Authors evaluated the accuracy of preoperative pelvic CT scan staging and its effects on management in 12 biopsy proved rectal cancer patients. Authors also studied postoperative CT in 5 patients to detect disease recurrence and metastasis. Preoperative CT staging was identical to surgical and/or pathological staging in 9 patients (75%), but it was underestimated in two cases and overestimated in one instance than in surgical stagings. In 7 cases, CT scan did not alter original choice of procedures. However, preoperative CT staging gave definitive informations to change management plans in 5 cases otherwise the treatment would be difficult and inadequate. Postoperative CT showed local recurrence in one and liver metastases in 2 cases. One of them was not detected at exploratory laparotomy.
Biopsy ; Humans ; Laparotomy ; Liver ; Neoplasm Metastasis ; Rectal Neoplasms* ; Recurrence ; Tomography, X-Ray Computed*

Basal cell carcinoma (BCC) represents the most common cutaneous malignancy in caucasions. Most of the tumors usually occur on sun-exposed skin, and they are small and easily treated. Giant BCC is a rare variant of this tumor and is defined as a lesion greater than 5 cm at its largest diameter. For the development of giant BCC, several risk factors, including patient neglect, aggressive histological features and long duration, have been identified. We observed a very large BCC on the face and scalp of an elderly woman. She had been reclusive for a long time, and this problem might have played a crucial role in the development of the giant BCC.
Aged ; Carcinoma, Basal Cell* ; Female ; Humans ; Risk Factors ; Scalp ; Skin

Background: A lifelong thyroxine therapy is indicated in all patients who have hypothyroidism as a result of autoimmune thyroiditis. However, it has been reported that some hypothyroid patients with autoimmune thyroiditis have spontaneous remission with restriction of iodine intake instead of thyroxine therapy. The purpose of study was to investigate how many hypothyroid patients with autoimmune thyroiditis can recover from hypothyroidism with restriction of iodine intake instead of thyroxine therapy and which factors predict recovery from hypothyroidism. Methods: We studied 64 patients with autoimmune thyroiditis(goitrous autoimmune thyroiditis 56, atrophic autoimmune thyroiditis 8). Thyroxine therapy was discontinued in patients with goitrous autoimmune thyroiditis on the way(group 1, n=32) or from the beginning(group 2, n=24) and atrophic autoimmune thyroiditis on the way(group 3, n-8). All patients were asked to avoid iodine-rich foods and thyroid function was monitored every one to two months for up to 35 months. Serum T3, T4, TSH concentrations, antithyroglobulin and antimicrosomal antibodies were measured by radioimmunoassay(RIA). TSH binding inhibitor immunoglobulin(TBII) was measured in serum using radioreceptor assay. Two hundred micrograms of thyrotropin releasing hormone (TRH) were given as intravenous bolus and TSH levels were measured in blood samples taken at 0, 30, and 60 minutes. All values were expressed as mean+-SEM. Statistical analysis was done with paired or non-paired t-test, ANOVA, and the Chi-square test. Statistical significance was defined as p-value below 0.05. Results: Thirteen(40.6%) of 32 patients in group 1 remained euthyroid after 12-35 months of discontinuation of thyroxine therapy. The other 19(59.4%) patients in group 1 had recurrences of hypothyroidism within 3 months after discontinuation of thyroxine therapy. In 11(45.8%) out of 24 patients in group 2, serum TSH concentrations declined below 5 mU/L within 3 months without thyroxine therapy. The other 13(54.2%) patients in group 2 remained hypothyroid till 2-16 months and the thyroxine was given. In contrast, all 8 patients in group 3 had recurrences of hypothy- roidism within 3 months after stopping thyroxine therapy. When we compared the recovered patients of goitrous autoimmune thyroiditis with the non-recovered patients of goitrous autoimmune thyroiditis, regardless of thyroxine therapy from the beginning, age at onset of disease of the 24 recovered patients was significantly younger than the 32 non-recovered patients(30.1+2.0 years vs. 40.2+ 2.4 years; p=0.004). Concl#usion: These findings suggest that 42.9% of hypothyroid patients with goitrous autoim- mune thyroiditis remain or become spontaneously euthyroid with restriction of iodine intake instead of thyroxine therapy. Young age may be a predicting factor of recovery from hypothyroidism in goitrous autoimmune thyroiditis.
Age of Onset ; Antibodies ; Humans ; Hypothyroidism ; Iodine ; Radioligand Assay ; Recurrence ; Remission, Spontaneous ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Autoimmune ; Thyrotropin-Releasing Hormone ; Thyroxine

PURPOSE: For the first time, a nationwide survey in the Republic of Korea was conducted to determine the basic parameters for the treatment of esophageal cancer and to offer a solid cooperative system for the Korean Pattern of Care Study database. MATERIALS AND METHODS: During 1998~1999, biopsy-confirmed 246 esophageal cancer patients that received radiotherapy were enrolled from 23 different institutions in South Korea. Random sampling was based on power allocation method. Patient parameters and specific information regarding tumor characteristics and treatment methods were collected and registered through the web based PCS system. The data was analyzed by the use of the Chi-squared test. RESULTS: The median age of the collected patients was 62 years. The male to female ratio was about 91 to 9 with an absolute male predominance. The performance status ranged from ECOG 0 to 1 in 82.5% of the patients. Diagnostic procedures included an esophagogram (228 patients, 92.7%), endoscopy (226 patients, 91.9%), and a chest CT scan (238 patients, 96.7%). Squamous cell carcinoma was diagnosed in 96.3% of the patients; mid-thoracic esophageal cancer was most prevalent (110 patients, 44.7%) and 135 patients presented with clinical stage III disease. Fifty seven patients received radiotherapy alone and 37 patients received surgery with adjuvant postoperative radiotherapy. Half of the patients (123 patients) received chemotherapy together with RT and 70 patients (56.9%) received it as concurrent chemoradiotherapy. The most frequently used chemotherapeutic agent was a combination of cisplatin and 5-FU. Most patients received radiotherapy either with 6 MV (116 patients, 47.2%) or with 10 MV photons (87 patients, 35.4%). Radiotherapy was delivered through a conventional AP-PA field for 206 patients (83.7%) without using a CT plan and the median delivered dose was 3,600 cGy. The median total dose of postoperative radiotherapy was 5,040 cGy while for the non-operative patients the median total dose was 5,970 cGy. Thirty-four patients received intraluminal brachytherapy with high dose rate Iridium-192. Brachytherapy was delivered with a median dose of 300 cGy in each fraction and was typically delivered 3~4 times. The most frequently encountered complication during the radiotherapy treatment was esophagitis in 155 patients (63.0%). CONCLUSION: For the evaluation and treatment of esophageal cancer patients at radiation facilities in Korea, this study will provide guidelines and benchmark data for the solid cooperative systems of the Korean PCS. Although some differences were noted between institutions, there was no major difference in the treatment modalities and RT techniques.
Brachytherapy ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Endoscopy ; Esophageal Neoplasms* ; Esophagitis ; Female ; Fluorouracil ; Humans ; Korea* ; Male ; Photons ; Radiotherapy ; Republic of Korea ; Tomography, X-Ray Computed

Statin-induced rhabdomyolysis is a frequent complication in renal transplant recipients receiving cyclosporine, but incidences are different between different types of statins. Statins have different pharmacokinetic properties. Atorvsatatin, simvastatin, lovastatin, and cerivastatin are all metabolized by the cytochrome P450 isoenzyme 3A4 and co-administration of cyclosporine which may inhibit cytochrome P450 isoenzyme 3A4, increases statin levels and therefore increases the risk of rhabdomyolysis. Fluvastatin is metabolized by cytochrome P450 isoenzyme 2C9 and no clinically significant interactions with cyclosporine have been reported. Atorvastatin with co-administration of cyclosporine in renal transplant patients may induce drug interactions, therefore we recommend the routine monitoring of muscle enzymes, in these cases. Here, we reported a case of rhabdomyolysis in a patient who received atorvastatin and cyclosporine with the review of the literature.
Cyclosporine ; Cytochrome P-450 Enzyme System ; Drug Interactions ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Lovastatin ; Rhabdomyolysis* ; Simvastatin ; Transplantation* ; Atorvastatin Calcium

Objectives: The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. Methods: Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. Results: In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. Conclusions The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

Background: The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea. Methods: Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. Results: The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3–4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5–7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50–59, 60–69, 70–79, and ≥ 80 years of age, respectively. Conclusion In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.