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.

Sorafenib is an oral multikinase inhibitor with clinical activity against hepatocellular carcinoma (HCC) and renal cell carcinoma. Administration of sorafenib carries a variety of adverse cutaneous reactions. Common adverse effects induced by sorafenib include hand-foot skin reactions, facial erythema, splinter subungual hemorrhage, and alopecia. Although erythema multiforme (EM) related to sorafenib has been reported, delayed-type cutaneous hypersensitivity reactions are rare in patients treated with sorafenib and there has been no case of Stevens-Johnson syndrome (SJS) reported so far. We recently experienced 3 cases of delayed-type cutaneous hypersensitivity related to administration of sorafenib. The first case was a 47-year female had targetoid erythematous rashes on her arms 12 days after starting sorafenib for HCC. The rashes spread from the arms to the trunk rapidly except for the hands and feet, and erosive lesions developed in the oral mucosa and lips. She was diagnosed as SJS. The second case was an 81-year-old male had maculopapular eruptions with multiple targetoid lesions on the trunk, arms, and legs 10 days after starting sorafenib for his HCC. There was no evidence of mucosal involvement. He was diagnosed with EM. The last one was a 20-year-old female developed generalized maculopapular eruptions in the whole body 10 days after starting sorafenib for the treatment of HCC. All 3 patients completely recovered after discontinuation of sorafenib.
Aged, 80 and over ; Alopecia ; Arm ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Erythema ; Erythema Multiforme ; Exanthema ; Female ; Foot ; Hand ; Hemorrhage ; Humans ; Hypersensitivity* ; Hypersensitivity, Delayed ; Leg ; Lip ; Male ; Mouth Mucosa ; Skin ; Stevens-Johnson Syndrome ; Young Adult

Cheek ; Dentofacial Deformities ; Female ; Humans ; Male ; Orbit ; Smiling

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.
Aged ; Arthralgia ; Depression ; Family Practice ; Fatigue ; Female ; Humans ; Hypertension ; Leg ; Male ; Prevalence ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Snoring ; Stroke

BACKGROUND AND OBJECTIVES It is being increasing recognized that the morbidities of migraine and balance disorders are interrelated. In fact, migrainous vertigo (MV) is one of frequent causes of recurrent vertigo in patients presenting to specialized dizziness clinics. Nevertheless, not many studies have reported clinical manifestations and treatment. Therefore, the aim of study was designed to assess clinical features and treatment patterns by a nationwide multicenter study. MATERIALS AND METHODS Patients between 9 and 74 years of age who visited 17 Korean tertiary referral centers and 1 clinic from February to March 2009 were investigated using two forms of questionnaires. RESULTS Overall, 318 patients with MV were enrolled. MV was responsible for ~8.45% of visits to the specialized dizziness clinics. One hundred seventy-five of these patients had definite MV and were included in assessing the clinical features. Vertigo characteristics of patients with definite MV were various. Vertigo was regularly as sociated with headache in 87% of the patients. The duration of vertigo ranged from seconds to days. For the treatment patterns, an acute and prophylactic therapies were carried in most clinics. There were no differences in either acute or prophylactic therapies between department of neurology and otorhinolaryngology. CONCLUSIONS The results of this study suggest that MV the clinical features of MV also varies in Korea. In addition, most clinics provide similar patterns of practice in treatment for MV. The syndrome of MV deserves further research activity as it is relatively common and clinically relevant.
Dizziness ; Headache ; Humans ; Korea ; Migraine Disorders ; Neurology ; Prospective Studies ; Tertiary Care Centers ; Vertigo

Bites and Stings ; Bone Screws ; Humans ; Lip ; Mandible ; Mastication ; Orthodontics ; Osteogenesis, Distraction ; Osteotomy ; Tooth ; Tooth Mobility ; Walking

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media (CSOM) is a common infectious disease in childhood of poor hygiene group. In addition, in industrialized countries, with rising popularity of tympanostomy tubes for management of otitis media with effusion, CSOM is a potential problem in any child who had inserted ventilating tubes previously. Hearing loss following CSOM can negatively affect learning, speech, and cognitive function, so effective and timely management of CSOM is mandatory. The surgical procedure may be necessary in some children with CSOM, but when it is performed at a too early age, there might be more chances of recurrence than adults. SUBJECTS AND METHOD: Used in the study were 51 ears from patients who received tympanomastoidectomy due to CSOM in tertiary referral center from 1995 through 2004. The mean age was 9 years and 6 months. Cholesteatoma was found in 30 cases (58.8%). Age at operation, hearing outcomes, and the surgical results were retrospectively reviewed. RESULTS: Canal wall down mastoidectomy was performed in 23 cases and canal wall up procedure in 28 cases. Revision surgery was performed in 9 cases (17.6%) and mean duration between first and revision surgery was 27 months. In the cases of cholesteatoma, the rate of revision surgery was different between under 6 years old and over 7 years old group (p=.045). The age at 1st operation and postoperative hearing outcome had no correlation. CONCLUSION: Since the1st operation is performed earlier, the rate of revision may increase, especially in cases of cholesteatoma.
Adult ; Child ; Cholesteatoma ; Communicable Diseases ; Developed Countries ; Ear ; Hearing ; Hearing Loss ; Humans ; Hygiene ; Learning ; Middle Ear Ventilation ; Otitis Media ; Otitis Media with Effusion ; Otitis Media, Suppurative* ; Otologic Surgical Procedures ; Recurrence ; Retrospective Studies ; Tertiary Care Centers

Isolated tuberculous hepatic abscess is rare and surgical treatment is often needed when the size of abscess is large or increasing, when abscess is resistant to antituberculous medication or undergoing secondary change. We report an unusual case of recurrent tuberculous hepatic abscess following surgical resection and antituberculous medication. A 67-year-old woman was admitted due to right upper abdominal pain. She had operation history of segmental resection of the liver due to tuberculous hepatic abscess refractory to antituberculous medication. Preoperative abdominal CT scan demonstrated a enlarging multifocal cystic lesion at segment 8 of the liver in spite of antituberculous medication. Right lobectomy was done and the biopsy revealed caseous necrosis and acid-fast bacilli on microscopic finding. Second- line antituberculous medication was started and no evidence of recurrence was noted.
Abdominal Pain ; Abscess ; Aged ; Biopsy ; Female ; Hepatectomy* ; Humans ; Liver ; Liver Abscess* ; Necrosis ; Recurrence ; Tomography, X-Ray Computed

The object of this study was to evaluate how friction that occurs during the sliding movement of an orthodontic archwire through orthodontic brackets is differently affected by variant designs and ingredients of brackets and archwires and bracket-archwire angles. In order to simulate the situations which could occur during orthodontic treatment with fixed appliances, 4 types of brackets (Gemini(R), a stainless steel twin bracket; Mini Uni-Twin(R), a stainless steel bracket with a single bracket design and narrow mesio-distal width; Clarity(R), a metal-reinforced ceramic bracket; Transcend(R), a ceramic bracket) and 3 types of orthodontic archwires (0.016", 0.016 x 0.022" stainless steel, 0.016" Nitinol) were used and the bracket-archwire angles were controlled as 0 degrees, 3 degrees, 6 degrees, and 9 degrees, Gemini(R) significantly showed the lowest static and kinetic frictions (P < 0.001). Clarity showed the highest static and kinetic frictions with a bracket-archwire angle of 0 degrees, and Transcend at 6 degrees and 9 degrees (P < 0.001). An 0.016 x 0.022" stainless steel rectangular archwire significantly showed the highest static and kinetic frictions (P < 0.01). The lowest static and kinetic frictions were observed when the bracket-archwire angles were 0 degrees and 3 degrees with 0.016" stainless steel round archwires (P < 0.01), and 6 degrees and 9 degrees with 0.016 Nitinol (P < 0.001). The static and kinetic frictions were increased as the bracket-archwire angles were increased (P < 0.001).
Ceramics ; Friction* ; Humans ; Orthodontic Brackets* ; Stainless Steel

PURPOSE: To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was performed. MATERIALS AND METHODS: A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998~999 from 15 hospitals were reviewed. RESULTS: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the casses, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast+supraclavicular fossa (SCL) in 5% of the cases, and breast+SCL+posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45~9.4 Gy (median 50.4) and boost dose was 8~20 Gy (median 10 Gy). The total radiation dose delivered was 50.4~70.4 Gy (median 60.4 Gy). CONCLUSION: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Estrogens ; Humans ; Korea* ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental* ; Radiotherapy