Multiple primary malignancies (MPMs) are defined as the presence of two or more malignancies in different organs, without a subordinate relationship. Although rarely reported, hepatocellular carcinoma (HCC) occasionally presents with simultaneous or metachronous primary malignancies in other organs. In this report, we describe a patient with lung adenocarcinoma and lymph node and bone metastases, treated with five chemotherapeutic regimens for 24 months. Changing the chemotherapy regimen based on the suspicion of metastasis of a new liver mass did not lead to improvements. This prompted a liver biopsy and a revised diagnosis of HCC. Sixth-line treatment with the concurrent use of cisplatin-paclitaxel for lung cancer and sorafenib for HCC, stabilized the disease. The concurrent treatment was not tolerated and was discontinued owing to adverse events. Considering our findings, treatment with increased efficacy and lower toxicity for MPMs is warranted.

PURPOSE:To evaluate the role of unenhanced CT in diagnosing the acute appendicitis. METHOD AND MATERIALS: We retrospectively analyzed conventional contrast-enhanced abdominal CT scans of 197 normal patients and barium enemas of 26 out of the 197 patients. Additional unenhanced CT scans of right lower abdomen were performed on 30 patients who were suspected of having acute appendicitis;barium enema was performed in 26 patients. RESULTS: in the analysis of the conventional CT scans, we could detect 132(67%) normal appendicies. On barium enema of 26 out of 197 patients, abruptly narrowed appendix was visualized in 5 cases and luminal irregularity in 4 cases but all 26 cases showed normal appendix on CT. In the 30 cases of unenhanced CT, all appendicies were visualized. Among 12 Cases which were proved as acute appendicitis, barium enenma was done in 10 case;abruptly narrowed appendix was shown in 3 and luminal irregularity in 1. Among 18 cases which were diagnosed as normal appendix, nonvisualization of appendix' was in 1 case, abruptly narrowed lumen in 3, and luminal irregularity in 9. CONCLUSION:Unenhanced CT in the area of the cecum may be an effective and safe diagnostic tool for acute appendicitis.
Abdomen ; Appendicitis* ; Appendix ; Barium* ; Cecum ; Enema* ; Humans ; Phenobarbital ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVES: Alcohol-induced oxidative stress has been known to injure various tissues or organs. This stress is related with free radicals which are produced as the result of long-term alcohol consumption. Malonyldialdehyde(MDA) is produced by the interaction of free radicals and cell membrane lipids, and indicates the degree of lipid peroxidation indirectly. The purpose of this study was to investigate the relationship between red blood cell(RBC) membrane lipid peroxidation by free radicals, and associated hepatic injuries and hematologic changes. METHODS: Thirty-three subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated within 72 hours after discontinuing alcohol drinking. Clinical characteristics were evaluated by CAGE questionnaire and Korean Michigan Alcoholism Screening Test(MAST). RBC membrane MDA level was measured as the marker of RBC membrane lipid peroxidation. Aspartate aminotransferase(AST), alanine aminotransferase(ALT) and gamma-glutamyltransferase(GGT) were used as the biochemical markers of liver damage due to alcohol ingestion. The alcohol-induced hematologic change was assessed by mean corpuscular volume(MCV). RESULTS: The results were as follows. Clinical characteristics were not different between two groups having normal and abnormal levels of AST, ALT, GGT or MCV. The levels of MDA were not correlated with the clinical characteristics and serum levels of AST, ALT and GGT. However, there was a significant correlation between the levels of MDA and the value of MCV(p=0.017). CONCLUSIONS: These findings suggest that oxidative stress in alcohol dependence may not be reflected in liver enzyme markers such as AST, ALT and GGT, but may be reflected in MCV.
Alanine ; Alcohol Drinking ; Alcoholism* ; Aspartate Aminotransferases ; Aspartic Acid ; Biological Markers ; Diagnostic and Statistical Manual of Mental Disorders ; Eating ; Erythrocyte Indices* ; Erythrocytes* ; Free Radicals ; Humans ; Lipid Peroxidation* ; Liver* ; Mass Screening ; Membrane Lipids ; Membranes* ; Michigan ; Oxidative Stress ; Surveys and Questionnaires

BACKGROUND/OBJECTIVES: Artemisinin, a natural product isolated from Gaeddongssuk (artemisia annua L.) and its main active derivative, dihydroartemisinin (DHA), have long been used as antimalarial drugs. Recent studies reported that artemisinin is efficacious for curing diseases, including cancers, and for improving the immune system. Many researchers have shown the therapeutic effects of artemisinin on tumors such as breast cancer, liver cancer and kidney cancer, but there is still insufficient data regarding glioblastoma (GBM). Glioblastoma accounts for 12-15% of brain cancer, and the median survival is less than a year, despite medical treatments such as surgery, radiation therapy, and chemotherapy. In this study, we investigated the anti-cancer effects of DHA and transferrin against glioblastoma (glioblastoma multiforme, GBM). MATERIALS/METHODS: This study was performed through in vitro experiments using C6 cells. The toxicity dependence of DHA and transferrin (TF) on time and concentration was analyzed by MTT assay and cell cycle assay. Observations of cellular morphology were recorded with an optical microscope and color digital camera. The anti-cancer mechanism of DHA and TF against GBM were studied by flow cytometry with Annexin V and caspase 3/7. RESULTS: MTT assay revealed that TF enhanced the cytotoxicity of DHA against C6 cells. An Annexin V immune-precipitation assay showed that the percentages of apoptosis of cells treated with TF, DHA alone, DHA in combination with TF, and the control group were 7.15 ± 4.15%, 34.3 ± 5.15%, 66.42 ± 5.98%, and 1.2 ± 0.15%, respectively. The results of the Annexin V assay were consistent with those of the MTT assay. DHA induced apoptosis in C6 cells through DNA damage, and TF enhanced the effects of DHA. CONCLUSION: The results of this study demonstrated that DHA, the derivative of the active ingredient in Gaeddongssuk, is effective against GBM, apparently via inhibition of cancer cell proliferation by a pharmacological effect. The role of transferrin as an allosteric activator in the GBM therapeutic efficacy of DHA was also confirmed.
Annexin A5 ; Antimalarials ; Apoptosis ; Brain Neoplasms ; Breast Neoplasms ; Cell Cycle ; Cell Proliferation ; DNA Damage ; Drug Therapy ; Flow Cytometry ; Glioblastoma* ; Immune System ; In Vitro Techniques ; Kidney Neoplasms ; Liver Neoplasms ; Therapeutic Uses* ; Transferrin*

PURPOSE: To investigate the time course and occurrence of foveal retinal detachment presenting with symptoms of metamorphopsia and decreased visual acuity after successful surgery for macula-off retinal detachment. METHODS: This study included 9 eyes of 9 patients who were diagnosed with foveal retinal detachment using optical coherence tomography (OCT) among 198 patients who had decreased visual acuity and metamorphopsia after successful rhegmatogenous retinal detachment surgery. RESULTS: All eyes were diagnosed with foveal retinal detachment by OCT. Foveal retinal detachment occurred after scleral buckling surgery in 8 eyes (88%) and after vitrectomy and pneumoretinopexy in 1 eye. The degree and frequency of foveal retinal detachment was milder and lower after vitrectomy and pneumoretinopexy than after scleral buckling surgery. All foveal retinal detachments were reattached spontaneously after 9 months (range, 5~14 months). In all eyes, the symptom of metamorphopsia was improved and visual acuity increased after the foveal retinal detachment was reattached. CONCLUSIONS: OCT can be used to diagnose foveal retinal detachment in cases when the fundus and fluorescein angiography do not show specific findings but, presenting symptoms of decreased visual acuity and metamorphopsia. In all cases evaluated, the foveal retinal detachment was reattached spontaneously without treatment.
Fluorescein Angiography ; Humans ; Retinal Detachment* ; Retinaldehyde* ; Scleral Buckling ; Tomography, Optical Coherence* ; Vision Disorders ; Visual Acuity ; Vitrectomy

No abstract available.
Fistula* ; Pyriform Sinus* ; Thyroiditis, Suppurative*

A wide variety of cancers metastasize to the ovaries. In a majority of instances the primary site is the gastrointestinal tract, breast, or other gynecologic organs. The best known tumor of this type is signet-ring cell adenocarcinoma. The gallbladder and bile duct are rare sources of these metastases. The authors have had an experience of a case that was presented of Krukenberg tumor metastatic from the gallbladder and report the case with brief review of literature.
Adenocarcinoma ; Bile Ducts ; Breast ; Female ; Gallbladder* ; Gastrointestinal Tract ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Ovary

PURPOSE: To investigate long-term visual outcomes and prognostic factors to predict visual outcomes in patients with anatomic success after macular hole surgery. METHODS: Medical records of 36 eyes with successfully repaired stage 3 or 4 idiopathic macular hole and with at least 24 months of follow-up were reviewed. Hole height, stage of macular hole, base diameter, minimum diameter, hole form factor, macular hole index, and hole closure type were measured or calculated, and the correlations of visual outcomes with variables of preoperative optical coherence tomography (OCT) were analyzed. RESULTS: The patients were classified into 3 groups according to the time period necessary to achieve the best corrective visual acuity. The visual acuity of 16 eyes (44.4%) recovered in a mean of 6 months, 13 eyes (36.1%) improved slowly and continuously, and 7 eyes had no improvement despite successful anatomical closure. There were no statistical differences in hole height, base diameter, minimum diameter, hole form factor, macular hole index, or closure type among the 3 groups. CONCLUSIONS: The improvement in visual acuity after successful macular hole surgery persisted at the 24-month follow-up and after. There were no correlations between delayed visual acuity after macular hole surgery and minimum diameter, base diameter, hole height, hole form factor, macular hole index, or closure type.
Eye ; Follow-Up Studies ; Humans ; Medical Records ; Retinal Perforations ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: Granisetron is a potent, the most selective 5-HT3 receptor antagonist and is reported to be effective in treatment of radiation-induced emesis. The antiemetic efficacy and safety of oral granisteron was evaluated in patients with receiving highly emetogenic treatment by conventional fractionated irradiation. MATERIAL AND METHODS: Patients with various cancers who were being treated with irradiation were accrued into the present study. The intensity of nausea was evaluated on first 24 hours and on day-7 by patients according to the degree of interference with normal daily life as followings; a) none; b) present but no interference with normal daily life (mild); c) interference with normal daily life (moderate); and d) bedridden because of nausea (severe). Non or mild state was considered to indicate successful treatment. The efficacy of antiemetic treatment was graded as follows; a) complete response; no vomiting, no worse than mild nausea and receive no rescue antiemetic therapy over the 24h period, b) major response; either one episode of vomiting or moderate/severe nausea or had received rescue medication over 24h period, or any combination of these, c) minor response; two to four episodes of vomiting over the 24h period, regardless of nausea and rescue medication, d) failure; more than four medication. The score of the most sympto m was recorded and the total score over 24 hours was summarized. The complete or major response was considered to indicate successful treatment. RESULTS: A total of 10 patients were enrolled into this study, and all were assessable for efficacy analysis. Total nausea control was achieved in 90% (9/10:none=60% plus mild=30%) of total patients after 7 days. The cotrol of vomiting by granisteron was noted in seven patients (70%) of complete response and three (30%) of major response with a hundred-percent successful treatment over 7 days. The minor response or treatment failure were not observed. No significant adverse events or toxicities from granisetron were recorded in patient receiving granisetron. CONCLUSION: We concluded that granisetron is a highly effective antiemetic agent in controlling radiotherapy-induced nausea or vomiting with a minimal toxicity profile.
Granisetron* ; Humans ; Nausea* ; Radiotherapy ; Receptors, Serotonin, 5-HT3 ; Treatment Failure ; Vomiting*

PURPOSE: It is not easy to determine the cause of pulmonary consolidative lesion. Even without any definite mass, malignancy cannot be ruled out. And sometimes, it is difficult to differentiate tuberculosis from pneumonia. To differentiate malignant consolidative lesion from benign one, we studied patterns of air bronchogram, mucoid impaction, and computed tomographic anglogram etc. MATERIALS AND METHODS: Fifty seven cases of pulmonary consolidative lesions(23 cases of malignancy,34 cases of benign lesion) were retrospectively reviewed by three radiologists. RESULTS: Among the 28 cases which showed a little air bronchogram(less than 1/3 of the whole lesion in volumetric measure with the eye) 19 cases were malignancy and nine cases were benign lesions. All of the 12 cases which showed profound air bronchogram over 2/3 of the whole lesion were benign lesions. Bronchiectasis was detected in 31 cases(four of malignancy and 27 of benign lesions). Among the 20 cases which didn't show the mucoid impaction five cases were malignancy and 15 cases were benign lesions. Out of eight cases with mucoid impaction filling the long segments(branching tree shape), seven cases were malignancy and one case was benign lesion. So called CT anglogram was detected in nine cases of malignancy and two cases of benign lesions. All of nine cases of malignancy showed CT anglogram which was like arborizing tree. CONCLUSION: Scanty air bronchogram, profound arborizing mucoid impaction and/or CT angoigram within consolidative lesion could suggest malignancy.
Bronchiectasis ; Pneumonia ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed* ; Tuberculosis