PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.
Aromatase ; Asian Continental Ancestry Group ; Bone Density ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cholesterol ; Consent Forms ; Female ; Humans ; Observational Study ; Quality of Life*

Since 2013, the Hospital-based Influenza Morbidity and Mortality (HIMM) surveillance system began a H7N9 influenza surveillance scheme for returning travelers in addition to pre-existing emergency room (ER)-based influenza-like illness (ILI) surveillance and severe acute respiratory infection (SARI) surveillance. Although limited to eastern China, avian A/H7N9 influenza virus is considered to have the highest pandemic potential among currently circulating influenza viruses. During the study period between October 1st, 2013 and April 30th, 2016, 11 cases presented with ILI within seven days of travel return. These patients visited China, Hong Kong, or neighboring Southeast Asian countries, but none of them visited a livestock market. Seasonal influenza virus (54.5%, 6 among 11) was the most common cause of ILI among returning travelers, and avian A/H7N9 influenza virus was not detected during the study period.
Asian Continental Ancestry Group ; China ; Emergency Service, Hospital ; Hong Kong ; Humans ; Influenza A Virus, H7N9 Subtype ; Influenza, Human ; Livestock ; Mortality ; Orthomyxoviridae ; Pandemics ; Seasons

OBJECTIVE: To detect meconium peritonitis for the fetal period is important for prenatal counseling. The aim of this study was to evaluate prenatal ultrasound finding for diagnosing meconium peritonitis and postnatal clinical course and outcomes. METHODS: The prenatal and postnatal medical records of all patients to our institutions with confirmed meconium peritonitis were reviewed, with emphasis on prenatal ultrasound findings, postnatal investigations, operative findings, outcomes of meconium peritonitis. RESULTS: Fourteen fetuses were confirmed to have meconium peritonitis at birth by operation. Eight cases were diagnosed correctly because of prenatal ultrasound showing ascites and calcification/dilated or hyperechoic bowel loops. In the other 6 cases, prenatal ultrasound showed only ascites. One patient was operated on first day of life and its intra-operative finding was malrotation of small bowel, volvulus with strangulation, perforation and jejunal atresia. Most cases were operated on 2nd or 3rd day of life. Intra-operative findings were ileal atresia and perforation in 11 cases and jejunal atresia and perforation in 3 cases. Four patients underwent ileostomy but all patients survived and prospered. CONCLUSION: All patients do not present typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be taken into consideration. Favorable outcome of intrauterine meconium peritonitis is reassuring in prenatal counselling and stems from multidisplinary team approach.
Ascites ; Counseling ; Fetus ; Humans ; Ileostomy ; Intestinal Atresia ; Intestinal Volvulus ; Meconium ; Medical Records ; Parturition ; Peritonitis ; Pregnancy ; Prenatal Diagnosis

Metastasis to the skin occurs rarely in gynecologic cancer. Although carcinoma of the cervix is the fifth most common malignancy in Korean women, cutaneous involvement originating from cervical cancer is unusual. Common pattern of occurrence is multiple nodule in abdomen, vulva, lower extremities. We report a case of metastasis from squamous cell carcinoma of cervix to vulva. The patient was diagnosed with cervical cancer IIA. The extensive skin lesion on the vulva occurred 3 months after neoadjuvant chemotherapy, radical hysterectomy and concurrent chemoradiation. We have experienced such a case and report the case with brief review of literatures.
Abdomen ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Hysterectomy ; Lower Extremity ; Neoplasm Metastasis ; Skin ; Uterine Cervical Neoplasms ; Vulva

BACKGROUND: Clinical trials that utilize imaging findings as surrogate endpoints are considered to be cost-effective. However, unlike numeric data, magnetic resonance imaging (MRI) findings are not quantifiable. Thus, we have begun to develop a software package that is able to convert qualitative MRI findings into quantifiable data. METHODS: Computer software (DUIH_Image) was created with which every patient's MRI data can be registered on a standard brain template. Interuser and intrauser reliabilities for the registration were measured, and then a proof-of-principle experiment was conducted to determine whether the system could identify factors that were associated with a greater National Institutes of Health Stroke Scale (NIHSS) score at admission. We studied 40 consecutive patients [65.1+/-14.2 years old (mean+/-SD); 22 males and 18 females] with first-ever acute lacunar infarction of the corona radiata, who were divided into two groups according to their NIHSS score (i.e., low: 0-2; high: > or =3). The following parameters were compared between these two groups: (1) data retrieved from clinical profiles, including demographic and risk factor variables; and (2) accumulated diffusion MRI lesions mapped on a standard template. RESULTS: Modest levels of interuser and intrauser reliability were observed (p<0.05, R(2)=0.63-0.84, Pearson correlations). Regarding the clinical profiles, no significant difference was found for the numeric data sets or infarct size between the two groups. However, on the accumulated lesion map image, the lesion area that overlapped the most was located more posterolaterally in the high NIHSS score group than in the low NIHSS score group. CONCLUSIONS: In this pilot study we have demonstrated the potential usefulness of the DUIH_Image software. We plan to update this software to enable its utilization in actual clinical trials.
Biomarkers ; Brain ; Computer Systems ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging ; Male ; National Institutes of Health (U.S.) ; Pilot Projects ; Risk Factors ; Software ; Stroke ; Stroke, Lacunar

OBJECTIVE: Tamoxifen is a nonsteroidal hormone that functions as a selective estrogen-receptor (ER) modulator in breast tissue. It is the first-choice drug for the postoperative treatment of ER-positive breast cancer patients. However, tamoxifen, if administered for a prolonged duration, has estrogen-like effects on the uterus, leading to an increased risk for the development of endometrial diseases such as endometrial hyperplasia, endometrial polyp, and endometrial cancer. This study was designed to investigate the effects of tamoxifen treatment on endometrium in breast cancer patients. METHODS: Fifty-five tamoxifen-treated breast cancer patients visited an outpatient gynecology clinic. We analyzed the endometrial pathology with consideration to the duration of tamoxifen treatment the patient symptoms and the endometrial thickness, as measured by transvaginal ultrasonography. Endometrial polypectomy was performed to obtained polyps from women presenting with abnormal bleeding (17 polyps from postmenopausal women who had not been treated with tamoxifen and 14 from women who had been treated with this drug). To investigate the effects of tamoxifen treatment on the endometrial polyps, we performed immunohistochemical staining for ER, the progesterone receptor (PR), and Ki67 on the polyps obtained from both groups of women. RESULTS: In 29 (52.7%) of 55 tamoxifen-treated breast cancer patients, the endometrium was more than 10 mm thick, and in 19 (65.5%) of these patients, the abnormalities noted comprised 11 endometrial polyps, 5 endometrial carcinomas, 2 submucosal myomas, and 1 endometrial hyperplasia. The incidence of endometrial proliferation was significantly higher in patients who had been treated with tamoxifen for less than 1 year (P=0.037) than in those who had been treated for more than 1 year. Although the endometrial carcinomas, submucosal myomas, and endometrial hyperplasia were found in the patients who had been treated for more than 1 year, this result was not statistically significantwhen compared with the other group. As compared to the endometrial polyps obtained from women who had not received tamoxifen treatment, those obtained from patients who had received the treatment exhibited significantly lower levels of ER expression (P=0.000) in the glands and increased levels of PR (P=0.031) and Ki-67 expression (P=0.000) in the stroma. CONCLUSIONS: During tamoxifen treatment for breast cancer, the endometrial pathology should be investigated if transvaginal ultrasonography reveals the tissue to be more than 10 mm thick. Although tamoxifen has significant effects on the expression of hormone receptors, the mechanism underlying the development of endometrial polyps does not appear to be mediated by the ER.
Breast ; Breast Neoplasms ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Myoma ; Outpatients ; Polyps ; Receptors, Progesterone ; Tamoxifen ; Uterine Diseases ; Uterine Hemorrhage ; Uterus

OBJECTIVE: The need for early and correct prescription for bone densitometry led to the research for decision model useful for clinicians to address women to bone densitometry. there are few studies that have focused on both pre- and postmenopausal groups simultaneously in healthy pre-and postmenopausal Korean women. METHODS: The authors analyzed the easily obtained biometrical variables such as factors used at clinical decision rules for BMD testing and evaluated predictive values and robustness of a decision model for prediction of lumbar BMD in total , pre-and postmenopausal Korean women. RESULTS: After stepwise multiple regression analysis, Lumbar BMD in total population is 1.083-0.153 (status of menopause)-0.007 (age of menopause)+0.0039 (body weight) (R2=0.52). Postmenopausal women is 0.563-0.0077 (duration after menopause)+0.0054 (body weight) (R2=0.30) and premenopausal women is 0.23+0.0048 (height) (R2=0.05). Although its validity (52%) in total population was sufficiently high for the prediction of lumbar BMD in clinical settings, In postmenopausal women only 30% of the decision model can be explained by the predictors of bone demineralization which is not completely satisfactory in determining lumbar BMD and in premenopausal women 5% is the very low explanatory value which is necessary for identifying possible factors influencing BMD. CONCLUSIONS: Because of difference in underlying risk, as well as differences in the distribution of different risk factors according to menopausal status, this study present different robustness of prediction models according to menopausal status and suggest that it be need to design prediction models divided by menopausal status. More research is needed for computer-based screening aids useful to clinician which overcome some limitation of our study.
Bone Density ; Densitometry ; Female ; Humans ; Korea ; Mass Screening ; Prescriptions ; Risk Factors

Non-Hodgkin's lymphoma presented as a malignancy of the uterine cervix is exceedingly rare disease and accounts for approximately only 0.12-0.6% of extranodal lymphomas. There is no consensus on the management and prognosis of the disease because of its extreme rarity. Previously, treatment of this disease has been radiation therapy, surgery or chemotherapy either alone or in combination. We present the case of a 45-year-old woman diagnosed with diffuse, large B-cell non-Hodgkin's lymphoma of the uterine cervix. We administered neoadjuvant chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone) followed by hysterectomy and bilateral salpingo-oophorectomy. The patient is alive 20 months after the initial diagnosis. We report the case with a brief review of literature.
B-Lymphocytes ; Cervix Uteri* ; Consensus ; Diagnosis ; Doxorubicin ; Drug Therapy* ; Female ; Humans ; Hysterectomy ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prognosis ; Rare Diseases ; Vincristine

OBJECTIVE: The causal link between oncogenic HPV(Human Papilloma Viruses) and the development of CIN (rvical intraepithelial neoplasia) and cervical cancer are now well established. Several medical therapeutic candidates aimd at the treatment of precancerous lesions and invasive carcinoma of the cervix. The objective of this study was to develop the pH-sensitive chitosan/alginate gels (pH=3.8-4.5) and temperature sensitive multiblock copolymers of PEG/PLA (poly (L-lactic acid)/polyethylene glycol) gels (temperature=37 degrees C) for controlled delivery of the paclitaxel (PTX). We had also evaluated whether PTX entrapped in chitosan/alginate gels or multiblock copolymers of PEG/PLA 1 could inhibit tumor growth in vivo. METHODS: PTX entrapped as microsphere in Chitosan/Alginate Microspheres were obtained using a spray-drying method. PTX-entrapped PEG/PLA gels were prepared by the solvent displacement method. We had prepared the multiblock copolymers of PEG/PLA which has the sol-gel-sol transition temperature at body temperature. The in-vivo efficacy of PTX in chitosan microphere or PTX in PEG/PLA mutiblock copolymer micelle were conducted in HeLa-tumor bearing Balb/c Nu/Nu athymic mice at an equivalent paclitaxel dose of 10 mg/kg with 48 hr interval. The inhibition of tumor growth was evaluated after 8 days of treatment. RESULTS: On 8 days after the transcutaneous treatment of PTX-containing chitosan microphere or PTX in PEG/PLA mutiblock copolymer micelle. significant inhibition in tumor growth was observed in balb/c nu/nu nude mouse carrying xenograft tumors (HeLa cells; HPV-18 positive state). Among these formulations, PTX in PEG/PLA mutiblock copolymer have shown improved therapeutic efficacy as compared to PTX-ivgroup. CONCLUSION: PTX-containing chitosan microphere or PTX in PEG/PLA mutiblock copolymer nanoparticles are a unique pH-sensitive and temperature sensitive drug delivery system. These formulations elicits enhanced efficacy as an effective and minimally invasive treatment in mice bearing human cervical cancer (HeLa Cells) xenograft.
Animals ; Body Temperature ; Cervix Uteri ; Chitosan ; Drug Delivery Systems ; Female ; Gels ; Heterografts ; Human papillomavirus 18 ; Humans ; Mice ; Mice, Nude ; Microspheres ; Nanoparticles ; Paclitaxel ; Papilloma ; Polymers* ; Transition Temperature ; Uterine Cervical Neoplasms

PURPOSE: Capecitabine is an oral fluoropyrimidine carbamate and it is known as an effective radiosensitizer. Capecitabine and its metabolite reach their peak concentration in the plasma at 1~2 hours after a single oral administration of capecitabine and the levels fall rapidly thereafter. To verify the radiosensitizing effect of capecitabine that is based on such pharmacokinetic characteristics, we performed a retrospective analysis on the optimal timing of capecitabine administration with performing preoperative chemoradiation for locally advanced rectal cancer. MATERIALS AND METHODS: Among 171 patients who were treated with preoperative radiotherapy and concurrent capecitabine administration for rectal cancer, 56 patients were administered capecitabine at 1~2 hours before radiotherapy (group A), and at other time in the other 115 patients (group B). Total mesorectal excision was done at 4 to 6 weeks after the completion of chemoradiation. The radiosensitizing effect of capecitabine was evaluated on the basis of the pathological response. RESULTS: Complete pathological regression of the primary tumor was observed in 12 patients (21.4%) for group A and in 11 patients (9.6%) for group B (p=0.031). Residual disease less than 0.5 cm (a good response) was observed in 19 patients (33.9%) for group A and in 23 patients (20.0%) for group B (p=0.038). On multivariate analysis, the capecitabine ingestion time showed marginal significance. CONCLUSION: When performing preoperative chemoradiation for locally advanced rectal cancer, the radiosensitizing effect of capecitabine was enhanced when it was administered 1 hour before radiotherapy.
Administration, Oral ; Combined Modality Therapy ; Eating ; Humans ; Multivariate Analysis ; Plasma ; Radiation-Sensitizing Agents ; Radiotherapy ; Rectal Neoplasms* ; Retrospective Studies ; Capecitabine