Purpose: This study aimed to evaluate the incidence and prognosis of second non-breast primary cancer (SNBPC) among Korean survivors of breast cancer. Materials and Methods: Data from the Korean National Health Insurance Service were searched to identify women who received curative surgery for initial breast cancer (IBC) between 2003 and 2008 (n=64,340). Among them, patients with the following characteristics were excluded: other cancer diagnosis before IBC (n=10,866), radiotherapy before IBC (n=349), absence of data on sex or age (n=371), or male (n=248). Accordingly, data of 52,506 women until December 2017 were analyzed. SNBPC was defined as a newly diagnosed SNBPC that occurred 5 years or more after IBC diagnosis. Results: The median follow-up time of all patients was 12.13 years. SNBPC was developed in 3,084 (5.87%) women after a median of 7.61 years following IBC diagnosis. The 10-year incidence of SNBPC was 5.78% (95% confidence interval [CI], 5.56 to 6.00). Higher SNBPC incidence was found in survivors with the following factors: old age at IBC diagnosis, low household income, and receiving combined chemotherapy with endocrine therapy, whereas receiving radiotherapy was related to a lower incidence of SNBPC (hazard ratio, 0.89; p < 0.01). Among the patients with SNBPC, the 5-year survival rate was 62.28% (95% CI, 65.53 to 69.02). Conclusion Approximately 5% of breast cancer survivors developed SNBPC within 10 years after IBC diagnosis. The risk of SNBPC was associated with patient’s age at IBC diagnosis, income level, and a receipt of systemic treatments.

Estimation of the minimum post-mortem interval (PMI-min) by means of forensic entomology is mainly based on the results of the growth rate studies on necrophagous flies. However, results of these studies are difficult to use because these studies have only been undertaken for a select few necrophagous flies, and experimental methods and results processing have not been standardized. In this review, we have summarized the current state of growth rate studies on necrophagous fly species that are frequently found in human cadavers. Criteria have been suggested in order to select reliable data, and the accumulated degree hours and base temperatures to be used in the calculation of PMI-min for each species have been tabulated.

To estimate postmortem interval, it is essential to obtain information regarding fly growth. Analyzing the relationship between growth period and body length using a sigmoid function is widely accepted in animal science. However, in forensic entomology, it is difficult to find studies related to growth period and body length. Therefore, we compared growth curve models for forensically important flies using sigmoid functions. we used the data from flour fly species (Calliphora lata, Calliphora vicina, Chrysomya pinguis, and Lucilia illustris) and fited these against five sigmoid functions: quadratic-plateau model, logistic model, Gompertz model, von Bertalanffy model, and Brody model. Model evaluation criteria were, R2 mean squared error (MSE), Akaike information criterion (AIC), and Bayesian information criterion (BIC). The von Bertalanffy model yielded the highest R2 value and the lowest MSE, AIC, and BIC values for C. lata, whereas the logistic model was the best fit for the data from the other three species C. vicina, Ch. pinguis, and L. illustris.

Hydatid disease in humans is a parasitic disease typically caused by the larvae of Echinococcus granulosus. Although the disease can occur in any body part, it most frequently affects the liver. Hydatid disease is usually diagnosed incidentally and presents with various types of cystic lesion in the infected anatomical locations. Among the many potential complications of hepatic hydatid cysts, including rupture, infection, biliary communication, and peritoneal seeding, spontaneous rupture of the cyst into the hollow viscera is exceptionally rare and has been reported in less than 0.5% of cases. We report the case of a patient with hepatic hydatid disease complicated by spontaneous rupture into stomach causing gastric ulcer and peritoneal seeding.

PURPOSE: To determine if there is a difference in surgically induced astigmatism (SIA) of the posterior corneal surface between superior and temporal incision and its effect on total corneal power in patients who underwent clear corneal incision cataract surgery. METHODS: A retrospective study of 81 patients (84 eyes) who underwent clear corneal incision phacoemulsification by one surgeon. Patients were divided into two groups according to the steep axis: the temporal and superior groups. Anterior, posterior and total corneal SIA (simulated keratometry [Sm K], posterior keratometry [PK] and total corneal power [TCP] respectively) were measured using autorefractive keratometry (ARK) and dual Scheimpflug imaging before and after surgery. RESULTS: There were 61 eyes with temporal incision and 23 eyes with superior incision. The mean SIA was larger in the superior incision group than in the temporal incision group according to ARK, Sm K, PK and TCP (p < 0.05). There were no significant cylindrical changes in ARK in the temporal incision group, however, there was a significant decrease in the superior incision group before and after the operation (p < 0.05). Change in the amount and axis of PK before and after operation were not significantly different, for both incision groups. There was a significant correlation between post-operative TCP and both pre-operative ARK and Sm K for both groups. However, there was no correlation between post-operative TCP and pre-operative PK. In all patients, when pre-operative PK was more than 0.5 D, SIA-ARK, SIA-Sm K and SIA-TCP were all significantly larger than when pre-operative PK was less than 0.5 D, whereas SIA-PK was not. When pre-operative PK was more than 0.5 D, there were no significant differences in SIA-ARK, SIA-Sm K, SIA-PK or SIA-TCP in the temporal incision group. However, SIA-ARK was significantly larger in the superior incision group. CONCLUSIONS: There was no significant cylindrical change in PK before and after operation in both the temporal and superior incision groups. Therefore, when predicting post-operative TCP, it might be meaningful to consider SIA-ARK and SIA-Sm K.
Astigmatism* ; Cataract ; Humans ; Phacoemulsification ; Retrospective Studies

PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.
Aged ; Anemia ; Bevacizumab ; Biopsy ; Bone Marrow ; Dexamethasone ; Drug Therapy ; Epistaxis ; Humans ; Hypertension ; Lymphoma ; Macular Edema ; Retinal Hemorrhage ; Retinal Vein* ; Veins ; Visual Acuity ; Waldenstrom Macroglobulinemia*

Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.
Aged ; Atrophy* ; Autopsy ; Chemotherapy, Adjuvant ; Fibrosis* ; Forearm ; Free Tissue Flaps ; Head and Neck Neoplasms ; Humans ; Mouth Floor ; Mouth Neoplasms* ; Neck Dissection* ; Neck Muscles* ; Neck* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Survivors

PURPOSE: The 21-gene (Oncotype DX) recurrence score (RS) assay is useful in predicting the benefits of adjuvant chemotherapy for early breast cancer patients and is widely used in Western countries. However, to date, it has not gained much popularity in East Asia. We analyzed the results from five institutions' experience from using the 21-gene assay and examined the impact of assay results on decision making of chemotherapy in Korean breast cancer patients and the associations between RS and clinicopathologic characteristics. MATERIALS AND METHODS: The 21-gene assay was performed on 212 patients with estrogen receptor-positive early breast cancer in five institutions. Each center made systemic treatment decisions both before and after the knowledge of assay results. RESULTS: Among the 212 patients, 132 (62.3%) had a low RS of < 18, 60 (28.3%) had an intermediate RS of 18-30, and 20 (9.4%) had a high RS of > or = 31. Histologic grade, presence of micrometastases, Ki-67, and presence of lymphatic invasion were statistically associated with the RS results. Treatment decisions were changed in 115 of 212 patients (54.2%) in 109 of 212 (51.4%) from chemotherapy plus hormone therapy to hormone therapy, and in six of 212 (2.8%) from hormone therapy to chemotherapy plus hormone therapy. CONCLUSION: The 21-gene breast cancer assay proved to have a significant impact on treatment decision- making. The test reduces chemotherapy use in more than 50% of Korean estrogen receptor-positive, early breast cancer patients.
Breast Neoplasms* ; Chemotherapy, Adjuvant ; Decision Making ; Drug Therapy ; Estrogens ; Far East ; Humans ; Korea ; Neoplasm Micrometastasis ; Recurrence*

Forensic entomology investigates postmortem interval (PMI) estimation using insect evidence. We estimated the minimum PMI of a putrefied male cadaver using pupae in the soil and maggots found in the body. Most of the maggots, collected during the autopsy, were postfeeding third instar larvae with empty crop contents, which developed freezing injuries when the cadaver was placed in the freezer. Pupae in the soil were collected 45 days after the discovery of the body. DNA barcoding revealed that most pupae and maggots were Chrysomya pinguis, with a few exceptions. The minimum PMI was estimated at 10 days before the discovery time based on the scene investigation, maggot developmental stage, distribution of pupae moving away from the body toward pupariation sites, DNA barcoding results, and weather information. To reduce the gap between the minimum and maximum PMI values, complete entomological evidence collection should be conducted at the time of discovery.
Autopsy ; Cadaver ; Diptera* ; DNA ; Entomology* ; Forensic Sciences ; Freezing* ; Humans ; Insects ; Larva* ; Male ; Postmortem Changes ; Pupa* ; Soil ; Weather

To estimate the postmortem interval (PMI) by using entomological evidence, species identification of forensically important flies is mandatory. However, the traditional species identification method, which relies on the key morphological features of adult flies, is not always available to investigators and has limitations to the immature samples. Because of these limitations, species identification using DNA sequences has long been an issue in the field of forensic entomology. In this review, I have briefly described the basic principles of molecular species identification and phylogenetic analysis and their applications in forensic entomology. I also recommend an experimental and statistical method to identify unknown fly samples obtained from the field.
Adult ; Base Sequence ; Diptera* ; DNA Barcoding, Taxonomic ; Entomology ; Forensic Sciences ; Humans ; Korea* ; Research Personnel ; Species Specificity