The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

BACKGROUND AND OBJECTIVES: Despite the favorable efficacy of new antiplatelet agents demonstrated in randomized controlled trials, their clinical implications in Korea are unclear. The purpose of this study was to investigate trends in antiplatelet agent use for acute myocardial infarction (AMI) and their impact on 30-day clinical outcomes. METHODS: AMI patients undergoing percutaneous coronary intervention between 2010 and 2015 were assessed using claim data from the Health Insurance Review and Assessment Service. RESULTS: The use of new antiplatelet agents has rapidly increased since 2013 and has been preferred over clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals) since 2015. Both prasugrel (Effient; Eli Lilly and Company) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.31–0.67; p < 0.001) and ticagrelor (Brilinta; AstraZeneca Pharmaceuticals LP) (OR, 0.84; 95% CI, 0.71–0.98; p=0.032) had an independent effect on lowering 30-day mortality in a weighted multivariable logistic regression model. However, new antiplatelet agents had no significant effect on other clinical outcomes including myocardial infarction, stroke, bleeding, and readmission within 30 days. CONCLUSION: The use of new antiplatelet agents is rapidly increasing, and they have been used more commonly than clopidogrel since 2015. We demonstrated that new antiplatelet agents have a favorable effect on reducing 30-day mortality in AMI patients in Korea.

Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness

BACKGROUND: Infarct of the anterior spinal artery is the most common subtype of spinal cord infarct, and is characterized by bilateral motor deficits with spinothalamic sensory deficits. We experienced a case with atypical anterior-spinal-artery infarct that presented with bilateral hand weakness but without sensory deficits. CASE REPORT: A 29-year-old man presented with sudden neck pain and bilateral weakness of the hands. Magnetic resonance imaging (MRI) of the brain did not reveal any lesion. His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers. Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction. CONCLUSIONS: Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

Fatal Interstitial Pneumonitis Rapidly Developed after the First Cycle of CHOP with Etoposide Combination Chemotherapy in a Patient with Lymphoma / 결핵및호흡기질환

Several chemotherapeutic agents are known to develop pulmonary toxicities in cancer patients, although the frequency of incidence varies. Cyclophosphamide is a commonly encountered agent that is toxic to the lung. Additionally, granulocyte colony-stimulating factor (G-CSF) being used for the recovery from neutropenia can exacerbate lung injury. However, most of the patients reported previously that the drug-induced interstitial pneumonitis were developed after three to four cycles of chemotherapy. Hereby, we report a case of peripheral T cell lymphoma which rapidly developed a fatal interstitial pneumonitis after the first cycle of combined chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisolone, and etoposide and the patient had also treated with G-CSF during neutropenic period.

Gecko Proteins Exert Anti-Tumor Effect against Cervical Cancer Cells Via PI3-Kinase/Akt Pathway

Anti-tumor activity of the proteins from Gecko (GP) on cervical cancer cells, and its signaling mechanisms were assessed by viable cell counting, propidium iodide (PI) staining, and Western blot analysis. GP induced the cell death of HeLa cells in a dose-dependent manner while it did not affect the viability of normal cells. Western blot analysis showed that GP decreased the activation of Akt, and co-administration of GP and Akt inhibitors synergistically exerted anti-tumor activities on HeLa cells, suggesting the involvement of PI3-kinase/Akt pathway in GP-induced cell death of the cancer cells. Indeed, the cytotoxic effect of GP against HeLa cells was inhibited by overexpression of constituvely active form of Akt in HeLa cells. The candidates of the functional proteins in GP were analyzed by Mass-spectrum. Taken together, our results suggest that GP elicits anti-tumor activity against HeLa cells by inhibition of PI3-kinase/Akt pathway.

Multiple Ischemic Stroke as an Initial Manifestation of a Concealed Pancreatic Adenocarcinoma

No abstract available.

A Case of Desmoplastic Malignant Mesothelioma

Malignant mesothelioma (MM) is a rare tumor that associated with asbestos exposure. For the reliable diagnosis, the adequate representative tissue samples are essential for the histology and immunohistochemical staining. We report a case of desmoplastic malignant mesothelioma (DMM), accounting for only 5 to 10% of all MM and having poor prognosis. A 76-year-old male visited emergency room presenting with chest pain. Chest computed tomography showed focal lobulated pleural enhancing mass in posterior aspect of left upper lobe. After video-assisted thoracoscopic surgery and several immunohistochemical stains, we could diagnose as DMM. The patient refused chemotherapy, but received analgesics and palliative radiation for the painful back area. Subsequently, he was transferred to hospice clinic after 17 months from appearance of the initial symptom.

Bronchopathia Osteochodroplastica Mimicking Lung Malignancy / 대한흉부외과학회지

Tracheobronchopathia osteochondroplastica (TO) is an uncommon benign disease of an unknown etiology and it affects the cartilaginous walls of large airways. Most cases of TO have been reported to involve the lower two-thirds of the trachea and the proximal bronchi. Unlike the usual cases of TO, exclusive bronchial involvement and the formation of a solitary mass are very rare. We experienced an unusual case that had exclusive bronchial involvement and the formation of a solitary mass and this all mimicked lung malignancy. After surgical resection, we were finally able to diagnose the mass as bronchopathia osteochondroplastica.

Myocardial Infarction in a Young Man due to a Hypoplastic Coronary Artery

Hypoplastic coronary artery disease (HCAD) is a rare condition that may lead to myocardial infarction (MI) and sudden death. We discovered HCAD in a young man who developed chest pain after heavy drinking and who was found to have suffered an MI. His ECG showed ST-segment elevation with Q waves in the anterior leads, and echocardiography revealed apical dyskinesia with moderate left ventricular (LV) dysfunction. Coronary angiography showed hypoplasia of the left anterior descending (LAD) artery. (99m)Tc-tetrofosmin-gated myocardial perfusion scintigraphy showed a large, fixed perfusion defect in the anteroseptal and apical segments. Sixty-four-slice cardiac CT and cardiac MR imaging demonstrated thinning of the apical wall with calcification and delayed enhancement, supporting the diagnosis of long-standing MI. The patient was discharged symptom-free on medication for ischemic heart failure two weeks after admission. Although HCAD is very uncommon, it should be considered in children and young adults who suffer MI or sudden cardiac death.

A case of alveolar rhabdomyosarcoma of the uterine cervix / 대한산부인과학회지

Uterine rhadomyosarcoma (RMS) is a rare tumor accounting for 2~6% of the patients with uterine malignant neoplasm and it happens under 1% of the patients with genitourinary malignancies. RMS can be classified in four types; embryonal, alveolar, pleomorphic, and undifferenciated. About twenty percent of RMS occurs in the genitourinary tract, with sligtly more than half being embryonal rhadomyosarcoma. Alveolar rhabdomyosarcoma (ARMS) of the uterine cervix is very rare. Emerich et al. reported the first case of ARMS of the cervix in 1996. So, little information is available regarding its prognosis and therapy. We report a case of a 56 year-old woman with ARMS of the uterine cervix with a review of the literature. She was received the operation and radiotherapy. She has since been disease-free. We herein report a case of very rare ARMS of the cervix.

TRAIL-induced cell death and caspase-8 activation are inhibited by cisplatin but not carboplatin / 부인종양

OBJECTIVE: Platinum (Pt) based drugs including cisplatin and carboplatin are widely used as anticancer drugs in various human cancers. Many studies have shown that chemotherapeutic agents synergistically enhance cell death induced by death ligands. However it has been recently reported that cisplatin may inhibit tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced cell death through inactivation of caspases. Thus, we investigated whether carboplatin also inhibits TRAIL-induced cell death. METHODS: HeLa cells were treated with TRAIL in the presence of cisplatin or carboplatin, and cell death was analyzed using the crystal violet staining method. Caspase activation was checked through detection of Bid cleavage by Western blotting using anti-Bid antibody. RESULTS: Cisplatin inhibits TRAIL-induced cell death in HeLa cells; however, carboplatin enhanced TRAIL-induced cell death. Whereas cisplatin inhibited caspase-8-mediated Bid cleavage, carboplatin had no effect on caspase-8 activity. CONCLUSION: Although cisplatin and carboplatin are platinum-containing cancer therapeutic agents, they have the opposite effects on TRAIL-induced cell death.

The effectiveness of thermal uterine balloon therapy in patients with abnormal uterine bleeding / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness and safety of uterine thermal balloon ablation therapy (UBT) for the treatment of abnormal uterine bleeding . METHODS: From May 2005 to June 2007, a total of 40 women who visited to our hospital and Wallace memorial baptist had their charts and telephones reviewed for demographics, procedure data, clinical history, and follow up. RESULTS: The mean age was 43.5+/-4.7 years old. A decrease in days per cycle (7.2+/-2.5 vs 5.2+/-2.7 days, P<0.0001), and in pads per day (9.9+/-2.3 vs 5.8+/-3.1 pads/d, P<0.0001) and an increase in hemoglobin (g/dL, mean+/-SD) /hematocrit (%, mean+/-SD) (7.2+/-0.5/29.4+/-2.7 vs 10.3+/- 1.7/36.4+/-4.4, P<0.0001) and an improvement in self-reported quality of life scores (discomfort score: 7.1+/-2.1 vs 2.5+/-1.7, P<0.0001, limitation of life: 1.9+/-1.5 vs 0.6+/-1.5, P<0.0001) were observed after UBT. Assessment of the level of satisfaction showed that 76% of patients were satisfied with the procedure. No major complications or deaths were found. The prognostic factors of UBT were age, parity, uterine pressure and depth, position. But age and uterine pressure had no significant difference statistically. CONCLUSION: UBT is a safe and efficient method to treat abnormal uterine bleeding. It reduces the menstrual flow, improves the quality of life, and remarkably satisfies patients with a desire to preserve a uterus.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

Development of a Multidisciplinary Care System for Lung Cancer Patients

PURPOSE : Since the year 2000, lung cancer has been the leading cause of cancer death in South Korea and also in many other parts of the world. MATERIALS AND METHODS : We developed a multidisciplinary (MD) care system for lung cancer patients in 1996. Here, we report the results obtained in the process of development of MD team (MDT). RESULTS : The MDT was launched with including medical doctors, chest surgeons, radiation oncologists, radiologists, nuclear medicine specialists and physician assistants. To facilitate co-operation between the MDT members, a specialized out-patient clinic was located within a sector of the hospital. A common ward was allocated for lung cancer patients regardless of the department of the attending physician. Shared electronic medical record forms that were specialized for lung cancer were developed. The MDT operates weekly lung cancer conferences and multidisciplinary out-patient clinics. To make diagnostic or therapeutic decisions early on, the electronic medical records of the patients were previewed or consulted by the specialists before they meet the individual patients. CONCLUSION : Despite every effort, we still need to shorten the waiting time from presentation to the first treatment and we need to improve the patients' satisfaction. We also have a mission to develop our own regulations and guidelines for our lung cancer MD care system. Clinical trials and basic research should also be encouraged along with improving the quality of life of the team members

Clinical Features and Adequate Indication of CRRT in Severely Burned Patients

PURPOSE: Acute renal failure is not a rare event in severe burns and the prognosis of a burn patient becomes remarkably unfavorable with the onset of renal insufficiency. Several studies have reported that the incidence of ARF in severe burns is 0.5 ~ 30% and the mortality rate is 73 ~ 90%. This study analyzed the clinical features of severe burns requiring continuous renal replacement therapy (CRRT) to determine the adequate indication for CRRT. METHODS: Thirty-nine patients requiring CRRT out of 492 burned patients who were admitted to the burn intensive care unit in the Burn center, Hangang Sacred Heart Hospital from January 2003 to December 2004, were reviewed. CRRT was indicated when azotemia, fluid overload, acidosis, or hyperkalemia were observed. The APACHE II score, BUN, creatinine, creatine kinase, bicarbonate and base excess were analyzed at admission and at the initiation of CRRT for the survival group and non-survival group. RESULTS: The incidence of ARF requiring CRRT in severely burned patients was 7.9%. The average of burn area was 51.1%. The mean delay in initiating CRRT was 16.6 days and the mean duration of CRRT was 7.0 days. There was no difference between the survival group and the non- survival group in the data obtained upon admission, but there was a significant difference in the BUN level at the initiation CRRT. Therefore, the BUN level at the initiation CRRT has corelation with the mortality. CONCLUSION: CRRT is helpful for treating severely burned patients who have ARF, particularly those with accompanying with hemodynamic instability. This study showed that the BUN level at the initiation of CRRT associated with mortality. Therefore, the BUN level is an important criterion for initiating CRRT in these patients. However, a prospective randomized control study will be needed to accurately define BUN level.

The Usefulness of Air Insufflation Helical CT in Colorectal Cancer

PURPOSE: In patients with colorectal carcinoma, helical CT using air as a contrast agent provides axial images and a three-dimensional CT colonogram similar to that provided by barium enema. The purpose of this study was to assess the usefulness of air insufflation helical CT in colorectal cancer patients. MATERIALS AND METHODS: Thirty-three patients with colorectal carcinoma confirmed by surgery underwent air insufflation helical CT scanning after the infusion of air through the anus. In eleven who underwent barium studies, CT colonograms were also obtained. Two radiologists, who reached a consensus, analysed the detection rate, location and staging of the tumors; staging was based on the modified Dukes (Astler-Coller) classification. RESULTS: Using axial helical CT, the detection rate was 97%; staging was correct in 23 of the 33 patients, with an overall accuracy of 70%. Pathologic correlation was correct in 30 of the 33 cases (three were overestimated), and sensitivity, specificity and accuracy were 100%, 50%, and 91%, respectively. With regard to the involvement of lymph nodes, pathologic correlation was correct in 25 of the 33 patients; four were overestimated and four were underestimated. Sensitivity, specificity and accuracy were 69%, 80%, and 76%, respectively. The detection rate of CT colonography was 100%, but because in one case there was a discrepancy between CT colonography and barium enema as to the shape of the carcinoma, the agreement rate was 91%. CONCLUSION: Air insufflation helical CT, which provides a higher detection rate and more precise staging of colorectal carcinoma than the use of positive contrast materials and three dimensional depiction of tumor location, is helpful for the evaluation of colorectal carcinoma.

Diffusion Weighted MR Image of Intracranial Hemorrhage

PURPOSE: To determine changes in the signal intensity of intracerebral hemorrhagic lesions according to the time interval, between the onset of symptoms and MR imaging in the T1-weighted (T1W1), T2-weighted (T2W1) and diffusion-weighted modes. MATERIALS AND METHODS: Thirty-four patients with hemorrhagic stroke who underwent DWI and conventional MRI were involved in this study. Hemorrhagic phase was determined according to the time interval between the onset of symptoms and MR scanning, and was as follows: acute (3 days or less): eight patients); early subacute (7 days or less): ten patients; late subacute (4 weeks or less): seven patients; early chronic (3 months or less) : four patients); and late chronic (more than 3 months): five patients. Using a 1.5T MR imager and the single-shot echo-planar imaging technique, T1-weighted, fast spin-echo T2-weighted, and diffusion-weighted were obtained. In all cases qualitative signal intensity (SI) at the center of a lesion was recorded, and the ratio between this and normal brain parenchyma was calculated. RESULTS: SI at the center of a lesion was found to be iso or high/high/high (T1WI/T2WI/DWI) in five of eight acute-phase cases (interval of 24 hours or less) and low/low/low in the remaining three (interval of 72 hours or less). Other signal intensities were as follows: early subacute phase: high/low/low (all ten cases); late subacute phase: high/high/high (all seven cases); early chronic phase: high/high/high (all four cases); late chronic phase: low/high/low (all five cases). Mean SIRs were as follows: in the five acute-phase cases in which SI was iso or high: 1.42+/-0.78 / 2.58+/-0.84 / 1.35+/-0.08 (T1WI / T2WI / DWI); in the remaining three acute-phase cases: 0.94 +/-0.18 / 0.63+/-0.16 / 0.27+/-0.10; in the early subacute phase, 1.35+/-0.01 / 0.97+/-0.21 / 0.86+/-0.22 in early subacute phase, 1.58+/-0.04 / 1.54+/-0.09 / 1.44+/-0.14; in the early chronic phase: 1.26+/-0.11 / 1.06+/-0.14 / 0.97+/-0.12; and in the late chronic phase: 0.65+/-2.23 / 1.51+/-0.12 / 0.23+/-0.18. CONCLUSION: The DWI findings of intracerebral hemorrhage reflect the findings of T2WI. When interpreting the DWI findings in patients with intracerebral hemorrhage, an understanding of the temporal evolution of this is very helpful.

Calcified Mesoblastic Nephroma in an Adult: A Case Report

Mesoblastic nephroma is an uncommon renal tumor reported in infants but rarely in adults. We describe a case of calcified mesoblastic nephroma occurring in an adult. It is difficult, on the basis of radiologic images, to differentiate between calcified mesoblastic nephroma and calcified renal cell carcinoma.

The Effect of the Swimming Exercise on Functional Recovery after Experimental Contusive Spinal Cord Injury in the Rats

OBJECTIVE: This study was designed to see the effect of swimming exercise in the rats after experimental contusive spinal cord injury. METHOD: Twenty six Sprague-Dawley rats (weight, 300 to 350 g) were divided into control (n=9) and experimental swimming groups (n=17). With the Spinal Cord Dropping Device (NYU, U.S.A.), contusive injury to the spinal cord was induced at the eighth thoracic level in both groups. Rats of the experimental group put to swim for 5 minutes a day during the second week and then swimming times a day were increased in one number to each week. But the other ten rats were remained without swimming exercise as the control. Functional recovery of the hind limb was evaluated by the inclined board plane test, the Bassoe Beattie Bresnahan (BBB) locomotor rating scales and histological findings of injured spinal cord. RESULTS: 1) Upward maximal angles of the inclined plane test were significantly greater in experimental group than control group after 10 days post-injury (p<0.05). 2) BBB scores were higher in experimental group than control group at 14 days after injury (p<0.05). CONCLUSION: This study suggests that swimming applied from the early phase after spinal cord injury be beneficial in the early recovery of motor function.

Total Hip Replacement Arthroplasty in Tuberculous Arthritis of the Hip / 대한정형외과학회잡지

Although the incidence of tuberculous arthritis of the hip is being decreased with improvement of hygiene, preventive measures and chemotherapy, it remains as important disease in orthopedic surgery. In the tuberculous arthritis of the hip, eradication of the disease with improvement of joint function is ideal treatment. But classical treatment of anti-tuberculous chemotherapy, synovectomy, and especially hip fusion which was done in most cases in adults, have their own limitation in functional results. Recently the methods of total hip replacement arthroplasty done in tuberculous arthritis with treatment of infection by antituberculous chemotherapy reported good results. During the period from January 1970 to December 1984, total hip replacement arthroplasty were done in 55 patients of tuberculous arthritis of the hip in Seoul National University Hospital. The average follow-up period was 3 years and 1 months. And, the following results were obtained. l. of the 55 cases, 50 cases(90.9%) were resulted in success without reactivation of tuberculosis, and 5 cases(9.1%) were resulted in failure. In those cases, the follow-up period were more than 1 year. 2 . The average period of immediate preoperative anti-tuberculous chemotherapy was higher in the success cases with 10.0 weeks than in the failure cases with 4.5 weeks. 3 . The average preoperative ESR was lower in the success case with 12.4mm/ hr than in the failure cases with 28mm/hr. 4 . Failure cases were restricted to active cold abscess in operative finding. 5. The positive bacteriology was fewer in the success cases with 4% than in the failure cases with 60%. 6. Follow-up functional results of the success cases were superior to any other methods of treatment. It is our conclusion that preoperative anti-tuberculous chemotherapy is important to reduce inflammatous reaction, and although granulation or caseation necrosis is found in operation field, total hip replacement can be successful if there is no active cold abscess.