ABSTRACT
A rapid increase in cancer incidence accompanied by aging population requires evidence-based supportive cancer care practices.Cancer therapies often accompany adverse events which induce malnutrition and declined quality of life. We conducted an 8-weeknon-randomized clinical trial to evaluate efficacy of cereal-based oral nutritional supplement (ONS) intervention on nutritional status,quality of life and inflammatory responses in cancer patients undergoing cancer therapy with 5% < weight loss. The study included34 pateints (24 in control group, 10 in intervention group) with 15 drop-outs. ONS used in this intervention contained 0.5% arabinoxylan-rich fermented rice bran powder and 5.5% black rice powder as active ingredients in a regular cereal-based formula. Resultsshowed that ONS intervention for 8 weeks did not show significant improvement in blood biomarkers of nutritional status or patient-generated subjective global assessment scores. However, 8-week of intervention showed reduced interleukin (IL)-6 and IL-1bsecretion in lipopolysaccharide-stimulated peripheral blood mononuclear cells while IL-12p70 level was increased. For health-relatedquality of life (HRQoL) indices, emotional functioning and fatigue symptoms were improved after 4 weeks only in the interventiongroup although no difference was found at week 8. These results suggest that ONS intervention may improve chronic inflammatorystatus and HRQoL indices (at week 4) in cancer patients receiving treatments.
ABSTRACT
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-to-intermediate malignant tumor of endothelial origin. Computed tomography (CT) findings of PEH demonstrate multiple small bilateral nodules; however, to the best of our knowledge, there were no reports on PEH coexisting with other malignancies. Here, we reported on a case involving PEH in a patient with colon cancer and breast cancer which was misconceived as pulmonary meta-stasis. A 63-year-old woman who suffered from constipation for 2 weeks visited our hospital. Colonoscopy showed a large mass with obstruction on hepatic flexure. The histological diagnosis was adenocarcinoma of the ascending colon. Multiple nodules in both lungs and breast were observed on a chest CT scan. A core biopsy of a breast nodule was performed and a diagnosis of invasive ductal carcinoma of the left breast was made. Pulmonary nodules observed on the chest CT scan was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed and pathological diagnosis was PEH. Radiologic features of PEH were difficult to distinguish from lung metastasis. Therefore the author reported a rare case involving PEH in a patient with primary malignancy of colon and breast.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Biopsy , Breast , Breast Neoplasms , Carcinoma, Ductal , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Constipation , Diagnosis , Hemangioendothelioma , Hemangioendothelioma, Epithelioid , Lung , Neoplasm Metastasis , Tomography, X-Ray ComputedABSTRACT
Acquired factor V deficiency is a rare bleeding disorder, the severity of which ranges from mild to fatal. There are various suggested treatments, including transfusion of fresh frozen plasma (FFP) or platelets, plasmapheresis and immunosuppressive therapy. We encountered a case of idiopathic acquired factor V deficiency with fatal retroperitoneal bleeding treated with steroid and cyclophosphamide.
Subject(s)
Adrenal Cortex Hormones , Blood Coagulation Factor Inhibitors , Blood Platelets , Cyclophosphamide , Factor V , Factor V Deficiency , Glucocorticoids , Hemorrhage , Plasma , Plasmapheresis , Platelet TransfusionABSTRACT
Acquired factor V deficiency is a rare bleeding disorder, the severity of which ranges from mild to fatal. There are various suggested treatments, including transfusion of fresh frozen plasma (FFP) or platelets, plasmapheresis and immunosuppressive therapy. We encountered a case of idiopathic acquired factor V deficiency with fatal retroperitoneal bleeding treated with steroid and cyclophosphamide.
Subject(s)
Adrenal Cortex Hormones , Blood Coagulation Factor Inhibitors , Blood Platelets , Cyclophosphamide , Factor V , Factor V Deficiency , Glucocorticoids , Hemorrhage , Plasma , Plasmapheresis , Platelet TransfusionABSTRACT
Mammary-like glands are poorly recognized structures of normal vulvar skin. Here, we report the first case of primary mammary-like gland adenocarcinoma of the vulva in Korea and discuss the differential diagnosis and treatment of this rare tumor. A 62-year-old woman presented with an itching sensation and palpable mass of the vulva. Abdominal computed tomography showed multiple variable-sized nodules with peripheral rim enhancement in the liver. The pathology of the vulva and liver lesions was consistent with invasive ductal carcinoma of the breast, with positive staining for estrogen receptors, progesterone receptors, HER-2, and GCDFP-15. Ultrasonography and magnetic resonance imaging of the breast were normal. Given the histological findings in conjunction with the absence of a breast lesion, a diagnosis of primary mammary-like gland adenocarcinoma of the vulva was made. She died of pneumonia 7 weeks after the diagnosis.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Breast , Carcinoma, Ductal , Diagnosis, Differential , Korea , Liver , Magnetic Resonance Imaging , Pneumonia , Pruritus , Receptors, Estrogen , Receptors, Progesterone , Sensation , Skin , VulvaABSTRACT
BACKGROUND/AIMS: Helicobacter pylori infection is a recognized cause of chronic gastritis, peptic ulcer and gastric adenocarcinoma. However, both positive and negative associations with colorectal neoplasia have been reported. The aim of this study was to determine whether H. pylori infection is associated with an increased risk of colonic neoplasia in a Korean population. METHODS: We examined 1,590 subjects (1,297 men and 293 women) who underwent colonoscopy and serologic testing for IgG antibodies against H. pylori at the Health promotion Center in Kangbuk Samsung Hospital and at Samsung Medical Center. We compared the prevalence of colonic neoplasia in the seropositive subjects with that of the seronegative subjects. RESULTS: The overall prevalence of H. pylori in our study population was 56.2%. There were no significant differences of the baseline characteristics between the two groups. There was no statistically significant difference in the prevalence of colonic neoplasia between the seropositive group and the seronegative group (p=0.090). CONCLUSIONS: These findings suggest that there is no significant association between H. pylori infection and colonic neoplasia.
Subject(s)
Humans , Male , Adenocarcinoma , Antibodies , Colon , Colonoscopy , Gastritis , Health Promotion , Helicobacter , Helicobacter pylori , Immunoglobulin G , Peptic Ulcer , Prevalence , Serologic TestsABSTRACT
BACKGROUNDS/AIMS: The epidemiology of hepatitis A is associated with socioeconomic and hygiene status. Recently, the prevalence of hepatitis A in young adults has been steadily increasing in Korea. This study is to investigate the age-specific seroprevalence of hepatitis A virus in Korea. METHODS: Stored sera from 250 healthy adult subjects who visited the health promotion center in Samsung Medical Center between July and August 2006 were tested for IgG hepatitis A virus antibody (anti-HAV). RESULTS: The prevalence of anti-HAV was 2%, 72%, 92%, 94%, 100% in 20's, 30's, 40's, 50's, and 60's, respectively. The prevalence of anti-HAV was significantly lower in subjects below age 40 compared to those above 40 (37.0% vs. 95.3%, p<0.001). The seroprevalence was higher in area outside of Seoul compared to those living in Seoul in age group below 40 (25.6% vs. 55.6%, p=0.01). In Seoul area, the prevalence was significantly lower in Kangnam-Gu, Seocho-Gu, and Songpa-Gu district compared to the other areas of Seoul in the age group below 40 (20.0% vs. 42.1%, p<0.05). CONCLUSION: The seroprevalence of hepatitis A virus antibody in Korean population below 40 is quite low and immunity to hepatitis A virus in those subjects can be a public health issue. In view of changing seroepidemiology, a policy for hepatitis A vaccination in population below 40 might be warranted.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Demography , Hepatitis A/prevention & control , Hepatitis A Antibodies/blood , Hepatitis A Virus, Human/immunology , Korea , Seroepidemiologic StudiesABSTRACT
Rituximab targets CD20+ B cells and has been used increasingly for the treatment of B-cell Non-Hodgkin Lymphoma, alone or in combination with cytotoxic agents. Rituximab can kill CD20+cells by multiple mechanisms. Rituximab therapy has often been associated with an infusion-related symptom complex consisting of fever, chills, and rigors that is usually self-limited. These complications are transient without long-term effects. Several delayed pulmonary events involving interstitial reactions and bronchiolitis obliterans with organizing pneumonia have recently been described in conjunction with the use of Rituximab. In the lymphoma patient presented here there was no respiratory symptoms; however, respiratory difficulty developed after the third round of Rituximab plus CHOP chemotherapy. High resolution computed tomography (HRCT) and positive emission tomography (PET) were performed and revealed diffuse ground glass opacities. We report a patient with Non-Hodgkin Lymphoma in whom interstitial lung disease developed after Rituximab therapy.
Subject(s)
Humans , B-Lymphocytes , Bronchiolitis Obliterans , Chills , Cytotoxins , Drug Therapy , Fever , Glass , Lung Diseases, Interstitial , Lung , Lymphoma , Lymphoma, Non-Hodgkin , Pneumonia , RituximabABSTRACT
PURPOSE: The benefit of consolidation high-dose chemotherapy (HDC) for high-risk primary breast cancer is controversial. We evaluated the efficacy and safety of consolidation HDC with cyclophosphamide, thiotepa and carboplatin (CTCb) followed by autologous stem-cell transplantation (ASCT) in resected breast cancer patients with 10 or more positive lymph nodes. MATERIALS AND METHODS: Between December 1994 and April 2000, 22 patients were enrolled. All patients received 2 to 6 cycles of adjuvant chemotherapy after surgery for breast cancer. The HDC regimen consisted of cyclophosphamide 1, 500 mg/m2/day, thiotepa 125 mg/m2/day and carboplatin 200 mg/m2/day intravenous for 4 consecutive days. RESULTS: With a median follow-up of 58 months, 11 patients recurred and died. The median disease-free survival (DFS) and median overall survival (OS) were 49 and 69 months, respectively. The 5-year DFS and OS rates were 50% and 58%, respectively. The 12 patients with 10 to 18 involved nodes had better 5-year DFS (67%) and OS (75%) than 10 patients with more than 18 involved nodes (30% and 38%, respectively). The most common grade 3 or 4 nonhematologic toxicity was diarrhea, which occurred in 5 patients (23%). No treatment-related death was observed. CONCLUSION: Consolidation HDC with CTCb followed by ASCT for resected breast cancer with more than 10 positive nodes had an acceptable toxicity but does not show promising survival.
Subject(s)
Humans , Breast Neoplasms , Breast , Carboplatin , Chemotherapy, Adjuvant , Cyclophosphamide , Diarrhea , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lymph Nodes , Peripheral Blood Stem Cell Transplantation , ThiotepaABSTRACT
We report a gastrointestinal stromal tumor (GIST) patient with male gynecomastia and testicular hydrocele after treatment with imatinib mesylate. A 42 yr-old male patient presented for management of hepatic masses. Two years earlier, he had undergone a small bowel resection to remove an intraabdominal mass later shown to be a GIST, followed by adjuvant radiation therapy. At presentation, CT scan revealed multiple hepatic masses, which were compatible with metastatic GIST, and he was prescribed imatinib 400 mg/day. During treatment, he experienced painful enlargement of the left breast and scrotal swelling. Three months after cessation of imatinib treatment, the tumors recurred, and, upon recommencing imatinib, he experienced painful enlargement of the right breast and scrotal swelling. He was diagnosed with male gynecomastia caused by decreased testosterone and noncommunicative testicular hydrocele. He was given androgen support and a hydrocelectomy, which improved his gynecomastia. The mechanism by which imatinib induces gynecomastia and hydrocele is thought to be associated with an inhibition of c-KIT and platelet-derive growth factor. This is the first report, to our knowledge, describing concurrent male gynecomastia and testicular hydrocele after imatinib treatment of a patient with GIST.
Subject(s)
Adult , Humans , Male , Androgens/therapeutic use , Antineoplastic Agents/adverse effects , Gastrointestinal Stromal Tumors/drug therapy , Gynecomastia/chemically induced , Testicular Hydrocele/chemically induced , Piperazines/adverse effects , Pyrimidines/adverse effects , Testis/drug effectsABSTRACT
PURPOSE: Autologous stem cell transplantation (ASCT) is increasingly used in patients with non-Hodgkin's lymphoma (NHL). Various clinical parameters-were evaluated to obtain significant predictors of the outcome following ASCT in patients with NHL. MATERIALS AND METHODS: Between April 1994 and December 2003, ASCT was performed on 80 patients with NHL at the Asan Medical Center. RESULTS: Patients had various histological subtypes and disease status. The two year progression free survival (PFS) and overall survival for all patients were 34 and 31%, respectively. A univariate analysis showed the performance status, stage, modified extranodal involvement category, International Prognostic Index (IPI) at mobilization, disease status at mobilization, and history of radiation prior to mobilization as significant predictors of the outcome following ASCT. Four risk groups, with different 2 year PFS, were identified by the age adjusted IPI at mobilization (mAAIPI): low risk 44%; low intermediate risk 40%; high intermediate risk 19%; and high risk 0% (p=.0003). A multivariate analysis revealed 3 significant factors for the PFS: disease status, prior RT and mAAIPI. CONCLUSIONS: The mAAIPI was found to be an independent predictor of the outcome of NHL patients undergoing ASCT. This powerful prognostic tool should be used to evaluate potential candidates for ASCT.
Subject(s)
Humans , Disease-Free Survival , Hematopoietic Stem Cell Mobilization , Lymphoma, Non-Hodgkin , Multivariate Analysis , Prognosis , Stem Cell Transplantation , Stem CellsABSTRACT
PURPOSE: The benefit of high-dose chemotherapy (HDC) for metastatic breast cancer (MBC) is controversial. We evaluated the efficacy and safety of HDC with cyclophosphamide, thiotepa, and carboplatin (CTCb) followed by autologous stem-cell transplantation (ASCT) for MBC patients. MATERIALS AND METHODS: From September 1994 to December 1999, 23 MBC patients were enrolled. All the patients received 2 to 10 cycles of induction chemotherapy. Before transplantation, 12 patients were in complete response (CR), nine were in partial response (PR), and two had progressive disease (PD). The HDC regimen consisted of cyclophosphamide 1, 500 mg/m2/day, thiotepa 125 mg/m2/day and carboplatin 200 mg/m2/day intravenously for 4 consecutive days RESULTS: After ASCT, 13 patients (56%) had a CR, five (22%) had a PR, three (13%) had no change, while two (9%) showed a PD. Seventeen patients relapsed or progressed during the median follow-up of 78 months. The median progression-free survival (PFS) time was 11 months and the median overall survival (OS) time was 23 months. The 5-year PFS and OS rates were 22% and 25%, respectively. On the multivariate analyses, less than 4 involved lymph nodes was predictive of a better PFS and OS. CONCLUSION: HDC with CTCb for MBC has acceptable toxicity; however, this treatment does not show a survival benefit.
Subject(s)
Humans , Breast Neoplasms , Breast , Carboplatin , Cyclophosphamide , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Induction Chemotherapy , Lymph Nodes , Multivariate Analysis , ThiotepaABSTRACT
BACKGROUND: We performed this study to compare response rate and survival according to treatment modalities, such as allogeneic bone marrow transplantation (BMT), immunosuppressive therapy (IS) and androgen therapy in patients with aplastic anemia (AA). METHODS: Medical records of one hundred and thirty-seven patients who diagnosed with aplastic anemia at the Asan Medical Center from September 1989 to December 2000 were retrospectively analyzed. RESULTS: Forty-one patients received supportive care only. Ninety-five out of 96 treated patients were evaluable for response. In severe AA group (N=79), the response rate according to treatment modalities was 25.0% in the androgen group (N=4), 30.3% in the ALG or ATG group (N=33), 25.0% in the cyclosporine (CSA) group (N=8), 44.4% in the ATG plus CSA group (N=9), and 73.8% in the BMT group (N=23) (P<0.001). Five- and 10-year survival of overall patients was 67.5% and 50.9%, respectively. Ten-year survival according to disease severity was 42.3% in severe AA group and 75.8% in non-severe AA group (P=0.0043). Five- year survival according to treatment modalities in patients with severe AA was 75.0% in the androgen group, 49.0% in the ALG or ATG group, 75.0% in the CSA group, and 88.9% in the ATG plus CSA group. Five-year survival was 82.6% in the BMT group and 57.7% in the IS group (P=0.0259). CONCLUSION: This study showes that BMT resulted in significantly better response rate and overall survival compared to IS in patients with severe AA.
Subject(s)
Bone Marrow TransplantationABSTRACT
Purposes: Although the standard management of limited stage small cell lung cancer is concurrent platinum-based chemotherapy with thoracic radiotherapy (TRT), the optimal timing of the TRT remains controversial. We investigated the feasibility of concurrent chemoradiation for the patients with limited stage small cell lung cancer after 2 cycles of combination chemotherapy with Etoposide/Cisplatin (EP). MATERIALS AND METHODS: EP consisted of Etoposide 100 mg/m2 on day 1 to 3 and Cisplatin 70 mg/m2 on day 1. Six cycles were given to the responders every 4 weeks. Total 55 Gy (1.8 Gy once-daily or 1.2 Gy twice-daily, 5 days per week) of TRT were given to the patients who showed at least a partial response after 2 cycles of EP. The other patients were treated by the physician's decision. The patients with complete remission were recommended to receive prophylactic cranial irradiation. RESULTS: Fifty patients were enrolled. Thirty-five (70%) of them showed responses (2 complete remissions and 33 partial remissions) after 2 cycles of EP. Thirty-three of the responders were given TRT starting with the 3rd cycle of EP. The nonresponders were treated with salvage chemotherapy and TRT. After completion of treatment for 50 patients, the overall response rate was 86% (29 complete remissions, 14 partial remissions). One patient (2%) showed stable disease, and 6 (12%) showed a progressive disease. The median progression free survival was 326 days and the median survival time was 410 days. One-, 2-, 3-, 4- and 5-year survival rates were 62%, 24%, 14%, 9% and 6%, respectively. As hematologic toxicities during chemoradiation, 35.1% with grade III/IV neutropenia and 18.9% with grade III/IV thrombocytopenia were noted. Grade II/III radiation pneumonitis and radiation esophagitis were noted in 5/1 and 13/1 patients (15.2%/ 3.0% and 39.4%/3.0%), respectively. One patient died of septicemia during chemoradiation. CONCLUSION: The concurrent EP and TRT after 2 cycles of EP was feasible in limited stage small cell lung cancer. Further study is required for the indentification of optimum timing of TRT during combination chemotherapy.