No abstract available.

The authors examined 9 condylomas, 26 cervical intraepithelial neoplasms(CIN) and 22 invasive squamous cell carcinomas for the presence of human papillomavirus(HPV) DNA sequences by DNA-DNA in situ hybridization. In situ hybridization revealed target HPV DNA sequences mostly in the nuclei of the superficial cells from epithelium which contained either maturation or koilocytotic atypias. With the use of biotinylated HPV DNA probes 6/11, 16/18 and 31/33/35, 42 of the 57(73.7%) were positive with HPV-6/11, 23 with HPV-16/18, 32 with HPV-31/33/35 and 18 with two or more mixed probes. HPV-31/33/35 was wht most prevalent in CIN and invasive squamous cell carcinomas, follwed by HPV-16/18. The incidence of HPV DNA increased from 66.7% to 86.4% with increasing severity of the lesions from condylomas to invasive squamous cell carcinomas. Flat condyloma was most freuently accompanied by CIN.
Humans ; Incidence

PURPOSE: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). MATERIALS AND METHODS: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. RESULTS: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). CONCLUSION: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
Academic Medical Centers ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Treatment Outcome

Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

PURPOSE: The objective of the study was to identify preoperative predictive factors of prolonged bladder catheterization after anterior vaginal wall sling operation. MATERIALS AND METHODS: Eighty-seven patients who had undergone vaginal wall sling to treat stress urinary incontinence were reviewed retrospectively. All had got preoperative evaluations that included history, physical examination, voiding cystourethrography and urodynamic study. Voiding difficulty was the main outcome measure. This was determined by the time of suprapubic catheter removal. According to the catheter removal time, we divided the patients into 3 groups: Group A(<10 days), Group B(10-20days), Group C(>20 days). Fourteen parameters of the patients in 3 groups were compared. RESULTS: Median duration of postoperative catheterization was 10 days (range 2 to 50). There was no case of permanent urinary retention. Forty-five patients(52%) were free of catheter within 10 days after operation(Group A). Group B consisted of 24 patients (27%) and group C consisted of 18 patients(21%). There was no significant relationship between preoperative parameters and the duration of catheterization. CONCLUSIONS: We could not find any preoperative predictive factors that prolonged the duration of postoperative catheterization. Risk of prolonged catheterization did not depend on the patients characteristics. Other factors which have not been assessed in this study, such as the amount of tension applied to the sling, should be evaluated as the predictive factors in the further study.
Catheterization ; Catheters ; Humans ; Outcome Assessment (Health Care) ; Physical Examination ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Urodynamics

Pernicious anemia (PA) is an autoimmune disease characterized by atrophic gastritis and deficiency in intrinsic factor leading to impairment of vitamin B12 absorption in the ileum. Anemia is commonly found in rheumatoid arthritis (RA); however, PA is rarely found in RA. There are few reports describing patients with both conditions; none in Korea to date. We report on a case of a 46-year-old female who presented with hypesthesia and general weakness. She was previously diagnosed as seropositive RA with myelodysplastic syndrome. She had severely impaired sensation, especially for vibration and proprioception in all limbs. Subacute combined degeneration was observed on her magnetic resonance imaging and serum vitamin B12 level was very low. Further exam results were consistent with PA and her symptoms improved with cobalamin injection. This case demonstrates that PA should be considered in RA patients presenting with both central nervous system manifestations and anemia.
Absorption ; Anemia ; Anemia, Pernicious* ; Arthritis, Rheumatoid* ; Autoimmune Diseases ; Central Nervous System* ; Extremities ; Female ; Gastritis, Atrophic ; Humans ; Hypesthesia ; Ileum ; Intrinsic Factor ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Myelodysplastic Syndromes ; Proprioception ; Subacute Combined Degeneration ; Vibration ; Vitamin B 12

BACKGROUND: There are cases in which shoulder pain persists long after shoulder joint surgery and this pain can not be reduced by intravenous patient controlled analgesia (IVPCA). Our purpose was to evaluate the effect of stellate ganglion block (SGB) on postoperative shoulder pain and also to investigate the effect of preventive SBG on complex regional pain syndrome (CRPS). METHODS: Forty patients, who were evaluated to ASA class 1 and 2 and who were scheduled for shoulder joint surgery under general anesthesia, were randomly divided into 2 groups. The experimental group of patients (n = 20) received SGB with 0.5% mepivacaine 8 ml after induction of general anesthesia. The control group of patients (n = 20) received only general anesthesia. Their postoperative pain was assessed using the visual analog scale (VAS) at 30 min, 1, 2, 6, 12, 24 and 48 hours postoperatively. Whenever patients wanted supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for supplemental analgesia was recorded. RESULTS: The experimental group of patients had significantly lower pain scores at 30 min, 1, 2 and 6 hours and also significantly lower analgesic requirement at 1, 2 and 6 hours. CONCLUSIONS: We found SGB was effective for controlling postoperative pain after shoulder joint surgery. Also, we could expect that SGB reduced the incidence of CRPS.
Analgesia ; Analgesia, Patient-Controlled ; Anesthesia, General ; Diclofenac ; Humans ; Incidence ; Mepivacaine ; Pain, Postoperative* ; Shoulder Joint* ; Shoulder Pain ; Shoulder* ; Stellate Ganglion* ; Visual Analog Scale

No abstract available.
Holmium* ; Lasers, Solid-State* ; Lithotripsy* ; Ureter* ; Ureteral Calculi*

PURPOSE: The prognosis of stage III non-small cell lung cancer (NSCLC) treated with radiotherapy alone has been disappointing. Combined therapy including chemotherapy and radiotherapy has potential of improving both local and distant metastatic control. Paclitaxel and cisplatin have demonstrated activity as radiation sensitizers. The aim of this study was to evaluate the efficacy of paclitaxel and cisplatin with concurrent radiotherapy for stage III NSCLC. MATERIALS AND METHODS: Between April 2000 and July 2002, twenty-four previously untreated patients with unresectable stage III NSCLC received paclitaxel (60 mg/m2) and cisplatin (20 mg/m2) with concurrent radiotherapy. Chemotherapy was given on the first day of each week during radiotherapy. Concurrent radiotherapy was performed in 1.8 Gy daily fractions to a total dose of 54~59.4 Gy in 6~7 weeks (median: 59.4 Gy). RESULTS: Among 24 evaluable patients, the overall response was 83.3%, with four complete responses and 16 partial responses. Median survival was 16 months, with survival rates of 62.5% at 1 year and 28.7% at 2 years. Serious side effect was generally limited to grade 3 pulmonary toxicity in 37.5% of patients. CONCLUSION: Paclitaxel and cisplatin with concurrent radiotherapy has acceptable response with manageable toxicity in patients with stage III NSCLC. More randomized studies with a larger group of patients are required to improve the true efficacy
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy ; Humans ; Paclitaxel* ; Prognosis ; Radiation-Sensitizing Agents ; Radiotherapy* ; Survival Rate

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate