The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

“Itch” is an unpleasant sensation that elicits a desire to scratch. It is a common complaint among many patients and is associated with a markedly reduced quality of life. The pathogenesis of itch begins with various pruritogens stimulating free nerve endings in the skin, which causes an itch signal to travel through the spinothalamic tract to the brain where the sensation is processed. Scratching an itch initially activates the reward systems in the midbrain and striatum, and this positive reinforcement leads to the repetitive scratching behavior that damages the skin barrier. Mediators such as histamine, serotonin and cytokines are released from the damaged skin, which further aggravates the itch and initiates a vicious “itch-scratch cycle.” Such processes may eventually lead to neural sensitization, where weaker stimuli can cause a more severe pruritic sensation. Chronic itch is one that lasts beyond 6 weeks. Pathologic pruritus can be classified into four different categories based on its cause: dermatologic, systemic, neuropathic, and psychogenic itch. Regardless of the cause, antihistamines are often prescribed as a first-line treatment of chronic itch, but more often than not they prove to be ineffective in bringing symptom relief. Both topical and systemic therapies are used to treat itch, and adequate treatment selection is considered according to symptom severity and chronicity. As the pathogenesis of itch becomes elucidated, more exciting new therapeutic options targeting pruritogenic mediators are becoming increasingly available. This review provides an overview of the pathophysiology, causes and the treatment of chronic itch.

PURPOSE: The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea. METHODS: Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity. RESULTS: The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs. CONCLUSIONS: Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.
Asthma* ; Cost of Illness ; Cough ; Delivery of Health Care ; Diagnosis ; Efficiency ; Health Care Costs ; Humans ; Korea* ; Nose ; Observational Study* ; Presenteeism ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Tract Diseases ; Rhinitis, Allergic*

The prevalence of obesity is continuing to increase. Self-perceived body image among women has drawn a lot of attention in Korea due to unhealthy weight control trials. This study was conducted to determine the relationship between self-perceived body image and dietary intakes among Korean women. For the analysis, 1,747 subjects were selected after eliminating those who were likely to have recently altered their diet based on the 2010 Korea National Health and Nutrition Examination Survey (KNHANES) data. The subjects were divided into three groups: underweight, normal, and obese groups according to their perception of body image. Daily nutrient intakes, NAR (Nutrient Adequacy Ratio), and food intake frequency were assessed according to age group and body image perception. Only energy intake showed differences among the three body image perception groups across all age groups, but not statistical differences. Analysis of NAR and the order of most frequently consumed food items confirmed these findings. The ratio of underweight women that perceived their body size as normal or overweight was higher with younger age. Incorrect body image perception and unhealthy weight control behaviors can cause nutritional problems. This study confirmed that nutritional knowledge is important for healthy weight control trials. Nutritional education for healthy dieting should be emphasized among Korean women.
Body Image* ; Body Size ; Diet ; Eating ; Education ; Energy Intake ; Female ; Humans ; Korea ; Nutrition Surveys* ; Obesity ; Overweight ; Prevalence ; Thinness

BACKGROUND/OBJECTIVES: To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS: An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS: The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS: The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.
Child* ; Food Labeling ; Humans ; Korea ; Meals* ; Nutritive Value ; Parents ; Power (Psychology) ; Restaurants*

Anaphylaxis is a medical emergency and all healthcare professionals need to be familiar with its diagnosis, acute management, long-term management including prevention of future episodes, and plan for patient education. Correct diagnosis and management for anaphylaxis is critical, but it is not easy in clinical setting. Up to the present, several practical guidelines for anaphylaxis are available for the practitioners. Among them, World Allergy Organization guideline for the assessment and management has recently been released and widely used. In this article, we reviewed and summarized the epidemiology, risk factors, diagnosis, management, prevention, and education based on case reports and studies of anaphylaxis in Korean and other countries. Although there are many controversies, this practical overview for anaphylaxis would provide a clinical guidance for Korean healthcare professionals.
Anaphylaxis ; Delivery of Health Care ; Emergencies ; Hypersensitivity ; Patient Education as Topic ; Risk Factors

BACKGROUND: The aim of this study was to investigate alterations in homocysteine levels with delays in the initiation time of centrifugation. Attempts were made to improve the processing of samples by analyzing the homocysteine levels of patients from a health promotion center, where delays in the initiation of sample centrifugation were expected because of the nature of the workload and operational procedures. METHODS: Forty healthy adults were selected for the measurement of homocysteine levels. The two samples those were obtained from each individual simultaneously and separately were designated as group A (centrifugation initiation time < or =20 minutes after blood sampling) and group B (> or =2 hours). The degree of deviation from the homocysteine reference interval was also evaluated with samples from 1,134 adults who had medical check-up at a health promotion center from August 1, 2009 to July 31, 2010. RESULTS: The mean serum homocysteine level in group B was significantly higher than that of group A (12.4 vs. 10.6 micromol/L, P<0.0001). Homocysteine level increased with a mean of 19.4% when the initiation of centrifugation was delayed over 2 hours. In the 1,134 adults who had medical check-up, the numbers outside the reference interval were 334 (29.5%). Abnormal samples with homocysteine levels out of the reference interval were reduced to about 7% in July 2011 through improving sample processing to minimize delays in centrifugation initiation time. CONCLUSIONS: Homocysteine levels rapidly increase as blood sample centrifugation is delayed. Therefore, in order to provide accurate test results immediate centrifugation of blood samples is critical.
Adult ; Centrifugation ; Health Promotion ; Homocysteine ; Humans

Emphysematous prostatitis is a rare condition that is characterized by gas and abscess accumulation in the prostate. This uncommon but serious disease requires special attention because of its nonspecific presentation such as dysuria, frequency, urgency, fever, acute urinary retension and/or perineal pain. We report here on a case of emphysematous prostatitis that was combined with a liver abscess caused by Klebsiella pneumoniae. A 55-year-old man was admitted due to a 3-day history of urinary retention with a febrile sensation. He had histories of liver cirrhosis and uncontrolled diabetes mellitus. After blood and urine cultures, levofloxacin 500 mg was started intravenously. On the third hospital day, he displayed septic shock. The kidneys-ureters bladder (KUB) X-ray showed pockets of air-accumulation in the lower pelvic cavity, and abdominopelvic computed tomography (CT) with contrast enhancement taken on the third day showed a 5-cm liver abscess with an emphysematous prostate. Intravenous antibiotics was changed to metronidazole 500 mg q.i.d. and cefotaxime 2 g t.i.d. On the sixth day, transurethral resection and drainage were performed under spinal anesthesia. However, the postoperative bleeding continued and hypovolemic shock persisted, which then provoked multiorgan failure. The patient died on the 11th hospital day. K. pneumoniae was cultured from the liver abscess aspirate, blood and prostatic tissue, and the bacteria were sensitive to both levofloxacin and cefotaxime. Emphysematous prostatitis is a difficult to diagnose because of its rarity and nonspecific symptoms. A delayed diagnosis can cause high mortality and morbidity, so making a prompt clinical diagnosis of this condition is essential. Appropriate antibiotics with early adequate incision and drainage are also needed.
Abscess ; Anesthesia, Spinal ; Anti-Bacterial Agents ; Bacteria ; Cefotaxime ; Delayed Diagnosis ; Diabetes Mellitus ; Drainage ; Dysuria ; Fever ; Hemorrhage ; Humans ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Liver Cirrhosis ; Metronidazole ; Middle Aged ; Ofloxacin ; Pneumonia ; Prostate ; Prostatitis ; Sensation ; Shock ; Shock, Septic ; Urinary Bladder ; Urinary Retention

Sclerosing epithelioid fibrosarcoma (SEF) is a rare and poorly recognized variant of fibrosarcoma of deep soft tissue. We report the case of a 34-year-old woman who presented with a painful and palpable mass in the left buttock that was diagnosed as SEF.
Adult ; Buttocks ; Female ; Fibrosarcoma ; Humans