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1.
Article in English | WPRIM | ID: wpr-129686

ABSTRACT

Although thrombotic thrombocytopenic purpura (TTP) is a rare disease, when it develops in a post-cardiac surgery patient, it may have a fatal outcome. Since the frequency of early-onset thrombocytopenia in post-cardiac surgery patients is high, platelet concentrates are commonly transfused during postoperative management. However, when TTP is the likely diagnosis, platelet transfusion is not recommended. We experienced a postoperative TTP in a cardiac surgery patient and discovered the importance of identifying the etiology of postoperative thrombocytopenia. Here, we report the case with a brief review of the literature.


Subject(s)
Humans , Blood Platelets , Fatal Outcome , Platelet Transfusion , Purpura, Thrombotic Thrombocytopenic , Rare Diseases , Thoracic Surgery , Thrombocytopenia , Thymine Nucleotides
2.
Article in English | WPRIM | ID: wpr-129671

ABSTRACT

Although thrombotic thrombocytopenic purpura (TTP) is a rare disease, when it develops in a post-cardiac surgery patient, it may have a fatal outcome. Since the frequency of early-onset thrombocytopenia in post-cardiac surgery patients is high, platelet concentrates are commonly transfused during postoperative management. However, when TTP is the likely diagnosis, platelet transfusion is not recommended. We experienced a postoperative TTP in a cardiac surgery patient and discovered the importance of identifying the etiology of postoperative thrombocytopenia. Here, we report the case with a brief review of the literature.


Subject(s)
Humans , Blood Platelets , Fatal Outcome , Platelet Transfusion , Purpura, Thrombotic Thrombocytopenic , Rare Diseases , Thoracic Surgery , Thrombocytopenia , Thymine Nucleotides
3.
Article in English | WPRIM | ID: wpr-114749

ABSTRACT

PURPOSE: To determine the quantitative parameters of breast MRI that predict tumor invasion in biopsy-proven DCIS. MATERIALS AND METHODS: From January 2009 to March 2010, 42 MRI examinations of 41 patients with biopsy-proven DCIS were included. The quantitative parameters, which include the initial percentage enhancement (E1), peak percentage enhancement (E(peak)), time to peak enhancement (TTP), signal enhancement ratio (SER), arterial enhancement fraction (AEF), apparent diffusion coefficient (ADC) value, long diameter and the volume of the lesion, were calculated as parameters that might predict invasion. Univariate and multivariate analyses were used to identify the parameters associated with invasion. RESULTS: Out of 42 lesions, 23 lesions were confirmed to be invasive ductal carcinoma (IDC) and 19 lesions were confirmed to be pure DCIS. Tumor size (p = 0.003; 6.5 +/- 3.2 cm vs. 3.6 +/- 2.6 cm, respectively) and SER (p = 0.036; 1.1 +/- 0.3 vs. 0.9 +/- 0.3, respectively) showed statistically significant high in IDC. In contrast, E1, Epeak, TTP, ADC, AEF and volume of the lesion were not statistically significant. Tumor size and SER had statistically significant associations with invasion, with an odds ratio of 1.04 and 22.93, respectively. CONCLUSION: Of quantitative parameters analyzed, SER and the long diameter of the lesion could be specific parameter for predicting invasion in the biopsy-proven DCIS.


Subject(s)
Humans , Breast , Carcinoma in Situ , Carcinoma, Ductal , Carcinoma, Intraductal, Noninfiltrating , Diffusion , Lymphokines , Magnetic Resonance Imaging , Multivariate Analysis , Odds Ratio , Thymine Nucleotides
4.
Korean Journal of Medicine ; : 303-307, 2013.
Article in Korean | WPRIM | ID: wpr-34182

ABSTRACT

Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome (TTP-HUS) is an acute condition with abnormalities of multiple organ systems. It is characterized by microangiopathic hemolytic anemia and thrombocytopenia. Several chemotherapeutic agents have been implicated in causing TTP-HUS. We report a case of TTP-HUS during treatment with sunitinib in a patient with metastatic renal cell carcinoma. A 53-year-old woman visited our hospital for fever and cough. She was diagnosed with sunitinib-induced TTP. Discontinuation of sunitinib and plasmapheresis improved her TTP. When she experienced disease progression after a prolonged period without treatment, sorafenib was tried, resulting in a partial response without recurrence of TTP-HUS.


Subject(s)
Female , Humans , Anemia, Hemolytic , Carcinoma, Renal Cell , Cough , Disease Progression , Fever , Hemolytic-Uremic Syndrome , Indoles , Niacinamide , Phenylurea Compounds , Plasmapheresis , Purpura, Thrombotic Thrombocytopenic , Pyrroles , Recurrence , Thrombocytopenia , Thymine Nucleotides
5.
Article in Korean | WPRIM | ID: wpr-76694

ABSTRACT

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are related diseases with high rates of fatality. Plasma exchange therapy improves survival rates in patients with TTP and HUS. The aim of this study is to evaluate our experience in conduct of plasma exchange procedures for treatment of patients with TTP-HUS over the past nine years, and to identify risk factors for poor response to this treatment. METHODS: Between January 2003 and August 2011, 230 plasma exchange procedures were performed for treatment of 22 TTP-HUS patients at Pusan National University Hospital. We conducted a retrospective analysis of data from clinical records and plasma exchange records for these patients. RESULTS: Fourteen female patients and eight male patients were included in the study. The majority of patients (86%) had neurologic symptoms; and 41% of patients had a fever. Eight patients presented with an additional disorder; three patients presented with Systemic Lupus Erythematosus. The mean number of plasma exchange procedures was 10.5 per patient. The overall rate of mortality following plasma exchange therapy was 27% and relapse was observed in only one patient. Rate of mortality varied with different comorbid diseases. Female patients and patients who underwent fewer plasma exchange procedures tended to be unresponsive to plasma exchange therapy, but the results are not statistically significant. Aggressive treatment involving two plasma exchange procedures within 24 hours of diagnosis and choice of any replacement fluid did not show an association with improved mortality. CONCLUSION: No association of the factors analyzed with mortality rate and responsiveness to plasma exchange was observed.


Subject(s)
Female , Humans , Male , Fever , Hemolytic-Uremic Syndrome , Lupus Erythematosus, Systemic , Plasma , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic , Recurrence , Retrospective Studies , Risk Factors , Survival Rate , Thymine Nucleotides
6.
Article in Korean | WPRIM | ID: wpr-186827

ABSTRACT

PURPOSE: To report a case of bilateral central retinal vein occlusion (CRVO) as one of the initial signs of disseminated intravascular coagulation (DIC). CASE SUMMARY: A 33-year-old woman with a history of pregnancy-induced thrombotic thrombocytopenic purpura presented to our hospital with bilateral visual loss. On her initial visit, visual acuity was counting fingers at 30 cm in both eyes. Based on the findings of a funduscopic examination, the patient was diagnosed with bilateral CRVO. Laboratory tests confirmed the diagnosis of DIC combined with thrombotic thrombocytopenic purpura (TTP). Plasma exchange and transfusion of cryoprecipitate with fresh frozen plasma was performed. The ocular fundus findings did not improve. Despite medical treatment, the patient's systemic condition deteriorated and she died of metabolic acidosis two weeks later. CONCLUSIONS: Bilateral central retinal vein occlusion occurred as a sign of aggravation of preexisting TTP and progression to DIC in the presented case. In patients with severe bilateral retinal venous changes, there should be a very high level of suspicion for presence or progression of systemic disease, with the possibility of effective early systemic evaluation and therapy.


Subject(s)
Adult , Female , Humans , Acidosis , Dacarbazine , Disseminated Intravascular Coagulation , Eye , Fingers , Plasma , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic , Retinal Vein , Retinaldehyde , Thymine Nucleotides , Visual Acuity
7.
Article in English | WPRIM | ID: wpr-34648

ABSTRACT

PURPOSE: The aims of this study are to find out whether the sequence of chemotherapeutic regimens including second- and third-line taxane and irinotecan influences the survival of patients with unresectable gastric carcinoma and to identify clinical characteristics of patients with improved response. MATERIALS AND METHODS: Fifty gastric carcinoma patients who were treated by third-line sequential chemotherapy between November 2004 and July 2010 were enrolled in this study. Their overall survival (OS) and time to progression (TTP) were set up as primary and secondary end points. For the sequence of chemotherapy regimen, two arms were used. Arm A was defined as 5-fluorouracil (5-FU)+cisplatin (FP) or folinic acid, 5-FU and oxaliplati (FOLFOX), followed by folinic acid, 5-FU and irinotecan (FOLFIRI), and paclitaxel or docetaxel plus 5-FU, with or without epirubicin. Arm B was defined as FP or FOLFOX, followed by paclitaxel or docetaxel plus 5-FU, and FOLFIRI. RESULTS: The median OS of all patients was 16.0 months (95% confidence interval, 13.6 to 18.3 months), which is longer than historical control of patients who did not receive third-line chemotherapy. The sequence of second and third-line regimen, including irinotecan and taxane, did not present significant difference in OS or TTP after failure of 5-FU with platinum chemotherapy. In survival analysis of patients' clinicopathologic characteristics, poor prognosis was shown in patients with poorly differentiated histologic features, elevated serum carcinoembryonic level, and shorter TTP of first line chemotherapy. CONCLUSION: It is possible for patients to respond differently to chemotherapy due to differences in clinical features and underlying gene expression profiles. Development of individualized chemotherapy regimens based on gene expression profiles is warranted.


Subject(s)
Humans , Arm , Bridged-Ring Compounds , Camptothecin , Epirubicin , Fluorouracil , Leucovorin , Organoplatinum Compounds , Paclitaxel , Platinum , Prognosis , Salvage Therapy , Stomach Neoplasms , Taxoids , Thymine Nucleotides , Transcriptome
8.
Article in English | WPRIM | ID: wpr-720121

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) is a critical complication of treatment with mitomycin C. We retrospectively describe the case of a patient with progressive renal cell carcinoma and mitomycin-induced TTP refractory to plasma exchange and glucocorticoids; we describe the clinical course, successful management of TTP with rituximab, and follow-up of this case. Mitomycin-induced TTP resolved completely by a total of 4 infusions of rituximab 375 mg/m2 on a weekly basis, and it took up to 12 months to obtain a platelet count of >100,000/microL. Rituximab is indicated for the treatment of mitomycin-induced TTP refractory to plasma exchange and glucocorticoids, and it could improve the patient's quality of life despite the presence of underlying malignancy.


Subject(s)
Humans , Antibodies, Monoclonal, Murine-Derived , Carcinoma, Renal Cell , Follow-Up Studies , Glucocorticoids , Mitomycin , Plasma Exchange , Platelet Count , Purpura, Thrombotic Thrombocytopenic , Quality of Life , Retrospective Studies , Thymine Nucleotides , Rituximab
9.
Article in English | WPRIM | ID: wpr-155211

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy characterized by endothelial cell damage, resulting in microangiopathic hemolytic anemia, thrombocytopenia, and various degrees of neurological and renal impairment caused by microvascular thrombi. It is rare in children and frequently follows a fatal course. TTP is divided into 2 types: one is inherited and associated with ADAMTS-13 gene mutations and the other is acquired and associated with anti-ADAMTS-13 autoantibodies. The measurement of ADAMTS-13 activity in plasma, identification of ADAMTS-13 circulating inhibitor, anti-ADAMTS-13 IgG, and ADAMTS-13 gene sequencing are crucial to the diagnosis of TTP. Plasma exchanges are the first-line treatment for acquired TTP, combined with steroids and immunosuppressive drugs. Here, we describe the case of an adolescent patient with TTP, confirmed by decreased level of ADAMTS-13 activity and an increased level of ADAMTS-13 inhibitor, who was successfully treated by plasma exchanges.


Subject(s)
Adolescent , Child , Humans , Anemia, Hemolytic , Autoantibodies , Endothelial Cells , Immunoglobulin G , Plasma , Plasma Exchange , Purpura , Purpura, Thrombotic Thrombocytopenic , Steroids , Thrombocytopenia , Thrombotic Microangiopathies , Thymine Nucleotides
10.
Article in English | WPRIM | ID: wpr-33279

ABSTRACT

PURPOSE: Systemic chemotherapy is the only option for patients with unresectable/metastatic hepatocellular carcinoma (HCC) who are not candidates for local/regional treatment. However, the response to such treatment and survival are poor, especially in hepatitis B virus (HBV) endemic areas. The aim of this study was to determine the efficacy of cisplatin-based combination chemotherapy and identify a subgroup of advanced HCC patients with favorable responses. MATERIALS AND METHODS: The medical records of all consecutive patients with unresectable/metastatic HCC who received cisplatin-based combination chemotherapy between January 2003 and October 2009 were reviewed. Time to progression (TTP) and overall survival (OS) were determined using Kaplan-Meier analysis. Univariate and multivariate analyses were performed to identify prognostic factors for TTP and OS. RESULTS: Data for 46 patients were analyzed. First-line chemotherapies consisted of cisplatin-based combination treatment with doxorubicin, fluoropyrimidines and gemcitabine. The response rate for all patients was 4.3%. The median TTP and OS were 1.8 (95%confidence interval [CI], 1.1 to 2.5) and 7.2 (95% CI, 3.0 to 11.5) months, respectively. Eastern Cooperative Oncology Group (ECOG) performance status (PS), Child classification, Cancer of the Liver Italian Program (CLIP) score and portal vein thrombosis (PVT) were identified by univariate analyses as prognostic factors for TTP and OS. ECOG PS (hazard ratio [HR], 4.51; 95% CI, 1.61 to 12.6; p=0.004) and PVT (HR, 2.12; 95% CI, 1.10 to 4.11; p=0.026) were independent prognostic factors for TTP. CONCLUSION: Cisplatin-based combination chemotherapy in patients with advanced HCC has a low response rate and short TTP regardless of the chemotherapy regimen used. Patients with a good ECOG PS and without PVT can be considered candidates for cisplatin-based combination chemotherapy.


Subject(s)
Child , Humans , Carcinoma, Hepatocellular , Deoxycytidine , Doxorubicin , Drug Therapy, Combination , Hepatitis B virus , Kaplan-Meier Estimate , Liver Neoplasms , Medical Records , Multivariate Analysis , Niacinamide , Phenylurea Compounds , Platinum , Portal Vein , Prognosis , Thrombosis , Thymine Nucleotides
11.
Article in Korean | WPRIM | ID: wpr-93622

ABSTRACT

We report on three patients with transient focal neurologic deficits that completely resolved. In all cases, initial perfusion-weighted imaging (PWI) performed 1 hour after being free of symptoms showed a defect in the time-to-peak (TTP) map in the area with normal diffusion-weight imaging (DWI) findings. After 24 hours, DWI showed a high signal intensity in exactly the same area as the TTP defect. Therefore, early PWI provides a rapid evaluation of cerebral hemodynamics in transient ischemic attack.


Subject(s)
Humans , Hemodynamics , Ischemic Attack, Transient , Magnetic Resonance Angiography , Neurologic Manifestations , Perfusion , Thymine Nucleotides
12.
Protein & Cell ; (12): 284-290, 2010.
Article in English | WPRIM | ID: wpr-757727

ABSTRACT

Current in vitro assays for the activity of HIV-RT (reverse transcriptase) require radio-labeled or chemically modified nucleotides to detect reaction products. However, these assays are inherently end-point measurements and labor intensive. Here we describe a novel non-radioactive assay based on the principle of pyrosequencing coupled-enzyme system to monitor the activity of HIV-RT by indirectly measuring the release of pyrophosphate (PP(i)), which is generated during nascent strand synthesis. The results show that our assay could monitor HIV-RT activity with high sensitivity and is suitable for rapid high-throughput drug screening targeting anti-HIV therapies due to its high speed and convenience. Moreover, this assay can be used to measure primase activity in an easy and sensitive manner, which suggests that this novel approach could be wildly used to analyze the activity of PP(i)-generated and ATP-free enzyme reactions.


Subject(s)
Humans , Anti-HIV Agents , Pharmacology , Colorimetry , Diphosphates , Metabolism , Drug Evaluation, Preclinical , HIV , HIV Reverse Transcriptase , Metabolism , In Vitro Techniques , Nevirapine , Pharmacology , Reverse Transcriptase Inhibitors , Pharmacology , Sequence Analysis, DNA , Thymine Nucleotides , Metabolism
13.
Article in Korean | WPRIM | ID: wpr-187836

ABSTRACT

Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that's characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia,and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.


Subject(s)
Humans , Arthritis, Rheumatoid , Early Diagnosis , Korea , Neurologic Manifestations , Plasma , Plasma Exchange , Purpura, Thrombocytopenic , Purpura, Thrombotic Thrombocytopenic , Thrombocytopenia , Thymine Nucleotides , Trimethoprim, Sulfamethoxazole Drug Combination
14.
Article in Korean | WPRIM | ID: wpr-720085

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) is a rare medical condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic manifestations, and infrequently, renal involvement. In many cases, TTP is associated with deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, and treatment with plasma exchange is effective in the majority of patients. We report a patient with acute TTP in whom remission was not achieved by initial treatment consisting of plasma exchange and corticosteroids. In view of the severe autoantibody-mediated ADAMTS-13 deficiency, treatment was initiated with rituximab, a chimeric monoclonal antibody directed against the CD 20 antigen present on B lymphocytes. The patient received 4 weekly infusions of rituximab (375 mg/m2). Four weeks after the last infusion of rituximab, a complete clinical and laboratory remission was documented. We conclude that rituximab should be considered in patients with TTP with acquired ADAMTS-13 deficiency, who fail to respond to standard treatment with plasma exchange and corticosteroids. Rituximab may result in a lowered requirement for plasmapheresis and avoid the complications of salvage immunosuppressive therapy.


Subject(s)
Humans , Adrenal Cortex Hormones , Anemia, Hemolytic , Antibodies, Monoclonal, Murine-Derived , B-Lymphocytes , Neurologic Manifestations , Plasma Exchange , Plasmapheresis , Purpura , Purpura, Thrombotic Thrombocytopenic , Thrombocytopenia , Thymine Nucleotides , Rituximab
15.
Article in Korean | WPRIM | ID: wpr-229129

ABSTRACT

The introduction of plasma exchange has significantly improved the outcome of thrombotic thrombocytopenic purpura (TTP) and the survival rate was increased from 10 to 80-90%. TTP refractory to plasma exchange therapy, however, is still a therapeutic challenge. We describe here a patient who partially responded to plasma exchange therapy, but remained dependent on plasma infusions. To discontinue plasma therapy, several attempts using agents such as rituximab, vincristine, and cyclosporine A had been tried, but all failed. After splenectomy, serum LDH and blood platelet count were normalized. Plasmapheresis were we able to discontinue after 2 weeks of splenectomy. Steroid and cyclosporine were tapered off after 3 months and 5 months after splenectomy respectively, and the patient has been staying in remission ever since. We suggest that splenectomy is a worthwhile treatment option in patients with refractory TTP.


Subject(s)
Humans , Antibodies, Monoclonal, Murine-Derived , Cyclosporine , Plasma , Plasma Exchange , Plasmapheresis , Platelet Count , Purpura, Thrombotic Thrombocytopenic , Splenectomy , Survival Rate , Thymine Nucleotides , Vincristine , Rituximab
16.
Article in Korean | WPRIM | ID: wpr-167355

ABSTRACT

BACKGROUND: Recent studies show that the time to positivity (TTP) of peripheral blood culture is a useful marker for some clinical characteristics such as the source of infection and the clinical outcome in bacteremia caused by some virulent bacteria, since TTP has relationship with bacterial blood concentration. One recent study of candidemia also reported the usefulness of TTP in the differentiation between central venous catheter (CVC)-related candidemia and non-CVC-related candidemia. OBJECTIVE: We investigasted the clinical usefulness of TTP in the patients with candidemia. METHODS: Fifty-four admitted patients with candidemia were detected between March 2006 and July 2008. After the exclusion, we reviwed the medical records of 45 patients and investigasted the relationship of clinical characteristics of candidemia with TTP, which was recorded by the BACTEC 9240 system. RESULTS: Most episodes of candidemia developed in non-neutropenic patients, except 4 episodes. Majority of the patients with candidemia had the history of previous antibiotic use (88.6%) and CVCs (62.2%). CVC-related candidemia was observed in more thant a half (24/45, 53.3%) of the patients. However, only in 10 (41.7%) of them, CVCs were removed early. The persistence of candidemia (> or = 3 days) and the fatal outcome (within 30 days) were observed in 14 (31.3%) and 17 (37.8%) patients, respectively. TTP was shorter in CVC-related candidemia (31.3+/-13.2 hours) than that in non-CVCrelated candidemia (52.1+/-37.8 hours) (p=0.032). The patients with the persistence of candidemia had shorter TTP (28.9+/-11.2 hours) than those without the persistence (45.7+/-28.6) (p=0.012). The value of TTP cutoff predicting the CVC-related candidemia and the persistence of candidemia was 38 hours (area under the receiver-operator characteristic curve of 0.70 and 0.75, respectively). CONCLUSION: TTP may be helpful for the differentiation of the source of candidemia and the prediction of the persistence of candidemia in the patients without neutropenia. The early removal of CVC may prevent the persistence of candidemia in non-neutropenic patients with candidemia of short TTP (< or = 38 hours).


Subject(s)
Humans , Bacteremia , Bacteria , Candida , Candidemia , Central Venous Catheters , Fatal Outcome , Medical Records , Neutropenia , Thymine Nucleotides
17.
Article in Korean | WPRIM | ID: wpr-169225

ABSTRACT

PURPOSE: To assess the diagnostic value of dynamic perfusion MR imaging for differentiation between benign and malignant musculoskeletal lesions. MATERIALS AND METHODS: Dynamic perfusion MR imaging was performed using a 3.0 T system in 32 female and 30 male patients (aged 10-90 years, mean age, 43 years). Following the assessment of the precontrast imaging, a dynamic study was performed. This dynamic technique allowed for 638 images to be obtained at 11 levels throughout the lesion. Twenty-eight lesions originated within bone (8 benign, 20 malignant), whereas 34 lesions were of soft tissue origin (22 benign, 12 malignant). The final diagnosis was histopathologically confirmed in all patients. To differentiate between benign and malignant lesions, we analyzed the four parameters: (maximal relative enhancement (MRE), time to peak (TTP), wash in rate (WI), steepest slope (SS) and the distribution of time intensity curve (TIC) patterns. RESULTS: The TTP, WI, and SS values of malignant lesions were statistically significant from those of benign lesions (p < 0.05). However, the difference for the MRE values was not statistically significant. The distribution of TIC patterns was a helpful indicator of benign or malignant state, however the difference between the two states was not significant. CONCLUSION: Dynamic perfusion MR imaging is a helpful tool in differentiating benign and malignant musculoskeletal lesions.


Subject(s)
Female , Humans , Male , Bone Neoplasms , Musculoskeletal Diseases , Perfusion , Soft Tissue Neoplasms , Thymine Nucleotides , Tics
18.
Article in English | WPRIM | ID: wpr-109497

ABSTRACT

PURPOSE: Anthracycline and taxanes are effective agents in advanced breast cancer and prolong survival times. Some patients achieve prolongation of life with capecitabine, gemcitabine, or vinorelbine, even after failure of both anthracycline and taxanes. We analyzed the efficacy and toxicity of gemcitabine and vinorelbine combination chemotherapy in anthracycline- and taxane-pretreated advanced breast cancer. MATERIALS AND METHODS: The medical records of anthracycline- and taxane-pretreated metastatic breast cancer patients who received gemcitabine and vinorelbine combination chemotherapy at the Seoul National University Hospital were reviewed. Gemcitabine (1,000 mg/m2) and vinorelbine (25 mg/m2) were administered intravenously on days 1 and 8 every 3 weeks. RESULTS: Between 2000 and 2006, 57 patients were eligible (median age, 45 years), and the median number of previous chemotherapy regimens was 3 (range, 1~5). The overall response rate was 30% (95% CI, 18.1~41.9), and the disease control rate was 46% (PR, 30%; SD, 16%). The median duration of follow-up was 33.4 months, the median time-to-progression (TTP) was 3.9 months, and the median overall survival was 10.8 months. None of thepatients with patients with anthracycline and taxane primary resistance showed a response and the median TTP for these patients was significantly shorter than that of other patients (1.9 vs. 4.4 months; p=0.018). Although the efficacy was unsatisfactory in patients with both anthracycline and taxane primary resistance, gemcitabine and vinorelbine combination chemotherapy showed comparable efficacy in anthracycline- and/or taxane-sensitive patients and the patients with secondary resistance, even after failure of second-line therapy. Grade 3/4 hematologic toxicities included neutropenia (18.1%) and febrile neutropenia (0.3%), and non-hematologic toxicities were tolerable. CONCLUSION: Gemcitabine and vinorelbine combination chemotherapy in anthracycline- and taxane-pretreated advanced breast cancer was effective and tolerable.


Subject(s)
Humans , Breast , Breast Neoplasms , Bridged-Ring Compounds , Deoxycytidine , Drug Therapy, Combination , Fluorouracil , Follow-Up Studies , Life Support Care , Medical Records , Neutropenia , Taxoids , Thymine Nucleotides , Vinblastine , Capecitabine
19.
Article in Korean | WPRIM | ID: wpr-45136

ABSTRACT

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.


Subject(s)
Humans , Blood Volume , Brain , Constriction, Pathologic , Diffusion , Magnetic Resonance Imaging , Middle Cerebral Artery , Perfusion , Stroke , Thymine Nucleotides
20.
Article in Korean | WPRIM | ID: wpr-54103

ABSTRACT

Thrombotic thrombocytopenic purpura (TTP) in the acute postoperative setting is a syndrome that presents with various symptoms such as microangiopathic hemolytic anemia, thrombocytopenia, fever, renal failure, and change of the patient's mental status. Though most of the previous reports of postoperative TTP have been in conjunction with cardiac or vascular surgery, it has also been reported following orthopedic and abdominal surgeries. We present here a case of a 78 year-old female who was diagnosed with rectal cancer and who developed TTP the 2nd day following her cancer surgery. Because the presentation can be confused with other early postoperative complications, TTP should be considered in the differential diagnosis of the patient who develops unexplained anemia and thrombocytopenia following an abdominal surgery. Awareness of this syndrome is essential because starting plasmapheresis early can be life-saving.


Subject(s)
Female , Humans , Anemia , Anemia, Hemolytic , Diagnosis, Differential , Fever , Orthopedics , Plasmapheresis , Postoperative Complications , Purpura, Thrombocytopenic , Purpura, Thrombotic Thrombocytopenic , Rectal Neoplasms , Renal Insufficiency , Thrombocytopenia , Thymine Nucleotides
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