BACKGROUND: Penile cancer is a rare malignancy associated with high rates of mortality and morbidity. Currently, the efficacy of adjuvant treatment (AT), including radiotherapy and chemotherapy, for penile cancer remains unclear. Therefore, we investigated the prognostic factors for treatment outcomes and the efficacy of AT in consecutive patients who underwent penectomy for penile cancer at multiple Korean institutions between 1999 and 2013. METHODS: AT was defined as the administration of chemotherapy, radiotherapy, or both within 12 months after initial treatment. All patients were divided into two groups according to the AT status. RESULTS: Forty-three patients (median age 67.0 years) with a median follow-up after penectomy of 26.4 (interquartile range: 12.0–62.8) months were enrolled. Patients with AT had a significantly higher pathologic stage. However, no differences in age, histologic grade, or type of surgery were identified according to the presence of AT. The 3- and 5-year cancer-specific survival (CSS) rates were 79.0% and 33.0%, respectively. In a multivariate analysis, American Joint Committee on Cancer (AJCC) stage ≥ III disease was an independent predictor of CSS and recurrence-free survival (RFS). However, AT was not associated with CSS and RFS. The type of primary surgical treatment and inguinal lymph node dissection at diagnosis were also not significantly associated with overall survival, CSS, or RFS. CONCLUSION: AJCC stage ≥ III disease, which mainly reflects lymph node positivity, is a significant prognosticator in patients with penile cancer. By contrast, AT does not seem to affect CSS and RFS.
Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Joints ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Multivariate Analysis ; Penile Neoplasms* ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant

BACKGROUND AND OBJECTIVES: Although increasing evidence has indicated that radial access is a beneficial technique, few studies have focused on Korean subjects. The aim of this study was to evaluate current practice of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using radial access in South Korea. SUBJECTS AND METHODS: A total of 6338 subjects were analyzed from Korean Transradial Intervention prospective registry that was conducted at 20 centers in Korea. After evaluating the initial access, subjects intended for radial access were assessed for their baseline, procedure-related, and complication data. Subjects were categorized into three groups: group of overall subjects (n=5554); group of subjects who underwent PCI (n=1780); and group of subjects who underwent primary percutaneous coronary intervention (PPCI) (n=167). RESULTS: The rate of radial artery as an initial access and the rate of access site crossover was 87.6% and 4.4%, respectively, in overall subjects. Those rates were 82.4% and 8.1%, respectively, in subjects who underwent PCI, and 60.1% and 4.8%, respectively, in subjects who underwent PPCI. For subjects who underwent CAG, a 6-F introducer sheath and a 5-F angiographic catheter was the most commonly used. During PCI, a 6-F introducer sheath (90.6%) and a 6-F guiding catheter were standardly used. CONCLUSION: The large prospective registry allowed us to present the current practice of CAG and PCI using radial access. These data provides evidence to achieve consensus on radial access in CAG and PCI in the Korean population.
Catheters ; Consensus ; Coronary Angiography* ; Korea ; Percutaneous Coronary Intervention ; Prospective Studies* ; Radial Artery ; Registries

OBJECTIVES: The purpose of this article is to analyze the incidence, demographic distribution, type, and etiology of mandible fractures that were treated by the Department of Oral and Maxillofacial Surgery in Kyung Hee University Dental Hospital from January 2002 to December 2012. MATERIALS AND METHODS: This was a descriptive and analytic retrospective study that evaluated 735 patients that were treated for mandible fracture. RESULTS: This study included 1,172 fractures in 735 patients. The ratio of male to female patients was 5.45 : 1; the maximum value was in patients between 20 and 29 years (38.1%) and the minimum in patients over 70 years old. The monthly distribution of facial fractures peaked in the fall and was lower during winter. No specific correlation was identified based on the annual fracture distribution. Among the 735 fracture patients, 1.59 fracture lines were observed per patient. The most frequent site was the symphysis, which accounted for a total of 431 fractures, followed by the angle (348), condyle (279), and body (95). The symphysis with angle was the most common site identified in combination with fracture and accounted for 22.4%, followed by symphysis with condyle (19.8%). The angle was the most frequent site of single fractures (20.8%). The major cause of injury was accidental trauma (43.4%), which was followed by other causes such as violence (33.9%), sports-related accidents (10.5%), and traffic accidents (10.1%). Fracture incidents correlated with alcohol consumption were reported between 10.0%-26.9% annually. CONCLUSION: Although mandible fracture pattern is similar to the previous researches, there is some changes in the etiologic factors.
Accidents, Traffic ; Alcohol Drinking ; Female ; Humans ; Incidence ; Jaw Fractures ; Male ; Mandible* ; Mandibular Fractures ; Retrospective Studies* ; Surgery, Oral ; Violence

BACKGROUND/AIMS: The aim of this study was to compare palliative treatments such as chemotherapy, chemoradiotherapy or radiotherapy with best supportive care in patients with inoperable advanced esophageal cancer. METHODS: A total of 67 patients with inoperable advanced esophageal cancer visiting Kosin University Gospel Hospital between January 2000 and July 2010 were included in a retrospective analysis. Patients were categorized as having palliative treatment or best supportive care to compare their prognosis. RESULTS: The median survival was 6.4 months in 67 patients. There was significant difference in median survival between the palliative and best supportive treatment (9.8 months vs. 4.5 months, p=0.01). The patients who underwent palliative treatment had superior 1-year and 3-year overall survival rate than those with best supportive treatment (27%, 10% vs. 5%, 5%, respectively). The 1-year and 3-year overall survival rate of palliative treatment was 18% (1-year overall survival rate) in chemotherapy, 33% (1-year overall survival rate) in radiotherapy, 45% and 9% in concurrent chemoradiotherapy, and 20% and 20% in sequential chemoradiotherapy, respectively. CONCLUSIONS: These results may suggest that palliative treatments are more effective than best supportive care. Further prospective studies are still needed to elucidate beneficial effect of palliative treatments on inoperable advanced esophageal cancer.
Aged ; Aged, 80 and over ; Combined Modality Therapy ; Esophageal Neoplasms/mortality/*therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; *Palliative Care ; Prognosis ; Retrospective Studies

A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally significant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insufficiency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.
Angioplasty ; Arm ; Basilar Artery ; Blood Pressure ; Cardiovascular Diseases ; Constriction, Pathologic ; Humans ; Male ; Peripheral Vascular Diseases ; Stents ; Subclavian Artery ; Subclavian Steal Syndrome ; Upper Extremity ; Vertebral Artery ; Vertebrobasilar Insufficiency

PURPOSE: In cases of locally advanced non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy (CCRT) is the leading therapeutic modality. However, much controversy exists about the chemotherapeutic regimens and radiation methods. MATERIALS AND METHODS: During concurrent chemoradiotherapy, three or four cycles of gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were administered every two weeks while 50.4 Gy of irradiation was administered in 28 fractions (once/day, 5 treatment days/week) to the tumor site, mediastinum, and the involved lymph node region. In addition, a booster irradiation dose of 18 Gy in 10 fractions was administered to the primary tumor site unless the disease progressed. Two or three cycles of consolidation chemotherapy were performed with gemcitabine (1,200 mg/m2, 1st and 8th day) and cisplatin (60 mg/m2) every three weeks. RESULTS: A total of 29 patients were evaluable for modality response. Response and treatment toxicities were assessed after concurrent chemoradiotherapy and consolidation chemotherapy, respectively. One patient (4%) achieved a complete response; whereas 20 patients (69%) achieved a partial response after concurrent chemoradiotherapy. Following the consolidation chemotherapy, three patients (10.3%) achieved complete responses and 21 patients (72.4%) achieved partial responses. The median follow-up period was 20 months (range 3m39 months) and the median survival time was 16 months (95% CI; 2.4m39.2 months). The survival rates in one, two, and three years after the completion of treatment were 62.7%, 43.9%, and 20%, respectively. Complications associated to this treatment modality included grade 3 or 4 esophagitis, which occurred in 15 patients (51.7%). In addition, an incidence of 24% for grade 3 and 14% for grade 4 neutropenia. Lastly, grade 2 radiation pneumonitis occurred in 6 patients (22%). CONCLUSION: The response rate and survival time of concurrent chemoradiotherapy with biweekly gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were encouraging in patients with locally advanced NSCLC. However, treatment related toxicities were significant, indicating that further modification of therapy seems to be warranted.
Incidence ; Chemoradiotherapy ; Lung Neoplasms

PURPOSE: The incidence of accidentally detected small renal tumors is increasing throughout the world. In this multi-institutional study performed in Korea, histopathological characteristics of contemporarily surgically removed renal tumors were reviewed with emphasis on tumor size. MATERIALS and METHODS: Between January 1995 and May 2005, 1,702 patients with a mean age of 55 years underwent surgical treatment at 14 training hospitals in Korea for radiologically suspected malignant renal tumors. Clinicopathological factors and patient survival were analyzed. RESULTS: Of the 1,702 tumors, 91.7% were malignant and 8.3% were benign. The percentage of benign tumors was significantly greater among those < or = 4cm (13.2%) than those > 4cm (4.5%) (p < 0.001). Among renal cell carcinoma patients, the percentage of tumors classed as stage > or = T3 was significantly less among tumors < or = 4cm (5.2%) than those > 4cm (26.8%) (p < 0.001). The percentage of tumors classed as Fuhrman's nuclear grades > or = 3 was also significantly less among tumors < or = 4cm (27.3%) than tumors > 4cm (50.9%) (p < 0.001). The 5-year cancer-specific survival rate was 82.7%, and T stage (p < 0.001), N stage (p < 0.001), M stage (p = 0.025), and Fuhrman's nuclear (p < 0.001) grade were the only independent predictors of cancer-specific survival. CONCLUSION: In renal tumors, small tumor size is prognostic for favorable postsurgical histopathologies such as benign tumors, low T stages, and low Fuhrman's nuclear grades. Our observations are expected to facilitate urologists to adopt function-preserving approach in the planning of surgery for small renal tumors with favorable predicted outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney Neoplasms/classification/*pathology/*surgery ; Male ; Middle Aged ; Neoplasm Staging

PURPOSE: We examined the effect of lowering prostate-specific antigen (PSA) threshold on the number of Korean men requiring a prostate biopsy. MATERIALS AND METHODS: We evaluated men who had serum PSA levels tested at routine physical check-ups between 1999 and 2005 at 11 domestic hospitals. Men with PSA> or =10ng/ml or patients with prostate cancer were excluded. A total of 45,074 men(aged 50 to 79 years) were enrolled and split into three age groups: 50-59 years, 60-69 years, and 70-79 years. For each age group, we calculated the number and proportion of men whose PSA level exceeded potential biopsy thresholds: 2.5ng/ml, 3.0ng/ml, and 4.0ng/ml. Results were extrapolated to the 4.992 million men older than 50 years old, or 21.3% of the Korean male population in 2005. RESULTS: The number of biopsy candidates at the threshold of 4.0ng/ml, 3.0ng/ml, and 2.5ng/ml were 1,321(2.9%), 2,248(5.4%), and 3,577(7.9%), respectively. Extrapolating to the male population in Korea, lowering the PSA threshold from 4.0ng/ml to 3.0 or 2.5ng/ml would increase the number of men needing biopsy by 1.75 and 2.49 times, respectively. CONCLUSIONS: Lowering the PSA threshold would increase the number of men receiving prostate biopsy despite the low reference age for PSA in Korea. Considering the low incidence of prostate cancer, physicians should be careful in altering the PSA threshold.
Biopsy ; Humans ; Incidence ; Korea ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

PURPOSE: To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs. PATIENTS AND METHODS: Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder. RESULTS: A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms. CONCLUSION: In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.
Adult ; Aged ; Aged, 80 and over ; Chronic Disease/*economics ; Depression/*complications/diagnosis/*economics ; Female ; *Health Care Costs ; Humans ; Male ; Middle Aged ; *Outpatients ; Regression Analysis ; Sex Factors

PURPOSE: The incidence of prostate cancer is increasing in Korea, but compared with western counties, the incidence is relatively low. The detection rate of prostate cancer, according to the serum prostate-specific antigen (PSA) level, is reportedly different in Korean men, but this remains to be confirmed. We retrospectively reviewed the data of prostate biopsies, and evaluated the detection rate of prostate cancer from biopsies, according to the serum PSA level in Korean men. MATERIALS AND METHODS: We retrospectively reviewed the results of 2,422 Korean men who had undergone prostate biopsies at 12 medical centers. Prostate biopsies were performed in cases of high PSA levels, greater than 4ng/ml, or abnormal findings on digital rectal examination. RESULTS: Of the 2,422 men, 39.7% had a positive biopsy. With PSA levels between 4 and 10ng/ml, the detection rate of prostate cancer was 15.9%. This rate was similar to that of the Japanese (15.8%), but quite different from that of American men (25%). With PSA levels above 10ng/ml, 59.5% of men had a positive biopsy. For PSA levels > or= 4ng/ml and > or= 10ng/ml, the detection rates were 42.1 and 59.5%, respectively. CONCLUSIONS: When the serum PSA levels were divided into 4 subdivisions (4.0-10.0, 10.0-20.0 and 20.0-100.0ng/ml and more than 100.0ng/ml), the detection rates were 15.9, 34.1, 66.2 and 93.8%, respectively.
Asian Continental Ancestry Group ; Biopsy ; Digital Rectal Examination ; Humans ; Incidence ; Korea ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Retrospective Studies