PURPOSE: We conducted a phase II study in previously untreated patients with unresectable stage IIIB or IV non-small cell lung cancer to evaluate the response rate and toxicity of the combination chemotherapy regimen of etoposide, ifosfamide and cisplatin. MATERIALS AND METHODS: From September 1993 to December 1996, twenty patients with advanced non-small cell lung cancer (stage IIIB 5 and IV 15) (squamous cell 8, adeno- carcinoma 12), were enrolled in this study. There were 13 (65%) males and 7 (35%) females, and median age of patients were 56 years (range: 34~66). Eighteen patients had performance status (ECOG) 0~1, two patients had performance status 2. Treatment was consisted of cisplatin (20 mg/m2 i.v., day 1~4), VP-16 (etoposide) (75 mg/m2 i.v., day 1~4), ifosfamide (1000 mg/m2 i.v., day 1~4) with mesna. This treatment was repeated every four weeks. RESULTS: The overall response rate was 25%. Complete response rate was 5% (1/20) and partial response rate was 20% (4/20). The median cycle of response was 4 (2~6) cycles. The median overall survival time was 28 weeks (9~98 weeks). The median time to progression was 10 weeks (3~50 weeks). Toxicities were evaluated by WHO criteria. Toxicity > GradeIII included: leukopenia 1.6%, thrombocytopenia 3.2%, nausea and vomiting 15%, alopecia 30%, stomatitis 10%. These toxicities were tolerable and reversible. CONCLUSION: VIP regimen was not superior to previous regimens for advanced non-small all lung cancer, and the toxicities were tolerable.
Alopecia ; Carcinoma, Non-Small-Cell Lung ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide ; Female ; Humans ; Ifosfamide* ; Leukopenia ; Lung Neoplasms ; Male ; Mesna ; Nausea ; Small Cell Lung Carcinoma* ; Stomatitis ; Thrombocytopenia ; Vomiting

PURPOSE: In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data. MATERIALS AND METHODS: The authors analyzed retrospectively pathological features of 95 patients who underwent paraacntic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation Bom May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unlmown causes of death in survival analysis. RESULTS: The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSRs) in relation to the paraaortic lymph node (No16) status was 0.096 in No16+, and 57.8Po in Nol6 with D4 of advanced gastric cancer. The 5 YSRs were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, nl, n2 and n.3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively. CONCLUSION: The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Bonmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p < 0.05).
Cardia ; Causality ; Cause of Death ; Drug Therapy* ; Granisetron* ; Hospitals, General ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Nausea* ; Neoplasm Metastasis ; Platinum* ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate ; Vomiting*

No abstract available.
Doxorubicin* ; Drug Therapy, Combination* ; Etoposide* ; Stomach Neoplasms*

PURPOSE: In attempt to provide a feasible chemotherapeutic regimen for advanced gastric cancer patients, the combination of cisplatin, epirubicin, leucovorin and fluorouracil (PELF) has been developed. A trial was performed to confirm the clinical activity, in terms of response rate and toxicity and duration of survival, of the PELF combination chemotherapy. MATERIALS AND METHODS: From April 1995 to July 1997, patients with measurable unresectable and/or metastatic gastric cancer received PELF combination chemotherapy. The regimen consisted of cisplatin 40 mg/m2 IV on days 1 and 5; epirubicin 30 mg/m2 IV on days 1 and 5; 5-fluorouracil 300 mg/m2 and leucovorin 20 mg/m2 IV on days 1 through 4. The cycle was repeated every 3 weeks. RESULT: Among 21 evaluable patients, 1 patient achieved complete response (5.3%) and 8 patients, partial response (42.1%). The median survival of overall patients was 36 weeks, the median time to progression of 21 evaluable patients was 27 weeks. There was severe myelosuppression; leucopenia 73.1%, WHO grade 3~4 11.5% of cycles. Non-hematologic toxicities were also severe nausea or vomiting in 100% of patients, grade 3~4 13.0% of patients, alopecia in 91.3% of patients, grade 3~4 52.2% of patients. CONCLUSION: This study showed that the PELF combination is effective in overall response rates. However, it is not recommended for routine clinical use because of its toxicities. Further phase III study will be warranted.
Alopecia ; Cisplatin ; Drug Therapy, Combination* ; Epirubicin ; Etoposide* ; Fluorouracil* ; Humans ; Leucovorin* ; Nausea ; Stomach Neoplasms* ; Vomiting

BACKGROUND: Platelet refractoriness has been reported to occur in 30-70% of multitransfused patients. This can result by either immune or nonimmune mechanisms. The predominant immune cause of platelet refractoriness is alloimmunization to HLA class I antigens. Recently, acid-treated platelets have been used in a few patients with platelet refractoriness due to HLA alloantibodies. However, the effect of acid-treated platelets has not been consistent. The aim of this study was to evaluate the in vivo survival of acid-treated, HLA-eluted platelets in HLA-immunized rabbits. METHODS: For in vivo survival test, 14 New Zealand White rabbits were studied. Four rabbits were in the nonimmunized control and 10 were immunized by weekly transfusions of human pooled platelets for six weeks. The HLA-immunized group was separated into two groups with transfusion of acid-treated platelets and untreated platelets. The survival of transfused platelets in rabbits with immunization and control group was estimated by a flow cytometer using FITC-labeled anti-CD42a. We also examined the HLA re-expression in acid-treated platelets due to regeneration and adsorption of HLA from human plasma. RESLUTS: The half-life of untreated platelets in nonimmunized rabbits was 11.8 +/- 3.7 hr. The half-life of acid-treated platelets in rabbits with HLA antibodies was 9.5 +/- 5.5 hr and the half-life of untreated platelets in rabbits with HLA antibodies was 5.9 +/- 2.9 hr. The difference between untreated platelets in the nonimmunized control group and acid-treated platelets in rabbits with HLA antibodies was statistically insignificant (p=0.221). Re-expression of HLA-A,B,C by endogenous resynthesis occurred continuously, and after 24 hrs it reached 84% of pre-elution level. Adsorption of HLA antigens from human plasma was completed within four hrs. CONCLUSIONS: Acid-treated, HLA-eluted platelets may be applicable for the patients with refractoriness to platelet transfusion, especially, in case of unavailability of HLA-compatible donors and fatal bleeding such as intracranial hemorrhage and pulmonary hemorrhage. However, the post-transfusion increment of the platelet count could not be maintained over 24 hrs because of the endogenous resynthesis of HLA antigens.
Adsorption ; Antibodies ; Blood Platelets ; Half-Life ; Hemorrhage ; Histocompatibility Antigens Class I ; HLA Antigens ; Humans ; Immunization ; Intracranial Hemorrhages ; Isoantibodies ; Plasma ; Platelet Count ; Platelet Transfusion ; Rabbits* ; Regeneration ; Tissue Donors

BACKGROUND: Multiple myeloma is a malignant prolif eration of plasma cells producing monoclonal immunog lobulins. The pathogenesis of this disease is still unkno wn. Karyotypic complexity and stepwise disease progre ssion in multiple myeloma suggest that the development of multiple myeloma is a multistep process in genetic events, such as oncogene activation or tumor suppressor gene inactivation. Alterations of ras oncogene or p53 tumor sup pressor gene are involved in various type of human cancers. The aim of this study was to determine the frequency of ras and p53 gene mutations in multiple myeloma, and to analyze its association with clinical parameter and clinical outcome. METHODS: Mutations of N-, K-ras exon 1 & 2 and p53 exon 5-8 were observed in 33 patients with multiple myeloma. Genomic DNA was isolated from mononuclear cells separated from bone marrow samples. Extracted DNAs were screened for mutations by single-strand con formation polymorphism analysis of PCR products (PCR SSCP). DNA fragments displaying an altered electrophore tic mobility were further studied by direct sequencing to confirm and characterize the nature of the mutations. RESULTS: No mutation was found at N-, K-ras exon 1, K-ras exon 2 or p53 exon 5-8. Only one patient has N-ras exon 2 mutation(1/33 patients, 3%). By direct sequencing of PCR products, I confirmed and detected a CAA-->AAA transversion(glutamine-->lysine). The patient was a 61-year-old male in progressive state. M protein was IgG/kappa type. Bone marrow aspirate revealed a 67% plasma cell infiltration. CONCLUSION: Although the number of patients is small, these data revealed low frequency of N-ras, K-ras and p53 gene mutation in multiple myeloma. Ras and p53 gene mutations may have limited role in pathogenesis of mulitple myeloma and may associate with tumor progres sion rather than initiation.
Bone Marrow ; DNA ; Exons ; Genes, p53* ; Genes, ras ; Genes, Tumor Suppressor ; Humans ; Male ; Middle Aged ; Multiple Myeloma* ; Oncogenes ; Plasma Cells ; Polymerase Chain Reaction ; Tics

No abstract available.
Gene Rearrangement* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Polymerase Chain Reaction*

Background Oenanthe javanica is an aquatic perennial herb originated from East Asia.Nowadays,the effects of Oenanthe javanica have been proven in various disease models.Studies regarding the antioxidant effect of Oenanthe javanica in the kidney are still unclear.Methods This study was therefore performed to investigate the effect of the Oenanthe javanica extract (OJE) in the rat kidney using immunohistochemistry for antioxidant enzymes,copper,zinc-superoxide dismutase (SOD1),manganese superoxide dismutase (SOD2),catalase (CAT) and glutathione peroxidase (GPx).Sprague-Dawley rats were randomly assigned to three groups:(1) normal diet fed-group (normal-group),(2) diet containing ascorbic acid (AA)-fed group (AA-group) as a positive control,(3) diet containing OJE-fed group (OJE-group).AA and OJE were supplied during 28 days.Results The side-effects were not observed in all the groups.Immunoreactivities of SOD1,SOD2,CAT and GPx were easily detected in the distal tubules of the kidney,and their immunoreactivities in the AA-and OJE-groups were increased to about 1.4-1.5 times and 2 times,respectively,compared with those in the normal-group.Conclusion OJE significantly increased expressions of SOD1 & 2,CAT and GPx immunoreactivities in the distal tubules of the rat kidney,and this finding suggests that significant enhancements of endogenous enzymatic antioxidants by OJE treatment may be a legitimate strategy for decreasing oxidative stresses in the kidney.

Background Hippophae rhamnoides L.(HL) exerts antioxidant activities against various oxidative stress conditions.In this study,we investigated effects of extract from HL leaves (HLE) on cell proliferation and neuroblast differentiation in the subgranular zone (SGZ) of the dentate gyrus (DG) of aged gerbils.Methods Aged gerbils (24 months) were divided into vehicle (saline)-treated-and HLE-treated-groups.The vehicle and HLE were orally administered with 200 mg/kg once a day for 20 days before sacrifice.Cell proliferation and neurobiast differentiation were examined in the DG using Ki67 and doublecortin (DCX),respectively.We also observed changes in immunoreactivities of superoxide dismutase 1 (SOD1) and superoxide dismutase 2 (SOD2),brain-derived neurotrophic factor (BDNF),and phospho-glycogen synthase kinase-3-beta (p-GSK-3β) to examine their relation with neurogenesis using immunohistochemistry.Results The administration of HLE significantly increased the number of Ki67-positive cells and DCX-positive neuroblasts with well-developed processes in the SGZ of the DG of the HLE-treated-group.In addition,immunoreactivities of SOD1,SOD2,BDNF,and p-GSK-3β were significantly increased in granule and polymorphic cells of the DG in the HLE-treated-group compared with those in the vehicle-treated-group.Conclusions HLE treatment significantly increased cell proliferation and neuroblast differentiation,showing that immunoreactivities of SOD1,SOD2,BDNF,and p-GSK-3β were significantly increased in the DG.These indicate that increased neuroblast differentiation neurogenesis may be closely related to upregulation of SOD1,SOD2,BDNF,and p-GSK-3β in aged gerbils.

PURPOSE: To evaluate the educational effectiveness of practice-based program for procedural skills at Kangwon National University College of Medicine. METHODS: In 2005, we conducted the training program composed of 19 procedural skills for third-year medical students during their first semester clerkship. The 14-week training used simulation models and was held for 3 hours per week, one hour for didactic session and 2 hours for practical exercise. A lecture was given only for wound dressing. OSCE, consisting of four 5-minute stations, was administered to analyze the students' achievement. 53 third-year students were given a survey following skills training and OSCE. RESULTS: Most students reported that the practice-based program was interesting and helpful in learning procedural skills. Students preferred practice to didactic medium. Students were satisfied with the faculty's instruction, but suggested that the training should be providedprior to clerkship. OSCE had an overall reliability coefficient (Cronbach's alpha) of 0.78. The mean score in the dressing case was lower than those in other cases. CONCLUSION: The practice-based program for procedural skills was effective in motivating students' learning as well as improving theirtechnical skills. Self-directed exercises and appropriate feedback are more effective training tools than lectures.
Bandages ; Education ; Exercise ; Gangwon-do ; Humans ; Learning ; Lectures ; Students, Medical ; Wounds and Injuries