PURPOSE: The quality of life has become increasingly important as an outcome when assessing patients who have had surgery for advanced gastric cancer in the elderly. The purpose of this study was to study the validity of quality of postoperative life as a criterion in the decision-making process as well as the results of operation for advanced gastric cancer in the elderly. MATERIALS AND METHODS: Spitzer's quality of life index, postoperative mortality and survival were evaluated in 67 patients(over 65 years of age) with advanced gastric cancer who had undergone operation between 1988 and 1997 at the Department of Surgery, Kangnam Sacred Heart Hospital. RESULTS: The quality of life score and median survival correlated with TNM clinical stage(IIIa; 7.1+/-1.8, 36.0 months vs. IIIb: 5.8+/-2.8, 28.6 months vs. IV: 2.9+/-1.9, 4.5 months), resectability(reseetion: 5.9+/-2.7, 21.0 months vs. no resection: 3.0+/-2.0, 4.0 months), curability(curative operation: 6.5+/-2.4, 29.0 months vs. palliative operation: 3.3+/-2.4, 6.0 months), type of gastrectomy(subtotal gastrectomy: 6.4+/-2.7, 28.0 months vs. totai gastrectomy: 4.5+/-2.6, 9.0 months), but not with age or sex. There was a difference in operative mortality according to age group(65~70 years: 7.8% vs. >70 years: 18.8%), resectability(resection: 7.4% vs. no resection: 23.0%) and curability (curative operation: 2.3% vs. palliative operation: 25.0%). CONCLUSION: The results suggest that surgical resection offers the only chance for improved survival and qulaity of life. Gastric resection, even with total gastrectomy, can be undertaken to reduce tumor burden, decrease threats of obstruction, hemarrhage, or perforation and improve quality of life in the elderly if there is little coexisting impairment.
Aged* ; Gastrectomy ; Heart ; Humans ; Mortality ; Quality of Life ; Stomach Neoplasms* ; Tumor Burden

Nausea and vomiting during early pregnancy is a common phenomenon, but very little data is available about the mechanism of this condition, and the etiology of hypereme sis is still unknown. One of the most popular hypothesis is that abnormal hormone levels, especi-ally thyroid hormone, may be possible etiologic factor of nausea and vomiting. The object of this study is to investigate the relationship between the presence or ab- sence of nausea and vomiting in early pregnancy and thyroid function. Twenty patients suffering from hyperemesis gravidarum of first trimester of pregnancy and twenty from morning sickness were selected. 20 non-pregnant and 20 pregnant women without nausea and vomiting were selected to age-matched control groups. Thyroid function was evaluated by using T3, T4, and TSH radioimmunoassay. Comparison between groups were analyzed with the paired t-test. In this study, we found that a significant increase in serum total T4(p<0.001) and T3 (p<0.05), and a significant decrease in serum TSH(p<0.001) were observed in pregnancy with hyperemesis gravidarum relative to the level in normal pregnancy. These results were correlated with the severity of nausea and vomiting. In conclusion, highly elevated T3 and T4 were closely linked to the cause of the vomi- ting in pregnancy with hyperemesis gravidarum. Further study is needed to evaluate more clearly the thyroid status of patients with hyperemesis gravidarum and to seek a therapy.
Female ; Humans ; Hyperemesis Gravidarum* ; Morning Sickness ; Nausea ; Pregnancy ; Pregnancy Trimester, First ; Pregnant Women ; Radioimmunoassay ; Thyroid Gland* ; Tolnaftate ; Vomiting

BACKGROUND: Myelodysplastic syndromes (MDS) are clonal hematologic stem cell disorders characterized clinically and morphologically by ineffective hematopoiesis. A consensus-defined French-American-British (FAB) classification and International Prognostic Scoring System (IPSS) for predicting outcome and planning therapy in MDS has been developed, but its prognostic value in a large and independent series remains unproven. So we investigate clinical characteristics and prognosis of MDS, according to French-American-British (FAB) classification and International Prognostic Scoring System (IPSS). METHODS: A retrospective analysis of 50 patients who were diagnosed as myelodysplastic syndrome at Ajou University Hospital was performed from November, 1994 to April, 2003. The patients with secondary MDS were excluded. All patients were classified according to the FAB classification and calculated prognostic scores for IPSS. Patients were evaluated for clinical features and for blood and bone marrow findings at the time of diagnosis, and were followed up for survival and leukemic progression. Survival curves were based on the Kaplan-Meier method. All reported p values less than or equal to 0.05 were regarded as stastistically significant. RESULTS: The peak age was in the fifth decade and the male to female ratio was 1.5:1. RA (36%) was observed most frequently. Thereafter, RAEB-t (26%), RAEB (24%), RARS (12%) and CMML (2%) were observed, respectively. The initial symptoms on admission were fever (24%), dizziness and headache (16%), general weakness (16%), hemorrhage (14%), dyspnea (12%), abdominal pain (4%) and vomiting (4%). Cytogenetic studies were performed in 34 patients with MDS. They were classified as good, intermediate, poor group by chromosome score of IPSS. The median survival was 16.4 months for the good group, 15 months for the intermediate, 10.3 months for the poor. The median survival according to FAB classified groups were RA (33.8 mo), RARS (12.5 mo), RAEB (16.4 mo), RAEB-t (6.7 mo) and CMML (1.3 mo). Survival according to IPSS scoring system were 67.2 months for low, 27.1 months for intermediate-1, 10.3 months for intermediate-2 and 6.0 months for high groups. These data were statistically significant (p<0.05). CONCLUSIONS: In our experiencies, FAB and IPSS classification would be good predictors in clinical outcomes. But, because of the heterogeneity of MDS, large multicenter studies will be needed to define the issue of a new classification for these disorders.
Abdominal Pain ; Anemia, Refractory, with Excess of Blasts ; Bone Marrow ; Classification* ; Cytogenetics ; Diagnosis ; Dizziness ; Dyspnea ; Female ; Fever ; Headache ; Hematopoiesis ; Hemorrhage ; Humans ; Male ; Myelodysplastic Syndromes* ; Population Characteristics ; Prognosis* ; Retrospective Studies ; Stem Cells ; Vomiting

PURPOSE: The main aim of this study was to compare spiral CT and MR imaging in the detection and characterization of focal hepatic masses. MATERIALS AND METHODS: Seventy-nine patients with 155 focal hepatic masses confirmed pathologically, or radiologically and clinically [hepatocellular carcinoma(HCC) (n =52), hemangioma (n=36), cysts (n =35), metastasis (n =27), intrahepatic cholangiocarcinoma (n =5)], underwent two- or three-phase spiral CT, and T1-, T2- weighted, and dynamic contrast-enhanced MR imaging. The detection and characterization of focal hepatic masses by these modalities were evaluated and compared. RESULT: The detection rates of spiral CT and MR imaging, respectively, were as follows: HCC, 81%(42/52) and 94%(49/52); hemangioma, 75%(27/36) and 100%(36/36); cysts, 80%(28/35) and 100%(35/35); metastasis, 67%(18/27) and 100%(27/27); and intrahepatic cholangiocarcinoma, 100%(5/5) and 100%(5/5). MR imaging was superior to spiral CT in mass detection of HCC, hemangioma, cysts, and metastasis (p < .05). The characterization rates of spiral CT and MR imaging, respectively, were as follows: HCC, 52%(27/52) and 71%(37/52); hemangioma, 67%(24/36) and 100%(36/36); cysts, 63%(22/35) and 100%(35/35); metastasis, 37%(10/27) and 100%(27/27); and intrahepatic cholangiocarcinoma, 40%(2/5) and 80%(4/5). In the mass characterization of HCC, hemangioma, cysts, and metastasis, MR imaging was superior to spiral CT (p< .05). CONCLUSION: In the detection and characterization of focal hepatic masses, including hepatocellular carcinoma, hemangioma, hepatic cyst and metastasis, MR imaging is superior to spiral CT.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Hemangioma ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Tomography, Spiral Computed*

We report one family with bilateral renal hypoplasia and ocular coloboma in two consecutive generations. Ophthalmological examination revealed optic disc coloboma and decreased visual acuity. Fragments spanning exon 1-12 of the PAX2 gene were amplified from genomic DNA using PCR primers. The PCR products were purified and directly sequenced. No definite mutation was detected in the PAX2 genes in these patients, but two coding region single nucleotide polymorphisms were identified. This result suggests that the optic disc coloboma with bilateral renal hypoplasia might be genetically heterogenous or other genes could be responsible.
Clinical Coding ; Coloboma ; DNA ; Exons ; Family Characteristics ; Humans ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Visual Acuity

BACKGROUND: This study was designed to examine the prevalence of aberrant promoter methylation in a selected panel of genes potentially involved in lymphoid tumors. METHODS: The promoter hypermethylation status of MGMT, DAPK1, hMLH1, CDH1, SHP1, and HIC1 was measured by methylation-specific PCR for 82 cases of B-cell lymphoma. Immunohistochemical staining using MGMT and SHP1 antibodies was conducted on 43 out of 82 cases. RESULTS: The number of MGMT aberrant methylations was lower in diffuse large B-cell lymphoma (DLBCL) than in other malignant lymphomas. The methylation of DAPK1 was frequently detected in follicular lymphoma (FL), marginal zone B-cell lymphoma (MZL) and DLBCL. With one exception, methylation of hMLH1 was not observed in B-cell lymphomas. The methylation frequency of CDH1, and HIC1 was similar in B-cell lymphomas. However, the methylation of SHP1 gene was more frequently observed in cases of FL, DLBCL, and MZL than in chronic lymphocytic lymphoma. MGMT and SHP1 promoter methylation were inversely correlated with the protein expression observed upon immunohistochemical staining. CONCLUSIONS: Aberrant promoter methylation of multiple genes occurs with variable frequency throughout the B-cell lymphomas, and methylation of hMLH1 is rarely observed in B-cell lymphomas.
Antibodies ; B-Lymphocytes ; DNA ; DNA Methylation ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Follicular ; Methylation ; Polymerase Chain Reaction ; Prevalence

Biphenotypic acute leukemia (BAL) is a subtype of leukemia of ambiguous lineage in the World Health Organization classification system. About one third of the cases have the Philadelphia chromosome, and some cases are associated with other structural abnormalities involving 11q23. BAL is known to have a poor prognosis in both children and adults. According to the previously reported BAL cases with positive BCR-ABL fusion gene, most of the BCR-ABL mRNA transcript type was e1a2. So, we describe here a 30-year-old adult BAL case with the karyotype 46,XY,t(9;22)(q34;q11.2) resulting in a very rare b3a2 type of BCR-ABL mRNA transcript.
Adult ; Child ; Classification ; Humans ; Karyotype ; Leukemia ; Leukemia, Biphenotypic, Acute* ; Philadelphia Chromosome ; Prognosis ; RNA, Messenger* ; World Health Organization

Rituximab is a chimeric monoclonal antibody that specifically targets the CD20 molecule on the B cell surface. Although rituximab was originally introduced for the treatment of lymphoid neoplasms such as non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL), it is now emerging as an effective and relatively safe therapeutic option for the patients with refractory immune thrombocytopenic purpura (ITP). We report here on a case of life-threatening toxic epidermal necrolysis (TEN) that was related with the use of rituximab in a patient with refractory ITP. The patient developed extensive erythematous papules and bullous lesions on his whole body associated with fever and visual disturbance during the second cycle of rituximab. The rituximab was discontinued and high dose intravenous immunoglobuline and steroid were administrated. Four weeks later, he fully recovered without any sequelae. A review of the literature reveals this to be the first reported case of TEN associated with rituximab injection in Korea.
Antibodies, Monoclonal, Murine-Derived ; Blister ; Epidermal Necrolysis, Toxic ; Fever ; Humans ; Immunoglobulins ; Korea ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma, Non-Hodgkin ; Purpura, Thrombocytopenic, Idiopathic ; Rituximab

PURPOSE: Second-generation tyrosine kinase inhibitors (second TKIs) such as nilotinib and dasatinib control the activity of most ABL kinase domain mutations observed in patients with imatinib resistance. Although in vitro data show that both agents can inhibit all mutations except T315I, some discrepancies have been observed in a small subset of mutation clones. Cytogenetic clonal evolution is the important resistance mechanism of chronic myeloid leukemia (CML). Accordingly, we observed the clinical significance of coexisting with clonal evolution and BCR-ABL mutant in CML patients treated with second TKIs. MATERIALS AND METHODS: We monitored BCR-ABL transcript kinetics, interrelationship of clones expressing non-mutated and mutant transcripts and clonal aberrations within Philadelphia (Ph) positive and negative clones, respectively, in eight patients with CML receiving dasatinib or nilotinib for 3~41 months. RESULTS: Clinical responses were correlated with in vitro sensitivity of the BCR-ABL mutants to the second TKIs in four patients. Four patients showed resistance to the second TKIs as compared to in vitro observations; three of them developed chromosomal abnormalities in the Ph chromosome positive or negative metaphases. Another patient lost the original mutation but acquired a more resistant new mutation and became resistant to the second TKI. CONCLUSION: Cytogenetic clonal evolution is an independent poor prognostic factor in CML, which could explain the onset of mechanisms for second TKIs resistance to ABL kinase domain mutations. The results indicate that an additional evaluation of chromosomal abnormalities is warranted when BCR-ABL mutants are more resistant than indicated by in vitro data.
Benzamides ; Chromosome Aberrations ; Clonal Evolution ; Clone Cells ; Cytogenetics ; Dasatinib ; Humans ; Hydrogen-Ion Concentration ; Kinetics ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Metaphase ; Philadelphia ; Phosphotransferases ; Piperazines ; Protein-Tyrosine Kinases ; Pyrimidines ; Thiazoles ; Tyrosine ; Imatinib Mesylate

BACKGROUND: Signal transducer and activator of transcription 3 (STAT3) is not only a key signaling molecule in the regulation of growth but is also involved in malignant transformation. We investigated the prognostic significance of STAT3 expression in 94 non-elderly adult patients (aged 38 to 65 yr) with newly diagnosed multiple myeloma (MM). METHODS: Tumor cell-specific phosphotyrosine-STAT3 (PY-STAT3) expression at the time of diagnosis was evaluated with dual immunohistochemical (IHC) staining for PY-STAT3 and CD138. RESULTS: PY-STAT3 positivity was detected in 10 patients (10.6%), including three who showed strong expression. PY-STAT3-positive patients had higher serum C-reactive protein and calcium levels at diagnosis than did PY-STAT3-negative patients. PY-STAT3 positivity had predictive value for poor progression-free survival (PFS; P=0.001) and overall survival (OS; P=0.003). Among the 60 patients who received frontline autologous stem cell transplantation, PY-STAT3-positive patients had poorer PFS than did PY-STAT3-negative patients (4.2 vs. 19.2 mo, respectively; P=0.013). Multivariate analysis identified PY-STAT3 expression as an independent prognostic factor for PFS (relative risk [RR]=2.706, P=0.014) and OS (RR=3.091, P=0.044). CONCLUSION: These data show that PY-STAT3 positivity, as determined using dual IHC, is a marker of poor prognosis in non-elderly adult patients with MM.
Adult* ; C-Reactive Protein ; Calcium ; Diagnosis ; Disease-Free Survival ; Humans ; Multiple Myeloma* ; Multivariate Analysis ; Prognosis ; STAT3 Transcription Factor ; Stem Cell Transplantation