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Purpose@#Treatment with dopamine agonists (DAs) has been the first-line standard treatment for prolactinoma, and surgery has been reserved for drug intolerance and resistance for several decades. We evaluated whether surgery plays a primary role in prolactinoma management. @*Materials and Methods@#We conducted a retrospective study of 210 prolactinoma patients who had received surgical treatment at our institution. We analyzed the treatment outcomes according to tumor extent, sex, and preoperative DA medication. @*Results@#Overall hormonal remission was achieved in 164 patients (78.1%), and complete removal was achieved in 194 patients (92.4%). When the tumors were completely removed, the remission rate increased to 84.5%. Anterior pituitary function was normalized or improved in 94.6% of patients, whereas only 4.1% of patients showed worsening of hormone control. Hormonal remission was higher in patients who had not received DA preoperatively than in those who had received preoperative DA treatment. Smaller tumor size (<1 cm), no invasion into the cavernous sinus, and female sex were predictors of good surgical outcomes. @*Conclusion@#Although DAs remain the first-line standard treatment for prolactinomas, surgery can be an excellent option and should be considered as an alternative primary treatment modality when patients are predicted to achieve a good surgical outcome.
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Purpose@#This study is to investigate the distribution of natural tooth shades in the Korean elderly population to quantify the correlation and changes of tooth color with age and gender. In addition, the possible effects of habits on tooth color were assessed. @*Materials and Methods@#The tooth color of one of the maxillary central incisors of 200 Korean individuals aged 50 to 89 years, males and female, was measured using the portable intraoral spectrophotometer (VITA Easyshade V).CIELab and CIELCh color coordinates were recorded. We conducted the survey about the tobacco smoking, chronic disease, medication, eating habits, oral health behaviors and satisfaction with tooth color. Experimental data were statistically analyzed by using the t-test (P<0.05), two-way analysis of variance and Pearson’s correlation test.Result: The most frequent color in the Korean elderly population was 3M3 & A3.5 shade. L* and h* values decreased, whereas C*, a* and b* values increased progressively with age. There was a significant interaction between age and color coordinates for b* values (r=0.245, P<0.05). Males generally have significantly higher C*, a*, b* values and lower L*, h* value compared to females. Individuals who consumed alcohol had a higher L* value (P<0.05). @*Conclusion@#Within the limitation of this study, the central incisors were getting darker, more reddish, and yellowish with age. Information on the chromatic range of natural teeth by age and gender could help to select colors for esthetic dental restorations.
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Background@#Rathke’s cleft cysts (RCCs) are benign tumors of the pituitary gland. Small, asymptomatic RCCs do not require surgical treatment, whereas surgical treatment is required for symptomatic RCCs. @*Methods@#We retrospectively reviewed medical records of patients with an RCC who were diagnosed and managed in our institution between April 2004 and April 2020 and generated two different cohorts: the observation (n=114) and the surgical group (n=99). Their initial MRI signal characteristics were analyzed. The natural course focusing on cyst size was observed in the observation group and postoperative visual and endocrine outcomes were evaluated in the surgical group. @*Results@#The characterization of MRI signals of cyst contents in both T1-weighted (T1W) and T2-weighted (T2W) images revealed nine combinations for our 213 patients. Among 115 patients with a high T2W signal, the cysts showed hypo-, iso-, and hyper-intensity on T1W images in 72, 39, and 44 patients, respectively; Type S-low, Type S-iso, and Type S-high. One more major group of 35 patients showed RCCs with hyperintensity on the T1W images and hypointensity on the T2W images named as Type M. In the comparison between observation and surgical groups, we identified only two major groups in which the number of patients in the surgical and observation groups was statistically different: more Type S-low in a surgical group (p<0.001) and more Type M in an observation group (p=0.007). In subgroup analysis, the range of change in the cyst size was the highest in Type S-high in the observation group (p=0.028), and intergroup differences in visual and endocrine outcomes were not evident in the surgical group. @*Conclusion@#MRI characteristics help to predict the natural course of RCCs. We identified subgroups of RCCs which are more or less likely to require surgical intervention.
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Background@#Transsphenoidal surgery is one of the important treatment options in the manage-ment of prolactinomas; however, complete resection of the tumor does not always lead to endocrinological remission. While many studies have investigated preoperative factors associated with surgical outcome, little has been known about the relationship between postoperative factors and long-term surgical outcomes; moreover, there is no consistency in results. The aim of this study was to demonstrate the reliability of immediate postoperative prolactin levels as predictors of long-term outcomes. @*Methods@#A total of 105 female patients who underwent complete removal of their histologically confirmed prolactinomas were included, and their medical records were retrospectively reviewed. To evaluate the predictability of immediate postoperative prolactin levels for long-term remission, prolactin levels were measured at 2, 6, 12, 18, 24, 48, and 72 h after surgery. @*Results@#From the 105 included patients, 95 (90.5%) and 10 (9.5%) belonged to the remissionand non-remission groups, respectively. A significant difference was observed in the prolactin level measured 6 h after surgery between the remission and non-remission groups, and this difference stayed apparent until 72 h after surgery. We derived a cut-off value for every postoperative time point that showed a significant relationship with disease remission. @*Conclusion@#Our study suggests that immediate postoperative measurement of prolactin levels is a reliable predictor of long-term remission and can contribute to early identification of patients who require adjuvant treatment after surgery.
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Objective@#: Pituitary adenomas frequently extend into the suprasellar space. After a suprasellar tumor is removed, the superiorly extended arachnoid becomes redundant and sinks down into the intrasellar space which often hiders visualization and accessibility to the hidden space behind the evaginated arachnoid. We introduced arachnoid remodeling by clipping technique, and evaluated its usefulness and safety during TSS. @*Methods@#: Total 223 patients who underwent arachnoid remodeling with our new clipping technique were included. Redundant arachnoid was clipped along the dural edge with multiple 2.6-mm titanium clips until the redundant arachnoid membrane no longer blocked the surgical route. To check for possible deterioration of hormonal function by this technique, we assessed anterior pituitary function of 166 patients who underwent arachnoid remodeling by clipping and compared this with those of other 429 control patients. @*Results@#: Our technique greatly enhanced the accessibility and visualization of intrasellar and parasellar spaces, both of which are generally hindered by redundant arachnoid during transsphenoidal surgery (TSS). We found no difference in anterior pituitary function between a clip-assisted arachnoid remodeling group and the control group, implying that this technique does not result in hypopituitarism. @*Conclusion@#: During TSS for pituitary adenomas with suprasellar extension, arachnoid remodeling by clipping technique is very useful and convenient for the management of the redundant arachnoid membrane to enhance visualization and surgical accessibility.
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Purpose@#The aim of this study was to investigate the outcomes of endodontic treatment of mandibular second molar with C-shaped canal in elderly patients and related factors affecting the survival of the tooth. @*Materials and Methods@#From 2010 to 2015, the survival rate following endodontic treatment was evaluated in elderly patients over 60 years who visited the Veterans Health Service Medical Center for endodontic treatment. The presence of C-shaped canals was confirmed using clinical records and radiographic features. Patientʼs age, sex, systemic diseases, tooth location, vitality, signs and symptoms, fractures, caries, apical radiolucency, canal shaping methods, sealer leakage, filling voids, and restoration of prosthesis were included in the analyses as confounding variables. The survival rate of teeth was analyzed using Kaplan–Meire analysis and the relationship between the survival rate and variables was analyzed using Simple and Multiple Cox regression analysis.Result: In total, 107 teeth in elderly patients had C-shaped canal. The survival rate of teeth that received endodontic treatment was 63.70%. None of the factors investigated significantly influenced the survival rate (P>0.05). @*Conclusion@#In elderly patients with C-shaped canal, the survival rate after root canal treatment was not significantly different from that of other mandibular molars.
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Background@#Hyponatremia is a common complication after transsphenoidal surgery (TSS) for pituitary adenomas. This study retrospectively reviewed various clinical factors of pituitary adenoma patients who underwent TSS and aimed to identify possible risk factors of postoperative hyponatremia. @*Methods@#Total 1,343 patients who underwent TSS for their pituitary adenomas in a single institution were enrolled to this study. We identified and analyzed 93 patients (6.9%) with postoperative hyponatremia and compared them with other 1,250 patients in a control group. Patients’ age, sex, tumor extent based on the modified Hardy classification, tumor size and hormonal type of the tumors were analyzed in comparison between two groups. The results of pre- and post-operative combined pituitary function test and their comparison were analyzed to elucidate a possible association between postoperative hyponatremia and hypopituitarism. @*Results@#The onset of postoperative hyponatremia was 7.8 days after surgery (range: postoperative day 3-13). The initial level of serum sodium (Na) level at the start of treatment was 123.5 mmol/L (range: 114-131 mmol/L) and the duration of treatment was 2.7 days (range: 1-9 days). Female predominance was evident in the hyponatremia group (77.4% vs. 61.4%, p=0.02). Preoperative hypopituitarism (58.5% vs. 71.5%, p=0.007) and postoperative hypocortisolism (33.7% vs. 23.4%, p=0.029) were related to postoperative hyponatremia. Other pre- and post-operative clinical factors were not associated with postoperative hyponatremia. @*Conclusion@#Postoperative hyponatremia is a common complication after TSS and is potentially fatal. Female patients were more likely to develop delayed hyponatremia. We demonstrated possible associations of delayed postoperative hyponatremia with preoperative and postoperative pituitary functions, but the mechanism behind it should be further investigated.
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Background@#Hyponatremia is a common complication after transsphenoidal surgery (TSS) for pituitary adenomas. This study retrospectively reviewed various clinical factors of pituitary adenoma patients who underwent TSS and aimed to identify possible risk factors of postoperative hyponatremia. @*Methods@#Total 1,343 patients who underwent TSS for their pituitary adenomas in a single institution were enrolled to this study. We identified and analyzed 93 patients (6.9%) with postoperative hyponatremia and compared them with other 1,250 patients in a control group. Patients’ age, sex, tumor extent based on the modified Hardy classification, tumor size and hormonal type of the tumors were analyzed in comparison between two groups. The results of pre- and post-operative combined pituitary function test and their comparison were analyzed to elucidate a possible association between postoperative hyponatremia and hypopituitarism. @*Results@#The onset of postoperative hyponatremia was 7.8 days after surgery (range: postoperative day 3-13). The initial level of serum sodium (Na) level at the start of treatment was 123.5 mmol/L (range: 114-131 mmol/L) and the duration of treatment was 2.7 days (range: 1-9 days). Female predominance was evident in the hyponatremia group (77.4% vs. 61.4%, p=0.02). Preoperative hypopituitarism (58.5% vs. 71.5%, p=0.007) and postoperative hypocortisolism (33.7% vs. 23.4%, p=0.029) were related to postoperative hyponatremia. Other pre- and post-operative clinical factors were not associated with postoperative hyponatremia. @*Conclusion@#Postoperative hyponatremia is a common complication after TSS and is potentially fatal. Female patients were more likely to develop delayed hyponatremia. We demonstrated possible associations of delayed postoperative hyponatremia with preoperative and postoperative pituitary functions, but the mechanism behind it should be further investigated.
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The aim of the present study was to evaluate the incidence of the second mesiobuccal (MB2) canal, root fusion, and C-shaped root canal configuration in the Koreanmaxillary first (MM1) and second (MM2) molars by analyzing cone-beam computed tomographic (CBCT) images. Materials and methods: Patients undergoing presurgicalCBCT examination were included in the current study. The CBCT images of 1498 MM1 and 1742 MM2 from 1658 Korean patients were assessed to determine the incidenceof a MB2 canal, the types of canal configurations, root fusion, and C-shaped root canal configurations. Further, the correlations between the incidence of MB2 canaland age, gender, and tooth position were analyzed. Results: The study population was relatively old (mean age: 66.1 years). The percentage of MB2 canals in MB roots was60.1% and 28.0% in MM1 and MM2, respectively, with the most common configurations being Weine type III in MM1 and Weine type II in MM2. Additionally, the frequencyof a MB2 canal decreased with age in both molars and was higher in men than in women in the MM1 only. Furthermore, root fusion was present in 2.3% and 26.2% of theMM1 and MM2, respectively, whereas C-shaped root canals were observed in 0.4% and 2.7% of the MM1 and MM2, respectively. Conclusion: The MB2 canal was foundmore frequently in the MM1, whereas root fusion and C-shaped root canals were both seen more frequently in the MM2. (J Korean Acad Prosthodont 2020;58:95-102)
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A 56-year woman presented eyeball pain and blurred vision. MRI revealed a small well-delineated solid tumor in the apex of right orbit with optic nerve compression. Intraoperatively, the tumor was found very fibrous, hypervascular and adhesive to surrounding structures. The tumor was completely removed with the combination of endoscopic and microscopic technique. Patient experienced transient oculomotor nerve palsy, which completely recovered 3 months after surgery. Herein we report a rare case of angioleiomyoma in the orbital apex.
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Femelle , Humains , Adhésifs , Angiomyome , Endoscopie , Imagerie par résonance magnétique , Atteintes du nerf moteur oculaire commun , Nerf optique , Orbite , Tumeurs de l'orbiteRésumé
OBJECTIVE: Silent corticotroph adenomas (SCA) are endocrine-inactive pituitary adenomas with positive immunohistochemistry staining for adrenocorticotropic hormone (ACTH). We investigated whether SCA-associated clinical profiles were more aggressive than hormonally negative adenomas (HNA).METHODS: Among 627 patients with pathologically proven endocrine-inactive pituitary adenomas between 2004 and 2013, positive immunohistochemistry revealed 55 SCAs and 411 HNAs. Surgical outcomes and radiological and endocrinological characteristics were compared.RESULTS: Strong female predominance was observed in the SCA group (p<0.001). Cavernous sinus invasion was identified in 22 (40%) SCA patients and 72 (17.6%) HNA patients (p<0.001). There were no differences in ACTH or cortisol levels between the two groups. The incidence of preoperative hypopituitarism and postoperative hormonal outcome did not differ between two groups. Total resection was achieved in 35 patients (63.7%) with SCA and 332 patients (80.8%) with HNA (p=0.007). When tumors were completely removed, recurrence rates were not statistically different between two groups (p=0.60). When complete resection was not achieved, tumors regrew from these remnants in seven patients (35.0%) with SCA and 12 patients (15.2%) with HNA (p=0.05).CONCLUSION: Total surgical resection for SCA is often challenging as these tumors frequently invade a cavernous sinus. Early remnant tumor intervention is justified, because untreated residual pituitary tumors regrow when patients were followed up for a long time. Prophylactic radiotherapy is not warranted for completely resected SCAs as tumor recurrence is uncommon.
Sujets)
Femelle , Humains , Adénome à ACTH , Adénomes , Hormone corticotrope , Sinus caverneux , Cellules corticotropes , Hydrocortisone , Hypopituitarisme , Immunohistochimie , Incidence , Tumeurs de l'hypophyse , Radiothérapie , RécidiveRésumé
PURPOSE: The aim of this study was to evaluate the influence of polishing methods on the color stability of composite resins. MATERIALS AND METHODS: Two bulk-fill and four conventional resin composites were filled in cylindrical molds (6 mm diameter, 4 mm height) and light-cured. The specimens were stored in 34℃ distilled water for 24 h. Spectrophotometer was used to determine the color value according to the CIE L(*)a(*)b(*) color space. Each group was divided into three groups according to polishing methods (n = 5). Group 1 was control group (Mylar strip group), group 2 was polished with PoGo, and group 3 was polished with Sof-Lex Spiral wheels. Color evaluation was performed weekly for 4 weeks after immersion in 34℃ distilled water. The results were analyzed by generalized least squares method (P < 0.05). RESULTS: Generalized least squares analysis revealed that Sof-Lex Spiral wheels group showed the significantly lower ΔE values compared to PoGo and control group (P < 0.05). The ΔE values of polished group showed the significantly lower than the ΔE values of unpolished group (P < 0.05). Regarding color changes of composite resins, there was no significant difference between the ΔE values of Filtek Z250 and Filtek Z350 XT Universal restorative in all time intervals (P < 0.05). Tetric N-Ceram Bulk Fill showed the significantly lower ΔE values compared to other composite resins in 1, 2, 3 weeks (P < 0.05). CONCLUSION: Within the limitations of this study, polishing methods influence the color stabilities of composite resins. The group polished with Sof-Lex Spiral Wheels showed more resistance to discoloration than group polished with PoGo.
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Absorption , Résines composites , Champignons , Immersion , Méthode des moindres carrés , Méthodes , EauRésumé
OBJECTIVE: Silent corticotroph adenomas (SCA) are endocrine-inactive pituitary adenomas with positive immunohistochemistry staining for adrenocorticotropic hormone (ACTH). We investigated whether SCA-associated clinical profiles were more aggressive than hormonally negative adenomas (HNA). METHODS: Among 627 patients with pathologically proven endocrine-inactive pituitary adenomas between 2004 and 2013, positive immunohistochemistry revealed 55 SCAs and 411 HNAs. Surgical outcomes and radiological and endocrinological characteristics were compared. RESULTS: Strong female predominance was observed in the SCA group (p<0.001). Cavernous sinus invasion was identified in 22 (40%) SCA patients and 72 (17.6%) HNA patients (p<0.001). There were no differences in ACTH or cortisol levels between the two groups. The incidence of preoperative hypopituitarism and postoperative hormonal outcome did not differ between two groups. Total resection was achieved in 35 patients (63.7%) with SCA and 332 patients (80.8%) with HNA (p=0.007). When tumors were completely removed, recurrence rates were not statistically different between two groups (p=0.60). When complete resection was not achieved, tumors regrew from these remnants in seven patients (35.0%) with SCA and 12 patients (15.2%) with HNA (p=0.05). CONCLUSION: Total surgical resection for SCA is often challenging as these tumors frequently invade a cavernous sinus. Early remnant tumor intervention is justified, because untreated residual pituitary tumors regrow when patients were followed up for a long time. Prophylactic radiotherapy is not warranted for completely resected SCAs as tumor recurrence is uncommon.
Sujets)
Femelle , Humains , Adénome à ACTH , Adénomes , Hormone corticotrope , Sinus caverneux , Cellules corticotropes , Hydrocortisone , Hypopituitarisme , Immunohistochimie , Incidence , Tumeurs de l'hypophyse , Radiothérapie , RécidiveRésumé
PURPOSE: The purpose of this study is to compare the performance of the T1 3D subtraction technique and the conventional 2D dynamic contrast enhancement (DCE) technique in diagnosing Cushing's disease. MATERIALS AND METHODS: Twelve patients with clinically and biochemically proven Cushing's disease were included in the study. In addition, 23 patients with a Rathke's cleft cyst (RCC) diagnosed on an MRI with normal pituitary hormone levels were included as a control, to prevent non-blinded positive results. Postcontrast T1 3D fast spin echo (FSE) images were acquired after DCE images in 3T MRI and image subtraction of pre- and postcontrast T1 3D FSE images were performed. Inter-observer agreement, interpretation time, multiobserver receiver operating characteristic (ROC), and net benefit analyses were performed to compare 2D DCE and T1 3D subtraction techniques. RESULTS: Inter-observer agreement for a visual scale of contrast enhancement was poor in DCE (κ = 0.57) and good in T1 3D subtraction images (κ = 0.75). The time taken for determining contrast-enhancement in pituitary lesions was significantly shorter in the T1 3D subtraction images compared to the DCE sequence (P < 0.05). ROC values demonstrated increased reader confidence range with T1 3D subtraction images (95% confidence interval [CI]: 0.94–1.00) compared with DCE (95% CI: 0.70–0.92) (P < 0.01). The net benefit effect of T1 3D subtraction images over DCE was 0.34 (95% CI: 0.12–0.56). For Cushing's disease, both reviewers misclassified one case as a nonenhancing lesion on the DCE images, while no cases were misclassified on T1 3D subtraction images. CONCLUSION: The T1 3D subtraction technique shows superior performance for determining the presence of enhancement on pituitary lesions compared with conventional DCE techniques, which may aid in diagnosing Cushing's disease.
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Humains , Imagerie par résonance magnétique , Courbe ROC , Technique de soustractionRésumé
PURPOSE: The purpose of this study was to evaluate tissue dissolving capacity, antimicrobial effect of Hydroxyethylidene bisphosphonate (HEBP) interacting with sodium hypochlorite (NaOCl), Ethylenediaminetetraacetic acid (EDTA) as conventional endodontic irrigants and to determine tissue dissolving efficacy depended on temperature. MATERIALS AND METHODS: A total of 80 bovine muscles were randomly distributed into 8 groups (n = 10). After their initial weights determined on a precision scale, the specimens in each group were immersed in the solutions for 5, 10 and 15 min and reweighted at each time period. Agar diffusion test inoculated with Enterococcus faecalis was performed for antimicrobial effect of each endodontic irrigants. RESULTS: The ability to dissolve organic matter was greater in NaOCl group following NaOCl and HEBP mixture. Heated NaOCl (40℃) and NaOCl/HEBP mixture was greater tissue dissolving efficacy than room temperature (25℃). Antimicrobial effect was greater and significant in the following order EDTA > EDTA + 1% NaOCl > 1% NaOCl ≥ 1% NaOCl + HEBP. CONCLUSION: HEBP as soft chelating agent does not disturb antimicrobial effect and less affected tissue dissolving efficacy as inherent properties of NaOCl. In the heated NaOCl/HEBP mixture analyzed, it dissolved more the organic matter than room temperature.
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Agar-agar , Diffusion , Acide édétique , Enterococcus faecalis , Température élevée , Muscles , Hypochlorite de sodium , Poids et mesuresRésumé
OBJECTIVE: To investigate the survival outcomes in patients with bulky stage IIIC and IV ovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvant chemotherapy (NAC) according to institutional criteria. METHODS: Medical records for advanced ovarian cancer patients who were treated at National Cancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewed in the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases were included. Current NCC indication for NAC is determined based on patients' performance status and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially including chemotherapy-resistant cancer cells, were surgically removed. RESULTS: Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136 (49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achieved in 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. The median progression-free survival (PFS) and overall survival (OS) time were 20 months and not reached, but might be estimated more than 70 months in the PDS group and 15 and 70 months in the NAC group, respectively. CONCLUSION: Extensive cytoreductive surgery to minimize residual tumor and selective use of NAC based on the institutional criteria could result in improved survival outcomes. Until further studies can be done to define the selection criteria for NAC after surgery, institutional criteria for NAC should consider the ability of the surgeon and institutional capacity.
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Humains , Interventions chirurgicales de cytoréduction , Survie sans rechute , Traitement médicamenteux , Dossiers médicaux , Traitement néoadjuvant , Maladie résiduelle , Tumeurs de l'ovaire , Sélection de patients , Études rétrospectivesRésumé
We report the first case of severe fever with thrombocytopenia syndrome (SFTS) and a spontaneous acute subdural hematoma (SDH) in Korea. A 79-year-old male presented with fever and thrombocytopenia. On the third day of hospitalization, his mental changed from drowsy to semi-coma. Brain computed tomography indicated an acute subdural hemorrhage on the right convexity. He was given early decompressive craniectomy, but did not survive. Real-time reverse transcription polymerase chain reaction analysis of a blood sample indicated the presence of SFTS virus (SFTSV). This is the first reported case with intracranial hemorrhage and SFTS. This case report describes our treatment of a patient with acute SDH and an infection from a tick-borne species of Bunyaviridae.
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Sujet âgé , Humains , Mâle , Encéphale , Bunyaviridae , Craniectomie décompressive , Fièvre , Hématome subdural , Hématome subdural aigu , Hospitalisation , Hémorragies intracrâniennes , Corée , Orthobunyavirus , Réaction de polymérisation en chaîne , Transcription inverse , Thrombopénie , TiquesRésumé
PURPOSE: The purpose of this study is to compare the outcomes of first-line systemic targeted therapy (TT) and immunotherapy (IT) in patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: This study was a retrospective review of the data of 262 patients treated with systemic IT or TT with tyrosine kinase inhibitors between 2003 and 2013. The objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were assessed using Response Evaluation Criteria in Solid Tumor ver. 1.0 criteria and the Kaplan-Meier method with log-rank test. RESULTS: During the median 4.3-month treatment and the 24-month follow-up period, the ORR/PFS/OS of the overall first-line and second-line therapy were 41.9%/8.1 months/16.8 months and 27.5%/6.5 months/15.3 months, respectively. The first-line TT/IT/sequential IT had a PFS of 9.3/6.4/5.7 months and an OS of 15.8/16.5/40.6 months (all p < 0.05). The second-line of TT/IT had a PFS of 7.1/2.1 months (both p < 0.05) and an OS of 16.6/8.6 months (p=0.636), respectively. Pazopanib provided the best median PFS of 11.0 months (p < 0.001) and a quadruple IT regimen had a superior PFS (p=0.522). For OS, sequential treatment with IT and TT was superior compared to treatment with either IT or TT alone (40.6/16.5/15.8 months, p=0.014). The prognosis according to the Memorial Sloan Kettering Cancer Center model showed that favorable/intermediate/poor risk groups had a PFS of 8.5/10.4/2.3 months, and an OS of 43.1/20.4/5.6 months, respectively. The prognosis calculated using the Heng model showed that the favorable/intermediate/poor risk groups had a PFS of 9.2/3.9/2.7 months, and an OS of 32.4/16.5/6.1months, respectively (all p < 0.001). CONCLUSION: In patients with mRCC, TT provided a better PFS and OS compared with IT.
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Humains , Néphrocarcinome , Survie sans rechute , Études de suivi , Immunothérapie , Méthodes , Thérapie moléculaire ciblée , Métastase tumorale , Pronostic , Protein-tyrosine kinases , Études rétrospectivesRésumé
Mucinous cystadenocarcinoma (MC) of the kidney is a rare epithelial tumor originating from the renal pelvic urothelium and few study cases have been reported. Because of the rarity of these tumors and their unknown histogenesis, its diagnosis is difficult until surgical exploration. We report here on a 55-year-old man referred to the urology department from the hepatology department because of a cystic renal mass measuring approximately 5 cm in size, which was detected incidentally under ultrasonography during the routine examination of liver. The renal mass was finally diagnosed as MC originating from kidney after partial nephrectomy and the patient still showed no evidence of recurrence until 12 months postoperatively. This is the first report on a case of renal MC in a patient who underwent partial nephrectomy. The aim of this report is to present our unusual case of MC and also review the previous literature on the pathological and radiological aspects of MC of kidney.
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Humains , Adulte d'âge moyen , Cystadénocarcinome mucineux , Diagnostic , Gastroentérologie , Rein , Foie , Mucines , Néphrectomie , Récidive , Échographie , Urologie , UrothéliumRésumé
BACKGROUND: Cabergoline is typically effective for treating prolactinomas; however, some patients display cabergoline resistance, and the early characteristics of these patients remain unclear. We analyzed early indicators predicting long-term response to cabergoline. METHODS: We retrospectively reviewed the cases of 44 patients with macroprolactinomas who received cabergoline as first-line treatment; the patients were followed for a median of 16 months. The influence of various clinical parameters on outcomes was evaluated. RESULTS: Forty patients (90.9%) were treated medically and displayed tumor volume reduction (TVR) of 74.7%, a prolactin normalization (NP) rate of 81.8%, and a complete response (CR; TVR >50% with NP, without surgery) rate of 70.5%. Most patients (93.1%) with TVR > or =25% and NP at 3 months eventually achieved CR, whereas only 50% of patients with TVR > or =25% without NP and no patients with TVR 25% at 3 months without NP, particularly those with huge prolactinomas, because a delayed response may be achieved. As surgery can reduce the cabergoline dose necessary for successful disease control, it should be considered for cabergoline-resistant patients.