National Cancer Screening Program

Cancer is the most common cause of disease-related mortality in Korea and is the key target for the solution to promote the national health and stabilize the health insurance. Without the development of a definitive prevention or treatment method, the proportion of cancer-related mortality will further increase with the advent of aging society and transition of life pattern. Nationally-based cancer screening program has been expanded to cover a larger target population in Korea since 1999. Despite the existence of some flaw in the present cancer screening program between the participants and medical institutions, the number of people taking part in the cancer screening program has been increasing. With the reinforcement of the quality control and supervision, medical institutions participating in national cancer screening program can be expected to become well acquainted with related regulations and procedures. It is necessary for all parties involved to exercise a substantial effort to achieve health examiner's best satisfaction and the quality of the cancer screening program.

A Case of Granular Cell Tumor of the Stomach in a Patient with Extramammary Paget's Disease / 대한소화기내시경학회지

Granular cell tumor is an uncommon submucosal neoplasm of uncertain etiology and histogenesis. Having been reported in virtually all other sites, granular cell tumors of the gastrointestinal tract are rare. Reported cases in the gastrointestinal tract account for 5~9% of all granular cell tumors, most commonly in the esophagus. Only one case of gastric granular cell tumor has been reported in Korea. We report a case of asymptomatic gastric granular cell tumor coexisting with gastric adenoma in 56-year-old male who had extramammary Paget's disease in the right scrotum, and it was successfully managed by endoscopic polypectomy.

A Case of Polyp with High Grade Dysplasia in Ulcerative Colitis / 대한소화기내시경학회지

Patients with ulcerative colitis (UC) have the increased risk of colorectal cancer. The risk of colorectal cancer development in UC is associated with the extent of colitis and duration of disease. It is generally agreed that there is little or no increased risk associated with proctitis or proctosigmoiditis. A dysplasia-associated lesion or mass (DALM) is difficult to distinguish from sporadic adenoma. The DALM indicate a high association with colon cancer. The presence of DALM as a premalignant lesion has been considered as an indication for colectomy because of the high risk of progression to malignancy within a short period. We report a case of polyp with high grade dysplasia in a 27-year-old man of ulcerative colitis confined to rectum and sigmoid colon.

A Case of Crohn's Disease with Giant Pseudopolyposis and Ileocolic Fistula / 대한소화기내시경학회지

Pseudopolyp is a common association of ulcerative colitis but may also occur in Crohn's disease, ischemic colitis and infective colitis. Pseudopolyps are results of the repair process, representing islands of granulation tissue surrounded by mucosa with ulceation. When a pseudopolyp is larger than 1.5 cm, it is often called a "giant pseudopolyp". Such lesions of inflammatory origin are often confused with polypoid carcinoma or infiltrating submucosal malignancy. We report a case of asymptomatic Crohn's disease as giant pseudopolyposis mimicking malignancy on sigmoid colon, with a review of relevant literatures.

Outcomes in Relation to Time of Tracheostomy in Patients with Mechanical Ventilation / 결핵

BACKGROUND: Despite widespread use of tracheostomy in intensive care unit, it is still controversial to define the best timing from endotracheal intubation to tracheostomy under prolonged mechanical ventilation. Early tracheostomy has an advantage of easy airway maintenance and enhanced patient mobility whereas a disadvantage in view of nosocomial infection and tracheal stenosis. However, there is a controversy about the proper timing of tracheostomy. METHODS: We conducted a retrospective study of the 35 medical and 15 surgical ICU patients who had admitted to Ewha Womans University Mokdong Hospital from January 1996 to August 1998 with the observation of APACHE III score, occurrence of nosocomial infections, and clinical outcomes during 28 days from tracheostomy in terms of early (n=25) vs. late (n=25) tracheostomy. We defined the reference day of early and late tracheostomy as 7th day from intubation. RESULTS: 1. The number of patients were 25 each in early and late tracheostomy group. The mean age were 48 +/- 18 years in early tracheostomy group and 63 +/- 17 years in late tracheostomy group, showing younger in early tracheostomy group. The median duration of intubation prior to tracheostomy was 3 days and 13 days in early and late tracheostomy groups. Organs that caused primary problem were nervous system in 27 cases(54%), pulmonary 14(28%), cardiovascular 4(8%), gastrointestinal 4(8%) and genitourinary 1(2%) in the decreasing order. Prolonged ventilation was the most common reason for purpose of tracheostomy in both groups. 2. APACHE III scores at each time of intubation and tracheostomy were slightly higher in late tracheostomy group but not significant statistically. Day to day APACHE III scores were not different between two groups with observation upto 7th day after tracheostomy. 3. Occurrence of nosocomial infections, weaning from mechanical ventilation, and mortality showed no significant difference between two groups with observation of 28days from tracheostomy. 4. The mortality was increased as the APACHE III score up to 7 days after tracheostomy increased, but there were no increment for the mortality in terms of the time of tracheostomy and the days of ventilator use before tracheostomy. CONCLUSION: The early tracheostomy seems to have no benefit with respect to severity of illness, nosocomial infection, duration of ventilatory support, and mortality. It suggests that the time of tracheostomy is better to be decided on clinical judgement in each case. And in near future, prospective, randomized case-control study is required to confirm these results.

A Case of Pulmonary Artery Aneurysm with Pulmonary Hypertension

Clinical experiences of pulmonary artery aneurysm are distinctly rare and current knowledge is mainly derived from autopsy findings. Pulmonary artery aneurysms are associated with congenital heart disease, most frequently patient ductus arteriosus, followed in decreasing order by ventricular septal defect, atrial septal defect. In the remaining cases, such aneurysms are associated mainly with secondary acquired lesions, such as Behcet's disease, bacterial endocarditis, syphilis, tuberculosis, atherosclerosis, vasculitis, hypertension, trauma. Angiography was the gold standard for diagnosing pulmonary artery aneurysms, but MRI imaging has been potentially useful diagnostic modality in demonstrating aneurysm and other fine pathologic processes with high resolution. Surgery was main, but there are no firm guidelines for optimal treatment of pulmonary artery aneurysm. We experienced a case of pulmonary artery aneurysm with pulmonary hypertension in a 58 year-old female and observed for 2 years. The aneurysmal size was 5.19 cm initially and inreased to 5.5cm for two years, accompanying by pulmonary hypertension. We report this case of pulmonary artery aneurysm with a brief review of literature.