Purpose: Fertility preservation (FP) is an important issue for young survivors of breast cancer. Although international guidelines recommend pre-treatment fertility counseling for women with breast cancer, there is no standardized protocol or referral system for FP in South Korea. There are also barriers to discussing FP that make patient-centered decision making difficult. This study aimed to develop a shared decision making program for FP and compare the rates of FP procedures between the usual care and shared decision making groups. We hypothesized that multidisciplinary shared decision making for FP would increase the rate of FP procedures and patient satisfaction. Methods The multidisciplinary shared decision making for FP in young women with breast cancer (MYBC) is a multicenter, clustered, stepped-wedge, randomized trial. A total of 1100patients with breast cancer, aged 19–40 years, from nine hospitals in South Korea, will be enrolled. They will be randomized at the institutional level and assigned to usual care and shared decision making groups. Four institutions, each of which can recruit more than 200 patients, will each become a cluster, whereas five institutions, each of which can recruit more than 50 patients, will become one cluster, for a total of five clusters. The shared decision making groups will receive multidisciplinary programs for FP developed by the investigator. The primary outcome is the rate of FP procedures; secondary outcomes include fertility results, satisfaction, and quality of life. Outcomes will be measured at enrollment, treatment initiation, and the 1-, 3-, and 5-year follow-ups after starting breast cancer treatment.Discussion: A multidisciplinary shared decision making program for FP is expected to increase fertility rates and satisfaction among young patients with breast cancer. This study will provide the evidence to implement a multidisciplinary system for patients with breast cancer.

Colorectal cancer is the third most common cancer in Korea; it is the second most common cancer in men and the third most common in women. The incidence rate in Korea has continuously increased since 1999 when the National Cancer Registry statistics began. Currently; there are several screening modalities; that have been recommended by expert societies, including fecal occult blood test, colonoscopy, computed tomographic colonography The annual fecal immunochemical test (FIT) has been used in adults aged 50 and older as part of the National Cancer Screening Program in Korea since 2004. Although several study results from regional or national colorectal cancer screening programs in other countries have been reported, the National Cancer Screening Program in Korea has not yet been evaluated with evidence-based methods. Herein report the consensus statements on the National Screening Guideline for colorectal cancer developed by a multi-society expert committee in Korea, as follows: 1) We recommend annual or biennial FIT for screening for colorectal cancer in asymptomatic adults, beginning at 45 years of age and continuing until 80 years (recommendation B). 2) There is no evidence for the risks or benefits of FIT in adults older than 80 years (recommendation I). 3) Selective use of colonoscopy for colorectal cancer screening is recommended, taking into consideration individual preference and the risk of colorectal cancer (recommendation C). 4) There is no evidence for the risks or benefits of double-contrast barium enema for colorectal cancer screening in asymptomatic adults (recommendation I). 5) There is no evidence for the risks or benefits of computed tomographic colonography for colorectal cancer screening in asymptomatic adults (recommendation I).
Adult ; Barium ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms* ; Consensus ; Early Detection of Cancer ; Enema ; Female ; Humans ; Incidence ; Korea ; Male ; Mass Screening* ; Occult Blood

Since the discovery of Helicobacter pylori infection as the major cause of gastroduodenal disorders including acute and chronic gastritis, gastroduodenal ulcer, chronic atrophic gastritis, and gastric malignancy almost three decades ago, the possibility of preventing these clinical diseases through eradication has been the focus of active research and debate, especially since eradication can prevent cancer. Eradication intervenes with the initiation and progression of mucosal atrophy, metaplasia, dysplasia and gastric cancer. Our group hypothesized that nutritional interventions can rejuvenate the atrophic mucosa and ameliorate H. pylori-associated gastric inflammation. In this review article, the experience and outcomes regarding nutritional applications to rejuvenate gastric atrophy will be introduced. Korean red ginseng, garlic extracts, cancer preventive Korea Kimchi, n-3 polyunsaturated fatty acids, special form of licorice, and probiotics will be reviewed. The detailed effects of dietary and bacterial eradication therapy on disease progression and lesion reversibility are discussed.
Atrophy ; Carcinogenesis ; Disease Progression ; Fatty Acids, Omega-3 ; Garlic ; Gastritis ; Gastritis, Atrophic ; Glycyrrhiza ; Helicobacter pylori* ; Inflammation ; Korea ; Metaplasia ; Mucous Membrane ; Panax ; Peptic Ulcer ; Probiotics ; Rejuvenation ; Stomach Diseases* ; Stomach Neoplasms*

BACKGROUND: We investigated the prevalence of diabetic autonomic neuropathy (DAN) and vestibular dysfunction (VD) in diabetic patients with peripheral neuropathy. METHODS: Thirty-five diabetic patients with peripheral neuropathy were enrolled from August 2008 to July 2009. All subjects underwent autonomic function tests. Nineteen of the patients (54.3%) underwent videonystagmography. RESULTS: Diabetic autonomic neuropathy was observed in 28 patients (80%). A mild degree of autonomic failure was observed in 18 patients (64.3%), and a moderate degree of autonomic failure was observed in ten patients (35.7%). Factors related to DAN included diabetic nephropathy (P=0.032), degree of chronic kidney disease (P=0.003), and duration of diabetes (P=0.044). Vestibular dysfunction was observed in 11 of 19 patients (57.9%). There was no significant association between DAN and VD. CONCLUSION: Diabetic autonomic neuropathy was observed in 28 diabetic patients (80%) with peripheral neuropathy. Vestibular dysfunction was observed in nearly 60% of diabetic patients with peripheral neuropathy who complained of dizziness but showed no significant association with DAN. Diabetic patients who complained of dizziness need to examine both autonomic function and vestibular function.
Diabetic Nephropathies ; Diabetic Neuropathies ; Dizziness ; Humans ; Peripheral Nervous System Diseases ; Prevalence ; Renal Insufficiency, Chronic

BACKGROUND: The purpose of this study was to investigate the prevalence of rhabdomyolysis and its association with both clinical course and prognosis and to evaluate the factors associated with rhabdomyolysis in patients with hyperglycemic emergencies. METHODS: We reviewed the medical records of patients with hyperglycemic emergencies who visited our hospital from May 2003 to April 2010. We assessed the clinical characteristics, biochemical profiles and clinical course of patients and analyzed these data according to the presence of rhabdomyolysis. RESULTS: The prevalence of rhabdomyolysis was 29 patients (28.4%) among 102 patients. Mean serum osmolarity, glucose and serum creatinine levels were higher in patients with rhabdomyolysis than those without rhabdomyolysis. Patients with rhabdomyolysis had higher rates of hemodialysis and mortality than those without the condition. The factors associated with rhabdomyolysis in the hyperglycemic emergency state were increased serum osmolarity and APACHE II score on admission (P < 0.05). CONCLUSION: Rhabdomyolysis commonly occurred in patients with hyperglycemic emergencies and this could aggravate their clinical course and increase mortality.
APACHE ; Creatinine ; Diabetic Ketoacidosis ; Emergencies ; Glucose ; Humans ; Medical Records ; Osmolar Concentration ; Prevalence ; Prognosis ; Renal Dialysis ; Rhabdomyolysis

Thyrotoxic periodic paralysis is not a rare complication of hyperthyroidism in Asian people, but the cases of paralysis with normal serum potassium levels are very rare. A 36-year-old Korean man who had been diagnosed with Graves' disease had experienced recurrent paralysis for 9 months in spite of normokalemia. We measured the patient's serum potassium levels nine times at the time of paralysis. All measurements fell in the range 3.3~4.7 mmol/L. We treated the patient with methimazole, Lugol's solution, beta-blockers, and radioactive iodine. Thyroid function was normalized after anti-thyroid treatment and then no further paralytic attacks have occurred.
Adult ; Asian Continental Ancestry Group ; Graves Disease ; Humans ; Hyperthyroidism ; Iodides ; Iodine ; Methimazole ; Paralysis ; Potassium ; Thyroid Gland ; Thyrotoxicosis

BACKGROUND/AIMS: In a previous issue published in Gut and Liver, we found that erosive changes in the esophagogastroduodenal mucosa were strongly correlated with increased levels of volatile sulfur-containing compounds (VSC), suggesting that halitosis could be a symptom reflecting the erosive status of the upper gut mucosa. Together with other studies showing a possible association between halitosis and gastroesophageal reflux disease (GERD), under the premise that halitosis could be one of extraesophageal manifestations of erosive GERD (ERD), we investigated the significance of Halimeter ppb levels on ERD compared to non-erosive gastroesophageal reflux disease (NERD). METHODS: Subjects were assigned to the NERD group if there was no evidence of esophageal erosive changes on endoscopy, despite reflux symptoms, and to the ERD group if they had GERD A, B, C, or D (according to the Los Angeles classification). The VSC levels were measured in all patients with either a Halimeter (before endoscopy) or by gas chromatography of the gastric juices aspirated during endoscopy. RESULTS: The VSC level differed significantly between the NERD and ERD groups (p<0.0001), suggesting that this can be used to discriminate between NERD and ERD. However, the VSC level did not differ significantly with the severity of GERD. Even though hiatal hernia and a body mass index of >24 kg/m2 was significantly associated with ERD, there was no correlation with Halimeter ppb levels. Minimal-change lesions exhibited the highest VSC levels, signifying that minimal change lesions can be classified as ERD based on our finding that halimeter ppb levels were descrimitive of erosive change. CONCLUSIONS: Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.
Body Mass Index ; Chromatography, Gas ; Discrimination (Psychology) ; Endoscopy ; Esophagogastric Junction ; Gastric Juice ; Gastroesophageal Reflux ; Halitosis ; Hernia, Hiatal ; Humans ; Liver ; Los Angeles ; Mucous Membrane

OBJECTIVES : The aims of this study are to estimate the prevalence of the DSM-IV psychiatric disorders in the Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI), and to compare those with previous studies. METHODS : The Korean Epidemiologic Catchment Area study Replication (KECA-R) was conducted between August 2006 and April 2007. The sampling of the subjects was carried out across 12 catchment areas. A multistage, cluster sampling design was adopted. The target population included all eligible residents aged 18 to 64 years. Face-to-face interviews were conducted with the Korean version of Composite International Diagnostic Interview (K-CIDI) based on the DSM-IV (N=6,510, response rate=81.7%). RESULTS : A total of 6,510 participants completed the interview. The lifetime and 12-month prevalence rates for all types of DSM-IV disorders were 30.0% and 17.3%, respectively. Those of specific disorders were as follows : 1) alcohol use disorder, 16.2% and 5.6% ; 2) nictotine use disorder, 9.0% and 6.0%;3) specific phobia, 3.8% and 3.4%;4) major depressive disorder, 5.6% and 2.5% ; and 5) generalized anxiety disorder, 1.6% and 0.8%. Data relating to nicotine and alcohol use disorder revealed a very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among females than males. CONCLUSION : The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in the distribution of psychiatric disorders across the country and times were observed.
Adult ; Aged ; Anxiety Disorders ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Health Services Needs and Demand ; Humans ; Male ; Mental Disorders ; Mood Disorders ; Nicotine ; Phobic Disorders ; Prevalence

BACKGROUND: The epidural steroid injection is commonly used in the management of chronic low back pain and radiating pain. We compared the efficacy of 40, 60, and 80 mg of methylprednisolone acetate in patients with lumbar herniated disc disease treated with caudal epidural block. METHODS: Seventy-two patients with lumbar herniated nucleus purposes on magnetic resonance imaging were included.All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle.After confirming the catheter tip position at the affected nerve root, contrasts were injected until patients felt discomfort in their site of pain.24 patients in each group received 40 mg, 60 mg, 80 mg of methylprednisolone acetate, respectively.We evaluated the improvements by pain relief scale (0-100%) after 2 weeks. RESULTS: There are no significant differences in the pain improvement between three groups (P = 0.537 ). CONCLUSIONS: Sixty and 80 mg methylprednisolone acetate injection during caudal epidural block showed no further benefit compared to 40 mg injection.
Catheters ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement ; Low Back Pain ; Magnetic Resonance Imaging ; Methylprednisolone

Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglyc-erides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.
Thyroid Function Tests ; Methimazole/therapeutic use ; Insulin/therapeutic use ; Hyperthyroidism/*complications/therapy ; Hyperglycemic Hyperosmolar Nonketotic Coma/*etiology ; Humans ; Graves Disease/*complications ; Fluid Therapy ; Female ; Diabetes Mellitus, Type 2/*complications ; Adult