PURPOSE: The chemokine receptor CXCR4 has been reported to be aberrantly expressed in human cancer and has been shown to participate in cancer metastasis. We compared the expression of CXCR4 in conventional high-grade and low-grade central osteosarcomas, and determined if an association between CXCR4 expression and prognosis could be made. MATERIALS AND METHODS: We performed the immunohistochemistry for CXCR4 in a total of 63 patients with osteosarcoma and determined the relationships according to the clinicopathologic variables and overall survival rates. RESULTS: CXCR4 was detected in 76.3% of conventional high-grade osteosarcoma patients and in 36% of low-grade central osteosarcomas. Diffuse expression was noted in 47.4% of the high-grade osteosarcomas and all low-grade cases were focal positive. CXCR4 expression was significantly correlated with histologic grade (p<0.0001). While overall survival rate was reduced significantly with increased CXCR4 expression (p=0.0058), higher histologic grade (p<0.0001), and younger age (p=0.0140), survival rate did not correlate with gender, tumor size, or AJCC stage. CONCLUSION: Our results suggest that CXCR4 expression is associated with higher-grade tumors and with poor prognosis for osteosarcoma patients.
Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Osteosarcoma ; Prognosis ; Survival Rate

PURPOSE: Renal vascular clamping during a laparoscopic partial nephrectomy is a time-consuming procedure with a risk of renal ischemia. To study the feasibility of laparoscopic partial nephrectomy without renal arterial clamping, we compared the procedure with laparoscopic partial nephrectomy with vascular clamping. MATERIALS AND METHODS: Seventeen patients underwent laparoscopic partial nephrectomy without renal arterial clamping (group 1) from February 2004 to June 2008. The operative results were reviewed retrospectively and compared with those of 16 patients who underwent laparoscopic partial nephrectomy with arterial clamping (group 2). Patient characteristics did not differ significantly between the 2 groups. However, exophytic tumors were detected in 13 patients in group 1 and 3 patients in group 2 (p=0.001). Scores on the preoperative aspects and dimensions used for an anatomical (PADUA) classification were 6.9 in group 1 and 7.7 in group 2 (p=0.037). All surgeries by the transperitoneal approach were performed by a single surgeon. RESULTS: The mean operative times were 103 and 130 minutes in groups 1 and 2, respectively (p=0.312). The mean renal arterial clamping time of group 2 was 27.6 minutes (range, 20-42 minutes). The mean estimated blood loss was 327 ml in group 1 and 315 ml in group 2 (p=0.971). The mean postoperative change in the glomerular filtration rate was 20.11 ml/min/1.73 m2 in group 1 and 18.95 ml/min/1.73 m2 in group 2 (p=0.748). The mean times to postoperative initiation of ambulation and of oral intake were 1.6 and 1.7 days (p=0.486) and 1.3 and 1.6 days (p=0.811) in groups 1 and 2, respectively. The mean length of hospital stay was 7.4 and 7.9 days in groups 1 and 2, respectively (p=0.9). The mean tumor size was 2.1 cm (range, 1-7 cm) in group 1 and 3.3 cm (range, 1.5-9 cm) in group 2. CONCLUSIONS: Laparoscopic partial nephrectomy without renal arterial clamping is feasible for a localized renal tumor. However, patients should be selected carefully, such as those with an exophytic tumor.
Constriction ; Glomerular Filtration Rate ; Humans ; Ischemia ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Retrospective Studies ; Walking

BACKGROUND: Carbonic anhydrase IX (CA9) is reportedly overexpressed in several types of carcinomas, but little is known about the expression pattern of CA9 in osteosarcoma. We aimed to assess the prevalence of CA9 expression and its prognostic implications in osteosarcoma patients. METHODS: We compared immunohistochemical expression of CA9 between conventional, high-grade and low-grade, central osteosarcomas. Specimens were obtained before chemotherapy and stained with anti-human CA9 antibody. We also evaluated the histologic grade, presence of metastasis, and patient prognosis. RESULTS: Among 38 samples of conventional high-grade osteosarcoma, 22 (57.9%) tumors displayed CA9 overexpression. Twenty-five cases of low-grade central osteosarcomas were all negative (p < 0.0001). CA9 expression was significantly associated with the presence of metastasis (p = 0.0010). The overall survival rate was significantly reduced with increased CA9 expression (p = 0.0012), higher histologic grade (p < 0.0001), and younger age (p = 0.0140). However, the overall survival rate was not significantly correlated with gender, tumor size, or American Joint Committee on Cancer stage. CONCLUSIONS: CA9 expression is a frequent and tumor-specific event in osteosarcoma. CA9 expression is associated with higher grade tumors, metastasis and poor prognosis for the osteosarcoma patients.
Antigens, Neoplasm ; Carbon ; Carbonic Anhydrases ; Humans ; Joints ; Neoplasm Metastasis ; Osteosarcoma ; Prevalence ; Prognosis ; Survival Rate

Severe clinical ovarian hyperstimulation syndrome (OHSS) may occur after ovarian stimulation with gonadotropins A hypercoagulable state, a serious form of OHSS, is due to hemoconcentration as a result of a shifting of the intravascular fluid into the third space. Antiphospholipid syndrome is also a well-known hypercoagulable state, which manifests as an arterial or venous thrombosis and recurrent fetal loss. If OHSS, combined with a hypercoagulable state, such as antiphospholipid syndrome, develops, the potential of a thrombosis can be synergistically enhanced, creating a vicious cycle that results in serious thromboembolic complications. A 30-year-old woman, with an unusual right internal jugular venous thrombosis, occurring secondary to the development of OHSS and antiphospholipid syndrome, was treated.
Adult ; Antiphospholipid Syndrome ; Female ; Fertilization in Vitro* ; Gonadotropins ; Humans ; Jugular Veins* ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Thrombosis* ; Venous Thrombosis

PURPOSE: We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. MATERIALS AND METHODS: Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. RESULTS: All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. CONCLUSIONS: Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.
Body Mass Index ; Female ; Gloves, Surgical ; Humans ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Male ; Nephrectomy ; Operative Time ; Ureter ; Ureteral Neoplasms ; Urinary Bladder ; Urinary Tract* ; Wound Infection ; Wounds and Injuries

PURPOSE: We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. MATERIALS AND METHODS: Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. RESULTS: All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. CONCLUSIONS: Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.
Body Mass Index ; Female ; Gloves, Surgical ; Humans ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Male ; Nephrectomy ; Operative Time ; Ureter ; Ureteral Neoplasms ; Urinary Bladder ; Urinary Tract* ; Wound Infection ; Wounds and Injuries

Posterior neck pain is a common complaint of patients in the pain clinic. The atlas (C1) burst fracture is known to be a cause of posterior neck pain and instability. Although the atlas burst fracture and instability can be discovered by plain X-rays which show lateral mass displacement or widening of the atlantodental interval, assessment of an atlas burst fracture can be difficult if there is no instability in the imaging study. Here we report a case of a 46-year-old female patient who had complained of sustained posterior neck pain for 6 months. Plain X-rays showed only disc space narrowing at C4/5 and C5/6, without any cervical instability. However, an unrecognized C1 lateral mass fracture was detected by CT and MRI. The patient's pain was then successfully treated after atlantoaxial joint injection with a C2 DRG block.
Atlanto-Axial Joint ; Cervical Atlas ; Diagnosis-Related Groups ; Displacement (Psychology) ; Female ; Humans ; Middle Aged ; Neck Pain ; Pain Clinics ; Spinal Fractures

BACKGROUND: Descriptive diagnosis reports have been causing some problems in communication. Our institution decided to use the category diagnosis system since June, 2008. So we evaluated the effectiveness of this change. METHODS: The category system is composed of unsatisfactory, suboptimal for diagnosis but suggestive of, most probably benign, indeterminate, suspicious for malignancy and malignancy. We evaluated 1,525 cases from June, 2008 to September, 2009. We analyzed 159 cases of the indeterminate category. RESULTS: Among the 159 cases, 21 were re-aspirated and 63 underwent an operation. The diagnoses of the re-aspirated cases were 2 positive for malignancy, 5 indeterminate, 13 most probably benign, and 1 unsatisfactory. The surgical diagnoses were 39 malignancies, 2 follicular adenomas and 1 Hurthle cell adenoma, and 21 benign lesions. Re-aspiration for the indeterminate cases could help decide whether the lesions need to be operated or not at above 70%. The indeterminate category could predict the surgical diagnosis of the thyroid nodule with statistical significance when the subcategories were indicated (p < 0.001). CONCLUSIONS: The category diagnosis is replacing the descriptive diagnosis for the thyroid fine needle aspiration. The indeterminate category is useful and effective for making the decision to operate and especially when the indeterminate subcategories are used.
Adenoma ; Biopsy, Fine-Needle ; Thyroid Gland ; Thyroid Nodule

PURPOSE: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX) for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. METHODS: Third-year medical school students (n=313) in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP) note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. RESULTS: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students' performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5%) identified essential problem early and only 58 (18.5%) performed systematic history taking and physical examination. One hundred seventy-three of them (55.3%) communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. CONCLUSION: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.
Checklist ; *Clinical Competence ; Communication ; Comprehension ; *Education, Medical, Undergraduate ; Educational Measurement/*standards ; Humans ; Medical History Taking ; Medical Records ; Observer Variation ; Physical Examination ; Physician-Patient Relations ; *Problem-Based Learning ; Reproducibility of Results ; Republic of Korea ; *Schools, Medical ; *Students, Medical ; Surveys and Questionnaires ; *Thinking ; Universities

OBJECTIVES: Metabolic syndrome is a cluster of risk factors for type 2 diabetes mellitus and cardiovascular disease. Associations between metabolic syndrome and several types of cancer have recently been documented. METHODS: We analyzed the sample cohort data from the Korean National Health Insurance Service from 2002, with a follow-up period extending to 2013. The cohort data included 99 565 individuals who participated in the health examination program and whose data were therefore present in the cohort database. The metabolic risk profile of each participant was assessed based on obesity, high serum glucose and total cholesterol levels, and high blood pressure. The occurrence of cancer was identified using Korean National Health Insurance claims data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for age group, smoking status, alcohol intake, and regular exercise. RESULTS: A total of 5937 cases of cancer occurred during a mean follow-up period of 10.4 years. In men with a high-risk metabolic profile, the risk of colon cancer was elevated (HR, 1.40; 95% CI, 1.14 to 1.71). In women, a high-risk metabolic profile was associated with a significantly increased risk of gallbladder and biliary tract cancer (HR, 2.05; 95% CI, 1.24 to 3.42). Non-significantly increased risks were observed in men for pharynx, larynx, rectum, and kidney cancer, and in women for colon, liver, breast, and ovarian cancer. CONCLUSIONS: The findings of this study support the previously suggested association between metabolic syndrome and the risk of several cancers. A high-risk metabolic profile may be an important risk factor for colon cancer in Korean men and gallbladder and biliary tract cancer in Korean women.
Biliary Tract Neoplasms ; Blood Glucose ; Breast ; Cardiovascular Diseases ; Cholesterol ; Cohort Studies ; Colon ; Colonic Neoplasms ; Diabetes Mellitus, Type 2 ; Female ; Follow-Up Studies ; Gallbladder ; Humans ; Hypertension ; Kidney Neoplasms ; Larynx ; Liver ; Male ; Metabolome ; National Health Programs ; Obesity ; Ovarian Neoplasms ; Pharynx ; Proportional Hazards Models ; Rectum ; Risk Factors ; Smoke ; Smoking