Phase II Study of Irinotecan Plus Cisplatin as First Line therapy in Extensive Small-Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: Irinotecan (topoisomerase I inhibitor) is effective as a monotherapy against small-cell lung cancer(SCLC). Cisplatin is also an important drug against SCLC. A phase II study of irinotecan combined with cisplatin was carried out to evaluate the efficacy and toxicity of this combined regimen as a first line treatment in patients with extensive SCLC. METHODS: Thirty-nine patients with previously untreated extensive SCLC were enrolled in this study. Irinotecan 60mg/m(2) was administered intravenously on days 1, 8 and 15, and in combination with cisplatin 60mg/m(2) on day 1 and every 28 days thereafter. Four cycles of chemotherapy were given to the patients. RESULTS: The overall response rate was 77% with a complete response (CR) rate of 8%. The median survival time, 1- and 2-year survival rate were 14.8 months, 60.9% and 27.6%, respectively. The median progression free survival time, 6-and 12-month progression free survival rate were 8.4 months, 75% and 18.8%, respectively. The WHO grade 3 or more toxicity encountered were leukopenia (23%), diarrhea (26%). Two patients changed their chemotherapeutic regimen and one patient died from severe diarrhea. CONCLUSION: The combination of irinotecan and cisplatin is effective as a first line therapy in extensive SCLC is effective , but has severe or fatal diarrhea as toxicity.

Diaphragmatic Paralysis Following Cervical Herpes Zoster / 결핵및호흡기질환

Herpes zoster is well-known viral disease in immune compromised that produces inflammatory lesions in the posterior root ganglia and is characterized clinically by pain and skin eruptions along the distribution of the affected ganglia. However, motor involvement after a herpes zoster is an uncommon complication. We report a case of diaphragmatic paralysis that occurred after a herpes zoster in 63-year-old woman. The diaphragmatic paralysis occurred one month after the typical herpes zoster eruptions affecting the C3 and C4 dermatomes in the right neck, shoulder and back area.

The Role of Heme Oxygenase-1 in Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Heme oxygenase-1 (HO-1) is an inducible enzyme that catalyzes the oxidative degradation of heme to form biliverdin, carbon monoxide (CO), and free iron. The current evidence has indicated a critical role of HO-1 in cytoprotection and also in other, more diverse biological functions. It is known that the high expression of HO-1 occurs in various tumors, and that HO-1 has an important role in rapid tumor growth because of its antioxidative and antiapoptotic effects. Therefore, the role of HO-1 was analyzed in human lung cancer cell lines, and especially in the A549 cell line. MATERIAL AND METHODS: Human lung cancer cell lines, i.e., A549, NCI-H23, NCI-H157 and NCI-H460, were used for this study. The expression of HO-1 in the untreated state was defined by Western blotting. ZnPP, which is the specific HO inhibitor we used, and the viability of cells were tested for by conducting MTT assaysy. The HO enzymatic activity, as determined via the bilirubin level, was also indirectly measured. Moreover, the generation of intracellular hydrogen peroxide (H2O2) was monitored fluorimetrically with using a scopoletin-horse radish peroxidase (HRP) assay and 2',7'-dichlorofluorescein diacetate (DCFH-DA). We have also transfected small HO-1 interfering RNA (siRNA) into A549 cells, and the apoptotic effects were evaluated by flow cytometric analysis and Western blotting. RESULTS: The A549 cells had a greater expression of HO-1 than the other cell lines, whereas ZnPP significantly decreased the viability of the A549 cells more than the viability of the other lung cancer cells in a dose-dependant fashion. Consistent with the viability, the HO enzymatic activity also was decreased. Moreover, intracellular H2O2 generation via ZnPP was induced in a dose-dependent manner. Apoptotic events were, then induced in the HO-1 siRNA transfected A549 cells. CONCLUSION: HO-1 provides new important insights into the possible molecular mechanism of the antitumor therapy in lung cancer.

A Case of Lambert-Eaton Myasthenic Syndrome with Positive VGCC Antibodies Diagnosed in Small Cell Lung Cancer / 결핵및호흡기질환

Lambert-Eaton myasthenic syndrome (LEMS), a rare autoimmune neurological syndrome, is caused by defects in the secretion of acetylcholine from the presynaptic membrane, and is associated with the destruction of voltage gated calcium channels (VGCC) in the neuromuscular junction. LEMS can be confirmed by repetitive nerve stimulation and by the clinical symptoms, which are characterized by proximal muscle weakness in the lower extremities, decreased deep tendon reflexes and autonomic dysfunctions. In about 60% of patients with this disorder, underlying cancer-small cell lung cancer may be detected. Clinical symptoms may precede the diagnosis of malignancy, with the early diagnosis and treatment of the underlying malignancy being possible through the diagnosis of LEMS. A case of LEMS, with positive VGCC antibodies, in a 48-year-old man, which improved after chemotherapy of the underlying small cell lung cancer, is reported.

The Comparison of the Effect of Cigarette and Stop Smoking-aiding Cigarette on Release of IL-6 from Bronchial Epithelial Cell / 결핵및호흡기질환

BACKGROUND AND AIMS: Cigarette smoking induces an inflammatory response in the airways, which may play a key role in the pathogenesis of chronic obstructive pulmonary disease. Interleukin-6 (IL-6) is one of the cytokines that plays an important role in inducing bronchial inflammation. The aim of this study was to determine if the level of the pro-inflammatory cytokine, Interleukin-6 , is increased when the bronchial epithelial cells are exposed to a cigarette smoke extract (CSE) and an extract from stop smoking-aiding cigarettes, and examined the safety of these commercially available stop smoking-aiding cigarettes. METHOD: Bronchial epithelial cells were exposed to CSE from cigarette and stop smoking-aiding cigarettes for 24 hours. ELISA was used to measure the IL-6 levels in the supernatant from each condition. The IL-6 mRNA levels were measured by Taqman Real time RT-PCR. N-acetyl-L-cysteine(NAC) was added to each condition to determine if NAC can inhibit the release of IL-6 from the bronchial epithelial cells when they are exposed to CSE from cigarette and stop smoking-aiding cigarettes. RESULT: When bronchial epithelial cells were exposed to a CSE from cigarettes and stop smoking- aiding cigarettes, each type of CSE stimulated IL-6 production from the bronchial epithelial cells. The IL-6 mRNA level in the Bronchial epithelial cells was also elevated and NAC was found to inhibit the release of IL-6 from bronchial epithelial cells when they were exposed to the CSE from cigarettes and stop smoking-aiding cigarettes. CONCLUSION: Commercially available stop smoking-aiding cigarette can induce bronchial inflammation and can be harmful to smokers. Therefore, the safety of these cigarettes for smoking cessation should be evaluated.

Adjuvant Chemotherapy after Surgical Resection for Small-Cell Carcinoma of Lung / 결핵및호흡기질환

BACKGROUND: Small-cell carcinoma of lung has a tendency of rapid growth and early wide metastasis. In spite of high response rate of combination chemotherapy alone or with radiotherapy, overall long-term survival rate is very disappointed. According to autopsy findings, the common cause of failure is local recurrence in primary cancer site. So, surgical resection with combined chemotherapy has been recently attempted for very early stage of small-cell carcinoma of lung. METHODS: 10 patients (TNM I: & II: 5 cases) undergoing surgical resection for small-cell carcinoma of lung with adjuvant chemotherapy in an attempt to prolong survival. Of these, 9 patients received chemotherapy, and retrospective study was undertaken for survival (Kaplan-Meier analysis). RESULTS: Median survival time was 26 months, 2-, 5-year survival rate was 68.6%, 46.7%. If 1 patient without chemotherapy was excluded, 2-, 5-year survival rate was 76.2%, 50.8%. No survival difference was seen between patients with TNM I, II stages. CONCLUSION: Adjuvant chemotherapy after surgical resection results in prolonged survival for patients with TNM stage I, II small-cell carcinoma of lung.

A Case of Meigs' Syndrome / 결핵

Meigs' syndrome is defined as presence of pleural effusion, with ovarian tumor associated ascites, which spontaneously resolve soon after the removal of the tumor. The pathogenesis of the pleural effusion, in patients with Meigs' syndrome, is thought to be the passage of fluid from the peritoneal cavity into the pleural cavity, through small holes in the diaphragm. A case of Meigs' syndrome, in a 63-year-old woman, who had been referred for control of pleural effusion is reported.

An Immunohistochemical Study on the Expression of the Bauhinia Purpurea in the Reed-Sternberg Cells

The diagnosis of Hodgkin's disease is based on the morphologic identification of Reed-Sternberg (RS) cells and its variants in paraffin-embedded sections. The origin of RS cells remains a subject of controversy, and cells resembling RS cells are observed in some non-Hodgkin's lymphoma of T-cell lineage. In this study, eighteen cases of Hodgkin's disease (3 nodular sclerosis, 6 diffuse lymphocyte predominance, and 9 mixed cellularity) were studied with peanut agglutinin(PNA), anti-Leu-M1(CD15), LN2(CD74), Ber-H2(CD30) and bauhinia purpurea (BPA) by the avidin-biotin-peroxidase complex(ABC) method in paraffin-embedded sections. RS cells and their variants revealed positive reactions with one or more of the reagents in all examined cases. BPA staining was positive in 17 of 18 cases (94.4%), PNA staining was positive in 9 of 18 cases (50.0%), Leu MI was positive in 7 of 18 cases(38.9%), Ber-H2 was positive in 11 of 18 cases (61.1%), and LN2 was positive in 8 of 18 cases(44.4%). The staining properties of examined markers were recognized as paranuclear, diffuse cytoplasmic and cellular membranous patterns, but LN2 disclosed diffuse cytoplasmic staining in the positive cells. BPA also showed dense cytoplasmic staining reaction with macrophage-histiocytes. BPA reactivity was not affected by fortnalin fixation or paraffm embedding. Thirty six cases of non-Hodgkin's lymphomas(IO T-cell and 26 B-cell type) were also examined. The neoplastic cells of those cases did not stain positive with BPA, PNA, and Leu-Mi, but stained positively with LN2 in 3 cases of T-cell lymphomas and 14 cases of B-cell lymphomas, and BeT-H2 in T-cell lymphomas. In conclusion, to facilitate the detection of RS cells and related variants in paraffm sectionse of Hodgkin's disease, BPA can be used as a useful marker because of its high-detection rate, reproducible staining pattem, and resistance to fixative.