PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.
Aromatase ; Asian Continental Ancestry Group ; Bone Density ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cholesterol ; Consent Forms ; Female ; Humans ; Observational Study ; Quality of Life*

OBJECTIVES: Many patients diagnosed with cancer suffer from various psychiatric symptoms such as depression, anxiety and insomnia as well as cancer itself. Patients with cancer are more vulnerable to possible adverse events of psychotropic medications. Although antidepressants are widely used among cancer patients, there is little information about tolerability of antidepressants. This study was conducted to compare tolerability of antidepressants in cancer patients referred for psychiatric consultation. METHODS: The participants were cancer patients who had been referred to psychiatrist for their psychiatric symptoms. We retrospectively analyzed the data of patients diagnosed with cancer from 9 general hospitals in Korea. The discontinuation rate for a 6 months period after treatment initiation for three antidepressants(Escitalopram, Mirtazapine, Paroxetine) were compared. RESULTS: Antidepressants were prescribed for 96.3% of subjects and Escitalopram 150(47.2%), Mirtazapine 92 (28.9%) and Paroxetine 76(23.9%) were prescribed frequently in order There were no significant differences in discontinuation rates among the three antidepressants during the 6 month period after initiation of pharmacotherapy. But there was a difference in discontinuation rates between inpatients versus outpatients(p<0.0001). CONCLUSIONS: In a naturalistic setting for the antidepressant treatment for cancer patients, it seems that there are no differences in discontinuation rates among these three antidepressants. It is therefore essential that such interactions are carefully considered when treating patients of antidepressants who already have cancer.
Antidepressive Agents ; Anxiety ; Citalopram ; Depression ; Hospitals, General ; Humans ; Inpatients ; Korea ; Mianserin ; Paroxetine ; Psychiatry ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: Antidepressants are frequently used for treatment of psychological distress among cancer patients. The aim of this study is to investigate the characteristics of psychiatric consultations and antidepressant use for cancer patients. METHODS: Participants in the study included cancer patients who had been referred for psychiatric consultation. A total of 488 patients were recruited from nine general hospitals in Korea. Questionnaires based on medical records, including antidepressants prescribed, were investigated by psychiatrists. RESULTS: The most common psychiatric diagnosis of subjects was depressive disorders (72.4%), followed by anxiety disorders (13.0%), and adjustment disorders (7.3%). Antidepressants were prescribed for 96.3% of subjects and escitalopram, mirtazapine, and paroxetine were prescribed frequently, in order. Anxiolytics and hypnotics were used for 58.2% of the subjects, for which lorazepam and alprozolam were preferred. During the study period, 226 (46.8%) subjects discontinued treatment and the most common cause was improvement of symptoms (123, 54.4%). CONCLUSION: Our results showed a tendency of prescription of antidepressants and anxiolytics and common psychiatric problems in Korean cancer patients. We suppose that these data would be helpful to clinicians who manage psychiatric symptoms of cancer patients.
Adjustment Disorders ; Anti-Anxiety Agents ; Antidepressive Agents ; Anxiety Disorders ; Citalopram ; Depressive Disorder ; Hospitals, General ; Humans ; Hypnotics and Sedatives ; Korea ; Lorazepam ; Medical Records ; Mental Disorders ; Mianserin ; Paroxetine ; Prescriptions ; Surveys and Questionnaires ; Referral and Consultation

We report an unusual case of probable Creutzfeldt-Jakob disease (CJD) in hemodialysis patient. A woman 59 years of age with a past history of hypertension and end-stage renal disease presented with a stuporous state preceded by rapidly progressive cognitive dysfunction, myoclonus, and akinetic mutism. At first, the cause of the altered mental status was assumed to be uremic or hypertensive encephalopathy combined with fever. Proper managements, however, did not improve the neurologic symptoms. Diffusion-weighted magnetic resonance imaging revealed bilaterally asymmetric high signal intensity in both basal ganglia and cerebral cortices. Electroencephalography showed diffuse generalized theta-to-delta range slow wave and intermittent medium-to-high voltage complexes with a characteristic triphasic pattern on both hemispheres. Cerebrospinal fluid assay for the 14-3-3 protein was positive and diagnostic of CJD.
14-3-3 Proteins ; Akinetic Mutism ; Basal Ganglia ; Cerebral Cortex ; Creutzfeldt-Jakob Syndrome ; Dialysis ; Electroencephalography ; Female ; Fever ; Humans ; Hypertension ; Hypertensive Encephalopathy ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Manifestations ; Renal Dialysis ; Stupor

Advances in molecular biology have made it possible to understand the tumor biology of breast cancer at the molecular level and have revealed molecular targets for the therapy of breast cancer. Nowadays, targeting agents are used as mono-therapy or as combined therapy with other anti-cancer drugs for the treatment of breast cancer. Much more efforts is also being made in the development of better therapeutic agents targeting molecules having an important role in tumor biology. In this article, promising molecules for targeted therapy are reviewed for their roles in the pathophysiology and the treatment of breast cancer. We also introduce and summarize new preclinical agents, developed or on developing, with preliminary results from clinical trials. Given the progress currently being made, targeted therapy could become a main strategy for the treatment of breast cancer in the near future.
Biology ; Breast ; Breast Neoplasms ; Molecular Biology

PURPOSE: Thyroglobulin (Tg) is a valuable and sensitive tool as a marker for diagnosis and follow-up for several thyroid disorders, especially, in the follow-up of patients with differentiated thyroid cancer (DTC). Often, clinical decisions rely entirely on the serum Tg concentration. But the Tg assay is one of the most challenging laboratory measurements to perform accurately owing to antithyroglobulin antibody (Anti-Tg). In this study, we have compared the degree of Anti-Tg effects on the measurement of Tg between availale Tg measuring kits. MATERIALS AND METHODS: Measurement of Tg levels for standard Tg solution was performed with two different kits commercially available (A/B kits) using immunoradiometric assay technique either with absence or presence of three different concentrations of Anti-Tg. Measurement of Tg for patient's serum was also performed with the same kits. Patient's serum samples were prepared with mixtures of a serum containing high Tg levels and a serum containg high Anti-Tg concentrations. RESULTS: In the measurements of standard Tg solution, presence of Anti-Tg resulted in falsely lower Tg level by both A and B kits. Degree of Tg underestimation by A kit was more prominent than B kit. The degree of underestimation by B kit was trivial therefore clinically insignificant, but statistically significant. Addition of Anti-Tg to patient serum resulted in falsely lower Tg levels with only A kit. CONCLUSION: Tg level could be underestimated in the presence of anti-Tg. Anti-Tg effect on Tg measurement was variable according to assay kit used. Therefore, accuracy test must be performed for individual Tg-assay kit.
Diagnosis ; Follow-Up Studies ; Humans ; Immunoradiometric Assay* ; Thyroglobulin* ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND: Serum thyroglobulin(Tg) is a valuable and sensitive tool needed in the follow-up of patients with differentiated thyroid cancer(DTC), but antithyroglobulin antibody(Anti-Tg), common in patients with DTC, can interfere with the assay for Tg. In this study, we evaluated the influence of Anti-Tg on the measurement of Tg using the immunoradiometric assay(IRMA). METHODS: In using ELSA-hTg in vivo test(CIS international, Schering, France), a solid phase two-site IRMA was used to measure Tg(23.5ng/mL, 62.5ng/mL) under the absence or presence of three concentrations of Anti-Tg(25U/mL, 50U/mL, 100U/mL). We also performed Tg measurement using patients serum that was mixed with patients serum containing high Anti-Tg. ANOVA and Scheffe tests were performed to evaluate the effect of Anti-Tg on Tg IRMA, and an inverse regression was made to calculate the level of Tg from measured Tg and used Anti-Tg levels and also to assess the degree of effect of anti-Tg on Tg IRMA. RESULTS: In measuring Tg using the standard solution, the presence of Anti-Tg resulted in a falsely suppressed Tg value. The IRMAs for 23.5ng/mL of the standard Tg solution resulted in 24.5+/-.1 ng/mL under no Anti-Tg, 11.8+/-.4ng/mL under 25U/mL of Anti-Tg, 7.7+/-.1ng/mL under 50U/mL of Anti-Tg, and 4.5+/-.4ng/mL under 100U/mL of Anti-Tg. IRMAs 62.5ng/mL of the standard Tg solution resulted in 65.9+/-.7ng/mL under no Anti-Tg, 36.3+/-.2ng/mL under 25U/mL of Anti-Tg, 23.7+/-.7ng/mL under 50U/mL of Anti-Tg, and 14.0+/-.0ng/mL under 100U/mL of Anti-Tg. (ANOVA test, p=0.000). The degree of suppression of the measured Tg value was positively correlated with the Anti-Tg level (Quadratic model regression, Sig T=0.000). The presence of Anti-Tg also resulted in a falsely suppressed Tg value for the Tg measurement using patient's serum. CONCLUSION: The presence of Anti-Tg could consist of the use of Tg as a tumor, therefore Anti-Tg should be measured in all patients diagnosed with DTC. The interpretation of the Tg level must be performed with extreme caution in patients with Anti-Tg.
Humans ; Immunoradiometric Assay* ; Thyroglobulin* ; Thyroid Gland

Approximately 10% of pheochromocytomas are malignant and its major criteria are tumor invasion of capsular blood vessel as well as metastatic invasion of other tissues. It is general rule that all resectable masses have to be removed surgically. However, there is no definite treatment modality about unresectable masses or microinvasive lesions. We experienced a case of 45 year-old male patient who was referred to our hospital for treatment of hypertension and headache. The plasma and urine catecholamine were increased above normal values and its metabolites also were increased. 131I-metaiodobenzylguanidine (MIBG) scan showed right adrenal mass and metastatic lesion of left iliac bone. This lesion was consistent with findings of the abdomen computed tomography (CT) and electron beam tomography (EBT) scan. We diagnosed this case as malignant pheochromocytoma. We removed primary tumor mass by wide excision and treated this patient with high dose 131I-MIBG. We report this case who shows good response to the high dose 131I-MIBG after surgery.
3-Iodobenzylguanidine ; Abdomen ; Blood Vessels ; Headache ; Humans ; Hypertension ; Male ; Middle Aged ; Neoplasm Metastasis ; Pheochromocytoma* ; Plasma ; Reference Values ; Tomography, X-Ray Computed

OBJECTIVES: This study was conducted to investigate whether air pollution levels in Seoul have short term effects on respiratory disease outpatients. METHODS: We analyzed five air pollutants (CO, NOy, Oy, SOp, PMyp) and daily counts of outpatient for respiratory disease divided by age group ((15yrs, 15-64yrs, 65+yrs) during the period of July 1997-June 1998 using Generalized Additive Model(GAM). RESULTS: After controlling for seasonal trends, day of the week, week of the month, temperature and humidity, CO (RR=1. 041 ~ l. 051, 0-day lag) and NOy (RR=1. 024~1. 050, 3-day lag) were significantly associated with daily counts for respiratory disease in all age groups. 0, and SO, were associated, with a 3-day lag in the age group under 15 years (O RR=1. 047, 95% CI=1. 045- 1. 049 i SOp RR=1. 018, 95% CI=1. 017- l. 020) and with a 0-day lag in the age group 15 to 64 years (0, RR=1. 035, 95% CI=1. 032-1. 037; SO, RR=1. 037, 95% CI=1. 035-1. 039), in the age group over 65 years (O RR=1. 042, 95% CI=1. 033-1. 051; SO RR=1.029, 95% CI=1.022-1.036). PM was weakly associated, with a 1-day lag in the age group under 15 years (RR=1.011, 95% CI=1.010-1.013) and with a 0-day lag in the age group 15 to 64 years (RR=1. 021, 95% CI=1. 019-1. 023), in the age group over 65 years (RR=1. 025, 95% CI=1. 018-1. 032). In the two pollutant model, the magnitudes of the relative risk for CO, NOy and Oq were maintained, but SOy was not associated with daily counts for respiratory disease in the age group under 15 years after controlling for NO,. PMyp was not associated in all age groups after controlling for CO, so the association with PMyp in the single pollutant model might be confounded by CO. In this study, the impact Of PMyp on the respiratory disease was not large as compared with other pollutants. CONCLUSIONS: Air pollution in Seoul may increase the incidence of the respiratory disease, so more positive attention for the control of air pollution should be paid.
Air Pollutants* ; Air Pollution ; Humans ; Humidity ; Incidence ; Outpatients* ; Seasons ; Seoul*

PURPOSE: This study was undertaken to investigate the prognostic significance of lymphatic invasion (LI), vessel invasion (VI), and neural invasion (NI) in gastric cancer and their correlations with other standard prognostic variables, such as the TNM stage. METHODS: The case histories of 100 gastric adenocarcinoma patients who had undergone a curative resection from 1992 to 1996 at Taegu Hyosung- Catholic University Hospital, Taegu, Korea were analyzed retrospectively. The Chi-Square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rate were assessed using the log-rank test. The cox regression method was used for evaluation of independent prognostic significance. RESULTS: The 2-year survival rate was significantly lower (p<0.05) in LI (+) and NI (+) cases. The correlation between the T stage and LI, VI, and NI was statistically significant. Also, the correlation between the N stage and LI, VI, and NI was statistically significant. In the lymph node (+) group (n=43), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but this result was not statistically significant. In the lymph node (-) group (n=57), the 2-year cumulative survival rate was higher in LI (-), VI (-), and NI (-) cases, but only the result for the NI (-) group was significant. Multivariate analysis demonstrated that LI, VI, and NI were not significant factors influencing the prognosis, although they were significant in the univariate analysis. CONCLUSION: This study identifies LI, VI, and NI as possible prognostic factor in gastric adenocarcinoma cases, but more careful research is needed.
Adenocarcinoma ; Daegu ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Prognosis* ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate