PURPOSE: In this retrospective study, we analyzed the outcomes of prostate cancer patients treated with the CyberKnife radiotherapy system (Accuray). MATERIALS AND METHODS: Between 2007 and 2010, 31 patients were treated for prostate cancer by use of the CyberKnife radiotherapy system. After excluding six patients who were lost to follow-up, data for the remaining 25 patients were analyzed. Patients were divided into the CyberKnife monotherapy group and a postexternal beam radiotherapy boost group. Clinicopathologic features and treatment outcomes were compared between the groups. The primary endpoint was biochemical recurrence-free survival period based on the Phoenix definition. Toxicities were evaluated by using the Radiation Therapy Oncology Group scoring criteria. RESULTS: Of 25 patients, 17 (68%) and 8 (32%) were classified in the monotherapy and boost groups, respectively. With a median follow-up of 29.3 months, most of the toxicities were grade 1 or 2 except for one patient in the boost group who experienced late grade 3 gastrointestinal toxicity. The overall biochemical recurrence rate was 20% (5/25) and the median time to biochemical recurrence was 51.9 months. None of the patients with low or intermediate risk had experienced biochemical recurrence during follow-up. Among D'Amico high-risk populations, 16.7% (1/6) in the monotherapy group and 50.0% (4/8) in the boost group experienced biochemical recurrence. CONCLUSIONS: Our data support that prostate cancer treatment by use of the CyberKnife radiotherapy system is feasible. The procedure can be a viable option for managing prostate cancer either in a monotherapy setting or as a boost after conventional radiotherapy regardless of the patient's risk stratification.
Follow-Up Studies ; Humans ; Lost to Follow-Up ; Prostate* ; Prostatic Neoplasms* ; Radiosurgery ; Radiotherapy* ; Recurrence ; Retrospective Studies

BACKGROUND: Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. METHODS: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. RESULTS: A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56). CONCLUSIONS: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.
Adult* ; APACHE ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hematologic Neoplasms* ; Hemorrhage ; Humans ; Intensive Care Units ; Intracranial Hemorrhages ; Lung Injury ; Male ; Medical Records ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency* ; Retrospective Studies ; Tertiary Care Centers ; Weaning

BACKGROUND: Photoaged skin is characterized by actinic skin lesions such as wrinkling, elastosis, and premalignant and malignant lesions. Actinic keratosis (AK) is one of the most common precancerous lesions, and multiple actinic keratosis lesions are one of the risk factors for skin cancer. Few studies have investigated the prevalences of actinic skin lesions and compared the characteristics of the lesions and the patients with sinle and multiple AK lesions. OBJECTIVE: The aim of this study was to evaluate the prevalences of actinic skin lesions and to compare characteristics between single and multiple lesions in Korean patients with AK. METHODS: We retrospectively reviewed the medical records and biopsy specimens of 61 patients. RESULTS: Frequencies of deep wrinkle, solar elastosis, cutis rhomboidalis nuchae, and senile purpura were higher in the multiple lesions group. The ratio of males to females was 1:3.43 and the mean age was 79 years in the multiple lesions group, both of which were higher than those in the single lesion group (1:1.14, 72 years). The mean duration was longer in the multiple lesions group. Sun protective behavior was more frequent in the single lesion group, and the occupation of farmer was more common in the multiple lesions group. There was no statistically significant clinicopathological difference between the two groups. CONCLUSION: This study may improve our understanding of the characteristics of actinic keratosis with both single and multiple lesions.
Actins* ; Biopsy ; Farmers ; Female ; Humans ; Keratosis, Actinic* ; Male ; Medical Records ; Occupations ; Prevalence* ; Purpura ; Retrospective Studies* ; Risk Factors ; Skin Neoplasms ; Skin* ; Solar System

No abstract available.
Factor VIII* ; Polymorphism, Restriction Fragment Length*

Myxedema coma is the most extreme form of hypothyroidism and manifests as central nervous system dysfunction, defective thermoregulation, and cardiopulmonary decompensation. The curative treatment is based on the administration of thyroid hormones, but the dose and route of administration remain controversial. Here, we report a case of myxedema coma that was treated successfully with a large oral dose of levothyroxine
Body Temperature Regulation ; Central Nervous System ; Coma ; Hypothyroidism ; Myxedema ; Thyroid Hormones ; Thyroxine

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. Its fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome : A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, pustulosis.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Adult ; Arthritis ; Buttocks ; Female ; Humans ; Hyperostosis ; Male ; Osteitis ; Psoriasis ; Pyoderma Gangrenosum ; Skin ; Synovitis ; Thoracic Wall ; Young Adult

OBJECTIVE: This study was undertaken to review the disease course, clinical and laboratory manifestations, prognosis and treatment of adult onset Still s disease (AOSD) in Korea. METHODS: Thirty-two patients with AOSD were enrolled from 1986 to 1997 in Hanyang University Hospital. Diagnosis of AOSD was based on the criteria proposed by Yamaguchi. We classified the disease course into self-limited, inter mittent, or chronic disease course. RESULTS: Twenty-four (75%) patients were female. Skin rash occurred in 28 (88%) patients, lymphadenopathy in 8 (25%), hepatomegaly in 4 (13%), and pericarditis in 2 (6%) out of 32 patients. The most commonly affected joints were knee joints (88%). Elevated LDH was seen in 18 (60%) patients and decreased CK in 17 (61%) patients. Rheumatoid factor was detected in 4 (13%) patients and ANA in 12 (38%) patients. Anemia (Hb < 10 g/dL) was seen in 13 (41%) patients and hypoalbuminemia (<3. 5 g/dL) in 14 (52%) patients. Elevated ferritin (300 ng/mL) level was seen in 23 (79%) patients. Twenty-five (78%) patients had elevated serum transaminase. Bone marrow studies were performed in 16 patients. Nine out of 16 patients showed hyperplasia of the myeloid series and 2 patients displayed the features of a hemophagocytic syndrome. The mean duration of follow up of 32 patients was 32 months (range 3- 108). Eight (27%) patients had a self-limited, 9 (30%) an intermittent, and 13 (43%) a chronic disease course. The hypoalbuminemia was significantly associated with an "intermittent or chronic disease group" (p<0. 05). Thirty-two patients received systemic corticosteroids and 21 patients received single or combination of disease modifying antirheumatic drugs. CONCLUSION: We found that hypoalbuminemia at presentation was significantly associated with an unfavorable outcome, intermittent or chronic disease group. The clinical manifestations and disease course of AOSD in Korea were similar to those previously reported in other countries except significantly lower incidence of lymphadenopathy, hepatomegaly, and pericarditis.
Adrenal Cortex Hormones ; Adult* ; Anemia ; Antirheumatic Agents ; Bone Marrow ; Chronic Disease ; Diagnosis ; Exanthema ; Female ; Ferritins ; Follow-Up Studies ; Hepatomegaly ; Humans ; Hyperplasia ; Hypoalbuminemia ; Incidence ; Joints ; Knee Joint ; Korea* ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic ; Pericarditis ; Prognosis ; Rheumatoid Factor ; Still's Disease, Adult-Onset*

BACKGROUND: Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. METHODS: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015.
Adult ; APACHE ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Hematologic Neoplasms ; Hemorrhage ; Humans ; Intensive Care Units ; Intracranial Hemorrhages ; Lung Injury ; Male ; Medical Records ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Retrospective Studies ; Tertiary Care Centers ; Weaning

PURPOSE: Recombinant Interferon-alpha (rIFN-alpha) treatment is effective in treating chronic hepatitis C in the patients with end stage renal disease, and is also effective in preventing reactivation of hepatitis C virus (HCV) after renal transplantation. We here report our experience of rIFN-alpha treatment in renal transplant recipients and dialysis patients awaiting transplantation. METHODS: Total nine patients were enrolled. Four patients (2 Hemodialysis patients, 2 Peritoneal dialysis patients) were on waiting lists for renal transplantation and five patients were renal transplant recipients. All the patients were HCV antibody and HCV RNA positive with elevated ALT more than normal limit for at least 6 months. Five renal transplant recipients had stable renal function for at least 6 months. rIFN-alpha at a dose of 3 million units was administered by subcutaneous injection three times a week for 6 months. Two renal transplant recipient received rIFN-alpha in combination with ribavirin (600 mg orally per day). RESULTS: At the end of treatment, the rate of virological response (negative conversion of HCV RNA) was 67% (6/9 cases), and biochemical response (normalized ALT) was 88% (8/9 cases). The virological responders showed sustained loss of HCV RNA (sustained virological response 67%). and 7 out of 8 biochemical responder had normal ALT during follow-up period (sustained biochemical response 77%). Two patients who showed negative conversion of HCV RNA in the pre- renal transplantation period showed sustained loss of HCV RNA and normal ALT over post-renal transplantation period. There was no irreversible renal failure and acute rejection episode in renal transplant recipients during treatment of rIFN-alpha except one recipient with reversible and mild renal dysfunction, but two case of combination therapy of rIFN-alpha and ribavirin had hemolytic anemia. CONCLUSION: The rIFN-alpha therapy in pre-transplant patients may appear to exert a beneficial effect of the liver disease following renal transplantation and irreversible renal failure does not develop in renal transplant recipients.
Anemia, Hemolytic ; Dialysis ; Follow-Up Studies ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Injections, Subcutaneous ; Interferon-alpha* ; Interferons* ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver Diseases ; Peritoneal Dialysis ; Renal Dialysis ; Renal Insufficiency ; Ribavirin ; RNA ; Transplantation ; Waiting Lists

PURPOSE: The aim of this study was to evaluate the clinical course of chronic viral hepatits in renal transplant recipients. METHODS: During the period from January 1980 to December 1998, a total of 1122 cases of kidney transplantation (KT) were performed at the Kangnam St. Mary's Hospital. Eighty- one transplant recipients received azathioprine (AZA) and 1041 transplant recipients received cyclosporin A (CsA). We tested hepatitis B surface antigen (HBS Ag) and hepatitis C virus antibody (HCV Ab). According to duration of hepatic dysfunction, radiologic examination and liver biopsy, clinical course of hepatitis was classified; (1) Health carrier: HBs Ag or HCV Ab positive with normal laboratory finding. (2) Chronic hepatitis: clinical and/or laboratory evidence of hepatic dysfunction that persisted more than 6 months. (3) Liver cirrhosis and hepatocellular carcinoma (HCC); liver ultrasonography, abdominal CT and liver biopsy. RESULTS: (1) The patients with HBs Ag positive were 117 cases (10.4%). Sixteen cases died within 1 year after KT because of hepatic failure or other complication. We followed up 101 cases. Sixty-seven cases (66.4%) were health carrier and two of them progressed to HCC. Thirty-four cases (33.5%) developed chronic hepatitis B and liver cirrhosis was developed in 10 cases (29.4%). (2) Because of availability of diagnostic method, 877 cases were tested for HCV Ab. The patients with HCV Ab positive were 94 cases (10.7%). Four cases died within 1 year after KT. Thirteen cases (13.8%) were both HBs Ag and HCV Ab positive. We followed up 75 cases only HCV Ab positive. Fifty-three cases (70.7%) were health carrier and 22 cases (29.3%) progressed to chronic hepatitis C. Any case did not progressed to liver cirrhosis or HCC. (3) Eight cases of HCC were developed from chronic hepatitis B, and one case was both HBs Ag and HCV Ab negative. Among these, male gender is predominant (male : female=7 : 2). The average age at KT were 37.9 years. HCC was diagnosed at 102.6 (range 44 to 173) months after KT. Eight cases received CsA and prednisolone and only 1 case received AZA and prednisolone. Two cases underwent surgical intervention and the other 7 cases treated with transarterial chemoembolization and chemotherapy. The average survival was 10.4 (1 to 40) months, 3 cases are still alive. CONCLUSION: Clinical course of HCV infection is less aggressive than that of HBV infection in renal transplant recipients.
Azathioprine ; Biopsy ; Carcinoma, Hepatocellular ; Cyclosporine ; Drug Therapy ; Hepacivirus ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Kidney Transplantation ; Liver ; Liver Cirrhosis ; Liver Failure ; Male ; Prednisolone ; Tomography, X-Ray Computed ; Transplantation* ; Ultrasonography