• Asian Pacific Journal of Cancer Prevention
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• v.16 no.14
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• pp.6001-6006
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• 2015

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources. Materials and Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a pre-designed, coded questionnaire looking at patient characteristics, treatment given and outcome. Results: 101 patients were found to be eligible. Mean age was $56.7{\pm}12.8years$, the male to female ratio was 2:1 and most patients had a good performance status. More than half of the tumors were located in the head (57%, n=58) and almost all were adenocarcinomas (95%, n=96). Some 58% (n=59) received first line chemotherapy of which 49% (n=29) received gemcitabine-based regimens and 39% (n=23) received FOLFIRINOX. The median progression free survival for gemcitabine based treatment was 2.9 months (IQR=1.6-5.6) as opposed to 7.3 months (IQR=4.5-9.2) for FOLFIRINOX (P=0.02). Median overall survival was 4.9 months (IQR=2.3-9.5) for first line gemcitabine based treatment and 10.5 months (IQR=7.0-13.2) for first line FOLFIRINOX therapy (P=0.002). Patients on FOLFIRINOX had better survival across all subgroups. Inpatient admissions and dose reductions were more frequent with FOLFIRINOX but the difference between the two regimens was not statistically significant. FOLFIRINOX could be successfully administered as outpatient therapy to a number of patients. Conclusions: FOLFIRINOX remains a suitable first line option in patients with metastatic pancreatic cancer with good performance status even in a resource-poor country where diagnostic and supportive care facilities may be less than optimal and cost is a limitation.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6087-6094
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• 2014

Purpose: The aim of the present study was to invesitigate the impact of significant clinico-pathological prognostic factors on survival rates and to identify factors predictive of poor outcome in patients with ovarian carcinoma. Materials and Methods: A retrospective chart review of 74 women with pathologically proven ovarian carcinoma who were treated between January 2006 and April 2011 was performed. Patients were investigated with respect to survival to find the possible effects of age, gravida, parity, menstruel condition, pre-operative Ca-125, treatment period, cytologic washings, presence of ascites, tumor histology, stage and grade, maximal tumor diameter, adjuvan chemotherapy and cytoreductive success. Also 55 ovarian carcinoma patients were investigated with respect to prognostic factors for early 2-year survival. Results: The two-year survival rate was 69% and the 5-year survival rate was 25.5% for the whole study population. Significant factors for 2-year survival were preoperative CA-125 level, malignant cytology and FIGO clinical stage. Significant factors for 5-year survival were age, preoperative CA-125 level, residual tumor, lymph node metastases, histologic type of tumor, malignant cytology and FIGO clinical stage. Logistic regression revealed that independent prognostic factors of 5-year survival were patient age, lymph node metastasis and malignant cytology. Conclusions: We consider quality registries with prospectively collected data to be one important tool in monitoring treatment effects in population-based cancer research.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6339-6342
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• 2014

Background: The incidence of rectal cancer is increasing in younger age groups. Limited data is available regarding survival outcome in younger patients with conflicting results from western world. The goal of this study was to determine survival in patients with rectal cancer <30 years of age and compare it with their older counterparts in the Pakistani population. Materials and Methods: A retrospective chart review of patients operated for rectal adenocarcinoma between January 2005 and December 2010 was performed. Patients were divided into two groups, Group 1 aged ${\leq}30years$ and Group 2 aged >30years. Patient characteristics, surgical procedure, histopathological details and number of loco-regional and distant failures were compared. Expected 5 year survival was calculated using Kaplan Meier curves and significance was determined using the Log rank test. Results: There were 38 patients in group 1 and 144 in group 2. A significantly high number of younger patients presented with poorly differentiated histology (44.7% vs 9.7%) (p=0.0001) and advanced pathological stage (63.1% vs 38.1%) (p=0.04). Predicted overall 5 year survival was 38% versus 57% in groups I and II, respectively (p=0.05). Disease free survival was 37% versus 52% and was significantly different (p=0.007). Conclusions: Early onset rectal cancer is associated with poor pathological features and a worse outcome in Pakistani population.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4693-4697
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• 2013

Background: Malignant transformation arising in mature cystic teratoma (MCT) is one of the most serious complications of MCT. Squamous cell carcinoma is the most common malignant change. Some clinical findings such as advanced age group and large tumor size are significant risk factors of malignant transformation. This study was conducted in order to evaluate characteristics, cell types, treatment and outcome of malignant transformation arising from dermoid cysts in our institution. Materials and Methods: A retrospective chart review was performed. General characteristics, operative data, procedure, operative finding and operative outcome were analyzed. Statistical assessment was performed with SPSS version 17.0, using mean, mode, median and percentage to describe those data. Results: During the 10 years period, 11 cases of malignant transformation from a total of 753 cases (1.46% incidence) of MCT were reviewed. Mean age of the patients was 41.2 years (SD 4.34, range 24-70). The most common presenting symptom was a palpable mass (8 cases; 72.7%). Primary surgical staging was performed in 4 patients (36.4%). Re-staging was conducted in the other 4. Complete cytoreduction was obtained in 45.5% (5 cases) and optimal surgical resection was obtained in 36.4% (4 cases). Mean tumor size was 14.1 cm. (SD 1.55, range 6-20). Squamous cell carcinoma was found in 36.4% (4 cases) and mucinous cancer in the other 4. More than half of them were stage Ia (54.5%, 6 cases). All patients whose stage more than Ia received chemotherapy (45.5%). Mean disease free survival was 5.53 years (1.32, 0.3-10). Conclusion: According to our study, the incidence of malignant transformation was consistent with previous studies. The common malignant transformation histologic types are both squamous and mucinous carcinoma which differed from previous reports. Early detection for early stage disease and optimal surgery are important for long term survival.

• Korean Journal of Biological Psychiatry
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• v.23 no.4
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• pp.199-204
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• 2016

Objectives Although forgetfulness is a common complaint among menopausal depressed women, there is still a debate about the relationship between memory impairment and menopause. The aim of this study is to examine whether menopause is related to cognitive decline among women with depressive disorders. We hypothesized that postmenopausal depressed women show generally poorer performance than premenopausal depressed women on various cognitive function tests. Methods With a retrospective chart review, we identified a total of 87 female patients (45 premenopausal patients and 42 postmenopausal patients) who were hospitalized with depressive disorders from 2000 to 2016. Demographic and clinical variables and cognitive test results were compared between two groups. Results Education year is longer in premenopausal group than postmenopausal group whereas clinical characteristics (illness duration, recurrence, and symptom severity) and mean Intelligence Quotient (IQ) were similar between two groups. The postmenopausal group took longer time for Bender-Gestalt Test (BGT) recall, Trail Making Test (TMT)-A, and TMT-B than the premenopausal group. After controlling for age and education, significant difference was remained for BGT recall (p = 0.029). Conclusions Postmenopausal state may be related with decline of visuospatial memory function, in particular, among depressed female patients. Other areas of cognitive function including complex attention, verbal memory, auditory memory, and working memory might be interpreted while considering age and education level.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.142-151
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• 2012

Purpose : The purpose of this study was to describe arterial spin labeling MR image findings of status epilepticus. Materials and Methods: A retrospective chart review within our institute revealed six patients who had been clinically diagnosed as status epilepticus and had also undergone MR imaging that included ASL in addition to routine sequences. Results: Six patients with status epilepticus were studied by conventional MR and arterial spin labeling imaging. All patients showed increased regional CBF correlating with EEG pathology. Notably, in two patients, conventional MRI and DWI showed no abnormal findings whereas pCASL demonstrated regional increased CBF in both patients. Conclusion: Arterial spin labeling might offer additional diagnostic capabilities in the evaluation of patients with status epilepticus.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2211-2215
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• 2016

The purpose of this study was to evaluate the prevalence and predictors of post-Loop Electrosurgical Excision Procedure (LEEP) complications in Srinagarind Hospital, Khon Kaen, Thailand. Retrospective chart review was performed for 200 patients undergoing LEEP during January 2012 to February 2013. Their mean age was 45 years-old. Fifty-three (26.5%) were menopausal. The three most common preceding abnormal cervical cytology were high-grade squamous intraepithelial lesion (HSIL; 50%), atypical squamous cell cannot exclude HSIL (ASC-H; 10.5%), and low-grade squamous intraepithelial lesion (LSIL; 10%). The overall complications prevalence rate was 16.5% (95%CI, 11.4-21.6). Complications included bleeding (11%; 95%CI, 6.66-15.3), offensive discharge (4%; 95%CI, 1.28-6.72), and pelvic inflammatory disease (1.5%; 95%CI, 0.18-3.18). Only mode of delivery was an independent predictor of post-LEEP complications. Women with previous caesarean sections carried an increased risk of complications by 3.9 times (95%CI, 1.21-12.56) compared with vaginal delivery. In conclusion, LEEP is generally safe with an acceptable complication rate. Previous caesarean section was the only independent predictor for post-LEEP complications. However, this predictor still needs prudent evaluation as no clear cause-effect relationship was identified.

• Korean Journal of Biological Psychiatry
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• v.9 no.2
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• pp.129-139
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• 2002

Objective:This study was performed to investigate the prescribing patterns of antimanic agents in the treatment of acute bipolar disorder inpatients in Korea from 1990 through 2000. The results will serve as the basic data for the practice guideline for the pharmacotherapy of bipolar disorder patients in Korea. Method:Retrospective chart review of bipolar disorder inpatients of Soonchunhyang Medical Center in Seoul and Chun-An was conducted for each of the year 1990, 1995, and 2000. The following data are collected ; 1) demographic data, 2) history of bipolar disorder, 3) length of hospital stay, 4) detailed drug titration records of antimanic agents and antipsychotic agents. Results:During the last decade, the frequency of lithium monotherapy was decreased obviously. Instead, more than half of the patients in 2000 were on combination therapy of lithium and anticonvulsants. Lithiumvalproate combination was the preferred strategy and the use rate of carbamazepine has been decreased. In addition, most of the patients were given antipsychotic agents during the last 10 years. And recently, atypical antipsychotics were increasingly prescribed. These changes in the field of pharmacology of bipolar disorder have resulted neither in shorter hospital stays nor lower dosages of concurrent neuroleptics. Conclusions:The results indicate the trends in the prescribing of antimanic agents for the treatment of bipolar disorder in Korea across the past 10 years. Mostly, the change seems to correspond to the international practice guideline. More systematic research is needed to find out the clinical benefits of the anticonvulsants in the real practice of treatment of bipolar disorder.

• Archives of Plastic Surgery
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• v.42 no.5
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• pp.619-625
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• 2015

Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from $5{\times}4$ to $20{\times}8cm^2$. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.148-153
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• 2009

Purpose: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. Methods: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. Results: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. Conclusion: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.