Background: /Aim: We aimed to investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) in elderly patients with small hepatocellular carcinomas (HCC). Methods: Eighty-three patients (89 lesions) with HCC who underwent SBRT between January 2012 and December 2018 were reviewed in this retrospective observational study. The key inclusion criteria were as follows: 1) age ≥75 years, 2) contraindications for hepatic resection or percutaneous ablative therapies, 3) no macroscopic vascular invasion, and 4) no extrahepatic metastasis. Results: The patients were 75-90 years of age, and 49 (59.0%) of them were male. Most patients (94.0%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Seventy-four patients (89.2%) had Child-Pugh class A hepatic function before SBRT. The median tumor size was 1.6 cm (range, 0.7-3.5). The overall median follow-up period was 34.8 months (range, 7.3-99.3). The 5-year local tumor control rate was 90.1%. The 3-year and 5-year overall survival rate was 57.1% and 40.7%, respectively. Acute toxicity grade ≥3 was observed in three patients (3.6%) with elevated serum hepatic enzymes; however, no patient experienced a worsening of the Child-Pugh score to ≥2 after SBRT. None of the patients developed late toxicity (grade ≥3). Conclusions SBRT is a safe treatment option with a high local control rate in elderly patients with small HCC who are not eligible for other curative treatments.

Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.
Dermatitis, Atopic ; Education ; Electronic Mail ; Fees and Charges ; Humans ; Korea ; Medical Staff ; National Health Programs ; Nutritionists ; Patient Education as Topic ; Pharmacists ; Psychology

BACKGROUND: High-risk human papillomavirus (HR-HPV) infection and abnormal p53 expression are closely involved in carcinogenesis of squamous cell carcinoma (SqCC) of uterine cervix. Recent studies have suggested that virus-induced endoplasmic reticulum (ER) stress modulates various cell survival and cell death signaling pathways. The C/EBP homologous protein (CHOP) is associated with ER stress-mediated apoptosis and is also involved in carcinogenesis of several human cancers. We hypothesized that CHOP is involved in the carcinogenesis of uterine cervical cancer in association with HR-HPV and/or p53. METHODS: Immunohistochemistry was used to analyze CHOP and p53 protein expression of tissue sections from 191 patients with invasive cancer or preinvasive lesions of the uterine cervix (61 cases of SqCC, 66 cases of cervical intraepithelial neoplasia [CIN] III, and 64 cases of CIN I). RESULTS: CHOP was expressed in 59.4% of CIN I, 48.5% of CIN III, and 70.5% of SqCC cases. It was also significantly more frequent in invasive SqCC than in preinvasive lesions (p=0.042). Moreover, CHOP expression significantly correlated with HR-HPV infection and p53 expression (p=0.009 and p=0.038, respectively). CONCLUSIONS: Our results suggest that CHOP is involved in the carcinogenesis of the uterine cervix SqCC via association with HR-HPV and p53.
Apoptosis ; Carcinoma, Squamous Cell ; Cell Death ; Cell Survival ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; DNA Probes, HPV ; Endoplasmic Reticulum ; Female ; Humans ; Immunohistochemistry ; Transcription Factor CHOP ; Tumor Suppressor Protein p53 ; Uterine Cervical Neoplasms

OBJECTIVES: The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). METHODS: The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. RESULTS: The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. CONCLUSIONS: The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.
Humans ; Logistic Models ; Male ; *Mortality ; *Prejudice ; *Psychosocial Deprivation ; Republic of Korea ; Social Class ; Social Justice ; Socioeconomic Factors ; Statistics as Topic

PURPOSE: The aims of this study were to immunohistochemically identify lymph node micormetastases in Dukes' B colorectal cancer patients, and determine the relationship between lymph node micrometastases and other prognostic factors and recurrence rates. METHODS: A retrospective analysis was conducted of 990 lymph nodes from Dukes' B 42 patients who had undergone radical colorectal resection. These lymph nodes were immunohistochemically examined with monoclonal antibodies against cytokeratin-19. The prognostic factors and recurrent rates were compared between patients with and without lymph node micrometastases. RESULTS: Micrometastases were confirmed in 19 nodes (1.9%) from 9 patients (21.4%). No correlations were observed between micrometastases and the prognostic factors, with the exception of the preoperative CEA level. 8 of the 9 (88.9%) patients with micrometastases had preoperative CEA levels significantly elevated above 5 ng/ml (P<0.0001). There were no significant differences in the recurrent rates (P=0.0572) between patients with and without micrometastases during the short term follow up period (14.8 months) at the 95% confidence interval, but there were significant differences at the 90% confidence interval. CONCLUSION: High preoperative CEA levels increase the risk for micrometastases, and the presence of micrometastases might increase the possibility of recurrence. Thus, a routine immunohistochemical technique for identifying micrometastases is recommended in the patients with a high preoperative CEA level. However, a more definite clinical significance of lymph node micrometastases awaits further extensive prospective studies.
Antibodies, Monoclonal* ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Keratin-19* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Recurrence ; Retrospective Studies

PURPOSE: The aims of this study were to immunohistochemically identify lymph node micormetastases in Dukes' B colorectal cancer patients, and determine the relationship between lymph node micrometastases and other prognostic factors and recurrence rates. METHODS: A retrospective analysis was conducted of 990 lymph nodes from Dukes' B 42 patients who had undergone radical colorectal resection. These lymph nodes were immunohistochemically examined with monoclonal antibodies against cytokeratin-19. The prognostic factors and recurrent rates were compared between patients with and without lymph node micrometastases. RESULTS: Micrometastases were confirmed in 19 nodes (1.9%) from 9 patients (21.4%). No correlations were observed between micrometastases and the prognostic factors, with the exception of the preoperative CEA level. 8 of the 9 (88.9%) patients with micrometastases had preoperative CEA levels significantly elevated above 5 ng/ml (P<0.0001). There were no significant differences in the recurrent rates (P=0.0572) between patients with and without micrometastases during the short term follow up period (14.8 months) at the 95% confidence interval, but there were significant differences at the 90% confidence interval. CONCLUSION: High preoperative CEA levels increase the risk for micrometastases, and the presence of micrometastases might increase the possibility of recurrence. Thus, a routine immunohistochemical technique for identifying micrometastases is recommended in the patients with a high preoperative CEA level. However, a more definite clinical significance of lymph node micrometastases awaits further extensive prospective studies.
Antibodies, Monoclonal* ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Keratin-19* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Recurrence ; Retrospective Studies

PURPOSE: Symptomatic and/or malignant changes in hepatic cysts require surgical treatment, but there are few comparative studies with respect to the safety and long-term effectiveness. We compared the resection and non-resection of hepatic cysts from the view point of recurrence and complications. METHODS: We reviewed 24 patients who underwent surgery for hepatic cysts between 1990 and 2001 at a single institution. There included 15 resections and 9 non-resections. RESULTS: The median age was 59 years, with a male to female sex ratio of 9: 15. The median size of the dominant cyst was 12 cm, and 22 patients presented with symptoms. We treated 12 simple cysts, 3 polycystic liver diseases (PCLD), 3 cystadenomas, 1 cystadenocarcinoma, 2 hamartomas, 1 hydatid cyst, 1 traumatic cyst and 1 other. The causes requiring an operation were peritoneal irritation in 7, a mass effect such as early satiety or jaundice in 5, possible malignancy in 4, associated hepatobiliary diseases in 3, increase of cyst sizes in 2 and another disease in 2. We performed 5 right lobectomies, 2 left lobectomies, 1 left lateral segmentectomy, 3 non-anatomical resections, 3 cyst excisions, and 1 total hepatectomy for liver transplantation in the resection group. 6 unroofings and 3 fenestrations were performed in the non-resection group, in which a laparoscopic approach was applied in 3 cases. The incidence of postoperative complications were uncommon in both groups, whereas resection decreased the recurrence rate significantly (P=0.003). CONCLUSION: Resection is a safe and effective procedure to lower the recurrence of all cystic lesions in the liver.
Cystadenocarcinoma ; Cystadenoma ; Echinococcosis ; Female ; Hamartoma ; Hepatectomy ; Humans ; Incidence ; Jaundice ; Liver ; Liver Diseases ; Liver Transplantation ; Male ; Mastectomy, Segmental ; Postoperative Complications ; Recurrence ; Sex Ratio

PURPOSE: Surgery remains the treatment of choice for a hepatocellular carcinoma (HCC) confined within the liver. When there is no underlying liver disease, resection is the preferred option. In cases of HCC with cirrhosis, impaired hepatic reserve often precludes safe resection. Recently, acceptable transplantation outcomes have been shown in selected HCC patients. The aim of this study was to review the results of liver transplantation for HCC at the Asan Medical Center. METHODS: 73 HCC patients were treated by liver transplantation between August 1992 and April 2001. There were 7 in-hospital mortalities. The mean age of the patients was 51 years. The period of the median follow-up was 22 months. By reviewing the patients' medical records, we investigated tumor size, and number, TNM stage, survival rates, and recurrences. Statistical analysis was performed using Statistica 5.1 and SPSS 9.0. RESULTS: Among 67 patients, 8 (12%) developed a tumor recurrence or distant metastasis following the liver transplantation. The 3 year and 5 year survival rate were 88 and 57%, respectively. There were 12 incidentalomas. The 1 year and 3 year disease free survival rates of 54 cases, with the exception of the incidentalomas, were 80 and 50%, respectively. There were no statistically significant differences in the survival rates between the groups, with and without preoperative TACE (P=0.70). Also, there were no statistically significant differences in the survival rates between cadaveric donor liver transplantations (CDLT) and living donor liver transplantations (LDLT). CONCLUSION: We assume that transplantation for HCC, in carefully selected patients, may be the solution to HCC in cirrhotic livers. If the donor safety with a LDLT can be ensured, its application to patients with cirrhosis and early HCC may be a solution to the donor shortage, which could improve the survival of this group of patients.
Cadaver ; Carcinoma, Hepatocellular* ; Chungcheongnam-do ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Hospital Mortality ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Survival Rate ; Tissue Donors

PURPOSE: Although there has been recent progress in surgical techniques, such as perioperative management, immunosuppresive regimen and intervention radiology, a liver retransplantation remains as the only therapeutic option for patients with a failing liver allograft. The purpose of this study was to review our clinical experiences of liver retransplantation, performed at the Asan Medical Center. METHODS: Between August 1992 and March 2001, 400 cases of liver transplantations, including 331 in adults and 69 in pediatrics, were performed. Of the 331 adult cases, 10 cases of liver retransplantation, during the same period, were retrospectively analyzed. RESULTS: In the 331 cases of adult liver transplantation, 232 cases of living donor and 99 of cadaveric liver transplantations were carried out. The 331 adult cases also included 10 liver retransplantations. Therefore, the overall liver retransplantation rate was 3%. Primary non-function (PNF) was the leading cause of retransplantation. The conversion of living donor liver transplantation to a cadaveric liver retransplantation was the most common type of retransplantaion, with a cadaveric to cadaveric type the second most common. The in-hospital mortality was 40%. The causes of in-hospital mortality were hepatic artery pseudoaneurysm rupture, Aspergillus pneumonia, and multiple organ failure, initiated by jejuno-jejunostomy site bleeding and massive hepatic necrosis. CONCLUSION: In the current era of extreme organ shortage, retransplantation is the only therapeutic alternative for irreVersible graft failure, especially if the patient has no multiple organ failure (MOF) prior to the operation. Therefore, the careful selection of patients for a retransplantation is required. They should be given superurgent priority if the circumstances permit, and living donor liver transplantation (LDLT) offer a promising alternative.
Adult ; Allografts ; Aneurysm, False ; Aspergillus ; Cadaver ; Chungcheongnam-do ; Hemorrhage ; Hepatic Artery ; Hospital Mortality ; Humans ; Liver Transplantation ; Liver* ; Living Donors ; Massive Hepatic Necrosis ; Multiple Organ Failure ; Pediatrics ; Pneumonia ; Retrospective Studies ; Rupture ; Transplants

Caffeine is one of the most widely consumed neuroactive drugs, coming mostly from everyday beverages such as coffee and tea. To investigate whether caffeine induces apoptosis in the central nervous system, 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay, 4,6-diamidino-2-phenylindole (DAPI) staining, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) assay, flow cytometric analysis, DNA fragmentation assay, and caspase-3 enzyme assay were performed on SK-N-MC human neuroblastoma cells. Cells treated with caffeine at concentrations as high as 10 mM exhibited several characteristics of apoptosis. In addition, caffeine was shown to increase the caspase-3 activity. These results suggest that high-dose of caffeine induces apoptosis in human neuroblastoma cells, probably by increasing the caspase-3 enzyme activity.
Apoptosis/*drug effects ; Caffeine/*toxicity ; Caspase 3 ; Caspases/metabolism ; Cell Cycle/drug effects ; Cell Survival/drug effects ; Central Nervous System/cytology/*drug effects ; DNA Fragmentation ; Humans ; Neuroblastoma/enzymology/pathology ; Tumor Cells, Cultured