Correlation of the left ventricular diastolic function and the heart rate variability in patients with acute myocardial infarction / 대한내과학회지

BACKGROUND: Reduced heart rate varaibility (HRV) after acute myocardial infarction (AMI) is an important risk factor for mortality and life-threatening arrhythmias. The correlation between the left ventricular (LV) diastolic function and autonomic balance expressed by HRV in patients with AMI was evaluated in this study. METHODS: A 2-dimensional and Doppler echocardiography and a 24-hour Holter monitoring were performed at 5th to 7th day after attack in 50 patients with AMI. The restrictive filling pattern of the LV diastolic function was defined by E/A ratio >2 or deceleration time (DT) of the mitral inflow

Gemcitabine/Cisplatin Combination Chemotherapy in Advanced non-Small Cell lung Cancer / 결핵

BACKGROUND: To evaluate the efficacy and safety of gemcitabine and cisplatin chemotherapy in advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Forty patients (21 men, 19 women ; age range, 37 to 73 years; median, 63 years) with unresectable stage IIIB to IV NSCLC were evaluated. Patients received cisplatin 60mg/m2 (Day 1), gemcitabine 1200mg/m2 (Day 1 and 8) every 21 days. Eighteen patients had stage IIIB disease and 22 had stage IV. There were 28 patients of adenocarcinoma (70.0%), 11 of squamous cell carcinoma (27.5%), and one of large cell carcinoma (2.5%). RESULTS: Of 40 patients, no patients showed complete response while 15(37.5%) showed partial response, 7(17.5%) had stable diseases, 18(45%) had progressive diseases. During a total of 195 courses of chemotherapy, grade 3 or more granulocytopenia and thrombocytopenia occured in 12.5% and 2.5% of patients respectively. Non-hematologic toxicity was mild and easily controlled. There was one case of treatment-related death by pneumomia. The median survival was 55 weeks (95% CI, 34~75weeks), and the time to progression was 19 weeks (95% CI, 16~23weeks). One year survival rate was 55% and 2 year survival rate was 10%. CONCLUSION: The efficacy of cisplatin and gemcitabine combination chemotherapy was acceptable in the treatment of advanced NSCLC.

3 Cases of Thrombotic Microangiopathy Induced by Low Dose Mitomycin-C / 대한신장학회잡지

Mitomycin (MMC) is a naturally ocurring alkylating agent, introduced for clinical use as early as 1958. This drug is useful in the therapy of gastrointestinal carcinomas when used in combination with 5-fluorouracil. Nephrotoxicity among toxicities from MMC is unusual with cumulative doses less than 30 mg/m2. In large studies in which the incidence of MMC nephrotoxicity were assessed, 3-15% of patients developed total dose related renal dysfunction. Three patients in our clinical practice have developed thrombotic microangiopathy clearly related to MMC. We report the clinical and pathologic features of our cases. In view of the probable dose-related and delayed toxicity of MMC, it seems necessary to monitor regularly after initiation of chemotherapy. Early detection of the renal impairment and withdrawal of MMC might halt further progression of renal failure.

Use of small-bore catheter versus chest tube for talc slurry sclerotherapy in malignant pleural effusion / 대한내과학회지

BACKGROUN: Talc sclerotherapy is widely used for symptomatic malignant pleural effusion. The object of this study was to evaluate the outcome of talc slurry sclerotherapy, and to compare the efficacy of the small-bore catheter with that of chest tube in sclerotherapy of malignant pleural effusion. METHODS: From January 2000 to May 2002, 37 patients with malignant pleural effusion were enrolled and randomized to the chest tube (28F, n=17) or the small-bore catheter (14F, n=20) groups. The majority of patients had lung cancer (n=33, 89%) and two had breast cancer. The median age was 55 years. After verification of reexpansion of lung on chest radiogram. five grams of purified asbestos-free talc in 50 mL of normal saline were used for talc slurry sclerosis. The success of the procedure was defined as daily drainage below 50 mL within 1 week after talc slurry instillation. Side effects of the sclerotherapy and complications were compared by the drainage method and the recurrence rates in 3, 6 and 9 months were evaluated. RESULTS: Initial success rates of sclerotherapy by small-bore catheter was 80% and that of chest tube was 70.5% (p=0.07). The most common early complication after talc slurry instillation was pain followed by fever. But procedure related mortality or respiratory failure was not developed. The mean duration of drainage by small-bore catheter was 8.2days and that of chest tube was 8.8days (p=0.60). But the catheter-related complications of pain, subcutaneous infection and, emphysema were significantly less in the small-bore catheter group than the chest tube groups (15% vs 88%, 5% vs 23.5%, 0% vs 17.5% respectively) There was no statistically significant difference between the two groups in the recurrence rate at 3 months (37.5% for the small-bore catheter vs. 33.3% for the chest tube, p=0.45), 6 months (56.3% vs. 58.3%, p=0.75), and 9 months (87.5% vs. 83.3%, p=0.65). CONCLUSION: Talc slurry sclerotherapy via chest tube or small-bore catheter was a safe and effective method for the treatment of symptomatic malignant pleural effusion. But small-bore catheters are preferred to the chest tube in the sense of catheter-related complications.

Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer / 결핵

BACKGROUND: Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancers. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improve the survival rate by using the proper therapeutic methods. MATERIAL AND METHOD: The clinical data from 394 patients, who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. RESULT: There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 71 days, 211 days, and 419 days, respectively (p<0.001). The data emphasizes the importance of anticancer treatment for improving the survival time for patients. The group of concurrent chemoradiotherapy regimens (30 patients) showed a significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of the laboratory study were groups of leukocytes =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic sites. However, the median survival time of the patients with an ipsilateral pleural effusion was longer than the patients with other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). CONCLUSION: Disease stage and 5% body weight loss for the recent 3 months at the diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prolonged in recent years. It was suggested that the use of the EP (etoposide and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer / 결핵

BACKGROUND: Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancers. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improve the survival rate by using the proper therapeutic methods. MATERIAL AND METHOD: The clinical data from 394 patients, who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. RESULT: There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 71 days, 211 days, and 419 days, respectively (p<0.001). The data emphasizes the importance of anticancer treatment for improving the survival time for patients. The group of concurrent chemoradiotherapy regimens (30 patients) showed a significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of the laboratory study were groups of leukocytes =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic sites. However, the median survival time of the patients with an ipsilateral pleural effusion was longer than the patients with other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). CONCLUSION: Disease stage and 5% body weight loss for the recent 3 months at the diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prolonged in recent years. It was suggested that the use of the EP (etoposide and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

Expression of MAGE in the Induced Sputum of Lung Cancer Patients / 결핵

BACKGROUND: Tumor associated antigens, which are produced specifically by tumor cells, are promising targets for the early diagnosis and immunotherapy. Among the tumor associated antigens, MAGE (a melanoma antigen), BAGE, GAGE, PRAME and NY-ESO were named as cancer/testis specific antigens since they are detected exclusively in the testis or cancer cells. If MAGE is easily detectable in the sputum, it would become a convenient method for diagnosing lung cancer. This study was undertaken to investigate MAGE expression in the induced sputum obtained from lung cancer patients. METHOD: In 14 control patients and 30 lung cancer patients, the induced sputum was collected after inhaling 3% saline(5 cc) delivered by nebulizer for approximately 5 minutes after a mouth rinse and bronchodilator inhalation. The induced sputum was placed in a conservative-mixed solution (guanidinium isothiocyanate, Triton X-100). The total cellular mRNA was extracted from the cells and RT PCR and nested PCR were run in 30 and 35 cycles respectively, with two different types of primers specially designed to detect six subtypes of MAGE DNA simultaneously. RESULTS: MAGE expression was not detected in the 14 controls, but in the 30 cancer patients, MAGE was found in 24 patients (80%, p=0.001). In the cancer patients, there were no differences in the expression level according to the tissue types (squamous cell cancer 13/17, adenocarcinoma 7/9, and small cell cancer 4/4, p=0.56). Among the 24 MAGE-positive patients, the tumor was not visible on a bronchoscopy in 11 patients (45.8%). CONCLUSION: A study of MAGE in induced sputum appears to be a useful and complementary method in the diagnosis of lung cancer. A further prospective study with more patients is recommended.

A Case of Impending Paradoxical Embolus in a Patient with Acute Pulmonary Embolism

Paradoxical embolism refers to the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. Impending paradoxical embolism, in which a venous thrombus extends from the right atrium through a patent foramen ovale (PFO) into the left atrium, is usually diagnosed with echocardiography. The most common cause of paradoxical embolism through a PFO is the acute pulmonary embolism. We report a case of a 78-year-old woman with acute pulmonary embolism, complicated by impending paradoxical embolism.