• Title/Summary/Keyword: clinical stage

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Is Radiotherapy Necessary for Stage 1 Testicular Seminoma? (제1병기 성인 고환 정상피종에 대한 임상적 고찰 및 치료결과 분석)

  • Lee, Jung-Ae;Park, Won;Lim, Do-Hoon;Ahn, Yong-Chan;Huh, Seung-Jae;Yu, Jeong-Il;Choi, Han-Yong;Lee, Hyun-Moo;Cho, Eun-Yoon
    • Radiation Oncology Journal
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    • v.27 no.2
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    • pp.49-54
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    • 2009
  • Purpose: To report on the clinical outcome of patients with stage I testicular seminoma by postoperative radiotherapy (PORT) or surveillance after radical inguinal orchiectomy. Materials and Methods: This study is a retrospective review of 32 stage I pure seminoma patients treated between 1996 and 2005 at the Samsung Medical Center. Twenty two of the patients were treated by PORT, which was directed at the paraaortic lymphatics with a median dose of 25.2 Gy in 14 fractions for 3 weeks. The 10 remaining patients were managed by surveillance. The median follow-up period was 96 months with a range of 24 to 155 months. Results: Clinically, most patients presented with a testicular mass or discomfort. Two of the patients had a history of undescended testes. Pathologically, 23 of the patients had intratubular germ cell neoplasia with seminoma. Both recurrence-free survival (RFS) and overall survival (OS) rates of patients treated by PORT were 100%. In the control group, 1 of the 10 patients suffered a para-aortic lymph node relapse. The RFS and OS rates of the surveillance group were 88.9% and 100%, respectively. Conclusion: No difference in survival was observed between the two groups. Moreover, symptom recurrence was only observed in 1 patient in the control group. The use of PORT may reduce the risk of relapse. With the availability of effective diagnostic and salvage modalities, surveillance monitoring may be considered for patients in good compliance.

Prognostic Factors of Thymic Carcinoma (흉선암의 예후인자)

  • Park, In-Kyu;Kim, Dae-Joon;Kim, Kil-Dong;Bae, Mi-Kyung;Chung, Kyung-Young
    • Journal of Chest Surgery
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    • v.38 no.8 s.253
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    • pp.564-569
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    • 2005
  • Background: Thymic carcinoma is a rare malignant disease with sparse data for treatment and prognosis. We intended to investigate the prognostic factors of thymic carcinoma. Material and Method: Data of 42 patients, who were diagnosed and treated for thymic carcinoma from January of 1986 to August of 2003 were reviewed retrospectively. Influences of characteristics of patients, Masaoka stage, histologic grade, completeness of resection and adjuvant treatment on survival were evaluated. Result: There were 30 male and 12 female patients and their mean age was $52.0\pm15.7$ years old. There were 28 patients with low-grade histology and 13 patients with high-grade histology. Clinical stage according to Masaoka stage were I in 2, II in 2, III in 15 $(35.7\%)$, IVa in 10 $(23.8\%),\;and\;IVb\;in\;13\;(31\%)$ patients. Surgical resection was done in 22 patients, Complete resection was possible in 13 patients and incomplete resection was done in 9 patients. Among 20 patients without resection, 8 patients received chemotherapy, 7 patients received radiotherapy and 5 patients received combined therapy. Median survival time was $31.7\pm6.1$ months and 5 year survival rate was $28.5\%$. High grade histology (hazard ratio=3.009, $95\%\;confidence\;interval=1.178\sim7.685,$ p=0.021) and incompleteness of resection (hazard ratio=3.605, $95\%$ confidence interval= $1.1541\sim1.580$, p=0.023) were the prognostic factors of thymic carcinoma. Conclusion: In thymic carcinoma, low grade histology is a good prognostic factor and complete resection can prolong the survival of patients.

Increased Incidence of Endometrial Polyps in Women with Endometriosis; the Association with Severity (자궁내막증 여성에서 증가된 자궁내막용종의 빈도; 질환의 중증도와의 관련성)

  • Chang, Hye Jin;Hwang, Kyung Joo;Kim, Mi Ran;Ahn, Sang Tae;Byun, Jae Guang;Lee, Eun Hee;Park, Jin Young
    • Clinical and Experimental Reproductive Medicine
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    • v.33 no.3
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    • pp.199-205
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    • 2006
  • Objective: The aim of this study was to evaluate the correlation between severity of endometriosis and the incidence of endometrial polyp. Methods: The study population consisted of six hundred thirty-one women who had undergone laparoscopic operation due to infertility, severe dysmenorrhea or ovarian tumors. We divided two groups: 434 women with endometriosis (study group) and 197 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to revised The American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy, and compared endometrial polyp incidence according to severity of endometriosis. Results: There was no significant difference between groups with regard to age, mean duration of infertility. Endometrial polyps were found in 274 women (63.0%) with endometriosis and in 58 controls (29.8%, p=0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108 (67.6%, p<0.05), 66/94 (70.2%, p<0.05) in endometriosis stage I, II, III, and IV. There was a linear correlation between stage of endometriosis and endometrial polyps incidence (p=0.008). Conclusion: Endometriosis is accompanied by endometrial polyps. This results showed positive correlation between severity of the endometriosis and incidence of endometrial polyps. It is the possible mechanism for low pregnancy rate in the severe endometriosis.

mRNA Expression Differences of uPA, uPAR in Eutopic Endometrium of Advanced Stage Endometriosis Patients (중증 자궁내막증 환자의 자궁내막과 정상인 자궁내막에서 uPA, uPAR mRNA 발현의 차이에 관한 연구)

  • Hur, Sung Eun;Lee, Ji Young;Lee, Woon Jung;Chung, Hye-Sung;Chung, Hye Won
    • Clinical and Experimental Reproductive Medicine
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    • v.33 no.4
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    • pp.229-236
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    • 2006
  • Objective: We investigated the expression of uPA and uPAR in eutopic endometrium of advanced stage endometriosis and control patients. Methods: The 33 endometriosis patients and 32 controls were enrolled. Endometrial samples were obtained from 65 premenopausal women aged 29-44 years, undergoing laparoscopic surgery or hysterectomy for non-malignant lesions. Sufficient samples were collected from 33 patients with endometriosis stage Ill and IV and 32 controls without endometriosis confirmed by laparoscopic surgery. The mRNA expression of uPA and uPAR from eutopic endometrium were analyzed by RT-QC PCR. Results: The mRNAs of uPA and uPAR were expressed in eutopic endometrium from endometriosis and normal controls throughout the menstrual cycle. Uterine endometrium from women with endometriosis expresses significantly (p<0.05) higher levels of u-PA mRNA than endometrium from normal women without endometriosis in the proliferative phase. There were no significant differences in expression of uPAR in eutopic endometrium between controls and endometriosis patients. Conclusion: These results suggest that eutopic endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation because of greater u-PA mRNA expression than endometrium from women without endometriosis. Thus, increased proteolytic activity may be one etiology for the invasive properties of the endometrium resulting in the development of endometriosis.

Morphologic Parameters and in vitro Maturational Competence of Human Immature Oocyte Obtained from Stimulated IVF Cycle (미성숙난자의 형태학적 지표와 체외성숙능과의 관계)

  • An, So-Jung;Jee, Byung-Chul;Moon, Jeong-Hee;Lee, Jung-Ryeol;Suh, Chang-Suk;Kim, Seok-Hyun
    • Clinical and Experimental Reproductive Medicine
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    • v.35 no.4
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    • pp.285-291
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    • 2008
  • Objective: This study was performed to investigate whether cumulus morphology and oocyte diameter influence on in vitro maturation (IVM) of human germinal vesicle (GV) stage oocytes obtained from stimulated in vitro fertilization (IVF) cycles. Methods: Forty-one GV stage oocytes were obtained from 21 patients who received ovarian hyperstimulation and IVF. According to cumulus morphology before denudation, GV oocytes were classified into oocytes with dispersed cumulus cells (CCs) or compacted CCs. The diameters of denuded oocytes, both including and excluding the zona pellucida, were measured. All oocytes were cultured in commercial IVM medium. Maturation was defined as extrusion of the first polar body and the matured oocytes were inseminated by ICSI method. Results: Overall maturation and fertilization rate were 56.1% and 73.9%. Matured oocytes had significantly higher proportion of oocytes with dispersed CCs compared to oocytes failed to mature (91.3% vs. 55.6%, p=0.023). There were no significant differences of oocytes outer ($155.7{\mu}m$ vs. $152.4{\mu}m$, NS), inner ($114.3{\mu}m$ vs. $113.4{\mu}m$, NS) diameters and zona thicknesses ($41.3{\mu}m$ vs. $39.1{\mu}m$, NS) between matured and not-matured oocytes. In-vitro maturation rate of oocytes with dispersed CCs was significantly higher than which of oocytes with compacted CCs (67.7% vs. 20.0%, p=0.044). Oocyte diameters (outer and inner) and thicknesses were not related with maturational competence. Conclusion: Our results suggest that in vitro maturational competence of GV stage oocytes obtained from stimulated IVF cycles is closely associated with the cumulus morphology but not oocyte diameter.

Association between Endometriosis and Human ${\alpha}2$-Heremans Schmidt Glycoprotein (AHSG) Polymorphism (한국 여성에서 중증 자궁내막증과 Human ${\alpha}2$-Heremans Schmidt Glycoprotein (AHSG) 유전자 다형성의 연관성)

  • Kim, Jin-Ju;Chae, Soo-Jin;Kim, Jong-Mee;Lee, Gyoung-Hoon;Choi, Young-Min;Kim, Sung-Hoon;Shin, Jung-Ho;Lee, Taek-Hoo;Hur, Jun-Young;Lee, Byoung-Suk;Oh, Sung-Tack;Lee, Kyu-Sup;Lim, Young-Tack
    • Clinical and Experimental Reproductive Medicine
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    • v.35 no.4
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    • pp.267-274
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    • 2008
  • Objective: To evaluate the relationship between advanced stage endometriosis and polymorphisms in $\alpha$2-Heremans Schmidt glycoprotein (AHSG) gene in Korean women. Methods: One-hundred thirty women with endometriosis stage III and IV, and 224 women without endometriosis were enrolled. In these patients, we determined AHSG gene polymorphisms by PCR and RFLP (restriction fragment length polymorphism) analysis. Results: The genotype distribution of the AHSG gene polymorphism in the endometriosis group was not different from that of the control group (AHSG 1*1/AHSG 1*2/AHSG 2*2 frequencies were 56.2%/37.7%/6.2% and 55.8%/39.3%/4.9% for the endometriosis and control groups, respectively, p=.864). Also, the frequency of AHSG 2 haplotype was not different between endometriosis patients and controls (AHSG 1 haplotype /AHSG 2 haplotype rates were 75.0%/25.0% and 75.4%/24.6% for the endometriosis and control groups, respectively, p=0.894). Conclusion: AHSG gene polymorphism was not associated with the risk of advanced stage endometriosis in the Korean population.

Development of the Information Delivery System for the Home Nursing Service (가정간호사업 운용을 위한 정보전달체계 개발 I (가정간호 데이터베이스 구축과 뇌졸중 환자의 가정간호 전산개발))

  • Park, J.H;Kim, M.J;Hong, K.J;Han, K.J;Park, S.A;Yung, S.N;Lee, I.S;Joh, H.;Bang, K.S
    • Journal of Home Health Care Nursing
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    • v.4
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    • pp.5-22
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    • 1997
  • The purpose of the study was to development an information delivery system for the home nursing service, to demonstrate and to evaluate the efficiency of it. The period of research conduct was from September 1996 to August 31, 1997. At the 1st stage to achieve the purpose, Firstly Assessment tool for the patients with cerebral vascular disease who have the first priority of HNS among the patients with various health problems at home was developed through literature review. Secondly, after identification of patient nursing problem by the home care nurse with the assessment tool, the patient's classification system developed by Park (1988) that was 128 nursing activities under 6 categories was used to identify the home care nurse's activities of the patient with CAV at home. The research team had several workshops with 5 clinical nurse experts to refine it. At last 110 nursing activities under 11 categories for the patients with CVA were derived. At the second stage, algorithms were developed to connect 110 nursing activities with the patient nursing problems identified by assessment tool. The computerizing process of the algorithms is as follows: These algorithms are realized with the computer program by use of the software engineering technique. The development is made by the prototyping method, which is the requirement analysis of the software specifications. The basic features of the usability, compatibility, adaptability and maintainability are taken into consideration. Particular emphasis is given to the efficient construction of the database. To enhance the database efficiency and to establish the structural cohesion, the data field is categorized with the weight of relevance to the particular disease. This approach permits the easy adaptability when numerous diseases are applied in the future. In paralleled with this, the expandability and maintainability is stressed through out the program development, which leads to the modular concept. However since the disease to be applied is increased in number as the project progress and since they are interrelated and coupled each other, the expand ability as well as maintainability should be considered with a big priority. Furthermore, since the system is to be synthesized with other medical systems in the future, these properties are very important. The prototype developed in this project is to be evaluated through the stage of system testing. There are various evaluation metrics such as cohesion, coupling and adaptability so on. But unfortunately, direct measurement of these metrics are very difficult, and accordingly, analytical and quantitative evaluations are almost impossible. Therefore, instead of the analytical evaluation, the experimental evaluation is to be applied through the test run by various users. This system testing will provide the viewpoint analysis of the user's level, and the detail and additional requirement specifications arising from user's real situation will be feedback into the system modeling. Also. the degree of freedom of the input and output will be improved, and the hardware limitation will be investigated. Upon the refining, the prototype system will be used as a design template. and will be used to develop the more extensive system. In detail. the relevant modules will be developed for the various diseases, and the module will be integrated by the macroscopic design process focusing on the inter modularity, generality of the database. and compatibility with other systems. The Home care Evaluation System is comprised of three main modules of : (1) General information on a patient, (2) General health status of a patient, and (3) Cerebrovascular disease patient. The general health status module has five sub modules of physical measurement, vitality, nursing, pharmaceutical description and emotional/cognition ability. The CVA patient module is divided into ten sub modules such as subjective sense, consciousness, memory and language pattern so on. The typical sub modules are described in appendix 3.

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Expression of Tumor Markers and its Clinical Impacts in Resectable Gastric Cancer (절제 가능한 위암에서 종양표지자의 발현과 임상적 의의)

  • Koo Bon Yong;Kim Chan Young;Yang Doo Hyun;Hwang Yong
    • Journal of Gastric Cancer
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    • v.4 no.4
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    • pp.235-241
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    • 2004
  • Purpose: This study was performed to evaluate the effectiveness of the serum tumor markers CEA, CA 19-9, and CA 72-4 in monitoring the recurrence of gastric cancer and in its preoperative assessment. Materials and Methods: Two hundred fifty-five patients who underwent potentially curative surgery during period from January 1995 to December 2000 at the Department of Surgery were assessed. Serum samples were obtained preoperatively, 2 weeks after the surgery, and at 6-month intervals. The cut-off levels were established as 5 ng/ml for CEA, 36 U/ml for CA 19-9, and 4 U/ml for CA 72-4. The tumor stage was described according to the 5th edition of the Union Internationale Contra la Cancer (UICC) TNM classification in 1997. Results: The preoperative positivities were $10.5\%$ for CEA, $9.7\%$ for CA 19-9, and $12.4\%$ for CA 72-4. The serum levels of the three tumor markers decreased after curative surgery. The preoperative serum levels of the three tumor markers were significantly related to the depth of invasion, the tumor size, lymph-node metastasis, the pathologic stage, and recurrence, except that CEA was not associated with tumor size. The marker sensitivities in recurrent cases were $43.3\%$ for CEA, $\%41.8$ for CA 19-9, and $50.0\%$ for CA 72-4, and the marker specificities were $85.1\%$ for CEA, $96.8\%$ for CA 19-9, and $87.8\%$ for CA 72-4. Conclusion: The preoperative serum levels of CEA, CA 19-9, and CA 72-4 are not useful for the initial diagnosis of gastric cancer because of their low positivity. However, we should consider their relationship with depth of invasion, lymph-node metastasis, tumor size, pathologic stage, and recurrence. Also, the follow-up levels of the three markers have a statistical relationship with recurrence of gastric cancer even though their sensitivities are low.

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Aberrant Methylation of p16 Tumor Suppressor Gene and Death-Associated Protein Kinase in Non-Small Cell Lung Carcinoma (비소세포폐암 조직에서 p16 종양억제유전자와 Death-Associated Protein Kinase의 Aberrant Methylation의 양상)

  • Kim, Yun-Seong;Lee, Min-Ki;Jung, Kyung-Sik;Kim, Ki-Uk;Kim, Young-Dae;Lee, Hyung-Ryul;Lee, Chang-Hoon;Seok, Ju-Won;Kim, Yong-Ki;Jun, Eun-Sook;Choi, Young-Min;Rha, Seo-Hee;Park, Soon-Kew
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.2
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    • pp.108-121
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    • 2001
  • Background : The $p16^{INK4a}$ (p16) twnor suppressor gene is frequently inactivated in hwnan non-small cell lung cancers (NSCLCs), predominantly through homozygous deletion or in association with aberrant promotor hypermethylation. Death-associated protein kinase (DAPK) gene influences interferon $\gamma$-induced apoptotic cell death and has important role in metastasis of lung cancer in animal model. Hypermethylation of promoter region of DAP kinase gene may suppress the expression of this gene. Methods : This study was performed to investigate the aberrant methylation of p16 or DAP kinase in 35 resected primary NSCLCs by methylation-specific PCR (MSP), and demonstrated frequency, diagnostic value and clinical implication of aberrant methylation of two genes. Results : Thirty-two cases were male patients, and 3 cases were female patients with an average age was 57. $8{\pm}10.5$ years. The histologic types of lung cancer were 22 of squamous cell carcinoma, 12 of adenocarcinoma, 1 of large cell carcinoma. Pathologic stages were 11 cases of stage I (1 IA, 10 IB), 13 cases of stage II (1 IIA, 12 IIB), and 11 cases of stage III (9 IIIA, 2 IIIB). Regarding for the cancer tissue, p16 aberrant methylation was noted in 13 case of 33 cases (39.4%), DAP kinase in 21 cases of 35 cases (60%). Age over 55 year was associated with p16 aberrant methylation significantly (p<0.05). Methylation status of two genes was not different by smoking history, histologic type, size of tumor, lymph node metastasis and disease progression of lung cancer. There was no correlation between p16 and DAP kinase hypermethylation. Conclusion: This investigation demonstrates that aberrant methylation of p16 tumor suppressor gene or DAP kinase showed relatively high frequency (74.3%) in NSCLCs, and that these genes could be a biologic marker for early detection of lung cancer.

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Development of a Occupation-Based Bilateral Upper Extremity Training Protocol in a Medical Setting for Stroke Patients (뇌졸중 환자를 대상으로 한 병원 환경에서의 작업 기반 양측성 상지 훈련 프로토콜 개발)

  • Kim, Sun-Ho;Kim, Jung Ran;Park, Hae Yean;Han, A-Reum;Kim, Jong-Bae;Park, Ji-Hyuk
    • Therapeutic Science for Rehabilitation
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    • v.9 no.1
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    • pp.24-44
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    • 2020
  • Objective : To develop an occupation-based bilateral upper extremity training protocol that can be effectively applied in a medical setting Methods : The research process using the delphi technique was carried out in 3 stages. The first stage was an open questionnaire development stage, The first draft is prepared through literature review and open questions were developed through preliminary research based on the draft. The second stage was the delphi survey. Based on the responses of the experts obtained through the open Delphi survey, the adequacy of the training protocol was shown on a Likert 5 point scale. The items were edited and deleted, reconstructed by analyzing the mean and standard deviation, stability, convergence degree, consensus, and content validity ratio through the questionnaire. The third step was the completion of the protocol. After discussions between researchers, the finalized protocol contents were reorganized to complete the occupation-based bilateral upper extremity training protocol for medical setting. Results : The final protocol consisted of 9 items across 3 areas in the occupation-based intervention selection domain and 81 items across 4 areas in the bilateral upper extremity training domain, intervention period, and evaluation. Conclusions : This study suggests an evidence-based method that collects the opinions of occupational therapists in order to use occupation-based activities as interventions in a situation that currently sees occupational therapy primarily performed in hospitals. It is also meaningful that the bilateral upper extremity training can be applied effectively in clinical situations by concretely presenting.