Prognostic Value of Volume-Based Positron Emission Tomography/Computed Tomography in Patients With Nasopharyngeal Carcinoma Treated With Concurrent Chemoradiotherapy

OBJECTIVES: The aim of this study was to evaluate the prognostic value of volume-based metabolic parameters measured by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in patients with nasopharyngeal carcinoma (NPC). METHODS: Forty-four NPC patients who underwent 18F-FDG PET/CT for initial staging work-up before concurrent chemoradiotherapy (CCRT) were retrospectively evaluated. Maximum standardized uptake value (SUV), mean SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors were measured. The prognostic significance and predictive performance of these parameters were assessed by Cox proportional hazards regression analysis and time-dependent receiver operating characteristics (ROC) curve analysis. RESULTS: Multivariate analysis showed that American Joint Committee on Cancer stage 7th edition (hazard ratio [HR], 1.525; 95% confidence interval [CI], 1.062 to 2.188; P=0.022), and TLG (HR, 7.799; 95% CI, 2.622 to 23.198; P< or =0.001) were independent predictive factors associated with decreased disease-free survival (DFS). Time-dependent ROC curve analysis indicated that TLG was a better predictor of DFS than MTV (P=0.008). CONCLUSION: The TLG of the primary tumor was a significant independent metabolic prognostic factor of DFS in patients with NPC treated with CCRT.

Prognostic Value of Volume-Based 18F-Fluorodeoxyglucose PET/CT Parameters in Patients with Clinically Node-Negative Oral Tongue Squamous Cell Carcinoma

OBJECTIVE: To evaluate the prognostic value of volume-based metabolic parameters measured with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in patients with clinically node-negative (cN0) oral tongue squamous cell carcinoma (OTSCC) as compared with other prognostic factors. MATERIALS AND METHODS: In this study, we included a total of 57 patients who had been diagnosed with cN0 tongue cancer by radiologic, 18F-FDG PET/CT, and physical examinations. The maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors were measured with 18F-FDG PET. The prognostic significances of these parameters and other clinical variables were assessed by Cox proportional hazards regression analysis. RESULTS: In the univariate analysis, pathological node (pN) stage, American Joint Committee on Cancer (AJCC) stage, SUVmax, SUVavg, MTV, and TLG were significant predictors for survival. On a multivariate analysis, pN stage (hazard ratio = 10.555, p = 0.049), AJCC stage (hazard ratio = 13.220, p = 0.045), and MTV (hazard ratio = 2.698, p = 0.033) were significant prognostic factors in cN0 OTSCC patients. The patients with MTV > or = 7.78 cm3 showed a worse prognosis than those with MTV < 7.78 cm3 (p = 0.037). CONCLUSION: The MTV of primary tumor as a volumetric parameter of 18F-FDG PET, in addition to pN stage and AJCC stage, is an independent prognostic factor for survival in cN0 OTSCC.

International Travel and Imported Parasitic Diseases / 한양의대학술지

International travel has become increasingly common as travelers of various purposes. It is estimated that there are 900 million international tourist arrivals alone each year. Unfortunately, some health impairments were reported in about 50% of short term travelers to the tropics or sub-tropics, usually due to infectious agents. In this paper, the author reviewed imported parasitic diseases in Korea from 1970 to 2009 with literature and data collected by Korea Centers for Disease Control and Prevention (KCDC). The author also reviewed warning points about parasitic disease in pregnant and immune deficit travelers. Most prevalent imported parasitic disease was malaria. About 30~70 travelers infected with malaria are returned home anually from abroad, mostly South East Asia and Africa. Subtype of malaria classified from 2003~2006 surveillance data showed Plasmodium falciparum infection in about 55% of patients identified. Over 20 cases of hydatid disease and cutaneous leishmaniasis cases were reported respectively. Visceral leishmaniasis (5 cases), babesiosis (7 cases), loiasis (3 cases), cutaneous myiasis (1 case), pentastomiasis (1 case), gnathostomiasis (4 cases, 41 people), angiostrongylosis (1 case, 10 people), heterophyiasis (2 cases), schistosomiasis (13 cases), cyclosporiasis (1 case), cutaneous larva migrans (4 cases), ancylostomiasis (1 case) and syngamosis (1 case) were reported. Prevention and surveillance plan of imported parasitic diseases is organized and conducted by KCDC since 2001. According to increasing travel to developing or under developed countries, retraining of doctor and technician, systematization of consulting system for diagnosis of parasitic disease, supply of medication, supplement of the personnel, and financial supports are needed.

Removal of Neglected Foreign Body in Upper Extremities

PURPOSE: To describe the clinical manifestations, diagnosis, and treatments in the patients with delayed diagnosis after foreign body injury. MATERIALS AND METHODS: Seventeen patients with foreign body injury, who had delayed diagnosis more than two months, from January 2000 to August 2008, were enrolled in the present study. The clinical manifestation, materials, locations of foreign bodies, and diagnostic methods were assessed in this study. In addition, we investigated the treatment in the all patients. RESULTS: The interval between injury and removal surgery varied from two months to 16 years. The most common clinical manifestations were foreign body sensation and tenderness (13/17). Glasses (9/17), woods (3/17), needles (2/17), and pencil leads (2/17) were the common foreign bodies. In addition, the most common location of foreign body was palm (7/17), followed by finger (4/17) and wrist (3/17). In the major portion of patients (13/17), the diagnosis was made by simple roentgenogram at the time of presentation. Ultrasonogram (US) or magnetic resonance imaging (MRI) was performed in the residual four radiolucent foreign bodies. In the all 17 patients, surgical removal was performed. CONCLUSIONS: A doctor should perform the scrupulous history taking and physical examination when diagnosing injury by foreign body. In patients with history of prior surgical treatment due to laceration or penetration by foreign body, active examination, radiological diagnosis including roentgenogram, US, and MRI, and surgical removal are recommended.

Changes of cytokine mRNA expression and IgG responses in rats infected with Capillaria hepatica

The mRNA expression of several cytokines was evaluated in splenocytes and mesenteric lymph node (MLN) cells of rats infected with Capillaria hepatica by reverse-transcription (RT)-PCR until week 12 after infection. IgG1 and IgG2a, which are associated with Th1 and Th2 response, respectively, were also assessed by ELISA. The results indicated that the majority of cytokines, including the Th1 (IL-2 and IFN-gamma) and Th2 cytokines (IL-4, IL-5 and IL-10) were expressed at maximal levels during the early stage of infection (after week 1-2), and the ELISA data also evidenced a similar pattern of changes in IgG1 and IgG2a. Th1 and Th2 cytokines responded in a similar fashion in this rat model. The expression of cytokines in splenocytes was significantly higher than that in MLN cells, thereby indicating that cytokine production is controlled more by spleen than by MLN. In addition, the observation that IFN-gamma expression increased unexpectedly at the time of maximal egg production (6 weeks after infection) indicated that IFN-gamma is a cytokine reacting against egg production. However, increased IL-5 expression occurring in tandem with worm activity indicated that the activity of C. hepatica might be controlled by IL-5 expression.

Anatomical Investigations for Appropriate Needle Positioning in Thoracic Paravertebral Blockade / 대한마취과학회지

BACKGROUND: Thoracic paravertebral blockade (TPVB) can be effective in many clinical settings. However, many clinicians are reluctant to use this technique due to its adverse effects such as pneumothorax. The aim of this study was estimate the appropriate depth and width for safe needle positioning. METHODS: The depth from skin to the paravertebral space (PVS) and the width from the spinous process (SP) to the PVS and the lateral tip of the transverse process (LTTP) were measured in all available sections from 84 patients examined by chest computed tomography (CT). The correlation between age, gender, body mass index (BMI) and each measured value was analyzed. RESULTS: All 828 sections from the 84 patients aged between 19 and 65 years old were evaluated. The minimum and maximum values of the mean depth from the skin to PVS were 40.3-52.4 mm in men and 41.2-55.9 mm in women. The minimum and maximum values of the mean width from the SP to LTTP were 29.2-34.6 mm in men and 23.7-31.0 mm in women. At every thoracic level, the depth to PVS was similar in both genders but the width from the SP to the NEP in men was significantly higher than in women. Weight significantly influenced the width from the SP to LTTP in men but height and BMI did not. Also weight and BMI significantly influenced the depth from skin to PVS in almost all of the thoracic region at both sex, but height did not influence the depth from skin to PVS in both sex. CONCLUSIONS: We report clinically useful estimates that may be used to help avoid side effects such as pneumothorax and achieve a successful thoracic paravertebral blockade.

A Case of Primary Cutaneous Endometriosis at the Unbilicus / 대한산부인과학회지

Cutaneous endometriosis seems to be more common in women who have had a pelvic or abdominal operation and primary cutaneous endometriosis is very rare. In our hospital we experienced a 41-year-old woman who complained of the appearance at the umbilicus of a nodule and had not had operation. This nodule was responsible for recurrent pain and increasing in size and it was excised. Pathology findings revealed cutaneous endometriosis. So we present a case of primary cutaneous endometriosis with a brief review of literature.

Treatment of Persistent Hiccups with a Single Session of Gabapentin Therapy: A report of 2 cases / 대한통증학회지

Hiccups are due to an intermittent clonic spasm of the diaphragm. In most cases, hiccups are self-limiting disease, but persistent hiccups may be related to the presence of serious underlying systemic disease. Two patients who had persistent hiccups that were not controled by conventional methods and medications were referred to the pain clinic. We administered a single oral medication of gabapentin, and then the hiccups disappeared in both cases. We concluded that gabapentin should be considered as an alternative therapy to control persistent or intractable hiccup. It could be particularly useful for those patients with solid malignancies, either alone or as an "add-on therapy" with other oral agents.

Macropsia caused by Acute Posterior Cerebral Artery Infarction

Macropsia is a rare disorder of visual perception characterized by the perception of a definite increase in the size of objects. We report a 64-year-old man who presented with left hemimacropsia and left homonymus upper quadrantanopsia. A brain MRI showed a high intensity signal in the right lingual gyrus and fusiform gyrus including the Brodmann area 18 on the T2WI and DWI. Brain MRA showed occlusion of the right proximal PCA. This lesion was mainly in the posterior part of the ventral occipitotemporal visual pathway.

A Multi-center, Double-blind, Randomized and Comparative Clinical Study for the Safety and Analgesic Effect after four-week-treatment with Neurotropin(R) in Patients with Low Back Pain: Compared to Aceclofenac / 대한척추외과학회지

STUDY DESIGN: A Multicenter double-blind randomized clinical study comparing Neurotropin and Aceclofenac. OBJECTIVE: To evaluate the analgesic effect, efficacy and safety of Neurotropin in patients with low back pain. SUMMARY OF LITERATURE REVIEW: Non steroidal anti inflammatory analgesics are used as the main medical treatment in patients with low back pain. However, complications, such as gastrointestinal or cardiovascular problems, have been well documented. Neurotropin acts to recover the analgesic state arising from a decrease in pain threshold and has a completely different mechanism to that of existing anti-inflammatory and narcotic analgesics, with its action of restoring the immune system having been confirmed. MATERIALS & METHOD: 376 patients with back pain were randomly divided into two groups; one group was administered Neurotropin and the other Aceclofenac. The overall improvement after 4 weeks was used as the first efficacy variable, and with the second efficacy variable the improvements in spontaneous pain, tenderness, motion pain, radiating pain, severity, pain intensity, and the overall severity and Oswestry Disability Indices were used as the evaluation criteria. To evaluate safety, the abnormal clinical response and alternations on physical examination and the clinical laboratory values were used. RESULTS: A total of 358 patients received the experimental and comparison drugs, of which 351 were evaluated for safety. The overall improvement after 4 weeks, severity of symptoms, overall severity, and the pain intensity and Oswestry Disability Indices were decreased in both groups, but the differences between the two groups were not statistically significant. The overall decrease in the severity was greater in the Aceclofenac group, but both groups had statistically meaningful decreases after the administration of the drugs. i.e. Adverse drug reactions were less in the Neurotropin group, but these showed no significant statistical difference. CONCLUSIONS: Neurotropin and Aceclofenac are equally effective in patients with low back pain, but in terms of safety from a clinical view point Neurotropin is more reliable.

Anti-Hu Antibody Associated Sensory Neuronopathy Accompanied by Autonomic Dysfunction

Paraneoplastic sensory neuronopathy may present with autonomic dysfunction resulting either from autonomic neuropathy, or invasion/compression by tumor. We present a 61-year-old female presented with frequent syncope, anhidrosis, and sensory change. Investigations disclosed sensory-autonomic polyneuropathy with positive anti-Hu antibody. The chest computed tomography showed a left mediastinal mass with invasion to the brachiocephalic vein, and a small cell lung cancer was confirmed. She was treated with radiation therapy showing limited improvement. The possible causes of autonomic dysfunction in our patient were discussed.

A Case of Neurobehcet's Disease with Recurrent Transverse Myelitis

No abstract available.

Influence of calcium ion on host cell invasion and intracellular replication by Toxoplasma gondii

Toxoplasma gondii is an obligate intracellular protozoan parasite, which invades a wide range of hosts including humans. The exact mechanisms involved in its invasion are not fully understood. This study focused on the roles of Ca2+ in host cell invasion and in T. gondii replication. We examined the invasion and replication of T. gondii pretreated with several calcium modulators, the conoid extrusion of tachyzoites. Calmodulin localization in T. gondii were observed using the immunogold method, and Ca2+ levels in tachyzoites by confocal microscopy. In light microscopic observation, tachyzoites co-treated with A23187 and EGTA showed that host cell invasion and intracellular replication were decreased. The invasion of tachyzoites was slightly inhibited by the Ca2+ channel blockers, bepridil and verapamil, and by the calmodulin antagonist, calmidazolium. We observed that calcium saline containing A23187 induced the extrusion of tachyzoite conoid. By immunoelectron microscopy, gold particles bound to anti-calmodulin or anti-actin mAb, were found to be localized on the anterior portion of tachyzoites. Remarkably reduced intracellular Ca2+ was observed in tachyzoites treated with BAPTA/AM by confocal microscopy. These results suggest that host cell invasion and the intracellular replication of T. gondii tachyzoites are inhibited by the calcium ionophore, A23187, and by the extracellular calcium chelator, EGTA.

An outbreak of trichinellosis caused by ingestion of raw wild boar / 대한내과학회지

Trichinellosis is one of the most widespread helminthic zoonoses. Unlike other parasitic infestation, it has been reported in advanced countries where there is a great amount of meat consumption such as Europe and America. In Korea, trichinellosis has been suspected to be prevalent for a long time, but it had not been reported up to 1997. However, three reports of human trichinellosis were published recently. An outbreak of trichinellosis caused by ingestion of raw wild boar occurred in Inje-gun, Gangwon-do, Korea, in Mar 2003. 13 people ate raw wild boar meat together, and then they had high fever, myalgia, facial edema, etc. Hematologic and biochemical examinations revealed leukocytosis, eosinophilia, and elevated AST, ALT, LDH, CPK. Muscle biopsy in rectus femoralis was performed in one index case, we detected two parasites in muscle fibers. And we measured specific antibody titers against Trichinella spiralis ES Ag in 12 patients. More than 3~4 fold higher antibody titer was noted in 11 patients compared with normal controls. We treated these cases with albendazole and steroid for 5 days.

Three year Follow up of Laser Trabeculoplasty using Q-switched frequency doubled Nd: YAG laser

PURPOSE: To assess the efficacy and safety of selective laser trabeculoplasty treatment (SLT) using Q-switched frequency doubled Nd: YAG laser at three year follow-up. METHODS: Fifteen eyes of 12 primary open angle glaucoma patients treated between July and August 1997 with Q switched frequency doubled Nd: YAG laser were evaluated. With clinical examinations including slit-lamp examination, applanation tonometry and funduscopy, we evaluated preoperative and postoperative intraocular pressure (IOP) of treated eyes, IOP response between treated and untreated eyes, and complications at 3 year follow-up retrospectively. RESULTS: IOP before treatment was 25.2 2.3 mmHg. At one year after treatment, IOP was 20.3 4.1 mmHg (19.6% reduction). At 2 and 3 years follow-up, IOP's were 21.1 3.5 mmHg (16.4%) and 19.7 4.9 mmHg (23.2%) respectively. In the comparison between treated eyes and untreated fellow eyes, the mean IOP reduction in the untreated eyes showed 12.1%, the treated eyes showed significant reductions in IOP at all follow-ups (P=0.0003). Complication included anterior uveitis in one eye at intermediate follow-up and transient increased IOP in seven eyes. CONCLUSIONS: SLT showed stable IOP compared with preoperative intraocular pressure during 3 years follow-up period without severe complication.

A Case of Dentatorubropallidoluysian Atrophy with Corneal Endothelial Degeneration

Corneal endothelial degeneration has been reported in diseases associated with CAG repeat expansion including spinocerebellar ataxia type 1 (SCA1) and dentatorubropallidoluysian atrophy (DRPLA). We report a 35-year-old man who has cerebellar ataxia, myoclonic seizure, dystonia, chorea, mental retardation, and visual disturbance. Detailed ophthalmologic examination showed marked reduction of the corneal endothelial cell density. Genetic analysis revealed the presence of a pathological CAG expansion within the DRPLA gene. We suggest that corneal endothelial degeneration might be one of the signs differentiating DRPLA from other hereditary ataxias.

A Case of Dentatorubropallidoluysian Atrophy with Corneal Endothelial Degeneration

Corneal endothelial degeneration has been reported in diseases associated with CAG repeat expansion including spinocerebellar ataxia type 1 (SCA1) and dentatorubropallidoluysian atrophy (DRPLA). We report a 35-year-old man who has cerebellar ataxia, myoclonic seizure, dystonia, chorea, mental retardation, and visual disturbance. Detailed ophthalmologic examination showed marked reduction of the corneal endothelial cell density. Genetic analysis revealed the presence of a pathological CAG expansion within the DRPLA gene. We suggest that corneal endothelial degeneration might be one of the signs differentiating DRPLA from other hereditary ataxias.

Identification of Functionally Different Rat IgE in RBL-2H3 Exocytosis

BACKGROUND: IgE is closely related to the development of allergies. However, the poor relationship between the specific IgE level and the severity of allergic diseases suggests the possibility of functionally different IgE isoforms. With this in mind, rat basophilic leukemia (RBL)-2H3 activation was analyzed with each type of rat IgE for two parameters, exocytosis and IL-4 mRNA production. RBL-2H3 has been well documented in the rat mucosal mast cell line. METHODS: RBL-2H3 cells sensitized with each kind of rat IgE was activated by cross-linking FcRI with B5 (monoclonal anti-rat IgE mouse IgG antibodies). The RBL-2H3 exocytosis was measured by analyzing the beta-hexosaminidase level, and the level of IL-4 mRNA synthesis was analyzed using semi- quantitative RT-PCR. Rat IgE, which was produced by a parasite infection (REP), was prepared using either Paragonimus westermani metacercariae (REP-PW) or Anisakis simplex third stage larvae (REP-AS). A rat IgE prototype of IR162 was prepared by a peritoneal injection of immunocytoma. RESULTS: The level of exocytosis showed a linear relationship with the rat IgE concentration when REP-PW or REP-AS was applied. However, it exhibited a biphasic response with IR162. In addition, the time course of heating at 56oC illustrated the similarity between REP-PW and REP-AS, which differed from that of IR162. In contrast, the level of IL-4 mRNA synthesis in the RBL-2H3 cells with IR162 was comparable to that of either REP-PW or REP-AS. CONCLUSION: These results suggest that functionally different rat IgE isoforms exists in RBL-2H3 exocytosis.

Outcome of Vitreoretinal Surgery and Penetrating Keratoplasty using Temporary Keratoprosthesis

PURPOSE: Using a temporary keratoprosthesis(TKP), earlier surgical treatment became amenable in eyes with coexisting vitreoretinal and corneal disease. We analysed our experience with this type of surgery. METHOD: Medical records of patients who had undergone pars plana vitrectomy(PPV) using Eckardt TKP from 1994 to 2000 were reviewed. Analysis was focused on preoperative conditions, surgical outcome and complications. RESULT: Of 34 eyes of consecutive 34 patients, 25(73.5%) showed trauma-related indications and 4 had IOFB. Retinal detachments were present in 24(70.6%) eyes, proliferative vitreoretinopathy in 8(23.5%) and vitreous hemorrhage in 10(29.4%) eyes. Penetrating keratoplasty(PKP) with donor corneas were performed in only 3 patients at the time of surgery and patient's excised corneas were sutured to 31 patients, 9 of whom underwent PKP later. After mean follow up period of 14 months, retinas remained attached in 27(79.4%) eyes and 3 eyes were phthisical. Visual acuity improved in 18(53%) eyes and worsened in 5 eyes. CONCLUSIONS: In cases with coexisting corneal and vitreoretinal pathology, PPV using TKP was effective for preserving vision and globe. Timing of grafting clear cornea might be delayed when donor cornea was not available.

Retinopathy and Keratopathy Associated with Chronic Tamoxifen Medication

PURPOSE: Tamoxifen retinopathy is one of the uncommon side effects together with keratopathy, crystalline retinopathy and cystoid macula edema when tamoxifen is administered with high dose to breast cancer patients. We report here a case of retinopathy patient with five years of tamoxifen application. METHOD: A 46 year old female breast cancer patient complained about decreased visual acuity in both eyes after taking total amount of 37.28 g tamoxifen (20 mg/day) for 5 years. Whorl-like superficial corneal opacity was detected and yellowish white macular crystalline deposits were seen in both eyes. Moreover, decreased b wave amplitude of ERG was detected in electroretinography and RPE atrophy was found in FAG. RESULT: The patient stopped taking tamoxifen immediately after diagnosed with tamoxifen retinopathy. Two months later, it showed decreased corneal opacity and improved visual acuity in the left eye but also showed increased macular crystalline deposits in the left eye.