RESUMEN
A 71-year-old man who had no prior history of chemotherapy or radiation therapy was diagnosed with nodular sclerosis Hodgkin's disease (HD) and IgA-kappa multiple myeloma (MM) simultaneously. The patient achieved a complete response of HD and a minor response of MM after 6 cycles of COPP/ABV chemotherapy. Thereafter, he had received oral mephalan and prednisolone without disease progression for 12 months. At 27-month follow-up, he succumbed to overwhelming pneumonia and septic shock with progressive disease of MM. We present this case as a first report of simultaneous occurrence of HD and MM in South Korea.
Asunto(s)
Anciano , Humanos , Progresión de la Enfermedad , Quimioterapia , Estudios de Seguimiento , Enfermedad de Hodgkin , Corea (Geográfico) , Mieloma Múltiple , Neumonía , Prednisolona , Esclerosis , Choque SépticoRESUMEN
BACKGROUND/AIMS: This study evaluated the use and efficacy of chronic oral etoposide plus tamoxifen as a palliative treatment in 30 patients with far-advanced HCC in whom surgical resection, percutaneous ethanol injection or transarterial chemoembolization(TACE) was not possible. METHODS: To be eligible for the study, patients had to have objectively measurable or evaluable tumors, adequate hematologic profiles and hepatorenal functions, had to be between 20 and 75 years of age, and had to have an ECOG performance status of less than or equal to 2. The treatment included etoposide, 50 mg/m2/day, taken orally for 21 days, and tamoxifen, 40 mg/day, taken orally for 21 days. Each cycle was repeated every 5 weeks. RESULTS: Two patients(7%) achieved a partial response(PR) and 16 patients(53%) achieved a stable disease(SD) with a median time-to-progression of 5 months(range: 2-24). Median of patients survival with the response of PR or SD and those patients with the response of progressive disease(PD) was 10 months and 7 months, respectively(p=0.0004). Of the 20 patients with initial elevated serum alpha-fetoprotein(> or =500 ng/ml), 9 patients(45%) experienced a significant(> or =50%) decrease in their values after chemotherapy and all 9 patients achieved objective tumor response of more than or equal to SD. Among the 30 patients in the study, 10 patients(33%) achieved performance status improvements of grade according to the ECOG criteria and 6 patients(20%) experienced improvements of subjective symptoms, such as abdominal pain, abdominal fullness and anorexia. CONCLUSION: Based on our results, the use of chronic oral etoposide plus tamoxifen as a palliative treatment for the far-advanced hepatocellular carcinoma are beneficial. A randomized two-arm study may be warranted to validate the results of this study.
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Humanos , Dolor Abdominal , Anorexia , Carcinoma Hepatocelular , Quimioterapia , Etanol , Etopósido , Cuidados Paliativos , TamoxifenoRESUMEN
BACKGROUND: The utility of bone marow examination (BME) in suspected idiopathic thrombocytopenic purpura (ITP) is an unresolved issue. We have assessed the laboratory findings and the usefulness of routine of BME in children and adults with ITP. METHODS: Data were collected from hospital medical records and laboratory results of 27 children and 36 adults who had undergone BME for investigation of isolated thrombocytopenia between 1996 and 1999. RESULTS: Fifty-nine (94%) of the 63 patients had normal or increased number of megakaryocytes on BME. Fifty-six of them were diagnosed as ITP. One patient (4%) in children and 3 patients (8%) of adults had decreased number of megakaryocytes suggestive of other disorders. In ITP, platelet associated immunoglobulin and reticulated platelet had low sensitivities, 23% and 38% respectively. Mean platelet volume (MPV) waslower than normal control group (P<0.001), but higher than aplastic anemia group (P= 0.025). There was no significant difference in platelet distribution width (PDW) between ITP group and aplastic anemia group. Platelet count and MPV were positively correlated (r=0.606, P<0.001). CONCLUSION: The sensitivities of laboratory tests with peripheral blood for ITP were generally low. However, in childhood and adult patients with suspected ITP the routine performance of BME may be able to be decreased provided that BME should be performed only when the possibility of other disorders is high through a thorough clinical history, physical examination and laboratory findings of peripheral blood.
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Adulto , Niño , Humanos , Anemia Aplásica , Plaquetas , Examen de la Médula Ósea , Médula Ósea , Inmunoglobulinas , Volúmen Plaquetario Medio , Registros Médicos , Megacariocitos , Examen Físico , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática , TrombocitopeniaRESUMEN
RS3PE is used to describe patients who have peripheral seronegative polyarthritis and pitting edema, especially in a man older than 60. It is characterized by sudden onset, high sedimentation rate, lack of bony erosion, remission within 18 months and good prognosis. Whether the RS3PE is a unique disease or syndrome has long been discussed, but conclusion was not obtained. We describe a 72 year old man of RS3PE with a review of the literature.
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Anciano , Humanos , Artritis , Edema , Pronóstico , SinovitisRESUMEN
The relationship between malignancy and membranous nephropathy remains unresolved exactly, but it was suggeste d that nephrotic syndrome can be menifested as a prodrome to underlying malignancy. It has been reported that membranous nephropathy is associated with malignancy, however, a few cases were reported in Korea. We recently experienced a patient with stomach cancer which was detected during the follow-up of the membranous nephropathy. Proteinuria and microsopic hematuria disappeared after subtotal gastrectomy. We concluded that the stomach cancer might be a cause of glomerulonephritis in this case.
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Humanos , Estudios de Seguimiento , Gastrectomía , Glomerulonefritis , Glomerulonefritis Membranosa , Hematuria , Corea (Geográfico) , Síndrome Nefrótico , Proteinuria , Neoplasias Gástricas , EstómagoRESUMEN
Copper is an essential trace element for numerous vital enzymes. Recently, copper can be used clinically as assessing the disease activity, prognosis, therapeutic effect and early prediction of recurrence in patient with neoplasia. But overloading of copper can cause fatal outcome. Copper intoxication is usually encountered following accidental ingestion or suicidal intoxication. A 43-year old male was admitted because of epigastric pain and hematuria after ingestion of the copper hydroxide and organophosphate for suicidal purpose. The laboratory findings showed that the serum and urinary copper concentration are elevated, then the acute renal failure, hemolytic anemia and liver injury progressed. With conservative management, the hemolytic anemia was improved, but disseminated intravascular coagulation with sepsis and respiratory failure by pneumonia were developed, and then finally expired on the eighth hospital days. We experienced a case of a patient who presented with acute renal failure, hemolytic anemia and liver injury after ingestion of copper, and we reported with review of literature.
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Adulto , Humanos , Masculino , Lesión Renal Aguda , Anemia Hemolítica , Cobre , Coagulación Intravascular Diseminada , Ingestión de Alimentos , Resultado Fatal , Hematuria , Hígado , Neumonía , Pronóstico , Recurrencia , Insuficiencia Respiratoria , SepsisRESUMEN
Aplastic anemia is characterized by a failure of blood cell production resulting in varying degrees of pancytopenia with a markedly hypocellular bone marrow. Most cases of aplastic anemia are acquired, but the disease may also occur as the result of inherited abnormalities. In 50-65% of cases, however, the etiology is unknown. For acquired forms of aplastic anemia, a variety of causative factors, including radiation, viruses, chemicals and drugs, have been implicated. Antithyroid drugs(Carbimazole, Methimazole, Propylthiouracil) are usually listed among agents associated with the development of agranulocytosis, but aplastic anemia rarely follows their use. The first case of aplastic anemia followmg propylthiouracil was reported by Marte~lo et al. in 1967 and the second case was by Aksoy and Erdem in 1968. Recently, we experienced two cases of aplastic anemia following propylthiouracil therapy due to Graves disease, so we report here these cases with literature review.
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Agranulocitosis , Anemia Aplásica , Células Sanguíneas , Médula Ósea , Enfermedad de Graves , Metimazol , Pancitopenia , PropiltiouraciloRESUMEN
The development of glomerular injury in patients with malignancy is considered as paraneoplastic syndrome. The most frequently observed renal lesions associated with malignancies are the membraneous glomerulonephritis on carcinomas and minimal change nephrotic syndrome on Hodgkin's disease. However, glomerular diseases on non-Hodgkin's lymphoma were only occasionally reported. Here we report a case of IgA nephropathy associated with non-Hodgkin's lymphoma. A 53-year-old woman who had complained of gross hematuria and fever was admitted to Wonju Christian Hospital. A urinalysis revealed 2+ proteinuria and red blood cells >30/HPF. A 24-hour urinary protein excretion was 379mg. She was diagnosed as IgA nephropathy on renal biopsy. Subsequently, biopsy of her enlarged neck node was performed for evaluation of fever of unknown origin and it revealed non-Hodgkin's lymphoma (Ki-1 positive anaplastic lymphoma null cell type). Combination chemotherapy was instituted with cyclophosphamide, adriamycin, vincristine and prednisone. After 3 cycles of chemotherapy, she showed no evidence of proteinuria and hematuria with clinical and radiological improvement of malignant lymphoma. Therefore we suggest of certain association between IgA nephropathy and non-Hodgkin's lymphoma by the observation of corresponding disease activity.
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Femenino , Humanos , Persona de Mediana Edad , Biopsia , Ciclofosfamida , Doxorrubicina , Quimioterapia , Quimioterapia Combinada , Eritrocitos , Fiebre , Fiebre de Origen Desconocido , Glomerulonefritis , Glomerulonefritis por IGA , Hematuria , Enfermedad de Hodgkin , Inmunoglobulina A , Linfocitos Nulos , Linfoma , Linfoma no Hodgkin , Cuello , Nefrosis Lipoidea , Síndromes Paraneoplásicos , Prednisona , Proteinuria , Urinálisis , VincristinaRESUMEN
PURPOSE: To evaluate survival rate and prognostic factors affecting survival of patients with esophageal cancer treated with concurrent chemoradiation. MATERIALS AND METHODS: Eligibility included biopsy proven invasive carcinoma of the cervical or thoracic esophagus, confined to esophagus and mediastinum with or without regional lymph node and supraclavicular lymph node, and ECOG performance status H0-H2. Patients received radiation therapy with 5940 cGy over 7 weeks and chemotherapy, consisted of 5-FU (1000 mg/m2/day in continuous infusion for 5 days, days 1 to 5 and days 29 to 33) and mitomycin C (8mg/m2 intravenous bolus at day 1). After concurrent chemoradiation, maintenance chemotherapy was followed with 5-FU (1000 mg/m2/day in continuous infusion for 5 days at 9th, 13th, and 17th weeks) and cisplatin (80mg/m2 intravenous bolus at the first day of each cycle). RESULTS: From November 1989 to November 1995, 44 patients were entered in this study. After treatment, complete response rate and partial response rate were 59% and 41%. Overall 1, 2, and 5-year survivals were 59%, 38%, and 9.6% (median 17 months). Prognostic factors affecting survival were response to treatment and T-stage. Among 26 complete responders, there were 6 local recurrences, 3 distant recurrences, 1 local and distant recurrence, and 2 unknown site recurrences. Acute and chronic complication rates with grade 3 or more were 20% and 13.6% and there was no treatment-related mortality. CONCLUSION: Concurrent chemoradiation, compared with historical control groups that treated with radiation alone, improved median survival and did not significantly increase treatment-related complications. Complete responders had longer survival duration than partial responders. Predominant failure pattern was local failure. So, efforts to improve local control should be proposed.
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Humanos , Biopsia , Cisplatino , Quimioterapia , Neoplasias Esofágicas , Esófago , Fluorouracilo , Ganglios Linfáticos , Quimioterapia de Mantención , Mediastino , Mitomicina , Mortalidad , Recurrencia , Tasa de SupervivenciaRESUMEN
PURPOSE: We performed this study to determine the diagnostic significance and useful cut-off value of reticulated platelet, which can be used for discriminating the destructive thrombocytopenia from underproductive thrombocytopenia. METHODS: We evaluated 37 patients with thrombocytopenia who were admitted to the Wonju christian hospital from March to July, 1995. All patients were evaluated with bone marrow megakaryocyte count. We divided them into two groups, group 1 was consisted of underproductive thrombocytopenic patients and group 2 was consisted of destructive thrombocytopenic patients. We measured the peripheral blood reticulated platelet count by FACScan flowcytometry after thiazole orange staining. RESULTS: 1) Among 37 patients, underproductive group consisted of 21 patients and destructive group consisted of 16 patients. 2) There was no significant difference in platelet count between two groups (41.7 31.8x109/L vs. 41.0 29.1x109/L). 3) Destructive group showed higher reticulated platelet count than underproductive group (7.7 3.7% vs. 19.1 11.1% : p<0.01). 4) Ideal cut-off value of reticulated platelet count for the discrimination of two groups was 11%. Its sensitivity and specificity were 88% and 95%, respectively. CONCLUSIONS: We suggest that reticulated platelet count is closely correlated with thrombopoiesis of bone marrow. The measurement of reticulated platelet can be a simple and useful diagnostic tool to discriminate destructive thrombocytopenia from underproductive thrombocytopenia.
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Humanos , Plaquetas , Médula Ósea , Citrus sinensis , Discriminación en Psicología , Megacariocitos , Recuento de Plaquetas , Sensibilidad y Especificidad , Trombocitopenia , TrombopoyesisRESUMEN
Blood-borne metastatic involvement of the stomach by cancer is a rare entity. According to the number of reports in the literature, the most common tumors that spread to the stomach through the blood stream are malignant melanoma, breast carcinoma and lung carcinoma. Recently, two cases of metastatic involvement of the stomach secondary to lung carcinoma were diagnosed by gastroscopy. The first patient was a 66-year-old man who had primary lung carcinoma with multiple bone and subcutaneous metastases. Gastroscopy showed multiple submucosal tumors with central umbilications in the fundus and in the upper body of the stomach. Pathologic examination revealed massive submucosal infiltration and conical shaped and scanty deep mucosal infiltration of undifferentiated small cell carcinoma suggestive of metastatic involvement. The second patient was a 68-year-old man who had primary lung carcinoma with brain metastasis. Gastroscopy showed a large fungating mass in the greater curvature side of the stomach. Pathologic examination revealed poorly differentiated squamous cell carcinoma. We report the two cases of metastatic gastric cancer from lung carcinoma with the literature review.
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Anciano , Humanos , Masculino , Carcinoma de Células Pequeñas/secundario , Carcinoma de Células Escamosas/secundario , Neoplasias Pulmonares/patología , Neoplasias Gástricas/secundarioRESUMEN
There is increasing evidence that genes involved in normal cell growth and differentiation (oncogenes) or genes that encode for growth factors are important in determining the development and biologic aggressiveness of gastric carcinoma. This study was undertaken to define the prognostic value of the overexpression of p53 protein, c-erbB-2 protein, EGFr protein and PCNA in gastric carcinomas. Using monoclonal antibodies, immunohistochemical studies were performed on formalin-fixed, paraffin-embedded tissue sections from 84 primary gastric carcinomas. Overall, 34% of gastric carcinomas had nuclear-staining for p53 protein, 34% of carcinomas membrane staining for the c-erbB-2 and 74% of carcinomas membrane and cytoplasmic staining for EGFr, showing distribution in a heterogeneous fashion. PCNA was expressed as Grade 2 and 3 in 75% of patients with gastric carcinomas. Both c-erbB-2 and p53 staining was significantly associated with high grade expression of PCNA. p53 staining tended to be associated with positive nodal status and metastasis, and c-erbB-2 staining with positive nodal status only. Multivariate analysis using the Cox model showed that overexpression of p53 protein, c-erbB-2 protein and PCNA was not an independent prognostic variable in gastric carcinoma. These results suggest that expressions of p53 and c-erbB-2 protein are heterogeneous and that p53 and c-erbB-2 overexpressions are significantly associated with high proliferative activity in gastric carcinoma.
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Humanos , Antígenos de Neoplasias/análisis , Inmunohistoquímica , Análisis Multivariante , Proteínas de Neoplasias/análisis , Proteínas Nucleares/análisis , Pronóstico , Antígeno Nuclear de Célula en Proliferación , Proteínas Proto-Oncogénicas/análisis , Receptores ErbB/análisis , Receptor ErbB-2 , Estudios Retrospectivos , Neoplasias Gástricas/química , Tasa de Supervivencia , Proteína p53 Supresora de Tumor/análisisRESUMEN
No abstract available.