Keon Uk Park

Assessment of Change of Quality of Life in Terminally Ill Patients under Cancer Pain Management Using the EORTC Core Quality of Life Questionnaire (QLQ-C30) in a Korean Sample

Objective: The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) is composed of 5 multi-item function scales and 9 symptom scales. The Korean EORTC QLQ-C30 was drawn up by the EORTC itself. However, its validity and reliability in the palliative care has not been reported. The aim of this study was to evaluate the practicality, reliability, and validity of the Korean EORTC QLQ-C30 in terminally ill patients under cancer pain management. Methods: The study was conducted from March 2003 to February 2004. The main sample consisted of 159 patients with cancer-related pain during the past week. To assess the severity and impact of pain, the patients completed the Korean version of the Brief Pain Inventory. We enrolled the patients with substantial pain who rated their worst pain as 5 or higher. The participants reported their worst pain of the previous week using the Brief Pain Inventory and were given the EORTC QLQ-C30 to fill out. Two weeks later, the patients were asked to complete the questionnaire a second time while they were on cancer pain management. Results: The questionnaire was well accepted among terminally ill cancer patients. The scale reliability was very good [Cronbach’s alpha: 0.80–0.91 (before treatment), 0.81–0.92 (on treatment)], except for cognitive function. In the initial measure of the QLQ-C30 for each patient, clinical validity was found for all the functional scales using the Eastern Cooperative Oncology Group Performance Status Scale. Ninety-eight patients had improved cancer pain severity, 17 patients had deteriorated cancer pain, and 29 patients had unchanged pain. The differences in QLQ-C30 scores were compared between the improved and nonimproved cancer pain group. Statistically significant between-group differences over time were observed for the scales of global quality of life, fatigue, pain, nausea, and sleep disturbance. Conclusions: Cronbach’s alpha coefficient to judge internal consistency was very good except for cognitive functioning. The Korean QLQ-C30 has a strong validity in functional scales. Global quality of life, pain, fatigue, nausea, and sleep disturbance were improved after cancer pain management. These results support that the QLQ-C30 is a reliable and valid measure of quality of life in Korean cancer patients receiving cancer pain management. We consider that the QLQ-C30 can be used effectively in the palliative care settings in order to assess the effects of cancer pain management on quality of life of advanced-stage cancer patients.

Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction with Idiopathic Thrombocytopenic Purpura: A Case Report

Acute myocardial infarction (AMI) is rare in patients with idiopathic thrombocytopenic purpura (ITP). We describe a case of an AMI during thrombocytopenia in a patient with chronic ITP. A 47-yr-old woman presented with anterior chest pain and a low platelet count (21,000/µL) at admission. Urgent coronary angiography revealed total occlusion of proximal right coronary artery and primary percutaneous coronary intervention (PCI) was performed successfully. This case suggests that primary PCI may be a therapeutic option for an AMI in patients with ITP, even though the patient had severe thrombocytopenia.

Effect of the Combined Use of Tramadol and Milnacipran on Pain Threshold in an Animal Model of Fibromyalgia

Background/Aims Acidic saline injections produce mechanical hyperresponsiveness in male Sprague-Dawley rats. We investigated the effect of milnacipran in conjunction with tramadol on the pain threshold in an acidic saline animal model of pain. Methods The left gastrocnemius muscle of 20 male rats was injected with 100 µL of saline at pH 4.0 under brief isoflurane anesthesia on days 0 and 5. Rats administered acidic saline injections were separated into four study subgroups. After determining the pre-drug pain threshold, rats were injected intraperitoneally with one of the following regimens; saline, milnacipran alone (60 mg/kg), milnacipran (40 mg/kg) plus tramadol (20 mg/kg), or milnacipran (40 mg/kg) plus tramadol (40 mg/kg). Paw withdrawal in response to pressure was measured at 30 min, 120 min, and 5 days after injection. Nociceptive thresholds, expressed in grams, were measured with a Dynamic Plantar Aesthesiometer (Ugo Basile, Italy) by applying increasing pressure to the right or left hind paw until the rat withdrew the paw. Results A potent antihyperalgesic effect was observed when tramadol and milnacipran were used in combination (injected paw, p=0.001; contralateral paw, p=0.012). This finding was observed only at 30 min after the combination treatment. Conclusions We observed potentiation of the antihyperalgesic effect when milnacipran and tramadol were administered in combination in an animal model of fibromyalgia. Further research is required to determine the efficacy of various combination treatments in fibromyalgia in humans.

Biweekly irinotecan and cisplatin as second-line chemotherapy in pretreated patients with advanced gastric cancer: a multicenter phase II study.

The current phase II study was conducted to evaluate the response rate and safety of a combination regimen of biweekly irinotecan plus cisplatin in pretreated patients with advanced gastric cancer. Patients with previously treated metastatic or recurrent gastric cancer received intravenous irinotecan 70 mg/m2 and cisplatin 30 mg/m2 on day 1 and 15 every 4-week cycle. Thirty-two patients were enrolled in the current study. Of these, 31 patients were assessable for efficacy and all for toxicity. No complete response and 5 partial responses were confirmed, giving an overall response rate of 15.6% (95% CI; 2.3-28.9%). The median time to progression and median overall survival for all patients was 113 days and 184 days, respectively. Grade 3/4 neutropenia occurred in 6 patients (18.8%), yet no febrile neutropenia was observed. In addition, grade 3 anorexia was observed in 4 patients (12.5%) and grade 3 diarrhea occurred in 2 patients (6.2%). The combination chemotherapy of biweekly irinotecan and cisplatin was found to be moderately effective and well tolerated in pretreated patients with advanced gastric cancer. Accordingly, this regimen can be regarded as an important second-line treatment option for advanced gastric cancer.

Primary malignant melanoma of the lacrimal sac: a case report.

Malignant melanoma of the lacrimal sac is very rare and primary malignant melanoma is extremely rare. It is usually diagnosed at an advanced stage after excision or biopsy of a tumor. We treated a patient with tearing and bloody discharge from the left eye. We performed a dacryocystectomy with the suspicion of a chronic dacryocystitis. However, the pathological findings and the immunohistochemical studies showed a malignant melanoma of the lacrimal sac. The patient underwent postoperative irradiation therapy. Follow up two months after surgery revealed no evidence of recurrence. Early diagnosis is very important for prognosis in patients with malignant melanoma of the lacrimal sac. Because this tumor often presents with symptoms similar to dacryocystitis and may masquerade as a chronic dacryocystitis, it can be difficult to make an early diagnosis.

Two Cases of Acute Epiglottitis with Sitting up Position, Chin Thrust Forward, Having Dyspnea

급성 후두개염은 상기도 폐색에 따른 치명적인 결과를 초래할 수 있는 질환으로 주의 깊은 호흡관찰과 아울러 급성 상기도 폐색의 초기 징후를 빨리 인지하고 적절한 기관내 삽관술이나 기관 절개술 등으로 기도를 확보해야 하는 심각한 질환이다. 1978년 Cantrell 등은 호흡곤란을 동반한 소아의 급성 후두개염 환자에서 후두의 부종이 진행함에 따라 앉은 자세에서 상체를 구부리고 턱을 내밀어서 호흡하는 특이한 이학적 소견을 기술한 바 있는데, 이러한 자세를 취함으로서 기관이 당겨져 상부기도의 장력을 증가시켜 후두개 및 주위 연조직의 부종에 의한 기도 폐쇄를 완화시킬수 있기 때문인 것으로 생각된다. 따라서 급성 후두개염 환자에서 턱을 내말고 목을 쭉 뻗어서 호흡하는 이학적 소견은 후두 부종에 의한 상기도 폐색이 임박하였음을 시사하는 소견이라 할 수 있겠다. 본 저자들은 앉은 자세에서 목을 쭉 뻗어서 호흡하는 특이한 이학적소견을 보이는 급성 후두개염 환자 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 【Acute epiglottitis is a life threatening inflammatory. disease of the upper airway mainly in children, however, the recent reports about acute epiglottitis in adults are increasing. The common symptoms are sore throat, dysphagia, dyspnea and salivary drooling. As the laryngeal edema progresses, the patient sits up, leans forward, with the chin thrust forward, having obvious difficulty breathing. Early recognition and proper airway maintenance until the inflammatory edema subsides are essential steps to avoid a possible life threatening upper airway obstruction. We experienced two cases of acute epiglottitis with sitting up position, chin thrust forward, having dyspnea.】

A Case of Sarcoidosis with Bone Involvemnt

Sarcoidosis is a chronic multisystemic disorder of unknown cause characterized by presence of noncaseating Epithelioid granuloma in affected organ. It was first reported in 1887 by Hutchinson and is relatively common in western countries. But it is not commonly seen in East Asia including Korea. All parts of the body can be affected, but the lung is the most frequently affected organ. Other common site of involvement include lymph node, eye, skin, etc. It is known that 3~9% of all cases of sarcoidos is associated with bone involvement. Bone involvement usual1y cause no symptom and frequently affect bones in hands an feet. In many cases, it is known to be associated with skin involvement. We recently experienced one case of sarcoidosis which typically showed X-ray finding of sarcoidosis with associated skin lesion(lupus pernio) and report it with review of the literature.

Weaning Following a 30 Minutes Spontaneous Breathing Trial

Background : Weaning is the process of switching a patient from mechanical ventilator to spontaneous breathing. A number of different weaning techniques can be employed. At recent study, conventional spontaneous breathing trial was superior to other techniques, such as intermittent mandatory ventilation(IMV) or pressure support ventilation(PSV). But adequate observation time of the spontaneous breathing trial was not determined. We reported the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotrachial tube. In this study, we tried to shorten the spontaneous breathing time from 60 minutes to 30 minutes. If weaning success was predicted after 30 minutes spontaneous breathing, extubation was done without reconnection with ventilator. Methodes : Subjects consisted of 42 mechanically ventilated patients from August 1994 to July 1995. The weaning trial was done when the patients recovered sufficiently from respiratory failure that originally required ventilatory assistance, the patients became alert and showed stable vital sign, and arterial tension was adequated( > 55 mmHg) with less than 40% of inspired oxygen fraction. We conducted a careful physical examination when the patients was breathing spontaneously through the endobronchial tube for 30 minutes. We terminated the trial if a patients was any of following signs of distress; cyanosis, diaphoresis, tachypnea(above 30 breaths per minute), and extreme tachycardia. Patients who had none of this features during spontaneous breathing for 30 minutes were extubated promptly. Result : 17 weaning trials of 15 patients were done in 42 mechanically ventilated patients. Successful weaning and extubation was possible in 14 trials of total 17 trials. In this 14 patients, 8 patients were extubated after 30 minutes spontaneous breathing, 3 patients were extubated after 60 minutes spontaneous breathing, and 3 patients needed over 3 hours for extubation from weaning. We found similar overall success rate compared with weaning following a 60 minutes spontaneous breathing trial. Conclusion : From the result of present study, we believe that weaning and extubation from mechanical ventilation following a 30 minutes spontaneous breathing with supply through the endotracheal tube is a simple and effective method.

The Effect of Pleurodesis with Doxycycline in the Rabbit

Background: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. Method: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were devided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. Results: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. Conclusion: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.