ABSTRACT
OBJECTIVE: To assess the clinical efficacy of intraovarian artery stromal Doppler ultrasonography and serum glycodelin (placental protein 14, PP14) as prognostic factors of pregnancy in in vitro fertilization and embryo transfer (IVF-ET) cycles. METHODS: Fifty seven infertile women undergoing IVF-ET were recruited at SNUH from April, 2003 to March, 2004. All IVF-ET patients received controlled ovarian hyperstimulation (COH) using gonadotropins with either GnRH agonist or GnRH antagonist. Doppler ultrasonographic measurements were performed by Sonoace-8800 (Medison) with 5.5 MHz transvaginal probe. Pulsatility Index (PI) of intraovarian stromal artery was evaluated on the first day of ovarian stimulation and the day of hCG administration. Blood sampling for hormonal assay including PP14 was taken at the time of the first day of ovarian stimulation, hCG administration, oocyte retrieval, and embryo transfer (ET). Serum hormonal profiles, PI, and outcomes of COH and IVF-ET were compared between clinically pregnant (n=12) and nonpregnant (n=45) groups. RESULTS: Demographic and clinical characteristics of the patients were comparable in both groups except body mass index (BMI). There was no significant correlation between BMI and serum PP14 levels or PI measured in intraovarian stromal artery. Pregnant group had significantly higher fertilization rate and larger number of cryopreserved embryos. The mean serum levels of estradiol, progesterone, LH and FSH were not different between the two groups. When compared with the nonpregnant group, serum PP14 levels were lower in the pregnant group throughout the treatment cycle, but there was no statistical significance. PI of intraovarian stromal artery on hCG day was significantly lower in the pregnant group (1.2 +/- 0.4 vs. 1.8 +/- 0.8). There was no significant correlation between serum PP14 levels and PI. CONCLUSION: This study suggests that serum PP14 levels cannot be a prognostic factor in IVF-ET. The development of more sensitive assay method is required. PI of intraovarian stromal artery on hCG day can be clinically more useful in predicting the success of IVF-ET.
Subject(s)
Female , Humans , Pregnancy , Arteries , Body Mass Index , Embryo Transfer , Embryonic Structures , Estradiol , Fertilization , Fertilization in Vitro , Gonadotropin-Releasing Hormone , Gonadotropins , Oocyte Retrieval , Ovulation Induction , Progesterone , Ultrasonography, DopplerABSTRACT
The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.
Subject(s)
Adult , Aged , Female , Humans , Male , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bleomycin/administration & dosage , Central Nervous System Neoplasms/therapy , Central Nervous System Neoplasms/mortality , Cyclophosphamide/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Epirubicin/administration & dosage , Lymphoma/therapy , Lymphoma/mortality , Mechlorethamine/administration & dosage , Methotrexate/administration & dosage , Middle Aged , Neoplasm Recurrence, Local , Prednisolone/administration & dosage , Procarbazine/administration & dosage , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , Survival Rate , Treatment Failure , Vincristine/administration & dosageABSTRACT
PURPOSE: MOPP/ABV hybrid regimen incorporates MOPP and ABVD into a single regimen on the tenets of the Goldie-Coldman hypothesis. This study was performed to determine the efficacy of COPP/ABV hybrid regimen, in which cyclophosphamide was substituted for mechlorethamine, in patients with advanced Hodgkin's disease. MATERIALS AND METHODS: Patients with advanced Hodgkin's disease were treated with cyclophosphamide(600 mg/m2 iv, Dl), vincristine(1.4 mg/m2 iv, D1), procarbazine(100 mg/m2/d po, D1-7), prednisolone(40 mg/m2/d po D1-14), doxorubicin(35 mg/m2 iv, D8), bleomycin(10 mg/m2 iv, D8) and vinblastine(6 mg/m2 iv, D8). The treatment was repeated every 4 weeks. RESULTS: Between Aug. 1989 and Aug. 1996, 28 patients were enrolled. The median age was 33 years. Twenty one(75%) were previously untreated, newly diagnosed patients and 7(25%) were those who had relapsed after previous radiotherapy(RT). The common histologic types were nodular sclerosis(46%) and mixed cellularity(36%). Twenty three (82%) patients achieved complete remission(CR), three(11%) with the assistance of involved-field RT. Only one patient was primary treatment failure. The median follow-up duration was 56 months. Of the 23 patients achieving CR, three(13%) relapsed. Five-year relapse-free survival was 84.4%. Eight patients died. Five-year overall survival rate was 66.6% and 5-year failure-free survival rate was 66.3%. The survival rate of those who had relapsed after previous RT was significantly lower than that of newly diagnosed patients(P=0.03). The hematologic toxicities were common, but nonhernatologic toxicities were uncommon. Five patients died of treatment-related pneumonia or sepsis. Among them, four were those who had relapsed after previous RT. CONCLUSION: COPP/ABV hybrid regimen could cure significant proportion of patients with advanced Hodgkin's disease but the treatment-related mortality was high, especially in those who had relapsed after previous RT. Another regimen should be considered for those who received previous RT.
Subject(s)
Humans , Cyclophosphamide , Drug Therapy , Follow-Up Studies , Hodgkin Disease , Mechlorethamine , Mortality , Pneumonia , Radiotherapy , Sepsis , Survival Rate , Treatment FailureABSTRACT
Limb salvage operation was introduced to treat, low grade malignant bone tumors about 100 years ago. However, amputation has been the most popular choice for primary malignant bone tumors. Recent improvement of chemotherapy, diagnostic methods and surgical techniques enabled us to treat more malignant bone tumors such as osteogenic sarcoma with limb salvage operation. 6 cases of malignant bone tumors were treated with wide resection and tumor prosthesis from Oct., 1987 to Jan., 1989 at Dept. of Orthopedic Surgery, Seoul National University Hospital. 4 cases of osteosarcoma, 1 case of parosteal osteosarcoma and 1 case of chondrosarcoma were identified. MRI was useful for determining the extent of tumor and surgical planning. All the patients osteosarcoma had neoadjuvant chemotherapy. The mean follow-up was 14.5 months ranging from 8 to 22 months, and theirresults are so far good except one pulmonary metastasis and one local recurrence. We present this as a preliminary report.
Subject(s)
Humans , Amputation, Surgical , Chondrosarcoma , Drug Therapy , Follow-Up Studies , Limb Salvage , Magnetic Resonance Imaging , Neoplasm Metastasis , Orthopedics , Osteosarcoma , Prostheses and Implants , Recurrence , SeoulABSTRACT
Chloroma is a granulocytic sarcoma with it's characteristic greenish color. Recently there is an increased number of cases that are apparently aleukemic when the tumor mass is first presented. Recently we experienced a case of granulocytic sarcoma with characteristic green color (chloroma), which showed no evidence of leukemia in the bone marrow and peripheral blood. This patient presented headache, and was diagnosed brain tumor on computed tomography. A left parietal cranietomy was done to remove a large central dome-like mass, 8 cm, involving the dura with a slightly dusky greenish solid appearance. Compact nests of moderately mature granulocytes and immature cells comprised the tumor. Histochemical and electron microscopic studies confirmed these tumor cells as myeloid cells in varying stages of maturation. Several days after the operation, left cervical lymph nodes became palpated, and the biopsied lymph nodes revealed same neoplastic cells seen in the skull. However, bone marrow aspiration, biopsy and peripheral blood smears did not show any evidence of leukemia.