The aim of this study was to analyze long-term survivals in patients with stage IB to IIA cervical cancer treated by neoadjuvant chemotherapy setting. Between February 1989 and January 1998, 94 women with previously untreated stage IB to IIA carcinoma of the uterine cervix who received cisplatin based neoadjuvant chemotherapy were enrolled in this study. All of patients with chemoresponse (complete response, n=15; partial response, n=47) and 16 patients with chemoresistance received radical surgery (RS group). The other 16 patients with chemoresistance received radiotherapy for definite treatment (RT group). In the RS group, the 10 yr survival estimation in patients with bulky tumors (diameter > or =4 cm, n=26) was similar to that with non-bulky tumors (83.3% vs. 89.3%, p=NS). In selected patients with chemoresistance, those treated by radiotherapy (n=16) showed significantly poorer survivals than those treated by radical surgery (n=16) [10 yr survival rates of RT (25%) vs. RS (76.4%), p=0.0111]. Our results support that a possible therapeutic benefit of neoadjuvant chemotherapy plus radical surgery is only in patients with bulky stage IB to IIA cervical cancer. In cases of chemoresistance, radical surgery might be a better definite treatment option.
Uterine Cervical Neoplasms/drug therapy/*radiotherapy/*surgery ; Treatment Outcome ; Survival Analysis ; Retrospective Studies ; Prognosis ; Neoplasm Staging ; Multivariate Analysis ; Middle Aged ; Humans ; Follow-Up Studies ; Fluorouracil/administration & dosage ; Female ; Drug Resistance, Neoplasm ; Combined Modality Therapy ; Cisplatin/administration & dosage ; Chemotherapy, Adjuvant ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Adult

Benign paroxysmal positional vertigo (BPPV) is a disorder caused by otoconia in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head. BPPV with simultaneous ipsilateral sudden deafness is rare. A 82-year-old woman was admitted due to acute onset of right ear hearing impairment, tinnitus, and vertigo for a day. She had a history of hypertension for 5 years. On neurologic examination, spontaneous nystagmus was not observed. However, roll test showed direction-changing horizontal geotrophic nystagmus. Vestibular function test showed positional nystagmus compactable with right horizontal semicircular canal-BPPV (canalolithiasis). Brain MRI was unremarkable. Neuro-otologic evaluation reveals right ear sensorineural deafness. Barbecue maneuver was applied for treatment for BPPV. Dexamethasone 10 mg intravenous for 5 days after then methylprednisolone orally for 5 days was done. Vertigo improved after treatment, but deafness still remain. We report a case of sudden deafness concurrent with ipsilateral BPPV and consider the mechanisms of this lesion.
Aged, 80 and over ; Brain ; Deafness ; Dexamethasone ; Ear ; Ear, Inner ; Female ; Head ; Hearing Loss ; Hearing Loss, Sudden ; Humans ; Hypertension ; Methylprednisolone ; Neurologic Examination ; Nystagmus, Physiologic ; Otolithic Membrane ; Tinnitus ; Vertigo ; Vestibular Function Tests

OBJECTIVE: The purpose of the current study was to evaluate survival outcome according to the expression status of CD73 in patients with epithelial ovarian cancer. METHODS: A total of 167 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for CD73, CD8, FoxP3, and CD68 was performed using tissue microarray made with paraffin embedded tissue block. RESULTS: Among the enrolled patients, 29.9% of patients (n=50) showed negative expression for CD73, whereas 70.1% of patients (n=117) showed positive expression for CD73. The CD73 positive group showed better prognosis compared to the CD73 negative group (5-year overall survival of CD73 positive group, 73.0%; that of CD73 negative group, 50.1%; p=0.023). CD73 was more frequently expressed in mucinous adenocarcinoma and clear cell carcinoma compared to serous or endometrioid adenocarcinoma. In addition, CD73 overexpressions were more frequently detected in patients with known good prognostic factors, i.e., low stage, well/moderate differentiation, negative peritoneal cytology, no lymphovascular involvement, and no macroscopic residual tumor after debulking surgery. There was significantly more infiltration of regulatory T cells in the CD73 negative group compared to the CD73 positive group. CONCLUSION: Good prognosis in patients with overexpression of CD73 may be due to that overexpression of CD73 was more frequently observed in epithelial ovarian cancer patients with known good prognostic factors. Therefore, this result means that favorable differentiation and stage have more influence on survival outcome than adverse effect of CD73 per se.
5'-Nucleotidase ; Adenocarcinoma, Mucinous ; Carcinoma, Endometrioid ; Humans ; Medical Records ; Neoplasm, Residual ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms ; Paraffin ; Prognosis ; Retrospective Studies ; T-Lymphocytes, Regulatory

OBJECTIVE: The purpose of the current study was to evaluate survival outcome according to the expression status of CD73 in patients with epithelial ovarian cancer. METHODS: A total of 167 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for CD73, CD8, FoxP3, and CD68 was performed using tissue microarray made with paraffin embedded tissue block. RESULTS: Among the enrolled patients, 29.9% of patients (n=50) showed negative expression for CD73, whereas 70.1% of patients (n=117) showed positive expression for CD73. The CD73 positive group showed better prognosis compared to the CD73 negative group (5-year overall survival of CD73 positive group, 73.0%; that of CD73 negative group, 50.1%; p=0.023). CD73 was more frequently expressed in mucinous adenocarcinoma and clear cell carcinoma compared to serous or endometrioid adenocarcinoma. In addition, CD73 overexpressions were more frequently detected in patients with known good prognostic factors, i.e., low stage, well/moderate differentiation, negative peritoneal cytology, no lymphovascular involvement, and no macroscopic residual tumor after debulking surgery. There was significantly more infiltration of regulatory T cells in the CD73 negative group compared to the CD73 positive group. CONCLUSION: Good prognosis in patients with overexpression of CD73 may be due to that overexpression of CD73 was more frequently observed in epithelial ovarian cancer patients with known good prognostic factors. Therefore, this result means that favorable differentiation and stage have more influence on survival outcome than adverse effect of CD73 per se.
5'-Nucleotidase ; Adenocarcinoma, Mucinous ; Carcinoma, Endometrioid ; Humans ; Medical Records ; Neoplasm, Residual ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms ; Paraffin ; Prognosis ; Retrospective Studies ; T-Lymphocytes, Regulatory

OBJECTIVES: Internet addiction or pathologic internet use is one of the major mental health problems in children and adolescents in Korea. Internet addiction is defined as uncontrollable, markedly time-consuming internet use, which lasts for a period of at least six months. Internet addiction results in poor academic performance and negative parent-child relationships. By using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), we investigated the effects of internet addiction on functional changes occurring in the adolescent brain. METHODS: Adolescent patients with an internet addiction (4 boys and 2 girls; 15.6+/-1.2 years) participated in this study. Eight healthy young adults (5 males and 3 females; 18-30 years old) with no previous history of psychiatric illness also participated as normal controls. Brain FDG-PET data was obtained with the participants in the resting condition and with no addictive stimuli. RESULTS: Statistic parametric mapping analysis of the brain FDG-PET data revealed hypometabolic changes in the visual information processing circuits and hypermetabolic changes in the prefrontal areas in the adolescents with internet addiction, as compared with normal controls (p<.001). CONCLUSION: These results suggest a neuronal adaptation to excessive visual stimulation and synaptic plasticity due to internet addiction.
Adolescent ; Automatic Data Processing ; Brain ; Child ; Humans ; Internet ; Korea ; Male ; Mental Health ; Neurons ; Parent-Child Relations ; Photic Stimulation ; Plastics ; Young Adult

BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) has been associated with favorable clinical outcome in breast cancer patients. However, the possibility that the prognostic significance of pCR differs among various definitions has not been established. METHODS: We retrospectively evaluated the pathologic response after NAC in 353 breast cancer patients and compared the prognoses after applying the following different definitions of pCR: ypT0/is, ypT0, ypT0/is ypN0, and ypT0 ypN0. RESULTS: pCR was significantly associated with improved distant disease-free survival (DDFS) regardless of the definition (ypT0/is, p = .002; ypT0, p = .008; ypT0/is ypN0, p < .001; ypT0 ypN0, p = .003). Presence of tumor deposits of any size in the lymph nodes (LNs; ypN ≥ 0(i+)) was associated with worse DDFS (ypT0 ypN0 vs ypT0 ypN ≥ 0(i+), p = .036 and ypT0/is ypN0 vs ypT0/is ypN ≥ 0(i+), p = .015), and presence of isolated tumor cells was associated with decreased overall survival (OS; ypT0/is ypN0 vs ypT0/is ypN0(i+), p = .013). Residual ductal carcinoma in situ regardless of LN status showed no significant difference in DDFS or OS (DDFS: ypT0 vs ypTis, p = .373 and ypT0 ypN0 vs ypTis ypN0, p = .462; OS: ypT0 vs ypTis, p = .441 and ypT0 ypN0 vs ypTis ypN0, p = .758). In subsequent analysis using ypT0/is ypN0, pCR was associated with improved DDFS and OS in triple-negative tumors (p < .001 and p = .003, respectively). CONCLUSIONS: Based on our study results, the prognosis and rate of pCR differ according to the definition of pCR and ypT0/is ypN0 might be considered a more preferable definition of pCR.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Disease-Free Survival ; Drug Therapy* ; Humans ; Lymph Nodes ; Polymerase Chain Reaction ; Prognosis ; Retrospective Studies

PURPOSE: PIK3CA mutation is considered to be a possible cause for resistance to neoadjuvant chemotherapy (NAC) in human epidermal growth factor receptor 2 (HER2)-positive breast cancer. We investigated the association between PIK3CA mutations and the outcome of NAC in HER2-positive breast cancers. METHODS: A total of 100 HER2-positive breast cancer patients who had undergone NAC and surgery between 2004 and 2016 were examined. Mutation status was sequentially assessed in pre-NAC, post-NAC, and recurrent specimens taken from these patients. RESULTS: PIK3CA mutations were identified in the sequential specimens of 17 patients (17.0%). These 17 patients experienced shorter disease-free survival (DFS) than the rest of the patients (58.3 months vs. 119.3 months, p=0.020); however, there was no significant difference in pathologic complete response (pCR) and overall survival (OS) (pCR, 17.6% vs. 33.7%, p=0.191; OS, 84.5 months vs. 118.0 months, p=0.984). While there was no difference in pCR between the wild-type and mutant PIK3CA groups in pre-NAC specimens (25.0% vs. 31.8%, p=0.199), PIK3CA mutations correlated with lower pCR in post-NAC specimens (0.0% vs. 24.3%, p < 0.001). Multivariate analysis revealed significantly worse DFS in the mutant PIK3CA group than in the wild-type group (hazard ratio, 3.540; 95% confidence interval, 1.001–12.589; p=0.050). Moreover, the DFS curves of the change of PIK3CA mutation status in sequential specimens were significantly different (p=0.016). CONCLUSION: PIK3CA mutation in HER2-positive breast cancer was correlated with a lower pCR rate and shorter DFS. These results suggest that PIK3CA mutation is a prognostic marker for NAC in HER2-positive breast cancer, especially in post-NAC specimens.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Drug Therapy ; Epidermal Growth Factor* ; Humans ; Humans* ; Multivariate Analysis ; Neoadjuvant Therapy* ; Phosphatidylinositol 3-Kinases ; Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor* ; Receptor, ErbB-2

OBJECTIVE: Tremor is a common movement disorder that interferes with daily living. Since the medication for tremor has some limitations, surgical intervention is needed in many patients. In certain patients who cannot undergo aggressive surgical intervention, Gamma Knife thalamotomy (GKT) is a safe and effective alternative. METHODS: From June 2012 to August 2013, 7 patients with an intractable tremor underwent GKT. Four of these 7 patients had medical comorbidities, and 3 patients refused to undergo traditional surgery. Each patient was evaluated with the modified Fahn-Tolosa-Marin tremor rating scale (TRS) along with analysis of handwriting samples. All of the patients underwent GKT with a maximal dose of 130 Gy to the left ventralis intermedius (VIM) nucleus of the thalamus. Follow-up brain MRI was performed after 3 to 8 months of GKT, and evaluation with the TRS was also performed. RESULTS: Six patients showed objective improvement in the TRS score. Excluding one patient who demonstrated tremor progression, there was 28.9% improvement in the TRS score. However, five patients showed subjective improvement in their symptoms. On comparing the TRS scores between follow-up periods of more and less than 4 months, the follow-up TRS score at more than 4 months of GKT was significantly improved compared to that at less than 4 months of GKT. Follow-up MRI showed radiosurgical changes in 5 patients. CONCLUSION: GKT with a maximal dose of 130 Gy to the VIM is a safe procedure that can replace other surgical procedures.
Brain ; Comorbidity ; Follow-Up Studies ; Handwriting ; Humans ; Magnetic Resonance Imaging ; Movement Disorders ; Thalamus ; Tremor*

Platelet-rich plasma (PRP) contains growth factors that promote tissue regeneration. Previously, we showed that heparin-conjugated fibrin (HCF) exerts the sustained release of growth factors with affinity for heparin. Here, we hypothesize that treatment of skin wound with a mixture of PRP and HCF exerts sustained release of several growth factors contained in PRP and promotes skin wound healing. The release of fibroblast growth factor 2, platelet-derived growth factor-BB, and vascular endothelial growth factor contained in PRP from HCF was sustained for a longer period than those from PRP, calcium-activated PRP (C-PRP), or a mixture of fibrin and PRP (F-PRP). Treatment of full-thickness skin wounds in mice with HCF-PRP resulted in much faster wound closure as well as dermal and epidermal regeneration at day 12 compared to treatment with either C-PRP or F-PRP. Enhanced skin regeneration observed in HCF-PRP group may have been at least partially due to enhanced angiogenesis in the wound beds. Therefore, this method could be useful for skin wound treatment.
Animals ; Blotting, Western ; *Cell Proliferation ; Dermis/cytology/metabolism ; Female ; Fibrin/*metabolism ; Fibroblast Growth Factor 2/genetics/metabolism ; Heparin/metabolism ; Immunoenzyme Techniques ; Intercellular Signaling Peptides and Proteins/*secretion ; Mice ; Mice, Inbred BALB C ; Platelet-Rich Plasma/*metabolism ; Proto-Oncogene Proteins c-sis/genetics/metabolism ; RNA, Messenger/genetics ; Real-Time Polymerase Chain Reaction ; Regeneration ; Skin/*cytology/*metabolism ; Vascular Endothelial Growth Factor A/genetics/metabolism ; Wound Healing/*physiology

OBJECTIVE: The purpose of this study was to evaluate whether the preoperative serum level of CA 125 in patients with endometrial cancer could provide an additional information on determining the extent of surgical staging and which cutoff value might be optimal in this respect. METHODS: CA 125 levels were measured in 42 patients with endometrial carcinoma who underwent surgery at our institution between March 2000 and December 2004. Operative and postoperative pathologic findings were then correlated with preoperative CA 125 values. Statistical analysis was performed using Mann-Whitney U test, Kruskal-Wallis test, chi-square test and logistic regression model to evaluate the association of preoperative CA 125 levels with various factors. Receiver operating characteristic (ROC) curve was used to determine which cutoff value of the preoperative CA 125 was optimal. RESULTS: Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, extrauterine disease, and lymph node metastasis (P<0.05). The ROC curve showed that the best cutoff values to expect extrauterine disease and lymph node metastasis were 30 U/mL and 50 U/mL, respectively. Using the above cutoff value, the sensitivity and specificity for screening extrauterine disease were found to be 80% and 73%, and for lymph node metastasis to be 100% and 87%, respectively. CONCLUSION: Our data provide evidence that extrauterine disease can be strongly predicted at a preoperative CA 125 level of >30 U/mL whereas lymph node metastasis can be predicted at the CA 125 level of >50 U/mL.
Decision Making* ; Endometrial Neoplasms* ; Female ; Humans ; Logistic Models ; Lymph Node Excision* ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; ROC Curve ; Sensitivity and Specificity