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Kim W.,Boramae Medical Center
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2015

Alcoholic hepatitis (AH) is defined as an acute hepatic manifestation resulting from heavy alcohol intake. Histologically, alcoholic steatohepatitis (ASH) is characterized by hepatocellular steatosis, inflammation, and fibrosis. Alcohol abstinence is the sine qua non of therapy for AH and, in the milder forms, is prerequisite to clinical recovery. Severe ASH may lead to multi-organ failure such as acute kidney injury and infection, which has a major impact on survival and thus should be closely monitored. Patients with severe ASH have a drastic short-term mortality of up to 40-50%. Specific therapies should be considered for patients with severe ASH at risk of early death. Corticosteroids are the standard of care for patients with severe ASH. When corticosteroids are contraindicated, pentoxifylline may be an alternative option. Steroid responsiveness should be evaluated on the basis of Lille score. Tactically, we should explore novel therapeutic targets to suppress inflammation based on cytokine profiles, promote hepatic regeneration, limit innate immune responses, and restore altered gut mucosal integrity in severe ASH.

Ryu J.H.,Seoul National University | Lee S.W.,Seoul National University | Lee J.H.,Seoul National University | Lee E.H.,Seoul National University | And 2 more authors.
British Journal of Anaesthesia | Year: 2012

Background. The safety profiles and efficacies of remifentanil and dexmedetomidine (a sedativeanalgesic without respiratory depression) for sedation during flexible bronchoscopy were investigated. Methods. Seventy-two patients undergoing elective flexible bronchoscopy were randomly assigned to a propofolremifentanil group (Group PR, n36) or a propofoldexmedetomidine group (Group PD, n36). The primary outcome was the incidence of oxygen desaturation. Haemodynamic variables, adverse events, need of oral cavity suction, cough scores, satisfaction scores of patients and bronchoscopists, levels of sedation, and recovery times were also compared. Results. The incidence of oxygen desaturation was significantly lower in the PD group than in the PR group (P0.01). There were no significant differences between groups in terms of level of sedation, oxygen saturation, mean arterial pressure, heart rate over time, cough scores, or patient satisfaction scores (P>0.05). However, cough scores and bronchoscopist satisfaction scores (P<0.01) were lower in the PD group. In addition, topical anaesthesia (P<0.01) was required more frequently and recovery time (P0.00) was significantly longer in the PD group. However, oral suction (P0.03) was required less frequently in the PD group. Conclusions. Dexmedetomidine was associated with fewer incidents of oxygen desaturation and a reduced need for oral cavity suction than remifentanil during flexible bronchoscopy. However, dexmedetomidine was associated with a longer recovery time and poorer bronchoscopist satisfaction score. © The Author [2011].

Ryu H.-G.,Boramae Medical Center | Jung C.-W.,Boramae Medical Center | Lee C.-S.,Boramae Medical Center | Lee J.,Boramae Medical Center
American Journal of Transplantation | Year: 2011

Postreperfusion syndrome (PRS), an acute decrease in blood pressure after reperfusion of the liver graft, occurs frequently during liver transplantation surgery. We supposed that the activation of the kallikrein-kinin system leading to extensive systemic vasodilatation was a possible cause. The effect of pretreatment with nafamostat mesilate (NM), a broad spectrum serine protease inhibitor, on the occurrence of PRS was evaluated. Sixty-two adult liver recipients were randomized to receive an intravenous bolus of either 0.02 mg/kg of NM (NM group, n = 31) or an equal volume of normal saline (control group, n = 31) just before reperfusion of the liver graft. Occurrence of PRS and intraoperative use of vasoactive drugs were compared between the two groups. Postoperative recovery was also compared. PRS was significantly less frequent (48% vs. 81%, p = 0.016) requiring less vasopressors in the NM group compared to the control group. The NM group also showed faster recovery of the mean arterial pressure. Perioperative laboratory values were similar between the two groups. Pretreatment with 0.02 mg/kg of NM immediately before reperfusion decreases the frequency of PRS and vasopressor requirements during the reperfusion period in liver transplantation. © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Wee J.H.,National Medical Center | Park M.-H.,Seoul National University | Oh S.,Boramae Medical Center | Jin H.-R.,Seoul National University
JAMA Facial Plastic Surgery | Year: 2015

IMPORTANCE: Although autologous rib cartilage is a preferred source of graft material in rhinoplasty, rib cartilage for dorsal augmentation has been continuously criticized for its tendency to warp and for high donor-site morbidities. However, nometa-analysis or systemic review on complications associated with autologous rib cartilage use in rhinoplasty has been conducted. OBJECTIVE: To carry out a systematic review and ameta-analysis of available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty. DATA SOURCES: The studies reporting complications associated with the autologous rib cartilage use in rhinoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for sources published from 1946 through June 2013. STUDY SELECTION: The selected articles included clinical studies conducted with at least 10 patients and at least 1 postoperative long-term complication or donor-site morbidity in rhinoplasty. Excluded were nonhuman studies; review articles; case reports; abstracts; and reports of nasal reconstruction as indication for surgery, use of homologous rib cartilage, and diced or laminated methods. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed all studies and extracted the data using a standardized form. Ameta-analysis was performed using a random-effects model. MAIN OUTCOMES AND MEASURES: Number of patients; follow-up duration; and rates of complication, donor-site morbidity, and revision surgery. Also noted were study authors and year of publication. RESULTS: Ten studies involving a total 491 patients were identified. Mean follow-up across all studies was 33.3 months. In meta-analysis, the combined rates were 3.08%(95%confidence interval [CI], 0%-10.15%) for warping, 0.22%(95%CI, 0%-1.25%) for resorption, 0.56% (95%CI, 0%-2.61%) for infection, 0.39%(95%CI, 0%-1.97%) for displacement, 5.45%(95% CI, 0.68%-13.24%) for hypertrophic chest scarring, 0% (95%CI, 0%-0.32%) for pneumothorax, and 14.07%(95%CI, 6.19%-24.20%) for revision surgery. CONCLUSIONS AND RELEVANCE: The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low.Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon's attention. Because a limited number of studies and patients were eligible, and consistent definitions of complications were lacking in this meta-analysis, future studies with a larger series of patients and objective outcome measurements are needed to obtain more reliable results. Copyright 2014 American Medical Association. All rights reserved.

Kim J.H.,Boramae Medical Center | Kang G.H.,Seoul National University
World Journal of Gastroenterology | Year: 2014

Colorectal cancers (CRCs) with a high level of microsatellite instability (MSI-H) are clinicopathologically distinct tumors characterized by predominance in females, proximal colonic localization, poor differentiation, mucinous histology, tumor-infiltrating lymphocytes, a Crohn's-like lymphoid reaction and a favorable prognosis. In terms of their molecular features, MSI-H CRCs are heterogeneous tumors associated with various genetic and epigenetic alterations, including DNA mismatch repair deficiency, target microsatellite mutations, BRAF mutations, a CpG island methylator phenotype-high (CIMP-H) status, and a low level of genomic hypomethylation. The molecular heterogeneity of MSI-H CRCs also depends on ethnic differences; for example, in Eastern Asian countries, relatively low frequencies of CIMP-H and BRAF mutations have been observed in MSI-H CRCs compared to Western countries. Although the prognostic features of MSI-H CRCs include a favorable survival of patients and low benefit of adjuvant chemotherapy, there may be prognostic differences based on the molecular heterogeneity of MSI-H CRCs. Here, we have reviewed and discussed the molecular and prognostic features of MSI-H CRCs, as well as several putative prognostic or predictive molecular markers, including HSP110 expression, beta2-microglobulin mutations, myosin 1a expression, CDX2/CK20 expression, SMAD4 expression, CIMP status and LINE-1 methylation levels. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

Kim J.H.,Konyang University | Kang S.W.,Sungkyunkwan University | Kim T.-H.,Sungkyunkwan University | Kim S.J.,Sungkyunkwan University | Ahn J.,Boramae Medical Center
American Journal of Ophthalmology | Year: 2013

Purpose To investigate the structure of polypoidal choroidal vasculopathy (PCV) by tomographic localization of the branching vascular network and late geographic hyperfluorescence. Design Observational case series. Methods We examined 34 eyes with PCV by simultaneous indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (OCT) imaging. The margin of the branching vascular network and the late geographic hyperfluorescence on ICGA was colocalized on OCT, in a point-to-point manner, using innate software. The large vessels within the branching vascular network were also colocalized on OCT. Results Late geographic hyperfluorescence on ICGA was noted in 30 eyes. The extent of late geographic hyperfluorescence was larger than that of branching vascular network in 12 eyes. In the remaining eyes, the extent was the same. A double-layer sign on OCT, which consisted of two hyper-reflective lines, representing the retinal pigment epithelium and Bruch membrane, was noted in 29 eyes. In all 28 eyes exhibiting both late geographic hyperfluorescence and the double-layer sign, the extent of late geographic hyperfluorescence matched exactly the extent of double-layer sign on OCT. In 7 of 34 eyes, the thickness of the subretinal pigment epithelial space over the Bruch membrane was too thin to accommodate the large vessels of the branching vascular network. Although the double-layer sign showed mild reduction in area after photodynamic therapy, its general configuration was maintained. Conclusions Late geographic hyperfluorescence on ICGA corresponds with the double-layer sign on OCT in eyes with PCV. Our observations suggest that the double-layer sign consists mainly of fibrous tissue harbored by the branching vascular network, and late geographic hyperfluorescence may originate from the staining of tissue. © 2013 BY ELSEVIER INC. ALL RIGHTS RESERVED.

Lee Y.J.,Seoul National University | Cho S.Y.,Boramae Medical Center | Paick J.-S.,Seoul National University | Kim S.W.,Seoul National University
Urology | Year: 2015

Objective To investigate the impact of 2010 World Health Organization (WHO) reference values in patients who underwent microsurgical varicocelectomy. Methods This retrospective cohort study included 206 men who underwent microsurgical varicocelectomy for a clinical varicocele with at least 1 abnormal semen parameter according to the 1999 WHO criteria. The preoperative semen analysis findings were reclassified according to the 2010 WHO criteria, and an improved seminal result after varicocelectomy was defined as a >20% increase in sperm count or motility. Results Semen results of 114 men (55.3%) were reclassified as being above the reference values according to the 2010 WHO criteria. Among those with below reference values, 79.3% and 34.8% showed improved sperm counts and motility, respectively. However, in patients whose semen results converted to normal, 47.4% and 20.2% showed improved sperm counts and motility, respectively. Among those whose semen results were normal on the 2010 criteria, 58.8% showed improved sperm count or motility after microsurgical varicocelectomy. Conclusion More than half of the patients whose semen results converted to normal on the 2010 WHO criteria showed improved seminal results after microsurgical varicocelectomy. It is necessary to reconsider the 2010 WHO criteria when determining the surgical indication for microsurgical varicocelectomy. © 2015 Elsevier Inc.

Park S.J.,Seoul National University | Lee J.H.,Seoul National University | Woo S.J.,Seoul National University | Ahn J.,Boramae Medical Center | And 4 more authors.
Ophthalmology | Year: 2014

Objective To investigate the prevalence and risk factors of age-related macular degeneration (AMD) in the Korean population. Design A cross-sectional study using a complex, stratified, multistage, probability-cluster survey, which can produce nationally representative estimates. Participants Using the database of Korean National Health and Nutrition Examination Survey from 2008 through 2011, 14 352 participants 40 years of age or older with gradable fundus photographs were included. Methods Age-related macular degeneration was determined by fundus photograph. Prevalences of AMDs were estimated. Risk factor analyses were conducted using logistic regression analyses (LRAs). Main Outcome Measures Prevalence and risk factors of AMD. Results The prevalence of AMD was 6.62% (95% confidence interval [CI], 6.15%-7.09%) in the Korean population: 6.02% (95% CI, 5.56%-6.48%) were early AMD and 0.60% (95% CI, 0.45%-0.75%) were late AMD. The prevalence of early AMD in women (6.73%; 95% CI, 6.11%-7.35%) was higher than that in men (5.25%; 95% CI, 4.61%-5.89%; P<0.001), and the prevalence of late AMD in women (0.37%; 95% CI, 0.22%-0.52%) was lower than that in men (0.85%; 95% CI, 0.59%-1.12%; P<0.001). However, in multiple LRAs both early and late AMD had no association with gender, house income, residence, sun exposure, or systemic comorbidities, including hypertension, diabetes mellitus, and cardiovascular diseases. Early AMD had positive associations with older age groups (P<0.001), lower education (P = 0.027), occupation (P<0.001), anemia (P = 0.027), hepatitis B surface antigen carrier status (P<0.001), not being overweight (body mass index [BMI], P = 0.032; waist circumference, P = 0.041, in separate analyses), and higher serum high-density lipoprotein (HDL) level (P = 0.046), but not with smoking status. Late AMD had positive associations with age groups (P<0.001), current smokers (P = 0.022), and lower BMI (P = 0.037). Conclusions The results suggest that there are 1.21 million individuals with early AMD and 121 000 individuals with late AMD in Korea. Nonoverweight status and higher HDL levels, generally assumed as positive health indicators, as well as anemia and hepatitis B infection had harmful associations with AMD in our study, implying a possible different pathophysiologic process of AMD in Asians compared with that of white persons. © 2014 by the American Academy of Ophthalmology.

Cho S.Y.,Boramae Medical Center
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi | Year: 2013

Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach. We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012. The mean age was 48.9 years old and male to female ratio was 2.6 : 1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%). Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.

Kim J.H.,Seoul National University | Kim J.H.,Boramae Medical Center | Rhee Y.-Y.,Seoul National University | Bae J.M.,Seoul National University | And 2 more authors.
American Journal of Surgical Pathology | Year: 2013

Several previous studies have demonstrated that the CDX2-negative (CDX2) and/or CK20-negative (CK20-) phenotypes of colorectal cancers (CRCs) might be associated with high levels of microsatellite instability (MSI-H). The aim of this study was to investigate the clinicopathologic and molecular features of MSI-H CRCs with different CDX2/CK20 expression statuses. The CDX2- and CK20 expression statuses were immunohistochemically evaluated in 109 MSI-H CRC tissue samples, and the correlations of these statuses with clinicopathologic, molecular, and survival data were statistically analyzed. Of the 109 MSI-H CRCs, 15 were CDX2- (13.8%), and 19 were CK20- (17.4%). The simultaneous loss of CDX2 and CK20 expression (CDX2-/CK20-) was observed in 9 cases (8.3%). CDX2 loss was correlated with lymph node metastasis, poor differentiation, MLH1 loss, the mutation of BRAF, and CpG island methylator phenotype-high (CIMP-H) status. Right-sided tumor location, nodal metastasis, poor differentiation, and CIMP-H status were significant characteristics of CK20- tumors. The CDX2-/CK20- phenotype was associated with older age (above 56 y), higher stage (stage III or IV), deep invasion (pT3 or pT4), lymph node metastasis (pN1 or pN2), poor differentiation (nonmedullary/non-signet ring cell type), the mutation of BRAF, and CIMP-H status among MSI-H CRCs. Patients with CDX2-/CK20- tumors exhibited worse overall and disease-free survival compared with the patients with CDX2+ and/or CK20+ tumors (P<0.001). In the multivariate analysis for disease-free survival, the CDX2-/CK20- phenotype was an independent prognostic factor for MSI-H CRC (P=0.030, hazard ratio=3.288). The CDX-/CK20- phenotype defines a distinct subgroup of MSI-H CRCs with poor differentiation, CIMP-H status, and unfavorable prognosis. Copyright © 2013 by Lippincott Williams & Wilkins.

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