Ionizing radiation including I131 might produce chromosomal translocation, causing hematologic malignancy. The incidence of leukemia following radioactive iodine treatment for thyroid cancer has been reported to be approximately 0.1 to 2.0% in Western countries, whereas fewer cases have been reported in Korea. We hereby report four cases of secondary hematologic malignancy, who received iodine therapy for thyroid cancer after thyroidectomy: two cases of acute lymphoblastic leukemia with t(9;22)(q34;q11.2), a case of MDS with 5q deletion, and a case of MDS with normal karyotype. Three cases of hematologic malignancy have developed after cumulative dosage of less than 800 mCi. The treatment intervals in two cases were less than 12 months, and the other two cases had I131 therapy only once. Assessment of causality using the Naranjo probability scale for adverse drug reactions showed that a 'possible' relationship existed between the use of I131 and secondary hematologic malignancy in all of the four cases in this report.
Adult ; Chromosomes, Human, Pair 22 ; Chromosomes, Human, Pair 5 ; Chromosomes, Human, Pair 9 ; Female ; Gene Deletion ; Hematologic Neoplasms/*diagnosis/genetics ; Humans ; Iodine Radioisotopes/*adverse effects/therapeutic use ; Leukemia, Radiation-Induced/*diagnosis/etiology ; Middle Aged ; Myelodysplastic Syndromes/diagnosis/genetics ; Neoplasms, Second Primary/*diagnosis/genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/genetics ; Thyroid Neoplasms/*radiotherapy ; Thyroidectomy ; Translocation, Genetic

Purpose: This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for lifesustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. Methods: This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. Results: The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). Conclusion This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

Purpose: This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for lifesustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. Methods: This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. Results: The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). Conclusion This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

A malignancy is a fatal condition that could occur through various mechanisms. Forensic pathologists sometimes find unexpected findings during autopsy and post-mortem (PM) tests. Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. The deceased was a 64-year-old man with a medical history of right hemicolectomy due to colon cancer approximately two years earlier. He was found dead at his home. He was admitted to the hospital due to subdural hemorrhage (SDH) two days prior to his demise and was discharged without the permission of the doctor after one day of hospitalization. An autopsy was performed within two days of his death. After gross dissection, the cause and manner of death were assumed to be SDH and unnatural death, respectively. Microscopic examination revealed fresh SDH and dural metastasis of signet-ring cell carcinoma. Furthermore, metastasis was identified in the heart, stomach, and peritoneum. Immunohistochemical examination revealed cancer cells to originate from the colon. After meticulous PM examination, including gross dissection, microscopic examination, PM computed tomography, and PM laboratory tests, the cause and manner of death were determined as SDH and natural death, respectively. This case report highlights the importance of comprehensive PM evaluation for investigating death.

No abstract available.
Factor XII Deficiency* ; Humans

For the purpose of investigation of prevalence, etiology and its related factors of the dementia in the rural elderly, the author examined 650 elderly people aged 60 years or more via cluster sampling by using a door to door 2 phase design from June 1992 to July 1992. The cognitive impairment was assessed by MMSEK in the first screening phase, and in the second phase 252 people in the dementia suspected group (MMSEK score < 23) and 34 in the control group (MMSEK score > 24) were taken to the clinical examination for the diagnosing dementia. The results were as follows; 1. The prevalence rate of dementia was 21.3% in the rural elderly, and was higher in females (31.1%) than in males (10.7%) (p<0.01). 2. The prevalence rates of dementia in males aged 60-69, 70-79 and over 80 were 4.1%, 16.7% and 50.0% respectively and those in female were 8.7%, 49.3%, 72.2% respectively. The rates increased significantly with increasing age in both sexes (p<0.01). 3. The prevalence rates of the mild, moderate and severe dementia were 8.4%, 9.3% and 3.6% respectively and increased significantly with increasing age in females (p<0.001). 4. The proportional distribution of dementia type by etiological classification was 63.6% senile dementia of Alzheimer's type, 17.7% vascular dementia, 10.4% mixed dementia, 4.2% alcoholic dementia, 1.0% posttraumatic dementia and 3.1% for others. 5. In multiple logistic regression analysis for affecting factors of the dementia, the significant variables were level of physical activity, age, education and sex. The Odds ratios in factors were low level of physical activity 6.0 x (95% CI 2.4-15.1), age over 70 4.8 x (95% CI 2.2-10.7), no formal education 3.9 x (95% CI 1.1-13.8), and female sex 2.2 x (95% CI 1.0-5.0).
Aged* ; Alcoholics ; Alzheimer Disease ; Classification ; Dementia* ; Dementia, Vascular ; Education ; Female ; Humans ; Logistic Models ; Male ; Mass Screening ; Motor Activity ; Odds Ratio ; Prevalence*

OBJECTIVE: To discover the risk factor of postpartum depression and whether this is different from the induced factor of prepartum depression and to clarify what is the recovery factor from prepartum depression. METHODS: In the first test stage, 310 pregnant women were examined and with their postpartum follow-up survey, materials from 85 people in total were retrieved. In order to predict the postpartum depression and find out the recovery factor from prepartum depression, longitudinal study was carried out. For the statistical analysis hierarchical regression analysis and MANOVA were used. RESULTS: Postpartum depression (Beck Depression Inventory; BDI score of 16 or greater) was prevalent amongst 22.4% of pregnant women and prepartum depression was experienced by 10.5% in pregnant women. There were no significant on psychological variable factor of prepartum and postpartum depression. Only preatum depression redicted 33% for postaprtum depression. In the case of depressed during pregnancy but not depressed after pregnancy, recovery factor is related to increase in self-esteem, husband support and improvement in marital satisfaction. Postpartum depression showed twice higher depression ration than prepartum depression and it was serious in terms of degree of depression. CONCLUSION: Postpartum depression is related with lack of husband support that is recovery factor from prepartum depression. Also, unstable attachment is vulnerable to depression but even people with unstable attachment can be recovered from depression with better marriage relationship. Even people without unstable attachment if husband support is reduced then it is suggested that can be subject to vulnerability in depression.
Depression* ; Depression, Postpartum* ; Female ; Fibrinogen ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Marriage ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Risk Factors ; Spouses

The aim of the current study was to determine the clinical significance according to the subtypes of epidermal growth factor receptor (EGFR) mutations and presence of KRAS mutations in operable non-small-cell lung cancer (NSCLC). We sequenced exons 18-21 of the EGFR tyrosine kinase domain and examined mutations in codons 12 and 13 of KRAS in tissues of patients with NSCLC who had undergone surgical resection. EGFR mutations were more frequent in never-smokers than smokers (33% vs. 14%, respectively; p=0.009) and in females than in males (31% vs. 16%, respectively; p=0.036). Mutations in exon 18-19 and 20-21 were found in 10 and 22 patients, respectively. Never-smokers and broncho-alveolar cell carcinoma features were positively associated with a mutation in exon 18-19 (p=0.027 and 0.016, respectively). The five-year survival rate in patients with a mutation in exons 18-19 (100%) was higher than that in patients without such mutation (47%; p=0.021). KRAS mutations were found in 16 patients (12%) and were not related to the overall survival (p=0.742). Patients with an EGFR mutation in exons 18-19 had better survival than patients without such mutation. Subtypes of EGFR mutations may be prognostic factors in patients undergoing curative resection.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/diagnosis/*genetics/*surgery ; Disease-Free Survival ; *Exons ; Female ; Humans ; Lung Neoplasms/diagnosis/*genetics/*surgery ; Male ; Middle Aged ; *Mutation ; Proto-Oncogene Proteins p21(ras)/genetics ; Receptor, Epidermal Growth Factor/*genetics ; Sex Factors ; Treatment Outcome

Gefitinib is a novel drug used to treat advanced non-small cell lung cancer. However, drug-related interstitial pneumonia is a major life-threatening side effect, which has a worldwide prevalence of 0.3-0.4%. In Japan, the prevalence is high as 3-4% but the actual frequency in Korea has not been officially assessed. We report two cases of gefitinib-induced interstitial lung disease during the treatment of non-small cell lung cancer. High-resolution computerized tomography (HRCT) of one case showed nonspecific ground glass opacity and the chest x-ray of another case showed diffuse bilateral ground glass opacity. The former patient showed a rapid good response to corticosteroid treatment whereas the latter died despite receiving aggressive treatment with high dose corticosteroid and empirical antibiotics.
Anti-Bacterial Agents ; Carcinoma, Non-Small-Cell Lung ; Glass ; Humans ; Japan ; Korea ; Lung Diseases, Interstitial* ; Prevalence ; Thorax

A hidden primary tumor presenting as an isolated lung mass is a diagnostic challenge to physicians because the diagnosis of lung cancer is likely to be made if the histologic findings are not inconsistent with lung cancer. A large lung mass was found incidentally in a 59-year-old man. Although adenocarcinoma was diagnosed by percutaneous needle biopsy, thyroid transcription factor-1 (TTF-1) immunostaining was negative, raising suspicion that there was another primary site. There was no abnormal finding except for the lung mass on a 18FDG-PET/CT scan and the patient did not complain of any discomfort. Finally, prostatic cancer was confirmed through the study of tumor markers and prostate-specific antigen (PSA) immunostaining. Because of the rare presentation of a single lung mass in malignancies that have another primary site, physicians should carefully review all data before making a final diagnosis of lung cancer.
Adenocarcinoma ; Biopsy, Needle ; Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Nuclear Proteins ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Thyroid Gland ; Transcription Factors ; Biomarkers, Tumor