Clinical characteristics and treatment propensity in elderly patients aged over 80 years with colorectal cancer

BACKGROUND/AIMS: Elderly patients (≥ 80 years) with colorectal cancer (CRC) tend to avoid active treatment at the time of diagnosis despite of recent advances in treatment. The aim of this study was to determine treatment propensity of elderly patients aged ≥ 80 years with CRC in clinical practice and the impact of anticancer treatment on overall survival (OS). METHODS: Medical charts of 152 elderly patients (aged ≥ 80 years) diagnosed with CRC between 1998 and 2012 were retrospectively reviewed. Patients’ clinical characteristics, treatment modalities received, and clinical outcome were analyzed. RESULTS: Their median age was 82 years (range, 80 to 98). Of 152 patients, 148 were assessable for the extent of the disease. Eighty-two of 98 patients with localized disease and 28 of 50 patients with metastatic disease had received surgery or chemotherapy or both. Surgery was performed in 79 of 98 patients with localized disease and 15 of 50 patients with metastatic disease. Chemotherapy was administered in only 24 of 50 patients with metastatic disease. Patients who received anticancer treatment according to disease extent showed significantly longer OS compared to untreated patients (localized disease, 76.2 months vs. 15.4 months, p = 0.000; metastatic disease, 9.9 months vs. 2.6 months, p = 0.001). Along with anticancer treatment, favorable performance status (PS) was associated with longer OS in multivariate analysis of clinical outcome. CONCLUSIONS: Elderly patients aged ≥ 80 years with CRC tended to receive less treatment for metastatic disease. Nevertheless, anticancer treatment in patients with favorable PS was effective in prolonging OS regardless of disease extent.

Different Pattern of Chronic Obstructive Pulmonary Disease Assessment Test Score between Chronic Bronchitis and Non-chronic Bronchitis Patients / 결핵및호흡기질환

BACKGROUND: Chronic bronchitis (CB) is an important phenotype in chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate different pattern of COPD assessment test (CAT) score between CB and non-CB patients. METHODS: Patients were recruited from 45 centers in Korea, as part of the Korean COPD Subgroup Study cohort. CB was defined when sputum continued for at least 3 months. RESULTS: Total 958 patients with COPD were eligible for analysis. Among enrolled patients, 328 (34.2%) were compatible with CB. The CAT score was significantly higher in patients with CB than non-CB, and each component of CAT score showed a similar result. CB was significantly associated with CAT score when adjusted with age, sex, modified Medical Research Council, and post-bronchodilator forced expiratory volume in 1 second. Each component of CAT score between patients with CB and non-CB showed different pattern according to Global Initiative for Chronic Obstructive Lung Disease grade. CONCLUSION: CAT score is significantly higher in patients with CB than non-CB. Each component of CAT score was significantly different between two groups.

The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital / 대한중환자의학회지

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital / 대한구급학회지

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

Afatinib-Induced Acute Fatal Pneumonitis in Metastatic Lung Adenocarcinoma / 가정의학회지

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.

Afatinib-Induced Acute Fatal Pneumonitis in Metastatic Lung Adenocarcinoma / 가정의학회지

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.

Multiple Cavitary Pulmonary Nodules Caused by Mycobacterium intracellulare / 가정의학회지

Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.

Two Cases of Primary Esophageal Diffuse Large B Cell Lymphoma: Therapeutic Considerations and a Literature Review / 대한내과학회지

Primary esophageal lymphoma is very rare, and most reported cases are histologically mucosa-associated lymphoid tissue lymphoma. Therefore, the principle treatment strategy for primary esophageal lymphoma focuses on local treatments, such as endoscopic mucosal resection or radiation therapy, but systemic chemotherapy plays the central role in the treatment of diffuse large B cell lymphoma (DLBCL). Generally, standard treatment for DLBCL is six or three cycles of R-CHOP chemotherapy followed by involved field radiation therapy according to stage. However, the optimal treatment strategy for primary esophageal DLBCL, and the role of additional radiation is not settled, due to a paucity of cases. Moreover, the clinical characteristics related to the etiology and natural course are also unknown. Here, we present two cases of primary esophageal DLBCL with a literature review.

Necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis treated with delayed operation / 영남의대학술지

Portal vein gas and pneumatosis cystoides intestinalis are uncommon conditions and have been associated with poor prognosis. They are most commonly caused by necrotizing enterocolitis but may have other causes, and they can be associated with necrotizing and ischemic colitis, intra-abdominal abscess, small bowel obstruction, diverticulitis, colon cancer, and acute pancreatitis. With the more frequent use of computed tomography (CT) scans, portal vein gas and pneumatosis cystoides intestinalis have been increasingly detected in recent years. Because of its high mortality rate, necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis may be treated with emergent exploratory laparotomy. We report a case of necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis in a 47-year-old man treated with intensive medical management and delayed operation due to unstable condition and surgical mortality. He had good clinical results without complications after the delayed operation.

JAK2 V617F-positive polycythemia vera accompanied by renal artery stenosis

No abstract available.

Trichinosis Caused by Ingestion of Raw Soft-Shelled Turtle Meat in Korea

Reptiles, unlike mammals, have been considered to be unsuitable hosts of Trichinella spp., though larvae have been detected in their muscles and human outbreaks related to their consumption have, in fact, occurred. Herein we report 2 Korean cases of trichinosis, possibly transmitted via consumption of reptile meat. Both patients suffered from myalgia, headache, and facial edema. Laboratory examinations revealed leukocytosis with eosinophilia (54% and 39%, respectively) and elevated creatinine phosphokinase. ELISA was performed under the suspicion of trichinosis, showing positivity at the 29th and 60th day post-infection. Since they had consumed raw soft-shelled turtle meat, turtle was strongly suggested to be an infection source of trichinosis in Korea next to the wild boar and badger.

Comparative enamel bond strength between light- and dual-cured composites bonded by self-etching adhesives / 대한치과보존학회지

This study compared the microshear bond strength (microSBS) of light-cured and dual-cured composites to enamel bonded with three self-etching adhesives. Crown segments of extracted human molars were cut mesiodistally, and 1 mm thickness of specimen was made. They were assigned to three groups by used adhesives: Xeno group (Xeno III), Adper group (Adper Prompt L-Pop), and AQ group (AQ Bond). Each adhesive was applied to cut enamel surface as per manufacturer's instruction. Light-cured (Filtek Z 250) or dual-cured composite (Luxacore) was bonded to enamel of each specimen using Tygon tube. After storage in distilled water for 24 hours, the bonded specimens were subjected to microSBS testing with a crosshead speed of 1 mm/minute. The mean microSBS (n = 20 for each group) was statistically compared using two-way ANOVA, Tukey HSD, and t test at the 0.05 probability level. The results of this study were as follows; 1. The microSBS of light-cured composite was significantly higher than that of dual-cured composite when same adhesive was applied to enamel. 2. For Z 250, the microSBS of AQ group (9.95 +/- 2.51 MPa) to enamel was significantly higher than that of Adper goup (6.74 +/- 1.80 MPa), but not significantly different with Xeno group (7.73 +/- 2.01 MPa). 3. For Luxacore, the microSBS of Xeno group (5.19 +/- 1.32 MPa) to enamel was significantly higher than that of Adper goup (3.41 +/- 1.19 MPa), but not significantly different with AQ group (4.50 +/- 0.96 MPa).

Influence of appication time of self-etching primers on dentinal microtensile bond strength / 대한치과보존학회지

This study evaluated the influence of application time of self-etching primers on microtensile bond strength (microTBS) to dentin using three self-etching primer adhesive systems. Dentin surfaces were exposed from forty-eight human molars. They were conditioned with three self-etching primers (Clearfil SE Bond [SE], Unifil Bond [UF], Tyrian SPE + One Step Plus [TY]) and different primining times (10s, 20s, 30s and 40s). Composite resins were bonded to dentin surfaces and specimens were made. microTBS was tested and statistically compared using by one-way ANOVA and Tukey's Test The results of this study presented that priming time for 10s in SE and UF groups and for 30s and 40s in TY group was highly decreased microTBS to dentin.

Effect of rewetting agent on dentinal microtensile bond strength / 대한치과보존학회지

This study investigated that the effect of rewetting agent on dentinal microtensile bond strength (microTBS). Human molars were sectioned to expose the superficial dentin surfaces. Samples were divided into two groups according to type of adhesives-Single Bond (S) and One-Step (O)], and again subdivided into five groups by different dentin surface treatment-dry for 15s (D), blot dry (BD) or dry for 15s, and rewet with different rewetting agents [distilled water (DW), Gluma Desensitizer (GD) and Aqua-Prep (AP)] for 30s. After application of adhesive, composite resin was built up on the bonding surface. Each tooth was sectioned to obtain stick with 1 mm2 cross sectional area and the microTBS was determined by EZ test. In the S group, the mean microTBS of GD, AP and BD group was significantly higher than that of DW and D group (p < 0.05). In the O group, the mean microTBS of AP, GD, BD and DW group was significantly higher than that of D group (p < 0.05). The data suggested that Gluma Desensitizer and Aqua-Prep could be successfully used as rewetting agents, and Distilled water could be acceptable in aceton based adhesive system only.

Marginal microleakage of single step adhesives / 대한치과보존학회지

This study evaluated the marginal microleakage of five single step adhesives. Class V cavity preparations with occlusal margins in enamel and gingival margins in dentin were prepared on both buccal and lingual surfaces of extracted human molar teeth. Prepared teeth were randomly divided into five groups and restored using one of the single step adhesives and composite resins: Prompt L-Pop/Filtek Z-250 (Group 1), AQ Bond/Metafil CX (Group 2), One-Up Bond F/Palfique Toughwell (Group 3), Futurabond/Admira (Group 4), Xeno III/Spectrum TPH (Group 5). The restored teeth were thermocycled. Microleakage was assessed by dye penetration using 2% methylene blue dye solution. The teeth were bisected buccolingually and evaluated for microleakage under steromicroscope. The data were statistically analysed by Kruskal-Wallis test and Mann-Whitney tests. The results of this study were as follows; 1. Microleakage of enamel margins in group 3 was statistically higher than that in groups 1, 2, 4, 5 (p < 0.05). 2. Microleakage of dentin margins in group 1 was statistically higher than that in groups 2, 5, and that in group 3 was statistically higher than that in groups 2, 4, 5 (p < 0.05). 3. Dentin marginal microleakage was higher than enamel marginal microleakage in all experimental groups. In conclusion, Prompt L-Pop showed the least leakage at enamel margin, and AQ Bond showed at dentin margin in this study. Marginal miroleakage in dentin was higher than that in enamel.

Effect of wetness on the enamel bonding / 대한치과보존학회지

This study evaluated the microleakage and interfacial gap between enamel and composite resin under the dry and wet condition of the enamel surface. V shaped class 5 cavities were prepared on the occlusal portion of extracted human molars. Samples were divided into three groups: D group (air dry for 10-15 s), BD group (blot dry with moist cotton pellet), and DR group (air dry for 10-15 s and rewet with Aqua-Prep F for 20 s). Cavities were filled using Aelitefil composite resin after applied One-Step. Microleakage was tested by 2% methylene blue dye solution and the data were statistically analysed by Kruskal-Wallis test and Mann-Whitney test. Also Enamel-resin interface was observed under SEM. Group BD showed statistically lower microleakage than group D (p 0.05). At the enamel-resin interface, group D showed the gap of 2 microm thickness, but group BD and DR showed close adaptation. In conclusion, the use of blot dry and rewetting agent (Aqua-Prep F) resulted in decreased microleakage and improved adhesion between enamel and resin when using One-Step.

The effect of delayed composite resin filling on microtensile bond strength / 대한치과보존학회지

The purpose of this study was to evaluate the effect of immediate or delayed composite resin filling on dentinal microtensile bond strength (microTBS) after applied the adhesive. The coronal dentin of human third molars was exposed. Single-Bond or One-Step was applied on the dentin surfaces, and composite resin were constructed immediately (group 1) or 5 min., 10 min., 15 min., 20 min. and 30 min. (groups 2-6) after an adhesive was applied. The specimens were sectioned and made bar-shaped. Each surface area of them was about 1mm2. The microTBS test was performed by EZ test. The results were analysed by One-way ANOVA and Tukey's test at 95% significance level. The results suggested that the microTBS of Single-Bond to dentin was decreased when the composite resin was constructed 20 min. and 30 min. after Single-Bond was applied. But the microTBS of One-Step was not affected by delayed composite resin filling.