Purpose: Fertility preservation (FP) is an important issue for young survivors of breast cancer. Although international guidelines recommend pre-treatment fertility counseling for women with breast cancer, there is no standardized protocol or referral system for FP in South Korea. There are also barriers to discussing FP that make patient-centered decision making difficult. This study aimed to develop a shared decision making program for FP and compare the rates of FP procedures between the usual care and shared decision making groups. We hypothesized that multidisciplinary shared decision making for FP would increase the rate of FP procedures and patient satisfaction. Methods The multidisciplinary shared decision making for FP in young women with breast cancer (MYBC) is a multicenter, clustered, stepped-wedge, randomized trial. A total of 1100patients with breast cancer, aged 19–40 years, from nine hospitals in South Korea, will be enrolled. They will be randomized at the institutional level and assigned to usual care and shared decision making groups. Four institutions, each of which can recruit more than 200 patients, will each become a cluster, whereas five institutions, each of which can recruit more than 50 patients, will become one cluster, for a total of five clusters. The shared decision making groups will receive multidisciplinary programs for FP developed by the investigator. The primary outcome is the rate of FP procedures; secondary outcomes include fertility results, satisfaction, and quality of life. Outcomes will be measured at enrollment, treatment initiation, and the 1-, 3-, and 5-year follow-ups after starting breast cancer treatment.Discussion: A multidisciplinary shared decision making program for FP is expected to increase fertility rates and satisfaction among young patients with breast cancer. This study will provide the evidence to implement a multidisciplinary system for patients with breast cancer.

Background/Aims: This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex. Methods: We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex. Results: During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female. Conclusions QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.

OBJECTIVES: An outbreak of acute febrile illness occurred in the Republic of Korea Air Force boot camp from May to July 2011. An epidemiological investigation of the causative agent, which was of a highly infective nature, was conducted. METHODS: Throat swabs were carried out and a multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay was performed to identify possible causative factors. RESULTS: The mean age of patients who had febrile illness during the study period was 20.24 years. The multiplex RT-PCR assay identified respiratory syncytial virus (RSV) as the causative agent. The main symptoms were sore throat (76.0%), sputum (72.8%), cough (72.1%), tonsillar hypertrophy (67.9%), and rhinorrhea (55.9%). The mean temperature was 38.75degreesC and the attack rate among the recruits was 15.7% (588 out of 3750 recruits), while the mean duration of fever was 2.3 days. The prognosis was generally favorable with supportive care but recurrent fever occurred in 10.1% of the patients within a month. CONCLUSIONS: This is the first epidemiological study of an RSV outbreak that developed in a healthy young adult group. In the event of an outbreak of an acute febrile illness of a highly infective nature in facilities used by a young adult group, RSV should be considered among the possible causative agents.
Adolescent ; Adult ; Antiviral Agents/therapeutic use ; Body Temperature ; Disease Outbreaks ; Humans ; Male ; Military Personnel ; Multiplex Polymerase Chain Reaction ; Oseltamivir/therapeutic use ; Pharynx/virology ; RNA, Viral/chemistry/genetics/metabolism ; Republic of Korea/epidemiology ; Respiratory Syncytial Virus Infections/drug therapy/*epidemiology/virology ; Respiratory Syncytial Viruses/*genetics/isolation & purification ; Sputum/virology ; Young Adult

PURPOSE: To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment. MATERIALS AND METHODS: In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites. RESULTS: The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (> or =37 U/mL) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001). CONCLUSION: Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Celiac Artery ; Cystic Duct ; Disease-Free Survival ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Ligaments ; Mesenteric Artery, Superior ; Multivariate Analysis ; Prognosis ; Radiotherapy, Adjuvant* ; Recurrence ; Risk Factors ; Survival Analysis ; Survival Rate

Unexpected occurrence of local anesthetic toxicity is not rare and can cause fatal complications that do not respond to any known drug of intervention. Recently, the successful use of lipid emulsion for local anesthetic toxicity has been reported and recommended as a rescue method for cardiac or neurologic complications. We report a case of seizure attack and respiratory arrest successfully recovered with the use of intravenous lipid emulsion. Clinicians must be aware of the beneficial role of lipid emulsion in cases of local anesthetic toxicity.
Anesthetics, Local ; Ankle* ; Antidotes ; Fat Emulsions, Intravenous ; Neurotoxicity Syndromes ; Resuscitation* ; Seizures

Sauchinone has been known to have anti-inflammatory and antioxidant effects. We determined whether sauchinone is beneficial in regional myocardial ischemia/reperfusion (I/R) injury. Rats were subjected to 20 min occlusion of the left anterior descending coronary artery, followed by 2 hr reperfusion. Sauchinone (10 mg/kg) was administered intraperitoneally 30 min before the onset of ischemia. The infarct size was measured 2 hr after resuming the perfusion. The expression of cell death kinases (p38 and JNK) and reperfusion injury salvage kinases (phosphatidylinositol-3-OH kinases-Akt, extra-cellular signal-regulated kinases [ERK1/2])/glycogen synthase kinase (GSK)-3beta was determined 5 min after resuming the perfusion. Sauchinone significantly reduced the infarct size (29.0% +/- 5.3% in the sauchinone group vs 44.4% +/- 6.1% in the control, P < 0.05). Accordingly, the phosphorylation of JNK and p38 was significantly attenuated, while that of ERK1/2, Akt and GSK-3beta was not affected. It is suggested that sauchinone protects against regional myocardial I/R injury through inhibition of phosphorylation of p38 and JNK death signaling pathways.
Animals ; Benzopyrans/*pharmacology ; Dioxoles/*pharmacology ; Glycogen Synthase Kinase 3/metabolism ; JNK Mitogen-Activated Protein Kinases/*metabolism ; Mitogen-Activated Protein Kinase 1/metabolism ; Mitogen-Activated Protein Kinase 3/metabolism ; Myocardial Reperfusion Injury/*metabolism/pathology/prevention & control ; Phosphorylation ; Protective Agents/*pharmacology ; Rats ; Signal Transduction/*drug effects ; p38 Mitogen-Activated Protein Kinases/*metabolism

PURPOSE: Although laparoscopic liver resection has become popular and it has shown good surgical safety and feasibility, the oncologic safety is still not established. Therefore, we analyzed the mid-term survival and disease free survival rates after laparoscopic liver resection for HCC to establish the oncologic safety. METHODS: Between September 2003 and August 2008, 64 patients with hepatocellular carcinoma underwent laparoscopic liver resection. The clinical data of these patients was analyzed by the Kaplan-Meier method. RESULTS: There were 19 major hepatic resections and 45 minor hepatic resections without any mortality. There were 15 complications, including 9 cases of abdominal fluid collection, 3 cases of bile leakage, 2 cases of ascites and 1 case of ileus. The 3 years overall survival and disease free survival rates were 87.8% and 67.3%, respectively. CONCLUSION: We confirmed that laparoscopic liver resection for hepatocellular carcinoma is safe and feasible. The 3 years survival rates and disease free survival rates were as high as those of open resection for hepatocellular carcinoma.
Ascites ; Bile ; Carcinoma, Hepatocellular ; Disease-Free Survival ; Hepatectomy ; Humans ; Ileus ; Laparoscopy ; Liver ; Survival Rate

PURPOSE: Although laparoscopic liver resection has become popular and it has shown good surgical safety and feasibility, the oncologic safety is still not established. Therefore, we analyzed the mid-term survival and disease free survival rates after laparoscopic liver resection for HCC to establish the oncologic safety. METHODS: Between September 2003 and August 2008, 64 patients with hepatocellular carcinoma underwent laparoscopic liver resection. The clinical data of these patients was analyzed by the Kaplan-Meier method. RESULTS: There were 19 major hepatic resections and 45 minor hepatic resections without any mortality. There were 15 complications, including 9 cases of abdominal fluid collection, 3 cases of bile leakage, 2 cases of ascites and 1 case of ileus. The 3 years overall survival and disease free survival rates were 87.8% and 67.3%, respectively. CONCLUSION: We confirmed that laparoscopic liver resection for hepatocellular carcinoma is safe and feasible. The 3 years survival rates and disease free survival rates were as high as those of open resection for hepatocellular carcinoma.
Ascites ; Bile ; Carcinoma, Hepatocellular ; Disease-Free Survival ; Hepatectomy ; Humans ; Ileus ; Laparoscopy ; Liver ; Survival Rate

PURPOSE: Distal pancreatectomy has historically been accompanied by splenectomy, due to the proximity and common blood supply of the pancreas and spleen. However, spleen-preserving distal pancreatectomy was introduced in order to prevent postoperative sepsis. The aim of this study was to evaluate the feasibility and outcomes of spleen and splenic vessel preservation during laparoscopic distal pancreatectomy (LDP). METHODS: Between June 2004 and March 2007, 30 patients underwent LDP for pancreatic neoplasms. Preservation of both the spleen and splenic vessels was pursued for benign and borderline malignant tumors. RESULTS: There were 11 male and 19 female patients, with a mean age of 47 years (range; 24~79 years). In 4 patients with suspicious malignancy, the spleen and its vessels were sacrificed. Preservation of the spleen and its vessels was successfully performed in 20 of 26 patients (76.9%) in whom it was initially sought. The mean tumor size was 4.3 cm (range; 1.5~11 cm), the mean operation time was 231 min (range; 70~490 min), and the mean blood loss was 316.67 ml (range; 50~1000 ml). During LDP, no conversion to open surgery occurred. The mean hospital stay was 11 days (range; 6~23 days). There was no mortality or reoperation. Postoperative complications occurred in 9 patients (30%), but all patients recovered after conservative management. CONCLUSION: LDP is a relatively safe and feasible procedure for the management of benign or borderline malignant tumors of the distal pancreas. Preservation of the spleen and splenic vessels may be feasibly pursued during LDP.
Conversion to Open Surgery ; Female ; Glycosaminoglycans ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Postoperative Complications ; Reoperation ; Sepsis ; Spleen ; Splenectomy

This study was aimed to evaluate the efficacy of a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) as compared with daily administrations of short-acting GnRHa in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) cycles. The mean dosage of recombinant follicle-stimulating hormone (rFSH) required for COH (2,354.5+/-244.2 vs. 2,012.5+/-626.1 IU) and the rFSH dosage per retrieved oocyte (336.7+/-230.4 vs. 292.1+/-540.4 IU) were significantly higher in the long-acting GnRHa group (N= 22) than those in the short-acting GnRHa group (N=28) (p<0.05). However, the mean number of visit to the hospital that was required before ovum pick-up (3.3+/-0.5 vs. 22.2+/-2.0) and the frequency of injecting GnRHa and rFSH (12.8+/-1.2 vs. 33.5+/- 3.5) were significantly decreased in the long-acting GnRHa group (p<0.0001). The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different between the 2 groups. So, we suggest that a single administration of long-acting GnRHa is a useful alternative for improving patient's convenience with clinical outcomes comparable to daily administrations of short-acting GnRHa in COH for IVF-ET cycles.
Adult ; Buserelin/*therapeutic use ; *Embryo Transfer ; Female ; *Fertilization in Vitro ; Follicle Stimulating Hormone/therapeutic use ; Goserelin/therapeutic use ; Humans ; Leuprolide/*therapeutic use