Choon Hae Chung

Small Cell Carcinoma of the Kidney

Up to 5% of all small cell carcinomas develop at extrapulmonary sites. Primary small cell carcinomas originating in the kidney are extremely rare neoplasms. Here we report a case of primary small cell carcinoma of the kidney. A nephrectomy was performed on a 52-year-old female patient to remove a large tumor located in the right kidney. The histology and immunohistochemistry of the resected tumor revealed a pure small cell carcinoma with invasion into the renal capsule. The patient received postoperative adjuvant chemotherapy with etoposide and cisplatin. The patient has been monitored with regular check ups and remains stable with no recurrence at 28 months after the initial diagnosis.

Lupus anticoagulant-hypoprothrombinemia in healthy adult

The presence of lupus anticoagulant is associated with an elevated risk of venous and arterial thrombosis, and recurrent miscarriages as well. For some cases, this disease can present with bleeding as a consequence of lupus anticoagulant hypoprothrombinemia (LAHPS). LAHPS is a rare disease and it is reported to be most frequent in young females with/without systemic lupus erythematosus or in healthy children who are suffering with a viral infection. In such cases, steroid therapy is usually effective in normalizing the biological abnormalities and controlling the bleeding problems. A 34-year-old previously healthy man was admitted to our department because of his prolonged coagulation times; these abnormalities were discovered before performing orthopedic surgery. The prothrombin time (PT) was 15.2 sec, and the activated partial thromboplastin time (APTT) was 37.7 sec. A 1:1 dilution of patient plasma with normal plasma nearly corrected the PT, but this failed to correct the APTT. Evaluation of the clotting factors revealed decreased levels of factors II, V, VIII, IX and XI. The presence of LA was demonstrated by the dRVVT test, and the patient was diagnosed with LAHPS. He was successfully treated with corticosteroid before performing the orthopedic surgery.

Health-related Quality of Life Among Cancer Survivors in Korea: The Korea National Health and Nutrition Examination Survey

OBJECTIVE The purpose of this study was to investigate the quality of life among cancer survivors compared with individuals without a history of cancer (noncancer controls) using the Korea National Health and Nutrition Examination Survey. METHODS The study subjects were 783 adult cancer survivors and 36 456 noncancer controls who participated in the third, fourth and fifth Korea National Health and Nutrition Examination Survey. Demographic factors, health-related behavior, clinical characteristics and health-related quality of life were assessed with self-reported questionnaires. The EuroQoL-5Dimension was used to evaluate health-related quality of life. Descriptive statistics and multiple regression analysis were used to compare health-related quality of life between cancer survivors and noncancer controls. RESULTS About 67% were women and the mean age of the cancer survivors was 60.9 ± 12.4 years. About 52% of survivors were diagnosed with cancer between 45 and 64 years, and more than half of cancer survivors were diagnosed 5 years or less before the interview. The pain/discomfort dimension was the highest reported problem: 43.6% for cancer survivors. The proportion of any reported problem was significantly higher among cancer survivors compared with noncancer controls in terms of mobility (adjusted odds ratio (aOR), 1.56, 95% confidence interval, 1.24-1.97), usual activities (aOR, 1.45, 95% confidence interval, 1.11-1.89), pain/discomfort (aOR, 1.26, 95% confidence interval, 1.04-1.52) and anxiety/depression (aOR, 1.61, 95% confidence interval, 1.29-2.01). CONCLUSIONS Cancer survivors had a significantly lower quality of life compared with noncancer controls. The pain/discomfort dimension was the highest reported problem in cancer survivors.

Successful treatment of small-cell lung cancer with irinotecan in a hemodialysis patient with end-stage renal disease.

The prognosis of patients with end-stage renal disease has improved with advances in hemodialysis techniques. However, many patients who undergo hemodialysis suffer from various types of cancer. Limited data is available to guide clinical management of these patients who may have impaired renal function. Here, we report our experience with the use of irinotecan for the treatment of a hemodialysis patient with small-cell lung cancer and end-stage renal disease.

Influence of pentobarbital-Na on stimulation-evoked catecholamine secretion in the perfused rat adrenal gland.

Objectives The present study was attempted to investigate the effects of pentobarbital-Na, one of the barbiturates which are known to depress excitatory synaptic transmission in the central nervous system at concentrations similar to those required for the induction and maintenance of anesthesia, on catecholamines (CA) secretion evoked by cholinergic stimulation and membrane-depolarization from the isolated perfused rat adrenal gland, and to clarify the mechanism of its action. Methods Mature male Sprague-Dawley rats were anesthetized with thiopenal-Na(40mg/kg, s.c.). The adrenal gland was isolated by the methods of Wakade. A cannula used for perfusion of the adrenal gland was inserted into the distal end of the renal vein. The adrenal gland was carefully removed from the animal and placed on a platform of a leucite chamber. Results The perfusion of pentobarbital-Na(30–300uM) into an adrenal vein for 20 min produced relatively dose-dependent inhibition in CA secretion evoked by ACh(5.32mM) DMPP(100uM for 1 min), McN-A-343(200uM for 2 min), Bay-K-8644(10uM) and high potassium(56mM), while it did not affect the CA secretion of cyclopiazonic acid(10uM). Also, in the presence of thiopental-Na (100uM), CA secretory responses evoked by ACh, DMPP, McN-A-343 and high K+ were markedly depressed. Moreover, in adrenal glands preloaded with ketamine(100uM for 20 min), which is known to be a dissociative anesthetic, CA secretion evoked by ACh, DMPP, McN-A-343 and high K+ were significantly attenuated. Conclusion Taken together, these experimental results suggest that pentobarbital-Na depresses CA release evoked by both cholinergic stimulation and membrane-depolarization from the isolated rat adrenal medulla and that this inhibitory activity may be due to the result of the direct inhibiton of Ca++ influx into the chromaffin cells without any effect on the calcium mobilization from the intracellular store.

Chronic eosinophilic leukemia with 46,XY,1,der(1;7)(q10;p10) translocation.

Chronic eosinophilic leukemia (CEL) is a rare hematologic malignancy difficult to distinguish from hypereosinophilic syndrome (HES). If a clonal cytogenetic abnormality is detected, then it is diagnostic of CEL [1]. We report the first case of a patient with CEL with 46,XY,1,der(1;7) (q10;p10) translocation. A 58-year-old Korean man had already been treated in 1990 for rectal cancer with only surgical resection. The patient complained of nonproductive cough in April 2002, and pneumonia was diagnosed. At the time of diagnosis, leukocytosis with eosinophilia was also revealed. Physical examination showed mild hepatosplenomegaly. The WBC count was 38,000 mm, with eosinophils 21,000 mm; Hb was 14.3 g/dl and platelets 222,000 mm. Examination of bone marrow (BM) aspiration showed 90–95% cellularity with 35% eosinophils and without excess of blasts. Chromosome analysis of BM showed 46,XY,1,der(1;7) (q10;p10) translocation in the metaphases analyzed (Fig. 1), whereas Philadelphia chromosome specific for chronic myelogenous leukemia was not detected. The echocardiogram showed no evidence of eosinophilic infiltration. Gastroduodenoscopy and biopsy revealed early gastric cancer. Colonoscopy showed no evidence of recurrent rectal cancer. The results of chest computed tomography scan revealed pneumonic infiltration on the right upper lung field and thrombosis of the descending aorta. On the basis of the BM and cytogenetical abnormality, the patient was diagnosed as having CEL, rather than HES, or reactive eosinophilia due to rectal or gastric cancer. His CEL with pneumonic infiltration was treated with hydroxyurea and α-interferon. Thereafter, WBC count decreased to 5060 mm (eosinophil count 3000 mm), and cough and pneumonic infiltration improved. He is on anticoagulant therapy for thrombosis. Numerous cytogenetic abnormalities, including trisomy 8, isochromosome 17, monosomy 7, and translocations involving the long arm of chromosome 5 have been described [2, 3]. Some cytogenetical abnormalities are frequently found, especially aberration of the long arm of chromosome 5, where genes implicated in eosinophilopoiesis are located such as interleukin-5. A recent review by Cools described that about half of HES cases harbor the FIP1P1–PDGFRA fusion gene and that these are clonal in origin and should be reclassified as CEL [4, 5]. The cytogenetical finding in our patient is a 46,XY,1,der(1;7) (q10;p10). To our knowledge, this is the first case report of CEL with 46,XY,1,der(1;7)(q10;p10).

A Case of Focal Segmental Glomerulosclerosis Associated with Aplastic Anemia

The pathogenic mechanism of focal segmental glomerulosclerosis (FSGS) and aplastic anemia are associated with immunologic events which lead to glomerular cell injury or hematopoietic cell destruction. We present an extremely rare case of FSGS with aplastic anemia in a 30-yr-old woman. The laboratory examination show-ed hemoglobin 7.2 g/dL, white blood count of 4,200/µl, platelet count 70,900/µl. Proteinuria (2+, 3.6 g/day) and microscopic hematuria were detected in urinalysis. The diagnosis of FSGS and aplastic anemia were confirmed by renal and bone marrow biopsy. She was treated with immunosuppressive therapy of prednisone 60 mg/day orally for 8 weeks and cyclosporine A 15 mg/kg/day orally. She responded with gradually improving her clinical manifestation and increasing peripheral blood cell counts. Prednisone was maintained at the adequate doses with tapering after 8 weeks and cyclosporine was given to achieve trough serum levels of 100-200 ng/mL. At review ten month after diagnosis and initial therapy, the patient was feeling well and her blood cell counts increased to near normal (Hb 9.5 g/dL, Hct 32%, WBC 8,300/µl, platelet 123,000/µl) and renal function maintains stable with normal range proteinuria (0.25 g/day).