Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

BACKGROUND: It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. METHODS: We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. RESULTS: The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. CONCLUSIONS: This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.
Adult ; Aged ; Bone Plates ; Device Removal ; Female ; Forearm/physiopathology/surgery ; Fracture Fixation, Internal/*methods ; Hand Strength ; Humans ; Male ; Middle Aged ; Muscle Strength ; Muscle, Skeletal/physiopathology/*surgery ; Radius Fractures/radiography/*surgery ; Range of Motion, Articular ; Wound Healing ; Young Adult

BACKGROUND: The Korean version of the Michigan Hand Outcomes Questionnaire (K-MHQ) was recently validated; however, the questionnaire's responsiveness as well as the degree to which the instrument is sensitive to change has not been thoroughly evaluated in a specific condition in Koreans. We evaluated the responsiveness of the K-MHQ in a homogenous cohort of patients with carpal tunnel syndrome (CTS) and we compared it with that of the Korean version of the Disability of the Arm, Shoulder, and Hand Questionnaire (K-DASH), which was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS. METHODS: Thirty-seven patients with CTS prospectively completed the K-MHQ and the K-DASH before and 6 months after surgery. The responsiveness statistics were assessed for both the K-MHQ and the K-DASH by using the standardized response mean (SRM), which was defined as the mean change of the original scores after surgery divided by the standard deviation of the change. RESULTS: All domains of the K-MHQ significantly improved after carpal tunnel release (p < 0.001). The SRM for all scales but one (the aesthetics scale) showed large responsiveness of > or = 0.8. The aesthetics scale showed medium responsiveness of 0.6. The combined function/symptom scale of the K-DASH significantly improved after surgery (p < 0.001). The SRM of the K-DASH revealed large responsiveness of 0.9. CONCLUSIONS: The K-MHQ was found to have a large degree of responsiveness after carpal tunnel release for Korean patients with CTS, which is comparable not only to the K-DASH, but also to the original version of the MHQ. The region-specific K-MHQ can be useful for outcomes research related to carpal tunnel surgery, especially for research comparing CTS with various other hand and wrist health conditions.
Activities of Daily Living ; Adult ; Aged ; Carpal Tunnel Syndrome/*surgery ; *Disability Evaluation ; Female ; Humans ; Male ; Middle Aged ; Questionnaires ; Republic of Korea

A previously healthy 22-year-old woman was admitted with a complaint of right upper quadrant abdominal pain for 2 weeks. Her past history was not remarkable. On admission, HBsAg and anti-HCV were negative and alpha-FP was within normal range. Abdominal sonography and CT showed a mass in liver measuring 10 11 cm with features of central necrosis and hemorrhage. On 6th hospital day, hemoperitoneum developed suddenly. She underwent emergency laparotomy and trisegmentectomy. Intraoperative finding revealed a hemoperitoneum with a tumor filled with liquefied necrotic tissues. Microscopically, the tumor was mostly composed of pleomorphic spindle cells with abundant anastomosing vascular channels and partly composed of tumor cells with trabecular arrangement. On immunohistochemical staining, tumor cells reacted with cytokeratin and vimentin, while CD34 and hepatocyte staining revealed negative. She died 2 months after the operation. We report a case of rapidly deteriorated primary sarcomatoid hepatocellular carcinoma in a young female without any risk factor.
Adult ; Carcinoma, Hepatocellular/diagnosis/*pathology ; Female ; Humans ; Liver Neoplasms/diagnosis/*pathology ; Sarcoma/diagnosis/*pathology

PURPOSE: To determine whether COX-2 expression is associated with clinicopathological parameters, including c-erb-B2 overexpression and angiogenesis, and the disease- free survival of patients with operable breast cancer. MATERIALS AND METHODS: Paraffin-embedded tissue samples were selected from 205 patients surgically resected for breast cancer, between 1991 and 1997, and followed- up for at least 4 years. Samples were immunohistochemically stained with antibodies to COX-2, c-erb-B2 and CD34. RESULTS: COX-2 and c-erb-B2 expressions were detected in 118/205 (57.6%) and 58/205 (28.3%) patients, respectively. COX-2 expression was significantly higher in c-erb-B2 positive than c-erb-B2 negative tumors (75.9% vs. 49.7%, p-value 0.001). COX-2 expression was positively correlated with microvessel count (13.3+/-8.0 vs. 6.6+/-7.0, p-value 0.050), but not with other clinicopathological characteristics, including tumor size, involved axil lary lymph nodes and estrogen or progesterone receptor status. Although COX-2 expression itself was not a prognostic marker, breast cancer patients with tumors that co-expressed both COX-2 and c-erb-B2 had a poorer 5-year disease-free survival rate than those that did not (60.2% vs. 78.3%, p-value 0.0527). CONCLUSION: Our data suggest that COX-2 expression occurs frequently in c-erb-B2 positive breast cancer, and co-expression of COX-2 and c-erb-B2 may be a useful prognostic marker in patients with operable breast cancer.
Antibodies ; Breast Neoplasms* ; Breast* ; Cyclooxygenase 2* ; Disease-Free Survival ; Estrogens ; Humans* ; Lymph Nodes ; Microvessels ; Receptors, Progesterone

BACKGROUND: Neurodegenerative diseases (ND) are associated with oxidative stress, and antioxidants including epigallocatechin gallate (EGCG) have been tried as potential therapeutic regimens of an experimental model of ND. We performed this study to determine the neuroprotective role of EGCG on up stream and down stream signals in oxidative-stress-injured PC12 cells by exposing them to H2O2. METHODS: Following 100 microM H2O2 exposure, the viability of PC12 cells (not pretreated vs EGCG or z-VAD-fmk pretreated) was evaluated by using a MTT assay. Immunoreactivity (IR) of cytochrome c, caspase-3, poly (ADP-ribose) polymerase (PARP), PI3K/Akt and GSK-3 was examined by using a Western blot. RESULTS: EGCG or z-VAD-fmk pretreated PC12 cells showed increased viability. Dose-dependent inhibition of caspase-3 activation and PARP cleavage was demonstrated by the pretreatment of both agents. However, the inhibition of cytochrome c release was only detected in EGCG pretreated cells. On the pathway through PI3K/Akt and GSK-3, however, the result of a western blot in EGCG pretreated cells showed decreased IR of Akt and GSK-3 and increased IR of p85a PI3K, phosphorylated Akt and GSK-3, and contrasted with that in z-VAD-fmk pretreated cells showing no changes. CONCLUSIONS: These data show that EGCG affects apoptotic pathways through upstream signals including PI3K/Akt and GSK-3 pathways as well as downstream signals including cytochrome c and caspase-3 pathways. Therefore, these results suggest that EGCG mediated activation of PI3K/Akt and inhibition GSK-3 could be a new protective mechanism on the pathogenesis of ND.
Animals ; Antioxidants ; Apoptosis ; Blotting, Western ; Caspase 3 ; Cytochromes c ; Glycogen Synthase Kinase 3 ; Glycogen Synthase* ; Glycogen* ; Models, Theoretical ; Neurodegenerative Diseases ; Oxidative Stress ; PC12 Cells* ; Rivers

Impetigo herpetiformis is a rare disease which has not been cleary defined in the European or American literature and is currently not fully appreciated or accepted as a clinical entity. According to Baker & Ryan, Impetigo herpetiformis was reffered to as the Exanthematous type of generalized pustular psoriasis. Impetigo herpetiformis starts suddenly without any preceding lesions of psoriasis as an extensive eruption of pustules on an erythematous base, and may. occur repeatedly during successive pregancies but may occur also without any known cause. A case of Impetigo herpetiformis affecting 30 year old 8 month pregnent woman, who has been suffering from generalized coaIesced pustular eruption with slight itching & buming sensation with fever & chill. 15days before, The Eruption began as an erythematous macule which developed pustules along the margin. There was extension by the development of fresh peripheral pustules and coalescence of these patches and central clearing. Diagnasis was confirmed by histopathologic finding and treated with cortico.teroid and Antibiotics, But improvement was not noted.
Adult ; Anti-Bacterial Agents ; Female ; Fever ; Humans ; Impetigo ; Pruritus ; Psoriasis ; Rare Diseases ; Sensation

Subungual exostosis is a solitary fibrus nodule on the inner border of the terminal phalanx of the great toe. Rarely, the terminal phalanges of other toes, particularly the little toe, or even the fingers are involved. The first appearance is a small pinkish growth projecting slightly beyond the inner free edge of the nail, which pushes upward and backward. A case of Subungual exostosis affecting 20 year old man, who has been suffering from bean sized nolule on subungual area of terminal phalanx of left 5th toe. The skin iesion developed 1 year ago, and increased size insidiously and tendemess on pressure or tight shoes was noted. Diagnosis was confirmed by histopathologic and radiologic studies, and treated witb complete excision of tumor mass.
Diagnosis ; Exostoses* ; Fingers ; Humans ; Shoes ; Skin ; Toes ; Young Adult

Sporotrichosis is an infection of worldwide distribution caused by the fungal organiam sporotrichum schenckii. The disease is usually of the primary cutaneous variety with involvement of regionaI lymphatics, although dissemination may occur. A case of lymphatic type of Syorotrichosis affecting 33 years old, barber, who has been suffering from painless multiple nodules on right hand 4 forearm, is presented. The skin lesions developed about 3months ago, and increased sise and numbers of the lesion insidiously. Diagnosis was confirmed by characterietic clinical, mycological, histopathological studies He was treated with potassium iodide and there was markedly improved.
Adult ; Diagnosis ; Forearm ; Hand ; Humans ; Potassium Iodide ; Skin ; Sporothrix ; Sporotrichosis*