Humans ; Female ; Mastectomy, Segmental ; Margins of Excision ; Reoperation ; Breast Neoplasms/surgery* ; Retrospective Studies ; Carcinoma, Ductal, Breast/surgery* ; Neoplasm Recurrence, Local

Background: The digits-in-noise (DiN) test is a speech-in-noise test to measure speech recognition threshold in noise adaptively. Herein, we aimed to develop the Korean version of the DiN test to provide a useful hearing screening tool for clinical as well as research purposes.Method: Spoken monosyllabic digits from 0 to 9 were recorded by a female speaker. The test list was constructed such that each digit was placed in three different positions. An optimization procedure was conducted to equate the audibility of each digit. After the optimization, the smartphone application for the Korean DiN (K-DiN) test was developed. For the adaptive measurement procedure, 180 new DiN triplets separated into six lists of 30 were created. Mean speech recognition threshold values for each list and session were measured to examine the test-retest and training effects of the test materials. In addition, speech recognition threshold values measured by different devices were compared to determine whether the speech recognition threshold levels differed. Results: Optimization results showed that the mean speech recognition threshold and slope were −11.55 dB signal-to-noise ratio and 10.21%/dB, respectively, which are comparable to levels shown in different-language versions of the DiN test. The results of the test-retest and training effects revealed no significant differences among the test sessions and lists. Additionally, the mean speech recognition threshold values measured by four different devices were not different, indicating the reliability of the test materials. Conclusion We believe this study is the first to attempt to develop a K-DiN test. Our results indicate that this test can be used as a potentially reliable hearing screening tool.

PURPOSE: The optimal indications for omitting adjuvant radiation therapy (RT) after breast-conserving surgery are still controversial in ductal carcinoma in situ (DCIS) of the breast. The purpose of this study was to validate the role of postoperative RT in DCIS patients aged ≤50 years and with tumor margin widths of <1 cm, both of which have been proven to be high-risk features for recurrence in cohorts not receiving RT. METHODS: Using two multicenter retrospective studies on DCIS, a pooled analysis was performed among patients aged ≤50 years and with margin widths < 1 cm. All patients underwent breast-conserving surgery. Two hundred thirty-two patients received postoperative RT, while 54 did not. The median follow-up period was 77 months (range, 2–190 months) and 70 months (range, 5–166 months) in the patients who received RT and those who did not, respectively. RESULTS: The patients who received RT had larger tumors (p < 0.001), higher nuclear grade (p < 0.001), closer margin width (p < 0.001), and negative estrogen receptor expression (p=0.010) compared with those who did not receive RT. During the follow-up period, there were 17 ipsilateral breast tumor recurrences (IBTRs) as follows: invasive carcinoma in 10 patients and DCIS in seven. In the univariate analysis, the treatment with RT and human epidermal growth factor receptor 2 (HER2) status were significant risk factors for IBTR. The 7-year IBTR rates with and without postoperative RT were 3.6% and 13.1%, respectively (p=0.008). HER2-positive tumors had a higher IBTR rate than the HER2-negative tumors (7-year rate, 13.6% vs. 3.9%; p=0.003). CONCLUSION: Postoperative RT following breast-conserving surgery significantly reduced the 7-year IBTR rate in the DCIS patients aged ≤50 years and with margin widths < 1 cm. HER2 positivity was associated with increased IBTR in these patients.
Age Factors ; Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Cohort Studies ; Estrogens ; Follow-Up Studies ; Humans ; Mastectomy, Segmental* ; Radiation Oncology* ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Recurrence ; Retrospective Studies ; Risk Factors

Transcatheter arterial chemoembolization (TACE) has become an effective alternative treatment strategy for patients with inoperable hepatocellular carcinoma (HCC). Although TACE is relatively safe, acute respiratory distress syndrome associated with pulmonary lipiodol embolism is a rare and potentially fatal complication. We report a rare case of acute respiratory distress syndrome after TACE for inoperable HCC. A 75-year-old man, with huge HCC in right lobe, was treated by TACE for the first time. Seven hours after uneventful TACE procedure, he felt dyspneic and his oxygen saturation recorded by pulse oximetry (SpO2) fell to 80% despite of applying non-rebreathing mask. He underwent mechanical ventilation with a protective ventilatory strategy. We experienced a case of acute respiratory distress syndrome after TACE for HCC.
Carcinoma, Hepatocellular ; Embolism ; Ethiodized Oil ; Humans ; Masks ; Oximetry ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult

Lemierre syndrome is caused by acute oropharyngeal infections with secondary septic thrombophlebitis of the internal jugular vein and is characterized by frequent metastatic infections. A 56-year-old man presented with severe reddish inflammatory swelling of the right cervical soft tissue. Thrombophlebitis in the right internal jugular vein and multiple pulmonary embolisms were identified on neck and chest computed tomography (CT). He was treated with antibiotics and heparin for 4 weeks and then discharged without other complications.
Anti-Bacterial Agents ; Heparin ; Humans ; Jugular Veins ; Lemierre Syndrome ; Middle Aged ; Neck ; Pulmonary Embolism ; Thorax ; Thrombophlebitis ; Thrombosis

BACKGROUND/AIMS: Elderly patients with advanced gastric cancer (AGC) have generally been excluded from clinical trials, and there are few data available on the treatment of these patients. The efficacy of palliative S-1 monotherapy as a first-line treatment regimen for elderly patients has not been well elucidated. METHODS: For this study, 25 AGC patients were enrolled between January 1, 2007 and March 31, 2009; 4 cases were recurrent AGC and 21 cases were metastatic AGC at the time of diagnosis. These patients received S-1 therapy at a dose of 40 mg/m2 twice daily for 14 days every 3 weeks. All of the patients were older than 70 years. RESULTS: The median follow-up duration, the median progression-free survival, and the overall survival time were 8.7 months (range, 4.9 to 12.5 months), 4.9 months (range, 3.5 to 6.3 months), and 10.8 months (range, 6.6 to 15.0 months), respectively. Grade 3/4 nonhematologic toxicities were rare. Grade 3/4 neutropenia was noted in two patients. The partial response rate was 21.7% and stable disease was observed in 34.8% of the patients. Two patients (8%) died due to chemotherapy-associated toxicity during treatment (septic shock/intracranial hemorrhage). CONCLUSIONS: Oral S-1 chemotherapy seems to be effective as a first-line treatment regimen for elderly patients with metastatic or recurrent AGC. However, elderly patients receiving S-1 treatment should undergo continuous toxicity monitoring, since they are highly susceptible to adverse effects.
Aged ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neutropenia ; Stomach Neoplasms

BACKGROUND: We wanted to evaluate whether a minimal extrathyroid extension (METE) is associated with the clinicopathological parameters that are indicative of a poor prognosis, including lymph node metastasis, distant metastasis at the time of the initial diagnosis and tumor recurrence, in patients with papillary thyroid carcinoma (PTC), and especially in the patients with papillary thyroid microcarcinoma (PTMC). METHODS: We retrospectively evaluated the medical records of patients with PTC and who had undergone total thyroidectomy with/without subsequent 131I remnant ablation at the Korea Cancer Center Hospital from January 1998 through December 2005. A total of 557 patients with PTC were enrolled in the study. We excluded 13 patients with an unknown status of extension and 29 patients with massive ETE. RESULTS: Of the 515 patients, 401 were found to have a METE. We analyzed the 464 patients who were without distant metastasis at the time of the initial diagnosis and who had a follow-up duration of more than 6 months. METE was not significantly associated with tumor recurrence during the follow-up period (median follow-up period: 122 months, range: 6-142 months): 8% vs. 15% of the patients with and without METE had tumor recurrence, respectively (P = 0.069 by the log-rank test). We analyzed the effect of tumor size in the patients with METE. Size was not significantly associated with tumor recurrence (P = 0.374 by the log-rank test). CONCLUSION: These findings suggest that METE might not be a prognostic factor to predict tumor recurrence in patients with PTC, including PTMC.
Carcinoma ; Carcinoma, Papillary ; Factor IX ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

A 43-yr-old patient visited our department with intermittent chest pain he had suffered with for the past 2 months. Chest CT showed an egg shaped mass in the left chest wall. Local resection was performed for distinguishing the mass from a neurogenic tumor. The diagnosis was periosteal Ewing sarcoma of the rib. Since there was no evidence of metastasis based on the PET-CT, a 2nd operation was done with wide resection and thoracoplasty. The patient was then treated with combined chemotherapy. There has been no local recurrence for the last 1 year. The patient's age and tumor origin were distinct from the usual characteristics of Ewing's sarcoma. Periosteal Ewing's sarcoma of the rib has rarely been reported. We report here on a case of periosteal Ewing's sarcoma of the rib along with a review of the relevant medical literature.
Chest Pain ; Humans ; Neoplasm Metastasis ; Ovum ; Recurrence ; Ribs ; Sarcoma, Ewing ; Thoracic Wall ; Thoracoplasty ; Thorax

BACKGROUND: The gut is an important area for inflammatory responses. Gut manipulation during open laparotomy compared with laparoscopic surgery, increases the inflammatory responses. Laparoscopic assisted colectomy (LC) with less bowel manipulation might minimize the inflammatory responses and oxidative stress, and offer a faster postanesthetic recovery than an open colectomy (OC). This study evaluated the effect of N-acetyl-cysteine (NAC), an antioxidant, on the recovery after colectomy. METHODS: 116 colorectal tumor patients were reviewed retrospectively. The patients were divided into 3 groups; LC by surgeon A (A - L), OC by surgeon A (A - O) and OC by surgeon B (B - O). The postanesthetic recovery scores (PARS) were compared. In the prospective randomized controlled trial, the colorectal tumor patients were assigned to one of four groups; laparoscopic assisted colectomy (L - N) with NAC infusion (L + N), open colectomy (O - N) with NAC infusion (O + N). In the NAC groups, NAC (5 mg/kg/h) was infused after intubation to extubation. The PARS were compared. RESULTS: In the retrospective study, the time to reach 10 points, which satisfies the discharge criteria in the PACU, was significantly lower in the A-L group than in the other groups. In the prospective study, the time to 10 points was shorter in the O + N group than in the O-N group. NAC offered no added benefits to the L + N and L-N groups. CONCLUSIONS: NAC offered faster recovery in the OC group but not in the LC group.
Colectomy ; Colorectal Neoplasms ; Colorectal Surgery* ; Humans ; Intubation ; Laparoscopy ; Laparotomy ; Oxidative Stress ; Prospective Studies ; Retrospective Studies

BACKGROUND: Despite of numerous researches on the mechanisms and new therapeutic methods of chronic pain, patients are still suffering even with the help of opioids. In recent years, however, with the development of molecular-biology cell transplantation gives us a new chance for treating intractable chronic pain. The major purpose of the present study was to determine if the chromaffin cells have robust analgesic effects in the spinal atlanto-occipital subarachnoid space even without nicotine stimulation. METHODS: In order to determine whether cultured bovine adrenal medullary chromaffin cells transplanted in the spinal cord can produce analgesic effects, we purified adrenal medullary chromaffin cells and implanted them into the subarachnoid space of rats' (n = 10) spinal cord without immunosuppression, and investigated the hot sensitivity of rats' hind-paw by a light-beam test. RESULTS: It was found that compared with the control group, hot response latency of the group which received adrenal medullary chromaffin cells had increased at 14 days and the analgesic efficacy was maintained for at least 3 months. CONCLUSIONS: Adrenal medullary chromaffin cells transplanted in the rats' spinal cord may provide a permanent and locally available source of neuropeptides for the relief of intractable pain. Furthermore, these kinds of analgesic effect even produced without any stimulation such as nicotine.
Analgesics, Opioid ; Animals ; Cell Transplantation ; Chromaffin Cells* ; Chronic Pain ; Humans ; Immunosuppression ; Neuropeptides ; Nicotine ; Pain, Intractable ; Rats* ; Reaction Time ; Spinal Cord* ; Subarachnoid Space ; Transplants