Journal of Yeungnam Medical Science

Resident fellow section: Clinical vignette

Cephalosporin-induced encephalopathy in patients with hematologic malignancies: a significant concern: Young Seob Park, Min Kyoung Kim, Kyung Hee Lee, Sung Ae Koh, Ji Yoon Jung, Byeong Il Jang, Se-Jin Lee; J Yeungnam Med Sci. 2023;40(Suppl):S137-S141. Published online November 14, 2023; DOI: https://doi.org/10.12701/jyms.2023.00864

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Review article

An update on immunotherapy with PD-1 and PD-L1 blockade: Sung Ae Koh; Yeungnam Univ J Med. 2021;38(4):308-317. Published online September 9, 2021; DOI: https://doi.org/10.12701/yujm.2021.01312

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Cancer is the leading cause of death and is on the rise worldwide. Until 2010, the development of targeted treatment was mainly focused on the growth mechanisms of cancer. Since then, drugs with mechanisms related to tumor immunity, especially immune checkpoint inhibitors, have proven effective, and most pharmaceutical companies are striving to develop related drugs. Programmed cell death-1 and programmed cell death ligand-1 inhibitors have shown great success in various cancer types. They showed durable and sustainable responses and were approved by the U.S. Food and Drug Administration. However, the response to inhibitors showed low percentages of cancer patients; 15% to 20%. Therefore, combination strategies with immunotherapy and conventional treatments were used to overcome the low response rate. Studies on combination therapy have typically reported improvements in the response rate and efficacy in several cancers, including non-small cell lung cancer, small cell lung cancer, breast cancer, and urogenital cancers. The combination of chemotherapy or targeted agents with immunotherapy is one of the leading pathways for cancer treatment.

Citations

Citations to this article as recorded by

Immune checkpoint inhibitors associated cardiovascular immune-related adverse events
Wonyoung Jo, Taejoon Won, Abdel Daoud, Daniela Čiháková
Frontiers in Immunology.2024;[Epub] CrossRef
Therapeutic Targeting of Thioredoxin Reductase 1 Causes Ferroptosis while Potentiating Anti-PD-1 Efficacy in Head and Neck Cancer
Ming-Shou Hsieh, Hang Huong Ling, Syahru Agung Setiawan, Mardiah Suci Hardianti, Iat-Hang Fong, Chi-Tai Yeh, Jia-Hong Chen
Chemico-Biological Interactions.2024; : 111004. CrossRef

Original article

Treatment decision for cancer patients with fever during the coronavirus disease 2019 (COVID-19) pandemic: In Hee Lee, Sung Ae Koh, Soo Jung Lee, Sun Ah Lee, Yoon Young Cho, Ji Yeon Lee, Jin Young Kim; Yeungnam Univ J Med. 2021;38(4):344-349. Published online August 23, 2021; DOI: https://doi.org/10.12701/yujm.2021.01144

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Abstract PDF: Background
Cancer patients have been disproportionally affected by the coronavirus disease 2019 (COVID-19) pandemic, with high rates of severe outcomes and mortality. Fever is the most common symptom in COVID-19 patients. During the COVID-19 pandemic, physicians may have difficulty in determining the cause of fever (COVID-19, another infection, or cancer fever) in cancer patients. Furthermore, there are no specific guidelines for managing cancer patients with fever during the COVID-19 pandemic. Thus, this study evaluated the clinical characteristics and outcomes of cancer patients with fever during the COVID-19 pandemic.
Methods
This study retrospectively reviewed the medical records of 328 cancer patients with COVID-19 symptoms (fever) admitted to five hospitals in Daegu, Korea from January to October 2020. We obtained data on demographics, clinical manifestations, laboratory test results, chest computed tomography images, cancer history, cancer treatment, and outcomes of all enrolled patients from electronic medical records.
Results
The most common COVID-19-like symptoms were fever (n=256, 78%). Among 256 patients with fever, only three (1.2%) were diagnosed with COVID-19. Most patients (253, 98.8%) with fever were not diagnosed with COVID-19. The most common solid malignancies were lung cancer (65, 19.8%) and hepatobiliary cancer (61, 18.6%). Twenty patients with fever experienced a delay in receiving cancer treatment. Eighteen patients discontinued active cancer treatment because of fever. Major events during the treatment delay period included death (2.7%), cancer progression (1.5%), and major organ dysfunction (2.7%).
Conclusion
Considering that only 0.9% of patients tested for COVID-19 were positive, screening for COVID-19 in cancer patients with fever should be based on the physician’s clinical decision, and patients might not be routinely tested.

Review article

Function of hepatocyte growth factor in gastric cancer proliferation and invasion: Sung Ae Koh, Kyung Hee Lee; Yeungnam Univ J Med. 2020;37(2):73-78. Published online February 20, 2020; DOI: https://doi.org/10.12701/yujm.2019.00437

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Abstract PDF

Cancer incidence has been increasing steadily and is the leading cause of mortality worldwide. Gastric cancer is still most common malignancy in Korea. Cancer initiation and progression are multistep processes involving various growth factors and their ligands. Among these growth factors, we have studied hepatocyte growth factor (HGF), which is associated with cell proliferation and invasion, leading to cancer and metastasis, especially in gastric cancer. We explored the intercellular communication between HGF and other surface membrane receptors in gastric cancer cell lines. Using complimentary deoxyribonucleic acid microarray technology, we found new genes associated with HGF in the stomach cancer cell lines, NUGC-3 and MKN-28, and identified their function within the HGF pathway. The HGF/N-methyl-N’-nitroso-guanidine human osteosarcoma transforming gene (c-MET) axis interacts with several molecules including E-cadherin, urokinase plasminogen activator, KiSS-1, Jun B, and lipocalin-2. This pathway may affect cell invasion and metastasis or cell apoptosis and is therefore associated with tumorigenesis and metastasis in gastric cancer.

Citations

Citations to this article as recorded by

Reciprocal Regulation of Cancer-Associated Fibroblasts and Tumor Microenvironment in Gastrointestinal Cancer: Implications for Cancer Dormancy
Shih-Hsuan Cheng, Hsin-Ying Clair Chiou, Jiunn-Wei Wang, Ming-Hong Lin
Cancers.2023; 15(9): 2513. CrossRef
Expression of E-cadherin and N-cadherin in Epithelial-to-Mesenchymal Transition of Osteosarcoma: A Systematic Review
Leo Issagholian, Ethan Tabaie, Akshay J Reddy, Muhammad S Ghauri, Rakesh Patel
Cureus.2023;[Epub] CrossRef
Remodelling of the tumour microenvironment by the kallikrein-related peptidases
Srilakshmi Srinivasan, Thomas Kryza, Jyotsna Batra, Judith Clements
Nature Reviews Cancer.2022; 22(4): 223. CrossRef
Identification of hub pathways and drug candidates in gastric cancer through systems biology
Seyed Reza Salarikia, Mohammad Kashkooli, Mohammad Javad Taghipour, Mahdi Malekpour, Manica Negahdaripour
Scientific Reports.2022;[Epub] CrossRef
Signaling pathways and therapeutic interventions in gastric cancer
Zi-Ning Lei, Qiu-Xu Teng, Qin Tian, Wei Chen, Yuhao Xie, Kaiming Wu, Qianlin Zeng, Leli Zeng, Yihang Pan, Zhe-Sheng Chen, Yulong He
Signal Transduction and Targeted Therapy.2022;[Epub] CrossRef
Proteomic Signatures of Diffuse and Intestinal Subtypes of Gastric Cancer
Smrita Singh, Mohd Younis Bhat, Gajanan Sathe, Champaka Gopal, Jyoti Sharma, Anil K. Madugundu, Neha S. Joshi, Akhilesh Pandey
Cancers.2021; 13(23): 5930. CrossRef

Case report

Rapid progression from trochlear nerve palsy to orbital apex syndrome as an initial presentation of advanced gastric cancer: Eunjung Kong, Sung Ae Koh, Won Jae Kim; Yeungnam Univ J Med. 2019;36(2):159-162. Published online February 15, 2019; DOI: https://doi.org/10.12701/yujm.2019.00129

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Abstract PDF

The most cases with orbital metastases have been reported in patients with a prior established diagnosis of cancer and widespread systemic involvement. However, ocular symptoms can be developed as an initial presentation of cancer in patients without cancer history. We report a case of rapid progression from trochlear nerve palsy to orbital apex syndrome as an initial presentation of advanced gastric cancer.

Citations

Citations to this article as recorded by

Neoplastic nerve lesions
Deep K. Patel, Kelly G. Gwathmey
Neurological Sciences.2022; 43(5): 3019. CrossRef

Case Reports

Metastatic eyelid cancer from gastric adenocarcinoma.: Ji Yoon Jung, Eun Joo Goo, Jae Chang Lee, Jay Song, Sung Ae Koh, Kyung Hee Lee, Young Kyung Bae; Yeungnam Univ J Med. 2016;33(2):142-145. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.142

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Abstract PDF: Gastric cancer is the most common cancer in Korean males and can easily spread to distant organs such as the liver, lungs, brain, or bones. However, skin metastasis, particularly of the eye, is rare. Metastatic eyelid cancer is extremely rare; metastases from internal organs have not been reported so far. We recently experienced a patient with metastatic eyelid cancer from adenocarcinoma of the stomach. A 62-year-old female was admitted with a right upper eyelid mass and foreign body sensation. She had a history of stomach cancer of 3 years. She was treated by chemotherapy and radiotherapy for pathologic fracture. After receiving supportive care for 2 years, the mass appeared on her right pupil. Punch-biopsy of the mass was performed and histological examination revealed adenocarcinoma, the same as the initial histological result. We report this case with a review of related literature.

Immune thrombocytopenia associated with sarcoidosis.: Da Eun Jeong, Min Kyoung Kim, Sung Ae Koh, Kyoung Hee Lee, Joon Hyuk Choi, Young Hoon Hong, Jae Ho Cho, Eun Ju Goo, Myung Soo Hyun; Yeungnam Univ J Med. 2015;32(1):26-30. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.26

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Abstract PDF: Sarcoidosis is a systemic disease of unknown cause involving multiple organs and is characterized by noncaseating granuloma. Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased peripheral platelet destruction due to the presence of an antibody to the platelet and abnormal platelet production. There is no known pathogenesis that occurs concurrently with ITP and sarcoidosis. However, considering together of 2 known pathogenesis, abnormal immune response triggers either ITP or sarcoidosis. The disease that develops first stimulates secondary disease. After development of secondary disease, they stimulate each other. A few cases of ITP associated with sarcoidosis are well documented in English; however, the disease has rarely been reported in Korea. Here, we report on a case of ITP with sarcoidosis in a 29-year-old man. He suffered from easy bruising. The chest X-ray and the contrast-enhanced computed tomography scan showed bihilar lymphadenopathy and reticulonodular infiltrates. Bone marrow study and fluoroscopy-guided percutaneous needle biopsy were performed and the patient was diagnosed with sarcoidosis and ITP. He was put on 400 mg/kg of intravenous immunoglobulin for 5 days and administered oral steroids and further follow-up will be carried out. He has shown a good response without significant bleeding event. However, administration of more oral steroid and additional follow-up is required than for single disease, whether sarcoidosis or ITP.

A Case of Type 1 Neurofibromatosis Associated with Multiple Metastatic Gastrointestinal Stromal Tumors.: Hyo Jin Jang, Sung Ae Koh, Da Eun Jeong, Ji Yoon Jung, Eun Ju Goo, Kyoung Hee Lee, Joon Hyuk Choi, Myung Soo Hyun; Yeungnam Univ J Med. 2013;30(2):105-108. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.105

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Abstract PDF: Type 1 neurofibromatosis (von Recklinghausen's disease, NF-1) is an autosomal-dominant neurocutaneous-disorder characterized by systemic cafe'-au-lait spots, multiple cutaneous neurofibromas, axillary or inguinal freckling, and Lisch nodules (pigmented iris hamartomas). Approximately 10-25% of NF1 patients have gastrointestinal neoplasms. Gastrointestinal stromal tumor (GIST) in patients with neurofibromatosis is most commonly found in the small bowel and the stomach, and approximately 60% of such patients have multiple tumors or multiple tumor sites. Although, the increased incidence of GIST in patients with neurofibromatosis is well documented in pathology literature in English, but has rarely been documented in Korea. Here, we report a case of multiple GISTs in a 48-year-old woman accompanied by NF1. She was admitted to Yeungnam University Hospital with complaints of melena and dyspnea. A contrast-enhanced computed tomography (CT) scan revealed that multiple soft tissue masses were occupying the entire peritoneal cavity. An ultrasonogram- guided biopsy was performed and the tumors were found to have been composed of tumor cells that were positive for c-kit protein. The patient was put on Imatinib mesylate treatment, and further follow-up will be carried out.

Treatment of Hemangiopericytoma-Associated Hypoglycemia with Glucocorticoid Therapy.: Sung Woo Park, Dong Geun Kim, Myung Jin Kim, Hyo Jin Jang, Se Hoon Sohn, Sung Ae Koh, Ha Young Lee, Min Kyoung Kim, Kyoung Hee Lee, Myung Soo Hyun; Yeungnam Univ J Med. 2011;28(1):77-83. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.77

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Abstract PDF: Non-islet cell tumor-induced hypoglycemia (NICTH) is associated with mesenchymal tumor types, including hemangiopericytoma, fibrosarcoma, mesothelioma, and neurofibroma, as well as carcinoma of the liver, adrenal glands, and kidneys. Non-islet cell tumors induce hypoglycemia by overproducing an abnormal form of insulin-like growth factor II (IGF II). Complete removal of the tumor or reduction of the tumor mass is a successful therapeutic strategy in cases of NICTH. However, if the tumor re-grows, curative resection is nearly impossible, and hypoglycemia occurs repeatedly. Glucocorticoids are effective in terms of long-term relief from hypoglycemia through promotion of gluconeogenesis in the liver, tumor suppression, production of 'big'-IGF-II, and correction of the attendant biochemical abnormalities involving the growth hormone (GH)-IGF axis. We found that administration of corticosteroid therapy to a patient suffering from NICTH resulted in improvement of hypoglycemia associated symptoms.

Paratesticular Alveolar Rhabdomyosarcoma with Multiple Lymph Nodes Metastasis Successfully Treated with Chemotherapy.: Ha young Lee, Myung Soo Hyun, Kyung Hee Lee, Min Kyoung Kim, Sung Ae Koh, Se Hoon Sohn, Sung Woo Park, Dong Geun Kim, Myung Jin Kim, Hyo Jin Jang, Mi Jin Kim; Yeungnam Univ J Med. 2011;28(1):70-76. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.70

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Abstract PDF: Rhabdomyosarcomas are soft tissue sarcomas; while extremely rare in adults, they are one of the most common neoplasms in children and adolescents. Histologically, they can be classified into embryonal(ERMS), alveolar(ARMS), pleomorphic, and undifferentiated types. The ARMS type is very rare, and is associated with a poor prognosis. Common primary sites of ARMS are the trunk and extremities. We report on a case of paraaortic, supraclavicular, and axillary lymph node metastasis from paratesticular ARMS treated with VAC(vincristine, dactinomycin, cyclophosphamide)/ IE(ifosfamide, etoposide) chemotherapy in a young adult. Administration of six cycles of chemotherapy with VAC/ IE resulted in complete remission. The patient has maintained complete remission over the past 27 months.

Original Article

Early or Late Gefitinib, Which is Better for Survival?: Retrospective Analysis of 228 Korean Patients with Advanced or Metastatic NSCLC.: Dong Gun Kim, Min Kyoung Kim, Sung Hwa Bae, Sung Ae Koh, Sung Woo Park, Hyun Je Kim, Myung Jin Kim, Hyo Jin Jang, Kyung Hee Lee, Kwan Ho Lee, Jin Hong Chung, Kyung Chul Shin, Hun Mo Ryoo, Myung Soo Hyun; Yeungnam Univ J Med. 2011;28(1):31-44. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.31

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Abstract PDF: BACKGROUND
The optimal timing of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) in NSCLC patients has not yet been determined. METHODS: We separated 228 patients with advanced/metastatic NSCLC treated with gefitinib into an early gefitinib group (patients who received gefitinib as first- or second-line treatment) and a delayed gefitinib group (patients who received gefitinib as third or fourth-line treatment) and attempted to determine whether the timing of gefitinib treatment affected clinical outcomes. RESULTS: Median overall survival (OS), progression free survival (PFS), and median OS from first-line treatment of advanced/metastatic disease (OSt) for 111 patients in the early gefitinib group were 6.2 months, 3.3 months, and 11.6 months. However, median OS, PFS, and OSt for 84 patients in the delayed gefitinib group were 7.8 months, 2.3 months, and 22.7 months. No differences in OS and PFS were observed between the 2 groups. However, OSt was significantly longer in the delayed gefitnib group. Timing of gefitinib therapy was one of the independent predictors of OSt. Hb > or = 10 g/dl, and having never smoked, and ECOG performance status < or =1 were independent predictors of better PFS. CONCLUSION: Deferral of gefitinib therapy in patients with advanced or metastatic NSCLC may be preferable if they are able to tolerate chemotherapy.

Case Reports

A Case of Pneumatosis Intestinalis in Peritoneal Dialysis Peritonitis.: Sun Young Jung, Ji Hun Na, Yun Jung Choi, Sung Ae Koh, Ku Hyang Choi, Jong Won Park, Jun Young Do, Kyeng Woo Yun; Yeungnam Univ J Med. 2009;26(1):49-55. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.49

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Abstract PDF: Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumatosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

A Case of Tarsal Bone Tuberculosis in a Patient with Polycythemia Vera.: Sung Ae Koh, Se Hun Shon, Dong Gun Kim, Sung Woo Park, Choong Ki Lee, Kyung Hee Lee, Min Kyoung Kim, Myung Soo Hyun; Yeungnam Univ J Med. 2009;26(1):44-48. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.44

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Abstract PDF: Talus tuberculosis is a rare disease, even in an endemic tuberculosis area. In reviews of the worldwide literature, only 18 cases of talus tuberculosis have been reported. Recently, we experienced a case of a 70-year-old polycythemia vera patient with right metatarsopharyngeal joint pain for 2 months duration who was diagnosed with talus tuberculosis with prostate involvement. Tuberculosis should be considered as one of the causes of monoarticulitis, especially in countries, where the disease is endemic. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.

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