Current Status of Bariatric and Metabolic Surgery in Daejeon and Chungcheong Province: Early Experiences after Public Medical Insurance Coverage in 2019

Purpose@#This study aimed to investigate the current status of bariatric and metabolic surgery in Daejeon and Chungcheong province and to describe the early experiences after public medical insurance coverage in 2019. @*Materials and Methods@#Between January 2019 and August 2019, 64 cases of bariatric and metabolic surgery were performed in patients with morbid obesity or uncontrolled type 2 diabetes. We prospectively collected and analyzed data regarding the patients’ demographics and comorbidities, surgical results, and early complications. The patient information before and after the insurance coverage was also compared. @*Results@#The number of surgeries in 9 years has been caught up only in the last 8 months after insurance coverage (58 vs. 64 patients). The mean body mass index was 37.7±5.8 kg/m2 (range, 22.7-52.1 kg/m2). The most frequently performed surgery was sleeve gastrectomy (53 cases, 82.8%), followed by Roux-en-Y gastric bypass (9 cases, 14.1%), and adjustable gastric banding (2 cases, 3.1%). Postoperative complications occurred in 6 patients (9.4%), and there was no mortality. The mean operation time (225.3±85.4 vs. 156.1±61.8 min, P＜0.001) and postoperative stay (5.9±4.5 vs. 4.3±2.0 days, P=0.013) after the insurance coverage were significantly shorter than those before the insurance coverage. @*Conclusion@#We could assess the patients who had bariatric and metabolic surgery in Daejeon and Chungcheong province after public medical insurance coverage in 2019.

The Molecular Subtype Dependent Effect of Concurrent Radiotherapy and Systemic Therapy on Breast Cancer: Analysis of a Human In Vivo Model of Metastatic Brain Lesions

PURPOSE: The molecular subtype of breast cancer is an important predictive factor. Therefore, we investigated the effects of concurrent or serial radiotherapy and systemic therapy on metastatic brain lesions according to the molecular subtype of breast cancer. METHODS: The present retrospective study examined data from 66 patients with breast cancer and metastatic brain lesions, who were treated using radiotherapy between January 1990 and July 2014. Patients were classified into the following three subtypes based on their hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status: HR+/HER2− (luminal A, 13 patients), HR+/HER2+ (luminal B, 21 patients), HR−/HER2+ (HER2, 22 patients), or HR−/HER2− (triple negative, 10 patients). The brain lesions and their responses to treatment were evaluated using brain computed tomography or magnetic resonance imaging. Progression of brain disease was defined by a ≥20% increase in the sum of the lesion's diameters or the development of a new brain lesion. Progression-free survival was calculated from the initiation of radiotherapy to the first instance of brain disease progression or last follow-up. RESULTS: Patients in the HER2 group who had received concur-rent radiotherapy and systemic therapy (mainly HER2-targeted therapy) exhibited significantly better progression-free survival than did patients who had received radiotherapy followed by systemic therapy (p=0.037). However, concurrent radiotherapy and systemic therapy did not significantly improve progression-free survival in the luminal A (p=0.527), luminal B (p=0.462), or triple negative (p=0.558) groups. CONCLUSION: Concurrent radiotherapy and mainly HER2-targeted systemic therapy significantly prolonged progression-free survival in the HER2 group.

Unexpected Pathologic Diagnosis of the Mitral Valvular Mass

A 59-year-old man with multifocal cerebral infarction was found to have the large obstructive mitral valvular mass. Although benign tumor was under suspicion before surgery, he was finally diagnosed as chronic infective endocarditis by microscopic evaluation. The precise diagnosis and the proper management of a cardiac mass are very important since even the benign tumor may cause fatal complications. However, primary cardiac mass has the broad spectrum from pseudo-tumor to malignancy and the differential diagnosis using non-invasive methods is not easy even with the currently available imaging techniques.

Health Behavior and Health Condition of the Rural Young-Old and the Rural Old-Old in an Agricultural District / 農村醫學 地域保健

OBJECTIVES: The purpose of this study is to garner useful information through a comparative analysis of health behaviors and health states between the young-old and old-old elderly in a rural Korean area. METHODS: We define the young-old elderly as those 65 to 74 years of age, and the old-old as those over 70. The survey was administered in October and November of 2009 at senior citizen centers in Sangju City, Kyongsangbuk-do, South Korea. The number of subjects surveyed approximated the demographics of the aged population of the administrative district of centers of 24 eup, myeon, and dong. RESULTS: Compared with the young-old elderly, the old-old were vulnerable to population sociological characteristics. While there were many cases of contraction of diseases, only a small percentage of old-old elderly were engaged in regular exercise. In addition, the old-old elderly lagged behind the young-old in terms of physical activity, mental and oral health, hearing, and vision. CONCLUSIONS: The vulnerability of the old-old elderly in terms of physical and mental health needs to be acknowledged as various characteristics of the elderly that appears according an age group. A variety of disease prevention and health promotion programs that focus on the health behavior and status of the young-old and old-old elderly need to be developed and put into practice.

Study on Factors Related to of Clonorchiasis Infection among the Inhabitants in the Nakdong Riverside Area

PURPOSE: This study investigated the factors of C. sinensis infection among the residents in vicinity of the Nakdong River and the infection status of fishes in the stream with C. sinensis maetacercaria. METHODS: Selected five regions of the Nakdong River and collected freshwater fishes from the stream to examine their metacercarial infections; and studied the status and causes of C. sinensis infection in 552 residents living within 5 kilometers from the river. RESULTS: Among the 552 residents studied, 13.8% were infected with C. sinensis, and among 379 freshwater fishes of 20 species collected from the five regions, 41 fishes of 8 species were infected with C. sinensis metacercaria. CONCLUSION: In order to prevent human C. sinensis infection and transition to chronic liver ions, we need to develop and apply good programs such as continuous health education, personal hygiene improvement, active medical treatment for those infected with C. sinensis, and residents' voluntarily stop of eating freshwater fishes in the raw state.

Diagnosis and Arthroscopic Treatment of Symptomatic Medial Patellar Plica Syndrome of the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of physical examination and dynamic arthroscopy in the diagnosis and treatment of medial patellar plica syndrome which is likely to be overlooked. SUBJECTS AND METHODS: 23 cases diagnosed as medial patellar plica syndrome from August 1998 through December 1999 were evaluated. Diagnosis was made by a symptom of a pain and a click sound during knee flexion, a physical examination of mass palpation and dynamic arthroscopy. RESULT: A dynamic rotation test was an useful physical examination having 96% rate of sensitivity. The results of excellent and good cases were in 19 cases (83%) and there was no worsened case symptomatically after arthroscopic resection. Postoperative complications were 3 cases including incomplete excision (1 case), postoperative hemarthrosis (1 case) and medial meniscus instability due to incorrect arthroscopic technique (1 case). In patients younger than 30 year old, the result of arthroscopic excision was better than that in older ones. CONCLUSION: Careful physical examination with dynamic arthroscopy is a useful method to diagnose the medial patellar plica syndrome which is likely to be overlooked, and arthroscopic complete excision result in excellent results which is of benefit to fast rehabilitation.

Short - Term Results of Hydroxyapatite - coated Total Hip Arthroplasty / 대한정형외과학회잡지

The cement-free hip prosthesis coated with hydroxyapatite was developed to obtain primary firm fixation by an enhanced anatomic design and secondary biologic stable fixation by hydroxyapatite which is bioactive and has the same chemical and structural components with those of human bone tissue in total hip arthroplasty. Between January 1992 and June 1994, we used ABG cement free hip prosthesis (Anatomique Benoist Giraud, Howmedica Europe, Staines, England) in 28 hips (avascular necrosis of femoral head; 17, osteoarthritis; 6, posttraumatic arthritis; 3, rheumatoid arthritis; 2) of 25 patients in Pusan National University Hospital. Those cases had a minimum of two years and maximum of four years and five months (average three years and six months) of follow up, including analysis of the clinical and radiological data. The results were obtained as follows: 1. The average Modified Harris Hip Score increased from 51 points preoperatively to 96 points at last follow up. Almost all cases (97%) were excellent or good results in Modified Harris Hip Score. 2. In radiologic results, no migration of the cup, no change in the inclination of the cup, ar.d no oste-olysis around the cup and the stem were observed. Endosteal bone apposition around the cup was found in 54% of the cases and subcortical cancellous densification around the stem was found in 89%. This results indicate that we obtained direct and biologic firm fixation without fibrous tissue interposition between bone and metallic component by inducing on-growth of bone. 3. In the radiologic follow up according to the initial bone quality, it was demonstrated that the incidences of cortical hypertrophy, calcar resorption, and radiolucent line in type B and type C were higher than those in type A. The early clinical and radiological results of the cement-free hip prosthesis coated with hydroxyapatite are encouraging, although a longer follow up period is necessary.