Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

The dramatic spread of Coronavirus Disease 2019 (COVID-19) has profound impacts on every continent and life. Due to humanto-human transmission of COVID-19, nuclear medicine staffs also cannot escape the risk of infection from workplaces. Everystaff in the nuclear medicine department must prepare for and respond to COVID-19 pandemic which tailored to the characteristicsof our profession. This article provided the guidance prepared by the Korean Society of Nuclear Medicine (KSNM) incooperation with the Korean Society of Infectious Disease (KSID) and Korean Society for Healthcare-Associated InfectionControl and Prevention (KOSHIC) in managing the COVID-19 pandemic for the nuclear medicine department.We hope that thisguidance will support every practice in nuclear medicine during this chaotic period.

Strongyloides stercoralis is an intestinal nematode that often causes chronic diarrhea and may develop severe complicated form of hyperinfection or disseminated infection in immunocompromised patients. Here, we report a case of recurrent strongyloidiasis presenting with pulmonary and meningeal involvement. A 55-year-old male diagnosed with pancreatic cancer 4 months ago was admitted due to chronic diarrhea, abdominal pain, and weight loss for 2–3 months. He had been treated with albendazole for chronic recurrent strongyloidiasis 13 years ago and again 2 years ago. He developed sepsis of Klebsiella pneumoniae and Escherichia coli on Days 3 and 7, respectively, and then meningitis of E. coli on Day 42. Strongyloidiasis was diagnosed by detection of abundant filariform larvae in sputum specimens on Day 15. He was treated for disseminated strongyloidiasis with albendazole and ivermectin for five weeks until clearance of larvae was confirmed in sputum and stool specimens. Laboratory diagnosis is important to guide appropriate treatment and to prevent chronic and recurrent strongyloidiasis.
Abdominal Pain ; Albendazole ; Clinical Laboratory Techniques ; Diarrhea ; Escherichia coli ; Humans ; Immunocompromised Host ; Ivermectin ; Klebsiella pneumoniae ; Larva ; Male ; Meningitis ; Middle Aged ; Pancreatic Neoplasms ; Sepsis ; Sputum ; Strongyloides stercoralis ; Strongyloidiasis ; Weight Loss

BACKGROUND: Arginine vasopressin (AVP) is widely used as a vasopressor agent. Some recent studies have suggested that AVP may exert an immunomodulatory effect. However, the mechanism about the anti-inflammatory effect of AVP is not well known. We investigated the effect of AVP on the ihibitor of kappa B (IkappaBalpha)/nuclear factor-kappa B (NF-kappaB) pathway in RAW 264.7 cells. METHODS: Cultured RAW 264.7 cells were pretreated with AVP and stimulated with lipopolysaccharide (LPS). To evaluate the effect of AVP on inflammatory cytokines, the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assessed by an enzyme-linked immunosorbent assay technique. The expression of IkappaBalpha and nuclear translocation of NF-kappaB p65 were measured by Western blotting, and IkappaB kinase (IKK) activity was analyzed by an in vitro immune complex kinase assay. To confirm the AVP effect on IkappaBalpha/NF-kappaB cascade and via V2 receptor, we added tolvaptan (V2 receptor antagonist) after AVP pretreatment. RESULTS: The increase of IL-6 and TNF-alpha in LPS-stimulated RAW 264.7 cells was suppressed by a treatment with AVP. Pretreatment of AVP inhibited increasing of IKK activity and IkappaBalpha degradation induced by LPS in RAW 264.7 cells. Furthermore, LPS induced and NF-kappaB transcription was inhibited by AVP pretreatment. The observed changes in IKK activity, IkappaBalpha degradation and NF-kappaB transcription by AVP was abolished by tolvaptan treatment. CONCLUSIONS: Our results suggest that AVP showed anti-inflammatory effect on LPS-induced IkappaBalpha/NF-kappaB cascade in mouse macrophages via V2 receptors.
Animals ; Antigen-Antibody Complex ; Arginine Vasopressin ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; I-kappa B Kinase ; Interleukin-6 ; Macrophages ; Mice ; NF-kappa B ; Phosphotransferases ; Receptors, Vasopressin ; Tumor Necrosis Factor-alpha

BACKGROUND: Arginine vasopressin (AVP) is widely used as a vasopressor agent. Some recent studies have suggested that AVP may exert an immunomodulatory effect. However, the mechanism about the anti-inflammatory effect of AVP is not well known. We investigated the effect of AVP on the ihibitor of kappa B (IkappaBalpha)/nuclear factor-kappa B (NF-kappaB) pathway in RAW 264.7 cells. METHODS: Cultured RAW 264.7 cells were pretreated with AVP and stimulated with lipopolysaccharide (LPS). To evaluate the effect of AVP on inflammatory cytokines, the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assessed by an enzyme-linked immunosorbent assay technique. The expression of IkappaBalpha and nuclear translocation of NF-kappaB p65 were measured by Western blotting, and IkappaB kinase (IKK) activity was analyzed by an in vitro immune complex kinase assay. To confirm the AVP effect on IkappaBalpha/NF-kappaB cascade and via V2 receptor, we added tolvaptan (V2 receptor antagonist) after AVP pretreatment. RESULTS: The increase of IL-6 and TNF-alpha in LPS-stimulated RAW 264.7 cells was suppressed by a treatment with AVP. Pretreatment of AVP inhibited increasing of IKK activity and IkappaBalpha degradation induced by LPS in RAW 264.7 cells. Furthermore, LPS induced and NF-kappaB transcription was inhibited by AVP pretreatment. The observed changes in IKK activity, IkappaBalpha degradation and NF-kappaB transcription by AVP was abolished by tolvaptan treatment. CONCLUSIONS: Our results suggest that AVP showed anti-inflammatory effect on LPS-induced IkappaBalpha/NF-kappaB cascade in mouse macrophages via V2 receptors.
Animals ; Antigen-Antibody Complex ; Arginine Vasopressin ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; I-kappa B Kinase ; Interleukin-6 ; Macrophages ; Mice ; NF-kappa B ; Phosphotransferases ; Receptors, Vasopressin ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: Colonoscopic polypectomy should be performed on the five to seven hour of clock (standard position). However, outcomes of polypectomy at non-standard positions have not yet been investigated. This study was to compare the clinical outcomes of colonoscopic polypectomy including procedure time, status of resection margin and complications between standard and non-standard position. METHODS: Patients who underwent screening colonoscopy were prospectively recruited from Oct 2011 to Feb 2012 at Dongguk University Ilsan Hosptial, Goyang, Korea. Standard position was defined as polyps which were located from 5 to 7 hour of clock on colonoscopic view. RESULTS: A total of 168 adenomatous polyps of 114 patients were investigated. Mean size of polyp was 7.1+/-3.2 mm. The most common shape of polyps was sessile in 77 cases (45.8%). Mean overall procedure time per patient was 25.5+/-12.3 min. 130 adenomatous polyps were resected in standard position (77.4%) and 38 polyps were in non-standard position (22.6%). Overall complete resection rate was 63.7% and immediate bleeding rate was 9.8%. There was no significant difference in overall polypectomy time per polyp (2.9+/-1.3 min vs. 3.0+/-1.8 min, P=0.32). Complete resection rates and complication were not statistically different. CONCLUSIONS: There was no difference according to procedure time, status of resection margin and complications between standard position and non-standard position. Colonoscopic polypectomy is thus safe and feasible on any position.
Adenomatous Polyps ; Colonic Polyps ; Colonoscopy ; Hemorrhage ; Humans ; Korea ; Mass Screening ; Polyps ; Prospective Studies

OBJECTIVES: This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. METHODS: Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. RESULTS: AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. CONCLUSIONS: AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.
Decision Support Systems, Clinical ; Delivery of Health Care ; Disasters ; Electronic Health Records ; Electronics ; Electrons ; Hospital Information Systems ; Information Systems ; Monitoring, Physiologic ; Privacy ; Quality of Health Care

PURPOSE: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis surgery. Materials and METHODS: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50+/-16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using (99m)Tc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. RESULTS: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. CONCLUSION: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.
Acetazolamide ; Brain ; Cerebral Arteries ; Humans ; Middle Cerebral Artery ; Perfusion ; Tomography, Emission-Computed, Single-Photon

PURPOSE: The purpose of this study was to compare the in-vivo efficiency of vascular occlusion on radiofrequency ablation (RFA) lesion size in a rabbit kidney model. MATERIALS AND METHODS: RFA lesions were created in a single kidney in 20 rabbits using an internally cooled electrode. Twenty ablation zones (1 per kidney) were created using 4 different regimens: RFA without vascular occlusion (n = 5), RFA with renal artery occlusion (n = 5), RFA with renal vein occlusion (n = 5), RFA with renal artery and vein occlusion (n = 5). Seven days later, the rabbits were sacrificed and the lesions were excised. These groups were then compared with respect to the dimensions of the ablation zones and the changes in impedance and current during RFA. RESULTS: The maximum ablation zone width was the greatest in the renal artery and vein occlusion group (21.0+/-1.4 mm), followed by the renal artery occlusion group (17.8+/-1.0 mm), the renal vein occlusion group (17.4+/-1.1 mm), and the nonocclusion group (7.8+/-2.4 mm) (p < 0.05). No significant differences were observed for impedances and currents between the 4 groups. CONCLUSION: Vascular occlusion combined with RFA effectively increased ablation zone dimensions compared with RFA alone, and the best effect was accomplished by combined renal artery and vein occlusion.
Catheter Ablation* ; Electric Impedance ; Electrodes ; Kidney* ; Open Bite ; Rabbits ; Renal Artery* ; Renal Veins ; Veins*