SEALONE (Safety and Efficacy of Coronary Computed Tomography Angiography with Low Dose in Patients Visiting Emergency Room) trial: study protocol for a randomized controlled trial

OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. METHODS: The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. RESULTS AND CONCLUSION: Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.

Two Cases of Uterine Papillary Serous Carcinoma / 대한산부인과학회잡지

Uterine papillary serous carcinoma (UPSC) behave more aggressively than other endometrial carcinomas and have a propensity for intraabdominal spread, simulating the behavior of ovarian carcinoma. Because of high relapsing rate, and high mortality rate of UPSC, many gynecologist studied about its treatment regimen and recommended many treatment method. Many investigators recommended that patients with UPSC should undergo a staging laparotomy and they suggested the surgery should include at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic lymphadenectomy, paraaortic lymphadenectomy, peritoneal washing and peritoneal cytology, By and large, adjuvant systemic Platinum based chemotherapy or, paclitaxel based chemotherapy and adjuvant whole abdominal irradiation or pelvic irradiation was prescribed. We experienced two cases of the UPSC stage IIIc and stage IV diagnosed after explolaparotomy. We present these cases and review the literatures about the optimal treatment regimen of UPSC.

Usefulness of Phosphorylated Insulin-like Growth Factor Binding Protein-1 for Prediction of Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate whether the presence of phIGFBP-1 in cervical secretion of patients with symptoms suggestive of preterm labor predicts preterm delivery. METHODS: Patients who were examined at the Department of Obstetrics and Gynecology, Daegu Fatima hospital between 24 weeks' and 34 weeks' gestation with intact membrane, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilatation or=10 microgram/L. Tocolysis and corticosteroids were used when clinically indicated after specimen collection. RESULTS: phIGFBP-1 was detected in 21 patients among 50 patients analysis. Compared with patients who had negative results, patients who had positive results for phIGFBP-1 were more likely to deliver before 37 weeks (p<0.001), before 34 weeks (p=0.008) and within 7 days (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 77.3%, 85.7%, 81.0%, and 8.28%. Patients with positive results were also treated more with tocolysis and corticosteroids use than patients with negative results. Gestational age at delivery (p<0.001) and birthweight (p<0.001) were lower for patients with positive results. CONCLUSION: In a population of patients with symptoms, the presence of phIGFBP-1 in cervical secretions defines a subgroup at increased risk for preterm delivery.