Achievements, Problems, and Future Direction of the Quality Control Program for Special Periodic Health Examination Agencies in Republic of Korea

The ultimate goal of the quality control program for special periodic health examination agencies is to diagnose the health condition of a worker correctly, based on accurate examination and analysis skills, leading to protect the worker’s health. The quality control program on three areas, chemical analysis for biological monitoring since 1995, and pneumoconiosis, audiometric testing since 1996, has contributed to improve the reliability of occupational health screenings by improving the issues including standardization of testing methods, tools, diagnostic opinions, and reliability of analysis for biological monitoring. It has contributed to improving the reliability of occupational health monitoring by rectifying the following issues associated with previous monitoring: absence of standardized testing methods, testing tools that are not upgraded, mismatching diagnostic opinions, and unreliable results of biological specimen analysis. Nevertheless, there are issues in need of further improvement such as lack of expertise or the use of inappropriate method for health examination, and passive and unwilling participation in the quality control. We suggested solutions to these problems for each area of quality control program. Above all, it is essential to provide active support for health examiners to develop their expertise, while encouraging all the health screening agencies, employers, and workers to develop the desire to improve the system and to maintain the relevance.

Recurrence of gastric cancer in patients who are disease-free for more than 5 years after primary resection.

BACKGROUND: Late recurrence of gastric cancer is rare and there are few data on recurrence in patients who are disease free for >5 years after gastrectomy. The aim of this study was to evaluate the predictors and status of tumor recurrence among these patients. METHODS: Clinicopathologic characteristics, patterns of recurrence, and postrecurrence survival were analyzed in patients who were diagnosed as disease free at 5 years postoperatively and thereafter experienced recurrence. Independent factors associated with the late recurrence were analyzed. RESULTS: Among 1,573 patients who underwent curative surgery from June 1992 to December 2006, 348 patients had recurrence. Of them, 7.6% (n = 25) suffered from late recurrence after 5 years after gastrectomy. Among patients who were diagnosed as disease free at 5 years after surgery, it accounted for 2.8% (25/902). Cases with late recurrence were characterized by more aggressive clinicopathologic features than those without recurrence. The median time to recurrence was 88.8 months (range, 64.8-238.0); of the 25 patients, 18 (72.0%) had recurrence within 8 years after surgery. The most common pattern was peritoneal recurrence (n = 19; 76.0%). The estimated median survival after recurrence was 9.4 months. On multivariate analysis, pT4 classification was the only independent risk factor for late recurrence. There were 185 patients with pT4 tumor who had no recurrence at 5 years after surgery; 19 (10.3%) had late recurrence. CONCLUSION: pT4 tumor was the only important predictor of late recurrence. Whether extended follow-up for T4 tumors affects survival needs to be demonstrated in more large-scale studies.

A Technique for Simultaneous Cholecystectomy During Bariatric Surgery.

BACKGROUND AND OBJECTIVES: Cholecystectomy performed during bariatric surgery is technically demanding. Herein is described a technique we term the Glissonian approach along with an evaluation of its effectiveness and safety. METHODS: From April 1, 2009, through February 28, 2014, laparoscopic cholecystectomy was performed during laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in 38 patients with proven cholecystopathy on diagnostic imaging. Perioperative outcomes were compared between the patients operated on with the Glissonian approach and those who underwent conventional laparoscopic cholecystectomy. RESULTS: The Glissonian approach was adopted in 13 patients-11 during LRYGB and 2 during LSG-and the conventional operation was performed on 16 patients during LRYGB and 9 during LSG. Mean body mass indexes were 40.1 kg/m(2) in the Glissonian-approach group and 37.6 kg/m(2) in the conventional group. Laparoscopic cholecystectomy by the Glissonian approach saved a mean operative time of 7 minutes compared with the operative time of the conventional operation. No surgical complications related to cholecystectomy were noted in either group. CONCLUSION: This simple technique can be performed safely in morbidly obese patients, with low resultant morbidity and acceptable operation times.

Prognostic significance of lymphovascular invasion in node-negative gastric cancer.

BACKGROUND: The aim of this study was to investigate the prognostic value of lymphovascular invasion (LVI) in gastric cancer patients without lymph node metastasis. METHODS: A total of 699 patients with primary tumor pT1-3/pN0-1 gastric adenocarcinoma who underwent curative resection from 2001 to 2010 were categorized into 3 groups: One-hundred and eleven patients with pN0/LVI(+), 475 with pN0/LVI(-), and 103 with pN1. RESULTS: The tumors in patients with N0/LVI(+) had more aggressive clinicopathologic features than those in patients with N0/LVI(-). However, there was no significant difference in patient characteristics between patients with pN0/LVI(+) and those with pN1, except for histologic grade. There were no significant differences in the overall survival rate in patients with pN0/LVI(+) compared to those with pN0/LVI(-) or the pN1 stage. However, the recurrence-free survival rate of the pN0/LVI(+) group was lower than that of the pN0/LVI(-) group (p < 0.001), while no significant difference was observed between the pN0/LVI(+) and the N1 groups (p = 0.216). In multivariate analysis, LVI was identified as a poor prognostic factor related to recurrence-free survival in node-negative gastric cancer patients. pT3 stage and less than D2 lymphadenectomy were poor prognostic factors affecting recurrence-free survival, and less than D2 lymphadenectomy was an independent poor prognostic factor for overall survival in pN0/LVI(+) patients. CONCLUSIONS: LVI could be an indicator of biological aggressiveness and may be a reliable prognostic factor for node-negative gastric cancer. LVI should be considered in postoperative management of gastric cancer.

The effect of adjuvant chemotherapy on stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer.

PURPOSE: The optimal chemotherapeutic strategy for gastric cancer patients has not been determined, especially with respect to stage and the curability of gastric cancer. The aim of this study was to evaluate the results of adjuvant chemotherapy on stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer after curative gastrectomy between a chemotherapy (CTX) group and non-chemotherapy (non-CTX) group. MATERIALS AND METHODS: Among 1,760 patients who underwent gastric surgery by 1 surgeon in a single institution, 162 stage IV gastric cancer patients with curative gastrectomy were analyzed retrospectively, excluding patients with TanyNanyM1. One hundred twenty-five patients who received different chemotherapeutic regimens were compared to 37 patients who did not receive chemotherapy for reasons of old age or according to their expressed desire. RESULTS: The clinicopathologic factors which showed a clinically significant difference between the two groups were age and histology, which were not associated with patient survival. The CTX group was younger, and had a larger proportion of undifferentiated gastric cancers than the non-CTX group. The mode of treatment failure revealed no significant difference between the CTX and non-CTX groups. The 1, 3, and 5-year disease-free survival and the 1, 3, and 5-year disease-specific survival of the CTX group were 63.9%, 38.4%, and 32.0%, and 85.4%, 52.3%, and 39.6%, respectively, which were more favorable than the non-CTX group (p=0.015 and p=0.001, respectively). Postoperative adjuvant CTX was an independent risk factor for disease-specific survival of stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer patients after curative gastrectomy by multivariate analysis (odds ratio=2.153; 95% confidence interval=1.349-3.435; p=0.001). CONCLUSIONS: Adjuvant CTX may be associated with survival benefit for younger patients with stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer with undifferentiated histology after curative gastrectomy. A randomized controlled trial to reveal the effect of stage-specific adjuvant chemotherapy should be conducted.

A Study on the Health Status, Burnout, and Burden of Primary Family Caregivers of the Elderly In-Patients

PURPOSE: This study was to explore the level of health status, burnout, and burden of primary family caregivers of the elderly inpatients, and to identify the relations among the factors. METHOD: The subjects were a total of 232 primary family caregivers of elderly in-patients at K and E Medical Center, and were surveyed from March 1 to April 10, 2007. Measures were a health status measuring tool based on CMI developed by Brodman et al. (1945), the burnout measuring tool developed by Pines et al. (1981), and the burden measuring tool revised by Jung, Soo-Jin (1998). Data were analyzed by SPSS-WIN 12.0. RESULTS: Firstly, the mean of health status was 1.69, which means that they were mostly healthy, and the mean of burnout was 2.66, which means that they were a little burned out. The mean of burden was 2.71, which means that they were a little burdened. Second, there were high correlations between health status and burnout, between health status and burden, and between burnout and burden. Third, there were significant difference in health status and burnout according to sex and relationship, and in burden according to sex, education level and relationship. CONCLUSIONS: Nurses need to consider the characteristics, health status, burnout, and burden of primary family caregivers.

Pulmonary Thromboembolism following Mastectomy with Immediate TRAM in the Patients with Breast Cancer : a Prospective Study / 한국유방암학회지

PURPOSE: : Skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and a good cosmetic effect for patients with breast cancer. However, this procedure takes longer operation time than mastectomy, and the risk of pulmonary thromboembolism (PTE) and deep vein thrombosis may be increased. The purpose of this study was to evaluate the incidence of PTE. METHODS: Between January and May in 2005, 54 breast cancer patients who underwent skin-sparing mastectomy with immediate transverse rectus abdominalis myocutaneous flap (TRAM) at Asan Medical Center were prospectively investigated according to the clinicopathologic data. Patients were placed in compression stockings on the day of operation, and lung perfusion, inhalation scans,and serum D-dimer assays were performed on the first three postoperative days. If findings were suspicious, we performed embolism computed tomography. We compared patient age, body mass index (BMI), clinical risk factors, operative findings, pathologic results, and the clinical course between PTE patients and non-PTE patients. RESULTS: There were 9 cases of intermediate probability and 6 cases of high probability for PTE according to lung perfusion and inhalation scans, and they underwent embolism CT. Eleven patients (20.4%) were diagnosed with embolism CT or with lung perfusion and inhalation scans;2 patients were symptomatic and 9 patients were asymptomatic. There was significant difference between PTE and non-PTE patients for age, but none for BMI, clinical risk factors, operation time, serum D-dimer, or stage. CONCLUSION: The incidence of PTE after mastectomy with immediate TRAM is relatively high, and a strategy for the prevention and treatment of PTE is required. Although age is a risk factor for PTE on this study, future studies are needed to determine the risk factors for and to confirm proper treatment and prevention of PTE.