Solitary schwannoma of the ascending colon / 영남의대학술지

No abstract available.

A Case of Gastritis Cystica Profunda Presenting with a Submucosal Cystic Tumor / 대한소화기내시경학회지

Gastritis cystica profunda (GCP) is a lesion characterized by elongation of the gastric foveolae with hyperplasia and cystic dilatation of the gastric glands that extends into the submucosal layer. In most cases, gastritis cystica profunda develops in patients who have undergone a gastroenterostomy, with or without gastric resection. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps, but GCP is also rarely seen as a giant gastric mucosal fold. A patient arrived at our hospital with dyspepsia. Gastroduodenoscopy (EGD) showed the presence of a submucosal tumor measuring 3 cm in the widest diameter in the body of the stomach. A CT scan demonstrated the cystic nature of the lesion and endoscopic ultrasound (EUS) depicted a homogeneous hypoechoic, unilocular cystic mass without any internal solid component. EGD, CT and EUS findings suggested that the lesion was more likely to be benign than malignant. The lesion was treated with an endoscopic mucosal resection (EMR), and the lesion was finally diagnosed as gastritis cystica profunda. A follow-up EGD demonstrated that all mucosal surfaces were well healed four weeks after the EMR.

Docetaxel-Cisplatin-5-FU Combination Chemotherapy as a First-line Treatment in Patients with Metastatic or Recurred Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of 'docetaxel-5-FU-cisplatin' combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. METHODS: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received 'docetaxel-5-FU-cisplatin' combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. RESULTS: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. CONCLUSIONS: 'docetaxel-5-FU-cisplatin' combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer.

Amiodarone-induced Hepatitis and Polyneuropathy

Amiodarone chlorhydrate is a diiodated benzofuran derivative, and it is used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone, and symptomatic hepatic dysfunction occurs in fewer than 1% of the patients taking amiodarone. Cirrhosis is a rare complication that's been confirmed in 12 cases. Peripheral neuropathy occurs in 10% of patients taking aminodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity and peripheral neurotoxicity. A 75 year old man with normal liver function was given amiodarone for treating his atrial fibrillation and heart failure. He developed nausea, vomiting, muscle weakness and wasting after 17.8 months therapy with amiodarone (400 mg orally once per day). Liver biopsy showed the presence of foam cells in the hepatic sinusoids and Mallory bodies in the periportal hepatocytes on light microscopy. Sural nerve biopsy showed demyelination, and nerve conduction studies showed mixed sensorimotor polyneuropathy. These observations show the necessity of monitoring the hepatic function and conducting neurologic examination of the patients treated with amiodarone.

A Case of Intestinal Obstruction Caused by Strangulated Femoral Hernia Accompanying Soft Tissue Necrosis / 대한소화기학회지

Intestinal obstruction involves a partial or complete blockage of the bowel which results in the failure of intestinal contents to pass through. The mechanical causes of obstruction may include the followings: hernias, postoperative adhesions or scar tissue, impacted feces, gallstones, tumors, granulomatous processes, intussusception, volvulus, foreign bodies, and etc. Hernias are the third leading cause of intestinal obstruction by 10% approximately. However, most hernias are the cases with abdominal wall, inguinal or internal hernia. Femoral, obturator, lumbar, or sciatic hernia as the cause of obsturction is rare. Furthermore, the cases accompanying soft tissue necrosis are seldomly reported. Herein, we report a case of intestinal obstruction caused by strangulated femoral hernia accompanying soft tissue necrosis in a 78-years-old female patient.

Abnormalities of liver function tests in patients with hyperthyroidism / 대한내과학회지

BACKGROUND: Abnormalities of liver function tests are common in patients with hyperthyroidism and may reflect thyroid hormone status. The aim of our study was to analyze the frequency of abnormal liver function tests in the patients with hyperthyroidism at diagnosis and the association with the thyroid function state after antithyroid therapy. METHODS: Three hundred seventy eight patients with hyperthyroidism who visited Chungnam National University Hospital from June 2004 to May 2005 and had no other causes for abnormal liver function tests were examined. At diagnosis, 272 of 378 patients had various abnormalities seen on the liver function tests. Among 272 patients, 65 were followed up for liver function tests and were analyzed for sex, age, use of an antithyroid drug, and thyroid function tests after administration of an antithyroid drug. We analyzed the frequency of liver function abnormalities and the relevance between abnormalities of liver function and the thyroid function state. RESULTS: Abnormalities in AST, ALT, total bilirubin, alkaline phosphatase and GGT were observed in 16.4%, 31.0%, 3.2%, 48.7% and 26.9% of the 378 patients with hyperthyroidism, respectively. The level of alkaline phosphatase was the most common abnormal parameter. After antithyroid therapy, 48 (73.8%) of 65 patients had normalization of their liver function abnormalities. The normalization rate for AST, ALT, alkaline phosphatase and GGT were higher in the euthyroid status group than the sustained hyperthyoid status group. The normalization rate for ALT was significantly higher in the female group than in the male group, but the effect of antithyroid drug use and age on the normalization rate was not statistically significant. CONCLUSIONS: These findings indicate that abnormalities of liver function tests are common in patients with hyperthyroidism and these abnormalities are strongly associated with thyroid hormone status.

Docetaxel as Second-line Monotherapy for Advanced Non-small Cell Lung Cancer / 결핵및호흡기질환

BACKGROUND: The survival benefit associated with first-line chemotherapy in lung cancer has led to the need for second-line chemotherapy, for which Docetaxel (Taxotere(R)) has proven efficacy in both settings. This study evaluated the safety and efficacy of docetaxel in patients with non-small cell lung cancer who had failed first-line platinum- based chemotherapy. METHODS: Thirty one patients with non-small-cell lung cancer, who had failed first-line platinum-based chemotherapy, between March 1999 and August 2003, were enrolled in this study. Patients received intravenous docetaxel, either 75 mg/m2 or 100 mg/m2, with routine premedication every three weeks. RESULTS: Fourteen patients (45.2%) had a partial response. The median survival and progression-free survival times were 12.5 months (95% CI 7.3-17.6) and 3.0 months (95% CI 1.6-4.5), respectively. This study showed 2 factors gave different survival benefits; the age ( or = 60 years: 6.6 months, p = 0.0105) and the histological type (adenocarcinoma: 25.6 months vs. others: 7.9 months, p=0.0055). The predominant toxicity was neutropenia, which occurred as WHO grade 3 or 4 in 38.7 % of patients. One treatment-related death was also reported. Non-hematological toxicity was minor and easily controlled. There were no significant statistical differences in the survival benefit and toxicity between the two doses. CONCLUSION: Docetaxel, as second-line monotherapy, was well tolerated and effective in patients with non-small- cell lung cancer who failed first-line platinum-based chemotherapy.

Multimodality Treatment Based on Induction Chemotherapy for Stage III NSCLC

PURPOSE : The aim of this study was to validate the effect and the feasibility of induction chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC) on multimodality treatment. MATERIALS AND METHODS : From January 2002 to December 2003, 84 chemonaive patients with Stage III NSCLC, median age of 64 years, ECOG perfomance satus 0, 1, or 2, and without other comorbid disease were enrolled this study and received chemotherapy every 3 weeks. After two or three cycles of induction chemotherapy (gemcitabine with cisplatin), patients were reevaluated by chest CT and then underwent resection, radiotherapy, further chemotherapy, or observation. RESULTS : Overall clinical responses were seen in 43 (57%) of the 76 assessable patients. Response rates were 61% and 53% in patients with stage IIIA and IIIB disease, respectively. Twenty-eight patients out of initially unresectable 70 patients (19 of 32 stage IIIA and 9 of 38 stage IIIB) after induction chemotherapy seemed to be resectable. Operation was done in 23 out of 32 patients who achieved clinically resectable stage after induction chemotherapy and 20 (87%) resections were complete and 3 were incomplete including 1 case of open & closure. Thirty-two patients were treated with chest radiation after chemotherapy. Eighteen patients were treated with chemotherapy upto 6 cycles and 6 patients refused further treatment after induction chemotherapy. Median follow up of all patients was 16.2 months, median survival was 16 months, and estimated disease progression free interval was 11 months. Survival and disease progression free interval were different with between induction chemotherapy followed by complete resection subgroup and followed by radiation therapy subgroup (24 vs. 14 months, p=0.04). Grade 3/4 neutropenia and thrombocytopeina were noticed in 29% and 10%, respectively and one chemotherpy related death was also noticed. CONCLUSION : Induction chemotherapy followed by surgery with or without adjuvant radiation might be the recommendable management to improve the survival in locally advanced NSCLC with feasible toxicity

Gemcitabine Plus Vinorelbine as Second-line Chemotherapy of the Patients of Previously Treated Non-small Cell lung Cancer: Phase II Trial / 결핵및호흡기질환

BACKGROUND: Both gemcitabine and vinorelbine are effective anticancer drugs with mild toxicity on non-small cell lung cancer, and monotherapy of these drugs are effective as a second-line chemotherapy. The aim of this trial was to assess the response and toxicity of a combination of gemcitabine and vinorelbine in patients of previously treated for non-small cell lung cancer. MATERIALS AND METHODS: 24 patients, initial stage III A/B,IV and previously treated with platinium and taxane based regimens, were enrolled from June 2000 to March 2004. The regimens consisted of vinorelbine 25mg/m2 followed by an infusion of gemcitabine 1000mg/m2 on day 1 and day 8 every three weeks. This course was repeated more than twice. RESULTS: Twenty-four patients were analyzed for the response, survival rate, and toxicities. The overall response was 17% with a complete remission rate of 4%. The median time-to progression (TTP) was 3.1 months (95%, CI 1-10months), and the survival time was 8.2 months (95%, CI 1-23 months). The grade 3/4 toxicities encountered were neutropenia (12.5%), anemia (0%), thrombocytopenia (0%). Non-hematological 3/4 toxicities were not observed. CONCLUSION: A combination of gemcitabine and vinorelbine in patients previously treated for non-small cell lung cancer provides a relatively good response rate, and a low toxicity profile. However, further study will be needed to confirm its effectiveness.

Multimodality Treatement in Patients with Clinical Stage IIIA NSCLC / 결핵및호흡기질환

BACKGROUND: To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC METHODS: From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. RESULTS: Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(p=0.506). After induction chemotherapy, only 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(p=0.024) and the 2-year overall survival rate was 80% and 41% . In the complete resection group, adjuvant postoperative RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, p= 0.007) but did not significantly improve overall survival(32.2months vs. 34.9months, p=0.48). CONCLUSION: Induction CTx is a possible method in the multimodality treatments, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated.

Prognostic Factors for Survival in Patients with Stage IV Non-small Cell Lung Cancer / 결핵

BACKGROUND: Although patients with stage IV non-small cell lung cancer areknown to have a poor prognosis, the prognostic factors for survival have not been well evaluated. Such factors may be different from those for overall survival. This study was performed to analyze the prognostic factors for survival and the variation of survival according to metastatic organ, in patients with stage IV non-small cell lung cancer. MATERIALS AND METHODS: From January 1997 to December 2000, 151 patients with confirmed stage IV non-small cell lung cancer were enrolled into this study retrospectively. The clinical and laboratory data were analyzed using univariate Kaplan-Meier and Multivariate Cox regression models. RESULTS: On univariate analysis, age, performance status, serum albumin level, weight loss, forced expiratory volume in one second (FEV1), systemic chemotherapy, the number of metastatic organs and serum lactate dehydrogenase (LDH) level were significant factors (p<0.05). In multivariate analysis, important factors for survival were ECOG performance (relative risk of death [RR]: 2.709), systemic chemotherapy (RR: 1.944), serum LDH level (RR: 1.819) and FEV1 (RR: 1.774) (p<0.05). Metastasis to the brain and liver was also a significant factor on univariate analysis). The presence of single lung metastasis was associated with better survival than that of other metastatic organs (p=0.000). CONCLUSION: We confirmed that performance status and systemic chemotherapy were independent prognostic factors, as has been recognized. The survival of stage IV non-small cell lung cancer patients was different according to the metastatic organs. Among the metastatic sites, only patients with metastasis to the lung showed better survival than that of other sites, while metastasis of the brain or liver was associated with worse survival than that of other sites.