TNF-alpha were not changed by HDF treatment. CONCLUSION: Compared to conventional HD, on-line HDF may offer additional benefits with improved cardiovascular stability, enhanced middle molecule clearance, improvement of anemia and good control of subjective symptoms.

Central Venous Stenosis in Chronic Hemodialysis Patients: The Effect of Percutaneous Angioplasty and Stenting / 대한신장학회잡지

BACKGROUND: Central venous stenosis in chronic hemodialysis patients occurs in about 17% of all venous stenosis and it is associated with central vein catheterization. We evaluated the effect of percutaneous angioplasty and stenting in the treatment of central venous stenosis in hemodialysis patients. METHODS: We retrospectively investigated medical records of total 31 dialysis patients who had central venous stenosis. We reviewed the causes of central venous stenosis, clinical manifestations, venographic findings, and patency rate of radiological intervention. RESULTS: Of the total 31 patients, 28 patients had past history of central vein catheterization ipsilateral to vascular access. Mean duration of the catheterization was 32+-14 days. Venography showed complete obstruction of central vein (n=14) and stenosis (n=17). The site of venous lesion was right subclavian vein (n=11), innominate vein (n=9), left subclavian vein (n=7), and superior vena cava (n=14). total 30 procedures of angioplasty with or without stenting were performed in 26 of 31 patients. Initial success rate was 96.1% and there was no severe complication such as rupture or bleeding. The primary patency rate at 6, 12, 24, and 48 month after the procedure was 87.3%, 75.6%, 67.9%, 65.4%, respectively. The cumulative patency rate at the same time point was 96.0%, 90.6%, 74.0%, 72.8%, respectively. CONCLUSION: Our data suggest that angioplasty with or without stenting is safe and effective in the treatment of central venous stenosis in hemodialysis patients.