Economic Evaluation of Rosuvastatin and Atorvastatin for the Treatment of Dyslipidemia from a Korean Health System Perspective

OBJECTIVE: This study aims to analyze cost-effectiveness of two most-commonly used statins from the perspective of the Korean national health system. METHODS: The scope of the analysis included rosuvastatin (5 mg, 10 mg, and 20 mg) and atorvastatin (10 mg, 20 mg, 40 mg, and 80 mg). Effectiveness was defined as percentage (%) and absolute (mg/dL) reductions of low-density lipoprotein cholesterol (LDL-C) from the baseline. They were derived from published randomized controlled studies for rosuvastatin and atorvastatin. Effectiveness was defined as reductions in LDL-C levels per mg dose of the drugs. The annual direct medical costs including drug acquisition costs and monitoring costs over the one-year time horizon were calculated for each alternative. The average cost-effectiveness ratios (ACERs) and incremental cost-effectiveness ratios (ICERs) for each statin dose were calculated. RESULTS: The ACERs for all doses of rosuvastatin (5 mg, 10 mg, and 20 mg) were lower than those for all doses of atorvastatin (10 mg, 20 mg, 40 mg, and 80 mg). Rosuvastatin 10 mg was the most cost-effective statin for LDL-C reduction. In cost-effectiveness analyses for corresponding doses of rosuvastatin and atorvastatin, rosuvastatin was the superior strategy which suggests both higher effectiveness and lower costs than atorvastatin. However, we have to consider this analysis is highly influenced by current price of statins in each market. CONCLUSIONS: For reduction of LDL-C levels in Korean patients with dyslipidemia, rosuvastatin 10mg is the most cost-effective statin in the current Korean market.

Methylation Patterns of Tumor Suppressor Genes in Breast DCIS Tumors

PURPOSE: The methylation of tumor suppressor genes has been implicated in the development of breast cancer. However, the role of methylation in the progression of cancer is still unclear. In this study, the methylation stati of nine tumor suppressor genes (p14, p16, DAPK, E-cadherin, RASSF1 alpha, TWIST, RAR beta, HIN-1, cyclin D2) in normal, benign, DCIS and invasive cancer tissues were examined, and the methylation patterns in DCIS and hypermethylated genes investigated to see if a change in the methylation status would lead to the development of cancer and progression to an invasive tumor. METHODS: A total of 96 patients, who underwent surgery between March 2003 and March 2005, were retrospectively studied. DNA was extracted from tumor tissues, and the samples examined for aberrant hypermethylation using methylation-specific PCR (MSP). RESULTS: The total number of methylated genes in each tissue type (normal tissues; 2.97+/-1.74, benign tumors; 4.36+/-1.42, DCIS; 5.73+/-1.35, invasive cancers; 5.42+/-2.05) increased with tumor progression (P<0.001). In benign tumors, HIN-1 (83%) was the most frequently methylated gene, but in DCIS, p14 (100%), RASSF (100%) and TWIST (91%) were frequently methylated. In invasive cancer, RAR beta (60%) and p16 (37%) were frequently methylated compared to the other tissue types. In a multivariate study, TWIST was commonly hypermethylated in DCIS and invasive cancer; whereas, RAR beta and p14 were frequently independently hypermethylated in invasive cancers. CONCLUSION: Methylation induced gene silencing appears to affect multiple genes in breast tissues, which increases with cancer progression. TWIST was hypermethylated in both DCIS and invasive cancers; therefore, it was concluded that methylation of the TWIST promoter may be an early event in the development of breast cancer. The hypermethylations of RAR beta and p16 are useful marker for the progression of a DCIS lesion to invasive cancer. The methylation patterns of tumor suppressor genes in DCIS were similar to those found in invasive cancer, but also showed intermediate levels of methylation between benign tumors and invasive cancers.

Fine Needle Aspiration Cytology of Periductal Mastitis (Subareolar Abscess) and its Clinical Significance of Cytological Diagnosis / 대한세포병리학회지

Periductal mastitis is a specific clinicopathologic entity, and is referred to by several names: recurrent subareolar abscess, squamous metaplasia of the lactiferous duct, and Zuska's disease. Clinically, the differentiation of periductal mastitis from other benign lesions and carcinomas around the nipple frequently proves a difficult proposition. We reviewed the fine needle aspiration cytology (FNAC) of 14 cases of periductal mastitis, which had been diagnosed either radiologically, histologically, or clinically. The patient group included 13 female patients, and one male. The majority of the patients in this group had presented with subareolar masses. All cases evidenced characteristic anucleated squamous cell clusters within a mixed inflammatory background. A diagnosis of periductal mastitis can be rendered fairly readily on excisional biopsy. However, FNAC is considered to be superior to excisional biopsy as an initial diagnostic procedure for any palpable mass in subareolar lesions of the breast. FNAC can also be a useful diagnostic technique in cases of periductal mastitis, even in the early phases of the disease. A definitive diagnosis of subareolar abscess via FNAC will enable the clinician to select the most appropriate medical or surgical treatment.

Risk Factors of Bladder Stone Formation in Spinal Cord Injuries / 대한비뇨기과학회지

Patients with spinal cord injury are prone to the development of bladder calculi. Although bladder stones can by managed effectively, predictive and preventive measures remain a significant challenge for clinicians. We reviewed the medical records of the bladder stone formation group (81 patients) and the control group (153 patients) in the course of follow-up check after spinal cord injury. We analysed the risk factors of the Bladder stone formation including neurologic level and extent (completeness) of injury. method of bladder drainage management, presence of pyuria, specific organisms infecting the urinary tract, urine pH, residual and 24-hour urine volume, serum and 24-hour urine Ca, P, urio acid levels, renal function (BUN/cr./Ccr), and frequency of bladder irrigation. In Was found that most of the patients developing bladder calculi had neurologically complete lesions, indwelling catheters (suprapubic or urethral), large amount of residual urine, high urine pH, pyuria and bacteriuria.

Torsion of the Cryptorchid Testis: Report of Two Cases / 대한비뇨기과학회지

Because of its usually abnormal mesorchial attachments the undescended testis is more prone to undergo torsion than normally-sited organ, but the incidence of this complication appears to have lessened in recent years. We present two cases with torsion of the unilateral cryptorchid testis and a review of the literature. Two cryptorchids complained of the painful mass on the inguinal area. Exploration revealed testicular torsion and orchiectomy was done.

A Case of Tuberculous Epididymitis in 3-year-old Boy / 대한비뇨기과학회지

We experienced a case of tuberculous epididymitis in 3-year-old boy who presented with a chief complaint of right scrotal swelling without evidences of tuberculosis of other organs. Physical examination revealed bilateral epididymal induration and beaded vas with another firm and tender nodule on right epididymal tail. During anti-Tbc chemotherapy, right scrotal draining sinus developed and so right epididymectomy was performed. Tuberculous epididymitis was confirmed pathologically.