Evaluation of Prognostic Factors for the Parotid Cancer Treated With Surgery and Postoperative Radiotherapy

Objectives@#. To investigate the prognostic factors and treatment outcomes of primary parotid carcinoma treated with surgery and postoperative radiotherapy (PORT). @*Methods@#. We reviewed retrospectively 57 patients with primary parotid carcinoma who were treated with surgery and PORT between 2005 and 2014. Superficial parotidectomy was performed in 19 patients, total parotidectomy in 10 patients, and total parotidectomy with lymph node dissection in 28 patients PORT on the tumor bed was performed in 41 patients, while PORT on tumor bed and ipsilateral cervical lymph nodes was performed in 16 patients. @*Results@#. With a median follow-up of 66 months, the 5-year overall survival, disease-free survival, locoregional control, and distant control rates were 77.0%, 60.2%, 77.6%, and 72.8%, respectively. The 5-year overall survival by stage was 100%, 100%, 80.0%, and 46.4% in stage I, II, III, and IV, respectively. Recurrences at primary lesions were found in seven patients, while at cervical nodes in six patients. Distant recurrences were developed in 12 patients. No patient with the low and intermediate histologic grade developed distant failure. As prognostic factors, the histologic grade for overall survival (P=0.005), pathological T-stage (P=0.009) and differentiation grade (P=0.009) for disease-free survival, pathological T-stage for locoregional control (P=0.007), and lympho-vascular invasion (P=0.023) for distant recurrence were significant on multivariate analysis. @*Conclusion@#. This study revealed that differentiation grade, histologic grade, pathological T-stage, and lympho-vascular invasion were significant independent prognostic factors on clinical outcomes.

Analysis of Risk Factors for Myringosclerosis Formation after Ventilation Tube Insertion

Background@#This study examined possible risk factors for myringosclerosis formation after ventilation tube insertion (VTI). @*Methods@#A retrospective study was performed in a single tertiary referral center. A total of 582 patients who underwent VTI were enrolled in this study. Patients were divided into two groups based on the presence or absence of myringosclerosis: MS+ and MS−. Characteristics of patients were collected through medical chart review; these included age, gender, nature and duration of effusion, type of ventilation tube (VT), duration and frequency of VTI, incidence of post-VTI infection, incidence of intraoperative bleeding, and presence of postoperative perforation. Incidences of risk factors for myringosclerosis and the severity of myringosclerosis in association with possible risk factors were analyzed. @*Results@#Myringosclerosis developed in 168 of 582 patients (28.9%) after VTI. Patients in the MS+ group had an older mean age than those in the MS− group. The rates of myringosclerosis were higher in patients with older age, serous otitis media, type 2 VT, post-VTI perforation, and frequent VTI. However, there were no differences in occurrence of myringosclerosis based on gender, duration of effusion, duration of VT placement, incidence of post-VTI infection, or incidence of intraoperative bleeding. The severity of myringosclerosis was associated with the duration of effusion and frequency of VTI. @*Conclusion@#Older age, serous effusion, type 2 VT, presence of post-VTI perforation, and frequent VTI may be risk factors for myringosclerosis after VTI; the severity of myringosclerosis may vary based on the duration of effusion and frequency of VTI.

Analysis of Risk Factors for Myringosclerosis Formation after Ventilation Tube Insertion

Background@#This study examined possible risk factors for myringosclerosis formation after ventilation tube insertion (VTI). @*Methods@#A retrospective study was performed in a single tertiary referral center. A total of 582 patients who underwent VTI were enrolled in this study. Patients were divided into two groups based on the presence or absence of myringosclerosis: MS+ and MS−. Characteristics of patients were collected through medical chart review; these included age, gender, nature and duration of effusion, type of ventilation tube (VT), duration and frequency of VTI, incidence of post-VTI infection, incidence of intraoperative bleeding, and presence of postoperative perforation. Incidences of risk factors for myringosclerosis and the severity of myringosclerosis in association with possible risk factors were analyzed. @*Results@#Myringosclerosis developed in 168 of 582 patients (28.9%) after VTI. Patients in the MS+ group had an older mean age than those in the MS− group. The rates of myringosclerosis were higher in patients with older age, serous otitis media, type 2 VT, post-VTI perforation, and frequent VTI. However, there were no differences in occurrence of myringosclerosis based on gender, duration of effusion, duration of VT placement, incidence of post-VTI infection, or incidence of intraoperative bleeding. The severity of myringosclerosis was associated with the duration of effusion and frequency of VTI. @*Conclusion@#Older age, serous effusion, type 2 VT, presence of post-VTI perforation, and frequent VTI may be risk factors for myringosclerosis after VTI; the severity of myringosclerosis may vary based on the duration of effusion and frequency of VTI.

Prognostic significance of lymphovascular invasion in patients with prostate cancer treated with postoperative radiotherapy

PURPOSE: To determine prognostic significance of lymphovascular invasion (LVI) in prostate cancer patients who underwent adjuvant or salvage postoperative radiotherapy (PORT) after radical prostatectomy (RP) MATERIALS AND METHODS: A total of 168 patients with prostate cancer received PORT after RP, with a follow-up of ≥12 months. Biochemical failure after PORT was defined as prostate-specific antigen (PSA) ≥0.2 ng/mL after PORT or initiation of androgen deprivation therapy (ADT) for increasing PSA levels regardless of the value. We analyzed the clinical outcomes including survivals, failure patterns, and prognostic factors affecting the outcomes. RESULTS: In total, 120 patients (71.4%) received salvage PORT after PSA levels were >0.2 ng/mL or owing to clinical failure. The 5-year biochemical failure-free survival (BCFFS), clinical failure-free survival (CFFS), distant metastasis-free survival (DMFS), overall survival, and cause-specific survival rates were 78.3%, 94.3%, 95.0%, 95.8%, and 97.3%, respectively, during a follow-up range of 12–157 months (median: 64 months) after PORT. On multivariate analysis, PSA level of ≤1.0 ng/mL at the time of receiving PORT predicted favorable BCFFS, CFFS, and DMFS. LVI predicted worse CFFS (p = 0.004) and DMFS (p = 0.015). Concurrent and/or adjuvant ADT resulted in favorable prognosis for BCFFS (p < 0.001) and CFFS (p = 0.017). CONCLUSION: For patients with adverse pathologic findings, PORT should be initiated as early as possible after continence recovery after RP. Even after administering PORT, LVI was an unfavorable predictive factor, and further intensive adjuvant therapy should be considered for these patients.

Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

PURPOSE: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT).MATERIALS AND METHODS: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group.RESULTS: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080).CONCLUSION: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients

Treatment of Laser Therapy-Induced Punctate Leukoderma Using a 308-nm Excimer Laser

Punctate leukoderma presents as numerous, distinct, round or oval depigmented spots. Recently, laser therapy-induced punctate leukoderma associated with various Q-switched laser and carbon dioxide laser have been reported. A 25-year-old man presented with numerous, discrete, round, confetti-like, depigmented macules on his left neck. He had undergone 3 sessions of 532-nm Q-switched Neodymium: Yttrium-Aluminum-Garnet laser treatment for café-au-lait macules three years ago. After the last laser treatment session, the punctate leukoderma had been developed. We started treatment with the 308-nm excimer laser twice a week. After 7 months of treatment duration, complete repigmentation was achieved without serious adverse effects. We recommend the 308-nm excimer laser as an effective treatment modality for laser therapy-induced punctate leukoderma.

A Case of Venous Malformation of the Pyriform Sinus Treated with Ethanol Sclerotherapy

We describe a case of venous malformation of pyriform sinus in 63 year-old patient, discovered incidentally. Venous malformation are the most common vascular malformations to arise in the head and neck. However venous malformation of the hypopharynx in the adult papulation are rare. The author performed successfully ethanol sclerotherapy for venous malformation of pyriform sinus, so we present the case with a review of the related literatures.

Treatment outcomes of neoadjuvant concurrent chemoradiotherapy followed by esophagectomy for patients with esophageal cancer

PURPOSE: To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT). MATERIALS AND METHODS: We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). RESULTS: The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. CONCLUSION: Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.

A Phase I/II Trial to Evaluate the Technical Feasibility of Partial Breast Irradiation with Three-Dimensional Conformal Radiation Therapy in Korean Women with Stage I Breast Carcinoma: An Initial Report of the Korean Radiation Therapy Oncology Group (KROG / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This prospective study was designed to verify the technical feasibility of partial breast irradiation in breast cancer patients with small breasts, which are commonly encountered in Korean women. MATERIALS AND METHODS: A total of 40 Gy, administered in 10 fractions on consecutive days (one fraction per day), was prescribed to the isocenters of the fields using three-dimensional conformal radiotherapy (3-DCRT). For all patients, treatment planning and dose parameters strictly adhered to the constraints set forth in the Radiation Therapy Oncology Group (RTOG) 0319 protocol. This study was designed such that if fewer than five of the first 42 evaluable patients received unacceptable scores, the treatment would be considered reproducible. RESULTS: Ten treatment plans (23.8%) were determined to have major variations. There was no major variation in planning target volume (PTV) coverage. The ipsilateral and contralateral breast dose limitations were not met in four (9.5%) and four cases (9.5%), respectively. Major variations in ipsilateral and contralateral lung dose limitations were observed in two cases (4.8%). Major variations in the heart and thyroid dose limitations were observed in one (2.4%) and one case (2.4%), respectively. In multivariate analysis, a ratio of PTV to ipsilateral breast volume (PTV/IB) > 0.16 was the only significant factor that statistically affected major variations. CONCLUSION: We concluded that partial breast irradiation using 3-DCRT could not be reproduced in Korean breast cancer patients, particularly small-volumed breast surrogated as PTV/IB > 0.16. The dominant cause was the major variation in surrounding normal breast tissues.

The Effect of Memantine on Experimentally Gentamicin Induced Vestibulotoxicity in Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In general, aminoglycosides are known to cause ototoxicity through the glutamate induced nitric oxide production. The N-methyl-D-aspartate (NMDA) related glutamate receptors have a pivotal role in aminoglycoside induced ototoxicity. Memantine is known as a safe NMDA antagonist and is also used in some neurologic insults, such as the Alzheimer disease. In this study, we observed the effect of memantine on gentamicin induced vestibulotoxicity in an animal model. MATERIALS AND METHOD: Vestibulotoxicity was induced with intratympanic administration of gentamicin and memantine was injected intraperitoneally to a study group. Histomorphological studies for vestibule were performed via light and electron microscopy. Immunohistochemical studies were performed for iNOS, nitrotyrosine and apoptosis via TUNEL staining. RESULTS: The numbers of hair cells were decreased significantly in the gentamicin group than in the gentamicin-memantine group. Increased immunoreactivities for iNOS and nitrotyrosine were observed in the gentamicin group than in the memantine-pretreated gentamicin group. TUNEL positive cells were more frequently observed in the gentamicin group than in the memantinepretreated gentamicin group. CONCLUSION: This result shows that memantine has a protection effect on gentamicin-induced vestibulotoxicity in an animal model.

Formation of Biofilm in Patients with Chronic Otitis Media and Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In many chronic infections, bacteria are present as a form of biofilms. Recently, bacterial biofilm has been implicated in persistent or recurrent chronic otolaryngologic infections, because they are highly resistant to treatment with antimicrobial agents and capable of shedding individual bacteria to the surrounding tissues. In this study, we aimed to evaluate biofilm in chronic middle ear infections. SUBJECTS AND METHOD: A total of 85 cases with chronic middle ear infections were included in this study. Histomorphologic studies for middle ear granulations and cholesteatomas were performed using light and electron microscopy. RESULTS: In middle ear granulations, about 33% of the cases showed the evidence of bacterial biofilm. In comparison, about 64% of the cases in cholesteatoma tissues have the evidences of bacterial biofilm. CONCLUSION: Biofilms are associated with chronic middle ear infection and they may play a role in the pathogenesis of refractory or persistent chronic middle ear infections.

Effects of Nasal Instillation of Staphylococcal Enterotoxin B on Allergic Inflammation in Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The role of Staphylococcus aureus enterotoxin B (SEB) in allergic rhinitis remains controversial. We used a mouse model of airway allergy to determine the effects of nasal instillation of SEB on allergic inflammation. MATERIALS AND METHOD: BALB/c mice were intranasally sensitized with compound of Aspergillus melleus proteinase (AMp) and ovalbumin (ova) in the presence (group 3) or absence of SEB (group 2). Control mice were intranasally sensitized with either phosphate buffered saline (PBS)(group 1) or SEB (group 4) alone. The production of serum antigen-specific antibodies and total IgE, and concentrations of cytokines including interleukin-4 (IL-4), IL-5, interferon-gamma (IFN-gamma) in nasal lavage fluid (NLF) and broncoalveolar lavage fluid (BALF) were compared among the groups. Pathologic studies for eosinophilic infiltrations in the nasal mucosa and peribronchial area were also conducted. RESULTS: Serum ova-specific immunoglobulin E (IgE) & immunoglobulin G1 (IgG1) were significantly increased in group 2 and 3 compared to group 1. The concentrations of IL-4 in BALF were significantly increased in group 2, 3, and 4 compared to group 1. The concentrations of IL-5 in BALF and NLF were significantly increased in Group 2, 3, and 4 compared to group 1. The concentrations of IFN-gamma were significantly increased in group 3 and 4 compared to group 2 although there was no significant difference among the groups in NLF. Group 2 demonstrates increased infiltration of eosinophils in the nasal mucosa and peribronchial area compared to group 3 and 4. CONCLUSION: These results suggest that the nasal exposure to SEB did not aggravate inflammation in allergic mice.

CSF Leak and Pneumocephalus Caused by Neck Stab Wound / 대한이비인후과학회지

Pneumocephalus is defined as the presence of air within the cranial cavity. Trauma such as automobile accidents, motorcycle accidents, and missile injuries is the most common cause of pneumocephalus. There have previously been four reported cases of pneumocephalus following stab wounds to the neck in the English literature. We present an unusual case of pneumocephalus following a neck stab wound with a review of the literatures.

A Case of Fibromatosis Occurring in the Levator Scapulae / 대한이비인후과학회지

Fibromatosis is a benign tumor arising from the musculoaponeurotic tissues of the body. The natural history of fibromatosis is slow, progressive growth with invasion of adjacent tissues but this tumor has no malignant or metastatic potential. Complete surgical excision is the mainstay of treatment. However, it is often difficult due to the complex anatomy, close proximity of vital structures in the head and neck region. Preoperative core needle biopsy and MR images can make it possible to diagnose preoperatively and outline the tumor extent, which are very important to treat patients with fibromatosis. In this report, a rare case of fibromatosis occurring in the levator scapulae muscle is presented with a review of literatures.

A Case of Mucoepidermoid Carcinoma Occurring in External Auditory Canal / 대한이비인후과학회지

Malignant tumors of the external auditory canal (EAC) are very rare. Squamous cell carcinoma, adenoid cystic carcinoma and basal cell carcinoma on the decreasing frequency are the most common pathologic forms of EAC malignancy. Mucoepidermoid carcinoma (MEC) of the EAC is extremely rare. Only three cases of MEC occurring in EAC were reported to date in the English literature. We present a case of MEC occurring in the EAC with the review of related literatures.

Computational Analysis of Neighboring Genes on Arabidopsis thaliana Chromosomes 4 and 5: Their Genomic Association as Functional Subunits

The genes related to specific events or pathways in bacteria are frequently localized proximate to the genome of their neighbors, as with the structures known as operon, but eukaryotic genes seem to be independent of their neighbors, and are dispersed randomly throughout genomes. Although cases are rare, the findings from structures similar to prokaryotic operons in the nematode genome, and the clustering of housekeeping genes on human genome, lead us to assess the genomic association of genes as functional subunits. We evaluated the genomic association of neighboring genes on chromosomes 4 and 5 of Arabidopsis thaliana with and without respectively consideration of the scaffold/matrix-attached regions (S/MAR) loci. The observed number of functionally identical bigrams and trig rams were significantly higher than expected, and these results were verified statistically by calculating rho-values for weighted random distributions. The observed frequency of functionally identical big rams and trig rams were much higher in chromosome 4 than in chromosome 5, but the frequencies with, and without, consideration of the S/MAR in each chromosome were similar. In this study, a genomic association among functionally related neighboring genes in Arabidopsis thaliana was suggested.

Unilateral Renal Lymphangiectasia with Renal Vein Thrombosis / 대한신장학회잡지

Renal lymphangiectasia is a rare cystic kidney disorder. This disorder has been termed renal lymphangioma, renal lymphangiomatosis, pararenal lymphatic cyst. We report on a 32-year-old man admitted with complaints of abdominal discomfort, in whom unilateral renal lymphangiectasia with renal vein thrombosis was diagnosed. Abdominal computed tomography revealed left perirenal fluid collection with multiloculation. Left renal vein was completely obliterated due to thrombosis and inferior vena cava (IVC) was partially obliterated. Perirenal fluid collection and renal vein thrombosis were treated initially with percutaneous drainage and anticoagulation therapy. The biochemical features of the drained fluid were compatible with lymphatic fluid. Since there was no decrease in the amount of daily drainage, left nephrectomy and IVC thrombectomy was performed on the 34th day of hospitalization. Left kidney was enlarged (15x10x18 cm, 750 g) and composed of numerous smooth, thin-walled cysts. Pathologic diagnosis was renal lymphangiectasia.

A case of broad ligamentary pregnancy / 대한주산의학회잡지

No abstract available.