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*

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

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

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

The extract from Smilax china root has been used as medicinal remedy and reported to retain antimicrobial and antimutagenic acitivities. In this study, a possible presence of antioxidant activity of Smilax china root extract was investigated. Methanol extract (Me) revealed the presence of high 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity (IC50 7.4 microg/ml) and protective property of cell's viability. Further fractionation with various solvent extraction and assay showed high levels of DPPH free radical scavenging activity in the ethyl acetate, butanol and water extracted fractions. In addition, V79-4 cells treated with Me of Smilax china root induced an increase of superoxide dismutase, catalase and glutathione peroxidase activities in a dose-dependent manner between 4-100 microg/ml. These results suggest that the medicinal component of the root of Smilax china extracts also contains antioxidant activity.
Animal ; Antioxidants/*pharmacology ; Catalase/drug effects/metabolism ; Cell Line ; Cell Survival ; Dose-Response Relationship, Drug ; Fibroblasts/drug effects/metabolism ; Free Radical Scavengers/chemistry/isolation & purification/*pharmacology ; Free Radicals/metabolism ; Glutathione Peroxidase/drug effects/metabolism ; Hamsters ; Lipid Peroxidation/drug effects ; Lung/cytology ; Plant Extracts/chemistry/*pharmacology ; Plant Roots/*chemistry ; Plants, Medicinal ; Superoxide Dismutase/drug effects/metabolism

The extract from Smilax china root has been used as medicinal remedy and reported to retain antimicrobial and antimutagenic acitivities. In this study, a possible presence of antioxidant activity of Smilax china root extract was investigated. Methanol extract (Me) revealed the presence of high 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity (IC50 7.4 microg/ml) and protective property of cell's viability. Further fractionation with various solvent extraction and assay showed high levels of DPPH free radical scavenging activity in the ethyl acetate, butanol and water extracted fractions. In addition, V79-4 cells treated with Me of Smilax china root induced an increase of superoxide dismutase, catalase and glutathione peroxidase activities in a dose-dependent manner between 4-100 microg/ml. These results suggest that the medicinal component of the root of Smilax china extracts also contains antioxidant activity.
Animal ; Antioxidants/*pharmacology ; Catalase/drug effects/metabolism ; Cell Line ; Cell Survival ; Dose-Response Relationship, Drug ; Fibroblasts/drug effects/metabolism ; Free Radical Scavengers/chemistry/isolation & purification/*pharmacology ; Free Radicals/metabolism ; Glutathione Peroxidase/drug effects/metabolism ; Hamsters ; Lipid Peroxidation/drug effects ; Lung/cytology ; Plant Extracts/chemistry/*pharmacology ; Plant Roots/*chemistry ; Plants, Medicinal ; Superoxide Dismutase/drug effects/metabolism

BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. METHODS: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. RESULTS: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. CONCLUSIONS: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.
Hip Dislocation ; Hip* ; Humans ; Infant ; Mass Screening* ; Orthopedics ; Ultrasonography*

BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. METHODS: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. RESULTS: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. CONCLUSIONS: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.
Hip Dislocation ; Hip* ; Humans ; Infant ; Mass Screening* ; Orthopedics ; Ultrasonography*

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: 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