PURPOSE: We studied the effectiveness and toxicities of 5-fluorouracil+leucovorin, combination chemotherapy in advanced or recurred colo-rectal cancer patients, who didn't have previous chemotherapy and enrolled from August 1993 to July 1998. MATERIALS AND METHODS: All patients were treated with leucovorin followed by 5-fluorouracil for 5 consecutive days every 4 weeks. Among 43 patients who were enrolled, 40 patients received treatment at least 2 courses, and they were evaluable. Male to female ratio was 21 to 19. In serum CEA level, 27 patients were greater than 5 ng/ml and 13 were less than 5 ng/ml. And primary site was colon in 21 patients and rectum in 19 patients. RESULTS: The complete response rate was 7,5% and the partial response rate was 25%. The median survival duration was 14.7 months, the median response duration was 16.0 months, and median time to progression was 7.3 months. In the analysis of response, survival duration, time to progression according to various characteristics of patients, serum CEA level and liver involvement were revealed significant difference in survival duration, time to progression (p=0.0122, 00350 & 0.0202, 0.0123) on univariate analysis, but no significant difference on multivariates. Hematologic and non-hematologic toxicities were mild and tolerable. CONCLUSION: This study indicates that the combination of 5-fluorouracil (370 mg/m) and leucovorin (20 mg/m) is effective and tolerable regimen in advanced or recurred colo-rectal cancer patients without previous chemotherapy.
Colon ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Fluorouracil* ; Humans ; Leucovorin* ; Liver ; Male ; Rectal Neoplasms* ; Rectum

BACKGROUND: Acute myeloid leukemia (AML) is a hematologic malignant disease characterized by an uncontrolled proliferation of myeloid cells in marrow and arrest in their maturation. Immunophenotyping is a widely used method to diagnose and classify leukemia, and cytogenetic studies can help providing the clues of disease progression and monitoring remission status after chemotherapy. METHODS: From August 1997 to July 2000, 68 patients with AML were treated with ara-C and idarubicin for remission induction, then followed by consolidation therapy. A panel of monoclonal antibodies (CD5, CD7, CD10, CD19, CD22, CD14, CD13, CD33, HLA-DR) were used to characterize immunologic phenotypes by flow cytometry. Chromosomal abnormalities by high resolution banding technique were evaluated. Patients were divided into three groups (favorable : A, intermediate : B, unfavorable : C). RESULTS: The incidence of chromosomal abnormalities was 57% (39/68), and the proportion of patients per groups were 21% (14/68) for group A, 57% (39/68) for group B, and 22% (15/68) for group C. The median follow- up duration of the 68 evaluable patients was 12.7 months. The complete remission (CR) rate was 63.2% (43/68). The CR rate in group A, B, and C were 92.9% (13/14), 66.7% (26/39) and 26.7% (4/15), respectively (P=0.005). The AML patients who expressed CD19 (P=0.048) or did not express CD14 (P=0.013) had better CR than other groups. The median leukemia free survival duration of group A and B were 39.5 months and 11.9 months, respectively, and the leukemia free survival duration of group C has not been reached at median value (P=0.038). The median overall survival duration was 12.3 months, the survival duration of group A has not been reached at median value, and the median survival duration of group B and C were 12.0 months and 1.5 months, respectively (P=0.001). The AML patients without CD7 (P=0.029), without CD14 (P=0.023), or with CD19 (P=0.047) showed a better survival than other groups. In multivariate analysis, karyotype proved to be a significant prognostic factor (P=0.018). CONCLUSION: This study demonstrated that karyotype was an important prognostic factor in AML patients. Among surface marker expressions, CD7, CD14, CD19 may be used as a prognostic factor. Further study will be needed to confirm the role of immunophenotyping in AML.
Antibodies, Monoclonal ; Bone Marrow ; Chromosome Aberrations* ; Cytarabine ; Cytogenetics ; Disease Progression ; Drug Therapy ; Flow Cytometry ; Humans ; Idarubicin ; Immunophenotyping ; Incidence ; Karyotype ; Leukemia ; Leukemia, Myeloid, Acute* ; Multivariate Analysis ; Myeloid Cells ; Phenotype ; Remission Induction

No abstract available.
Emergencies ; Humans

PURPOSE: The purpose of this study was to compare the clinical outcomes between laparoscopic (LS) and conventional open splenectomies (OS) in benign splenic diseases. METHODS: We retrospectively reviewed the medical records of patients who had undergone a splenectomy between June 1991 and April 2004. The patients' demographics and operative outcomes were also evaluated. RESULTS: Fifty-four patients were identified; LS and OS were performed in 41 and 13 patients, respectively. The age, gender and operative times between the two groups were similar. The time to resumption of oral intake was faster in the LS patients (2.0 +/- 0.9 vs. 4.0 +/- 5.1 days; P<0.0001). The length of hospital stay was shorter in the LS patients (4.0 +/- 2.4 vs. 12.0 +/- 7.4 days; P<0.0001). There were also significantly lower perioperative complications in the LS compared to the OS patients (4.8 vs. 38.5%; P=0.0017). In the patients with idiopathic thrombocytopenic purpura (ITP), there were no differences in the detection rate of an accessory spleens and the treatment response between the two groups. CONCLUSION: This study shows that LS is a safer than OS, and is an excellent surgical method: earlier diet tolerance, shorter hospital stay and fewer perioperative complications, with good cosmesis. Also, there was no difference in the surgical responses to treatment between the two procedures. Therefore, LS can become the gold standard for the treatment of benign diseases of the spleen.
Demography ; Diet ; Humans ; Length of Stay ; Medical Records ; Operative Time ; Purpura, Thrombocytopenic, Idiopathic ; Retrospective Studies ; Spleen ; Splenectomy* ; Splenic Diseases*

Purpose: We compared the changes in the perioperative peripheral lymphocyte subsets and the acute inflammatory reactants (CRP and SAA) to compare the immune responses between a Laparoscopy-assisted distal gastrectomy (LADG) and a conventional open distal gastrectomy (CODG). METHODS: 23 patients, who underwent an operation for early gastric cancer, between Nov. 2003 and Feb. 2004, were enrolled in this study. The total WBC, lymphocytes, peripheral lymphocyte subsets and acute inflammatory reactants (CRP and SAA) were evaluated on the preoperative day, and 2, and 24 hrs and on the 4th postoperative day in 20 of the 23 cases. RESULTS: There were no significant differences in the preoperative total WBC, lymphocyte, peripheral lymphocyte subsets, CRP and SAA between the two groups (P <0.05). The WBC levels were highest 2 hours after surgery, but had decreased at 24 hrs and on the 4th postoperative day in both groups. The numbers of lymphocyte subsets in both groups dropped at 2 hours, but increased gradually during the postoperative days (P >0.05). The postoperative CRP and SAA levels; however, gradually increased compared to the preoperative levels, and were significantly lower in the LADG than the CODG group (CRP: P=0.03 and SAA: P=0.01). Conclusion: No difference was detected in the immune-cell numbers in the gastric cancers between the LADG and CODG groups. The LADG was found to influence the acute inflammatory reaction less than the CODG.
Gastrectomy* ; Humans ; Lymphocyte Subsets ; Lymphocytes ; Stomach Neoplasms*

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new method of accessing intracavitary organs in order to minimize pain by avoiding incisions in the body wall. The aim of this study is to determine patients' acceptance of NOTES in Korea and to compare their views about laparoscopic surgery and NOTES for benign and malignant diseases. MATERIALS AND METHODS: The target number of total subjects was calculated to be 540. The subjects were classified into 18 sub-groups based on age groups, gender, and history of prior surgery. The questionnaire elicited information about demographic characteristics, medical check-ups, diseases, endoscopic and surgical histories, marital status and childbirth, the acceptance of NOTES, and the preferred routes for NOTES. In addition, the subjects chose laparoscopic surgery or NOTES for a hypothetical cholecystectomy and rectal cancer surgery, and responded to questions regarding the acceptable complication rate of NOTES, the appropriate cost of NOTES, and the reason(s) why they did not select NOTES. RESULTS: 486 of 540 patients (90.0%) who agreed to participate in this study completed the questionnaire. NOTES was preferred by the following patients: elderly; a history of treatment due to a disease; having regular check-ups; and a history of an endoscopic procedure (p<0.05). The most preferred route for NOTES was the stomach (67.1%). Eighty-four percent of the patients choosing NOTES responded that the complication rate of the new surgical method should be the same or lower than laparoscopic surgery. Vague anxiety over a new surgical method was the most common reason why NOTES was not selected in benign and malignant diseases (64% and 73%), respectively. CONCLUSION: Patients appear to be interested in the potential benefits of NOTES and would embrace it if their concerns about safety are met. We believe that qualified surgical endoscopists can meet these safety concerns, and that NOTES development has the potential to flourish.
Aged ; Anxiety ; Cholecystectomy ; Endoscopy* ; Humans ; Korea* ; Laparoscopy ; Marital Status ; Mass Screening* ; Methods ; Natural Orifice Endoscopic Surgery* ; Parturition ; Rectal Neoplasms ; Stomach

PURPOSE: This study was undertaken to reveal the molecular mechanism underlying sulindac-induced apoptosis in the human colon cancer cell line HT-29 (mutant p53). METHODS: Apoptosis was determined by using Hoechst 33342 staining, and translocation of proteins was established by using immunofluorescence, immunoelectron microscopy, and Western blotting after ultra- fractionation. RESULTS: This type of apoptosis was associated with decreased mitochondrial membrane potential, a translocation of the apoptosis-inducing factor (AIF) to the nucleus, and morphological evidence of nuclear condensation. However, DNA electrophoresis did not elucidate the ladder pattern of DNA fragments. Instead, a pulse-field gel electrophoresis showed that sulindac led to disintegration of nuclear DNA into-high- molecular-weight DNA fragments of about 100~300 kbp. CONCLUSIONS: Our findings indicate that sulindac induces large-scale DNA fragmentation, suggesting a predominantly AIF-mediated cell-death process, through translocation of the AIF to the nucleus in HT-29 cells.
Apoptosis Inducing Factor ; Apoptosis* ; Blotting, Western ; Cell Line ; Colonic Neoplasms ; DNA Fragmentation* ; DNA* ; Electrophoresis ; Fluorescent Antibody Technique ; HT29 Cells* ; Humans ; Membrane Potential, Mitochondrial ; Microscopy, Immunoelectron ; Sulindac

Patients with reduced dihydropyrimidine dehydrogenase (DPD) activity are at risk for experiencing serious adverse effects following 5-fluorouracil (5-FU) based chemotherapy. Neurotoxicity is considered an extremely rare side effect of 5-FU. We report here on an unusual case of 5-FU induced encephalopathy. A 38-year-old woman with advanced gastric carcinoma was treated with adjuvant chemotherapy that consisted of infused 5-FU (1,000 mg/m2) for 5 days and cisplatin (60 mg/m2) on day 1 following total gastrectomy. Nineteen days after starting chemotherapy, the patient displayed a sudden onset of slurred speech, confusion, cognitive disturbances and paranoia. A magnetic resonance image (MRI) of the brain showed no structural abnormalities, and the other laboratory tests provided no explanations for her symptoms, other than a slightly elevated ammonia level. The patient was treated with a lactulose retention enema and thiamine infusion, the 5-FU was halted and her symptoms then recovered after 7 days.
Adult ; Ammonia ; Brain ; Chemotherapy, Adjuvant ; Cisplatin ; Dihydrouracil Dehydrogenase (NADP) ; Enema ; Female ; Fluorouracil ; Gastrectomy ; Humans ; Lactulose ; Magnetic Resonance Spectroscopy ; Paranoid Disorders ; Retention (Psychology) ; Thiamine

PURPOSE: To assess the usefulness of adenosine triphosphate-based chemotherapy response assay (ATP-CRA) results in advanced gastric cancer patients receiving adjuvant chemotherapy. MATERIALS AND METHODS: Sixty-two patients underwent curative surgical resection between January, 2006 and December, 2008. Their highly purified surgical specimens were evaluated by ATP-CRAs. Of the 62, 49 had successful assay results and they received either oral 5-fluorouracil or other chemotherapies. We retrospectively analyzed data for 24 patients who were treated with oral 5-fluorouracil and whose assays were successful. RESULTS: The median observation time was 24.6 months (range, 10.1 to 40.9 months). The median treatment time was 11.2 months (range, 1.2 to 17.7 months). The median age was 66 years (range, 30 to 81 years). Patients were grouped into sensitive- and resistant-groups according to adenosine triphosphate-based chemotherapy response results for fluorouracil. The sensitive-group showed a significantly longer time to relapse (not reached in the sensitive-group vs. 24.8 months in the resistant-group, p=0.043) and longer overall survival compared to the resistant-group (not reached in the sensitive-group vs. 35.7 months in the resistant-group, p=0.16, statistically insignificant). CONCLUSION: Patients who receive curative surgical resection significantly benefit from sensitive adjuvant chemotherapy according to ATP-CRA results for time to relapse.
Adenosine ; Adenosine Triphosphate ; Chemotherapy, Adjuvant ; Fluorouracil ; Humans ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: To examine whether a synthetic bile acid derivatives (HS-1200) sensitizes the radiation-induced apoptosis in human breast cancer cells (MCF-7) and to investigate the underlying mechanism. MATERIALS AND MEHTODS: Human breast cancer cells (MCF-7) in exponential growth phase were treated with HS-1200 for 24 hours at 37degrees C with 5% CO2 in air atmosphere. After removal of HS-1200, cells were irradiated with 2~8 Gy X-ray, and then cultured in drug-free media for 24-96 hours. The effect of radiation on the clonogenicity of MCF-7 cells was determined with clonogenic cell survival assay with 16muM of HS-1200. The induction of apoptosis was determined using agarose gel electrophoresis and Hoechst staining. The expression level of apoptosis-related molecules, such as PARP, Bax, Bcl-2, Bak and AIF, were assayed by Western blotting analysis with 40muM of HS-1200 combined with 8 Gy irradiation. To examine the cellular location of cytochrome c, bax and AIF immunofluorescent stainings were undertaken RESULTS: Treatment of MCF-7 cells with 40muM of HS-1200 combined with 8 Gy irradiation showed several changes associated with enhanced apoptosis by agarose gel electrophoresis and Hoechst staining. HS-1200 combined with 8 Gy irradiation treatment also enhanced production of PARP cleavage products and increased Bax/Bcl-2 ratio by Western blotting. Loss of mitochondrial membrane potential (delta psi m) and increased cytochrome c staining indicated that cytochrome c had been released from the mitochondria in HS-1200 treated cells. CONCLUSION: We demonstrated that combination treatment with a synthetic chenodeoxycholic acid derivative HS-1200 and irradiation enhanced radiation-induced apoptosis of human breast cancer cells (MCF-7). We suggest that the increased Bax/Bcl-2 ratio in HS-1200 co-treatment group underlies the increased radiosensitivity of MCF-7 cells. Further futures studies are remained elusive.
Apoptosis* ; Atmosphere ; Bile ; Blotting, Western ; Breast Neoplasms* ; Breast* ; Cell Survival ; Chenodeoxycholic Acid ; Cytochromes c ; Electrophoresis, Agar Gel ; Humans* ; MCF-7 Cells ; Membrane Potential, Mitochondrial ; Mitochondria ; Radiation Tolerance