• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.275-278
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• 2017

Small cell lung carcinoma (SCLC) is a cancer that shows aggressive behavior, early spread to distant sites, and frequent association with distinct paraneoplastic syndromes. Spontaneous remission of cancer, particularly of SCLC, is a rare biological event. Cases involving spontaneous regression of SCLC were reported, and were associated with paraneoplastic syndromes of the nervous system. This article reports on a 78-year-old man with SCLC in remission, with neurological symptoms. The patient visited the hospital because of generalized weakness, and imaging studies revealed a mass in the lower lobe of the left lung, pathological evaluation showed SCLC. The patient refused oncologic treatment and was treated only with conservative care. In follow-up study the diameter of the mass had decreased from initial 32 mm, 9 months after admission to 20 mm, 17 months after admission to 13 mm. The patient kept complaining of generalized weakness, dizziness, and paresthesia of limbs. We assumed that, in this case, the spontaneous remission of lung cancer was related to the immunologic response directed against the tumor, which is believed to be an important factor in the pathogenesis of paraneoplastic neurologic syndromes.

• Journal of Chest Surgery
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• 제19권4호
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• pp.736-743
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• 1986

Thymus gland is a kind of endocrine organ which secretes thymosin and thymoprotein. There can be developed variable lesions like thymoma, thymic hyperplasia, thymic cyst, thymolipoma, and carcinoid tumor of the thymus gland. We have experienced 25 patients of thymic disease: thymoma 12, thymic hyperplasia 11, thymic cyst 1, carcinoid tumor 1. The age distribution were ranged from 3 to 66 years and the sex ratio was 1:1.8 [male to female]. Thymectomy was performed in all cases, but 3 cases with deep infiltration to the adjacent structures were not resectable completely. Malignancy [all thymoma] were 5 and the rest were benign. Two cases were died of recurrence after tumor resection. Myasthenia gravis occurred in 10 cases. Among them, 2 were thymoma and 8 were thymic hyperplasia. We could obtained the result that thymectomized cases reached 2 remission and 5 improvement. Myasthenia gravis treated medically [18 cases] had no remission and only 2 clinical improvement. In the light of these results, early radical thymectomy would be most favorable treatment in not only thymic tumor, but generalized myasthenia gravis.

• Journal of Chest Surgery
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• 제18권4호
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• pp.859-866
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• 1985

The characteristic features of myasthenia gravis, which are weakness of voluntary muscle and easy fatigability, result from defective neuromuscular transmission caused by an autoimmune response to acetylcholine receptor. Recently, we performed two cases of thymectomy for the treatment of myasthenia gravis, one was 50 year old man who had malignant thymoma and the other was 19 year old girl who had benign thymic hyperplasia. The former had long duration of symptoms, and showed poor postoperative result. The latter had short duration of symptoms, and showed complete remission. Herewith, we suggest that early thymectomy can give the clinical assets for myasthenia gravis. So we report these two experiences with review of literatures.

• Clinical and Experimental Pediatrics
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• 제54권4호
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• pp.179-182
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• 2011

Transient neonatal diabetes mellitus (TNDM) is a rare form of diabetes mellitus that presents within the first 6 months of life with remission in infancy or early childhood. TNDM is mainly caused by anomalies in the imprinted region on chromosome 6q24; however, recently, mutations in the ABCC8 gene, which encodes sulfonylurea receptor 1 (SUR1), have also been implicated in TNDM. Herein, we present the case of a male child with TNDM whose mutational analysis revealed a heterozygous c.3547C>T substitution in the ABCC8 gene, leading to an Arg1183Trp mutation in the SUR1 protein. The parents were clinically unaffected and did not show a mutation in the ABCC8 gene. This is the first case of a de novo ABCC8 gene mutation in a Korean patient with TNDM. The patient was initially treated with insulin and successfully switched to sulfonylurea therapy at 14 months of age. Remission of diabetes had occurred at the age of 16 months. Currently, the patient is 21 months old and is euglycemic without any insulin or oral hypoglycemic agents. His growth and physical development are normal, and there are no delays in achieving neurological and developmental milestones.

• Clinical and Experimental Pediatrics
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• 제54권3호
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• pp.95-105
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• 2011

Since the successful introduction of all-trans-retinoic acid (ATRA) and its combination with anthracycline-containing chemotherapy, the prognosis for acute promyelocytic leukemia (APL) has markedly improved. With ATRA and anthracycline-based-chemotherapy, the complete remission rate is greater than 90%, and the long-term survival rate is 70-89%. Moreover, arsenic trioxide (ATO), which was introduced for APL treatment in 1994, resulted in excellent remission rates in relapsed patients with APL, and more recently, several clinical studies have been designed to explore its role in initial therapy either alone or in combination with ATRA. APL is a rare disease in children and is frequently associated with hyperleukocytosis, which is a marker for higher risk of relapse and an increased incidence of microgranular morphology. The frequency of occurrence of the promyelocytic leu-kemia/retinoic acid receptor-alpha (PML/$RAR{\alpha}$) isoforms bcr 2 and bcr 3 is higher in children than in adults. Although recent clinical studies have reported comparable long-term survival rates in patients with APL, therapy for APL in children is challenging because of the risk of early death and the potential long-term cardiac toxicity resulting from the need to use high doses of anthracyclines. Additional prospective, randomized, large clinical trials are needed to address several issues in pediatric APL and to possibly minimize or eliminate the need for chemotherapy by combining ATRA and ATO. In this review article, we discuss the molecular pathogenesis, diagnostic progress, and most recent therapeutic advances in the treatment of children with APL.

• Radiation Oncology Journal
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• 제10권2호
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• pp.255-259
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• 1992

성인의 급성 백혈병 환자 64예를 1990년 1월부터 1991년 10월 사이에 충남대학교 병원에서 치료하였다. 극심한 백혈구 증다증이 동반된 20예를 선별하여 네가지 각기 다른 방법으로 치료하였으며 이 치료양상에 따른 급성 사망율과 완해율에 관하여 조사하여 보았다. 응급 두개부 방사선 조사 단독 또는 항암제 약물요법을 병행한 경우에 있어서 단지 보조적 요법만을 시행한 경우나 항암제 약물요법만을 시행한 경우에 비하여 초기 급성 사망율이 낮았다. 또 완해율에 있어서도 응급 두개부 방사선 조사 및 항암제 약물요법을 병행한 경우에 높았다. 따라서 우리는 성인의 급성 백혈병에서 극심한 백혈구 증다증이 동반된 경우 조기 두개부 방사선 조사가 초기 급성 사망율을 낮추고 후에 완해율을 높이는 데에도 효과가 있을 것이라고 추정해보았다.

• Clinical and Experimental Pediatrics
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• 제53권9호
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• pp.830-833
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• 2010

Crohn's disease is characterized by chronic inflammation involving any portion of the gastrointestinal tract. Treating Crohn's disease is a major challenge for clinicians, as no curative therapy currently exists. Pediatric Crohn's disease is characterized by frequent relapses, a wide extent of disease, a high prevalence of extraintestinal manifestations, and a severe clinical course. The classic therapeutic approach is known as the 'step-up' strategy, and follows a progressive course of treatment intensification as disease severity increases. Although this approach is usually effective for symptom control, many patients become either resistant to or dependent on corticosteroids. The efficacy of infliximab suggests that, rather than a progressive course of treatment, early intense induction may reduce complications associated with conventional treatment and improve quality of life. Intensive early therapy with infliximab is known as the 'top-down' strategy. Such therapy offers the potential for altering the natural history of Crohn's disease, and is changing treatment paradigms. However, the relatively new concept of an early aggressive or 'top-down' treatment approach is not yet widely accepted, especially in pediatric patients. The results of our current study demonstrate that early and intensive treatment of pediatric Crohn's disease patients with infliximab, at initial diagnosis, was more effective for maintaining remission and reducing flares.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.754-762
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• 2000

Objectives : The surgical results of 80 patients with growth hormone(GH)-producing pituitary adenoma were analyzed retrospectively to evaluate the clinical manifestations and to determine which preoperative factors significantly influenced the surgical outcome. Patients and Methods : The patients consisted of 39 men and 41 women and the age of patients at the time of initial operation ranged from 17 to 67 years(mean age, 40.5 years) Between January 1990 and June 1996, 77 patients underwent transsphenoidal surgery and 3 patients underwent craniotomy for GH-producing pituitary adenoma at our institution. Preoperative administration of octreotide was performed in 18 patients. Surgical control was defined as a postoperative serum basal level of GH less than 5ng/ml. A logistic regression model was used for univariate and multivariate analysis. Probability value of less than 0.05 was considered as statistically significant. Results : The most common presenting symptom was acromegaly, followed by headache, visual disturbance, and fatigability. Visual symptoms were present in 39% of the patients. Diabetes mellitus was associated in 24 patients and hypertension in 12. Preoperative mean basal level of GH was 93.2ng/ml(range 72-500ng/ml) which was closely related with tumor size(p<0.05). Grade II by Hardy's classification was the most common radiological type. Preoperative octreotide treatment significantly reduced the level of GH(p<0.05), but not enough to induce endocrinological remission. One patient died of cerebral infarction after craniotomy. The most common surgical complication was transient diabetes insipidus. The symptom of the earliest improvement after surgery was paresthesia and tightness of the hand and foot, followed by headache and easy fatigability. The preoperative visual symptom was improved in all patients. The patients who had hypertension or DM experienced alleviated symptoms in 67% and 92%, respectively. The overall rate of endocrinological remission was 44%. By multivariate logistic regression analysis, the size of tumor, extrasellar extension, and extent of removal were significant prognostic factors for endocrinologial remission. Conclusion : Early detection of a small tumor without extrasellar extension followed by a complete resection is highly recommended in order to achieve endocrinological cure of GH-producing pituitary adenomas.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.7-18
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• 2021

Purpose: The long-term efficacy and safety of infliximab (IFX) in children with ulcerative colitis (UC) have not been well-evaluated. Here, we reviewed the long-term durability and safety of IFX in our single center pediatric cohort with UC. Methods: This retrospective study included 20 children with UC who were administered IFX. Results: For induction, 5 mg/kg IFX was administered at weeks 0, 2, and 6, followed by every 8 weeks for maintenance. The dose and interval of IFX were adjusted depending on clinical decisions. Corticosteroid (CS)-free remission without dose escalation (DE) occurred in 30% and 25% of patients at weeks 30 and 54, respectively. Patients who achieved CS-free remission without DE at week 30 sustained long-term IFX treatment without colectomy. However, one-third of the patients discontinued IFX treatment because of a primary nonresponse, and one-third experienced secondary loss of response (sLOR). IFX durability was higher in patients administered IFX plus azathioprine for >6 months. Four of five patients with very early onset UC had a primary nonresponse. Infusion reactions (IRs) occurred in 10 patients, resulting in discontinuation of IFX in four of these patients. No severe opportunistic infections occurred, except in one patient who developed acute focal bacterial nephritis. Three patients developed psoriasis-like lesions. Conclusion: IFX is relatively safe and effective for children with UC. Clinical remission at week 30 was associated with long-term durability of colectomy-free IFX treatment. However, approximately two-thirds of the patients were unable to continue IFX therapy because of primary nonresponse, sLOR, IRs, and other side effects.

• 대한두경부종양학회지
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• 제29권2호
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• pp.58-61
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• 2013

Early glottic cancer can be effectively treated with surgery or radiotherapy showing the comparable treatment results. Since radiation therapy may be better in terms of voice preservation, it tends to be preferred in early glottic cancer. Most common recurrence site is glottis after radiation therapy and complete remission of glottic primary site followed by local recurrence limited to neck is very rare. The authors are reporting a patient with regional recurrence of central neck lymph nodes after radiation therapy for T1a glottic cancer.