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 aim of this study was to investigate survival rate, complications and associated risk factors after hip fracture surgery in patients with chronic kidney disease (CKD) by comparing to non-CKD patients. A total of 119 patients (130 hips, 63 hips CKD group, 67 hips non-CKD) who underwent hip fracture surgery were included. We assessed variables including age, gender, CKD, comorbidities, operation delay and operation time as risk factors for survival and complications after hip fracture surgery. The survival rate was 55.8% at 1-year, 45.8% at 3-year, and 31.4% at 5-year in CKD group, whereas 82.1%, 60.7%, and 36.8%, respectively in non-CKD. Age (more than 85) (hazard ratio [HR], 3.238; 95% confidence interval [CI], 1.736–6.042; P < 0.001), stages 4, 5 of CKD (HR, 2.004; 95% CI, 1.170–3.433; P = 0.001), cerebrovascular disease (HR, 2.213; 95% CI, 1.196–4.095; P = 0.001), and malignancy (HR, 3.086; 95% CI, 1.553–6.129; P = 0.001) were significant risk factors. Complications occurred in 17 hips of CKD group and 8 hips of non-CKD. Stage 4–5 of CKD (odds ratio [OR], 3.401; 95% CI, 1.354–8.540; P = 0.001), malignancy (OR, 3.184; 95% CI, 0.984–10.301; P = 0.050) were significant risk factor. When performing hip fracture surgery in patients with CKD, surgeons should consider age, severity of CKD, and presence of other comorbid disease, such as cerebrovascular disease and malignancy, as patients with these risk factors will need more intensive preoperative and postoperative care.
Cerebrovascular Disorders ; Comorbidity ; Hip* ; Humans ; Postoperative Care ; Renal Insufficiency, Chronic* ; Risk Factors ; Surgeons ; Survival Rate*

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

PURPOSE: Based on the Revised Nursing Work Index (NWI-R), this research aimed to develop a Korean Hospital General Inpatient Unite-Nursing Work Index (KGU-NWI). This study also aimed to compare the common points and differences between the subfactors of the KGU-NWI and the subfactors from previous studies. METHODS: Based on opinions from 3,151 nurses in Korean hospital general inpatient unit, this research used 57 items of NWI-R and the principal axis factor analysis for deriving subfactors. We evaluated the convergent validity through factor analysis and the content validity of KGU-NWI in terms of the association between nurses' job outcome and the subfactors derived. RESULTS: Six subfactors and 26 items for KGU-NWI were derived from NWI-R. Among them, 'physician-nurse relationship', 'adequate nurse staffing' and 'organizational support and management of hospital' were the same with results from previous studies. In addition, two subfactors, 'participation of decision-making processes' and 'education for improving quality of care', which were similar with results from previous Korean studies, were newly added by using Korean hospital cases. In contrast to previous Korean studies, a unique subfactor this study found was 'nursing processes'. This research confirmed that the six subfactors were highly correlated with job satisfaction, intention to leave, and quality of health care, which represented a nurse's job outcome. CONCLUSION: KGU-NWI including six subfactors and 26 items is an applicable instrument to investigate nurse work environment in Korean hospital general inpatient unit.
Axis, Cervical Vertebra ; Factor Analysis, Statistical ; Humans ; Inpatients ; Intention ; Job Satisfaction ; Nursing* ; Professional Practice ; Quality of Health Care ; Republic of Korea*

PURPOSE: To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. MATERIALS AND METHODS: A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (<48 hours, n=153) and dESWL (> or =48 hours, n=126). Success was defined as stone-free status as shown on a plain radiograph within 1 month of the first session. RESULTS: For all patients, the success rate in the eESWL group was significantly higher than that in the dESWL group. The eESWL group required significantly fewer ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones <10 mm, all treatment outcomes in the former group were superior to those in the latter group, but not for 38 patients with stones sized 10 to 20 mm. The superiority of eESWL over dESWL in the treatment outcomes was more pronounced for proximal ureteral stones than for mid-to-distal ureteral stones. Post-ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success. CONCLUSIONS: Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance.
Colic ; Humans ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Shock ; Ureter ; Ureteral Calculi

BACKGROUND: Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes. METHODS: This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition. RESULTS: According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.
Critical Illness ; Enteral Nutrition ; Hospital Mortality ; Hospitals, Teaching ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Lymphocyte Count ; Malnutrition ; Medical Records ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Prevalence ; Prognosis ; Respiration, Artificial ; Retrospective Studies

PURPOSE: To investigate the success rate of trial without catheter (TWOC) for postoperative urinary retention (POUR) after non-urological surgery and to determine predictors of successful TWOC. METHODS: A total of 104 patients who underwent non-urological surgery and were referred to the department of urology for POUR were included in this retrospective study. All eligible patients underwent indwelling catheterization as an initial treatment and then TWOC was performed 3 to 7 days later. POUR was defined as micturition difficulty with greater than 400 mL of postvoid residual (PVR) urine volume measured by catheterization after non-urological surgery. Successful TWOC was defined as voiding with less than 100 mL of PVR urine volume. Predictive factors were identified by multivariate regression analysis. All definitions corresponded to recommendations of the International Continence Society. RESULTS: The mean age of the patients was 65.2 (range, 23 to 92) years. There were 45 male and 59 female patients. Intraoperative indwelling catheterization was performed in 69 (66.3%) patients. Mean duration of indwelling catheterization for POUR was 5.0 (range, 3.0 to 7.0) days and 83 (79.8%) patients received medication with an alpha-blocker. A successful TWOC was observed in 70 (67.4%) patients. The mean age of the patients with failure of TWOC was significantly higher than that of the patients with successful TWOC. The percentages of female patients, spinal surgery, and prone position during surgery in patients with unsuccessful TWOC were higher than in those with successful TWOC. In the multivariate logistic regression analysis, age and location of surgery (spine vs. non-spine) were the independent predictors of successful TWOC for POUR. CONCLUSIONS: Our data suggest that older age and spinal surgery may be important risk factors for failure of TWOC for POUR after non-urological surgery. Thus, adequate prevention measures may be necessary for POUR after non-urological surgery, especially in patients with these risk factors.
Catheterization ; Catheters ; Catheters, Indwelling ; Female ; Humans ; Logistic Models ; Male ; Postoperative Care ; Prone Position ; Retrospective Studies ; Risk Factors ; Urinary Retention ; Urination ; Urology

OBJECTIVES: The research was aimed at analyzing the contents of university intranet for systematically execution of the healthy information provision and healthy consultation services from 2000 January to 2004 December. METHODS: We have analyzed 300(28.3%) the instances of accomplished health consultation cases from the whole 1,059 instances which were the replied in a university intranet. RESULTS: According to the contents of health consultation in ICPC code, a general symptom 91 cases(30.3%) was most, muscle-skeletal system 44 cases(14.7%), and digestive system 43 cases(14.3%) in order of cases of health counselling. The symptoms and complaint with 155 cases(51.7%) were most in the distribution of the health counselling contents by 17 charter of ICPC. The most common reason of counselling by 17 charter of ICPC were as follows; questions about the symptom and diagnosis(118 cases, 39.3%), the preventive and treatment methods(91 cases, 30.0%), and medical fee(20cases, 6.7%) in order. We mainly answer on the content of health counselling were as follows; make an offer of medical information and knowledge(48.3%), recommend visit clinic or hospital(23.7%), guide to treatment(12.7%), and so on. CONCLUSIONS: This research showed that the program of health counselling may not meet completely the high quality and adequate distribution of health counselling by the intranet in a university by content analysis. The finding suggests that health counselling by intranet in a university may be used to supplement of systemic improvement on the intranet Q/A format from current lack of essential health information and security for the quality of the health counselling.
Computer Communication Networks* ; Counseling* ; Digestive System

BACKGROUND/AIMS: Mesenchymal tumors are the most frequent submucosal tumors in gastrointestinal trail. We reviewed the mesenchymal tumors which are confirmed by pathology to examine whether the invasive approach of all mesenchymal tumors is necessary. METHODS: This study was performed on fifty-nine patients who has mesenchymal tumors confirmed by endoscopic or surgical resection from January 2000 to June 2004. RESULTS: Mesenchymal tumors consisted of thirty-six gastrointestinal stromal tumors (GISTs), 20 leiomyomas and 3 schwannomas. All the esophageal tumors were leiomyoma (12/12, 100%). In stomach, there were 32 GISTs (76.2%), 7 leiomyomas (16.7%) and 3 schwannomas (7.1%). And there were 4 GISTs (80.0%) and 1 leiomyoma (20.0%) in duodenum. Tumors less than 1 cm in maximal diameter were leiomyoma or GISTs with very low risk of aggressive behavior. 56.1% of the tumors larger than 1 cm consisted of low, intermediate or high risk GISTs. CONCLUSIONS: Biopsy must be considered according to its size and anatomic location of mesenchymal tumors. The invasive approach for every esophageal submucosal tumor is not necessary unless the size is very large, because most of them are benign in nature. However, the gastric submucosal tumor with more than 1 cm in diameter should be carefully and regularly followed up or biopsied because it cannot be assumed to be benign for any GIST more than 1 cm in size at the present time, safely.
Adult ; Aged ; *Biopsy, Needle ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Neoplasms/*pathology ; Gastrointestinal Stromal Tumors/*pathology ; Humans ; Leiomyoma/pathology ; Male ; Middle Aged ; Neurilemmoma/pathology ; Upper Gastrointestinal Tract

OBJECTIVE: Radiation injury includes radiation necrosis and apoptosis. Though some of its mechanism in brain are reported, those in spinal cord are not determined yet. The purpose of this study is to see whether nimodipine, one of calcium channel blockers, is effective for the prevention of high dose irradiation-induced apoptosis in the rat spinal cord. METHODS: Forty eight Sprague-Dawley rats were divided into four experimental groups, such as non-treated group(control group) after 5Gy and 10Gy irradiation(n=24), and nimodipine-treated group after 5Gy and 10Gy irradiation(n=24). Each group was divided by irradiation doses. After the drug was administered, the spinal cord was exposed to 5Gy and 10Gy dose of gamma rays using Ir-192. All spinal cord underwent histological examination at 4 hours, 8 hours, 12 hours after irradiation to evaluate the number of apoptotic cells. Apoptotic cells were detected by TUNEL assay, and determined by direct visual counting at x200, magnification RESULTS: In nimodipine-treated group, apoptotic cell counts were reduced significantly, compared to that of control group after irradiation(p < 0.05). CONCLUSION: These results suggest that nimodipine treatment may have effects on the prevention of radiationinduced apoptosis. If it could be established that calcium channel blockers inhibit radiation injury, they might be useful in radiation therapy.
Animals ; Apoptosis* ; Brain ; Calcium Channel Blockers ; Cell Count ; Gamma Rays ; In Situ Nick-End Labeling ; Necrosis ; Nimodipine* ; Radiation Injuries ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord*