The Examination of Ovarian Reserve in Premenopausal Patients with Hormone Receptor Positive Breast Cancer / 이화의대지

The evaluation of menopausal status is an important subject in the field of treatment of hormone receptor positive breast cancer. According to the menopausal status, endocrine therapy should be categorized by individual patient. However, the gonadal injury caused by various therapeutic drugs and its recovery would confuse the interpretation of clinical and biological markers for ovarian reserve. There are some methods to examine the functional ovarian reserve indirectly. Ultrasonography for counting follicles is a relatively reliable procedure, although it is not feasible because of time-labor consumption and high cost. Biological marker from blood samples such as serum follicle stimulating hormone (FSH), serum estradiol (E2), serum inhibin, or anti-Müllerian hormone (AMH) would be a better choice. The examination of serum FSH and E2 is already recommended as biomarkers for measuring functional ovarian reserve in many guidelines. However, there are limitation of serum FSH and E2 in patients with chemotherapy-induced amenorrhea and treated by tamoxifen. AMH is promising biomarker in the field of infertility treatment even in the patients treated by chemotherapy. It might be a possible biomarker to determine the menopausal status for decision-making whether aromatase inhibitor could be applicable or not in hormone positive breast cancer patients with chemotherapy induced amenorrhea or treated by tamoxifen.

Factors Associated with Metastatic Breast Cancer in Patients Who Show Long-Term Stable Disease Status

PURPOSE: This study aimed to analyze the basic clinical characteristics and survival of patients with breast cancer whose disease had been stably maintained for more than 24 months after systemic therapy. METHODS: We retrospectively reviewed the medical records of patients with primary breast cancer who underwent surgery. Among these patients, patients with stage IV disease at diagnosis or those who developed distant metastasis during the follow-up period after surgery were included in this analysis. Patients whose disease remained stable for more than 24 months were classified as the long-term stable disease group. The remaining patients were classified as the control group. RESULTS: A total of 245 patients were eligible for this analysis. Patients in the long-term stable disease group showed a lower rate of histologic type III, a higher rate of hormone receptor positivity, and received less adjuvant chemotherapy. In the long-term stable disease group, the most frequent site of metastasis was the lungs, whereas in the control group, it was the bones. Overall survival was significantly better in the long-term stable disease group than in the control group (p<0.001). In univariate analysis, factors affecting the overall survival rate were the duration from diagnosis to metastasis, the absence of lymphatic infiltration, and the presence of hormone receptors. In multivariate analysis, the duration from diagnosis to metastasis and the absence of lymphatic infiltration were significant factors affecting the overall survival rate. CONCLUSION: Disease progression was observed in many patients even after the disease had been stable for more than 24 months after systemic therapy. Although these patients had better outcomes compared with the others, continuous observation and possible additional treatment might be helpful for some patients.

Hepatectomy, combined with intraoperative radiofrequency ablation in patients with multiple hepatocellular carcinomas

BACKGROUNDS/AIMS: We compared the efficacy and safety of a hepatectomy, combined with intraoperative radiofrequency ablation to those of wider extent hepatectomy, alone, in patients with multiple hepatocellular carcinomas (HCCs). METHODS: Between January 2004 and December 2013, 78 patients with multiple HCCs underwent surgery. 25 patients were treated by hepatectomy, combined with intraoperative radiofrequency ablation (RFA) (group A), and 53 underwent hepatectomy only (group B). We retrospectively analyzed medical records to compare the clinical features of these two groups. RESULTS: Patients in group A had more limited resections (less than 2 segments) than those in group B (p<0.001). Patients in group A also tended to have fewer red blood cell transfusions than those in group B (p=0.060). Liver function- and surgery-related complications occurred only in group B. There were no in-hospital mortalities in both groups. The overall survival and disease-free survival outcomes were not significantly different between groups A and B (p=0.177 and p=0.305, respectively). CONCLUSIONS: Hepatectomy combined with intraoperative RFA could be a safe and effective treatment option for patients with multiple HCCs, comparable to extended hepatectomy alone.

Delayed Cerebral Hyperperfusion Syndrome Three Weeks after Carotid Artery Stenting Presenting as Status Epilepticus

Cerebral hyperperfusion syndrome (CHS) is increasingly recognized as an uncommon, but serious, complication subsequent to carotid artery stenting (CAS) and carotid endarterectomy (CEA). The onset of CHS generally occurs within two weeks of CEA and CAS, and a delay in the onset of CHS of over one week after CAS is quite rare. We describe a patient who developed CHS three weeks after CAS with status epilepticus.

Effect of YJ-7 (a calcium channel blocker) on blood pressure regulation in spontaneous hypertensive rat model

BACKGROUND: Farnesylacetone compounds that dilate blood vessels by blocking calcium channels in sargassum siliquastrum have been reported. And this study was done to demonstrate the effect of YJ-7, a synthetic material derived from these compounds, on vessel dilation and blood pressure control. METHODS: We used vasoconstricted basilar and carotid artery of rabbits. Changes in blood pressure were measured in vivo at 15, 30, 45, and 60 minutes after intravenous injection of YJ-7 3 microM, EC50 value from in vitro experiment, and nimodipine 10 microM through the tail vein of 20 rats. Spontaneous hypertensive rat (SHR) has its blood pressure higher than 190 mmHg. Measurements of blood pressure were done 6 times and the mean values were used for data analysis. RESULTS: Systolic and diastolic blood pressure before the injection of YJ-7 were 194.2 +/- 6.1 mmHg and 140.2 +/- 6.4 mmHg. Blood pressure were decreased with time, 157.2 +/- 2.6 / 120.8 +/- 4.2 mmHg at 15 minutes, 161.8 +/- 18.3 / 123.2 +/- 13.9 mmHg at 30 minutes, and 156.0 +/- 4.1 / 112.4 +/- 1.7 mmHg at 45 minutes. The blood pressure lowering effect lasted until 45 minutes. However, the blood pressure increased to 182.2 +/- 16.4 / 149.0 +/- 20.4 mmHg at 60 minutes reaching similar levels of before the injection (P < 0.05). CONCLUSIONS: We could see YJ-7 has vasorelaxation effect and would be helpful to control blood pressure with short recovery period than nimodipine.

Clinical Progress in Impending Central Retinal Vein Occlusion

PURPOSE: Impending central retinal vein occlusion is associated with mild or no loss of vision; however, its progress and vision prognosis have not been clearly defined until now. Therefore, we studied the progress and prognoses in patients with impending central retinal vein occlusion. METHODS: For this study, we selected ten subjects who had been diagnosed with impending central retinal vein occlusion, and we retrospectively reviewed their progress and prognoses. RESULTS: The average age of the subjects was 31.0 years (18 to 48 years). Eight patients were male and two were female. The average observational period was 5.5 months. Six out of ten subjects were found to have no underlying systemic disease, four subjects had underlying disease. All ten patients were affected unilaterally. When initially tested, the affected eyes showed an average vision of LogMar 0.30. The final vision test revealed an average of LogMar 0.04, which indicates good progress and prognosis. In one patient, retinal hemorrhage and macular edema progressively worsened after the diagnosis, and the patient was treated with radial optic neurotomy. CONCLUSIONS: The cases of impending central retinal vein occlusion that we observed seemed to primarily affect young patients with generally good prognoses. However, in some cases, the degrees of obstruction and hemorrhage increased as time progressed. This suggests that impending central retinal vein occlusion could develop into the prodromal phase of an acute attack.

A Case of Alopecia Universalis with Vogt-Koyanagi-Harada Syndrome / 대한피부과학회지

Vogt-Koyanagi-Harada (VKH) syndrome is an idiopathic autoimmune disease involving melanocytes. The characteristic features are uveitis, meningismus, tinnitus, alopecia, vitiligo and poliosis, dependent upon the site of melanocyte location. Among the skin manifestations, alopecia usually appears as discrete, alopecic patches around the head. We report a case of fifty-year-old woman who presented with typical features of VKH syndrome, plus alopecia universalis and nail dystrophy.

Thickness Changes in the Fovea and Peripapillary Retinal Nerve Fiber Layer Depend on the Degree of Myopia

PURPOSE: To investigate changes in the thickness of the fovea and peripapillary RNFL associated with myopia. METHODS: Sixty-five Korean adults (for a total of 130 eyes) between 23 and 26 years of age were selected as test subjects. Thirty-eight test subjects were male, and 27 were female. Subjects with glaucoma or other identified ocular diseases were excluded. Patients whose manifest refraction measurement values ranged between 0 to -2D were classified as group one (emmetropia and low myopia), those between -2 to -5D were classified as group two (moderate myopia), and those more than -5D were classified as group three (high myopia). Using the OCT, the thickness of the fovea and peripapillary RNFL were measured for every subject. RESULTS: The thicknesses of the fovea for each of three groups were 142.16+/-8.99 micrometer in group one (45 eyes), 153.58+/-17.63 micrometer in group two (43 eyes) and 158.86+/-11.93 micrometer in group three (28 eyes). The data showed significant differences in fovea thickness between the groups. The average thicknesses of the peripapillary RNFL for each of three groups were 113.29+/-10.80 micrometer in group one, 103.85+/-14.48 micrometer in group two and 100.74+/-9.15 micrometer in group three. A statistically significant difference was found between group one and the other groups (p<0.05). CONCLUSIONS: As the level of myopia increased, the thickness of the fovea also increased, while the thickness of the peripapillary RNFL decreased. Therefore, when interpreting OCT results in the clinic, careful consideration should be given to various changes associated with myopia.

A Case of Photic Retinal Injury Associated with Exposure to Plasma Arc Welding

PURPOSE: To report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions. METHODS: We describe a case report of a 37-year-old male, working in the steel industry, who presented with central scotoma in both eyes. RESULTS: On his first visit, one day after performing plasma arc welding with protective gear at work, his best corrected vision was 0.7 for both eyes. Ophthalmic examination of the fundus showed a round yellow lesion with an approximate size of 300 micrometers superonasal to the fovea of both eyes. On his next visit, one month later, his vision had recovered to 1.0, his symptoms had improved, and the ophthalmoscopic examination of the fundus revealed that the round yellow spots had disappeared from both eyes. CONCLUSIONS: To our knowledge, this is the first report of photic retinopathy induced by plasma arc welding, and the OCT (optical coherence tomography) results of damaged retinal lesions have not previously been reported. For these reasons, we report this case.

The Effect of Scleral Buckle in Experimental Penetrating Eye Injury

PURPOSE: Scleral buckles are frequently performed as an additional procedure in perforated ocular injury surgery, but little is known about their independent effect after ocular trauma. The authors made a posterior penetrating ocular injury model in rabbits to evaluate the isolated role of primary scleral buckle placement. METHODS: Twenty eyes underwent surgery. The penetrating injury consisted of two 5 mm circumferential incisions placed five clock hours apart and 7 mm behind the limbus. A segmental scleral buckle was placed over a randomly chosen penetrating injury site after wound closure. The degree of the fibrous proliferation, traction, and the presence of retinal detachment were evaluated on follow-up examination. After enucleation and fixation, tissue sectioning was performed including injury sites. The greatest dimension of the fibrous proliferation at both wound sites was measured. RESULTS: Two eyes were excluded from the study due to unsuccessful buckling. Four eyes developed a retinal detachment. The remaining 14 eyes showed varying degrees of proliferation and traction on the retina. The greatest dimension of the fibrous proliferation at the buckle site (1.69 +/- 0.29 mm) was significantly different from that at the non-buckle site (2.07 +/- 0.37 mm, P<0.05). CONCLUSION: Primary scleral buckle placement at the time of surgical repair reduces vitreous traction and decreases the degree of fibrous proliferation.

The Effect of Stellate Ganglion Block in Various Types of Glaucoma

PURPOSE: To examine the effect of stellate ganglion block (SGB) in various types of glaucoma and ocular hypertension. METHODS: The subjects were chosen from patients who visited our hospital for glaucoma and postoperative ocular hypertension in the 6-month period from A to B (Ed-give the dates). SGB was performed one or four times with 15 eyes from four types of glaucoma and postoperative ocular hypertension patients. The intraocular pressure (IOP) of eyes that had undergone SGB was checked after 1 hour following SGB. We investigated the efficacy of SGB on the 15 patients. RESULTS: In primary open-angle glaucoma (POAG), early secondary glaucoma and post-operative ocular hypertension, the mean IOP of eyes that had undergone SGB decreased after 1 hour following SGB. However, in primary angle-closure glaucoma (PACG) and advanced secondary glaucoma, there was a rise in mean IOP after 1 hour following SGB. CONCLUSIONS: In the present study, SGB may be effective in treating POAG, early secondary glaucoma and postoperative ocular hypertension. However, in PACG and advanced secondary glaucoma, SGB may be considered to be harmful treatment modality.

Antimalarial activity of thiophenyl- and benzenesulfonyl-dihydroartemisinin

Each diastereomer of 10-thiophenyl- and 10-benzenesulfonyl-dihydroartemisinin was synthesized from artemisinin in three steps, and screened against chloroquine-resistance and chloroquine-sensitive Plasmodium falciparum. Three of the four tested compounds were found to be effective. Especially, 10 beta-benzenesulfonyl-dihydroartemisinin showed stronger antimalarial activity than artemisinin.

Therapeutic Effect of Topical Autologous Serum in Recurrent Punctate Corneal Erosion

PURPOSE: To study the effect of topical autologous serum in the treatment of recurrent punctate corneal erosions. METHODS: A total of 10 eyes from recurrent corneal erosion patients, who had suffered from recurrence after initial treatment with conventional therapy were treated using topical autologous serum from October 2001 to April 2003. We investigated the efficacy of this method over conventional therapy by retrospective review of their medical records. RESULTS: The recurrence rate of erosions before treatment with autologous serum eyedrops ranged from once every 2months to twice a month. Mean follow-up time was 11.0 +/- 4.6 months (range, 6~19 months). There was one case of recurrence 3 months after first treatment with autologous serum eyedrops which was effectively cured with autologous serum eyedrops. No side effects were noted in any of the treated patients. CONCLUSIONS: Topical autologous serum application may be considered as an effective and safe treatment modality in recurrent corneal erosions.

Neuromyelitis Optica in Children after Steroid Therapy

PURPOSE: Neuromyelitis optica (Devic's disease) is a rare clinical syndrome of unknown etiology in which unilateral or bilateral optic neuritis and transverse myelitis occur within an 8-week time interval. It is a disorder that occurs more commonly in adults than in children. The authors report a case of neuromyelitis optica in a patient who had been treated for transverse myelitis with steroid. METHODS: An 11-year-old female who had been treated for transverse myelitis with steroids for 2 weeks developed visual loss in her left eye with viral prodromes. An afferent pupillary defect was noticed and papilledema and leakage from the optic disc were noticed on fundus examination and fluorescein angiography. We confirmed neuromyelitis optica. RESULTS: Symptoms were improved with high-dose corticosteroid therapy but the visual field remained decreased. CONCLUSIONS: The prognosis of neuromyelitis optica is better in children than in adults. It was better that the child with transverse myelitis had undergone ophthalmologic evaluation and close observation for more than 8 weeks. When optic neuritis was developed, high dose steroid therapy was performed for a sufficient period.

Reduction Mammoplasty using Modified Round Block Technique

The goals of reduction mammoplasty are to remove the appropriate amount of breast tissue and to make the nice cone-shaped breast. For these goals, various methods have been used and newly introduced. Recently, as women's interest in cosmetic attractiveness increases, surgeons make attempts to minimize postoperative scars. Periareolar approach has an advantage of invisible postoperative scar, but has many disadvantages - flattening of breast shape, recurrence of breast ptosis, hypertrophy and widening of periareolar scar, enlargement and distortion of areola caused by tension. After Benelli introduced Round block technique, this approach became one of the most popular methods. The characteristics of Round block technique are periareolar approach, superiorly based dermoglandular pedicle, criss-cross mastopexy, and Round block suture. Authors modified periareolar Round block technique to adjust to Korean women and have operated on 11 patients since 1997. We focused on medializing the lateral portion of inframammary fold and avoiding asymmetry and protrusion of nipple-areolar complex. Round block suture with uniform thickness and length must be applied at the same time to prevent areolar complications. In design, authors referred to the statistical analysis on Korean female. The results are aesthetically and functionally satisfactory and there has been no significant complication. In conclusion, this method is effective for young woman or mild macromastia with moderate ptosis. Besides, an accurate understanding of each step of operative procedure and enough knowledge of anatomy and physiology of the breast are essential.

A case of streptococcus pyogenes endophthalmitis following cataract surgery

A small number of cases of bacterial endophthalmitis due to Streptococcus pyogenes, a Gram positive organism, have previously been reported. In this case, rapidly progressive Streptococcus pyogenes endophthalmitis was developed five years after cataract surgery which had been. The previous cataract surgery was combined with intraocular lens implantation by trans-scleral suspension technique. Treatment included enucleation and intravenous antibiotic injection. In this case of delayed Streptococcus pyogenes endophthalmitis after extracapsular cataract extraction. It seems probable that progressive erosion of the suture material resulted in exogenous endophthalmitis.

The Histopathologic and Clinical Features of Idiopathic Macular Hole

PURPOSE: The purpose of this study was to assess surgical results of internal limiting membrane maculorrhexis and to better understand the ultrastructural features of excised tissue during surgery for idiopathic macular holes. METHODS: We studied 10 patients (10 eyes) with idiopathic macular hole, who had undergone trans-pars planar vitrectomy, peeling of internal limiting membrane with maculorrhexis maneuver, air-fluid exchange, and intravitreal gas tamponade. During the vitrectomy surgery for idiopathic macular hole, we excised specimens. These surgical specimens were evaluated with transmission electron microscopy for their histopathologic features. RESULTS: We achieved complete hole closure in all 10 eyes, postoperatively. Sixty percent of the patients achieved visual improvement of 2 or more lines on Snellen E visual acuity chart. In the ultrasutuctural findings, internal limiting membranes were noted. Some of them showed cellular components enmeshed in a collagenous matrix. In many cases, we could find that the internal limiting membranes were covered on its inner surface by a layer of cells. The most frequent cell type was myofibroblasts, followed by fibrocytes and fibrous astrocytes. CONCLUSIONS: Our study supports the hypothesis that idiopathic macular holes occur because of histopathologic changes of the prefoveal internal limiting membranes. And we postulate that intentional removal of internal limiting membrane with maculorrhexis is a logically reasonable surgical treatment for idiopathic macular holes.

Wernicke's Syndrome Induced by Hyperemesis Gravidarum

PURPOSE: Wernicke's syndrome, which is characterized by nystagmus, abducent and conjugate gaze palsies, ataxia, mental confusion, and amnesia, is caused by a deficiency in levels of thiamine and is observed mainly in persons who abuse alcohol. Recognized predisposing conditions other than alcoholism include chronic dietary deprivation(imbalanced diet, prolonged intravenous feeding.) and impaired absorption or intake of dietary nutrients. METHODS: We have experienced a 31-year-old female presented 15 weeks into pregnancy who complained of icteric skin color, diplopia, and gait disturbance after prolonged vomiting for 2 months. Neurologic examination demonstrated obtunded sensations, nystagmus and ataxia of gait. EEG showed a mild degree of slowly diffuse activity. The neurological signs pointed to a diagnosis of Wernicke's encephalopathy. RESULTS: We report a case of Wernicke's syndrome induced by hyperemesis gravidarum with the review of literature.

The Clinical Study on the Most Common Donor Sites in Head and Neck Reconstruction using Free Flaps

The technique of microvascular surgery and understanding of regional vascular anatomy permitted the surgeon to utilize a greater variety of free flaps for reconstruction. Especially, head and neck is the most common defect site for which free flaps have been applied, because trauma and tumor happen frequently and head and neck reconstruction needs a variety of tissues, such as muscle, tendon, nerve and bone. In a 10-year period, 74 free flaps were performed for head and neck reconstruction following major head and neck ablative surgery. Transverse rectus abdominis musculocutaneous flap(TRAM), radial forearm fasciocutaneous flap and latissimus dorsi(LD) free flap were applied to 16 cases, 16 cases and 12 cases of head and neck reconstruction, respectively. As the most common donor sites in head and neck reconstruction, the greatest use of these flaps has been in midface defects including skull base and orbital area and scalp defects including skull defects. The role of these flaps is mostly to fill large defects with skin and fatty tissue, muscle and to protect the principal organ from external trauma and infection. In addition to these donor sites, a variety of donor sites can be used for reconstruction. Before the choice of donor site, the surgeon must not only exam patients underlying condition, but also consider all sides of a donor site; volume, thickness and texture of donor flap, operative and postoperative patients position, the postoperative change of transferred flap and donor morbidity and so forth.

Choroidal Tuberculoma with Membranous Glomerulonephritis

We report treatment of a 24-year-old man with membranous glomerulonephritis (MGN) who developed a solitary choroidal tuberculoma in association with miliary tuberculosis during steroid therapy. In June 1995, the patient had developed nephrotic syndrome. He had refused renal biopsy at that time. So we treated him with corticosteroids having assumed a diagnosis of minimal change nephrotic syndrome. After initial corticosteroids and diuretics therapy for 5 months, his generalized edema resolved but proteinuria (3 positive) continued, suggesting the presence of other forms of glomerulonephritis. Renal biopsy performed in January 1996. The patient was diagnosed as having MGN. The patient was closely observed over a period of 34 months and remained stable without steroid therapy. However at 34 months, generalized edema was again noted and steroid therapy at high dosage was initiated. After 5 months of steroid therapy, he developed miliary tuberculosis and a solitary choroidal mass. An antituberculosis chemotherapeutic regimen was started and after a further 5 months, all clinical symptoms and signs of the pulmonary lesion were resolved and a measurable shrinking of the choroidal mass was recorded.