Laryngeal cancer is a malignant disease that occurs at a high incidence rate as compared with other forms of cancer of the head and neck, and its treatment is commonly conducted at a regional central hospital from diagnosis to recovery. In this study, we summarized the outcomes of first-line treatment for laryngeal cancer over the past 10 years at our hospital.　　The subjects consisted of 121 patients who received a first-line treatment for squamous cell carcinoma of the larynx between January 2000 and April 2010. Of these, 115 were male and six were female, with a mean age of 67.9 years. There were 56 cases of stage I laryngeal cancer, 30 of stage II, 14 of stage III, and 21 of stage IVa. Cases of stage IVc cancer with distal metastasis were excluded.　　The disease-specific 5-year survival rate was 100% in stage I, 81.8% in stage II, 100% in stage III, and 72.5% in stage IVa, respectively. Moreover, the laryngeal preservation rates was 93.7% in stage I, 69.4% in stage II, 34.2% in stage III, and 42.6% in stage IVa, respectively.　　Although the disease-specific 5-year survival rate in stage III was 100%, the laryngeal preservation rate was the lowest at 34.2%. In cases of stage III cancer, although the survival rate was certainly high when total laryngectomy was performed, we believe that in the future, radiation therapy and partial laryngectomy should be introduced to preserve the larynx.　　There were only three cases of stage II subglottic cancer in which both the laryngeal preservation rate and survival were low.

BACKGROUND AND PURPOSE: Not only clinical factors, including the CHADS2 score, but also echocardiographic findings have been reported to be useful for predicting the risk of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it remains to be determined which of these factors might be more relevant for evaluation of the risk of stroke in each patient. METHODS: In 490 patients with NVAF who underwent transesophageal echocardiography (TEE), we examined the long-term incidence of ischemic stroke events (mean follow-up time, 5.7+/-3.3 years). For each patient, the predictive values of gender, the CHADS2 risk factors (congestive heart failure, hypertension, age > or =75 years, diabetes mellitus, history of cerebral ischemia), the CHADS2 score, and the findings on echocardiography, including TEE risk markers, were assessed. RESULTS: The ischemic stroke rate was significantly correlated with the CHADS2 score (p<0.05). According to the results of univariate analyses, age > or =75 years, history of cerebral ischemia, CHADS2 score > or =2, and presence of TEE risk were significantly correlated with the incidence of ischemic stroke. Cox proportional hazards regression analyses identified age > or =75 years and presence of TEE risk as significant predictors of subsequent ischemic stroke events in patients with NVAF. As compared with that in persons below 75 years of age without TEE risk, the ischemic stroke rate was significantly higher in persons who were > or =75 years of age with TEE risk (4.3 vs. 0.56%/year, adjusted hazard ratio=8.94, p<0.001). CONCLUSIONS: TEE findings might be more relevant predictors of ischemic stroke than the CHADS2 score in patients with NVAF. The stroke risk was more than 8-fold higher in patients aged > or =75 years with TEE risk.
Aged ; Atrial Fibrillation ; Brain Ischemia ; Diabetes Mellitus ; Echocardiography ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Incidence ; Risk Factors ; Stroke

[Objective]To clarify the effects of electroacupuncture (EA) on the menstrual cycle at puberty, we investigated whether or not EA influences the menstrual cycle, the number of ovulations, and the duration of the high-temperature phase. Also we investigated the improvement of menstrual disorder and changes in body mass index (BMI) by EA treatment.
[Methods]Twenty-five female students participated in this study.
Non-treatment periods from three to four months were evaluated before EA treatment. During treatment, EA was performed once a week. We compared the menstrual cycle, the number of ovulations, and the duration of the high temperature phase for non-treatment and EA treatment periods. To evaluate the relation between BMI and improvement of menstrual disorder by EA, female students were divided into two groups, improvement or not-improvement group.
[Results]Twenty female students were analyzed in this study. In those with extended periods of amenorrhea, the menstrual cycle became significantly shorter during EA (P< 0.001). In those with polymenorrhea, the menstrual cycle became significantly longer during EA (P< 0.05), reaching a normal cycle length. Improvement of the menstrual cycle was found in 30.0%of the subjects. However, an increase in the number of ovulations and extended duration of the high temperature phase were found in 20.0%and 25.0%of the subjects, respectively. Although BMI did not vary significantly between the improvement and the not-improvement groups, the percentage of those with normal weight tended to be higher in the improvement group than in the not-improvement group.
[Conclusion]These findings suggest that EA influences follicular growth. However, it had been thought that EA could not influence ovulation or affect luteal function. Additionally, when BMI is nearly normal, it appears more likely that acupuncture is effective for menstrual disorder at puberty.

BACKGROUND AND PURPOSE: Plasma D-dimer levels are elevated during the acute phase of cerebral infarction (CI). We investigated whether the D-dimer level on admission and other clinical characteristics could be used to predict the poor outcome of patients with acute CI. METHODS: The clinical characteristics and plasma D-dimer levels measured within 3 days of onset were compared according to outcome among patients with acute CI. RESULTS: In total, 359 consecutive patients (mean age, 71.8 years) were examined, of which 174 had a poor outcome [score on the modified Rankin scale (mRS) > or =3] at 30 days after hospitalization. The mean mRS score was higher and a poor outcome was observed more frequently among women than among men (p<0.001 for each). The proportions of women, cardioembolism, atrial fibrillation, advanced age (> or =75 years), prior history of CI or transient ischemic attack, and elevated D-dimer level (> or =1.0 microg/mL) were significantly higher among patients with a poor outcome than among those with a good outcome. A multivariate analysis showed that elevated D-dimer level [> or =1.0 microg/mL; odds ratio (OR), 2.45; 95% confidence interval (95% CI), 1.52-3.89; p<0.01], advanced age (OR, 1.93; 95% CI, 1.21-3.07; p<0.01), and female gender (OR, 1.75; 95% CI, 1.08-2.83; p=0.02) were independent predictors of a poor outcome. CONCLUSIONS: Certain clinical characteristics (gender and advanced age) and an elevated D-dimer level upon admission can be used to predict the outcome of patients with acute CI at 30 days after hospitalization.
Atrial Fibrillation ; Cerebral Infarction ; Female ; Fibrin Fibrinogen Degradation Products ; Hospitalization ; Humans ; Ischemic Attack, Transient ; Male ; Multivariate Analysis ; Odds Ratio ; Plasma ; Stroke

PURPOSE: The purpose of this study is to evaluate the clinical results of treatment with a high dose of 3-dimensional conformal boost (3DCB) using a real-time tracking radiation therapy (RTRT) system in cervical cancer patients. MATERIALS AND METHODS: Between January 2001 and December 2004, 10 patients with cervical cancer were treated with a high dose 3DCB using RTRT system. Nine patients received whole pelvis radiation therapy (RT) with a median dose of 50 Gy (range, 40-50 Gy) before the 3DCB. The median dose of the 3DCB was 30 Gy (range, 25-30 Gy). Eight patients received the 3DCB twice a week with a daily fraction of 5 Gy. The determined endpoints were tumor response, overall survival, local failure free survival, and distant metastasis free survival. The duration of survival was calculated from the time of the start of radiotherapy. RESULTS: All patients were alive at the time of analysis and the median follow-up was 17.6 months (range, 4.9-27.3 months). Complete response was achieved in nine patients and one patient had a partial response. The 1- and 2-year local failure free survival was 78.8% and 54%, respectively. The 1- and 2-year distant metastasis free survival was 90% and 72%, respectively. Late toxicity of a grade 2 rectal hemorrhage was seen in one patient. A subcutaneous abscess was encountered in one patient. CONCLUSION: The use of the high dose 3DCB in the treatment of cervical cancer is safe and feasible where intracavitary brachytherapy (ICBT) is unable to be performed. The escalation of the 3DCB dose is currently under evaluation.
Adult ; Aged ; *Brachytherapy ; Female ; Humans ; Middle Aged ; Radiotherapy Planning, Computer-Assisted/adverse effects/*methods ; Treatment Outcome ; Uterine Cervical Neoplasms/mortality/pathology/*radiotherapy

[Objective]We examined the effects of acupuncture treatment at Sanyinjiao (SP6) on menstrual pain in female students. In addition, the correlation between the effects of acupuncture treatment and the neurosis were evaluated.
[Methods]Fifty-one female students were participated in this study as the subject. Acupuncture treatment using Ringheaded thumbtack needle were performed to bilateral SP6 for the three months. Non-treatment periods for three months were set in before and after acupuncture period, respectively. Patients received the Ringheaded thumbtack needle through four days in a week. The effectiveness of treatment was evaluated using the categorical scale for the severity of menstrual pain accompany with numbers of taking drugs for analgesic. To evaluate the correlation between effects of acupuncture and neurosis, the tendency of neurosis was confirmed by cornel medical index (CMI) and the perimenstrual symptoms were confirmed by menstrual distress questionnaire (MDQ).
[Results]Twenty-seven subjects were analyzed for evaluation in this present study. During Ringheaded thumbtack needle treatment periods (acupuncture periods), menstrual pain had reduced into 48%of subjects. The number of taking drugs for analgesic was decreased with the reduction of severity of menstrual pain during acupuncture periods (p<0.05). The correlation between the effect of acupuncture and the tendency of neurosis were observed. Acupuncture improved the menstrual pain in the subjects who belong to category I and/or II of CMI. However, no remarkable changes were observed in the III and/or IV subjects of CMI. Furthermore, the high score of fives specific pain into MDQ (shoulder pain, headache, etc) and negative feelings factor were obtained in subjects who accompany with strong menstrual pain still after acupuncture
[Discussion]These findings suggest that menstrual pain was reduced by Ringheaded thumbtack needle to bilateral SP6. Additionally this result was influenced by a psychological factor and/or some kind of pain which is not only menstrual pain.

A study was conducted to evaluate the clinical and hemodynamic performance of the 19-mm Medtronic Mosaic Valve (MMV) in the aortic position, which is a third-generation stented porcine bioprosthesis. Between 2003 and 2006, 9 patients underwent AVR using the 19-mm MMV. None of the patients were suitable for a 19-mm Perimount bioprosthetic valve due to having a small annulus and sinotubular junction. The patients included 3 men and 6 women with a mean age of 73.2±4.97 years and mean body surface area of 1.35±0.11m². Preoperatively, 8 patients were in New York Heart Association class II and 1 was in class III. The reason for surgery was aortic stenosis in 8 patients and aortic regurgitation due to infective endocarditis in 1 patient. Four patients had chronic renal failure and were on hemodialysis, while 1 patient had Crohn's disease. Concomitant coronary artery bypass grafting was performed in 3 patients, and tricuspid valve annuloplasty was done in 1 patient. The follow-up period was 12.0±7.71 months. No deaths occurred, but there was 1 cerebral infarction. Postoperatively, the peak pressure gradient decreased from 81.3±32.7 to 40.3±16.3mmHg (p<0.01). The mean pressure gradient also decreased significantly from 48.8±11.6mmHg to 23.9±9.32mmHg (p<0.01). Left ventricular end-diastolic diameter was 47.9±3.82mm preoperatively and 45.1±7.53mm postoperatively, showing no significant change. The left ventricular mass index also improved from 217.3±46.9 to 160±54.9g/m² (p<0.05). The ejection fraction was 72.0±8.93% preoperatively and 67.6±6.37% postoperatively, showing no difference. Although the postoperative indexed effective orifice area (EOAI) was 0.90±0.11cm²/m², mild patient-prosthesis mismatch (EOAI 0.77cm²/m²) was noted in 1 patient. In conclusion, the early clinical and hemodynamic performance of the 19-mm MMV in small elderly patients was acceptable.

Perivalvular leakage (PVL) is one of the serious complications of mitral valve replacement. Between 1991 and 2006, 9 patients with mitral PVL underwent reoperation. All of them had severe hemolytic anemia before surgery. The serum lactate dehydrogenase (LDH) level decreased from 2,366±780 IU/l to 599±426 IU/l after surgery. The site of PVL was accurately defined in 7 patients by echocardiography. PVL occurred around the posterior annulus in 3 patients, anterior annulus in 2, anterolateral commissure in 1, and posteromedial commissure in 1. The most frequent cause of PVL was annular calcification in 5 patients. Infection was only noted in 1 patient. In 4 patients, the prosthesis was replaced, while the leak was repaired in 5 patients. There was one operative death, due to multiple organ failure, and 4 late deaths. The cause of late death was cerebral infarction in 1 patient, subarachnoid hemorrhage in 1, sudden death in 1, and congestive heart failure (due to persistent PVL) in 1. Reoperation for PVL due to extensive annular calcification is associated with a high mortality rate and high recurrence rate, making this procedure both challenging and frustrating for surgeons.

A 38-year-old woman was referred to our hospital for treatment of infective endocarditis associated with abscesses in the brain and the left lower limb. A causative organism had not been detected by serial blood cultures. Preoperative brain CT revealed mycotic aneurysms and echocardiography showed a mobile vegetation (8mm in size) on the anterior leaflet of the mitral valve. We performed resection of the vegetation together with a small triangle of the anterior leaflet, after which the margins of the defect were approximated. Then bilateral Kay procedures and reinforcement with autologous pericardium were done to obtain proper coaptation. The patient's fever, left lower limb pain, and intracerebral mycotic aneurysms resolved after surgery. The brain abscess also became smaller. Mitral valve plasty should sometimes be considered in the active phase of endocarditis, even in patients with cerebral complications and without congestive heart failure.