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.

PURPOSE: The Korean Hereditary Tumor Registry, the first and one of the largest registries of hereditary tumors in Korea, has registered about 500 families with hereditary cancer syndromes. This study evaluates the temporal changes in clinicopathologic features and surgical patterns of Lynch syndrome (LS) patients. MATERIALS AND METHODS: Data on 182 unrelated LS patients were collected retrospectively. The patients were divided into the period 1 group (registered in 1990-2004) and 2 (registered in 2005-2014). The clinical characteristics of the two groups were compared to identify changes over time. RESULTS: The period 1 group included 76 patients; the period 2 group, 106 patients. The mean ages at diagnosis were 45.1 years (range, 13 to 85 years) for group 1 and 49.7 years (range, 20 to 84 years) for group 2 (p=0.015). The TNM stage at diagnosis did not differ significantly-period 1 group: stage 0-I (n=18, 23.7%), II (n=37, 48.7%), III (n=19, 25.0%), and IV (n=2, 2.6%); period 2 group: stage 0-I (n=30, 28.3%), II (n=35, 33.0%), III (n=37, 34.9%), and IV (n=4, 3.8%). Extended resection was more frequently performed (55/76, 72.4%) in the period 1 group than period 2 (49/106, 46.2%) (p=0.001). CONCLUSION: Colorectal cancer in patients with LS registered at the Korean Hereditary Tumor Registry is still diagnosed at an advanced stage, more than two decades after registry's establishment. Segmental resection was more frequently performed in the past decade. A prompt nationwide effort to raise public awareness of hereditary colorectal cancer and to support hereditary cancer registries is required in Korea.
Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis* ; Diagnosis ; Humans ; Korea ; Neoplastic Syndromes, Hereditary ; Registries ; Retrospective Studies

Dieulafoy's disease of the bronchus is rare but potentially life-threatening, and should be considered in patients with massive hemoptysis, especially from unknown etiology. We report a case of a patient with massive hemoptysis due to bronchial Dieulafoy's disease. He underwent bronchial artery embolization and surgical resection, and the post-operative specimen revealed dilated and tortuous arteries in the submucosa that presented as Dieulafoy's disease of the bronchus.
Arteries ; Bronchi ; Bronchial Arteries ; Hemoptysis ; Humans

PURPOSE: This study was performed to compare the characteristics and perceptions of medical school students and professional graduate medical school students. METHODS: Study subjects were 131 medical students from a national university and 113 applicants of a professional graduate medical school. We developed a self-reported questionnaire asking about socio-demographic characteristics; the level of satisfaction of educational environment; perception of missions of medical education and career plan and student activities during school. RESULTS: Students from the professional graduate medical school were significantly different from medical students in socio-demographic characteristics. They also showed higher satisfaction with their education, were more supportive of student union activities and were more anxious about economic and health problems than medical students. However, there was no difference between the two groups regarding perception of missions of medical education and career plan after graduation. CONCLUSION: Based on the above results, it is necessary to consider the characteristics and perceptions of professional graduate medical students when developing educational policies for these older students. The limitation of this study includes a restricted sample, and generalization of results should be done carefully. Thus, more extensive, wide-ranging studies would be useful.
Education ; Education, Medical ; Generalization (Psychology) ; Humans ; Missions and Missionaries ; Schools, Medical* ; Students, Medical ; Surveys and Questionnaires

Theophylline has been widely used in the treatment of asthma and chronic obstructive lung disease. To date, there have been very few reports on hepatotoxicity due to theophylline. We diagnosed, through biochemical testing and a liver biopsy, a case of acute cholestatic hepatitis developed after oral consumption of theophylline. A 43 year-old man was admitted to the department of internal medicine due to jaundice and pruritus which developed after ten days administration of oral theophylline (Etheophyl ). Liver function tests showed elevated serum bilirubin at 13.2 mg/dL with AST and ALT of 71 U/L and 194 U/L. Alkaline phosphatase and gamma-GTP were also elevated at 175 U/L and 301 U/L. There was no evidence of viral or autoimmune hepatitis in laboratory tests. The patient's symptoms and liver function tests were improved after conservative treatment. After 9 months oral theophylline was readministered for the control of relapsed asthma. Then, jaundice and pruritus again developed again. A liver biopsy showed a few lymphocytes and eosinophilic inflammatory cell infiltration in portal tract and cholestasis in the lobule. Drug-induced hepatitis was diagnosed with a typical clinical course; the exclusion of all possible causes of acute hepatic dysfunction; and a positive response to accidental readministration of drug. We report this case with a review of the literature.
Adult ; Alkaline Phosphatase ; Asthma ; Bilirubin ; Biopsy ; Cholestasis ; Drug-Induced Liver Injury ; Eosinophils ; Hepatitis* ; Hepatitis, Autoimmune ; Humans ; Internal Medicine ; Jaundice ; Liver ; Liver Function Tests ; Lymphocytes ; Pruritus ; Pulmonary Disease, Chronic Obstructive ; Theophylline

Because US plays a key role in the initial evaluation of hepatic hemangiomas,knowledge of the entire spectrum of US appearances of these tumors is impor-tant. Most hemangiomas have a distinctive US appearance, and even with those with atypical appearances on conventional gray-scale US, specific diagnoses can be made using pulse-inversion harmonic US with contrast agents. In this essay,we review the spectrum of US appearances of hepatic hemangiomas on conven-tional gray-scale, power Doppler, and pulse-inversion harmonic US with contrast agents.
Adult ; Aged ; Contrast Media ; Female ; Hemangioma/*ultrasonography ; Human ; Liver Neoplasms/*ultrasonography ; Male ; Middle Age ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

PURPOSE: To describe the radiologic features of computed tomography(CT) in hepatocelluar carcinoma(HCC) with bile duct involvement. MATERIALS AND METHODS: We retrospectively analyzed the two phase spiral CT findings of 31 patients in whom HCC with bile duct invasion (n=28) or compression (n=3), was diagnosed. Eight of these underwent follow-up CT after transarterial chemoembolization. We analyzed the size, type, location, enhancement pattern, and lipiodol retention of parenchymal and intraductal masses, as well as their and lymphadenopathy. RESULTS: In all patients with bile duct invasion, single or multiple masses were demonstrated in the bile ducts. Intraductal masses showed the same enhancement characteristics as the parenchymal mass (kappa 0.550, p < .001), and were contiguous to this mass. In 14 of 28 patients, intraductal masses filled the peripheral intrahepatic bile ducts and extended to the common bile ducts. In the other 14, the parenchymal mass extended to the area of the porta hepatis and then directly invaded the large ducts. In nine of the 28 patients, there was a hypoattenuated cleft between the intraductal mass and ductal wall. In six, a parenchymal mass was not apparent (n = 2), or was smaller than 2cm (n = 4). In five of eight patients (62.5%), follow-up CT after transarterial chemoembolization showed compact or partial lipiodol retention within the intraductal mass. In patients with bile duct compression, perihilar lymph nodes were noted along with the dilated intrahepatic duct but no intraductal mass was demonstrated in the duct. CONCLUSION: Hepatocellular carcinomas cause bile duct dilatation either by direct invasion or by extrinsic compression of the bile duct with surrounding enlarged nodes. For the diagnosis of this condition, CT is helpful.
Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Carcinoma, Hepatocellular* ; Common Bile Duct ; Diagnosis ; Dilatation ; Ethiodized Oil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Retrospective Studies ; Tomography, Spiral Computed

PURPOSE: To compare the accuracy of computed tomography (CT) with that of digital subtraction angiography (DSA) in predicting the resectability of Klatskin tumor on the basis of vascular invasion. MATERIALS AND METHODS: Twenty-five patients with Klatskin tumor who had undergone laparotomy were in-cluded in this study. In order to assess the surgical resectability of their tumors, the preoperative CT scans and DSA of these patients were retrospectively assessed in terms of vascular invasion. The criteria of unresectability were tumoral invasion of the proper hepatic artery or main portal vein, or simultaneous invasion of the hepatic artery on one side and the other side portal vein. RESULTS: Tumors were unresectable in 13 cases, and resectable in 12. CT and DSA predicted nine and three tumors as unresectable ones, respectively. The sensitivity, specificity, positive predictive value, negative predic-tive value and accuracy of CT in determining whether a tumor was unresectable were 61.5 %, 91.7%, 88.9 %, 6 8 .8 % and 76.0 %, respectively. For DSA, the respective figures were 23.1 %, 100 %, 100 %, 54.5 % and 6 0 .0 %. For the detection of vascular invasion without diameter change, CT was superior to DSA; for the evaluation of vascular anatomy, it was, however, less effective. CT failed to detect small hepatic metastasis (n=2), lymph node metastasis (n=1), variation of the bile duct (n=1), and the distal extent of tumor in the bile duct (n=1), factors which precluded surgical resection. CONCLUSION: CT is a reliable method for the detection of vascular invasion and tumor unresectability. For the detection of vascular anatomic variation, the combined use of CT and DSA would be helpful.
Anatomic Variation ; Angiography ; Angiography, Digital Subtraction* ; Bile Ducts ; Hepatic Artery ; Humans ; Klatskin's Tumor* ; Laparotomy ; Lymph Nodes ; Neoplasm Metastasis ; Portal Vein ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Peritoneal calcification, which can lead to intestinal obstruction and potentially lethal hemoperitoneum, is a rare complication of continuous ambulatory peritoneal dialysis. We describe a case in which extensive peritoneal calcification had arisen for this reason. Although the patient was asymptomatic, extensive calcification was present on the parietal and visceral peritoneum, including the hepatic and splenic surface.
Dialysis ; Hemoperitoneum ; Humans ; Intestinal Obstruction ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritoneum ; Rabeprazole

We report a case with low-grade MALT lymphoma of the rectum in a 32-year-old man. Primary lymphoma of thecolon is rare and comprises less than 1 % of large bowel malignancies. Recently, large part of colonic lymphomahave been shown to be MALT lymphoma, which is a distinct type of B-cell lymphoma. The radiologic findings of thiscase are mucosal nodularity with shallow ulcers in the rectum, as seen on bar-ium enema, and rectal wallthickening, as seen on CT. There was no evidence of intra-abdominal lym-phadenopathy nor hepatosplenomegaly. Suchradiologic findings are rather similar to the findings in cases of inflammatory bowel disease, rending thedifferential diagnosis difficult.
Adult ; Colon ; Diagnosis ; Enema ; Humans ; Inflammatory Bowel Diseases ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone* ; Rectum* ; Ulcer