The effects of medical students’ self-oriented perfectionism on academic procrastination: the mediating effect of fear of failure / 한국의학교육

Purpose@#Based on the logic that self-oriented perfectionism (SOP) is one of the most well-established predictors of academic procrastination (AP), we predicted that fear of failure (FF) would mediate the association between SOP and AP. The purpose of this study is to investigate the mediating effect of FF on the influence of SOP on AP in medical students. @*Methods@#A total of 156 undergraduate medical students completed a battery of questionnaires. This study is an analysis of cross-sectional data obtained through an offline survey. The self-report questionnaires assessed demographics and psychological scales, including the Multidimensional Perfectionism Scale, Performance Failure Appraisal Inventory, and Aitken Procrastination Inventory. The data were analyzed by descriptive statistics, correlations analysis, and multiple regression analyses using IBM SPSS ver. 22.0 (IBM Corp., Armonk, USA). @*Results@#SOP had a direct negative influence on AP (β=-0.420, p<0.001). Also, SOP had a significant indirect effect on AP through FF (β=0.0393; 95% confidence interval, 0.040–0.0936). These results indicated that the FF partially mediates the relationship between SOP and AP. @*Conclusion@#Although SOP among medical students might play an adaptive role to lessen AP, in cases FF gets higher, SOP could have opposing effects via the mediating effect of FF, leading to an actual increase in AP. Attempts to deal with the FF among medical students should be made for better academic achievements.

Voluntary peer-mentoring program for undergraduate medical students: exploring the experiences of mentors and mentees / 한국의학교육

Purpose@#We aimed to examine the participants’ satisfaction and evaluation of the program’s appropriateness, outcomes and benefits from participants’ perspectives and gather suggestions from students to improve peer mentor programs. @*Methods@#From 2016 to 2018, 67 mentees and mentors participated in the peer mentoring program. All program participants were asked to participate in the survey, and the respondents were invited to focus group interview (FGI). Quantitative data was collected from the survey questionnaire. Qualitative data was gathered from the open-end questions in the survey and supplemented from additional semi-structured FGIs. The interview data were analyzed using qualitative content analysis. @*Results@#Nineteen responded to the survey, and six participated in the further FGI. Qualitative data contained outcomes and mutual benefits, factors for mentoring success, negative experiences, and suggestions for improvement. Especially factors for mentoring success consisted of various methods of studying assistance, motivation, autonomy, responsibility, emotional support, and relational bonding as important topics concerning mentor-mentee experiences. The satisfaction scores about the program appropriateness, others’ attitudes, program implementation, ranged from 3.5 to 3.9 (5-point Likert scores) without significant difference between mentors and mentees. The only negative experience reported by a mentee was feeling the pressure. Specific guidelines on program implementation, pre-education for mentees, appropriate matching, and mentees’ clear purpose and spontaneity were suggested to improve the program. @*Conclusion@#Participants were generally satisfied with the peer mentoring program, gaining academic and non-academic achievements, including emotional support and improved relationships. Furthermore, we expect that this program can be improved with participants’ suggestions in the future.

Voluntary peer-mentoring program for undergraduate medical students: exploring the experiences of mentors and mentees / 한국의학교육

Purpose@#We aimed to examine the participants’ satisfaction and evaluation of the program’s appropriateness, outcomes and benefits from participants’ perspectives and gather suggestions from students to improve peer mentor programs. @*Methods@#From 2016 to 2018, 67 mentees and mentors participated in the peer mentoring program. All program participants were asked to participate in the survey, and the respondents were invited to focus group interview (FGI). Quantitative data was collected from the survey questionnaire. Qualitative data was gathered from the open-end questions in the survey and supplemented from additional semi-structured FGIs. The interview data were analyzed using qualitative content analysis. @*Results@#Nineteen responded to the survey, and six participated in the further FGI. Qualitative data contained outcomes and mutual benefits, factors for mentoring success, negative experiences, and suggestions for improvement. Especially factors for mentoring success consisted of various methods of studying assistance, motivation, autonomy, responsibility, emotional support, and relational bonding as important topics concerning mentor-mentee experiences. The satisfaction scores about the program appropriateness, others’ attitudes, program implementation, ranged from 3.5 to 3.9 (5-point Likert scores) without significant difference between mentors and mentees. The only negative experience reported by a mentee was feeling the pressure. Specific guidelines on program implementation, pre-education for mentees, appropriate matching, and mentees’ clear purpose and spontaneity were suggested to improve the program. @*Conclusion@#Participants were generally satisfied with the peer mentoring program, gaining academic and non-academic achievements, including emotional support and improved relationships. Furthermore, we expect that this program can be improved with participants’ suggestions in the future.

Seasonal trend and mortality in adults with viral pneumonia

OBJECTIVE: Viral infections are being identified increasingly in patients with pneumonia and can be fatal, particularly in immune-compromised patients. This study examined the seasonal trend and mortality in adult patients with viral pneumonia. METHODS: Retrospective data of adult patients who visited the emergency room and were diagnosed with viral pneumonia was collected between January 2012 and December 2015 at a tertiary referral center. The monthly incidence of each viral pathogen and in-hospital mortality were analyzed. RESULTS: A total of 1,179 patients were analyzed. The mean age was 66.0 years and male comprised 60.0% of cases. Multiple viral infections and viral-bacterial co-infection were found in 5.2% and 24.7% of patients, respectively. The underlying diseases were as follows: diabetes mellitus in 32.8%, malignancy in 30.3%, and chronic lung disease in 30.9%. In-hospital mortality occurred in 7.9% of the total patients. Rhinovirus was the most common viral pathogen throughout the year. Influenza A was the most common from January to March and rhinovirus was the most common from September to November. Among the viral pathogens, a coronavirus infection resulted in the highest mortality of 12.6% but there was no significant difference in mortality among the viral pathogens. Multivariate analysis for in-hospital mortality revealed a viral-bacterial co-infection (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.02–2.34), malignancy (OR, 2.34; 95% CI, 1.48–3.71), C-reactive protein (CRP; OR, 1.04; 95% CI, 1.02–1.07), CURB-65 score 2 (OR, 2.46; 95% CI, 1.47–4.12), and CURB-65 score ≥3 (OR, 4.60; 95% CI, 2.31–9.16) to be significantly associated with mortality. CONCLUSION: The outcome from viral pneumonia was poor in adult patients. A viral-bacterial co-infection, malignancy, elevated CRP, and CURB-65 score were significant predictors of mortality.

Do We Have to Check Pulmonary Thromboembolism in Patients with Deep Vein Thrombosis in Emergency Department?

PURPOSE: Deep vein thrombosis (DVT) is a risk factor of pulmonary thromboembolism (PTE), however it is not clear who should be evaluated for a PTE and a DVT at the same time. The purpose of this study is to determine the clinical characteristics of PTE in patients with DVT who visited the emergency department (ED). METHODS: This was a retrospective cohort study of ED patients who visited with DVT and were simultaneously evaluated for a PTE from January 2012 to December 2013. We compared clinical characteristics between non-PTE and PTE patients with confirmed DVT in the ED. RESULTS: Of these 166 patients, 96 patients (57.8%) were confirmed PTE by computed tomography. In multivariate analysis, patients with PTE had more systemic neoplasm (OR 2.03, 95% CI 1.04-3.93, p=0.037) and right heart strain pattern in electrocardiography (OR 5.29, 95% CI 1.71-16.36, p=0.004) than patients without PTE. Femoral DVT was more likely in the non-PTE group (87.1% vs. 65.6%, p=0.002) and popliteal DVT was more likely in the PTE group (62.9% vs. 80.2%, p=0.013). However the number of DVT sites including both femoral and popliteal vein was not statistically different. CONCLUSION: In patients with systemic neoplasm or right heart strain patterns in electrocardiography, simultaneous PTE evaluation may be required in patients with DVT.

Etiology of Pleural Effusions in Cancer Patients

PURPOSE: The purpose of this study is to examine the causes of Pleural effusion (PE) in cancer patients and to compare the clinical characteristics between malignant PE (MPE) and non-MPE. METHODS: All consecutive cancer patients with PE who underwent diagnostic thoracentesis from January 1, 2008 to March 31, 2011 were analyzed retrospectively. RESULTS: A total of 719 patients were included; mean age was 58.4+/-13.6 years and 44.5% were female. The most common cause of PE was MPE (57.7%), followed by parapneumonic or empyema in 16.3%. However, the etiology was significantly different according to primary tumor origin and subtypes of lung cancer. While MPE was most common in lung, breast, and gynecologic cancer, hepatic hydrothorax was the main cause in Hepatocellular carcinoma (HCC). MPE accounted for 85.2% in adenocarcinoma, and 30.2% and 58.8% in squamous cell and small cell carcinomas, respectively. Patients with MPE were younger (57.0 vs. 60.2 years) and female-dominant (55.4% vs. 29.6%) compared to those with non-MPE. MPE had the large size (53.5% vs. 34.9%) and left location of PE (31.3% vs. 19.4%) more frequently than non-MPE, and fewer neutrophils (15.4% vs. 30.6%) and more lymphocytes (32.2% vs. 28.2%), higher levels of pH (7.33 vs. 7.29), and lower levels of glucose (111.5 vs. 129.7 mg/dL) than non-MPE (p<0.001 for all). CONCLUSION: Overall, MPE was the most common cause of PE in cancer patients. However the etiology of PE was significantly different according to primary tumor origin and subtypes of lung cancer. A difference in age, gender, size and location of PE, cell count, pH, and glucose was observed between MPE and non-MPE.

Clinical Features of Acute Aortic Dissection Patients Initially Diagnosed with ST-segment Elevation Myocardial Infarction

PURPOSE: Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is critical, particularly in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. This study examined the clinical features of patients of STEMI concomitant with AAS that may be a diagnostic clue. METHODS: Between January 1, 2010 and December 31, 2014, 22 patients who had the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma, and ruptured thoracic aneurysm) in our emergency department were reviewed. Among them, 10 patients who were transferred from other hospitals and 4 patients with non-STEMI were excluded, leaving 8 patients of STEMI concomitant with AAS for analysis. RESULTS: The mean age of study patients was 57.5+/-16.31 years and five patients were Stanford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and 2 patients in inferior leads. Most patients had acute onset and severe chest pain, but none had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had Ddimer elevation. Aortic regurgitation or regional wall motion abnormality was detected in four patients, and widened mediastinum was observed in all study patients. CONCLUSION: Concomitant AAS might be suspected in patients with STEMI who have elevated D-dimer and widened mediastinum.

Comparison of Clinical Feature and Prognosis between Unilateral and Bilateral Acute Pyelonephritis

PURPOSE: Acute pyelonephritis (APN) usually presents as a mild disease. However, it has been shown to cause substantial morbidity and mortality on occasion. Therefore, it is important to distinguish between the complicated and uncomplicated APN. The purpose of this study was to determine the clinical significance of bilateral APN compared with unilateral APN in the emergency department (ED). METHODS: We analyzed the data of 303 consecutive patients with APN who underwent a abdominal computed tomography (CT) examination in the ED from January 2012 to December 2014. We compared the clinical presentation, progress, and outcomes between the unilateral and bilateral APNs that were identified on the CT scan. RESULTS: Of these 303 patients, 110 patients (36.3%) were confirmed as bilateral APN by the CT. The proportion of male was higher in the bilateral APN group (20.0% vs. 10.9%, p=0.029). Moreover, patients in the bilateral group visited the ED post symptom onset (6.5±7.8 vs. 3.6±3.1, p<0.001). However, symptom, sign, laboratory test, and CT findings were not statistically different between the two groups. In addition, severity, resistant pathogen, and outcomes such as occurrence of septic shock, hospital days, and mortality were also not different. CONCLUSION: This study suggests that bilateral APN, as determined by a CT, does not have clinical significance compared with unilateral APN.

Can Glasgow-Blatchford Score and Pre-endoscopic Rockall Score Predict the Occurrence of Hypotension in Initially Normotensive Patients with Non-variceal Upper Gastrointestinal Bleeding? / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department. METHODS: Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension. RESULTS: A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotesion within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; p<0.001). In the receiver operating characteristic curve analysis of hypotension development, the area under the curve of GBS and pre-E RS were 66% and 64%, respectively. The sensitivity and the specificity of GBS using optimal cut-off value were 81% and 46%, respectively, while those based on the pre-E RS were 74% and 46%, respectively. CONCLUSIONS: GBS and pre-E RS were both not sufficient for predicting the occurrence of hypotension in non-variceal upper gastrointestinal bleeding. Development of other scoring systems are needed.

Early Antibiotic Administration and Mortality in Patients with Septic Shock in Emergency Department

PURPOSE: The Surviving Sepsis Campaign recommend initiating broad spectrum antibiotics within the first hour of recognition of septic shock. An unknown proportion of the effectiveness of earlier antibiotics administration will remain in septic shock patients treated with an early quantitative resuscitation in emergency department (ED). We were to compare the 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) in septic shock patients in ED. METHODS: A total of 536 consecutive septic shock patients were prospectively collected from January 2010 to June 2012. We identified 357 patients who were developed shock at initial assessment, and measured the time of initial antibiotics administration. The primary outcome was 28-day mortality. RESULTS: Mean age was 62.8+/-13.7 years old and 222 patients were male (62.2%). The median time from shock recognition-to-antibiotics administration was 94.0 min (IQR 47.0-150.0) and 28-day mortality rate was 20.2%. When the relationship of 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) was compared, no significant difference was shown (19.5% vs. 20.5%, p=0.82). CONCLUSION: Earlier antibiotics administration may have no additional outcome value in septic shock patients treated with an early quantitative resuscitation in ED.

Clinical Characteristics and Predictive Factors of Septic Shock in Patients with Pyogenic Liver Abscess

PURPOSE: The aim of this study was to describe clinical, biochemical, and radiologic features in patients with pyogenic liver abscess and to investigate predictors of septic shock. METHODS: We consecutively included subjects who were diagnosed as pyogenic liver abscess in the emergency department (ED) from January 1st, 2010 to June 30th, 2013. Through review of medical records, clinical, biochemical, and radiologic data were collected. The primary endpoint was septic shock during hospitalization. RESULTS: A total of 228 patients were included, with a mean age of 60.8+/-12.8 years, and 63.2% were men. Among them, 198 patients presented with fever and GCS or =120/min, respiratory rate > or = 22/min, body temperature (BT) > or =38degrees C, WBC, platelet, BUN, creatinine, albumin, AST, alkaline phosphatase (ALP), Creactive protein (CRP), abscess size > or =5 cm, and bilobal involvement were significantly associated with septic shock (p or =38degrees C (OR 1.95, 1.36-2.78), BUN (OR 1.03, 1.01-1.06), ALP (OR 1.003, 1.000-1.005), and abscess size > or =5 cm (OR 2.31, 1.08-4.94) were independent predictors of septic shock. CONCLUSION: Low Systolic Bp, High Bt, Elevated Bun And Alp, And Abscess Size > or =5 Cm Were Independently Associated With Septic Shock In Patients With Pyogenic Liver Abscess.

The Usefulness of Procalcitonin and C-Reactive Protein as Early Diagnostic Markers of Bacteremia in Cancer Patients with Febrile Neutropenia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Procalcitonin (PCT) and C-reactive protein (CRP) are well known inflammatory markers. This study was designed to determine whether PCT and CRP are useful as early diagnostic markers for bacteremia in cancer patients with febrile neutropenia (FN) in the emergency department (ED). MATERIALS AND METHODS: In this retrospective study, 286 episodes of FN in the ED were consecutively included between June 2009 and August 2010. From medical records, clinical characteristics including PCT and CRP were extracted and analyzed. RESULTS: Bacteremia was identified in 38 (13.3%) of the 286 episodes. The median values of PCT (2.8 ng/mL vs. 0.0 ng/mL, p=0.000) and CRP (15.9 mg/dL vs. 5.6 mg/dL, p=0.002) were significantly higher in the group with bacteremia compared to the group without bacteremia. In univariate analysis, elevated PCT (>0.5 ng/mL) and CRP (>10 mg/dL) as well as older age, hypotension, tachycardia, tachypnea, and high body temperature were significantly associated with bacteremia. On multivariate analysis, elevated PCT (>0.5 ng/mL) (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4 to 9.2; p<0.01) and tachypnea (OR, 3.4; 95% CI, 1.4 to 8.5; p<0.01) were independent early diagnostic markers for bacteremia in FN patients. The area under the curve of PCT was 74.8% (95% CI, 65.1 to 84.6%) and that of CRP was 65.5% (95% CI, 54.8 to 76.1%). With a PCT cut-off value of 0.5 ng/mL, sensitivity and specificity were 60.5% and 82.3%, respectively, while the sensitivity and specificity were 57.6% and 67.3%, respectively, with a CRP cutoff of 10 mg/dL. CONCLUSION: These findings suggest that PCT is a useful early diagnostic marker for the detection of bacteremia in FN at the ED and has better diagnostic value than CRP.

The Usefulness of Procalcitonin and C-Reactive Protein as Early Diagnostic Markers of Bacteremia in Cancer Patients with Febrile Neutropenia / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Procalcitonin (PCT) and C-reactive protein (CRP) are well known inflammatory markers. This study was designed to determine whether PCT and CRP are useful as early diagnostic markers for bacteremia in cancer patients with febrile neutropenia (FN) in the emergency department (ED). MATERIALS AND METHODS: In this retrospective study, 286 episodes of FN in the ED were consecutively included between June 2009 and August 2010. From medical records, clinical characteristics including PCT and CRP were extracted and analyzed. RESULTS: Bacteremia was identified in 38 (13.3%) of the 286 episodes. The median values of PCT (2.8 ng/mL vs. 0.0 ng/mL, p=0.000) and CRP (15.9 mg/dL vs. 5.6 mg/dL, p=0.002) were significantly higher in the group with bacteremia compared to the group without bacteremia. In univariate analysis, elevated PCT (>0.5 ng/mL) and CRP (>10 mg/dL) as well as older age, hypotension, tachycardia, tachypnea, and high body temperature were significantly associated with bacteremia. On multivariate analysis, elevated PCT (>0.5 ng/mL) (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4 to 9.2; p<0.01) and tachypnea (OR, 3.4; 95% CI, 1.4 to 8.5; p<0.01) were independent early diagnostic markers for bacteremia in FN patients. The area under the curve of PCT was 74.8% (95% CI, 65.1 to 84.6%) and that of CRP was 65.5% (95% CI, 54.8 to 76.1%). With a PCT cut-off value of 0.5 ng/mL, sensitivity and specificity were 60.5% and 82.3%, respectively, while the sensitivity and specificity were 57.6% and 67.3%, respectively, with a CRP cutoff of 10 mg/dL. CONCLUSION: These findings suggest that PCT is a useful early diagnostic marker for the detection of bacteremia in FN at the ED and has better diagnostic value than CRP.

Initial Chest CT Findings of 2009 H1N1 Influenza Pneumonia in Helping Predict Clinical Outcomes / 결핵및호흡기질환

BACKGROUND: The aim of the present study was to evaluate whether findings on initial chest computed tomography (CT) of influenza pneumonia can help predict clinical outcome. METHODS: We reviewed all adult patients admitted to the Emergency Department (ED) with a confirmed diagnosis of novel influenza A H1N1 virus (2009 H1N1) pneumonia, who underwent chest CT upon admission between Aug 26, 2009 and Jan 31, 2010. Radiologic findings were characterized by type and pattern of opacities and zonal distribution. Clinical outcome measures were intensive care unit (ICU) admission, mechanical ventilation, and inhospital death. RESULTS: Of 59 patients diagnosed with 2009 H1N1 pneumonia, 41 (69.5%) underwent chest CT on admission into ED. Nine (22%) of these patients developed adverse clinical outcomes requiring the following treatments: 9 (22.0%) ICU admissions, 5 (12.2%) mechanical ventilation, and 3 (7.3%) inhospital deaths. Counting the number of patients with more than 4 involved lobes, the sensitivity, specificity, positive predictive value, and negative predictive value for detection of adverse clinical outcome were 67%, 84%, 55% and 80%, respectively. CONCLUSION: Extensive involvement of both lungs (over 4 lobes) is related to ICU admission, mechanical ventilation, and inhospital death. Initial chest CT may help predict an adverse clinical outcome of patients with 2009 H1N1 influenza pneumonia.

Predictors of Bacteremia in Cancer Patients with Febrile Neutropenia

PURPOSE: Febrile neutropenia (FN) still remains a life-threatening cancer treatment-related toxicity and may compromise further chemotherapy in individual cancer patients. In this study, we sought to determine predictors of bacteremia in cancer patients with FN at the time of their visiting the emergency department. METHODS: Between January 1, 2007 and December 31, 2008, 392 episodes of FN in 342 cancer patients were retrospectively reviewed. We assessed clinical and laboratory features, and MASCC risk-index scores at admission to the emergency department. Statistical analysis was done using SPSS ver. 11.0. RESULTS: Among a total of 392 episodes, 34 (8.7%) showed bacteremia. There was a significant difference between bacteremic episodes and non-bacteremic episodes in tachycardia (56% vs. 31%), tachypnea (24% vs. 8%), high temperature (36% vs. 16%), hemoglobin (9.4 vs. 10.1 g/dL), platelet (73.3 vs. 117.5 x 10(3)/mm3), BUN (24 vs. 13 mg/dL), creatinine (1.2 vs. 0.8 mg/dL), and CRP (12.6 vs. 8.5 mg/dL). On multivariate analysis, low platelet count (OR 5.6, 95% CI 2.5-12.5, p<0.001), elevated BUN (OR 4.8, 95% CI 2.1-11.0, p<0.001), tachypnea (OR 3.2, 95% CI 1.2-8.3, p=0.020), and high temperature (OR 2.7, 95% CI 1.2-6.2, p=0.019) were independent factors associated with bacteremia. MASCC score < 21 was more frequent in bacteremic than non-bacteremic patients (32% vs. 10%, p=0.001). CONCLUSION: Low platelet count, elevated BUN, tachypnea, and high temperature are independent predictors of bacteremia in cancer patients with FN. Also, the MASCC risk-index score is a useful predictor of bacteremia.

Sigmoid colon metastasis from hepatocellular carcinoma / 대한간학회지

Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC.

Effectiveness of a Specialized Emergency Department Unit for Cancer Patients in Management of Febrile Neutropenia

PURPOSE: Our medical institute developed an emergency department (ED) cancer unit that specialized in the management of oncologic emergencies; it was named the cancer emergency room (CER). The object of our study was to determine improvements in patient management, especially management of febrile neutropenia (FN). METHODS: This was a retrospective study of 137 febrile neutropenic episodes, including 70 episodes occurring between May 2008 and August 2008, and 67 episodes between May 2009 and August 2009. Episodes were grouped into two categories: those managed in the CER and those managed in the existing ED main treatment area of the main emergency room (MER). The time interval between presentation at the ED and first antibiotic administration, termed the door-to-needle time, clinical outcomes, and length of inpatient hospital stay were analyzed for those admitted. RESULTS: The median door-to-needle time in the CER was 2 hours (0.3-5.1), faster than the time, 3.5 hours (0.9-6.9) in the MER (p=0.000). The length of inpatient hospital stay in the CER was 4 days (1-16), shorter than that, 6 days (1-51), in the MER (p=0.034). Twelve episodes (26.1%) had adverse events in the CER and 42 (46.2%) in the MER (p=0.023). CONCLUSION: Management of FN in a unit specialized for oncologic emergencies showed faster antibiotic delivery time, more favorable outcomes and shorter duration of admission. This specialized cancer unit in the ED enables prompt and relevant management in oncologic emergencies, including events related to chemotherapy toxicity.

Clinical outcomes and predictive factors of spontaneous survival in patients with fulminant hepatitis A / 대한간학회지

BACKGROUNDS/AIMS: The occurrence of acute hepatitis A is increasing and its progression to fulminant hepatic failure (FHF) is frequent. We investigated the frequency and clinical outcomes of fulminant hepatitis A and also analyzed the predictive factors of spontaneous survival. METHODS: A total of 568 patients presented with acute hepatitis A from January 2003 to June 2008, of which the 35 (6.2%) patients with FHF were divided into two groups: spontaneous survival and transplant/death. These two groups were compared according to various clinical features including the MELD score and King's College Hospital (KCH) criteria. RESULTS: The rate of FHF development increased over time among patients with acute hepatitis A: 0% in 2003, 3.4% in 2004, 3.2% in 2005, 6.0% in 2006, 7.7% in 2007, and 13.0% in 2008. Twenty patients (57.1%) showed spontaneous survival, 13 (37.1%) received liver transplantation, and 5 (14.3%) died during hospitalization. The two groups of spontaneous survival (N=20) and transplant/death (N=15) showed significant differences in prothrombin time at admission and at its worst value, albumin at its worst value, and hepatic encephalopathy grade at admission and at its worst value. The MELD score was lower in the spontaneous-survival group than in the transplant/death group (27.0+/-7.8 vs. 37.0+/-7.1, mean+/-SD; P=0.001). However, KCH criteria did not differ significantly between the two groups. On multivariate analysis, HEP grade was the only significant predictive factor, being negatively correlated with spontaneous survival (OR=0.068, P=0.025). CONCLUSIONS: FHF due to hepatitis A has increased in recent years, and in our cohort the HEP grade was closely associated with spontaneous survival.

Does Adding Somatostatin to Proton Pump Inhibitor Improve the Outcome of Peptic Ulcer Bleeding? / 대한구급학회지

BACKGROUND: Somatostatin has been shown to offer a distinct advantage over antisecretory drugs in the management of peptic ulcer bleeding (PUB). However, rebleeding rates are still high in spite of endoscopic and medical treatment. In this study, we intended to determine whether combined therapy of a proton pump inhibitor (PPI) plus somatostatin is more beneficial than a PPI alone in patients with PUB. METHODS: We enrolled 90 consecutive patients who presented with PUB between January 2006 and October 2007. All the patients were managed with endoscopic hemostasis and divided into two treatment groups: 1) PPI alone (group A) and 2) PPI plus somatostatin (group B). The primary outcome was rebleeding within 72 hours. The secondary outcomes were rebleeding in 30 days, packed red blood cells (pRBC) transfused, length of hospital stay, need for surgery, and in-hospital mortality. RESULTS: Forty-five patients in the PPI group (A) and 45 patients in the PPI plus somatostatin group (B) were studied. There was no difference between the two groups with respect to clinical and endoscopic features at admission. After medical treatment, there was no difference between groups A and B in rebleeding at 72 hours (11% vs. 13%, p = NS), rebleeding in 30 days (13% vs. 16%, p = NS), pRBC transfused (mean, 3.2 vs. 4.5 units, p = NS), length of hospital stay (mean, 7.4 vs. 8.4 days, p = NS), and in-hospital mortality (2% vs. 7%, p = NS). CONCLUSIONS: Combined therapy with PPI and somatostatin did not result in better outcomes than PPI alone.

Biochemical Rather than Virologic Response to Interferon Therapy may be More Closely Associated with Decrease of Hepatocellular Carcinoma Incidence in Patients with Chronic Hepatitis B

BACKGROUND/AIMS: The authors examined whether the response to interferon (IFN) therapy can affect the development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. METHODS: Out of 353 biopsy-proven CHB patients, 229 (65%) were treated with IFN-alpha for 6 to 12 months. They were followed for a median period of 75 months (range, 6-120). In patients treated with IFN, biochemical and virologic responses were evaluated at the end of treatment (EOT). The cumulative incidence rates of HCC were calculated and analyzed in relation to baseline characteristics as well as biochemical and virologic responses to IFN therapy. RESULTS: The overall cumulative incidence of HCC was 0%, 0.8%, 3.7% and 5.5% at 3, 5, 7 and 8 years, respectively. Age, serum AFP levels and the stage of fibrosis were significantly associated with the occurrence of HCC. As a whole, IFN therapy did not affect the occurrence of HCC. Among the patients treated with IFN, biochemical responders had low HCC incidence rates compared with non-responders (p=0.018). However, the HCC incidence rates of virologic responders were not different from non-responders (p=0.203). CONCLUSIONS: Biochemical rather than virologic response to IFN therapy may be more closely associated with decrease of HCC incidence in CHB patients.