Maintenance of ovarian function in end-of-life cervical cancer patient following primary surgico-radiotherapy and ovarian transposition / 부인종양

A 35-year-old woman underwent laparoscopic radical hysterectomy, pelvic lymphadenectomy and ovarian transposition for stage IB2 cervical adenocarcinoma. She received adjuvant concurrent chemoradiation for poor pathologic risk factors but had tumor recurrence 20 months after the surgery. Transposed ovaries were uninvolved in the recurrence and progression. Salvage chemotherapy and radiotherapy were given. Despite systemic chemotherapy and repeat pelvic radiotherapy, the patient was able to maintain ovarian function. Ovarian transposition in cervical cancer is an easily performed procedure that does not alter the prognosis of the disease in some cases. Present recommendations for its use should be reevaluated so that more premenopausal cancer patients may benefit from this underutilized procedure.

Clinical application of RapidArc volumetric modulated arc therapy as a component in whole brain radiation therapy for poor prognostic, four or more multiple brain metastases

PURPOSE: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases. MATERIALS AND METHODS: Nine patients with multiple (> or =4) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions. RESULTS: The median biologically effective dose to metastatic tumors was 68.1 Gy10 and 67.2 Gy10 and the median brain volume irradiated more than 100 Gy3 were 1.9% (24 cm3) and 0.8% (13 cm3) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively. CONCLUSION: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.

A Case of Micropapillary Transitional Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

More than 90% of bladder cancers are transitional cell carcinomas. Transitional cell carcinoma of the urinary bladder ordinarily does not pose diagnostic difficulties and is well known its clinical behavior. However, variation from the classic histology can cause problems in recognition. Recently several variants of transitional cell carcinoma of the urinary bladder have been described to promote the recognition of, or to draw attention to, possible differences in clinical behavior. The presence of a micropapillary component in transitional cell carcinoma is associated with high-stage and high-grade transitional cell carcinoma with a tendency of vascular invasion, and with poor prognostic histologic feature. We report a case of micropapillary transitional cell carcinoma of the urinary bladder.

Relationship between IgA nephropathy and Histocompatibility Antigens (HLA) in Korean Population / 대한내과학회지

OBJECTIVES: Primary IgA nephropathy(IgAN), currently recognized as the most prevalent form of glomerular disease in the world, has tendency toward end stage renal failure at a rate of 20-30% in patients after a long-term follow-up of more than 20 years. But its etiology and pathophysiology is not fully understood. This study was designed to evaluate the pattern of histocompatibility antigens(HLA) and its association with poor prognostic factors in patients with IgAN. METHODS: Study population comprised the 69 patients with IgAN which was diagnosed by clinical and pathological findings, and control groups were 202 healthy Korean people. We evaluated the HLA class I serologic typing by standard microlymphocytotoxic technique and the HLA class II genotypes by the two-step polymerase chain reaction. RESULTS: 1. HLA-A was not associated with IgAN. 2. The phenotype frequency of HLA-B55 was 6.1% in patient group and 1.7% in normal control group. HLAB55 was associated with IgAN(relative risk 3.47, P<0.05). 3. HLA-DQB1*04 was also associated with IgAN (relative risk 3.57, P<0.05). 4. There was no significant difference in the distribution of HLA in IgAN patients according to histologic grading, blood pressure, renal function and proteinuria. CONCLUSIONS: Frequencies of HLA-B55, HLA-DQB1 *04 are higher in Korean patients with IgAN compared to general population. But we could not observe the significant relationships between HLA type and poor prognostic factors. Further study using larger population with IgAN may be necessary to identify the association of HLA locus with poor prognostic factors and progress decline in renal function in patients with IgAN.

The Effects of Mitomycin C on Trabeculectomy

Mitomycin C (MMC) is an antimetabolite, antibiotic which prevents the proliferation of fibroblast and fibrosis by inhibition of DNA-dependent RNA synthesis. It has been used to increase the success rate of filtering surgery. We performed trabeculectomy and peripheral iridectomy with 0.4 mg/ml MMC application for 3 minutes in poor prognostic glaucoma patient, 26 eyes of 24 patients from February 1992 to December 1994. The postoperative change of intraocular pressure (IOP) and complications were followed up from 3 to 30 months (mean 12.4 months). The preoperative and postoperative mean IOP after 24 months were 32.3 +/- 11.4 mmHg and 12.7 +/- 3.1 mmHg, respectively. The decrease rate of IOP was 60.7% and the success rate was 71.7%. The postoperative complications were 15 eyes including 5 eyes of shallow anterior chamber, 5 eyes of hyphema, 2 eyes of conjunctival wound leakage, one eye of bleb rupture, one eye of choroidal detachment, and one eye of cataract formation.