Risk of osteoporosis and fracture in long-term breast cancer survivors

Purpose@#High incidence of osteoporosis has been reported in breast cancer patients due to early menopause triggered by adjuvant treatment and temporary ovarian function suppression. In this study, we sought to determine whether long-term breast cancer survivors had an elevated risk of low bone density compared to the general population. @*Methods@#Long-term breast cancer survivors who had been treated for more than 5 years were selected for this study. Data were obtained from medical records and using a questionnaire from the Korea National Health and Nutrition Examination Survey (KNHANES). An agematched non-cancer control group was selected from the KNHANES records. Incidence of fracture and bone mineral density (BMD) were compared between the two groups. @*Results@#In total, 74 long-term breast cancer survivors and 296 non-cancer controls were evaluated. The incidence of fracture did not differ between the two groups (P=0.130). No differences were detected in lumbar BMD (P=0.051) following adjustment for body mass index, while hip BMD was significantly lower in breast cancer survivors (P=0.028). Chemotherapy and endocrine treatment were not related to low BMD in breast cancer survivors. In more than half of the survivors, the 10-year risk of osteoporotic fracture was less than 1%. @*Conclusion@#Long-term breast cancer survivors had low bone density but a comparable risk of fracture compared to non-cancer agematched controls. Further studies on the factors related to low bone density in long-term breast cancer survivors are required.

Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study

BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.

Laparoscopic Versus Open Central Pancreatectomy: Single-institution Comparative Study

PURPOSE: Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic central pancreatectomy (LCP) with open central pancreatectomy (OCP). The aim of this study was to compare clinical outcomes between LCP and OCP as a single institutional study. METHODS: During the study period (From January, 1998 to December, 2010), we performed central pancreatectomy in 95 cases. Among them, 26 cases of totally LCP and 55 cases of OCP were compared retrospectively. RESULTS: Benign pancreatic neoplasm was the main indication. The mean operation time for the LCP group (350.2 min) was longer than that for the OCP group (283.4 min). And there was no significant difference in mean actual blood loss (477 ml versus 714 ml, p=0.083) between the LCP and OCP groups. Return to a normal bowel movement and resumption of a liquid diet were achieved 5.5+/-2.6 days after the operation in the LCP group and 6.6+/-2.0 days after the operation in the OCP group (p=0.039). The mean duration of postoperative hospital stay was 13.8 days for the LCP group, which was significantly shorter than the 22.5 days for the OCP group (p=0.015). The overall complication rate was 42.3% (11 cases) in the LCP group and 45.5% (25 cases) in the OCP group (p=0.790). CONCLUSION: Use of LCP for benign or low grade malignant lesions of the pancreatic neck portion is feasible and safe. Compared to the open method, the laparoscopic approach to central pancreatectomy appears to provide advantages of early resumption of a normal diet and reduction of postoperative hospital stay without further complications.

Prenatal Detection of a Congenital Pancreatic Cyst by Ultrasound

We present a case of a fetal pancreatic cyst, a rare disease in fetal life, detected prenatally at 30 weeks' gestation by ultrasound. Routine ultrasound examination at 30 weeks' gestation by primary obstetrician showed a cyst on the fetal abdomen. Initially, the suspected diagnosis was a mesenteric cyst. Subsequent ultrasound examination at weeks 32, 36 showed a fetal retroperitoneal cyst. A 3.6 kg female neonate was born to 23 yr old woman by spontaneous vaginal delivery at 38 weeks' gestation. The fetus underwent exploratory laparotomy. Histopathologic and immunohistochemical diagnosis revealed the cyst to be a pancreatic cyst. Surgical outcome was excellent. Thus, we report this case of a pancreatic cyst detected via prenatal ultrasonography.

A Case of Thrombotic Thrombocytopenic Purpura Detected after Delivery in Preeclamptic Woman / 대한주산의학회잡지

TTP is a thrombotic microangiopathy not unique to pregnancy and with the increasing incidence in reproductive aged women. The estimated incidence is around one case per million people, sixty percent of the cases occur in women, the median age of onset is 35 years. Pregnancy is a predisposing factor of TTP and may be an inciting state for relapse. TTP usually develops during the antepartum, the mean gestational age of onset of the symptoms is 23.5 weeks, and 58% of patients initially present at or before 24 weeks of gestation. This report was a case of 36 years old mother who was performed cesarean-section at 31 weeks gestational age because of severe preeclampsia. Febrile sensation, convulsion, comatous mentation abruptly developed after cesarean section and we diagnosed TTP. The patient recovered after she was treated with plasmapheresis for 7 days. We recently experienced a unique case of TTP, which was diagnosed after cesarean delivery, because it overlapped with symptoms and thus report this case.

A case of treatment using high-dose Megestrol Acetate (Megace(R)) combined with PDT (Photodynamic Therapy) on early stage of endometrial carcinoma, in nulliparous woman / 대한산부인과학회지

Endometrial carcinoma is predominantly a disease of postmenopausal women, so we don't have to consider fertility. But in case of young women who want to preserve their fertility, it is very difficult to approach. We experienced one case of treatment using high-dose Megestrol Acetate (Megace(R)) combined with PDT (Photodynamic Therapy) on early stage of endometrial carcinoma, in young aged woman who wanted to preserve her fertility. And, we described briefly clinicopathologic findings, reviews of literatures and possibility of combined therapy with Megestrol and PDT.

Epidemiologic Study of Preterm Birth in Chosun University Hospital / 대한산부인과학회잡지

OBJECTIVE: To investigate the change of prognosis of the preterm infants delivered in Chosun University Hospital. METHODS: A study was conducted for 236 newborns who were born at Chosun University hospital from January 1. 2000 to December 31, 2002. The data were collected by review of the hospital record. RESULTS: 1) The survival rate of the preterm infants who weigh below 999 gm was 2% and 68.4% in 1,000-1,499 gm of infants 90.9% in 1,500-1,999 gm of infants and 92.7% in 2,000-2,499 gm of infants respectively. 2) The survival rate of the preterm infants who born 25% at 25-26 weeks, 50% at 27-28 weeks, 80% at 29-30 weeks, 88.2% at 31-32 weeks, 94.4% at 33-34 weeks and 95% after 35 wks respectively. 3) The cause of preterm delivery were premature rupture of membranes (41.7%), preterm labor (23.7%), pregnancy induced hypertension (10.9%), multiple pregnancy (8.3%) etc. 4) The perinatal complications of the preterm infants were hyperbilirubinemia (27.5%), respiratory distress syndrome (24.2%), sepsis (11.4%) etc. CONCLUSION: To increase the survival rates of preterm infants, the preterm labor should be controlled by 27 week's gestation and the birth weight of 1,000 gm minimally.

Torsion of The Follopian Tube in an Adolescent Female / 대한산부인과학회잡지

Torsion of the follopian tube is an infrequent but significant cause of acute lower abdominal pain in females that is difficult to recognize preoperatively, although prompt diagnosis and timely sugical treatment are vital to salvage the oviduct. Unless a high index of suspicion is maintained for torsion of the fallopian tube in a adolescent females, this disorder may not be detected until after tubal destruction.

Bilateral Massive Ovarian Leiomyoma in an Adolescent Female / 대한산부인과학회잡지

Ovarian leiomyoma is a very uncommon tumor that usually presents as an unilateral neoplasm typically associated with uterine leiomyoma in middle aged to postmenopuasal women. These probably originate from smooth muscle cells of the ovarian blood vessel or from the smooth muscle fibers near the attachment of the ovarian ligament. We report a case of ovarian leiomyoma, bilateral and massive in 17 year-old woman. We document the smooth muscle origin of the tumors with immunohistochemical studies that show appropriate staining with antibodies to actin, desmin, vimentin, S-100 protein.

Comparative Analysis of Multiplex PCR and Hybrid Capture System in the Detecttion of Human Papillomavirus in the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: To compare the multiplex-PCR and hybrid capture methods for detection of Human papillomavirus (HPV) in uterine cervical swab samples. METHODS: This study determined the HPV infection and its risk group (subtype) in uterine cervical swab samples of 91 Korean women by HPV hybrid capture I and multiplex-PCR method. RESULTS: The prevalence of HPV infection determined by muliplex-PCR was more higher than by hybrid capture method I. Of 65 women with nonspecific uterine cervical lesions, the frequence of HPV-positivity was 14/65 (12 low-risk and 2 high-risk HPV) by hybrid capture method I and was 37/65 (34 low-risk and 3 high- risk HPV) by multiplex-PCR method, respectively. The frequence of high-risk HPV was 2/6 in LSIL, 7/14 in HSIL, 4/6 in uterine cervical cancer by hybrid capture method I, and was 2/6 in LSIL, 8/14 in HSIL, 4/6 in uterine cervical cancer by multiplex-PCR method. CONCLUSION: These results suggest that multiplex-PCR is more sensitive, simple and cost-effective technique than Hybrid-capture I in the detection of HPV infection in the uterine cervix.

Hysteroscopic Findings in Abnormal Uterine Bleeding / 대한산부인과학회잡지

OBJECTIVE: Abnormal uterine bleeding is the most common disorder of gynecologic department. Organic causes of abnormal uterine bleednig are chronic cervicitis, submucosal myoma, endometrial polyp, endometrial malignancy. To find the exact cause of uterine bleeding, hysteroscopic endometrial biopsy was used. METHODS: 214 patients were included in the study, who received hysteroscopic endometrial biopsy from Feb. 2000 to Dec. 2002 with abnormal uterine bleeding, negative in urine pregnancy test, normal in cervix cytology, and without organic lesion causing uterine bleeding in pelvic examination and ultrasonography. Age, parity, hysteroscopic biopsy result were analyzed retrospectively. RESULTS: Mean age of study group was 42 and mean parity was 2.75. When final hysteroscopic biopsy histology were analysed, proliferative phase was most common (28.9%). Next followed secretory phase (18.2%), simple hyperplasia (13.5%), endometrial polyp (9.8%), chronic endocervicitis (5.1%). Submucosal myoma (4.2%), endometrial cancer (4.2%). Complex hyperplasia were detected in 3.2%. Of 214 patients, who complained uterine bleeding, only 99 (47.1%) patients were proved true non- organic uterine bleeding on hysteroscopic biopsy. Remainder had organic disorder (39.8%). CONCLUSION: When a patient visits the hospital with abnormal uterine bleeding, doctor should be suspicious of endometrial organic disease and treat the patient under exact diagnosis. In these patients, hysteroscopic examination and biopsy were very useful and safe method to determine exact diagnosis and treatment plan.