PURPOSE: To investigate chemosensitivity with an adenosine triphosphate-based chemotherapy response assay in patients with epithelial ovarian or peritoneal cancer according to tumor histology, grade, and disease status. MATERIALS AND METHODS: One hundred specimens were collected during primary or secondary debulking from 67 patients with primary ovarian cancer, 24 patients with recurrent ovarian cancer, 5 patients with primary peritoneal cancer, and 4 patients with recurrent peritoneal cancer; samples were collected between August 2006 and June 2009. Tumor cells were isolated and cultured for 48 hours in media containing chemotherapy. The chemosensitivity index (CI) was calculated as 300 minus the sum of the cell death rate at 0.2x, 1x, and 5x drug concentrations, and the CI values were compared. RESULTS: CI values were obtained from 93 of 100 patients. The most active agents against primary disease were ifosfamide and paclitaxel. For primary serous adenocarcinoma, paclitaxel and irinotecan were the most active, followed by ifosfamide. For clear cell carcinoma, ifosfamide was the most active, followed by paclitaxel and irinotecan. Although not statistically significant, the CIs of cisplatin, carboplatin, paclitaxel, and docetaxel decreased as tumor grade increased. In 14 cases of recurrent disease, paclitaxel was the most active, followed by ifosfamide and cisplatin. CONCLUSION: Ifosfamide and paclitaxel were the most active drugs for primary and recurrent disease. Therefore, we recommend further clinical studies to confirm the efficacy of paclitaxel, ifosfamide, and cisplatin combination chemotherapy for recurrent and primary ovarian cancer.
Adenocarcinoma, Clear Cell/*drug therapy/metabolism/pathology ; Adenosine Triphosphate/*metabolism ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Camptothecin/administration & dosage/analogs & derivatives ; Carboplatin/therapeutic use ; Cisplatin/administration & dosage ; Drug Resistance, Neoplasm ; Drug Screening Assays, Antitumor/methods ; Female ; Humans ; Ifosfamide/administration & dosage ; Middle Aged ; Neoplasm Recurrence, Local/*drug therapy ; Neoplasms, Glandular and Epithelial/*drug therapy/metabolism/pathology ; Ovarian Neoplasms/*drug therapy/metabolism/pathology ; Paclitaxel/therapeutic use ; Peritoneal Neoplasms/*drug therapy/metabolism/pathology ; Predictive Value of Tests ; Sensitivity and Specificity ; Taxoids/administration & dosage

Changes in radial and longitudinal left ventricular (LV) function were investigated in beagles with iatrogenic hypercortisolism. A total of 11 normal dogs were used, and 2 mg/kg prednisone was administered per oral q12 h for 28 days to 7 out of 11 dogs to induce iatrogenic hypercortisolism. Body weight, blood pressure, conventional echocardiography and tissue Doppler imaging (TDI) of normal and iatrogenic hypercortisolism groups were conducted. The myocardial wall velocity of the LV was measured using color TDI and myocardial deformation was determined by the strain and strain rate. Conventional echocardiography revealed that the diastolic LV free wall and interventricular septum in the hypercortisolism group were thickened relative to those in the normal group. The peak early diastolic myocardial velocity and early to late diastolic myocardial velocity ratio of TDI in the hypercortisolism group were significantly lower than those in the normal group. The strain values in the hypercortisolism group were significantly lower than those in the normal group, particularly for longitudinal wall motion. The lower values of myocardium from TDI and strain imaging could be used to investigate subclinical LV systolic and diastolic dysfunction in dogs with the iatrogenic hypercortisolism.
Animals ; Cushing Syndrome/etiology/*veterinary ; Dogs ; Echocardiography, Doppler/*veterinary ; Heart Ventricles/*ultrasonography ; Iatrogenic Disease/veterinary ; Male ; Reproducibility of Results ; *Ventricular Function, Left

OBJECTIVES: To explore classification rules based on data mining methodologies which are to be used in defining strata in stratified sampling of healthcare providers with improved sampling efficiency. METHODS: We performed k-means clustering to group providers with similar characteristics, then, constructed decision trees on cluster labels to generate stratification rules. We assessed the variance explained by the stratification proposed in this study and by conventional stratification to evaluate the performance of the sampling design. We constructed a study database from health insurance claims data and providers' profile data made available to this study by the Health Insurance Review and Assessment Service of South Korea, and population data from Statistics Korea. From our database, we used the data for single specialty clinics or hospitals in two specialties, general surgery and ophthalmology, for the year 2011 in this study. RESULTS: Data mining resulted in five strata in general surgery with two stratification variables, the number of inpatients per specialist and population density of provider location, and five strata in ophthalmology with two stratification variables, the number of inpatients per specialist and number of beds. The percentages of variance in annual changes in the productivity of specialists explained by the stratification in general surgery and ophthalmology were 22% and 8%, respectively, whereas conventional stratification by the type of provider location and number of beds explained 2% and 0.2% of variance, respectively. CONCLUSIONS: This study demonstrated that data mining methods can be used in designing efficient stratified sampling with variables readily available to the insurer and government; it offers an alternative to the existing stratification method that is widely used in healthcare provider surveys in South Korea.
Data Mining ; Decision Trees ; Efficiency ; Health Personnel ; Humans ; Inpatients ; Insurance Carriers ; Insurance, Health ; Korea ; Ophthalmology ; Population Density ; Republic of Korea ; Sampling Studies ; Specialization

Ipsilateral hemiparesis is a rare and challenging sign in clinical neurological practice.Although the etiology of this manifestation is poorly understood, recent studies have attempted to probe the pathomechanism of this sign with advanced radiological techniques.Additional knowledge about the lesion and unraveling the pathomechanisms causing neurological impairments are important to predict the prognosis and clinical course and to aid in rehabilitation. Therefore, we present a case of a patient with a traumatic subdural hematoma on the left hemisphere and left spastic hemiparesis. Using diffusion tensor imaging (DTI), we concluded that the right corticospinal tract injury caused by compression of the cerebral peduncle accounted for the ipsilateral hemiparesis, also known as Kernohan's notch phenomenon. Thus, this case report highlights the usefulness of the newer radiological techniques, such as DTI, to identify the pathomechanisms of neurological presentations.

BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) has been well known pathogen as a cause of travelers' diarrhea. Nowadays, however, ETEC is also increasingly recognized as the cause of foodborne or waterborne outbreaks. We investigated an outbreak of a high school in Gwangju metropolitan city to trace the source of infection and the mode of transmission of ETEC. MATERIALS AND METHODS: All symptomatic persons were interviewed and filled out the questionnaires. We surveyed their clinical symptoms and the foods that they ate. We checked the facilities of the school, dinning room and water supply system. Microbiologic examination were carried out on above symptomatic persons and many environmental specimens. All gathered samples were examined in Gwangju city Health & Environment Research Institute. ETEC isolates were submitted to Korea Center for Disease Control and Prevention (KCDC) for Pulsed-field gel electrophoresis (PFGE). We also requested water quality analysis of water samples to Waterworks Research Institute. RESULTS: The 39 students and one sibling who visited and ate school meal showed symptoms. All staffs and cooks showed no symptom. Among 51 stool specimens, ETEC was isolated from 19 (18: students, 1:cook). ETEC was also isolated from specimens from a purifier and a water tap of the dinning room and water tank (underground water). In PFGE test, isolates from 18 persons showed identical pattern, but the PFGE patterns from water were different. Isolates of water samples showed different PFGE patterns even within the same sample. Investigation of the water distribution system revealed that contaminated underground water had been supplied to the dinning room and students of the school were exposed to it. CONCLUSION: This is the outbreak of ETEC infection occurred in a high school. Besides students, ETEC was also isolated from water samples. Considering some epidemiologic features, we suspect the mode of transmission may be waterborne despite the inconsistent PFGE results.
Academies and Institutes ; Centers for Disease Control and Prevention (U.S.) ; Diarrhea ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxigenic Escherichia coli* ; Groundwater ; Gwangju ; Humans ; Korea ; Meals ; Siblings ; Water ; Water Quality ; Water Supply ; Surveys and Questionnaires

BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) has been well known pathogen as a cause of travelers' diarrhea. Nowadays, however, ETEC is also increasingly recognized as the cause of foodborne or waterborne outbreaks. We investigated an outbreak of a high school in Gwangju metropolitan city to trace the source of infection and the mode of transmission of ETEC. MATERIALS AND METHODS: All symptomatic persons were interviewed and filled out the questionnaires. We surveyed their clinical symptoms and the foods that they ate. We checked the facilities of the school, dinning room and water supply system. Microbiologic examination were carried out on above symptomatic persons and many environmental specimens. All gathered samples were examined in Gwangju city Health & Environment Research Institute. ETEC isolates were submitted to Korea Center for Disease Control and Prevention (KCDC) for Pulsed-field gel electrophoresis (PFGE). We also requested water quality analysis of water samples to Waterworks Research Institute. RESULTS: The 39 students and one sibling who visited and ate school meal showed symptoms. All staffs and cooks showed no symptom. Among 51 stool specimens, ETEC was isolated from 19 (18: students, 1:cook). ETEC was also isolated from specimens from a purifier and a water tap of the dinning room and water tank (underground water). In PFGE test, isolates from 18 persons showed identical pattern, but the PFGE patterns from water were different. Isolates of water samples showed different PFGE patterns even within the same sample. Investigation of the water distribution system revealed that contaminated underground water had been supplied to the dinning room and students of the school were exposed to it. CONCLUSION: This is the outbreak of ETEC infection occurred in a high school. Besides students, ETEC was also isolated from water samples. Considering some epidemiologic features, we suspect the mode of transmission may be waterborne despite the inconsistent PFGE results.
Academies and Institutes ; Centers for Disease Control and Prevention (U.S.) ; Diarrhea ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxigenic Escherichia coli* ; Groundwater ; Gwangju ; Humans ; Korea ; Meals ; Siblings ; Water ; Water Quality ; Water Supply ; Surveys and Questionnaires

Placenta increta is an uncommon and life-threatening complication of pregnancy characterized by complete or partial absence of the decidua basalis. Placenta increta usually presents with vaginal bleeding during difficult placental removal in the third-trimester. Although placenta increta may complicate first and early secondtrimester pregnancy loss, the diagnosis can be very difficult during early pregnancy and thus the lesion is difficult to identify. We encountered with a woman who was diagnosed with placenta increta after receiving emergency hysterectomy due to intraperitoneal bleeding 2 months after an uncomplicated dilatation and curettage in the first trimester. Therefore, we report this case with a brief review of the literature.
Abortion, Induced/*adverse effects ; Adult ; Diagnosis, Differential ; Female ; Humans ; Placenta Accreta/*diagnosis ; Pregnancy ; Tomography, X-Ray Computed ; Treatment Outcome ; Uterine Hemorrhage/*diagnosis

This study evaluated whether renal perfusion changes can be noninvasively estimated by using contrast-enhanced ultrasonography (CEUS) in renal ischemia-reperfusion injury and investigated the correlation between renal perfusion measured by CEUS and necrosis and apoptosis of renal tubular epithelial cells. In six dogs with experimentally induced renal ischemia-reperfusion injury, changes in time to peak intensity, peak intensity, and area under the curve were measured on CEUS. Peak intensity and area under the curve of the renal cortex began to decrease on day 1 (about 20% lower than baseline) and reached the lowest levels (about 50% of baseline) on day 4. They then gradually increased until day 10, at which time peak intensity was about 87% and area under the curve was about 95% of baseline; neither fully recovered. Both parameters were strongly correlated with the necrosis scores on histopathologic examination on day 4 (r = −0.810 of peak intensity and r = −0.886 of area under the curve). CEUS allowed quantitative evaluation of perfusion changes in acute renal ischemia-reperfusion injury, and CEUS results were correlated with renal tubular damage on histopathologic examination. Thus, CEUS could be a noninvasive, quantitative diagnostic method for determining progress of renal ischemia-reperfusion injury.
Animals ; Apoptosis ; Dogs* ; Epithelial Cells ; Evaluation Studies as Topic* ; Methods ; Necrosis ; Perfusion* ; Reperfusion Injury* ; Ultrasonography*

PURPOSE: We evaluated the expression of microsatellite instability (MSI) in sporadic ovarian tumors using 5 standard and 9 new MSI markers to determine the clinical significance of MSI in sporadic epithelial ovarian tumors. MATERIALS AND METHODS: MSI was examined in 21 borderline and 25 malignant ovarian tumors. Polymerase chain reaction (PCR) was performed using the 5 markers recommended by the National Cancer Institute (NCI) for colon cancer and 9 additional markers. MSI was determined using fractional analysis by mixing the PCR products and size markers. RESULTS: Using the 5 conventional MSI markers, MSI was found in 4 of 46 (8.6%) ovarian tumors, including 2 of 21 (9.5%) borderline ovarian tumors and 2 of 25 (8%) malignant ovarian tumors. Using the 9 additional MSI markers, MSI was observed in 7 of 46 (15.2%) ovarian tumors, including 3 of 21 (14.3%) borderline ovarian tumors and 4 of 25 (16%) malignant ovarian tumors. There was no statistically significant difference between MSI and clinicopathological factors, including histology and stage, although there was a trend toward an increased incidence of MSI in the serous type. CONCLUSION: MSI was infrequent in ovarian tumors, including both borderline and malignant tumors. MSI was found to be uncommon in sporadic ovarian tumors, even by using additional MSI markers. The clinical significance of MSI is not strong in patients with sporadic ovarian tumors.
DNA, Neoplasm/genetics ; Female ; Humans ; *Microsatellite Instability ; Ovarian Neoplasms/*genetics/*pathology ; Polymerase Chain Reaction

PURPOSE: To determine the most powerful cancer antigen 125 (CA125)-related prognostic factor for advanced epithelial ovarian cancer (EOC) and to identify cut-off values that distinguish patients with a poor prognosis from those with a good prognosis. MATERIALS AND METHODS: We included 223 patients who received staging laparotomy and were diagnosed with stage IIC-IV serous EOC. Cox regression analysis was used to determine the most significant prognostic factor among the following variables: serum CA125 before surgery and after the first, second, and sixth cycles of chemotherapy; the nadir CA125 value; the relative percentage change in CA125 levels after the first and second cycles of chemotherapy compared to baseline CA125; CA125 half-life; time to nadir; and time to normalization of the CA125 level. RESULTS: The CA125 level after the first chemotherapy cycle was the most significant independent prognostic factor for overall survival (OS). Time to normalization (p=0.028) and relative percentage change between CA125 levels at baseline and after the first chemotherapy cycle (p=0.021) were additional independent prognostic factors in terms of OS. The CA125 level after the first chemotherapy cycle (p=0.001) and time to normalization (p<0.001) were identified as independent prognostic factors for progression free survival (PFS). CONCLUSION: Among well-established CA125-related prognostic factors, serum CA125 levels after the first cycle of chemotherapy and time to normalization were the most significant prognostic factors for both OS and PFS.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*therapeutic use ; CA-125 Antigen/*blood/metabolism ; Disease-Free Survival ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Neoplasms, Glandular and Epithelial/*blood/*drug therapy/mortality ; Ovarian Neoplasms/*blood/*drug therapy/mortality ; Prognosis ; Regression Analysis