ABSTRACT
BACKGROUND: Gallbladder cancer (GBC) is a rare malignancy characterized by high invasiveness and poor survival. In a nation-wide cancer survey, the age-standardized incidence rate of GBC was the highest in Jeju Island compared to 15 other provinces in Korea. The purpose of this study was to compare the clinical outcomes of GBC according to the nature of diagnosis, that is, incidental versus non-incidental. MATERIALS AND METHODS: Consecutive patients who were newly diagnosed with GBC at the Digestive Disease Center and Department of Internal Medicine, Cheju Halla General Hospital, between November 2008 and November 2011, were enrolled and divided into 2 groups: incidental gallbladder cancer (IGBC) and non-incidental gallbladder cancer (NIGBC). Clinical outcomes were retrospectively compared between the two groups. RESULTS: Seventy-nine patients were enrolled and analyzed in our study. Thirty-three (41.8%) and 46 (58.2%) were identified as IGBC and NIGBC, respectively. The proportions of patients with gallstone disease, gallbladder polyp, and cholecystectomy were significantly different between the two groups. Additionally, the median survival rate was significantly higher for patients with IGBC than for those with NIGBC (11.4, 95% confidence interval, 5.6-13.7 vs 4.0, 95% confidence interval 3.03-5.96 months; p=0.01) during a median follow-up period of 5.7 months. CONCLUSIONS: Patients with IGBC showed better clinical prognosis than those with NIGBC. Therefore, patients with gallstone disease or gallbladder polyps, major predictive risk factors for IGBC, should undergo advanced work-up for chelecystectomy.
Subject(s)
Gallbladder Neoplasms/mortality , Gallbladder Neoplasms/surgery , Aged , Cholecystectomy , Cross-Sectional Studies , Female , Gallbladder/pathology , Gallbladder/surgery , Gallbladder Neoplasms/epidemiology , Gallstones , Humans , Incidental Findings , Male , Polyps , Republic of Korea , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: The goal of this study was to examine the association between low levels of lead and mercury in blood and symptoms of attention-deficit hyperactivity disorder (ADHD) among Korean children. METHODS: One thousand seven hundred and seventy eight children at 10 elementary schools in six South Korea cities participated in this study. Parents and guardians administered a questionnaire including Conners' parents rating ADHD scale to determine the presence of ADHD symptoms. In addition, clinical examinations of the children and determination of blood lead and mercury levels were included in the first Children's Health and Environment Research (CHEER) survey, which is now conducted annually in Korea. RESULTS: The risk for the appearance of ADHD symptoms was found to increase with the blood lead concentration. The mean blood lead concentration was low with a geometric mean of 1.8 microg/dl. The odds ratios (95% confidence intervals) for the presence of ADHD symptoms were 1.28 (0.57, 2.86), 1.32 (0.63, 2.74), 1.65 (0.77, 3.56), and 1.98 (0.76, 5.13) in children with blood lead levels of 1-<1.5, -<2.5, -<3.5, and >3.5 microg/dl, compared to those with blood lead levels of <1.0 microg/dl; these results statistically represented a borderline trend (p for trend: 0.07). The blood lead level showed a significant positive association with the Conners' ADHD score (beta=0.50, p<0.0001). However, the blood mercury levels were not found to be significantly associated with ADHD symptoms in children. The geometric mean mercury concentration in the blood was 2.4 microg/l. CONCLUSIONS: The observed association between blood lead concentration and the appearance of ADHD symptoms in Korean children suggests that lead, even at low concentrations, is a risk factor for ADHD.
