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

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*

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

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*

Most osteosarcomas arise spontaneously, but rarely they may be secondary to other benign osseous conditions and may occur following irradiation. Postradiation sarcoma of bone is approximately 5.5 percent of all osteogenic sarcoma. Diagnosis is possible when a sarcoma arising after long latent period(more than 3 years) in irradiated bone and the bone is normal or benign osseous lesion at the time of irradiation. The spontaneously arising osteogenic sarcomas are distribute mainly in the knee region, but postradiation sarcoma arise in any bones, such as long bone of the extremity, pelvic bone, vertebra, craniofacial bone and shoulder girdle bone. Recently we experienced a case of postradiation osteosarcoma of the pelvic bone who received radiation therapy for carcinoma of the uterine cervix 20 years ago.
Cervix Uteri ; Diagnosis ; Extremities ; Female ; Knee ; Osteosarcoma* ; Pelvic Bones* ; Sarcoma ; Shoulder ; Spine

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

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*

BACKGROUND: The purpose of this study was to clarify whether the patients' age is an independent prognostic factor in curatively resected gastric adenocarcinoma. METHODS: Clinicopathologic information was reviewed for consecutive patients undergoing curative gastrectomy for gastric cancer during 6-year period (Jan. 1996-Dec. 2001) at the Keimyung University School of Medicine at Daegu. Overall survival was examined by the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards was used to identify whether age had independent prognostic significance for survival. RESULTS: The patients were divided into two groups: 838 patients (72.4%) with age of less than 65 years old, and 320 patients (27.6%) with age more than 65 years old. In these two groups, there were statistically differences in WHO classification, Lauren classification, vascular invasion, T stage, total stage, operational morbidity and mortality, and overall survival rate. The 5-year overall survival rate of age less than 65 years old was 87.8%, and 83.0% of age more than 65 years old (p=0.019). Multivariate Cox regression analysis revealed that age was an independent prognostic factor to predict overall survival in curatively resected gastric cancer (p=0.038). However, after excluding cases who died within 1 month after gastric resection, overall survival rate was significantly different between two groups (p=0.050), but Cox regression analysis showed that age was not an independent prognostic factor (p=0.054). CONCLUSION: The age is not an independent prognostic factor in curatively resected gastric cancer patients, and survival differences are due to an increased operative mortality in elderly patients.
Adenocarcinoma ; Aged ; Classification ; Daegu ; Gastrectomy ; Humans ; Mortality ; Multivariate Analysis ; Prognosis ; Stomach Neoplasms* ; Survival Rate