PURPOSE: The optimal cytotoxic regimens have not been established for patients with non-small cell lung cancer (NSCLC) who develop disease progression on first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). MATERIALS AND METHODS: We conducted a multi-center randomized phase II trial to compare the clinical outcomes between pemetrexed plus cisplatin combination therapy followed by maintenance pemetrexed (PC) and pemetrexed monotherapy (P) after failure of first-line EGFR-TKI. The primary objective was progression-free survival (PFS), and secondary objectives included overall response rate (ORR), overall survival (OS), health-related quality of life (HRQOL), and safety and toxicity profiles. RESULTS: A total of 96 patientswere randomized, and 91 patientswere treated at 14 centers in Korea. The ORR was 34.8% (16/46) for the PC arm and 17.8% (8/45) for the P arm (p=0.066). With 23.4 months of follow-up, the median PFS was 5.4 months in the PC arm and 6.4 months in the P arm (p=0.114). The median OS was 17.9 months and 15.7 months in PC and P arms, respectively (p=0.787). Adverse events ≥ grade 3 were reported in 12 patients (26.1%) in the PC arm and nine patients (20.0%) in the P arm (p=0.491). The overall time trends of HRQOL were not significantly different between the two arms. CONCLUSION: The outcomes of pemetrexed therapy in NSCLC patients with disease progression after firstline EGFR-TKI might not be improved by adding cisplatin.
Arm ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Disease Progression ; Disease-Free Survival ; Epidermal Growth Factor ; Follow-Up Studies ; Humans ; Korea ; Lung Neoplasms ; Lung ; Pemetrexed ; Protein-Tyrosine Kinases ; Quality of Life ; Receptor, Epidermal Growth Factor ; Tyrosine

Cytochrome P450 1A1 (CYP1A1) is involved in the 2-hydroxylation of estrogen, the hormone that plays a critical role in the etiology of breast carcinoma. We evaluated the associations between two CYP1A1 polymorphisms [MspI (rs4646903); Ile462Val (rs1048943)] and breast cancer in a multicenter case-control study of 513 breast cancer cases and 447 controls in Korea. Women carrying the T allele of the CYP1A1 MspI polymorphism were found to have a 1.72-fold (95% CI 1.11-2.68) greater risk of developing breast cancer. No association was found between any CYP1A1 Ile462Val polymorphism and breast cancer. Haplotype analysis of the two loci showed that the CA haplotype was associated with the lowest risk of breast cancer, and CA/CA diplotypes were associated with a lower risk of breast cancer [OR = 0.28 (0.13-0.61)] than others/others diplotypes. Moreover, this reduced risk was more pronounced among women with a lower body mass index (BMI) [OR = 0.18 (0.06-0.58)] or with a shorter lifetime exposure to estrogen [OR = 0.23 (0.07-0.81)]. The results obtained suggest that the CYP1A1 MspI polymorphisms could affect susceptibility to breast cancer.
Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Breast Neoplasms/*genetics ; Case-Control Studies ; Cytochrome P-450 CYP1A1/*genetics ; *Disease Susceptibility ; Female ; Haplotypes ; Humans ; Korea ; Middle Aged ; *Polymorphism, Genetic

CYP17 gene is involved in steroidogenesis and steroid metabolism. Epidemiologic results on the association between the CYP17 polymorphism and breast cancer risk have been inconsistent. We examined the association between the MspAI polymorphism at +27 relative to the start of transcription in the 5'-untranslated region of CYP17 gene and breast cancer risk in Korean women. Four hundred and sixty-two incident cases and 337 controls were recruited from three teaching hospitals in Seoul during 1994-2001. Polymorphism of the CYP17 gene was determined by a single base extension assay. Demographic and lifestyle characteristics were identified using structured questionnaire. Age-adjusted (aOR) and multivariate odds ratios (mOR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression. The proportions of A1/A1, A1/A2 and A2/A2 genotypes among controls were 20.8%, 45.1% and 34.1%, respectively. Compared to the A1/A1 genotype, A1/A2 or A2/A2 genotype was not statistically significantly associated with overall breast cancer risk (i.e., mOR=1.01, 95% CI=0.69-1.47 and mOR=0.76, 95% CI=0.51-1.14, respectively). However, a significant association between CYP17 A2/A2 genotype and breast cancer was observed among women aged 50 years or less (mOR=0.58, 95% CI=0.34-0.99, P=0.04) and leaner women (body mass index < 22 kg/m2) (mOR=0.48, 95% CI=0.23-0.97, P=0.04). Our results suggest that genetic polymorphism in 5'-untranslated region of CYP17 might play a role in breast cancer development in Korean women among younger women aged less than 50 or leaner women with body mass index less than 22 kg/m2.
5' Untranslated Regions/*genetics ; Breast/metabolism/pathology ; Breast Neoplasms/enzymology/epidemiology/*genetics ; Case-Control Studies ; Comparative Study ; Demography ; Female ; *Genetic Predisposition to Disease ; Genotype ; Humans ; Korea/epidemiology ; Middle Aged ; Odds Ratio ; Polymorphism, Genetic/*genetics ; Questionnaires ; Research Support, Non-U.S. Gov't ; Risk Factors ; Steroid 17-alpha-Hydroxylase/*genetics

BACKGROUND: Idiopathic hypoparathyroidism is a relatively rare disease characterized by hypocalcemia and hyperphosphatemia due to parathyroid hormone deficiency of unknown cause. It usually develop at young age and various clinical symptoms and signs accompanied with hypocalcemia develop at late period. And rarely associated with polyglandular autoimmune syndrome during follow-up. So we reviewed retrospectively our clinical experiences in diagnosis and management. METHODS: We observed the 6 cases with idiopathic hypoparathyroidism from 1986 to 2002. Four female and two male patients were examined demographic characteristics, clinical manifestations, laboratory findings, radiologic finding, and occurrence of polyglandular autoimmune syndrome. RESULTS: All patients aged from 18 to 51 years and had no familial history. The most frequent two symptoms of idiopathic hypoparathyroidism were paresthesia (67%) and tetany (67%). The incidence of Chvostek's and Trousseau's sign were 83% and 67%, respectively. From the history taking, patient who had psychotic problem was two, ocular lesion was two, and Graves's disease was one before admission. One patient had transient hypogonadism because of acute illness but recovered during follow-up. One patient developed primary adrenal insufficiency after 2 years. Neuroimaging study revealed bilateral calcification and ECG showed Q-T interval prolong. CONCLUSION: Idiopathic hypoparathyroidism may be suspected in patients with various neurologic symptoms and signs associated with hypocalcemia. It was difficult to predict other endocrine dysfunction at diagnosis. Therefore, we need to follow-up laboratory examinations for early detection of accompanied autoimmune disease in idiopathic hypoparathyroidism patient.
Addison Disease ; Autoimmune Diseases ; Diagnosis ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Hyperphosphatemia ; Hypocalcemia ; Hypogonadism ; Hypoparathyroidism* ; Incidence ; Male ; Neuroimaging ; Neurologic Manifestations ; Parathyroid Hormone ; Paresthesia ; Rare Diseases ; Retrospective Studies ; Tetany

PURPOSE: To evaluate the potential association between the GSTP1 genotype and the development of breast cancer, a hospital based case-control study was conducted in South Korea. MATERIALS AND METGODS: The study population consisted of 171 histologically confirmed incidents of breast cancer cases, and 171 age-matched controls with no present, or previous, history of cancer. A PCR method was used for the genotyping analyses, and statistical evaluation was performed by an unconditional logistic regression model. RESULTS: No association was observed in the study subjects, or the premenopausal women group with GSTP1 Val allele. However, postmenopausal women with GSTP1 Val allele had a reduced risk of breast cancer (OR=0.3, 95% CI=0.1~0.7). When the data were stratified, by the known risk factors of breast cancer, a significant interaction was observed between the GSTP1 genotype and alcohol consumption (p for interaction = 0.01); women with GSTP1 Val allele, that drank regularly, had a 3.0-fold increased risk of breast cancer (95% CI=1.1~7.9), whereas women with GSTP1 Val allele, that never drink, had protective effects (OR=0.4, 95% CI=0.2~0.8). CONCLUSION: Our findings suggest that GSTP1 Ile105Val polymorphism influences the individual susceptibility to breast cancer, and that this effect may be modified by alcohol consumption.
Alcohol Drinking ; Alleles ; Breast Neoplasms* ; Breast* ; Case-Control Studies ; Female ; Genotype ; Glutathione Transferase* ; Glutathione* ; Humans ; Korea ; Logistic Models ; Polymerase Chain Reaction ; Polymorphism, Genetic* ; Risk Factors

Behcet's disease is a complex multisystem disease that features recurrent aphthous stomatitis, recurrent genital ulcerations, and eye lesions(uveitis or chorioretinitis). Among the systemic manifestat ions, pulmonary involvement is known to be rare and only a few cases have been documented. The most important features of pulmonary lesions in Behcet's disease are recurrent hemoptysis, which is often massive, and fatal pleuritic chest pain and recurrent high fever and fleeting nature of the pulmonary infiltrates. We report a case of Behcet's disease manifestated as high fever and pleural effusions which was complicated by pulmonary infarction ans a result of pulmonary arteritis.
Arteritis ; Chest Pain ; Fever ; Hemoptysis ; Ions ; Pleural Effusion* ; Pulmonary Infarction ; Stomatitis, Aphthous ; Ulcer

BACKGROUND: Adie's tonic pupil consists of mydriasis, accommodation defect, decreased light reflex, and tonic near reflex. When tonic pupil is combined with hypo- or areflexia, it is called Holmes-Adie syndrome. CASE: Fifty-two-year-old and 37-year-old female patients showed unilateral dilated irregular pupil, decreased light reflex, and decreased or absent DTR. When 0.125% pilocarpine was dropped on the dilated pupil, the pupil was constricted after pilocarpine application. Somatosensory evoked potentials were within normal ranges, and H-reflex responses were absent or delayed.
Adie Syndrome* ; Adult ; Evoked Potentials, Somatosensory ; Female ; H-Reflex ; Humans ; Mydriasis ; Pilocarpine ; Pupil ; Reference Values ; Reflex ; Tonic Pupil

BACKGROUND AND OBJECTIVE: Several recent studies have demonstrated that cognitive function is impaired in non-insulin dependent diabetes mellitus (NIDDM) patients compared with age-matched non-diabetic controls. However, the underlying pathophysiological mechanism of this diabetic central nervous involvement remains obscure. The present study was designed to explore further whether cognitive deficits are present in NIIDDM patients who do not show apparent symptoms and signs of central nervous system damage and to evaluate the influence of clinical parameters and diabetic complications on cognitive function. METHODS: Thirty patients over 50 years of age with NIDDM and 30 age-, sex- and education-matched normal controls were recruited for the study. P300 event-related potential test and neuropsychological tests (Mini-Mental State Examination, MMSE; Benton Visual Retention test; Digit Span Forward and Backward) were perfomed. P300 latencies were recorded according to the conventional technique using Counterpointer MK2. RESULTS: Compared with controls, NIDDM patients showed significant impairment in MMSE (P<0.05), Benton Visual Retention (P<0.05), and Digit Span Backward (P Blood Glucose ; Central Nervous System ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Event-Related Potentials, P300* ; Fasting ; Humans ; Neuropsychological Tests* ; Peripheral Nervous System Diseases ; Reference Values ; Triglycerides

Wilson's disease is an autosomal recessive disorder resulting from an excessive accumulation of copper in the liver, cornea, kidneys, and in the basal ganglia of the brain. The prominent speech disturbances of Wilson's disease include monopitch, monoloudness, slow rate, low pitch, delayed in initiating speech and rarely palilalia. A19-year-old woman developed palilalia which was characterized by compulsive repetition of a phrase with increasing rapidity and with a decrescendo of voice volume. Although she had been suffering from liver cirrhosis for the past 8 months, the palilalia was the only neurological sign at initial examination. She showed a low serum ceruloplasmin, low serum copper, increased urinary copper excretion, and Kayser-Fleischer rings. Brain magnetic resonance images showed high signals in the bilateral basal ganglia in T2-weighted images, and slight cortical atrophy.
Atrophy ; Basal Ganglia ; Brain ; Ceruloplasmin ; Copper ; Cornea ; Female ; Hepatolenticular Degeneration* ; Humans ; Kidney ; Liver ; Liver Cirrhosis ; Voice

BACKGROUND & OBJECTIVES: Hypertensive encephalopathy is an acute neurologic syndrome characterized by abrupt and marked elevation of blood pressure, headache, vomiting, seizure, visual disturbance, and altered mental status. This syndrome may occur as a complication of toxemia, renal artery stenosis and acute glomerulonephritis. We report 4 young patients with occipital lobe seizure, as a presenting sign of hypertensive encephatopathy, whose brain MRI and perfusion scans showed lesions on bilateral occipital lobes. Case : Four young patients experienced moderate to severe headache, visual illusion, generalized seizure, and loss of sight for a few days. Their systolic blood pressure was 150-170mmHg and diastolic blood pressure 100-120mmHg. Three patients had proteinuria and hematuria as the results of acute glomerulonephritis. CSF findings were within normal limits. EEG showed intermittent generali,ed or bilateral temporoparietooccipital slowings in all patients and continuous parietooccipital slowings in one patient. Brain MRI man showed hyperintensity signal in T2WI and hypointensity signal in TlWl on bilateral occipital lobes and SPECT scan showed normal perfusion three patients and increased perfusion on occipital areas in one patient. They were treated with antihypertemsive agents and anticonvulsants (phenobarbital or valporic acid) for 2-10 months. Seizure was well controlled and didn't recur though discontinuing anticonvulsant. CONCLUSION: In young age, acute hypertension may cause clinically occipital lobe seizure and radiologically bilateral occipital lobe lesions.
Adolescent* ; Anticonvulsants ; Blood Pressure ; Brain ; Electroencephalography ; Glomerulonephritis ; Headache ; Hematuria ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Illusions ; Magnetic Resonance Imaging ; Occipital Lobe* ; Perfusion ; Proteinuria ; Renal Artery Obstruction ; Seizures* ; Tomography, Emission-Computed, Single-Photon ; Toxemia ; Vomiting