PURPOSE: The prognosis of non-Hodgkins lymphoma (NHL) in elderly patients seems to be poorer than that in patients aged less than 60 years. This may be due to the lower tolerance for combination chemotherapy in the elderly. Aggressive combination chemo-therapy, which is the treatment of choice in intermediate and high grade NHL of adulthood, may be associated with unpredictab1y severe and lethal toxicity and worsened quality of life in the elderly. We investigated the treatment responses, toxicities and prognostic factors of NHL in elderly patients treated with combination chemotherapy. MATERIALS AND METHODS: We treated 116 elderly (>60 yrs) patients with NHL between January 1986 and June 1996 with adriamycin-containing regimens, such as CHOP (cyclo- phosphamide, adriamycin, vincristine, prednisolone), BACOP (bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone), and mBACOP (methotrexate, bleomycin, adriamycin, cyclophosphamide, vincristine, prednisolone). Patients in this study ranged from 60 to 81 (median 67) years of age. Fifty-five percent of patients were in stage I or II and the rest (45%) were in stage III or IV. The histologic grade was predominantly (91%) of intermediate and high grade type. RESULTS: The treatment responses were complete (CR) in 55% and partial (PR) in 25%. The median durstion of CR was 32 (3-132) months. The CR rate was significantly higher in patients treated with RDI (relative dose intensity) > 75% than that in the patients treated with RDI < 75% (p 0.003), but there was no significant difference in CR rate between treatment regimens (p-0.38). At a median follow up of 48-months (range, 12 to 132 months), the estimated 5-year ovetall survival was 46%. Ann Arbor Stage (I, II vs III, IV), ECOG performance (0-1 vs 2-3), RDI (>75% vs <75%) and the treatment response were important prognostic factors in the univariate analysis, and the treament response (CR vs non-CR) was the only independent prognostic parameter in the multivariate analysis. The most frequent and severe toxicity associated with chemotherapy was infection with or without neutropenia. The rate of severe infection was significantly decreased in the patients supported with G/GM-CSF but not in the dose-reduction group (RDI<75% vs >75%). CONCLUSION: Our data suggests that achievement of the CR after combination chemotherpy is the most important prognostic factor in the elderly patients with NHL. Suboptimal chemotherapy (RDI<75%) reduced the complete remission rate without reducing the likelihood of developing severe toxicities. Optimal chemotherapy with supportive cares involving the use of hematopoietic growth factors may be needed to improve the treatment response and the survival in the elderly patients with aggressive NHL.
Aged ; Bleomycin ; Cyclophosphamide ; Dimethoate ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Follow-Up Studies ; Hodgkin Disease* ; Humans ; Intercellular Signaling Peptides and Proteins ; Lymphoma, Non-Hodgkin ; Multivariate Analysis ; Neutropenia ; Prognosis* ; Quality of Life ; Vincristine

Nine typical cases of ossifying fibroma in the tibia or fibula were retrospectively reviewed for clinical and histopathological aspects of this disease. Along with the case analysis, light and polarized microscopic examinations were performed in each case. Differential points with monostotic fibrous dysplasia were as follows; 1) ossifying fibroma begins in the significantly younger age, which is in most cases below 10 years of age, 2) it is confined to diaphysis of tibia or fibula, 3) radiologically, multilocular osteolytic destructive change in eccentric pattern is usually combined with anterior or anterolateral bowing deformity, 4) microscopically, characteristic findings are presence of osteoblastic rimming, peripheral maturation, and zonal phenomenon. In the treatment of ossifying fibroma, definitive surgical treatment should be delayed until skeletal maturity, when segmental resection in wide margin including periosteum might be preferred.
Congenital Abnormalities ; Diagnosis ; Diaphyses ; Fibroma, Ossifying ; Fibrous Dysplasia, Monostotic ; Fibula ; Fluconazole ; Osteoblasts ; Periosteum ; Retrospective Studies ; Tibia

PURPOSE: The purpose of this study is to evaluate the effectiveness of low-dose gabapentin for interdigital neuroma. MATERIALS AND METHODS: Between April 2000 and June 2003, 32 patients (39 feet) with interdigital neuroma were treated with using low-dose gabapentin. Two of the 32 patients were male, and thirty were female, and the average age was 47.4 years. The follow-up was 6 to 44months (mean 15.1 months). All cases were diagnosed by physical examination and ultrasonography or MRI. Low-dose gabapentin (300-600 mg) was prescribed and shoe modification was recommended. The patients were evaluated through questionnaire. RESULTS: Neuroma was found in twenty one cases at the third intermetatarsal space, and thirteen at the second intermetatarsal space. The sensitivity of ultrasonography was 96% and that of MRI was 79%. Overall satisfaction was rated as excellent or good by 18 cases (57%). Average pain relief ratio was 50.3%, and in 14 cases, more than 80% of pain relief was noted. Nine (28%) of 32 patients showed they had no activity restrictions, such as daily activities or work, whereas 8 (25%) had mild restrictions and 15 (47%) had major restrictions. Twelve of 15 patient with major restrictions had been treated operatively (neurectomy; 10 cases, decompression; 2 cases). One case had gastrointestinal problem. CONCLUSION: Low-dose gabapentin for interdigital neuroma was one of the effective conservative treatments. The operation may be preserved for patient with the persist symptoms, nevertheless the conservative treatments and use of low-dose gabapentin.
Decompression ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma* ; Physical Examination ; Shoes ; Ultrasonography

No abstract available.
Abortion, Induced* ; Abortion, Spontaneous/genetics* ; Adult ; Chromosome Aberrations/epidemiology* ; Chromosome Disorders ; Female ; Human ; Korea ; Pregnancy ; Pregnancy Trimester, First

PURPOSE: We explored the possibility of DNA methylation as a mechanism of loss of type II collagen expression in dedifferentiating chondrocytes by culturing in monolayer. MATERIALS AND METHODS: Dedifferentiation was induced by low density subculturing primary porcine chondrocytes in vitro. The mRNA expression of Type I collagen, Type II collagen and DNA methyltransferase (DNMT) was measured by RT-PCR. Induction of redifferentiation in dedifferentiated chondrocytes was performed in 3-dimensional alginate bead culture system. As stimulating factors for reexpression of genes in dedifferentiated chondrocytes, 10 ng/ml TGF-beta1 and 5 micrometer 5-azacytidine were used. RESULTS: Type II collagen mRNAs was expressed strongly in freshly isolated cells but had decreased in monolayer cultured cells after 3 weeks up to 40%. In contrast, type I collagen expression was increased from 21 days and kept increasing during the 86 days of study. After treatment of 5 micrometer 5-azacytidine, fibroblast like morphology was changed to round shape such as traditional chondrocyte morphology at day 4. At day 10, type II collagen expression was increased by 5-azacytidine and TGF-beta1 marginally and also integrin beta1 expression was increased in all groups. RT-PCR analysis demonstrated that DNMT3A expression increased in dedifferentiating chondrocytes when compared with control cells for 40 days. CONCLUSION: Loss of type II collagen mRNA expression and increase of DNMT 3A expression were showed similar patterns during dedifferentiation. These results suggest that type II collagen gene expression may be influenced by DNA methylation. As stimulating factors, TGF-beta1 and 5-azacytidine have potential activity to increase the type II collagen expression in alginate culture system.
Antigens, CD29 ; Azacitidine ; Cells, Cultured ; Chondrocytes* ; Collagen Type I ; Collagen Type II* ; DNA Methylation* ; DNA* ; Fibroblasts ; Gene Expression ; RNA, Messenger ; Transforming Growth Factor beta1

No abstract available.

OBJECTIVES: Infection and replication of the hepatitis B virus are closely related to the host immunity. Anticancer chemotherapy decreases the immune response of the host, Especially, glucocorticoid can activate the replication of hepatitis B virus directly. It is well known that hepatitis B virus infection and hepatic complications are more common in patients with hematologic malignancies like malignant lymphoma. We studied the incidence of hepatitis B virus infection and hepatic complications following anti-cancer chemotherapy in patients with malignant lymphoma. METHODS: Among 224 cases diagnosed as malignant lymphoma from January 1989 to December 1993 at Yonsei University Medical Center, 77 cases tested for hepatitis B virus serology was studied. RESULTS: 1) Eighteen cases (23%) was HBsAg positive. 2) The results of hepatitis C virus serology in six cases were all negative. 3) Eight (57%) of 14 follow-up cases had hepatic complications, Two patients had fulminant hepatitis, two nonicteric hepatitis and four icteric hepatitis. 4) Interferon-alpha was administered in three cases among the patients with hepatic complications. Loss of HBeAg was observed in one case and loss of HBsAg in another case. CONCLUSION: Serious hepatic complications can be occurred following anticancer chemotherapy in HBsAg-positive patients with malignant lymphoma. Therefore, we recommend that patients being considered as candidates for anticancer chemotherapy should routinely undergo serologic test for Hepatitis B virus. In addition HBsAg-positive patients with anticancer chemotherapy should be regularly monitored for hepatic injury. And with the careful use of steroid and interferon, prolongation of survival might be searched for these patients.
Academic Medical Centers ; Drug Therapy* ; Follow-Up Studies ; Hematologic Neoplasms ; Hepacivirus ; Hepatitis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Humans ; Incidence ; Interferon-alpha ; Interferons ; Lymphoma* ; Serologic Tests

The mechanism of chronic pain is very complicated. Memory, pain, and opioid dependence appear to share common mechanism, including synaptic plasticity, and anatomical structures. A 48-yr-old woman with severe pain caused by bone metastasis of breast cancer received epidural block. After local anesthetics were injected, she had a seizure and then went into cardiac arrest. Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared. Also, her excruciating pain and opioid dependence had disappeared. This complication, although uncommon, gives us a lot to think about a role of memory for chronic pain and opioid dependence.
Amnesia/*diagnosis ; Anesthesia, Local/adverse effects ; Bone Neoplasms/drug therapy/radiotherapy/secondary ; Breast Neoplasms/drug therapy/pathology/radiotherapy ; *Cardiopulmonary Resuscitation ; Electroencephalography ; Female ; Heart Arrest/etiology ; Humans ; Magnetic Resonance Imaging ; Mepivacaine/adverse effects ; Middle Aged ; *Pain Management ; Seizures/etiology ; Tomography, X-Ray Computed

PURPOSE: We propose that cell attachment can be regulated by the modulation of FAK expression using an adenovirus vector. MATERIALS AND METHODS: Chondrocytes and chondroid cells were used in cell attachment test by blocking or non-blocking of antibodies and synthetic peptides on type II collagen precoated 96-well immunoplates. The C-terminal domain of FAK(FAK-CD) was transfected through infection of the recombinant adenovirus. Also tyrosine phosphorylation of FAK was checked by immunoprecipitation of FAK followed by western blot analysis with anti-phosphotyrosine antibody. For evaluating the change of integrin expression, semi-quantitative reverse-transcription polymerase chain(RT-PCR) reactions were done after transfection of FAK-CD. RESULTS: We observed more increased expression of FAK in the chondroid cells than that in chondrocytes using western blotting. The level of attachment to type II collagen was significantly inhibited by blocking with the monoclonal antibody of integrin-beta1 and synthetic RGD peptides. Also adenovirus mediated transfection of FAK-CD resulted in inhibition of phosphorylation of FAK and significantly inhibited cell attachment in only JJ102. Integrin-beta1 antibody blocking after transfection with FAK-CD showed inhibition of cell attachment in more than 95% of all cells. The mRNA expression of both Integrin a2 and integrin a5 was increased but was not significant. Protein expression of integrin a2 and integrin a5 showed no changes. CONCLUSION: We found that the attachment of FAK-overexpressing cells could be mediated through integrin-beta1 receptor. We concluded that the modification of FAK expression will contribute to increase the cell attachment to biomaterials and regeneration of cartilage defects.
Adenoviridae ; Adhesiveness* ; Antibodies ; Biocompatible Materials ; Blotting, Western ; Cartilage ; Chondrocytes ; Collagen Type II ; Focal Adhesion Protein-Tyrosine Kinases ; Focal Adhesions* ; Immunoprecipitation ; Peptides ; Phosphorylation ; Regeneration ; RNA, Messenger ; Transfection ; Tyrosine

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for enteral feeding that is convenient and safe. We investigated the satisfaction of enteral feeding by the use of a nasogastric tube and PEG as well as PEG-related complications. METHODS: A total of 57 patients (121 cases) who underwent PEG in a teaching hospital were investigated about complications based on the use of electronic medical records. Questionnaires comprised of 11 questions were administered by telephone or by direct contact with care providers. RESULTS: The median interval period of exchange for PEG was 184.94 days. The causes for exchange included regular exchange (36, 41.86%), accidental or self- removal of the PEG tube (26, 30.23%), profuse discharge, rash or infection around the PEG insertion site (13, 15.12%) and PEG tube malfunction (11, 12.79%). The satisfaction index (VAS scale) for the use of the nasogastric tube was 4.32, while the satisfaction index for the use of PEG was 7.72, which indicates that the care providers were more satisfied with nutrition provided by the use of PEG (p <0.0001). The 28 care providers (80.00%) replied that PEG was a good method to maintain a high quality of life. CONCLUSIONS: Care providers had a high degree of satisfaction for the use of PEG. PEG is safe and effective method for enteral nutrition. If continuous education or management to reduce accidental removal and to lessen complications is enforced, higher satisfaction can be expected.
Electronic Health Records ; Enteral Nutrition ; Exanthema ; Gastrostomy ; Hospitals, Teaching ; Humans ; Telephone ; Surveys and Questionnaires