Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

We report a case of salvage lymphadenectomy for an isolated metastatic lesion in the para-aortic lymph node (LN) in a 49-year old woman with a history of cervical cancer, initially treated with radical hysterectomy and adjuvant radiotherapy. Preoperative 3-dimensional (3D) computed tomography (CT) angiography clearly revealed a huge retro-crural metastatic LN with distinct demarcation. A metastatic lesion, more than 10 cm in size, was located behind the vena cava, aorta, and left kidney, encompassing the left renal and lumbar arteries. The metastatic LN was excised along with the left kidney. On histologic examination, the tumor was found to have invaded the pelvis of the left kidney. Compared with conventional imaging techniques, 3D CT angiography can more clearly visualize such lesions. Thus, 3D CT angiography provides useful anatomical information, such as the exact size and location, and provides clear visualization and demarcation.
Angiography* ; Aorta ; Arteries ; Female ; Humans ; Hysterectomy ; Kidney ; Lymph Node Excision* ; Lymph Nodes ; Pelvis ; Radiotherapy, Adjuvant ; Recurrence ; Uterine Cervical Neoplasms*

Clinical practice guidelines for gynecologic cancers have been developed by many organizations. Although these guidelines have much in common in terms of the practice of standard of care for uterine corpus cancer, practice guidelines that reflect the characteristics of patients and healthcare and insurance systems are needed for each country. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to produce the third edition of the guidelines as an advanced form based on evidence-based medicine, considering up-to-date clinical trials and abundant qualified Korean data. These guidelines cover screening, surgery, adjuvant treatment, and advanced and recurrent disease with respect to endometrial carcinoma and uterine sarcoma. The committee members and many gynecologic oncologists derived key questions from the discussion, and a number of relevant scientific literatures were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, together with other details. The objective of these practice guidelines is to establish standard policies on issues in clinical areas related to the management of uterine corpus cancer based on the findings in published papers to date and the consensus of experts as a KSGO Consensus Statement.
Committee Membership ; Consensus* ; Delivery of Health Care ; Drug Therapy ; Endometrial Neoplasms ; Evidence-Based Medicine ; Female ; Humans ; Insurance ; Korea* ; Mass Screening ; Sarcoma ; Standard of Care

A two-year-old spayed female pug presented with symmetrical hyperpigmented alopecic lesions on her axillary and inguinal regions. There were no remarkable findings in dermatologic examinations and hormonal assays. Histological examination of biopsied tissues revealed prominent lymphocytic perifolliculitis along with shrunk hair follicles. Immunohistochemistry for CD3, CD79a, CD4, and CD8 showed a positive stain for CD4 antigen around hair bulbs, suggesting CD4 positive T lymphocyte infiltration. This case suggests the possibility that CD4 T lymphocyte-mediated inflammatory reaction could be a main mechanism in canine alopecia areata. Additional studies are warranted to investigate the immunological mechanism in canine species.
Alopecia Areata* ; Alopecia* ; Antigens, CD4 ; Autoimmune Diseases ; Female ; Hair ; Hair Follicle ; Humans ; Immunohistochemistry ; Lymphocytes

BACKGROUND: Pathogen inactivation (PI) is a proactive approach to overcome the limitations of the current testing system and donor questionnaires. Effect of PI on non-leukoreduced platelet rich plasma derived platelets (PRP-PLTs) suspended in plasma has not yet been evaluated. This study was conducted in order to evaluate the effect of PI on the quality of non-leukoreduced PRP-PLTs suspended in plasma. METHODS: PRP-PLTs treated with the Mirasol PRT System and the Intercept Blood System were tested for PLT count, blood gas, PLT activation, and apoptosis on days 3, 5, and 7 of storage. RESULTS: PLT number showed a decrease after PI. No difference in pH was observed until day 5. At day 7, PLTs treated with Mirasol had a lower pH value (6.5), however, it satisfied the quality control criteria. PLTs treated with Mirasol had a lower pO2 compared to pre-inactivation PLTs. pO2 during storage differed significantly between the two PI groups. pCO2 showed a decrease after inactivation and both groups showed a significant difference, compared with the control. PLTs treated with Mirasol had increased P-selectin expression after inactivation; however, difference of P-selectin during storage was not significant compared to the control. P-selectin of PLTs treated with Intercept was significantly different compared to those treated with Mirasol and control. Annexin V showed an increase after inactivation in Mirasol treated PLTs and difference during storage was significant compared to control and Intercept. CONCLUSION: As both PI systems showed satisfactory pH values, the criteria showing a high correlation with in vivo PLT viability and generally applied to monitor quality of PLTs, quality of PRP-PLTs after PI appears not to be negatively affected.
Annexin A5 ; Apoptosis ; Blood Platelets ; Humans ; Hydrogen-Ion Concentration ; Organothiophosphorus Compounds ; P-Selectin ; Plasma ; Platelet-Rich Plasma ; Quality Control ; Tissue Donors ; Surveys and Questionnaires

Deep neck space infections usually arise from infectious conditions of the upper aerodigestive tract. Candida albicans is a normal commensal of humans but usually causes invasive infections in immunocompromised patients. We report an immunocompetent 70-year-old woman with a Candida abscess in the deep neck space. She did not have dental or oropharyngeal disease, medication use, or medical illnesses that could cause an immunocompromised condition, except stable chronic hepatitis C. She was admitted to the hospital with fever, shortness of breath, a drowsy consciousness, and swallowing difficulty. Despite empirical antibiotic therapy, her signs and symptoms did not improve. A deep neck space abscess in the retropharyngeal space was revealed by computed tomography (CT). An abscess culture yielded C. albicans. She was treated with an antifungal agent rather then antibiotics. After 5 weeks of antifungal agent treatment and external drainage, follow-up CT scans showed substantial improvement in the abscess.
Abscess ; Anti-Bacterial Agents ; Candida ; Candida albicans ; Consciousness ; Deglutition ; Drainage ; Dyspnea ; Female ; Fever ; Follow-Up Studies ; Hepatitis C, Chronic ; Humans ; Immunocompetence ; Immunocompromised Host ; Neck ; Retropharyngeal Abscess

OBJECTIVE: To compare clinicopathologic characteristics and surgical outcomes of laparoscopic surgery in women with endometrial cancer according to body mass index (BMI). METHODS: From June 2009 to October 2010, prospective observational study without randomization of 159 patients treated by laparoscopic surgery from 10 hospitals nationwide. RESULTS: Patients were divided according to the WHO guidelines for Asia-Pacific populations and the distributions of BMI were as follows: 3 patients (1.9%) in underweight (BMI < 18.5 kg/m2), 50 patients (31.4%) in normal weight (BMI, 18.5-22.9 kg/m2), 45 patients (28.3%) in overweight (BMI, 23.0-24.9 kg/m2), 49 patients (30.8%) in obese (BMI, 25.0-29.9 kg/m2), and 12 patients (7.5%) in morbid obese (BMI > or = 30.0 kg/m2). Age, history of previous surgery, surgery extend, and history of previous surgery were not different between non-obese patients (BMI < 25.0 kg/m2) and obese patients (BMI > or = 25.0 kg/m2). Co-morbidities were more common in obese patients but marginally significant (23.5% vs. 37.7%, p=0.072). Four patients (2.5%) were converted to abdominal surgery because of severe adhesion. Regarding to surgical outcomes, operation time was significantly longer in obese patients (199 min vs. 235 min, p=0.013) but blood loss, lymph node yield, hospital stay, Foley removal, transfusion rate and peri-operative complication were not statistically significant. Regarding to pathologic results, there were no difference in terms of lymphovasucular space invasion, tumor grade, histologic type, lymph node metastasis and FIGO stage. CONCLUSION: Clinicopathologic characteristics and surgical outcomes does not seem to be significantly influenced by BMI except operation time. So the laparoscopic approach can be the alternative method for obese patients.
Body Mass Index ; Endometrial Neoplasms ; Female ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Neoplasm Metastasis ; Obesity ; Overweight ; Prospective Studies ; Random Allocation ; Thinness

Syphilitic myelitis is a rare manifestation of neurosyphilis, whose magnetic resonance imaging findings are not well documented. The authors report on a case of a 48-year-old male who presented with acute onset of paraplegia and voiding difficulty and was diagnosed as having syphilitic myelitis. Among tests performed for the diagnosis, serum Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorbed (FTA-ABS) tests showed a positive result. Analysis of cerebrospinal fluid (CSF) showed a normal white blood cell count, increased protein, reactive VDRL, and FTA-ABS tests. Magnetic resonance imaging (MRI) of cervical and thoracic spines showed diffuse intramedullary T2-hyperintense signal intensity without T1-weighted gadolinium enhancement. The syphilitic myelitis was resolved after institution of intravenous high dose penicillin G therapy for two weeks. Additional follow-up CSF analysis performed three months after treatment showed decreased protein and negative VDRL. MRI taken nine months later appeared normal and VDRL in CSF was still negative. This case study reports on the first Korean case of acute transverse myelitis caused by syphilis.
Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Gadolinium ; Humans ; Leukocyte Count ; Magnetic Resonance Imaging ; Male ; Myelitis ; Myelitis, Transverse ; Neurosyphilis ; Paraplegia ; Penicillin G ; Sexually Transmitted Diseases ; Spine ; Syphilis