Predictive Factors for Psychological Distress in Patients with Lung Cancer Who Underwent Video-Assisted Thoracic Surgery Lobectomy

Purpose@#This study sought to identify potential predictors of psychological distress among patients with lung cancer who underwent video-assisted thoracic surgery (VATS) lobectomy. @*Methods@#Seventy patients with lung cancer were recruited. Patients’ data were collected between February and November 2021 using Distress Thermometer (DT) scale and problem lists. Patients were categorized into mild (DT score < 4 points) and moderate/severe (DT score) groups at six months postoperatively. Data analysis was performed with descriptive statistics, χ²-test, independent t-test, and logistic regression. @*Results@#Of the 70 participants, 40 (57.1%) displayed elevated distress, as indicated by DT score of ≥ 4, six months after VATS lobectomy. Depression (p=.008), nervousness (p=.002), sadness (p=.035), getting around (p=.016), and sexual problems (p=.019) were more frequent in the moderate/severe group. However, multivariate logistic regression analysis revealed that age < 65 years (odds ratio (OR)=4.41) and nervousness (OR=5.52) were predictive factors for high postoperative psychological distress. @*Conclusion@#More than half of patients with lung cancer had moderate/severe distress at six months after VATS lobectomy. Further research is needed to reduce symptoms or manifestations of distress such as nervousness in patients undergoing surgery for lung cancer, especially among patients who are under 65 years of age.

Laterality of Skin Temperature Depending on Sensory Symptoms in Patient with Wallenberg Syndrome

Background@#Wallenberg’s syndrome (WS) is caused by dorsal lateral medulla infarction. Clinical symptoms include hoarseness, dysphagia, sensory disturbance, vertigo, ataxia, and Horner’s syndrome. Recently, lateral difference of body surface temperature (BST) has been reported as a symptom of WS, resulting from the disturbances of the sympathetic nerve tract. Although sensory dysfunction is the major symptoms of WS, there is no evidence that BST influences these symptoms. We sought to evaluate the relationship between BST and sensory symptoms in WS using infrared thermography. @*Methods@#Patients with WS within 7 days of symptom onset from June 2018 to December 2020 were enrolled. Infrared thermography was conducted at 7±30 days and 90±30 days after the onset of stroke. Laterality of BST was defined as being positive when macroscopically different and discrepancy >0.5°C in thermography. @*Results@#The final analyses included 12 patients with a mean age of 59.9±11.85 years. Sensory symptoms in nine patients were most often described as numbness (56%), cold (44%), burning (33%), and heaviness (11%). Of these, burning symptoms lasted at 100%, cold 75%, and numbness 50% during 3 months follow-up. All patients with sensory dysfunction showed lateral BST differences. The BST laterality persisted in patients with remaining sensory dysfunction at 3 months follow-up. @*Conclusions@#All patients with sensory dysfunction in WS showed lateral BST differences which was detected with thermography. Laterality of BST and sensory dysfunction in WS might be associated with the disturbance of the connecting pathway of skin blood flow descending from the rostral ventrolateral medulla.

Infiltrative hepatocellular carcinoma with multiple lung metastasis completely cured using nivolumab: a case report

The current Food and Drug Administration-approved systemic treatments for advanced hepatocellular carcinoma (HCC) include multikinase inhibitors (tyrosine kinase inhibitor [TKI]) and immune checkpoint inhibitors (ICIs). Among ICIs, nivolumab is used as secondline therapy for advanced HCC after sorafenib failure or patient intolerance. In this case, a patient with infiltrative HCC and portal vein tumor thrombosis was treated with hepatic arterial infusion chemotherapy (HAIC) and radiation therapy. New lung metastasis developed after HAICs; thus, lenvatinib treatment was initiated. However, the disease progressed. Thereafter, sorafenib treatment was initiated but he developed intolerance, with grade 3 sorafenib-related diarrhea. Subsequently, nivolumab was administered as rescue therapy. He demonstrated a partial response to nivolumab after the third treatment and viable HCCs in the lungs and liver completely disappeared after the 24th treatment. These findings suggest that nivolumab could be used as an effective rescue therapy for advanced HCC progression after TKI treatment.

Laterality of Skin Temperature Depending on Sensory Symptoms in Patient with Wallenberg Syndrome

Background@#Wallenberg’s syndrome (WS) is caused by dorsal lateral medulla infarction. Clinical symptoms include hoarseness, dysphagia, sensory disturbance, vertigo, ataxia, and Horner’s syndrome. Recently, lateral difference of body surface temperature (BST) has been reported as a symptom of WS, resulting from the disturbances of the sympathetic nerve tract. Although sensory dysfunction is the major symptoms of WS, there is no evidence that BST influences these symptoms. We sought to evaluate the relationship between BST and sensory symptoms in WS using infrared thermography. @*Methods@#Patients with WS within 7 days of symptom onset from June 2018 to December 2020 were enrolled. Infrared thermography was conducted at 7±30 days and 90±30 days after the onset of stroke. Laterality of BST was defined as being positive when macroscopically different and discrepancy >0.5°C in thermography. @*Results@#The final analyses included 12 patients with a mean age of 59.9±11.85 years. Sensory symptoms in nine patients were most often described as numbness (56%), cold (44%), burning (33%), and heaviness (11%). Of these, burning symptoms lasted at 100%, cold 75%, and numbness 50% during 3 months follow-up. All patients with sensory dysfunction showed lateral BST differences. The BST laterality persisted in patients with remaining sensory dysfunction at 3 months follow-up. @*Conclusions@#All patients with sensory dysfunction in WS showed lateral BST differences which was detected with thermography. Laterality of BST and sensory dysfunction in WS might be associated with the disturbance of the connecting pathway of skin blood flow descending from the rostral ventrolateral medulla.

Infiltrative hepatocellular carcinoma with multiple lung metastasis completely cured using nivolumab: a case report

The current Food and Drug Administration-approved systemic treatments for advanced hepatocellular carcinoma (HCC) include multikinase inhibitors (tyrosine kinase inhibitor [TKI]) and immune checkpoint inhibitors (ICIs). Among ICIs, nivolumab is used as secondline therapy for advanced HCC after sorafenib failure or patient intolerance. In this case, a patient with infiltrative HCC and portal vein tumor thrombosis was treated with hepatic arterial infusion chemotherapy (HAIC) and radiation therapy. New lung metastasis developed after HAICs; thus, lenvatinib treatment was initiated. However, the disease progressed. Thereafter, sorafenib treatment was initiated but he developed intolerance, with grade 3 sorafenib-related diarrhea. Subsequently, nivolumab was administered as rescue therapy. He demonstrated a partial response to nivolumab after the third treatment and viable HCCs in the lungs and liver completely disappeared after the 24th treatment. These findings suggest that nivolumab could be used as an effective rescue therapy for advanced HCC progression after TKI treatment.

Pancreatic Arteriovenous Malformation Combined with Pseudocysts / 대한췌담도학회지

Pancreatic arteriovenous malformation (PAVM) is very rare anomaly. It occurs most commonly in the pancreatic head portion and gastrointestinal bleeding is the most common symptom. The management of PAVM is rather complex, with complete treatment usually accomplished by a total extirpation of the affected organ or at least its involved portion. We report the clinical presentation and management of 64 year-old male patient with PAVM, which was developed in pancreatic tail portion with sudden abdominal pain. Pancreatic computed tomography and magnetic resonance cholangiopancreatography were consistent with a vascular formation on pancreatic tail portion and simultaneously revealed with pseudocysts beside it. A subsequent superior mesenteric artery angiographic findings depicted PAVM on pancreatic tail portion. The patient underwent laparoscopic distal pancreatectomy and splenectomy and had a favorable outcome.

Skin Temperature Asymmetry in Patient with Lower Lateral Medullary Infarction

No abstract available.

Left hepatic artery pseudoaneurysm caused by acute pancreatitis

Objective: The aim of this work was to report a case of left hepatic artery pseudoaneurysm due to acute pancreatitis following endoscopic papillectomy

Clinical Presentation and Intervention: A 74-year-old female with an ampullary adenoma underwent papillectomy, which was complicated by acute pancreatitis. Computed tomography showed aneurysmal dilatation of the proximal left hepatic artery. An angiography with coli embolization was performed and was successful. The patient was doing well at the 1-year follow-up

Conclusion: This patient with left hepatic artery pseudoaneurysm following severe acute pancreatitis was successfully treated with coil embolization

The Level of Serum Cholesterol is Negatively Associated with Lean Body Mass in Korean non-Diabetic Cancer Patients

Due to poor nutrition and abnormal energy metabolism, cancer patients typically experience the loss of muscle mass. Although the diabetic conditions or dyslipidemia have been reported as a causal link of cancer but the consequence of such conditions in relation to gain or loss of skeletal muscle mass in cancer patients has not been well documented. The purpose of this study was to investigate the relationship of lean body mass and systemic parameters related to lipid metabolism in non-diabetic cancer patients using data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2011. As results the level of serum total cholesterol (total-C) was negatively associated with both total lean body mass and appendicular lean body mass in cancer patients after adjustment for sex, physical activity, energy intake and comorbidity. The associations between consumption of dietary factors (energy, carbohydrate, protein and fat) and lean body mass were disappeared after adjusting comorbidities of cancer patients. Multivariate-adjusted linear regression analysis by quartiles of serum total-C showed that higher quartile group of total-C had significantly lower percent of lean body mass than reference group in cancer patients. The data indicate that serum lipid status can be the potential estimate of loss of skeletal muscle mass in cancer patients and be referenced in nutrition care of cancer patients under the onset of cachexia or parenteral/enteral nutrition. This data need to be confirmed with large pool of subjects and should be specified by stage of cancer or the site of cancer in future studies.

A Case of Ciliated Foregut Cyst of the Gallbladder / 대한소화기학회지

Congenital cysts of the gallbladder are extremely rare, hence only a few ciliated foregut cysts of gallbladder have been reported. We report a case of a 20-year-old woman presenting with mild right upper quadrant abdominal discomfort, with normal levels of serum bilirubin and liver function tests. Abdominal ultrasonography revealed a well-defined cystic mass measured about 2 cm attached to the neck of gallbladder, with internal echogenic debris suggesting a complicated cyst, such as a hemorrhagic cyst. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed similar findings. Laparoscopic cholecystectomy showed a slightly distended gallbladder. The size of cyst on the neck was 1.6x1.2 cm, and it contained mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers. Histopathology identified a ciliated foregut cyst of gallbladder.

Ventricular Septal Rupture in a Case Suspected as Stress Induced Cardiomyopathy

An 87-year-old woman with continuous chest discomfort was referred to our hospital. ST-segment elevation in lead V1-4 was detected on electrocardiography and ventricular septal rupture (VSR) was observed on echocardiography. Post-acute myocardial infarction (AMI) VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography showed normal coronary artery. On the fourth day after admission, the patient died. We suspect that VSR was developed by stress induced cardiomyopathy, not by AMI.

Quantitative determination of 12-hydroxyeicosatetraenoic acids by chiral liquid chromatography tandem mass spectrometry in a murine atopic dermatitis model

Atopic dermatitis, one of the most important skin diseases, is characterized by both skin barrier impairment and immunological abnormalities. Although several studies have demonstrated the significant relationship between atopic dermatitis and immunological abnormalities, the role of hydroxyeicosatetraenoic acids (HETE) in atopic dermatitis remains unknown. To develop chiral methods for characterization of 12-HETE enantiomers in a 1-chloro-2,4-dinitrochlorobenzene (DNCB)-induced atopic dermatitis mouse model and evaluate the effects of 12-HETE on atopic dermatitis, BALB/c mice were treated with either DNCB or acetone/olive oil (AOO) to induce atopic dermatitis, after which 12(R)- and 12(S)-HETEs in the plasma, skin, spleen, and lymph nodes were quantified by chiral liquid chromatography-tandem mass spectrometry. 12(R)- and 12(S)-HETEs in biological samples of DNCB-induced atopic dermatitis mice increased significantly compared with the AOO group, reflecting the involvement of 12(R)- and 12(S)-HETEs in atopic dermatitis. These findings indicate that 12(R)- and 12(S)-HETEs could be a useful guide for understanding the pathogenesis of atopic dermatitis.

A Case of IgG4-Related Pancreas and Kidney Disease Mimicking a Renal Pelvic Malignancy / 대한내과학회지

IgG4-related sclerosing disease is a disease entity that has recently attracted attention, manifesting as a multiorgan disease characterized by high serum IgG4 levels, extensive IgG4-positive plasma cells and lymphocyte infiltration of the affected organs, with the pancreas (autoimmune pancreatitis) and kidney as representative targets. In cases of renal involvement, parenchymal lesions are predominant, such as renal cortical lesions or diffuse renal enlargement. However, mass-like lesions involving the renal pelvis are very rare, and mass forming or pelvic involvement types should be distinguished from lymphomas, metastatic cancers and other genitourinary malignancies to avoid unnecessary surgery. Herein, we report a case of IgG4-related sclerosing disease involving the kidney as an unusual involvement pattern presenting as a mass-like lesion with pelvic and perirenal involvement.

Quality of Life in Children and Adolescents with Cancer

PURPOSE: This study was done to provide basic data for developing nursing interventions to enhance quality of life of pediatric patients with cancer (children and adolescents) by examining the quality of life and related factors. METHODS: Participants were 134; 67 pediatric patients and 67 parents. The PedsQL(TM) 3.0 Cancer Module was employed to measure quality of life in the participants. The related factors included general and clinical characteristics of the participants. RESULTS: Mean score for quality of life in the patients was 75.07, and mean score for patient quality of life as perceived by their parents was 64.40. Among the quality of life subscales, treatment anxiety had the highest score whereas nausea had the lowest score. Mean score in adolescent patients (13-18 years of age) was 71.62, lower than the 78.04 for child patients (8-12 years of age). Regarding general and clinical characteristics of the participants, there were no significant differences in the scores. CONCLUSION: The results indicate that there is difference in perception of quality of life between patients and their parents, and between children and adolescents and these differences should be taken into account when planning and providing nursing care.

The Expression of Corticotropin-Releasing Factor in the Central Nucleus of the Amygdala, Induced by Colorectal Distension, is Attenuated by General Anesthesia

Corticotrophin-releasing factor (CRF), a key regulator of the hypothalamic-pituitary axis, is expressed in the central nucleus of the amygdala (CeA) and its expression is upregulated in stress-related disorders. We investigated here the effect of noxious colorectal distension (CRD) on the expression of CRF in the CeA of conscious and unconscious rats. Adult male rats with or without general anesthesia were exposed to visceral pain induced by CRD for 5 min; this procedure was repeated 3 times with 1 min resting after each distension. The rats were sacrificed and sections of the CeA were immunostained for CRF as an indicator for anxiety response, and for phosphorylated extracellular signal-regulated kinase (p-ERK) as a marker for pain-specific activation of neurons; sections of lumbosacral spinal cord were immunostained for c-Fos as a marker for activation of spinal neurons. CRD elicited a significant increase in the expression of CRF and p-ERK in the CeA and of c-Fos in the spinal cord. General anesthesia attenuated the increase in CRF and p-ERK in the CeA, but did not affect the expression of spinal c-Fos. These results suggest that conscious recognition of pain at higher brain centers is an important determinant of CRF expression in the CeA.

Gestational trophoblastic disease in a patient with twin pregnancy consisting of complete hydatidiform mole and co-existing live fetus after in vitro fertilization / 대한산부인과학회지

A 45-year-old, multigravida woman who had been pregnant with dichorionic twins after in vitro fertilization (IVF) was referred due to early onset of severe preeclampsia. Ultrasonographic findings were multicystic tumor and normal placenta with a live fetus appropriate for 14 weeks of gestation. After therapeutic abortion, the multicystic tumor showed hydropic feature. The fetus had no anomalous finding. Histopathologic analysis revealed complete hydatidiform mole and normal placental tissue attaching three vesseled umbilical cord. Gestational trophoblastic disease (GTD) was diagnosed due to rising levels of serial beta-hCG values and abnormal sonographic findings. The patient treated with combined chemotherapy. We report a case of a complete hydatidiform mole and coexisting normal live fetus after IVF, which was complicated with early onset severe preeclampsia and persistent GTD.

Clinical manifestations and risk factors of severe ovarian hyperstimulation syndrome by IVF-ET / 대한산부인과학회지

OBJECTIVE: The aim of this study is to determine the incidence, clinical predictors, clinical manifestations of severe ovarian hyperstimulation syndrome in a large group. METHODS: A retrospective analysis of all IVF-ET cycles was performed from January 2005 to October 2007. We analysed incidence of severe OHSS and clinical manifestation. We assessed transvaginal number of follicles on hCG, serum estradiol, numbers of oocytes as the predictive factors comparing severe OHSS group and control group. Chi-square test and Student's t-test were used. Pleural effusion group was assessed identically. RESULTS: 6,292 IVF-ET cycles were undertaken in which 133 cycles of severe OHSS was developed (incidence: 2.11%). Patients age, transvaginal number of follicles on hCG, serum estradiol, numbers of oocytes were high in severe OHSS group and lately developed OHSS patients were all pregnant. 43.6% of severe OHSS were diagnosed polycystic ovarian syndrome. Pleural effusion was develop in 28 patients (incidence : 0.45%) and there were no predictive factor of pleural efusion. CONCLUSIONS: The incidence of severe OHSS was 2.11%. The protocol of controlled ovarian hyperstimulation did not affect the incidence of severe OHSS. Transvaginal number of follicles on hCG, serum estradiol, numbers of oocytes, PCOS, pregnancy were meaningful risk factors. There were no predicting factor for the pleural effusion of severe OHSS.

Risk factors for ectopic pregnancy after fresh non-donor in vitro fertilization and embryo transfer / 대한산부인과학회지

OBJECTIVE: To find risk factors for ectopic pregnancy among women who conceived after fresh non-donor in vitro fertilization and embryo transfer (IVF-ET). METHODS: A total of 2,326 cycles conceived after fresh non-donor IVF-ET between January 2002 and December 2005 were studied with regard to patient factors, and factors related to the ART procedures through review of their medical chart. Risk factors in ectopic pregnancy were assessed by using chi-square test and multivariate logistic regression analysis. RESULTS: Of 2,326 pregnancies of fresh non-donor IVF-ET cycles, 135 (5.8%) were ectopic pregnancies. Most of ectopic pregnancies were tubal type (79 cases, 58.5%) and combined type (40 cases, 29.6%). Most of ectopic pregnancies (87.4%) were treated by laparoscopic surgery. In comparison with clinical pregnancy group, estradiol level checked on human chorionic gonadotrophin (hCG) injection day for final follicular maturation and mean number of oocytes retrived were higher in ectopic group. respectively, (2,228.9 vs. 1,906.9 pg/ml, p=0.022; 13.8 vs. 11.6, p=0.001). In univariate analysis, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.20-2.35) and, decreased among women with male factor infertility (OR 0.7, 95% CI 0.47-0.94) and use of intracytoplasmic sperm injection (ICSI) (OR 0.7, 95% CI 0.50-0.98). However, in multivariate logistic regression analysis, only tubal factor was an independent predictor for ectopic pregnancy. CONCLUSIONS: Tubal factor infertility is the main risk factor for ectopic pregnancy following fresh non-donor IVF-ET.

Clinical correlation of basal FSH level and IVF-ET outcome / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the value of basal follicular stimulating hormone level on clinical outcome in women undergoing IVF-ET. METHOD: A descriptive and retrospective study of 730 cycles of IVF-ET chosen from 2002 to 2004 in CHA fertility center. RESULTS: Basal FSH screening appeared to be a fairly informative predictor of achiving pregnancy especially in GnRH agonist long protocol in women undergoing IVF-ET. In addition, basal FSH level shows significant difference compared ongoing pregnancy with early abortion group in GnRH antagonist group. CONCLUSION: Therefore, we were able to predict the ovarian response and IVF-ET outcome using FSH level. Furthermore, this information allow more precise counseling for patients.

Clinical evaluation of ultrasound-guided embryo transfer / 대한산부인과학회지

OBJECTIVE: Clinical evaluation of the efficacy of ultrasound-guided embryo transfer (ET) comparing with embryo transfer without ultrasound guidance (Non-US). METHODS: From January 2003 to April 2003, we examined the efficacy of ultrasound-guided embryo transfer (ET) on clinical outcome from in-vitro fertilization (IVF-ET) cycle. One hundred thirty patients were prospectively randomized into two groups: 69 patients had ultrasound-guided ET (US) and 61 patients had clinical touch embryo transfer without ultrasound guidance (Non-US). RESULTS: There were no statistically significant differences between the two groups with respect to age, cause of infertility, and the characteristics of the IVF cycle. The pregnany rate (42.0%: 40.9%, p=0.9043) and implantation rate (26.6%: 23.1%; p=0.5057) were similar in both groups. CONCLUSION: There was no significant improvement in pregnancy and implantation rates, following the use of ultrasound guidance during ET, but ultrasound assistance would suggest that decrease in cervical and uterine trauma, decrease in the total duration of ET time, and increase in the easy transfer rate can play a positive role in embryo transfer.