Surgical resection of esophageal cance has played a prominent role in both cure and palliation. The radiologic evaluation of postesophagectomy patients is directed at the detection of normal and pathological appearances after surgical resection. Since early detection of recurrent tumor is important in the management of patients who have undergone esophagectomy, we undertook a retrospective study to evaluate the findings of recurrence on CT in postesophagectomy patients. Between January 1988 and July 1991, 26 patients who had undergone transthoracic esophagectomy with esophagogastrostomy for epidermoid carcinoma of the esophagus with following reoccurance were examined by chest CT. The group included 25 male and one female patients were aged 45-71 years(mean, 53). All patients had studies done immediate post operative 7-10 days. The CT were performed with a CT 9800 scanner (GE Medical System, Milwaukee) after administration of oral contrast media and intravenous injection of contrast media. The findings seen on CT were cnfirmed by biopsy in five cases and by clinical, radiological follow-up manifestation in 21 cases. The abnormalities that were demonstrated on follow-up CT were adenopathy-mediastinal node(ten cases) or abdominal node(five cases), local recurrence-previous tumor site (five case), anastomotic siteI(two cases) or thoracases), peicardial effusion(two cases). Our results indicate that serial chest CT play an important role in the evaluation of the patients after transthoracic esophagectomy with esophagogastrotomy.
Biopsy ; Carcinoma, Squamous Cell ; Contrast Media ; Esophageal Neoplasms* ; Esophagectomy* ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Injections, Intravenous ; Male ; Recurrence ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed*

BACKGROUND: When aortic stenosis is associated with atrial fibrillation, estimation of the aortic valve area(AVA) by continuity equation refuires averaging of 8-12 beats of LVOT-TVI and AV-TVI to calculate mean LVOT-TVI and mean AV-TVI. Since this method labour intensive, we therefore propose a new simplified method. METHODS: We studied 9 patients of aortic stenosis with atrial fibrillation. We recorded LVOT velocity and aortic valve velocity in 4-chamber view and measure the LVOT area in the parasternal long axis view. We measured RR interval(RR) and diastolic filling time(DFT) of preceding beat in ECG recorded simultaneously. AVA(mean)was defined as the aortic valve area calculated from the mean LVOT-TVI and mean AV_TVI of 10 veats by using continuity equation. AVA)RR), AVA(DFT), AVA(rTT) and AVA-rDDFT) were defined as the aortic valve area calculated from the 1 beat of LVOT-TVI and AV_TVI normalized by RR, DDFT, rRR and rDFT respectively. 20 sets of AVA(mean), AVA(RR), AVA(DFT),AVA(rTT) and AVA(DFT) were calculated in each patient and their means and standard deviations are compared. RESULTS: 1) R values of the correlation of RR, DFT, rTT, rDFT is 0.87, 0.87, 0.89 with LVOT-TVI and 0.91, 0.93, 0.94 with AV-TVI. 2) Averages of AVAs are AVA(mean) 0.76+/-0.35cm2, AVA(rRR) 0.75+/-0.04cm2, AVA(RR) 0.76+/-0.11cm2, AVA(DFT) 0.82+/-0.35cm2, AVA(rRR) 0.75+/-0.15cm2, AVA(rDFP) 0.76+/-0.10cm2. 3) Averages of AVAs showed no significant difference. Standard deviation of AVA(mean) was significantly smaller than other new AVAs(p<0.01). THe standard deviation of AVA(rDFT) was significantly smaller than that of AVA(RR), AVA(DFT) and AVA(RR)(p=0.35, p=0.05,p=0.008). CONCLUSION: When aortic stenosis is associated with atrial fibrillation, newly derived AVA(rDFT) could be more easily calculated compared to conventional AVA(mean) and was also a reproducibe and precise estmate of aortic valve area.
Aortic Valve Stenosis* ; Aortic Valve* ; Atrial Fibrillation* ; Axis, Cervical Vertebra ; Electrocardiography ; Humans

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/diagnosis/*mortality ; Comorbidity ; Coronary Angiography/*statistics & numerical data ; Coronary Stenosis/mortality/radiography ; Female ; Humans ; Incidence ; Kidney Diseases/*diagnosis/*mortality ; Kidney Function Tests/*statistics & numerical data ; Male ; Middle Aged ; Prognosis ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*statistics & numerical data

To report cases of metastasectomy for metastatic gynecologic malignancies, we reviewed the medical records of all patients who have undergone metastasectomy for metastatic gynecologic malignancies in Center for Uterine Cancer from June 2001 to October 2002. Six patients were identified with median age of 55 years (range 52-66 years). The metastatic sites and primary sites were as follows: 3 liver metastasis from ovary; 1 abdominal wall metastasis from uterus (endometrial cancer), 1 brain metastasis from ovary, 1 lung metastasis from uterus (sarcoma). The median disease free interval was 48 months (range 10 months-13 years). There was no perioperative mortality. Postoperative morbidity was tolerable with 1 case of bile leakage. In three patients with hepatectomy, one patient was dead of disease after 15 months, one patient is alive with disease at 20 months of follow up, one patient have no evidence of recurrence at 7 months follow up. The patient with brain metastasis was dead due to lung metastsis after 9 months later postoperatively. Remaining two patients with abdominal wall and lung metastasis have no evidence of tumor recurrence at 4, 7 months follow up respectively. Metastasectomy for metastatic gynecologic malignancies can be performed safely and may help prolong survival in carefully selected patients.
Abdominal Wall ; Bile ; Brain ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver ; Lung ; Medical Records ; Metastasectomy ; Mortality ; Neoplasm Metastasis ; Ovary ; Recurrence ; Uterine Neoplasms ; Uterus

PURPOSE: The optimal perioperative treatment for resectable esophageal squamous cell carcinoma (ESCC) remains controversial. We evaluated the efficacy and safety of leucovorin and 5-fluorouracil (LV5FU2) and LV5FU2 plus oxaliplatin (FOLFOX) combination chemotherapies administered adjuvantly for curatively-resected, node-positive ESCC. MATERIALS AND METHODS: Patients with pathologically node-positive esophageal cancer after curative R0 resection were enrolled and randomly assigned to receive LV5FU2 or FOLFOX biweekly for up to eight cycles. The primary endpoint was disease-free survival (DFS). RESULTS: Between 2011 and 2015, 62 patients were randomized into the two treatment groups (32 in the LV5FU2 arm and 30 in the FOLFOX arm). The median age was 60 years and both groups had similar pathologic characteristics in tumor, nodal status, and location. Treatment completion rates were similarly high in both groups. The DFS rate at 12 months was 67% in the LV5FU2 group and 63% in the FOLFOX group with a hazard ratio of 1.3 (95% confidence interval [CI], 0.66 to 2.62). After a median follow-up period of 27 months, the median DFS was 29.6 months (95% CI, 4.9 to 54.2) in the LV5FU2 arm and 16.8 months (95% CI, 7.5 to 26.1) in the FOLFOX arm (p=0.428), respectively, while the median overall survival was not reached in either arm. Grade 3 or 4 neutropenia was more frequent in patients in the FOLFOX arm than the LV5FU2 arm (20.0% vs. 3.1%). CONCLUSION: The addition of oxaliplatin (FOLFOX) did not lead to better efficacy compared to LV5FU2 chemotherapy in an adjuvant setting in node-positive ESCC patients.
Arm ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination ; Epithelial Cells* ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Neutropenia

PURPOSE: The optimal perioperative treatment for resectable esophageal squamous cell carcinoma (ESCC) remains controversial. We evaluated the efficacy and safety of leucovorin and 5-fluorouracil (LV5FU2) and LV5FU2 plus oxaliplatin (FOLFOX) combination chemotherapies administered adjuvantly for curatively-resected, node-positive ESCC. MATERIALS AND METHODS: Patients with pathologically node-positive esophageal cancer after curative R0 resection were enrolled and randomly assigned to receive LV5FU2 or FOLFOX biweekly for up to eight cycles. The primary endpoint was disease-free survival (DFS). RESULTS: Between 2011 and 2015, 62 patients were randomized into the two treatment groups (32 in the LV5FU2 arm and 30 in the FOLFOX arm). The median age was 60 years and both groups had similar pathologic characteristics in tumor, nodal status, and location. Treatment completion rates were similarly high in both groups. The DFS rate at 12 months was 67% in the LV5FU2 group and 63% in the FOLFOX group with a hazard ratio of 1.3 (95% confidence interval [CI], 0.66 to 2.62). After a median follow-up period of 27 months, the median DFS was 29.6 months (95% CI, 4.9 to 54.2) in the LV5FU2 arm and 16.8 months (95% CI, 7.5 to 26.1) in the FOLFOX arm (p=0.428), respectively, while the median overall survival was not reached in either arm. Grade 3 or 4 neutropenia was more frequent in patients in the FOLFOX arm than the LV5FU2 arm (20.0% vs. 3.1%). CONCLUSION: The addition of oxaliplatin (FOLFOX) did not lead to better efficacy compared to LV5FU2 chemotherapy in an adjuvant setting in node-positive ESCC patients.
Arm ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination ; Epithelial Cells* ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Neutropenia

BACKGROUNDThe zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies. However, this has not been thoroughly evaluated in ST elevation myocardial infarction.

METHODSThis was a prospective, randomized, controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction, treated with zotarolimus-eluting stents or sirolimus-eluting stents. From March 2007 to February 2009, 122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion. The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography, and secondary endpoints were percent diameter stenosis, binary restenosis rate, major adverse cardiac events (a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization), and late-acquired incomplete stent apposition.

RESULTSAngiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49 ± 0.65) mm vs. (0.10 ± 0.46) mm, P = 0.001). Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0 ± 17.9)% vs. (17.6 ± 14.0)%, P < 0.001). In-segment analysis showed similar findings. There were no significant differences in binary restenosis rate, major adverse cardiac events, and late-acquired incomplete stent apposition.

CONCLUSIONSCompared to sirolimus-eluting stents, the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction. Although there was no significant difference in 1-year clinical outcomes, the clinical implication of increased late lumen loss should be further studied.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; therapy ; Sirolimus ; analogs & derivatives ; therapeutic use ; Treatment Outcome