The 5 year survival rate after surgical resection for stage III non-small cell lung cancer(NSCLC) remains short, only 10-19%. Radiotherapy seems to show some benefit for local control, but it does not reflect to prolongation of survival, as distant metastasis prevails. Vinblastine is one of the most active agent against NSCLC. 5-Fluorouracil(5-FU) and cisplatin are synergistic in anti-cancer activity in adenocarcinoma of gastrointestinal tract and squamous cell cancer of head and neck. We initiated a phase II trial for advanced NSCLC to determine the effect of FVP regimen in response rate, survival and toxicities. The therapy consisted of 5-FU 500mg/m2/12 hours continious IV infusion for 36 hours from day 1, vinblastine 3mg/m2 IV bolus day 1 and 2, cisplatin 75mg/m2 IV infusion over 2 hours day 1 and it was repeated every 3 weeks. Among the 45 patients entered into this study, 40 patients were evaluable for response. The objective response rate was 50%(CR;1/40, 2.5% PRi19/40, 47.5%). The median survival of all the patients was 42.9 weeks(8.4+ - 140.6 weeks); the responding patients survived longer than the non-responders(mediansurvival; 54.4 weeks vs 29.7 weeks, p<0.05). The toxicities of this regimen were acceptable but 1 patient died of pneumonia associated with granulocytopenia. We concluded that the FVP regimen is effective in the treatment of advanced non-small cell lung cancer and a prospective randomized trial and long- term follow up is warranted.
Adenocarcinoma ; Agranulocytosis ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Dronabinol* ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil* ; Follow-Up Studies ; Gastrointestinal Tract ; Head ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Neoplasms, Squamous Cell ; Pneumonia ; Radiotherapy ; Survival Rate ; Vinblastine

The septum formation(web) of bile duct is an uncommon disease. Its rarity and vague symptoms result in delayed diagnosis. However, the increased use of endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic cholangiography(PTC) have resulted in greater awareness of this entity and understanding of its natural history as well as an increased frequency of diagnosis. We have experienced 4 cases of common bile duct web, which were associated with stones in the bile duct, confirmed by operation.
Bile Ducts ; Common Bile Duct* ; Delayed Diagnosis ; Diagnosis ; Natural History

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. Adrenal crisis in isolated ACTH deficiency is less common compared to primary adrenal insufficiency, but isolated ACTH deficiency is an important cause of hypoglycemia. Recently we experienced a 41-year-old man admitted because of mental confusion. On admission, plasma glucose and sodium concentration were 1.7, 132 mmol/L, respectively. Basal plasma ACTH and cortisol levels were low and other pituitary hormone showed normal response to combined pituitary stimulation test except growth hormone. Plasma ACTH concentration remained low even after intravenous injection of ovine corticotropin releasing factor. It suggest that the defect of ACTH secretion was apparently due to intrinsic pituitary rather than hypothalamic disease. The sellar CT showed the fossa to be filled by cerebrospinal fluid. After treatment with glucocorticoid, he had no further evidence of hypoglycemia and hyponatremia. In conclusion, we report a case of isolated ACTH deficiency with empty sella.
Addison Disease ; Adrenocorticotropic Hormone ; Adult ; Blood Glucose ; Cerebrospinal Fluid ; Corticotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypothalamic Diseases ; Injections, Intravenous ; Plasma ; Sodium

No abstract available.
Humans ; Insulin Resistance* ; Insulin*

PURPOSE: To assess the effect of the epidural steroid injection for patients suspected of having an internal disc disruption. MATERIALS AND METHODS: Thirteen patients at the pain intervention clinic that received a lumbar interlaminar epidural steroid injection and were suspected of having an internal disc disruption were prospectively enrolled in this study. The treatment outcome was assessed using a 5-point patient satisfaction scale (no pain, much improved, slightly improved, no effect, aggravated) two weeks after injection. A successful outcome required a patient satisfaction scale of "much improved" or "no pain". All patients received follow-up for two months. Two radiologists evaluated the presence of HIZ (high intensity zone), a dark disc by MR (n = 10) and a diffuse bulging disc by CT (n = 3). RESULTS: Nine (69%) of the 13 patients achieved a successful outcome two weeks after injection. These nine patients showed no recurrence during the two months months follow-up. Of the 22 abnormal discs demonstrated by MRI and CT, MRI showed a dark disc in six patients and HIZ in 13 patients. CT showed diffuse bulging in three discs. Nine of 10 patients showed at least one HIZ. CONCLUSION: An lumbar interlaminar epidural steroid injection might be an effective tool for managing patients suspected of having an internal disc disruption.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Patient Satisfaction ; Prospective Studies* ; Radiology, Interventional ; Recurrence ; Treatment Outcome

35-year-old female presented with recurrent spinal mass that was resected. Pathologic examination revealed mature teratoma consisting of thyroid follicles, fibroadipose tissue, and mature bony particles. And in this teratoma, focal area of papillary thyroid carcinoma component arising from the normal thyroid follicles were observed. This finding was clearly distinguished from metastasis from thyroid or from other sites. The patients underwent evaluation of thyroid gland, and there was a 1.2 x 1.1 x 2 cm sized nodule. It was well-margined, round, mixed and hyperechoic by sonographic evaluation, and its aspirates contained benign-looking follicular cells only. The patient refused further evaluation or treatment about thyroid cancer, and was discharged. To date, there are only one case of thyroid carcinoma arising from a sacrococcygeal mass containing thyroid tissue components alone (Thyroid 2004:14:548-552). We believe that this patient is a very rare case of thyroid cancer primarily arising from teratoma due to malignant transformation of its thyroid tissue component.
Adult ; Female ; Humans ; Neoplasm Metastasis ; Teratoma* ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography

Background: Conventional diagnostic approaches for adrenal tumors require multi-step processes, including imaging studies and dynamic hormone tests. Therefore, this study aimed to discriminate adrenal tumors from a single blood sample based on the combination of liquid chromatography-mass spectrometry (LC-MS) and machine learning algorithms in serum profiling of adrenal steroids. Methods: The LC-MS-based steroid profiling was applied to serum samples obtained from patients with nonfunctioning adenoma (NFA, n=73), Cushing’s syndrome (CS, n=30), and primary aldosteronism (PA, n=40) in a prospective multicenter study of adrenal disease. The decision tree (DT), random forest (RF), and extreme gradient boost (XGBoost) were performed to categorize the subtypes of adrenal tumors. Results: The CS group showed higher serum levels of 11-deoxycortisol than the NFA group, and increased levels of tetrahydrocortisone (THE), 20α-dihydrocortisol, and 6β-hydroxycortisol were found in the PA group. However, the CS group showed lower levels of dehydroepiandrosterone (DHEA) and its sulfate derivative (DHEA-S) than both the NFA and PA groups. Patients with PA expressed higher serum 18-hydroxycortisol and DHEA but lower THE than NFA patients. The balanced accuracies of DT, RF, and XGBoost for classifying each type were 78%, 96%, and 97%, respectively. In receiver operating characteristics (ROC) analysis for CS, XGBoost, and RF showed a significantly greater diagnostic power than the DT. However, in ROC analysis for PA, only RF exhibited better diagnostic performance than DT. Conclusion The combination of LC-MS-based steroid profiling with machine learning algorithms could be a promising one-step diagnostic approach for the classification of adrenal tumor subtypes.