Risk Factors for Local Recurrence in Patients With N1b Papillary Thyroid Carcinoma / 대한이비인후과학회지

Background and Objectives@#Papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis is known as a major risk factor for tumor recurrence after surgical treatment. The aim of this study is to identify risk factors for loco-regional recurrence in patients with PTC with lateral neck lymph node metastasis, which has a high risk of recurrence.Subjects and Method This study involved 319 patients who underwent total thyroidectomy, central lymph node (LN) and lateral LN dissection due to PTC. The patients’ demographics and pathological factors, including lymph node metastasis were retrospectively reviewed. Univariate, multivariate and C-index with variable selection analyses were performed to identify factors associated with recurrence-free survival (RFS). @*Results@#A mean follow-up of 101 months, 35 (10.9%) patients had a loco-regional recurrence. In multivariate analysis according to loco-regional recurrence, patients with a primary tumor of more than 4 cm, multifocality, vascular invasion, and bilateral lateral cervical metastasis were associated with worse RFS. In the variable selection analysis, lateral lymph node metastasis ratio was also statistically significant. @*Conclusion@#PTC with lateral neck lymph node metastasis included tumors larger than 4 cm. Multifocality, vascular invasion, high lateral lymph node metastasis ratio and bilateral neck lymph node metastasis are predictive factors of loco-regional recurrence, and these risk factors should be carefully followed-up after surgery.

Times to Discontinue Antidepressants Over 6 Months in Patients with Major Depressive Disorder

OBJECTIVE: The aim of the present study was to investigate differences in discontinuation time among antidepressants and total antidepressant discontinuation rate of patients with depression over a 6 month period in a naturalistic treatment setting. METHODS: We reviewed the medical records of 900 patients with major depressive disorder who were initially prescribed only one kind of antidepressant. The prescribed antidepressants and the reasons for discontinuation were surveyed at baseline and every 4 weeks during the 24 week study. We investigated the discontinuation rate and the mean time to discontinuation among six antidepressants groups. RESULTS: Mean and median overall discontinuation times were 13.8 and 12 weeks, respectively. Sertraline and escitalopram had longer discontinuation times than that of fluoxetine, and patients who used sertraline discontinued use significantly later than those taking mirtazapine. No differences in discontinuation rate were observed after 24 weeks among these antidepressants. About 73% of patients discontinued antidepressant treatment after 24 weeks. CONCLUSION: Sertraline and escitalopram tended to have longer mean times to discontinuation, although no difference in discontinuation rate was detected between antidepressants after 24 weeks. About three-quarters of patients discontinued antidepressant maintenance therapy after 24 weeks.

Clinical Application of Gamma Knife Dose Verification Method in Multiple Brain Tumors : Modified Variable Ellipsoid Modeling Technique

OBJECTIVE: The Leksell Gamma Knife(R) (LGK) is based on a single-fraction high dose treatment strategy. Therefore, independent verification of the Leksell GammaPlan(R) (LGP) is important for ensuring patient safety and minimizing the risk of treatment errors. Although several verification techniques have been previously developed and reported, no method has ever been tested statistically on multiple LGK target treatments. The purpose of this study was to perform and to evaluate the accuracy of a verification method (modified variable ellipsoid modeling technique, MVEMT) for multiple target treatments. METHODS: A total of 500 locations in 10 consecutive patients with multiple brain tumor targets were included in this study. We compared the data from an LGP planning system and MVEMT in terms of dose at random points, maximal dose points, and target volumes. All data was analyzed by t-test and the Bland-Altman plot, which are statistical methods used to compare two different measurement techniques. RESULTS: No statistical difference in dose at the 500 random points was observed between LGP and MVEMT. Differences in maximal dose ranged from -2.4% to 6.1%. An average distance of 1.6 mm between the maximal dose points was observed when comparing the two methods. CONCLUSION: Statistical analyses demonstrated that MVEMT was in excellent agreement with LGP when planning for radiosurgery involving multiple target treatments. MVEMT is a useful, independent tool for planning multiple target treatment that provides statistically identical data to that produced by LGP. Findings from the present study indicate that MVEMT can be used as a reference dose verification system for multiple tumors.

Factors Influencing Drinking Behavior during Pregnancy in Korean Women / 신경정신의학

OBJECTIVES: Drinking alcohol during pregnancy can result in various negative consequences. Nevertheless, few studies have been conducted in Korea to investigate alcohol consumption and factors influencing drinking behavior during pregnancy in Korean women. A survey was therefore conducted on pregnant women to investigate whether they drank alcohol and to identify factors predictive of drinking behavior during pregnancy. METHODS: Pregnant women at less than 30 days before expected delivery were asked to complete a self-report questionnaire. Demographic and obstetric characteristics and smoking history were investigated in addition to their history of alcohol use. RESULTS: Six hundred and sixty five subjects of average age 30.8+/-3.8 years were enrolled. Five hundred fifty five (83.5%) and 163 subjects (24.5%), respectively, consumed alcohol before becoming pregnant and after they were aware of being pregnant. Ninety six (14.4% of 665 subjects) and 20 subjects (3.0% of 665 subjects), respectively, smoked before becoming pregnant and after they were aware of being pregnant. Those who had consumed alcohol before becoming pregnant (OR=12.13, p<0.001), those who smoked before becoming pregnant (OR=2.24, p=0.001) and those with a family history of smoking (OR=1.59, p< or =0.05) were found to be more likely to drink alcohol when pregnant. CONCLUSION: Three factors, alcohol drinking before becoming pregnant, cigarette smoking before becoming pregnant and a family history of cigarette smoking, are predictive of alcohol consumption during pregnancy. These results strongly suggest that an anti-drinking educational program should be devised to target women of child bearing potential and, in particular, those at high risk.

Distribution Pattern of Prostatic Weight and Proposal of Its Normal Range / 대한비뇨기과학회지

No abstract available.

Tumor Angiogenesis as a Predictor of Malignancy Potential and Prognosis in Gastric Carcinoma / 대한암학회지

PURPOSE: In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and prognosis. MATERIALS AND METHODS: A total of 256 patients with gastric cancer who underwent curative surgery were included in this study. Microvessel count was determined by im-munohistochemical staining using monoclonal antibody against factor VIII-related antigen. RESULTS: The statistical significance between the microvessel count and clinicopathologic factors (age, sex, tumor invasion, lymph node involvement, histologic type) was analized. The tumor stage and histologic type were correlated with microvessel count. And also there was statistical significance with survival rate and recurrence-free survival rate between high (microvessel count> or =42) and low angiogeneic group (microvessel count< 42). The Cox's proportional hazard model showed that stage, histologic type, angiogeneic score were one of the significant and independent prognostic variables. CONCLUSION: The tumor angiogenesis of gastric carcinoma may be independent prognostic factor for predicting recurrence and survival.