Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.

Thyroid tuberculosis with papillary thyroid carcinoma is very rare. The current study shows the case of a 67-year-old female who was admitted to Ansan Hospital of Korea University, with her thyroid nodules showing signs of malignancy under ultrasonography. A histopathological examination proved the coexistence of papillary thyroid carcinoma (PTC) and thyroid tuberculosis (TB). A total thyroidectomy and excision of the enlarged left neck level II lymph node were performed. This report presents a rare case of coexistence of PTC and thyroid TB. Further investigation is needed to evaluate the possible role of PTC in thyroid mycobacterial infection.

BACKGROUND: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. METHODS: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. RESULTS: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). CONCLUSION: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.
Academies and Institutes ; Fee-for-Service Plans ; Fees and Charges ; Gwangju ; Hospices ; Hospitals, General ; Humans ; Insurance ; Palliative Care ; Reward

PURPOSE: Patients treated with anticancer agents often experience a variety of treatment-related skin problems, which can impair their quality of life. MATERIALS AND METHODS: In this cross-sectional study, Dermatology Life Quality Index (DLQI) and clinical information were evaluated in patients under active anticancer treatment using a questionnaire survey and their medical records review. RESULTS: Of 375 evaluated subjects with anticancer therapy, 136 (36.27%) and 114 (30.40%) were treated for breast cancer and colorectal cancer, respectively. We found that women, breast cancer, targeted agent use, and longer duration of anticancer therapy were associated with higher dermatology-specific quality of life distraction. In addition, itching, dry skin, easy bruising, pigmentation, papulopustules on face, periungual inflammation, nail changes, and palmoplantar lesions were associated with significantly higher DLQI scores. Periungual inflammation and palmoplantar lesions scored the highest DLQI. CONCLUSION: We believe our findings can be helpful to clinicians in counseling and managing the patients undergoing anticancer therapy.
Antineoplastic Agents* ; Breast Neoplasms ; Colorectal Neoplasms ; Counseling ; Cross-Sectional Studies* ; Dermatology ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Inflammation ; Medical Records ; Pigmentation ; Pruritus ; Quality of Life* ; Skin*

BACKGROUND/AIMS: Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer. METHODS: We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer. RESULTS: Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection. CONCLUSIONS: Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer.
Early Detection of Cancer ; Endoscopy ; Humans ; Korea ; Mass Screening* ; Multivariate Analysis ; Retrospective Studies ; Seoul ; Stomach Neoplasms*

OBJECTIVE: To evaluate the clinical features that could serve as predictive factors for improvement in gait speed after robotic treatment. METHODS: A total of 29 patients with motor incomplete spinal cord injury received 4-week robot-assisted gait training (RAGT) on the Lokomat (Hocoma AG, Volketswil, Switzerland) for 30 minutes, once a day, 5 times a week, for a total of 20 sessions. All subjects were evaluated for general characteristics, the 10-Meter Walk Test (10MWT), the Lower Extremity Motor Score (LEMS), the Functional Ambulatory Category (FAC), the Walking Index for Spinal Cord Injury version II (WISCI-II), the Berg Balance Scale (BBS), and the Spinal Cord Independence Measure version III (SCIM-III) every 0, and 4 weeks. After all the interventions, subjects were stratified using the 10MWT score at 4 weeks into improved group and non-improved group for statistical analysis. RESULTS: The improved group had younger age and shorter disease duration than the non-improved group. All subjects with the American Spinal Injury Association Impairment Scale level C (AIS-C) tetraplegia belonged to the non-improved group, while most subjects with AIS-C paraplegia, AIS-D tetraplegia, and AIS-D paraplegia belonged to the improved group. The improved group showed greater baseline lower extremity strength, balance, and daily living function than the non-improved group. CONCLUSION: Assessment of SCIM-III, BBS, and trunk control, in addition to LEMS, have potential for predicting the effects of robotic treatment in patients with motor incomplete spinal cord injury.
Gait* ; Humans ; Locomotion ; Lower Extremity ; Paraplegia ; Quadriplegia ; Rehabilitation ; Robotics ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Walking

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.
Adenocarcinoma, Mucinous/*pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen/blood ; Carcinoma, Pancreatic Ductal/*pathology ; Carcinoma, Papillary/*pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Pancreatic Neoplasms/*pathology ; Predictive Value of Tests ; ROC Curve ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma. METHODS: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively. RESULTS: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5+/-2.9 mm) and SLN (-) group (4.5+/-5.0 mm) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema. CONCLUSION: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.
Biopsy ; Extremities ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphedema ; Lymphoscintigraphy ; Melanoma ; Methylene Blue ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin

PURPOSE: To report a case of surgical treatment of bilateral bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease. CASE SUMMARY: A 64-year-old woman presented with decreased visual acuity, headache, and hearing loss for 2 months. Visual acuity was hand motion in the right eye and light perception in the left eye. Intraocular pressure was 16 mmHg in the right eye and 24 mmHg in the left eye. Slit lamp examimation disclosed corneal edema, conjunctival ciliary injection with chemosis, rubeosis iridis, and posterior synechia in both eyes. Fundus examination demonstrated bilateral bullous exudative retinal detachment. Lumbar puncture revealed pleocytosis and auditory function test showed neurosensory hearing loss. She was diagnosed as having bilateral bullous exudative retinal detachment associated Vogt-Koyanagi-Harada disease. On hospital day 3, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the right eye and on hospital day 6, intravitreal triamcinolone injection with external subretinal fluid drainage was performed in the left eye. Two months later, best corrected visual acuity was 0.2 in the right eye and 0.04 in the left eye. CONCLUSIONS: Intravitreal trimacinolone acetonide injection with external subretinal fluid drainage is one of the good treatment for bullous exudative retinal detachment associated with Vogt-Koyanagi-Harada disease.
Corneal Edema ; Drainage ; Eye ; Female ; Hand ; Headache ; Hearing Loss ; Humans ; Intraocular Pressure ; Leukocytosis ; Light ; Middle Aged ; Retinal Detachment ; Spinal Puncture ; Subretinal Fluid ; Triamcinolone ; Uveomeningoencephalitic Syndrome ; Visual Acuity