A Case of Ischemic Colitis Associated with Paclitaxel Loaded Polymeric Micelle (Genexol-PM(R)) Chemotherapy / 결핵및호흡기질환

Paclitaxel has been widely used for treating many solid tumors. Although colonic toxicity is an unusual complication of paclitaxel-based chemotherapy, the reported toxicities include pseudomembranous colitis, neutropenic enterocolitis and on rare occasions ischemic colitis. Genexol-PM(R), which is a recently developed cremophor-free, polymeric micelle-formulated paclitaxel, has shown a more potent antitumor effect because it can increase the usual dose of paclitaxel due to that Genexol-PM(R) does not include the toxic cremophor compound. We report here on a case of a 57-year-old man with advanced non-small cell lung cancer and who developed ischemic colitis after chemotherapy with Genexol-PM(R) and cisplatin. He complained of hematochezia with abdominal pain on the left lower quadrant. Colonoscopy revealed diffuse mucosal hemorrhage and edema from the sigmoid colon to the splenic flexure. After bowel rest, he recovered from his symptoms and the follow-up colonoscopic findings showed that the mucosa was healing. Since then, he was treated with pemetrexed monotherapy instead of a paclitaxel compound and platinum.

A clinico-pathological analysis of microinvasive cervical cancer / 대한산부인과학회잡지

OBJECTIVE: To evaluate correlation the of histological variables and the clinical features of microinvasive cervical cancer with the depth of invasion and to establish the adequate therapeutic modality. METHODS: One hundred and thirty-seven patients with microinvasive cervical cancer diagnosed by FIGO (1994) staging were reviewed, who were treated by conization, type I hysterectomy, type II hysterectomy and type III hysterectomy, in Gil Medical center from January 1997 to December 2001. We divided the depth of invasion to three groups of less than 1 mm, 1-3 mm and 3-5 mm. RESULTS: The age of the 137 women ranged from 24 to 71 years (mean age 47.4 years). The number of patients with FIGO stage IA1 and IA2 were 112 and 24, respectively. Of surgically treated 135 patients, lymph node involvement was present in 1 patient with a depth of invasion of less than 1 mm, 2 patients with 1-3 mm and 1 patient with 3-5 mm. Lymph-vascular space involvement was present in 3 patients with 1-3 mm, 4 patients with 3-5 mm. Transient bladder dysfunction was the most common complication after surgical procedures, occupying 5.6%. Other surgical complications included lymphedema (3.6%), wound complication (3.6%), ureter injury (1.1%), lymphocele (1.1%), anal incontinence (1.1%) and dyspareunia (1.1%). CONCLUSION: A management should be individualized. Patients with a depth of invasion of less than 1mm and clear resection margin may be managed by conization. Further follow-up study for a necessity of lymphadenectomy for the group with the depth of invasion of 1-3 mm irrespective of lymph-vascular space involvement is demanded.

Clinical Analysis of Atypical Glandular Cells of Undetermined Significance (AGUS) on Pap Smear according to Menopausal Status / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status. METHODS: One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status. RESULTS: Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018). CONCLUSION: AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.