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.

Purpose: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard management for relapsed or high-risk non-Hodgkin’s lymphoma (NHL). We reported the busulfan, melphalan, and etoposide (BuME) conditioning regimen was effective in patients with relapsed or high-risk NHL. Moreover, the busulfan, cyclophosphamide, and etoposide (BuCE) conditioning regimen has been used widely in ASCT for NHL. Therefore, based on these encouraging results, this randomized phase II multicenter trial compared the outcomes of BuME and BuCE as conditioning therapies for ASCT in patients with NHL. Materials and Methods: Patients were randomly assigned to receive either BuME (n=36) or BuCE (n=39). The BuME regimen was comprised of busulfan (3.2 mg/kg/day, intravenously) administered on days –7, –6, and –5, etoposide (400 mg/m2 intravenously) on days –5 and –4, and melphalan (50 mg/m2/day intravenously) on days –3 and –2. The BuCE regimen was comprised of busulfan (3.2 mg/kg/day intravenously) on days –7, –6, and –5, etoposide (400 mg/m2/day intravenously) on days –5 and –4, and cyclophosphamide (50 mg/kg/day intravenously) on days –3 and –2. The primary endpoint was 2-year progression-free survival (PFS). Results: Seventy-five patients were enrolled. Eleven patients (30.5%) in the BuME group and 13 patients (33.3%) in the BuCE group had disease progression or died. The 2-year PFS rate was 65.4% in the BuME group and 60.6% in the BuCE group (p=0.746). There were no non-relapse mortalities within 100 days after transplantation. Conclusion There were no significant differences in PFS between the two groups. Therefore, busulfan-based conditioning regimens, BuME and BuCE, may be important treatment substitutes for the BCNU-containing regimens.

Purpose: The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. Materials and Methods: A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. Results: AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001).Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). Conclusion AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.

Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

Background/Aims: Pheochromocytoma and paraganglioma (PPGL) are catecholamine-producing tumors that can cause blood pressure (BP) elevation and cardiovascular complications. Clinical presentation of these tumors may be changed through widespread use of imaging studies, which enables detection of PPGLs before onset of symptoms. We investigated clinical profiles of patients with surgically resected PPGLs. Methods: From 2005 to 2017, 111 consecutive patients with surgically resected PPGLs in two tertiary hospitals in Korea were studied. Results: Mean age was 52 ± 16 years, 57 patients (51.4%) were male and 54 (48.6%) were hypertensive. Twenty-nine PPGLs (26.1%) were extra-adrenal paragangliomas. Sixteen (14.4%) and seven patients (6.3%) (Group 1, n = 23) were diagnosed during work-up of hypertension and transient cardiomyopathy respectively, and the remainder (Group 2, n = 88) were incidentalomas detected during routine abdominal imaging. Patients in the Group 1 were younger and more frequently symptomatic, and had higher BPs, heart rates and levels of urinary catecholamines than those in the Group 2. Paragangliomas were less frequent and secretion of epinephrine and metanephrine was more predominant in the Group 1 than in Group 2. After the surgical resections, 18.2% of patients still needed antihypertensive medications. Conclusions Out of 111 patients with surgically resected PPGLs, 88 (79.3%) were diagnosed as incidentalomas. Seven patients presented with transient cardiomyopathy and 16 with hypertension. Tumor location and secretion of catecholamine may vary depending on the presence of symptoms.

BACKGROUND/AIMS: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. METHODS: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. RESULTS: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. CONCLUSIONS: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability.
Abdominal Pain/etiology ; Adult ; Constipation/etiology ; Diarrhea/etiology ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Irritable Bowel Syndrome/complications/*drug therapy ; Male ; Middle Aged ; Parasympatholytics/*therapeutic use ; Phenothiazines/*therapeutic use ; Severity of Illness Index ; Treatment Outcome ; Trimebutine/*therapeutic use

PURPOSE: To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur. MATERIALS AND METHODS: 162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors. RESULTS: 2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium. CONCLUSION: Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.
Aged ; Delirium ; Dementia ; Femur ; Hematocrit ; Hip Fractures ; Humans ; Incidence ; Length of Stay ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors

PURPOSE: To compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis, which was not treated conservatively. MATERIALS AND METHODS: Between January 2008 and October 2009, We divided to two groups, endoscopy (group A) 11 cases, open bursectomy (group B) 11 cases. The average follow up period was 15 months (range, 12 to 18), the mean age was 66 (range, 38 to 79). We compared patients satisfaction, complete healing time, operation time, complications and recurrence. RESULTS: Group A had significant difference in terms of the clinical satisfactions, complete healing time. operation time, complications. Group A showed satisfaction (excellent 9, good 2), mean complete healing time 11.9 (8~14) days, operation time 37 (25~45) minutes, 1 case recur. Group B showed satisfaction (excellent 4, good 3, fair 1, poor 3), complete healing time 32.7 (14~98) days, operation time 22 (18~26) minutes. complication were one case of skin necrosis, one case of wound dehiscence, two cases of superficial peroneal nerve injury, no recurrence. Significant advantages of endoscopic method include lower morbidity and rapid wound healing period (p<0.05). CONCLUSION: Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favourable results compared to the open resection. Significant advantages of this method include lower morbidiy and rapid wound healing.
Animals ; Ankle ; Bursitis ; Endoscopy ; Follow-Up Studies ; Humans ; Necrosis ; Peroneal Nerve ; Recurrence ; Skin ; Wound Healing

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Stenosis/surgery/*therapy ; Death, Sudden, Cardiac/etiology ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Thrombosis/etiology

PURPOSE: We evaluated the usefulness of radiographic parameters for osteoporosis by analyzing the results of radiographic parameters determined by digital hip radiographs and bone mineral density T-scores, as assessed by Dual Energy X-ray Absorptiometry (DEXA). MATERIALS AND METHODS: The authors reviewed 100 subjects in the hip fracture group and 50 in the non-fracture control group. Digital hip radiographs were assessed to determine the values of Singh index, Canal-to-Calcar Ratio, and Cortical Thickness Index (CTI). Bone mineral density was assessed by DEXA. RESULTS: Intraclass Correlation Coefficient (ICC) results of the CTI were above 0.8 in the fracture group. Compared to the control group, the fracture group showed higher ICCs. Interobserver ICCs were especially lower in the control group. There were statistically significant correlations between CTI and DEXA (r=0.50~0.58, p<0.05). In the analysis of ROC curves, a mean threshold for CTI set a value of 0.54 (0.53~0.55), and mean sensitivity and specificity were 75.5% (69~79%) and 67.8% (65~78%), respectively. CONCLUSION: CTI showed reasonable reliability and correlation with DEXA results. CTI was a useful radiographic parameter to alert the surgeon to recommend referral for osteoporosis evaluation in elderly hip fracture patients.
Absorptiometry, Photon ; Aged ; Bone Density ; Hip ; Humans ; Osteoporosis ; Referral and Consultation ; ROC Curve ; Sensitivity and Specificity