Background: and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke. Methods: This randomized, open-label, controlled trial assigned patients with recent ischemic stroke <90 days to rosuvastatin/ezetimibe 10/10 mg once daily (ROS10/EZT10) or to rosuvastatin 20 mg once daily (ROS20). The primary endpoint was LDL-C reduction ≥50% from baseline at 90 days. Key secondary endpoints were LDL-C <70 mg/dL and multiple lipid goal achievement, and composite of major vascular events. Results: Of 584 randomized, 530 were included in the modified intention-to-treat analysis. The baseline LDL-C level was 130.2±34.7 mg/dL in the ROS10/EZT10 group and 131.0±33.9 mg/dL in the ROS20 group. The primary endpoint was achieved in 198 patients (72.5%) in the ROS10/EZT10 group and 148 (57.6%) in the ROS20 group (odds ratio [95% confidence interval], 1.944 [1.352–2.795]; P= 0.0003). LDL-C level <70 mg/dL was achieved in 80.2% and 65.4% in the ROS10/EZT10 and ROS20 groups (P=0.0001). Multiple lipid goal achievement rate was 71.1% and 53.7% in the ROS10/EZT10 and ROS20 groups (P<0.0001). Major vascular events occurred in 1 patient in the ROS10/EZT10 group and 9 in the ROS20 group (P=0.0091). The adverse event rates did not differ between the two groups. Conclusion Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke. With the combination therapy, more than 70% of patients achieved LDL-C reduction ≥50% and 80% had an LDL-C <70 mg/dL at 90 days.

Purpose: Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms. Materials and Methods: This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day. Results: Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms. Conclusion The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.

Background: Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. Methods: We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. Results: For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). Conclusion Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

BACKGROUND/AIMS: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS: We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS: The mean age (+/-SD) of subjects was 60.9+/-10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P<0.05). The mean age of the right colon cancer group was higher than that for the left colon cancer group (P<0.05). Among symptomatic patients, the most frequent symptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer (P<0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P<0.05). The prevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance (P>0.05). CONCLUSIONS: Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.
Adenocarcinoma ; Colon, Transverse ; Colonic Neoplasms* ; Colonoscopy ; Demography ; Humans ; Male ; Mass Screening ; Population Characteristics ; Prevalence ; Primary Health Care* ; Rectum

BACKGROUND/AIMS: Stomach cancer is prevalent in Korea. The purpose of this study was to evaluate the characteristics of superficial gastric cancers detected at SOK Sokpeynhan Internal Medical Network, the nationwide primary health care institutions. METHODS: We prospectively analysed the clinicopathologic and endoscopic characteristics of 218 superficial gastric cancer patients diagnosed using gastric endoscopy at SOK network from January 2011 through December 2011. RESULTS: The mean age was 58.5 years old and male to female ratio was 1.7 : 1. Asymptomatic patients were most common (45.0%). The macroscopic classification revealed that simple types (63.8%) were more common than complex types (36.2%). The most common type was IIc (28.4%) and other types were as follows; IIb (16.1%), IIb+IIc (13.3%), IIa (10.6%), III (9.2%), IIa+IIc (7.3%), IIc+IIa (6.0%), IIc+IIb (5.0%). The most commonly involved sites were the body (53.1%) and greater curvature (32.6%) of the stomach. The size of lesion was less than 1 cm (69.3%) and less than 5 mm (33.5%) in diameter. The most common pathologic type was tubular adenocarcinoma (75.7%). Helicobacter pylori infection rate was 50.2%. Fifty five percent of the cases were diagnosed via endoscopy of National Health Insurance Corporation screenings. CONCLUSIONS: Superficial gastric cancers in 2011 at primary health care SOK network were different from those of previous reports. Type IIc was most common but type IIb was more prevalent and the body and greater curvature of the stomach were the most commonly involved sites. Therefore, careful observation of the proximal gastric mucosa and mucosal color change is needed.
Adenocarcinoma/pathology ; Adult ; Aged ; Aged, 80 and over ; Female ; Gastroscopy ; Helicobacter Infections/diagnosis ; Humans ; Male ; Middle Aged ; National Health Programs ; Primary Health Care ; Prospective Studies ; Stomach Neoplasms/*pathology

Cavernous hemangioma of the uterus is an uncommon mesenchymal tumor. Most cases have been reported in young, pregnant women and the condition is very rare in a postmenopausal patient. An 81-year-old woman presented with a huge pelvic mass. Abdominal computed tomography and magnetic resonance imaging results suggested a leiomyoma with degenerative change and hemorrhage. Microscopically, large, thick-walled and variable-sized vascular channels were evident in the majority part of myometrium; the lining cells were immunohistochemically reactive for CD31. Vascular tumors of the female genital tract should be cautiously excised due to the profuse intra-operative bleeding. The pathological examination of a hysterectomy specimen is the only method to confirm the diagnosis of this tumor.
Aged, 80 and over ; Animals ; Caves ; Female ; Hemangioma, Cavernous ; Hemorrhage ; Humans ; Hysterectomy ; Leiomyoma ; Magnetic Resonance Imaging ; Mice ; Myometrium ; Pregnant Women ; Uterus

OBJECTIVES: To investigate the changes in thalamic volumes in subjects at ultra-high risk (UHR) for psychosis. Subjects manifest changes which are similar to but different from those found in subjects with schizophrenia, and thalamic structural changes were often reported in schizophrenic subjects. METHODS: Thalamic volumes of 29 UHR subjects, 31 subjects with schizophrenia and 29 healthy controls, were measured from their T1-weighted coronal magnetic resonance (MR) images using manual tracing. RESULTS: UHR subjects showed greater right (6.243+/-0.848 cm3) and total (12.254+/-1.532 cm3) thalamic volumes compared to healthy control subjects (right thalamic volume=5.527+/-0.715 cm3, total thalamic volume=11.058+/-1.490 cm3) or patients with schizophrenia (right thalamic volume=5.855+/-0.938 cm3, total thalamic volume=11.513+/-1.784 cm3). The difference was significant for right (F=5.837, p=0.004) and total (F=4.217, p=0.018) thalamic volumes after intracranial volume had been accounted for as a covariate in ANCOVA. However, thalamic volume of subjects with schizophrenia showed no significant difference from controls. This difference was not affected by the presence of major depressive disorder or the magnitude of psychotic symptoms. Those among the UHR subjects taking antipsychotic agents did not show enlarged thalamic volume compared to controls. CONCLUSION: Our findings suggest that the possibility of a volumetric alteration of the thalamus characteristic of the UHR state.
Antipsychotic Agents ; Depressive Disorder, Major ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Psychotic Disorders ; Schizophrenia ; Thalamus

Bronchiolitis interstitial pneumonitis (BIP), an unclassified and newly described interstitial pneumonia, has a combined feature of prominent bronchiolitis, interstitial inflammation, and fibrosis. It is distinct from bronchiolitis obliterans or bronchiolitis obliterans organizing pneumonia (BOOP). BIP has a better prognosis than common cases of interstitial pneumonia. However, BIP has a poorer prognosis than BOOP. BIP's response to corticosteroids is not as successful as BOOP's response to this treatment. We encountered the case of a 31-year-old woman with BIP with an initial presentation of dyspnea and a cough that had lasted for 3 months. The patient's chest CT scan demonstrated patchy ground glass opacities and multiple ill-defined centrilobular nodules in both lungs, suggesting military tuberculosis or nontuberculous mycobacterial infection. A video-assisted thoracoscopic lung biopsy resulted in the diagnosis of BIP. Clinical symptoms, pulmonary lesions, and pulmonary function tests were improved after oral glucocorticoid therapy.
Adrenal Cortex Hormones ; Adult ; Biopsy ; Bronchiolitis ; Bronchiolitis Obliterans ; Cough ; Cryptogenic Organizing Pneumonia ; Dyspnea ; Female ; Fibrosis ; Glass ; Humans ; Inflammation ; Lung ; Lung Diseases, Interstitial ; Military Personnel ; Prognosis ; Respiratory Function Tests ; Thorax ; Tuberculosis

OBJECTIVE: Recent neuroimaging studies have suggested that brain changes occur in subjects at ultra-high risk (UHR) for psychosis while experiencing prodromal symptoms, among which depression may increase the risk of developing a psychotic disorder. The goal of this study is to examine brain metabolite levels in the anterior cingulate cortex, the left dorsolateral prefrontal cortex and the left thalamus in subjects at UHR for psychosis and to compare brain metabolite levels between the UHR subjects with comorbid major depressive disorder and healthy controls. METHODS: Proton magnetic resonance spectroscopy was used to examine brain metabolite levels. Twenty UHR subjects and 20 age- and intelligence quotient (IQ)-matched healthy controls were included in this study. RESULTS: Overall, no significant differences were observed in any metabolite between the UHR and healthy control group. However, UHR subjects with major depressive disorder showed significantly higher myo-inositol (Ins) levels in the left thalamus, compared to the healthy control. CONCLUSION: Our results demonstrate that increased thalamic Ins level is associated with prodromal depressive symptoms. Further longitudinal follow-up studies with larger UHR sample sizes are required to investigate the function of Ins concentrations as a biomarker of vulnerability to psychosis.
Brain ; Depression ; Depressive Disorder, Major ; Gyrus Cinguli ; Intelligence ; Magnetic Resonance Spectroscopy ; Neuroimaging ; Prefrontal Cortex ; Prodromal Symptoms ; Protons ; Psychotic Disorders ; Sample Size ; Schizophrenia ; Thalamus

OBJECTIVE: Recent neuroimaging studies have suggested that brain changes occur in subjects at ultra-high risk (UHR) for psychosis while experiencing prodromal symptoms, among which depression may increase the risk of developing a psychotic disorder. The goal of this study is to examine brain metabolite levels in the anterior cingulate cortex, the left dorsolateral prefrontal cortex and the left thalamus in subjects at UHR for psychosis and to compare brain metabolite levels between the UHR subjects with comorbid major depressive disorder and healthy controls. METHODS: Proton magnetic resonance spectroscopy was used to examine brain metabolite levels. Twenty UHR subjects and 20 age- and intelligence quotient (IQ)-matched healthy controls were included in this study. RESULTS: Overall, no significant differences were observed in any metabolite between the UHR and healthy control group. However, UHR subjects with major depressive disorder showed significantly higher myo-inositol (Ins) levels in the left thalamus, compared to the healthy control. CONCLUSION: Our results demonstrate that increased thalamic Ins level is associated with prodromal depressive symptoms. Further longitudinal follow-up studies with larger UHR sample sizes are required to investigate the function of Ins concentrations as a biomarker of vulnerability to psychosis.
Brain ; Depression ; Depressive Disorder, Major ; Gyrus Cinguli ; Intelligence ; Magnetic Resonance Spectroscopy ; Neuroimaging ; Prefrontal Cortex ; Prodromal Symptoms ; Protons ; Psychotic Disorders ; Sample Size ; Schizophrenia ; Thalamus