Background and Objectives: Preoperative assessment is one of the most important fields in surgery and anesthesia as it can reduce morbidity and mortality from surgery and detect abnormal findings not clinically observed through preoperative examination. However, excessive non-vital preoperative routine tests have been criticized. The aim of the study is to investigate the current use of elective preoperative evaluations using otorhinolaryngologic surgery covering patients of all ages with various levels of difficulty.Subjects and Method Using the Korean National Health Insurance Service National Sample Cohort data, we investigated 98890 subjects who underwent otorhinolaryngologic surgery during the year 2018. We evaluated sociodemographic characteristics, clinical characteristics, medical institutions, and operation characteristics of the subjects and analyzed in detail their routine blood and urine test items, sonographic exams and pulmonary function tests. Results: There were differences in the implementation of preoperative blood and urine tests, sonographic exams and pulmonary function tests according to sociodemographic characteristics, types and locations of medical institutions. Old age, low socioeconomic status, comorbid condition, high Charlson’s Comorbidity Index, tertiary hospital were the factors that increased preoperative evaluation tests. Conclusion Appropriate preoperative evaluation is needed for predicting and preparing for the possibility of treatment complications as well as improving treatment quality while reducing costs for perioperative management.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*

PURPOSE: To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. MATERIALS AND METHODS: Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. RESULTS: The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p = 0.10 and p = 0.62, respectively). CONCLUSION: The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.
Chemoradiotherapy ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Rectal Neoplasms ; Retrospective Studies

PURPOSE: Acute appendicitis is the most common disease requiring abdominal surgery, but for atypical clinical findings, a preoperative diagnosis is difficult and the frequency of a false positive and false negative diagnosis is high. The authors compared the diagnostic accuracy of a Technetium-99m-ciprofloxacin scan with that of the other diagnostic tools and evaluated its potential for clinical applications. METHODS: Seventeen patients were among those patients who visited the emergency room due to right lower quadrant (RLQ) pain were selected for this study. The decision for primary treatment was based on the clinical findings (RLQ pain, nausea, tenderness, rebound tenderness, leukocytosis, etc) and the radiological findings (abdominal ultrasonogram, abdominal computed tomography, etc). The 99mTc-ciprofloxacin scan was conducted regardless of the decision above. For the patients who underwent surgery, the final diagnosis of acute appendicitis was based on the pathologic result and for patients who did not undergo surgery, the final diagnosis was determined by the clinical course. RESULTS: Seventeen patients were enrolled in this study (7 males, 10 females). The patient's age ranged from 8 to 71 years and the average age was 29.2 years. The diagnostic accuracy of acute appendicitis is presented in order of the clinical findings, the radiological findings and the 99mTc- ciprofloxacin scan as follows: The sensitivity was 100%, 90.9% and 100%; the specificity rates was 33.3%, 50% and 67%; the positive predictive value was 87.5%, 90.9% and 93%; the negative predictive values was 100%, 50% and 100%; the false positive rate was 66.7%, 50% and 33.3%; the false negative rate was 0%, 9% and 0%. The respective p-values for the correlation between these results and the final diagnosis were 0.021, 0.049 and 0.002. CONCLUSION: A 99mTc-ciprofloxacin scan can decrease the false positive and the false negative rate and increase the diagnostic accuracy of acute appendicitis patients.
Appendicitis* ; Ciprofloxacin ; Diagnosis* ; Emergency Service, Hospital ; Humans ; Leukocytosis ; Male ; Nausea ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. MATERIALS AND METHODS: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. RESULTS: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. CONCLUSION: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.
Breast Neoplasms* ; Breast* ; Education ; Geography ; Humans ; Incidence ; Korea* ; Mastectomy, Radical ; Mastectomy, Segmental ; Radiotherapy

We report cases of two patients with acute generalized exanthematous pustulosis(AGEP). One patient had localized cutaneous infection and the other rhinoplasty. Both were being treated with ampicillin and developed intense erythemas followed by generalized subcorneal pustulation associated with fever and a neutrophilic leukocytosis. Histopathological findings were subcorneal spongiform pustules showing preponderance of polymorphonuclear leukocytes. Generalized pustular psoriasis, subcorneal pustular dermatosis, impetigo and pemphigus foliaceus should be differentiated from AGEP. The causative drug in both of our cases was ampicillin and fast resolution of pustules was observed with a low dosage of systemic steroid within 5 days.
Acute Generalized Exanthematous Pustulosis* ; Ampicillin* ; Erythema ; Fever ; Humans ; Impetigo ; Leukocytosis ; Neutrophils ; Pemphigus ; Psoriasis ; Rhinoplasty ; Skin Diseases, Vesiculobullous

We report a case of a 41-year-old female with acrogeria. She was in good health except for the prominent atrophy over the hands and feet. On microscopic examination of a biopsy specimen from the atropl6c skin, elastic fibers were clumped and fragmented. Electronmicroscopy revealed amorphous and granulous pseudoelastin, which is presumed to be consistent with acrogeria. Our patient had acro-osteolysis and an extra chromosome in addition to the normal 23 pairs of chromosomes in one of 20 cells examined, which have been very rarely reported in the literature. Further studies are needed to find out whether this chromosomal aberration might contribute to the pathogenesis.
Acro-Osteolysis ; Adult ; Atrophy ; Biopsy ; Chromosome Aberrations ; Elastic Tissue ; Female ; Foot ; Hand ; Humans ; Skin

Chronic dermatophyte infection rarely fails to respond to topical or systemic antifungal therapy. Such refractory condition relates to many factors and one of them is the decreased response of delayed type hypersensitivity. A plausible mechanism by which the delayed hypersensitivity response may cause dermatophyte inhibition has been proposed already. Our patient had skin rashes for 6 years. It was diagnosed as tinea corporis and treated with various systemic antifungal agents, such as griseofulvin, itraconazole, fluconazole, terbinafine and topical forms of econazole and terbinafine. But the skin lesions did not resolve completely and reaggravated frequently. Numerous verrucae planar were found on face, neck and both extremities. Trichophyton rubrum was identified by fungus culture study. Laboratory examination showed no response against multi-CMI test, DPCP sensitization and prick test for trichophytons. We challenged the therapy with the combined antifungal agents and immune stimulatory drugs. This case is thought to be a chronic dermatophyte infection due to the defects in the both cell mediated immunity and immediate type hypersensitivity which is crucial for the host defence mechanisms against fungal infection.
Antifungal Agents* ; Arthrodermataceae* ; Econazole ; Exanthema ; Extremities ; Fluconazole ; Fungi ; Griseofulvin ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Immunity, Cellular ; Itraconazole ; Neck ; Skin ; Tinea ; Trichophyton ; Warts

No abstract available.
Lip* ; Ulcer*

No abstract available.
Lip* ; Ulcer*