ERRATUM: Table Correction. Suppressive effects of long-term treatment with inhaled steroids on hypothalamic-pituitary-adrenal axis in asthma

Some parts of Tables 1 and 2 in this paper was described incorrectly.

Suppressive effects of long-term treatment with inhaled steroids on hypothalamic-pituitary-adrenal axis in asthma

PURPOSE: Long-term treatment with inhaled steroids (ICS), especially fluticasone that developed lately, may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This study investigated the relationship between ICS use and HPA axis suppression in asthmatics under ICS treatment for average 4.5 years. METHODS: The medical records of 129 adult asthmatics who received ICS treatment for 6 months or more and underwent a corticotropin stimulation test from January 2005 to August 2013 were retrospectively reviewed. RESULTS: The patients received ICS only (n=87) were found to have an abnormal response to the corticotropin test in as high as 32.2%, and those received ICS in combination with oral steroids (n=42) had a significantly higher prevalence of the response (71.4%, P<0.001). Abnormal responses to corticotropin occurred depending on ICS daily doses (low, n=8, 12.5%; medium, n=19, 36.8%; high, n=102, 49.0%; chi2=4.384, P=0.036). Among the subjects received ICS only, nasal steroid doses (P=0.016) but not ICS doses (P=0.159) were significantly higher in those with abnormal responses than the others. Among all the subjects, oral steroid use (odds ratio [OR], 4.27; 95% confidence interval [CI], 2.35-11.80; P<0.001) and nasal steroid dose (OR, 1.02; 95% CI, 1.00-1.04; P=0.015) were significant risk factors for HPA axis suppression. CONCLUSION: One-third of asthmatics under long-term treatment with ICS showed a suppression of the HPA axis in a dose-dependent manner. Oral or nasal steroid use may be a risk factor for the suppression. However, since our results may have been overestimated due to subject selection bias, further prospective case-control studies are warranted.

ERRATUM: Spelling Correction. Suppressive effects of long-term treatment with inhaled steroids on hypothalamic-pituitary-adrenal axis in asthma

On page 289 of this paper, the x-axis title in Fig. 3A has been incorrectly spelled.

Clinical Prognostic Factors for Locally Advanced Esophageal Squamous Carcinoma Treated after Definitive Chemoradiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Locally advanced esophageal cancers are generally treated with neoadjuvant chemoradiotherapy, followed by surgery in operable candidates. However, even if the patients were diagnosed as operable disease, surgery could not be performed on patients with poor condition or other comorbidity. In this case, definitive chemoradiotherapy (dCRT) is the other option for localized esophageal cancer. Therefore, the purpose of this study was to evaluate the efficacy and clinical prognostic factors for dCRT in locally advanced esophageal cancer. MATERIALS AND METHODS: We conducted a review of patients who received dCRT for locally advanced squamous esophageal cancer from 2004 to 2010, focusing on stages III and IVa. All patients received at least two cycles of platinum-based chemotherapy during radiation, and all tumor burdens were included in the radiation field. The treatment results were analyzed for patterns of failure and prognostic factors associated with survival. RESULTS: In total, 63 patients were enrolled in this study. The overall response rate was 84.1%. Relief from dysphagia after dCRT was achieved in 48 patients. The most frequent failure was local recurrence. The median overall survival (OS) was 23.0 months, and the 2-year survival rate was 45.4%. Similar results were observed for elderly study patients. Significant prognostic factors for OS were duration of smoking, high grade of dysphagia (score of 3 or 4), and shorter duration of progression-free and dysphagia-free survival. Maintenance chemotherapy after dCRT did not influence OS. However, "good risk" patients receiving maintenance chemotherapy showed better OS than those who did not receive maintenance chemotherapy (30.4 months vs. 12.0 months, p=0.002). CONCLUSION: dCRT has a major role in improving survival and palliation of dysphagia in inoperable advanced esophageal cancer, even in elderly patients. Maintenance chemotherapy after dCRT may be effective in prolonging survival in "good risk" patients.

A Case of Cardiogenic Shock after Chemotherapy with 5-Fluorouracil and Leucovorin in Rectal Cancer / 대한내과학회지

A 51-year-old man with rectal adenocarcinoma was admitted to hospital for neoadjuvant concurrent chemoradiotherapy. Three days after receiving 5-fluorouracil (425 mg/m2) and leucovorin (20 mg/m2) chemotherapy, the patient complained of chest pain. The patient had no history of cardiac disease. Electrocardiography showed ST segment elevation in leads II, III, and aVF, but the cardiac enzymes were normal. Transthoracic echocardiography revealed global hypokinesia with marked systolic dysfunction (ejection fraction 21.55%) and coronary angiography showed no significant stenosis. Unfortunately, he died of cardiogenic shock, despite intensive medical treatment.

Feasibility of an Ultrasonographic Categorical Reporting System for Thyroid Incidentaloma

PURPOSE: To evaluate the feasibility of an ultrasonographic category system for the proper management of incidentally found thyroid nodules. MATERIALS and METHODS: We retrospectively evaluated 2,688 patients who had thyroid nodules and underwent ultrasonography-guided fine needle aspiration biopsy. We made an ultrasonographic categorical reporting system by logistic regression analysis for comparison with the pathologic results of cytology and biopsy. RESULTS: The distribution of malignancy probability for benign nodules was 0.07 to 0.23 and for malignant nodules was 0.37 to 0.91 (95% confidence intervals). We stratified the distribution of the probability of malignancy of each nodule into 6 categories (category 0, no nodule; 1, highly suggestive of benignancy; 2, probably benign; 3, indeterminate; 4, probably malignant; and 5, highly suggestive of malignancy) and summarized the representative US findings. We compared the category of each nodule with the pathological results. In nodules with surgically proven pathologic diagnoses, benign lesions were 96.1% (348/361) in category 1 and malignant lesions were 98.6% (139/141) in category 5. CONCLUSION: We suggest that the ultrasonographic category system for thyroid incidentaloma may provide optimal strategies to manage incidentally found thyroid nodules.

Influence of immediate loading on the removal torque value of mini-screws / 대한치과교정학회지

OBJECTIVE: The purpose of this experimental study was to evaluate the effect of immediate orthodontic loading on the stability at the bone-implant interface of titanium miniscrews in a rabbit model. METHODS: Forty titanium miniscrews (1.6 mm diameter, 8 mm length) were inserted in the tibiae of 10 rabbits. Twenty test group miniscrews were subjected to continuous orthodontic forces of 200 g immediately after implantation for a period of 6 weeks. The remaining 20 control group miniscrews were left unloaded for the same follow-up interval. Removal torque values were recorded using a digital torque gauge. An independent t-test was performed. RESULTS: All the miniscrews were stable, and exhibited no mobility or displacement throughout the experimental period. Histologically, miniscrews were well-integrated into bone. No statistically significant differences in removal torque data were found between the loaded test and the unloaded control groups. CONCLUSIONS: These findings suggest that titanium miniscrews can be used as anchoring units for orthodontic tooth movement immediately after insertion.

Infection of Strongyloides Stercoralis in Stomach Cancer Patient

Strongyloides stercoralis is an intestinal nematode that infects a large portion of the world's population, especially in tropical climates, where the warm, moist soil offers an environment suited to the development of the larvae. In immuno-compromised hosts, receiving corticosteroids, immunosuppressive drugs or radiotherapy, especially in those with AIDS, large numbers of invasive strongyloides larvae can disseminate widely, which can be fatal. In Korea, several cases of strongyloides hyperinfection have been reported since 1959, and a case of strongyloides hyperinfection, accompanied with metastatic stomach cancer, was reported recently. We experienced a case of strongyloides infection, accompanied with early gastric cancer, and also suffering from bronchial asthma. The patient was treated with albendazole, 200 mg, twice-a-day for 3 days, 1 month after a radical gastric cancer operation. Thereafter, the respiratory symptoms of the patient, including asthmatic attacks, improved.

CT and MR Imaging of Primary Nasal Lymphoma: Usefulness at Initial Diagnosis and Follow-up

PURPOSE: To describe CT and MR findings of Primary nasal NK/T-cell lymphoma and to evaluate the usefulness ofCt and MR imaging for initial diagnosis and during follow-up. MATERIALS AND METHODS: Thirteen patients withbiopsy-proven primary nasal NK/T-cell lymphoma (M:8, F:5;age 30-78, mean:47.3 years) were included in this study.CT scans were obtained in seven patients and MR images in ten, and both CT and MR images in four. Duringfollow-up, CT images were obtained in four patients, MR images in eight, and both types of image in two. Signalintensity or attenuation, location, and shape of the tumor were assessed on CT and MR images, which were alsocompared in terms of evaluation of the extent of the tumor and the assessment of residual tumor during follow-up. RESULTS: Enhanced CT scans showed slightly lower(6/7) or iso-attenuation (1/7) or the tumor than of the wall ofthe nasal cavity. In all cases, the tumor was of slightly lower signal intensity on T2WI and gadolinium-enhancedT1WI than nasal cavity mucosa. Infiltrative wall thickening of the nasal cavity (13/13) and a polypoid mass (5/13)were demonstrated on CT and MR images. The tumor margin was partially indistinct (6/7) or distinct (1/7) oninitial CT, but distinctily identified on initial MR images in all cases. During follow-up, MR was superior to CTfor the assessment of residual tumor in two patients. CONCLUSION: Infiltrative wall thickening of the nasalcavity may be a characteristic feature of primary nasal NK/T-cell lymphoma, and MR images were superior to CT forthe assessment of tumor extent and for the diagnosis of residual tumor during follow-up.

A Case of polymyalgia rheumatica

Polymyalgia rheumatica is characterized by pain and stiffness of the shoulder and pelvic girdles, morning stiffness, constitutional symptoms and an elevated erythrocyte sedimentation rate. We have experienced a 45-year-old female patient with polymyalgia rheumatica who presented with pain and stiffness of the shoulder and pelvic girdle, an elevated erythrocyte sedimentation rate and dramatic response to low-dose steroids. To our knowledge, thes is the second case of polymyalgia rheumatica with a brief review of literature.

A case of temporal bone fibrous dysplasia causing central venous thrombosis and intracranial hypertension

Fibrous dysplasia is a slowly progressive benign fibro-osseous disorder of unknown cause. The predilection sites of the craniofacial bones are maxilia and mandible, but fibrous dysplasia of the temporal bone is rarely noted, The usual clinical manifestations of fibrous dysplasia of the temporal bone are mainly otologic complications such as progressive stenosis of the external auditory canal and conductive hearing loss. But its neurologic complications are very rarely reported except facial nerve paresis. We present a case of monostotic fibrous dysplasia of the temporal bone leading to intracranial hypertension with central venous thrombosis. To our knowledge, this association has not been previously described in the literature.

Predictors of Chronicity in Childhood Idiopathic Thrombocytopenic Purpura / 대한소아혈액종양학회지

BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) in children has a low morbidity and mortality, and most of cases are self limited illness. But some of them are not responsive to treatment and finally progress to chronic disease. The purpose of this study is to evaluate the factors which influence the outcome in childhood idiopathic thrombocytopenic purpura. METHOD: From January 1990 to December 1995, patients with ITP who were admitted to the Pediatric department of Pusan National University Hospital were divided into acute and chronic form depending on whether the platelet count had returned to normal(150 x 10(9)/1) by six months after diagnosis. Between two groups, the clinical and laboratory characteristics, response to treatment were compared. RESULT: 1) Out of 55 patients with ITP, 36 cases(65.5%) were acute and 19 cases(34.5%) were chronic ITP. 2) Sex, previous viral infection history, clinical manifestations were not significantly different between two groups, but the chronic ITP was rare in less than 1 year of age. 3) The duration of symptoms over >2 weeks at presentation was strongly predictive of chronic ITP. 4) Most of chronic disease (87.5%) showed platelet counts below 150 x 10(9)/1 at 28 days after diagnosis as compared with acute disease(25.0%). 5) Among 19 cases of chronic disease, 6 cases responded completely to treatment, but 11 cases(57.9%) did not respond to any treatments, 2 cases improved spontaneously. CONCLUSION: A history of symptoms over 2 weeks at presentation and platelet counts below 150 x 10(9)/1 at 28 days after diagnosis were strong predictors of chronic ITP in children.

A Case of squamous Cell Carcinoma Arising from an Actinic Cheilitis and Its Surgical Treatment / 대한피부과학회지

A sixity-three years old male admitted our department of dermatology showing generallized scaly, fissured, and swollen lower lip, we could diagnose it actinic cheilitis by the finding of skin biopsy specimen. And so we recomrnended him vermilioneciomy for the prophylaxis of squamous cell carcinoma, but he refused. After 2 months, above Iesion was changed a rapidly proliferating protruded mass in the centcr of the lower lip, which was diagnosed squamous cell carcinoma. For the treatment of squamous cell carcinoma and remained actinic cheilitis, we performed V-shaped excision of tumor mass and verrniliomy. After 5 months follow-up evaluation, the patient appeared excellent results without recurrence.

The Surgical Treatment of Gangrenous Skin Diseases : Surgical Debridment and Skin Graft / 대한피부과학회지

Gangrenous skin disease is characterized by rapidly progressive necrosis of the subcutaneoua tissue. It is mainly caused by Group A b-hemolytic Streptococcus. We are now reporting three cases of gangrenous skin diseases including gangrene due to Vibrio vulnificus, streptococcal gangrene, and ecthyma gangrenosum. Their treatment was as follows: early surgical debridment, the correction of fluidelectrolyte depletion, and antibiotics. When fresh granulation tissues were seen on the wound base, we performed so called Island skin graft. 3 to 5 weeks later, there were good cosmetic and functional results. These results reveals that among several curative measures of gangrenous skin diseases early surgical debridment is the most important one. We belive many dermatologists should be concerned about skin surgery progressively.