ABSTRACT
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against factor VIII (FVIII). Treatment with clopidogrel is a cause of AHA, but its clinical course is unknown. Recently, we treated a 65-year-old man who was hospitalized for cerebellar infarction and had a prolonged activated partial thromboplastin time (aPTT) with soft tissue oozing after 3 weeks of clopidogrel use. We terminated clopidogrel administration and transfused the patient with fresh frozen plasma. However, the aPTT increased up to 98.8 seconds, and the FVIII and FVIII inhibitor levels were <1% and 5.4 Bethesda units/mL, respectively. Clopidogrel-associated AHA was considered, and we began steroid treatment. Two months later, FVIII, FVIII inhibitor, and aPTT values were normalized. No further bleeding or aPTT prolongation has been reported during the 2-year follow-up period. AHA should be considered in patients taking clopidogrel and experiencing bleeding, unless the platelet count and coagulation screen are normal.
Subject(s)
Aged , Humans , Autoantibodies , Factor VIII , Follow-Up Studies , Hemophilia A , Hemorrhage , Infarction , Partial Thromboplastin Time , Plasma , Platelet Count , TiclopidineABSTRACT
BACKGROUND/AIMS: This study evaluated the use and efficacy of chronic oral etoposide plus tamoxifen as a palliative treatment in 30 patients with far-advanced HCC in whom surgical resection, percutaneous ethanol injection or transarterial chemoembolization(TACE) was not possible. METHODS: To be eligible for the study, patients had to have objectively measurable or evaluable tumors, adequate hematologic profiles and hepatorenal functions, had to be between 20 and 75 years of age, and had to have an ECOG performance status of less than or equal to 2. The treatment included etoposide, 50 mg/m2/day, taken orally for 21 days, and tamoxifen, 40 mg/day, taken orally for 21 days. Each cycle was repeated every 5 weeks. RESULTS: Two patients(7%) achieved a partial response(PR) and 16 patients(53%) achieved a stable disease(SD) with a median time-to-progression of 5 months(range: 2-24). Median of patients survival with the response of PR or SD and those patients with the response of progressive disease(PD) was 10 months and 7 months, respectively(p=0.0004). Of the 20 patients with initial elevated serum alpha-fetoprotein(> or =500 ng/ml), 9 patients(45%) experienced a significant(> or =50%) decrease in their values after chemotherapy and all 9 patients achieved objective tumor response of more than or equal to SD. Among the 30 patients in the study, 10 patients(33%) achieved performance status improvements of grade according to the ECOG criteria and 6 patients(20%) experienced improvements of subjective symptoms, such as abdominal pain, abdominal fullness and anorexia. CONCLUSION: Based on our results, the use of chronic oral etoposide plus tamoxifen as a palliative treatment for the far-advanced hepatocellular carcinoma are beneficial. A randomized two-arm study may be warranted to validate the results of this study.
Subject(s)
Humans , Abdominal Pain , Anorexia , Carcinoma, Hepatocellular , Drug Therapy , Ethanol , Etoposide , Palliative Care , TamoxifenABSTRACT
RS3PE is used to describe patients who have peripheral seronegative polyarthritis and pitting edema, especially in a man older than 60. It is characterized by sudden onset, high sedimentation rate, lack of bony erosion, remission within 18 months and good prognosis. Whether the RS3PE is a unique disease or syndrome has long been discussed, but conclusion was not obtained. We describe a 72 year old man of RS3PE with a review of the literature.
Subject(s)
Aged , Humans , Arthritis , Edema , Prognosis , SynovitisABSTRACT
PURPOSE: Osteosarcoma is one of the most common juvenile malignant tumors in Korea. Combined modality treatment [pre-operative chemotherapy + surgery (limb salvage or amputation) + adjuvant chemotherapy] had improved the overall survival and quality of life. To improve the local control rate, we introduced pre-operative chemotherapy combined with intra-arterial (IA) cisplatin and continuous intravenous infusion (CI) of adriamycin. We evaluated the efficacy and feasibility, such as limb salvage rate, recurrence pattern and the survival impact, based on the histologic response of pre-operative chemotherapy. MATERIALS AND METHODS: Fourty-one patients with histologically-proven high grade osteosarcoma of the extremities were enrolled from January 1990 to June 1996. Pre-operative chemotherapy, cisplatin 120 mg/m2 IA and adriamycin 75 mg/m2/72hrs CI, was administered for 3 cycles with 3 week interval, followed by surgery. Post-operative chemotherapy was applied by the tumor necrosis rate. If the tumor necrosis of the specimen was more than 90%, the same regimen af the preoperative one was administered for 3 cycles. A salvage regimen (Ifosfamide 7.5 gm/m2/5d IV + high dose MTX 10 gm/m2 IV VP-16 360 mg/m2/3d IV) was administered every 3 weeks for 6 cycles if the tumor necrosis was <90%. RESULTS: Of 41 patients, 37 were evaluable for efficacy and toxicities, because 4 refused further chemotherapy after 1 or 2 cycles. Twenty-one patients were male and 16 female, with the median age of 16 years (8-41). The tumor locations were as follows: distal femur 20, proximal tibia 8, humerus 6, distal tibia 2 and 1 in proximal femur. All but one patient, who died of neutropenic sepsis, completed the planned pre-operative therapy. Of the 36 patients who received surgery, limb salvage surgery was possible in 30 patients (83.3%) and 27 patients (75%) showed a good response (10 with grade III, 27.8%; 17 with grade IV, 47.2%). With a median follow-up of 23 months, 3-year disease-free survival rate was 54.7% and overall survival rate was 78.3%. Of the 15 patients who recurred, the major metastatic site was the lungs. No operation-related mortality was observed. Most patients experienced grade III-IV nausea, vomiting and hematologic toxicities, which were reversible with supportive care. CONCLUSION: Pre-operative chemotherapy combined with IA cisplatin and CI adriamycin induced higher good response rate without survival benefits. To improve the survival rate, the design of good salvage chemotherapy with a non-cross resistant regimen should be considered.
Subject(s)
Female , Humans , Male , Cisplatin , Disease-Free Survival , Doxorubicin , Drug Therapy , Etoposide , Extremities , Femur , Follow-Up Studies , Humerus , Infusions, Intravenous , Korea , Limb Salvage , Lung , Mortality , Nausea , Necrosis , Osteosarcoma , Quality of Life , Recurrence , Sepsis , Survival Rate , Tibia , VomitingABSTRACT
A 39-year-old woman developed a glioblastoma about 7 years and 10 months after local radiotherapy (4500 cGy) for pituitary adenoma. Clinical and histopathological details are presented, and previously reported cases of radiation-induced glioma are reviewed.
Subject(s)
Adult , Female , Humans , Glioblastoma , Glioma , Pituitary Neoplasms , RadiotherapyABSTRACT
PURPOSE: To evaluate survival rate and prognostic factors affecting survival of patients with esophageal cancer treated with concurrent chemoradiation. MATERIALS AND METHODS: Eligibility included biopsy proven invasive carcinoma of the cervical or thoracic esophagus, confined to esophagus and mediastinum with or without regional lymph node and supraclavicular lymph node, and ECOG performance status H0-H2. Patients received radiation therapy with 5940 cGy over 7 weeks and chemotherapy, consisted of 5-FU (1000 mg/m2/day in continuous infusion for 5 days, days 1 to 5 and days 29 to 33) and mitomycin C (8mg/m2 intravenous bolus at day 1). After concurrent chemoradiation, maintenance chemotherapy was followed with 5-FU (1000 mg/m2/day in continuous infusion for 5 days at 9th, 13th, and 17th weeks) and cisplatin (80mg/m2 intravenous bolus at the first day of each cycle). RESULTS: From November 1989 to November 1995, 44 patients were entered in this study. After treatment, complete response rate and partial response rate were 59% and 41%. Overall 1, 2, and 5-year survivals were 59%, 38%, and 9.6% (median 17 months). Prognostic factors affecting survival were response to treatment and T-stage. Among 26 complete responders, there were 6 local recurrences, 3 distant recurrences, 1 local and distant recurrence, and 2 unknown site recurrences. Acute and chronic complication rates with grade 3 or more were 20% and 13.6% and there was no treatment-related mortality. CONCLUSION: Concurrent chemoradiation, compared with historical control groups that treated with radiation alone, improved median survival and did not significantly increase treatment-related complications. Complete responders had longer survival duration than partial responders. Predominant failure pattern was local failure. So, efforts to improve local control should be proposed.
Subject(s)
Humans , Biopsy , Cisplatin , Drug Therapy , Esophageal Neoplasms , Esophagus , Fluorouracil , Lymph Nodes , Maintenance Chemotherapy , Mediastinum , Mitomycin , Mortality , Recurrence , Survival RateABSTRACT
The development of glomerular injury in patients with malignancy is considered as paraneoplastic syndrome. The most frequently observed renal lesions associated with malignancies are the membraneous glomerulonephritis on carcinomas and minimal change nephrotic syndrome on Hodgkin's disease. However, glomerular diseases on non-Hodgkin's lymphoma were only occasionally reported. Here we report a case of IgA nephropathy associated with non-Hodgkin's lymphoma. A 53-year-old woman who had complained of gross hematuria and fever was admitted to Wonju Christian Hospital. A urinalysis revealed 2+ proteinuria and red blood cells >30/HPF. A 24-hour urinary protein excretion was 379mg. She was diagnosed as IgA nephropathy on renal biopsy. Subsequently, biopsy of her enlarged neck node was performed for evaluation of fever of unknown origin and it revealed non-Hodgkin's lymphoma (Ki-1 positive anaplastic lymphoma null cell type). Combination chemotherapy was instituted with cyclophosphamide, adriamycin, vincristine and prednisone. After 3 cycles of chemotherapy, she showed no evidence of proteinuria and hematuria with clinical and radiological improvement of malignant lymphoma. Therefore we suggest of certain association between IgA nephropathy and non-Hodgkin's lymphoma by the observation of corresponding disease activity.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Cyclophosphamide , Doxorubicin , Drug Therapy , Drug Therapy, Combination , Erythrocytes , Fever , Fever of Unknown Origin , Glomerulonephritis , Glomerulonephritis, IGA , Hematuria , Hodgkin Disease , Immunoglobulin A , Lymphocytes, Null , Lymphoma , Lymphoma, Non-Hodgkin , Neck , Nephrosis, Lipoid , Paraneoplastic Syndromes , Prednisone , Proteinuria , Urinalysis , VincristineABSTRACT
OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.
Subject(s)
Humans , Adenoma , Gastrectomy , Hemorrhage , Ligation , Lymph Nodes , Mucous Membrane , Prospective Studies , SNARE Proteins , Stomach , Stomach NeoplasmsABSTRACT
No abstract available.
ABSTRACT
There is increasing evidence that genes involved in normal cell growth and differentiation (oncogenes) or genes that encode for growth factors are important in determining the development and biologic aggressiveness of gastric carcinoma. This study was undertaken to define the prognostic value of the overexpression of p53 protein, c-erbB-2 protein, EGFr protein and PCNA in gastric carcinomas. Using monoclonal antibodies, immunohistochemical studies were performed on formalin-fixed, paraffin-embedded tissue sections from 84 primary gastric carcinomas. Overall, 34% of gastric carcinomas had nuclear-staining for p53 protein, 34% of carcinomas membrane staining for the c-erbB-2 and 74% of carcinomas membrane and cytoplasmic staining for EGFr, showing distribution in a heterogeneous fashion. PCNA was expressed as Grade 2 and 3 in 75% of patients with gastric carcinomas. Both c-erbB-2 and p53 staining was significantly associated with high grade expression of PCNA. p53 staining tended to be associated with positive nodal status and metastasis, and c-erbB-2 staining with positive nodal status only. Multivariate analysis using the Cox model showed that overexpression of p53 protein, c-erbB-2 protein and PCNA was not an independent prognostic variable in gastric carcinoma. These results suggest that expressions of p53 and c-erbB-2 protein are heterogeneous and that p53 and c-erbB-2 overexpressions are significantly associated with high proliferative activity in gastric carcinoma.
Subject(s)
Humans , Antigens, Neoplasm/analysis , Immunohistochemistry , Multivariate Analysis , Neoplasm Proteins/analysis , Nuclear Proteins/analysis , Prognosis , Proliferating Cell Nuclear Antigen , Proto-Oncogene Proteins/analysis , ErbB Receptors/analysis , Receptor, ErbB-2 , Retrospective Studies , Stomach Neoplasms/chemistry , Survival Rate , Tumor Suppressor Protein p53/analysisABSTRACT
Blood-borne metastatic involvement of the stomach by cancer is a rare entity. According to the number of reports in the literature, the most common tumors that spread to the stomach through the blood stream are malignant melanoma, breast carcinoma and lung carcinoma. Recently, two cases of metastatic involvement of the stomach secondary to lung carcinoma were diagnosed by gastroscopy. The first patient was a 66-year-old man who had primary lung carcinoma with multiple bone and subcutaneous metastases. Gastroscopy showed multiple submucosal tumors with central umbilications in the fundus and in the upper body of the stomach. Pathologic examination revealed massive submucosal infiltration and conical shaped and scanty deep mucosal infiltration of undifferentiated small cell carcinoma suggestive of metastatic involvement. The second patient was a 68-year-old man who had primary lung carcinoma with brain metastasis. Gastroscopy showed a large fungating mass in the greater curvature side of the stomach. Pathologic examination revealed poorly differentiated squamous cell carcinoma. We report the two cases of metastatic gastric cancer from lung carcinoma with the literature review.