• Annals of Clinical Neurophysiology
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• 제13권1호
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• pp.31-37
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• 2011

Background: Carpal tunnel syndrome (CTS) and tarsal tunnel syndrome (TTS) are thought to share a similar pathophysiology, compression of the median and plantar nerve by the carpal tunnel and flexor retinaculum. A few reports introduced the relationship between idiopathic CTS and TTS without definite evidence of coexistence. The current study was designed to analyze the electrophysiologic characteristics of combined idiopathic CTS and TTS by comparing with each idiopathic CTS or TTS. Methods: We retrospectively collected patients with combined idiopathic CTS and TTS (CTS-TTS group) from June 2001 to February 2009. Patients with each idiopathic CTS or TTS were collected as controls. Electrophysiologic data of median and plantar nerves were compared between CTS-TTS group and controls. Results: CTS-TTS group was composed of 31 patients. Control group of each CTS or TTS were 50 CTS and 49 TTS patients. In comparison of median nerve conduction study between CTS-TTS group and CTS control group, decreased compound muscle action potential amplitude (p<0.001), decreased median sensory nerve action potential amplitude (p<0.001) and sensory nerve conduction velocity at finger stimulation (p=0.013) were prominent in CTS-TTS group. Decreased medial plantar sensory nerve action potential amplitude (p=0.034) was indicated when CTS-TTS groups and TTS control group were compared. Conclusions: If the electrophysiology study of patients with CTS or TTS was suggestive of severe degree of nerve injury, concerns about the possibility of combined CTS and TTS would be helpful.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8177-8182
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• 2014

Background: Blocking angiogenesis by targeting vascular endothelial growth factor (VEGF) signaling pathway to inhibit tumor growth has proven to be successful in treating a variety of different metastatic tumor types, including kidney, colon, ovarian, and lung cancers, but its role in castration-resistant prostate cancer (CRPC) is still unknown. We here aimed to determine the efficacy and toxicities of anti-VEGF agents in patients with CRPC. Materials and Methods: The databases of PubMed, Web of Science and abstracts presented at the American Society of Clinical Oncology up to March 31, 2014 were searched for relevant articles. Pooled estimates of the objective response rate (ORR) and prostate-specific antigen (PSA) response rate (decline ${\geq}50%$) were calculated using the Comprehensive Meta-Analysis (version 2.2.064) software. Median weighted progression-free survival (PFS) and overall survival (OS) time for anti-VEGF monotherapy and anti-VEGF-based doublets were compared by two-sided Student's t test. Results: A total of 3,841 patients from 19 prospective studies (4 randomized controlled trials and 15 prospective nonrandomized cohort studies) were included for analysis. The pooled ORR was 12.4% with a higher response rate of 26.4% (95%CI, 13.6-44.9%) for anti-VEGF-based combinations vs. 6.7% (95%CI, 3.5-12.7%) for anti-VEGF alone (p=0.004). Similarly, the pooled PSA response rate was 32.4% with a higher PSA response rate of 52.8% (95%CI: 40.2-65.1%) for anti-VEGF-based combinations vs. 7.3% (95%CI, 3.6-14.2%) for anti-VEGF alone (p<0.001). Median PFS and OS were 6.9 and 22.1 months with weighted median PFS of 5.6 vs. 6.9 months (p<0.001) and weighted median OS of 13.1 vs. 22.1 months (p<0.001) for anti-VEGF monotherapy vs. anti-VEGF-based doublets. Conclusions: With available evidence, this pooled analysis indicates that anti-VEGF monotherapy has a modest effect in patients with CRPC, and clinical benefits gained from anti-VEGF-based doublets appear greater than anti-VEGF monotherapy.

• Radiation Oncology Journal
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• 제13권1호
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• pp.19-26
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• 1995

Purpose : Surgery is the treatment of choice for resectable non-small cell lung cancer. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. A retrospective analysis of Patients with stage I non-samll cell lung cancer treated with curative radiation therapy was performed to determine the results of curative radiation therapy and patterns of failure, and to identify factors that may influence survival. Materials and Methods : From 1986 through 1993, 39 Patients with T2N0M0 non-small cell lung cancer were treated with curative radiation therapy at department of radiation oncology, Kyungpook national university hospital. All Patients were not candidates for surgical resection because of either Patient refusal (16 patients), poor pulmonary function (12 patients), old age (7 patients), Poor Performance (2 patients) or coexisting medical disease (2 patients). Median age of patients was 67 years. Histologic cell type was squamous cell carcinoma in 36, adenocarcinoma in 1, large cell carcinoma in 1 and mucoepidermoid carcinoma in 1. All patients were treated with megavoltage irradiation and radiation dose ranged from 5000cgy to 6150cGy with a median dose of 6000cGy. The median follow-up was 17 months with a range of 4 to 82 months, Survival was measured from the date therapy initiated. Results : The overall survival rate for entire Patients was $40.6\%$ at 2 years and $27.7\%$ at 3 years, with a median survival time of 21 months. The disease-free survival at 2 and 3 years was $51.7\%$ and $25.8\%$, respectively. Of evaluable 20 patients with complete response, 15 patients were considered to have failed. Of these, 13 patients showed local failure and 2 patients failed distantly. Response to treatment (p=0.0001), tumor size (p=0.0019) and age (p=0.0247) were favorably associated with overall survival. Only age was predictive for disease-free survival (p = 0.0452). Conclusion : Radiation therapy is an effective treatment for small (less than 3cm) tumors, and should be offered as an alternative to surgery in elderly or infirm patients. Since local failure is the prominent Patterns of relapse, potential methods to improve local control with radiation therapy are discussed.

• Asian Pacific Journal of Cancer Prevention
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• 제13권10호
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• pp.5081-5086
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• 2012

Background: The liver is one of the most common metastatic sites of breast cancer, hepatic metastases developing in 6%-25% of patients with breast cancer and being associated with a poor prognosis. The aim of this study was to analyze the survival and clinical characteristics of patients with hepatic metastases from breast cancer of different molecular subtypes and to investigate the prognostic and predictive factors that effect clinical outcome. Methods: We retrospectively studied the charts of 104 patients with breast cancer hepatic metastases diagnosed at Sun Yat-sen University Cancer Center from December 1990 to June 2009. Subtypes were defined as luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) enriched, triple-negative (TN). Prognostic factor correlations with clinical features and treatment approaches were assessed at the diagnosis of hepatic metastases. Results: The median survival time was 16.0 months, and the one-, two- three-, four-, five-year survival rates were 63.5%, 31.7%, 15.6%, 10.8%, and 5.4%, respectively. Median survival periods after hepatic metastases were 19.3 months (luminal A), 13.3 months (luminal B), 18.9 months (HER2-enriched), and 16.1 months (TN, P=0.11). In multivariate analysis, a 2 year-interval from initial diagnosis to hepatic metastasis, treatment with endocrine therapy, and surgery were independent prognostic factors. Endocrine therapy could improve the survival of luminal subtypes (P=0.004) and was a favorable prognostic factor (median survival 23.4 months vs. 13.8 months, respectively, P=0.011). Luminal A group of patients treated with endocrine therapy did significantly better than the Luminal A group of patients treated without endocrine therapy (median survival of 48.9 vs. 13.8 months, P=0.003). Conclusions: Breast cancer subtypes were not associated with survival after hepatic metastases. Endocrine therapy was a significantly favorable treatment for patients with luminal subtype.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.329-335
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• 2013

Objective : Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods : From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. Results : In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 $mm^3$ (range, 4.5-27745 mm3) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 $mm^3$ was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p<0.001, and hazard risk=1.46, p=0.046, respectively). Conclusion : GKRS has shown to be an effective and safe treatment modality for treating brain metastases of primary breast cancer. Most metastatic brain lesions initially respond to GKRS, though, many patients have further CNS progression in subsequent periods. Patients with poor Karnofsky performance status and multiple metastatic lesions are at risk of CNS progression and poor survival, and a more frequent and strict surveillance protocol is suggested in such high-risk groups.

• 대한정형도수물리치료학회지
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• 제12권1호
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• pp.16-26
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• 2006

The purpose of this study was to investigate the influence of the various knee angles and ground state on the muscular activities and fatigue of the ankle muscles by integrated electromyograms (iEMG) and median frequency of tibialis anterior (TA), peroneus longus (PL), flexor digitorum longus (FDL) and gastrocnemius (GC). Ten healthy male subjects were participated into stable and balance ball sessions at four angles of knee joint. The surface electromyograms (sEMG) were recorded from the TA, PL, FDL and GC on stable and balance ball with full weight bearing at four knee angles of $0^{\circ}$, $15^{\circ}$, $30^{\circ}$ and $45^{\circ}$. The time serial data of the surface electromyographic signals were transformed into integrated and frequency serial data by fast fourier transformation. On the stable ground, the iEMG signals of the TA, PL, FDL and GC were significantly higher at $45^{\circ}$ and $30^{\circ}$ of knee angles than $0^{\circ}$ and $15^{\circ}$ of knee flexion (p<0.05). On the balance ball, the iEMG of the TA, PL, FDL and GC were significantly higher at $45^{\circ}$ and $30^{\circ}$ of knee angles than $0^{\circ}$ and $15^{\circ}$ of knee flexion (p<0.05). The median frequency of the TA, PL, FDL and GC were significantly lower at $45^{\circ}$ and $30^{\circ}$ of knee angles than $0^{\circ}$ and $15^{\circ}$ of knee on the stable ground (p<0.05). On the balance ball, also the median frequency of the TA, PL, FDL and GC were significantly lower at $45^{\circ}$ and $30^{\circ}$ of knee angles than $0^{\circ}$ and $15^{\circ}$ of knee flexion (p<0.05). The iEMG of the TA, PL, FDL and GC were significantly higher on the balance ball at $0^{\circ}$, $15^{\circ}$, $30^{\circ}$ and $45^{\circ}$ of knee angles compared with stable ground. The median frequency of the TA, PL, FDL and GC were significantly lower on the balance ball at $0^{\circ}$, $15^{\circ}$, $30^{\circ}$ and $45^{\circ}$ of knee angles compared with stable ground. These results indicate that the ground conditions and angles of the knee joint involved to muscular activities and fatigue of ankles muscles, may performed at first on stable ground and then balance ball in order to $0^{\circ}$, $15^{\circ}$, $30^{\circ}$ and $45^{\circ}$ of knee flexion.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.251-260
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• 2019

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

• Journal of Korean Neurosurgical Society
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• 제65권6호
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• pp.816-824
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• 2022

Objective : Emergency superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis in patients with large vessel occlusion who fails mechanical thrombectomy or does not become an indication due to over the time window can be done as an alternative for blood flow restoration. The authors planned this study to quantitatively measure the degree of improvement in cerebral perfusion flow using perfusion magnetic resonance imaging (MRI) after bypass surgery and to find out what factors are related to the outcome of the bypass surgery. Methods : For a total of 107 patients who underwent emergent STA-MCA bypass surgery with large vessel occlusion, the National Institute of Health stroke scale (NIHSS), modified Rankin score (mRS), infarction volume, and hypoperfusion area volume was calculated, the duration between symptom onset and reperfusion time, occlusion site and infarction type were analyzed. After emergency STA-MCA bypass, hypoperfusion area volume at post-operative 7 days was calculated and analyzed compared with pre-operative hypoperfusion area volume. The factors affecting the improvement of mRS were analyzed. The clinical status of patients who underwent emergency bypass was investigated by mRS and NIHSS before and after surgery, and changes in infarct volume, extent, degree of collateral circulation, and hypoperfusion area volume were measured using MRI and digital subtraction angiography (DSA). Results : The preoperative infarction volume was median 10 mL and the hypoperfusion area volume was median 101 mL. NIHSS was a median of 8 points, and the last normal to operation time was a median of 60.7 hours. STA patency was fair in 97.1% of patients at 6 months follow-up DSA and recanalization of the occluded vessel was confirmed at 26.5% of patients. Infarction volume significantly influenced the improvement of mRS (p=0.010) but preoperative hypoperfusion volume was not significantly influenced (p=0.192), and the infarction type showed marginal significance (p=0.0508). Preoperative NIHSS, initial mRS, occlusion vessel type, and last normal to operation time did not influence the improvement of mRS (p=0.272, 0.941, 0.354, and 0.391). Conclusion : In a patient who had an acute cerebral infarction due to large vessel occlusion with large ischemic penumbra but was unable to perform mechanical thrombectomy, STA-MCA bypass could be performed. By using time-to-peak images of perfusion MRI, it is possible to quickly and easily confirm that the brain tissue at risk is preserved and that the ischemic penumbra is recovered to a normal blood flow state.

• Korean Journal of Radiology
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• 제22권5호
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• pp.697-705
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• 2021

Objective: To investigate the feasibility and the accuracy of the coronary CT angiography (CCTA)-derived Registry of Crossboss and Hybrid procedures in France, the Netherlands, Belgium and United Kingdom (RECHARGE) score (RECHARGECCTA) for the prediction of procedural success and 30-minutes guidewire crossing in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Materials and Methods: One hundred and twenty-four consecutive patients (mean age, 54 years; 79% male) with 131 CTO lesions who underwent CCTA before catheter angiography (CA) with CTO-PCI were retrospectively enrolled in this study. The RECHARGECCTA scores were calculated and compared with RECHARGECA and other CTA-based prediction scores, including Multicenter CTO Registry of Japan (J-CTO), CT Registry of CTO Revascularisation (CT-RECTOR), and Korean Multicenter CTO CT Registry (KCCT) scores. Results: The procedural success rate of the CTO-PCI procedures was 72%, and 61% of cases achieved the 30-minutes wire crossing. No significant difference was observed between the RECHARGECCTA score and the RECHARGECA score for procedural success (median 2 vs. median 2, p = 0.084). However, the RECHARGECCTA score was higher than the RECHARGECA score for the 30-minutes wire crossing (median 2 vs. median 1.5, p = 0.001). The areas under the curve (AUCs) of the RECHARGECCTA and RECHARGECA scores for predicting procedural success showed no statistical significance (0.718 vs. 0.757, p = 0.655). The sensitivity, specificity, positive predictive value, and the negative predictive value of the RECHARGECCTA scores of ≤ 2 for predictive procedural success were 78%, 60%, 43%, and 87%, respectively. The RECHARGECCTA score showed a discriminative performance that was comparable to those of the other CTA-based prediction scores (AUC = 0.718 vs. 0.665-0.717, all p > 0.05). Conclusion: The non-invasive RECHARGECCTA score performs better than the invasive determination for the prediction of the 30-minutes wire crossing of CTO-PCI. However, the RECHARGECCTA score may not replace other CTA-based prediction scores for predicting CTO-PCI success.

• Journal of Chest Surgery
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• 제38권12호
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• pp.835-843
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• 2005

배경: 분자학적 표지자들과 식도암과의 관련성에 대해서 아직 뚜렷하게 밝혀진 바가 없다. 본 연구에서는 먼저 p53, Cyclin D1과 Ki67 지수 등 종양 표식자가 국내 식도암 환자에서 수술 후 얻어진 식도암 조직의 병기, 악성도, 임파선 전이 여부 등과 어떠한 관련성이 있는가를 알아보고 이를 이용해 향후 국내 식도암 환자에 대한 예후 분석 및 치료방침 결정 그리고 조기발견에 이용할 수 있는지 알아보았다. 또한 본 연구는 분자학적 표지자들의 임상적용의 기초를 마련하고자 하는 목적으로 시행하였다. 대상 및 방법: 1992년 3월부터 수술 후 조직절편이 보존된 124명의 환자를 대상으로 하였다. 조직절편의 파라핀을 제거한 뒤에 p53 변이, Cyclin D1의 과발현, Ki67 지수에 대한 면역조직화학 염색법을 시행하였으며 조직슬라이드상에서 세포분열지수를 구하였다. 이 결과와 임상적인 변수들과의 상관관계를 분석하였고, 환자의 생존 및 재발 결과와 비교하였다. 결과: 환자의 성별, 나이, 병기, 종양 크기, 타장기 전이 여부, 국소적인 재발 여부와 p53의 변이, Cyclin D1의 과발현, Ki67 지수, 세포분열 지수에 따른 통계적으로 유의한 차이는 없었다. Ki67 지수는 40 미만인 경우와 40 이상인 경우로 나누었을 경우 통계적으로 유의하게 생존기간에 있어서 차이가 나는 것으로 나타났으나(p=0.011) 다른 표지자들은 생존기간에 유의한 차이를 보이지 않았다. 결론: 높은 Ki67지수는 식도의 편평상피암의 예후에 나쁜 영향을 미치는 것으로 나타났으나 다른 표지자들은 영향을 미치지 않았다 이번의 연구를 통해 분자학적인 지표들이 임상적으로 가치 있는 인자가 될 수 있다고 판단되었다.