H. Chung

Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: A case-matched comparison

BACKGROUND Uterine sarcomas are rare among all uterine malignancies, and frequently misdiagnosed as benign uterine diseases such as leiomyoma and adenomyosis because of lack of feasible tools for the preoperative diagnosis. Although some studies have suggested the role of serum CA-125 levels for the preoperative diagnosis, the efficacy is controversial. Since malignancy is known to be associated with systemic inflammation which leads to hematological alteration, we compared the efficacy for the preoperative diagnosis of uterine sarcomas between the neutrophil to lymphocyte ratio (NLR) and serum CA-125 levels using a case-match comparison. METHODS From November 2004 to December 2008, 55 patients with carcinosarcoma (n=21), leiomyosarcoma (n=20) and endometrial stromal sarcoma (n=14) were matched to 330 patients with leiomyoma (n=165) and adenomyosis (n=165) in terms of age at diagnosis, body mass index and uterine volume. RESULTS The receiver operating characteristic curve showed the best cut-off values of the NLR (>or=2.12) and serum CA-125 levels (>or=27.5U/ml) for the preoperative diagnosis of uterine sarcomas, demonstrating that the NLR was more powerful for the preoperative diagnosis of uterine sarcomas than serum CA-125 levels (sensitivity, 74.5% vs. 52.3%; specificity, 70.3% vs. 50.5%; positive predictive value, 29.5% vs. 15.1%; negative predictive value, 94.3% vs. 86.5%; accuracy, 60.6% vs. 49.6%; p<0.05). Furthermore, the NLR reflected recurrence and progression more accurately than serum CA-125 levels in patients with uterine sarcomas. CONCLUSIONS These findings suggest that the NLR may be more useful than serum CA-125 levels as a cost-effective tool for the preoperative diagnosis in patients with uterine sarcomas.

Impact of diagnostic laparoscopy on the management of chronic pelvic pain

BackgroundDiagnostic laparoscopy is a useful tool, especially when there is no definite anatomical abnormality visible on imaging modalities. We assess the role and clinical impact of diagnostic laparoscopy in the management of women with chronic pelvic pain.MethodsClinical data of 3,068 cases of diagnostic laparoscopy performed for chronic pelvic pain from June 1994 to August 2005 were analyzed. We compared the diagnoses after diagnostic laparoscopy and those after pelvic examination and imaging modalities such as ultrasound or computed tomography (CT), and we then checked the final pathologic diagnoses after operation.ResultsPelvic endometriosis was the most common (60.2%) laparoscopic finding in patients with chronic pelvic pain in this study, followed by normal pelvic findings (21.2%) and pelvic congestion (13.0%). Diagnostic laparoscopy had an influence on correcting previous plans based on imaging modalities in 42.7% of patients such as discarding unnecessary procedures or introducing new diagnostic or therapeutic plans. There were 3 cases of major complications requiring immediate correction.ConclusionsDiagnostic laparoscopy is a useful diagnostic tool for of women with chronic pelvic pain and can be used as a guideline for individualized treatment.

Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: A meta-analysis

BACKGROUND The impact of intraoperative rupture on prognosis is controversial in early-stage epithelial ovarian cancer (EOC). Thus, we performed a meta-analysis to determine its impact and to evaluate factors to increase its risk. METHODS We searched PubMed, Embase, and the Cochrane Library till May 2011, and 9 eligible studies including 2382 patients were evaluated. All patients were classified into three groups: no rupture; intraoperative rupture; preoperative involvement. RESULTS Preoperative involvement decreased progression-free survival when compared with intraoperative rupture (PFS; HR, 1.47; 95% CI, 1.01-2.14), which also showed poorer PFS than no rupture (HR, 2.41; 95% CI, 1.74-3.33). Although preoperative involvement reduced PFS when compared with intraoperative rupture (HR, 2.63; 95% CI, 1.11-6.20), there was no difference in it between intraoperative rupture and no rupture in patients who underwent complete surgical staging operation and adjuvant platinum-based chemotherapy if needed (HR, 1.49; 95% CI, 0.45-4.95). Furthermore, adhesion to adjacent tissues, grade 2 or 3 disease were more common (ORs, 2.01 and 2.47; 95% CIs, 1.20-3.37 and 1.12-5.46), whereas mucinous tumor was less frequent (OR, 0.51; 95% CI, 0.37-0.72) in intraoperative rupture than in no rupture. CONCLUSIONS Intraoperative rupture may not decrease PFS when compared with no rupture in patients with early-stage EOC who underwent complete surgical staging operation and adjuvant platinum-based chemotherapy. Furthermore, more adhesion to adjacent tissues and grade 2 or 3 disease, and less mucinous tumor are expected to increase the risk of intraoperative rupture.

Conservative treatment with medroxyprogesterone acetate plus levonorgestrel intrauterine system for early-stage endometrial cancer in young women: pilot study.

Objective: To assess the feasibility of using medroxyprogesterone acetate (MPA) and levonorgestrel intrauterine system (LNG-IUS) to treat early-stage endometrial cancer in young women who want to preserve their reproductive potential. Methods: Prospective observational study of 5 young patients (mean [SD] age, 38.4 [4.8] years; range, 33-41 years) with a grade 1 endometrial cancer that is presumably confined to the endometrium. The subjects were given a daily oral dose of 500 mg of MPA and LNG-IUS placement. They were followed with dilation and curettage every 3 months. Results: Complete remission was shown in 4 of 5 patients, and one patient showed partial remission. Biopsy results were negative in 2 patients at 3 months, in 1 patient at 6 months, and in 1 patient at 12 months. No treatment-related complications occurred. No recurrence was found during the follow-up period (mean [SD], 10.2 [3.6] months; range, 6-16 months). Conclusions: The concomitant use of MPA with LNG-IUS is feasible for conservative treatment of early-stage endometrial cancer in young women who want to preserve their reproductive potential.

Comparison of chemoradiation with radiation as postoperative adjuvant therapy in cervical cancer patients with intermediate-risk factors.

AIMS In cervical cancer patients with intermediate-risk factors, the optimal adjuvant therapy is still controversial. We retrospectively compared the treatment outcome of chemoradiation with that of radiation. METHODS From 1997 to 2005, 79 consecutive cervical cancer patients received postoperative adjuvant therapy indicated by intermediate-risk factors. Fifty-five women received chemoradiation and 24 women received radiation. Risk factors, recurrence-free survival (RFS), adverse events, and recurrence pattern were investigated and were compared between the chemoradiation and radiation groups. RFS was calculated by the Kaplan-Meier method and was compared by the log-rank test. RESULTS Risk factors were well-balanced between the two groups. Four patients recurred in the chemoradiation group and eight patients recurred in the radiation group. RFS rate of the chemoradiation group was significantly higher than that of the radiation group (P=0.01). Hematologic toxicity was more common in the chemoradiation group than in the radiation group (P<0.01). However, non-hematologic toxicity was similar between the two groups and most of the patients (97%) completed postoperative adjuvant therapy. Recurrence pattern was similar between the two groups. CONCLUSION In cervical cancer patients with intermediate-risk factors, chemoradiation was well-tolerated and more effective than radiation as a postoperative adjuvant therapy.

Clinical impact of under-diagnosis by frozen section examination is minimal in borderline ovarian tumors

AIMS The purpose of this study was to examine the clinical impact of under-diagnosis by frozen section examination in borderline ovarian tumors (BOTs). METHODS We reviewed 209 consecutive patients with BOTs who were diagnosed and treated at our institute between March 1988 and July 2007. Tumors from 182 of 209 patients were evaluated by frozen section examination. After excluding a case with a deferred diagnosis, the results of frozen section examinations were compared with the final paraffin section examination. In 61 patients, the frozen section examination under-diagnosed a BOT as a benign tumor. In 120 patients, the frozen section examination correctly diagnosed or over-diagnosed a BOT. The clinical impact of under-diagnosis was evaluated by comparing the extent of surgery and treatment outcome between the patients who were under-diagnosed (study group) and the patients who were not under-diagnosed (control group). RESULTS The study group had more mucinous (P=0.03) and/or stage 1A (P=0.02) tumors than the control group. Fewer patients in the study group received adjuvant chemotherapy than the patients in the control group (P=0.02). Fewer patients in the study group underwent radical surgery than the patients in the control group (P=0.02). However, the rates of treatment failure were similar between the two groups (no treatment failure in the study group and seven treatment failures in the control group; P=0.10). CONCLUSIONS The under-diagnosis by frozen section examination did not compromise the outcome in patients with BOTs, although under-diagnosis was associated with more conservative surgery.

Gracilimonas rosea sp. nov., isolated from tropical seawater, and emended description of the genus Gracilimonas.

A Gram-staining-negative, non-motile, spore-forming, rod-shaped, marine bacterial strain, CL-KR2(T), was isolated from tropical seawater near Kosrae, an island in the Federated States of Micronesia. Analysis of the 16S rRNA gene sequence of strain CL-KR2(T) revealed a clear affiliation with the genus Gracilimonas. Based on phylogenetic analysis, strain CL-KR2(T) showed the closest phylogenetic relationship to Gracilimonas tropica CL-CB462(T), with 16S rRNA gene sequence similarity of 96.6 %. DNA-DNA relatedness between strain CL-KR2(T) and G. tropica CL-CB462(T) was 6.7 % (reciprocal 9.5 %). Strain CL-KR2(T) grew in the presence of 1-20 % sea salts and the optimal salt concentration was 3.5-5 %. The temperature and pH optima for growth were 35 °C and pH 7.5. The major cellular fatty acids (≥10.0 %) of strain CL-KR2(T) were iso-C15 : 0, summed feature 3 (iso-C15 : 0 2-OH and/or C16 : 1ω7c) and iso-C17 : 1ω9c and the only isoprenoid quinone was MK-7. The polar lipids were diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, an unidentified phospholipid, two unidentified glycolipids and two unidentified lipids. The genomic DNA G+C content of strain CL-KR2(T) was 43.2 mol%. The combined phenotypic, chemotaxonomic and phylogenetic data showed that strain CL-KR2(T) could be distinguished from the only member of the genus Gracilimonas with a validly published name. Thus, strain CL-KR2(T) should be assigned to a novel species in the genus Gracilimonas, for which the name Gracilimonas rosea sp. nov. is proposed. The type strain is CL-KR2(T) ( = KCCM 90206(T) = JCM 18898(T)).

The role of serum CA-125 levels in early-stage epithelial ovarian cancer on preoperative CT and MRI

BACKGROUND We sought to identify the role of serum CA-125 levels in early-stage epithelial ovarian cancer (EOC) on preoperative CT and MRI. METHODS Clinical data of 101 patients with early-stage EOC on preoperative CT and MRI were collected between January 2000 and December 2007. Clinical stage I (n=59) was defined as tumor limited to the ovaries with or without ascites, whereas clinical stage II (n=42) was defined as tumor within the pelvis with or without ascites. The primary endpoint was to investigate the efficacy of serum CA-125 levels for the prediction of advanced-stage disease, and secondary endpoints were to evaluate the accuracy of preoperative CT and MRI, and to examine the role of serum CA-125 levels as a prognostic factor for survival. RESULTS The results of preoperative CT and MRI were concordant with no peritoneal implants outside the pelvis in 50/101 (50%) and no lymph node metastasis in 71/101 (70%) patients. The receiver operating characteristic curves showed that best cut-off values of serum CA-125 levels were 320 U/ml (71% sensitivity, 84% specificity) and 510 U/ml (67% sensitivity, 80% specificity) for the prediction of peritoneal implants outside the pelvis and lymph node metastasis. The serum CA-125 level (> or =320 U/ml) was a significant factor for the prediction of advanced-stage disease (adjusted OR, 7.43; 95% CI, 2.39-23.04). However, it was not an independent prognostic factor for survival. CONCLUSIONS Serum CA-125 levels may be very useful for the prediction of advanced-stage disease in early-stage EOC on preoperative CT and MRI.

Impact of guideline adherence on patient outcomes in early-stage epithelial ovarian cancer.

AIM The aim of this study was to evaluate the effects of adherence to National Comprehensive Cancer Network (NCCN) guidelines on survival outcomes in patients with early-stage epithelial ovarian cancer. METHODS Our institutional cancer registry data on 266 patients with Stage I epithelial ovarian cancer was reviewed retrospectively and compliance with treatment guidelines for surgery and adjuvant treatment was determined. Patients were categorized according to adherence or non-adherence. The primary endpoints were recurrence-free survival and disease-specific survival. Hazard ratios (HRs) for survival were estimated with a Cox proportional hazards model. RESULTS Of the 266 patients, 71 (26.7%) underwent adequate surgical staging in accordance with the guidelines. The guidelines for adjuvant chemotherapy were followed adequately in all 71 patients that were adherent to surgical staging and in 163 of the 195 patients with non-adherence to surgical staging (83.6%). Multivariate analysis, adjusted for prognostic factors, identified higher recurrence-free survival (HR, 0.36; 95% CI, 0.15-0.88) and disease-specific survival (HR, 0.42; 95% CI, 0.16-1.12) among patients whose treatment adhered to both surgical and chemotherapy guidelines, although disease-specific survival was not statistically significant. When excluding clear cell histology from the cohort, the guideline-adherent group had significantly better disease-specific survival than the non-adherent group (HR, 0.13; 95% CI, 0.02-0.94). CONCLUSION The results of this study suggest that adherence to NCCN guidelines may improve survival outcomes in patients with early-stage epithelial ovarian cancer, particularly in cases other than clear cell histology.

Evaluation of Physico-Mechanical Properties and Durability of Larix kaempferi Wood Heat-Treated by Hot Air

본 연구에서는 국내에서 상업적으로 이용되고 있는 국산 낙엽송 열처리재의 여러 가지 물성(밀도, 평형함수율, 수축률, 흡습/흡수성, 종/횡압축강도, 휨강도, 경도, 내부후성능)을 정량적으로 평가하기 위하여 수행되었다. 고온처리에 의해 목재의 소수성이 증가함에 따라 평형함수율이 감소하였다. 이에 따라 수축률 및 흡습/흡수성이 감소하여 치수안정성이 개선되었고, 낮은 함수율의 영향으로 압축강도가 증가하였으며, 목재 주성분의 변화와 낮은 함수율의 영향으로 내부후성능이 개선되었다. 하지만 열처리에 의해 밀도와 휨강도 및 경도는 감소하였다. 【This study was carried out to evaluate quantitatively some properties (density, equilibrium moisture content, shrinkage, water vapor adsorption, water absorptivity, compressive strength, bending strength, hardness and decay resistance) of Larix kaempferi lumber which was heat-treated by hot air and has been used commercially in Korea. Equilibrium moisture content of the heat-treated wood was decreased with increase of hydrophobicity. Dimensional stability of the wood was improved with decrease of shrinkage, water vapor adsorption and free water absorptivity. Also, with the thermo-chemical changes of wood component and lower equilibrium moisture content, decay resistance and compressive strength of heat-treated wood were increased. But, bending strength and hardness of wood were decreased.】