PURPOSE: The prognosis of non-Hodgkins lymphoma (NHL) in elderly patients seems to be poorer than that in patients aged less than 60 years. This may be due to the lower tolerance for combination chemotherapy in the elderly. Aggressive combination chemo-therapy, which is the treatment of choice in intermediate and high grade NHL of adulthood, may be associated with unpredictab1y severe and lethal toxicity and worsened quality of life in the elderly. We investigated the treatment responses, toxicities and prognostic factors of NHL in elderly patients treated with combination chemotherapy. MATERIALS AND METHODS: We treated 116 elderly (>60 yrs) patients with NHL between January 1986 and June 1996 with adriamycin-containing regimens, such as CHOP (cyclo- phosphamide, adriamycin, vincristine, prednisolone), BACOP (bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone), and mBACOP (methotrexate, bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone). Patients in this study ranged from 60 to 81 (median 67) years of age. Fifty-five percent of patients were in stage I or II and the rest (45%) were in stage III or IV. The histologic grade was predominantly (91%) of intermediate and high grade type. RESULTS: The treatment responses were complete (CR) in 55% and partial (PR) in 25%. The median durstion of CR was 32 (3-132) months. The CR rate was significantly higher in patients treated with RDI (relative dose intensity) > 75% than that in the patients treated with RDI < 75% (p 0.003), but there was no significant difference in CR rate between treatment regimens (p-0.38). At a median follow up of 48-months (range, 12 to 132 months), the estimated 5-year ovetall survival was 46%. Ann Arbor Stage (I, II vs III, IV), ECOG performance (0-1 vs 2-3), RDI (>75% vs <75%) and the treatment response were important prognostic factors in the univariate analysis, and the treament response (CR vs non-CR) was the only independent prognostic parameter in the multivariate analysis. The most frequent and severe toxicity associated with chemotherapy was infection with or without neutropenia. The rate of severe infection was significantly decreased in the patients supported with G/GM-CSF but not in the dose-reduction group (RDI<75% vs >75%). CONCLUSION: Our data suggests that achievement of the CR after combination chemotherpy is the most important prognostic factor in the elderly patients with NHL. Suboptimal chemotherapy (RDI<75%) reduced the complete remission rate without reducing the likelihood of developing severe toxicities. Optimal chemotherapy with supportive cares involving the use of hematopoietic growth factors may be needed to improve the treatment response and the survival in the elderly patients with aggressive NHL.
Aged ; Bleomycin ; Cyclophosphamide ; Dimethoate ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Follow-Up Studies ; Hodgkin Disease* ; Humans ; Intercellular Signaling Peptides and Proteins ; Lymphoma, Non-Hodgkin ; Multivariate Analysis ; Neutropenia ; Prognosis* ; Quality of Life ; Vincristine

Peripheral arterial disease (PAD) is defined as atherosclerotic disease of infrarenal aorta and arteries of the lower extremities. PAD is a frequent but underdiagnosed and undertreated disease with substantial cardiovascular morbidity and mortality. Accordingly, early recognition of PAD is crucial to initiation of therapy. The ankle-brachial index (ABI) is a simple, inexpensive and noninvasive test to confirm the diagnosis of PAD and also provides risk stratification for the future cardiovascular events. Therefore, ABI should be measured in all patients with suspected PAD. Lifestyle adjustment and supervised exercise program are a major support for the therapy. Modification of treatable risk factors in conjunction with antiplatelet therapy improves cardiovascular outcomes. Cilostazol can be used as the first-line pharmacotherapy agent for the relief of claudication symptoms. Mechanical revascularization should be reserved for patients with critical limb ischemia or lifestyle limiting claudication. Remarkable technological advances in endovascular treatment have shifted revascularization strategies from traditional open surgery toward lower-morbidity percutaneous endovascular treatments. The novel therapies for increasing pain-free walking distance are under investigation. Above all, improved awareness and education in both primary physicians and the patients with cardiovascular risk factors can decrease morbidity and mortality secondary to atherosclerotic vascular disease.
Ankle Brachial Index ; Aorta ; Arteries ; Extremities ; Humans ; Ischemia ; Life Style ; Lower Extremity ; Oxalates ; Peripheral Arterial Disease ; Risk Factors ; Tetrazoles ; Vascular Diseases ; Walking

In the published article by Choi et al., a part of expression of the Abstract and the Conclusion section in the main body text have been corrected. Underlined text should be read carefully.

BACKGROUND: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. METHODS: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. RESULTS: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. CONCLUSIONS: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.
Arthroscopy* ; Dislocations ; Elbow ; Humans ; Joint Instability ; Recurrence* ; Reoperation ; Risk Factors* ; Shoulder* ; Surgeons ; Suture Anchors* ; Sutures*

Ewing sarcomas constitute a group of small, round, blue cell tumors of the bone and soft tissue. Extraskeletal Ewing sarcoma (EES) is a rare malignant neoplasm that arises from soft tissues, and it usually affects children and young adults. EES of the thoracopulmonary region commonly presents with a palpable mass or pain. Although rarely reported, EES affecting the anterior chest wall may present as a breast mass. We report a case of EES arising from the chest wall and manifesting as a palpable breast mass in a 22-year-old woman. The large mass was initially misdiagnosed as a breast origin mass on ultrasonography, but subsequent CT and MRI showed that the mass originated from the chest wall. Radiologists should be aware of the imaging findings of EES, and they should understand that chest wall lesions may be clinically confused as breast lesions.

Synovial sarcoma is a malignant soft tissue tumor that usually involves the extremities, particularly near the knees; a synovial sarcoma originating in the chest wall is extremely rare. We describe a 26-year-old woman diagnosed with a synovial sarcoma originating in the chest wall, based on CT and MRI findings. Contrast-enhanced CT images revealed a small, well-defined enhancing mass with calcification, in the subpleural area. This lesion was initially diagnosed as a benign tumor; however, the patient developed sudden severe pain with spontaneous bleeding and hemothorax, suggesting the possibility of malignancy. MRI revealed a multilobulated mass with a fluid-fluid level, which characterizes a synovial sarcoma.

Beh et's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Vascular complications consist of venous thromboembolism, arterial aneurysms and occlusions, and they develop in about 25% of patients. Weakening of the aortic wall may lead to aneurysms that may rupture and cause life-threatening hemorrhage, but nothing in the surgical and nonsurgical techniques proposed for the treatment for aneurysms in Beh et's syndrome has proved to be satisfactory. The traditional treatment for thoracic aotic aneurysms is the surgical replacement of a prosthetic graft. Although advances in the operative care of patients with thoracic aortic aneurysms have been achieved, the associated morbidity and mortality are considerable, especially in those with coexisting conditions such as advanced age, coronary artery disease and heart failure. Currently, transluminally placed endovascular stent-grafts offer an alternative approach to treatment that is potentially less invasive with a lower risk. We report a 37-year-old male patient with thoracic aortic aneurysm associated with Beh et's syndrome. Transluminal endovascular stent-graft placement was attempted : the stent-graft was introduced through a 22-Fr sheath using a common femoral artery cut down and expanded to 25-30 mm in diamter. There was increased thrombosis of the aneurysm on a follow-up imaging study, and the patient was discharged without complications.
Adult ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Thoracic* ; Behcet Syndrome* ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mortality ; Rupture ; Thrombosis ; Transplants ; Ulcer ; Venous Thromboembolism

Beh et's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Vascular complications consist of venous thromboembolism, arterial aneurysms and occlusions, and they develop in about 25% of patients. Weakening of the aortic wall may lead to aneurysms that may rupture and cause life-threatening hemorrhage, but nothing in the surgical and nonsurgical techniques proposed for the treatment for aneurysms in Beh et's syndrome has proved to be satisfactory. The traditional treatment for thoracic aotic aneurysms is the surgical replacement of a prosthetic graft. Although advances in the operative care of patients with thoracic aortic aneurysms have been achieved, the associated morbidity and mortality are considerable, especially in those with coexisting conditions such as advanced age, coronary artery disease and heart failure. Currently, transluminally placed endovascular stent-grafts offer an alternative approach to treatment that is potentially less invasive with a lower risk. We report a 37-year-old male patient with thoracic aortic aneurysm associated with Beh et's syndrome. Transluminal endovascular stent-graft placement was attempted : the stent-graft was introduced through a 22-Fr sheath using a common femoral artery cut down and expanded to 25-30 mm in diamter. There was increased thrombosis of the aneurysm on a follow-up imaging study, and the patient was discharged without complications.
Adult ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Thoracic* ; Behcet Syndrome* ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mortality ; Rupture ; Thrombosis ; Transplants ; Ulcer ; Venous Thromboembolism

PURPOSE: Thallous-201 chloride produced at Korea Cancer Center Hospital(KCCH) is used in detecting cardiovascular disease and cancer. Thallium impurity can cause emesis, catharsis and nausea, so the presence of thallium and other metal impurities should be determined. According to USP and KP, their amounts must be less than 2 ppm in thallium and 5 ppm in total. In this study, the detection method of trace amounts of metal impurities in [201Tl]TlCl injection with polarography was optimized without environmental contamination. MATERALS AND METHODS: For the detection of metal impurities, Osteryoung Square Wave Stripping Voltammetry method was used in Bio-Analytical System (BAS) 50W polarograph. The voltammetry was composed of Dropping Mercury Electrode (DME) as a working electrode, Ag/AgCl as a reference electrode and Pt wire as a counter electrode. Square wave stripping method, which makes use of formation and deformation of amalgam, was adopted to determine the metal impurities, and pH 7 phosphate buffer was used as supporting electrolyte. RESULTS: T1, Cu and Pb in thallous-201 chloride solution were detected by scanning from 300 mV to -800 mV. Calibration curves were made by using TlNO3, CuSO4 and Pb(NO3)2 as standard solutions. Tl was confirmed at -450 mV peak potential and Cu at -50 mV. Less than 2 ppm of Tl and Cu was detected and Pb was not detected in KCCH-produced thallous-201 chloride injection. CONCLUSION: Detection limit of thallium and copper is approximately 50 ppb with this method. As a result of this experiment, thallium and other metal impurities in thallous-201 chloride injection, produced at Korea Cancer Center Hospital, are in the regulation of USP and KP. Polarograph could be applied for the determination of metal impurities in the quality control of radiopharmaceuticals conveniently without environmental contamination.
Calibration ; Cardiovascular Diseases ; Catharsis ; Copper ; Electrodes ; Hydrogen-Ion Concentration ; Korea ; Limit of Detection ; Metals, Heavy* ; Nausea ; Polarography* ; Quality Control ; Radiopharmaceuticals ; Thallium ; Vomiting

Communication between coronary arteries and cardiac chambers or large vessels is unusual type of congenital malformation. Aneurysmal formation of a coronary arteriovenous fistula is even rare. We report a case of 83-year-old women with giant aneurysm of the coronary arteriovenous fistula from the left anterior descending coronary artery treated by percutaneous deployment of embolization coil.
Aged, 80 and over ; Aneurysm* ; Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic ; Female ; Humans