• 보험의학회지
• /
• 제27권2호
• /
• pp.68-74
• /
• 2008

Medical verification of cancer diagnosis in insurance claims is a very important procedure in insurance administrations. Claims staffs are in need of medical experts' opinions about claim administration. This procedure is called medical claim review (MCR) and is composed of verification and advice. MCR verification evaluates the insured’s physical condition by medical records and compares it with product coverage. It is divided into assessment of living assurance benefit, verification of cancer, and assessment of the cause of death. Actually cancer verification of MCR is applicable to coding because the risk ratio in product development is usually coded data. There are some confusing neoplastic diseases in assessing the verification of cancer. This article reviews gastrointestinal stromal tumors (GIST) and mucosa-associated lymphoid tissue tumors (MALToma) of the stomach. The second most common group of stromal or mesenchymal neoplasms affecting the gastrointestinal tract is GIST. Nowadays there are many articles about the pathophysiology of GIST. However there are few confirmative theories except molecular cell biology of KIT mutation and some tyrosine kinase. Therefore, coding the GIST, which has previously been classified as an intermediate risk group according to NIH2001 criteria, for cancer verification of MCR is suitable for D37.1; neoplasm of uncertain or unknown behavior of digestive organs and the stomach. The gastrointestinal tract is the predominant site of extranodal non-Hodgkin's lymphomas. B-cell lymphomas of the MALT type, now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL/WHO classification, are the most common primary gastric lymphomas worldwide. Its characteristics are as follows. First, it is different from traditional stomach cancers such as gastric adenocarcinoma. Second, the primary therapy of MALToma is the eradication of H. pylori by antibiotics and the remission rate is over 80%. Third, it has a different clinical course compared to traditional malignant lymphoma. Someone insisted that cancer verification is not possible for the above reasons. However, there have been findings on pathologic mechanism, and according to WHO classification, MALToma is classified into malignant B-cell lymphoma and it must be verified as malignancy in MCR.

• 대한두경부종양학회지
• /
• 제18권1호
• /
• pp.50-55
• /
• 2002

Objectives: Thyroid cancer is the most common endocrine malignancy with favorable histologic and prognostic characteristics. Total or near total thyroidectomy has been used as a standard surgical procedure. The aims of this study are to determine the extent of resection of thyroid gland and to find the influencing factors of lymph node metastasis. Materials and Methods: The authors reviewed the records of 194 patients of thyroid cancer surgically treated at Department of General Surgery, Inje University Busan Paik Hospital from January, 1996 to December, 2000. Pathologic classifications, surgical procedures, and lymph node metastasis were analyzed. Results: There were 163 women and 31 men. The age ranged from 12 to 79 years old (mean age 43.2 years). The histological classifications of 194 cases revealed papillary cancer in 171 cases (88.1%), follicular cancer in 17 cases (8.8%), undifferentiated cancer in 3 cases (1.6%), medullary cancer in 2 cases (1.0%) and mixed cancer in 1 case (0.5%). Among the 194 patients, lobectomy was perfomed in 31 patients, subtotal thyroidectomy in 30 patients, near total thyroidectomy in 82 patients and total thyroidectomy in 51 patients. In the subgroup of papillary carcinoma 141 cases with lymph node dissection, lymph node metastasis had no statistical significance according to sex, age and primary tumor size. Conclusions: The mainly performed surgical procedures were total thyroidectomy and near total thyroidectomy. In thyroid cancer surgery, the extent of resection was influenced by age, differentiation and primary tumor size. The lymph node dissection should be decided by lymph node metastasis identified by preoperative radiologic evaluation or intraoperative lymph node findings.

• Tuberculosis and Respiratory Diseases
• /
• 제41권2호
• /
• pp.152-157
• /
• 1994

본 저자들은 양측성으로 반복되는 자연기흉 소견을 보인 21세 남자 환자에서BAL은 시행하여 조직구내 Birbeck granule을 찾음으로써 확진할 수 있었던 골 침범을 동반한 폐 조직구증 1예를 문헌 고찰과 함께 보고하는 바이다.

• Nuclear Medicine and Molecular Imaging
• /
• 제41권2호
• /
• pp.141-151
• /
• 2007

파킨슨병은 노년층에 가장 흔한 퇴행성 뇌질환 중의 하나로 진행성핵상마비, 다중계 위축, 루이체 치매 등과 같은 비전형 파킨슨병과 임상적으로 감별이 어려울 수 있다. 파킨슨병과 비전형 파킨슨병의 감별은 치료방침 결정과 예후평가뿐만 아니라 파킨슨병의 원인과 병태생리를 연구하고 새로운 치료법 개발에 있어서도 매우 중요하다. 파킨슨병과 비전형 파킨슨병과 같이 파킨슨 증후군을 유발하는 질환은 선조체내 도파민 신경의 퇴행성 변화를 흔히 동반하지만 병태생리학적으로 서로 다른 뇌피질 및 피질하 구조물에서의 신경세포 소실을 동반하고 있다. 따라서 국소 시냅스 활성도와 신경 및 시냅스의 손상, 그리고 원발병변과 기능적으로 연결된 원격부위의 기능이상 등을 대변하는 뇌포도당 대사를 F-18FDG PET으로 평가하는 것은 파킨슨 병의 감별진단과 병태생리를 평가하는데 유용하다.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제5권1호
• /
• pp.108-112
• /
• 2002

저자들은 복부 외상 후 크기가 증가하는 종괴와 동통을 주소로 내원한 13세 여아에서 췌장 원위부 절제술을 시행하여 조직학적으로 췌장 고형유두상피 종양을 진단하였기에 문헌고찰과 함께 보고하는 바이다.

• Parasites, Hosts and Diseases
• /
• 제23권1호
• /
• pp.165-172
• /
• 1985

Naegleria fowleri의 감염에 의한 생쥐의 원발성 아메바성 뇌수막염의 발생에 prednisolone투여가 어떠한 영향을 주는가를 관찰한 바 다음과 같은 결론을 얻었다. 1. 각 실험군 별로 $1{\times}10^5$의 N. fowleri를 감염시킨 후 생존기간을 관찰하였더니, prednisolone을 투여한 제1군의 평균 생존기간은 10.2일, 제2군은 10.6일, 제3군은은 11.3일로써 prednisolon을 투여한 군이 비투여군에 비하여 유의하게 생존기간이 단축됨을 알 수 있었으며, prednisolon투여군인 제1, 2, 3군 사이에 유의한 차이는 없었으나 전투여군인 제1군에서 생존시간이 단축되는 경향을 나타내었다. 2. 각 실험군 별로 감염 이후 20일까지 체중의 변화를 관찰한 결과, prenisolone 투여군에서는 서로 비슷한 양상을 나타내었는데 투여하는 시기부터 어느 정도 감소하다가 일정한 시간이 지나면서 회복현상을 나타내었다. 또한 prednisolon만 투여한 제 IV군에 비하여 제1, 2, 3군에서 체중이 더욱 심하게 감소하는 현상을 나타내었다. 그리고 대조군은 감염 8일 후부터 감소하기는 하였으나 큰 차이는 없는 것으로 보아 체중감소현상은 주로 prednisolone에 의해 영향을 받는 것으로 보인다. 3. Prednisolone 투여한 감염군은 대조군에 비하여 뇌와 폐조직에서 비교적 심한 병변이 나타났음을 알 수 있었다. 4. 감염된 생쥐의 임상증세는 감염 후 며칠이 지나면 머리를 비비고 고개를 떨구며, 식욕부진이 나타나 먹이를 먹지 않다가 발작이 오고, 빈사상태가 되어 사망하게 된다. 대부분의 생쥐에서 이러한 증세가 나타나는데, prednisolone 투여군에서는 감염 5일 이후부터 증세가 나타나는 경향을 보였고, 대조군은 감염 8일 이후에야 나타나 10일경에 사망하였다. 이상의 결과를 종합항 보면 prednisolone을 투여하여 인위적으로 면역반응을 억제시켜 줄 경우 N. fowleri에 감염된 생쥐의 생존기간은 단축되고 병변도 더욱 심하게 나타나며, 감염전에 투여해 주는 것이 가장 치명적인 영향을 줄 수 있음을 알 수 있었다.

• Journal of Korean Neurosurgical Society
• /
• 제52권4호
• /
• pp.417-419
• /
• 2012

Tumors of the central nervous system are common in the pediatric population and constitute the second most prevalent tumor type in children. Within this group, spinal cord tumors are relatively rare and account for 1 to 10% of all pediatric central nervous system tumors. We describe a very rare case of an intradural extramedullary spinal cord tumor with a subcutaneous mass and discuss its clinical presentation, pathogenesis, and treatment. A male infant was delivered normally, with uneventful development. At 16 days post-delivery, his family took him to a pediatrician because of a mass on his upper back. Magnetic resonance imaging of the thoracic spine revealed a well-demarcated soft-tissue mass with central cystic change or necrosis at the subcutaneous layer of the posterior back (T2-7 level). Another mass was found with a fat component at the spinal canal of the T1-3 level, which was intradural extramedullary space. After six weeks, the spinal cord tumor and subcutaneous mass were grossly total resected; pathologic findings indicated an atypical myxoid spindle cell neoplasm, possibly nerve sheath in type. The final diagnosis of the mass was an atypical myxoid spindle cell neoplasm. The postoperative course was uneventful, and the patient was discharged after nine days without any neurological deficit. We report a rare case of an intradural extramedullary spinal tumor with subcutaneous mass in a neonate. It is necessary to monitor the patient's status by examining consecutive radiologic images, and the symptoms and neurological changes should be observed strictly during long-term follow-up.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권5호
• /
• pp.2013-2020
• /
• 2014

Background: The aldehyde dehydrogenase 1 family member A1 (ALDH1A1) is one of the promising markers for identifying cancer stem cells in many cancer types, along with other markers including CD44. The aim of the present study was to evaluate the expression and clinical significance of putative cancer stem cell markers, CD44 and ALDH1A1, in a series of urothelial carcinomas of urinary bladder (UCUB) by tissue microarray (TMA). Materials and Methods: A total of 159 Urothelial Carcinomas (UC) including 96 (60%) low grade and 63 (40%) high grade carcinomas were immunohistochemically examined for the expression of CD44 and ALDH1A1. Correlations of the relative expression of these markers with clinicopathological parameters were also assessed. Results: High level expression of ALDH1A1 was found in 16% (25/159) of bladder UC which was significantly correlated with increased tumor size (p value=0.002), high grade (p value<0.001), pathologic stage (T1, p value=0.007 and T2, p value<0.001) and increased rate of recurrence (p value=0.013). A high level of CD44 expression was found in 43% (68/159) of cases, being positively correlated with histologic grade (p value=0.032) and recurrence (p value=0.039). Conclusions: Taken together, our results showed that ALDH1 was concurrently expressed in a fraction of CD44+ tumors and its expression correlated with poor prognosis in UCs. ALDH1A1 could be an ideal marker for targeted therapy of UCs in combination with conventional therapies, particularly in patients with high grade carcinomas. These findings indicate that cells expressing ALDH1A1 along with CD44 can be a potential therapeutic target in bladder carcinomas.

• Journal of Korean Neurosurgical Society
• /
• 제60권2호
• /
• pp.189-194
• /
• 2017

Objective : We evaluated the validity of bone cement-augmented percutaneous screw fixation for treating malignant spinal metastases. Methods : Between 2011 and 2015, 14 patients (eight men and six women) who underwent bone cement-augmented percutaneous screw fixation for malignant spinal metastases were enrolled in this study. Their life expectancy was considered to be more than one month and less than one year, based on the revised Tokuhashi scoring system. Clinical findings including the back pain scale score, functional outcome, procedure related complications, and survival were assessed preoperatively, postoperatively, and then six months after the procedure. Results : Twelve of the patients (86%) survived up to six months after the procedure. Three required mini-open decompressive laminectomy for severe epidural compression. Bone cement-augmented percutaneous screw fixation was performed one level above, one level below, and at the pathologic level itself. The mean operation time was 60 minutes (45-180) and blood loss was less than 100 mL. Prior to surgery, the mean pain score on the visual analogue scale was 8.8, while one month after the procedure, it had reduced to 3.0; this improvement was maintained until the six-month assessment in the surviving patients. All patients were able to sit within the first two days after surgery, and no patient experienced neurological deterioration at the one-month follow up after the surgery. No patient experienced screw loosening during the six months of follow-up. Asymptomatic cement leakage into the epidural space was observed in two patients, but no major complications were observed. Conclusion : For selected patients with malignant spinal metastases, bone cement-augmented percutaneous screw fixation can provide significant pain relief and improve quality of life.

• Journal of Cancer Prevention
• /
• 제23권4호
• /
• pp.183-190
• /
• 2018

Background: As the number of big-cohort studies increases, validation becomes increasingly more important. We aimed to validate administrative database categorized as colorectal cancer (CRC) by the International Classification of Disease (ICD) 10th code. Methods: Big-cohort was collected from Clinical Data Warehouse using ICD 10th codes from May 1, 2003 to November 30, 2016 at Seoul National University Bundang Hospital. The patients in the study group had been diagnosed with cancer and were recorded in the ICD 10th code of CRC by the National Health Insurance Service. Subjects with codes of inflammatory bowel disease or tuberculosis colitis were selected for the control group. For the accuracy of registered CRC codes (C18-21), the chart, imaging results, and pathologic findings were examined by two reviewers. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CRC were calculated. Results: A total of 6,780 subjects with CRC and 1,899 control subjects were enrolled. Of these patients, 22 subjects did not have evidence of CRC by colonoscopy, computed tomography, magnetic resonance imaging, or positron emission tomography. The sensitivity and specificity of hospitalization data for identifying CRC were 100.00% and 98.86%, respectively. PPV and NPV were 99.68% and 100.00%, respectively. Conclusions: The big-cohort database using the ICD 10th code for CRC appears to be accurate.