Outcome of dose-escalated intensity-modulated radiotherapy for limited disease small cell lung cancer

Purpose@#An optimal once-daily radiotherapy (RT) regimen is under investigation for definitive concurrent chemoradiotherapy (CCRT) in limited disease small cell lung cancer (LD-SCLC). We compared the efficacy and safety of dose escalation with intensity-modulated radiotherapy (IMRT). @*Materials and Methods@#Between January 2016 and March 2021, patients treated with definitive CCRT for LD-SCLC with IMRT were retrospectively reviewed. Patients who received a total dose <50 Gy or those with a history of thoracic RT or surgery were excluded. The patients were divided into two groups (standard and dose-escalated) based on the total biologically effective dose (BED, α/β = 10) of 70 Gy. The chemotherapeutic regimen comprised four cycles of etoposide and cisplatin. @*Results@#One hundred and twenty-two patients were analyzed and the median follow-up was 27.8 months (range, 4.4 to 76.9 months). The median age of the patients was 63 years (range, 35 to 78 years) and the majority had a history of smoking (86.0%). The 1- and 3-year overall survival rates of the escalated dose group were significantly higher than those of the standard group (93.5% and 50.5% vs. 76.7% and 33.3%, respectively; p = 0.008), as were the 1- and 3-year freedom from in-field failure rates (91.4% and 66.5% vs. 73.8% and 46.9%, respectively; p = 0.018). The incidence of grade 2 or higher acute and late pneumonitis was not significantly different between the two groups (p = 0.062, 0.185). @*Conclusion@#Dose-escalated once-daily CCRT with IMRT led to improved locoregional control and survival, with no increase in toxicity.

Clinical Outcome of Stereotactic Body Radiotherapy in Patients with Early-Stage Lung Cancer with Ground-Glass Opacity Predominant Lesions: A Single Institution Experience / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The detection rate of early-stage lung cancer with ground-glass opacity (GGO) has increased, and stereotactic body radiotherapy (SBRT) has been suggested as an alternative to surgery in inoperable patients. However, reports on treatment results are limited. Therefore, we performed a retrospective study to investigate the clinical outcome after SBRT in patients with early-stage lung cancer with GGO-predominant tumor lesions at a single institution. @*Materials and Methods@#This study included 89 patients with 99 lesions who were treated with SBRT for lung cancer with GGO-predominant lesions that had a consolidation-to-tumor ratio of ≤0.5 at Asan Medical Center between July 2016 and July 2021. A median total dose of 56.0 Gy (range, 48.0–60.0) was delivered using 10.0–15.0 Gy per fraction. @*Results@#The overall follow-up period for the study was median 33.0 months (range, 9.9 to 65.9 months). There was 100% local control with no recurrences in any of the 99 treated lesions. Three patients had regional recurrences outside of the radiation field, and three had distant metastasis. The 1-year, 3-year, and 5-year overall survival rates were 100.0%, 91.6%, and 82.8%, respectively. Univariate analysis revealed that advanced age and a low level of diffusing capacity of the lungs for carbon monoxide were significantly associated with overall survival. There were no patients with grade ≥3 toxicity. @*Conclusion@#SBRT is a safe and effective treatment for patients with GGO-predominant lung cancer lesions and is likely to be considered as an alternative to surgery.

Antimicrobial Resistance Patterns of Acinetobacter baumannii and Pseudomonas aeruginosa Isolated From Vulnerable Patients in Korea, 2021 / 대한임상미생물학회지

Background@#We compared the antimicrobial resistance rates (AMRs) of major glucose nonfermenting gram-negative bacilli, Acinetobacter baumannii and Pseudomonas aeruginosa, under different clinical conditions. The purpose of the study was to provide useful background data to set up infection control strategies for infection-vulnerable patients. @*Methods@#The AMRs of blood isolates were compared in various clinical conditions, using data from the Antimicrobial Resistance Surveillance System in Korea. @*Results@#A. baumannii blood isolates from patients with healthcare-associated infections, inpatients, or intensive care unit (ICU)-admitted patients consistently exhibited higher AMRs to most antimicrobials, except minocycline, tigecycline, and colistin, compared with those from patients with community-acquired infections, outpatients, or non-ICU-admitted patients, respectively. P. aeruginosa blood isolates from patients with healthcare-associated infections showed higher AMRs to most antimicrobials, except ceftazidime and aztreonam, compared with those from patients with community-acquired infections, but not compared to those from inpatients or ICU-admitted patients. @*Conclusion@#Higher AMRs were associated with A. baumannii bloodstream infections under various clinical conditions, such as healthcare-associated infections and infections in inpatients and ICU-admitted patients. Considering the high AMRs and the limited number of treatment options of A. baumannii, vigorous efforts should be used to prevent the spreading of A. baumannii infections in patients with vulnerable conditions.

Current Prevalence of the crpP Gene in Carbapenemase-Producing Pseudomonas aeruginosa Blood Isolates in Korea / 대한임상미생물학회지

Background@#Recently, CrpP enzymes have been described as a novel cause of ciprofloxacin resistance. The crpP gene encodes a novel protein that specifically confers resistance to ciprofloxacin through an adenosine triphosphate-dependent mechanism that phosphorylates the antimicrobial. In this study, the current prevalence of the crpP gene in carbapenemaseproducing Pseudomonas aeruginosa blood isolates was evaluated. @*Methods@#During the study of the Antimicrobial Resistance Surveillance System in Korea, 22 blood isolates of carbapenemase-producing P. aeruginosa were collected from nine general hospitals and two nursing homes in the year 2020. Resistance genes and phylogenic trees were analyzed with the whole genome sequencing data. @*Results@#A total of 11 P. aeruginosa blood isolates coharbored the crpP and carbapenemase genes (nine IMP-6 producers and two GES-5-producers). Nine NDM-1-producers coharbored aac(6')-Ib-cr and qnrVC1 . One GES-9-producer also carried aac(6')-Ib-cr, and one NDM-1-producer also carried qnrVC1. The phylogenic tree showed no epidemiologic link among the 22 carbapenemase-producing P. aeruginosa isolates. @*Conclusion@#This is the first report on the current prevalence of the crpP gene in carbapenemaseproducing P. aeruginosa blood isolates in Korea.

Analysis of thromboembolic events in head and neck cancer patients who underwent concurrent chemoradiotherapy with cisplatin

Background/Aims@#The study investigated the incidence of thromboembolic events (TEE) in head and neck (H&N) cancer patients who received concurrent chemoradiotherapy (CCRT) with cisplatin, and analyzed the factors affecting TEE occurrence @*Methods@#Two hundred and fifty-seven patients who started CCRT with cisplatin for H&N cancer from January 2005 to December 2019 were analyzed. @*Results@#TEE occurred in five patients, an incidence rate of 1.9%. The 2-, 4-, and 6-month cumulative incidences of TEE were 0.8%, 1.6%, and 1.9%, respectively. Khorana score was the only factor associated with TEE occurrence (p = 0.010). @*Conclusions@#The incidence of TEE in H&N cancer patients who underwent CCRT with cisplatin was relatively low when compared to other types of cancer. However, patients with a high Khorana score require more careful surveillance for possible TEE occurrence.

Incidence of Adverse Reaction to Transfusion in Pediatric Patients / 대한수혈학회지

Background@#Transfusions in pediatrics need to be performed carefully because of various variables, such as the blood volume and immature immune system. As a result, adverse transfusion reactions may appear differently from adults. This study examined the frequency and types of adverse transfusion reactions in pediatric patients. @*Methods@#From January 2018 to December 2021, this study was conducted on 58 children who requested red blood cells, platelets, and plasma blood components from Chungbuk National University Hospital. The frequency and types of adverse transfusion reactions were analyzed retrospectively by reviewing blood transfusion-related medical records and compared with previous studies. @*Results@#Approximately 0.9% of total blood components were transfused into pediatric patients; 1,179 units of blood components were transfused. The number of transfusions for red blood cells, platelets, and plasma was 383, 712, and 84 units, respectively. Among 58 patients, 23 adverse transfusion reactions were observed in 15 (25.9%) patients. Of these, 18 were febrile nonhemolytic transfusion reactions, and five were allergic transfusion reactions. Febrile nonhemolytic transfusion reactions occurred in 66.7% of cases with red blood cells, and allergic transfusion reactions occurred with platelets in 60% of cases. @*Conclusion@#This paper reported the incidence and types of adverse transfusion reactions in pediatric patients. This is expected to be more frequent in pediatric patients than adults, but most of them were relieved by supportive treatment because the symptoms were mild. As the awareness of hemovigilance is still low, it is essential to recognize and deal with adverse transfusion reactions through continuous education.

Multi-Institute, Single Group, Prospective Observational Study to Evaluate the Efficacy of Mucomyst® in Relieving Symptoms of Globus Pharyngeus Refractory to Proton Pump Inhibitor

Background and Objectives@#Globus pharyngeus is one of the most common symptoms of patients visiting otorhinolaryngology out-patient clinic, and usually long-lasting, difficult to treat, and frequently recurrent. Mucomyst®, N-acetyl cysteine is an inhalation agent mainly used for mucolysis and reducing inflammation in airway via antioxidative effect. The purpose of this study was to evaluate the efficacy of inhaled Mucomyst® treatment in patients with globus pharyngeus refractory to proton pump inhibitor (PPI).Materials and Method We prospectively evaluated the efficacy of Mucomyst® in relieving symptoms of globus pharyngeus refractory to PPI in nine medical centers. Three hundred and three patients enrolled and finally 229 patients finished the inhaled Mucomyst® therapy for 8 weeks. We analyzed the change of Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Visual Analogue Scale (VAS) for globus, and Globus Pharyngeus Symptom Scale (GPS) after use of Mucomyst® for 4 and 8 weeks. @*Results@#The GPS, RSI, RFS, and VAS score significantly decreased serially in patients who finished 8 week-inhalation treatment. The GPS improvement gap was significantly correlated with initial GPS (p<0.001) in multiple regression analysis. @*Conclusion@#Inhaled Mucomyst® therapy was effective for the reduction of both subjective and objective findings in refractory globus patients. This study might suggest new treatment option for patients with globus. However, further thorough studies would be needed to assess the real effect of inhaled Mucomyst® treatment as a standard treatment for globus.

Association Between Clinical Burden and Blood Eosinophil Counts in Asthma: Findings From a Korean Adult Asthma Cohort

Background@#Some reports have suggested that the clinical and economic burdens of asthma are associated with blood eosinophil levels. The association between clinical burden and blood eosinophil counts were evaluated in a Korean adult asthma cohort. @*Methods@#Clinical information including blood eosinophil counts that were not affected by systemic corticosteroids were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea database. Clinical burden was defined as 1) asthma control status, 2) medication demand and 3) acute exacerbation (AE) events during 1 consecutive year after enrollment. All patients were divided into atopic and non-atopic asthmatics. The associations between asthma outcomes and the blood eosinophil count were evaluated. @*Results@#In total, 302 patients (124 atopic and 178 non-atopic asthmatics) were enrolled. In all asthmatics, the risk of severe AE was higher in patients with blood eosinophil levels < 100 cells/µL than in patients with levels ≥ 100 cells/µL (odds ratio [OR], 5.406; 95% confidence interval [CI], 1.266–23.078; adjusted P = 0.023). Among atopic asthmatics, the risk of moderate AE was higher in patients with blood eosinophil levels ≥ 300 cells/µL than in patients with levels < 300 cells/µL (OR, 3.558; 95% CI, 1.083–11.686; adjusted P = 0.036). Among non-atopic asthmatics, the risk of medication of Global Initiative for Asthma (GINA) steps 4 or 5 was higher in patients with high blood eosinophil levels than in patients with low blood eosinophil levels at cutoffs of 100, 200, 300, 400, and 500 cells/µL. @*Conclusion@#The baseline blood eosinophil count may predict the future clinical burden of asthma.

The Prevalence of Lower Urinary Tract Symptoms and Overactive Bladder in South Korea: A Cross-Sectional, Population-Based Study / 대한배뇨장애요실금학회지

Purpose@#Lower urinary tract symptoms (LUTS) affect over half of the adults’ population worldwide, with an increasing prevalence among the older age groups. Therefore, with the increasing elderly population, LUTS is an important disease, highlighting the need for accurate data on its prevalence. This present study aimed to investigate the prevalence of LUTS in South Korea. @*Methods@#The study targeted individuals aged at least 19 years nationwide. We conducted computer-assisted telephone interviews, 80% mobile random digital dialing (RDD) sampling frame, and 20% landline RDD sampling frame between April and May 2020. Questionnaires included The International Prostate Symptom Score (IPSS), the overactive bladder symptom score (OABSS), and the characteristics of respondents. Current International Continence Society definitions were used for individual LUTS and OAB. @*Results@#There were 2,000 respondents, 1,009 (50.4%) were women and 546 (27.3%) were aged ≥60 years. Based on our IPSS questionnaire survey results, 77.9% of the respondents had LUTS; 63.7% had mild symptoms (1–7), 11.7% had moderate symptoms (8–19), and 2.4% had severe symptoms (20–35). The prevalence and severity of LUTS increased with age with 22.1% of respondents aged 60 years and above complaining of moderate or severe LUTS. According to the survey through OABSS, the prevalence of OAB was 9.6%, males were 10.3% and females were 9.0%. @*Conclusions@#Based on our survey results, 77.9% of the Korean adult population (over the age of 19) experienced at least one LUTS, and the severity increased with age. The prevalence and severity of OAB increased with age, especially after 40 years; the prevalence of OAB was 9.6%, and 13.4% of them were over 60 years old.

Clinical utility of chromosomal microarray analysis to detect copy number variants: Experience in a single tertiary hospital

Purpose@#To summarize the results of chromosomal microarray analysis (CMA) for copy number variants (CNVs) detection and clinical utility in a single tertiary hospital. @*Materials and Methods@#We performed CMA in 46 patients over the course of two years. Detected CNVs were classified into five categories according to the American College of Medical Genetics and Genomics guidelines and correlated with clinical manifestations. @*Results@#A total of 31 CNVs were detected in 19 patients, with a median CNV number per patient of two CNVs. Among these, 16 CNVs were classified as pathogenic (n=3) or likely pathogenic (LP) (n=11) or variant of uncertain significance (n=4). The 16p11.2 deletion and 16p13.11 deletion classified as LP were most often detected in 6.5% (3/46), retrospectively. CMA diagnostic yield was 24.3% (9/37 patients) for symptomatic patients. The CNVs results of the commercial newborn screening test using next generation sequencing platforms showed high concordance with CMA results. @*Conclusion@#CMA seems useful as a first-tier test for developmental delay with or without congenital anomalies. However, the classification and interpretation of CMA still remained a challenge. Further research is needed for evidence-based interpretation.

Correlation Between Testosterone Replacement Treatment and Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are frequent in elderly men and it considered the ultimate clinical symptoms of benign prostatic hyperplasia. With aging, male hypogonadism is increased which is defined as decreased ability of the testes to produce sperm and sex steroids because of a pituitary/hypothalamic, or testicular deficiency. In academic andrology associations, the term “male hypogonadism” is commonly used to categorize testosterone deficiency. Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue. Although the mechanism about testosterone-replacement therapy (TRT) effects on men with hypogonadism is not yet identified, TRT has been shown to effectively relieve the symptoms of TDS as well as LUTS by several studies. Although the present review demonstrates the effectiveness and safety of TRT in men with TDS by prior studies, future large scale of clinical trials should be conducted to present more high-quality evidence to clinicians and patients.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Objectives@#. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). @*Methods@#. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. @*Results@#. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). @*Conclusion@#. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Reliability and validity of Korean version of the OHIP for edentulous subjects: A pilot study / 대한치과보철학회지

Purpose@#The purpose of this pilot study is to evaluate the reliability and validity of the Korean version of the oral health impact profile (OHIP-EDENT K) for edentulous patients. @*Materials and Methods@#The study was conducted on 12 patients who fabricated overdenture in the Department of Prosthodontics, Korea University, Guro Hospital. All subjects completed the Korean version of Oral Health Impact Profile (OHIP K) questionnaire. Shorten version of the OHIP called OHIP-14 K and OHIP-EDENT K were derived from the datasets. Cronbach's alpha was used to measure internal consistency of the summary scores for OHIP-EDENT K. The Spearman's correlation coefficient between the summary scores for OHIP-EDENT K and OHIP K was calculated to evaluate concurrent validity. @*Results@#The reliability of the summary scores for OHIP-EDENT K was acceptable (α=.736). The Spearman's correlation coefficient of the summary scores for OHIP-EDENT K and OHIP K was 0.966, which was statistically significant (P<.001). OHIP-EDENT K exhibited less susceptibility to floor effects than OHIP-14 K and appeared to measure change as effectively as OHIP K. In order to prove the reliability, responsiveness and validity of OHIP-EDENT K, further studies with more samples are needed. @*Conclusion@#The OHIP-EDENT K, a questionnaire on oral health-related QOL comprising 19 items, has measurement properties comparable with the full 49-item version. This modified shortened version can be an alternative questionnaire to full version of OHIP K and OHIP-14 K in edentulous patients.

Transfusion Dependency in Patients with Acute Myeloid Leukemia during Induction Chemotherapy / 대한수혈학회지

Background@#Blood transfusion is frequently performed as a supportive therapy during the diagnosis and chemotherapy of acute myeloid leukemia (AML). This study examined the frequency of blood transfusion and analyzed the correlation with the treatment response during induction therapy in patients with AML. @*Methods@#From January 2018 to December 2020, blood transfusion information was collected from 23 patients diagnosed with AML during induction therapy. The frequency and volumes of blood transfusions according to the treatment response were collected and analyzed with the overall survival retrospectively. @*Results@#The blood transfusion was performed in all patients with AML during induction therapy. The transfusion frequency and volumes were a median of five (1∼13) times and nine (2∼27) units for red blood cells, respectively.In the platelets, the median frequency was seven (2∼21) times, and the transfusion volumes were 42 (12∼128) units. At the time of the treatment response evaluation, the transfusion dependence was 0% in morphological complete remission and 20% in the morphological leukemic-free state for both RBC and platelets, and 78% for RBC and 67% for platelets in treatment failure. Although not statistically significant, transfusion independence for more than eight weeks after induction therapy showed a better overall survival (P=0.312). @*Conclusion@#When the treatment response was good, the dependence on blood transfusion decreased. The transfusion frequency is expected to help predict the patient's treatment response and prognosis along with the peripheral blood counts.

Clinical utility of chromosomal microarray analysis to detect copy number variants: Experience in a single tertiary hospital

Purpose@#To summarize the results of chromosomal microarray analysis (CMA) for copy number variants (CNVs) detection and clinical utility in a single tertiary hospital. @*Materials and Methods@#We performed CMA in 46 patients over the course of two years. Detected CNVs were classified into five categories according to the American College of Medical Genetics and Genomics guidelines and correlated with clinical manifestations. @*Results@#A total of 31 CNVs were detected in 19 patients, with a median CNV number per patient of two CNVs. Among these, 16 CNVs were classified as pathogenic (n=3) or likely pathogenic (LP) (n=11) or variant of uncertain significance (n=4). The 16p11.2 deletion and 16p13.11 deletion classified as LP were most often detected in 6.5% (3/46), retrospectively. CMA diagnostic yield was 24.3% (9/37 patients) for symptomatic patients. The CNVs results of the commercial newborn screening test using next generation sequencing platforms showed high concordance with CMA results. @*Conclusion@#CMA seems useful as a first-tier test for developmental delay with or without congenital anomalies. However, the classification and interpretation of CMA still remained a challenge. Further research is needed for evidence-based interpretation.

Correlation Between Testosterone Replacement Treatment and Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are frequent in elderly men and it considered the ultimate clinical symptoms of benign prostatic hyperplasia. With aging, male hypogonadism is increased which is defined as decreased ability of the testes to produce sperm and sex steroids because of a pituitary/hypothalamic, or testicular deficiency. In academic andrology associations, the term “male hypogonadism” is commonly used to categorize testosterone deficiency. Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue. Although the mechanism about testosterone-replacement therapy (TRT) effects on men with hypogonadism is not yet identified, TRT has been shown to effectively relieve the symptoms of TDS as well as LUTS by several studies. Although the present review demonstrates the effectiveness and safety of TRT in men with TDS by prior studies, future large scale of clinical trials should be conducted to present more high-quality evidence to clinicians and patients.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-Institutional Analysis of 1,033 Cases

Objectives@#. Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). @*Methods@#. We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. @*Results@#. Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). @*Conclusion@#. A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Parachute Technique for Head and Neck Free-Flap Inset / 대한이비인후과학회지

The treatment outcome of advanced squamous cell carcinoma involving the head and neck is well known to be dire and usually needs multimodality treatment even including optimal reconstruction after ablative surgery. When a significant area of the soft tissue is resected, reconstruction of oral cavity or pharynx needs to minimize morbidities while achieving adequate functional outcomes. For the better functional outcome, invasive approaching procedures such as lip and jaw splitting, or extensive floor of mouth or pharyngeal muscle ablation should be avoided. Without these surgical procedures, reconstructive surgeons may encounter technical difficulties in flap inset due to deep and narrow space after head and neck cancer resection. In a deep and narrow surgical defect, accurate approximation and suture is extremely difficult. Eventually, repeated flap manipulation and stretch might be inevitable, and even pedicle kinking or injury could happen. Herein, we suggested the “parachute” technique, which was generally used in blood vessels or aortic valve suturing in a narrow surgical field and for avoiding mismatched suture. We applied this “parachute” technique for free-flap inset to head and neck defect, and we herein report our successful outcomes.

A Case of Transient Neonatal Diabetes Mellitus Attributable to a Nonspecific Mutation in the ABCC8 Gene

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia that persists for more than 2 weeks and requires insulin therapy. NDM principally occurs before 6 months of age. Transient NDM (TNDM) is a clinical form of NDM that persists for a median of 12 weeks and resolves completely by 18 months. However, it may relapse as type 2 DM during early adulthood. The major causes of TNDM are mutations in chromosome 6q24 or the KCNJ11 or ABCC8 genes; the latter encode the two subunits of the pancreatic adenosine triphosphate (ATP)-sensitive potassium channel (KATP-channel). This condition responds well to oral sulfonylurea therapy. Herein, we report a neonate who was small for gestational age and exhibited TNDM symptoms. Genetic analysis revealed a nonspecific mutation in ABCC8; he was successfully treated with oral sulfonylurea.

A Study on the Clinicopathological Characteristics Associated with Cervical Lymph Mode Metastasis and Extra-nodal Extension in Patients with Oral Cancer / 대한두경부종양학회지

Background/Objectives@#Extra-nodal extension (ENE) is one of the strongest prognosticators in oral cancers. Here we tried to evaluate clinicopathological factors associated with the presence of ENE.Materials & Methods: We retrospectively analyzed clinical information of 120 patients who diagnosed with oral cancer and received curative surgery at our hospital from Mar 2012 to Apr 2020. We comparatively analyzed clinicopathological factors associated with the presence of lymph node (LN) metastasis and ENE, respectively. @*Results@#Variable factors of primary tumor characteristics such as lymphovascular invasion, perineural invasion, largest diameter of tumor, depth of invasion and maximum standardized uptake value were significantly associated with the presence of cervical LN metastasis. The largest diameter of tumor was statistically significant also in multivariate analysis for predicting the LN metastasis. Meanwhile, the association between primary tumor characteristics and the presence of ENE were not statistically significant except the primary tumor size. Importantly, factors associated with LN characteristics including the maximum diameter and number of metastatic LNs were significantly associated with ENE. @*Conclusion@#In this study, several factors affecting cervical LN metastasis and ENE in oral cancer patients were identified. The ENE seems to be influenced by the status of the metastatic LNs, such as the number of metastatic LNs, rather than the characteristics of the primary tumor itself.