Early or Late Gefitinib, Which is Better for Survival?: Retrospective Analysis of 228 Korean Patients with Advanced or Metastatic NSCLC / 영남의대학술지

BACKGROUND: The optimal timing of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) in NSCLC patients has not yet been determined. METHODS: We separated 228 patients with advanced/metastatic NSCLC treated with gefitinib into an early gefitinib group (patients who received gefitinib as first- or second-line treatment) and a delayed gefitinib group (patients who received gefitinib as third or fourth-line treatment) and attempted to determine whether the timing of gefitinib treatment affected clinical outcomes. RESULTS: Median overall survival (OS), progression free survival (PFS), and median OS from first-line treatment of advanced/metastatic disease (OSt) for 111 patients in the early gefitinib group were 6.2 months, 3.3 months, and 11.6 months. However, median OS, PFS, and OSt for 84 patients in the delayed gefitinib group were 7.8 months, 2.3 months, and 22.7 months. No differences in OS and PFS were observed between the 2 groups. However, OSt was significantly longer in the delayed gefitnib group. Timing of gefitinib therapy was one of the independent predictors of OSt. Hb > or = 10 g/dl, and having never smoked, and ECOG performance status < or =1 were independent predictors of better PFS. CONCLUSION: Deferral of gefitinib therapy in patients with advanced or metastatic NSCLC may be preferable if they are able to tolerate chemotherapy.

Detection of Lung Cancer using MAGE A1-6 and SSX4 RT-PCR Expression Profiles in the Bronchial Wash Fluid / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Bronchial wash fluid may be a useful for detecting lung cancer. To increase the detection rates, we performed molecular analysis with using MAGE A1-6 and SSX4 RT-PCR on bronchial wash fluid specimens. MATERIALS AND METHODS: We obtained 57 lung cancer tissue specimens by bronchoscopic biopsy and 131 bronchial washes from 96 patients with lung cancer and 35 patients with benign lung diseases. The MAGE A1-6 and SSX4 gene expressions were investigated in the cancer tissue specimens and bronchial wash fluids. We evaluated the positive detection rates of these methods according to the cytology results and the clinical findings. RESULTS: For the cancer tissue specimens and the bronchial wash fluid, the positive detection rate of MAGE or SSX4 was 91.2% and 75.0%, respectively. Combined MAGE and SSX4 PCR and cytology tests showed an 83.3% detection rate for the bronchial wash fluid. From bronchial washes of patients with benign lung diseases, the positive rates of using MAGE or SSX4 was 11.4%. In the bronchial wash fluid of lung cancer patients, 66.7% of the peripheral cancers were detected by MAGE or SSX4, while examination with cytology did not detect any peripheral lung cancer. CONCLUSION: The application of both MAGE and SSX4 showed high sensitivity and specificity for the detection of lung cancer. Thus, MAGE and SSX4 RT-PCR may be effectively utilized as additional methods to improve detection of lung cancer with using bronchial wash fluids.

Scintigraphic Evaluation of Inhalation Injury in Fire Victims / 핵의학분자영상

PURPOSE: Conventional chest X-ray and pulmonary function test cannot sensitively detect inhalation injury. Bronchoscopy is known to be the gold standard but it is invasive method. We evaluated whether lung inhalation/perfusion scans can sensitively detect inhalation injury of fire victims. MATERIALS AND METHODS: Nineteen patients (male 9, female 10, mean age 31.6 yr) of fire victims were enrolled in this study. Inhalation lung scan was performed 2 days later after inhalation injury with 99mTc-technegas. Perfusion lung scan was performed 4 days later with 99mTc-MAA (macroaggregated albumin). Follow up lung scans were performed 16 and 18 days later for each. Chest X-ray was performed in all patients and bronchoscopy was performed in 17 of 19 patients at the same period. Pulmonary function test was performed in 9 patients. RESULTS: Four of 19 patients showed inhalation and perfusion defects and one showed inhalation defect but, normal perfusion scan findings. These five patients with abnormal scan findings showed abnormal bronchoscopic findings and severe respiratory symptoms. On chest X-ray, 2 of them had pulmonary tuberculosis and one of them showed pulmonary congestion. FEV1/FVC was abnormal in 3 patients. On the follow up scan, all patients with abnormal initial scan findings showed improved findings and they had improved clinical state. CONCLUSION: Inhalation/perfusion lung scans can detect inhalation burn injury noninvasively in early stage and may be useful in therapeutic decision making and follow up of patients.

The Cognitive and Cerebral Functions of Patients with Conduct Disorder / 신경정신의학

OBJECTIVES: In oder to investigate the cognitive and cortical functions of patients with conduct disorder, the present study was carried out with the neuropsychological test battery and Event-Related Potentials(ERPs:P300). METHODS: The subjects were consisted of 18 patients with conduct disorder who fulfilled DSM-IV criteria and 18 normal controls. For all subjects the neuropsychological test battery and ERPs were administered. The neuropsychological test battery consisted of attention tests, memory tests and Card Sorting Test which is used to evaluate the problem-solving and hypothesis-testing. The P300 was measured by oddball paradigm in which 1,000Hz tone was served as standard stimulus and 2,000Hz tone as target stimulus. The task of the subject was to press response-button whenever the target stimulus was presented. K-WAIS was administered in order to control the intelligence of the subjects. RESULTS: The results were as follows: 1) Among subtests of the neuropsychological test battery, only the result of Card Sorting Test showed significant difference between conduct disorder group and control group. The conduct disorder group showed significant low hit-rate compared with control group. 2) The conduct disorder group showed decreased P300 amplitude compared with control group on Fz and Cz. Among 18 patients with conduct disorder, 12 patients showed negative potentials on Fz. 3) The conduct disorder group showed prolonged P300 latency compared with control group on Fz. CONCLUSION: These results indicate that the patients with conduct disorder seem to have retarded functions of problem-solving and hypothesis-testing, and this retardation seems to be related to the frontal dysfunction.

Effects of Mianserin on Negative Symptoms of Chronic Schizophrenia / 신경정신의학

OBJECTIVES: Patient's behavior features are important factors which influences the clinical judgement including diagnosis. However, most psychiatrists build up a picture of patients' behavior from an amalgamation of their own brief observations and nurses' reports, which often lack in the objectiveness. Several behavioral scales have been developed to alleviate this difficulty, but the poor efficiency and reliability of these scales have made them less useful. The recently developed Ward Daily Behavior Scale is an objective tool for evaluating all the daily noteworthy behaviors of patients, and is easily applicable to wide ranges of diagnoses and ages. This study tried to prove the reliability and validity of the Ward Daily Behavior Scale-Korean version. METHODS: The 112 patients, 63 males and 49 females, at a chronic psychiatric inpatient ward were selected as subjects. Experienced and unexperienced nurses rated patients' behaviors independently with the Ward Daily Behavior Scale-Korean version, after observing behaviors of subjects for 8 hours during day duty time. And then we tested the inter-rater reliability, internal consistency, and concurrent validity of this scale. RESULTS: The Ward Daily Behavior Scale-Korean version proved to be both reliable and valid for measuring of behaviors of psychiatric inpatients. CONCLUSIONS: The Ward Daily Behavior Scale-Korean version will be a valuable tool to observe and quantify patients' behavior in psychiatric wards.

Report on 7 Cases of Anisakiasis Involved the Upper Gastrointestinal Tract / 대한소화기내시경학회지

The anisakiasis disease that is infected through various kinds of larvae of the anisakis family when sea fish ia eaten uncooked or half-cooked. Sinee Van Thiel, a Netherlander, found in 1960 that anisakis larvae parasitize upon the human intestinal tract of the patients who suffer from ahdomieal pain after eating herrings, there have been a number of similar reports in North America and Japan, and the clinical importance of anisakis larvae for the acute gastrontestinal infection is rising. In general, as raw sea fish is not regarded as a source of parasite infestation, the patients who had eaten it and suffered from acute abdominal pain and vomiting are considered as and to be treated of food poisoning. But it is highly possible that some of them suffer from the acute gastrointestinal symptom caused by anisakis larvae. Thereby we report on 7 examples of anisakiasis taken through endoscopic diagnosis of the patients who have the acute upper abdominal pain after eating raw sea fish.

A Case of Henoch - Shoenlein Purpura with Duodenal Involvement / 대한소화기내시경학회지

Henoch-Shonlein(H-S) purpura, or anaphylactoid purpura is a hypersensitivity vasculitis characterized by palpable purpura usually on buttock and low extremities; arthralgia mostly polyarhtralgia in the absence of frank arthritis; gastraintestinal involvement with colicky abdominal pain, nausea, vomiting, diarrhea, constipation and bleeding; and renal involvement, manifested chiefly by hematuria and proteinuria. Gastrointestinal involvement is seen in 70 percent of pediatric patients and one third of adult patients. Any portion of the gastrointestinal tract distal to the esophagus maybe involved, but most frequently affected sites are jejunum and ileum. We report one case of H-S purpura with duodenal involvement observed in 16, male patient.

Clinical observation of acute drug intoxications / 영남의대학술지

Clinical observations were made on 349 cases of acute drug intoxication who were visited to emergency room of Yeungnam University Hospital during recent 7 years from January 1984 to December 1990. The following results were obtained. 1) Total number of cases of acute drug intoxication was 349 which was 0.39% of the total patients of the emergency room during the same period. 2) The ratio of male to female was 1.1:1. The age incidence was highest in the third decade (26.7%). The monthly incidence was highest in May. Higher frequency was observed in summer season. 3) The most common drug of the intoxication was pesticides and herbicides (71.9%), the remainders were miscellaneous drugs (11.2%), sedatives (7.7%), rodenticides (6.3%) and unknown drug (3.2%) in orders. 4) The most common cause of drug intoxication was suicide (69.1%) and the others were accident, unknown cause, intention in orders. 5) Main clinical manifestations were the impairment of consciousness, nausea, vomiting and convulsion. Physical examination revealed increased pulses, increased blood pressure, miosis of the pupil and sweating. Above symptoms and signs were more prominent in pesticide intoxication. Leukocytosis, glycosuria and abnormal LFT were common findings in acute intoxications. 6) The complications were developed in 18.3% among 349 cases and the most common complication was respiratory failure, pneumonia, cardiovascular collapse and pulmonary edema in orders. 7) Overall mortality rate was 8.3% of total cases and mortality rate was highest in herbicide intoxication (22.2%).

Clinical Observation of the Vertical and the Marginal Fracture of the Patella / 대한정형외과학회잡지

Lately the incidences of the patella fracture have been increasing due to frequent traffic and industrial accident, popularity of sports activity and falling. Sixty-nine cases of patella fractures, which were treated at Department of Orthopedic Surgery, Hallym College in the years of 1980 to 1985, were reviewed and the authors obtained the following results : 1. Frequently involved were third to fifth decades. 2. Traffic accident was the most common cause of the fracture. 3. Out of 69 cases, 42 were treated by open reduction and internal fixation. Among them we used circumferential wiring for 22 cases, modified tension band wiring for 13 cases and tension band wiring for 7 cases respectively. The remaining 5 cases were treated by patellectomy. 4. The most favorable recovery from the fracture was obtsined from modified-tension-band-wiring group.

Spontaneous Healing of the Hypervascular Nonunion of Humeral Shaft: A Case Report / 대한정형외과학회잡지

No abstract available.