Purpose: Despite curative resection, the 5-year survival for patients with resectable pancreatic cancer is less than 20%. Recurrence occurs both locally and at distant sites and effective multimodality adjuvant treatment is needed. Materials and Methods: Patients with curatively resected stage IB-IIB pancreatic adenocarcinoma were eligible. Treatment consisted of chemotherapy with gemcitabine 1,000 mg/m2 on days 1 and 8 and cisplatin 60 mg/m2 on day 1 every 3 weeks for two cycles, followed by chemoradiotherapy (50.4 Gy/28 fx) with weekly gemcitabine (300 mg/m2/wk), and then gemcitabine 1,000 mg/m2 on days 1 and 8 every 3 weeks for four cycles. The primary endpoint was 1-year disease-free survival rate. The secondary endpoints were disease-free survival, overall survival, and safety. Results: Seventy-four patients were enrolled. One-year disease-free survival rate was 57.9%. Median disease-free and overall survival were 15.0 months (95% confidence interval [CI], 11.6 to 18.4) and 33.0 months (95% CI, 21.8 to 44.2), respectively. At the median follow-up of 32 months, 57 patients (77.0%) had recurrence including 11 patients whose recurrence was during the adjuvant treatment. Most of the recurrences were systemic (52 patients). Stage at the time of diagnosis (70.0% in IIA, 51.2% in IIB, p=0.006) were significantly related with 1-year disease-free survival rate. Toxicities were generally tolerable, with 53 events of grade 3 or 4 hematologic toxicity and four patients with febrile neutropenia. Conclusion Adjuvant gemcitabine and cisplatin chemotherapy followed by chemoradiotherapy with gemcitabine and maintenance gemcitabine showed efficacy and good tolerability in curatively resected pancreatic cancer.

PURPOSE: The optimal treatment strategy for locally advanced pancreatic cancer (LAPC), particularly the role of concurrent chemoradiotherapy (CCRT), remains debatable. We compared the clinical outcomes of CCRT and palliative chemotherapy alone (CA) in patients with unresectable LAPC. MATERIALS AND METHODS: Patients with LAPC who were consecutively treated between 2003 and 2010 were included. Resectability was evaluated according to National Comprehensive Cancer Network ver. 1.2012. The clinical outcomes for each treatment group (CCRT vs. CA) were evaluated retrospectively. RESULTS: Sixty-three patients (58.9%) and 44 patients (41.1%) were treated with CCRT and CA, respectively. The CCRT cohort included patients who were treated with CCRT with or without chemotherapy backbone (CCRT alone, induction chemotherapy-CCRT, CCRT-maintenance chemotherapy, and induction-CCRT-maintenance chemotherapy). Median progression-free survival (PFS) and overall survival (OS) of all patients were 7.2 months and 13.1 months. PFS of the CCRT and CA groups was 9.0 months and 4.4 months, respectively (p=0.020). OS of the CCRT and CA groups was 15.4 months and 9.3 months, respectively (p=0.011). In multivariate analysis, the adjusted hazard ratio of CCRT was 0.536 (p=0.003) for OS and 0.667 (p=0.078) for PFS. Although the pattern of failure was similar in the CCRT and CA groups, the times to both local and distant failure were significantly longer in the CCRT group. CONCLUSION: In patients with unresectable LAPC, those who underwent CCRT during their entire treatment courses had longer OS than patients treated with chemotherapy alone.
Chemoradiotherapy* ; Cohort Studies* ; Disease-Free Survival ; Drug Therapy* ; Humans ; Multivariate Analysis ; Pancreatic Neoplasms* ; Prognosis ; Retrospective Studies*

OBJECTIVES: To understand the risk factors of demographic data in geriatric depression scale, and suicidality among in elderly who live alone at one urban region. METHODS: In 2009, 589 elderly who live alone(age> or =65) were carried out a survey about several socio-demographic data, Korean version of the Geriatric Depression Scale(SGDS-K) and Suicidal Ideation Questionnaire (SIQ). Statistical analysis was performed for the collected data. RESULTS: Mean age of elderly who live alone is 75.69(SD 6.17). 40.1% of participants uneducated, 31.4% graduate from elementary school, 12.9% graduate from high school, 11.7% graduate from middle school, 3.2% graduate from university. Religionless, having past history of depression or physical diseases, low subjective satisfaction of family situation, and not having any social group activity have significance to depressive symptoms of elderly who live alone. Having past history of depression, religionless, low subjective satisfaction of family situation have significance to suicidality. Especially, low subjective satisfaction of family situation and having past history of depression are powerful demographic factor both depressive symptoms and suicidality of elderly who live alone. CONCLUSIONS: When we take care elderly who live alone, we should consider many things, but especially the social support network such as family satisfaction and past history of depression for reducing or preventing their depression and suicide both elderly depression and suicide who live alone.
Aged* ; Demography ; Depression* ; Humans ; Questionnaires ; Risk Factors* ; Suicidal Ideation ; Suicide

PURPOSE: A newly isolated mediastinal lymph node (LN) or a small pulmonary nodule, which appears during breast cancer surveillance, may pose a diagnostic dilemma with regard to malignancy. We conducted this study to determine which clinical factors were useful for the differentiation of malignant lesions from benign lesions under these circumstances. MATERIALS AND METHODS: We enrolled breast cancer patients who were presented with a new isolated mediastinal LN or small pulmonary nodule that arose during surveillance, and whose lesions were pathologically confirmed. Tissue diagnosis was made by mediastinoscopy, video-assisted thoracic surgery or thoracotomy. RESULTS: A total of 43 patients were enrolled (mediastinal LN, 13 patients; pulmonary nodule, 30 patients). Eighteen patients (41.9%) were pathologically confirmed to have a benign lesion (benign group), and 25 patients (58.1%) were confirmed to have malignant lesion (malignant group). Between the two groups, the initial tumor size (p=0.096) and N stage (p=0.749) were similar. Hormone receptor negativity was more prevalent in the malignant group (59.1% vs. 40.9%, p=0.048). The mean lesion size was larger in the malignant group than in the benign group (20.8 mm vs. 14.4 mm, p=0.024). Metastatic lesions had a significantly higher value of maximal standardized uptake (mSUV) than that of benign lesions (6.4 vs. 3.4, p=0.021). CONCLUSION: Hormone receptor status, lesion size, and mSUV on positron emission tomography are helpful in the differentiation of malignant lesions from benign lesions in breast cancer patients who were presented with a new isolated mediastinal LN or small pulmonary nodule during surveillance.
Breast Neoplasms* ; Diagnosis ; Humans ; Lymph Nodes* ; Mediastinoscopy ; Neoplasm Metastasis ; Positron-Emission Tomography ; Thoracic Surgery, Video-Assisted ; Thoracotomy

A 75-year-old female presented with subarachnoid hemorrhage. Angiography revealed a partial duplication (fenestration) in the proximal A1 segment and a ruptured aneurysm at the distal end of A1 fenestration. This congenital anomaly accompanying an aneurysm was associated with duplicated ipsilateral middle cerebral artery (MCA). Congenital defect of the arterial wall and hemodynamic factors at the fenestrated A1 are considered to play a significant role in the development of this aneurysm. The present case is peculiar because not only the ruptured A1 aneurysm was related with the anterior and middle cerebral artery duplication but also the location of A1 fenestration and the origin of A1 aneurysm in a fenestration are quite unusual.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Congenital Abnormalities ; Female ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Subarachnoid Hemorrhage

Frontometaphyseal dysplasia is a rare genetic syndrome first described by Gorlin and Cohen in 1969. This disease affects the skeletal system and connective tissue, and could be characterized by hyperostosis of the skull, prominence of supraorbital ridges, additional skeletal and extraskeletal abnormalities. It is believed that the condition is an X-linked dominant trait with severe manifextations in males and extreme variability in females. We described a case of 15-year-old boy manifested a pronounced supraorbital ridge associated with exorbitism. He also had bilateral progressive hearing deficit, thoracic spine scoliosis, chest wall deformity, bilateral maxillary sinusitis and both 5th finger arachnodactyly. The patient underwent a fronto-temporo-orbital cranioplasty through a coronal incision. The frontal bone including supraorbital region, orbital lateral rim and temporal bone were extensively contoured with burr. And then, burring of the medial aspect of lateral orbital wall was made to increase both orbital volume for correction of exorbitism. Postoperative results show well corrected prominent supraorbital ridge, hyperostosis of frontotemporal bone and exorbitism. The patient was satisfied with the improved appearance. No recurrence occurred during the 6 months of follow-up period. We report this case as it shows esthetically good result without any complication.
Adolescent ; Arachnodactyly ; Congenital Abnormalities ; Connective Tissue ; Female ; Fingers ; Follow-Up Studies ; Frontal Bone ; Hearing ; Humans ; Hyperostosis ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Orbit ; Recurrence ; Scoliosis ; Skull ; Spine ; Temporal Bone ; Thoracic Wall

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). MATERIAL AND METHODS: Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. RESULTS: Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides beta-lactams. CONCLUSION: Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.
Anti-Bacterial Agents ; Arthritis, Infectious ; Bacteremia ; beta-Lactams ; Colon ; Demography ; Ear ; Epidemiology ; Humans ; Insurance, Health ; Korea* ; Medical Records ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Risk Factors ; Skin ; Soft Tissue Infections

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). MATERIAL AND METHODS: Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. RESULTS: Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides beta-lactams. CONCLUSION: Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.
Anti-Bacterial Agents ; Arthritis, Infectious ; Bacteremia ; beta-Lactams ; Colon ; Demography ; Ear ; Epidemiology ; Humans ; Insurance, Health ; Korea* ; Medical Records ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Risk Factors ; Skin ; Soft Tissue Infections

BACKGROUND: Four platelet derived growth factor (PDGF) family members have been identified; the classical PDGFs, PDGF-A and PDGF-B, and the novel PDGFs, PDGF-C and PDGF-D, which were only recently discovered. METHODS: The present study was designed to determine the changes of the platelet derived growth factor (PDGF) subtypes (C & D) and their receptors (PDGFR)-alpha & beta expression in kidneys during pre- and postnatal development. RESULTS: All the protein levels of PDGFR-alpha and -beta and the mRNA levels of PDGF-C and D were high in kidneys during the prenatal period and decreased differently during the postnatal period. PDGFR-alpha was expressed in the interstitial space at embryo day 18. PDGFR-beta protein were expressed in metanephric blastema at embryo day 18. PDGF-C mRNA was expressed in metanephric blastema, developing glomerulus at embryo 18 day and in collecting duct at postnatal day 7. PDGF-D mRNA was expressed in the parietal and vesceral epithelial cells during pre and postnatal period. CONCLUSION: These results indicate that the PDGF subtypes (C & D) and their receptors (PDGFR-alpha & -beta) are differently expressed in the kidney during the prenatal and postnatal period.
Embryonic Structures ; Epithelial Cells ; Humans ; Kidney ; Platelet-Derived Growth Factor ; Rabeprazole ; Receptors, Platelet-Derived Growth Factor* ; RNA, Messenger

Rabies is a uniformly fatal encephalitis and cannot be treated, therefore efforts must be focused on preventing the disease. The incidence of rabies in humans and animals has decreased with the introduction of rabies vaccination for animals since the early 1950s in Korea. There was no rabies occurrence either in human or animal for 8 years from 1985 to 1992. However, a case of animal rabies recurred in 1993. Since then, rabies endemic areas were expanded into 17 counties near the demilitarized zone, and 6 human cases were reported from the endemic areas of animal rabies. According to epidemic studies, wild raccoon dogs were suspected to be the transmission source of rabies in dogs, domestic animals, and other wild animals, which resulted in human rabies. Rabies prevention strategies were aimed at the animals capable of transmitting rabies or vaccination for the high risk group and postexposure prophylaxis for the bitten patients. Unfortunately, these activities were not conducted appropriately and substantially. All rabies victims were either not treated or did not receive timely and appropriate postexposure treatment. Prevention of rabies can only be achieved by securing political and financial support for an effective rabies program. Key activities for rabies prevention should include changing current public perception regarding rabies, strengthening surveillance for the exposed person to suspected rabid animals, and laboratory-based rabies surveillance.
Animals ; Animals, Domestic ; Animals, Wild ; Dogs ; Encephalitis ; Epidemiology* ; Financial Support ; Humans ; Immunoglobulins ; Incidence ; Korea* ; Rabies* ; Raccoon Dogs ; Vaccination