OBJECTIVES: To explore the naturalistic outcome of the schizophrenics, we evaluated key clinical outcome-drop-out rate and readmission rate among the 33 risperidone and 17 conventional antipsychotics(such as haloperidol, chlorpromazine, mesoridazine) treated patients who met DSM-IV diagnostic criteria for schizophrenia at psychiatric department of a university hospital. METHOD: Outcome data was extracted from the charts of 50-schizophrenic patients who were more than 2 years after initiation of treatment with risperidone and conventional anti-psychotics. RESULTS: During over the 2-year period, the drop-out rate of the conventional antipsychotics treated schizophrenics was significantly higher than that of risperidone treated patients. But no significant factors(such as age, education level, duration of illness) were found between these two differently treated groups. Among the risperidone treated patients, the percentage of readmission was 18.2% at 12 months and 45.5% at 24 months. CONCLUSIONS: Reduced drop-out and rehospitalization rate suggest that risperidone was better than conventional antipsychotics among schizophrenic patients in a university hospital. Our data may contribute essential functional outcome information to assist the clinician in long-term, comparative treatment evaluation in 'real' clinical practice.
Antipsychotic Agents* ; Chlorpromazine ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Haloperidol ; Humans ; Outcome Assessment (Health Care)* ; Risperidone* ; Schizophrenia

PURPOSE: Multiple transfusions in patients with chronic anemia can result in excessive iron deposition in tissues and organs. Effective iron chelation therapy in chronically transfused patients can only be achieved when iron chelators remove sufficient amounts of iron equivalent to those accumulated in the body from transfusions, thus leading to maintain body iron load at a non-toxic level. This study was retrospectively carried out to investigate the effect of intravenous iron chelation therapy with deferoxamine in patients who have received multiple transfusions. METHODS: From March 2005 to January 2007, 15 patients who have received multiple transfusions were included in this study. Transfusion dependent patients were defined as those receiving >1 packed red blood cell (RBC) units/month for at least 6 months. They received intravenous deferoxamine for 7 days (10-30 mg/kg/day, 24 hour continuous infusions). Before and after deferoxamine infusions and 3 months later, we compared serum iron, TIBC, and ferritin in transfusion dependent patients and transfusion independent patients. RESULTS: There were 6 males and 9 females and their age range was 5.6-21.3 (median 8.3) years. Transfusion dependent patients were 7 and 8 were transfusion independent states after stem cell transplantation or chemotherapy. There was no significant change in ferritin level after deferoxamine treatment for the transfusion dependent patients but significant falling of ferritin level was observed for the transfusion independent patients 3 months later compared with baseline ferritin level (P=0.046). Some adverse events were observed but symptoms were mild and tolerable. CONCLUSION: Seven days of intravenous deferoxamine was safe and effective in transfusion independent patients. In transfusion dependent patients, chelation therapy should be maintained, in order to minimize or prevent iron accumulation and storage in the tissues.
Anemia ; Blood Transfusion ; Chelating Agents ; Chelation Therapy ; Deferoxamine* ; Drug Therapy ; Erythrocytes ; Female ; Ferritins ; Humans ; Injections, Intravenous ; Iron ; Male ; Retrospective Studies ; Stem Cell Transplantation

PURPOSE: The purpose of this study was to identify the clinical and pathological factors that differentiate pleomorphic invasive lobular carcinoma (PILC) from classic invasive lobular carcinoma (CILC). METHODS: We retrospectively reviewed the medical records of 65 patients (4.0% of all invasive breast cancer patients) who underwent surgical excision for invasive lobular carcinoma (ILC) between January 2000 and November 2013. All 65 patients were diagnosed with ILC with negative immunohistochemical staining for E-cadherin in the tumor cells. All hematoxylin and eosin slides of the previously diagnosed ILC were reviewed and confirmed by two expert pathologists and we compared the clinicopathologic features between CILC and PILC. RESULTS: CILC was found in 46 cases and PILC, in 19 cases. Of the mammographic findings, a mass or asymmetric density was the most common feature (42.3% of all ILC patients). The most common ultrasonographic feature was a mass (94.9% of all ILC patients). Tumor multiplicity was noted in 10 patients (15.4%) among all ILC patients; eight patients (17.4%) had CILC and two patients (10.5%) had PILC. PILC patients had more grade III tumors (66.7% vs. 8.7%, p=0.002) and a higher Ki-67 labeling index (55.6% vs. 18.6%, p=0.004) than those with CILC. There were no statistical differences in the type of combined in situ component, extensive intraductal component, tumor size, lymphovascular invasion, stage, hormone receptor status, human epidermal growth factor receptor 2 status, distribution of intrinsic subtype, or imaging findings. Moreover, there was no significant difference in survival between CILC and PILC. CONCLUSION: PILC showed more pathological aggressiveness than CILC in terms of tumor grade and Ki-67 index.
Breast ; Breast Neoplasms ; Cadherins ; Carcinoma, Lobular* ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Medical Records ; Receptor, Epidermal Growth Factor ; Retrospective Studies

PURPOSE: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. METHODS: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation (SpO2). When we evaluated 96 pairs of PaO2 and SpO2 measurements, oxygen saturation was 90-94% at a PaO2 of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a SpO2 90-94% (period II). Before the change in practice, high alarms for SpO2 were set at 100% and low alarms at 95% (period I). RESULTS: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in SpO2 targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. CONCLUSION: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.
Anoxia ; Birth Weight ; Blood Gas Analysis ; Dissociative Disorders ; Ductus Arteriosus, Patent ; Humans ; Hyperoxia ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Oximetry ; Oxygen ; Oxyhemoglobins ; Partial Pressure ; Pregnancy ; Retinopathy of Prematurity

Herein, we report five cases of occult breast cancer treated with axillary node dissection only, without breast surgery or whole breast radio-therapy. The patients complained of a large, hard mass in the axillary area, although no breast masses were palpable. Biopsy of the axillary mass was performed in each case, and histological examination showed a metastatic carcinoma. No malignant findings were observed by mammography or ultrasonography. Magnetic resonance imaging and systemic examinations revealed no extramammary primary lesions. All patients underwent axillary lymph node dissection without breast surgery, and were administered adjuvant chemotherapy but not whole breast radiation therapy. The median follow-up period was 56 months (range, 15–241 months). The patients were all alive with no evidence of disease at the end of the follow-up period.
Axilla ; Biopsy ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Magnetic Resonance Imaging ; Mammography ; Neoplasms, Unknown Primary ; Ultrasonography

PURPOSE: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. MATERIALS AND METHODS: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. RESULTS: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. CONCLUSION: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.
Axis, Cervical Vertebra ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Recurrence ; Retrospective Studies ; Spine ; Survival Rate

PURPOSE: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and METHODS: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of > or =45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). RESULTS: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. CONCLUSION: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.
Cisplatin ; Drug Therapy, Combination ; Endoscopy ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies

PURPOSE: p16 gene, mapped to the 9p21 chromosomal region, has emerged as a candidate tumor suppressor gene in human neoplasm. It is an inhibitor of cyclin-dependent kinase and inhibits Rb phosphorylation. In a variety of tumors including childhood acute lymphoblastic leukemia (ALL), deletion and/or mutation of the p16 gene has been found. Despite their high frequency, the prognostic importance of p16 alterations is still controversial in ALL and has been reported to be either unfavorable or similar to that of other patients. We studied the correlation between loss of p16 protein confirmed by immunohistochemical staining and clinical outcomes of patients diagnosed as ALL. METHODS: We performed an immunohistochemical staining for p16 protein in 74 cases of bone marrow biopsy slide initially diagnosed as ALL between January 1998 and December 2006. We reviewed the clinical manifestations, laboratory findings, treatment outcomes retrospectively. RESULTS: Of 74 slides, 12 were negative for p16 protein. Seven were males and 5 were females with a median age at diagnosis was 5.8 (1.3-18.8) years. Initial WBC were 17,225 (500-403,300)/microL. By immunologic surface marker analysis, 7 patients were early pre-B CALLA (+) and 5 patients were T-cell ALL. Two patients of intermediate risk group had relapsed and died. Three patients had family history of breast cancer. Four patients died and overall survival rates were 53.5+/-18.7%. CONCLUSION: Loss of p16 protein is supposed to be an independent risk factor of childhood ALL associated with poor outcomes. In clinical setting, the clinician must take into account p16 status, not only at the genomic but also at the protein level. Further clinical experience on thoroughly investigated cases will help a better understanding between p16 status and clinical outcomes.
Biopsy ; Bone Marrow ; Breast Neoplasms ; Female ; Genes, p16 ; Genes, Tumor Suppressor ; Humans ; Leukemia ; Male ; Phosphorylation ; Phosphotransferases ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Risk Factors ; Survival Rate ; T-Lymphocytes

BACKGROUND: World health organization (WHO) recommended daily sodium intake less than 2 g. To assess the validity of WHO recommendation, we investigated the relationship between daily sodium intake and obesity. METHODS: A total of 14,694 participants aged > or =19 years who had no missing data for nutrition, chronic disease, health behavior, economic status and laboratory findings from the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V), which was performed from 2010 to 2012. Obesity was defined as having a body mass index of 25 kg/m2 or higher. Daily sodium intake was calculated from 24 hour recall and divided into five categories (<2 g, 2-4 g, 4-6 g, 6-8 g, > or =8 g). The association between daily sodium intake and obesity was analyzed using multiple logistic regressions. RESULTS: Higher sodium intake in men had an increased risk of obesity with odds ratios (ORs) of 1.27 for 2-4 g intake (95% confidence interval [CI], 0.97-1.67), 1.40 for 4-6 g intake (95% CI, 1.07-1.85), 1.41 for 6-8 g intake (95% CI, 1.05-1.89), and 1.61 for > or =8 g intake (95% CI, 1.19-2.18), compared to men with less than 2 g intake, after adjusting for confounding factors. The P value for trend of ORs in each group for men was 0.020. In women, compared to the lesser than 2 g intake, only > or =8 g intake group had an OR of 1.28 (95% CI, 1.02-1.62) without showing significant P for trend (P value for trend=0.221) CONCLUSIONS: We found that sodium intake more than 2 g per day was independently related to the increased risk of obesity in men. Therefore, to minimize the risk of obesity, we suggest taking sodium less than 2 g per day.
Adult* ; Body Mass Index ; Chronic Disease ; Energy Intake ; Female ; Health Behavior ; Humans ; Logistic Models ; Male ; Nutrition Surveys ; Obesity* ; Odds Ratio ; Sodium* ; World Health Organization

Background: The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules. Methods: Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled. Results: Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change. Conclusion K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.