Comparison of Pregnancy Prognosis for Gestational Diabetes Diagnosed by the 1-Step and 2-Step Methods

Purpose@#To compare pregnancy complications between the 2 groups of patients with gestational diabetes mellitus (GDM): those diagnosed by the 1-step method and those diagnosed by the 2-step method. @*Methods@#In this retrospective cohort study, the data from outpatient and hospitalization medical records of 201 patients diagnosed with GDM between 2013 and 2017 were reviewed. We compared the pregnancy complications of these patients based on whether they were diagnosed by the 1-step or 2-step method. SPSS ver. 20.0 was used to analyze the data from the 2 groups. The odds ratio and 95% confidence interval of the pregnancy outcomes were estimated using binary logistic regression analysis. @*Results@#On comparing pregnancy-related complications between the groups, there was no significant difference in the incidence of preeclampsia or delivery by cesarean section (p>0.99 and p=0.50, respectively). In the 1-step and 2-step groups, the prevalence of premature birth was significantly high at 19.7 % and 40.3% (p=0.01), respectively. There were no significant differences between the 2 groups in terms of macrosomia, large for gestational age (LGA), small for gestational age (SGA), low APGAR score, and neonatal hypoglycemia (p>0.99, p>0.26, p>0.62, p>0.57, and p>0.45, respectively). @*Conclusion@#On comparing the 2 groups, we found that the 1-step and 2-step GDM groups had similar risks of pregnancy complications, namely preeclampsia, delivery by cesarean section, macrosomia, LGA, SGA, low APGAR scores, and neonatal hypoglycemia.

Extraordinary radiation super-sensitivity accompanying with sorafenib combination therapy: what lies beneath?

Primary liver tumor, especially hepatocellular carcinoma (HCC), is a common cause of cancer death worldwide. The incidence is generally higher in Asian countries than in western countries. Carcinogenesis of HCC is often associated with hepatitis viral infections. Current standard treatment of HCC is surgical resection or transplantation in patients with early stage disease. However, the patient with advanced stage disease, surgical resection is often limited. Sorafenib or other treatment modalities are not so effective as well. We report a case of unusual radiation super-sensitivity in advanced stage HCC, and review the literature.

Effect of Coenzyme Q10 on Radiation Nephropathy in Rats

The kidney is one of the most radiosensitive organs in the abdominal cavity and is the dose-limiting structure in cancer patients receiving abdominal or total body irradiation. In the present study, the effect of coenzyme Q10 (CoQ10) on radiation nephropathy was evaluated in rats. A total of 72 rats were equally randomized into 4 groups: Control, CoQ10, irradiation with 10 Gy (RT) + placebo, or RT + CoQ10. The 2 RT groups received single 10 Gy of abdominal irradiation. The 2 CoQ10 groups were supplemented daily with 1 mL of soybean oil containing 10 mg/kg of CoQ10. The RT + placebo and control groups received same dose of soybean oil. After 24 weeks, laboratory and histopathologic findings were compared. The 2 RT groups showed significant increases in blood urea nitrogen (BUN) and creatinine levels and significant pathologic changes such as glomerulosclerosis and tubulointerstitial fibrosis. CoQ10 supplementation resulted in significant reductions of BUN and creatinine levels compared with the RT + placebo group (P < 0.001 and P = 0.038, respectively). CoQ10 treatment significantly attenuated glomerular and tubular changes of irradiated kidney in semiquantitative analysis (P < 0.001 for both). Administration of CoQ10 can alleviate the radiation-induced nephropathy.

Three-dimensional conformal radiotherapy for portal vein tumor thrombosis alone in advanced hepatocellular carcinoma

PURPOSE: We sought to evaluate the clinical outcomes of 3-dimensional conformal radiation therapy (3D-CRT) for portal vein tumor thrombosis (PVTT) alone in patients with advanced hepatocellular carcinoma. MATERIALS AND METHODS: We retrospectively analyzed data on 46 patients who received 3D-CRT for PVTT alone between June 2002 and December 2011. Response was evaluated following the Response Evaluation Criteria in Solid Tumors. Prognostic factors and 1-year survival rates were compared between responders and non-responders. RESULTS: Thirty-seven patients (80.4%) had category B Child-Pugh scores. The Eastern Cooperative Oncology Group performance status score was 2 in 20 patients. Thirty patients (65.2%) had main or bilateral PVTT. The median irradiation dose was 50 Gy (range, 35 to 60 Gy) and the daily median dose was 2 Gy (range, 2.0 to 2.5 Gy). PVTT response was classified as complete response in 3 patients (6.5%), partial response in 12 (26.1%), stable disease in 19 (41.3%), and progressive disease in 12 (26.1%). There were 2 cases of grade 3 toxicities during or 3 months after radiotherapy. Twelve patients in the responder group (15 patients) received at least 50 Gy irradiation, but about 84% of patients in the non-responder group received less than 50 Gy. The 1-year survival rate was 66.8% in responders and 27.4% in non-responders constituting a statistically significant difference (p = 0.008). CONCLUSION: Conformal radiotherapy for PVTT alone could be chosen as a palliative treatment modality in patients with unfavorable conditions (liver, patient, or tumor factors). However, more than 50 Gy of radiation may be required.

Helical Tomotherapy in Elderly Prostate Cancer Patients

BACKGROUND: Helical tomotherapy is a new form of image-guided intensity modulated radiation therapy that may improve local control and decrease radiation toxicity. The aim of this study was to evaluate if high-dose helical tomotherapy is tolerated by patients aged 75 years or older and if the side effects are comparable with those experienced by younger patients. METHODS: Between January 2011 and August 2012, patients with prostate cancer who underwent helical tomotherapy without elective pelvic irradiation as definitive aim were reviewed and divided into two age groups: > or =75 years and <75 years. Acute genitourinary (GU) and lower gastrointestinal (GI) toxicities between the two groups were compared. RESULTS: Twenty patients aged 75 years or older and 23 patients younger than 75 years were evaluated. Radiotherapy was administered to a total dose of 76-78Gy in 38-39 fractions or 70Gy in 28 fractions. There was no grade 3 or 4 acute toxicity and no grade 2 acute lower GI symptom, but the patients complained of grade 2 acute GU toxicity, 25.0% for the older group and 13.0% for the younger group. There was no significant difference in the rate of acute toxicity between the age groups. Hypofractionation showed a significant association with higher grade 2 acute GU toxicity (p=0.024) with the grade 2 acute GU toxicity having no significant correlation with T-stage, Gleason score, prostate specific antigen level, androgen deprivation therapy, and comorbidities. CONCLUSION: High-dose helical tomotherapy to the prostate without pelvic irradiation was well tolerated by elderly prostate cancer patients 75 years and older.

Short-course palliative radiotherapy for uterine cervical cancer

PURPOSE: The purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer. MATERIALS AND METHODS: Seventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions. RESULTS: The median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity. CONCLUSION: Short-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.

Neoadjuvant intra-arterial chemotherapy combined with radiotherapy and surgery in patients with advanced maxillary sinus cancer

PURPOSE: The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. MATERIALS AND METHODS: Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, 500 mg/m2) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. RESULTS: At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. CONCLUSION: Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

Treatment Planning for Minimizing Carotid Artery Dose in the Radiotherapy of Early Glottic Cancer / 대한방사선종양학회지

PURPOSE: To examine the feasibility of the treatment planning for minimizing carotid artery dose in the radiotherapy of early glottic cancer. MATERIALS AND METHODS: From 2007 to 2010, computed tomography simulation images of 31 patients treated by radiotherapy for early glottic cancer were analyzed. The virtual planning was used to compare the parallel-opposing fields (POF) with the modified oblique fields (MOF) placed at angles to exclude the ipsilateral carotid arteries. Planning target volume (PTV), irradiated volume, carotid artery, and spinal cord were analyzed at a mean dose, V35, V40, V50 and with a percent dose-volume. RESULTS: The beam angles were arranged 25 degrees anteriorly in 23 patients and 30 degrees anteriorly in 8 patients. The percent dose-volume of PTV shows no statistical difference. Conversely, the cumulative percent dose-volume of carotid artery shows the significant difference (p<0.001). The mean doses of carotid artery were 38.5 Gy for POF and 26.3 Gy for MOF and the difference was statistically significant (p=0.012). Similarly, V35, V40, and V50 also showed significant differences between POF and MOF. CONCLUSION: The modified oblique field was respected to prevent a carotid artery stenosis and reduce the incidence of a stroke based on these results.

Effect of Ketamine on Phenylephrine-Induced Contraction in Isolated Rat Thoracic Aorta / 대한마취과학회지

BACKGROUND: Ketamine causes a dose-dependent vasodilation of a norepinephrine-precontracted pulmonary arterial ring. The goals of the present in vitro study were to investigate the effects of ketamine on phenylephrine-induced contraction and to elucidate its cellular mechanism. METHODS: Following endothelial denudation, isolated thoracic aortic rings were suspended for isometric tension recording. Contractile response to 60 mM KCl (potassium chloride) was measured in the absence or presence of ketamine (5x10(-5), 10(-4), 10(-3) M) in the rings. Phenylephrine dose (10(-8) to 10(-5) M)-response curves were generated in the absence or presence of ketamine. In rings pretreated with verapamil (10(-5) M) or with combined verapamil (10(-5) M) and ryanodine (2x10(-5) M), phenylephrine dose-response curves were also generated in the absence or presence of ketamine. RESULTS: Ketamine attenuated the contractile response to 60 mM KCl compared with rings without ketamine in a concentration-dependent manner, and ketamine (5x10(-5), 10(-4), 10(-3)M) caused a rightward shift of the dose-response curve to phenylephrine in a concentration-dependent manner. In verapamil 10(-5) M pretreated rings, ketamine 10(-3) M attenuated phenylephrine-induced contraction compared to rings without ketamine, but a low-dose of ketamine (5x10(-5), 10(-4)M) had no effect. In rings pretreated with combined verapamil 10(-5) M and ryanodine 2 x 10(-5) M, ketamine 10(-3) M attenuated phenylephrine-induced contraction compared with rings without ketamine. CONCLUSIONS: These results indicate that clinically relevant concentration (5 x 10(-5) M) of ketamine attenuates phenylephrine-induced contraction by inhibiting the L-type calcium channel.

Effects of Clonidine Pretreatment on Bupivacaine-Induced Cardiac Toxicity Resuscitation in Dogs / 대한마취과학회지

BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.

A Case of Open Heart Surgery in a Patient with Huge Sinoatrial Nodal Artery Aneurysm -A case report- / 대한마취과학회지

An intrathoracic mass that manifested compression sign of large vessel and heart by mass was confirmed as huge sinoatrial nodal artery aneurysm and resection of aneurysm was performed. Preoperative precise diagnosis of coronary artery aneurysm is difficult because the most coronary artery aneurysm is incidentally confirmed during diagnostic coronary angiography or autopsy. So huge coronary artery aneurysm which manifests compression sign of large vessel and heart by the mass may be misdiagnosed as simple mediastinal mass. We reports huge coronary artery aneurysm that manifested compression sign of large vessel and heart by the mass with reviews of anesthetic management and diagnostic approach.