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

OBJECTIVE: The incidence of leptomeningeal dissemination from malignant glioma is rare, so the clinical features of this are not well documented yet. We attempted to determine the clinical features of leptomeningeal dissemination from malignant gliomas. METHODS: We retrospectively analyzed 11 cases of leptomeningeal dissemination of malignant glioma, who were treated at our institution between 2006 and 2009. We investigated the clinical features of these patients by considering the following factors : tumor locations, the events of ventricular opening during surgery and the cerebrospinal fluid (CSF) profiles, including the cytology. RESULTS: The group was composed of 9 males and 2 females. The histological diagnosis of their initial intracranial tumors were 4 primary glioblastoma, 3 anaplastic astrocytoma, 1 anaplastic oligoastrocytoma, 2 ganglioglioma and 1 pleomorphic xanthoastrocyotma with anaplastic features. The mean age of the patients at the time of the initial presentation was 42.8+/-10.3 years. The mean time between surgery and the diagnosis of spinal dissemination was 12.3+/-7.9 (3-28) months. The mean overall survival after dissemination was 2.7+/-1.3 months. All our patients revealed a history of surgical opening of the ventricles. Elevated protein in the CSF was reported for eight patients who had their CSF profiles checked. CONCLUSION: We propose that in the malignant gliomas, the surgical opening of ventricles can cause the spinal leptomeningeal dissemination and the elevated protein content of CSF may be a candidate marker of leptomeningeal dissemination.
Astrocytoma ; Female ; Ganglioglioma ; Glioblastoma ; Glioma ; Humans ; Incidence ; Male ; Retrospective Studies

OBJECTIVE: The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. METHODS: All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. RESULTS: Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%), remained stable in 8 (33.4%), and worsened in 2 (8.3%). CONCLUSION: The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.
Adolescent ; Child ; Congenital Abnormalities ; Conus Snail ; Early Diagnosis ; Follow-Up Studies ; Foot ; Humans ; Leg ; Lipoma ; Lower Extremity ; Meningomyelocele ; Neural Tube Defects ; Neurologic Manifestations ; Retrospective Studies ; Traction ; Urinary Bladder ; Young Adult

The clinicopathological findings in previous studies concerning food protein-induced proctocolitis (FPIPC) are quite diverse in terms of results and conclusions. The aim of this study was to suggest advanced clinicopathological diagnostic criteria that facilitate the early confirmation of FPIPC. Data of 38 FPIPC patients, who had received sigmoidoscopy and biopsy, was analyzed. Microscopic findings were compared with observations of previous studies. Feeding at onset of bleeding was exclusively breast-fed (94.7%) and formula-fed or mixed-fed (5.3%). Endoscopic abnormalities were observed in all patients; nodular hyperplasias with circumscribed and/or central pit-like erosions in 94.7% and erythema in 5.3%. Histopathological findings were; lymphoid aggregates in 94.7%, eosinophils in lamina propria of > or =60 cells/10 HPF in 97.4% and of >20 cells/HPF in 63.2%, epithelial or muscularis mucosa eosinophil infiltration in 97.4%, and crypt abscess in 2.6%. The majority of FPIPC patients are exclusively breast-fed and nodular hyperplasias with erosions may be a disease specific endoscopic finding. Histologic diagnosis of FPIPC is compatible with eosinophils in the lamina propria of > or =60 cells/10 high power fields; however, >20 cells/HPF is not an appropriate diagnostic criterion.
Sensitivity and Specificity ; Reproducibility of Results ; Rectal Diseases/*diagnosis/etiology ; Proctocolitis/*diagnosis/*etiology ; Male ; Infant, Newborn ; Infant ; Humans ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Female ; Dietary Proteins/*adverse effects ; Diagnosis, Differential ; Breast Feeding/*adverse effects

OBJECTIVE: The authors tried to reveal some unique features of lipomeningomyelocele (LMMC), including clinical presentation, factors precipitating onset of symptoms, pathologic entities of LMMC associated with tethered cord syndrome, and surgical outcome in LMMC patients. METHODS: Seventy-five patients with LMMC were enrolled in this study. Neuro-imaging and intraoperative findings allowed classification of LMMC into three Types. The patients were divided into two groups by age : A (51 patients), from birth to 3 years, and B (24 patients), from 3 to 24 years. For prevention of retethering of the cord, a mega-dural sac rebuilding procedure was performed in 15 patients. RESULTS: During a mean postoperative follow-up period of 4 years, the surgical outcome was satisfactory in terms of improved pain and motor weakness, but disappointing with reference to the resolution of bowel and bladder dysfunction. Among these 75 patients with LMMC, preoperative deficits were improved after surgery in 29 (39%), remained stable in 28 (37%), changed slightly in 13 (17%), and worsened in 5 (7%). Patients in group A achieved better outcomes than those in group B. Depending on the type of lesion, patients with types I and II LMMC have better outcomes than those with type III LMMC. Finally, retethering of the cord with neurological deterioration occurred in 4 (5.3%) of the 75 patients, but no retethering was found in the 15 patients who were recently treated with a mega-dural sac rebuilding procedure. CONCLUSION: Our data continue to support the opinion that early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC, since there is a high likelihood of residual neurological functions that can be preserved. Based on our surgical experience of untethering and decompression of lipomas, a mega-dural sac repair is useful to prevent retethering of the cord.
Classification ; Decompression ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lipoma ; Neural Tube Defects* ; Parturition ; Urinary Bladder

OBJECTIVE: This study was conducted in order to investigate the professionalism, job stress and job satisfaction in western and oriental doctors in Korea. METHODS: The authors conducted a survey using a selfadministered questionnaire, conducted between August and September, 2001. The study subjects were 457 western doctors and 161 oriental doctors practicing at local clinics in Daegu City. RESULTS: For the professionalism scale, the score for 'belief in service to the public' of western doctors was significantly higher than that of oriental doctors (p< 0.05) whereas the scores for 'sense of calling to the field' and 'feeling of autonomy' were higher in oriental doctors (p< 0.01). For the job stress scale, the scores for 'work factor', and 'clinical responsibility/decision factor' of western doctors were significantly higher than those of oriental doctors (p< 0.01). Of the western doctors, 59.7% expressed satisfaction with their job as a doctor, 69.5% responded that the role of a doctor was appropriate to their aptitude, and 61.8% answered that they wouldn't consider other kinds of job even if offered. In case of oriental doctors, these responses were83.1%, 82.5%, and 82.3%, espectively. CONCLUSION: The job stress scores of western doctors were higher than those of oriental doctors, but the job satisfaction was lower. The reasons for the above results are not clear. Further studies are required to understand the characteristics of job stress and job satisfaction in doctors.
Aptitude ; Daegu ; Job Satisfaction* ; Korea ; Professionalism

BACKGROUND: Adjuvant chemotherapy is the most accepted treatment for localized osteosarcoma. We studied the effectiveness of preoperative cisplatin and adriamycin combination chemotherapy in non-metastatic osteosarcoma. METHODS: Twenty four cases of patient with osteosarcoma were divided into two groups except four patients treated only conservatively. Group A (14 patients) received chemotherapy before operation and Group B (6 patients) received chemotherapy after operation. The chemotherapy regimen consisted of cisplatin (120 mg/m2 on day 1) and adriamycin (adriamycin 25 mg/m2 on days 2 to 4). RESULTS: The average age of the 20 patients was 27.5 years and the median follow-up duration was 39.3 months. 12 patients of group A were treated with limb-salvage operation and 2 patients with amputation because of tumor growing. According to Kaplan-Meier's plot, one year, three year overall survival rate were 100%, 85% in Group A and 100%, 75% in Group B. Histologic responses were assessed in patients received preoperative chemotherapy. Tumor necrosis over 90% is noted in 9 patients, under 90% necrosis is noted 5 patients. Their mean survival was 82 months and 25 months, respectively (p>0.05). CONCLSUION: Adjuvant chemotherapy with cisplatin and adriamycin was feasible in non-metastatic osteosarcoma and clinically significant adverse effect was neutropenia.
Amputation ; Chemotherapy, Adjuvant ; Cisplatin* ; Doxorubicin* ; Drug Therapy* ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Limb Salvage ; Necrosis ; Neutropenia ; Osteosarcoma* ; Survival Rate

OBJECTIVE: This study was conducted in order to investigate professional job perception, job stress and job satisfaction in doctors. METHOD: The authors conducted a survey using a self-administered questionnaire, conducted between August and September, 2001. The study subjects were 457 doctors practicing at local clinics in Daegu City. RESULTS: For the professionalism scale, the score for 'sense of calling to field' and 'feeling of autonomy' were relatively high. Age, working hours per day, and perception of socioeconomic status significantly influenced the professionalism scale scores (p< 0.01). For the job stress scale, the scores for 'clinical responsibility/ decision' factor were the highest of all the surveyed factors. Working hours per day significantly influenced the job stress scores (p< 0.01). To investigate the overall relationship between the variables, the authors conducted a linear structural equation model analysis. The equation was statistically appropriate and a good fit. The job stress, and the professionalism factors, respectively influenced job satisfaction negatively and positively (T> 2.0). The working hours per day and status perception also influenced their job satisfaction (T> 2.0). CONCLUSION: To promote the job satisfaction of doctors, the development of coping tools and other intervention methods are needed to increase doctor's professional job perception and reduce their job stress. Further studies are required to understand the characteristics of job satisfaction and for its promotion with doctors.
Daegu* ; Job Satisfaction* ; Methods ; Professionalism ; Social Class

We describe a case of brain abscess which developed in a 64-year-old man after hepatic artery chemoem-bolization(HACE) for hepatocellular carcinoma(HCC).On his first admission, percutaneous liver biopsy led to a diagnosis of type-C liver cirrhosis, he readmitted 5 years later and HCC was diagnosed. The patient underwent two HACE procedures, with a two-month interval. Three month later, he was readmitted to hospital with headache and brief loss of consciousness; brain magnetic resonance imaging(MRI) revealed a brain abscess. Stereotactic aspiration was performed and antibiotics sensitive to the klebsiella pneumonia bacteria cultured in the abscess were administrated intraveously. One month later, the abscess size became smaller and the patient was discharged. This report reviews the literature and discusses the pathogenesis of brain abscess after intra-arterial embolization.
Abscess ; Anti-Bacterial Agents ; Bacteria ; Biopsy ; Brain Abscess* ; Brain* ; Carcinoma, Hepatocellular* ; Diagnosis ; Headache ; Hepatic Artery* ; Humans ; Klebsiella ; Liver ; Liver Cirrhosis ; Middle Aged ; Pneumonia ; Unconsciousness

The staged decompression(posterior and anterior) of foramen magnum was performed in the patient with Chiari I malformation associated with basilar invagination. Three years prior to admission, the patient was admitted due to ataxia and dysmetria. After the posterior decompression of foramen magnum, the patient's cerebellar sign improved significantly. But spastic gait disturbace was noted two years later. We performed a transoral anterior decompression to relieve brain stem compression, and an occipitocervical fusion with contoured rod to prevent possible instability. Following the operation, the spasticity improved. The authors believe this sets the successful staged decompression of Chiari I malformation associated with basilar invagination.
Ataxia ; Brain Stem ; Cerebellar Ataxia ; Decompression* ; Foramen Magnum ; Gait Disorders, Neurologic ; Humans ; Muscle Spasticity