Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal. Materials and Methods: We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation. Results: Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529). Conclusion In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.

Purpose: To derive the optimized intraocular lens (IOL) constants from automated and manifest refraction after cataract surgery in Korean patients, and to evaluate whether there is a difference in optimized IOL constants according to the refraction method. Methods: This retrospective multicenter cohort study enrolled 4,103 eyes of 4,103 patients who underwent phacoemulsification and in-the-bag IOL implantation at 18 institutes. Optimized IOL constants for the SRK/T, Holladay, Hoffer Q, and Haigis formulas were calculated via autorefraction or manifest refraction of samples using the same biometry and IOL. The IOL constants derived from autorefraction and manifest refraction were compared. Results: Of the 4,103 eyes, the majority (62.9%) were measured with an IOLMaster 500 followed by an IOLMaster 700 (15.2%). A total of 33 types of IOLs were used, and the Tecnis ZCB00 was the most frequently used (53.0%). There was no statistically significant difference in IOL constants derived from autorefraction and manifest refraction when IOL constants were optimized with a large number of study subjects. On the other hand, optimized IOL constants derived from autorefraction were significantly smaller than those from manifest refraction when the number of subjects was small. Conclusions It became possible to use the IOL constants optimized from Koreans to calculate the IOL power. However, if the IOL constant is optimized using autorefraction in a small sample group, the IOL constant tends to be small, which may lead to refractive error after surgery.

Purpose: This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment. Materials and Methods: This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I-II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT. Results: With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding. Conclusion We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I-II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment.