Comparative analysis of the use of complementary and alternative medicine by Korean patients with androgenetic alopecia, atopic dermatitis and psoriasis.

BACKGROUND: Complementary and alternative medicine (CAM) is being increasingly used among Koreans with chronic dermatologic diseases, such as androgenetic alopecia (AGA), atopic dermatitis (AD) and psoriasis. OBJECTIVE: To quantify the usage of CAM in Korean patients with AGA, AD or psoriasis, and to offer valid information for the physicians frequently encountering such disorders. METHODS: Outpatients (n = 678) from three tertiary hospitals were investigated independently by constructed and self-directed questionnaire. RESULTS: Of the respondents, 62.1% (421/678) of the subjects reported current or previous use of CAM for their dermatologic conditions (AGA, 67.2%; AD, 68.9%; psoriasis, 46.6%). In AGA, topical applicants (50.2%) were most often used, followed by dietary therapy and health supplements. In AD, bath therapy (39.4%) was most often used, followed by oriental medicine and topical applicants. In psoriasis, oriental medicine (33.9%) was most frequently used, followed by bath therapy and health supplements. The proportion of patients who believed that CAM helped to improve their skin condition was relatively low (AGA, 16.1%; AD, 31.7%; psoriasis, 15.0%). LIMITATIONS: The results may not be applicable to other countries and generalized to general populations. CONCLUSION: These results indicate that CAM is widely used in Korean patients with chronic dermatological diseases despite their dissatisfactions. Thus, the advantages and disadvantages of CAM must be considered before its clinical practice.

Endobronchial adenoid cystic carcinoma.

A case of endobronchial adenoid cystic carcinoma of the lung is presented. This is probably the first report of endobronchial brachytherapy being applied for recurrent adenoid cystic carcinoma of the lung with a good response. We found that endobronchial implantation therapy is very useful in the control of endobronchial adenoid cystic carcinoma. In addition, a clinical history and options for treatment are briefly discussed.

Reoperation for glioblastoma.

The results of a second operation for tumor removal in 24 adult patients with supratentorial glioblastoma multiforme or anaplastic astrocytoma were analyzed. The median survival time after reoperation was 14 weeks. Five of the 24 patients lived 6 months or longer after reoperation. Only three of these patients maintained a Karnofsky rating (KR) of at least 60 for 6 months or longer after reoperation. Preoperative neurological status (KR) is the most significant determinant of survival after reoperation (p = 0.02). When the KR is at least 60, median survival after reoperation is 22 weeks. When the KR prior to reoperation is less than 60, median survival is 9 weeks. Only one of 13 patients with a KR of less than 60 prior to reoperation survived longer than 6 months after the second operation. The interval between first and second operation is significantly related to survival (p = 0.03), but when adjustment is made for the KR the interoperative interval is no longer significantly related to survival after the second operation (p = 0.39). Age, sex, and location of tumor were not significantly related to duration of survival. This study suggests that reoperation is most likely to produce the best result when the KR is at least 60 and the interval between operations is longer than 6 months. Using these criteria, one-third of the patients could be expected to survive with a KR of at least 60 for 6 months. The study indicates that reoperation should not be carried out when the KR is less than 60.

Prognostic factors in medulloblastoma.

Clinical data on 30 patients with cerebellar medulloblastoma treated at this institution were analyzed. This review presents data on the clinical features, natural history of disease, and prognostic factors, as well as survival. Patients were treated uniformly using similar methods and tumor doses. The two important factors were use of optimum techniques and dosage of radiotherapy, and extent of the disease. The development of hydrocephalus had significant bearing on the prognosis, and there was a correlation between survival and clinical evidence of hydrocephalus.

Palliative radiotherapy for synchronous bilateral lung cancers.

Scant information is available about the outcomes of patients with synchronous bilateral lung cancers (SBLC) treated with radiation. We report on 32 patients with SBLC who were treated for palliation by external beam irradiation during a 19-year period. The overall median survival was 7 months; 20 individuals (63%) survived at least 6 months. Among the evaluable patients, the complete/partial subjective and objective response rates were 100% and 60%, respectively. Survival was not significantly influenced by the total dose applied. Radiotherapy is effective for palliation of symptoms associated with SBLC. However, the dismal prognosis of SBLC managed by nonradical radiotherapy alone warrants investigation of treatment using curative doses of radiotherapy or chemotherapy with radiotherapy.

Interstitial 252Cf neutron therapy for glioblastoma multiforme.

252Cf brachytherapy has been combined with whole brain photon beam therapy to 6000 rads in 5-7 weeks. In early phase I studies, all patients selected for study tolerated the procedure and the subsequent photon beam therapy. All showed improvement in performance status and decreased tumor size by CT scan evaluation, but it became clear that these tumors are of large size and bulk, produce marked adjacent brain edema, and require individualized implant therapy as well as high-dose external beam irradiation if response is to occur.

Spinal epidural compression in head and neck cancer. Report of five cases.

Patients with newly diagnosed head and neck cancer (HNC) during a 13-year period were retrospectively studied for the development of spinal epidural compression (SEC). Of the 759 patients studied, 5 developed epidural compression (1%), 4 of whom were relatively young. SEC occurred simultaneously with HNC in 2 patients and long after the diagnosis of HNC in 3 individuals. There was no observed tendency to involve a particular segment of the spine. Local control of HNC following definitive treatment along with regained ability to walk after palliative radiotherapy in a patient was associated with long-term survival. Recommendations are made for aggressive treatment of SEC to achieve a satisfactory outcome.

Screening bone scintigraphy in the staging of locally advanced head and neck cancer.

A retrospective determination of the yield from screening bone scintigraphy in detecting bone metastasis when used for disease staging of 93 asymptomatic patients with locally extensive head and neck cancer was undertaken. The bone scintigraphy findings were correlated with observations from other radioimaging studies done within 1 month of head and neck cancer diagnosis. Bone scintigraphy did not reveal a single case of bone metastasis outside the head and neck region. On the other hand, 3 cases (8%) of resectable and 2 cases (5%) of non-resectable bone metastasis located within the head and neck area were observed among the 40 patients with abnormal bone scintigraphy. Old rib fracture or degenerative disease was responsible for the increased radionuclide uptake in bony areas below the clavicle in less than half of the remaining 35 cases. We conclude that the routine use of bone scintigraphy for disease staging in asymptomatic patients with locally advanced head and neck cancer is not warranted because the positive yield is low.

Wrist fractures.

The various types of wrist fractures are described. Keeping in mind the anatomy and biomechanics of the wrist assists in the detection of these injuries. The clinical and radiographic findings are discussed and the various associated injuries that may go undiscovered without maintaining a high index of suspicion.

Ligamentous wrist injuries.

The wrist is one of the most complex joints of the body. Wrist injuries are quite common, yet improper diagnosis of ligamentous injuries as simply 'sprains' often occurs. Understanding the functional anatomy and mechanics of the wrist is extremely important in appreciating the spectrum of injuries that occur there. A review of the analysis and detection of potential injuries is provided.

Radiotherapy alone for extradural compression by spinal myeloma.

Between 1976 and 1992, 18 patients with a histologically proven diagnosis of plasma cell myeloma (PCM) were treated for palliation of spinal extradural compression (EC) by radiotherapy alone. Eighty-five percent of the evaluable symptomatic individuals obtained significant pain relief. Ambulatory ability was retained or regained in 11 (65%) patients. The overall median period of survival was 11 months. Extended median survival was noted in post-treatment ambulatory patients (compared with nonambulatory patients) and in individuals whose primary presentation of PCM was EC (versus individuals who developed EC during the course of the disease). These results suggest that radiotherapy alone may be used in the palliative management of patients with EC by PCM.

Radiotherapy for mediastinal obstruction and intrathoracic lymphadenopathy in chronic lymphocytic leukemia.

Four of 65 patients (6%) with chronic lymphocytic leukemia (CLL) were treated by megavoltage teleradiotherapy for palliation of symptoms arising from mediastinal obstruction or intrathoracic lymphadenopathy. External beam irradiation was found to be effective treatment for these disease complications associated with CLL.

Standardization of dosimetry chart checks.

This paper reports on a standardized report form that can be used to analyze dose error rates from radiation therapy. An error classification scheme of Types 1 to 5 was developed to indicate increasing severity of errors. Type 1 (charting errors) and Type 3 (daily dose errors) were the most prominent types. Dosimetry errors were reduced by using the results of the reports to correct operating procedures. Type 1 error rates decreased from 17% initially to an average of 3.9%. An average error rate of 1.7% for Type 3 dose errors was found to be consistent with normal operation. Use of the report form is useful in documenting and correcting errors and as a reporting record for use in a quality assurance program.

The hepatoprotective effects of Taiwan folk medicine ham-hong-chho in rats.

Bidens pilosa L. var minor (Blume) Sherff, B. pilosa L. and B. chilensis DC (compositae), commonly known as "Ham-hong-chho" in Taiwan, have been traditionally used for medicinal purposes. To clarify and compare the hepatoprotective effects of these three plants, we evaluated their potential effectiveness on CCl4- and acetaminophen-induced acute hepatic lesions in rats. The results indicated that the increase in SGOT and SGPT activities caused by CCl4 (3.0 ml/kg, s.c.) and acetaminophen administration (600 mg/kg, i.p.) could be significantly reduced by treating with the extracts of all the three kinds of "Ham-hong-chho" and the extract of B. chilensis exhibited the greatest hepatoprotective effects. These phenomena were also confirmed by histological observation. Liver damage induced by CCl4 and acetaminophen was markedly improved in the extract of B. chilensis treated groups, while groups treated with the extracts of B. pilosa var minor and B. pilosa demonstrated only moderate protective effects. The pharmacological and pathological effects of these three crude groups were compared with Bupleurum chinense, which has been reported previously as a treatment criteria in the CCl4 model, and with silymarin as a standard reference medicine in the acetaminophen model. The results suggest that B. pilosa var minor, B. pilosa and B. chilensis can protect liver injuries from various hepatotoxins and have potential as broad spectrum antihepatic agents.

Positron emission tomography and its role in the evaluation of brain tumors.

Positron emission tomography (PET) is a newly evolving, biological method for quantitative imaging of regional function and metabolism within various organs of the living human body. Whereas existing conventional tomographic imaging modalities--CT and MRI--provide only anatomical information, positron emission tomography provides quantifiable information about organ metabolism and function. Brain tumors are the disease entities for which positron emission tomography is most widely applied. PET has the great potential for providing clinically important information about disease processes. PET has not only had a major impact on the diagnostic role of radiology in brain tumors, but also has potential role for therapeutic application to brain brachytherapy.

Primary non-Hodgkin's lymphoma of the central nervous system.

In the past few years, non-Hodgkin's lymphoma of the central nervous system has been the object of increasing attention because of the recent rise in its incidence. Part of this increase can clearly be attributed to the AIDS epidemic. This tumor responds unsatisfactorily to the traditional treatments. Various studies to determine the most effective treatment modality have yielded inconclusive results. A concise review of non-Hodgkin's lymphoma of the central nervous system is presented along with a case study of cerebellar non-Hodgkin's lymphoma.

Modern therapeutic approach for high grade astrocytoma: intracranial Ir-192 brachytherapy.

Prognosis of high-grade astrocytoma has been extremely disappointing and the median survival of patients with this tumor is less than 10 months at best. The most common cause of failure is local persistence of the tumor. Many neuro-oncologists have now turned to an alternative therapeutic approach involving brain brachytherapy (interstitial implantation) for the treatment of high-grade astrocytomas because in this manner a higher dose can be delivered to the tumor bed without excessively irradiating the surrounding normal brain tissue. Brachytherapy has shown some evidence of superior results in survival of malignant astrocytomas if properly performed by a qualified brachytherapy team. The objective of this report is to discuss the rationale and technique of brachytherapy in the management of high-grade astrocytoma as well as future prospects concerning this particular treatment modality.