BACKGROUND/AIMS: Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy. METHODS: A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics. RESULTS: Among 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence. CONCLUSIONS: A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.
Adenoma ; Asia ; Colon ; Colonic Polyps ; Colonoscopy ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Prospective Studies ; Recurrence ; Risk Factors

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.
Activities of Daily Living ; Dermatitis, Contact ; Eczema* ; Female ; Hand* ; Health Personnel ; Humans ; Korea* ; Medical Records ; Occupations ; Prevalence ; Quality of Life ; Seasons ; Skin ; Surveys and Questionnaires

The incidence of colorectal carcinoid tumor is recently increasing as screening colonoscopy increased. Traditional carcinoid tumor had been known as low grade, malignant neuroendocrine cell orign tumor. In 2000, World Health Organization (WHO) suggested that carcinoid was called well-differentiated neuroendocrine tumor (NET). It recently updated in 2010 by WHO; according to the differentiation and malignant potential, NET classified with NET Grade 1, Grade 2, and neuroendocrine carcinoma. They suggested that NET had malignant potential in accordance with histopathologic characteristics. Therefore, WHO recommended the behavior code of NET as malignant. However, European Neuroendocrine Tumor Society (ENETS) proposed the behavior of NET to four grades based on the histopathologic features; benign, benign or low grade malignant, low grade malignant, and high grade malignant. Also, American Joint Committee on Cancer (AJCC) suggested that topography codes of NET were defined as malignant. Korean Standard Classification of Diseases (KCD) described the different codings of carcinoid (NET). The discrepancies of behavior code or coding system exist among WHO, ENETS, AJCC and KCD. Also, there were differences in the perception for topographic coding system between clinicians and pathologists. NETs of colorectum were reported with the variable clinical characteristics (especially, metastasis) and long term prognosis from many studies. Especially, risk of metastasis and long term prognosis of small sized NET (<1 cm) had some discrepancies and should be investigated prospectively. Therefore, the consensus about topographic codes of NET should be needed with multidisplinary approach among gastroenterologists, pathologists and surgeons.
Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Clinical Coding ; Colonoscopy ; Consensus ; Incidence ; Joints ; Mass Screening ; Neoplasm Metastasis ; Neuroendocrine Cells ; Neuroendocrine Tumors ; Prognosis ; World Health Organization

BACKGROUND: The TRUE test is a commercially available ready-to-apply patch test widely used in many countries, but no large-scale study is available on the TRUE test in Korea. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in the common contact allergens in Korea using the TRUE test. METHODS: From January 2009 to March 2010, TRUE tests were performed on patients with contact dermatitis at the Departments of Dermatology of 15 hospitals. The epidemiological findings of patients, and the results of the patch tests were analyzed. RESULTS: In total, 795 patch tested cases (246 males, 549 females) were compiled and analyzed. The oldest age distribution was the third decade in both males and females, and housewives and office-workers were the most common jobs, comprising 29.7% and 19.8% of the occupations, respectively. Overall, 65.1% of patients had at least one positive reaction, and the most common allergens were nickel sulfate (34.1%), thimerosal (12.6%), cobalt chloride (11.1%), and p-phenylenediamine (8.4%), in order of frequency. A univariate analysis of multiple variables including age, gender, occupation, and affected sites was conducted and a comparison with a previous multicenter study was also analyzed. CONCLUSION: These results provide the basis for use of the TRUE test in patients with contact dermatitis in Korea.
Age Distribution ; Allergens ; Cobalt ; Dermatitis, Contact ; Dermatology ; Female ; Humans ; Korea ; Male ; Nickel ; Occupations ; Patch Tests ; Phenylenediamines ; Thimerosal

The Korean Standard Classification of Diseases (KCD), which reflects the International Classification of Diseases (ICD), is a fundamental coding system for the diagnosis of colorectal epithelial tumors. The KCD coding of colorectal lesions is entirely up to the clinician and is based on pathologic reports. However, coding discrepancies have arisen among physicians using the KCD and pathologists using the ICD for Oncology-3 (ICD-O-3). The Korean Society of Pathologists recently proposed a standardized pathology-reporting format and guidelines for the coding of colorectal cancer to decrease these discrepancies among pathologists. However, ICD and ICD-O are simple classification codes based on pathologic reports, and are neither intended nor suitable for indexing of distinct clinical entities. For appropriate diagnostic coding using the KCD, a corrected coding principle based upon pathologic reports is required, and unified coding between KCD and ICD-O is necessary. A standardized pathologic report format and communication with understanding between physicians and pathologists should be established. Additionally, the private medical insurance system for colorectal cancer should be revised to reduce conflicts among patients, clinicians, and insurance companies over the medical coding system.
Abstracting and Indexing as Topic ; Clinical Coding ; Colorectal Neoplasms ; Humans ; Insurance ; International Classification of Diseases

Angiosarcoma is a malignant vascular neoplasm that usually involves the skin or soft tissues. A primary rectal angiosarcoma is exceedingly rare. A 77-year-old female was admitted to the hospital for evaluation of constipation and hematochezia. The patient had a history of uterine cervix carcinoma which was treated with surgery and radiation therapy. A colonoscopy revealed a friable, ulceroinfiltrative tumor with multiple hyperemic mucosae in the rectum. Microscopically, the tumor exhibited vasoformative growth with nuclear atypism and numerous mitoses. The tumor cells were strongly positive for CD31, CD34, and Factor VIII. We report a case of rectal angiosarcoma that developed after radiation therapy.
Aged ; Cervix Uteri ; Colonoscopy ; Constipation ; Factor VIII ; Female ; Gastrointestinal Hemorrhage ; Hemangiosarcoma ; Humans ; Mitosis ; Mucous Membrane ; Rectum ; Skin ; Vascular Neoplasms

Angiosarcoma is a malignant vascular neoplasm that usually involves the skin or soft tissues. A primary rectal angiosarcoma is exceedingly rare. A 77-year-old female was admitted to the hospital for evaluation of constipation and hematochezia. The patient had a history of uterine cervix carcinoma which was treated with surgery and radiation therapy. A colonoscopy revealed a friable, ulceroinfiltrative tumor with multiple hyperemic mucosae in the rectum. Microscopically, the tumor exhibited vasoformative growth with nuclear atypism and numerous mitoses. The tumor cells were strongly positive for CD31, CD34, and Factor VIII. We report a case of rectal angiosarcoma that developed after radiation therapy.
Aged ; Cervix Uteri ; Colonoscopy ; Constipation ; Factor VIII ; Female ; Gastrointestinal Hemorrhage ; Hemangiosarcoma ; Humans ; Mitosis ; Mucous Membrane ; Rectum ; Skin ; Vascular Neoplasms

PURPOSE: Pulmonary infiltrates are often encountered in mechanically ventilated burned patients and represent a challenge for pulmonologists and burn intensivists. The etiology is often multiple and empiric therapy is frequently initiated on the basis of clinical diagnosis, which is of uncertain accuracy. This approach can lead to inadequate treatment with increasing the risks of possible adverse events, while potentially reversible causes may be unrecognized. We performed bronchoalveolar lavage (BAL) study to know the causes of lung infiltration in severely burned patients. METHODS: From August 2003 to August 2008, severely burned patients who have been managed in burn intensive care unit (ICU) and shown diffuse lung infiltration during the courses were included prospectively. BAL was used to make the diagnosis of the respiratory infection, with 104> or = organisms considered a positive result. We also analyzed BAL isolates such as fungus, atypical pathogens and virus. RESULTS: Total 50 patients (M 43, F 7) were enrolled. The percent of total body surface area burn was 48.1+/-19.0% and APACHE II score was 10.0+/-5.6. Overall mortality was 64% (32 cases). 44 cases (88%) met criteria for positive BAL culture and 12 cases (24%) of those were combined with alveolar hemorrhage. The frequent bacterial isolates were Acinetobacter species in 19 cases (38%), Pseudomonas aeruginosa in 18 cases (36%) and methicillin-resistant Staphylococcus aureus in 14 cases (28%). Through BAL study, respiratory viruses were isolated in 15 cases (30%), and Legionella pneumonia, Tuberculosis and Pneumocystis pneumonia were reported in one of each (2%). CONCLUSION: BAL seems to be a useful tool for identifying infectious pathogens and may give guidance for adequate choices of antimicrobial agents in severely burned patients with diffuse lung infiltrations.
Acinetobacter ; Anti-Infective Agents ; APACHE ; Body Surface Area ; Bronchoalveolar Lavage ; Burns ; Fungi ; Hemorrhage ; Humans ; Intensive Care Units ; Legionella ; Lung ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Pneumocystis ; Prospective Studies ; Pseudomonas aeruginosa ; Tuberculosis ; Viruses

Although miliary tuberculosis is uncommon during pregnancy. it is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection, and it is difficult to diagnose when associated with pregnancy. There is no solid evidence that pregnancy has an adverse effect on tuberculosis, thus routine therapeutic abortion is not indicated. If the early diagnosis and promptly adequate chemotherapy was done, the outcome of pregnancy in a women with miliary tuberculosis is likely to be good. Recently we have experienced a case of miliary tuberculosis at 20 weeks gestation without any risk factors of tuberculosis. So we report this case with a brief review of literature.
Abortion, Therapeutic ; Alcoholism ; Drug Therapy ; Early Diagnosis ; Female ; HIV ; Humans ; Pregnancy* ; Risk Factors ; Substance Abuse, Intravenous ; Tuberculosis ; Tuberculosis, Miliary*

A previous report by this laboratory demonstrated that bacterial iron chelator (siderophore) triggers inflammatory signals, including the production of CXC chemokine IL-8, in human intestinal epithelial cells (IECs). Microarray-based gene expression profiling revealed that iron chelator also induces macrophage inflammatory protein 3 alpha (MIP-3alpha)/ CC chemokine-ligand 20 (CCL20). As CCL20 is chemotactic for the cells involved in host adaptive immunity, this suggests that iron chelator may stimulate IECs to have the capacity to link mucosal innate and adaptive immunity. The basal medium from iron chelator deferoxamine (DFO)-treated HT-29 monolayers was as chemotactic as recombinant human CCL20 at equivalent concentrations to attract CCR6+ cells. The increase of CCL20 protein secretion appeared to correspond to that of CCL20 mRNA levels, as determined by real-time quantitative RT-PCR. The efficacy of DFO at inducing CCL20 mRNA was also observed in human PBMCs and in THP-1 cells, but not in human umbilical vein endothelial cells. Interestingly, unlike other proinflammatory cytokines, such as TNF-alpha and IL-1beta, a time-dependent experiment revealed that DFO slowly induces CCL20, suggesting a novel mechanism of action. A pharmacologic study also revealed that multiple signaling pathways are differentially involved in CCL20 production by DFO, while some of those pathways are not involved in TNF-alpha-induced CCL20 production. Collectively, these results demonstrate that, in addition to some bacterial products known to induce host adaptive immune responses, direct chelation of host iron by infected bacteria may also contribute to the initiation of host adaptive immunity in the intestinal mucosa.
Calcium/metabolism ; Cell Movement/drug effects ; Chemokines, CC/genetics/*metabolism ; Deferoxamine/*pharmacology ; Egtazic Acid/analogs & derivatives/pharmacology ; HT29 Cells ; Humans ; Immunity, Mucosal/*drug effects ; Intestinal Mucosa/*drug effects/immunology/metabolism ; Iron Chelating Agents/*pharmacology ; Macrophage Inflammatory Proteins/genetics/*metabolism ; NF-kappa B/metabolism ; Phosphoprotein Phosphatase/physiology ; Protein Transport/drug effects ; Protein-Serine-Threonine Kinases/physiology ; RNA, Messenger/genetics/metabolism ; Receptors, Chemokine/metabolism ; Research Support, Non-U.S. Gov't