Clinical Characteristics of Pancreatic Cancer According to the Presence of Diabetes Mellitus / 대한소화기학회지

BACKGROUND/AIMS: Pancreatic cancer is fatal with a dismal 6-month median survival from diagnosis. Diabetes mellitus is reported to be present up to 33.3 percent of patients with pancreatic cancer. The reason for the high frequency of diabetes is unknown. We studied the prevalence and duration of diabetes in patients with pancreatic cancer and the relationship between the two diseases. METHODS: A total of 152 patients with pancreatic cancer diagnosed at Yeungnam University Hospital from January 1999 to December 2001 were enrolled in this study. Clinical features, family history, smoking history, and characteristics of the tumor were compared between diabetic and non-diabetic groups. RESULTS: Among 152 patients with pancreatic cancer, 43 patients (28.3%) had diabetes. In diabetic group, mean age of diagnosis was significantly younger than non- diabetic group (62.0 +/- 7.2 vs. 65.0 +/- 8.8, p<0.05). Most of the patients with diabetes had non-insulin dependent diabetes mellitus (NIDDM) and did not have family history. Diabetes was diagnosed within 2 years after the diagnosis of pancreatic cancer in 35 patients (74.3%) of the diabetic group. There were no differences in the location and stage of tumor, chief complaints, presence of weight loss, and body mass index between the two groups. CONCLUSIONS: Diabetes mellitus occurs frequently in patients with pancreatic cancer and does not influence clinical features of pancreatic cancer. Pancreatic cancer should be suspected in patients with recent onset diabetes, especially in patients without family history of diabetes and with type of NIDDM.

Anatomical Characterization of Vanilloid Receptor 1 (VR1)-positive Primary Afferents in Lower Lumbar Cord in the Rat / 대한해부학회지

Primary afferents sensitive to capsaicin and noxious heat express vanilloid receptor 1(VR1) in both their peripheral and central fibers and terminals. We used multiple immunofluorescence and confocal microscopy to characterize their pattern of termination in rat spinal cord, colocalization of neurochemical markers of primary afferents and other presynaptic receptors. VR1-positive unmyelinated fibers mainly terminate in lamina I, where they co-stain for CGRP, and to a limited extent for SP, and in lamina II, especially its medial half, where they co-stain for IB4. VR1 positive thin myelinated fibers terminate in lamina I and co-stain for the neurochemical tracer CTB, injected in the sciatic nerve. As revealed by simultaneous staining for the synaptic marker synaptophysin, VR1-positive terminals are abundant in lamina I and sparse in lamina II. In L6-S1 spinal cord, VR1-positive fibers and terminals were abundant in Lissauer's tract, lamina I-V, medial collateral path to lamina X, and lateral collateral path to sacral parasympathetic nucleus. Most of VR1 positive fibers in Lissuer's tract and LCP are colocalized with SP. In conclusion, it is suggested that VR1 positive fibers in spinal cord are both peptidergic and non-peptidergic, IB4 positive fibers, mediating both somatic and visceral sensations, and that peptidergic VR1 positive fibers are mainly related with visceral sense.

Survival Difference of Combination Chemotherapy versus Supportive Care in the Patients with Stage IV Non-Small Cell Lung Cancer / 결핵

BACKGROUND: The survival benefit of combination chemotherapy comparing supportive care to patients with advanced non-small cell lung cancer, especially stage IV non-small cell lung cancer patients with metastatic disease, is controversial. The main goal of this study was to evaluate the difference in survival between patients treated with chemotherapy and those who were not and to identify prognostic factors in the patients with stage IV non-small cell lung cancer. METHODS: From January 1989 to December 1994, total 67 patients including 20 patients treated with combination chemotherapy and 47 patients treated with only supportive care in stage IV non-small cell lung cancer patients with metastatic disease were enrolled in this study. Combination chemotherapy consisted of etoposide 120mg/m2 iv for 3 days and cis-platin iv day 1 every 4 weeks. The treatment groups were retrospectively analyzed by age, sex, histologic cell type, weight loss, serum LDH level, ECOG performance status and major organ metastasis. RESULTS: The significant prognostic factors influencing survival on this study were ECOG performance status and histologic subtype. Overall response rate by combination chemo-therapy was 30%(complete response 0%, partial response 30%). Median survival of overall patients was 13.6 weeks and median survival of chemotherapy group, 20 weeks, was significantly longer than that of supportive care group, 11.7 week(p<0.01). Median survival of responder in patients receiving chemotherapy, 45.5 weeks, was significantly longer than that of non-responder, 17.3 weeks(p<0.05). 1 year-survival rate of chemotherapy group and supportive care group was 15% and 8%, respectively. Nausea or vomiting, alopecia and anemia were seen in nearly most cases after this combination chemotherapy. Toxicities above grade 3 included neutropenia, anemia, thrombocytopenia, infection, fever, nausea, vomiting and alopecia. But this combination chemotherapy was relatively well tolerated except one treatment-related death from sepsis associated with severe granulocytopenia. CONCLUSION: These results suggest that systemic chemotherapy might be helpful to the stage IV non-small cell lung cancer patients with good performance status and large scale randomized prospective trials should be performed.