Our aim was to identify histologic changes in cervical carcinoma tumor cells due to chemotherapy,by electron microscopic examination. Cisplatin and 5-fluorouracil were used between March 1, 1994 and February 28, 1995 on a total of 16 patients. The treatment schedule consisted of 75 mg/m2 cisplatin via iv with hyperhydration on Day 1, in combination with 1000 mg/m2 5-fluorouracil via continuous iv on Day 1 to 5. The treatment was repeated every 4 weeks with a maxinum of 3 courses. Ultrastructurally, chemotherapy induced apoptosis,indicated by condensation of nucleus and cytoplasm,fragmentation of nuclei, and apoptotic bodies. Due to repeat chemotherapy, increased levels of desmosomes were noted and parts of tumor nests were replaced by mature squamous cells. Tumor nests were reduced in size, mitochondria exhibited swelling, the endoplasmic reticulum was dilated, and infiltration of inflammatory cells increased after chemotherapy. These results suggest that chemotherapy induces apoptosis and injury to the cytoplasm and nuclei of tumor cells. However, the exact selection mechanism of the biochemical pathway of cell death is not fuUy understood. Further study of the molecular biologic actions of cell death after chemotherapy is warranted.
Apoptosis ; Appointments and Schedules ; Cell Death ; Cisplatin ; Cytoplasm ; Desmosomes ; Drug Therapy* ; Endoplasmic Reticulum ; Fluorouracil ; Humans ; Mitochondrial Size

PURPOSE: Many patients who may be treated in primary care clinics resort to emergency centers during the off hours of such clinics. This may cause overcrowding of emergency centers and increased medical expenses. The aim of this study is to consider the optimal management of medical facilities for pediatric patients at night or on holidays. METHODS: The medical records of patients under the age of 16 years who had visited a pediatric emergency medical center during a two-year period between January 2012 and December 2013 were reviewed retrospectively. We examined how factors including the age group, disease/injury distinction, tentative diagnosis, use of the emergency medical service ambulances, and the final disposition of the patients varied depending on the availability of medical facilities. RESULTS: Among the 32,951 pediatric patients, approximately half visited the center on holidays (51.6%), and a quarter were injury patients (26.4%). Fever (38.8%) and head injury (16.1%) were the most frequent tentative diagnosis in diseases and injuries, respectively. More visits of infants and toddlers and disease patients occurred on days and hours of low medical service availability, and there were relatively few injury patients in the late night hours. CONCLUSION: These findings suggest that closing pediatric clinics around midnight is reasonable. More facilities operating at night and on holidays for pediatric patients are needed.
Ambulances ; Craniocerebral Trauma ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Epidemiology ; Fever ; Health Resorts ; Holidays ; Humans ; Infant ; Medical Records ; Pediatrics ; Primary Health Care ; Retrospective Studies

PURPOSE: To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. MATERIALS AND METHODS: A total of 289 apparently healthy personnel at Yonsei University (male: 170, female: 119, age: mean(SD=54.9 +/-7.1 years) underwent EBT (electron bean tomography). The risk factors for atherosclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58 % ) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. RESULTS: The prevalence of CAC was 40% in men and 18.5% in women (mean score: 29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141, 41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6% ) , respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity (p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score (p=0.118). CONCLUSION: This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans.
Arteries ; Atherosclerosis ; Calcium* ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Obesity ; Prevalence ; Risk Factors ; Smoke ; Smoking

PURPOSE: Magnetic resonance pancreatography(MRP) is a non-invasive imaging technique for visualization of the pancreatic duct system, and is similar to those obtained by means of endoscopic retrograde pancreatography (ERP). To determine the role of MRP in the diagnosis of pancreatic tumors, the diagnostic confidence and imaginal difference of MRP and ERP were compared. MATERIALS AND METHODS: Twenty patients (13 male and 7 female, mean age 59 years) with pancreatic tumors underwent MRP and ERP. The former involved the use of a single shot fast spinecho sequence on a 1.5T system. All images were retrospectively reviewed by a radiologist and a gastroenterologist, working together. Both MRP and ERP were compared for separate visualization of the head, body and tail portion of the pancreatic duct, and scored as excellent (4), good (3), fair (2), poor (1), or no visualization (0). In addition, the overall diagnostic confidence of both modalities was graded subjectively from non-diagnoses (0) to definite information (4). The final diagnoses derived from surgical findings (n=9) or imaging findings and clinical follow-up (n=7) were as follows : pancreatic cancer (n=12), mucin-producing pancreatic cancer (n=2), mucinous ductectatic tumor (n=4), serous cystadenoma (n=2). To assess the statistical significance of difference, the paired t-test was used. RESULTS: Mean scores of visualization of the pancreatic duct by MRP and ERP were 2.91 and 3.15 in the pancreatic head (p=NS), 3.11 and 2.18 in the pancreatic body (p=NS), and 3.07 and 1.09 in the pancreatic tail (p<0.01). The mean score of diagnostic confidence was 4.03 for MRP and 2.51 for ERP, a statistically significant difference (p <0.05). In 11 patients with obstruction of the pancreatic duct due to malignant lesions, MRP visualized the duct both proximally and distally to the site of obstruction, while ERP visualized only the distal duct to the site of obstruction. MRP was also better at defining the extent of tumor by visualization of surrounding pancreatic parenchyma. In two cases of serous cystadenoma with lack of communication between the pancreatic duct and cystic neoplasm, MRP depicted the lesion clearly whereas ERP showed no information. CONCLUSION: MRP is better than ERP at visualizing the of pancreatic duct proximal to obstruction, assessment of tumoral extent, and diagnosis of a cystic neoplasm which does not communicate with the pancreatic duct.
Cystadenoma, Serous ; Diagnosis* ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Mucins ; Pancreatic Ducts ; Pancreatic Neoplasms ; Retrospective Studies

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Optic neuritis in SLE is very rare and the prevalence can be estimated to be approximately 1% of the patients of SLE. The main pathogenesis of optic neuritis with SLE is that of a vaso-occlusive disease in small vessels and the histopathologic appearance has varied from demyelination to definite vascular disease with axonal necrosis. The visual outcome of optic neuritis in SLE has often been poor. The treatments of optic neuritis in SLE are intravenous methylprednisolone, immunosuppressive agents and plasmapheresis. The authors experienced a case of lupus nephritis and CNS lupus which was complicated by optic neuritis in 18-year-old female patient who complained of sudden visual disturbance of the both eyes After treatment with plasmapheresis and systemic corticosteroid, her visual deficit was gradually recovered.
Adolescent ; Antigen-Antibody Complex ; Autoantibodies ; Axons ; Demyelinating Diseases ; Female ; Humans ; Immunosuppressive Agents ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Necrosis ; Optic Neuritis* ; Plasmapheresis ; Prevalence ; Vascular Diseases

Objective: The aim of this study was to investigate and compare the dietary patterns of Korean women diagnosed with endometrioma or other benign ovarian cysts. Methods: A total of 66 patients, comprising 39 patients who were surgically diagnosed with ovarian endometrioma and 27 control patients with other benign ovarian cysts, were included in this case-control study. Trained interviewers identified and interviewed the case patients and controls on the day before the laparoscopic ovarian surgery, using a semiquantitative food frequency questionnaire developed by the Ministry of Health and Welfare of Korea. Statistical analysis was performed using the Wilcoxon sum-rank test for continuous variables and the χ2 test or Fisher’s exact test for categorical variables. Results: The calcium intake from daily food consumption was significantly lower in patients with endometrioma than in those with other benign ovarian cysts. The dietary intakes of vitamin D, iron, and zinc were also relatively lower in patients with endometrioma than in patients with other benign ovarian cysts, although they did not reach the statistical significance threshold. Conclusion The risk of endometrioma is significantly associated with a lower dietary intake of calcium. Future studies including a larger number of patients on a nationwide scale are urgently required for further clarification.

PURPOSE: Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17-06 study. MATERIALS AND METHODS: Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated. RESULTS: In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol. CONCLUSION: The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.
Brain ; Carcinoma, Non-Small-Cell Lung ; Compliance ; Hippocampus ; Lung Neoplasms ; Neoplasm Metastasis ; Prospective Studies ; Radiation Oncology ; Radiotherapy

BACKGROUND: The aim of this study was to evaluate the response, survival, and toxicities of a less intensive combination of paclitaxel and carboplatin, which is used in advanced non-small cell lung cancer (NSCLC) patients older than 60 years of age including those with a poor performance status. METHODS: Thirty patients received 135 mg/m2 of paclitaxel on day 1, and carboplatin was administered to the patients on day 1 every 4 weeks over an area under the concentration-time curve of 6. RESULTS: The response rate was 40%, the median overall survival was 9.1 months (95% CI, 4.2 to 14 months), and the 1 year survival rate was 31%. The median progression-free survival was 7.7 months (95% CI, 3.1 to 12.2 months). In addition, the toxicities were generally mild and reversible. CONCLUSION: This study demonstrates that a less intensive combination of paclitaxel/carboplatin is active and well tolerated in advanced NSCLC patients who are older than 60 years including those with a poor PS 3~4.
Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use ; Carboplatin/administration & dosage/adverse effects ; Carcinoma, Non-Small-Cell Lung/*drug therapy/pathology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms/*drug therapy/pathology ; Male ; Middle Aged ; Neoplasm Staging ; Paclitaxel/administration & dosage/adverse effects ; Sickness Impact Profile ; Survival Analysis ; Treatment Outcome

Strumal carcinoid tumor of the ovary is a rare subtype of ovarian carcinoid tumors; it is characterized by an intimate mixture of thyroid and carcinoid tissues. We present a case of a 64-year-old woman who presented with the chief complaint of persistent, severe constipation for over 5 years; she was later found to have an ovarian strumal carcinoid tumor. Computed tomography showed a well-defined solid mass measuring 6.4 cm at the right adnexa. The patient underwent right salpingo-oophorectomy and was histopathologically diagnosed as having a strumal carcinoid tumor. Immunohistochemical examination showed immunoreactivity for peptide YY (PYY), which exerts an inhibitory effect on the peristaltic actions of the distal intestine. After surgery, the patient's constipation resolved rapidly, suggesting a correlation between PYY producing ovarian carcinoid tumor and constipation. This is the first case report of PYY producing primary strumal carcinoid tumor of the ovary associated with persistent, severe constipation from Korea.
Carcinoid Tumor* ; Constipation* ; Female ; Humans ; Intestines ; Korea ; Middle Aged ; Ovary* ; Peptide YY* ; Thyroid Gland

Between January, 1974 and December 1986, fifty eight patients with locoregional recurrent breast carcinoma who did not have evidence of distant metastasis after initial treatment of surgery with or without adjuvant chemotherapy were treated with radiation therapy. Among them, five patients were excluded from this study because of incomplete record or incomplete treatment. The 5-year overall survival and disease free survival from the time of locoregional recurrence was 27% and 15% respectively. In univariate analysis of prognostic variables, the clinical stage at initial diagnosis, recur duration, number of recurrence sites, size of recurrences, response to the treatment, remission duration were all found to have no significant effect on survival or disease free survial. On the other hand, menopausal status at initial diagnosis, number of positive node at initial surgery, whether or not the use of adjuvant chemotherapy after initial mastectomy had definite prognositc significance. In multivariate analysis of prognostic variables, remission duration, menopausal status at diagnosis, number of axillary node at mastectomy had definite prognostic significance. On the other hand, remission duration more than 12 months, premenopaus at initial mastectomy, less than four positive axillary lymph nodes at mastectomy predicted a good prognosis.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Diagnosis ; Disease-Free Survival ; Hand ; Humans ; Lymph Nodes ; Mastectomy ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Recurrence