The decision making for reimbursement has become more difficult than before because of the high cost innovative new technologies and limitation of healthcare resources. Evidence-based healthcare system has been introduced in Korea since 2007. Not infrequently, however, decision makers have been confronted with uncertainties caused by lack of information related to comparative effectiveness, real world outcomes, off-label drug use, combination therapy and cost-effectiveness. Under these circumstances, the decision making of whether or not to reimburse is inadequate because undesirable results may be induced. Managed entry agreement has been introduced globally. This kind of decision is conditional and linked with monitoring and following the results and adjusting the policy according to the results. Especially access with evidence development is a form of prospective data correction with conditional coverage in the case of existing uncertainties of effectiveness and safety. In Korea, there have been several examples including off-label drug use in oncologic drugs, new healthcare intervention and re-evaluation of existing drugs. Even though there has been some conflict and confusion because of inadequate systematization, it is strongly recommended to establish the conditional decision making system in Korea since this is a unique answer to manage the uncertainty in maintaining development of health science, keeping patients' right and using healthcare resources rationally.
Decision Making ; Delivery of Health Care ; Evidence-Based Medicine ; Korea ; Patient Rights ; Uncertainty

Despite expanding knowledge in the molecular landscape of acute myeloid leukemia (AML) and an increasing understanding of leukemogenic pathways, little has changed in the treatment of AML in the last 40 years. Since introduction in the 1970s, combination chemotherapy consisting of anthracycline and cytarabine has been the mainstay of treatment, with major therapeutic advances based on improving supportive care rather than the introduction of novel therapeutics. Over the last decades, there have been extensive efforts to identify specific target mutations or pathways with the aim of improving clinical outcomes. Finally, after a prolonged wait, we are witnessing the next wave of AML treatment, characterized by a more “precise” and “personalized” understanding of the unique molecular or genetic mapping of individual patients. This new trend has since been further facilitated, with four new FDA approvals granted in 2017 in AML therapeutics. Currently, a total of eight targeted agents have been approved since 2017 (as of Jan. 2020). In this review, we will briefly discuss these newer agents in the context of their indication and the basis of their approval.

Septoria centellae associated with leaf spot of Centella asiatica is reported for the first time in Korea. The fungus is described and illustrated in detail. It is also compared with related species of Septoria present on Centella and Hydrocotyle spp. with taxonomic comments. Two monoconidial isolates from Jeju and Wando were successfully cultured and have been deposited in the Korean Agricultural Culture Collection.
Centella ; Fungi ; Korea

Here, we report on a 20-year-old patient with a primary nonseminomatous mediastinal germ cell tumor (MGCT) who developed myelodysplastic syndrome (MDS) 2 months following chemotherapy with cisplatin, etoposide, ifosfamide, and paclitaxel. Bone marrow examinations revealed that the MDS was a refractory anemia with excess type II blasts and complex chromosomal abnormalities. With the onset of MDS occurring rapidly following chemotherapy, it is unlikely to have been caused by the therapy. We discuss the association between primary nonseminomatous MGCTs and hematological malignancies, including the possibility of a common clonal origin.
Anemia, Refractory ; Bone Marrow Examination ; Chromosome Aberrations ; Cisplatin ; Drug Therapy* ; Etoposide ; Germ Cells* ; Hematologic Neoplasms ; Humans ; Ifosfamide ; Myelodysplastic Syndromes* ; Neoplasms, Germ Cell and Embryonal* ; Paclitaxel ; Young Adult

Cases of phenotypic heterogeneity of cells within tumors have recently been reported. Here, we report on a patient with characteristic intra-tumor double primary metastases in the lung. This patient was a 40-year-old Korean woman who had been diagnosed with breast cancer (T1N0M0, estrogen receptor/progesterone receptor/HER2 +/+/+) and papillary thyroid cancer three years prior and underwent a complete surgical resection followed by appropriate adjuvant treatment with radiation, hormone, and radioactive iodine. She was recently admitted for newly developed pulmonary nodules. Metastasectomy through video-assisted thoracoscopic surgery revealed recurrent double primary cancer with two different components (metastatic ductal carcinomas from the breast and metastatic papillary carcinomas from the thyroid gland) in each pulmonary nodule in the right upper lobe and right middle lobe. To the best of our knowledge, this is the first report of simultaneous recurrent double metastasis in one organ from different primary origins.
Adult ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Papillary ; Estrogens ; Female ; Humans ; Iodine ; Lung* ; Metastasectomy ; Neoplasm Metastasis ; Population Characteristics ; Thoracic Surgery, Video-Assisted ; Thyroid Gland ; Thyroid Neoplasms*

No abstract available.
Candida albicans* ; Candida* ; Korea*

Allogeneic hematopoietic stem cell transplantation is the only option for chemotherapy-refractory chronic myeloid leukemia (CML). Extramedullary relapse after transplantation is rare and usually accompanies marrow relapse. Generally, the prognosis of extramedullary relapse is poor. Here, we report a man with extramedullary relapsed CML after stem cell transplantation that presented as an isolated cardiac mass, which has shown an indolent course for more than 2 years, without evolving to medullary relapse during that period. This case implies that the CML clone might contribute to the development of quiescent extramedullary relapse with a benign course.
Bone Marrow ; Clone Cells ; Heart Neoplasms ; Hematopoietic Stem Cell Transplantation ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Prognosis ; Recurrence ; Sarcoma, Myeloid ; Stem Cell Transplantation

Lymphoepithelioma-like carcinoma (LELC) of the esophagus is an extremely rare tumor and the prognosis is favorable. We present here a case an esophageal LELC that showed no definite progression for 5 years. An esophageal tumor was found during screening endoscopy for a 72-year-old asymptomatic Korean woman. At first the histology showed no abnormal findings. No treatment was done for the lesion. Five years later, a follow-up endoscopy showed the same tumor in the esophagus. The size and shape of the esophageal tumor seemed unchanged during the follow-up. The lesion was a round elevated lesion that measured approximately 2.5 cm in the lower esophagus. The covering mucosa looked smooth, but there were erosions on top of the tumor. Biopsy showed an undifferentiated carcinoma associated with a dense lymphocytic and plasma cell infiltration, which are typical findings of LELC.
Aged ; Biopsy ; Carcinoma ; Endoscopy ; Esophageal Neoplasms ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Mucous Membrane ; Plasma Cells ; Prognosis

We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5x8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD.
Anoxia ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Atria ; Heart Septal Defects, Atrial ; Hematoma ; Hemorrhage ; Humans ; Mediastinal Cyst ; Middle Aged ; Thorax

We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5x8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD.
Anoxia ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Atria ; Heart Septal Defects, Atrial ; Hematoma ; Hemorrhage ; Humans ; Mediastinal Cyst ; Middle Aged ; Thorax