Rehabilitation of Advanced Cancer Patients in Palliative Care Unit

OBJECTIVE: To evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit. METHODS: Advanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire. RESULTS: Forty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p < 0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p < 0.05). CONCLUSION: Advanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.

What caused hemolytic anemia and colicky abdominal pain? Lead!

No abstract available.

Association between Seasonal Changes in Vitamin D and Bone Mineral Density / 대한폐경학회지

OBJECTIVES: Vitamin D deficiency, which causes secondary hyperparathyroidism, is considered to be a major contributor to osteoporosis. Because the serum 25-hydroxyvitamin D (25-OHD) level depend on sun exposure and, varies by season, the level of serum 25-OHD in each season at which vitamin D status can lead to changes in bone mineral density (BMD) is not known. METHODS: A total of 2,878 women who underwent periodic health examinations at Ajou University Hospital were included in this study. We measured the serum 25-OHD concentrations using radioimmunoassay and BMDs using dual energy x-ray absorptiometry (DXA). The differences in serum 25-OHD levels among groups as a function of age, season, and BMD were tested by one-way ANOVA. RESULTS: The serum 25-OHD level was not different based on age, but by season, with higher levels in the summer and autumn than in the winter and spring. However, the 25-OHD level did not have a significant relationship with BMD in any season. CONCLUSION: The serum 25-OHD level represents vitamin D status at the time of testing, which is not associated with long-term changes in BMD. When the 25-OHD levels are used to make clinical decisions related to the treatment of osteoporosis, careful interpretation is required.

Association with Left Ventricular Diastolic Function Parameters and Right Brachial-ankle Pulse Wave Velocity in Hemodialysis Patients / 대한신장학회지

PURPOSE: Arterial stiffness is a major independent risk factor for cardiovascular morbidity and mortality in hemodialysis patients. It is hypothesized that arterial stiffness factor is attributable to the structural and functional changes of left ventricle (LV) caused by increased cardiac workload. So we investigated the relationship between brachial-ankle pulse wave velocity (baPWV) and diastolic dysfunction of left ventricle using echoardiographic transmitral blood flow pattern. METHODS: For 96 subjects (48 control patients, 48 hemodialysis patients), baPWV and echocardiographic indices for diastolic function, i.e. transmitral E, A, E/A, DT, IVRT were measured just before hemodialysis session. Role of baPWV was tested in a multiple regression model including age, gender, body mass index, predialysis blood pressure, heart rate, LV mass index and interdialysis weight gain. RESULTS: In the control group, LV mass index (beta=-0.350) and rbaPWV (beta=-0.403) had an independently correlation with E/A ratio. Rt-baPWV was independently correlated with DT (beta=-0.410) and IVRT (beta=0.500). In the hemodialysis group, systolic blood pressure (beta=-0.389) and heart rate (beta=-0.403) were the factors of E/A ratio. Rt-baPWV (beta=-0.557) was the factor determining E/A ratio only in female hemodialysis patients. CONCLUSION: PWV is independently correlated with E/A ratio only in female hemodialysis patients. Their relationship is limited or weak compared to normal control group.

Acute Pulmonary Edema after Cardioversion for Torsade de Pointes:A Case Report / 대한구급학회지

Cardioversion used for the treatment of various cardiac arrhythmias is a safe and effective procedure with infrequent complication. The restoration of sinus rhythm is followed by a improvement in hemodynamics, but acute pulmonary edema has been reported as a rare complication following successful electrical reversion of various tachyarrhythmia to normal sinus rhythm. This report describes a 42-year-old woman with a history of schizophrenia who experienced pulmonary edema after cardioversion for torsade de pointes. She had taken chlorpromazine and haloperidol for schizophrenia. The antipsychotic drugs were suspected to induce QT interval prolongation and resultant torsade de pointes. Two hours after cardioversion, pulmonary edema developed on chest X-ray and chest computed tomography. She responded to conservative treatment including oxygen therapy and the pulmonary edema improved on the second hospital day. The mechanism of pulmonary edema after cardioversion is still uncertain and remains controversial.

Phase II Study of Oxaliplatin, 5-fluorouracil, and Leucovorin in Relapsed or Metastatic Colorectal Cancer as Second Line Therapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of the study was to assess the efficacy and safety of biweekly oxaliplatin in combination with leucovorin (LV)-modulated bolus plus infusion of 5-fluorouracil (5-FU) in patients with relapsed or metastatic colorectal cancer (CRC) as a second line therapy. MATERIALS AND METHODS: Between November 2002 and October 2005, 26 patients with histologically confirmed relapsed or metastatic CRC were enrolled. All patients were previously treated with irinotecan-based combination chemotherapy. The chemotherapy regimen consisted of oxaliplatin 85 mg/m2 on day 1; LV 200 mg/m2 on days 1 and 2; and 5-FU 400 mg/m2 bolus IV with 600 mg/m2 with a 22-hour infusion on days 1 and 2 every 2 weeks. RESULTS: The median age of the 26 patients was 50.5 years (range, 31~72). Their metastatic sites included: the liver (42.3%), peritoneum (26.9%), lung (23.1%) and ovary (7.7%). Twenty five patients were evaluated for their response. Four patients achieved partial responses and 15 patients had stable disease. The overall response rate was 16% (95% confidence interval; 1.7~30.3%). The median follow-up duration for the surviving patients was 7.4 months (range, 2.08~21.2). Median overall survival (OS) and 1-year OS rates were 16.7 months and 63.9%, respectively. The most common hematological toxicities were: NCI grade I/II leucopenia (49.3%), grade I/II neutropenia (41%) and grade I/II anemia (65.2%). The main non-hematological toxicities were: grade I/II peripheral neuropathy (16.1% and 21.5%, respectively) and nausea/ vomiting (23.6%/18.5%). There was no life-threatening toxicity. CONCLUSION: The oxaliplatin, 5-FU and LV combination chemotherapy, scheduled as a biweekly protocol, was effective and well tolerated in the treatment of relapsed or metastatic colorectal cancer patients as second line chemotherapy.

Outcomes of Kidney Transplantation from Spousal Donors: Comparison with Kidney Transplantation from Living-related Donors / 대한신장학회잡지

BACKGROUND: Although transplantation is the best treatment for many people with end-stage renal disease, the gap between the number of organs and the number of potential recipients continues to widen. In addition to living-related individuals, the primary source of donor kidney, the severe organ shortage has led to consideration of genetically unrelated but emotionally related persons as donor candidates. The aim of this study was to compare the results of spousal kidney transplantation with those of living-related kidney transplantation and to analyze the characteristics of spousal kidney transplantation. METHODS: Clinical data were retrospectively analyzed from 21 patients with spousal kidney transplantation and 205 patients with living-related kidney transplantation. Cumulative renal allograft survival was compared between the two groups using Kaplan-Meier curve and log-rank test. Subgroup analysis was done within the patients with spousal kidney transplantation. RESULTS: The patients were significantly older in spousal group (43.7+/-7.8 years) than in living-related group (36.2+/-10.8 years). Donor age was also significantly higher in spousal group (43.0+/-8.4 years) than in living-related group (39.8+/-13.9 years). The number of HLA mismatch was significantly larger in spousal group (3.79+/-1.03) than in living-related group (2.60+/-1.21). The episodes of acute rejection occurring within a year after the transplantation were more frequent in spousal group (5/21) than in living-related group (13/205). Kaplan-Meier curves for cumulative survival of renal allograft revealed no difference between spousal group and living-related group. Renal allograft survival rates in spousal group were 85.2% at 1 year, 75.2% at 5 years, and 67.7% at 10 years after the transplantation. In living-related group, renal allograft survival rates were 96.6% at 1 year, 85.9% at 5 years, and 69.9% at 10 years after the transplantation. Within the patients with spousal kidney transplantation, cumulative renal allograft survival was superior in cases with absent acute rejection, husband-to-wife transplantation, and the number of HLA mismatch less than 5. CONCLUSION: Spousal kidney transplantation shares comparable results with living-related kidney transplantation despite older age, poorer HLA matching and a higher rate of acute rejection. Spousal donor transplants could be a real alternative especially when the donors are husband and the number of HLA mismatch is less than 5.

Tumor Lysis Syndrome in Lymphoblastic Crisis of CML

Tumor lysis syndrome (TLS) defines the metabolic derangements that occur with tumor breakdown following the initiation of cytotoxic therapy. TLS results from the rapid destruction of malignant cells and the abrupt release of intracellular materials and their metabolites into the extracellular space. The syndrome causes hyperuricemia, hyperkalemia, hyperphosphatemia, secondary hypocalcemia and uremia. It can result in acute renal failure and be fatal. Early recognition of patient at risk and preventive measures are important. There is a high incidence of TLS in tumors with high proliferative rates and large burden such as acute lymphoblastic leukemia and Burkitt's lymphoma. It less commonly occurs in solid tumors such as testicular cancer, breast cancer and small cell lung cancer. There are only a few reports on TLS complicated in CML in blast crisis. So we report a 45-yr-old woman presenting with TLS associated with CML in lymphoblastic crisis after the initiation of cytotoxic chemotherapy.

A Case of Steroid Refractory Acute GVHD Treated with IL-2 & TNF-alpha Blocker in a Myelodysplastic Syndrome Patient who Underwent Unrelated Allogeneic Stem Cell Transplantation

Hematopoietic stem cell transplantation has evolved as a central treatment modality for the management of various hematologic malignancies. Despite adequate posttransplantation immunosuppressive therapy, acute GVHD remains a major cause of morbidity and mortality, even for the patients who have received HLA identical sibling grafts. Once established, acute GVHD is difficult to treat, and the best primary treatments such as corticosteroid have shown responses of approximately 50%. Once GVHD becomes steroid-refractory, the chances of survival are slim at best, and the possibility of long-term complications from chronic GVHD is almost always the rule. Many agents are currently being evaluated to treat this malady, including ATG, monoclonal antibodies, pentostatin, denileukin diftitox, etc. We reported here on a case of steroid refractory acute GVHD that was treated with IL-2 and TNF-alpha blocker in myelodysplastic syndrome patient who underwent unrelated allogeneic stem cell transplantation.

Changes in Heart Rate Variability after Weight Reduction in the Obese

BACKGROUND: Obesity increases morbidities and mortalities due to cardiovascular diseases. In previous studies, decrease in heart rate variability was associated with cardiovascular death and reduced heart rate variability in the obese had been reported. The authors investigated immediate changes in the heart rate variability after weight reduction in obese individuals. METHODS: The subjects for this study were 39 Korean adults (35 female, 4 male), who visited obesity clinic in a university hospital from January 2002 to July 2003. At first visit, weight, height, body mass index (BMI) and waist circumference of the subjects were measured. We also measured parameters of heart rate variability: Mean Heart Rate (MHR), Standard Deviation of N-N interval (SDNN), The Square Root of the Mean Squared Difference of successive NN intervals (RMSSD), Total Power (TP), Low Frequency (LF), High Frequency (HF), and LF/HF ratio. Weight reduction protocol included nutritional counseling, exercise, behavioral modification and anti-obesity medications, if needed. RESULTS: At 12 weeks of intervention, weight, BMI, waist circumference, fat mass, and lean body mass significantly decreased (3.90+/-3.11 kg, -1.50+/-1.21 kg/m2, -4.45+/-5.61 cm, -3.03+/-2.45 kg, -1.32+/-1.16 kg, P <0.01, respectively). MHR (-6.17+/-9.65 bpm, P <0.01) and LF/ HF (-0.61+/-1.56, P <0.05) showed significant reduction. Changes of weight and LF were positively correlated (r=0.338, P <0.01). Changes of waist circumference was correlated with changes of SDNN (r= 0.331, P <0.05). Changes of BMI showed positive correlation with changes in TP (r=0.327, P <0.05) and LF (r=0.345, P <0.05). CONCLUSION: Short term intervention for obese people decreased sympathetic nervous activity.