Single-center study on clinicopathological and typical molecular pathologic features of metastatic brain tumor

Background@#The metastatic brain tumor is the most common brain tumor. The aim of this study was to demonstrate the clinicopathological and molecular pathologic features of brain metastases (BM). @*Methods@#A total of 269 patients were diagnosed with BM through surgical resection at Seoul St. Mary’s Hospital from January 2010 to March 2020. We reviewed the clinicopathological features and molecular status of primary and metastatic brain tissues using immunohistochemistry and molecular pathology results. @*Results@#Among 269 patients, 139 males and 130 females were included. The median age of primary tumor was 58 years (range, 13 to 87 years) and 86 patients (32.0%) had BM at initial presentation. Median BM free interval was 28.0 months (range, 1 to 286 months). The most frequent primary site was lung 46.5% (125/269), and followed by breast 15.6% (42/269), colorectum 10.0% (27/269). Epidermal growth factor receptor (EGFR) mutation was found in 50.8% (32/63) and 58.0% (40/69) of lung primary and BM, respectively. In both breast primary and breast cancer with BM, luminal B was the most frequent subtype at 37.9% (11/29) and 42.9% (18/42), respectively, followed by human epidermal growth factor receptor 2 with 31.0% (9/29) and 33.3% (14/42). Triple-negative was 20.7% (6/29) and 16.7% (7/42), and luminal A was 10.3% (3/29) and 7.1% (3/42) of breast primary and BM, respectively. In colorectal primary and colorectal cancer with BM, KRAS mutation was found in 76.9% (10/13) and 66.7% (2/3), respectively. @*Conclusions@#We report the clinicopathological and molecular pathologic features of BM that can provide useful information for understanding the pathogenesis of metastasis and for clinical trials based on the tumor’s molecular pathology.

Disseminated Herpes Zoster in an Immunocompetent Elderly Patient

Herpes zoster is a cutaneous infection that is characterized by an acute vesicobullous rash with ipsilateral one or two dermatomal distribution and painful allodynia, while predominantly being found in the elderly. Extensive cutaneous dissemination has been reported in immune-compromised patients, such as those who suffer from HIV infections, cancer, chemotherapy, and corticosteroid therapy patients. However, we report a case of disseminated herpes zoster infection in an immuno-competent elderly individual.

Occurrence of Trochlear Nerve Palsy after Epiduroscopic Laser Discectomy and Neural Decompression

Epiduroscopic laser discectomy and neural decompression (ELND) is known as an effective treatment for intractable lumbar pain and radiating pain which develop after lumbar surgery, as well as for herniation of the intervertebral disk and spinal stenosis. However, various complications occur due to the invasiveness of this procedure and epidural adhesion, and rarely, cranial nerve damage can occur due to increased intracranial pressure. Here, the authors report case in which double vision occurred after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome (FBSS).

The effect of priming with rocuronium on onset time and intubation conditions during endotracheal intubation with low-dose rocuronium / 대한마취과학회지

BACKGROUND: A priming dose of rocuronium can shorten the onset time of neuromuscular blockade. The purpose of this study was to evaluate the effect of priming with rocuronium on the onset time and intubation conditions during tracheal intubation with low-dose rocuronium (0.35 mg/kg) and to compare results with those for rocuronium 0.45 mg/kg. METHODS: One hundred twenty four patients were randomly allocated to three groups. Following induction of anesthesia, groups I and III received normal saline while group II received a priming dose of rocuronium (0.05 mg/kg). Three minutes after priming, groups I, II and III received, respectively, 0.45 mg/kg, 0.3 mg/kg and 0.35 mg/kg rocuronium. Intubation was performed 2 minutes after the administration of an intubating dose and intubation conditions were evaluated. Neuromuscular blockade was assessed by accelerography. RESULTS: The proportion of cases having optimal intubation conditions in group I was higher than in groups II and III. There was no significant difference in the onset times among groups. Neuromuscular blockade at 60, 90 and 120 seconds after an intubating dose was similar among all groups except at 60 sec. Maximal blockade for group I was deep compared to groups II and III. CONCLUSIONS: Rocuronium 0.35 mg/kg does not provide satisfactory intubation conditions. There are no effects on onset time and intubation conditions due to priming during tracheal intubation with rocuronium 0.35 mg/kg.

Effect of Low-dose Rocuronium on Tracheal Intubating Conditions during Induction of 8 vol% Sevoflurane with Remifentanil

BACKGROUND: We evaluated the effect of low doses of rocuronium on tracheal intubating conditions and hemodynamic changes during induction of anesthesia with 8 vol% sevoflurane and remifentanil 1microg/kg. METHODS: Eighty four patients were randomized into one of three groups; Group I, II, III. Each group received normal saline, 0.3, 0.45 mg/kg of rocuronium respectively. Predetermined drugs for each group and remifentanil 1microg/kg were administered during induction of 8 vol% sevoflurane. After induction of 8 vol% sevoflurane, tracheal intubation was preformed. The tracheal intubation conditions and hemodynamic responses to tracheal intubation were assessed. RESULTS: Tracheal intubation was successful in all patients. The incidence of clinically acceptable intubating conditions was 79% in Group I, 100% in Group II, and 100% in Group III. There was no significant difference in intubating condition between Group II and Group III. The hemodynamic responses to tracheal intubation were blunted in all groups. CONCLUSIONS: After induction with 8 vol% sevoflurane and remifentanil 1microg/kg, low-dose rocuronium provides more satisfactory tracheal intubation conditions.

The Predicting Factor of Vascular Endothelial Dysfunction in Healthy Premenopausal Obese Women

BACKGROUND: Vascular endothelial dysfunction (VED) plays a pivotal role in the pathogenesis of atherosclerosis and is associated with insulin resistance and with visceral obesity. Therefore, in this study the predicting factor of vascular endothelial dysfunction was investigated in healthy premenopausal obese women by pulse-wave analysis (PWA) combined with provocative pharmacological testing. METHODS: Thirty three obese women (BMI> or =25), aged 20~45 y and 25 age-matched control subjects (BMI; 18.5~22.9) were examined. All women were sedentary (<1 hr/wk of physical activity), non-smoker and were excluded if they had type 2 diabetes melitus, hypertension, hyperlipidemia, cardiovascular disease, or acute inflammatory disease and were studied in folicullar phase of the cycle, within the first week after cessation of menstrual bleeding. They underwent determination of anthropometric measurements, metabolic variables, adipose tissue regional distribution, and endothelial function by performing pulse-wave analysis (PWA) combined with provocative pharmacological testing. RESULTS: Augmentation Index (AIx) fell significantly after the administration of salbutamol, which causes endothelium-dependent vasodilatation, but response was significantly reduced in obese women compared with controls (10.28 6.72% vs 17.2 6.84%, P=0.0003). The change in after Nitroglycerin, which causes endothelium-independent vasodilatation, did not differ significantly (30.86 9.67% vs 30.6 10.11%, P=0.9172). In our obese subjects, visceral adipose tissue area was independently a significant predictor of vascular endothelial dysfunction (beta= 0.1381, P=0.0038, Adj-R2=0.348). CONCLUSION: Increased abdominal adiposity is a powerful independent predictor of VED in obese healthy women. Future studies of vascular endothelial function should account for the independent effects of abdominal fat.