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Purpose: Most malignant peritoneal or pleural effusions caused by advanced malignancy are unresponsive to systemic chemotherapy except for chemotherapy sensitive tumors, and they are equally ineffective to regional therapy or radiotherapy. Thus, for the purpose of palliating the symptoms related to malignant effusion and to reduce fluid reaccumulations, we evaluated the therapeutic feasibility and efficacy of intracavitary ^(166)Ho-CHICO (chitosan complex) instillation for intractable malignant effusions. Materials and Methods: Thirty one patients with cytologically or pathologically proven malignant effusions underwent intracavitary ^(166)Ho-CHICO therapy from May 1996 to March 1998 at Ajou University Hospital. The subjective and objective responses were evaluated 4 weeks after the treatment, including the changes of symptoms, weight, abdominal girth, doses of diuretics, frequencies and amounts of repeat aspirations for fluid reaccumulations, and imaging studies of chest radiograph and ultrasounds. Results: The response rates treated with ^(166)Ho-CHICO were 50% in patients with peritoneal effusion and 46% in patients with pleural effusion (overall 49%). The response rates between ^(166)Ho-CHICO doses of 50-80 mCi and 90-100 mCi were similar (50% vs 47%). Response rate of 70% was noted in patients with even distribution of radioisotope on the post-therapy scan, but, the response rate was lower in cases with focal (44%) and uneven (29%) distribution pattern. There was no difference in response by the effusion sites. All patients tolerated intracavitary ^(166)Ho-CHICO instillation well, although the majority of patients experienced Grade I/II side effects such as pain, fever, weakness and dyspnea. But, no serious complications of Grade III or IV degree were observed with ^(166)Ho-CHICO therapy. Conclusion: Intracavitary ^(166)Ho-CHICO instillation was clinically efficacious in control- ling malignant effusions without a significant toxicity seen with conventional sclerotic therapy. The therapeutic modality appeared to offer similar benefits obtained with the conventional intracavitary therapy.
( Ho Chan Lee ), ( Kyeong Ok Kim ), ( Se Hoon Sohn ), ( Jae Hyun Park ), ( Yo Han Jeong ), ( Sung Bum Kim ), ( Kook Hyun Kim ), ( Si Hyung Lee ), ( Byung Ik Jang ), ( Tae Nyeun Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Backgrounds: Advanced age is known as a risk factor of poor outcomes of colitis including pseudomembranous colitis(PMC). The aim of the present study was to compare the clinical outcomes of hospitalized case of pseudomembranous colitis between young and old patients. Methods: From Jan 2007 to Dec 2013, inpatients who were diagnosed as PMC were included and their clinical data were analyzed retrospectively. The patient`s baseline- characteristics, clinical courses and outcomes were compared according to the age with the cutoff 65years. Results: Among total 241,391 inpatients during the study period, 217 patients(0.09%) had been diagnosed as PMC. Mean age of the patients was 67.4 years and 71 patients (32.7%) were younger than 65years old and the other 146 patients(67.3%) were older than 65years old. Mean age was 49.6 and 76.1 years in each groups and male to female ratio was 0.82 and 0.59 respectively. The Rt. colon involvement was more common in old age (21.2% vs 41.7%, p=0.042). Leukocytosis(40.8% vs 65.0%, p=0.001) and severe PMC scored above 3 points(77.5% vs 89.0%, p=0.024) was more common in old age. Failure to 1st line treatment was more common in old age(16(22.5%) vs 54(37.0%), p=0.033). As an initial treatment, use of vancomycin, instead of metronidazole was more frequent in old age(1(1.4%) vs 16(11.0%), p=0.014). Mean duration of NPO was 3.65 and 4.1days in each group (p=0.357). Recurrence rate did not show any signifi cant difference according to age 8.5% vs. 14.4% ,p=0.214). Conclusions: There was no difference symptom duration and recurrence rate between young and old PMC patients. However, severe colitis and failure to 1st line treatment was signifi cantly more common in old patients. We should consider more aggressive treatment at fi rst in PMC patients above 65years.