Reported cases of gastrosplenic fistulas are extremely rare in the literature. Malignancy is the primary cause in 50% of patients, followed by perforated peptic ulcer (40%). Fistulas can cause spleen rupture and potential bleeding that threaten the life of the patient. Lymphoma is the most common cause of malignancy complicated with gastrosplenic fistula. Most gastrosplenic fistulae caused by lymphoma eventually close following chemotherapy, although splenectomy should be performed to avoid further complications. We experienced a case of non-Hodgkin's lymphoma complicated with gastrosplenic fistula in a 21 year-old man. He was admitted to our hospital because of LUQ mass. On the abdominal CT, a splenic mass with central necrosis and gas was discovered. The biopsy specimen of the stomach and spleen displayed diffuse, large B cell type non-Hodgkin's lymphoma. After one cycle of CHOP chemotherapy, the LUQ mass was markedly regressed although the gastrosplenic fistula was still present on the follow-up CT. The fistula was treated by splenectomy and a partial resection of gastric fundus. Follow-up chemotherapy was continued after surgery.
Biopsy ; Drug Therapy ; Fistula* ; Follow-Up Studies ; Gastric Fundus ; Hemorrhage ; Hodgkin Disease* ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Necrosis ; Peptic Ulcer ; Rupture ; Spleen ; Splenectomy ; Stomach ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: The prognosis of non-Hodgkin's lymphoma (NHL) is disappointing for patients who experience primary treatment failure or relapse after an initial response. Patients in relapse may respond again to chemotherapy, however the time to disease progression becomes shorter and eventually the disease becomes resistant. The aim of this study was to evaluate the efficacy and safety of the MINE regimen in the treatment of patients with relapsed or refractory NHL. Material and Methods: Forty-three pretreated patients with a median age of 56 years were enrolled into the study between October 1995 and June 2000. Most patients (60.5%) had a performance status of 0 to 1, and a diffuse large cell subtype (55.8%). Seventy-four percent of patients had stage III or IV disease at the start of MINE treatment. Eighteen (41.9%) patients had complete response, 5 (11.6%) had partial response, and 20 (46.5%) had failed to respond to prior therapy. Ifosfamide 4 g/m2 was divided over 3 days and administered IV over a 1 hour period. Mitoxantrone 8 mg/m2 was administered as a short IV infusion on day 1. Etoposide (65 mg/m2/day) was infused over 1 hour on days 1 to 3. A total of 144 cycles was administered, with a mean of 3.34 cycles per patient (range, 1-8). The mean relative dose intensity was 87.4%. RESULTS: 1) Nine patients achieved a complete response and nine patients achieved a partial response, resulting in an overall response rate of 43.8% of the 41 assessable patients. 2) The median survival time was 6 months (95% CI, 4 to 8 months), and the median time to failure was 5 months (95% CI, 3 to 7 months). 3) A statistically significant association with complete response rates was found for complete response to prior therapy (p=0.049). The significant factors for overall survival were a complete response after MINE chemotherapy and serum 2-microglobulin (p=0.003, p=0.012, respectively). The significant factors for time to treatment failure were a complete response after MINE chemotherapy and serum 2-microglobulin (p=0.003, p=0.044, respectively). 4) The main result of toxicity of MINE was bone marrow suppression. CONCLUSION: The response to MINE chemotherapy and serum 2-microglobulin were both independent prognostic factors for overall survival and time to treatment failure. As the median time to treatment failure for complete responses was 14 months, the best use of this regimen could be in a strategy that includes prompt consolidation of a complete response with intense chemotherapy, with or without hematopoietic stem cell rescue.
Bone Marrow ; Disease Progression ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Hematopoietic Stem Cells ; Humans ; Ifosfamide* ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Mitoxantrone* ; Prognosis ; Recurrence ; Time-to-Treatment ; Treatment Failure

PURPOSE: We evaluated the survival rate, prognostic factors and patterns of failure in malignant and atypical meningiomas, and investigated the role of radiation therapy in the treatment of these tumors. MATERIALS AND METHODS: We retrospectively reviewed nineteen patients treated at Asan Medical Center between Mar. 1994 and Jun. 2000 with histologically confirmed malignant or atypical meningiomas. The median patient age was 52 years. The extent of surgery prior to radiation was gross total resection in 13 and subtotal resection in 6. Eleven patients were referred for radiation immediately after diagnosis and the remainder after at least one recurrence. All patients received megavoltage radiation to a median dose of 55.8 Gy. The median follow-up period was 41 months. RESULTS: Eleven patients (57.9%) showed no evidence of disease, five patients died of meningioma and three were alive with disease. The 5-year overall and relapse-free survivals were 75.9 and 50.6%, respectively. There were no statistically significant prognostic factors found to be associated with relapse-free survival by univariate or multivariate analysis. During the follow-up period, no significant treatment-related complications were detected. CONCLUSION: The major patterns of failure were in-field recurrence. In order to reduce local failure, a higher radiation dose may be needed and a high precision therapy should be considered.
Chungcheongnam-do ; Diagnosis ; Follow-Up Studies ; Humans ; Meningioma* ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: In order to investigate the role of Fas on the chemosensitivity of cancer cells in regards to chemotherapeutic agents, the Fas/FasL signaling pathway of apoptosis was explored in human hepatoma cells. MATERIALS AND METHODS: Fas expression of hepatoma cells including Chang, Huh7, HepG2, and Hep3B cells, was determined by RT-PCR and flow cytometry analysis. Cell viability was measured by MTT assay and apoptosis was assessed by DNA fragmentation assay. The catalytic activity of the caspase-family proteases including caspase-3, 6, 8, and 9 proteases, was tested using fluorogenic biosubstrates. The expression of apoptotic mediators including cytochrome c, PARP, and Bcl2 family proteins were measured from cytosolic and mitochondrial compartments. Mitochondrial membrane potential was measured by fluorescence staining with JC-1, rhodamine 123. RESULTS: Fas mRNA was constitutively expressed in Chang and HepG2 as defined as Fas (+) cells, but not in Huh7 and Hep3B cells, defined as Fas (-) cells. Fas (+) cells were markedly sensitive to 5-FU whereas Fas (-) cells were resistant and able to survive. 5-FU increased Fas expression of Fas (+) HepG2 cells and simultaneously resulted in apoptotic death, characterized by the ladder-pattern fragmentation of genomic DNA. Moreover, it increased the catalytic activity of caspase-8 protease, which eventually cleaved the Bid into truncated Bid which translocated into mitochondria only in Fas (+) cells. It also increased the caspase-9 protease activity with Bax expression, cytosolic release of cytochrome c, and mytochondrial dysfunction only in Fas (+) HepG2 cells. Furthermore, 5-FU increased the enzymatic activity of caspase-3 protease with PARP digestion in HepG2 cells. CONCLUSION: 5-FU exerted cytotoxicity against hepatoma cells via activation of Fas-mediated apoptotic signaling including caspase cascades and mytochondrial dysfunction. Our data suggests that Fas may be an important modulator of the chemosensitivity of cancer cells vis- -vis anticancer chemotherapeutic agents.
Apoptosis* ; Carcinoma, Hepatocellular ; Caspase 3 ; Caspase 8 ; Caspase 9 ; Cell Survival ; Cytochromes c ; Cytosol ; Digestion ; DNA ; DNA Fragmentation ; Flow Cytometry ; Fluorescence ; Fluorouracil* ; Hep G2 Cells* ; Humans ; Membrane Potential, Mitochondrial ; Mitochondria* ; Peptide Hydrolases ; Rhodamine 123 ; RNA, Messenger

PURPOSE: Insulin-like growth factor-I (IGF-I) is an important mitogen in many types of malignancies. The purpose of this study was to evaluate the role of the IGF system on cell proliferation and cell death in mouse lung cancer cell lines (3LL). MATERIALS AND METHODS: Northern analysis was performed in 3LL cells. We evaluated the phosphorylation of IGF-I receptor (IGF-IR) with IGF-I stimulation. MTT assay was performed after treating 3LL cells with IGF-I and the treatment effect on cell death in the presence of anticancer drug was investigated. RESULTS: Northern analysis revealed the presence of IGF-I and IGF-IR mRNA expression in 3LL cells. IGF-I increased cellular proliferation in serum free media. IGF-I also stimulated the tyrosine phosphorylation of two proteins: one, with a molecular mass of 95 kDa, was the beta-subunit of IGF-IR; the other, with an approximate molecular mass of 185 kDa, was originally identified as the insulin receptor substrate-I (IRS-I). IGF-I at a low concentration inhibited the cell death induced by adriamycin. CONCLUSION: IGF-I, a mitogen through the phosphorylation of the IGF-IR beta-subunit, acts as a survival factor to inhibit cell death. Therefore, these findings suggest that IGF-I and IGF-IR are involved in both the cell proliferation and cell death associated with cancer cell growth.
Animals ; Cell Death ; Cell Line ; Cell Proliferation ; Culture Media, Serum-Free ; Doxorubicin ; Insulin-Like Growth Factor I ; Lung Neoplasms* ; Lung* ; Mice* ; Phosphorylation ; Receptor, IGF Type 1 ; Receptor, Insulin ; RNA, Messenger ; Tyrosine

PURPOSE: beta-catenin is an intracellular protein that is an integral component of the cadherin-mediated cell-cell interaction and a downstream transcriptional activator in the wnt signal transduction pathway. Inappropriate activation of beta-catenin has recently been implicated in the development of hepatocellular carcinoma and cholangiocarcinoma. Nuclear beta-catenin expression is strongly associated with gene mutation. This study was designed to evaluate the pattern of beta-catenin expression between hepatocellular carcinoma and cholangiocarcinoma. MATERIALS AND METHODS: Immunohistochemical expression of beta-catenin was studied in 7 normal livers, 33 hepatocellular carcinomas and 20 cholangiocarcinomas, that were formalin fixed and paraffin embedded. RESULTS: beta-catenin was expressed mainly in the cytoplasmic membrane of the normal hepatocytes and bile ducts. Nuclear expressions, not noted in the normal liver, were noted in 30% of the hepatocellular carcinomas and 10% of the cholangiocarcinomas. And, nuclear expression was more common in the high grade (50%) hepatocellular carcinomas than the low grade (18%) hepatocellular carcinomas (p<=0.05). CONCLUSION: The above results indicate that nuclear expression of beta-catenin is observed in the carcinoma but not the normal liver, and is associated with high grade liver carcinoma.
beta Catenin* ; Bile Ducts ; Carcinoma, Hepatocellular* ; Cell Membrane ; Cholangiocarcinoma* ; Formaldehyde ; Hepatocytes ; Liver ; Paraffin ; Signal Transduction

PURPOSE: To evaluate the efficacy and toxicity of a Gemcitabine, UFT-E, Leucovorin combination chemotherapy in the treatment of advanced pancreatic adenocarcinoma. PATIENTS AND METHODS: Patients <=70 years, with no prior chemotherapy and with bidimensionally measurable advanced pancreatic adenocarcinoma, ECOG performance status <=2, and adequate bone marrow, kidney, and liver function were eligible for this trial. Eligibility criteria for clinical benefit assessment were pain with at least a daily analgesic consumption of two nonsteroidal anti-inflammatory drugs or a Karnofsky performance status between 50 and 70. Treatment consisted of 1,000 mg/m2 of Gemcitabine on days 1, 8 and 15, repeated every 4 weeks, with UFT-E administered orally 500 mg-700 mg by body surface area (BSA). Leucovorin was administered 45 mg/day orally. Dosages of UFT-E and Leucovorin were divided and administered three times per day from day 1 to day 21. After 7 days of rest, UFT-E and Leucovorin were administered repeatedly. RESULTS: Twenty-three patients were enrolled between April 1999 to April 2000. Eighty two cycles (median, four cycles) were delivered to all patients. The objective response rate was 15.8% in 19 assessable patients and 13.0% in the intent-to-treat population. Twelve patients (57.9%) displayed stable disease. Grade 3 or 4 neutropenia occurred in 30.4% of patients, nausea/vomiting in 8.3%, diarrhea in 4.3%, and mucositis in 4.3%. The median time to progression was 8 months. The median survival was 8 months in the assessable population and 6 months in the intent-to-treat population Clinical benefit was achieved in 11 (57.9%) of 19 assessable patients. CONCLUSION: Gemcitabine, UFT-E, Leucovorin combination chemotherapy is a well-tolerated and safe regimen in cases of advanced pancreatic adenocarcinoma. Although the response rate is low, it shows a survival benefit and clinical benefit and deserves further evaluation in a phase III trial.
Adenocarcinoma* ; Body Surface Area ; Bone Marrow ; Diarrhea ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Karnofsky Performance Status ; Kidney ; Leucovorin* ; Liver ; Mucositis ; Neutropenia ; Pancreatic Neoplasms

PURPOSE: Helicobacter pylori (H. pylori) is now generally accepted to be strongly associated with the development of gastric cancer, as well as intakes of some salted foods, charred foods, etc. To evaluate the association among dietary habits, H. pylori infection, and early gastric cancer in Koreans, a hospital based case-control study was conducted. Material and Method: A total of 268 persons participated in this case-control study. Sixty nine patients were newly diagnosed as an early gastric cancer (EGC) at the Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea. One hundred ninety-nine subjects with no symptoms who visited the Health Promotion Center for their general checkups were selected as the controls. All subjects were examined for H. pylori infection, biochemical blood test the life style, and dietary habit were interviewed by a trained dietition with semi-quantitative food frequency question naire (FFQ) and adaptive salt concentration were taste evaluated. RESULTS: H. pylori seropositivity was observed in 88.4% in cases, as compared with 74.9% in controls (OR=2.5, 95% CI: 1.1-5.7). The adaptive salt concentration was associated with early gastric cancer risk (chi-squir=50.8, p<0.001). The analysis of food intake frequency demonstrated that early gastric cancer risk was reduced by the intake of clear soups, raw vegetables, fruits and juices, beef with vegetables and soybean curds. On the other hand, high intake of salt-fermented fish and kimchi elevated the risk of early gastric cancer. CONCLUSION: These results suggest that some dietary factors and H. pylori infection have a significant association with the development of early gastric cancer.
Case-Control Studies ; Chungcheongnam-do ; Eating ; Food Habits* ; Fruit ; Gastroenterology ; Hand ; Health Promotion ; Helicobacter pylori* ; Helicobacter* ; Hematologic Tests ; Humans ; Internal Medicine ; Korea ; Life Style ; Seoul ; Soybeans ; Stomach Neoplasms* ; Trout ; Vegetables

PURPOSE: The purpose of this study was to develop and test an Information Needs Scale for Korean outpatients undergoing chemotherapy (INS-C). MATERIALS AND METHODS: Thirty-three items of the INS-C had content validity based upon findings in the literature and the experiences of expert oncology physicians and nurses. Each item consisted of a five-point Likert scale from 1 (don't want to know) to 5 (want to know very much). The items were administered to 175 Korean outpatients undergoing chemotherapy. The data obtained was analysed using a factor analysis for construct validity and Cronabch's alpha for internal consistent reliability. RESULTS: From the factor analysis, six subscales were derived significantly. The six subscales explained 64.62% of the variance. The subscales were named Side-Effects/Investigative Tests (9 items), Spread of Disease (4 items), Financial Cost (2 items), Treatment (7 items), Activities/ Eating (6 items), and Interrelationships/Support (5 items). The Cronbach's alpha of the total INS-C was .95, and the alpha of the subscales ranged from .77 to .91. CONCLUSION: The present study suggests that the INS-C is a reliable and valid instrument to measure the information needs of outpatients undergoing chemotherapy. Health professionals caring for patients with cancer should assess the informational needs of their patients using a reliable and valid instrument and be prepared to provide accurate information.
Drug Therapy* ; Eating ; Health Occupations ; Humans ; Outpatients*

PURPOSE: Axillary lymph node metastases are the single most important predictor of overall survival in patients with breast cancer. Micrometastases are defined by the American Joint Committee on Cancer as tumor foci less than or equal to 2 mm in greatest dimension. Recently, up to 30% of breast cancer patients were reported to have micrometastases. In this paper, to assess the rate of micrometastases in patients with stage I breast cancer, we attempted to determine the most useful marker of the micrometastases in node negative cases by routine histopathologic examination of regional lymph nodes and comparison of the results with the influencing factors on prognosis. MATERIALS AND METHODS: We performed immunohisto chemical staining for pancytokeratin, cytokeratin 7, cytokeratin 20 and CEA to identify which protein was the most useful marker for the detection of micrometastases in 86 node negative cases and determined the correlation between histological and clinical data. RESULTS: A total of 5 lymph nodes in 5 separate cases showed micrometastases among the total 1,296 lymph nodes and 86 cases. The rates of micrometastases of lymph nodes and cases were 0.38% and 5.8%, respectively. The tumor type of micrometastasis was infiltrating ductal carcinoma in all cases. None of the microme tastases cases showed any relationship with tumor grade, tumor size, expression of ER and PR, patient survival rate or recurrence rate. The most useful marker to detect micrometastases was pancytokeratin. CONCLUSION: The results of this study indicate that micrometastasis of axillary lymph nodes does not carry any independent prognostic significance.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Humans ; Immunohistochemistry ; Joints ; Keratin-20 ; Keratin-7 ; Keratins* ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Prognosis ; Recurrence ; Survival Rate