PURPOSE: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. MATERIALS AND METHODS: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. RESULTS: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). CONCLUSION: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.
Biopsy ; Carcinosarcoma ; Follow-Up Studies ; Humans ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors

PURPOSE: The prevalence of congenital heart anomalies is known to be higher in patients with clefts of the lip and/or palate(CL/P). The purpose of this study was to determine the prevalence and type of congenital heart anomalies in patients with CL/P. METHODS: We investigated congenital heart anomalies in 756 patients presented with CL/P from January 1986 to December 1997 by reviewing their clinical records. RESULTS: The prevalence rate of congenital heart anomalies in patients with CL/P was 4.2% (32 of 756). Congenital heart anomalies in those were ventricular septal defect (15 of 32), atrial septal defect (4 of 32), tetralogy of Fallot (3 of 32), patent ductus arteriosus (2 of 32), double outlet right ventricle(2 of 32), pulmonary stenosis (1 of 32), transposition of the great arteries (1 of 32), pulmonary atresia (1 of 32), coarctation of aorta (1 of 32), anomalous systemic venous drainage (1 of 32), and aortic aneurysm with patent ductus arteriosus (1 of 32). It was significant that the prevalence rate of congenital heart anomalies in cleft palate with or without cleft lip (CP+/-L) was 6.8% (30 of 442), because the prevalence rate of congenital heart anomalies in cleft lip alone was not higher than in normal population (0.6%; 2 of 314). Of the 30 patients with congenital heart anomalies, 12 patients (40 %) had conotruncal defects. CONCLUSION: The prevalence of congenital heart anomalies in patients with CP+/-L was much higher than normal population. Cardiac defects were predominantly conotruncal. Predominance of conotruncal defects among congenital heart anomalies in those was associated with abnormalities of neural crest cell proliferation and migration developing into conotruncus and palate.
Aortic Aneurysm ; Aortic Coarctation ; Arteries ; Cell Proliferation ; Cleft Lip ; Cleft Palate ; Drainage ; Ductus Arteriosus, Patent ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Lip* ; Neural Crest ; Palate* ; Prevalence ; Pulmonary Atresia ; Pulmonary Valve Stenosis ; Tetralogy of Fallot

To avoid improper tumor volume contouring in radiation therapy (RT) and other invasive procedures, we report a case of uterine adenomyosis showing increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) mimicking malignant tumor in a 44-year-old woman during concurrent chemoradiation therapy (CCRT) for uterine cervical cancer. The adenomyosis was not associated with her menstrual cycle or with normal endometrium uptake, and it resolved one month after completion of RT. This case indicates that uterine adenomyosis in a premenopausal woman may show false positive uptake of 18FDG-PET/CT associated with CCRT.
Adenomyosis ; Adult ; Endometrium ; Female ; Humans ; Menstrual Cycle ; Positron-Emission Tomography ; Tumor Burden ; Uterine Cervical Neoplasms

PURPOSE: To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). RESULTS: The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (> or =50 Gy10) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (< or =1 month) with improved DPFS, and WLRT with improved DPFS and OS, respectively. CONCLUSION: High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.
Brain ; Breast Neoplasms* ; Breast* ; Disease Progression ; Disease-Free Survival ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies

BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.
Aged* ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Humans ; Lung Diseases ; Postoperative Complications ; Smoke ; Smoking ; Spirometry

Aneurysmal subarachnoid hemorrhage in a pregnant woman is a rare catastrophic situation that places both the mother and fetus at high risk. When this situation arises, numerous relevant issues must be individualized in the effort to reduce hazards threatening both the mother and fetus. A 29 year old woman who was 39 weeks pregnant presented with a subarachnoid hemorrhage, secondary to a ruptured left ophthalmic artery aneurysm. Following initial full recovery, the simultaneous sequence of cesarean section followed by aneurysmal clipping was electively underwent. Successful maternal and perinatal outcome was achieved. The anesthetic management of the case is described and discussed.
Adult ; Anesthesia ; Aneurysm* ; Cesarean Section* ; Female ; Fetus ; Humans ; Intracranial Aneurysm* ; Mothers ; Ophthalmic Artery ; Pregnancy ; Pregnant Women ; Subarachnoid Hemorrhage

With time after transplantation, the recurrence of IgA nephropathy (IgAN) becomes a relevant cause of graft dysfunction and failure. However, only limited information has been published regarding the related clinical and histological features. In this article, we review studies on recurrent IgAN in the English literature and describe our own clinical experience. The clinical and histological features related to recurrence are still indeterminate, but features associated with graft dysfunction include proteinuria, glomerulosclerosis, mesangial proliferation, glomerular crescents and interstitial fibrosis.
Glomerulonephritis, IGA/*physiopathology/*surgery ; Humans ; Kidney/*physiopathology ; *Kidney Transplantation ; Recurrence ; Research Support, Non-U.S. Gov't ; Transplantation, Homologous

Smell used to be a common diagnostic tool in medicine, and physicians were trained to use their sense of smell during their medical training. Latterly, odor disgnostics have been relegated to secondary status as a diagnostic method. Array-based gas sensors ("Electronic Nose") now offer the potential of a robust analytical approach to exhaled breath analysis for medical use. Many diseases are accompanied by characteristic odor, and their recognition can provide diagonostic clues, guide the laboratory evaluation, and affect the choice of immediate therapy. We are developing an intelligent sensor system for non-invasive health care monitoring combined laboratory based sensor module, pattern recognition subsystem and non-invasive sampling of volatile emitted from a patient into a highly intelligent sensor system that allows the rapid processing of these samples. It is capable to assist early and rapid disgnosis of changes in state of patient, and aid decision making by medical personnel in the treatment of such patients. In this paper, we introduce exhaled breath analysis for potential primary lung disease screening using electronic nose system incorporating an automated solid-phase microextraction (SPME) desorption to enable the system to be used. Aiming to increase the sensitivity, SPME preconcentration is used for sampling of headspace air and the response of sensor module to variable concentration of volatile emitted from SPME fiber is evaluated. The initial result shows the distinguished difference between the lung cancer patients and healthy normal individuals according to the analysis of the respective expiratory gases.
Decision Making ; Delivery of Health Care ; Electronic Nose* ; Exhalation ; Gases ; Humans ; Lung Diseases* ; Lung Neoplasms ; Mass Screening ; Odors ; Smell

PURPOSE: To evaluate the short-term therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain, and to determine patient satisfaction. MATERIALS AND METHODS: Forty-four multiparous women aged 26-73 (mean, 39.9) years in whom chronic pelvic pain due to unknown causes had lasted for more than six months, and whose gynecologic findings and laboratory data suggested PCS, underwent transabdominal or transvaginal ultrasonography and selective ovarian venography. PSC was finally diagnosed in 21 of th 44, who underwent 22 ovarian vein embolizations (in one case, bilaterally). The simple pain rating system was used at admission, with a 'minimal' or 'moderate' grade representing discomfort in daily life, and 'severe' indicating the need for medication. Indications for coil embolization included dilatation of the ovarian vein to a diameter of more than 6 mm, reflux involving an incompetent valve, congestion of the pelvic venous plexus (involving the stasis of contrast media), and/or opacification of the ipsilateral internal iliac vein (or contralateral filling). Embolizations were undertaken using coils of optimal size and number, and the mean follow-up period was 217 (31-267) days. By means of a telephone questionnaire, the outcome was classified as a cure, pain reduction, or 'no change, or aggravation', and on the basis of whether or not they would opt for the same treatment, or recommend embolization to others, patient satisfaction was graded as 'substantial', 'moderate', or 'absent. RESULTS: Venous occlusion was confimed at postembolization venography in all 22 cases. Clinical treatment led to symptomatic relief in 76.2% of patients a cure in 33.3% (7/21), pain reduction in 42.9% (9/21) and no imchange, or aggravation, in 23.8% (5/21). Eighteen patients (85.8%) were very (9/21, 42.9%) or moderately (9/21, 42.9%) satisfied with coil embolization. In two, the coil migrated, and was successfully retrieved using a snare loop. CONCLUSION: In this study, ovarian vein embolization using coils for PCS appeared to be both safe and effective in controlling pain. If other causes of pelvic pain are absent, it is thought to be a valuable alternative to surgical procedures.
Dilatation ; Embolization, Therapeutic ; Estrogens, Conjugated (USP)* ; Female ; Follow-Up Studies ; Humans ; Iliac Vein ; Patient Satisfaction ; Pelvic Pain ; Phlebography ; Surveys and Questionnaires ; SNARE Proteins ; Telephone ; Ultrasonography ; Veins*

The status of intestinal parasitic infections and seroprevalence of cystic echinococcosis in the inhabitants in Dornod and Selenge, Mongolia, was observed with stool and serum samples from 165 and 683 residents from August 9 to August 15, 2003. A total of 10 inhabitants (6.1%) were found to be infected with protozoan cysts or oocysts by stool examinations; 7, 1 and 2 cases with Entamoeba coli, Giardia lamblia and Cryptosporidium parvum, respectively. A total of 62 people (9.1%) revealed significantly high levels of specific antibodies against Echinococcus granulosus by enzyme-linked immunosorbent assay (ELISA). The surveyed areas are rural areas and the sanitized tab water is not available. There is a possibility of endemic transmission of water-borne protozoan diseases in these areas. The clinical echinococcosis is needed to be searched from the seropositive inhabitants.
Protozoan Infections/*epidemiology/parasitology ; Mongolia/epidemiology ; Humans ; Giardia lamblia/isolation & purification ; Gastrointestinal Diseases/*epidemiology/*parasitology ; Entamoeba/isolation & purification ; Echinococcosis/*epidemiology ; Cryptosporidium parvum/isolation & purification ; Animals