Colorectal cancer during pregnancy is rare but the trend for women to delay pregnancy until later in life may result in increased incidence of colorectal cancer during pregnancy. The most common symptoms are rectal bleeding, abdominal discomfort, abdominal distension, anorexia, nausea, vomiting, constipation, anemia and weight loss. Rectal bleeding, if it is occurred, is often attributed to hemorrhoids, a common finding of pregnancy and many of these symptoms are commonplace in normal pregnancy. This delays diagnosis of colorectal cancer during pregnancy and leads to more advanced stage and poor prognosis compared to the general population. We experienced a woman at 27 weeks gestation who complained of low abdominal distention and was diagnosed of sigmoid colon cancer and underwent cesarean section and hemicolectomy at 30 weeks gestation, so we present it with brief review of literature."
Anemia ; Anorexia ; Cesarean Section ; Colorectal Neoplasms* ; Constipation ; Diagnosis ; Female ; Hemorrhage ; Hemorrhoids ; Humans ; Incidence ; Nausea ; Pregnancy* ; Prognosis ; Sigmoid Neoplasms ; Vomiting ; Weight Loss

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed.In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

A hand-arm vibration syndrome, local vibration illness, occurs in some workers who use hand held vibration tools. It consists of white fingers, diffusely distributed finger neuropathy, pain in the hand and arm, and a small excess risk of osteoarthritis. This study is aimed to identify effective methods to confirm local vibration illness among various health exams, which are mentioned in worker's special health exam regulation. In addition, this study is aimed to quantitatively assess the daily vibration exposure level as a major determinant of vibration illness. The subjects, 46 vibration workers, were selected according to the results of the first special health exam about vibration hazards at shipbuilding industry in 1997. They all had experiences of work related blanching of fingers. Fifteen controls, who had no vibration exposure at all, were also recruited to compare their test results with the results of vibration workers. We adopted 1 subjective and 6 objective tests to evaluate the effectiveness and feasibility for confirming local vibration illness. These tests were history taking of subjective symptoms according to the Stockholm classification, checking blood pressure of finger, checking grasp power, checking finger skin temperature, nail-bed pressing test, vibration perceptional threshold test, and skin prick test for pain perception. Among these, checking skin temperature, nail-bed pressing test, and vibration perception test included cold water provocations. We also estimated some vibration exposure levels of hand held vibration tools by using previously published data from one automobile company. In conclusion, history taking of subjective symptoms according to the Stockholm classification, nail-bed pressing test, and vibration perceptional threshold test were discovered to be effective to diagnose local vibration illness. Furthermore, vibration perceptional threshold on right fingers showed a dose-response relationship to daily vibration exposure levels. The parameter beta was 0.0005(+/-0.0002), and statistically significant by REM (random effects model).
Arm ; Automobiles ; Blood Pressure ; Classification ; Fingers ; Hand ; Hand Strength ; Hand-Arm Vibration Syndrome ; Osteoarthritis ; Pain Perception ; Skin ; Skin Temperature ; Vibration* ; Water

BACKGROUND: Intracranial pressure monitoring gives useful information in many neurosurgical conditions. And, measurement of the extradural pressure has always seemed an attractive alternative for intracranial pressure (ICP) monitoring. Also, choice of anesthetic agent may affect the management of intracranial pressure. The aim of this study was to evaluate the effect of propofol, isoflurane and enflurane on ICP by measuring lumbar epidural pressure. METHODS: Forty seven adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to anesthetic agent for maintenance: group I (isoflurane, n = 15), group P (propofol, n = 17), and group E (enflurane, n = 15). Premedication was performed by intramuscular injection of 0.2 mg of glycopyrrolate. ECG, noninvasive blood pressure monitoring device, and pulse oximeter was used for patient monitoring. A twenty gauge epidural catheter was placed 3-4 cm above the insertion site (L3-4). The pressure monitoring kit was connected to a catheter and was zeroed at the middle ear level. Epidural pressure was cheked every 10 min and compared to the control and among groups during maintenance of anesthesia. RESULTS: Demographic data showed no difference among groups. Preinduction epidural pressures were 7.4 +/- 1.4, 7.1 +/- 1.1, 7.2 +/- 1.0 mmHg in group P, I and E, respectively. During maintenance, group I did not show any statistically significant changes in epidural pressure, but pressure was reduced in group P and elevated in group E significantly 100 min after administering the maintenance anesthetics. CONCLUSIONS: Among the three anesthetic agents, propofol may be a more suitable maintenanace anesthetic agent for patients with increased ICP.
Adult ; Anesthesia ; Anesthetics ; Blood Pressure Monitors ; Catheters ; Ear, Middle ; Electrocardiography ; Enflurane* ; Glycopyrrolate ; Humans ; Injections, Intramuscular ; Intracranial Pressure ; Isoflurane* ; Monitoring, Physiologic ; Orthopedics ; Premedication ; Propofol*

Gadopentetate dimeglumine(Gd-DTPA) has low toxicity and good tolerance and it is said that the observed adverse drug reaction of Gd-DTPA is compatible to those of iodinated nonionic contrast media. The overall incidence of adverse drug reaction of Gd-DTPA is even lower than those of iodinated nonionic contrast media. Then, the possibility of potential adverse drug reaction of these contrast media is not fully known and recently, many authors have a growing interest in this point. We have taken 2501 cases of MRI and exccure 1467 cases of Gd-DTPA enhancement scaning(58.7%0 and experienced 12 cases of adverse drug reaction(11 cases: mild reaction. 1 case: severe anaphylactic shock)and the overall incidence of our adverse drug reaction of Gd-DTPA was 0.8%. In conclusion, the adverse drug reaction of Gd-DTPA is not rare and the severe adverse drug reaction of Gd-DTPA may occur. So, the possibility of adverse drug reaction after Gd-DTPA injection should always be kept in mind, especially when the patient has a history of reaction to contrast material, allergy(particularly asthma) and cardiac disease. For the safe use of Gd-DTPA, well trained personnel and nearby emergent care facilities should be available.
Contrast Media ; Drug-Related Side Effects and Adverse Reactions* ; Gadolinium DTPA ; Heart Diseases ; Humans ; Incidence ; Magnetic Resonance Imaging*

PURPOSE: The prevalence of renal anomalies in Turner syndrome(TS) has been reported to vary from 33% to 60%. The purpose of this study was to clarify the true incidence of renal malformations in Korean TS. METHODS: We evaluated 33 patients with Turner syndrome diagnosed by karyotype in Inje University Busan Paik hospital and Youngnam University from January 1995. Intravenous pyelography(IVP) was performed on all patients; abdominal ultrasonography and 99mTc-DMSA renal scan were performed on some. Cytogenetic analysis was performed on all patients with peripheral blood lymphocytes. RESULTS: Of the total 33 patients, the karyotype showed 45, X in 18(54.5%) patients, mosaicism in 11(33.3%) patients and structural aberration in 4(12.2%) patients. The overall incidence of renal anomalies was 36.4%. The renal anomalies included four cases of horeshoe kidney, six cases of abnormal renal collecting system one case of single kidney and one case of malrotation. The incidence of renal anomalies in 45, X karotype(44.4%) showed a higher rate than that of mosaicism and structural aberration(26.7%), but there is no statistical significance. CONCLUSION: The incidence of renal anomalies in Korean TS reveals 36.4%. This rate is similar to other foreign TS studies. We recommend that renal ultrasonography or IVP for investigation of renal anomalies should be done as a screening procedure for the better quality of life in patients with TS.
Busan ; Child* ; Cytogenetic Analysis ; Humans ; Incidence ; Karyotype ; Kidney ; Lymphocytes ; Mass Screening ; Mosaicism ; Prevalence ; Quality of Life ; Technetium Tc 99m Dimercaptosuccinic Acid ; Turner Syndrome* ; Ultrasonography

PURPOSE: This study was aimed at assessing the difference of the prevalence of iron deficiency and iron deficiency anemia among rural and urban middle school students in relation to dietary habit. METHODS: With a questionnaire, blood samples were obtained from 439 apparently healthy rural and urban middle school students residing in Ulsan. Anemia was defined as hemoglobin level of 12.6 g/dL or less for boys and 11.9 g/dL or less for girls. Iron deficiency was defined as serun ferritin level less than 12 micrograms/L or/and transferrin saturation less than 14%. Iron deficiency anemia was defined as iron deficiency plus low hemoglobin. RESULTS: 1) In boys, the prevalence rate of anemia was 17.2%. Among these anemias, 5.4% were found to be iron deficiency anemia. In girls, the prevalence of anemia increased with age. The prevalence of iron deficiency anemia was 6.9%. 2) In girls, the prevalence rate of anemia in rural area was higher than that of anemia in urban area (12.6% in rural, 6.1% in urban, P<0.01). 3) The prevalence of anemia and iron deficiency in the students with menstruation was 10.6% and 33.1%, which was higher than the prevalence of 2.5% and 7.5% in those who did not have the menarche (P<0.001 and P<0.001, respectively). 4) Dietary intake of rural and urban middle school students was estimated lower in energy, iron than the recommeded dietary allowance (RDA). In girls, dietary intake of rural middle school students was estimated lower in iron, niacin, and vitamin C than that of urban middle school students. 5) Nutritional factors such as energy, carbohydrate, protein, and phosphorus showed positive correlation with RBC, hemoglobin (P<0.05). CONCLUSION: It is recommended to enforce the nutritional education to take enough iron in middle school students to reduce the high prevalence rate of anemia among pubertal students.
Anemia* ; Anemia, Iron-Deficiency ; Ascorbic Acid ; Education ; Female ; Ferritins ; Food Habits ; Humans ; Iron* ; Menarche ; Menstruation ; Niacin ; Phosphorus ; Prevalence ; Surveys and Questionnaires ; Transferrin ; Ulsan*

PURPOSE: Most terminally ill cancer patients die from cancer anorexia-cachexia syndrome. This study evaluated a prognostic role of plasma leptin levels in terminally ill cancer patients. METHODS: This study enrolled 69 terminally ill cancer patients who were aged above 20 years old from July 2009 to July 2010. For univariate analysis, an association between leptin levels and patient's characteristics or other variables was examined using Spearman's correlation analysis, Wilcoxon's rank-sum test or Kruskal-Wallis test, as appropriately. For multivariable analysis, Cox's proportional hazard regression model was used to evaluate a clinical significance of plasma leptin levels as a prognostic factor and to determine factors which affect the risk of death in terminally ill cancer patients. RESULTS: A statistically significant positive correlation between plasma leptin levels and survival time was found. Univariate Cox's proportional hazard regression analyses also showed a moderately significant association between plasma leptin levels and survival time. However, after adjusting variables for sex, white blood cell counts, total bilirubin, AST, ALT, albumin and CRP levels, plasma leptin levels were not significantly associated with survival time. CONCLUSION: No significant association was found between plasma leptin levels and survival time in terminally ill cancer patients. However, this study suggested a prognostic value of plasma leptin levels in gastrointestinal cancer patients.
Aged ; Bilirubin ; Gastrointestinal Neoplasms ; Hospice Care ; Humans ; Leptin ; Leukocyte Count ; Life Expectancy ; Plasma ; Survival Rate ; Terminally Ill

The purpose of this study was to compare food intakes between Korean breast cancer patients and a healthy control group. We compared the intake of nutrients of 117 food items between Korean breast cancer patients (n=97) and age matched healthy controls (n=97). Nutrient intake was estimated using a quantitative food frequency questionnaire. The mean caloric intake of breast cancer patients and healthy controls was not significantly different. Breast cancer patients consumed significantly less fat and antioxidant nutrients such as vitamin A, retinol, beta-carotene, vitamin C and vitamin E when compared to the control subjects. Among the food items, the intake of eggs (p<0.01), legumes (p<0.05), vegetables (p<0.05), seasonings (p<0.001), and oils and fats (p<0.01) in breast cancer patients was significantly lower than that in the controls. These results suggest that Korean breast cancer patients consumed less amount of soy and vegetables, which are rich source of antioxidant nutrients and phytosterols. Thus, dietary guidance to increase intake of these foods may be beneficial in the prevention of breast cancer.
Ascorbic Acid ; beta Carotene ; Breast Neoplasms* ; Breast* ; Eating* ; Eggs ; Energy Intake ; Fabaceae ; Fats ; Female ; Humans ; Oils ; Ovum ; Phytosterols ; Surveys and Questionnaires ; Seasons ; Vegetables ; Vitamin A ; Vitamin E ; Vitamins

Purpose: To report the effect of removal of a central descemet membrane on the endothelial function, morphology, and clinical symptoms of eyes with Fuch’s endothelial dystrophy. Methods: From August 2019 to January 2021, patients with Fuch’s endothelial dystrophy, i.e., with confluent, central corneal guttae and cataracts that required surgery, underwent phacoemulsification, intraocular lens implantation, and central descemet membrane stripping. To evaluate the effect of descemet stripping only (DSO), visual acuity and intraocular pressure were measured, and corneal pachymetry, slit-lamp and specular microscopy, and anterior segment optical coherence tomography performed, before surgery and at 1, 7, and 30 days and 3 and 6 months after surgery. Results: Seven patients (10 eyes) were included. Visual acuity improved from 1.01 ± 0.40 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.33 ± 0.22 logMAR 6 months after surgery (p = 0.008). The mean central corneal thickness decreased from 578.50 ± 36.88 μm preoperatively to 568.50 ± 48.61 μm 6 months after surgery; the difference was not significant (p = 0.507). The endothelial cell count increased significantly from 663.80 ± 356.40/mm2 preoperatively to 1,082.00 ± 274.46/mm2 6 months after surgery (p = 0.043). Conclusions DSO can serve as a useful alternative when corneal transplantation is not possible in patients with Fuch’s endothelial dystrophy, but treatment efficacy and safety require further evaluation.