Successful Simultaneous Treatment of Benign Stricture and Colonic Neoplasm Arising from Colonic Interposition after Esophagectomy: A Case Report / 대한소화기학회지

Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session.Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.

Comparative analysis of machine learning approaches for predicting frequent emergency department visits.

BACKGROUND: Emergency Department (ED) overcrowding is an emerging risk to patient safety. This study aims to assess and compare the predictive ability of machine learning (ML) models for predicting frequent ED users. METHOD: Korean Health Panel data from 2008 to 2015 were used for this study. Individuals with four or more visits per year were considered frequent ED users. Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM) as well as two ensemble models, namely Bagging and Voting, were trained and tested to examine their predictive performance. RESULTS: The ML classification algorithms identified frequent ED users with high precision (90%-98%) and sensitivity (87%-91%), whereas LR showed fair precision (65%) and sensitivity (67%). The ML algorithms showed a high area under the curve (AUC) values from 89% for SVM to 96% for Random Forest, while LR showed the lowest AUC (65%). The classification error varied among algorithms; LR had the highest classification error (24.07%) while RF had the least (3.8%). CONCLUSIONS: Results show that ML classification algorithms are robust techniques to predict frequent ED users, and the variables in administrative health panels are reliable indicators for this purpose.

High-dose versus Low-dose 5-Fluorouracil and Cisplatin Based Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma

BACKGROUND/AIMS: Hepatic arterial infusion chemotherapy (HAIC) has been reported as an effective treatment for advanced hepatocellular carcinoma. The aim of this study is to compare the effect and safety between a high-dose regimen (750 mg/m2 5-fluorouracil [FU] and 25 mg/m2 cisplatin on day 1–4) and a low-dose regimen (500 mg/m2 5-FU on day 1–3 with 60 mg/m2 cisplatin on day 2). METHODS: A total of 48 patients undergoing HAIC were retrospectively analyzed. Thirty-two patients were treated with the high-dose and 16 patients with the low-dose regimen. RESULTS: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease were noted in one (3.1%), 15 (46.9%), three (9.4%), and 13 patients (40.6%) in the highdose group, and 0 (0%), one (6.3%), eight (50%), and seven patients (43.8%) in the low-dose group (P=0.002). The disease control rate (CR, PR, and SD) did not differ between groups (59.4% vs. 56.3%, P=1.000), but the objective response rate (CR and PR) was significantly higher in the high-dose group (50.0% vs. 6.3%, P=0.003). The median progression free survival did not differ between groups (4.0 vs. 6.0, P=0.734), but overall survival was significantly longer in the high-dose group (not reached vs. 16.0, P=0.028). Fourteen (43.8%) patients in the high-dose group and two patients (12.5%) in the low-dose group experienced grade 3–4 toxicities (P=0.050). CONCLUSIONS: High dose HAIC may achieve better tumor response and may improve overall survival compared to a low-dose regimen. However, the high-dose regimen should be administered cautiously because of the higher incidence of adverse events.

Acute Pulmonary Infarction Complicated with Thromboembolism as the First Manifestation of Hepatocellular Carcinoma

Acute pulmonary infarction by tumoral thromboemboli is an extremely rare fatal complication as the first clinical manifestation of hepatocellular carcinoma (HCC) patient with tumoral thrombi in the inferior vena cava. The treatment method has not been established and shown to very poor prognosis despite of trying various modalities such as anticoagulation, radiotherapy and thromboembolectomy. Here, we describe a 74-year-old man who was diagnosed with HCC that presented as pulmonary thromboembolism and subsequent pulmonary infarction as the first manifestation.

Complete Response of Single Nodular Large Hepatocellular Carcinoma with Pulmonary Metastasis by Sequential Transarterial Chemoembolization and Sorafenib: A Case Report

Current guidelines recommend sorafenib as the first-line molecular target agent for advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis and unresectable HCC. Sorafenib was reported to show survival benefit for patients with advanced HCC. However, complete response is extremely rare in patients treated with sorafenib. Here, we report a 52-year-old man with advanced HCC and pulmonary metastasis who showed complete response by sequential transarterial chemoembolization and continuous sorafenib. Complete response was sustained for 53-month until now.

Validity and reliability of the Zarit Burden Interview in assessing caregiving burden

<p><b>INTRODUCTION</b>This study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore.</p><p><b>MATERIALS AND METHODS</b>Adult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey.</p><p><b>RESULTS</b>A total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149).</p><p><b>CONCLUSION</b>The results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.</p>

Influence of Incudomalleolar joint and Hearing in rats dosed with Ciprofloxacin / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Quinolone-induced arthropathy is an unusual toxic effect observed in juvenile animals of multiple species. Such toxic effects are usually found in joint cartilages. The reports of chondrotoxic potential of quinolones in juvenile animals were mainly performed in weight bearing joints such as hips and knees. The purpose of this study was to investigate the morphological changes in the incudomalleolar joint of immature rats dosed with ciprofloxacin, and to draw relationship between the incudomalleolar joint pathology and hearing. MATERIALS AND METHODS: An experimental group of 21-day-old rats were administrated intraperitoneally with 200 mg ciprofloxacin/kg for 10 days. The hearing threshs of the control and experimental animals were determined with auditory brainstem response (ABR). Their ossicles were obtained and fixed, and we observed them with light microscopy (LM) and transmission electron microscopy (TEM). RESULTS: The ABR threshs were increased in the ciprofloxacin administrated group, and the increased latency of the first waves were identified in the ciprofloxacin administrated group, but there were no differences in the interval of wave I-III. The LM findings of incudomalleolar joint in the ciprofloxacin administrated group showed cartilage lesions such as disrupted articilar surface, irregular cellularity of the chondrocytes, matrix swelling, cleft formation, decreased matrix staining. The TEM findings of the incudomalleolar joint cartilage in the ciprofloxacin administrated group showed decreased bundle-like matrix and cell process, condensed nucleus, and vacuolated cytoplasm. CONCLUSION: From the results of recent works and the present study, we suggest that ciprofloxacin may induce morphological changes in the incudomalleolar joint, and that such morphological changes may induce conductive hearing loss.

Histopathologic Changes of Cochlea and Hearing Threshold Changes according to Duration of Noise-Exposure in the Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The degree of noise induced hearing loss was determined principally according to the level and duration of noise and patient's state. The purpose of this study was to investigate the cochlear histopathology and hearing threshold immediately after noise exposure according to duration of noise exposure, and finally to draw relationship between the cochlear pathology and hearing threshold. MATERIALS AND METHOD: Each group of animals (6 ears) has been exposed for 10 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 24 hours and 48 hours to an octave band of noise with a center frequency of 4000 Hz and a sound pressure level of 110 dB. After noise exposure, the hearing thresholds of the subjects were determined with auditory brainstem response (ABR) and immediately their inner ear were fixed and observed with transmission electron microscopy (TEM). RESULTS: ABR thresholds were increased according to lengthening of duration of noise exposure. TEM findings of outer hair cells, Deiters' cells and ganglion cells showed more severe degeneration according to lengthening of duration of noise exposure. Damages of all kinds of cells appeared almost at the same time. CONCLUSION: Through the foregone study, cochlear pathology was proportioned to increased hearing threshold, and the damages of outer hair cells and ganglion cells appeared almost at the same time. It seems that not only damages of outer hair cells, but also damages of ganglion cells contribute to early hearing threshold shift during continuous intense noise exposure.

A Case of Craniocervical Necrotizing Fasciitis / 대한이비인후과학회지

Necrotizing fasciitis is a rapidly progressive invasive soft tissue infection that is rarely seen in craniocervical area. In the majority of cases described in the medical literature, there has been an identifiable initiating event such as instrumentation or other trauma to the skin. Because of the rapid progression of the infection, the key to a successful outcome is early recognition and rapid initiation of definitive surgical management. A case is presented in which necrotizing fasciitis was seen in a craniocervical area with instrumentation especially dental extraction.