PURPOSE: Colorectal cancer patients with liver-confined metastases are classified as stage IV, but their prognoses can differ from metastases at other sites. In this study, we suggest a novel method for risk stratification using clinically effective factors. MATERIALS AND METHODS: Data on 566 consecutive patients with colorectal liver metastasis (CLM) between 1989 and 2010 were analyzed. This analysis was based on principal component analysis (PCA). RESULTS: The survival rate was affected by carcinoembryonic antigen (CEA) level (p < 0.001; risk ratio, 1.90), distribution of liver metastasis (p=0.014; risk ratio, 1.46), and disease-free interval (DFI; p < 0.001; risk ratio, 1.98). When patients were divided into three groups according to PCA score using significantly affected factors, they showed significantly different survival patterns (p < 0.001). CONCLUSION: The PCA scoring system based on CEA level, distribution of liver metastasis, and DFI may be useful for preoperatively determining prognoses in order to assist in clinical decisionmaking and designing future clinical trials for CLM treatment.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Humans ; Liver* ; Neoplasm Metastasis* ; Odds Ratio ; Passive Cutaneous Anaphylaxis ; Principal Component Analysis ; Prognosis ; Survival Rate

BACKGROUND: Scabies is an old and common contagious skin disease. The incidence of scabies has decreased through the economic growth of Korea. However, recent outbreaks in medical facilities have created a suspicion that the infection of scabies is an emerging public health problem. OBJECTIVE: We evaluated the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. This prospective study follows the retrospective study already performed by the same authors in 2011. METHODS: A multicenter, prospective study of scabies was performed at 25 hospitals in Korea. We included 914 patients who were diagnosed with scabies. Microscopic examination revealed scabies mites or eggs, or clinical improvement after treatment. Patients were asked to provide information on scabies, especially regarding the contact source, and the physicians examined them. RESULTS: Of the participants, 432 patients were men and 482 were women. Patients aged younger than 10 years and 60~69 years were the most common groups. Scabies more commonly affected patients during the fall and winter. Of the patients, 68.0% were thought to be infected at their homes, followed by nursing homes or hospitals (25.7%), and 31.6% through contact with other patients or, occasionally, staff members, including caregivers. CONCLUSION: We confirmed that scabies is an emerging threat in institutions, especially medical facilities. In addition, we suggest that public and in-hospital education is essential to minimize the problems associated with scabies.
Caregivers ; Disease Outbreaks ; Economic Development ; Education ; Eggs ; Epidemiologic Studies* ; Epidemiology ; Female ; Humans ; Incidence ; Korea ; Male ; Mites ; Nursing Homes ; Ovum ; Prospective Studies* ; Public Health ; Scabies* ; Skin Diseases

BACKGROUND: Scabies is one of the common skin diseases observed in developing countries. The incidence of scabies has decreased dramatically since the late 1980s in Korea. However, recent outbreaks in nursing homes or hospitals have been raising public health concerns. OBJECTIVE: We intended to evaluate the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. In particular, we tried to investigate the changing trend of contact sources in our society. METHODS: A multi-center cross sectional study was performed at 25 hospitals in Korea. We included 1,539 patients who were diagnosed with scabies. These patients showed scabies mites or eggs under microscopic examination, or clinical improvement after treatment. Their medical records with information of contact sources were reviewed. RESULTS: Six hundred and ninety-three patients were males and 826 were females. Patients' age from 70 to 79 was the most common followed by patients below 10 years of age. More patients were found in the fall and winter months. 66.7% of patients were thought to be infected at their homes which were situated next to nursing homes or hospitals (23.1%). Place of infection could not be verified in 39.3% of patients. 25.8% of patients were suggested to be infected through contact with medical staff or patients from hospitals or nursing homes. CONCLUSION: We confirmed that the contact sources of scabies are changing in our society; nursing homes and hospitals are emerging sources of infection. The majority of patients are old or very young who are vulnerable to many diseases. Therefore, dermatologists should pay attention to new contact sources and appropriate care of patients.
Developing Countries ; Disease Outbreaks ; Eggs ; Female ; Humans ; Hypogonadism ; Incidence ; Korea ; Male ; Medical Records ; Medical Staff ; Mites ; Mitochondrial Diseases ; Nursing Homes ; Ophthalmoplegia ; Ovum ; Public Health ; Retrospective Studies ; Scabies ; Skin Diseases

PURPOSE: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of performing renal replacement therapy in patients with chronic renal failure. A significant complication of CAPD is malfunction of the catheter because of catheter adhesion that leads to catheter malposition. So we evaluated the effect of an anti-adhesive agent called Guardix-Sol(R). METHODS: We prospectively evaluated the clinical results of 78 patients who had received CAPD catheter insertion from Sep. 2007 to May 2009. A test group of 34 patients used the anti-adhesion agent and a control group of 44 patients did not use it. All the procedures were standardized and performed by a single surgeon. RESULTS: The patients consisted of 49 males and 29 females. The common reasons for CAPD insertion were diabetic nephropathy (47 patients) and hypertension (20 patients). Fifteen patients needed reposition operations during their postoperative course, which were done under spinal anesthesia. Out of 15 patients, 3 were from the test group (Guardix-Sol(R) group) and 12 from the control group (P=0.0526). All the repositioned patients had a malpositioned catheter because the greater omentum had adhered to the catheter, except for one patient in each group (P=0.0315). CONCLUSION: Using an anti-adhesive agent for CAPD insertion is an effective method to reduce the incidence of greater omental adhesion. So the rate of reoperation cases for catheter repositioning is decreased.
Anesthesia, Spinal ; Catheters ; Diabetic Nephropathies ; Female ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic ; Male ; Omentum ; Peritoneal Dialysis, Continuous Ambulatory ; Prospective Studies ; Renal Replacement Therapy ; Reoperation

BACKGROUND: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The GISTs are immunohistochemically defined as KIT (CD117) positive tumors. To evaluate the prognostic factors for GISTs, we investigated the clinicopathological factors and the patient's survival rate. METHODS: Between 1996 and 2002, 37 patients were diagnosed with GIST at Dong-A University Medical Center, and 34 of these patients with localized GIST underwent surgical resection. For the immunohistochemical staining, we used KIT, CD34, s100 and SMA. RESULTS: The primary tumor site was the stomach (60%), and this was followed by small intestine (40%). The most common tumor morphology was spindle cell (83%) followed by epithelial cell (17%). An immunohistochemical analysis revealed that KIT was expressed 100% and CD34 was expressed in 29 cases (78.4%), SMA in 13 patients (35%), and s100 in 7 patients (18.9%). According to the tumor size and mitotic count, 4 patients were classified as very low, 8 were low, 14 were intermediate and 8 patients were high risk. Nine patients (24.3%) underwent adjuvant chemotherapy. The median follow up duration was 29 months. The 5-year disease free survivalrate was 55.1%, and 5-year overall survival rate was 72.8%. The 5-year disease free survival rates for patients with very low and low risk classifications were 100%, and the intermediate risk and high risk were 76.4% and 38.9%, respectively (p=0.1489). The five year overall survival rates for patients with very low and low risk classification were 100%, and intermediate risk and high risk were 90.0% and 0%, respectively (p=0.0179). However, age, pathologic subtype, adjuvant chemotherapy, and immunohistochemical stain results were not significant prognostic factors. CONCLUSION: These results suggest that risk stratification was the most important prognostic factor in GISTs.
Academic Medical Centers ; Chemotherapy, Adjuvant ; Classification ; Disease-Free Survival ; Epithelial Cells ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Stomach ; Survival Rate

OBJECTIVE: This study was conducted to analyze the psychological factors which influence myofascial pain syndrome and to evaluate whether the electromyographic study on the myofascial trigger point in shipyard workers satisfied the diagnostic criteria of myofascial pain syndrome. METHOD: We studied 61 patients who were employed in the shipbuilding industry and diagnosed myofascial pain syndrome. We investigated them using the Minnesota Multiphasic Personality Inventory (MMPI) and the visual analogue scale (VAS) and also obtained spontaneous electrical activity (SEA) by electromyographic study on myofascial trigger point. RESULTS: Mean VAS of subjects was 5.88. On the MMPI profile, the patients scored highest in psychopathic deviate, and then in hypochondriasis, depression and hysteria, in that order. The correlation of the VAS with results of electromyographic study and with the MMPI were not significant. In the electromyographic study, 19 patients out of 61 (31%) showed initial positive deflection on spontaneous electrical activities. CONCLUSION: This study suggested that considering the psychosocial aspect of myofascial pain syndrome, as well as organic aspects in hard manual labor such as shipyard work might be useful for treatment.
Depression ; Humans ; Hypochondriasis ; Hysteria ; MMPI ; Myofascial Pain Syndromes* ; Psychology ; Trigger Points

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis. METHOD: We studied 89 women with postmenopausal osteoporosis (T-score<2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment. RESULTS: 1) BMD at the lumbar spine increased significantlyin two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles. CONCLUSION: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism.
Alendronate* ; Biomarkers* ; Bone Density* ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Estrogens* ; Female ; Femur ; Femur Neck ; Humans ; Lipid Metabolism ; Osteocalcin ; Osteoporosis, Postmenopausal* ; Rehabilitation ; Spine ; Triglycerides

PURPOSE: The association of varicoceles and subfertility has been well documented. Although varicoceles remain the most common surgically correctable cause of male infertility the subjective diagnosis of varicocele, especially the small ones remains a challenge. MATERIALS AND METHODS: We evaluated 40 young men (16 volunteers, 24 varicocele patients) with scrotal blood pool scan using 99mTc RBC. RESULTS: Complete correlation between physical findings and the scrotal scan was found. The postoperative scans of 12 patients with surgically corrected high grade varicoceles demonstrated symmetrical photon accumulation in the scrotum. The technique which most accurately correlated the clinical grade was the varicocele index using total count at Valsalva maneuver. CONCLUSIONS: We believe that the 99mTc RBC scrotal scan with technical refinement is a useful procedure in the objective diagnosis and followup of varicoceles.
Diagnosis ; Follow-Up Studies ; Humans ; Infertility ; Infertility, Male ; Male ; Scrotum ; Valsalva Maneuver ; Varicocele* ; Volunteers

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous infalmmation, which was compatible with tuberculosis. Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin. In patients with severe diarrhea receining anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.
Aged ; Anti-Bacterial Agents ; Biopsy ; Chest Pain ; Clostridium difficile ; Diarrhea ; Dyspnea ; Enterocolitis, Pseudomembranous* ; Ethambutol ; Gastrointestinal Tract ; Humans ; Isoniazid ; Lung ; Metronidazole ; Mucous Membrane ; Physical Examination ; Pleural Effusion ; Respiratory Sounds ; Rifampin* ; Sigmoidoscopy ; Sputum ; Thorax ; Tuberculosis ; Vancomycin

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. METHODS: A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveloar lavage or lung biopsy. RESULTS: Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD (3.27±3.15 mg/dl vs. 1.19±0.94 md/dl, p=0.030). The corresponding drop in hemoglobin level was 2.69±1.26 g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by 1.38±4.22 days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). CONCLUSION: The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.
Anemia ; Biopsy ; Collagen ; Cough ; Creatinine ; Diagnosis ; Dyspnea ; Female ; Fever ; Hemoptysis ; Hemorrhage* ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Mortality ; Prognosis ; Radiography, Thoracic ; Retrospective Studies* ; Therapeutic Irrigation ; Thorax ; Vascular Diseases