The purpose of this study was to evaluate the sequential signal intensity changes in post-traumatic vertebral compression fractures of varying ages. Sixty-six patients with 115 post-traumatic vertebral compression fractures underwent MR imaging. The ages of fractures at the time of MR images ranged from 1 day to 6 years. Sequential follow-up MR imagings were obtained in 4 patients for 2 years after initial MR examination. The fracture sites in all 52 fractures with traumatic events less than 3 months prior were hypointense on T1-weighted images and hyperintense on T2-weighted images (type I). A type I fracture could be subdivided into 3 patterns depending on its morphologic appearance: diffuse (type Ia); patchy (type Ib); and bandlike (type Ic). In 12 fractures of 3 to 5 months after trauma, six showed focal hypointensity (type II) in all pulse sequences, and six showed isointensity (type IV). Four of 51 fractures with trauma over 5 months showed focal hyperintensity on T1-weighted images and isointensity on T2-weighted images (type III); and the remaining 47 fractures showed isointensity on all sequences (type IV). In conclusion, MR imaging is useful in predicting the age of known traumatic compression fractures, so familiarity with these sequential MR findings would be helpful in distinguishing benign from malignant fractures.
Adult ; Aged ; Female ; Human ; Lumbar Vertebrae/*injuries ; *Magnetic Resonance Imaging ; Male ; Middle Age ; Spinal Fractures/*diagnosis ; Time Factors

We analyzed the efficacy and toxicity of a modified Cancer and Leukemia Group B (CALGB) 19802 regimen in adult acute lymphoblastic leukemia (ALL). From February 2002 to August 2005, 25 adults with untreated ALL were enrolled in the study. Compared to the original regimen, the modified CALGB 19802 regimen consisted of a 4-drug induction (cyclophosphamide, daunorubicin, vincristine, and prednisone) instead of a 5-drug induction (L-asparaginase was added to the previous regimen). This was followed by high-dose methotrexate (1,000 mg/m(2)X3 days) and cytarabine (2,000 mg/m(2)X4 days) for the consolidation cycles. High-dose systemic and intrathecal methotrexate was given for central nervous system prophylaxis. Twentythree patients (92%) achieved a complete remission (CR), and two patients (8%) had refractory disease. With a median follow-up of 21.5 months, 10 patients (40%) were alive and continued to be in CR. The 3-yr probability of an event-free survival and the overall survival were 39.0% and 47.4%, respectively. Treatment related mortality and major grade 3 to 4 neurotoxicity occurred in 1 patient and 3 patients, respectively. The modified CALGB 19802 regimen demonstrated a high remission rate and a favorable survival rate.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cyclophosphamide/*administration & dosage ; Daunorubicin/*administration & dosage ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy ; Prednisone/*administration & dosage ; Remission Induction ; Treatment Outcome ; Vincristine/*administration & dosage

The association between a multiple myeloma and a secondary solid tumor is not well established. Some reports showed an increased risk of secondary solid neoplasms in multiple myeloma patients, but others have not. Three cases of the synchronous occurrence of multiple myelomas and solid tumors, namely, a small cell carcinoma of the lung, an adenocarcinoma of the colon and a squamous carcinoma of the pyriform sinus were experienced at our hospital. Therefore, herein is reported the clinical courses and treatment results. The stage of multiple myeloma was Durie-Salmon stage I in all of three cases; therefore, the solid tumors were treated as a primary target because the prognosis of early stage multiple myeloma is generally better than that of advanced solid tumor, while a smoldering or stage I myeloma do not need primary therapy until progression of the multiple myeloma. Two patients died of their solid tumors, but one patient is alive.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Colon ; Humans ; Lung ; Multiple Myeloma* ; Neoplasms, Multiple Primary ; Neoplasms, Second Primary ; Prognosis ; Pyriform Sinus

BACKGROUND: The significant improvement in the treatment of adults with acute myeloid leukemia (AML) has been achieved in recent years. However, many patients still fail to achieve a complete remission and long term survival because of either toxic death during aplasia periods of induction chemotherapy or resistance to induction chemotherapy. The P-glycoprotein (Pgp) associated with Multidrug Resisitance (MDR) gene is the best characterized mechanism of resistance to induction chemotherapy. In this study, the authors effort to examine the functional activity of Pgp using the rhodamine123 functional efflux assay and discuss for the predictive value of MDR functional assay for treatment outcomes of AML. METHODS: Between January 1996 and June 2003, 45 patients with AML were enrolled in this study. For evaluation of functional MDR activity using the rhodamine123 functional efflux assay, mononuclear cells isolated from bone marrow aspirates of 45 patients were used. All patients were received induction chemotherapy and consolidation therapy with high dose chemotherapy or stem cell transplantation. RESULTS: Among the 45 AML patients, 30 (66.7%) patients showed positive functional MDR activity and 15 (33.3%) patients negative functional MDR activity. Complete remission rate was lower in the group with positive functional MDR activity than negative, but no statistical significance was observed (P=0.453). Survival time in both groups was investigated. Leukemia free survival was 40.9 months in negative group and 18.7 months in positive group (P=0.336). Overall survival was 48.5 months and 26.6 months respectively (P=0.513). CONCLUSION: The functional MDR activity using the rhodamine123 functional efflux assay does not significantly affect induction rate and survival rate of AML patients.
Adult ; Bone Marrow ; Drug Resistance, Multiple* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Myeloid, Acute* ; P-Glycoprotein ; Remission Induction* ; Stem Cell Transplantation ; Survival Rate

A 43-year-old male presented with a painless left testicular mass. The pathologic diagnosis of the radical orchiectomy specimen was peripheral T-cell lymphoma, unspecified (PTCL-u). According to the Ann Arbor staging system, his initial stage was III because of the right nasopharyngeal involvement. After first-line chemotherapy with four courses of the CHOP regimen and this was followed by involved-field radiotherapy, he achieved complete remission. Two months later, disease recurred to the left ciliary body of the left eye without evidence of involvement at other sites. Although the patient received intensive chemotherapy with autologous hema-topoietic stem cell transplantation, he ultimately died of leptomeningeal seeding. Because both the central nervous system (CNS) and the orbit are sanctuary sites for chemotherapy, orbital infiltration of lymphoma should prompt physicians to evaluate involvement of the CNS and to consider performing prophylactic intrathecal chemotherapy as a treatment option.
Adult ; Central Nervous System ; Ciliary Body ; Diagnosis ; Drug Therapy ; Eye Neoplasms ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Peripheral ; Male ; Orbit* ; Orchiectomy ; Radiotherapy ; Recurrence* ; Stem Cell Transplantation ; T-Lymphocytes* ; Testis

BACKGROUND: Anthracycline is the most important chemotherapy drug of acute myelocytic leukemia (AML). It has been reported that idarubicin could have better complete remission (CR) rate than daunorubicin. However, it is not completely established concerning the effectiveness of idarubicin. There are many prognostic indicators of AML, however, many discrepancies still exist in prognostic indicators among each centers. METHODS: We analyzed initial CR rate of 39 AML patients treated with combination of cytarabine plus idarubicin or daunorubicin at Samsung Medical Center from April, 1995 to December, 1997. We subgrouped the patients according to age, sex, initial WBC count, status of initial CR, CD34, and chromosome. We analyzed the initial CR rate and long term survival of each subgroups. RESULTS: Initial CR rates of idarubicin and daunorubicin were 76.5% and 72.7%, respectively. The median survival days of 39 patients was 727+/-308.8 days. 1-year survival rate and 1-year event free survival rate were 64.2% and 59.6%, respectively. Patients who had failure of initial CR, old age (>60 years), and initial high WBC counts (>100,000/L) showed a statistically significant shorter survival in univariate analysis. However, we could not find the significant difference in the positivity of CD34 and chromosomal abnormalities. CONCLUSION: The effectiveness of idarubicin may be equivalent to that of daunorubicin. Failure of initial CR, old age, and high WBC counts were regarded as a prognostic risk factors of AML. However, a more definitive characterization of prognostic factors is warranted in further prospective study.
Chromosome Aberrations ; Cytarabine ; Daunorubicin* ; Disease-Free Survival ; Drug Therapy ; Humans ; Idarubicin* ; Leukemia, Myeloid, Acute* ; Risk Factors ; Survival Rate

Herein, a case of solitary, unilateral renal metastasis in a patient with curatively resected thoracic esophageal carcinoma, who achieved a pathological complete remission after neoadjuvant concurrent chemoradiotherapy, is reported. The kidney is the 4th or 5th most common visceral metastasis site of a primary esophageal carcinoma. More than 50% of renal metastases typically show bilateral involvement. Solitary, unilateral renal metastasis is extremely rare. Renal metastases from a primary esophageal carcinoma are usually latent and its diagnosis is very unusual in a live patient. The solitary renal metastasis in this case was not accompanied by metastases to other sites. The value of a nephrectomy in solitary renal metastasis of esophageal cancer is not known due to the rarity of such cases. A nephrectomy could be justified in limited situations, such as with uncertainty of histological diagnosis, severe life-threatening hematuria, which cannot be controlled by embolization, or solitary renal metastasis with a long disease-free interval.
Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Diagnosis ; Esophageal Neoplasms ; Hematuria ; Humans ; Kidney ; Neoplasm Metastasis ; Nephrectomy ; Uncertainty