Gemcitabine and Vinorelbine Combination Chemotherapy in Anthracycline- and Taxane-pretreated Advanced Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Anthracycline and taxanes are effective agents in advanced breast cancer and prolong survival times. Some patients achieve prolongation of life with capecitabine, gemcitabine, or vinorelbine, even after failure of both anthracycline and taxanes. We analyzed the efficacy and toxicity of gemcitabine and vinorelbine combination chemotherapy in anthracycline- and taxane-pretreated advanced breast cancer. MATERIALS AND METHODS: The medical records of anthracycline- and taxane-pretreated metastatic breast cancer patients who received gemcitabine and vinorelbine combination chemotherapy at the Seoul National University Hospital were reviewed. Gemcitabine (1,000 mg/m2) and vinorelbine (25 mg/m2) were administered intravenously on days 1 and 8 every 3 weeks. RESULTS: Between 2000 and 2006, 57 patients were eligible (median age, 45 years), and the median number of previous chemotherapy regimens was 3 (range, 1~5). The overall response rate was 30% (95% CI, 18.1~41.9), and the disease control rate was 46% (PR, 30%; SD, 16%). The median duration of follow-up was 33.4 months, the median time-to-progression (TTP) was 3.9 months, and the median overall survival was 10.8 months. None of thepatients with patients with anthracycline and taxane primary resistance showed a response and the median TTP for these patients was significantly shorter than that of other patients (1.9 vs. 4.4 months; p=0.018). Although the efficacy was unsatisfactory in patients with both anthracycline and taxane primary resistance, gemcitabine and vinorelbine combination chemotherapy showed comparable efficacy in anthracycline- and/or taxane-sensitive patients and the patients with secondary resistance, even after failure of second-line therapy. Grade 3/4 hematologic toxicities included neutropenia (18.1%) and febrile neutropenia (0.3%), and non-hematologic toxicities were tolerable. CONCLUSION: Gemcitabine and vinorelbine combination chemotherapy in anthracycline- and taxane-pretreated advanced breast cancer was effective and tolerable.

A case of secondary amyloidosis presenting acute renal failure in rheumatoid arthritis patient / 대한내과학회지

Amyloidosis is a heterogenous group of often fatal disorders characterized by extracellular deposition of a proteinaceous material with a unique fibrillar form in various tissues and organs. Deposition of amyloid may cause widespread dysfunction of the involved organs. A secondary amyloidosis is AA amyloidosis and rheumatoid arthritis is one of the main underlying disease. We report a case of secondary amyloidosis in a 52 year old woman with rheumatoid arthritis. She had suffered from rheumatoid arthritis for 17 years and her hands and feet were deformed. She was presented with oliguric acute renal failure. She was confirmed by showing apple green birefringence under the polarized microscope with Congo-red stain through renal and rectal biopsy. We couldn't find any previous report of the secondary amyloidosis among the patients presenting oliguric acute renal failure without proteinuria in the Korean literatures.

Gouty Tophus on the Tibial Tuberosity with Accompanied Chemical Cellulitis Localized at the Upper Tibia / 대한류마티스학회지

Gout is characterized by hyperuricemia and recurrent attacks of acute arthritis. Gout is a clinical syndrome resulting from the deposition of urate (monosodium urate monohydrate) crystals. Urate deposition occurs in articular cartilage, subchondral bone, synovial membrane, joint capsule and periarticular tissues, with articular cartilage being especially susceptible. The first metatarsophalangeal joint is commonly involved at presentation and other commonly affected joints are the ankle, knee and tarsal area. Gouty tophus located on the tibial tuberosity has never been reported in korea. We report a case of gouty tophus on the tibial tuberosity with (chemical) cellulitis occurred at the upper tibial area in a 46- year-old man.

Comparison of efficacy and safety of simvastatin, 10 mg and 20 mg in the treatment of hypercholesterolemia / 대한내과학회지

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day. METHODS: One hundred six patients with hyperlipidemia (triglycerides130 mg/dL) were randomized to receive either simvastatin 10 mg/day (n=43) or 20 mg/day (n=63). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol. RESULTS: Of the one hundred six patients randomized to treatment, forty patients were men and sixty-six patients were women. Fifty-five percent of patients had hypertension, nine percent coronary artery disease and thirteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 258 (total cholesterol), 201 (triglycerides), 50 (HDL) and 167 mg/dL (LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters (p< 0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater (p< 0.001) reductions from baseline LDL cholesterol (34.9 mg/dL vs 20.8 mg/dL). But 10 mg of simvastatin was more effective than 20 mg of simvastatin at reducing triglycerides level (42.7 mg/dL vs 22.3 mg/dL). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline (ATP III) were 81% and 80% for patients in low risk but 35% and 50% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients (4.8%) in the 20 mg group and one patient (2.3%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION : In patients with hypercholesterolemia in Korea, both doses (10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients' preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.