No abstract available.
Chondrosarcoma*

BACKGROUND: There has been a change in the causes of aortic stenosis when comparence of rheumatioc aortic stenosis in recent year. Therefore, we studied the etiology factor of pure aortic stenosis. METHODS: The gross surgical pathologic features of the aortic valves were reviewed in 92 patients with pure aotic stenosis whom underwent aortic valve replacement at Yonsei University, Cardiovascular center between July 1989 and June 1994. RESULTS: The three most frequent causes were 1) calcification of congenital bicuspid valve in 30%, 2) degenerative calcification of aortic valve in 22%, 3) rheumatioc valvular change in 48%. The mean age at the time of aortic valve replacement for the entire series of patients was 54.4 years. The range of age was from 18 years to 77 years. Males predominated for degenerative disease and congenital bicuspid valves, but there were reversed rheumatic origin. One or more complications occured in 17% of patients undergoing operation. The surgical mortality was 3.3%. CONCLUSION: Our data suggest that more common cause of aortic stenosis is non-rheumatic disease rather than rheumatinc origin.
Adult* ; Aortic Valve ; Aortic Valve Stenosis ; Constriction, Pathologic* ; Humans ; Male ; Mitral Valve ; Mortality

PURPOSE: To determine the activity and toxicities of PEF (Cisplatin, Etoposide, 5-Fluorouracil) chemotherapy for stomach cancer. MATERIALS AND METHODS: Patients with previously untreated metastatic stomach cancer were treated with PEF regimen which consisted of cisplatin (20 mg/m2 i.v. days 1~5), etoposide (100 mg/m2 i.v. days 1, 3, 5), and 5-fluorouracil (5-FU)(800 mg/m2 i.v. infusion for 12 hours days 1~5). Chemotherapy was repeated every 3 weeks until disease progressed or toxicities were intolerable. RESULTS: Between May 1989 and July 1990, 40 patients were enrolled in this protocol. Twelve patients were lost to follow up after one cycle of chemotherapy and inevaluable. After 2~8 cycles (median 3) of chemotherapy, 20 out of 28 evaluable patients showed objective responses without any complete response, making the response rate 71% (95% confidence interval: 54~89%). The responses lasted from 4+ to 39 weeks (median: 38 weeks). The overall survival of total evaluable patients was 4+ ~50+ weeks (median 38 weeks). Among total 109 cycles of chemotherapy, cycles were delayed or doses were reduced in 48 cycles (44%) because of leukopenia (in 61 cycles: 56%) and/or thrombocytopenia (in 14 cycles: 13%). However, there was no treatment-related death. Nausea/vomiting and alopecia were experienced in most of patients. The stomatitis was experienced in 7 patients (25%) but completely reversible. In contrast, the peripheral neuropathy which developed in 4 patients (14%) after 5 cycles of chemotherapy was not reversible. CONCLUSION: The PEF regimen was active and tolerable in stomach cancer.
Alopecia ; Cisplatin ; Drug Therapy* ; Etoposide* ; Fluorouracil* ; Humans ; Leukopenia ; Lost to Follow-Up ; Peripheral Nervous System Diseases ; Stomach Neoplasms* ; Stomach* ; Stomatitis ; Thrombocytopenia

The diffuse large B-cell lymphoma category of the Revised European American Classification of Lymphoid Neoplasms (REAL) encompasses different morphologic lymphoma subtypes in a single entity, especially the diffuse large cell (DLC) and the immunoblastic (IBL) subtypes by Working Formulation (WF). The aim of this study is to determine the influence of the morphologic subdivision within this category with respect to clinical outcome and proliferative index using Ki-67 immunostainig combined with image analysis. We retrospectively reviewed 74 patients from 1990 to 1996, who were diagnosed with diffuse large B-cell lymphoma. All cases were reclassified according to REAL and Working Formulation (WF), and Ki-67 immunostaining was performed in all the cases. Fifty-eight cases (78.4%) were classified as DLC and 16 cases (21.6%) as IBL, according to WF. Twenty one cases (28.4%) showed nodal involvement and 53 cases (71.6%), extranodal involvement. All cases were found to display a variable degree of nuclear Ki-67 staining. A proliferative index of 50% or higher identified a group of patients (77%) who had poor clinical results. Overall survival was significantly reduced in these patients displaying high Ki-67 associated proliferative index compared to those with a low proliferative index (p=0.007). 5-year survival estimates were 93% in the low proliferative index group and 55% in the high proliferative index group. A multivariate regression analysis incorporating commonly used clinical prognostic factors confirmed the independent effect of proliferation index on survival. Moreover, all of the 16 IBL cases showed Ki-67 positivity of 50% or higher, which correlates with the poor clinical outcome compared to 70.7% of DLC (p=0.014). We conclude that subdivision of the diffuse large B-cell lymphoma category of the REAL classification is necessary in terms of prognostic significance in correlation with Ki-67 proliferative index.
B-Lymphocytes* ; Classification ; Humans ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Retrospective Studies

Osteogenic sarcoma arise from primitive bone forming mesenchyme which is transformed into neoplastic osteoid and bone. Most osteogenic sarcomas originate in long bone, only rarely do they occur as primary tumor of the spine. A case is presented in which a patient who had suffered from paraplegia and self voiding difficulty. It was diagnosed as osteogenic sarcoma of the 5th thoracic spine which was operated and confirmed by microscopically, and is discussed with a brief review of the literatures.
Humans ; Mesoderm ; Osteosarcoma* ; Paraplegia* ; Spine*

Subacute thyroiditis is a frequent benign thyroid disease associated with previous viral upper respiratory tract infection. Known complications of this disease are long-standing subclinical hypothyroidism, persistent anterior neck pain and rarely Graves disease. In general, thyroid abscess is an uncommon disease because of anatomic isolation of the gland and its rich system of drainage for blood and lymph. Especially, development of thyroid abscess in subacute thyroiditis is extremely rare phenomenan, but significant bad outcomes can be resulted. Its clinical BACKGROUND containes immune-suppressed state, anatomic defect, presence of underlying other thyroid disease and of non-thyroidal infectious foci. We experienced a case of subacute thyroiditis complicated with streptococcal thyroid abscess during glucocorticoid therapy. The patient was a 19-year-old female who was admitted due to anterior neck pain for 1 month. Typical subacute thyroiditis was suggested from initial laboratory findings including CBC, erythrocyte sedimentation rate, serum T3, T4, TSH levels, thyroid scan & thyroid uptake. But during oral prednisolone therapy, unexpected bacterial thyroid abscess was developed. We report this unusual case with review of literatures.
Abscess ; Blood Sedimentation ; Drainage ; Female ; Graves Disease ; Humans ; Hypothyroidism ; Neck Pain ; Prednisolone ; Respiratory Tract Infections ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis, Subacute* ; Young Adult

Primary hyperparathyroidism is a generalezed disorder of calcium, phosphorus and bone metabolism due to an increased secretion of parathyroid hormone. Single parathyroid adenoma is the most common cause of primary hyperparathyroidism. Because parathyroid hormone has been proposed as an important inhibitor of renal bicarbonate reabsorption of proximal tubule, proximal renal tubular acidosis is not rare in primary hyperparaphyroidism. After parathyroid resection, significant hypocalcemia and hypophosphatemia requiring prolonged medical management may develop, termed hungery bone syndrome. We experienced a case of primary hyperparathyroidism associated with proximal renal tubular acidosis, and severe hungry bone syndrome after resection of the adenoma of parathyroid gland.
Acidosis ; Acidosis, Renal Tubular ; Adenoma ; Calcium ; Hyperparathyroidism, Primary ; Hypocalcemia ; Hypophosphatemia ; Kidney Tubules, Proximal ; Metabolism ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Phosphorus

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) has been broaden in reccent years. However,we considered many aspects in performing angioplasty in patient with multivessel disease. There were procedural success rate, complication, risk, restenosis and long-term effect. So we evaluated the initial success rate, safety and follow-up results. METHODS: To assess the likelihood of initial success in patients with multivessel coronary artery disease, single or multiple site angioplasy were performed at 449 lesions from 273 patients(Male 202,Female 71, Mean age 60.0+/-9.4 years). To evaluate the restenosis rate of angioplasty in multivessel disease, follow-up coronary angiogram were performed at 164 lesions from 95 patients at average 6months after angioplasty. RESULTS: The extent of coronary artery disease revealed that two vessel disease were 200(73.3%) and triple vessel disease were 73(26.7%). Single vessel angioplasty(SVA) was performed in 180(40.1%) lesions and multivessel angioplasty(MVA) was performed in 269(59.9%) lesions. Procedural success was achieved 377(84.0%) out of total 449 lesions. The proccdural success rate was 81.1% in SVA and 85.9% in MVA. According to major epicardial coronary artery, procedural success rate of left anterior descending artery was 82.0%, left circumflex artery 92.4% and right coronary artery 79.4%. According to angiographic morphology of lesions, procedural success rate of type A was 95.7%, type B 88.9% and type C 56.4%. Complete revascularization was done in 87 patients(31.9%) out of 273 patients. Major cause of failure of angioplasty in multivessel disease was inability to pass the guide wire cross the lesion due to total occlusion. Complications included dissection in 101, acute closure in 7(9.7%), coronary artery perforation in 2, cardiogenic shock in 1 and ventricular fibrillation in 1. Follow-up coronary angiography revealed the restenosis rate was 42.2%. CONCLUSION: Coronary angioplasty in selected patients with multivessel coronary artery disease might be useful and have relatively good immediate and long-term results.
Angioplasty* ; Arteries ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Shock, Cardiogenic ; Ventricular Fibrillation

PURPOSE: Drug resistance is one of the major obstacles to treatment of cancer. Multidrug resistance (MDR) caused by overexpression of p-glycoprotein (Pgp) in cancer cell membrane is a well-known mechanism of drug resistance in in vitro system and was reported to be a significant mechanism of resistance in non-Hodgkins lymphoma (NHL). Verapamil, a calcium channel blocker, is proven in vitro to overcome the MDR caused by Pgp. We performed a phase II trial of verapamil in patients with NHL refractory to EPOCH regimen (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin) to overcome the MDR caused by Pgp. MATERIALS AND METHODS: Verapamil was administered via intravenous route from 1 hour before to 12 hour after the 96-hour infusion of etoposide, doxorubicin, and vincristine which were known to be substrates of Pgp in EPOCH regimen. The dose of verapamil was 0.15 mg/Kg in bolus and 0.2 mg/Kg/hr in infusion at the beginning and escalated by 0.05 mg/Kg/hr every 24 hours if there was no dose-limiting toxicities such as 2nd or 3rd degree AV block, hypotension, or congestive heart failure. Plasma verapamil concentrations were measured every 24 hour by gas chromatography. Mdrl expression level in tumor tissues was measured by RT-PCR. RESULTS: From Feb. to Nov. 1994, 14 patients were treated with this protocoL However, poor tolerability and no response in these patients led to early closure of the study at this 1st stage of patient accrual according to Gehans method. Among 14 patients, 12 experienced 2nd or 3rd degree AV block and/or hypotension and required temporary cessation of infusion and reduction of verapamil dose. However, there was no congestive heart failure or treatment-related death. The peak concentrations of verapamil were 0.29-1.94 pM (mean 0.93 pM) and mean concentrations during the 4-day infusion were 0.22-1.21 pM (mean 0.6 pM). Mdrl expression levels measured in 6 patients were 0.99-14.43 U (median 4.39). CONCLUSION: These results suggest that verapamil in this dose and schedule was neither tolerable nor effective for the reversal of drug resistance in NHL patients.
Appointments and Schedules ; Atrioventricular Block ; Calcium Channels ; Cell Membrane ; Chromatography, Gas ; Cyclophosphamide ; Doxorubicin ; Drug Resistance* ; Drug Resistance, Multiple ; Etoposide ; Heart Failure ; Hodgkin Disease* ; Humans ; Hypotension ; Lymphoma, Non-Hodgkin ; P-Glycoprotein ; Plasma ; Prednisolone ; Verapamil* ; Vincristine

OBJECTIVE: Endometriosis is a very common gynecological condition in which tissue similar to endometrium proliferates at sites outside the uterine cavity. Although it generally remain a benign condition, malignant transformation has been documented, and it is commonly found in association with endometrioid subtype ovarian carcinoma. In order to identify the genomic change in those areas possibly involved in the pathogenesis of endometriosis, we performed LOH analysis. METHODS: Twenty seven cases of endometriosis were analyzed for the detection of LOH using 5 microsatellite markers. LOH analysis was performed by PCR, capillary electrophoresis and gene scan analysis using DNA from sections of tumor and normal tissue pairs. RESULTS: Twenty two of 27 (81.5%) cases demonstrated LOH at one or more loci. The frequency of LOH was 37.0% (D18S69), 25.9% (D22S274), 14.8% (D22S283), 7.4% (D6S286), 7.4% (D13S160). CONCLUSION: The frequencies of LOH was increased in higher stage of endometriosis. Most notable findings were found at chromosome 18 and 22 loci (D18S69, D22S274). These region might involve the some candidate genes closely related with the pathogenesis of endometriosis.
Chromosomes, Human, Pair 18 ; DNA ; Electrophoresis, Capillary ; Endometriosis* ; Endometrium ; Female ; Loss of Heterozygosity* ; Microsatellite Repeats ; Polymerase Chain Reaction