The number of cancer survivors is increasing dramatically. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. Concerns regarding the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public and private sector. This article summarizes economic burden of cancer survivors, main post-treatment health problems including secondary primary cancer and comorbidities, health behaviors such as smoking, exercise and physical activity, nutrition, and psychosocial problems. Faced with various health and psychosocial problems specific to this population, several healthcare and policy models are being suggested to address these issues, including 'shared care model' and 'integrative supportive care service delivery system for cancer survivors'. More effort is needed to make the cancer survivorship agenda a reality, attended by a wide variety of stakeholders including researchers, patients, providers, and policy makers.
Delivery of Health Care ; Health Behavior ; Health Services Needs and Demand ; Humans ; Mental Health ; Neoplasms/economics/pathology/*therapy ; Neoplasms, Second Primary/epidemiology/mortality/pathology ; *Public Health ; Republic of Korea

Follicular thyroid carcinoma is the second most common form of thyroid cancer. It accounts for 10 percent of all thyroid cancer, and is found three times more frequently in men than in woman. It is well known that follicular thyroid carcinoma usually occurs in regions where it is hard for people to intake iodine. Most follicular thyroid carcinomas occur asymptomatically but occasionally reveal as masses in the thyroid nodules. The occurence of metastasis of follicular thyroid cancer in the lymph node is less than 10%, which is relatively low compared to that of papillary cancer. Follicular carcinomas are metastasized hematogenously and are common in the bone, liver, lung and brain. It is especially rare for metastatic follicular thyroid cancer to be diagnosed as renal tumor. We recently experienced and further investigated a case of follicular thyroid carcinoma that metastasised to the kidney in a 57-year-old woman, who had had abdominal distension. We report this case with a review of the reference.

Metastatic cancers to the thyroid gland are rare, with the most common primary site being the kidney. The next most common sites are the breast, lung, melanoma, colon and larynx. In the case of thyroid metastasis of renal cell carcinoma, the thyroid metastasis may be the initial manifestation and the incidence of this type seems disproportionate to the frequency of the primary renal cell carcinoma. 3Ve have recently experienced two cases of thyroid metastasis of renal cell carcinoma and report them with a brief review of the related literature.
Breast ; Carcinoma, Renal Cell* ; Colon ; Incidence ; Kidney ; Larynx ; Lung ; Melanoma ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms

Leiomyosarcomas of the ovarian vein are very rare. Four cases have been reported in the English language clinical literature. We present a case of leiomyosarcomas where the use of multi-detector CT had a substantial role in the establishment of the preoperative diagnosis. The radiological images as well as intraoperative features are illustrated. We also discuss the radiological findings of the ovarian vein leiomyosarcoma in comparison with those of other venous or retroperitoneal leiomyosarcomas. We expect that the use of multi-detector CT will be the choice for the diagnostic work-up of vascular leiomyosarcomas.
Adult ; Female ; Humans ; Leiomyosarcoma/*radiography/surgery ; Ovary/*blood supply ; Tomography, X-Ray Computed ; Vascular Neoplasms/*radiography/surgery ; Veins

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal ; Aortic Valve Insufficiency ; Bacteremia ; Early Diagnosis ; Endocarditis* ; Fever ; Fistula ; Groin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Technetium Tc 99m Exametazime ; Transplants*

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal ; Aortic Valve Insufficiency ; Bacteremia ; Early Diagnosis ; Endocarditis* ; Fever ; Fistula ; Groin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Technetium Tc 99m Exametazime ; Transplants*

PURPOSE: We investigated the positivity rate and the time period to the positive color change of the urease test in children and adults and assessed the correlation of the urease test to histopathologic findings. METHODS: From 1995 to 2000, endoscopic biopsies of the antrum and body were collected from 811 children and 224 adults and subjected to urease tests and histopathology. RESULTS: The positivity rate of the urease test was 49.4% for 0-4 years, 48.4% for 5-9 years, 47.3% for 10-15 years, and 62.5% for 20-29 years in the antrum. The positivity rate was 85.1% in 0-4 years, 82.3% in 5-9 years, 74.7% in 10-15 years, and 74.1% in 20-29 years for the body. In the antrum, the highest positivity rate was <1 hour for the group aged 10-29 years and 6-24 hours in the group <10 years old (p<0.0001). In the body, the highest positivity rate was <1 hour in adults and 6-24 hours in children (p<0.0001). The proportions of the positive reactions within 1 hour were similar for the antrum and the body. In the cases of more severe chronic gastritis, active gastritis, and Helicobacter pylori infiltration, a positive urease test reaction occurred more quickly (p<0.0001). CONCLUSION: There were significant differences in urease tests according to age and sampling site. The discrepancy between the antrum and the body was greater in younger children. These results might be related to the low density and patchy distribution of bacteria in children and in the body.
Adult ; Aged ; Bacteria ; Biopsy ; Child ; Gastritis ; Helicobacter ; Helicobacter pylori ; Humans ; Urease

PURPOSE: We tried to evaluate whether the detection rate of Helicobacter pylori in gastric biopsy specimens could be improved by using pre-embedding immunoelectron microscopy. METHODS: A total of 119 children who complained of upper gastrointestinal symptoms were endoscoped at the Gyeongsang National University Hospital from July, 1996 to July, 1999. Five biopsy specimens(three for urease test, one for hematoxylin-eosin(H and E) staining, and one for pre- embedding immunoelectron microscopy) were obtained from each antrum and body. Immunoblotting analysis were also performed. RESULTS: Among the 119 patients, H. pylori were found in 116 patients(97.5%) by the immunoelectron microscopy. Among three patients who were found H. pylori negative in immunoelectron microscopy, two patients showed H. pylori in H and E stained slides and one patient was urease test positive(color change within six hours). Urease tests were positive in 107 patients(89.9 %). The positive rate of immunoblotting tests was 81.5%. However, only 13 patients(10.9%) showed H. pylori on the H and E stained antrum or body tissue. CONCLUSION: In this study, we found H. pylori histopathologically in most of the pediatric patients who complained of upper gastrointestinal symptoms. This study showed that pre-embedding immunoelectron microscopic examinations can be used as a gold standard in the diagnosis of childhood H. pylori infection. However, this method also has limited capacity to detect widely scattered H. pylori compared to the other histopathologic diagnostic methods.
Biopsy ; Child ; Diagnosis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoblotting* ; Microscopy, Immunoelectron* ; Urease

Helicobacter pylori is a causative agent of type B gastritis and plays a central role in the pathogenesis of gastroduodenal ulcer and gastric cancer. To elucidate the host-parasite relationship of the H. pylori infection on the basis of molecular biology, we tried to evaluate the genomic diversity of H. pylori. An ordered overlapping bacterial artificial chromosome (BAC) library of a Korean isolate, H, pylori 51 was constructed to set up a genomic map. A circular physical map was constructed by aligning ApaI, Notl and SfiI-digested chromosomal DNA. When the physical map of H. pylori 51 was compared to that of unrelated strain, H. pylori 26695, completely different restriction patterns were shown. Fifteen known genes were mapped on the chromosome of H. pylori 51 and the genetic map was compared with those of strain 26695 and J99, of which the entire genomic sequences were reported. There were some variability in the gene location as well as gene order among three strains. For further analysis on the genomic diversity of H. pylori, when comparing the genomic structure of 150 H. pylori Korean isolates with one another, genomic macrodiversity of H. pylori was characterized by several features: whether or not susceptible to restriction digestion of the chromsome, variation in chromosomal restriction fingerprint and/or high frequency of gene rearrangement. We also examined the extent of allelic variation in nucleotide or deduced amino acid sequences at the individual gene level. fucT, cagA and vacA were confirmed to carry regions of high variation in nucleotide sequence among strains. The plasticity zone and strain-specific genes of H. pylori 51 were analyzed and compared with the former two genomic sequences. It should be noted that the H. pylori 51-specific sequences were dispersed on the chromosome, not congregated in the plasticity zone unlike J99- or 26695-specific genes, suggesting the high frequency of gene rearrangement in H. pylori genome. The genomc of H. pylori 51 shows differences in the overall genomic organization, gene order, and even in the nucleotide sequences among the H. pylori strains, which are far greater than the differences reported on the genomic. diversity of H. pylori.
Amino Acid Sequence ; Base Sequence ; Chromosomes, Artificial, Bacterial ; Dermatoglyphics ; Digestion ; DNA ; Gastritis ; Gene Order ; Gene Rearrangement ; Genome ; Helicobacter pylori* ; Helicobacter* ; Host-Parasite Interactions ; Molecular Biology ; Peptic Ulcer ; Plastics ; Stomach Neoplasms

PURPOSE: The status of axillary lymph node (LN) metastasis is the most important prognostic factor in breast cancer. Postoperative regional nodal radiotherapy is recommended usually based on the number of metastatic LNs, which is associated with the total number of removed LNs during the axillary dissection. We evaluated the prognostic impact of the ratio of metastatic LNs to removed LNs on disease free survival and overall survival in breast cancer patients. METHODS: The medical records of 743 breast cancer patients with metastatic axillary LNs and treated at Samsung Medical Center between 1994 and 2003 were retrospectively analyzed. The ratio of metastatic/removed LNs as well as the other prognostic factors were analyzed. RESULTS: Both disease-free survival and overall survival rates were significantly worse in patients with a ratio of metastatic/removed LNs greater than 20% compared to those patients with a ratio of less than 20% (p=0.028, p<0.001, respectively). In patients with T1-2 and N1 breast cancer, the ratio of metastatic/removed LNs greater than 20% was significantly associated with poorer disease-free survival (p=0.027). CONCLUSION: A ratio of metastatic/removed LNs greater than 20% in the axilla can be an adverse prognostic factor in breast cancer patients with axillary node metastasis. In T1-2 N1 breast cancer patients, adjuvant radiotherapy as well as more aggressive chemotherapy therapy may be indicated.
Axilla ; Breast ; Breast Neoplasms ; Disease-Free Survival ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate ; Sydnones