A history of stereotactic radiosurgery may predict failure of procedure following percutaneous glycerol rhizotomy for trigeminal neuralgia.

BACKGROUND: Both stereotactic radiosurgery (SRS) and percutaneous glycerol rhizotomy are excellent options to treat TN in patients unable to proceed with microvascular decompression. However, the influence of prior SRS on pain outcomes following rhizotomy is not well understood. METHODS: We retrospectively reviewed all patients undergoing percutaneous rhizotomy at our institution from 2011 to 2022. Only patients undergoing percutaneous glycerol rhizotomy following SRS (SRS-rhizotomy) or those undergoing primary glycerol rhizotomy were considered. We collected basic demographic, clinical, and pain characteristics for each patient. Additionally, we characterized pain presentation and perioperative complications. Immediate failure of procedure was defined as presence of TN pain symptoms within 1-week of surgery, and short-term failure was defined as presence of TN pain symptoms within 3-months of surgery. A multivariate logistic regression model was used to evaluate the relationship of a history SRS and failure of procedure following percutaneous glycerol rhizotomy. RESULTS: Of all patients reviewed, 30 had a history of SRS prior to glycerol rhizotomy whereas 371 underwent primary percutaneous glycerol rhizotomy. Patients with a history of SRS were more likely to endorse V3 pain symptoms, p = 0.01. Additionally, patients with a history of SRS demonstrated higher preoperative BNI pain scores, p = 0.01. Patients with a history of SRS were more likely to endorse preoperative numbness, p < 0.0001. A history of SRS was independently associated with immediate failure [OR = 5.44 (2.06-13.8), p < 0.001] and short-term failure of glycerol rhizotomy [OR = 2.41 (1.07-5.53), p = 0.03]. Additionally, increasing age was found to be associated with lower odds of short-term failure of glycerol rhizotomy [OR = 0.98 (0.97-1.00), p = 0.01] CONCLUSIONS: A history of SRS may increase the risk of immediate and short-term failure following percutaneous glycerol rhizotomy. These results may be of use to patients who are poor surgical candidates and require multiple noninvasive/minimally invasive options to effectively manage their pain.

Enhanced Accuracy of Airborne Volcanic Ash Detection Using the GEOKOMPSAT-2A Satellite.

In this study, a technique facilitating the enhanced detection of airborne volcanic ash (VA) has been developed, which is based on the use of visible (VIS), near-infrared (NIR), and infrared (IR) bands by meteorological satellite systems. Channels with NIR and IR bands centered at ~3.8, 7.3, 8.7, 10.5, and 12.3 µm are utilized, which enhances the accuracy of VA detection. The technique is based on two-band brightness temperature differences (BTDs), two-band brightness temperature ratios (BTRs), and background image BTDs. The physical effects of the observed BTDs and BTRs, which can be used to distinguish VA from meteorological clouds based on absorption differences, depend on the channel and time of day. The Advanced Meteorological Imager onboard the GEOKOMPSAT-2A (GK-2A) satellite has several advantages, including the day- and nighttime detection of land and ocean. Based on the GK-2A data on several volcanic eruptions, multispectral data are more sensitive to volcanic clouds than ice and water clouds, ensuring the detection of VA. They can also be used as an input to provide detailed information about volcanoes, such as the height of the VA layer and VA mass. The GK-2A was optimized, and an improved ash algorithm was established by focusing on the volcanic eruptions that occurred in 2020. In particular, the 3.8 µm band was utilized, the threshold was changed by division between day and night, and efforts were made to reduce the effects of clouds and the discontinuity between land and ocean. The GK-2A imagery was used to study volcanic clouds related to the eruptions of Taal, Philippines, on 12 January and Nishinoshima, Japan, from 30 July-2 August to demonstrate the applicability of this product during volcanic events. The improved VA product of GK-2A provides vital information, helping forecasters to locate VA as well as guidance for the aviation industry in preventing dangerous and expensive interactions between aircrafts and VA.

Causality analysis on health care evaluation criteria for state-operated mental hospitals in Korea using Malcolm Baldrige National Quality Award model.

Hospitals today are pressured to move away from the conventional health services management techniques and provide higher-quality health care to survive in intense competition. In our study, we aimed to develop health care evaluation criteria for the mental health care sector based on the existing Malcolm Baldrige National Quality Award model, and verify the causality of the evaluation model to lay groundwork for future research on the outcomes of national quality awards for mental health care. We focused on comparison groups comprising five state-operated mental hospitals in Korea using 92 survey questions derived from the MBNQA criteria for health care through structural equation modeling techniques. We verified that Leadership drives Foundation and Direction, which affect System that creates Results with 15 hypotheses supported out of 18 hypotheses established. We believe our findings will provide valuable implications to the top management of mental hospitals for self-examining quality management and promoting competitiveness.

A combination therapy with transarterial chemo-lipiodolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management.

PURPOSE: Hepatocellular carcinoma (HCC) invading the portal vein is a medical challenge. We evaluated the therapeutic efficacy of a combination of transarterial and systemic chemo-infusion for large HCC with portal vein thrombosis (PVT) compared with conservative management. PATIENTS AND METHODS: This was a case-control cohort study of 103 consecutive patients with Child-Pugh class A who had a large (>10 cm) HCC with PVT. The patients were assigned to receive either combined transarterial epirubicin (50 mg/m(2)) plus cisplatin (60 mg/m(2)) chemo-lipiodolization and systemic 5-fluorouracil (200 mg/m(2)) chemo-infusion (ECF regimen) at monthly intervals (n=80) or conservative management (n=23). RESULTS: The objective tumor response (21.3 vs. 0%, P=0.011) and overall survival (8.7 vs. 3.5 months, P<0.001) were significantly better in the treatment group than in the conservative group. The prognostic factors for survival were tumor type (P=0.007), bilobar involvement (P=0.001), distant metastasis (P=0.009) and objective tumor response (P<0.001) for the treatment group. Survival benefits with the treatment were also maintained in each subgroup after stratification of these variables. CONCLUSIONS: This study suggests that when the hepatic function is preserved, a therapeutic strategy could be more beneficial than conservative management for such a large extensive HCC. As a therapeutic option, a combination therapy using ECF regimen may provide a significantly better tumor response and survival benefit in patients with large HCC invading the portal vein.

[Portal and superior mesenteric venous thrombosis treated with urokinase infusion via superior mesenteric artery].

Portal and mesenteric venous thrombosis is an uncommon disease, but clinically important, because it accounts for 5% to 15% of acute mesenteric ischemia. The diagnosis is often delayed because the conditions are nonspecific abdominal symptoms. In addition, when this occurs in young individual without any known predisposing factor, the diagnosis may become even more difficult. The treatment of mesenteric venous thrombosis involves anticoagulation therapy alone or in combination with surgery. The addition of thrombolytic therapy to the treatment of portal and mesenteric venous thrombosis may enhance the clearance of thrombus and hasten the clinical improvements. We present a case of mesenteric venous thrombosis treated with catheter-directed infusion of urokinase via the superior mesenteric artery and systemic anticoagulation.

[A case of hepatoid carcinoma of the pancreas].

Hepatoid carcinoma is a primary extrahepatic neoplasm exhibiting features of hepatocellular carcinoma (HCC) in terms of morphology, immunohistochemistry, and behavior. In many cases, tumor cytoplasm is positive for alpha- fetoprotein (alpha-FP) with elevated serum alpha-FP level. Because not all hepatoid carcinomas are associated with alpha- FP overproduction, diagnosis should be made essentially by histological features of the tumor. We present a case of hepatoid carcinoma of the pancreas in a 21-year-old male patient. Abdominal computed tomography and magnetic resonance imaging revealed an inhomogeneously enhanced pancreatic head mass. Serum alpha-FP level was markedly elevated. He underwent pylorus-preserving Whipple's operation. The tumor showed hepatoid and neuroendocrine components simultaneously. The histopathological diagnosis was hepatoid carcinoma associated with neuroendocrine tumor of the pancreas. Seven months after the surgery, the patient is healthy without evidence of recurrence. To date, only 7 cases of hepatoid carcinoma of the pancreas have been reported in the literature, and this is the first case report in Korea.

[Clinical and biochemical parameters of nutrition to predict hepatic encephalopathy in cirrhotic patients].

BACKGROUND/AIMS: Protein-calorie malnutrition is a common complication in cirrhosis. Protein restriction for the treatment of hepatic encephalopathy (HE) may cause disease progression and poor prognosis. Therefore, we evaluated important clinical parameters for nutritional state in cirrhotic patients with or without HE to predict the development of HE. METHODS: Twenty-two cirrhotic patients were divided into two groups; group A-13 patients without HE and group B-9 patients with HE. Clinical and biochemical parameters, serum proteins {serum albumin, insulin-like growth factor-1 (IGF-1), transferrin, leptin, etc}, immunologic parameters and anthropometry were measured. RESULTS: Child-Pugh score and Model for End-stage Liver Disease (MELD) scale were higher in group B (p<0.01). After correction of various factors affecting nutritional assessment, especially of Child-Pugh score and MELD scale, leptin was higher in group B (p<0.05). There was no difference in anthropometric measurements. Transferrin correlated inversely with MELD scale in group A (p<0.01). IGF-1 correlated inversely with total lymphocyte count in group B (p<0.05). Leptin correlated with Child-Pugh scores, total lymphocyte count and mid-arm muscle circumference in group A (p<0.05, p<0.05 and p<0.05, respectively), and correlated inversely with CD8 in group B (p<0.05). CONCLUSIONS: Leptin level is higher in patients with HE, and further studies for parameters of nutrition to predict HE in many cirrhotic patients will be needed.

[A case of portal vein thrombosis associated with acute pancreatitis and cholangitis].

Portal vein thrombosis is a rare complication accompanied with acute pancreatitis or cholangitis/cholecystitis. The main pathogenesis of portal vein thrombosis in pancreatitis or cholangitis/cholecystitis are suggested to be venous compression by pseudocyst and an imbalance between the blood coagulation and fibrinolysis. In this case report, we experienced a 63 year old male who developed portal vein thrombosis later in the course of the treatment of acute gallstone pancreatitis with cholangitis/cholecystitis without any symptom or sign. The diagnosis of portal vein thrombosis was given on follow up CT scan and serum protein S activity was decreased to 27% in laboratory study. Immediate anticoagulation therapy with heparin and thrombolytic therapy with urokinase and balloon dilatation were performed. Despite the aggressive treatment, complete reperfusion could not be obtained. With oral warfarin anticoagulation, the patient showed no disease progression and was discharged. We report a case of portal vein thrombosis as a complication of acute pancreatitis and cholangitis/cholecystitis with a review of literatures.

A case of hemolysis in ABO-unmatched liver transplantation: use of washed group O red blood cells and steroids.

Liver transplantation is the only curative therapy for patients with end-stage liver disease. The high success rate and the increasing demand for the transplantation sometimes calls for ABO-compatible but nonidentical blood group orthotopic liver transplantation (OLT), which affords the opportunity to the production of antibody to red blood cells. Hemolytic anemia usually occurs 1 to 2 weeks after transplantation. Although mild in most patients, it can be life-threatening. Until now, a few cases showing hemolytic anemia due to donor ABO antibody formation after ABO-nonidentical OLT have been reported. In the reported cases of hemolytic anemia, most ABO-nonidentical OLT cases were O-to-A, but few reports are available on this subject with O-to-B ABO-nonidentical OLT. Herein, we report the experience with hemolysis after ABO-nonidentical OLT in a group O donor into a group B recipient and the successful treatment with transfusion of washed group O red blood cells and 60 mg dose of prednisolone for 3 days.