A Study on Cognitive Attitudes toward Death according to MBTI Personality Types / 한국호스피스완화의료학회지

PURPOSE: The aim of this study was to investigate attitudes toward death according to personality types and to suggest the need to develop related hospice programs. METHODS: Personality types were identified by the Korean version of the Myers-Briggs Type Indicator (MBTI) Form G. A questionnaire with 26 five-point Likert items was used to survey participants' attitudes toward death. RESULTS: The ESFP personality type was most common (20%) among available 100 participants. Significant differences were observed in the attitudes towards death preparation according to personality type s. Participants with personality preference types E, T and J showed positive attitudes (P<0.05) toward death, but no significant differences were shown based on the SN index. CONCLUSION: The attitudes toward death differed by personality types. Therefore, this study points to the need to develop diverse hospice programs based on the personality types.

Extramedullary Solitary Plasmacytoma of the Lymph Nodes / 대한내과학회지

Extramedullary plasmacytomas are uncommon malignant neoplasms that can occur in any organ. They arise most frequently from the upper aerodigestive tract. Lymph nodes are exceedingly rare sites of extramedullary plasmacytomas. Most extramedullary plasmacytomas of the lymph node arise in the cervical lymph nodes. Here, we report a case of an extramedullary plasmacytoma of the lymph node arising from a cervical lymph node. A 43-year-old male patient was admitted to our hospital and presented with a non-tender mass on the left side of his neck, which had been growing slowly for 1 month. The mass was excised. The pathology showed diffuse infiltration of immature plasma cells that were encapsulated by a layer of lymphoid cells, indicating an extramedullary plasmacytoma. He was treated with local radiation of the left cervical area. As of March 2009, he is doing well and shows no further evidence of the disease.

Pericardial Amyloidosis Associated with Light-chain Myeloma / 대한내과학회지

Amyloidosis is characterized by the deposition of amyloid fibrils, which cause both functional and structural damage to organs. Cardiac involvement with amyloids is a common cause of secondary cardiomyopathy and leads to congestive heart failure. Pericardial amyloidosis usually occurs at the late or terminal stage of the disease after myocardial involvement, but it is extremely rare for pericardial amyloidosis to proceed with myocardial involvement. Here, we report a rare case of a 66-year-old patient with light-chain myeloma, who presented with pericardial effusion but no evidence of cardiomyopathy.

A Case of Hepatocellular Carcinoma with Progressive Metastasis to the Oral Cavity / 대한내과학회지

Hepatocellular carcinoma (HCC) usually metastasizes to the lung, breast, lymph nodes, gastrointestinal tract, bone, kidney, and/or adrenal gland. Metastasis of HCC to the hard palate and tonsils is a rare phenomenon. Thus, we report a case of HCC with metastasis to the hard palate and both tonsils in a 45-year-old man. The patient was admitted to our hospital with a complaint of oral bleeding. Physical examination revealed a bleeding tumor located in the hard palate and histological examination showed metastasis from HCC. The patient died 2 months later due to multiple organ failure, although bleeding was controlled by radiotherapy.

A case of sclerosing epithelioid fibrosarcoma / 대한내과학회지

Sclerosing epithelioid fibrosarcoma (SEF) is a rare and poorly recognized variant of fibrosarcoma of deep soft tissue. We report the case of a 34-year-old woman who presented with a painful and palpable mass in the left buttock that was diagnosed as SEF.

A Comparison of Clinical Outcomes between Decompressive Laminectomy Alone and with Arthrodesis in Lumbar Single Level Spinal Stenosis

OBJECTIVE: By comparing the data of patients with spinal stenosis who had undergone decompressive laminectomy alone or with arthrodesis, we retrospectively analysed the advantages and disadvantages of the subsequent surgical techniques. METHODS: We analyzed the radiological parameters, surgical techniques, and clinical outcomes of 35 patients, who had undergone operation for spinal stenosis. The patients were divided into two groups, laminectomy alone(15 patients) and laminectomy with arthrodesis(17 patients) and the patients' subjective outcomes and radiological results were compared. RESULTS: Subjective satisfaction was higher in patients who had received decompressive degrees laminectomy alone(80%) than patients who received degrees decompressive laminectomy with arthrodesis(70%). The mean preoperative spinal lordotic angle in the laminectomy alone groups improved from 32.3 degree to 33.9 degree, postoperatively, and 33.1 degree at the last follow up. The mean preoperative spinal lordotic angle in the laminectomy with arthrodesis groups improved from 33.5 degree to 37.8 degree postoperatively, and 37.4 degree at last follow up. The lamine- ctomy with arthordesis group showed better results regarding spinal lordotic angle correction but this was not directly related to the clinical outcomes CONCLUSION: There was no significant correlation in clinical outcome, correction of spinal lordosis angle and patients' subjective satisfaction between decompressive laminectomy alone and with arthrodesis. Therefore, we suggested that decompressive laminectomy alone was achived good outcomes in patients who has single level spinal stenosis with no proven spinal instability at preoperative stage.

Follow-up Comparison Study of Single-level Posterior Dynamic Stabilization in Lumbar Degenerative Disease 'Interspinous U'vs. 'DIAM'

OBJECTIVES: Although successful fusion rates have approached almost 100%, fusion may increase the biomechanical stresses imposed on the adjacent segments leading to transitional disease. These issues have leg some investigators to explore novel approaches, that is 'posterior dynamic stabilization'. In this study, we compared clinical outcome of two different posterior dynamic stabilization instruments: 'Interspinous U' and 'DIAM' device, respectively. METHODS: A retrospective review was performed for all the patients with disc degenerative diseases treated with decompression procedure from 2004 to 2007. The plain lateral and flexion-extension views were taken immediately after surgery and at each follow-up. The disc height ratio(DH), total lumbar lordotic angle (TLA) and segmental lordotic angle (SLA) were used to observe the change of initial status. The clinical outcome was measured by Odom's criteria and compared. Also, in lateral view, decrease of bony density around instruments was regarded as bony erosion. RESULTS: Mean follow-up durations for 'Interspinous U' and 'DIAM' were 39 and 14 months, respectively. Instruments were used for 21 and 16 patients for 'Interspinous U and 'DIAM' groups, respectively. Satisfactory groups were 61% and 74% for 'Interspinous U and 'DIAM' groups. But, there was no statistical difference between two groups in the change of DH, TLA and SLA. In 'Interspinous U' group, two cases showed spinal instability with bony erosion, and five cases showed bony erosion around instruments. CONCLUSION: 'DIAM'group showed higher patient satisfaction and no bony erosion. To ascertain the difference, analysis with larger population and a long-term follow-up period will be needed.

Late Complications of the Single Level 'Interspinous U' in Lumbar Spinal Stenosis with Mild Segmental Instability

OBJECTIVE: Decompression and/or fusion have traditionally been used to treat the spinal stenosis and spondylosis. Recently, several devices for dynamic posterior stabilization have been developed in treatment of lumbar spinal stenosis and degenerative spine diseases. This special technique of dynamic posterior stabilization of the lumbar spine may be defined as a system that would alter favorably the movement and load transmission of a spinal motion segment, without the fusion. At present, the 'interspinous U' has been using as one of favor device for dynamic posterior stabilization. METHODS: From January 2003 to November 2004, we have used the 'interspinous U' for 48 patients with lumbar spinal stenosis with mild segmental instability, after bilateral foraminotomy. All patients were checked the follow-up simple X-ray stress view after more than 12 months and evaluated the stability and the outcome of the patients. RESULTS: The patients were consisted of 26 men and 22 women, and mean ages was 55.3 years. The average follow- up period was approximately 22 months. The clinical outcomes were evaluated as excellent 15, good 19, fair 12 and poor 2. Especially, the patient group of unsatisfactory outcome(fair and poor) mainly complained the sudden burst back pain with the position change and this symptom was aggravated more and more during follow-up periods. In the flexion/extension lateral X-ray view, the evidence of bony absorption of the spinous process at the contacting side with 'interspinous U' device was found in 15 cases and also the minor instability was seen. CONCLUSION: 'interspinous U' is harder than any other ones for dynamic posterior stabilization, it is difficult to act like the "shock-absorber" and so the power to clamp the spinous process might be weak in spacer. Our preliminary results suggest that the late complications of the 'interspinous U' device in posterior dynamic stabilization may be the bone absorption of spinous process and minor instability, that is bone-implant interface failure.

A Case of Congenital Hemolytic Anemia of Unknown Cause Combined with Gilbert's Syndrome

Congenital hemolytic anemia is mainly developed due to intrinsic defects of erythrocytes, but in some cases the cause of hemolytic anemia is unclear. Gilbert's syndrome shows mild, chronic unconjugated hyperbilirubinemia that is due to reduced UDP glucuronosyltransferase (UGT-1A1) activity and this develops because of UGT-1A1 gene mutation. We report here on a case of severe hyperbilirubinemia in a 17-year-old male who was diagnosed with congenital hemolytic anemia of an unknown cause combined with Gilbert's syndrome.

Akinetic Mutism following Spontaneous Subarachnoid Hemorrhage: A Case Report / 대한뇌혈관외과학회지

Akinetic mutism (AM) is a rare complication of spontaneous subarachnoid hemorrhage (SAH). It is characterized by mutism and general hypokinesis in a patient superficially fully awake in that the eyes remain open and follow objects. Most common cause of AM in patients with SAH is secondary infarction in the distal anterior cerebral artery (DACA) territory. Sometimes post-SAH hydrocephalus has also been implicated in a delayed form of AM because of disruption of dopaminergic pathway. We report a case of 64-year-old woman who presented with sudden bursting headache without neurologic deficit. She was referred from the other hospital with a diagnosis of spontaneous SAH on head computed tomography (CT) which showed high density on sylvian, interhemispheric fissures and basal cistern. We performed computed tomographic cerebral angiography (CTA) and trans-femoral catheter cerebral angiography (TFCA), that revealed no definitive intracranial aneurysm, arterial dissection, or other vascular abnormality of the SAH. During admission period, she developed mutism and motor weakness of all limbs without spontaneous movement. We performed brain magnetic resonance (MR) image and RI cisternography. Also we prescribed levodopa. On the 33th hospital day, she had neurological recovery with drowsy mentality and grade 4 weakness of all limbs, but she was observed to suddenly develop general weakness and became cardiac arrest on the 55th hospital day. Efforts to resuscitate her failed, no more treatment could not be applied. In our case, we couldn't find infarction in the DACA terriority, midbrain or cerebellum except communicating hydrocephalus. This case may alert neurosurgeon to recognize the possibility of such rare complication after spontaneous SAH.

The Immunological Effect of Mistletoe Extract on Gastric Cancer Patients

PURPOSE: Mistletoe (Viscum album L.) extract is one of the most widely used agents in alternative cancer therapeutic regimens in Europe. This study was conducted to determine the effect of mistletoe extract on immune function in gastric cancer patients. MATERIALS AND METHODS: Ten patients that had undergone a curative gastrectomy were enrolled in the prospective study. ABNOBAviscum Q(R) was injected subcutaneously three times a week from postoperative-day 7 to week 16 with an increasing dose. All of the patients simultaneously received chemotheraphy with mitomycin, oral 5-FU and a cisplatin regimen. The WBC count, differential count, lymphocyte/WBC ratio and the level of cytokines (IL-1beta, IL-2, IL-6, IFN-gamma, TNF-alpha) were checked in the peripheral blood preoperatively, at postoperative week 8 and at postoperative week 16. RESULTS: The WBC and neutrophil counts significantly decreased after treatment on week 8 and week 16 (P=0.001), but the total eosinophil count was slightly increased (P=0.15). The total lymphocyte count also decreased during treatment but the lymphocyte/WBC ratio was slightly increased without statistical significance (P=0.91). The cytokine levels did not significantly change during treatment. CONCLUSION: It is somewhat difficult to determine the direct effect of mistletoe therapy on immune function as the effect may be compromised by the concurrent chemotherapy. It can be assumed that the slightly increased lymphocyte/WBC ratio and eosinophil count may be a result of the immunomodulatory effect of the mistletoe extract.

Cases of Pathology-Proven Lung Adenocarcinoma Presenting as Pneumonic Pattern

Lung adenocarcinoma is the cancer originated in terminal bronchiole or alveolar epithelium and its incidence is on the increase. The most common radiologic pattern of lung adenocarcinoma is peripheral nodule or mass, but it can be showed various findings such as hilar mass, consolidation, atelectasis or multicentric lesions. Sometimes it is difficult to differentiate lung adenocarcinoma from other diseases, especially pneumonia. We experienced three patients with lung adenocarcinoma, just only presented as pneumonic consolidation on chest X-ray and CT scan. The clinician should consider seriously lung adenocarcinoma including bronchioloalveolar carcinoma in patients who did not respond to antibiotics. And in such cases, pathologic diagnosis must be perfomed at proper time to confirm disease.

Expression of the Peroxisome-proliferator-activated Receptor-gamma in Human Gastric Cancer

PURPOSE: Recently, interest in peroxisome-proliferator-activated receptors (PPAR) has increased, although clinical studies of the effect of PPAR-gamma expression on gastric cancer have not been reported yet. In this study, we investigated the role of PPAR-gamma expression in gastric cancer patients. MATERIALS AND METHODS: One hundred twenty-eight (128) samples of both gastric cancer and normal tissues were obtained from 128 patients who had undergone at a curative gastrectomy at Seoul Medical Center from Jan. 2001 to Dec. 2005. PPAR-gamma expression was determined by using immunohistochemical staining, and the results were analyzed. The statistical analysis was based on clinicopathological findings and the differences in survival rates. RESULTS: The mean age of the patients was 61, and the male:female ratio was 1.9:1. PPAR-gamma expression was significantly higher in cancer tissues than in normal tissue (81.3% vs. 57.0%, P<0.001). There was insignificant difference between well and moderately differentiated types and poorly differentiated types in terms of the expression of PPAR-gamma (87.0% vs. 74.6%, P=0.074). In the univariate analysis the survival rate was significantly increased when PPAR-gamma was expressed in normal tissue (P=0.003). In the multivariate analysis, only the UICC TNM staging had significance related to the survival rate. CONCLUSION: The rate of PPAR-gamma expression was higher in cancer tissue than it was in normal tissue from gastric cancer patients. In the univariate analysis, PPAR-gamma expression in normal tissue had significance with respect to survival, but the multivariate analysis showed no such significance. Thus, we should further evaluate more cases to determine whether or not such a significance exists.

Two cases of acute toxic hepatitis and renal failure after ingestion of the extract of elm bark in lung cancer patients / 대한내과학회지

Traditional remedies, especially the extract of elm bark, are frequently used in Korea. But the exact efficacy and adverse effects are not known. Cancer patients are frequently recommended various traditional remedies by family members. However such remedies may lead to life-threatening complications. We observed two cases of severe hepatic and renal toxicities that developed after ingestion of elm extract. One patient was a 67-year-old man diagnosed with stage IV non-small cell lung cancer (NSCLC). He ingested the bark extract of elm for 2 weeks during routine work-up prior to chemotherapy. He abruptly showed acute toxic hepatitis with cardiac tamponade. The other patient was a 57-year-old woman diagnosed with extensive disease-small cell lung cancer (ED-SCLC). She consumed the extract of root bark of elm for 5 months during complete remission status and developed acute renal failure. These cases suggest that use of the extract of elm bark in cancer patients must be more careful.