Preliminary results of entire pleural intensity-modulated radiotherapy in a neoadjuvant setting for resectable malignant mesothelioma

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). MATERIALS AND METHODS: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. RESULTS: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). CONCLUSION: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.

High-Dose Thoracic Re-irradiation of Lung Cancer Using Highly Conformal Radiotherapy Is Effective with Acceptable Toxicity / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Thoracic re-irradiation (re-RT) of lung cancer has been challenged by the tolerance doses of normal tissues. We retrospectively analyzed local control, overall survival (OS) and toxicity after thoracic re-RT using highly conformal radiotherapy, such as intensity modulated radiotherapy and stereotactic body radiotherapy. MATERIALS AND METHODS: Thirty-one patients who received high-dose thoracic re-RT were analyzed. Doses were recalculated to determine biologically equivalent doses. The median interval to re-RT was 15.1 months (range, 4.4 to 56.3 months), the median initial dose was 79.2 Gy₁₀ (range, 51.75 to 150 Gy₁₀), and the median re-RT dose was 68.8 Gy₁₀ (range, 43.2 to 132 Gy₁₀). RESULTS: Eighteen (58.1%) and eleven (35.5%) patients showed loco-regional recurrence and distant metastasis, respectively, after 17.4 months of median follow-up. The 1-year and 2-year local control rates were 60.2% and 43.7%, respectively. The median loco-regional recurrence-free-survival (LRFS) was 15.4 months, and the median OS was 20.4 months. The cumulative and re-RT biologically equivalent dose for α/β=10 (BED₁₀) doses were the most significant prognostic factors. Cumulative BED₁₀ ≥145 Gy₁₀ and re-RT BED₁₀≥68.7 Gy₁₀ were significantly associated with longer OS (p=0.029 and p=0.012, respectively) and LRFS (p=0.003 and p=0.000, respectively). The most frequent acute toxicity was grade 1-2 pulmonary toxicity (41.9%). No acute grade 3 or higher toxicities occurred. CONCLUSION: Our results show that high-dose thoracic re-RT of lung cancer can be safely delivered using highly conformal radiotherapy with favorable survival and acceptable toxicity. An optimal strategy to select patients who would benefit from re-RT is crucial in extending the indications and improving the efficacy with a sufficiently high dose.

Herpes Simplex Encephalitis after Concurrent Chemoradiotherapy in Nasopharyngeal Cancer: A Case Report / 대한내과학회지

Herpes simplex encephalitis (HSE) is a rare viral encephalitis in adults. A high (70%) mortality rate with serious complications has been reported even after active, appropriate management. The association between HSE and immune suppression is unclear, but there are case reports of cancer patients in which HSE concomitantly developed after whole brain radiation or high-dose steroid treatment. The clinical manifestations and laboratory findings of these patients are atypical compared to the general population. Although brain magnetic resonance images reveal typical HSE findings, cerebrospinal fluid (CSF) analysis might be normal in cancer patients. We report a case of HSE in a 48-year-old male diagnosed with nasopharyngeal cancer and treated with concurrent chemoradiation. This patient had a normal cell count in CSF, but HSE was finally diagnosed from positive polymerase chain reaction test results. After administration of acyclovir and systemic steroid treatment, the patient had a good clinical course with few neurologic sequelae.

Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis (RP) in lung cancer patients and evaluated the relationship between interstitial lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. MATERIALS AND METHODS: Medical records and dose volume histogram data of 60 lung cancer patients from August 2005 to July 2006 were analyzed. All patients were treated with three dimensional (3D) conformal RT of median 56.9 Gy. We assessed the association of symptomatic RP with clinical and dosimetric factors. RESULTS: With a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation Therapy Oncology Group grade > or = 2 RP was observed in 14 patients (23.3%). Five patients (8.3%) died from RP. The interstitial changes in the pre-RT chest CT, mean lung dose (MLD), and V30 significantly predicted RP in multivariable analysis (p=0.009, p or = 2, > or = 3, or > or = 4 was higher in the patients with interstitial lung change (grade 2, 15.6% to 46.7%, p=0.03; grade 3, 4.4% to 40%, p=0.002; grade 4, 4.4% to 33.3%, p=0.008). Four of the grade 5 RP patients had diffuse interstitial change in pre-RT CT and received chemoradiotherapy. CONCLUSION: Our study identified diffuse interstitial disease as a significant clinical risk for RP, particularly fatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidence and severity of RP.

A case of nephrogenic systemic fibrosis following gadolinium exposure in a peritoneal dialysis patient / 대한내과학회지

Nephrogenic systemic fibrosis is a systemic illness that only affects patients with kidney failure. Exposure to gadolinium-based contrast agents has been associated with the subsequent development of nephrogenic systemic fibrosis in patients with decreased renal function. Nephrogenic systemic fibrosis is characterized by skin induration after swelling and limited joint movement through a loss in flexibility that preferentially affects the extremities. A 58-year-old man in peritoneal dialysis developed swelling and stiffness of the lower limbs following gadolinium exposure for brain magnetic resonance imaging. This patient was diagnosed with nephrogenic systemic fibrosis by CD34 immunoreactivity of subcutaneous fibroblasts in a skin biopsy. We report, for the first time in Korea, that nephrogenic systemic fibrosis developed after gadolinium exposure in a peritoneal dialysis patient.

The Usefulness of Immunohistochemical Staining for Diagnosis of Thyroid Nodule in Preoperative Ultrasonography-Guided Core Needle Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The diagnosis of thyroid nodular diseases is critical for clinical management. Because of the histological similarity of follicular patterned thyroid lesions, the differential diagnosis is often difficult to determine, even with permanent sections. For this reason, we assessed the preoperative diagnostic usefulness of immunohistochemical staining for the four potential markers of malignant thyroid nodule, beta-galactosil binding lectin (Galectin-3), Hector Battifora Mesothelial cell (HBME-1), cytokeratin-19 (CK-19) and high molecular weight cytokeratin (HMW-CK) in tissues obtained by ultrasound-guided core needle biopsy. SUBJECTS AND METHOD: The immunohistochemical expression of Galectin-3, HBME-1, CK-19 and HMW-CK were evaluated in 43 preoperative thyroid lesions obtained to assess their potential as markers in the diagnosis and classification of thyroid malignancy. We compared the preoperative expression of the four markers with the results of postoperative permanent pathology. RESULTS: The expression patterns and positive rates of four markers were the variables in 4 thyroid lesions; however, all markers were strong in malignant thyroid nodules, especially in papillary carcinoma. There were no significant differences in the expression rates of the four markers between follicular carcinoma and follicular adenoma. The sensitivity of HBME-1 for thyroid malignancy was the highest (86%) among the four markers, but the sensitivity of combinational expression using two markers, especially Galectin-3 or HBME-1 (95%), HBME-1 or HMW-CK (90%), was higher than that of the expression using one marker for thyroid malignancy. CONCLUSION: The four markers were reliable markers for papillary carcinoma. In preoperative differential diagnosis of thyroid nodule, we suggest that the combinational expression using two makers is more useful than a single marker expression.

Histopathologic Study on the Obliteration of the Temporal Dorsal Bullae in Rat Using Hydroxyapatite Cement and Demineralized Bone Matrix / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration surgery is a useful technique for otitis media either with or without cholesteatoma. Obliterating materials have to satisfy low antigenecity, less inflammation, little tissue resorption, high regeneration power and good integration into the host tissue. The aim of our study is to evaluate histopathological changes and effectiveness resulting from the different obliterating materials in the temporal dorsal bullae in rats. MATERIALS AND METHOD: We divided the rats into two groups. Group A was untreated, but group B underwent removal of mastoid mucosa with 2% trichloroacetic acid (TCA). Both groups had mastoid obliteration by the implantation of hydroxyapatite cement (Mimix(R)) and demineralized bone matrix (Regenafil(R)). Twelve weeks after the implantation, a histological study was performed to evaluate remaining implanted material, new bone formation and the formation of cysts within the bullae. RESULTS: There was no or minimal inflammation or foreign body reactions in the mastoid obliteration groups with Mimix(R) and Regenafil(R). In the obliterated group that was not treated with 2% TCA, the remaining implanted material with Mimix(R) group was more than in the Regenafil(R) group (p<0.05). The obliterated groups of Mimix(R) and Regenafil(R) were similar with respect to new bone formation. The mucocele formation in the obliterated groups treated with 2% TCA was less than in the obliterated groups not treated with 2% TCA (p<0.05). CONCLUSION: We suggest that Mimix(R) and Regenafil(R) could be valuable resources as graft materials for mastoid obliteration procedures. The research continues for evaluation of long term results of these materials and their potential as graft materials.

Tumor Angiogenesis as a Predictor of Malignancy Potential and Prognosis in Gastric Carcinoma / 대한암학회지

PURPOSE: In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and prognosis. MATERIALS AND METHODS: A total of 256 patients with gastric cancer who underwent curative surgery were included in this study. Microvessel count was determined by im-munohistochemical staining using monoclonal antibody against factor VIII-related antigen. RESULTS: The statistical significance between the microvessel count and clinicopathologic factors (age, sex, tumor invasion, lymph node involvement, histologic type) was analized. The tumor stage and histologic type were correlated with microvessel count. And also there was statistical significance with survival rate and recurrence-free survival rate between high (microvessel count> or =42) and low angiogeneic group (microvessel count< 42). The Cox's proportional hazard model showed that stage, histologic type, angiogeneic score were one of the significant and independent prognostic variables. CONCLUSION: The tumor angiogenesis of gastric carcinoma may be independent prognostic factor for predicting recurrence and survival.

Relapsing Polychondritis Diagnosed after Stellate Ganglion Block: A case report / 대한마취과학회지

Relapsing polychondritis (RP) is an uncommon disorder of unknown etiology characterized by inflammation and destruction of the cartilaginous structures of many organs, including the tracheobronchial tree. We experienced a rare case of RP diagnosed after stellate ganglion block. A 56-year-old female has been treated under impression of rheumatoid arthritis and bronchial asthma for several years, but her symptoms were not markedly relieved. We performed right stellate ganglion block with 8 mL of 1% mepivacaine for the relief of the right shoulder pain. About 5 minutes later, she complained severe dyspnea and became cyanotic. Bronchoscopic finding was diffuse bronchoconstriction during expiration. We confirmed the diagnosis of relapsing polychondritis by bronchoscopic biopsy finding. Unfortunately, she died 3 months later due to recurrent pneumonia and acute respiratory distress syndrome.

Influence of Propofol and Enflurane on the Postoperative Nausea & Vomiting after Pediatric Strabismus Surgery / 대한마취과학회지

INTRODUCTION: Nausea & vomiting are one of the most distressful events after strabismus surgery in pediatric patients. Propofol is known to reduce the incidence of postoperative emesis. The aim of this study was to compare the influence of propofol to that of enflurane on the postoperative nausea & vomiting after pediatric strabismus surgery. METHODS: Forty children scheduled for strabismus surgery were randomly assigned into two groups according to the induction agent and main anesthetics. Propofol group (n=20) received propofol, Enflurane gruop (n=20) thiopental as an induction agent and anesthesia were maintained either propofol- O2-air or enflurane-O2-air. The incidence of postoperative nausea & vomiting was assessed at awakening period, in the recovery room and at the 1st, 2nd day after operation. Operation time, awakening time and the incidence of oculocardiac reflex were evaluated. RESULTS: The operation time was not different between two groups, and the awakening time was shorter in Propofol group than in Enflurane group. Although oculocardiac reflexes were more frequently seen in Propofol group, no cases of postoperative nausea & vomiting were seen in Propofol group. The incidence of postoperative nausea & vomiting was not significantly different between two groups except at the 1st day after operation. At that time, the incidence of nausea was greater in Enflurane group than in Propofol group. CONCLUSION: These findings indicated that propofol resulted in a more rapid recovery and less postoperative nausea & vomiting than enflurane, but more oculocardiac reflexes were seen in propofol.

In vitro activities of eight antibiotics against methicillin-resistant S. aureus and S. epidermidis strains isolated in Korea

Staphylococcus aureus and Staphylococcus epidermidis strains isolated at eight large medical centers in Korea were examined for methicillin resistance and resistance to eight other antibiotics; cefazolin, cefamandole, cefuroxime, cefoxitin, cefotaxime, moxalactam, penicillin G and vancomycin. Methicillin resistance was found in 296 of 1225 strains (24.2%) of S. aureus and 126 of 348 strains (36.2%) of S. epidermidis. Methicillinresistant strains were isolated from all sources with the frequency of isolation ranging from 11% to 60%. From pleural effusion, throat swab and blood, methicillin-resistant strains of S. aureus were more frequently isolated with statistical significance (Chi-squared test, 95% confidence). Almost all of Methicillin-resistant S. aureus (MRSA) and S. epidermidis (MRSE) strains were multiply resistant to one or more tested eight antibiotics. However only 7(2.4%) of 296 MRSA strains and 2(1.6%) of 126 MRSE strains were resistant to vancomycin. Vancomycin was the most effective antibiotic against staphylococcal isolates as well as MRSA and MRSE.

A Case of Endothelial Sinus Tumor of the Vagina

No abstract available.