A Phase II Study of Preoperative Chemoradiotherapy with Capecitabine Plus Simvastatin in Patients with Locally Advanced Rectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The purpose of this phase II trial was to evaluate whether the addition of simvastatin, a synthetic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, to preoperative chemoradiotherapy (CRT) with capecitabine confers a clinical benefit to patients with locally advanced rectal cancer (LARC). @*Materials and Methods@#Patients with LARC (defined by clinical stage T3/4 and/or lymph node positivity) received preoperative radiation (45-50.4 Gy in 25-28 daily fractions) with concomitant capecitabine (825 mg/m2 twice per day) and simvastatin (80 mg, daily). Curative surgery was planned 4-8 weeks after completion of the CRT regimen. The primary endpoint was pathologic complete response (pCR). The secondary endpoints included sphincter-sparing surgery, R0 resection, disease-free survival, overall survival, the pattern of failure, and toxicity. @*Results@#Between October 2014 and July 2017, 61 patients were enrolled; 53 patients completed CRT regimen and underwent total mesorectal excision. The pCR rate was 18.9% (n=10) by per-protocol analysis. Sphincter-sparing surgery was performed in 51 patients (96.2%). R0 resection was achieved in 51 patients (96.2%). One patient experienced grade 3 liver enzyme elevation. No patient experienced additional toxicity caused by simvastatin. @*Conclusion@#The combination of 80 mg simvastatin with CRT and capecitabine did not improve pCR in patients with LARC, although it did not increase toxicity.

Regional Metabolic Changes Influencing Three-Dimensional Perception in Parkinson’s Disease

Background@#and Purpose Stereopsis refers to the perception of depth and awareness of the distance of an object from the observer that results from the brain receiving visual stimuli from both eyes in combination. Patients with idiopathic Parkinson’s disease (PD patients) typically experience problems with vision, eyeball movements, and visual perception due to degeneration of the cells that generate dopamine in the brain. We therefore hypothesized that stereopsis is affected more by visual cortical dysfunction in idiopathic PD than by retina and subcortical structural dysfunction. @*Methods@#We analyzed stereopsis in 12 PD patients and 7 healthy controls using a three-dimensional (3D) television (TV). Before allowing patients to watch TV, we examined their visual acuity and strabismus using the Titmus Stereo Fly Test, and evaluated their cognitive function using cognitive tests. The patients watched 3D and two-dimensional (2D) versions of a movie with an approximate duration of 17 minutes, and then completed a questionnaire about stereopsis. All subjects underwent brain F-18 fluorodeoxyglucose (FDG) positronemission tomography after watching the 3D version of the movie. One week later, subjects watched the 2D version of the same movie under the same conditions. Each scan was analyzed using statistical parametric mapping (version 8) software. @*Results@#The visual cortex was activated less in the PD patients than in the healthy controls when watching the 2D or 3D movie. However, there was no significant difference between watching 2D and 3D movies in the PD patients or healthy controls. @*Conclusions@#The lower activation of the primary visual cortex in PD patients suggests the presence of dysfunction of the visual cortex. In addition, there was less activation of the visual association cortex in PD patients when watching a 3D movie than in controls under the same conditions. This might be one reason why PD patients do not recognize real and dynamic stereopsis. These findings have clinical significance since they suggest that safety needs to be considered when making devices or programs using 3D or virtual reality for use by patients with various cerebral degenerative diseases.

The Rise of Cerebellar Ataxia in South Korea: 2002–2016

No abstract available.

Prescription Pattern of Antidepressants in Korea for Major Neurological Disorders: Before the Policy Change in 2017

BACKGROUND: It is well known that patients with neurological disorders are vulnerable to depression. However, in Korea, National Health Insurance services had banned non-psychiatrists from prescribing antidepressants for more than 2 months until January 2017. Now, neurologists are able to prescribe antidepressants to patients with only four neurological disorders. Due to this recent change in national health insurance policy, there will be a large change in the prescription pattern of antidepressants. In this study, we performed an analysis of antidepressant prescription patterns in Korea prior to this recent policy change. METHODS: The source population of this retrospective cohort study is the Health Insurance Review & Assessment Service database. We analyzed the claim database for patients who have one of four major neurologic disorders and had healthcare documentation submitted by healthcare providers between January 1, 2011 and December 31, 2016. RESULTS: During 2012–2016, antidepressant prescription rates of 6.21% (127,192 of a total 2,048,165 patients), 9.93% (81,861 out of 824,290), 10.12% (173,582 of 1,714,776), and 13.36% (48,530 of 363,347) were found for cerebrovascular disease, epilepsy, dementia, and Parkinson's disease respectively. The most frequently prescribed antidepressant in cerebrovascular disease and epilepsy was tricyclic antidepressants (TCAs). In Parkinson's disease and dementia, the most frequently used antidepressant was selective serotonin reuptake inhibitors. CONCLUSIONS: The overall prescription rate of antidepressants was much lower than the estimated rates reported in other countries. TCAs were the primarily prescribed antidepressant. It is now expected that TCAs will be replaced by newer antidepressants.

A Case of Creutzfeldt-Jakob Disease Presented as Rapid Progressive Parkinsonism

No abstract available.

Posterior Type of Alzheimer's Dementia Presenting with Homonymous Hemianopsia

BACKGROUND: Alzheimer's disease is a chronic neurodegenerative condition, mostly affecting the medial temporal lobe and associated neocortical structures. In this report, we present a rare clinical manifestation of this disease. CASE REPORT: A 61-year-old female with word finding difficulty and memory disturbances was diagnosed with Alzheimer's disease. Two years later, she complained of right homonymous hemianopia without optic ataxia, ocular apraxia, and simultagnosia. No findings other than parenchymal disease were apparent in magnetic resonance imaging and laboratory tests. CONCLUSIONS: In this case, in a patient initially diagnosed with Alzheimer's dementia with progressive disease, we found only homonymous hemianopia, without signs of Balint's syndrome or Gerstmann's syndrome. After careful investigation showing that Alzheimer's dementia with visual symptom was not associated with parenchymal disease, we concluded a case of atypical variant of Alzheimer's disease.

Robotic versus Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Comparative Study of Short-term Outcomes

PURPOSE: Intersphincteric resection (ISR) is a surgical option to preserve the anal sphincter for treatment of low rectal cancer. Laparoscopic ISR has been reported to be technically challenging. The Aim of this study was to assess the short-term outcomes of robotic ISR compared with a laparoscopic approach. METHODS: Ninety four consecutive patients who underwent laparoscopic (n=60) or robotic (n=34) ISR with hand-sewn coloanal anastomosis for low rectal cancer from January 2011 to December 2014 were included. Patient demographics, operative data, and histopathologic and postoperative outcomes were analyzed. RESULTS: There were no differences in demographic data including tumor location, which was 2.5+/-0.7cm from the anal verge in the laparoscopic group and 2.7+/-0.9 cm in the robotic group. Mean operation time was significantly longer in the robotic group compared with the laparoscopic group (278+/-65.3 minutes versus 225+/-66.9, p<0.001). With respect to histopathologic outcomes, patients with circumferential resection margin (CRM) less than 2 mm were observed more frequently in the laparoscopic group than in the robotic group (18.3% versus 5.9%, p=0.050). The rate of postoperative morbidity was lower in the robotic group than in the laparoscopic group (14.7% versus 35.0%, p=0.035). Patients in the robotic group showed a low Clavien-Dindo score more frequently than those in the laparoscopic group (p=0.049). CONCLUSION: Robotic ISR is a safe and feasible procedure associated with a lower rate of narrow CRM and postoperative morbidity in spite of a longer operation time, compared with the laparoscopic approach. Prospective clinical trials with larger numbers of cases evaluating long-term oncologic and functional outcomes are required.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis

PURPOSE: This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). METHODS: This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. RESULTS: Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). CONCLUSION: The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.