Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.
Classification* ; Constriction, Pathologic* ; Drug Therapy ; Fluorescein ; Fluorouracil ; Humans ; Lacrimal Apparatus ; Lacrimal Apparatus Diseases* ; Silicon ; Silicones ; Tears

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women, and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.
Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Registries ; Republic of Korea/epidemiology ; Skin Neoplasms/*epidemiology/*secondary ; Young Adult

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.
Surveys and Questionnaires ; Delivery of Health Care ; Dizziness ; Electronic Mail ; Korea ; Otolaryngology ; Otolithic Membrane ; Public Opinion ; Vertigo

OBJECTIVES: The aim of this study was to determine the relationship between the core properties of professional socialization and social status satisfaction, economic reward satisfaction, and subjective class identification. METHODS: Medical knowledge and skill, autonomy, and professional value factors were used as essential properties of professional socialization to determine the association with job satisfaction and subjective class identification. The authors used a self-administered questionnaire survey and collected nationwide data between July and August 2003, with 211 responses used for final analysis. RESULTS: 'Age' and 'trust and respect' were positively associated with social status satisfaction, and 'occupation' was negatively associated. 'Income' and 'trust and respect' were positively related to economic reward satisfaction, and 'practicing for oneself', and 'a sense of duty and attendance' were negatively related. 'Practicing for oneself', 'not believing explanations', and 'a sense of duty and attendance' had a positive relationship with subjective class identification. 'Income', 'knowledge system', 'medical mistakes', 'treating like goods', 'meaning and joy', and 'trust and respect' had a negative relationship. CONCLSIONS: The core property variables of professional socialization had a different relationship with social status satisfaction, economic reward satisfaction and subjective class identification. In particular, many core property variables were associated with subjective class identification positively or negatively. The development of professional socialization would help promote job satisfaction and subjective class identification.
Adult ; Age Factors ; Aged ; Female ; Humans ; Income ; *Job Satisfaction ; Korea ; Male ; Middle Aged ; Physicians/*psychology ; Professional Autonomy ; *Social Class ; Trust

BACKGROUND/AIMS: Multiple passages of biopsy forceps increase wear and tear on both the channel of endoscope and forceps. The two-bite technique can save time in obtaining sufficient specimens and also reduce the wear of the instruments. The aim of this study was to assess prospectively the efficacy of two-bite forceps technique in relation to time-saving. METHODS: A total 84 patients needed histopathologic diagnosis for Helicobacter pylori were randomized into two groups (one-bite technique: 41 patients, two-bite technique: 43 patients). An experienced endoscopist carried out upper endoscopy and used same biopsy forceps (FB-25K(R), Olympus, Tokyo, Japan). Mucosal biopsy specimens were obtained as follow: two from the antrum followed by two from the body. Rebiopsy was done when biopsy specimen was lost. The mean time in obtaining specimens and missing rate were analyzed. An experienced pathologist blinded to the technique of obtaining the samples evaluated the specimens for diameter, depth, crush artifact, and adequacy for histopathologic diagnosis. RESULTS: A total 336 specimens were obtained from 84 patients. Of these, 12 (7.0%) samples were missed with the two-bite technique but only 1 (0.6%) with the one-bite technique (p=0.003). Regarding histopathologic evaluation, there were no significant differences between samples taken with the two-bite technique and the one-bite technique. The mean time with two-bite technique (47.6 sec) was compared with one-bite technique (62.6 sec)(p<0.001). But there was no significant time difference if samples were missing during the process (62.5 sec). CONCLUSIONS: Although two- bite technique saves the time for biopsy, the main limitation is that there is a significant risk of losing samples.
Artifacts ; Biopsy ; Diagnosis ; Endoscopes ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Prospective Studies ; Surgical Instruments

STATEMENT OF PROBLEM: Temporary soft relining materials are used in a diverse clinical situations such as tissue conditioner, relining material, functional impression by varying its viscoelasticity. However, reproduction of consistent viscoelasticity has been not possible. MATERIALS AND METHODS: Considering setting mechanism of this material, this study has measured the effect of varying amount of void in dynamic viscoelasticity of soft relining material, with three different mixing methods. In each methods 10 specimens were made and subjected to dynamic viscoelastic test which were measured at specific times over period of 72 hours. RESULTS: The analysis of the result shown that there was no statistically significant differences between different mixing methods. CONCLUSION: Different mixing methods had no effect over control of viscoelasticity of soft lining material. Further research is recommended for under similar oral environmental condition.
Reproduction

BACKGROUND: The aim of this study was to elucidate the mediastinal lymphatic drainage of non- small-cell lung cancer (NSCLC). METHODS: We retrospectively analyzed the frequency of enlarged mediastinal lymph node (LN) in 256 NSCLC patients with N2 or N3 diseases on CT scan, especially with respect to the location of primary tumor. RESULTS: In 57 patients with right upper lobe (RUL) tumors, right lower paratracheal LN (89.5%) was the most commonly enlarged, followed by subcarinal LN (54.4%). In 61 patients with left upper lobe (LUL) tumors, left lower paratracheal (70.5%) and subaortic LNs (52.5%) were commonly enlarged. Subcarinal LN enlargement without ipsilateral superior mediastinal LN enlargement was rarely found in both upper lobe tumors; RUL 8.8%, LUL 6.6%. In patients with right or left lower lobe (RLL or LLL) tumors, the most commonly enlarged LN was subcarinal; 88.2%, 65.7%, respectively. In RLL tumors with both subcarinal and superior mediastinal LN enlargements, the frequency of ipsilateral superior mediastinal LN involvement was similar to that of bilateral superior mediastinal involvement. In LLL tumors with both subcarinal and superior mediastinal LN enlargements, bilateral superior mediastinal involvement was more frequent than ipsilateral superior mediastinal involvement. CONCLUSION: The results of this study suggest that both upper lobe tumors are mainly drained directly to ipsilateral superior mediastinal LNs, and that both lower lobe lesions are drained to superior mediastinal LN via subcarinal LNs.
Drainage ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: Increased technologic capabilities have allowed for the expanded use of ultrasound beyond simple differentiation of a lesion as solid versus cystic nature, allowing us to classify lesions into various categories based on a number of descriptive features. The purpose of this study was to investigate whether to predict the preoperative prognosis of breast cancer through the correlation between ultrasonographic images and the grade of malignancy. MATERIALS AND METHODS: The patient population for this study consisted of 107 patients with infiltrative ductal carcinoma who were evaluated using ultrasound technology. Ultrasonographic findings were divided as follows: Type I, round or oval shape and regular border; Type II, partially round or oval shape and partially irregular border; and Type III, irregular shape and irregular border. RESULTS: 1. The frequency of grade 1 (G1) was significantly higher in the Type I group than the othergroups. 2. In the 2.0 cm sized mass, the lymph node metastasis rate was significantly lower in the Type I group than the other groups. 3. In all the groups, Estrogen receptor (ER) positivity was insignificant regardless of tumor size and type. 4. In the 2.0 cm sized mass, c-erbB-2 positivity was significantly lower in the Type I than the other groups. There was no clear difference among the three groups in tumors greater than 2.0 cm in size. CONCLUSION: These results show that our classification of ultrasonographic images reflect the grade of malignancy in terms of clinicopathological features in breast cancers less than 2.0 cm in size. Therefore, ultrasonographic findings may help predict the preoperative prognosis in T1 size breast cancer, although further study is required.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Diagnosis ; Estrogens ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pathology ; Prognosis ; Ultrasonography

Nowadays in the field of plastic surgery, operations with no general anesthesia have been much increased, using daily surgery center. We used "Propofol TCI system" to control exact target concentration of conscious sedation and to reduce any systemic complication of the other local anesthetics. Twenty of ASA Class I or II patients were scheduled for elective surgery using Diprifusor(R) TCI system at 0.8-1.9 ug/ml target concentration. We estimated the proper target concentration, time of awakening, postoperative patient satisfaction and presence of postoperative amnesia. All the patients was satisfied except one patients who underwent nasal tip plasty. The target concentration of the conscious sedation varies with age and the type of operation but average concentration was 1.4-1.6 ug/ml. The average time of awakening, which we estimated by the time of eye opening was 2.6 minutes. Postoperative systemic complication and unusual vital sign were not present. We present here our satisfactory results using propofol infused by TCI(Target controlled infusion) system. This system is called 'Diprifusor(R)' and has a benefit of excellent sedative effect, low complication rate, safety, and rapid awakening time which enables the patient to return to his normal life cycle.
Amnesia ; Anesthesia, General ; Anesthesia, Intravenous* ; Anesthesia, Local* ; Anesthetics, Local ; Conscious Sedation ; Humans ; Hypnotics and Sedatives ; Life Cycle Stages ; Patient Satisfaction ; Propofol* ; Surgery, Plastic* ; Vital Signs