Epigenetic Role of Histone 3 Lysine Methyltransferase and Demethylase in Regulating Apoptosis Predicting the Recurrence of Atypical Meningioma

Alteration of apoptosis is related with progression and recurrence of atypical meningiomas (AMs). However, no comprehensive study has been conducted regarding histone modification regulating apoptosis in AMs. This study aimed to determine the prognostic values of certain apoptosis-associated factors, and examine the role of histone modification on apoptosis in AMs. The medical records of 67 patients with AMs, as diagnosed during recent 13 yr, were reviewed retrospectively. Immunohistochemical staining was performed on archived paraffin-embedded tissues for pro-apoptotic factors (CASP3, IGFBP, TRAIL-R1, BAX, and XAF1), anti-apoptotic factors (survivin, ERK, RAF1, MDM2, and BCL2), and the histone modifying enzymes (MLL2, RIZ, EZH1, NSD2, KDM5c, JMJD2a, UTX, and JMJD5). Twenty-six (38.8%) patients recurred during the follow-up period (mean duration 47.7 months). In terms of time-to-recurrence (TTR), overexpression of CASP3, TRAIL-R1, and BAX had a longer TTR than low expression, and overexpression of survivin, MDM2, and BCL2 had a shorter TTR than low expression (P<0.05). Additionally, overexpression of MLL2, UTX, and JMJ5 had shorter TTRs than low expression, and overexpression of KDM5c had a longer TTR than low expression. However, in the multi-variate analysis of predicting factors for recurrence, low expression of CASP3 (P<0.001), and BAX (P<0.001), and overexpression of survivin (P=0.007), and MDM2 (P=0.037) were associated with recurrence independently, but any enzymes modifying histone were not associated with recurrence. Conclusively, this study suggests certain apoptosis-associated factors should be associated with recurrence of AMs, which may be regulated epigenetically by histone modifying enzymes.

Assessment of depression, anxiety, sleep disturbance, and quality of life in patients with chronic low back pain in Korea / 대한마취과학회지

BACKGROUND: Chronic low back pain (CLBP) has a significant effect on quality of life and imposes a great economical burden on society. In a number of studies, validated questionnaires had been given to CLBP patients to determine their health-associated quality of life, sleep disturbance, and psychological status. However, such outcome studies had not been performed previously in Korea. METHODS: We used self-report questionnaires to compare CLBP patients with an age- and sex-matched healthy control group. Between September 2012 and August 2013, we enrolled 47 patients who had CLBP for more than 3 months (group P) and 44 healthy age- and sex-matched controls (group C), who completed the following self-report questionnaires: 36-Item Short Form Health Survey (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Oswestry Disability Index (ODI), and Pittsburgh Sleep Quality Index (PSQI). RESULTS: The scores from the ODI, BDI, and BAI were significantly higher in group P than in group C. The SF-36 scores were significantly lower in group P than in group C, suggesting lower quality of life in group P. The incidence of depression and anxiety was significantly higher in group P than in group C. However, neither the PSQI score nor the incidence of sleep disturbance was significantly different between the groups. CONCLUSIONS: Patients with CLBP showed considerable functional disability and significant impairment of psychological status with a low quality of life. Hence, it is important to evaluate CLBP patients to provide adequate psychological support.

Clinically Significant Cardiac Arrhythmia in Patients with Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: Many previous studies have shown that electrocardiographic (ECG) changes occur patients with subarachnoid hemorrhage (SAH). This study was designed to identify the frequency, influencing factors, and outcome of clinically significant cardiac arrhythmias after SAH. METHODS: We retrospectively analyzed clinical data of 122 patients including ECG finding, age, sex, the Hunt-Hess grade, the Fisher's grade, the history of hypertension, peak blood pressure and heart rate, location of aneurysm, Glasgow Outcome Scale (GOS) score, the days of admission to the intensive care unit, the presence of symptomatic vasospasm. RESULTS: Of 122 SAH patients, 50% (n = 61) had a verified clinically significant arrhythmia. There were no statistically significant independent factors associated with clinically significant arrhythmia in multivariate analysis. Although adjustments for the effects of age, Hunt-Hess grade, and the presence of symptomatic vasospasm on death were made, clinically significant arrhythmias were still independently predictive of death (no arrhythmia versus arrhythmia, 11.5% versus 27.9%, adjusted odds ratio [OR] 3.524, 95% confidence interval [CI] 1.229-10.100, p = 0.019) and poor outcome (GOS < or = 2, 13.1% versus 29.5%, adjusted OR 3.202, 95% CI 1.174-8.732, p= 0.023). CONCLUSION: Clinically significant arrhythmias after SAH are associated with a high mortality rate, and serious cardiac and neurological comorbidity. Patients with an abnormal ECG on admission should undergo close cardiac monitoring, and the presence of rhythm disturbances should prompt aggressive measures to treat myocardial infarction (MI), maintain a normal cardiac rhythm, and minimize the presence of autonomic stress.

Influence of Couch and Collimator on Dose Distribution of RapidArc Treatment Planning for Prostate Cancer in Radiation Therapy / 의학물리

We investigated the influence of photon energy, couch and collimator angle differences between arcs on dose distribution of RapidArc treatment planning for prostate cancer. RapidArc plans were created for 6 MV and 10 MV photons using 2 arcs coplanar and noncoplanar fields. The collimator angle differences between two arcs were 0degrees, 15degrees, 30degrees, 45degrees, 60degrees, 75degrees and 90degrees. The plans were optimized using same dose constrains for target and OAR (organ at risk). To evaluate the dose distribution, plans were analyzed using CI (conformity index), HI (homogeneity index), QOC (quality of coverage), etc. Photon energy, couch and collimator angle differences between arcs had a little influence on the target and OAR. The difference of dosimetric indices was less than 3.6% in the target and OAR. However, there was significant increase in the region exposed to low dose. The increase of V15% in the femur was 6.4% (left) and 5.5% (right) for the 6 MV treatment plan and 23.4% (left), 24.1% (right) for the noncoplanar plan. The increase of V10% in the Far Region distant from target was 54.2 cc for the 6 MV photon energy, 343.4 cc for the noncoplanar and 457.8 cc for the no collimator rotation between arcs.

Study on the 6 MV Photon Beam Characteristics and Analysis Method from Medical Linear Accelerators Using Geant4 Medical Linac2 Example / 의학물리

In this study, Geant4 based Monte Carlo simulations were carried out for medical linear accelerator. Modified Medical Linac2 toolkit was used for calculation. The energy spectrum, most probable energy and the photon mean energy compared with the published results using the EGS4 code. The results well agreed with published results. The calculated results of photon fluence, energy fluence and mean energy according to the radius from the centre of the beam were analyzed. Monte Carlo simulation using Medical Linac2 code is considered to be useful for analysis of medical linear accelerator. Because the calculated results varies depending on Physics List model for same head structure. It it important to choose the right model for research purpose. Monte Carlo simulation using GEANT4 Medical Linac2 is a valuable for any novice to adopt this code to the study related to 6 MV photon fluence from medical linear accelerator.

Calculation of Energy Spectra for Electron Beam of Medical Linear Accelerator Using GEANT4 / 의학물리

The energy spectra for electron beam of medical linear accelerator were calculated using a GEANT4 Medical Linac 2 example code. The incident electron mean energy were 6, 9, 12, 16, 20 MeV. This code was designed to calculate electron beam energy spectra according to material, thickness and location of electron scattering foil affecting electron beam characteristic. Lead, Copper, Aluminum and Gold were used for scattering foil. The energy distribution for electron and photon were analyzed by changing position of scattering foil in the head of linear accelerator. The effect of electron scattering foil on energy spectra which is basic data of simulation for medical linear accelerator were presented. The calculated results would be used in design of medical accelerator head.

Imatinib Mesylate (Gleevec(TM))-induced Lichenoid Drug Eruption Improved by Tentative Dose-reduction and Topical Steroid / 대한피부과학회지

Imatinib mesylate (Gleevec(TM)) is an oral anticancer drug. It works as a selective and competitive inhibitor of tyrosine kinases such as bcr-abl protein, c-kit, and platelet-derived growth factor receptors (PDGFR). Gleevec(TM) is a first-line therapeutic agent for chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors, but causes various adverse cutaneous reactions. We herein report on a case of lichenoid drug eruption induced by Gleevec(TM) in a patient with a malignant gastrointestinal stromal tumor.

Primary Cutaneous Follicular B Cell Lymphoma That Arose on the Scalp / 대한피부과학회지

Primary cutaneous follicular B cell lymphomas are rare entities of an unknown cause, except for those induced by Epstein-Barr virus (EBV) or Borrelia burgdorferi. Follicular B cell lymphoma has been thought to rarely occur primarily in the skin. The lesions are generally solitary plaques or nodules that are localized on the head and neck. It shows considerable variation in the clinical presentation, the histological features, the immunophenotype and the prognosis. In this case, a 79-year-old man presented with a 3-month history of lesions on his head. Clinical examination revealed two deep-seated subcutaneous tumors with uneven surfaces located on the both sides of the frontoparietal area of the scalp. Biopsy of the skin lesion disclosed a massive dermal lymphocytic infiltrate with a follicular pattern. On immunohistochemical staining, the lymphocytes strongly expressed CD20 and Ki-67, but not Bcl-2. He was diagnosed with primary cutaneous follicular B cell lymphoma. This case illustrates a rarely reported example of primary cutaneous follicular B cell lymphoma that arose on the scalp.

Cutaneous Metastasis of Lung Angiosarcoma to the Scalp / 대한피부과학회지

Angiosarcoma is a rare malignant tumor of an endothelial cell derivation and it accounts for less than 2% of all sarcomas. It is a highly aggressive neoplasm with a poor prognosis and most patients die within a short period after presentation. Although angiosarcoma may occur in any location on the body, it rarely arises from major vessels, but has a decided predilection for the skin and superficial soft tissue. A 39-year-old man was referred to our department with an asymptomatic, firm, ulcerative nodule on his scalp that was noticed almost 2 months previously. He had been diagnosed with lung angiosarcoma 9 month earlier. Histopathologically, the skin specimen showed angiosarcoma. The histological findings of the metastatic skin cancer are usually the same as that of the primary cancer. Metastatic cutaneous angiosarcoma is uncommon. Based on these clinical and histopathological findings, our case seems to be skin metastasis at the scalp from the lung angiosarcoma.

Flushing in a Young Woman: Skin Manifestation of Carcinoid Syndrome / 대한피부과학회지

Carcinoid tumors are derived from enterochromaffin cells that are capable of producing a wide range of neuroendocrine mediators including serotonin or 5-hydroxytryptamine. Carcinoid syndrome occurs when mediators produced by the tumor and normally metabolized by the liver escape into the systemic circulation. The syndrome classically involves the gastrointestinal tract, respiratory system, cardiovascular system and the skin. Flushing is almost universal in the syndrome. A 23-year-old woman came to our hospital presenting with flushing on face and trunk. The patient had experienced flushing for 2 years and it was aggravated by emotional change, stress, exercise, and eating spicy food. The patient also had abdominal pain, diarrhea, weight loss and hepatomegaly. Urinary 5-hydroxyindoleacetic acid was elevated (81.5 mg/day). Abdominal computed tomography scans showed multiple hepatic masses diagnosed as a carcinoid tumor by computed tomography-guided needle biopsy. Physicians should consider carcinoid syndrome when patients present with flushing and systemic symptoms.

Sinus Pericranii: Case Report / 대한뇌혈관외과학회지

OBJECTIVE: Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal communication between the extracranial and intracranial venous systems, usually involving the superior sagittal sinus (SSS) and occasionally, the transverse sinus. CASE REPORT: A 28-year-old man was presented with a round, fluctuant, nonpulsatile scalp mass in the frontal area near the midline, the size of which changed, depending on his head position. Magnetic resonance imaging showed an extracranial vein extending through a bony defect in the vertex of the skull and draining into the superior portion of the sagittal sinus. RESULTS: The lesion was completely removed by surgery. The presence of vascular endothelium in the pathologic specimen suggests a congenital or spontaneous origin. CONCLUSION: SP is a rare vascular malformation that requires surgical or endovascular treatment for the prevention of life-threatening complications.

A Case of Guttate Psoriasis after Treatment with IFN-alpha / 대한피부과학회지

Psoriasis is considered to be an autoimmune disease of abnormal keratinocyte proliferation induced by T lymphocytes. An association with several cytokines has been suggested. Interferon (IFN) is a cytokine secreted by virus-infected cells and has the ability to prevent further infection of cells that were exposed to it. It has therefore been used as a therapeutic agent for many chronic viral diseases such as chronic hepatitis C. Recently, however, IFN has also been considered to be a triggering factor in the development of psoriasis. We describe an 18-year-old woman presenting with guttate psoriasis, who suffered soft tissue sarcoma and underwent chemotherapy containing IFN-alpha. This is possibly the first case of guttate psoriasis associated with IFN-alpha in the Korean literature.

A Case of Skin Metastasis of Ovarian Cancer (Mucinous Cystadenocarcinoma) / 대한피부과학회지

Metastasis to the skin from internal malignant neoplasms is an uncommon event. Although carcinoma of the ovary is the second most common malignancy in women, cutaneous involvement originating from ovarian cancer is particularly unusual. A 30-year-old woman had been treated with chemotherapy for ovarian cancer 4 years previously. She showed an erythematous indurated subcutaneous nodule on her left shoulder and scalp. Histopathologic findings showed multiple cribriform pattern cellular masses and some cords or tubular structures floating on a mucinous pool, which were similar to primary mucinous cystadenocarcinoma. We report this case of cutaneous metastasis from ovarian cancer.

Olfactory Schwannoma: Case Report

Intracranial schwannomas preferentially arise from the vestibular branch of the eighth nerve, and rarely from the trigeminal nerve, facial nerve, and lower cranial nerves. Anterior cranial fossa schwannomas are extremely uncommon and few details about them have been reported. The patient was a 39-year-old woman whose chief complaints were anosmia and frontal headache for 2 years. The gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed an extra-axial mass from ethmoid sinus to right frontal base region near the midline, with solid enhancement in lower portion and multicystic formation in upper portion. The tumor was totally resected via basal subfrontal approach. At operation, the tumor had cystic portion with marginal calcification and the anterior skull base was destructed by the tumor. The olfactory bulb was involved, and the tumor capsule did not contain neoplastic cells. The histopathological diagnosis was schwannoma. We report a rare case of anterior cranial fossa schwannoma with literature review.

Clinical Analysis of Patients who Survived for Less than 3 Months After Brain Metastatectomy

In the patients with brain metastasis (BM), it is impossible to determine who will benefit from surgery because of limited survival. In an attempt to identify optimal candidates for brain metastatectomy, we analyzed patients who survived for <3 months after craniotomy for a single BM lesion. Between January 1st, 1997 and July 31st, 2007, 83 patients with a single BM underwent craniotomy. Of these patients, 25 patients (30.1%) died within 3 months of craniotomy. The primary lesions were non-small call lung cancer in 15, colon cancer in 6, and breast cancer, renal cell carcinoma, ovarian cancer, or esophageal cancer in one apiece. Of the 25 patients, 19 (79%) were of tumor stage IV and had extra-cranial metastasis. Eleven (44%) of the 25 primary cancers had a well-controlled status. Twelve patients (48%) had a Karnofsky Performance Scale (KPS) score of <70, and 13 (52%) were of Recursive Partitioning Analysis (RPA) class 3. Primary cancer status, RPA class, and functional status were found to be critical factors for consideration when selecting surgical candidates. In addition, adjuvant therapy was found to have an important role on survival.

Predisposing Factors Related to Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. METHODS: Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (> or =14 days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. RESULTS: Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence on the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not correlate with the development of shunt-dependent chronic hydrocephalus. CONCLUSION: Hydrocephalus after aneurysmal SAH seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.

Cerebrospinal Fluid Rhinorrhea Secondary to Acute Sphenoid Sinusitis

Acute sphenoid sinusitis is a relatively uncommon disease in the post-antibiotic era. Furthermore direct bony destruction and intracranial complications secondary to sphenoid sinusitis are extremely rare. However, it can have a high morbidity and mortality rate. If the diagnosis is delayed, serious problems can occur, so early diagnosis and treatment are required. We represent and discuss a case of cerebrospinal fluid (CSF) rhinorrhea with wide bony destruction directly, secondary to acute sphenoid sinusitis.

Removal of Intradural-Extramedullary Spinal Cord Tumors with Unilateral Limited Laminectomy

Total laminectomy for the removal of intradural-extramedullary spinal cord tumors has been used widely, but postoperative complications often develop, such as kyphosis, spinal instability, and persistent back pain. In this study, we evaluated seven patients with intradural-extramedullary spinal cord tumors with respect to the value of unilateral limited laminectomy. Our cases included six schwannomas, and one meningioma. The cervical region was involved in four cases, the thoracolumbar region in two cases, and the lumbar region in one case. The rationale for choosing a unilateral approach is to preserve musculoligamentous attachments and posterior bony elements as much as possible. The patients were mobilized on the third postoperative day and preoperative neurological symptoms were recovered within a few weeks. We did not observe any complication relating to unilateral limited laminectomy and at follow-up evaluation (at 3 and 12 months postoperatively), none of the patients showed spinal deformity or spinal instability. We think that the unilateral limited laminectomy is a safe and efficient technique for the treatment of intradural-extramedullary spinal cord tumors. We suggest that this technique is one of the best treatments for these tumors.

Therapeutic Strategies of the Intracranial Meningioma in Elderly Patients

OBJECTIVE: The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospective study to validate the use of the Clinical-Radiological Grading System (CRGS) as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. METHODS: From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. RESULTS: High CRGS score was associated with a higher probability of good outcome (p=0.004) and a lower probability of postoperative complications (p=0.049). Among the different subset items of the CRGS score, larger maximum tumor diameters (D> or =4cm) and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications (p<0.05). Additionally, the critical location of the tumor was also correlated with poor outcome (p<0.05). CONCLUSION: A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.

Evaluation of the MAST CLA Allergy System for Measuring Total and Allergen Specific IgE in Child and Adult Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The multiple allergosorbent test chemiluminescent assay (MAST-CLA) system is a simple method for measuring total and allergen-specific IgE antibodies in the serum of patients with atopic dermatitis. Total IgE, however, is much frequently higher, even if no allergen-specific IgE antibodies can be detected in serum. OBJECTIVE: The purpose of this study was to evaluate total IgE class, the allergen frequencies and their correlations in MAST-CLA in child and adult atopic dermatitis patients respectively. METHODS: A total of fifty two adult patients and ninety child patients with atopic dermatitis were evaluated by MAST-CLA between march 2002 and march 2005 at Soonchunhyang hospital. Positive rates of specific IgE and the total serum IgE level of the MAST-CLA allergy system were compared between child and adult patients. RESULTS: Among the subjects, 84.5% (80.0% for child patients and 92.3% for adult patients) of patients showed an elevated serum total IgE (more than class level 2) and 54.9% (45.6% for child patients, 71.2% for adult patients) revealed at least more than one allergen-specific IgE by MAST-CLA. The average 3.76 (3.39 for child patients, 4.16 for adult patients) different allergens was simultaneously detected in a single positive serum. Commonly-positive allergen rates, in descending order, were D. farinae 44.4%, D. pteronyssynos 38.7% and house dust 26.8%. Furthermore, the higher total serum IgE level in adult patients, the more probability of allergen-specific IgE positive results being disclosed (p<0.05). The number of allergen-specific IgE positive results was increased in a higher serum total IgE level (p<0.05). But total IgE positive rates which had allergen-specific antibody negative patients was 37.5% (45.8% for child patients, 25.0% for adult patients). Good correlation was obtained between total IgE levels and number of positive allergen-specific IgE in MAST-CLA, with 0.551 correlation coefficiency (p<0.05). CONCLUSION: Our study suggested that the MAST-CLA allergy system is a useful screening test to detect allergen- specific IgE and to evaluate patients with atopic dermatitis. But other allergen screening tests should be used for detecting allergens, when MAST-CLA total IgE class is increased over class 2 with no detectable specific IgE.