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.

A thymoma commonly occurs in the superior mediastinum or the upper part of the anterior mediastinum but can be located in other places in rare cases. Cystic degeneration in a thymoma is a relatively common but focal event. In rare cases, the process proceeds to the extent that most if not all of the lesion becomes cystic. We report a case of a patient with a paracardial cystic thymoma in the lower aspect of the anterior mediastinum. A 49-year-old woman was referred to our hospital because of a mass discovered incidentally on a chest X-ray. She showed no symptoms or signs. Contrast-enhanced chest CT scan revealed a 5x5cm sized, well-marginated, right paracardial cystic mass with a curvilinear and oval enhancing solid portion. A Surgical resection was performed. The mass was discontinuous with normal thymic tissue. Microscopy revealed a type B1 thymoma with prominent foci of medullary differentiation according to the WHO classification. There was no capsular or local invasion. The postoperative course was uneventful and the patient was discharged in good health.
Classification ; Female ; Humans ; Mediastinum ; Microscopy ; Middle Aged ; Thorax ; Thymoma* ; Tomography, X-Ray Computed

The purpose of the present study was to evaluate the effects of several implant surface treatments to the bone formation, by placing Machined implants, 75 micrometer Calcium phosphate-blasted implants and Al2O3- blasted and acid-etched implants in rabbit tibia through histomorphometric study. Two animals of each group were sacrificed at 2, 4, 8 weeks. The specimens containing the implants were dehydrated and embedded into hard methylmethacrylate plastic. Thereafter, the sections were ground to 50 micrometer. The specimens were stained with Villanueva bone stain for a light microscopic study. The results were as follows; 1. When the surface roughness of three different implants was measured by Surfcorder, the Ra of the Machined group, the RBM group and the SLA group was 0.16 micrometer, 0.44 micrometer, and 1.08micro meter. 2. When examining the surfaces of the implants in the scanning microscope, Machined implant has the smooth surface with a few scratches, RBM implant has the rough surface with curled ridges and valleys, and SLA implant has the rough surface structures such as sharp protruding parts and micropits measuring 1-2 micrometer in diameter. 3. After 2 weeks of implantation, the percentage of bone-to-implant contact of the Machined group, the RBM group and the SLA group was 26.86%, 35.40% and 45.99%. However, its differences between each group decreased during the healing periods. 4. After 2 weeks of implantation, the percentage of bone area inside the threads of the Machined group, the RBM group and the SLA group were 21.55%, 30.43% and 41.18%. However, its difference of bone area between machined group and surface treatment groups was maintained but the difference within the surface treatment groups decreased during the healing periods. In summary, the amount of bone formation in RBM and SLA group was greater than Machined group in early healing stage. These results suggest that RBM and SLA implants can reduce the healing period for osseointegration and may be suitable for early function.
Animals ; Calcium ; Dental Implants* ; Methylmethacrylate ; Osseointegration ; Osteogenesis ; Plastics ; Tibia*

Malignant eccrine poroma is a rare skin appendage tumor, originating from the intraepidermal and upper dermal eccrine ducts. It is a locally aggressive neoplasm with a high propensity to metastasize. A 47-year-old woman was admitted to the hospital because of dyspnea. One and half years before admission, she had been diagnosed porocarcinoma of left sole and treated with wide local excision. One months after excision, examination had revealed an inguinal lymph node metastasis and she had been treated with lymph node resection and radiotherapy. During the two weeks before admission, the patient had increasing exertional dyspnea, which was accompanied by Rt-sided chest wall pain. On admission right pleural effusion and multiple nodular densities were noted at initial chest radiograph. A computed tomographic (CT) scan of the chest showed lymphatic and hematogenous lung metastasis with pleural seeding of unknown primary tumor. Fine-needle aspiration biopsy of the pleura revealed typical cytologic findings of porocarcinoma. She was treated with therapeutic thoracentesis and pleurodesis with bleomycin. Because porocarcinoma is resistant to chemotherapy and radiotherapy, she has been treated with conservative treatment.
Biopsy, Fine-Needle ; Bleomycin ; Drug Therapy ; Dyspnea ; Eccrine Porocarcinoma* ; Female ; Humans ; Lung* ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis* ; Neoplasms, Unknown Primary ; Pleura ; Pleural Effusion ; Pleurodesis ; Radiography, Thoracic ; Radiotherapy ; Skin ; Thoracic Wall ; Thorax

We had experienced a case of hematogenous brain abscess which occurred at the site of spontaneous intracerebral hemorrhage. The 41-year-old patient was admitted with sponetaneous intracerebral hemorrhage on left basal ganglia and sepsis. Brain abscess was incidentally detected by stereotactic aspiration of intracerebral hemorrhage, followed by the gram staining and culture of aspirated material.
Adult ; Basal Ganglia ; Brain Abscess* ; Brain* ; Cerebral Hemorrhage* ; Humans ; Sepsis

BACKGROUND: Diagnosis of AMI in the patients presenting with chest pain of an atypical nature or with a nondiagnostic ECG requires the evaluation of certain biochemical markers. Biochemical markers most often used for the early detection of myocardial damage are CK-MBact, troponin, and myoglobin. The clinical value of measuring serum myoglobin was compared to that of troponin and CK-MBact in the patient with acute chest pain syndrome. METHOD: We studied timed, sequential measurements of serum myoglobin, CK-MBact and troponin-T obtained from 72 patients who were admitted for the evaluation of suspected AMI within 12 hours after the chest pain onset. Patients with a history of recent trauma, cardiogenic shock, renal failure, or who had received recent cardiopulmonary resuscitation were excluded. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value. Data were analyzed with the Chi-square test for differences in proportion. A value of p<0.05 was considered statistically significant. RESULT: 1) The mean time from symptom onset to arrival at the emergency department was 3.5+/-0.6 hours. 2) There were no statistical differences in age, sex and risk factors between AMI, angina pectoris and atypical chest pain group. 3) The negative predictive value of myoglobin was significantly higher than those of CK-MBact and troponin-T from 3 to 6 hours after the onset of chest pain. 4) The time to peak of myoglobin level was shorter than those of CK-MBact and troponin-T in AMI patients. CONCLUSION: Within 3 to 6 hours after the onset of symptoms, myoglobin is a better marker than CK-MBact or troponin-T in ruling out AMI for the patient with acute chest pain syndrome.
Angina Pectoris ; Biomarkers* ; Cardiopulmonary Resuscitation ; Chest Pain ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Myocardial Infarction* ; Myoglobin* ; Renal Insufficiency ; Risk Factors ; Sensitivity and Specificity ; Shock, Cardiogenic ; Troponin ; Troponin T

Since the introduction of PTCA by Gruntzig in 1977, this is now widely used in some subsets of patients with coronary artery disease and is an effective alternative to surgery for many patients. In the 3 years from June 1983 to June 1985, PTCA was attempted in 33 patients with coronary artery disease at the Severance Hospital. There were 26 men and 7 women, whose mean age was 51 years(31-68year). Seven patients had a previous myocardial infarction. Thirty one of 33 patiens presented with chest pain. Twenty four patients had unstable angina and 7 stable angina. the median duration of angina was 5 months(1-120months). 29 had one vessel disease. One had left main disease, 1 two-and 2 three-vessel disease. PTCA was attempted on lesions located in the left anterior descending artery in 26 patients, right coronary artery in1. Successful dilation(stenosis opened by 20% or more of the normal luminal diameter)was achieved in 24 patients(73%). Seventy seven of the stenosis of the LAD and 75% of the RCA was succesfully dilated, whereas PTCA was failed in all 2 patients with a stenosis of the LCX. One patients with a stenosis of the left main artery was succesfully dilated. The mean degree of stenosis was reduced from 77+/-2% to 34+/-2%(P<0.001). The mean pressure gradient was diminished from 53+/-8mmHg to 18+/-6mmHg(P<0.001). Acute coronary occlusion occured in 4 patients(12%). Three of them developed acute myocardial infarction. Emergency coronary bypass operation was done in 2 patients, but one died on the day of operation. Follow-up clinical assessment in the hospital after successful angioplasty indicated freedom from angina in the most of successfully dilated patietns. Eleven patients who underwent successful dilation had basesline and follow-up(within 2 weeks after PTCA) transmill tests. Nine of 11 patients with a positive treadmill test before PTCA obtained negative results after successful angioplasty. Mean exercise duration increased from 316+/-46sec to 601+/-34sec(P<0.001). Eight patients have developed recurrence of angina(recurrence rate;33%) during follow-up period of 3 to 36 months(medial;10 months). In 6 of these cases, restenosis has been documented angiographically within 3 months of dilatation. Four asymptomatic patients have had follow-up angiography. In all patients, the dilated segments was unchanged or improved. Repeat PTCA was attempted in 5 patients with a success rate of 80% without any complications. This initial expierence with PTCA indicates that it is an effective method of relieving coronary stenosis and ischemic symptoms in selected patients. But it carries an inherent risk of serious complications. Also restenosis is a persistent problem with PTCA. Repeat PTCA can be done with a high success and a low complication rate.
Angina, Stable ; Angina, Unstable ; Angiography ; Angioplasty ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Occlusion ; Coronary Stenosis* ; Coronary Vessels* ; Dilatation ; Emergencies ; Exercise Test ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Myocardial Infarction ; Phenobarbital ; Recurrence

To evaluate the diagnostic value of thallium-201 stress myocardial scintigraphic imaging and stress electrocardiography, sensitity, specificity and predicitive value of thallium-201 stress myocardial scintigraphic imaging were compared to simultaneously recorded 12 lead electrocardiography in 17 normal subjects and 30 patients with coronary artery disease who proved by coronary arteriography. The following results were obtained. 1) The mean age was 49.5+/-10.7 years(mean+/-SD)in subjects with normal coronary arteries and 53.1+/-8.8 years in patients with stenotic coronary arteries. 2) Fourteen patients had one-vessel disease, 10 two-vessel disease and 6 three-vessel disease. 3) Sensitivity of thallium myocardial scintigraphic imaging was higher than that of stress electrocardiography(86.7% vs 76.7%). 4) Specificity of both tests was same(70.6% vs 70.6%). 5) Sensitivity of thllium-201 stress myocardial scintigraphic imaging and stress electrocardigraphy in relation to the extent of coronary artery disease showed 78.6% vs 64.3% in one vessel disease, 90% vs 80% in two-vessel disease and 100% vs 100% in three-vessel disease. 6) Predictive value of thallium-201 stress myocardial scintigraphic imaging and stress electrocardiography revealed 83.9% vs 82% in the postive test and 75% vs 63.2% in the negative test. In conclusion, even though thallium-201 stress myocardial scintigraphic imaging was superior to stress electrocardiography in diagnosing coronary artery disease, scintigraphic defects were noted in 5 subjects with normal coronary arteries which could mislead to erroneous diagnosis of coronary artery disease. This point should be taken into consideration in the interpretation of thallium-201 stress myocardial scintigraphic imaging.
Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Electrocardiography* ; Humans ; Sensitivity and Specificity ; Thallium

Since recognition of coronary arterial clloateral circulation in living patients has been made possible by coronary arteriography, controversy has existed about the functional importance of these vessel and their ability to protect the myocardium against ischemia. The coronary arteriograms and left ventriculograms of 279 consecutive patients were reviewed. All had at least 50% diameter reduction of 1 or more major coronary arteries. In 94 patients(111 arteries), at least 1 major branch was totally occluded. Collateral circulation was seen in 85 of 111(76.6%) totally occlued arteries versus 22 of 107(20.6%) with > or =90% but <100% stenosis(P<0.01). No artery with <90% stenosis(254 arteries) recieved angiographically detectable collateral vessels. An analysis was made of the relation between left ventricular segmental wall motion and the quality of collateral circulation in 68 totally occluded arteries among 60 patients with myocardial infarction(Group 1) and in 43 totally occluded arteries among 34 patients without prior myocardial infarction(Group 2). Good collateral vessels went to 62.8% of Group 2, but 38.8% of Group 1(P<0.05). LV contraction was abnormal in all Group 1 patients with good collateral circulation. Of 27 with good collateral circulation in Group 2, LV contraction was normal in 59.3% and abnormal in 40.7%. But there was no statistically significant difference between the effect of good or poor collateral circulation in LV wall motion in each Group. Also we have studied the frequency of collateral circulation appearance in 34 patients, in whom the date of symptom onset of transmural infarction was definitely documented. The presence of collateral vessels was significantly higher in the patients studied 1-15 day period after symptom onset vs those studied within 1 day(77.8% vs 14.3%, P<0.05). but there was no significant differance in the apperance of collaterals in the patients studied in the 1-15 day vs the 15 day-2 month, and vs the 2-36 month period(77.85, 66.7% and 66.7%, NS). These observation indicate that collateral circulation cannot be seen angiographically unless there is total or near-total occlusion, and that the pressence of good collaterals may play a patrial role in preserving myocardial function and preventing myocardial infarction. The development of collaterals in myocardial infarction seems to be occurred within 15 days after the symptom onset of transmural infarction. But any benefits can not be expected from newly developed collateral circulation after myocardial infarction.
Angiography ; Arteries ; Collateral Circulation* ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Infarction ; Ischemia ; Myocardial Infarction ; Myocardium

To investigate the discriminative values of different lipid and lipoproteins in the presence and severity of coronary artery disease(CAD), liporotein profiles and other risk factors were measured in 333 patients age 30-69 years who were admitted at Severance Hospital from January 1980 to Agust 1986. The extent of atherosclerosis was quantified by a coronary atheosclerosis score(CAS) based on number and severity of lesions in eight proximal segments of the follows; 1) In age 30-49 and 50-69 groups, there were no significant differences of age, hypertension, smoking, diabetes, obesity to compare with control groups. 2) In age 30-49 group, the extent of CAD was more severe in male patients(1.7+/-0.7 vessel disease) than female(1.3+/-0.6 vessel disease)(P<0.05). But, no significant difference was showed between male(2.0+/-0.9 vessel disease) in age 50-69 group. CAS was significantly increased in male patients(6.1+/-3.7)to compare with female(3.7+/-2.6) in age 30-49 group(P<0.01). But, there was no difference in age 50-69 group. However, stronger liner correlations were demonstrated between the age and CAS in male patients(r=0.227, P<0.005) and in female patients(r=0.317, p<0.05). 3) Total cholesterol(TC), triglyceride(TG), HDL/c, HDL-TC and HDL-C/LDL-C were significantly associated with the presence of CAD in age 30-69 male patients; HoweverTC and LDL-C had disciriminatory value only for age 50-69 female patients. 4)The concentration of TC, LDL/C, HDL-C/TC and HDL_C/LDL-C showed a strong correlation with CAS in male patients, TC and LDL-C in female patents. But, HDL-C had no significant correlation with CAS on both groups. Above data suggest that TC, TG and HDL-C are the significants markers in man and TC and LDL-C on female for presence of CAD. The concentration of TC and LDL-C are related to the severity of CAD in both sexes. Further studies of lipoproteins and risk factors with large population are needed.
Adult* ; Atherosclerosis ; Coronary Artery Disease* ; Coronary Vessels* ; Female ; Humans ; Hypertension ; Lipoproteins* ; Male ; Obesity ; Risk Factors ; Smoke ; Smoking