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.

Objective: To investigate the antibacterial activity of SHH extracted with either water or ethanol against methicillin-resistant Staphylococcus aureus (MRSA) and combinatory antimicrobial effect with ciprofloxacin (CIP) by time kill assay and checkerboard dilution test. Methods: The antibacterial activity determined by broth dilution method indicated that the antibacterial activity of Sami-Hyanglyun-Hwan (SHH) water extract (SHHW) and SHH ethanol extract (SHHE) ranged from 250 to 2. 000 μg/mL and 125 to 1. 000 μg/mL against MRSA, respectively. Results: In the checkerboard method, the combinations of SHHE with CIP had a partial synergistic or synergistic effect against MRSA. The time-kill curves showed that a combined SHHE and CIP treatment reduced the bacterial counts dramatically after 24 h. Conclusions: The present study demonstrates the therapeutic ability of SHHE against MRSA infections.

Alternative sources of mesenchymal stem cells (MSCs) for replacing bone marrow (BM) have been extensively investigated in the field of bone tissue engineering. The purpose of this study was to compare the osteogenic potential of canine MSCs derived from adipose tissue (AT), BM, umbilical cord blood (UCB), and Wharton's jelly (WJ) using in vitro culture techniques and in vivo orthotopic implantation assays. After canine MSCs were isolated from various tissues, the proliferation and osteogenic potential along with vascular endothelial growth factor (VEGF) production were measured and compared in vitro. For the in vivo assay, MSCs derived from each type of tissue were mixed with beta-tricalcium phosphate and implanted into segmental bone defects in dogs. Among the different types of MSCs, AT-MSCs had a higher proliferation potential and BM-MSCs produced the most VEGF. AT-MSCs and UCB-MSCs showed greater in vitro osteogenic potential compared to the other cells. Radiographic and histological analyses showed that all tested MSCs had similar osteogenic capacities, and the level of new bone formation was much higher with implants containing MSCs than cell-free implants. These results indicate that AT-MSCs, UCB-MSCs, and WJ-MSCs can potentially be used in place of BM-MSCs for clinical bone engineering procedures.
Adipocytes, White/cytology/physiology ; Alkaline Phosphatase/metabolism ; Animals ; Biocompatible Materials/metabolism/*therapeutic use ; Bone Diseases/*therapy ; Bone Marrow Cells/cytology/physiology ; Calcification, Physiologic ; Calcium/metabolism ; Calcium Phosphates/metabolism/therapeutic use ; Cell Proliferation ; Dogs ; Female ; Fetal Blood/cytology/physiology ; Flow Cytometry ; Male ; Mesenchymal Stromal Cells/cytology/*metabolism ; *Osteogenesis ; Polyesters/metabolism/therapeutic use ; Tissue Engineering/*methods ; Vascular Endothelial Growth Factor A/metabolism

Anesthesia and surgery in a patients with undiagnosed or untreated hypothyroidism can carries the risk of potential complications such as prolonged unconsciousness, respiratory insufficiency, hypotension, hyponatremia, congestive heart failure, and even coma. A 33-year-old gravida was admitted at 36 weeks gestation with hypertension, proteinuria, generalized edema, and intrauterine fetal growth retardation. She had thyroidectomy for thyroid mass six years ago. Because of doubt of uterine abruption, emergency cesarean section was performed without result of thyroid function test. Preeclamsia and mild hypothyroidism show similar symptoms and it can make difficult to diagnose hypothyroidism. We experienced delayed recovery and respiratory insufficiency in a patient with preeclamsia and undetected hypothyroidism during emergence from general anesthesia. She was fully recovered after ventilatory care in intensive care unit.
Adult ; Anesthesia ; Anesthesia, General ; Cesarean Section ; Coma ; Edema ; Emergencies ; Female ; Fetal Growth Retardation ; Heart Failure ; Humans ; Hypertension ; Hyponatremia ; Hypotension ; Hypothyroidism ; Intensive Care Units ; Pregnancy ; Proteinuria ; Respiratory Insufficiency ; Thyroid Function Tests ; Thyroid Gland ; Thyroidectomy ; Unconsciousness

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.
Blood Volume ; Brain ; Constriction, Pathologic ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Stroke ; Thymine Nucleotides

BACKGROUND AND PURPOSE: Cilostazol, a phosphodiesterase III inhibitor, is known to be a useful antiplatelet agent that inhibits the progression of atherosclerosis in ischemic stroke. This study investigated the effects of combining cilostazol with aspirin on the expressions of P-selectin and PAC-1 on activated platelets in acute ischemic stroke. METHODS: We analyzed 70 patients with acute ischemic stroke (<72 hrs of an ischemic event). The daily intake was 100 mg of aspirin in 37 patients and 100 mg of aspirin plus 200 mg of cilostazol in 33 patients. The expressions of P-selectin and PAC-1 on activated platelets were measured on the day of admission and 5 days later. We also evaluated the clinical progression using the National Institutes of Health Stroke Scale (NIHSS) at the same times. RESULTS: After 5 days the extent of PAC-1 expression on activated platelets was significantly lower for combined aspirin and cilostazol treatment (61.0+/-19.3%, p=0.008; mean+/-standard deviation) than the baseline level (70.9+/-12.9%), but did not differ between aspirin alone (66.0 +/-19.0%) and baseline (70.1+/-15.7%). The expression of P-selectin did not differ between combined aspirin and cilostazol treatment and baseline. The clinical progression did not differ between the two groups, as indicated by the absence of significant changes on the NIHSS in the acute period. CONCLUSIONS:This study found that the combined regimen of aspirin and cilostazol exerts the beneficial effect of reducing PAC-1 activity on activated platelets in acute ischemic stroke. However, the clinical outcome of this regimen was no better than that of the aspirin-only regimen. Therefore, further detailed studies of the possible clinical benefits of cilostazol in acute ischemic stroke are needed.
Aspirin ; Atherosclerosis ; Blood Platelets ; Cyclic Nucleotide Phosphodiesterases, Type 3 ; Humans ; National Institutes of Health (U.S.) ; P-Selectin ; Stroke ; Tetrazoles

OBJECTIVE: To evaluate the early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: The RF ablation treatment was performed on 17 tumors from 16 patients (mean age, 60.5 years; range, 43-73 years) with RCC. The treatment indications were localized, solid renal mass, comorbidities, high operation risk, and refusal to perform surgery. All tumors were treated by a percutaneous CT (n = 10), followed by an US-guided (n = 2), laparoscopy-assisted US (n = 2), and an open (n = 2) RF ablation. Furthermore, patients underwent a follow-up CT at one day, one week, one month, three and six months, and then every six months from the onset of treatment. We evaluated the technical success, technical effectiveness, ablation zone, benign periablation enhancement, irregular peripheral enhancement, and complications. RESULTS: All 17 exophytic tumors (mean size, 2.2 cm; range, 1.1-5.0 cm) were completely ablated. Technical success and effectiveness was achieved in all cases and the mean follow-up period was 23.8 months (range, 17-33 months). A local recurrence was not detected in any of the cases; however, five patients developed complications as a result of treatment, including hematuria (n = 2), mild thermal injury of the psoas muscle (n = 1), mild hydronephrosis (n = 1), and fistula formation (n = 1). CONCLUSION: The RF ablation is an alternative treatment for exophytic RCCs and represents a promising treatment for some patients with small RCCs.
Adult ; Aged ; Carcinoma, Renal Cell/radiography/*surgery ; *Catheter Ablation/adverse effects ; Female ; Humans ; Kidney Neoplasms/radiography/*surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

Probably the three most important components to a comprehensive evaluation of patients with attention-deficit hyperactivity disorder(ADHD) are the clinical interview, the medical examination, and the completion and scoring of behavior rating scales. Teachers and other school personnel are often the first to recognize that a child or adolescent might have ADHD, and often play an important role in the help-seeking/referral process. A diagnostic evaluation for ADHD should include questions about ADHD symptoms, other problems including alcohol and drug use, family history of ADHD, prior evaluation and treatment for ADHD. Screening interview or rating scales as well as interviews should be used. When it is feasible, clinicians may wish to supplement these components of the evaluation with objective assessments of the ADHD symptoms, such as psychological tests. These tests are not essential to reaching a diagnosis, however, or to treatment planning, but they may yield further information about the presence and severity of cognitive impairments that could be associated with some cases of ADHD. Screening for intellectual ability and academic achievement skills is also important in determining the presence of comorbid developmental delay or learning disabilities. The number and type of symptoms required for a diagnosis of ADHD vary depending on the specific subtype. To receive a diagnosis of ADHD, the person must be experiencing significant distress or impairment in daily functioning, and must not meet criteria for other mental disorders which might better account for the observed symptoms such as mental retardation, autism or other pervasive developmental disorders, mood disorders, anxiety disorders. This report aims to suggest a practice guideline of assessment and diagnosis for children and adolescents with ADHD in Korea.
Adolescent ; Anxiety Disorders ; Autistic Disorder ; Child ; Diagnosis* ; Humans ; Intellectual Disability ; Korea ; Learning Disorders ; Mass Screening ; Mental Disorders ; Mood Disorders ; Psychological Tests ; Weights and Measures

Parathyroid carcinoma is an uncommon cause of PTH-related hypercalcemia with a reported incidence of 0.4% to 5% of all cases of primary hyperparathyroidism. Even though the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma than in those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma preoperatively. Parathyroid carcinomas are usually larger and firmer than parathyroid adenomas and patients with parathyroid carcinoma have a higher incidence of renal dysfunction, bone disease and gastrointestinal symptoms. Anemia is an uncommon clinical feature of parathyroid carcinoma. There have been no prior cases of ectopic parathyroid carcinomas reported to date. In this article, we report the case of a 26-year-old man who developed severe anemia and acute renal failure due to an ectopic parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. His serum calcium levels returned to normal and the anemia resolved postoperatively.
Acute Kidney Injury ; Adenoma ; Adult ; Anemia* ; Bone Diseases ; Calcium ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Incidence ; Parathyroid Neoplasms* ; Renal Insufficiency*