Clinical characteristics and treatment outcome of acute myeloid leukemia in elderly patients in Korea: a retrospective analysis

BACKGROUND: The clinical characteristics of elderly patients with AML differ from those of younger patients, resulting in poorer survival and treatment outcomes. We analyzed retrospectively the clinical data of AML patients 65 years old and above to describe patients' characteristics and treatment patterns, and to define meaningful prognostic factors of survival in the Korean population. METHODS: Basic patients' characteristics, clinical outcomes according to treatments, and prognostic factors associated with survival and treatment intensity were examined in a total of 168 patients diagnosed in 5 institutes between 1996 and 2012 as having AML. RESULTS: Herein, 84 patients (50.0%) received high-intensity regimens (HIR), 18 (10.7%) received low-intensity regimens (LIR), and 66 (39.3%) received supportive care (SC) only. The median survival of all patients was 4.5 months; and median survival times with HIR, LIR, and SC were 6.8 months, 10.2 months, and 1.6 months, respectively. Median survival times with HIR and LIR were significantly longer than that with SC (P<0.0001 and P=0.006, respectively). Multivariate analysis identified age, Eastern Cooperative Oncology Group-performance status (ECOG-PS), hemoglobin (Hb) level, and serum creatinine (Cr) level as statistically significant prognostic factors for survival. In the HIR group, prognostic factors for survival were ECOG-PS, Hb level, and C-reactive protein level. CONCLUSION: Even in elderly AML patients, an intensive treatment regimen could be beneficial with careful patient selection. Further prospective studies designed to identify specific prognostic factors are required to establish an optimal treatment strategy for elderly AML patients.

Clinical Features of Wrist Drop Caused by Compressive Radial Neuropathy and Its Anatomical Considerations

OBJECTIVE: Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy. METHODS: Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records. RESULTS: Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients. CONCLUSION: Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.

A Case of Etoposide Therapy in a Patient Newly Diagnosed with Classic Kaposi's Sarcoma and Rheumatoid Arthritis / 대한내과학회지

Kaposi's sarcoma typically occurs in immunocompromised patients, especially those with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) and human immunodeficiency virus (HIV) may play important roles in the development of Kaposi's sarcoma. We report the case of a 75-year-old male who presented with progressive multiple purplish papules and nodules on the skin for 3 months. Social and past medical histories seemed incompatible with an immunesuppressed condition and tests for HIV antibodies and HHV-8 were negative. He was newly diagnosed with rheumatoid arthritis, according to the 2010 ACR-EULAR criteria. Typical findings of Kaposi's sarcoma were confirmed by biopsy. After treatment with metronomic oral etoposide 25 mg once daily for 9 months, the skin lesions had almost resolved with no serious complication. Thus, we report a rare case of Kaposi's sarcoma developing in a patient with newly diagnosed rheumatoid arthritis who showed a good response to oral etoposide.

Pulsed Radiofrequency Neuromodulation for the Treatment of Saphenous Neuralgia

A 65-year-old male presented with pain in his right medial calf. An imaging study revealed no acute lesions, and a diagnosis of saphenous neuralgia was made by a nerve conduction study. He received temporary pain relief with saphenous nerve blocks twice in a one-week interval. Pulsed radiofrequency neuromodulation reduced pain to 10% of the maximal pain intensity. At 6 months after the procedure, the pain intensity was not aggravated even without medication. Pulsed radiofrequency neuromodulation of the saphenous nerve may offer an effective and minimally invasive treatment for patients with saphenous neuralgia who are refractory to conservative management.

Development and Evaluation of the Semi-quantitative Food Frequency Questionnaire to Assess Folate Intake in Women of Child-bearing Age / 대한지역사회영양학회지

The aim of this study was to develop and evaluate the simple semi-quantitative food frequency questionnaire (FFQ) for assessing folate intake in women of reproductive age. We developed a 30-item FFQ, and tested the reliability and validity in 97 women aged between 20 and 39 yrs using the FFQs and 24-h recalls, which were carried out twice, respectively. Assessing the reliability, the correlation coefficients were 0.53 (Spearman's) and 0.49 (Pearson's) for folate. There was no significant difference of folate intake between FFQ1 and FFQ2. 36.1% subjects were classified into the same quartile and 83.5% into the same or adjacent quartile divided by folate intake. On determining the validity, the mean folate intake obtained from the FFQ (FFQ1) and 24h-recalls (2-d) were 306.6 +/- 167.2 microg/d and 326.9 +/- 103.3 microg/d, respectively. There was no significant difference between folate intakes from the two methods. The correlation coefficients for folate were 0.24 (Spearman's) and 0.26 (Pearson's). 39.2% of the subjects were categorized into the same quartile and 70.1% were into the same or adjacent quartile. In addition, sensitivity (64.3%) and specificity (62.3%) were estimated to evaluate the adequacy of folate intake. These results suggest that this FFQ would be a useful and a valuable instrument to assess the intake of folate among the Korean women of child-bearing age.

Outcomes after Arthroscopic Repair of Anterior Shoulder Instability after Metal Anchor to Biodegradable Anchor Fixation

PURPOSE: We compared the results of arthroscopic Bankart repair using metal and biodegradable anchor fixation. MATERIALS & METHODS: We reviewed 26 patients with anterior shoulder instability treated by arthroscopic Bankart repair from October, 2006, to March, 2007, 15 patients with metal anchors and 11 patients with biodegradable anchors. The average age was 27.4 years old (range: 17~55) and mean follow-up was 14 months (range: 12~17 months). Functional outcome was evaluated using the Korean Shoulder Score for Instability (KSSI), Rowe's Bankart Grading scale (RBGS), ASES score, and UCLA scores. RESULTS: In the metal-anchor group, the improvements of mean KSSI, ASES, UCLA score, and RBGS were 20.6, 24.0, 4.0, and 45.5, respectively. In the biodegradable anchor group, improvements of mean KSSI, ASES, UCLA score, and RBGS were 21.0, 23.6, 4.6, and 48.9. The improvements in final outcomes were not significantly different (p>.05). One metal problem and one traumatic redislocation occurred in the metal group. CONCLUSION: Both techniques produced satisfactory outcomes in the treatment of traumatic anterior instability. The biodegradable anchor group could also avoid problems with metal anchors.

Ganglion Cyst in the Patellar Tendon: A Case Report

The ganglion cyst in the knee joint is relatively rare. Also ganglion cyst in the patellar tendon is extremely rare, we found one case report in Turkey and another one case in France, but we did not found in Korea. Most ganglion cysts in knee joint have been found incidentally by arthroscopy or MRI. We diagnosed the ganglion cyst within the patellar tendon incidentally after trauma by MRI, and treated by surgery. We report a case of the ganglion cyst within patellar tendon, improved remarkably in knee joint pain especially during extension after surgery.