Serum CA 19-9 and CEA Levels as a Prognostic Factor in Pancreatic Adenocarcinoma

PURPOSE: To investigate the use of pretreatment carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) as prognostic factors to determine survival in pancreatic adenocarcinoma. MATERIALS AND METHODS: A retrospective review of the medical records of patients who were diagnosed with pancreatic adenocarcinoma and received surgery, chemoradiotherapy or chemotherapy was performed. Factors, including CA 19-9 and CEA, associated with the survival of pancreatic cancer patients were analyzed. RESULTS: Patients with the median age of 65 years were included (n=187). Elevated serum CA 19-9 levels and CEA levels were observed in 75.4% and 39% of patients at diagnosis, respectively. CEA was correlated with tumor stages (p=0.005), but CA 19-9 was not. CA 19-9 and CEA were elevated in 69.0% and 33.3% of patients with resectable pancreatic cancer, and elevated in 72.9% and 47.2% of patients with advanced pancreatic cancer, respectively. The median overall survival of the normal serum CEA group was longer than that of the elevated serum CEA group (16.3 months vs. 10.2 months, p=0.004). However, the median overall survival of the normal serum CA 19-9 group was not different from that of the elevated serum CA 19-9 group (12.4 months vs. 13.5 months, p=0.969). The independent factors associated with overall survival were advanced pancreatic cancer [harzard ratio (HR) 4.33, p=0.001] and elevated serum CEA level (HR 1.52, p=0.032). CONCLUSION: Patients with elevated serum CEA level at diagnosis demonstrated poor overall survival. Pretreatment CEA level may predict the prognosis of patients with pancreatic adenocarcinoma.

A Case of Actinomycosis in a Patient Treated with Chemotherapy Due to Recurrent Pancreatic Cancer / 대한내과학회지

A 46-year-old male patient with recurrent pancreatic cancer was admitted with a newly developed abdominal mass. The patient had a history of diabetes and underwent total pancreatectomy with partial gastrectomy followed by adjuvant concurrent chemoradiation therapy and palliative chemotherapy. Abdominal CT scan during palliative chemotherapy showed an abdominal wall mass. We performed excisional biopsy for diagnosis. Histological examination revealed actinomycosis of the abdominal wall. The patient was treated with penicillin G. This case showed that actinomycosis can occur in a patient receiving chemotherapy and may mimic cancer recurrence. Therefore, when evaluating a newly developed abdominal mass in patients who are receiving chemotherapy or radiotherapy, the probability of actinomycotic infection must also be considered, especially in patients with a history of surgery and diabetes mellitus.

A Case of Actinomycosis in a Patient Treated with Chemotherapy Due to Recurrent Pancreatic Cancer / 대한내과학회지

A 46-year-old male patient with recurrent pancreatic cancer was admitted with a newly developed abdominal mass. The patient had a history of diabetes and underwent total pancreatectomy with partial gastrectomy followed by adjuvant concurrent chemoradiation therapy and palliative chemotherapy. Abdominal CT scan during palliative chemotherapy showed an abdominal wall mass. We performed excisional biopsy for diagnosis. Histological examination revealed actinomycosis of the abdominal wall. The patient was treated with penicillin G. This case showed that actinomycosis can occur in a patient receiving chemotherapy and may mimic cancer recurrence. Therefore, when evaluating a newly developed abdominal mass in patients who are receiving chemotherapy or radiotherapy, the probability of actinomycotic infection must also be considered, especially in patients with a history of surgery and diabetes mellitus.

The Prevalence and Clinical Characteristics of Esophageal Involvement in Patients with Behcet's Disease: A Single Center Experience in Korea

While a significant amount of clinical information has been reported concerning intestinal involvement in Behcet's disease (BD), esophageal involvement in BD has not yet been studied extensively. The aim of this study was to evaluate the prevalence of esophageal involvement in BD and its clinical characteristics. We retrospectively reviewed the medical records of 842 patients diagnosed with BD at a single tertiary institution in Korea between January 1990 and June 2006. Of the 842 patients with BD, 129 patients (15.3%) experienced upper gastrointestinal symptoms that required inspection through esophagogastroduodenoscopy. Esophageal involvement was found in 6 (4.7%) of the 129 patients. The activity index of Behcet's disease did not differ among patients with or without esophageal involvement. All patients with esophageal involvement responded well to medical treatment and no one experienced serious complications. The results of our study demonstrate that the prevalence of esophageal involvement in BD is very low and that most patients with such involvement face few complications and respond well to medical treatment.

Comparison of the Naranjo and WHO-Uppsala Monitoring Centre criteria for causality assessment of adverse drug reactions / 대한내과학회지

BACKGROUND/AIMS: Several criteria have been proposed to increase the objectivity, reliability and validity of causality assessment of adverse drug reactions (ADR). We compared the Naranjo probability scale and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality categories to evaluate the validity and clinical usefulness of these criteria. METHODS: We evaluated 100 ADR cases with the Naranjo probability scale and the WHO-UMC causality categories. The Spearman rank coefficient was used to determine the correlation of these criteria. The evaluation of the ADR was categorized into four groups for the Naranjo system: definite, probable, possible, and doubtful, and six groups for the WHO UMC: certain, probable, possible, unlikely, conditional/unclassified, and unassessable. RESULTS: The criteria used form these two systems showed some differences when compared with the same ADR cases. The Spearman rank coefficient was 0.519 (p<0.001) and the agreement was 55% between the Naranjo probability scale and the WHO-UMC causality categories. The Naranjo probability scale includes measurements for drug concentration, objective evidence of ADR, ADR to previous exposures, responses to placebo, and the dose adjustment of drugs. However, few cases were evaluated for all of these measures. CONCLUSIONS: The Naranjo probability scale may be helpful for assessing unexpected ADRs and useful for evaluators with little experience. However, some of the items are not utilized and there are discrepancies when compared with the WHO-UMC causality criteria.

Efficacy of Endoscopic Resection for Small Rectal Carcinoid: A Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: Well differentiated rectal carcinoid tumors which are less than 1cm in diameter can be treated by endoscopic resection. We aimed to evaluate the efficacy of endoscopic resection in treating small sized rectal carcinoids. METHODS: Medical records of 30 rectal carcinoid cases treated by endoscopic resection in Yonsei University College of Medicine, Severance Hospital between January 1995 and March 2007 were reviewed retrospectively. RESULTS: Mean age was 49.7 years and male to female ratio was 1:0.88. Mean size of tumor was 6.29+/-3.06 mm and 25 out of 30 patients (83.3%) had tumors of diameter less than 10 mm. Twenty-two out of 30 patients treated by conventional polypectomy, 6 by endoscopic mucosal resection using a transparent cap (EMR-C) and 2 by endoscopic submucosal dissection (ESD). Histological examination revealed that 9 patients had resection margin positive for tumor; 7 (31.8%) were in polypectomy group, 1 (16.7%) in EMR-C group, and 1 (50%) in ESD group (p=0.868). Five patients underwent transanal excision to remove residual tumor. No residual tumor was found in additionally resected tissue. Mean follow-up duration was 19. 3 months (range 0-122), and there were no recurrence. CONCLUSIONS: Endoscopic resection is an effective method in the treatment of small rectal carcinoids. However, long-term outcome remains to be elucidated by a large scaled prospective study.

Two Cases of Calcinosis Cutis Combined with Rheumatologic Disease / 대한류마티스학회지

The calcinosis, dystrophic soft tissue calcification, occurs in damaged or devitalized tissues normal calcium/phosphorus metabolism. It is the subcutaneous tissues of connective tissues disease ?primarily systemic lupus erythematosus, scleroderma, or dermatomyositis - and may involve a relatively localized area. The calcinotic accumulations may result in muscle atrophy, joint contractures, and skin ulceration complicated by recurrent episodes of local inflammation and infection. Calcinosis may be the source of both pain and disability in connective tissue disease patients. While various therapeutic modality have been used, no treatment has convincingly prevented or reduced calcinosis. We report two cases of calcinosis cutis combined with rheumatic disease.

A Case of Concurrent Thymic Carcinoma with Systemic Lupus Erythematosus / 결핵및호흡기질환

A thymic carcinoma is a rare malignant neoplasm of the thymus epithelium, which can be distinguished from a benign or invasive thymoma. Contrary to a thymoma, the association of a thymic carcinoma and autoimmune disease is rare, with only a few cases having been reported. Herein, a case of thymic carcinoma diagnosed concurrently with systemic lupus erythematosus (SLE) is reported. A 49 year-old man presented at our clinic with myalgia. He was diagnosed with SLE, based on an oral ulcer, lymphopenia, and positive ANA and anti-Sm antibodies. Incidentally, a routine chest X-ray showed a large mediastinal mass. Pathological examination of the mediastinal mass revealed an undifferentiated thymic carcinoma, of WHO classification type C. Further work-up for staging showed multiple bone and lung metastases. With a palliative aim, he received systemic chemotherapy, but refused further chemotherapy after the 2nd course. Currently, the patient has not been followed up since the chemotherapy.