Relationship of Circulating Cytomegalovirus Levels Obtained Through Antigenemia Testing and Quantitative PCR Differs Between Children and Adults

No abstract available.

A Study on Laparoscopic Sacral Colpopexy for Uterine Prolapse

OBJECTIVES: We sought to describe the perioperative and postoperative adverse events associated with sacral colpopexy and evaluate the surgical outcome, complications, and benefits of laparoscopic sacral fixation for patients with pelvic prolapse. METHODS: Ninety-two women with uterine prolapse underwent sacral colpopexy between January 2011 and September 2016 at Chosun University Hospital. Patients' electronic medical records were investigated for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Patients' outcomes were documented with 1 self-administered quality of life questionnaires: the Pelvic Floor Distress Inventory-20 focused on symptom distress. The primary analysis looking at perioperative and postoperative adverse events was descriptive and statistics were reported for all groups as n/N (%) with 95% confidence intervals for categorical variables and as mean ± standard deviation and mean (range) for all continuous variables. RESULTS: Their mean age was 69 ± 8.1 years, mean follow-up duration was 12 months, and mean operating time was 61 minutes. There were seven conversions due to anesthetic or surgical difficulties. Follow-up was performed using a telephone questionnaire and physical examination at 12 months. There were three cases of sacral pain with strong analgesics, one of vaginal erosion, two of transient urinary retentions, one of spondylitis, and two of mesh infection. Of the patients, 98.9% were satisfied with the surgical results, while none complained of sexual dysfunction or problems performing her usual activities. CONCLUSIONS: Laparoscopic sacral colpopexy is a feasible and highly effective technique that offers good long-term results with complication rates similar to those of open surgery with the added benefit of being minimally invasive.

Erratum to: Raloxifene Administration in Women Treated with Long Term Gonadotropin-releasing Hormone Agonist for Severe Endometriosis: Effects on Bone Mineral Density

The author and author's affiliation should be corrected.

Erratum: Figure Correction

The author line was published incorrectly.

Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis

OBJECTIVE: To evaluate the effect of orally administered dienogest (DNG) for dysmenorrhea and pelvic pain associated with endometriosis. METHODS: For this study we recruited 89 patients with dysmenorrhea and pelvic pain associated with endometriosis diagnosed by laparoscopy. All patients complained of persistent dysmenorrhea and pelvic pain despite surgical treatment 6 months previously. After 6 months of DNG treatment, we used a 0 to 3 point verbal rating scale to measure the severity of disability in daily life due to dysmenorrhea and pelvic pain, and the use of analgesics. Weight gain, serum lipid and liver enzyme tests were performed before treatment and after 6 months of DNG treatment. RESULTS: Total dysmenorrhea scores assessed by the verbal rating scale significantly decreased by the end of treatment (P<0.001). The mean (±standard deviation) pain score for dysmenorrhea before and after treatment were 1.42±1.1 and 0.1±0.3, respectively. The mean non-menstrual pelvic pain scores before and after treatment were 0.52±0.6 and 0.18±0.3, respectively, showing a significant difference (P<0.001). The use of analgesics significantly decreased by the end of the treatment (P<0.001). The associated adverse effects were weight gains (in 56 of 89 patients, 63%) and uterine bleeding (in 28 of 89 patients, 31.5%). The weight gain (before treatment, 57.9±9.7; after treatment, 61.1±12.6) was statistically significant (P<0.040). CONCLUSION: This study demonstrated that orally administered DNG could be used to effectively treat dysmenorrhea and pelvic pain associated with endometriosis although the side effects of weight gain and uterine bleeding should be considered.

Raloxifene Administration in Women Treated with Long Term Gonadotropin-releasing Hormone Agonist for Severe Endometriosis: Effects on Bone Mineral Density

OBJECTIVES: To evaluate the efficacy of raloxifene in preventing bone loss associated with long term gonadotropin-releasing hormone agonist (GnRH-a) administration. METHODS: Twenty-two premenopausal women with severe endometriosis were treated with leuprolide acetate depot at a dosage of 3.75 mg/4 weeks, for 48 weeks. Bone mineral density (BMD) was evaluated at admission, and after 12 treatment cycles. RESULTS: At cycle 12 of GnRH-a plus raloxifene treatment, lumbar spine, trochanter femoral neck, and Ward's BMD differed from before the treatment. A year after treatment, the lumbar spine and trochanter decreased slightly, but were not significantly different. CONCLUSIONS: Our study shows that the administration of GnRH-a plus raloxifene in pre-menopausal women with severe endometriosis, is an effective long-term treatment to prevent bone loss.

Multimodality Diagnostic Imaging in Unilateral Acute Idiopathic Maculopathy

PURPOSE: To report multimodality diagnostic imaging in a case of unilateral acute idiopathic maculopathy. CASE SUMMARY: A 32-year-old woman with reduced vision in the right eye had experienced fatigue and flu-like symptoms, including sore throat and fever a few days before. Her best corrected visual acuity (BCVA) was 1.0 in the right eye. There were no cells in the anterior chamber and vitreous. Fundus photographs of the right eye on presentation showed gray-white thickening of the fovea and retinal hemorrhage next to the fovea. Fluorescein angiography demonstrated ring-shaped mottled hyperfluorescence in the early phase and dye pooling in the late phase. Spectral-domain optical coherence tomography (OCT) showed abnormal hyper-reflective thickening at the level of the outer retina and retinal pigment epithelium (RPE) and detachment of the neurosensory retina in the foveal lesion. The inner segment/outer segment junction and photoreceptor elevation/disruption was noted. Nineteen months after onset, the BCVA of the right eye was 1.0 and fundus photographs showed increased retinal pigment hyperplasia, and residual RPE changes resembling a bull's eye maculopathy. The OCT of the right macula showed that the inner segment/outer segment junction elevation/disruption almost completely regressed. The patient was diagnosed with unilateral acute idiopathic maculopathy. CONCLUSIONS: We report a typical case with flu-like symptoms of unilateral acute idiopathic maculopathy. It is a very rare macular disease and a case such as ours with long-term follow-up using multimodality diagnostic imaging has not been previously reported.

Comparison of Laparoscopic Radiofrequency Myolysis (LRFM) and Ultrasonographic Radiofrequency Myolysis (URFM) in Treatment of Midline Dysmenorrhea

OBJECTIVES: To access the effectiveness of radiofrequency myolysis (RFM) in women with midline dysmenorrhea. METHODS: We designed RFM in two ways laparoscopic RFM (LRFM), vaginal ultrasound-guided RFM (URFM). One hundred and thirty-two patients were in the LRFM group and, 140 patients were in the URFM group. RESULTS: Upon receipt of surgery, both the LRFM and the URFM groups demonstrated a significant decrease (P < 0.001) in the mean pain score when compared to those before and after surgery. CONCLUSION: The RF uterine myolysis procedure provides an alternative for those patients who suffer from intractable midline dysmenorrhea. LRFM is an alternative choice because it is relatively safe and, simple to perform and moreover, it is satisfactory. LRFM appears to increasingly succeed in the treatment of midline dysmenorrhea.

A Case of Bilateral Macular Hole in a Patient with Bilateral Macular Telangiectasia

PURPOSE: To report a case of bilateral macular holes in a patient with bilateral macular telangiectasia (Mac Tel). CASE SUMMARY: A 61-year-old male presented with decreased central vision in both eyes. His best corrected visual acuity (BCVA) was 0.8 in the right eye and 0.6 in the left eye. On fundoscopy, fluorescein angiography (FAG), and optical coherence tomography (OCT), he was diagnosed with Mac Tel type 2 combined with stage 1A of the right eye and stage 1B impending macular hole in the left eye. Two years and 8 months later, the BCVA of both eyes was unchanged. On fundoscopy, FAG and OCT, there were no definitive changes in both eyes. The patient was observed without treatment. CONCLUSIONS: Patients with Mac Tel type 2 may be predisposed to the development of a macular hole.

Primary Central Nervous System ALK Positive Anaplastic Large Cell Lymphoma with Predominantly Leptomeningeal Involvement in an Adult

A 31-year-old Korean male presented with altered consciousness and severe headache. Brain MRI delineated focal leptomeningeal enhancement without any intracerebral lesions. Diagnosis was made based on a brain biopsy showing anaplastic large cell lymphoma (ALCL), immunohistochemical stains revealing positivity for anaplastic lymphoma kinase (ALK) and an absence of involvement in any other organs; specifically, the primary central nervous system ALK+ALCL. Complete remission was achieved following 5 cycles of systemic chemotherapy with a high dose of Methotrexate and a simultaneous 7 cycles of intrathecal triple chemotherapy. Diagnosis of primary leptomeningeal ALK+ALCL is challenging given its rarity and non-specific symptoms along with non-pathognomonic radiologic findings. We present the first case of primary leptomeningeal ALK-positive ALCL where the clinical course, pathologic characteristics and treatment modality are described as well as a review of literature.

The Effects of Laser Refractive Surgery for Correcting Residual Refractive Error after Implantation of ReSTOR(R) Multifocal IOL

PURPOSE: To evaluate the clinical effects of excimer laser refractive surgery on eyes with residual refractive error after implantation of ReSTOR(R) multifocal intraocular lenses. METHODS: We retrospectively reviewed the medical records of 10 eyes of 6 patients who had undergone cataract surgery with implantation of multifocal intraocular lenses. Photorefractive keratectomy (PRK) (5 eyes) and laser-assisted in situ keratomileusis (LASIK) (5 eyes) was performed on 10 eyes with residual refractive error. RESULTS: After cataract surgery and before laser surgery, the mean spherical equivalent (SE) was -0.34 +/- 0.89 D and the mean astigmatism was 2.08 +/- 0.55 D. Six months after laser surgery, the mean SE was -0.33 +/- 0.30 D (p = 0.354) and the mean astigmatism was 0.23 +/- 0.28 D. The changes in astigmatism between paired preoperative and postoperative values were statistically significant (p < 0.0001). At 6 months after surgery, uncorrected distance visual acuity significantly improved to 0.11 +/- 0.10 (log MAR) (p < 0.0001) There were no significant changes in the best corrected distance visual acuity and uncorrected near visual acuity (p = 0.073, p = 0.100). CONCLUSIONS: On the basis of predictability and stability, excimer laser surgery appears to be a clinically useful procedure to correct residual refractive error after implantation of ReSTOR(R) multifocal intraocular lenses.

The Antifibrotic Effects of alpha-Tocotrienols in Primary Cultured Orbital Fibroblasts from Thyroid-Associated Ophthalmopathy Patients

PURPOSE: To evaluate the antiproliferative and antifibrotic effects of alpha-tocotrienols in primary cultured orbital fibroblasts from thyroid-associated ophthalmopathy (TAO) patients. METHODS: Orbital fibroblasts were cultured (5 eyes from TAO patients, 5 eyes from normal patients) and classified into a control group, alpha-tocotrienol group and alpha-tocopherol group. The cell viability was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The proliferation of orbital fibroblasts was measured using the Click-iT(TM) assay. The collagen production of the control and alpha-tocotrienol groups was measured using a hydroxyproline assay. RESULTS: The alpha-tocotrienol and alpha-tocopherol groups showed no cytotoxicity up to 150 microm in orbital fibroblasts from TAO and normal patients. The proliferation of orbital fibroblasts from TAO and normal patients was significantly inhibited with alpha-tocotrienol at 80 microm and 120 microm. The collagen production of orbital fibroblasts from TAO patients was significantly inhibited with alpha-tocotrienol at 120 microm. CONCLUSIONS: The results from the present study indicate that non-toxic concentrations of alpha-tocotrienol have significant antiproliferative and antifibrotic effects on orbital fibroblasts from TAO patients.

Prognostic Factors after Intravitreal Triamcinolone Injection for Macular Edema due to Branch Retinal Vein Occlusion

PURPOSE: To evaluate prognostic factors for improvement of visual acuity after intravitreal triamcinolone acetonide injection (IVTA) for treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty-eight eyes of 68 consecutive patients treated with IVTA for ME due to BRVO were retrospectively reviewed. Patients were categorized into 2 groups according to the final visual acuity. The 'gainer group' consisted of eyes with a gain of 2 or more Snellen chart lines and the 'non-gainer group' consisted of eyes with less than 2 lines improvement or which had worsened at the last follow-up visit. Comparative clinical characteristics and ophthalmoscopic examinations were analyzed between the 2 groups. RESULTS: Out of the 68 eyes, 38 (56%) showed improved vision and were categorized as the gainer group; 30 eyes (44%) were categorized as the non-gainer group. The duration of symptoms in the non-gainer group was longer than the gainer group. Additionally, patients with a better baseline vision were expected to show greater improvement. The number of early visual acuity gainers who showed visual improvement at 1 month after IVTA was significantly higher in the gainer group. The number of eyes with angiographically documented macular ischemia was significantly higher in the non-gainer group. Existence of subretinal fluid has been identified as a positive factor for visual improvement. CONCLUSIONS: The cases with early treatment, good baseline visual acuity, case of favorable response to the initial IVTA, absence of macular ischemia, and baseline subretinal fluid are favorable prognostic factors for the outcome of visual acuity after IVTA for ME due to BRVO.

Differentiation Culture of Hematopoietic Stem Cells from Embryonic Stem Cells / 대한혈액학회지

BACKGROUND: This study was designed to verify the effective culture condition for the differentiation of human hematopoietic stem cells from SNU-3 embryonic stem cell line. METHODS: Control group was that of which embryonic stem cells were directly cultured to LTC-IC assay. Study group was that of which an embryonic body manufactured from embryonic stem cells was cultured to LTC-IC assay. CD34+ cells were separated by MACS method at 1, 3, 5, 7, 10, 14, 21 days of LTC-IC assay in both groups. Thereafter, CD34+ cell were cultured to semisolid methyl-cellulose media to count CFUs. CD34+CD45- cell percentage was measured with FACS method at 5 days of LTC-IC assay. This study was repeated for 14 times. RESULTS: In control group, CD34+ cells were hardly separated in any period of LTC-IC assay. In study group, the median count of CD34+ cells was 0.7 (0.4-1.2)x10(4), 1.8 (1.4-2.6)x10(4), 0.6 (0.5-0.7)x10(4) and the median count of CFUs was 0.5 (0.2-0.8)x10(2), 1.0 (0.6-1.3)x10(2), 0.2(0.1-0.4)x10(2) at 3, 5, 7 days of LTC-IC assay, respectively. Median CFUs count per CD34+ cell was 0.0071, 0.0056, 0.0033 at 3, 5, 7 days of LTC-IC assay, respectively. In study group, the count of CD34+ cells and CFUs was significantly higher at 5 days of LTC-IC assay than at any other days (P<0.01). CFUs count per CD34+ cell was significantly higher at 3 days of LTC-IC assay than at any other days (P<0.01). CD34+CD45- cells detected by FACS method of study group(1.16%(0.92-1.97) was significantly higher than that of control group (0.09% (0.00-0.23)) (P<0.01). CONCLUSION: The differentiation of hematopoietic stem cells from SNU-3 embryonic stem cell line is effective in the condition of which an embryonic body manufactured from embryonic stem cells is cultured to LTC-IC assay. The period of which embryonic stem cells differentiate to hematopoietic stem cells is between 3 to 7 days of LTC-IC assay.

Infusion-Related Toxicities of DMSO Containing Cryopreserved Blood / 대한수혈학회지

PURPOSE: We retrospectively evaluated infusion-related toxicities in the patients transfused with frozen-thawed blood mixed with dimethyl-sulfoxide (DMSO). METHODS: The incidence and severity of infusion-related toxicities in the 25 patients transfused with frozen-thawed blood containing hematopoietic stem cells mixed with 10% DMSO were compaired with those of other 18 patients (11 patients;transfused with ABO-compatible allogeneic marrow blood without DMSO, 7 patients;transfused with platelet concentrates which were frozen with 6% DMSO and washed after thawing to remove DMSO). RESULT: The median transfusion volume of blood containing DMSO was 280cc and that of blood without DMSO was 180cc. The infusion-related toxicities of blood containing DMSO were nausea (96%, 24/25), febrile sensation (88%, 22/25), vomiting (48%, 12/25), hematuria (32%, 8/25), dyspnea (16%, 4/25), convulsion (8%, 2/25), and sudden death (4%, 1/25). That of blood without DMSO was febrile sensation (5.6%, 1/18). The incidence of infusion-related toxicities of blood containing DMSO was significantly higher than that of blood without DMSO (p<0.05). CONCLUSION: It could be suggestive that the infusion-related toxicities of blood containing DMSO was occured more frequently and severely than those of blood without DMSO.

Results of CHOP-Bleo / CMED Alternating Chemotherapy for Aggressive Non - Hodgkin's Lymphoma / 대한암학회지

PURPOSE: To assess the efficacy and toxicity of a new protocol that consists of CHOP- Bleo alternated with a new regimen of Cyclophosphamide, methotrexate, etoposide, and dexamethasone(CMED) for aggressive Non-Hodgkin's Lymphoma(NHL). PATIENTS AND METHODS: Between January 1991 and December 1996, forty-six patients with Ann Arbor stages II-IV aggressive NHL were treated with alternating cycles of CHOP-Bleo and CMED for a total of 12 cycles. All eligible patients were evaluated for response, disease-free survival, and overall survival. RESULTS: Twenty-two patients(47.8%) achieved a complete response and overall response rate was 83.9%. The range of survival duration was 1-68+months and the median survival time was 42 months. Overall 3-year survival rate was 54%. The range of disease-free survival time was 6-63+months and 3-year disease-free survival rate was 61%. The most common hematologic toxicity was leukopenia and the incidence of severe leukopenia(<1,000/mm3) was 11%. And alopecia(84.8%) was the most common non-hematologic toxicity. CONCLUSION: The results of CHOP-Bleo/CMED alternating chemotherapy for patients with aggressive Non-Hodgkin's Lymphoma is not superior to other results of previous studies. Therefore further study will be warranted to determine clinical effectiveness of alternating chemotherapy.

5-Fluorouracil , Cisplatin , and Pirarubicin Combination Chemotherapy for Advanced Gastric Cancer / 대한암학회지

PURPOSE: Gastric cancer is the most common malignacy in Korea, However, standard systemic combination chemotherapy regimen has not been settled for advanced gastric cancer. 5-FU, Cisplatin, and Pirarubicin combination chemotherpay regimen has been tried to evaluate the response rate and toxicity in advanced gastric cancer patients. MATERIALS AND METHODS: Elligibility included biopsy proven inoperable or relapsed adenocarcinoma of stomach with adequate bone marrow, hepatic, and renal functon. Thirty seven patients with histologically confinned locally advanced or metastatic gastric cancer were treated with cisplatin 15 mg/m2 IV day 1~5, pirarubicin 60 mg/m2 day 1, 5-fluorouracil 750 mg/m2 day 1~5 as a continuous intravenous infusion. RESULTS: Twenty nine patients had measurable disease, 5 had received prior chemotherapy. Performance status was 0~1 in 24 and 2 in 13. There was 1 complete response and 13 partial response with an overall response rate of 48.3%(95% confidence interval 29.9~67.1%). The median survival is 7 months(95% confidence interval 5.4~8.6 months) and median response duration is 6 months. 19 patients experienced severe(WHO grade 3~4) leucopenia, 7 was thrombocytopenia, 13 was nausea and vomiting during chemotherapy. 11 patients experienced chemotherapy dose reduction or chemotherapy time delay due to severe hematologic or non-hematologic toxicities. There was no clinically recognizable cardiac toxicities. CONCLUSION: We experienced 48.3% overall response rate, 7 months median survival, and 51.3% severe hematologic toxicities with 5-fluorouracil, pirarubicin and cisplatin combination chemotherapy regimen in advanced or metastatic gastric cancer patients.

The Evaluation of Auto-Transfusion with Red Blood Cells Thawed after Freezing at -80degrees C / 대한혈액학회지

BACKGROUND: The need for auto-transfusion has been increased because the allo-transfusion has many problems such as infection and allo-immunization. But, the maximal storage period of blood at 4degrees C is 28~35 days. For long-term storage, the cryopreservation of blood is essential. However, the cryopreservation research of blood has been done rarely in Korea. Therefore, we evaluated the effects of auto-transfusion of RBCs thawed after freezing at -80degrees C. METHODS: Twelve healthy donors of allogeneic bone marrow transplantation were participated in this study. Control group was composed with 6 persons auto-transfused with 4degrees C stored blood collected at 3, 2, and 1 week prior to bone marrow harvest. Study group was composed with 6 persons auto-transfused with -80degrees C stored frozen-thawed RBCs, employing a high glycerol technique, collected at 5, 4, and 3 week prior to bone marrow harvest. To evaluate the effects of auto-transfusion at both group, the amount of harvested bone marrow and the changes of hemoglobin (Hb) and hematocrit (Hct) between pre-harvest and post-transfusion 24 hours were compaired. To assess the efficacy of cryopreservation, the studies for RBC recovery rate, the level of K+ and plasma Hb, bacterial culture and complications of transfusion were performed. RESULTS: 1) The amount of harvested bone marrow and the changes of Hb and Hct: The harvested bone marrow (mL) was 1,350+/-87 in control group and 1,300+/-70 in study group. At pre-bone marrow harvest, the Hb (g/dL) and Hct (%) levels were 13.2+/-0.60, 40.1+/-2.7 in control group and 12.8+/-0.50, 38.3+/-1.9 in study group, respectively. After 24 hours of auto-transfusion, the Hb (g/dL) and Hct (%) levels were 12.9+/-0.42, 38.1+/-1.1 in control group and 12.6+/-0.56, 37.3+/-1.2 in study group, respectively. There were no significant differences in Hb and Hct between pre-harvest and post-transfusion of control and study groups. 2) The efficacy of cryopreservation: The RBC recovery rates were 72~80% and the levels of K+ and plasma Hb were 1.5~3.5mEq/L and 251~840mg/dL, respectively. There was no bacterial growth of frozen-thawed blood culture and no complication associated with transfusion of frozen-thawed blood. CONCLUSION: It could be suggested that the method of RBC cryopreservation at -80degrees C with high glycerol technique was practically applicable to auto-transfusion.

A Case of Head and Neck Cancer Diagnosed In a Systemic Lupus Erythematosus Patient / 대한암학회지

Systemic lupus erythematosus (SLE) is one of the connective diseases characterized by altered immunity and has a high incidence of cancers, such as malignant lymphoma, leukemia, breast cancer and cervical cancer. Lymphadenopathy is one of the clinical findings of SLE. But it is also seen in cancer metastasis. Therefore, if the SLE patient has lymphadenopathies from cancer metastasis it is very difficult to make a differential diagnosis between the manifestation of SLE and that of cancer metastasis. In Korea, there is no report on SLE associated with lymphadenopathies from cancer metastasis. This is the first report of a case of SLE with a cervical lympadenopathy that comes from the metastasis of head and neck squamous cell carcinoma.