Use of 18F-FDG PET to predict tumor progression and survival in patients with intermediate hepatocellular carcinoma treated by transarterial chemoembolization

BACKGROUND/AIMS: 18F-Fluorodeoxyglucose positron-emission tomography (18F-FDG PET) has been used to assess the biological behavior of hepatocellular carcinoma (HCC). In this study, we investigated the usefulness of 18F-FDG PET for predicting tumor progression and survival in patients with intermediate Barcelona Clinic Liver Cancer (BCLC) intermediate-stage HCC treated by transarterial chemoembolization (TACE). METHODS: From February 2006 to March 2013, 210 patients treated with TACE, including 77 patients with BCLC intermediate-stage HCC, underwent examination by 18F-FDG PET. 18F-FDG uptake was calculated based on the tumor maximum (Tmax) standardized uptake value (SUV), the liver mean (Lmean) SUV, and the ratio of the Tmax SUV to the Lmean SUV (Tmax/Lmean). RESULTS: The mean follow-up period for the 77 patients (52 males, 25 females; average age, 63.3 years) was 22.2 months. The median time to progression of HCC in patients with a low Tmax/Lmean ( or = 1.83) was 17 and 6 months, respectively (p < 0.001). The median overall survival time of patients with a low and high Tmax/Lmean was 44 and 14 months, respectively (p = 0.003). Multivariate analysis revealed that the Tmax/Lmean was an independent predictor of overall survival (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.210 to 3.156; p = 0.006) and tumor progression (HR, 2.05; 95% CI, 1.264 to 3.308; p = 0.004). CONCLUSIONS: 18F-FDG uptake calculated by the Tmax/Lmean using PET predicted tumor progression and survival in patients with BCLC intermediate-stage HCC treated by TACE.

Effect of Structured Information on Immediate Preoperative Anxiety and Uncertainty for Women Undergoing Laparoscopic Hysterectomy

PURPOSE: Purpose of this study was to identify the effect of structured information on immediate preoperative anxiety and uncertainty for women undergoing total laparoscopic hysterectomy. METHODS: Sixty women who were admitted for total laparoscopic hysterectomy were recruited at a university hospital in Gyeonggi-do from June to October 2014. Thirty women were assigned to either the experimental or the control group. Women in the experimental group were provided structured information, which consisted of visual and auditory materials about surgical preparation and process, practical experience on devices such as IV-PCA pump and Inspiro-meter and actual experience on route to go to the operating room. State-anxiety, uncertainty, and blood pressure and pulse rate as biological indicators were measured before and after the intervention to examine the effect. RESULTS: Significant group differences were found on state anxiety, uncertainty, including ambiguity, inconsistency, and unpredictability at the holding area. There was a significant difference on pulse rate in the operating room between the two groups. CONCLUSION: Findings demonstrated that the structured information provided for women undergoing laparoscopic hysterectomy preoperatively was effective on immediate preoperative anxiety and uncertainty. Nurses may contribute to decreasing patients' anxiety and uncertainty by utilizing this structured information preoperatively.

Does Metformin Affect The Incidence of Colonic Polyps and Adenomas in Patients with Type 2 Diabetes Mellitus?

BACKGROUND/AIMS: Colorectal cancer (CRC) develops from colonic adenomas. Type 2 diabetes mellitus (DM) is associated with a higher risk of CRC and metformin decreases CRC risk. However, it is not certain if metformin affects the development of colorectal polyps and adenomas. This study aimed to elucidate if metforminaffects the incidence of colonic polyps and adenomas in patients with type 2 DM. METHODS: Of 12,186 patients with type 2 DM, 3,775 underwent colonoscopy between May 2001 and March 2013. This study enrolled 3,105 of these patients, and divided them in two groups: 912 patients with metformin use and 2,193 patients without metformin use. Patient clinical characteristics, polyp and adenoma detection rate in the two groups were analyzed retrospectively. RESULTS: The Colorectal polyp detection rate was lower in the metformin group than in the non-meformin group (39.4% vs. 62.4%, P<0.01). Colorectal adenoma detection rate was significantly lower in the metformin group than in the non-metformin group (15.2% vs. 20.5%, P<0.01). Fewer advanced adenomas were detected in the metformin group than in the non-metformin group (12.2% vs. 22%, P<0.01). Multivariate analysis identified age, sex, Body mass index and metformin use as factors associated with polyp incidence, whereas only metforminwas independently associated with decreased adenoma incidence (Odd ratio=0.738, 95% CI=0.554-0.983, P=0.03). CONCLUSIONS: In patients with type 2 DM, metformin reduced the incidence of adenomas that may transform into CRC. Therefore, metformin may be useful for the prevention of CRC in patients with type 2 DM.

A Case of Septic Knee Arthritis Caused by Salmonella Enteritidis

Salmonella septic arthritis in a healthy, immunocompetent patient is extremely rare. We experienced a case of septic arthritis of the knee caused by Salmonella Group D in a patient with Non-small cell lung cancer. A 43-year-old female receiving steroid therapy for treatment of Non-small cell lung cancer with metastasis to the spinal cord complained of painful swelling of the right knee joint. Culture of synovial fluid obtained by aspiration yielded growth of Salmonella Group D. The patient was treated with ceftriaxone; however, she expired on the ninth day after treatment.

A Case of Behcet's Syndrome with Acute Myocardial Infarction and Intracardiac Thrombosis / 대한내과학회지

A 36-year-old man with a history of Behcet's syndrome and vascular complications visited the emergency room due to sudden chest pain and dyspnea. He had no coronary risk factors. Electrocardiography showed ST elevations in multiple precordial leads. Echocardiography showed akinesia of the anterior wall, interventricular septum, and apex, with a movable round mass measuring 1.4 x 1.5 cm in the right atrium. Cardiac computed tomography (CT) suggested the presence of a thrombus in the coronary sinus protruding into the right atrium. Coronary angiography revealed total occlusion with thrombi in the proximal left anterior descending coronary artery. Thrombectomy and stent insertion were performed. After the procedure, the patient was prescribed warfarin. Follow-up CT indicated the disappearance of the thrombi originating from the coronary sinus.

Complete Remission of Refractory Hepatic Hydrothorax in Patient with Advanced Liver Cirrhosis and Hepatocellular Carcinoma Using Transjugular Intrahepatic Portosystemic Shunt

Hepatic hydrothorax is defined as the presence of pleural fluid (>500 mL) in the absence of primary cardiac or pulmonary disease. Initial treatments consist of a low salt diet, diuretics, and thoracentesis. If these are not effective, other modalities should be considered. The transjugular intrahepatic portosystemic shunt (TIPS) placement is one of the modalities for treatment of hepatic hydrothorax. However, the effects of TIPS placement have been contradictory. A 42-year-old man was diagnosed hepatic hydrothorax with liver cirrhosis. He was managed with medical therapy, but it was not effective to control hepatic hydrothorax. This case is reported with a review of relevant literature.

A Case of Gastrointestinal and Cervical Lymph Nodal Kaposi's Sarcoma in a Patient with Acquired Immunodeficiency Syndrome

Kaposi's sarcoma was the first malignancy to be recognized as a cancer defining acquired immunodeficiency syndrome (AIDS). Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions but it may be widely disseminated internally such as digestive, respiratory organ, spleen, or lymph node. The incidence of Kaposi's sarcoma in patients with AIDS has declined in the era of effective antiretroviral therapy (ART), and cases of disseminated Kaposi's sarcomas have rarely been reported in Korea. Chemotherapy is usually used in symptomatic or rapidly progressive disease, and interferon-alpha can be applied as a treatment option. We report a successfully treated case of gastrointestinal and cervical lymph nodal Kaposi's sarcoma in a patient with AIDS who had combined treatment with ART, interferon-alpha, and paclitaxel.

A Case of Parathyroid Carcinoma in a Patient with Stage 3 Chronic Kidney Disease / 대한내과학회지

Parathyroid carcinoma is a rare disease in patients with primary hyperparathyroidism. We experienced a case of parathyroid carcinoma presenting with hyperparathyroidism. A 62-year-old male patient had hypercalcemia, chronic kidney disease, and an elevated parathyroid hormone level for at least 3 months. An ultrasonogram and parathyroid scan did not show parathyroid neoplasm. He underwent left hemithyroidectomy and parathyroidectomy. Biopsy revealed a parathyroid carcinoma. His azotemia and hypercalcemia improved after surgery.

A Case of Behcet's Syndrome with Acute Myocardial Infarction and Intracardiac Thrombosis / 대한내과학회지

A 36-year-old man with a history of Behcet's syndrome and vascular complications visited the emergency room due to sudden chest pain and dyspnea. He had no coronary risk factors. Electrocardiography showed ST elevations in multiple precordial leads. Echocardiography showed akinesia of the anterior wall, interventricular septum, and apex, with a movable round mass measuring 1.4 x 1.5 cm in the right atrium. Cardiac computed tomography (CT) suggested the presence of a thrombus in the coronary sinus protruding into the right atrium. Coronary angiography revealed total occlusion with thrombi in the proximal left anterior descending coronary artery. Thrombectomy and stent insertion were performed. After the procedure, the patient was prescribed warfarin. Follow-up CT indicated the disappearance of the thrombi originating from the coronary sinus.