Toxicity Profile of Temozolomide in the Treatment of 300 Malignant Glioma Patients in Korea

This study evaluated the toxicity profiles of temozolomide in the treatment of malignant glioma as either concurrent or adjuvant chemotherapy. We retrospectively reviewed the medical records of 300 malignant glioma patients treated with temozolomide in two medical institutions in Korea between 2004 and 2010. Two hundred nine patients experienced a total of 618 toxicities during temozolomide therapy. A total of 84.8% of the 618 toxicities were Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or 2, while 15.2% were grade 3 or 4. Among the hematologic toxicities, thrombocytopenia (13.7%), anemia (11.0%), and AST/ALT increases (7.0%) were common. Among the non-hematologic toxicities, nausea (44.3%), vomiting (37.0%), and anorexia (14.3%) were the three most common toxicities. There was no mortality due to temozolomide. Although temozolomide showed many types of toxicities, the majority of the toxicities were tolerable and of lower grade. Gastrointestinal troubles are the most common toxicities in Korean patients treated with temozolomide.

Analysis of Heavy Metals in the Hair of Children with Attention-Deficit Hyperactivity Disorder and Tourette's Syndrome

OBJECTIVES: The purpose of this study was to examine the association of exposures to heavy metals with positive diagnosis for attention-deficit hyperactivity disorder (ADHD) and Tourette's syndrome (TS). METHODS: Study participants included 27 children diagnosed with ADHD (9.9+/-2.9 years of age), 21 diagnosed with Tourette's disorder (10.7+/-2.2 years of age), and 45 normal control children (9.6+/-0.5 years of age). A Perkin-Elmer mass spectrometer was used to measure the concentrations of 5 heavy metals (Pb, Cd, U, Be, Hg) in hair samples obtained from each participant. Each heavy metal concentration was compared among the groups by use of a Kruskal-Wallis test. RESULTS: The levels of lead (p=.006) and cadmium (p=.037) observed in the hair of children diagnosed with ADHD were significantly higher than those found in the control subjects. There were no significant differences observed for heavy metal levels when comparing TS and control subjects. CONCLUSION: We confirmed that lead exposure is a risk factor for ADHD. We also identified that cadmium may be a new candidate risk factor for manifestation of ADHD. We did not find an association between heavy metals and manifestation of TS.

The Prognostic Factors That Influence Long-Term Survival in Acute Large Cerebral Infarction

OBJECTIVE: We retrospectively evaluated the prognostic factors that can influence long-term survival in patients who suffered acute large cerebral infarction. METHODS: Between June 2003 and October 2008, a total of 178 patients were diagnosed with a large cerebral infarction, and, among them, 122 patients were alive one month after the onset of stroke. We investigated the multiple factors that might have influenced the life expectancies of these 122 patients. RESULTS: The mean age of the patients was 70+/-13.4 years and the mean survival was 41.7+/-2.8 months. The mean survival of the poor functional outcome group (mRS> or =4) was 33.9+/-3.3 months, whereas that of the good functional outcome group (mRS or =70 years) was 29.7+/-3.4 months, whereas that of the younger patients (<70 years) was much better as 58.9+/-3.2 months (p value=0.000). Involvement of ACA or PCA territory in MCA infarction is also a poor prognostic factor (p value=0.021). But, other factors that are also known as significant predictors of poor survival (male gender, hypertension, heart failure, atrial fibrillation, diabetes mellitus, a previous history of stroke, smoking, and dyslipidemia) did not significantly influence the mean survival time in the current study. CONCLUSION: Age (older versus younger than 70 years old) and functional outcome at one month could be critical prognostic factors for survival after acute large cerebral infarction. Involvement of ACA or PCA territory is also an important poor prognostic factor in patients with MCA territorial infarction.

Thalamic Volumes in Patients with Untreated First-Episode Schizophrenia / 신경정신의학

OBJECTIVES: Thalamic structural changes were implicated in the pathophysiology of schizophrenia by some studies. So, we investigated the differences in thalamic volumes between previously untreated patients with first-episode schizophrenia and controls. METHODS: Thalamic volumes of 24 subjects with schizophrenia and 24 controls were measured from their T1-weighted coronal magnetic resonance images using manual tracing. The thalamus was further segmented into regions that roughly reflected individual thalamic nuclei. RESULTS: Comparing to the controls, significantly smaller volumes were found in the left posterior subdivision of thalamus in patient group. Tendency of volume differences were also seen in right posterior subdivision of thalamus in patient group. These regions primarily comprised the pulvinar, a thalamic nucleus thought to be an important component of aberrant circuitry in schizophrenia. CONCLUSION: Our findings suggest the possibility of a volumetric alteration of the thalamus in patients with first-episode schizophrenia.

Comparison of Blood Donor Reactions in Whole Blood Donations, Plasmapheresis and Plateletpheresis / 대한수혈학회지

BACKGROUND: Several kinds of adverse reactions can occur during blood donation such as vasovagal reaction (VVR), hematoma, citrate toxicity, etc. These adverse reactions are not common, but they are important because they cause a decrease in re-donation. The cost for maintaining a repeat donation is very low compared to that for securing first-time donors. Whole blood donation differs from apheresis in some aspects, and this could have an influence on blood donor reactions. We compared whole blood donation with apheresis for blood donor reactions. METHODS: From January to December in 2007 at Busan Red Cross Blood Center, 109,004 donations were investigated for blood donor reactions. 76,098 (69.8%) donations were from male donors and 32,906 (30.2%) were from females. 77,813 (71.3%) donations were for whole blood, 25,224 (23.2%) were for plasmapheresis and 5,967 (5.5%) were for plateletpheresis. RESULTS: The frequencies of VVR were 0.10% (75/77,813) for the whole blood donations, 0.15% (37/25,224) for plasmapheresis and 0.03% (2/5,967) for plateletpheresis (P<0.05). The frequency of hematoma was 0.05% (37/77,813) for whole blood donation, 0.25% (62/25,224) for plasmapheresis and 0.27% (16/5,967) for plateletpheresis (P<0.05). Citrate toxicity was extremely rare. VVR was most common in plasmapheresis, and it was rare in plateletpheresis. CONCLUSION: The kinds of donated blood components had an influence on blood donor reactions. Understanding these characteristics helps to prevent adverse reaction. Having people re-donate is essential for keeping a large sized donor pool. So, appropriate management to prevent donor reactions is very important.

Gamma Knife Surgery for the Pineal Region Tumors

OBJECTIVE: Gamma Knife Surgery(GKS) for the management of pineal region tumors is challengeable strategy as direct access to this area is not easy. The experiences of pineal region tumor patients treated with GKS were analyzed to evaluate the effectiveness. METHODS: Seven patients with tumors in the pineal region were treated with GKS between September 1998 and May 2005. The histological diagnosis were pineal parenchymal tumor (2 patients), low-grade astrocytoma (2 patients), immature teratoma (1 patient), and choriocarninoma (1 patient). One patient was diagnosed as metastatic brain tumor based on histological diagnosis for primary site and brain imaging study. The median marginal dose was 15Gy (range; 11~20) at the 50% isodose line. The median target volume was 2.5cm3 (range; 0.8~12.5). The median clinical follow up period was 29 months (range; 13~93) and the median radiological follow up period was 18 months (range; 6~73). RESULTS: Tumor volume measured in follow-up images showed reduction in six patients, disappearance in one. No adverse effect due to GKS was found during the follow-up period . The performance status was preserved in all patients except one who died due to progression of primary cancer in spite of controlled metastatic brain lesion. CONCLUSION: Gamma Knife Surgery can be applied to pineal region tumors irrespective of their histology whenever surgery is not indicated.

Osteoma of the Frontal Sinus with Secondary Subdural Empyema Formation

Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. The authors report an unusual case of a frontal sinus osteoma leading to subdural emyema formation. A 19-year-old man presented with headache and fever one month after minor facial trauma. Neuroradiological studies revealed subdural empyema in left frontal lobe with moderate cerebral edema and a osteoma in the left frontal sinus with sinusitis of maxillary sinus. The patient was surgically treated in one stage operation of decompressive craniectomy, removal of subdural empyema with frontal sinus osteoma, and endoscopic sinus surgery via cranial and nasal route. The patient recovered very well after surgery and postoperative antibiotic therapy. The etiology of intracranial infection and the treatment strategy are to be discussed.