Effects of Adding Intravenous Pamidronate to Ongoing Menopausal Hormone Therapy in Postmenopausal Korean Women with Low Bone Mineral Density

OBJECTIVES: We evaluated the effects of adding intravenous pamidronate to ongoing menopausal hormone therapy (MHT) on bone mineral density (BMD) in postmenopausal Korean women with low BMD.METHODS: This retrospective cohort study included 74 postmenopausal women who received MHT for at least 1 year and had a BMD T-score of less than −2.0. Maintaining the same MHT regimen, these women were divided into two groups: oral placebo group (n = 44) and a pamidronate group of patients with gastrointestinal discomfort (n = 30) who received 15–30 mg pamidronate intravenously every 3–12 months. BMD was reviewed at 12-month follow-up. Bone resorption markers in both groups, urinary deoxypyridinoline levels in the placebo group, and serum N-telopeptide of type I collagen in the pamidronate group were assessed at 6 and 12 months.RESULTS: At baseline, the body mass index (BMI), duration of previous MHT, and femur neck (FN) BMD differed between the groups. Within-group analysis revealed that BMD of the lumbar spine (LS) and total hip (TH) significantly increased in the placebo group, whereas those of the LS, FN, and TH increased in the pamidronate group. The increase in BMD of LS was significantly greater in the pamidronate group, after adjusting for BMI and duration of previous MHT (mean change: 3.7% vs. 6.2%; P < 0.001). There were no changes in bone resorption markers in either group.CONCLUSIONS: Adding intravenous pamidronate to ongoing MHT for 12 months might increase LS BMD in postmenopausal Korean women with low BMD.

GnRH Agonist Therapy to Protect Ovarian Function in Young Korean Breast Cancer Patients

The increased survival of patients with breast cancer has given rise to other problems associated with the complications of chemotherapy. One major complication is premature ovarian failure, an especially harmful outcome for women of reproductive age. This study was performed to evaluate the efficacy of GnRH agonist (GnRHa) treatment on protecting ovarian function in young breast cancer patients (30.59+/-5.1 yr) receiving chemotherapy after surgery. Twenty-two women were enrolled and given subcutaneous injections of leuprolide acetate (3.75 mg) every 4 weeks during chemotherapy. Follow-up laboratory tests (luteinizing hormone [LH], follicle stimulating hormone [FSH], and estradiol) were performed 1, 3, and 6 months after chemotherapy. Menstruation patterns and clinical symptoms were followed up for a mean duration of 35.6+/-1.7 months. FSH and LH levels were normal in all patients 6 months after completing chemotherapy (8.0+/-5.3, 4.4+/-2.7 mIU/mL, respectively). During follow-up, none of the patients complained of menopausal symptoms and 81.8% experienced recovery of menstruation. This report is the first trial of GnRHa as a treatment modality to protect ovarian function during adjuvant chemotherapy in young Korean breast cancer patients.

Clinical characteristics of cerebral palsy following preterm or term birth; 10 years' experience / 대한산부인과학회지

OBJECTIVE: To investigate the perinatal and clinical characteristics of cerebral palsy (CP) following preterm or term birth. METHODS: A total of 75 infants born and diagnosed as CP in our hospital from October 1994 to December 2004 were recruited retrospectively. Their maternal and perinatal outcomes and the type, involved lesion and severity of CP were analyzed. RESULTS: The incidence of CP was 0.23%, which showed decreasing pattern according to advancing gestational age at birth. CP was more frequent (6.7-times) in multifetal pregnancy. Male to female ratio was 1.5: 1. After excluding five infants with major congenital anomalies, 55 (79%) infants were born before 37 weeks' gestation (preterm CP) and 15 (21%) infants were born beyond 37 weeks' gestation (term CP). Eighty-six percent of preterm CP had significant neonatal morbidities, but only 6 out of 15 infants in term CP had significant perinatal events including hypoxic ischemic encephalopathy, meconium aspiration syndrome, and seizure of unknown origin. The most common type of preterm CP was spastic (95%), whereas the types of term CP were more diverse; spastic in 67%, athetoid in 20%, dystonic in 7%, and hypotonic in 7%. Regarding the involved lesions, the most common type was diplegic in preterm CP and quadriplegic in term CP. CONCLUSION: In contrast to preterm CP, term CP had significantly less perinatal risk factors, and their type and involved lesion showed more diverse patterns. These findings may implicate that more heterogenous etiologies are involved in pathogenesis of term CP.

Clinical parameters and treatment results in granulosa cell tumor of the ovary / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the patients' characteristics and treatment results for 31 granulosa cell tumors (GCTs) of the ovary. METHODS: We retrospectively reviewed the medical records of 31 patients with GCT who received treatment from January, 1997 to April, 2005. They were grouped into 21 adult types, 4 juvenile types and 6 recurrent GCTs. Clinicopathological characteristics, treatment results and follow-up data were investigated from medical records and/or telephone surveys. RESULTS: In adult types, the median age of patients was 42 years (20 to 81 years). The most common present symptom was vaginal bleeding (10/21, 47.6%). All patients with adult type had FIGO stage I with median follow-up of 32 months (5-103 months). No recurrence developed in this group. In juvenile types, the median age was 8 years (2-14 years). Precocious puberty was presented in 2 of 4 (50%). Three had FIGO stage I and one had FIGO stage IIIa. Two patients were given adjuvant chemotherapy with bleomycin, etoposide, cisplatin (BEP) regimens for six cycles. No recurrence was found during median follow-up of 20.5 months (16-27 months). In recurrent GCTs, cytoreductive surgery and adjuvant chemotherapy were given to 5 patients. One patient, who had a disease with multiple liver and multiple lung metastases, was given palliative chemotherapy. All patients were alive, two were clinically in complete response. CONCLUSION: There was no recurrence in adult types and juvenile types, and no dead of disease in recurrent group. However, because of the propensities of GCT to recur years after initial diagnosis and to grow slowly with indolent course, prolonged surveillance with serial physical examination and imaging studies is reasonable.

The Relationship between Expression of E-Cadherin, Clinical Staging and Differentiation in Squamous Cell Carcinomas of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In recent years, much attention has been directed towards cell adhesion molecules. This study was designed to confirm the significance of E-cadhcrin as a marker for differentiation and invasiveness of squamous cell carcinomas of the head and neck. MATERIALS AND METHODS: Twenty-nine patients with squamous cell carcinoma of the head and neck were used in this study. The specimens of formalin-fixed paraffin-embedded tissues were investigated by immunohistochemical analysis using monoclonal anti-E-cadherin antibody. RESULTS: The results showed that here was a statistically significant correlation in the head and neck squamous cell carcinoma between the T and the N stage and the expression of E-cadherin (p=0.025, p=0.015). The cell differentiation was also correlated with the reduction of E-cadherin (p =0.005). CONCLUSION: E-cadherin may be linked to progression and differentiation of the head and neck squamous cell carcinoma. E-cadherin immunostaining in the primary tumor appear to be a good marker for the invasiveness and the metastasis of tumors.

A Clinical Study of Head and Neck Tumors Involving the Superior Mediastinum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, approaches to the superior mediastinum for head and neck surgeons are mainly limited to stomal recurrence. Recently, the need to approach to the superior mediastinum is increasing due to increasing thyroid surgery by head and neck surgeon. This study was designed to evaluate the approaches to mediastinum in head and neck tumors involving the superior mediastinum and to analyse the outcome of surgery in terms of morbidity and mortality. MATERIALS AND METHODS: At the department of otolaryngology-head and neck surgery of Hallym university, 15 patients who had been diagnosed as head and neck tumors involving the superior mediastinum from May 1990 to August 1998 were evaluated retrospectively. RESULTS: Of the 15 patients, the tumors involving the superior mediastinum were thyroid cancer (5 cases), hypopharyngeal cancer (4 cases), cervical esophageal cancer (2 cases), laryngeal cancer (1 case), and substernal goiter (3 cases). The surgical techniques used for approach to the superior mediastinum were suprasternal approach, clavicle resection, median sternotomy, and sternal manubrium resection. Eight patients are alive without recurrence, one patient is alive with disease, and six patients died, among them, four patients died of postoperative complication and two died of recurrent cancer. CONCLUSION: The mediastinal approach in itself is not complex and dangerous, however, in the treatment of head and neck cancers involving mediastinum, the surgeon should be careful in choosing the surgical method and approach. The surgeion should also take into consideration morbidity and mortality of the surgery, degree of tumor invasion and others, such as age of the patient.

Selection of Olfactory Identification Items for Koreans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The olfactory identification test has been used in clinical assessment of olfactory ability for the following reasons: it is fast, it yields results compatible to a threshold test, and it gives a picture of how well the patient can deal with odors of everyday life. However, items in UPSIT (University of Pennsylvania Smell Identification Test)and CCCRC (Connecticut Chemosensory Clinical Research Center)identification test which are widely used in the world are selected for western people. Accordingly, these items in the tests are not appropriate for Koreans of different cultural background. MATERIALS AND METHODS: For the selection of proper items for the olfactory identification test, 42 natural odors familiar to Koreans were applied to 40 normal subjects and 40 patients with decreased sense of smell without sinonasal diseases. Among 42 items, 16 items with high identifiability and familiarity were chosen according to the results of test-retest in normal subjects. RESULTS: The results of olfactory identification test using 16 selected items showed high correlation with olfactory threshold. CONCLUSION: These 16 items can be used for an olfactory identification test for Koreans.

Anatomical Study of the Artery and the Nerve of the Thyroid Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An awareness of the surgical anatomy and the possible dispositions of the superior, recurrent laryngeal nerve and the thyroid arteries are very helpful in avoiding injury during thyroidectomy. MATERIALS AND METHODS: The relationship of the superior and recurrent laryngeal nerve to the superior and inferior thyroid artery and the incidence of the thyroid ima artery were studied in 43 adult cadavers. RESULTS: The superior thyroid artery (STA) arose commonly from the external carotid artery (59.3%). And the superior laryngeal nerve (SLN) was closely related to the STA. The inferior thyroid artery (ITA) arose commonly from the thyrocervical artery (81.4%) and eight different types of relationship between the ITA and the recurrent laryngeal nerve (RLN) were found. Among them, the most common type was the RLN which passed in front of the ITA (39.5%). And the incidence of the thyroid ima artery was 9.3%. CONCLUSION: The course and anatomic relationship of laryngeal nerve to the thyroid arteries is not constant, therefore careful identification of these structures should be performed during operation to decrease the surgical complications, such as vocal cord paralysis or hemorrhage.