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Kim DH, Moon SJ, Lee J, Cha JK, Kim MH, Park JS, Ban B, Kang J, Kim BJ, Kim WS, Yoon CH, Lee H, Kim S, Kang EK, Her AY, Yoon CW, Rha JH, Woo SI, Lee WK, Jung HY, Lee JH, Park HS, Hwang YH, Kim K, Kim RB, Choi NC, Hwang J, Park HW, Park KS, Yi S, Cho JY, Kim NH, Choi KH, Kim J, Han JY, Choi JC, Kim SY, Choi JH, Kim J, Sohn MK, Choi SW, Shin DI, Lee SY, Bae JW, Lee KS, Bae HJ. Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea. J Korean Med Sci 2022; 37:e305. [PMID: 36325609 PMCID: PMC9623032 DOI: 10.3346/jkms.2022.37.e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. METHODS Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. RESULTS Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. CONCLUSIONS Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.
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Affiliation(s)
- Dae-Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Seok-Joo Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Kwan Cha
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Jong-Sung Park
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Byeolnim Ban
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won-Seok Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hwan Yoon
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heeyoung Lee
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seongheon Kim
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Kyoung Kang
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae-Young Her
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Cindy W Yoon
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Joung-Ho Rha
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Seong-Ill Woo
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Won Kyung Lee
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Han-Young Jung
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Hun Sik Park
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Ha Hwang
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Keonyeop Kim
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jinyong Hwang
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun-Woong Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Soo Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - SangHak Yi
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Nam-Ho Kim
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kang-Ho Choi
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Juhan Kim
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Song-Yi Kim
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Joon-Hyouk Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Jei Kim
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min Kyun Sohn
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Si Wan Choi
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong-Ick Shin
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Jang-Whan Bae
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hee-Joon Bae
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Kim CH, Kang J, Kim SK, Choi NC. Abstract TP312: Direct Visits to Comprehensive Stroke Centers Reduce Time Delays for Thrombolytic Therapy in Acute Ischemic Stroke. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose
The benefits of thrombolytic therapy for the treatment of acute ischemic stroke are time-dependent. However, many hospitals are not capable of performing endovascular thrombectomy, so patients are often transferred to comprehensive stroke centers, resulting in a delay of treatment. We evaluated the differences in time to thrombolytic therapy between directly admitted patients and referred patients.
Methods:
Between July 2014 and February 2018, 382 patients (mean age: 69.0±11.4 years; men: 52.5%) who received thrombolytic therapies within specified therapeutic time windows were included in this study. We identified stroke patients who received intravenous tissue plasminogen activator within 4.5 hours and/or endovascular thrombectomy within 6 hours of symptom onset. We divided the patients into two groups - those who presented to our center directly, and those who were referred from outside hospitals. Baseline characteristics and time variables were compared between the two groups, and we also evaluated the factors associated with favorable outcomes at 3 months.
Results:
A total of 108 (28.2%) patients were referred from other hospitals, whereas 275 (71.8%) patients presented to our hospital directly. Direct visit patients received thrombolytic therapies faster than the referred group, according to the onset-to-needle time (126 vs. 163 minutes, p < 0.001) and onset-to-puncture time (194 versus 226 minutes, p < 0.001). Younger age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.92-0.97; p<0.001), lower National Institutes of Health Stroke Scale (NIHSS) score (OR 0.86; 95% CI 0.82-0.90; p<0.001), and direct presentation to the stroke center (OR 1.75; 95% CI 1.02-3.03; p=0.044) were independently associated with favorable outcomes at 3 months.
Conclusions:
Bypassing local hospitals to present directly to the comprehensive stroke center reduced time delays for thrombolytic therapies and improved favorable outcomes in patients with acute ischemic stroke.
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Affiliation(s)
- Chang Hun Kim
- Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Jongsoo Kang
- Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Soo-Kyoung Kim
- Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Nack-Cheon Choi
- Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
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Kang J, Kang CH, Roh J, Yeom JA, Shim DH, Kim YS, Lee SW, Kim YS, Park KH, Kim CH, Kim SK, Choi NC, Kwon OY, Kang H, Baik SK. Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation. J Neurocrit Care 2018. [DOI: 10.18700/jnc.180059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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4
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Shin H, Cho MC, Kim RB, Kim CH, Choi NC, Kim SK, Koh EH. Laboratory measurement of apixaban using anti-factor Xa assays in acute ischemic stroke patients with non-valvular atrial fibrillation. J Thromb Thrombolysis 2018; 45:250-256. [PMID: 29198080 DOI: 10.1007/s11239-017-1590-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Apixaban is effective and safe for preventing stroke, and its usage has increased exponentially in recent years. However, data concerning the therapeutic range of apixaban is limited. This study determined the trough and peak levels of apixaban-specific anti-factor Xa activity (AFXaA) in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF) in Korea. The study included 85 patients who received apixaban. Blood samples were taken to measure the trough and peak levels of AFXaA using a chromogenic anti-factor assay, as well as prothrombin time (PT) and activated partial thromboplastin time (aPTT). We also reviewed complications such as major bleeding of patients treated with apixaban. In patients given a 5.0-mg apixaban dose, the median trough and peak levels of AFXaA were 104.5 and 202.0 ng/mL. In patients given a 2.5-mg apixaban dose, the median trough and peak AFXaA levels were 76.0 and 151.0 ng/mL. The PT showed a positive correlation with increased AFXaA activity at both levels (Trough R = 0.486, Peak R = 0.592), but the aPTT had no relationship with AFXaA activity at both levels (Trough R = 0.181, Peak R = 0.129). Two cases with intracranial bleeding belonged to the highest AFXaA quartile (Trough, p = 0.176; Peak, p = 0.053). In conclusion, we determined the trough and peak levels of AFXaA in patients with NVAF while being treated with the apixaban in Korea. Our results could be used as a starting point when setting the reference ranges for laboratories using anti-Xa assay. Large-scale studies are needed to establish the reference range for AFXaA in patients with NVAF.
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Affiliation(s)
- Hyoshim Shin
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju, 660-702, South Korea
| | - Min-Chul Cho
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju, 660-702, South Korea
| | - Rock Bum Kim
- Research Department, Gyeongnam Regional Cancer Center, Jinju, South Korea
| | - Chang-Hun Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Soo-Kyung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Eun-Ha Koh
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju, 660-702, South Korea.
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea.
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5
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Jin Z, Jung Y, Yi CO, Lee JY, Jeong EA, Lee JE, Park KJ, Kwon OY, Lim BH, Choi NC, Roh GS. Atorvastatin pretreatment attenuates kainic acid-induced hippocampal neuronal death via regulation of lipocalin-2-associated neuroinflammation. Korean J Physiol Pharmacol 2018; 22:301-309. [PMID: 29719452 PMCID: PMC5928343 DOI: 10.4196/kjpp.2018.22.3.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/31/2017] [Accepted: 02/07/2018] [Indexed: 11/15/2022]
Abstract
Statins mediate vascular protection and reduce the prevalence of cardiovascular diseases. Recent work indicates that statins have anticonvulsive effects in the brain; however, little is known about the precise mechanism for its protective effect in kainic acid (KA)-induced seizures. Here, we investigated the protective effects of atorvastatin pretreatment on KA-induced neuroinflammation and hippocampal cell death. Mice were treated via intragastric administration of atorvastatin for 7 days, injected with KA, and then sacrificed after 24 h. We observed that atorvastatin pretreatment reduced KA-induced seizure activity, hippocampal cell death, and neuroinflammation. Atorvastatin pretreatment also inhibited KA-induced lipocalin-2 expression in the hippocampus and attenuated KA-induced hippocampal cyclooxygenase-2 expression and glial activation. Moreover, AKT phosphorylation in KA-treated hippocampus was inhibited by atorvastatin pretreatment. These findings suggest that atorvastatin pretreatment may protect hippocampal neurons during seizures by controlling lipocalin-2-associated neuroinflammation.
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Affiliation(s)
- Zhen Jin
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Yohan Jung
- Department of Neurology, Changwon Fatima Hospital, Changwon 51394, Korea
| | - Chin-Ok Yi
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Jong Youl Lee
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Eun Ae Jeong
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Jung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Ki-Jong Park
- Department of Neurology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Oh-Young Kwon
- Department of Neurology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Byeong Hoon Lim
- Department of Neurology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Nack-Cheon Choi
- Department of Neurology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Gu Seob Roh
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
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6
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Kim DH, Kwon OY, Jung SW, Jeong H, Son S, Kim SK, Kang H, Park KJ, Choi NC, Lim B. Location of Irritative Zone in Epileptic Brains of Schizencephalic Patients. Clin EEG Neurosci 2016; 47:235-42. [PMID: 25253435 DOI: 10.1177/1550059414548859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/03/2014] [Indexed: 11/16/2022]
Abstract
Although many schizencephaly patients suffer from epilepsy, the relationship between schizencephalic lesions and epileptic foci remains unclear. Previous studies have shown that schizencephalic lesions may be associated with, rather than contain, epileptogenic zones. Thus, the purpose of this study was to investigate the current source distribution (CSD) of epileptiform discharges in schizencephalic patients and to correlate this activity with existing structural lesions. A consecutive series of 30 schizencephalic patients who were diagnosed using brain magnetic resonance imaging (MRI) were selected retrospectively and prospectively. Of the original 30 subjects selected, 13 had epilepsy, and 6 of these patients exhibited schizencephaly, epilepsy, and interictal spikes on electroencephalograms (EEG) and were enrolled in the present study investigating the current source analysis of interictal spikes. The CSDs of the initial rising phases and the peak points of the interictal spikes were obtained using standardized low-resolution brain electromagnetic tomography (LORETA). Five patients exhibited a single focus of interictal spikes, while 1 patient showed 2 foci. Relative to the structural brain lesions, 5 patients displayed extrinsically localized CSDs, while 1 patient showed a partially intrinsically localized CSD. The present findings demonstrate that the CSDs of interictal spikes in schizencephalic patients are in general anatomically distinct from the cerebral schizencephalic lesions and that these lesions may display an extrinsic epileptogenicity.
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Affiliation(s)
- Do-Hyung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Oh-Young Kwon
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Suck-Won Jung
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Heejeong Jeong
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seongnam Son
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Heeyoung Kang
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ki-Jong Park
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Nack-Cheon Choi
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - ByeongHoon Lim
- Department of Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Park KH, Kim YS, Kim SK, Choi NC, Kwon OY, Lim B, Park KJ. Toxocara canis-Associated Myelitis with Eosinophilic Pneumonia. Exp Neurobiol 2016; 25:139-42. [PMID: 27358582 PMCID: PMC4923358 DOI: 10.5607/en.2016.25.3.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/12/2016] [Accepted: 05/01/2016] [Indexed: 11/19/2022] Open
Abstract
The existence of Toxocara canis-specific antibodies has recently been reported in patients with atopic myelitis. Here, we report the case of a 35-year-old male patient admitted with a chief complaint of right lower limb hypoesthesia lasting for a month. The patient was diagnosed with eosinophilic pneumonia 3 months ago, and a spine MRI revealed the presence of myelitis in the cervicothoracic cord. After confirming the presence of hyper-IgE-emia and Toxocara canis antibodies, the patient was treated with steroids and albendazole treatment, which improved his symptoms. To our knowledge, this is the first case of Toxocara canis-associated myelitis with eosinophilic pneumonia.
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Affiliation(s)
- Kee Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Korea
| | - Young-Soo Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Korea
| | - Soo-Kyung Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Korea
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Korea.; Department of Neurology, Gyeongsang National University, School of Medicine, Gyeongsang Institue of Health Science, Jinju 52727, Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Korea.; Department of Neurology, Gyeongsang National University, School of Medicine, Gyeongsang Institue of Health Science, Jinju 52727, Korea
| | - ByeongHoon Lim
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Korea.; Department of Neurology, Gyeongsang National University, School of Medicine, Gyeongsang Institue of Health Science, Jinju 52727, Korea
| | - Ki-Jong Park
- Department of Neurology, Gyeongsang National University, School of Medicine, Gyeongsang Institue of Health Science, Jinju 52727, Korea.; Department of Neurology, Gyeongsagn National University Changwon Hospital, Changwon 51472, Korea
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Kim SK, Jeong DH, Choi NC, Kim R, Park KS, Son S. Abstract WP424: Prevalence and Determinants of Non-adherence to Secondary Preventive Medication in Stroke Patients. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Nonadherence to secondary preventive medication is associated with adverse outcomes and higher costs of care in stroke patients. The purpose of this study is to investigate the prevalence and major determinants of nonadherence to secondary preventive medication in stroke survivors.
Hypothesis:
We assessed the hypothesis that the determinants of nonadherence to secondary preventive medication in stroke patients may be different in both intentional and nonintentional, or/and in various classes of medication.
Methods:
We enrolled the 252 patients taking medicines > 1 year after stroke onset. Adherence was measured by a self-reported questionnaire, and nonadherence was classified to be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage, three items) or unintentional (e.g., forgetting to take medication, four items). The devices to assess the determining factors of adherence included Belief about Medication Questionnaire, Morisky Medication Adherence Scales, Lubben Social Network Scale-6, and Geriatiric Depression Scale. We also conducted a survey to assess healthy adherence effects and satisfaction level of education program about medication and healthy behaviors.
Results:
About 60% of patients were non-adherent (n=150, 59.5%). Among them, 56 (37.3%) patients were unintentionally and 94 (62.7%) patients were intentionally nonadherent to their stroke preventive medication. The determinants of nonadherence were age [Exp(B)=1.041, p=0.045], necessity [Exp(B)=1.106, p=0.057], social network [Exp(B)=1.021, p=0.044] and familial support [Exp(B)=1.032, p=0.044]. Classic oral anticoagulation therapy showed better adherence compared with antiplatelet therapy (83.6% vs. 69.7%,
p
=0.002). The behavioral education was a determinant for adherence to the classic oral anticoagulation therapy.
Conclusion:
In conclusion, nonadherence to medication in stroke surviviors was generally high. Necessity was an important determinant of both intentional and unintentional nonadherence. Older age was predictive of unintentional nonadherence, and building social networks and familial support were important for the intentionally nonadherent patients.
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Affiliation(s)
- Soo-Kyoung Kim
- Dept of Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Da-hye Jeong
- Dept of Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Nack-Cheon Choi
- Dept of Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Rokbum Kim
- Dept of Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Ki-Soo Park
- Dept of Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
| | - Seungnam Son
- Dept of Neurology, Gyeongsang National Univ Hosp, Jinju, Korea, Republic of
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Son S, Kim YW, Oh MK, Kim SK, Park KJ, Choi NC, Kwon OY, Lim BH, Choi HC, Choi DS. Initial factors affecting the clinical outcome after successful recanalization via MR-based mechanical thrombectomy in patients with acute ischemic stroke due to basilar artery occlusion. J Neurointerv Surg 2015; 8:889-93. [DOI: 10.1136/neurintsurg-2015-011912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 11/04/2022]
Abstract
Background and purposeTo determine the initial factors, including patient characteristics, stroke etiology and severity, time factors, and imaging findings, that could affect the clinical outcome of patients with acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) where successful recanalization was achieved via mechanical thrombectomy.MethodsBetween March 2011 and December 2014, 35 patients with AIS caused by BAO received MRI/MR angiography-based mechanical thrombectomies, and recanalization was achieved with a Thrombolysis In Cerebral Infarction score of >2b. The patients were divided into a good outcome group (n=19), defined as those with a modified Rankin Scale (mRS) score of 0–2 at 3 months after stroke onset, and a poor outcome group (n=16), defined as a mRS score of 3–6. The differences between the groups were analyzed.ResultsInitial National Institutes of Health Stroke Scale (NIHSS) score (good vs poor: 17.9±8.9 vs 27.6±8.5, p=0.003), posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) based on initial diffusion-weighted images (DWI) (good vs poor: 7.8±1.6 vs 5.4±1.8, p=0.001), pc-ASPECTS based on contrast staining on the post-thrombectomy control CT (good vs poor: 9.2±1.5 vs 6.3±2.2, p<0.001), and presence of contrast staining in the brainstem on that CT (good vs poor: 15.8% vs 81.6%, p<0.001) were significantly different between the groups.ConclusionsPatients with AIS caused by BAO with a lower initial NIHSS score, fewer lesions on initial DWI, and less contrast staining on the post-thrombectomy control CT have higher probabilities of a good clinical outcome after successful recanalization via a mechanical thrombectomy.
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Choi NC, Kanarek DJ, Kazemi H. Prospective study of pulmonary tolerance to radiotherapy or radiotherapy plus multidrug chemotherapy for loco-regional lung carcinoma. Antibiot Chemother (1971) 2015; 41:213-9. [PMID: 3245690 DOI: 10.1159/000416207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- N C Choi
- Department of Radiation Medicine, Massachusetts General Hospital, Boston
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Choi NC, Carey RW. Reassessment of loco-regional failure rate in relation with radiation dose in combined modality approach of multidrug chemotherapy and radiotherapy for limited-stage small-cell lung carcinoma. Antibiot Chemother (1971) 2015; 41:70-6. [PMID: 2854448 DOI: 10.1159/000416184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- N C Choi
- Department of Radiation Medicine, Massachusetts General Hospital, Boston
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Son S, Choi DS, Oh MK, Hong J, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH. Comparison of Solitaire thrombectomy and Penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg 2014; 8:13-8. [DOI: 10.1136/neurintsurg-2014-011472] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/30/2014] [Indexed: 11/03/2022]
Abstract
Background and purposeAcute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) is a very severe neurological disease with a high mortality rate and poor clinical outcomes. In this study, we compared our experience of mechanical thrombectomy using the Solitaire stent (Solitaire thrombectomy) and manual aspiration thrombectomy using the Penumbra reperfusion catheter (Penumbra suction thrombectomy) in patients with AIS caused by BAO.Materials and methodsBetween March 2011 and December 2011, 13 patients received Solitaire thrombectomy. In January 2012, the Korean Food and Drug Administration banned the use of the Solitaire stent as a thrombectomy device, and a further 18 patients received Penumbra suction thrombectomy until December 2013. We compared parameters between patients treated with each device.ResultsSuccessful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b: 84.6% vs 100%, p=0.168) and clinical outcomes (judged by the modified Rankin Scale scores recorded at 3 months: 3.6±2.6 vs 3.2±2.6, p=0.726) were not significantly different between the two groups. However, complete recanalization rates (TICI score of 3: 23.1% vs 72.2%, p=0.015) and total procedure times (101.9±41.4 vs 62.3±34.8 min, p=0.044) were significantly higher, and shorter, respectively, in patients treated by Penumbra suction thrombectomy.ConclusionsThe two thrombectomy devices were associated with similar recanalization rates and clinical outcomes in patients with AIS caused by BAO. However, Penumbra suction thrombectomy seemed to allow more rapid and complete recanalization than Solitaire thrombectomy.
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Lee SH, Choi NC, Jang IS, Kang TS, Kang C, Jeong JH, Kim DS. Simultaneous event of brachial artery occlusion and acute embolic stroke. Am J Emerg Med 2014; 33:477.e3-4. [PMID: 25227978 DOI: 10.1016/j.ajem.2014.08.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/17/2014] [Indexed: 11/28/2022] Open
Abstract
Although the rapid and accurate diagnosis of both acute ischemic stroke and extremity ischemia is essential to the timely and appropriate treatment, it is not always easy to differentiate between true stroke and stroke mimics. Although in general, limb ischemia due to extremity embolism is not included in stroke mimics or misdiagnosis, limb arterial embolism should be considered in thedifferential diagnosis of acute monoparesis because the diagnosis maybe missed if the other typical manifestations of this presentation(pain, pallor, pulselessness, sensory loss, and coolness of the arm) are overlooked. Therefore, it is important to ensure that important signsare not missed whether the evaluation of the patient is done at thebedside. We report a case of a male patient presented to an emergency department with acute right upper extremity pain with headache, gait disturbance, and confused mentality. He was diagnosed by simultaneou sbrachial artery occlusion and acute stroke, which resulted in emergency surgical embolectomy and anticoagulation therapy.
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Affiliation(s)
- Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea.
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea
| | - In Seok Jang
- Department of Thoracic Cardiovascular Surgery, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Tae-Sin Kang
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Jin Hee Jeong
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea
| | - Dong Seob Kim
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Republic of Korea
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Kim J, Hwang YH, Kim JT, Choi NC, Kang SY, Cha JK, Ha YS, Shin DI, Kim S, Lim BH. Establishment of government-initiated comprehensive stroke centers for acute ischemic stroke management in South Korea. Stroke 2014; 45:2391-6. [PMID: 24994720 DOI: 10.1161/strokeaha.114.006134] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE In 2008, the Ministry of Health and Welfare of South Korea initiated the Regional Comprehensive Stroke Center (CSC) program to decrease the incidence and mortality of stroke nationwide. We evaluated the performance of acute ischemic stroke management after the Regional CSC program was introduced. METHODS The Ministry of Health and Welfare established 9 Regional CSCs in different provinces from 2008 to 2010. All Regional CSCs have been able to execute the critical processes independently for stroke management since 2011. The Ministry of Health and Welfare was responsible for program development and financial support, the Regional CSC for program execution, and the Korea Centers for Disease Control and Prevention for auditing the execution. We analyzed prospectively collected data on the required indices from 2011 and repeated the analysis the following year for comparison. RESULTS After the Regional CSCs were established, the first brain image was taken within 1 hour from arrival at the emergency room for all patients with stroke; the length of hospital stay decreased from 14 to 12 days; for the rapid execution of thrombolysis, the first brain image was taken within 12 minutes; intravenous and intra-arterial thrombolysis were started within 40 and 110 minutes, respectively, after emergency room arrival; and the hospital stay of thrombolytic patients decreased from 19 to 15 days. CONCLUSIONS The Regional CSC program has improved the performance of acute stroke management in South Korea and can be used as a model for rapidly improving stroke management.
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Affiliation(s)
- Jei Kim
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
| | - Yang-Ha Hwang
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Joon-Tae Kim
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Nack-Cheon Choi
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Sa-Yoon Kang
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Jae-Kwan Cha
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Yeon Soo Ha
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Dong-Ick Shin
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Seongheon Kim
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
| | - Byeong-Hoon Lim
- From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.)
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Yang TW, Son S, Choi DS, Oh MK, Lee CH, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH. Factors Affecting Acceptable Behavior Toward Decompressive Craniectomy For Malignant Middle Cerebral Artery Infarction. J Neurocrit Care 2014. [DOI: 10.18700/jnc.2014.7.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
Infections involving endovascular devices are rare and, to our knowledge, only three cases of infection with an inserted carotid stent have ever been reported. A 68-year-old man underwent carotid artery stenting (CAS) of the left proximal internal carotid artery. Two days after CAS the patient developed a high fever and investigation showed that the inserted carotid stent was infected. The infection could not be controlled despite adequate antibiotic therapy. Eventually a rupture of the carotid artery occurred and the patient underwent emergency resection of the left carotid bifurcation in addition to stent removal and reconstruction with a saphenous vein interposition graft. The patient recovered fully without any neurological sequelae.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea
| | - Nack-Cheon Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dae Seob Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Oh Hyun Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
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Son S, Choi NC, Choi DS, Cho OH. Carotid stent infection: a rare but potentially fatal complication of carotid artery stenting. BMJ Case Rep 2014; 2014:bcr-2014-011143. [PMID: 24675803 DOI: 10.1136/bcr-2014-011143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infections involving endovascular devices are rare and, to our knowledge, only three cases of infection with an inserted carotid stent have ever been reported. A 68-year-old man underwent carotid artery stenting (CAS) of the left proximal internal carotid artery. Two days after CAS the patient developed a high fever and investigation showed that the inserted carotid stent was infected. The infection could not be controlled despite adequate antibiotic therapy. Eventually a rupture of the carotid artery occurred and the patient underwent emergency resection of the left carotid bifurcation in addition to stent removal and reconstruction with a saphenous vein interposition graft. The patient recovered fully without any neurological sequelae.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
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Son S, Choi DS, Oh MK, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH. Emergency carotid artery stenting in patients with acute ischemic stroke due to occlusion or stenosis of the proximal internal carotid artery: a single-center experience. J Neurointerv Surg 2014; 7:238-44. [PMID: 24634445 DOI: 10.1136/neurintsurg-2014-011141] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The feasibility, safety and effectiveness of emergency carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to proximal internal carotid artery (ICA) stenosis or occlusion are still controversial. In this study we analyzed our experience with eCAS in patients with AIS. METHODS Twenty-two eCAS procedures for proximal ICA stenosis or occlusion were performed in 22 patients at our institution between January 2011 and November 2013. The mean time from stroke symptom onset to presentation was 204 min (range 50-630 min) and the mean initial score on the National Institutes of Health Stroke Scale (NIHSS) was 12.55 (range 5-23). Ten patients had total occlusion of the proximal ICA and the remaining 12 patients had near total occlusion or severe stenosis (mean degree 90.7%, range 80-100%). Eleven patients also had tandem occlusion on the more distal intracranial arteries. RESULTS Successful stent insertion was achieved in all patients and additional thrombectomy using a Solitaire stent or Penumbra aspiration catheter achieved a Thrombolysis In Cerebral Infarction grade of more than 2a in all patients with distal tandem occlusion. Procedure-related complications occurred in one patient (cerebral hyperperfusion syndrome) who recovered successfully. The mean NIHSS score at discharge was 3.55 (range 0-18). The mean modified Rankin Scale score at 3 months was 1 ± 1.67 (range 0-6). CONCLUSIONS eCAS in patients with AIS due to proximal ICA stenosis or occlusion appears to be a technically feasible and effective method for achieving good clinical outcomes.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea
| | - Dae Seob Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Kyun Oh
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea Rehabilitation Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea
| | - Heeyoung Kang
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki-Jong Park
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byeong Hoon Lim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea Gyeongnam Regional Cardiocerebrovascular Disease Center, Jinju, Korea Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Son S, Choi DS, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH. Carotid artery stenting in patients with near occlusion: A single-center experience and comparison with recent studies. Clin Neurol Neurosurg 2013; 115:1976-81. [DOI: 10.1016/j.clineuro.2013.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/10/2013] [Accepted: 06/04/2013] [Indexed: 12/20/2022]
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Son S, Kwon OY, Jung S, Kim YS, Kim SK, Kang H, Park KJ, Choi NC, Lim BH. Relationship between Hyperventilation-Induced Electroencephalographic Changes and PCO2 Level. J Epilepsy Res 2012; 2:5-9. [PMID: 24649453 PMCID: PMC3952317 DOI: 10.14581/jer.12002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 03/29/2012] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: We conducted this study to define the relationship between the hyperventilation-induced EEG changes (HV-EEG changes) and PCO2 Methods: In consecutive EEG recordings of 190 patients, we gathered data on PCO2 during the hyperventilation procedure. The data included baseline PCO2 (B-PCO2), PCO2 after 5 min of hyperventilation (5 min-PCO2), the mean value of the PCO2 (M-PCO2), and the difference between B-PCO2 and 5 min-PCO2 (ΔPCO2). We divided the enrolled patients into two groups by hyperventilation response (response group and no-response group), presence of epilepsy (epileptic group and non-epileptic group) and age (child-adolescent group and adult group) repeatedly. We compared the four variables between the two groups in each pair. Results: ΔPCO2 was 14.2±5.0 mmHg (mean±SD) in response group (n=48) and 12.4±5.0 in no-response group (n=142; p=0.033) for all the patients. For adult patients only, 5 min-PCO2 was 24.3±3.4 in response group (n=30) and 26.2±4.6 in no-response group (n=115; p=0.048), and ΔPCO2 was 15.8±4.0 and 12.9±5.0, respectively (p=0.004). In non-epileptic patients, 5min-PCO2 was 23.4±2.2 in response group (n=7) and 26.3±3.8 in no-response group (n=44; p=0.026), and ΔPCO2 was 15.9±4.3 and 12.7±3.9, respectively (p=0.053). Conclusions: In adults and non-epileptic patients, ΔPCO2 and 5 min-PCO2 may be crucial to the induction of EEG changes by hyperventilation. PCO2 could be a crucial factor for provoking HV-EEG changes in a limited group of patients.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seokwon Jung
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Soo Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Heeyoung Kang
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki-Jong Park
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byeong Hoon Lim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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21
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Son S, Choi DS, Choi NC, Lim BH. Serial magnetic resonance images of a right middle cerebral artery infarction : persistent hyperintensity on diffusion-weighted MRI over 8 months. J Korean Neurosurg Soc 2011; 50:388-91. [PMID: 22200025 DOI: 10.3340/jkns.2011.50.4.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/04/2011] [Accepted: 10/06/2011] [Indexed: 11/27/2022] Open
Abstract
A lesion that is hyperintense on diffusion-weighted imaging (DWI) and hypointense on the apparent diffusion coefficient (ADC) map is a characteristic magnetic resonance imaging (MRI) finding in acute ischemic infarction. In some cases, however, these findings can persist for a few months after infarct onset. It is thought that these finding reflect the different evolution speeds of the infarcted tissue. We report a patient with a right middle cerebral artery territory infarction with persistent hyperintensity on DWI and hypointensity on the ADC map for over 8 months. To our knowledge, this is the most persistent case of hyperintensity lesion on DWI and the serial MRI images of this patient provide important information on the evolution of infarcted tissue.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
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22
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Sequist LV, Heist RS, Shaw AT, Fidias P, Rosovsky R, Temel JS, Lennes IT, Digumarthy S, Waltman BA, Bast E, Tammireddy S, Morrissey L, Muzikansky A, Goldberg SB, Gainor J, Channick CL, Wain JC, Gaissert H, Donahue DM, Muniappan A, Wright C, Willers H, Mathisen DJ, Choi NC, Baselga J, Lynch TJ, Ellisen LW, Mino-Kenudson M, Lanuti M, Borger DR, Iafrate AJ, Engelman JA, Dias-Santagata D. Implementing multiplexed genotyping of non-small-cell lung cancers into routine clinical practice. Ann Oncol 2011; 22:2616-2624. [PMID: 22071650 DOI: 10.1093/annonc/mdr489] [Citation(s) in RCA: 297] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Personalizing non-small-cell lung cancer (NSCLC) therapy toward oncogene addicted pathway inhibition is effective. Hence, the ability to determine a more comprehensive genotype for each case is becoming essential to optimal cancer care. METHODS We developed a multiplexed PCR-based assay (SNaPshot) to simultaneously identify >50 mutations in several key NSCLC genes. SNaPshot and FISH for ALK translocations were integrated into routine practice as Clinical Laboratory Improvement Amendments-certified tests. Here, we present analyses of the first 589 patients referred for genotyping. RESULTS Pathologic prescreening identified 552 (95%) tumors with sufficient tissue for SNaPshot; 51% had ≥1 mutation identified, most commonly in KRAS (24%), EGFR (13%), PIK3CA (4%) and translocations involving ALK (5%). Unanticipated mutations were observed at lower frequencies in IDH and β-catenin. We observed several associations between genotypes and clinical characteristics, including increased PIK3CA mutations in squamous cell cancers. Genotyping distinguished multiple primary cancers from metastatic disease and steered 78 (22%) of the 353 patients with advanced disease toward a genotype-directed targeted therapy. CONCLUSIONS Broad genotyping can be efficiently incorporated into an NSCLC clinic and has great utility in influencing treatment decisions and directing patients toward relevant clinical trials. As more targeted therapies are developed, such multiplexed molecular testing will become a standard part of practice.
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Affiliation(s)
- L V Sequist
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston.
| | - R S Heist
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - A T Shaw
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - P Fidias
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - R Rosovsky
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston; The Mass General/North Shore Cancer Center, Danvers
| | - J S Temel
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - I T Lennes
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - S Digumarthy
- Harvard Medical School, Boston; Department of Radiology
| | | | - E Bast
- Massachusetts General Hospital Cancer Center, Boston
| | - S Tammireddy
- Massachusetts General Hospital Cancer Center, Boston
| | - L Morrissey
- Massachusetts General Hospital Cancer Center, Boston
| | - A Muzikansky
- Harvard Medical School, Boston; Department of Biostatistics
| | - S B Goldberg
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - J Gainor
- Harvard Medical School, Boston; Department of Medicine
| | - C L Channick
- Harvard Medical School, Boston; Division of Pulmonary and Critical Care Medicine
| | - J C Wain
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - H Gaissert
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - D M Donahue
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - A Muniappan
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - C Wright
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - H Willers
- Harvard Medical School, Boston; Department of Radiation Oncology, Massachusetts General Hospital, Boston
| | - D J Mathisen
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - N C Choi
- Harvard Medical School, Boston; Department of Radiation Oncology, Massachusetts General Hospital, Boston
| | - J Baselga
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - T J Lynch
- Yale University School of Medicine and Yale Cancer Center, New Haven
| | - L W Ellisen
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - M Mino-Kenudson
- Harvard Medical School, Boston; Department of Pathology, Massachusetts General Hospital, Boston, USA
| | - M Lanuti
- Harvard Medical School, Boston; Division of Thoracic Surgery
| | - D R Borger
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - A J Iafrate
- Harvard Medical School, Boston; Department of Pathology, Massachusetts General Hospital, Boston, USA
| | - J A Engelman
- Massachusetts General Hospital Cancer Center, Boston; Harvard Medical School, Boston
| | - D Dias-Santagata
- Harvard Medical School, Boston; Department of Pathology, Massachusetts General Hospital, Boston, USA
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23
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Son S, Kang DH, Kim BH, Choi NC. Incidentally discovered a self-inflicted a nail in the brain of schizophrenia patient. Psychiatry Investig 2011; 8:272-4. [PMID: 21994517 PMCID: PMC3182395 DOI: 10.4306/pi.2011.8.3.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 11/19/2022] Open
Abstract
The self-infliction of foreign bodies into the brain represents rare a clinical phenomenon that has been reported primarily in cases involving accidents and suicide attempts. However, various motivations for self-injurious behaviors as well as suicide attempts have been reported, especially in patients with psychotic illnesses. A 47-year-old man with a history of schizophrenia presented to our hospital due to the presence of a nail on his plain skull X-ray. He diagnosed paranoid type of schizophrenia about 17 years earlier, and his psychiatric symptoms were well controlled by medication. Interestingly, he was not aware of the presence of the nail in his brain and showed no neurological deficits. In the course of detailed history taking, we discovered that the nail was driven into his brain during a hallucinatory experience that had occurred more than 10 years earlier. Because we believed that removing the nail from his brain would be more dangerous than maintaining the status quo, the nail was not removed. This is a very rare case of a self-inflicted injury involving inserting a nail into the brain under the influence of hallucinations. The absence of adverse effects or neurological symptoms/signs related to the presence of a foreign metallic body in the brain for over 10 years is exceptional.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong-Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byung-Hyo Kim
- Department of Psychiatry, Jinju Seongnam Hospital, Jinju, Korea
| | - Nack-Cheon Choi
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Son S, Kang DH, Choi DS, Choi NC. A case of broncho-paraspinal fistula induced by metallic devices: delayed complication of thoracic spinal surgery. J Korean Neurosurg Soc 2011; 50:64-7. [PMID: 21892410 DOI: 10.3340/jkns.2011.50.1.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 04/12/2011] [Accepted: 07/08/2011] [Indexed: 11/27/2022] Open
Abstract
We present a case report of a 45-year-old woman with spontaneous pneumocephalus accompanied by pneumorrhachis of the thoracic spine, which is a very rare condition generally associated with trauma and thoracic or spinal surgery. The patient had undergone an operation about 10 years earlier to treat a giant cell tumor of the thoracic spine. During the operation, a metallic device was installed, which destroyed the bronchus and caused the formation of a broncho-paraspinal fistula. This is the suspected cause of her pneumocephalus and pneumorrhachis. To our knowledge, this is a very rare case of pneumocephalus accompanied by pneumorrhachis induced by metallic device, and when considering the length of time after surgery these complications presented are also exceptional.
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Affiliation(s)
- Seungnam Son
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
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25
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Kang H, Choi NC, Park KJ, Kwon OY, Lim BH, Jeong HJ. P3‐163: Correlation between serum uric acid and cerebral ischemia in patients with alzheimer dementia. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Ki-Jong Park
- Gyeongsang National University HospitalJinju Korea
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26
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Jeong HJ, Kang H, Kang K, Park KJ, Choi NC, Kwon OY, Lim BH. P1‐026: Transient global amnesia: Is cranial atherosclerosis the risk factor to transient global amnesia ? Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hee-Jeong Jeong
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
| | - Heeyoung Kang
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
| | - Kyusik Kang
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
| | - Ki-Jong Park
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
| | - Nack-Cheon Choi
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
| | - Oh-Young Kwon
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
| | - Byeong Hoon Lim
- Department of Neurology Gyeongsang National University School of MedicineJinju Korea
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27
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Mak RH, Mamon HJ, Ryan DP, Miyamoto DT, Ancukiewicz M, Kobayashi WK, Willett CG, Choi NC, Blaszkowsky LS, Hong TS. Toxicity and outcomes after chemoradiation for esophageal cancer in patients age 75 or older. Dis Esophagus 2010; 23:316-23. [PMID: 19788436 DOI: 10.1111/j.1442-2050.2009.01014.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Randomized trials of chemoradiation for esophageal cancer have included very few patients age > or = 75. In this retrospective study, we describe the outcomes and toxicity of full-dose chemoradiation in elderly patients with esophageal cancer. Patients, age > or = 75, treated with full-dose chemoradiation for esophageal carcinoma from 2002 to 2008 were retrospectively reviewed. Thirty-four patients were identified with a median age of 79.5 (range 75-89). The median Eastern Cooperative Oncology Group performance status was 1 (range 0-3) and the median Adult Comorbidity Evaluation-27 score was 1 (range 0-3). Twenty-eight patients received definitive and six received neoadjuvant chemoradiation. The median radiation dose delivered was 50.4 Gray (range 3.6-68.4 Gray). Platinum-based chemotherapy was used in 79.4% of patients. Fifty percent of the patients completed all planned radiation therapy (RT) and chemotherapy; 85.3% completed RT. Acute toxicity > or = grade 4 occurred in 38.2% of patients, and 70.6% of the patients required hospitalization, emergency department visit, and/or RT break. Median follow-up was 14.5 months among 7 survivors, and median survival was 12.0 months (95% confidence interval [CI]: 9.7 to 24.1 months). The actuarial overall survival at 2 years was 29.7% (95% CI: 16.6 to 52.6%). There were four treatment-related deaths. The median time to any recurrence was 10.4 months. Nineteen patients had a local and/or distant recurrence. In conclusion, elderly patients experienced substantial morbidity from chemoradiation, and long-term survival was low. Future efforts to improve treatment tolerability in the elderly are needed.
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Affiliation(s)
- R H Mak
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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28
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Trofimov A, Yock AD, Choi NC. WE-C-BRC-10: The Utility of Surrogates of the Distribution of Pulmonary Function in Individualizing Thoracic Radiotherapy. Med Phys 2009. [DOI: 10.1118/1.3182478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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29
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Ha EO, Park KJ, Kim S, Kang H, Kang K, Choi NC, Kwon OY, Lim BH. PF1.4 Usefulness of Autonomic Function Tests for Evaluation of Neurocardiogenic Syncope. Clin Neurophysiol 2009. [DOI: 10.1016/s1388-2457(09)60063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Choi NC, Choi JW, Kim SB, Park SJ, Kim DJ. Two-dimensional modelling of benzene transport and biodegradation in a laboratory-scale aquifer. Environ Technol 2009; 30:53-62. [PMID: 19213466 DOI: 10.1080/09593330802503669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this study biodegradation of aqueous benzene during transport in a laboratory-scale aquifer model was investigated by conducting a 2-D plume test and numerical modelling. Benzene biodegradation and transport was simulated with the 2-D numerical model developed for solute transport coupled with a Haldane-Andrews type function for inclusion of an inhibition constant which is effective for high concentrations. Experimental data revealed that in the early stages the benzene plume showed a rather clear shape but lost its shape with increased travel time. The mass recoveries of benzene at 9, 16, and 22 h were 37, 13 and 8%, respectively, showing that a significant mass reduction of aqueous benzene occurred in the model aquifer. The major processes responsible for the mass reduction were biodegradation and irreversible sorption. The modelling results also indicated that the simulation based on the microbial parameters from the batch experiments slightly overestimated the mass reduction of benzene during transport. The sensitivity analysis demonstrated that the benzene plume was sensitive to the maximum specific growth rate and slightly sensitive to the half-saturation constant of benzene but almost insensitive to the Haldane inhibition constant. The insensitivity to the Haldane inhibition constant was due to the rapid decline of the benzene peak concentration by natural attenuation such as hydrodynamic dispersion and irreversible sorption. An analysis of the model simulation also indicated that the maximum specific growth rate was the key parameter controlling the plume behaviour, but its impact on the plume was affected by competing parameter such as the irreversible sorption rate coefficient.
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Affiliation(s)
- N C Choi
- Environmental Biocolloid Engineering Laboratory, Program in Rural System Engineering, Seoul National University, Seoul, Korea
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31
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Mori S, Wolfgang J, Lu H, Choi NC, Chen G. SU-EE-A1-03: Range Fluctuation Analysis Due To Respiratory Motion in Charged Particle Lung Therapy. Med Phys 2007. [DOI: 10.1118/1.2760366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
A 44-year-old woman developed a severe right frontotemporal headache, retro-orbital pain, and, later, diplopia owing to right sixth nerve palsy. The brain MRI demonstrated strong enhancement of the right cavernous sinus. The sixth nerve palsy and headache improved with steroid therapy after 6 weeks. At that time, she suffered right peripheral facial nerve palsy. Enhancement of the distal canalicular and labyrinthic segment of the right facial nerve was found on contrast-enhanced MRI. To our knowledge, this is a very rare case of Tolosa-Hunt syndrome with facial nerve palsy, with simultaneous enhancement of the cavernous sinus and facial nerve on contrast-enhanced MRI.
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Affiliation(s)
- Heeyoung Kang
- Department of Neurology, Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Chiram-dong, Jinju, Korea
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Kim JH, Lee SJ, Shin T, Kang KH, Choi PY, Kim JH, Gong JC, Choi NC, Lim BH. Correlative assessment of hemodynamic parameters obtained with T2*-weighted perfusion MR imaging and SPECT in symptomatic carotid artery occlusion. AJNR Am J Neuroradiol 2000; 21:1450-6. [PMID: 11003277 PMCID: PMC7974052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/1999] [Accepted: 02/17/2000] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE Perfusion MR imaging and single-photon emission CT (SPECT) are commonly used to evaluate hemodynamic status in patients with symptomatic occlusive cerebrovascular disease. These techniques rely on different underlying physiological mechanisms, and the data may not correspond. We studied the relationship between hemodynamic parameters obtained with these two methods. METHODS We performed perfusion MR imaging and SPECT in 10 patients with symptomatic unilateral internal carotid artery occlusion. Relative cerebral blood volume (rCBV) and uncorrected mean transit time (uMTT) were obtained with dynamic contrast-enhanced T2*-weighted MR imaging. Relative cerebral blood flow (rCBF) and vascular reserve capacity were measured with 99mTc-HMPAO SPECT; vascular reserve capacity was calculated by the difference in CBF before and after acetazolamide challenge. Ratios of these hemodynamic parameters between the affected and contralateral vascular territories were calculated and compared. RESULTS Normal-to-increased CBV, prolonged uMTT, decreased CBF, and normal-to-diminished vascular reserve capacity were observed in the affected vascular territories. Reduction of vascular reserve capacity corresponded well with uMTT but not with CBF and CBV. CBF, CBV, and uMTT did not correspond to one another. CONCLUSION uMTT is more sensitive than the other parameters in estimating vascular reserve capacity. The relationship between parameters obtained with perfusion MR imaging and SPECT should be considered in assessing the hemodynamic status of patients with symptomatic occlusive cerebrovascular disease.
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Affiliation(s)
- J H Kim
- Gyeongsang Institute for Neuroscience, Gyeongsang National University Hospital, Chinju, South Korea
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Lee KH, Cho SJ, Byun HS, Na DG, Choi NC, Lee SJ, Jin IS, Lee TG, Chung CS. Triphasic perfusion computed tomography in acute middle cerebral artery stroke: a correlation with angiographic findings. Arch Neurol 2000; 57:990-9. [PMID: 10891981 DOI: 10.1001/archneur.57.7.990] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the usefulness of triphasic perfusion computed tomography (TPCT) in diagnosing middle cerebral artery (MCA) occlusion and in assessing the perfusion deficit and collateral circulation in patients with acute ischemic stroke. BACKGROUND Conventional angiography is the criterion standard for the diagnosis of MCA occlusion and for the assessment of perfusion deficit and collateral blood supply. The risk of hemorrhagic transformation after recanalization of occluded arteries by thrombolytic therapy is considered high when pretherapeutic residual flow is markedly reduced. PATIENTS AND METHODS In 8 patients within 3 hours of onset of acute MCA stroke, precontrast computed tomographic scans were taken, and then TPCT was performed after power-injector controlled intravenous administration of contrast media. Sequential images of early, middle, and late phases were obtained. The whole procedure took 5 minutes. Perfusion deficit on TPCT was graded as "severe" or "moderate," depending on the state of collateral flow. Digital subtraction angiography (DSA) was performed in all patients within 6 hours of acute stroke. Direct intra-arterial urokinase infusion was begun immediately after the angiographic superselection of the MCA occlusion site in 6 of the 8 patients within 7 hours of onset (range, 4.3-6.2 hours). RESULTS The DSA findings showed occlusion of the MCA stem (n = 1) and at the bifurcation (n = 4). The sites of proximal MCA occlusion could be identified on the early and middle images of TPCT in all 5 patients. On DSA findings, all 8 patients had a zone of perfusion deficit with markedly slow leptomeningeal collaterals and a zone of perfusion deficit with no collaterals. The zone of severe perfusion deficit on TPCT corresponded to the zone of perfusion deficit with no or few collaterals on angiography, and the zone of moderate perfusion deficit on TPCT corresponded to that of perfusion deficit with markedly slow leptomeningeal collaterals. Early parenchymal hypoattenuation on precontrast computed tomography was confined to the zone of severe perfusion deficit on TPCT. The initial National Institutes of Health Stroke Scale score correlated better with the total extent of severe perfusion deficit and moderate perfusion deficit on TPCT than that of severe perfusion deficit alone. After direct intra-arterial thrombolysis within 7 hours of onset, symptomatic hemorrhagic transformation did not develop in 4 patients with small severe perfusion deficit (33% or less of the presumed MCA territory). However, the remaining 2 patients with large severe perfusion deficit (more than 50% of the presumed MCA territory) deteriorated to death with hemorrhagic transformation. CONCLUSIONS Triphasic perfusion computed tomography is useful for diagnosing proximal MCA occlusion and assessing perfusion deficit and collateral circulation as reliably as DSA. The zone of severe perfusion deficit on TPCT may be presumed to be the ischemic core, and that of moderate perfusion deficit, the penumbra zone. Triphasic perfusion computed tomography may be used as a rapid and noninvasive tool to make thrombolysis safer.
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Affiliation(s)
- K H Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea.
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35
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Komaki R, Sause WT, Byhardt RW, Curran WJ, Fuller D, Graham MV, Ko B, Weisenburger TH, Kaiser LR, Leibel SA, Choi NC. Non-small cell lung cancer, nonsurgical, aggressive therapy. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1319-30. [PMID: 11037549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- R Komaki
- MD Anderson Cancer Center, Houston, Tex., USA
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36
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Byhardt RW, Sause WT, Curran WJ, Fuller D, Graham MV, Ko B, Komaki R, Weisenburger TH, Kaiser LR, Leibel SA, Choi NC. Neoadjuvant therapy for marginally resectable (clinical N2), non-small cell lung cancer. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1331-45. [PMID: 11037550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- R W Byhardt
- Medical College of Wisconsin, Milwaukee, USA
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37
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Myojin M, Choi NC, Wright CD, Wain JC, Harris N, Hug EB, Mathisen DJ, Lynch T, Carey RW, Grossbard M, Finkelstein DM, Grillo HC. Stage III thymoma: pattern of failure after surgery and postoperative radiotherapy and its implication for future study. Int J Radiat Oncol Biol Phys 2000; 46:927-33. [PMID: 10705015 DOI: 10.1016/s0360-3016(99)00514-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE With the conventional approach of surgery and postoperative radiotherapy for patients with Masaoka Stage III thymoma, progress has been slow for an improvement in the long-term survival rate over the past 20 years. The objective of this study was to evaluate the pattern of failure and survival after surgery and postoperative radiotherapy in Stage III thymoma and search for a new direction for better therapy outcome. METHODS AND MATERIALS Between 1975 and 1993, 111 patients with thymoma were treated at Massachusetts General Hospital. Of these, 32 patients were determined to have Masaoka Stage III thymoma. The initial treatment included surgery for clinically resectable disease in 25 patients and preoperative therapy for unresectable disease in 7 patients. Surgical procedure consisted of thymectomy plus resection of involved tissues. For postoperative radiotherapy (n = 23), radiation dose consisted of 45-50 Gy for close resection margins, 54 Gy for microscopically positive resection margins, and 60 Gy for grossly positive margins administered in 1.8 to 2.0 Gy of daily dose fractions, 5 fractions a week, over a period of 5 to 6.6 weeks. In preoperative radiotherapy, a dose of 40 Gy was administered in 2.0 Gy of daily dose fractions, 5 days a week. For patients with large tumor requiring more than 30% of total lung volume included in the target volume (n = 3), a preoperative radiation dose of 30 Gy was administered and an additional dose of 24-30 Gy was given to the tumor bed region after surgery for positive resection margins. RESULTS Patients with Stage III thymoma accounted for 29% (32/111 patients) of all patients. The median age was 57 years with a range from 27 to 81 years; gender ratio was 10:22 for male to female. The median follow-up time was 6 years. Histologic subtypes included well-differentiated thymic carcinoma in 19 (59%), high-grade carcinoma in 6 (19%), organoid thymoma in 4 (13%), and cortical thymoma in 3 (9%) according to the Marino and Müller-Hermelink classification. The overall survival rates were 71% and 54% at 5 and 10 years, respectively. Ten of the 25 patients who were subjected to surgery as initial treatment were found to have incomplete resection by histopathologic evaluation. The 5- and 10-year survival rates were 86% and 69% for patients (n = 15) with clear resection margins as compared with 28% and 14% for those (n = 10) with incomplete resection margins even after postoperative therapy, p = 0.002. Survival rates at 5 and 10 years were 100% and 67% for those with unresectable disease treated with preoperative radiation (n = 6) and subsequent surgery (n = 3). Recurrence was noted in 12 of 32 patients and 11 of these died of recurrent thymoma. Recurrences at pleura and tumor bed accounted for 77% of all relapses, and all pleural recurrences were observed among the patients who were treated with surgery initially. CONCLUSION Incomplete resection leads to poor results even with postoperative radiotherapy or chemoradiotherapy in Stage III thymoma. Pleural recurrence is also observed more often among patients treated with surgery first. These findings suggest that preoperative radiotherapy or chemoradiotherapy may result in an increase in survival by improving the rate of complete resection and reducing local and pleural recurrences.
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Affiliation(s)
- M Myojin
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Abstract
OBJECTIVES Our goal was to assess patient survival and response to treatment for superior sulcus tumors treated with combined radiation therapy and surgery when possible, or with radiation alone when surgery was not possible. METHODS Seventy-three patients were treated for primary non-small cell carcinoma of the superior pulmonary sulcus. Thirty-four patients received combined resection and irradiation. Thirty-nine patients who had extensive primary disease, distant metastases, or who were medically unfit for surgery were treated with radiation alone. Thirty-one patients (91%) assigned to the resection/irradiation group completed treatment. Combined therapy patients routinely received 40 Gy before the operation, with additional postoperative irradiation based on the surgical findings. RESULTS Overall survival at 5 years was 19% and disease-specific survival was 20% for all patients. Overall survival and disease-specific survival at 5 years for the resection/irradiation group were 33% and 38%, respectively. Significant indicators of poor prognosis included unresected primary disease, low performance score, T4 stage, or positive node status. Eighty-two percent of the patients who received irradiation alone were treated with palliative intent. Freedom from local-regional progression, achieved initially in 66% of these patients, was associated with a median survival of 8 months. Median survival for 7 patients considered for definitive irradiation was 25 months. During the first 18 months, distant failures occurred in approximately 35% of patients in each treatment group. CONCLUSIONS Selection of medically fit patients with resectable disease for combined surgery and aggressive radiation therapy resulted in a high likelihood of local control. Overall survival for the resection/irradiation group was significantly poorer for patients with T4 stage, nodal disease, or Horner's syndrome. Distant metastases eventually developed in 56% of patients undergoing resection. Median survival in the resection/irradiation group was significantly prolonged for those patients who could tolerate high-dose radiation treatment.
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Affiliation(s)
- M P Hagan
- Departments of Radiation Oncology and Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Kim JH, Shin T, Park JH, Chung SH, Choi NC, Lim BH. Various patterns of perfusion-weighted MR imaging and MR angiographic findings in hyperacute ischemic stroke. AJNR Am J Neuroradiol 1999; 20:613-20. [PMID: 10319971 PMCID: PMC7056024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE Various clinical subtypes of patients presenting with sudden-onset ischemic stroke have been recognized, but classification of those types is not simple. We identified various patterns of perfusion-weighted MR imaging and MR angiographic findings in hyperacute ischemic stroke with relation to clinical outcomes. METHODS Twelve patients with symptoms of acute ischemic stroke due to middle cerebral artery occlusion underwent perfusion-weighted MR imaging and MR angiography within 6 hours after the onset of symptoms. Perfusion-weighted imaging was performed with a conventional dynamic contrast-enhanced T2*-weighted sequence, and cerebral blood volume (CBV) maps were then created. CBV maps and MR angiographic findings were compared with 99mTc-HMPAO brain SPECT scans, short-term outcomes, and follow-up imaging findings. RESULTS The combined CBV and MR angiographic findings were classified into three patterns: arterial occlusion and decreased CBV (n = 8), arterial occlusion and increased CBV (n = 2), and no arterial occlusion and normal CBV (n = 2). These three patterns were strongly related to SPECT findings, short-term outcomes, and follow-up imaging findings. Perfusion on SPECT decreased markedly in the affected regions in all patients with the first pattern, decreased slightly in the second pattern, and was normal in the third pattern. Symptoms were not significantly changed at 24 hours after onset in any of the patients with the first pattern, but resolved completely in all patients with the latter two patterns. Follow-up imaging showed large infarctions in all patients with the first pattern. Initially, no infarction was seen in the second pattern, but watershed infarction developed later in one of these patients. CONCLUSION Hyperacute ischemic stroke may be differentiated into three imaging patterns with different clinical outcomes. The combined use of perfusion-weighted MR imaging and MR angiography may play a substantial role in guiding the choice of treatment of this disease.
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Affiliation(s)
- J H Kim
- Gyeongsang Institute for Neuroscience, Gyeongsang National University, Department of Radiology, and Gyeongsang National University Hospital, Chinju, South Korea
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Choi NC, Herndon JE, Rosenman J, Carey RW, Chung CT, Bernard S, Leone L, Seagren S, Green M. Phase I study to determine the maximum-tolerated dose of radiation in standard daily and hyperfractionated-accelerated twice-daily radiation schedules with concurrent chemotherapy for limited-stage small-cell lung cancer. J Clin Oncol 1998; 16:3528-36. [PMID: 9817271 DOI: 10.1200/jco.1998.16.11.3528] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE An improvement in radiation dose schedule is necessary to increase local tumor control and survival in limited-stage small-cell lung cancer. The goal of this study was to determine the maximum-tolerated dose (MTD) of radiation (RT) in both standard daily and hyperfractionated-accelerated (HA) twice-daily RT schedules in concurrent chemoradiation. METHODS The study design consisted of a sequential dose escalation in both daily and HA twice-daily RT regimens. RT dose to the initial volume was kept at 40 to 40.5 Gy, while it was gradually increased to the boost volume by adding a 7% to 11 % increment of total dose to subsequent cohorts. The MTD was defined as the radiation dose level at one cohort below that which resulted in more than 33% of patients experiencing grade > or = 4 acute esophagitis and/or grade > or = 3 pulmonary toxicity. The study plan included nine cohorts, five on HA twice-daily and four on daily regimens for the dose escalation. Chemotherapy consisted of three cycles of cisplatin 33 mg/m2/d on days 1 to 3 over 30 minutes, cyclophosphamide 500 mg/m2 on day 1 intravenously (IV) over 1 hour, and etoposide 80 mg/m2/d on days 1 to 3 over 1 hour every 3 weeks (PCE) and two cycles of PE. RT was started at the initiation of the fourth cycle of chemotherapy. RESULTS Fifty patients were enrolled onto the study. The median age was 60 years (range, 38-79), sex ratio 2.3:1 for male to female, weight loss less than 5% in 73%, and performance score 0 to 1 in 94% and 2 in 6% of patients. In HA twice-daily RT, grade > or = 4 acute esophagitis was noted in two of five (40%), two of seven (29%), four of six (67%), and five of six patients (86%) at 50 (1.25 Gy twice daily), 45, 50, and 55.5 Gy in 1.5 Gy twice daily, 5 d/wk, respectively. Grade > or = 3 pulmonary toxicity was not seen in any of these 24 patients. Therefore, the MTD for HA twice-daily RT was judged to be 45 Gy in 30 fractions over 3 weeks. In daily RT, grade > or = 4 acute esophagitis was noted in zero of four, zero of four, one of five (20%), and two of six patients (33%) at 56, 60, 66, and 70 Gy on a schedule of 2 Gy per fraction per day, five fractions per week. Grade > or = 3 pneumonitis was not observed in any of the 19 patients. Thus, the MTD for daily RT was judged to be at least 70 Gy in 35 fractions over 7 weeks. Grade 4 granulocytopenia and thrombocytopenia were observed in 53% and 6% of patients, respectively, during the first three cycles of PCE. During chemotherapy cycles 4 to 5, grade 4 granulocytopenia and thrombocytopenia were noted in 43% and 29% of patients at 45 Gy in 30 fractions over 3 weeks (MTD) by HA twice-daily RT and 50% and 17% at 70 Gy in 35 fractions over 7 weeks (MTD) by daily RT, respectively. The overall tumor response consisted of complete remission (CR) in 51% (24 of 47), partial remission (PR) in 38% (1 8 of 47), and stable disease in 2% (one of 47). The median survival time of all patients was 24.4 months and 2- and 3-year survival rates were 53% and 28%, respectively. With regard to the different radiation schedules, 2- and 3-year survival rates were 52% and 25% for the HA twice-daily and 54% and 35% for the daily RT cohorts. CONCLUSION The MTD of HA twice-daily RT was determined to be 45 Gy in 30 fractions over 3 weeks, while it was judged to be at least 70 Gy in 35 fractions over 7 weeks for daily RT. A phase III randomized trial to compare standard daily RT with HA twice-daily RT at their MTD for local tumor control and survival would be a sensible research in searching for a more effective RT dose-schedule than those that are being used currently.
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Affiliation(s)
- N C Choi
- Department of Radiation Oncology, Massachusetts General Hospital, Boston 02114, USA.
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Kim JH, Shin T, Chung JD, Kwon OY, Choi NC, Chung SH, Lim BH. Temporal pattern of blood volume change in cerebral infarction: evaluation with dynamic contrast-enhanced T2*-weighted MR imaging. AJR Am J Roentgenol 1998; 170:765-70. [PMID: 9490971 DOI: 10.2214/ajr.170.3.9490971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purposes of this study were to evaluate the temporal pattern of blood volume change in cerebral infarction and to provide a guideline in the interpretation of blood volume data, which are known to vary according to the stage of infarction. SUBJECTS AND METHODS Thirty-three patients with large middle cerebral infarctions were examined one to three times (one time in 20 patients, two times in eight patients, and three times in five patients) after the onset of stroke by dynamic contrast-enhanced T2*-weighted MR imaging and MR angiography. A total of 54 infarctions (29 in an acute stage [up to 7 days], 15 in a subacute stage [8-21 days], and 10 in a chronic stage [22-35 days]) were included. After blood volume maps were created, blood volume ratios (blood volume of the infarcted region divided by blood volume of corresponding contralateral region) were compared at different stages. Likewise, findings on MR angiography were compared at different stages. RESULTS Mean blood volume ratios in each stage of infarction were 0.46 in the acute stage, 1.48 in the subacute stage, and 0.73 in the chronic stage (p < .001). Recanalization of occluded arteries occurred in 21% of infarctions in the acute stage and 80% in the subacute stage. Infarctions with recanalization had higher blood volume ratios than did those without recanalization (p < .001). A biphasic pattern of blood volume ratios was found in 13 patients who underwent at least two MR examinations: increased blood volume in the subacute stage and decreased blood volume in the chronic stage, regardless of recanalization (p < .01). CONCLUSION Blood volume that initially decreases in cerebral infarction increases in the subacute stage, reflecting reperfusion hyperemia. Blood volume decreases again in the chronic stage. The time interval between onset of stroke and MR examination must be considered for correct interpretation of blood volume data in cerebral infarction at various stages.
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Affiliation(s)
- J H Kim
- Gyeongsang Institute for Neuroscience, Gyeonsang National University, Chinju, South Korea
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Wright CD, Wain JC, Lynch TJ, Choi NC, Grossbard ML, Carey RW, Moncure AC, Grillo HC, Mathisen DJ. Induction therapy for esophageal cancer with paclitaxel and hyperfractionated radiotherapy: a phase I and II study. J Thorac Cardiovasc Surg 1997; 114:811-5; discussion 816. [PMID: 9375611 DOI: 10.1016/s0022-5223(97)70085-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Induction chemoradiotherapy followed by surgery may improve survival rates among patients with esophageal carcinoma. We designed a novel intense induction regimen with paclitaxel and high-dose hyperfractionated radiotherapy to maximize complete response rates. METHODS Forty patients with esophageal cancer were treated in a phase I and II trial of induction chemotherapy (cisplatin, 5-fluorouracil, and paclitaxel) at three dosage levels (75, 125, and 100 mg/m2) and concurrent hyperfractionated radiotherapy (45 Gy to the mediastinum, 58.5 Gy to the tumor). The mean age was 62 years, and 32 patients (80%) had adenocarcinoma. Twenty-eight of 40 (70%) patients had locally advanced tumors (T3, or stage IIB or greater). RESULTS The average hospitalization for induction treatment was 17 days. Toxicity was substantial, with esophagitis necessitating nutritional support the most common complication. The maximum tolerated dose of paclitaxel was 100 mg/m2. Two patients died during induction treatment. Thirty-six patients (90%) underwent resection. The median length of stay was 10 days, and two patients died after the operation. Fourteen of 36 patients (39%) had a pathologic complete response. Patients who received all prescribed chemotherapy had a higher pathologic complete response rate (50%) than did patients who required dose reduction (17%; p = 0.076). The 2-year survival rate was 61% (95% CI 35% to 86%) with a median follow-up of 11.9 months. CONCLUSIONS Paclitaxel at a dose of 100 mg/m2 appears to have acceptable toxicity. The high pathologic complete response rate in this regimen is encouraging, but it is associated with substantial toxicity. The toxicity of this regimen is not acceptable and will require substantial reduction in the radiation component. Survival data are too short-term to confirm enhanced survival.
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Affiliation(s)
- C D Wright
- Section of Thoracic Surgery, Massachusetts General Hospital, Boston 02114, USA
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Choi NC, Lim BH, Lee KH, Chung CS, Lee SJ. 2-07-17 The value of three-phase spiral CT in acute middle cerebral artery territory ischemic stroke. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lee SJ, Lee KH, Choi NC, Chung CS, Kim YB, Byun HS. 1-07-21 Hemorrhagic transformation in intra-arterial thrombolysis for acute ischemic stroke on the basis of initial CT scan signs. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)84878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perry MC, Deslauriers J, Albain KS, Choi NC, Depierre A, Johnston MR, Lacquet LK, Payne DG, Putnam JB, Sculier JP, Shepherd FA. Induction treatment for resectable non-small-cell lung cancer. Lung Cancer 1997; 17 Suppl 1:S15-8. [PMID: 9213297 DOI: 10.1016/s0169-5002(97)00038-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M C Perry
- University of Missouri Ellis Fischel, Columbia, USA
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Choi NC, Carey RW, Daly W, Mathisen D, Wain J, Wright C, Lynch T, Grossbard M, Grillo H. Potential impact on survival of improved tumor downstaging and resection rate by preoperative twice-daily radiation and concurrent chemotherapy in stage IIIA non-small-cell lung cancer. J Clin Oncol 1997; 15:712-22. [PMID: 9053497 DOI: 10.1200/jco.1997.15.2.712] [Citation(s) in RCA: 217] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The main objectives of this study were (a) to ascertain the feasibility and toxicity of preoperative twice-daily radiation therapy and concurrent chemotherapy, surgery, and postoperative therapy in stage IIIA (N2) non-small-cell lung cancer (NSCLC), and (b) to evaluate tumor response, resection rate, pathologic tumor downstaging, and survival. METHODS Eligibility included biopsy-proven N2 lesion (stage IIIA) by mediastinoscopy, Karnofsky performance score > or = 70, and weight loss less than 5% in the 3 months before diagnosis. The treatment program consisted of two courses of preoperative cisplatin, vinblastine, and fluorouracil (5-FU); 42 Gy concurrent radiation at 1.5 Gy per fraction in two fractions per day; surgery on day 57; and one more course of postoperative chemotherapy and 12 to 18 Gy of concurrent twice-daily radiation. RESULTS Forty-two patients with stage IIIA (N2) NSCLC (27 men and 15 women, age 38 to 77 years) were enrolled onto this prospective study. Forty of 42 patients tolerated the intended dose (42 Gy) of preoperative radiation and 37 of 39 resected patients received prescribed postoperative radiation. The intended dose of chemotherapy was given in 100%, 70%, and 60% of patients for the first, second, and third courses of chemotherapy. Marked dysphagia that required intravenous hydration was noted in 14% of patients (six of 42). Myelotoxicities included grade > or = 3 granulocytopenia in 23% and thrombocytopenia in 6% of 113 chemotherapy courses. Febrile neutropenia that required hospital admission was noted in 9% of 113 chemotherapy courses. Surgical resection was performed in 93% of patients. Treatment-related mortality was noted in 7% of patients. The overall survival rates by the Kaplan-Meier method were 66%, 37%, and 37% at 2,3, and 5 years, respectively, with a median follow-up time of 48 months. Pathologic examination of the surgical specimen showed a downward shift in tumor extent from stage IIIA (N2) to stage II (N1) in 33%, to stage I (NO) in 24% (10 of 42), and to stage 0 (TONO) in 9.5%, for a total of 67%. The degree of tumor downstaging was also translated into a survival benefit: 5-year survival rates from the time of surgery were 79%, 42%, and 18% for postoperative tumor stages 0 and I, II, and III, respectively (P = .04). CONCLUSION Concurrent chemoradiotherapy using twice-daily radiation is an effective induction regimen that resulted in 67% tumor downstaging, and an encouraging 37% 5-year survival rate. The degree of tumor downstaging may be a useful intermediate end point for survival benefit in stage IIIA (N2) NSCLC.
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Affiliation(s)
- N C Choi
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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Hunter GJ, Hamberg LM, Alpert NM, Choi NC, Fischman AJ. Simplified measurement of deoxyglucose utilization rate. J Nucl Med 1996; 37:950-5. [PMID: 8683318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED The reliability of the dose uptake ratio (DUR), a widely used index of 18F-fluoro-2-deoxy-D-glucose (18FDG) metabolism in a variety of tumors, depends on the overall rate of removal of 18FDG from the circulation. Correcting for this factor is important if DUR is to be used quantitatively for pre- and post-treatment assessments of tumors. METHODS We developed a simplified kinetic method (SKM), based on measured blood curves from a control group, which requires one venous blood sample. We compared the simplified method to the conventional kinetic method and the widely used DUR index in 13 patients with grade 3 or 4 non-small-cell lung carcinoma. Studies were obtained before and after treatment. In all patients, dynamic PET imaging and blood activity measurement was performed for 80 min. The utilization rate of 18FDG (MRDGlc) was calculated by using a three-compartment model and correlated with a 55-min measurement of DUR and with the simplified kinetic method. RESULTS Coefficients of determination (R2) between MRDGlc and DUR before and after treatment were 0.53 and 0.71, respectively. Using the SKM, these values improved significantly (p < 0.0001) to 0.96 and 0.94, respectively. The pooled pre- and post-treatment coefficient of determination for DUR versus MRDGlc was 0.81; for SKM, it improved significantly (p < 0.001) to 0.98. CONCLUSION These results indicate that the observed tumor tissue uptake of 18FDG, corrected for blood 18FDG activity and glucose concentration, can reliably predict glucose metabolic rate from a single static image acquired at between 45 min and 1 hr after injection. This has substantial implications for the quantitative use of 18FDG PET to diagnose and manage malignancy.
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Affiliation(s)
- G J Hunter
- Department of Radiology, Massachusetts General Hospital, Boston 02114, USA
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Wright CD, Mathisen DJ, Wain JC, Grillo HC, Hilgenberg AD, Moncure AC, Carey RW, Choi NC, Daly M, Logan DL. Evolution of treatment strategies for adenocarcinoma of the esophagus and gastroesophageal junction. Ann Thorac Surg 1994; 58:1574-8; discussion 1578-9. [PMID: 7979718 DOI: 10.1016/0003-4975(94)91635-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between 1980 and 1988, 91 patients with adenocarcinoma of the esophagus were treated by surgical resection and selective postoperative therapy. Operative mortality was 2%. Pathologic stage was I in 4, II in 26, and III in 61. Actuarial 2- and 5-year survival was 24% and 8%. From 1987 to 1989, 16 patients with adenocarcinoma of the esophagus were treated with two cycles of 5-fluorouracil and cisplatin followed by surgical resection. There was 1 complete response (6%), 5 partial responses (31%), and 10 with no response (63%). Twelve patients had resection. Pathologic stage was I in 1, II in 4, and III in 8. There was one chemotherapy-related death and one surgical death. Actuarial 4-year survival is 42%. From 1990 to 1993, 22 patients with adenocarcinoma of the esophagus were treated with two cycles of etoposide, doxorubicin, and cisplatin followed by surgical resection. There was 1 complete response (5%), 11 partial responses (50%), and 10 with no response (45%). Eighteen patients had resection. Pathologic stage was 0 in 1, II in 8, and III in 9. There were no treatment-related deaths. The actuarial 2-year survival is 58%. Conclusions are necessarily limited because the patients were not treated in a randomized fashion. These preliminary results with preoperative chemotherapy appear improved (p = 0.04 and p = 0.004, respectively) as compared with results from 1980 to 1988 without preoperative chemotherapy.
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Affiliation(s)
- C D Wright
- General Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114
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Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl Med 1994; 35:1308-12. [PMID: 8046485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
UNLABELLED The dose uptake ratio (DUR) has been used as a quantitative index of glucose metabolism for tumor classification and monitoring response to treatment. In order to provide consistent results, DUR measurements should be made when the concentration of tracer has reached a plateau. The time of this plateau cannot be identified from a single static acquisition. METHODS In this study, we investigated the changes in DUR as a function of time in eight patients with stage III lung cancer. All patients underwent a quantitative dynamic 18F-FDG PET study before and after treatment and the data were analyzed with a three-compartment model. Using the fitted model parameters, the DUR was predicted at the plateau and intermediate times. RESULTS Tumor concentrations of 18F-FDG did not reach a plateau within the 90 min of imaging in any of the pre-treatment studies and only in one case post-treatment. The average time to reach 95% of the plateau value pre-treatment was 298 +/- 42 min (range: 130-500 min); in post-treatment, it was 154 +/- 31 min (range: 65-240 min). The difference between the plateau DUR and the 60-min value was 46% +/- 6% pre-treatment and 17% +/- 5% post-treatment. CONCLUSIONS These data indicate that DUR can vary widely with the time of measurement and that DUR should be interpreted with caution in any individual patient.
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Affiliation(s)
- L M Hamberg
- Department of Radiology, Massachusetts General Hospital, Charlestown 02129
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Abstract
Physiological changes in pulmonary function (PF) as a result of radiation therapy (RT) or radiation therapy plus chemotherapy (RT + CT) for unresectable lung cancer were evaluated in an ongoing prospective study and an attempt was also made to define a guideline which can be used to minimize adverse effect of RT on pulmonary function before RT is given. The study design consisted of: (a) standard overall pulmonary function test (PFT); (b) regional PFT, i.e. a quantitative analysis of regional distribution of ventilation, perfusion and volume using 13N and a positron camera before RT; and (c) follow-up studies of standard PFT every 6 months for 3 years after RT or RT + CT. Predicted post-RT PF prior to RT was calculated by a formula: predicted FEV1 after RT = FEV1 before RT x (1 - an average of the percent of ventilation and perfusion contributed by lung tissue within the RT treatment volume). A total of 267 patients with unresectable, but still potentially curable lung cancer by RT were entered into this study, and 135 patients who were free of recurrence underwent repeat studies. Loss of PF as a result of RT is closely related to the degree of PF reserve prior to RT. Patients with FEV1 > 50% of the predicted showed a statistically significant decrease in FEV1, FVC, MBC, peak expiratory flow rate and DLCO, i.e. a 22% loss of the initial value. Airway resistance was increased by 31%. Two-thirds of this group of patients showed a decrease in PF as predicted by the above formula. For patients with limited PF reserve defined by FEV1 < 50% of the predicted, the pattern of PF loss after RT was quite different. An improvement in PF although it was < or = 10%, contrary to the prediction, was noted in 50% of patients, and another 37% of patients showed a small decrease in PF (< or = 10% of the initial value). Only 13% of patients showed a loss of pulmonary function as predicted by regional PF data. Patients with a significant shift (> 10%) of ventilation and/or perfusion to the uninvolved side of the lung by centrally located primary tumor or involved lymph nodes showed an increase in PF in 60% of patients after RT, and another 20% of patients showed a minor decrease in PF (< 10% of the initial value). Only 20% of these patients showed a decrease in pulmonary function as predicted by regional PF data. Guidelines for minimizing adverse effect of RT on PF, which are based on the initial PF reserve and regional PF data, are presented.
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Affiliation(s)
- N C Choi
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Centre, Boston 02114
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