Temporal Changes of Psychosocial Status in Neuroblastoma Survivors Over Time / 신경정신의학

OBJECTIVES: The survival rate of all childhood cancers has been increasing, and latent effects on childhood cancer survivors have been gaining researchers' attention. It has been shown that childhood cancer survivors experience social maladaptation and a decreased quality of life. Although neuroblastoma is one of the most common solid cancers in childhood, there are few reports on psychosocial status in neuroblastoma survivors. The purpose of this study was to investigate temporal changes in psychosocial status in neuroblastoma survivors. METHODS: This study was conducted by undertaking retrospective chart reviews of neuroblastoma survivors that were treated between January 1997 and February 2016 at Samsung Medical Center, Seoul, Korea. Among the 54 survivors identified, data for 28 patients who underwent psychological evaluation before and after treatment completion were selected for further analysis. We compared intelligence score, Korea-Child Behavior Checklist (K-CBCL), and Korean Personality Rating Scale for Children (K-PRC) scores before and after treatment completion. Time derivatives for each variable were calculated to identify temporal changes in scores. RESULTS: After treatment completion, K-CBCL scores for total competence (t=−2.34, p=0.044), somatic complaints (t=−2.43, p=0.022), and thought problems (t=−3.03, p=0.006) were higher than the scores prior to treatment. Familial relationship in K-PRC was significantly improved after treatment (t=2.11, p=0.045). Time derivatives of the significant K-CBCL subscales, except for the withdrawal and externalizing symptom scores, showed a tendency to increase with time. CONCLUSION: Although familial relationship and social competence improved after treatment, the levels of somatic complaints and thought problems increased following neuroblastoma treatment.

Phase II study of cyclophosphamide, doxorubicin, and vincristine (CAV) and etoposide plus cisplatin (EP) alternating chemotherapy combined with radiotherapy in small cell lung cancer

The development of drug resistance is the major limiting factor influencing the survival of patients with small cell lung cancer (SCLC). We have thus examined the activity of cyclophosphamide, doxorubicin and vincristine (CAV) alternating with etoposide and cisplatin (EP) in 35 patients with SCLC. The treatment courses were alternated every 3 or 4 weeks. After induction chemotherapy, patients with limited disease (LD) received thoracic radiotherapy (5000 cGy), prophylactic cranial irradiation (3000 cGy) and maintenance chemotherapy and patients with extensive disease (ED) received maintenance chemotherapy only. In this group of 35 patients, 13 had limited disease (LD) and 22 had extensive disease (ED). After completion of the therapy, 100% of the patients with LD achieved complete plus partial remission (CR + PR) and 68% of the patients with ED achieved CR + PR. The median survival time was 66 weeks (15.3 months) in patients with LD and 44 weeks (10.2 months) in patients with ED. The over all survival for patients with LD was superior to that for patients with ED (p less than 0.05). Also, median response duration for patients with LD (35 wks) was longer than that for patients with ED (17 weeks) (p less than 0.05). The primary site was the most vulnerable site to relapse (18 patients). Toxicity was mild to moderate and acceptable, and there were no treatment-related deaths. These results suggest that the alternation of CAV and EP is effective treatment strategy in the management of SCLC. A randomized controlled study will be required to discriminate the actual effect of this alternating regimen.

Relationship between the result of preoperative pulmonary function test and postoperative pulmonary complications

Good preoperative screening and evaluation of patients undergoing surgery is necessary because it serves to identify the individual who is at risk of increased intra-operative and postoperative morbidity and mortality. The retrospective study was done in an attempt to determine if abnormalities in preoperative pulmonary function, detected by routine pulmonary function tests, would predict which patients would suffer from pulmonary complications following surgery. Pulmonary complications in the postoperative period included fever, atelectasis and respiratory failure. The overall incidence of pulmonary complications from our 78 patients undergoing surgery was 37 percent based on clinical criteria. This incidence was high in patients with FEV1 less than 1.0 L/sec, MVV less than 40% of predicted value and PCO2 more than 45 mmHg.

A Study of Clinical Correlations between Skin Test, Radioallergosorbent Test and Bronchial Provocation Test in House Dust Asthmatics

We evaluated the correlations between the allergy skin test for house dust radioallergosorbent test (RAST) and the bronchial provocation test for revealing the sensitivity of the skin test and RAST, and for aiding in the search for the causative allergen in house dust asthmatics. There was an overall 72.5% agreement between the prick test and RAST, a 73.8% agreement between the prick test and house dust bronchoprovocation test (HD-BPT), and a 71.3% agreement between HD-BPT and RAST. A positive RAST was found with a positive HD-BPT in 71.2% of cases, and if RAST was negative, HD-BPT was negative in 46.9% of cases. 69.6% of the positive cases on prick test (more than 21 mm of erythema) were positive with RAST. All of the cases with a negative skin reaction to the prick test were negative to RAST. A positive skin test was found with a positive HD-BPT in 77.1% of cases, and if the prick test was negative, the HD-BPT was negative in 50.0% of cases. 87.5% of cases with a RAST positive exhibited a positive result with HD-BPT. A significant correlation was found between the results of prick tests and those of RASTs in the early response group of HD-BPT, but not in the late and dual response groups. There were significant correlations between total serum IgE and the results of HD-BPT, and total serum IgE value and the results of RAST. The greater the size of the prick test, the greater the likelihood of a positive HD-BPT. All 5 cases with an end point of intradermal skin test of a 5 degrees -5(-l) X 10(-2) dilution of house dust noted a negative HD-BPT. There was no significant correlation between total serum IgE and total eosinophil count. There was no significant correlation between wheal and erythema size of prick test and PC20 of methacholine.

The Role of Whole Body Bone Scan in Bronchogenic Carcinoma

One hundred and sixty patients having bronchogenic carcinoma were evaluated for bone metastasis by means of 99mTc-monodiphosphate bone scanning, correlative radiographic bone survey and their clinical findings. In all patients, diagnosis was histologically proved. Bone scan demonstrated the possible evidence of bone metastasis in 75 patients (46.9%) and radiography, in 29 patients (18.1%). False negative was noted in 1 patient-Bone scan correlated with radiography in 37.3%, and with accompanying bone pain in 52% of the patients. But there was no correlation with the level of serum calcium, inorganic phos- phorus and alkaline phosphatase. In connection with their clinical stages before scanning, bone scans were positive in 33.3% of clinical stage I, 10.8% of clinica1 stage II and 54.1% of clinical stage III. Our Study suggests that bone scanning with 99m-monodiphosphate detected early bone metastasis in patients with bronchogenic carcinoma before their lesions became evident clinically or radiographically, and also important to determine operability.

Sensitivity and Specificity of Transbronchial Lung Biopsy (TBLB)

Twenty-five patients underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance. All patients had an endoscopically invisible pulmonary lesion suggestive of malignancy. A diagnostic specimen was obtained in 23 of the 25 patients (92%). A pathological finding of lung cancer was obtained in 14 patient (56%) through the transbronchial lung biopsy (12 cases) and by washing cytology (2 cases). Remaining 11 patients who were undiagnosed for pulmonary malignancy were followed by clinically had roentgenographically over 6 months. We evaluated the sensitivity and specificity of the TBLB procedures including brushing cytology and noted an 82.4% in sensitivity and 100% in specificity.

An Experience in Fiberopticbronchoscopy in the Diagnosis of Pulmonary Diseases

We analysed the results of the 521 bronchofiberscopies which was carried out at the Severance Hospital during 1977-1980. The purpose of the bronchofiberscopic procedures were diagnostic in 488 cases (93.8%), therapeutic in 18 cases (3.4%) and follow up observation in 15 cases (2.8%). It's major role is in the diagnosis of lung cancer and the tuberculosis in our hospital. In 190 patients of lung cancer confirmed positive typing was possible in 72.9% by bronchial biopsy, 52.6% by washing cytology. In 48 patient with tuberculosis who was not diagnosed before bronchofiberscopy, tubercle bacilli were found in 20% by AFB smear, 51% by AFB culture and 68.4% by bronchoscopic biopsy. Complications were minimal(1.9%).

Tracheal Hamartoma Causing Unique Stridor and a Review of the Literature

A 47-year-old maIe, who had been treated under the diagnosis of bronchial asthma, was admitted to this department with the complaints of progressive dyspnea of 3 years duration and upper air way obstruction causing unique stridor. Through roentgenography and bronchoscopy, lower tracheal hamartoma was confirmed, but a pulmonary function test precipitated acute hypoxia with mental somnolence. The tumor was removed as quickly as possible by multiple punch biopsy, through a rigid bronchoscope, for life saving air way maintenance.