Purpose: This study investigated the incidence of secondary malignancy in multiple myeloma (MM) patients compared with that in the general population using a population-based database covering all residents in Korea. Materials and Methods: Based on the national health insurance system in Korea, all people primarily diagnosed with MM between January 1, 2010 to December 31, 2018 were identified. A total of 9,985 MM patients aged ≥ 20 years in Korea were included. Results: Among them, 237 (2.4%) developed secondary malignancies by 2018. The standardized incidence rates (SIRs) of all secondary malignancies in MM patients were 0.87 (95% confidence interval [CI], 0.76 to 0.98), with a higher incidence of hematologic malignancies than in the general population with an SIR of 3.80 (95% CI, 2.61 to 5.00). The incidence rates of both lymphoid malignancy (SIR, 3.56; 95% CI, 2.31 to 4.82) and myeloid malignancy (SIR, 3.78; 95% CI, 1.16 to 6.39) were higher in MM patients than in the general population. In contrast, a lower incidence of solid cancer was observed in MM patients than in the general population (SIR, 0.76, 95% CI, 0.65 to 0.86). There was no significant difference in survival in MM patients without secondary malignancies, with hematologic malignancy, and with solid cancer (p=0.413). Conclusion MM patients had a greater risk of secondary malignancies, especially hematologic malignancies, than the general population. Future studies with a focus on analyzing patients’ history, treatment details, and genetic information in various stages of MM patients are needed to better understand the mechanism behind this increased risk.

PURPOSE: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. METHODS: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. CONCLUSION: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when operating on large, toxic or neoplastic glands.
Acoustics ; Fatigue ; Female ; Follow-Up Studies ; Humans ; Laryngeal Diseases ; Laryngeal Nerve Injuries ; Laryngeal Nerves ; Muscles ; Neck Dissection ; Noise ; Phonation ; Prospective Studies ; Signal-To-Noise Ratio ; Singing ; Thyroid Gland ; Thyroidectomy* ; Vocal Cord Paralysis ; Voice*

PURPOSE: In elderly and patients with underlying diseases, mortality rate is increased when compared to rib fractures which occurred in other patients. Because there is a shortage of emergency physicians or real-time consultation with radiologists in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad, which was highly portable, with that of liquid crystal display (LCD) monitor. METHODS: Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians. A total of 108 cases were divided 1st to 54th and 55th to 108th. Two sessions were separated with a four-week interval. If the reviewer interpreted the 1st to 54th with iPad, they did 55th to 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured ribs, and diagnostic confidence of 5-scale. RESULTS: The interobserver agreement among reviewers in LCD and iPad was 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools for each reviewer was 0.410-0.859 (Mean=0.628+/-0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810- 0.966 (Mean=0.879+/- 0.054) in LCD, 0.828-1.000 (Mean=0.898+/-0.052) in iPad. The specificity was 0.520- 0.860 (Mean=0.750+/-0.117) in LCD and 0.560-0.880 (Mean=0.708+/-0.111) in iPad. Therefore, remote consultation of X-ray by iPad with a specialist was possible with minimized temporal and spatial limits in the emergency room. CONCLUSION: In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, remote consultation of X-ray by iPad with a specialist in the emergency room was possible, with temporal and spatial limits by iPad.
Aged ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Liquid Crystals ; Mortality ; Remote Consultation ; Rib Fractures* ; Ribs* ; Sensitivity and Specificity ; Specialization ; Teleradiology

No abstract available.

BACKGROUND AND OBJECTIVES: Epidermal characteristics of cholesteatoma such as invasion, migration, uncoordinated proliferation, and altered differentiation may arise as a result of defectiVe wound healing process, induction of preneoplastic transformation or genetic alteration. To date, a number of genes haVe been shown to be differentially regulated in cholesteatoma, which might be responsible for these clinical characteristics. HoweVer, it is still unclear whether these phenomena is only oVert when cholesteatoma is under specific conditions such as inflammation or infection. If these genetic alterations in the deVelopment of cholesteatoma are transient, the pathology of cholesteatoma may be reVersible. We hypothesized that once cholesteatoma is in the normal environment, the cellular or molecular pathology of cholesteatoma can return to normal epidermal characteristics. The aim of this study was to determine whether common molecular characteristics are reVersible or not after removal of inductive factors in aural cholesteatoma induced gerbils. MATERIALS AND METHODS: We induced canal ligation cholesteatoma using Mongolian gerbils. The treated group was untied and managed for 2 weeks. We examined differences between treated cholesteatoma and untreated cholesteatoma by using a TUNEL staining and immunohistochemical technique with proliferation markers (PCNA, cytokeratin 13/16). RESULTS: With PCNA and CK 13/16, untreated group showed positive staining in the suprabasal cells as well as in the basal cells, but the treated group showed weakly positive staining only in the basal cell layer. With TUNEL staining, positive cells increased more in the untreated group than in the treated group. CONCLUSION: These results encourage our belief that some cholesteatomas, especially cholesteatoma in early stages, might be managed with only minimal treatments such as control of inflammation and maintenance of adequate Ventilation.
Cell Differentiation ; Cholesteatoma* ; Cholesteatoma, Middle Ear ; Gerbillinae* ; In Situ Nick-End Labeling ; Inflammation ; Keratins ; Ligation ; Pathology ; Pathology, Molecular ; Proliferating Cell Nuclear Antigen ; Ventilation ; Wound Healing

BACKGROUND AND OBJECTIVES: Parapharyngeal infections are rare but they cause life-threatening complications such as mediastinitis, rupture or aneurysm of the internal carotid artery, internal jugular vein thrombophlebitis. So, until now, the recommended treatment of parapharyngeal abscess is early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. MATERIALS AND METHOD: A retrospective study was peformed on 34 cases with parapharyngeal abscess in patients admitted for deep neck infection during a 8-year period from June 1994 to January 2003. All had contrast-enhanced computed tomography (CT) imaging and had confirmation of an abscess in parapharyngeal space. RESULTS: All patients were treated with intravenous antibiotics, 19 cases (conservative group) were treated with antibiotics only or needle aspiration, 15 cases (surgical group) were treated with intraoral or external drainage. The mean period of hospitalization was 8.2 days in conservative group and 11.6 days in surgical group. There was no complication except the mediastinitis in one case of conservative group. Five patients required tracheotomy because of severe dyspnea. CONCLUSION: Neck CT scan is useful diagnostic tool to detect and establish treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to parapharyngeal space and treated conservatively with no need for early open surgical drainage.
Abscess* ; Aneurysm ; Anti-Bacterial Agents ; Carotid Artery, Internal ; Drainage ; Dyspnea ; Hospitalization ; Humans ; Jugular Veins ; Mediastinitis ; Neck ; Needles ; Retrospective Studies ; Rupture ; Thrombophlebitis ; Tomography, X-Ray Computed ; Tracheotomy

Background: As the importance of the esthetic function of teeth increases, the use of esthetic restoration materials and whitening treatment are increasing. The purpose of this study was to investigate the color change of esthetic restoration materials upon using staining and whitening toothpaste. Methods: Light curing (LC) packable composite resin, LC flowable resin, LC glass ionomer (GI), and self-curing GI specimens were colored in coffee or curry for three hours a day for seven days. After that, regular toothpaste, whitening toothpaste containing hydrogen peroxide, and whitening toothpaste containing activated charcoal were applied for three minutes three times a day for two weeks. Luminosity (L), chromaticity a (a), and chromaticity b (b) were measured using a spectrophotometer once a week. Results: In the coffee-colored group, the change in L2 *a2 *b2 (E2 ) with time was significant (p=0.004), there was no difference for different toothpaste types (p=0.646), and there was significant difference (p＜0.001) for different esthetic restorative materials.The change of E2 in the curry-colored group was significant only for different esthetic restorative materials (p＜0.001). In the coffee-colored group, the L, a, and b values of the light-curing GI showed greater change than other materials after staining and one week after whitening, turning dark, red, and yellow. In the curry-colored group, L did not differ for different materials and times, and a and b showed the greatest difference in light-curing GI after staining and one and two weeks after whitening. Conclusion The use of whitening toothpaste for two weeks was not different from the use of general toothpaste in the removal of staining or whitening. Since light-curing GI is the most vulnerable to coloration, it is recommended that coloring by food chromogen should be explained in advance, before using light-curing GI for teeth restoration.

Although the association of genetic polymorphisms in glutathione S-transferase(GST) and N-acetyltransferase(NAT) with bladder cancer has been reported, limited numbers of studies have been indicated the association of CYP2E1 with bladder cancer, particularly in Asian population. A hospital based case-control study was conducted in South Korean, consisting of 232 histologically confirmed prevalent bladder cancer cases and 165 controls to evaluate the association between genetic polymorphisms of CYP2E1(RsaI) and development of bladder cancer. The frequency of CYP2E1(RsaI) c1/c1 genotype in bladder cancer cases was higher than in controls; 114 of 201(56.7%) vs. 62 of 146(42.5%). Men with CYP2E1(RsaI) c1/c1 genotype had increased risk of development of bladder cancer compared to men with at least one c2 allele(OR=1.7, 95% CI=1.1-2.7). The bladder cancer risk increased as the number of c1 allele increased(p for trend=0.005). The risk increased as the amount of smoking increased(p for trend=0.009). When data were analyzed for the interaction between smoking and CYP2E1 genetic polymorphisms, smokers with c1/c1 genotype have 2.5 greater risk in development of bladder cancer(95% CI=1.0-6.2) compared to nonsmokers with c2 allele(p for interaction=0.008). Our findings suggest that the interaction between genetic polymorphisms of CYP 2E1 (RsaI, c1/c1) and smoking may play an important role for development of bladder cancer among Koreans.
Alleles ; Asian Continental Ancestry Group ; Case-Control Studies ; Cytochrome P-450 CYP2E1* ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Genotype ; Glutathione ; Humans ; Korea* ; Male ; Polymorphism, Genetic* ; Smoke ; Smoking ; Urinary Bladder Neoplasms* ; Urinary Bladder*

OBJECTIVES: Cases of human brucellosis in Korea have recently increased due to the increasing incidence of bovine brucellosis. The authors conducted this study to elucidate the status of brucellosis through seroepidemiologic study. METHODS: We selected our study population from a high risk group. We conducted a questionnaire survey and obtained blood samples to determine the seroprevalence of brucellosis antibodies for 10 days in February, 2005. The titers of brucellosis were measured by the combination of standard tube agglutination test (STA) and enzyme-linked immunosorbent assay (ELISA) test. RESULTS: Our study subjects comprised 1,075 cases: 971 livestock workers, 51 veterinarians, and 53 artificial inseminators. In the STA test, 27 cases (2.5%) had titers of greater than or equal to 1:20. Of 1,068 cases (7 cases were excluded due to previous brucellosis), 7 cases of brucellosis were diagnosed with titers of 1:160, giving a seroprevalence of brucellosis of 0.66%. The seroprevalence in the male group was 0.95%, and that of livestock workers, veterinarians, and artificial inseminators was 0.52%, 4.17%, and 0.00%, respectively. The Spearman's correlation coefficient between the positive rate of bovine brucellosis per capita and household and human brucellosis was 0.806 and 0.744, respectively. The concordance rate between the Korea National Institute of Health and the Gyeongsangbuk-do Institute of Health and Environment by the STA and ELISA tests was 94.7% and 100.0%, respectively. CONCLUSIONS: The study results indicated in higher seroprevalence rate among veterinarians than among livestock workers and artificial inseminators. Because veterinarians may be exposed to this high risk, effective working guidelines for veterinarians to guard against brucellosis must be developed. Moreover, more extensive epidemiologic research for laboratory workers and meat handlers is needed.
Adult ; Aged ; Agriculture ; Animal Husbandry ; Animals ; Brucellosis/*epidemiology ; Brucellosis, Bovine/epidemiology ; Cattle ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Korea/epidemiology ; Middle Aged ; Occupational Diseases/*epidemiology ; Seroepidemiologic Studies ; Veterinarians

Occupational asthma is defined as a disease that is characterized by airway narrowing and bronchial hyperresponsiveness caused by specific working environment. It is estimated that occupational asthma cases in Korea have been underreported. This study, using Korean Medical Insurance Data(KMID), examined the distribution of asthma patients' occupations and the frequency of high risk occupations for occupational asthma in Seoul, Korea to evaluate the usefulness of the KMID data as a database for active occupational asthma surveillance system. Six hundreds and forty two(30.7%) of 2093 patients who were finally chosen as a study population by using 1995-year KMID, were contacted by telephone. 296 persons(47.4%) of 642 patients replied that they were diagnosed as asthma. The occupations of 296 asthma patients were classified by Korean standardized industrial classfication (KSIC). The most common occupations included Wholesale and Retail trade(19.5%), Real estate, Renting and Business activities(14.9%), Construction(14.9%), Manufacturing(12.3%). Forty(13.5%) of 296 patients who could be classified by KSIC were working at high risk jobs for occupational asthma. KMID could be used as a useful data for occupational asthma surveillance system if the limitations of KMID, which is the accuracy of diagnosis, data accessibility, difficulty of following up study subjects, would be solved. The prevalence of occupational asthma could be estimated if the follow-up study diagnosing occupational asthma for asthma patients working in high risk jobs would be held.
Asthma ; Asthma, Occupational* ; Commerce ; Diagnosis ; Follow-Up Studies ; Humans ; Insurance ; Korea* ; Occupations ; Prevalence ; Seoul ; Telephone