Purpose: The selection of primary tumor resection (PTR) vs. self-expanding metallic stents (SEMS) in obstructive unresectable stage IV colorectal cancer (CRC) is critical, profoundly impacting patient outcome. This study evaluates the influence of PTR and SEMS on overall survival (OS) in conjunction with chemotherapy. Methods: The analysis included 137 patients with obstructive, unresectable stage IV CRC who underwent PTR or attempted SEMS placement. The primary objective was to assess the OS of patients, specifically examining how PTR and SEMS interventions influence these survival outcomes. Results: In a cohort of 137 patients with obstructive, unresectable stage IV CRC, 30 initially opted for PTR, while stent placement was attempted in 107 cases. Following 14 stent failures, which resulted in 8 diversions and 6 additional PTR interventions, exclusions due to elective surgeries led to a final analysis of 36 PTR and 72 SEMS cases. Cox regression analysis identified no significant survival advantage between PTR and SEMS interventions (hazard ratio [HR], 0.848; 95% confidence interval [CI], 0.555–1.298; P = 0.449). Critical findings highlighted that the absence of chemotherapy markedly reduced survival prospects (HR, 1.963; 95% CI, 1.200–3.211; P = 0.007). These insights were substantiated through propensity score matching. Conclusions The comparative analysis reveals that neither PTR nor SEMS offers a definitive survival advantage in managing obstructive, unresectable stage IV CRC. However, the necessity for subsequent invasive interventions is notably lower in the PTR group.

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.

Purpose: This study was conducted to explore the healthcare experience of residents participating in the CommunityBased Hypertension and Diabetes Registry Program. Methods: This study used qualitative content analysis. Data were collected from in depth interviews of fifteen participants, who either participated in the program hosted by the Training Center for Hypertension and Diabetes for more than two years or participated in an intensive one-on-one education program. Results: The results showed that the core theme in healthcare of participants was ‘Proactive healthcare with attention and systematic guidance of experts’. The positive reinforcement of staffs and the improvement of self-efficacy through effective close management were found to be positive influencing factors of participation. The theme consisted of the following categories: ‘Participation in the program with positive expectations on healthcare’, ‘Interest in body and health’, ‘Vitality in life’, ‘Confidence in dealing with disease’, ‘Thankfulness for close care and attention’, and ‘Desire for continuous care’. Conclusion When establishing policies on managing chronic diseases, a strategy that reflects the results of the study is required. It is necessary to build up emotional relationship among stakeholders, and expand opportunities for close healthcare such as one-on-one customized training, and mutual cooperation with various organizations in the local community.

BACKGROUND/OBJECTIVES: Papillary thyroid carcinoma (PTC) has generally an indolent character with a good prognosis. However, recurrence remains a major concern for the patients during their lifetime. Despite the slowly progressing character of PTC, recurrence can occur within a short period after initial surgery.This study aimed to determine the clinical findings and cause of recurrence in patients who underwent re-operative surgery due to neck node recurrence by reviewing the CT (computed tomographic) scan imaging of the recurrence of PTC retrospectively.MATERIALS #SPCHAR_X0026; METHODS: We reviewed the medical records of patients referred to Ajou University Hospital from January 2002 to January 2018. All patients had re-operative surgery due to neck node recurrence and CT scan results of preoperative evaluation and postoperative follow up. Over this period, 110 patients who underwent re-operation due to neck node recurrence with a CT scan were included in our cohort, resulting in a total of 220 re-operations.RESULTS: The time from initial operation to first re-operation was examined in 110 patients. The median time to re-operation was 28 months, with a range of 4 months to 186 months. Most re-operations (82.7%) occurred within the first five years, 43.6% were in the first two years from the initial surgery. The result of the retrospective CT review showed newly developed cases (21,19.1%), missed diagnosis cases (42,38.2%), real recur cases after surgery (33,30.0%), and remnant lymph nodes (LNs) cases (14,12.7%). We further sub-analyzed 14 cases with remnant LNs. Reasons for remnant LNs included insufficient operation (N=5) and beyond general surgical extent. (N=9).CONCLUSION: Re-operation due to cervical lymph node recurrence is mostly a persistent disease. They included a missed diagnosis and incomplete operation. These finding may reduce the reoperation of cervical lymph node recurrence by accurate preoperative evaluation and complete surgical resection at the initial surgery.
Cohort Studies ; Diagnosis ; Follow-Up Studies ; Humans ; Lymph Nodes ; Medical Records ; Neck ; Prognosis ; Recurrence ; Reoperation ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to determine the effectiveness of a community-based muscle and joint self-management program with muscle stretching and muscle strengthening exercises for community-dwelling older adults. METHODS: The study was a pre-and-post design in a single group, which examined the effects after the intervention of muscle and joint self-management program for 6 weeks, on the 42 subjects of the elderly who registered in a Community Senior Center in J city. Data analyses were conducted with paired t-test by using a SAS (version 9.2 for Windows) program. RESULTS: The effectiveness of muscle and joint self-management program on shoulder flexibility and right knee extension (flexibility) were significantly improved (t=2.72, p=.010; t=−2.26, p=.029). Joint symptoms (pain, stiffness), physical functioning, depression, fatigue, and left knee extension were not significantly improved after the muscle and joint self-management program. CONCLUSION: The results showed the possibility of this 6-week exercise program in improving shoulder and knee flexibility for community-dwelling older adults.
Adult* ; Aged ; Depression ; Exercise ; Fatigue ; Humans ; Joints* ; Knee ; Muscle Strength ; Pliability ; Self Care* ; Senior Centers ; Shoulder ; Statistics as Topic

PURPOSE: Traditional transcutaneous incision and transconjunctival incision methods are commonly used in the lower blepharoplasty. The transconjunctival method leaves no visible scars nor does it change the shape of lower eyelid contour and the surgical technique is not difficult. However removal of excess baggy skin is not possible through this method. Therefore, the transconjunctival incision method is useful only for patients who still have normal elasticity of the lower eyelids and fat that is protruding only anterocaudally. The Author will introduce a technique, which complements the limitations of these two methods mentioned above. METHODS: The author combined the transconjunctival approach and lower blepharoplasty with only the excised skin flap method. This method does not go beyond the previous methods but does apply the advantages of them. RESULTS: From March 2007 to October 2010, this new technique was performed in a total of 62 patients. Fat was removed and repositioned through transconjunctival incision. Drooped skin was excised as in the traditional blepharoplasty but only the skin flap was elevated. This prevents post-operative complications such as ectropion, sclera show, and deformation of the shape of the lower eyelids or under-resection of fat. All patients were satisfied with the post-operative appearance. CONCLUSION: The author was able to get satisfactory results while avoiding complications of traditional transcutaneous technique with this combined technique of the transconjunctival approach and the lower blepharoplasty method of skin flaps only.
Blepharoplasty ; Cicatrix ; Complement System Proteins ; Ectropion ; Elasticity ; Eyelids ; Humans ; Sclera ; Skin

PURPOSE: The aim of this study was to determine whether allergic rhinitis (AR) without asthma is associated with bronchial hyperresponsiveness (BHR) and symptoms of asthma in Korean adolescents. METHODS: A questionnaire survey was conducted on 724 high school students (males 556; females, 168) from Seoul City. We also performed the lung function test, methacholine challenge test, skin prick test, and allergy-related blood biomarkers. This cross-sectional study was conducted in the subjects excluding current asthmatic patients. RESULTS: AR (+), BHR (+) patients tended to show a high prevalence of wheeze ever, a high diagnosis rate of asthma ever, low forced expiratory volume in one second (FEV(1)), low forced expiratory flow at the 25% and 75% of pulmonary volume (FEF(25-75%)) high total IgE and frequent sensitizaion to house dust mites compared with AR (-), BHR (-) patients. In atopy AR (+) group, wheeze ever and treatment of asthma during the last 12 months were significantly higher than atopy (-), AR (-) patients or atopy (+), AR (-) patients (P<0.05). In atopy (+), AR (+) patients, BHR and peripheral eosinophil percent were significantly higher than in other patients (P<0.05) and PC(20) was also significantly lower than in other patients (P<0.05). CONCLUSION: BHR in current AR was associated with FEV(1), FEF(25-75%), total IgE, and sensitization to house dust mites. Current AR was associated with symptoms of asthma, peripheral eosinophilia and BHR, regardless of atopy. This study showed a significant association between allergic rhinitis and asthma or BHR among Korean adolescents. This cross-sectional study supports the concept of 'one airway, one disease' between the AR and asthma.
Adolescent ; Asthma ; Biomarkers ; Cross-Sectional Studies ; Eosinophilia ; Eosinophils ; Female ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; Korea ; Methacholine Chloride ; Prevalence ; Pyroglyphidae ; Surveys and Questionnaires ; Respiratory Function Tests ; Rhinitis ; Rhinitis, Allergic, Perennial ; Skin Tests

OBJECTIVES: We tried to evaluate the agreement of the Charlson comorbidity index values (CCI) obtained from different sources (medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay). METHODS: Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. RESULTS: The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree (kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables (beta = 0.112, 95% CI = [0.017-1.267]). CONCLUSIONS: There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.
Aged ; Comorbidity ; Female ; Humans ; Insurance Claim Review ; *Length of Stay ; Male ; Medical Records ; Middle Aged ; Neoplasm Staging ; Prognosis ; Severity of Illness Index ; Stomach Neoplasms/diagnosis/*mortality

PURPOSE: To evaluate the radiological and clinical outcomes of the operative treatment for the unstable distal radius fractures with displaced ulnar styloid process fractures. MATERIALS AND METHODS: From 2002 to 2005, 17 patients with unstable distal radius fractures with displaced ulnar styloid process fractures were treated operatively, using external fixation or internal fixation for distal radius and open reduction with tension band wiring for ulnar styloid process fractures. We evaluated postoperative outcomes with Mayo wrist score, range of motion, ulnar side wrist pain, wrist stress test, grip strength as well as radiological evaluation. RESULTS: All ulnar styloid process fractures were completely united, and according to Mayo wrist score, 7 cases(41%) were excellent, 8 cases(47%) were good. 14 cases(82%) had no ulnar wrist pain and 15 cases(88%) had grip strength more than 50% when compared with the normal side. Posterior instability of ulnar head occurred at 1 case. CONCLUSION: We got acceptable clinical and radiological results of operative treatment of ulnar styloid process fractures and concluded that ulnar styloid process fractures combined with distal radius fractures should be carefully evaluated and treated operatively according to their fracture types.
Exercise Test ; Hand Strength ; Head ; Humans ; Radius ; Radius Fractures ; Range of Motion, Articular ; Wrist

PURPOSE: We wanted to evaluate the clinical features after treating of bilateral sequential hip fractures in the elderly. MATERIALS AND METHODS: We reviewed the clinical records of 21 patients who were older than 75 years and who underwent bilateral bipolar hemiarthroplasty for sequential hip fractures between March 1999 and November 2005. The minimum follow up period was 2 years. We analyzed the results by conducting radiological and clinical evaluations such as assessing the patient's walking ability, the activities of daily living, the mechanism of fracture and the associated medical conditions and arthritis. RESULTS: Walking ability was recovered by 18 cases of primary fracture and by 14 cases of sequential fracture. Return to the activities of daily living was achieved by 14 cases of primary fracture and by 14 cases of sequential fracture. The fracture mechanism was a fall/slip in 20 cases and a fall from a height in 1 case. The associated arthritis was in the spine in 14 cases, the knee in 11 cases, the shoulder in 8 cases and Hallux valgus in 5 cases, and the associated medical conditions were mainly urge incontinence in 17 cases and cardiovascular disease in 16 cases. The other previous fractures were spine compression fracture in 11 cases, ankle fracture in 6 cases, distal radius fracture in 5 cases and pelvic ramus fracture in 2 cases. CONCLUSION: Preventing recurrent falls plays a role in preventing bilateral sequential hip fractures. We think that the treatment of curable associated medical conditions and arthritis is necessary to prevent recurrent falls.
Activities of Daily Living ; Aged ; Animals ; Ankle ; Arthritis ; Cardiovascular Diseases ; Follow-Up Studies ; Fractures, Compression ; Hallux Valgus ; Hemiarthroplasty ; Hip ; Hip Fractures ; Humans ; Knee ; Radius Fractures ; Shoulder ; Spine ; Urinary Incontinence, Urge ; Walking