Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

Background: The proximal humerus, a common site for osteoporotic fractures, is frequently overlooked in osteoporosis evaluations. This study aimed to evaluate the relationship between the conventional bone mineral density (BMD) measurement (at the lumbar spine and femur) and the BMD measurement at both proximal humeri (the asymptomatic side and the side with a rotator cuff tear [RCT]) in patients with unilateral RCT. Furthermore, we investigated clinical features indicative of osteoporosis in RCT patients and assessed the utility of proximal humerus BMD measurements. Methods: From April 2020 to September 2020, 87 patients who underwent arthroscopic repairs for unilateral RCTs were examined for age, onset, body mass index, menopause duration, passive range of motion, global fatty degeneration index, and RCT and retraction size. The regions of interest (ROIs) for the conventional BMD included the lumbar spine, femur neck, femur trochanter, and total femur. For the proximal humerus BMD, the ROIs included the head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total humerus. Results: The conventional BMD of the lumbar spine, femur neck, femur trochanter, and femur total were 1.090, 0.856, 0.781, and 0.945 g/cm2 , respectively. The head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total BMD of the asymptomatic-side proximal humerus were 0.547, 0.544, 0.697, 0.642, 0.554, and 0.610 g/cm2 , respectively. The average of proximal humerus BMD was significantly lower than that of conventional BMD (p < 0.001). All ROIs BMD of the RCT-side proximal humerus were 0.497, 0.507, 0.619, 0.598, 0.517, and 0.560 g/cm2 . There was no correlation between the conventional BMD and each proximal humerus BMD. All ROI BMD of the RCT-side proximal humerus was not significant in the multiple regression analysis with age, onset, body mass index, passive range of motion, global fatty degeneration index, and RCT and retraction size (p > 0.05). Conclusions The proximal humerus BMD showed a completely different trend from that of conventional BMD and had no significant association with clinical features. Therefore, the proximal humerus BMD needs to be measured separately from the conventional BMD, as it may provide important information before rotator cuff repair surgery.

Objective: To determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies. Materials and Methods: We retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician’s initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT’s consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed. Results: Of the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (odds ratio, 4.48; p = 0.017). Conclusion MDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.

The deep inferior epigastric perforator (DIEP) flap has been widely used for autologous breast reconstruction after mastectomy. In the conventional surgical method, a long incision is needed at the anterior fascia of the rectus abdominis muscle to obtain sufficient pedicle length; this may increase the risk of incisional hernia. To shorten the incision, several trials have investigated the use of endoscopic/robotic devices for pedicle harvest; however, making multiple additional incisions for port insertion and operating in the intraperitoneal field were inevitable. Here, we describe the first case, in which a DIEP free flap was successfully made using the da Vinci SP model. Our findings can help surgeons perform operations in smaller fields with a single port in the extraperitoneal space. Moreover, this method is expected to lead to fewer donor-related complications and faster healing.

We report 17 patients with human granulocytic anaplasmosis between January 2015 and September 2018 at two tertiary university hospitals in Korea. Monthly incidence peaked in May and June. Among these patients, we identified three who were co-infected with scrub typhus, and one patient with hemorrhagic fever with renal syndrome.
Anaplasmosis ; Animals ; Coinfection ; Hemorrhagic Fever with Renal Syndrome ; Hospitals, University ; Humans ; Incidence ; Korea ; Scrub Typhus

Administration of a hyaluronic acid (HA) filler injection is a common aesthetic procedure widely used for facial soft-tissue augmentation. Owing to their low immunogenicity, hyaluronic acid fillers have rarely been linked with serious long-term adverse effects. Although generally safe, reports of adverse events linked to hyaluronic acid filler injection are increasing following its extensive usage globally. We describe the case of a 33-year-old woman who presented with multiple facial nodules at sites of filler injection. To the best of our knowledge, this is the first reported case of facial pseudocyst related to monophasic hyaluronic acid filler injection, in Korea.
Adult ; Female ; Humans ; Hyaluronic Acid* ; Korea

Administration of a hyaluronic acid (HA) filler injection is a common aesthetic procedure widely used for facial soft-tissue augmentation. Owing to their low immunogenicity, hyaluronic acid fillers have rarely been linked with serious long-term adverse effects. Although generally safe, reports of adverse events linked to hyaluronic acid filler injection are increasing following its extensive usage globally. We describe the case of a 33-year-old woman who presented with multiple facial nodules at sites of filler injection. To the best of our knowledge, this is the first reported case of facial pseudocyst related to monophasic hyaluronic acid filler injection, in Korea.
Adult ; Female ; Humans ; Hyaluronic Acid* ; Korea

BACKGROUND/AIMS: Fragmented care in nephrology can cause treatment delays. Nephrologists are qualified to perform vascular access-related procedures because they understand the pathophysiology of renal disease and perform physical examination for vascular access. We compared treatment delays associated with tunneled hemodialysis catheter (TDC) placement between interventional radiologists and nephrologists. METHODS: We collected data by radiologists from January 1, 2011 through December 31, 2011 and by nephrologists from since July 1, 2012 through June 30, 2013. We compared the duration from the hemodialysis decision to TDC placement (D-P duration) and hemodialysis initiation (D-H duration), catheter success and the complication rate, and the frequency and the usage time of non-tunneled hemodialysis catheters (NDCs) before TDC placement. RESULTS: The study analyzed 483 placed TDCs: 280 TDCs placed by radiologists and 203 by nephrologists. The D-P durations were 319 minutes (interquartile range [IQR], 180 to 1,057) in the radiologist group and 140 minutes (IQR, 0 to 792) in the nephrologist group. Additionally, the D-H durations were 415 minutes (IQR,260 to 1,091) and 275 minutes (IQR, 123 to 598), respectively. These differences were statistically significant (p = 0.00). The TDC success rate (95.3% vs. 94.5%, respectively; p = 0.32) and complication rate (16.2% vs. 11%, respectively; p = 0.11) did not differ between the groups. The frequency (24.5 vs. 26%, respectively; p = 0.72) and the usage time of NDC (8,451 vs. 8,416 minutes, respectively; p = 0.91) before TDC placement were not statistically significant. CONCLUSIONS: Trained interventional nephrologists could perform TDC placement safely, minimizing treatment delays.
Catheters* ; Nephrology ; Physical Examination ; Renal Dialysis* ; Vascular Access Devices

BACKGROUND: Efforts to overcome poor outcomes in patients with adult acute lymphoblastic leukemia (ALL) have focused on combining new therapeutic agents targeting immunophenotypic markers (IPMs) with classical cytotoxic agents; therefore, it is important to evaluate the clinical significance of IPMs. METHODS: Baseline characteristics and clinical outcomes of patients with adult ALL were retrospectively analyzed. The percentage of blasts expressing IPMs at diagnosis was measured by multicolor flow cytometry analysis. Samples in which > or =20% of blasts expressed an IPM were considered positive. RESULTS: Among the total patient population (N=230), almost all (92%) were in first or second hematological complete remission (HCR) and 54% received allogeneic hematopoietic cell transplant (allo-HCT). Five-year hematologic relapse-free survival (HRFS) and overall survival (OS) rates were 36% and 39%, respectively, and 45.6% and 80.5% of patients were positive for the IPMs CD20 and terminal deoxynucleotidyl transferase (TdT), respectively. Expression of CD20, CD13, CD34, and TdT was associated with HRFS rate, and expression of CD20 and CD13 was associated with OS rate, as was the performance of allo-HCT. In multivariate analysis, positivity for CD20 (HRFS: hazard ratio [HR], 2.21, P<0.001; OS: HR, 1.63, P=0.015) and negativity for TdT (HRFS: HR, 2.30, P=0.001) were both significantly associated with outcomes. When patients were categorized into three subgroups according to positivity for CD20 and TdT, there were significant differences in HRFS and OS among the subgroups. CONCLUSION: Positivity for CD20 and TdT expression and clinical risk group were prognostic factors in adult ALL.
Adult* ; Cytotoxins ; Diagnosis ; DNA Nucleotidylexotransferase ; Flow Cytometry ; Humans ; Multivariate Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Retrospective Studies ; Transplants

BACKGROUND: Anti-atherosclerotic effect of dipeptidyl peptidase-4 (DPP-4) inhibitors has been suggested from previous studies, and yet, its association with cardiovascular outcome has not been demonstrated. We aimed to evaluate the effect of DPP-4 inhibitors in reducing mortality and coronary revascularization, in association with baseline coronary computed tomography (CT). METHODS: The current study was performed as a multi-center, retrospective observational cohort study. All subjects with diabetes mellitus who had diagnostic CT during 2007-2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users were compared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularization therapy after 90 days of CT in addition to all-cause mortality. RESULTS: DPP-4 inhibitors users had significantly less adverse events [0.8% vs. 4.4% in users vs. non-users, adjusted hazard ratios (HR) 0.220, 95% confidence interval (CI) 0.102-0.474, p = 0.0001 for primary outcome, 4.1% vs. 7.6% in users vs. non-users, HR 0.517, 95% CI 0.363-0.735, p = 0.0002 for secondary outcome, adjusted variables were age, sex, presence of hypertension, high sensitivity C-reactive protein, glycated hemoglobin, statin use, coronary artery calcium score and degree of stenosis]. Interestingly, DPP-4 inhibitor seemed to be beneficial only in subjects without significant stenosis (adjusted HR 0.148, p = 0.0013 and adjusted HR 0.525, p = 0.0081 for primary and secondary outcome). CONCLUSION: DPP-4 inhibitor is associated with reduced all-cause mortality and coronary revascularization in diabetic patients. Such beneficial effect was significant only in those without significant coronary stenosis, which implies that DPP-4 inhibitor may have beneficial effect in earlier stage of atherosclerosis.
Atherosclerosis ; C-Reactive Protein ; Calcium ; Cohort Studies ; Constriction, Pathologic ; Coronary Stenosis ; Coronary Vessels ; Diabetes Mellitus ; Hemoglobin A, Glycosylated ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Mortality* ; Retrospective Studies