PURPOSE: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. MATERIALS AND METHOD: We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wall invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included squamous (24), adenocarcinoma (6) and unclassified squamous cell (2). The clinical stages of the patients were T1 in 5, T2 in 25, T3 in 2 patients. Initial tumor size was < or =3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. All patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 48.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. RESULTS: The overall survival rate was 44.6% at 2 years and 24.5% at 5 years, with the median survival time of 23 months. Of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0% at 2 years and 33.5% at 5 years. The disease-free survival rate was 38.9% at 2 years and 28.3 % at 5 years. The local-relapse-free survival rate was 35.1%, 28.1%, respectively. On univariate analysis, tumor size was significant variable of overall survival ( p=0.0015, 95% C.I.; 1.4814-5.2815), disease-free survival ( p=0.0022, 95% C.I.; 1.4707-5.7780) and local-relapse-free survival ( p=0.0048, 95% C.I.; 1.2910- 4.1197). T stage was significant variable of overall survival ( p=0.0395, 95% C.I.; 1.1084-65.9112) and had borderline significance on disease-free survival ( p=0.0649, 95% C.I.; 0.8888-50.7123) and local-relapse-free survival ( p= 0.0582, 95% C.I.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival ( p=0.6919, 955 C.I.; 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95% C.I.; 0.9720- 4.9657). Tumor size was also significant variable of disease-free survival ( p=0.0317, 95% C.I.; 1.1028-8.4968). CONCLUSION: Radical radiotherapy is an effective treatment for small (T1 or < or =3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hyperfractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.
Abdomen ; Adenocarcinoma ; Aged ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Disease-Free Survival ; Disulfiram ; Drug Therapy ; Follow-Up Studies ; Heart ; Humans ; Lung ; Lung Neoplasms ; Medical Records ; Multivariate Analysis ; Particle Accelerators ; Radiotherapy* ; Survival Rate ; Survivors ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

A 70 years old female patient with thyroid cancer received palliative radiation therapy for neck swelling and hemoptysis. She had a cardiac pacemaker under her chest due to complete AV block since 8 years ago. We present clinical detail and review previously reported articles.
Aged ; Atrioventricular Block ; Female ; Hemoptysis ; Humans ; Neck ; Radiotherapy* ; Thorax ; Thyroid Neoplasms

PURPOSE: This study was conducted to evaluate differences in pain, pain interference, and fatigue, according to the level of physical activity in the elderly with chronic pain. METHODS: Data were collected between January and March 2011 from 116 elders with chronic pain living in community settings. The data were analyzed using the SPSS/WIN 17.0 program for descriptive statistics, 2 test, t-test, ANOVA and ANCOVA. The reliability of the instruments was tested with Cronbach's alpha coefficient, which ranged from .91 to .93. RESULTS: The results were as follows. The mean total physical activity was 2287.4 MET-min/week, and 41.4% of the investigated subjects were classified into the low physical activity group. After adjusting for age and sex, the moderate and high physical activity groups were significantly lower in pain (F=6.33, p=.002), pain interference (F=11.57, p<.001), and fatigue (F=3.16, p=.046) than the low physical activity group. CONCLUSION: Results from this study suggest that the level of physical activity can influence pain, pain interference and fatigue. Therefore, incorporating more physical activities into daily routines, inactive elderly individuals may improve their pain, pain interference and fatigue.
Aged* ; Chronic Pain* ; Fatigue* ; Humans ; Motor Activity*

BACKGROUND: This study was performed to develop a dietary self-efficacy questionnaire and to determine how dietary self-efficacy is related to selected biochemical markers and health-related quality of life in hemodialysis patients. METHODS: Participants included 172 patients who had been participating in a dialysis program for at least 6 months at two teaching hospitals. A questionnaire was used to assess socio-demographic factors, dialysis-related factors, dietary self-efficacy, and kidney disease quality of life (KDQOL). Serum levels of potassium and phosphorus and interdialytic weight gain were also measured. RESULTS: The internal reliability of dietary self-efficacy was 0.944 (Cronbach's alpha). Principal component analysis resulted in two factors, situational self-efficacy of compliance with dietary guidelines and self-efficacy of food choice. The correlation analysis showed a significant association between situational self-efficacy of compliance with dietary guidelines and serum potassium and KIDQOL. The average scores of situational self-efficacy of compliance with dietary guidelines and self-efficacy of food choice in the participants were 3.52+/-0.72 and 3.61+/-0.71 respectively. Multiple linear regression analysis showed that the situational self-efficacy of compliance with dietary guidelines was significantly associated with serum potassium level and KDQOL and self-efficacy of food choice was significantly associated with KDQOL. CONCLUSIONS: Based on our results, the developed dietary self-efficacy questionnaire may be a suitable survey tool for hemodialysis patients, which can play a role in predicting clinical indicators of patient and health-related quality of life. We recommend further research into clarifying whether the positive effects of increased dietary self-efficacy is maintained in long-term dialysis patients.
Biomarkers ; Compliance ; Dialysis ; Diet ; Hospitals, Teaching ; Humans ; Kidney Diseases ; Linear Models ; Phosphorus ; Potassium ; Principal Component Analysis ; Quality of Life ; Renal Dialysis ; Self Efficacy ; Weight Gain

Heat shock protein of 72 kDa (HSP70) has a role in the functional modulation of sex steroid hormone receptors and in p53-associated oncogenesis and inhibits apoptosis associated with bcl-2. However, the exact role of HSP70 in the development of endometrial adenocarcinoma has not been well established. The aim of this study is to evaluate the role of HSP70 in relation with ER, PR, p53 and bcl-2 expressions and apoptosis in benign and malignant endometrial lesions. Immunohistochemical studies for HSP70, ER, PR, p53, bcl-2 and TUNEL method for apoptosis were performed in 30 cases of adenocarcinoma and 30 cases of benign endometrial lesions consisted of each 10 cases of disordered proliferative endometrium (DP), simple or complex hyperplasia (HP), and atypical hyperplasia (AH). There were no significant differences of HSP70 and bcl-2 expression rates and apoptotic index (AI) between DP, HP, AH, and adenocarcinoma. p53 expression rate in adenocarcinoma was 36.7%, but no p53 expression was identified in DP, HP and AH (p<0.05). In adenocarcinoma, HSP70 expression rate was higher in ER and PR negative adenocarcinoma (p<0.05), and p53 expression rate was higher in nonendometrioid type and FIGO grade II and III (p<0.05), but no significant difference of bcl-2 expression rate according to the histological type and FIGO grade. AI was higher in nonendometrioid type (p<0.05). There was no correlation between HSP70, p53 and bcl-2 expressions, and no significant difference of AI according to HSP70, ER, PR, p53, and bcl-2 expressions. In conclusion, higher HSP70 expression rate in poorly differentiated and ER and PR negative adenocarcinoma suggests that HSP70 inhibits ER and PR expression and may be involved in the development of poorly differentiated endometrial adenocarcinoma.
Adenocarcinoma* ; Apoptosis* ; Carcinogenesis ; Endometrium ; Female ; Heat-Shock Proteins ; Hyperplasia ; In Situ Nick-End Labeling

BACKGROUND: Discrepancies exist in the existing researches regarding the association between social capital and self-efficacy, and most of these researches have been done in developed countries. The aims of this study were to assess the independent association between individual social capital and self-efficacy and to assess the associations between individual social capital, self-efficacy and self-rated health. METHODS: Data were obtained from the Gyeongnam health survey (6,500 persons) conducted in 2008. A self-administered questionnaire was additionally administered to gather information on demographic variables, health behaviors, chronic diseases, self-efficacy, social capital, and self-rated health status. Total study population was 3,843 as those with chronic diseases were excluded. RESULTS: In males, trust was positively associated with confidence and preference to task difficulty, and participation was negatively associated with confidence and positively associated with regulation and preference to task difficulty. In females, trust was positively associated with confidence and preference to task difficulty and negatively associated with regulation. Participation was positively associated with preference to task difficulty. In males, the odds for self-rated health status was better for persons with confidence (95% confidence interval, CI 1.088-1.705), trust (95% CI 1.172-1.821) and participation (95% CI 1.268-2.117). In females, the odds for self-rated health status was better for those with confidence (95% CI 1.250-1.803), preference of task difficulty (95% CI 1.019-1.683) and participation (95% CI 1.024-1.555). CONCLUSIONS: High social capital measured at an individual level may promote self-efficacy and health status.
Chronic Disease ; Developed Countries ; Female ; Health Behavior ; Health Surveys ; Humans ; Male ; Self Efficacy ; Surveys and Questionnaires

Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.
Acetabulum* ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteolysis ; Polyethylene ; Transplants

Subjective life expectancy (SLE) is the predictive value of actual life expectancy. SLE has been notably associated with mortality. The 2006 Korean Longitudinal Study of Aging (KLoSA) representative sample of 10,254 Koreans aged over 45 years to assess the associations between factors of SLE. Descriptive analysis, correlations, and age-adjusted regression analyses were used to examine the relationship between SLE and demographic, socioeconomic, and health factors. We also linked the 2018 KLoSA death statistics to the 2006 data to evaluate the association between actuarial life expectancy and SLE. We found that chronic illnesses and limitations in activities of daily living affect the life expectancy of individuals. Marriage, gainful employment, and high educational qualifications increase life expectancy. People who exercise expect to live longer, while those who smoke and drink expect to live somewhat shorter lives. Better self-rated health is associated with higher SLE. People who own a house expect to live longer than non-owners, and individuals living in metropolitan cities and urban areas assume a longer life expectancy than those living in rural areas. Participants who died between 2006 and 2018 had previously predicted a lower life expectancy than those who survived until 2018. The results of the study suggest that current health status, health behaviors, socioeconomic status, and actual life expectancy showed significant associations with SLE in the expected directions. These findings imply that we could use SLE as a database of health status, health behavior, and actual life expectancy. This information could help us intervene and improve policies related to SLE.

Uterine papillary serous carcinoma (UPSC) behave more aggressively than other endometrial carcinomas and have a propensity for intraabdominal spread, simulating the behavior of ovarian carcinoma. Because of high relapsing rate, and high mortality rate of UPSC, many gynecologist studied about its treatment regimen and recommended many treatment method. Many investigators recommended that patients with UPSC should undergo a staging laparotomy and they suggested the surgery should include at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic lymphadenectomy, paraaortic lymphadenectomy, peritoneal washing and peritoneal cytology, By and large, adjuvant systemic Platinum based chemotherapy or, paclitaxel based chemotherapy and adjuvant whole abdominal irradiation or pelvic irradiation was prescribed. We experienced two cases of the UPSC stage IIIc and stage IV diagnosed after explolaparotomy. We present these cases and review the literatures about the optimal treatment regimen of UPSC.
Drug Therapy ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Laparotomy ; Lymph Node Excision ; Mortality ; Paclitaxel ; Platinum ; Research Personnel

Ultrasonographic Doppler techniques have improved greatly over the years, allowing more sophisticated evaluation of breast tumor vascularity. Superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) with second-generation contrast agents are two representative up-to-date techniques. SMI is a sensitive Doppler technique that adopts an intelligent filter system to separate low-flow signals from artifacts. With the development of second-generation contrast agents, CEUS has also emerged as a useful Doppler technique for evaluating tumor microcirculation. Both techniques can improve the diagnostic performance of gray-scale ultrasonography by providing vascular information useful not only for the morphologic assessment of microvessels, but also for the quantitative analysis of perfusion. In this review, we explain the imaging principles and previous research underlying these two vascular techniques, and describe our clinical experiences.
Artifacts ; Breast Neoplasms* ; Breast* ; Contrast Media ; Microcirculation ; Microvessels ; Perfusion ; Ultrasonography* ; Ultrasonography, Doppler