The Effects of Counseling about Death and Dying on Perceptions, Preparedness, and Anxiety Regarding Death among Family Caregivers Caring for Hospice Patients:A Pilot Study / 한국호스피스완화의료학회지

Purpose@#This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. @*Methods@#Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants’ scores before and after counseling were compared using the paired t-test. @*Results@#Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P＜0.001) and preparedness for death and dying (t=-16.23, P＜0.001)improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. @*Conclusion@#The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones.Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

Positive response of a primary leiomyosarcoma of the breast following salvage hyperthermia and pazopanib

No abstract available.

Everolimus-induced activation of latent Mycobacterium tuberculosis infection in a patient with metastatic renal cell carcinoma

No abstract available.

Epithelioid sarcoma with spontaneous pneumothorax and massive pleural effusion

No abstract available.

Imatinib mesylate-induced interstitial lung disease in a patient with prior history of Mycobacterium tuberculosis infection

No abstract available.

A Case of a Huge Mass Due to Pleural Metastasis and Management of Dyspnea in a Patient with Terminal Breast Cancer / 한국호스피스완화의료학회지

Pleural metastasis from breast cancer is a common manifestation. While pleural effusion is the most frequent finding, it is relatively rare for pleural nodularity and plaque that do not accompany pleural effusion. We report a patient with a rapidly growing huge pleural mass without pleural effusion caused by breast cancer. The patient was treated for severe dyspnea caused by the pleural mass. Along with the case report, we performed a systematic review of management of dyspnea in terminal cancer patients.

Clinical Features and Treatment of Collecting Duct Carcinoma of the Kidney from the Korean Cancer Study Group Genitourinary and Gynecology Cancer Committee / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Collecting duct carcinoma (CDC) of the kidney is an aggressive disease with a poor prognosis, accountings for less than 1% of all renal cancers. To date, no standard therapy for CDC has been established. The aim of this study is an investigation of clinicopathologic findings of CDC and correlation of the disease status with a prognosis. MATERIALS AND METHODS: From 1996 to 2009, 35 patients with CDC were treated at eight medical centers. The diagnosis of CDC was made based on nephrectomy in 27 cases and renal biopsy in eight cases. RESULTS: Median PFS and OS for all patients were 5.8 months (95% CI 3.5 to 9.2) and 54.4 months (95% CI 0 to 109.2), respectively. The OS of patients with Stages I-III was 69.9 months (95% CI 54.0 to 85.8), while that of patients with Stage IV was 8.6 months (95% CI 0 to 23.3), which showed a statistically significant difference (p=0.01). In addition, among patients with Stage IV, the OS of patients who received a palliative treatment (immunotherapy, chemotherapy, or targeted therapy) was 18.4 months, which was higher than the OS of patients without treatment of 4.5 months. CONCLUSION: CDC is a highly aggressive form of renal cell carcinoma. Despite most of the treatments, PFS and OS were short, however, there were some long-term survivors, therefore, conduct of additional research on the predictive markers of the several clinical, pathological differences and their treatments will be necessary.

Successful treatment of myelodysplastic syndrome and Behcet colitis after allogeneic hematopoietic stem cell transplantation

No abstract available.

Autologous peripheral blood stem cell transplantation with high-dose therapy for anaplastic large cell lymphoma with progressive myelofibrosis / 대한내과학회지

Myelofibrosis is a myeloproliferative neoplasm characterized by abnormal bone marrow megakaryocyte proliferation with reticulin and collagen fibrosis, leukoerythroblastosis, anemia, increased level of serum lactate dehydrogenase and splenomegaly. Myelofibrosis associated with malignant lymphoma is rare and survival rates appear to have been poor. Herein, we describe our experience in a patient who remained in complete remission with high-dose therapy (HDT) with autologous peripheral blood stem cell transplantation (PBSCT) for ALK-negative ALCL presenting with rapidly progressing myelofibrosis.

Effect of Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura: Report of 3 cases / 대한내과학회지

There are several reports suggesting Helicobacter pylori can initiate and perpetuate idiopathic thrombocytopenic purpura (ITP) and eradication of H. pylori can increase the platelet counts, however, the prevalence of H. pylori infection in patients with ITP is similar to that found in the general population and a recovery of thrombocytopenia after H. pylori eradication therapy has not been identified reliably. We report three different cases of H. pylori infected patients with ITP who recovered completely after eradication of H. pylori. The first case was refractory, the second was recurred after conventional treatment for ITP, and the third was treated with H. pylori eradication on first line treatment. We believe that the eradication of H. pylori is useful in some patients with ITP in Korea and well controlled randomized study is necessary for further identification of such population.

A case of recurred malignant melanoma of the stomach and peritoneum / 대한내과학회지

Malignant melanoma may spread through the lymphatic channels or via the bloodstream. The lung, liver, bone and brain are common sites of hematogenous metastases. Malignant melanoma that has recurred to the stomach or peritoneum is not common. An 83-year old male patient was admitted to the Department of Oncology due to abdominal distension; 13 years ago, the patient had previously received a complete surgical resection for malignant melanoma of the right heel. According to a computed tomography (CT) scan of the abdomen, peritoneal carcinomatosis was suggested. Under a gastrofiberoscopic examination, two small sized polyps with central umbilication were found on the midbody of the stomach. The gastric polyps were histopathologically confirmed as metastatic melanoma. We report a rare case of metastatic malignant melanoma that has recurred to the stomach and peritoneum 13years after its initial diagnosis.

Recurrent Pneumomediastinum and Subcutaneous Emphysema Complicating Chronic Graft versus Host Disease after Allogeneic Bone Marrow Transplantation / 대한혈액학회지

Several noninfectious pulmonary complications can be associated with chronic graft versus host disease (GVHD). Obstructive airway disease can be a clinical feature of chronic GVHD and the histopathology reveals characteristic lesions of bronchiolitis obliterans. Bronchiolitis obliterans is an obstructive pulmonary disorder affecting the small airways, and it was first described as a late complication of allogeneic bone marrow transplantation (BMT). Spontaneous pneumomediastinum and subcutaneous emphysema can occur in the setting of severe bronchiolitis obliterans and only rarely are they the first sign of such disease. We describe here a case of a 27-year old woman who developed recurrent pneumomediastinum and subcutaneous emphysema that were secondary to the bronchiolitis obliterans that complicated chronic GVHD after allogeneic BMT.

Regression of Extensive Colonic Extranodal Marginal Zone B Cell Lymphoma after Treatment with Rituximab / 대한혈액학회지

We report here on a case of colonic extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) in a 17-year-old male with a history of selective IgA deficiency. The colonoscopic findings showed prominent lymphoid hyperplasia along the terminal ileum and multiple ulceroinfiltrative nodular lesions at the transverse colon and rectum. Immunohistochemically, an extensive infiltration by a CD20-positive lymphoid cell population that displayed a prominent lymphoepithelial structure was detected. Multiple hypermetabolic lymph nodes were found in the cervical, axillary, mediastinal and abdominal regions, in addition to the colon, by performing PET-CT. After administering rituximab weekly for 4 weeks, he had significant regression of the colonic lesions and the lesions in multiple lymph nodes. He remains progression free 10 months after finishing the treatment. This case report demonstrates the potential efficacy of rituximab as a single therapeutic agent for patients with colonic extranodal marginal zone B-cell lymphoma, and even for a patient with an extensive disease status.

A Case of Right Coronary Artery to Left Ventricle Fistula with Progression to Spontaneous Closure: Echocardiographic Findings

Coronary artery fistula (CAF) is a rare congenital cardiac anomaly, which mainly drains to the right side heart. As the progression to spontaneous closure in CAF was rare, it needed surgery or catheteric embolization in asymptomatic patients due to the future risk of congestive heart failure, myocardiac infarction or sudden death. With the advent of high resolution two-dimensional and color doppler echocardiography during the past decade, more cases of CAF have been diagnosed and spontaneously closed cases have been increased. Here we report a healthy neonate except heart murmur, who showed a right coronary to left ventricle fistula with progression to spontaneous closure at 11months of age. As the natural course of CAF is still poorly defined and spontaneous closure is increasing, it will be desirable to be followed up regularly by echocardiography in asymptomatic cases, rather than to be corrected surgically.

Clinical analysis of malignant gastrointestinal obstruction in terminal cancer patients / 대한내과학회지

BACKGROUND: Untreated malignant gastrointestinal obstruction is rapidly fatal and causes various symptoms and malnutrition, and so decreases the quality of life and shortens the survival. We reviewed clinical characteristics and analyzed prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction. METHODS: We retrospectively reviewed the medical records of 63 patients with malignant gastrointestinal obstruction who had been confirmed by endoscopy or colonoscopy, upper gastrointestinal series or barium study and proper radiologic study at Sam Anyang hospital from May in 2002 to December in 2004. We excluded patients with palliative tumor resection. We analyzed prognostic factors for overall survival and symptom-free survival. RESULTS: There were 30 males (48%) and 33 females (52%), and median age of 63 patients was 64 years. The cause of malignant gastrointestinal obstruction was colorectal (26 patients, 41%), stomach (19, 30%), pancreas (4, 6%) and others (14, 23%). Twenty one patients (33%) had Eastern Cooperative Oncology Group (ECOG) performance status of 2 score and 42 patients (67%) 3 or 4 score. Forty two patients (67%) have been performed palliative procedures and 21 patients (33%) have not. Median survival of patients with palliative procedure was significantly higher than that of patients who have not been performed palliative procedures (144 days v 45 days, p=0.0001). By mutivariate analysis, palliative procedures and performance status were independent prognostic factors. However, age, gender, primary cancer, site of obstruction, and previous chemotherapy were not independent prognostic factors. Performance status was only independent prognostic factor that improves symptom free survival in patients with palliative procedures (p=0.014) and median symptom free survival was 90 days. There was no mortality on palliative procedures. CONCLUSIONS: We confirmed that palliative procedures and performance status are significant independent prognostic factors in terminal cancer patients with malignant gastrointestinal obstruction.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A Case of Primary Upper Esophageal Small Cell Cancer with Cervical Lymph Node Metastasis / 대한소화기내시경학회지

Esophageal small cell carcinoma is a very rare disease. Primary extra-pulmonary small cell carcinoma was reported to account for 4% of primary small cell carcinoma and only 2% of all esophageal malignancy. Because the rate of early distant metastasis is very high, the prognosis is very poor. In Korea, 20 cases were reported. Seventeen cases were located at the mid or lower esophagus and 3 cases were located at the upper esophagus. We have experienced a case of primary upper esophageal small cell cancer, a 65-year-old female with cervical lymph node metastasis, which were diagnosed by endoscopy, open surgical lymph node biopsy and immunohistochemical analysis.

A case of adenocarcinoma, signet ring cell type, in 2nd portion of duodenum associated with neurofibromatosis type I / 대한내과학회지

The neurofibromatoses are a rare group of hereditary diseases of autosomal dominant fashion with the overall incidence of one in 3,000~4,000 and with two distinct forms, type I (Von Recklinghausen's neurofibromatosis) characterized by skin lesions including multiple cutaneous neurofibromas, axillary and groin freckling, and cafe-au-lait spots and type II by the presence of bilateral vestibular schwannomas. The neurofibromatosis type I is associated with the mutation of NF-I gene on chromosome 17q 11.2, which has a tumor suppressive role and with resultant development of the wide variety of tumors with the malignant incidence of about 2~16 %. Although the cases of malignant tumors in the neurofibromatosis type I have been reported in various tumors with the neural origin, lymphoma, pheochromocytoma and some cases of gastrointestinal tumors, the gastrointestinal tumors were found in only hepatobiliary system and large and small bowels and the cases of the malignant tumors of upper GI origin in duodenum and stomach have not been reported yet in Korea. We report a case of a 64-year-old man admitted with epigastric pain and diagnosed to adenocarcinoma, signet ring cell type, in 2nd portion of duodenum associated with neurofibromatosis type I.

A Case of Improved Menetrier's Disease after the Eradication of the Helicobacter pylori and Long Term Treatment with Proton Pump Inhibitor / 대한소화기내시경학회지

Menetrier's disease is a protein losing hypertrophic gastropathy characterized by hypoproteinemia, and often is associated with the development of gastric cancer. Though the cause of Menetrier's disease has been unknown, the association with Helicobacter pylori was reported. A 30-year-old man was hospitalized for the evaluation of progressive dyspepsia for 2 years, hypoproteinemia, and recently aggravated epigastric pain with weight loss. Gastroscopy revealed prominent folds and multiple variable sized polypoid eminence in the body and antrum with positive CLO test. Histological findings revealed gastritis with erosions and foveolar hyperplasia. Any other diseases causing protein losing enteropathy were excluded. After the eradication of the H. pylori and long term treatment with proton pump inhibitor, clinical, endoscopic, and biochemical resolution ensued. Thus, we suggest that H. pylori eradication should be tried in patients with Menetrier's disease before invase treatment modalities such as surgical resection.