Understanding Cancer Pain and Controlling Pain: Focusing on Patients With Metastatic Urologic Cancer

Urinary tumors include cancers that commonly occur throughout the population, such as bladder cancer, kidney cancer, ureter cancer, and prostate cancer. The incidence of urological tumors in Korea is increasing. As the treatments of patients with cancer, such as operation, target therapy, immunotherapy, and gene therapy, are being developed, the life expectancy has been increasing. However, significant number of patients experience disease progression despite of existing treatments. Therefore, symptom direct treatment is crucial in oncologic era. Symptoms of patients with cancer vary but pain is one of the most common symptoms. Therefore, proper pain management is essential for the patients to improve the quality of life. Pain in cancer has as many complex pathological and physical characteristics as various tumor types. Both pharmacological and nonpharmacological interventions are important to address the full spectrum of cancer pain in patients. Many approaches to pain control, including opioid analgesics, radiation, and interventional care, are included in pain control therapy. Clinicians working with urinary tumors should be familiar with these pain control options. This review is intended to provide practical help to clinicians in treating patients with urological tumors. Updates to current knowledge and concepts of cancer pain management are included.

Structural and Resting-State Brain Alterations in Trauma-Exposed Firefighters: Preliminary Results

Purpose@#To analyze the altered brain regions and intrinsic brain activity patterns in trauma-exposed firefighters without posttraumatic stress disorder (PTSD). @*Materials and Methods@#Resting-state functional MRI (rsfMRI) was performed for all subjects. Thirty-one firefighters over 40 years of age without PTSD (31 men; mean age, 49.8 ± 4.7 years) were included. Twenty-six non-traumatized healthy controls (HCs) (26 men; mean age, 65.3 ± 7.84 years) were also included. Voxel-based morphometry was performed to investigate focal differences in the brain anatomy. Seed-based functional connectivity analysis was performed to investigate differences in spontaneous brain characteristics. @*Results@#The mean z-scores of the Seoul Verbal Learning Test for immediate and delayed recall, Controlled Oral Word Association Test (COWAT) score for animals, and COWAT phonemic fluency were significantly lower in the firefighter group than in the HCs, indicating decreased neurocognitive function. Compared to HCs, firefighters showed reduced gray matter volume in the left superior parietal gyrus and left inferior temporal gyrus. Further, in contrast to HCs, firefighters showed alterations in rsfMRI values in multiple regions, including the fusiform gyrus and cerebellum. @*Conclusion@#Structural and resting-state functional abnormalities in the brain may be useful imaging biomarkers for identifying alterations in trauma-exposed firefighters without PTSD.

Study on relationship between caffeine intake level and metabolic syndrome and related diseases in Korean adults: 2013 ~ 2016 Korea National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: This study examined the relationship between caffeine intake and metabolic syndrome in Korean adults using the 2013 ~ 2016 Korea National Health and Nutrition Examination Survey data (KNHANES). METHODS: The caffeine database (DB) developed by Food and Drug Safety Assessment Agency in 2014 was used to estimate the caffeine consumption. The food and beverage consumption of the 24 hr recall data of 2013 ~ 2016 KNHANES were matched to items in the caffeine DB and the daily caffeine intakes of the individuals were calculated. The sample was limited to non-pregnant healthy adults aged 19 years and older, who were not taking any medication for disease treatment. RESULTS: The average daily caffeine intake was 41.97 mg, and the daily intake of caffeine of 97% of the participants was from coffee, teas, soft drinks, and other beverages. Multivariate analysis showed that the caffeine intake did not affect metabolic syndrome, hypertension, low HDL-cholesterol, and abdominal obesity. Diabetes and hypertriglyceridemia, however, were 0.76 (95% CI: 0.63 ~ 0.93), and 0.87 (95% CI: 0.77 ~ 0.98) in third quintile (Q3), and 0.66 (95% CI: 0.53 ~ 0.82) and 0.83 (95% CI: 0.73 ~ 0.94) in fourth quintile (Q4) compared to Q1, respectively. Therefore, caffeine intake of 3.66 ~ 45.81 mg per day is related to a lower risk of diabetes and hypertriglyceridemia. CONCLUSION: The study showed that adequate caffeine intake (approximately 45 mg) was associated with a lower prevalence of diabetes and hypertriglyceridemia. Therefore, it can be used as a guideline for the adequate level of caffeine intake for maintaining health.

Bilateral Ureteral Obstruction Related to Pelvic Rhabdomyosarcoma Presenting with Acute Kidney Injury: A Case Report

Bilateral renal obstruction is a rare critical condition, requiring a prompt diagnostic approach and treatment to restore the renal function. The most commonly observed obstructive uropathy in children is congenital malformation, such as posterior urethral valves and bilateral ureteropelvic junction obstruction. Malignant pelvic masses obstructing the ureter are widely reported in adults but are rarely observed in children. The treatment of ureteral obstruction related to pelvic malignancy is a therapeutic challenge with a median survival duration of 3–7 months in adults; however, pediatric patients with pelvic malignancy leading to ureteral obstruction had better outcomes, with a reported 5-year mortality rate of 20%, than the adult patients. Here, we report a rare case of bilateral ureteral obstruction associated with pelvic rhabdomyosarcoma presenting with acute kidney injury treated by ureteral diversion with double J stent, and concommittent emergency hemodialysis, leading to restoration of good renal function. We suggest that bilateral ureteral obstruction should be released as soon as possible using surgical or interventional approach to minimize the obstruction period, and subsequential chemotherapy may contribute to improvement of survival and recovery of renal function.

Sonographic Growth Charts for Kidney Length in Normal Korean Children: a Prospective Observational Study

Kidney length is the most useful parameter for clinical measurement of kidney size, and is useful to distinguish acute kidney injury from chronic kidney disease. In this prospective observational study of 437 normal children aged between 0 and < 13 years, kidney length was measured using sonography. There were good correlations between kidney length and somatic values, including age, weight, height, and body surface area. The rapid growth of height during the first 2 years of life was intimately associated with a similar increase in kidney length, suggesting that height should be considered an important factor correlating with kidney length. Based on our findings, the following regression equation for the reference values of bilateral kidney length for Korean children was obtained: kidney length of the right kidney (cm) = 0.051 × height (cm) + 2.102; kidney length of the left kidney (cm) = 0.051 × height (cm) + 2.280. This equation may aid in the diagnosis of various kidney disorders.

Dexamethasone Inhibits TGF-β1-Induced Cell Migration by Regulating the ERK and AKT Pathways in Human Colon Cancer Cells Via CYR61 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: One of the features in cancer development is the migration of cancer cells to form metastatic lesions. CYR61 protein promotes migration and the epithelial-mesenchymal transition in several cancer cell types. Evidence suggests that CYR61 and dexamethasone are relevant to colorectal cancer. However, relationships between them and colorectal cancer are still unclear. Understanding the molecular mechanism of colorectal cancer progression related with CYR61 and dexamethasone, which is widely used for combination chemotherapy, is necessary for improved therapy. MATERIALS AND METHODS: We used colorectal cancer cells, HCT116, co-treated with transforming growth factor β1 (TGF-β1) and dexamethasone to examine the inhibitory migration effect of dexamethasone by migratory assay. Alternatively, both migratory pathways, expression of AKT and ERK, and the target factor CYR61 was also tested by co-treatment with TGF-β1 and dexamethasone. RESULTS: We report that dexamethasone significantly inhibited TGF-β1-induced cell migration, without affecting cell proliferation. Importantly, we observed that TGF-β1 promoted the epithelial-mesenchymal transition process and that dexamethasone co-treatment abolished this effect. ERK and AKT signaling pathways were found to mediate TGF-β1-induced migration, which was inhibited by dexamethasone. In addition, TGF-β1 treatment induced CYR61 expression whereas dexamethasone reduced it. These observations were compatible with the modulation of migration observed following treatment of HCT116 cells with human recombinant CYR61 and anti-CYR61 antibody. Our results also indicated that TGF-β1 enhanced collagen I and reduced matrix metalloproteinase 1 expression, which was reversed by dexamethasone treatment. CONCLUSION: These findings suggested that dexamethasone inhibits AKT and ERK phosphorylation, leading to decreased CYR61 expression, which in turn blocks TGF-β1-induced migration.

Pazopanib for Non-small Cell Lung Cancer: The First Case Report in Korea / Journal of the Korean Cancer Association, 대한암학회지

Pazopanib is a potent multitargeted tyrosine kinase inhibitor that has been shown to have good efficacy in patients with renal cell carcinoma. A previous phase II trial demonstrated that short-term pazopanib administration was generally well tolerated and showed antitumor activity in patients with early-stage non-small cell lung cancer. Herein, we report on the case of a 66-year-old man with simultaneous metastatic squamous cell carcinoma of the lung and renal cell carcinoma who was treated with pazopanib. The patient showed an unexpected partial response and experienced a 10-month progression-free survival without significant toxicity. To the best of the authors' knowledge, this is the first report of pazopanib treatment in a non-small cell lung cancer patient in Korea. The results in this patient suggest that pazopanib may be a valid treatment option for advanced non-small cell lung cancer.

A Case of Acute Myeloid Leukemia Developing after Treatment for Brucellosis with Pancytopenia

Human brucellosis is an important zoonotic disease and has a wide clinical spectrum. Nonspecific hematologic abnormalities related to brucellosis are frequently found, but pancytopenia is uncommon. Malignant diseases have been infrequently reported as a rare cause of pancytopenia in patients with brucellosis. We describe a patient with brucellosis and pancytopenia who was later diagnosed with acute myeloid leukemia. A 71-yr-old man was admitted to a hospital with fever and pancytopenia. Brucella was cultured from blood, and the bone marrow findings were in accordance with brucellosis. The patient's clinical symptoms improved; however, he still showed pancytopenia after completion of medical treatment. After approximately 6 months, he was readmitted with pneumonia and pancytopenia. The second bone marrow examination revealed hypercellular marrow with increased number of blasts. The chromosome analysis showed 46,XY,trp(8)(q11.2q22)[8]/46,idem,del(7)(q22)[12]. The patient was diagnosed with acute myeloid leukemia with myelodysplasia-related changes. He refused further evaluation and therapy, and subsequently died while receiving conservative treatment.

A Case of Primary Effusion Lymphoma in a Patient with Chronic Kidney Disease / 대한내과학회지

Human herpes virus-8 (HHV-8)-negative primary effusion lymphoma (PEL) is frequently observed in patients with chronic liver disease. We describe herein a case of PEL in a patient with chronic kidney disease. A 59-year-old woman presented with dyspnea. The patient had a history of uncontrolled pleural effusion. The pleural effusion revealed a malignant cell-dominant exudate. Serological tests were negative for human immunodeficiency virus (HIV). Initial chest and abdomen computed tomography showed bilateral pleural effusion; however, no evidence of a tumor mass or lymph node enlargement was found. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural fluid cytology. Immunohistochemical staining of malignant cells was negative for HHV-8. She was treated with rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy. We report a case of PEL in a patient with chronic kidney disease that may be a plausible predisposing factor for HHV-8-negative PEL.

Immediate Breast Reconstruction after Skin-Sparing Mastectomy

No abstract available.

Correction of Alar Cartilage Malposition

The alar cartilage malposition is defined as any displacement of lateral crura from the usual parallel alignment with nostril rims. It has several characteristics including parentheses deformity, notches in alar rims, flat nasal tip, square basal perimeter. It tends to be misdiagnosed as cartilaginous hump or bulbous tip because of its longitudinally prominent lobule. But, exact diagnosis can be easily attained with careful examination and recognition in the clinical diagnosis of bulbous or ambiguous tips. It is confirmed by the resistless collapse of lateral alar rim when light compression is applied by cotton stick. Its incorrect diagnosis can bring about inappropriate tip graft, soft tissue resection, rasping, humpectomy and secondary nasal deformity may develope as a result. Authors performed open approach followed by meticulous dissection of displaced alar cartilages. Each medial portion, corresponding to the cephalic portion of normal lateral crus, was resected. Then, each lateral crus was symmetrically rotated in the infero-lateral direction along the axis of the medial crura. If needed, autocartilage on-lay graft and dorsal augmentation were done for optimal aesthetic result. We believe accurate evaluation of the anatomical variation should be checked out preoperatively and recommend out method for the effective correction of unusual bulbous or broad tips.

Correction of Blunt Nasal Tip with "Contour Tip Gragt" and Alar Cartilage Modification

The aim of aesthetic rhinoplasty is to produce harmonious contour of the nasal tip as well as to provide dorsal augmentation. The nasal tip should look definite but not too pointed or artificial. Natural contour is most desirable. Among the patients(n = 140) who had augmentation rhinoplasty between 1995 to 1999, 107 patients were classified to have blunt tips. The cases who have other types of tip deformities were excluded. In this study, we present our tip plasty technique for the correction of blunt tips. The blunt tip deformities were divided into bulbous tip(n = 82) and broad tip(n = 25). As for the operation, different tip thinning procedures were done according to this classification. Then dorsal augmentation with silastic implant was performed. Authors used "Contour Tip Graft" technique to produce aesthetic oriental nasal tip. This technique made use of the graft of stacked autogenous cartilages with small pieces of diced cartilage around it. The stacked cartilages were for tip projection and surrounding pieces for natural contour. This method can yield more natural appearance of the tip and lobule. Our tip plasty technique combined with dorsal augmentation is very useful and effective procedure in the correction of blunt tip.