Use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute cerebral infarction secondary to aortic dissection is challenging because of a narrow time window and potential life-threatening complications. An 80-year-old woman with right middle cerebral artery infarction was treated with rt-PA. Although she had no history, symptoms, or sign of aortic dissection, carotid CT angiography revealed aortic arch dissection. Mediastinal widening, which did not show on initial chest X-ray, developed on follow-up chest X-ray. This observation indicates that physicians should monitor patient symptoms for signs of aortic dissection during thrombolysis and perform chest X-ray or carotid angiography immediately after thrombolysis even if the patient has no symptoms or signs of aortic dissection on onset of acute cerebral infarction.
Aged, 80 and over ; Angiography ; Aorta, Thoracic ; Cerebral Infarction* ; Female ; Follow-Up Studies ; Humans ; Infarction, Middle Cerebral Artery ; Thorax ; Thrombolytic Therapy ; Tissue Plasminogen Activator

No abstract available.
Adult ; Humans ; T-Lymphocytes

Insulinoma with hyperproinsulinemia and normal serum insulin level is a rare disease. Because of the neuroglycopenic symptoms, the initial diagnosis tends to be made as epilepsy or as psychosis. A 43-year-old man was admitted to our hospital because of recurrent confusional episodes. Symptoms are intermittent and consist of staring, confusion, amnesia, and bizarre behavior. Vital signs during the episode were normal but the serum glucose level was 27 mg/dl. The serum level of insulin during the episode was lower than normal and those of proinsulin and growth hormone were higher than normal. Solitary pancreatic mass was found by abdominal CT, measuring 15 mm in diameter. Pathologic evaluation showed islet cell tumor. This suggests that the serum level of proinsulin should be checked when insulinoma with neuroglycopenic symptom is suspected.
Adenoma, Islet Cell ; Adult ; Amnesia ; Blood Glucose ; Diagnosis ; Epilepsy ; Growth Hormone ; Humans ; Insulin ; Insulinoma* ; Proinsulin ; Psychotic Disorders ; Rare Diseases ; Seizures* ; Tomography, X-Ray Computed ; Vital Signs

Sulfasalazine, one of disease modifying anti-rheumatic drugs, is widely used in various rheumatic diseases. Very rarely, sulfasalazine causes drug-associated hypersensitivity syndrome that resembles infectious mononucleosis. Clinical signs include fever, lymphadenopathy, maculopapular skin rash and multivisceral involvement which appear 2 to 5 weeks after administration of drug. Atypical lymphocytosis, liver dysfunction and splenomegaly are also frequently observed. Severe infectious mononucleosis-like syndrome in sulfasalazine treated patients can be caused by reactivation of viruses such as human herpes virus-6, that often result in hypersensitivity syndrome. We report a case of patient who developed infectious mononucleosis-like syndrome after administration of sulfasalazine for the treatment of rheumatoid arthritis. This case warrents careful observation for infectious mononucleosis-like syndrome after sulfasalazine treatment.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Infectious Mononucleosis ; Liver Diseases ; Lymphatic Diseases ; Lymphocytosis ; Rheumatic Diseases ; Splenomegaly ; Sulfasalazine*

BACKGROUND: Carcinoma of the esophagus traditionally has been treated with surgery or radiation therapy. The aim of this study was to assess the effect and safety of chemoradiation therapy on patients with advanced esophageal cancer. METHODS: We performed a retrospective study of twenty eight cases with inoperable carcinoma of the esophagus treated with definitive chemoradiation at single institute between April 2001 and December 2004. Twenty eight patients with esophageal squamous cell carcinomas were treated with concurrent chemoradiation therapy. Of 28 patients, 22 had stage III disease, 6 had stage II disease, and 26 were males and 2 were females. The median age of the patients was 63.0 years (range, 4475 years). The regimen involved four cycles of chemotherapy, cisplatin, 75 mg/m2 intravenously on the first day of weeks 1, 5, 9, and 13, and 5-fluorouracil, 1,000 mg/m2 per day on the first 4 days of weeks 1, 5. 9. and 13, concurrently with a dose of 5,400 cGy external beam radiotherapy. RESULTS: The overall response rate was 89%. The median overall survival was 24.7 months, the 1-year and 3-year overall survival rate was 71% and 32%, respectively. The 1-year and 3-year progression-free survival rate was 86% and 54%, respectively. Grade 3/4 hematological toxicities included neutropenia in 50% of the patients, anemia in 25%, and thrombocytopenia in 14%. Grade 3 and 4 non-hematological toxicities were less common. CONCLUSIONS: These results suggest that concurrent chemoradiotherapy is an effective regimen.
Anemia ; Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Cisplatin ; Combined Modality Therapy ; Disease-Free Survival ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Female ; Fluorouracil ; Humans ; Male ; Neutropenia ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Thrombocytopenia

PURPOSE: The purpose of this study was to investigate the prognostic significance of the expression of EGFR and C-erbB-2 gene products by immunohistochemical analysis for curatively resected gastric adenocarcinoma. MATERIALS AND METHODS: Between January 1996 and December 2001, 739 patients with curatively resected gastric cancer patients underwent Immunohistochemical staining for EGFR and C-erbB-2 proteins, and we retro spectively analyzed their correlation with the clinical outcome. RESULTS: The overexpressions of EGFR and C-erbB-2 were 25.4% and 26.2%, respectively. The overexpressions of EGFR was associated with the more poorly differentiated tumor (p=0.000) and with neuronal invasion (p=0.03). Overexpression of C-erbB-2 was associated with less vascular invasion (p=0.001). Tumor depth or node metastasis was not related to the overexpression of EGFR or C-erbB-2. The seven-year overall survival and relapse-free survival rates were 87.2% and 75.8%, respectively. Upon multivariate Cox regression analysis, the tumor stage, tumor size and patient age were important prognostic factors for overall survival, and tumor stage was the important factor for relapse-free survival. Overexpressions of EGFR or c-erbB-2 were not significant prognostic factors. CONCLUSION: Immunohistochemical staining of EGFR and C-erbB-2 gene products were not independent prognostic factors for predicting the overall survival and the relapse-free survival in curatively resected gastric cancer.
Adenocarcinoma ; Genes, erbB-2 ; Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Neurons ; Prognosis ; Receptor, erbB-2 ; Regression Analysis ; Stomach Neoplasms*

Treatment with certain DNA-damaging agents induce a complex cellular response comprising pertubation of cell cycle progression and/or apoptosis on proliferating mammalian cells. Our studies were focused on the cellular effects of nickel (II) acetate, DNA-damaging agent, on Chinese hamster ovary (CHO) cells. Fragmented DNAs were examined by agarose gel electrophoresis and cell cycle was determined by DNA flow cytometry using propidium iodide fluorescence. Apparent DNA laddering was observed in cells treated with 240 microM nickel (II) and increased with a concentration-dependent manner. Treatment of nickel (II) acetate resulted in apoptosis which was accompanied by G2/M cell accumulation. Proportion of CHO cells in G2/M phase was also significantly increased in cells exposed to at least 480 microM nickel (II) from 57.7% of cells in the G0/G1 phase, 34.7% in the S phase, and 7.6% in the G2/M1 phase for 0 microM nickel (II), to 58.6%, 14.5%, and 26.9% for 640 microM nickel (II). These findings suggest that nickel (II) can modulate cellular response through some common effectors involving in both apoptotic and cell cycle regulatory pathways.
Animal ; Apoptosis/drug effects* ; CHO Cells/drug effects* ; CHO Cells/cytology ; Cell Cycle/drug effects* ; DNA Fragmentation/drug effects ; Flow Cytometry ; G2 Phase/drug effects ; Hamsters ; Mitosis/drug effects ; Nickel/pharmacology*

Choriocarcinoma is a HCG-producing epithelial neoplasm derived from either trophoblastic or totipotential germ cells. It is a highly malignant tumor, which is rapidly invasive and widely metastatic, and in most cases develops within the uterus after a normal or abnormal gestation, including ectopic pregnancy. Non-gestational choriocarcinoma rarely occur as a primary neoplasm in the gonads or in the extragonadal midline locations such as mediastinum, retroperitoneum, and pineal gland. It also has been reported very rarely to arise in parenchymal organs such as the prostate, lung, breast, brain, liver, kidney, bladder, vagina, and gastrointestinal tract. A 58-year old man was admitted to our hospital with symptoms of tarry stool and epigastric discomfort. The endoscopic biopsy specimen initially revealed pooly differentiated carcinoma of stomach with regional lymph node metastasis. Patient underwent distal gastrectomy with Billroth II anastomosis. Choriocarcinoma of stomach with well differentiated tubular adenocarcinoma was diagnosed by the surgical biopsy specimen, and the serum level of beta-HCG was 2,775 mIU/mL.In three months after operation, the patient presented with pain on right upper quadrant abdomen, and the CT scan revealed multiple liver metastasis. Bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy were administered, but he died three months after the initial diagnosis.
Abdomen ; Adenocarcinoma* ; Biopsy ; Bleomycin ; Brain ; Breast ; Choriocarcinoma* ; Choriocarcinoma, Non-gestational ; Cisplatin ; Diagnosis ; Drug Therapy, Combination ; Etoposide ; Female ; Gastrectomy ; Gastroenterostomy ; Gastrointestinal Tract ; Germ Cells ; Gonads ; Humans ; Kidney ; Liver ; Lung ; Lymph Nodes ; Mediastinum ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial ; Pineal Gland ; Pregnancy ; Pregnancy, Ectopic ; Prostate ; Stomach ; Tomography, X-Ray Computed ; Trophoblasts ; Urinary Bladder ; Uterus ; Vagina

BACKGROUND: Cancer pain impacts the patient and improved pain management increases the quality of life (QOL) for the patient and entire family. One tablet of Ultracet(R) is composed of 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen. Mechanism of action of Ultracet(R) is multiple blocking to pain transmission with 3 synergistic actions. Ultracet(R) shows high performance analgesic efficacy with good tolerability and fast onset in previous studies. METHODS: From February 2003 to January 2004, we treated 97 patients who had cancer pain. Brief pain inventory, WHO QOL-BREF, and EORTC QLQ-C30 were evaluated before, and after median duration of treatment of 17.9 days with Ultracet(R). RESULTS: Among 97 patients, male was 59 (61%) and female was 38 (39%). Mean age was 60.3+/-12.0 (range: 25-81 years). Stomach cancer was in 19, lung cancer in 14, lymphoma in 11, unknown primary carcinoma in 8, colorectal cancer in 7, in order of frequency. Pre/post treatment visual analogue scale (VAS) score was 6.43/4.46 (p=0.000). Mild pain in 11 patients and pre/post treatment VAS score of 2.09/1.91 (p=0.875), moderate pain in 33 and 5.21/3.64 (p=0.000), and severe pain in 53 and 8.09/5.51 (p=0.000). Change of QOL after pain management was significant in emotion (65.9/72.1, p=0.012) in functional scales, and pain in symptom scales (62.0/50.9, p=0.000), sleep disturbance (p=0.018), and constipation (p=0.038) in symptom scales. We compared a QOL scales of 3 groups by response to Ultracet(R); improvement (67), no change (17), and aggravation (13). Global health (p=0.000). fatigue (p=0.019), and sleep disturbance (p=0.003) were statistically different among 3 groups. CONCLUSION: Ultracet(R) is effective in moderate to severe cancer pain and contribute an improvement of quality of life (QOL) of cancer patients.
Acetaminophen ; Analgesics ; Colorectal Neoplasms ; Constipation ; Fatigue ; Female ; Humans ; Lung Neoplasms ; Lymphoma ; Male ; Pain Management ; Quality of Life* ; Stomach Neoplasms ; Tramadol ; Weights and Measures

Metastases to the adrenal glands are frequently found at autopsy. In practice, adrenal metastases have generally been accepted as evidence of blood-borne systemic disease. So, clinically curable adrenal metastases is a rare malady. The role for surgical resection in adrenal metastases has not been clearly defined. A 45-year-old man initially underwent total gastrectomy with D2 lymph node dissection for treating his advanced gastric cancer. A solitary adrenal metastases was resected 1 year later. The patient has survived for 3 years and no further evidence of disease was found on his last follow-up examination. We report here on this case to show that for selected cases, surgical resection of adrenal metastases is feasible and this procedure may extend survival for metastatic gastric cancer patients.
Stomach Neoplasms/*pathology/surgery ; Middle Aged ; Male ; Humans ; Gastrectomy ; *Adrenalectomy ; Adrenal Gland Neoplasms/*secondary/*surgery ; Adenocarcinoma/pathology/surgery