It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate

No abstract available.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate

This study aimed to analyze changes in the causes of death in the Korean population in 2016 and to provide some insights regarding how to cope with related issues of public health and welfare. The causes of death made available by Statistics Korea were classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision as well as the KCD-7 (Korean Standard Classification of Diseases and Causes of Death), which has been modified to fit circumstances in Korea. The total number of deaths was 280,827, which was an increase of 4,932 (1.8%) from 2015. The crude death rate was 549.4 per 100,000 population, which was an increase of 7.9 (1.5%) from 2015. The 10 leading causes of death, in order, were malignant neoplasms, heart diseases, cerebrovascular diseases, pneumonia, intentional self-harm, diabetes mellitus, chronic lower respiratory diseases, liver diseases, hypertensive diseases, and transport accidents. The rank of hypertensive diseases rose from 10th in 2015 to 9th in 2016, while that of transfer accidents dropped from 9th in 2015 to 10th in 2016. The proportion of the number of deaths caused by cancer was 27.8%. The death rate due to cancer was 153.0 per 100,000 population, which was an increase of 1.4% from 2015; 16.5 deaths per 100,000 population were due to colon cancer, and 16.2 were due to stomach cancer. The above trends in causes of death reflect aspects of the population structure, disease patterns, lifestyle, and medical care in present-day Korean society.
Cause of Death ; Cerebrovascular Disorders ; Classification ; Colonic Neoplasms ; Diabetes Mellitus ; Heart Neoplasms ; Hypertension ; International Classification of Diseases ; Korea ; Life Style ; Liver Diseases ; Mortality ; Pneumonia ; Public Health ; Republic of Korea ; Stomach Neoplasms

BACKGROUND: A national burden of disease estimation enables priority setting in health policy, baseline and post hoc evaluation of public health service. But, lack of elementary statistics had kept it from having been fully appraised in Korea. Years of life lost(YLL) due to premature death of 1995 was estimated from National Death Certificate data. This study was launched as necessary step for assessing global burden of disease(GBD)which will include years lived with disability (YLD) and disabillity-adjusted life year(DALY). METHODS: National Death Certificate data in 1995 and 1991 were available with individual information. Diseases classification system suggested by GBD researchers were modified into 60 entities, reflecting death pattern in Korea. Some tropical, infectious, non-fatal conditions were combined and occupational injury category was newly defined. Potential years of life lost (PYLL) to 60-85 years by 5 years, death rate, standard expected years of life lost(SEYLL) were calculated according to new disease categories. RESULTS: Cancer followed by traffic accident and Cardiovascular disease was the most important cause of PYLL and SEYLL by 24 categories classification, and traffic accident (TA) contributes by far the largest part of PYLL and SEYLL by 60 categories classification. SEYLL is thought to be a better single index for YLL, and 20 leading causes of SEYLL were calculated (by 60 categories). Such entities as self injury, leukemia, congenital anomaly, occupational injury among 20 leading causes showed discrepancy between relatively low death rate and larger YLLs. CONCLUSION: TA, stomach, liver, lung cancers, cerebrovascular attacks, chronic liver diseases, cardiovascular diseases still shows high death rate and enormous YLLs. The importance of controling them cannot be over-emphasized. Diseases with larger YLLs and lower death rate should be reassessed and attentioned in view of public health promotion. This study could be a basis for health policy making and reference of further studies.
Accidents, Traffic ; Cardiovascular Diseases ; Classification ; Death Certificates ; Health Policy ; Health Priorities* ; Korea* ; Leukemia ; Liver ; Liver Diseases ; Lung Neoplasms ; Mortality ; Mortality, Premature ; Occupational Injuries ; Public Health ; Stomach ; United States Public Health Service

OBJECTIVE: Although metastasis of hepatocellular carcinoma to the brain is uncommon, it is associated with a very high mortality rate and most patients usually expire within 1 year after brain metastasis. The aim of this study is to identify the effectiveness of the active interventions such as gamma knife radiosurgery or surgical intervention for these patients. METHODS: We retrospectively reviewed the medical records and imaging data of 59 patients with metastatic brain tumors from hepatocellular carcinoma from May 2004 to September 2012. The study included patients with available clinical and radiological data who had been diagnosed with metastatic hepatocellular carcinoma of the brain, confirmed by magnetic resonance imaging. The overall survival time was analyzed and compared according to each risk factor. RESULTS: The mean age at diagnosis of metastatic brain tumor was 52.2 years (14-77). The mean follow-up duration was 13.3 weeks (0.1-117.6). Overall median survival was 4.3 weeks (95% confidence interval, 2.2-6.4). The results from an analysis of clinical factors related to survival revealed that treatment modalities were significantly related to the patient's survival (log rank, p=0.006). Twenty patients (32.8%) experienced tumor bleeding, and the survival time of the patients with tumor bleeding tended to be shorter, although the result was not statistically significant (log rank, p=0.058). Hepatic reserve, by Child-Pugh classification, was grade A in 38 patients (64.4%), grade B in 16 patients (27.1%), and grade C in 5 patients (8.5%), and was significantly related to the patient's survival (log rank, p=0.000). CONCLUSION: Although patients with metastatic brain tumors from hepatocellular carcinoma showed poor survival, active intervention including surgical resection or gamma knife radiosurgery may result in better survival, especially if patients have preserved liver function.
Brain Neoplasms* ; Brain* ; Carcinoma, Hepatocellular* ; Classification ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Magnetic Resonance Imaging ; Medical Records ; Mortality ; Neoplasm Metastasis ; Radiosurgery* ; Retrospective Studies ; Risk Factors

BACKGROUND: From 1987 to 1997, a total of 500 patients underwent surgery for esophageal cancer in our department. To determine the lon g-term results, recurrence patterns and prognostic factors, we reviewed the 11 y ears experiences. MATERIAL AND METHOD: Double pr imary tumors, cancers of the pharyngoesophageal and esophagogastric junction, pa lliative bypass surgery or esophageal prosthesis and exploration only were exclu ded in this study. Resection was usually performed through right thoracotomy(Ivo r Lewis operation) and anastomosis was made with staplers. Extended lymph node d issection was performed from August 1994 but not before. The stomach was used as a substitute for the esophagus in 96.8%. All reconstruction was done through po steromediastinal route except cervical reconstruction. RESULT: 474(94.8%) had confirm ed squamous cell carcinoma. Most(58.2%) of the tumors were located in the middle third of the esophagus, 47.4% of patients had operative pathologic stage III di sease, and 25% had stage IIA disease. Of the resections, 392 were classified as curative and 74 palliative, blunt dissection(transhiatal esophagectomy) and jeju nal free graft(34) were excluded in these classifications. The overall morbidity rate was 38.4%. The operative mortality rate was 5.8%, mainly due to respirator y complications and anastomosis leakages. The follow-up rate of these patients w as 99.8%. Overall actuarial 1, 2, and 5-year survival rates were 63.5%, 38.9%, a nd 19.4% including operative mortality. In standard lymph node dissection group, the actuarial 1, 2, and 5-year survival rates were 60.7%, 35.9%, and 16.9%(oper ative mortality rate: 4.3%), but in extended lymph node dissection group, the ac tuarial 1, 2, and 4-year survival rates were 70.2%, 46.5% and 30.9%(operative mo rtality rate: 6.5%), respectively. In curative resection group, the actuarial 1, 2, and 5-year survival rates were 69.4%, 43.9%, and 21.9%, but in palliative re section group, these were 37.8%, 17.6%, and 7.3%, respectively. The 4-year survi val rate was 35.6% in curative resection with extended lymph node dissection gro up. Postoperative recurrence was found in 226 patients. Site of recurrence were mainly lymph nodes(69%; neck, paratracheal and abdominal) and other systemic rec urrence was detected at liver, lung, bone, brain etc. CONCLUSION: We think that cura tive resection with extensive lymph node dissection is necessary for long term s urvival, but adequate postoperative care is a prerequisite. In advanced esophage al cancer, more effective multimodal adjuvant regimens remain to be established.
Brain ; Carcinoma, Squamous Cell ; Classification ; Ear ; Esophageal Neoplasms* ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neck ; Oceans and Seas ; Postoperative Care ; Prostheses and Implants ; Recurrence ; Stomach ; Survival Rate ; Ventilators, Mechanical

This is a retrospective clinical analysis of 156 patient with colorectal cancer who were surgically treated from January 1988 to June 1996 at the Department of Surgery, Seoul Adventist Hospital. The results are as follows: 1) The peak age incidence was in the 7th decade (31.4% of the cases), and the sex ratio of males to females was 1.03 : 1. 2) The most common location of the tumor was the rectum in 77 cases (49.4%); next were the sigmoid colon in 25 cases (16.0%) and the ascending colon in 25 cases (16.0%). 3) In the right colon, the most frequent symptoms and signs were abdominal pain, a palpable mass, weight loss; in the left colon and rectum, bloody tarry stool and bowel- habit change were the most common symptoms and signs. 4) The duration of the symptoms and signs prior to admission was most commonly less than 3 month (46.8% of the cases). 5) The diagnostic methods were digital rectal examination, sigmoidoscopy, colonofiberoscopy, barium enema, and abdominal CT. In two cases,an exploratory laparotomy was done. Also, 2.8 studies were done per patient. 6) The operations performed included an abdominoperineal resection in 36 cases (24.0%) and a right hemicolectomy (18.7%). The operability was 96.2%, and the total resectability was 79.5%. 7) The staging of the tumor was performed during the initial operation according to the Aster Coller classification and the TNM classification. Stages C2 (33.8%) and B2 (29.1%) and T3N0M0 were the most frequent stages in both classification. 8) The most common histologic type was an adenocarcinoma (96.8%). 9) The most common macroscopic finding was of the annular type (59.6%) 10) The most common distant metastasis sites were the pelvic organs and the liver. 11) The most frequent postoperative complication was wound infection (14.7%). The complication rate and perioperative mortality were 32.7% and 2%, respectively.
Abdominal Pain ; Adenocarcinoma ; Barium ; Classification ; Colon ; Colon, Ascending ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms* ; Digital Rectal Examination ; Enema ; Female ; Humans ; Incidence ; Laparotomy ; Liver ; Male ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Rectal Neoplasms ; Rectum ; Retrospective Studies ; Seoul ; Sex Ratio ; Sigmoidoscopy ; Tomography, X-Ray Computed ; Weight Loss ; Wound Infection