Helicobacter pylori (H. pylori) has been recognized as a main cause of gastritis and most cases of peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. An immunological response to H. pylori infection has been suggested to play a major role in determining gastroduodenal damage through the production of cytokines and the autoantibody against gastric epithelial cell. H. pylori has been implicated in the pathogenesis of some autoimmune disease, such as Sjogren disease, Henoch-Schnlein purpura, rheumatoid arthritis, autoimmune thyroid disease, and idiopathic thrombocytopenic purpura (ITP). Serveral studies recently showed a high prevalence of H. pylori infection in patients with ITP and reported a platelet recovery after bacterial eradication therapy. We report a case of a 54-year-old man with chronic ITP who was resolved after eradication of H. pylori.
Adenocarcinoma ; Arthritis ; Autoimmune Diseases ; Blood Platelets ; Cytokines ; Epithelial Cells ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Lymphoma, B-Cell, Marginal Zone ; Middle Aged ; Peptic Ulcer ; Prevalence ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic, Idiopathic* ; Thyroid Diseases

Oral cholecystography is one of the most relible and widely used x-ray examination which enables us to observe not only morphological features of the gallbladder (GB) but also its functioning state. It was disclosed that functional evaluation of the GB is mandatory to recognize such kinetic disorders of the viscus as acalculous cholecystitis or dyskinesia. For the purpose of functional evaluation, fat meal has been used traditionally. Recently, cholecystokinin(CCK) and ceruletide were introduced into clinical diagnosis of the GB, the usefulness of which we have confirmed. In the present study we have made an attempt at improving cholecystagogic effect of conventional fat meals(FM) such as whole mild and egg yolk by changing the posture of the examined from sitting up to right decubitus position after the ingestion of fat meal. The hypothesis involved in this study is that the presence of quantitatively more fat meal in the duodenum per unit time may result in more effective cholecystagogic action and such a setting would be created by enhancement of pyloric passage of fat meal by decubitus posturing. Clinical materials consisted of 280 normal oral GB series (136 males and 144 females) andthey were divided into 4 equally numbered groups of mild sitting and mild decubitus and egg sitting and eggdecubitus. Upon confirming satisfactory opacification of the GB 11 hours after the ingestion of 3g of sodiumipodate or iopanoci acid either 2 pieces of medium sized hen's egg yolk were given. The xaminess were then allowed either sitting up comfortably on a bench or lying down on the right flank on a couch. After the ingestion of fat mean, x ray was taken at the end of 30 minutes in all but the mild decubitus group in which x rays were taken serially at the end of 5, 15, 30 and 60 minutes. The frontal area of each opacified GB was measured by using aplanimeter and the contraction rate before and after fat meal stimulation was calculated by the following equation and delineation of the biliary tree was analyzed in each group. Contraction rate (%) = (1
Acalculous Cholecystitis ; Biliary Tract ; Ceruletide ; Cholecystography ; Deception ; Diagnosis ; Duodenum ; Dyskinesias ; Eating ; Egg Yolk ; Gallbladder ; Humans ; Male ; Meals ; Ovum ; Posture

PURPOSE: This study was conducted to investigate the current role of medical oncologists in cancer care with a focus on increasing the recognition of medical oncology as an independent specialty. MATERIALS AND METHODS: Questionnaires modified from the Medical Oncology Status in Europe Survey dealing with oncology structure, resources, research, and patterns of care given by medical oncologists were selected. Several modifications were made to the questionnaire after feedback from the insurance and policy committee of the Korean Association for Clinical Oncology (KACO). The online survey was then sent to KACO members. RESULTS: A total of 214 medical oncologists (45.8% of the total inquiries), including 71 directors of medical oncology institutions, took the survey. Most institutions had various resources, including a medical oncology department (94.1%) and a department of radiation oncology (82.4%). There was an average of four medical oncologists at each institution. Medical oncologists were involved in various treatments from diagnosis to end-of-life care. They were also chemotherapy providers from a wide range of institutions that treated many types of solid cancers. In addition, 86.2% of the institutions conducted research. CONCLUSION: This is the first national survey in Korea to show that medical oncologists are involved in a wide range of cancer treatments and care. This survey emphasizes the contributions and proper roles of medical oncologists in the evolving health care environment in Korea.
Delivery of Health Care ; Diagnosis ; Drug Therapy ; Europe ; Insurance ; Korea* ; Medical Oncology* ; Radiation Oncology ; Surveys and Questionnaires

BACKGROUND: Hepatocellular carcinoma remains a highly chemoresistant neoplasm and is a common malignancy with poor prognosis in Korea. We performed a phase II study to evaluate the efficacy and toxicities of topotecan and cisplatin combination chemotherapy for advanced hepatocellular carcinoma. METHODS: Between November 1999 and May 2001, ten patients with histologically proven hepatocellular carcinoma were enrolled in this study. The median age was 54 (range: 53~74) years and all were male. Six patients demonstrated stage IV, 1 stage IIIC, 2 stage IIIB and 1 stage IIIA. Six patients showed a ECOG performance status of 1. The treatment regimen consisted of topotecan 1.25 mg/m2 and cisplatin 20 mg/m2 for 5 days. The treatment was repeated every 4 weeks. Toxicities were evaluated according to WHO toxicity criteria. RESULTS: All ten patients were evaluable for response and toxicity. There was only one patient who achieved partial response. The overall response rate was 10% (95% C.I.) and the response duration was 46 weeks. The median survival of all patients was 21 (range: 17~54+) weeks. During a total of 24 cycles, neutropenia of WHO grade 3 and 4 occurred in 33%, thrombocytopenia in 33% and anemia in 21%. In non-hematologic toxicity, diarrhea and hepatoxicity of grade 3 occurred in 1 and 2 patients, respectively. But there was no treatment-related death. CONCLUSION: When used in this dose and schedule, topotecan and cisplatin combination chemotherapy does not seem to be effective for patients with advanced hepatocellular carcinoma.
Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy ; Cisplatin/*administration & dosage ; Human ; Liver Neoplasms/*drug therapy ; Male ; Middle Aged ; Topotecan/*administration & dosage ; Treatment Outcome

BACKGROUND: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, their is no adequate medical service at present. We studied terminal cancer patients'behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. METHODS: From 271 patients'families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we able to had been contact were interviewed by three student nurses with a structured questionnaire. RESULTS: The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. CONCLUSIONS: There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.)
Agaricales ; Complementary Therapies ; Delivery of Health Care* ; Emergencies ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Medicine, East Asian Traditional ; Outpatients ; Quality of Life ; Telephone ; Ulmus ; Surveys and Questionnaires

Multiple primary lung cancers are characterized as either synchronous (detected or resected simultaneously) or metachronous (defined by a time interval between the detection of a subsequent primary lesion). The diagnosis of multiple primary lung cancers requires the temporal, histologic, and anatomic classification of tumors or simultaneous detection of two tumors. The incidence of multiple primary lung cancers has been increasing recently due to the widespread use of imaging modalities and life extension. Here, we report a 65-year-old male patient with multiple primary lung cancers comprising three different cell types (adenocarcinoma, squamous cell carcinoma, and small cell carcinoma).
Aged ; Carcinoma, Squamous Cell ; Classification ; Diagnosis ; Humans ; Incidence ; Life Expectancy ; Lung Neoplasms* ; Lung* ; Male ; Neoplasms, Multiple Primary ; Neoplasms, Second Primary

PURPOSE: The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. MATERIALS AND METHODS: A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t test, and the chisquare test were performed for the analyses. RESULTS: A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of “terminal state,” and mostrespondents tried to disclose the patient's condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussionwas consideredwhen metastasis or disease recurrence occurred orwhen withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. CONCLUSION: This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-Making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.
Advance Care Planning ; Delivery of Health Care ; Drug Therapy ; Education ; Humans ; Korea ; Neoplasm Metastasis ; Recurrence ; Surveys and Questionnaires

BACKGROUND/AIMS: Immune thrombocytopenic purpura (ITP) is an autoimmune disease that is mediated by anti-platelet antibodies. Based on the pathogenesis of ITP we evaluated the efficacy of intravenous anti-D immunoglobulin for adult chronic ITP. METHODS: Fourteen patients (4 without splenectomy and 10 with splenectomy) with refractory chronic ITP were treated with 50-70 microgram/kg of intravenous anti-D immunoglobulin only once. Treatment effects were evaluated by measuring the platelet counts and hemoglobin levels. RESULTS: Five patients (36%) showed a response; improvement in the platelet count lasted for on average 7 days (range: 2~24 days). There were no serious adverse effects. CONCLUSION: Anti-D immunoglobulin, which is associated with an Fc receptor blockade, appeared to be safe and effective for the treatment of adults with chronic ITP. Further studies are needed to confirm these findings and define further potentially effective treatment protocols with intravenous anti-D immunoglobulin.
Adult ; Antibodies ; Autoimmune Diseases ; Clinical Protocols ; Hemoglobins ; Humans ; Immunoglobulins ; Isoantibodies ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Receptors, Fc ; Rho(D) Immune Globulin ; Splenectomy

Hand-foot syndrome (HFS) is a well-known adverse event associated with capecitabine, a prodrug of 5-Fluorouracil (5-FU). HFS manifests as acral erythema, with swelling and dysesthesia of the palms and plantar aspects of the feet, which in the absence of dosage reduction or drug cessation, progresses to moist desquamation and ulceration, resulting in serious infections and loss of function. We report a case of HFS, with scleroderma-like changes, apparently induced by capecitabine. In our case, capecitabine, given in the recommended dosage was observed to lead to hyperpigmentation of the palms and soles, followed by a distinct keratoderma-like thickening unfamiliar to usual cases of HFS. This case may provide important clues for revising the definition of HFS, and allow the formation of effective preventive strategies for this side effect of chemotherapy.
Administration, Oral ; Aged ; Antimetabolites, Antineoplastic/administration & dosage/*adverse effects ; Deoxycytidine/administration & dosage/adverse effects/*analogs & derivatives ; Fluorouracil/administration & dosage/adverse effects/*analogs & derivatives ; Foot Dermatoses/*chemically induced/diagnosis ; Hand Dermatoses/*chemically induced/diagnosis ; Humans ; Male ; Risk Factors ; Scleroderma, Localized/*chemically induced/diagnosis

Angiosarcomas are extremely rare in the nasal cavity and para-nasal sinus. Upto the present only nineteen cases have been reported in the literature. A 31-year-old male presented with right facial swelling and large oral cavity mass. He was treated with wide excision of the tumor by radical maxillectomy. The tumor was diagnosed as angiosarcoma by immunohistochemical staining with factor VIII-reactive antigen. No adjuvant radiotherapy after surgery was done. After 9 montbs from surgery, the tumor recurred in the primary sites of oral cavity and right maxillary sinus and metastasized to the both lungs. He was treated with palliative chemotherapy and showed a stable disease in follow-up magnetic resonance image of para-nasal sinus and simple chest X-ray after second cycle of chemotherapy. He is undergoing further chemotherapy without any problems. We report first in Korea a case of primary angiosarcoma of the right maxillary sinus in a 31-year-old male.
Adult ; Drug Therapy ; Follow-Up Studies ; Hemangiosarcoma* ; Humans ; Korea ; Lung ; Male ; Maxillary Sinus* ; Mouth ; Nasal Cavity ; Radiotherapy, Adjuvant ; Thorax