PURPOSE: This study aims to investigate the trend in medical travel by non-Seoul residents to Seoul for treatment of prostate cancer and also to investigate the possible factors affecting the trend. MATERIALS AND METHODS: This study represents a retrospective cohort study using data from theKoreanNationalHealth Insurance System from 2002 to 2015. Annual trends were produced for proportions of patients who traveled according to the age group, economic status and types of treatment. Multiple logistic analysiswas used to determine factors affecting surgeries at medical facilities in Seoul among the non-Seoul residents. RESULTS: A total of 68,543 patients were defined as newly diagnosed prostate cancer cohorts from 2005 to 2014. The proportion of patients who traveled to Seoul for treatment, estimated from cases with prostate cancer-related claims, decreased slightly over 9 years (28.0 at 2005 and 27.0 at 2014, p=0.02). The average proportion of medical travelers seeking radical prostatectomy increased slightly but the increase was not statistically significant (43.1 at 2005 and 45.4 at 2014, p=0.26). Income level and performance ofrobot-assisted radical prostatectomy were significant positive factors for medical travel to medical facilities in Seoul. Combined comorbidity diseases and year undergoing surgery were significant negative factors for medical travel to medical facilities in Seoul. CONCLUSION: The general trend of patients travelling from outside Seoul for prostate cancer treatment decreased from 2005 to 2014. However, a large proportion of traveling remained irrespective of direct distance from Seoul.
Cohort Studies ; Comorbidity ; Geography ; Health Services Accessibility ; Humans ; Insurance ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Retrospective Studies ; Seoul*

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.
Female ; Gynecologic Surgical Procedures ; Humans ; Manuals as Topic ; Ovarian Neoplasms ; Research Personnel

We report a case of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule (SPN). A 35-year-old male was admitted due to a SPN in the right upper lobe which was detected on the chest radiography being examed due to recurrent cough for 1 year. The computed tomography (CT) revealed a spiculated nodule containing air-bronchogram, which was suspicious of malignancy. We performed transbronchial biopsy and the pathology showed granulomatous inflammation with caseous necrosis. Under the presumptive diagnosis of pulmonary tuberculosis, we started anti-tuberculous medication including isoniazid, rifampin, ethambutol, and pyrazinamide. In one month, however, the sputum culture was positive for Mycobacterium intracellulare. The follow-up chest CT showed slight aggravation of the previous lesions. Under the final diagnosis of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule, we changed the regimen to rifampin, ethambutol, and clarithromycin. The follow-up chest CT after the completion of treatment, revealed resolution of the previous lesions.
Adult ; Biopsy ; Clarithromycin ; Cough ; Ethambutol ; Follow-Up Studies ; Humans ; Inflammation ; Isoniazid ; Lung ; Lung Diseases ; Male ; Mycobacterium avium Complex ; Mycobacterium Infections, Nontuberculous ; Necrosis ; Pyrazinamide ; Rifampin ; Solitary Pulmonary Nodule ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

We report a case of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule (SPN). A 35-year-old male was admitted due to a SPN in the right upper lobe which was detected on the chest radiography being examed due to recurrent cough for 1 year. The computed tomography (CT) revealed a spiculated nodule containing air-bronchogram, which was suspicious of malignancy. We performed transbronchial biopsy and the pathology showed granulomatous inflammation with caseous necrosis. Under the presumptive diagnosis of pulmonary tuberculosis, we started anti-tuberculous medication including isoniazid, rifampin, ethambutol, and pyrazinamide. In one month, however, the sputum culture was positive for Mycobacterium intracellulare. The follow-up chest CT showed slight aggravation of the previous lesions. Under the final diagnosis of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule, we changed the regimen to rifampin, ethambutol, and clarithromycin. The follow-up chest CT after the completion of treatment, revealed resolution of the previous lesions.
Adult ; Biopsy ; Clarithromycin ; Cough ; Ethambutol ; Follow-Up Studies ; Humans ; Inflammation ; Isoniazid ; Lung ; Lung Diseases ; Male ; Mycobacterium avium Complex ; Mycobacterium Infections, Nontuberculous ; Necrosis ; Pyrazinamide ; Rifampin ; Solitary Pulmonary Nodule ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

Bronchobiliary fistula is a rare disorder consisting of an abnormal communication between the bronchial tree and the biliary duct. In Western countries, trauma, postoperative biliary stenosis, and biliary lithiasis are the predominant causative factors of bronchobiliary fistula. Bilioptysis (bile stained sputum) is a pathognomic finding for bronchobiliary fistula. To date, there are just a few reported cases of bronchobiliary fistula after sclerosis of a liver cyst. We describe the case of a 74-year-old woman who developed bronchobiliary fistula after sclerosing therapy of a liver cyst. The diagnosis was confirmed by the presence of bilioptysis and the chest and dynamic liver CT findings. The patient was successfully treated with antibiotics and percutaneous transhepatic catheter drainage.
Aged ; Anti-Bacterial Agents ; Catheters ; Constriction, Pathologic ; Drainage ; Female ; Fistula ; Humans ; Lithiasis ; Liver ; Sclerosing Solutions ; Sclerosis ; Thorax

The ulcerative colitis is a chronic inflammatory bowel disease with an unknown etiology. The major symptoms of ulcerative colitis are diarrhea, abdominal pain and hematochezia. However, arthritis, skin disorders, hepatobiliary inflammation and uveitis are occasionally recognized as systemic complications. Although there are few reports of coexistent pulmonary and inflammatory bowel disease, the lung is not generally considered to be a target organ in ulcerative colitis. We report a patient with ulcerative colitis-related bronchilolitis obliterans organizing pneumonia confirmed by video-assisted thoracoscopic surgery, who responded to corticosteroid therapy.
Abdominal Pain ; Arthritis ; Colitis, Ulcerative ; Cryptogenic Organizing Pneumonia ; Diarrhea ; Gastrointestinal Hemorrhage ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Lung ; Pneumonia ; Skin ; Thoracic Surgery, Video-Assisted ; Ulcer ; Uveitis

When all the conventional treatments have failed for patients with acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) can offer these patients a chance to survive. We report here on a case of successful treatment with prolonged ECMO support for a patient with severe ARDS. A 41-year-old female patient with acute A-viral hepatitis developed pneumonia and progressive ARDS. After tracheostomy, her clinical condition deteriorated despite proper antibiotic administration and other conventional treatments, including the recruitment maneuver and steroid use. Venoarterial ECMO was given for the management of refractory hypoxemia that developed 14 days after the initiation of mechanical ventilation. The duration of ECMO support was 4 weeks, and she was successfully weaned off ECMO and mechanical ventilation.
Adult ; Anoxia ; Extracorporeal Membrane Oxygenation ; Female ; Hepatitis ; Humans ; Critical Care ; Pneumonia ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Tracheostomy

The middle mediastinum contains several important organs and pluripotent cells. It is difficult to make a definitive diagnosis in patients with middle mediastinal tumors due to a wide range of diseases. The likelihood of malignancy is influenced primarily by the following factors: patient age, size, tumor location, and the presence or absence of symptoms. We describe a case of a middle mediastinal tumor, which was suspected on chest x-ray; chest computed tomography revealed the eccentric mass of distal esophagus. This case emphasizes the diagnostic importance of the chest x-ray to the physicians. The possible differential diagnoses are reviewed.
Diagnosis, Differential ; Esophagus ; Humans ; Leiomyoma ; Mediastinal Neoplasms ; Mediastinum ; Thorax

Purpose: This multiinstitutional study was to investigate the accuracy of the Kattan nomograms for the prediction of recurrence after definitive surgery for renal cell carcinoma (RCC) in Korean patients and develop a nomogram revised to complement the shortcomings. Materials and Methods: Clinical and pathological data of 1,866 patients with RCC who had been followed for at least 2 years after surgery in each participating institutes were reviewed as well as evidence of disease recurrence, defined to include local recurrence and distant metastasis. Accuracy of the Kattan nomograms' predictability in tumors 7cm or less was tested by calculating the area under the receiver-operating characteristics curve (AUC) and actuarial recurrence-free survival by Kaplan- Meier method. We used the Cox proportional hazard analysis to identify significant variables and develop prediction nomogram, and internally validated by bootstrapping method. Mean follow-up was 56.5 months (24-184). Results: Recurrence occurred in 12.5% of the patients and correlated with the pathological stage, with 4.3%, 7.9%, 15.0%, 22.6%, 38.4%, 58.3% for stages T1a, T1b, T2, T3a, T3b/c and T4, respectively (p<0.001). The AUC of the Kattan nomograms was 0.276. Factors significantly predictive of recurrence were T stage (p<0.0001), presentation (p=0.006), preoperative hemoglobin (p=0.023) and gender (p=0.032). Actuarial 60-month recurrence- free survival was 87.9% and using the prognostic factors, nomogram predicting 60-month recurrence-free survival was constructed. Conclusions: Korean nomogram complementing the preexisting nomograms for the prediction of recurrence-free survival after definitive surgery for RCC has been constructed, which may be useful in patient prognostication, counseling and follow-up planning.
Academies and Institutes ; Area Under Curve ; Carcinoma, Renal Cell* ; Complement System Proteins ; Counseling ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; Neoplasm Metastasis ; Nomograms* ; Recurrence

PURPOSE: Dysembryoplastic neuroepithelial tumor (DNET) is a newly described, pathologically benign tumor arising within the supratentorial cortex. We reviewed the MR appearance of five patients with DNET, emphasizing the clinical and radiologic features. MATERIALS AND METHODS: MR images in the five patients (three male and two female) with a history of epileptic seizure and pathologically-proven DNET were retrospectively reviewed. We analyzed the location, configuration, signal intensity, contrast enhancement, vasogenic edema and calcifications of these tomors. RESULTS: The tumors were located mainly in the cortical to subcortical area with very little perifocal mass effect on MR imaging. They were essentially hypointense on T1-weighted imaging, and showed a hyperintense well circumscribed mass on T2-weighted imaging and a thick gyrus-like configuration was retained within the lesions. On contrast enhanced study, focal nodular enhancement was seen in one patient, and multifocal nodular enhancement in two. CONCLUSION: DNET is rare benign tumor resulting in often medically intractable epileptic seizure and shows a characteristic gyriform configuration, well-described lobular tumor margins and sometimes multifocal nodular enhancement. These radiologic features may aid in differentiating DNET from ganglioglioma and other gliomas.
Edema ; Epilepsy ; Ganglioglioma ; Glioma ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasms, Neuroepithelial* ; Retrospective Studies