• Journal of Gastric Cancer
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• v.21 no.4
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• pp.426-438
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• 2021

Purpose: While the incidence of Barrett's neoplasia has been increasing in Western countries, the disease remains rare in Asian countries. Therefore, very few studies have investigated the endoscopic treatment for Barrett's neoplasia in Korea. Endoscopic submucosal dissection (ESD) enables en bloc and complete resection of gastrointestinal neoplastic lesions. This study aimed to evaluate the therapeutic outcomes of ESD for Barrett's neoplasia in a single center in Korea and to examine the predictive factors for incomplete resection. Materials and Methods: We conducted a retrospective observational study of 18 patients who underwent ESD for superficial Barrett's neoplasia (dysplasia and early cancer) between January 2010 and December 2019 at Pusan National University Hospital. The therapeutic outcomes of ESD and procedure-related complications were analyzed. Results: En bloc resection, complete resection, and curative resection were performed in 94%, 72%, and 61% of patients, respectively. Histopathology (submucosal or deeper invasion of the tumor) was a significant predictive factor for incomplete resection (P=0.047). Procedure-related bleeding and stenosis were not observed, whereas perforation occurred in one case. During the median follow-up period of 12 months (range, 6-74 months), local recurrence occurred in 2 patients with incomplete resection, one patient underwent repeat ESD, and the other patient received concurrent chemoradiotherapy. The 3-year overall and disease-specific survival rates were 73% and 93%, respectively. Conclusions: ESD seems to be an effective and safe treatment for superficial Barrett's neoplasia in Korea. Nevertheless, the suitability of ESD for Barrett's cancer cases should be determined considering the high risk of deep submucosal invasion.

• Korean Journal of Veterinary Research
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• v.61 no.4
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• pp.36.1-36.8
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• 2021

The objective of this study was to evaluate the beneficial effects of the short-term application of insect-based diet in canine allergic dermatitis. Total 19 atopic dogs with concurrent cutaneous adverse food reactions were enrolled and classified into 3 groups. The treatment group (n = 7) was fed insect-based diet, the positive control group (n = 6) was fed salmon-based diet, and the negative control group (n = 6) was fed commercial or homemade diet for 12 weeks. The degree of skin lesions was evaluated based on canine atopic dermatitis extent and severity index (CADESI-4). Additionally, transepidermal water loss (TEWL) and pruritus visual analog scale were evaluated. All indices were evaluated every 4 weeks after the initial administration of hypoallergenic diets. In the treatment group, significant decrease in the CADESI-4 score was observed at 8 weeks compared to the baseline score (p = 0.031). There were significant differences in the CADESI-4 score between the groups at 8 weeks (p = 0.008), 12 weeks (p = 0.012), and TEWL at 12 weeks (p = 0.022). This preliminary result demonstrates the potential hypoallergenicity of an insect-based diet through features that diminish cutaneous lesions and skin barrier dysfunction.

• Journal of Korean Medicine for Obesity Research
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• v.24 no.1
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• pp.41-53
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• 2024

Objectives: We used the Korea Health Panel Annual Data 2019 to analyze factors related to visits to both Korean medicine and Western medicine (WM) outpatient clinics among patients with overweight and obesity. Methods: The inclusion criteria for this study are as follows: 1) adults over 18 years of age, 2) overweight or obese with a body mass index of 25.0 or more, 3) visited WM outpatient clinics at least once during 2019. Total 2,963 individuals were included in WM group or integrative medicine (IM) group. Using the Andersen healthcare utilization model, factors related to healthcare utilization of the participants were classified. Binomial logistic regression analysis was used to analyze factors associated with IM use. Results: Among the participants, 80.49% (n=2,385) were assigned to WM group and 19.51% (n=578) to IM group. As a result of the regression analysis, factors significantly related to the use of IM included the elderly over 65 years of age, sex (men), college or higher education level, residential area (Gwangju/Jeolla/Jeju), presence of cancer, and presence of musculoskeletal disease. The main diagnosis associated with both WM and IM use was most frequently musculoskeletal conditions. Also, IM group received WM treatment for musculoskeletal conditions more frequently compared to WM group. Conclusions: This study is the first to analyze healthcare utilization patterns among overweight or obese patients in Korea. The current findings suggest that the presence of musculoskeletal conditions, especially in this population, may be strongly associated with concurrent use of IM services.

• Radiation Oncology Journal
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• v.24 no.2
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• pp.123-127
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• 2006

Purpose: The purpose of this study was to investigate the clinical findings, treatment, and outcome of patients with glassy cell carcinoma of cervix. Materials and Methods: We reviewed all cases of glassy cell carcinoma of the uterine cervix confirmed and treated at the Dongsan Medical Center, Keimyung University, between January 1993 and December 2005. There were 7 cases with histopathologically confirmed gassy cell carcinoma. A tumor was diagnosed as glassy cell carcinoma if over 50% of the tumor cell type displayed glassy cell features. Six patients with stage IB had radical hysterectomy and bilateral pelvic node dissection, and 2 of them received adjuvant external pelvic irradiation with concurrent chemotherapy. Remaining one patient with stage IIA had curative concurrent chemoradiotherapy with external pelvic irradiation and brachytherapy. Results: There were 7 patients diagnosed as glassy cell carcinoma among the 3,745 (0.2%) patients of carcinoma of uterine cervix. The mean age of 7 patients was 44 years with range of 35 to 53 years of age. The most frequent symptom was vaginal bleeding (86%). By the punch biopsy undertaken before treatment of 7 cases, 2 only cases could diagnose as glassy cell carcinoma of uterine cervix, but remaining of them confirmed by surgical pathological examination. The mean follow up duration was 73 months with range of 13 to 150 months. All 7 patients were alive without disease after treatment. Conclusion: Glassy cell carcinoma of the uterine cervix is a distinct clinicopathologic entity that demonstrates an aggressive biologic behavior. However for early-stage disease, we may have more favorable clinical outcome with radical surgery followed by chemoradiothery.

• Radiation Oncology Journal
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• v.25 no.1
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• pp.34-42
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• 2007

[ $\underline{Purpose}$ ]: We performed a retrospective non-randomized clinical study of locally advanced rectal cancer, to evaluate the anal sphincter preservation rates, down staging rates and survival rates of preoperative chemoradiotherapy. $\underline{Materials\;and\;Methods}$: From January 2002 to December 2005, patients with pathologically confirmed rectal cancer with clinical stage T2 or higher, or patients with lymph node metastasis were enrolled in this study. A preoperative staging work-up was conducted in 36 patients. All patients were treated with preoperative chemoradiotherapy, and curative resection was performed for 26 patients at Hallym University Sacred Heart Hospital. Radiotherapy treatment planning was conducted with the use of planning CT for all patients. A total dose of $45.0{\sim}52.2\;Gy$ conventionally fractionated three-dimensional radiotherapy was delivered to the whole pelvis. Chemotherapy was given at the first and fifth week of radiation therapy with continuous infusion i.v. 5-FU (Fluorouracil) and LV (Leucovorine). Surgical resection was performed 2 to 4 weeks after the completion of the chemoradiotherapy regimen. $\underline{Results}$: The complete resection rate with negative resection margin was 100% (26/26). However, a pathologically complete response was not seen after curative resection. Surgery was done by LAR (low anterior resection) in 23 patients and APR (abdomino-perineal resection) in 3 patients. The sphincter preservation rate was 88.5% (23/26), down staging of the tumor occurred in 12 patients (46.2%) and down-sizing of the tumor occurred in 19 patients (73%). Local recurrence after surgical resection developed in 1 patient, and distant metastasis developed in 3 patients. The local recurrence free survival rate, distant metastasis free survival rate, and progression free survival rate were 96.7%, 87% and 83.1%, respectively. Treatment related toxicity was minimal except for one grade 3, one grade 4 anemia, one grade 3 leukopenia, and one grade 3 ileus. $\underline{Conclusion}$: Preoperative concurrent chmoradiotherapy for locally advanced rectal cancer seems to have some potential benefits: high sphincter preservation and down staging. Treatment related toxicity was minimal and a high compliance with treatment was seen in this study. Further long-term follow-up with a larger group of patients is required.

• Radiation Oncology Journal
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• v.29 no.1
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• pp.11-19
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• 2011

Purpose: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. Materials and Methods: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). Results: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1 %. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). Conclusion: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.

• Journal of the Korean Society of Radiology
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• v.18 no.3
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• pp.249-256
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• 2024

The study aimed to evaluate the efficacy of treatment plans using full Arc and Partial Arc Coplanar volumetric modulated arc therapy and Non-Coplanar volumetric modulated arc therapy to minimize radiation treatment side effects, such as pneumonia, and protect normal organs in esophageal cancer radiotherapy. 30 patients who underwent Concurrent Chemoradiotherapy for esophageal cancer were included. Compared planning target volume, lung, heart, spinal cord and total monitor units among three treatment plans: fVMAT(2 Full Arc), pVMAT(4 Partial Arc), and ncVMAT(2 Partial Arc + 2 Non-Coplanar Arc). All plans met the PTV criteria, showing uniform distribution. The average dose to the heart was 5.8 Gy for fVMAT, 6.97 Gy for pVMAT, and 7.6 Gy for ncVMAT, with the lowest value in fVMAT, which was statistically significant. However, the average lung dose was 9.01 Gy for fVMAT, 7.71 Gy for pVMAT, and 7.12 Gy for ncVMAT, with V_5Gy(%) values of 52.22%, 38.61%, 36.35% and V_10Gy(%) values of 37.8%, 27.33%, 24.15% respectively. ncVMAT showed the lowest values, while fVMAT had the highest, with statistical significance. In conclusion, ncVMAT effectively reduces lung radiation exposure in esophageal cancer radiotherapy, potentially reducing the incidence of side effects such as pneumonia. However, considering factors like setup accuracy and treatment time, applying an appropriate treatment plan may lead to better outcomes.

• Journal of Veterinary Clinics
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• v.25 no.4
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• pp.295-302
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• 2008

Two dogs were referred to Veterinary Medical Center, Chungbuk National University with the clinical signs of vomiting, diarrhea, anorexia, and jaundice. Both dogs were diagnosed as extrahepatic biliary tract obstruction(EHBO) with concurrent pancreatitis based on dilated common bile duct and hyperechoic or mixed-echoic pancreas in abdominal ultrasonographic examination and serum biochemical abnormalities, such as high serum bilirubin, cholesterol, and increased cholestatic enzyme activity. Percutaneous ultrasound-guided cholecytocentesis(PUCC) was performed to examine bile and decompress the gall bladder. After PUCC with medical therapy, both dogs were steadily improved clinical signs of jaundice and anorexia. Also, cholestatic enzyme activity and serum bilirubin concentration decreased. Any complications that have been described in previous studies, such as peritonitis resulting from bile leakage and hemorrhage, were not identified. It is assumed that percutaneous ultrasound guided cholecystocentesis may be an useful diagnostic and therapeutic tool in canine gallbladder disease and can be used easily and safely to gain bile for diagnosis of bacterial cholecytitis.

• Radiation Oncology Journal
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• v.29 no.3
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• pp.181-190
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• 2011

Purpose: Thoracic radiotherapy is a major treatment modality of stage III non-small cell lung cancer. The normal lung tissue is sensitive to radiation and radiation pneumonitis is the most important dose-limiting complication of thoracic radiation therapy. This study was performed to identify the clinical and dosimetric parameters related to the risk of radiation pneumonitis after definitive radiotherapy in stage III non-small cell cancer patients. Materials and Methods: The medical records were reviewed for 49 patients who completed definitive radiation therapy for locally advanced non-small cell lung cancer from August 2000 to February 2010. Radiation therapy was delivered with the daily dose of 1.8 Gy to 2.0 Gy and the total radiation dose ranged from 50.0 Gy to 70.2 Gy (median, 61.2 Gy). Elective nodal irradiation was delivered at a dose of 45.0 Gy to 50.0 Gy. Seven patients (14.3%) were treated with radiation therapy alone and forty two patients (85.7%) were treated with chemotherapy either sequentially or concurrently. Results: Twenty-five cases (51.0%) out of 49 cases experienced radiation pneumonitis. According to the radiation pneumonitis grade, 10 (20.4%) were grade 1, 9 (18.4%) were grade 2, 4 (8.2%) were grade 3, and 2 (4.1%) were grade 4. In the univariate analyses, no clinical factors including age, sex, performance status, smoking history, underlying lung disease, tumor location, total radiation dose and chemotherapy were associated with grade ${\geq}2$ radiation pneumonitis. In the subgroup analysis of the chemotherapy group, concurrent rather than sequential chemotherapy was significantly related to grade ${\geq}2$ radiation pneumonitis comparing sequential chemotherapy. In the univariate analysis with dosimetric factors, mean lung dose (MLD), $V_{20}$, $V_{30}$, $V_{40}$, MLDipsi, $V_{20}$ipsi, $V_{30}$ipsi, and $V_{40}$ipsi were associated with grade ${\geq}2$ radiation pneumonitis. In addition, multivariate analysis showed that MLD and V30 were independent predicting factors for grade ${\geq}2$ radiation pneumonitis. Conclusion: Concurrent chemotherapy, MLD and $V_{30}$ were statistically significant predictors of grade ${\geq}2$ radiation pneumonitis in patients with stage III non-small cell lung cancer undergoing definitive radiotherapy. The cutoff values for MLD and $V_{30}$ were 16 Gy and 18%, respectively.

• Korean Journal of Clinical Pharmacy
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• v.22 no.4
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• pp.340-346
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• 2012

Background: Amphotericin B is a mainstay in the treatment of many systemic fungal infections due to its wide antifungal spectrum and low incidence of resistance. However, the use of amphotericin B is limited by its nephrotoxicity. Objectives: The objective of this study was to evaluate the incidence and risk factors of renal adverse drug reactions (ADRs) of conventional amphotericin B (Fungizone$^{(R)}$). In addition, we compared the changes of serum creatinine (SCr) between patients who remained conventional amphotericin B and patients who were switched to liposomal amphotericin B after occurrence of renal adverse reactions. Methods: Adult hospitalized patients who reported renal adverse reactions caused by conventional amphotericin B from January 2011 to July 2012 at pharmacovigilance center in Yonsei University Healthcare System included in this study. ADRs scored as 'doubtful' in Naranjo probability ADR scale were excluded. We retrospectively analyzed patients' basic clinical characteristics, concurrent diseases or nephrotoxic drugs in order to find variables that can correlate with occurrence of renal ADRs. Changes in SCr were compared between conventional amphotericin B group and liposomal amphotericin B group. Results: A total of 231 ADRs after administration of conventional amphotericin B in 75 patients were reported to pharmacovigilance center and assessed their severities as 'possible', 'probable', or 'definite'. Renal adverse reaction was the most common ADR with incidence rate of 42% (96 of 231 ADRs). Mean change in SCr from baseline was 0.26 mg/dL (change % 37.8) and statistically significant (p=0.000). Simple correlations analysis revealed that the number of concurrent diseases and number of nephrotoxic drugs were positively correlated with changes in SCr, but these results were not statistically significant. Among 43 patients who remained amphotericin B after occurrence of renal ADRs, 27 patients was administered conventional amphotericin B and 16 patients changed to liposomal amphotericin B. Mean change in SCr in amphotericin B group was 0.23 mg/dL (32.75%), whereas mean change in SCr in liposomal amphotericin B group were -0.28 mg/dL (19.38%) and difference between two groups was statistically significant (p=0.003). The numbers of patient with SCr elevation more than 30% were 9 (33.3%) in amphotericin B group and 2 (12.5%) in liposomal amphotericin B group (Odd Ratio=3.50, 95% Confidence Interval 0.65-18.85; p=0.130). Conclusion: An analysis of ADRs due to amphotericin B administration revealed significant mean changes in SCr from baseline. Switching to liposomal amphotericin B showed significant decrease in SCr compared with conventional amphotericin B.