Background/Aims: This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC). Methods: A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score. Results: A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P<0.05). In patients with lower endoscopic activity, higher body mass index, and higher serum albumin levels at baseline, the clinical response rate was higher at week 8. In patients with lower Mayo scores and C-reactive protein levels, clinical responses, and mucosal healing at week 8, the clinical response rate was higher at week 56. Serious adverse drug reactions were identified in 2.8% of patients. Conclusions ADA is effective and safe for induction and maintenance in Korean patients with UC, regardless of prior anti-TNF-α therapy. The ADA drug level is associated with the efficacy of induction therapy. Patients with better short-term outcomes were predictive of those with an improved long-term response.

BACKGROUND: Previous studies have recommended a 2- to 5-year waiting time prior to kidney transplantation (KT) in patients with end-stage renal disease (ESRD) and symptomatic renal cell carcinoma (RCC) and no delay for incidental early-stage RCC. Data on Asian KT recipients are unavailable.METHODS: This is a Korean single-center retrospective study on 35 KT recipients with ESRD and RCC. Patients were classified into two groups: early KT (KT performed within 1 year after nephrectomy for RCC, including KT with simultaneous nephrectomy) and delayed KT (KT performed over than 1 year after nephrectomy for RCC). Patient survival, graft survival, and cancer recurrence were compared between both groups.RESULTS: There were no statistically significant differences in patient survival (P = 0.388), graft survival (P = 0.317), or graft rejection rate (P = 0.207) between the early and delayed KT groups. Additionally, there were no differences in pathological characteristics or RCC stage other than cancer histology: acquired cystic disease-associated RCC (47.4%) was the most common RCC type in the early KT group, whereas clear cell type (62.5%) was the most common RCC type in the delayed KT group. No RCC recurrence was observed.CONCLUSION: Patients with early-stage and asymptomatic RCC do not require a mandatory observational period prior to KT after curative nephrectomy
Asian Continental Ancestry Group ; Carcinoma, Renal Cell ; Graft Rejection ; Graft Survival ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Kidney ; Nephrectomy ; Recurrence ; Retrospective Studies ; Transplant Recipients

PURPOSE: To determine the efficacy of cognitive targeted prostate biopsy using biparametric magnetic resonance imaging (b-MRI) for patients with prostate-specific antigen levels under 10 ng/mL. MATERIALS AND METHODS: We reviewed data from 123 consecutive patients who underwent cognitive targeted prostate biopsy using prostate MRI. Of these patients, the first 55 underwent prostate biopsy using multiparametric MRI (mp-MRI), and the remaining 68 underwent prostate biopsy using b-MRI. For b-MRI, we generated T2 weighted axial imaging and diffusion-weighted imaging sequences. We found that 62 of the 123 men had suspicious lesions on MRI (32 of the 55 men in the mp-MRI group and 30 of the 68 men in the b-MRI group). We compared the prostate cancer detection rates and the proportions of clinically significant prostate cancer between the different MRI sequences. RESULTS: Between the two MRI groups, there were no statistically significant differences in prostate cancer detection rate and proportions of clinically significant prostate cancer (41.8% vs. 30.9%, p=0.208 and 82.6% vs. 76.2%, p=0.598). Among the 62 men who had suspicious lesions on MRI, the prostate cancer detection rates were 62.5% and 63.3% (p=0.709) in the mp-MRI and b-MRI groups, respectively, and the proportions of clinically significant prostate cancer were 95.0% and 84.2% (p=0.267). CONCLUSION: Prostate biopsy using b-MRI showed similar performance to that using mp-MRI for detecting prostate cancer and clinically significant prostate cancer. Considering the satisfactory performance and cost effectiveness of b-MRI, this technique could be a good option for obtaining intraprostatic information for first round prostate biopsy.
Biopsy* ; Cost-Benefit Analysis ; Humans ; Magnetic Resonance Imaging* ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name “primary degenerative sagittal imbalance” (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.
Activities of Daily Living ; Agriculture ; Animals ; Asian Continental Ancestry Group ; Back Muscles ; Congenital Abnormalities ; Farmers ; Female ; Humans ; Kyphosis ; Life Style ; Lordosis ; Occupations ; Posture ; Spine

PURPOSE: This study compared the oncologic results of docetaxel chemotherapy (DOC) in castration-resistant prostate cancer (CRPC) according to continuous addition of androgen deprivation therapy (ADT) during chemotherapy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 106 patients who received DOC in 6 medical institutes. Among them, 72 patients had a complete medical record: 28 patients with ADT (DOC+continuous ADT group) and 44 without ADT (DOC only group). We compared the progression-free survival of these groups after DOC. RESULTS: Docetaxel was administered an average of 28 months after primary ADT as the first treatment. A median number of 6 cycles of DOC was administered in both groups. In the DOC+continuous ADT group, orchiectomy was performed in 18 patients and luteinizing hormone-releasing hormone agonist was injected in 10 patients. During DOC treatment, prostate-specific antigen (PSA) progression-free survival was statistically different (6.0±4.75 months in DOC+continuous ADT group vs. 4.8±3.2 months in DOC only group, p=0.024), whereas radiologic progression-free survival was not statistically different (5.0±3.12 months in DOC+continuous ADT group vs. 5.0±2.79 months in DOC only group, p=0.387). CONCLUSIONS: In our cohort, continuous addition of ADT showed a significant benefit in PSA progression-free survival during DOC in CRPC patients. Further prospective studies are needed to confirm these observations.
Academies and Institutes ; Cohort Studies ; Disease-Free Survival ; Drug Therapy* ; Gonadotropin-Releasing Hormone ; Humans ; Medical Records ; Orchiectomy ; Prospective Studies ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Retrospective Studies

PURPOSE: Gastric cancer is the third-leading cause of cancer-related death in Korea. As the Korean population is ageing, the number of extremely old patients with this disease is increasing. This study examined the clinicopathological characteristics of gastric cancer in extremely old (over 85 years) patients who received treatment or conservative observations and compared the treatment outcomes according to the treatment modality. MATERIALS AND METHODS: A total of 170 patients over 85 years of age were diagnosed with gastric cancer. Of these, 81 underwent treatment for gastric cancer and 89 received conservative observations. The clinicopathological characteristics of the treatment and conservative groupswere compared. RESULTS: The mean age of the patients was 86.5 years. The conservative group included significantly more patients with older ages, macroscopically advanced cancer and upper-middle located cancer. The overall survival rate of the treatment group was significantly higher than that of the conservative group. The disease-specific mortality rate was significantly lower in the treatment group than in the conservative group. Multivariate analysis revealed the clinical course, alarm sign, and macroscopic classification to be independent prognosis factors. CONCLUSION: By itself, the chronological age should not be used as a strategy to determine whether treatmentwill be administered for gastric cancer. Patients who have early gastric cancer or lower-risk preexisting comorbidities should not be discouraged from treatment, even if they are older than 85 years.
Aged, 80 and over ; Classification ; Comorbidity ; Humans ; Korea ; Mortality ; Multivariate Analysis ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample. MATERIALS AND METHODS: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively. RESULTS: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period. CONCLUSION: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
Biopsy ; Chemoradiotherapy* ; Disease-Free Survival ; Follow-Up Studies ; Glioblastoma* ; Humans ; Korea* ; Methylation ; Radiotherapy ; Retrospective Studies* ; Survival Rate

Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.
Abdominal Pain ; Adult ; Ascites ; Delayed Diagnosis ; Gastrointestinal Tract ; Humans ; Ileum ; Intestine, Small ; Korea ; Leiomyosarcoma* ; Male ; Outpatients

Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.
Abdominal Pain ; Adult ; Ascites ; Delayed Diagnosis ; Gastrointestinal Tract ; Humans ; Ileum ; Intestine, Small ; Korea ; Leiomyosarcoma ; Male ; Outpatients

PURPOSE: To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL. MATERIALS AND METHODS: In total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core). RESULTS: The mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001). CONCLUSION: MRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL.
Adenocarcinoma/blood/diagnosis/*pathology ; Aged ; Biopsy/*methods ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods ; Humans ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging, Interventional/methods ; Male ; Middle Aged ; Neoplasm Grading ; Prostate/diagnostic imaging/*pathology ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/blood/diagnosis/*pathology ; Ultrasonography, Interventional/methods