Factors Associated with Burnout among Healthcare Workers during an Outbreak of MERS

Objective@#Although healthcare workers (HCWs) experienced significant stress during the 2015 outbreak of Middle East Respiratory Syndrome (MERS), the factors associated with this stress remain unknown. Thus, the present study assessed burnout among HCWs during the MERS outbreak to identify the influential factors involved in this process. @*Methods@#This study was a retrospective chart review of the psychological tests and questionnaires completed by 171 hospital employees from two general hospitals that treated MERS patients. The tests included the Oldenburg Burnout Inventory, Positive Resources Test, the questionnaires assessed exposure to the MERS outbreak event and perceptions about MERS. @*Results@#Of the 171 HCWs, 112 (65.5%) experienced disengagement and 136 (79.5%) suffered from exhaustion. Disengagement was associated with lower levels of purpose and hope, a higher perception of job risk, and exposure to the media. Exhaustion was associated with lower levels of purpose and hope, a higher perception of little control of the infection, a higher perception of job risk, prior experience related to infections, and being female. @*Conclusion@#Our results revealed the risk and protective factors associated with burnout among HCWs during an outbreak of MERS. These findings should be considered when determining interventional strategies aimed at ameliorating burnout among HCWs.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Psychiatric Findings in Suspected and Confirmed Middle East Respiratory Syndrome Patients Quarantined in Hospital: A Retrospective Chart Analysis

OBJECTIVE: Little is known about the psychiatric complications or risk factors for depression in suspected or confirmed Middle East Respiratory Syndrome (MERS) patients quarantined in hospital. METHODS: A retrospective chart review was performed of all the patients admitted to the acute MERS inpatient unit at the NMC during the 2015 outbreak. RESULTS: 30 (75%) were confirmed to be MERS-CoV positive among 40 admitted cases. Among the 24 MERS survivors, 17 (70.8%) exhibited psychiatric symptoms and 10 (41.7%) received a psychiatric diagnosis and medication during their hospital stay. Suspected MERS patients did not exhibit psychiatric symptoms or receive a psychiatric diagnosis. 27 suspected or confirmed MERS patients (age 41.15±18.64, male 37.0%) completed psychological assessments. A multiple linear regression analysis revealed that the Korean National Health and Nutrition Examination Survey-Short form and the Impact of Event Scale-Revised scores were significantly positively correlated with Patient Health Questionnaire-9 scores. CONCLUSION: Our findings indicate that the acute treatment of MERS-CoV infections in quarantine had a significant impact on the patients’ mental health. Furthermore, assessment of the risk factors for depression may identify vulnerable patients who require psychiatric care and attention during hospital quarantine.

Subcortical Ischemic Change as a Predictor of Driving Cessation in the Elderly

OBJECTIVE: Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS: Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into ‘now driving’ and ‘driving cessation (driven before, not driving now)’. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS: In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p < 0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from ‘now driving’ state to ‘driving cessation’ state over time in the elderly (β=-0.508, p < 0.001). CONCLUSION: In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.

Reliability and Validity of the Korean Version of the PTSD Checklist Civilian Version in North Korean Defectors / 신경정신의학

OBJECTIVES: This study was conducted for development of the Korean version of the Posttraumatic stress disorder (PTSD) Checklist civilian version (PCL-C) by evaluating its reliability and validity for the North Korean defectors population. METHODS: A total of 69 North Korean defectors participated in this study. All patients were recruited from the psychiatric outpatient or inpatient ward. We categorized the participants into two groups according to the Clinician-Administered PTSD Scale (CAPS) diagnosis of PTSD (PTSD, n=32 ; Non-PTSD, n=37). All Subjects completed psychometric assessments, including the PCL-C, Minnesota Multiphasic Personality Inventory (MMPI-PTSD), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). RESULTS: Findings provided support for psychometric properties of the Korean version of the PCL-C. The PCL-C showed good internal consistency (Cronbach alpha=0.93), and a significantly positive correlation with CAPS and MMPI-PTSD (r=0.47, r=0.61, respectively). The optimal cutoff point of PCL-C for the North Korean defectors was at a total score of 56 with sensitivity and specificity of 0.88, and 0.50, respectively. CONCLUSION: Overall, the Korean version of the PCL-C appears to be a valid and reliable measure of PTSD symptoms among the North Korean defectors.

Clinical Characteristics and Use of Psychotropic Agents among HIV-Infected/AIDS Patients Referred for Psychiatric Consultation / 정신신체의학

OBJECTIVES: This study aimed to investigate the psychiatric status of HIV-infected/AIDS inpatients in a general hospital over the past 2.5 years. METHODS: A retrospective chart review was conducted of psychiatric consultations performed between January 1, 2011, and July 30, 2013. The records of 97 HIV-infected/AIDS patients were analyzed. These included a total of 282 psychiatric consultations. RESULTS: Of the 97 patients, 91(93.8%) were male, the mean age was 48 years, and mean number of consultations was 2.8. Depressed mood was reported in 102 consultations(23.8%), insomnia in 60(14.0%), and anxiety in 31(7.2%). Psychiatric disorders diagnosed on initial consultation included depressive disorder(37 patients ; 37.0%), cognitive disorder(11 ; 11.0%), and delirium(9 ; 9.0%). Recommended psychotropic medication included Lorazepam(99 ; 17.2%), Escitalopram(90 ; 15.7%), and Quetiapine(84 ; 14.6%). CONCLUSIONS: The main complaints of HIV-infected/AIDS patients were depressed mood, insomnia, and suicidal ideation(including suicide attempts). In total, 85(93.3%) patients of those consulted were diagnosed as meeting the criteria for a psychiatric condition. However, considering that only 16.9% of patients consulted received follow-up treatment, longitudinal research is needed to examine the influence of psychiatric disorders on the transmission of HIV-infection/AIDS, as well as on prognosis and treatment adherence.

The Effect of Subjective Physical and Mental Health on Cognitive Decline in the Elderly

OBJECTIVES: The aim of this study was to describe subjective physical and mental health assessed by the single item self-rated physical health (SRPH), and self-rated mental health (SRMH) had influence on the cognitive decline in community-dwelling elderly. METHODS: This study was based on the Suwon Project, a cohort comprising of non-random convenience samples of ethnic Koreans aged 60 years and above. 1,356 individuals were assessed at 2 time points 2 years apart for questionnaire which included demographic characteristics, medical history, Korean Mini-Mental State Examination (K-MMSE), Korean version of Geriatric Depression Scale (SGDS-K), SRPH, and SRMH. Multiple logistic regression was used to assess K-MMSE score change from the SRPH, and SRMH. RESULTS: At baseline, both SRPH (beta=0.18, p<0.01) and SRMH (beta=0.19, p<0.01) score positively associated with the K-MMSE score. At follow-up, subjects with baseline lower SRMH score had significantly greater decline in K-MMSE score (beta=0.09, p=0.007). However, baseline SRPH score showed no effect to follow up K-MMSE score before and after adjusting age, sex, education, number of chronic disease, SGDS-K, and baseline K-MMSE score (p=0.89). CONCLUSION: Brief and easily collected subjective mental health may predict the risk of cognitive decline, but subjective physical health may not.

The Effects of Triallelic Serotonin Transporter Gene Polymorphism and Stressful Life Event on Depression in Patients with Alcohol Dependence

OBJECTIVES: The purpose of this study is to investigate the relationship between the triallelic serotonin transporter gene and stressful life events to determine their effect on depression with alcohol dependence. METHODS: Ninety-five hospitalized patients with alcohol dependence (73 male, 22 female) were enrolled in this study. Thirty-two (33.7%) of the total patients were diagnosed with major depressive disorder and dysthymic disorder by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV. The characteristics of stress were evaluated using the stressful life events scale, and depressive symptoms were assessed using the depression scale (Beck Depression Inventory, BDI). Alcoholism with depression (n = 32) and alcoholism without depression (n = 63) were genotyped for the triallelic serotonin transporter gene (LA : higher expressing allele, LG/S : lower expressing allele). RESULTS: There was no significant difference in the allele frequency between the depression group and the non-depression group (chi2 = 0.345, p = 0.619). LG/S alleles had more comorbid depression in the higher score of stressful life events scale [Mental-Haenszel (MH)-chi2 = 4.477, p = 0.034]. But there was no significant difference in the comorbidity according to the scores from the stressful life event scale in the LA alleles (MH-chi2 = 0.741, p = 0.399). In the results, alcohol-dependent individuals with LG/S alleles had more comorbid depression than those with LA alleles when they had experienced severe stressful life events (MH-odds ratio = 2.699, p = 0.028). CONCLUSIONS: These results suggest that there is no direct relationship between triallelic serotonin transporter gene and depression in the alcohol dependent patients. But alcohol dependent individuals with the lower expressing alleles of the serotonin transporter gene were more susceptible to depression than those with the higher expressing alleles in response to stressful life events.

A Study of Psychiatric Problems of North Korean Refugees Who Visited a Psychiatric Clinic / 수면정신생리

PURPOSE: According to the statistics announced by the Ministry of Unification, the number of North Korean refugees living in South Korea has increased by 200 on average monthly in 2010. The number of refugees increased only by 300 annually until 2000. The total number of refugees as of February 2012 was 20,956. This study aims to investigate the psychobiology of the North Korean refugees who consulted psychiatric clinics among those living daily life in South Korea. METHODS: The subjects of this study were 85 North Korean refugees that consulted psychiatric clinics from January 1, 2005 to July 2011. This study obtained demographic and psychiatric information in a retrospective approach. RESULTS: Among the 85 North Korean refugees, 75 (88.2%) were females and their average age was 48 years of age. A total of 16 (18.8%) were admitted to a clinic and among the inpatients, 4 were admitted twice and two were admitted three times. As for the claimed symptoms of outpatients, insomnia was shown in 47 (55.3%) patients, headaches in 37 (43.5%), anxiety in 20 (23.5%), depression in 19 (22.4%), etc. The major symptoms represented by inpatients were insomnia in 14 (87.5%) patients, depression in 12 (75%), and headaches in 8 (50%), etc. CONCLUSION: The most frequent psychiatric symptoms of North Korean refugees living in South Korea were insomnia and headaches. It suggests that when performing psychiatric diagnosis and treatment of North Korean refugees, we have to take into consideration the fact that they claimed the physical symptoms more than the emotional ones. Also, from the aspect that most symptoms of North Korean refugees were insomnia, more profound research on sleep is required in the future.

Psychiatric and Psychological Characteristics of Sexual Offenders in Korea / 신경정신의학

OBJECTIVES: In an effort to increase understanding of the relationship between sexual violence and mental illness, we conducted an investigation of the prevalence of psychiatric illness and associated psychological features of sexual offenders. METHODS: Twenty-two male sex offenders were referred for psychiatric diagnosis from the prosecutor's office and admitted to the hospital between August 2010 and May 2011. In order to identify Axis I and II disorders, including sexual disorders, we conducted the Korean version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. All participants completed psychological assessment batteries, including the Korean-Wechsler Adult Intelligence Scale, and self-report scales, including the Barratt Impulsiveness Scale, State-Trait Anger Expression Inventory, and the Rape Myth Acceptance Scale. Information on participants' legal, personal, and psychiatric family histories was also gathered. RESULTS: Many of the participants received diagnosis of Axis I disorders : Eight subjects (36.4%) had paraphilia, and five (22.7%) had pedophilia. Two subjects (9.1%) had schizophrenia, five (22.7%) had depressive disorder, and three (13.6%) had alcohol dependence. Participants also showed high rates of Axis II disorders : four of them (18.2%) had mental retardation or borderline intellectual functioning and seven (31.8%) had cluster B personality disorders. Participants' serum free testosterone level showed statistically significant correlation with motor impulsiveness (p<0.05). CONCLUSION: Sex offenders included in this study displayed high rates of mental illness, including paraphilia and intellectual disability. On the basis of our findings, we asserted that sex offenders should undergo careful evaluation for mental illness, and that management programs for sex offenders should include psychiatric evaluation and intervention.

Relationship between Social Activity and Cognitive Function in Korean Elderly

OBJECTIVES: Among non-pharmaceutical measures for preventing cognitive impairment, involving in social activities is known to be very effective. We tried to examine the correlation between social activity and cognitive function. METHODS: This study was based on the Suwon Project, a cohort comprising of non-random convenience samples of ethnic Koreans aged 60 years and above. All the subjects completed the study questionnaire which included demographic characteristics, current and past history of illnesses, drug history, Korean version of Mini Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale, and Beck Anxiety Inventory. We checked the time consumed in each 9 social activities through the checklist. RESULTS: On multiple logistic regression analysis, the total time spent in social activities wasinversely associated with the K-MMSE score after adjusting confounding variables like age, sex, education level, depression, anxiety and vascular risk factor (beta=-0.041, p=0.024). On the other hand, correlation was found between K-MMSE score and time spent in participating in religious party (beta=0.053, p=0.003) as well as time spent in elder's university (beta=0.040, p=0.025) after adjustingage, sex, education, depression, anxiety and vascular risk factor. CONCLUSION: Our results suggest that involving in quality social activities might be more effective in improving cognitive function than spending longer total time in any social activity.

Six Cases of Reconstruction with Latissimus Dorsi Pedicled Flap for Head and Neck Defects in the Era of Free Flap Reconstruction / 대한이비인후과학회지

Reconstruction with free flaps has become the choice of reconstruction for most patients with head and neck defects. However, pedicled flaps, such as pectoralis major pedicled flap and latissimus dorsi pedicled flap (LDPF), can also be used instead in selected patients. We performed LDPFs in 6 patients from November 2007 to September 2009. Five of the patients were females with either vascular diseases or large skin defects, or they were highrisk old patients. One male patient received LDPF as a salvage after tongue reconstruction with a free flap failed. Various types of head and neck defects were effectively managed with LDPF without complications. LDPF can be one option for head and neck reconstruction especially in patients who may hve high risk in undergoing free flap reconstruction.

Pseudocyst of the Vocal Fold: Distinct Disease Entity or Not? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Koufman described a pseudocyst of the vocal folds for the first time in 2001. A pseudocyst in all parts of the body and that is related to secretory glands is already well known, but such a lesion of the vocal folds has only been mentioned a few times. It is unclear whether or not to define a pseudocyst of the vocal folds as a benign lesion of the vocal folds. The objective of this study was to introduce the demographic and clinical findings of pseudocyst and to discuss our diagnostic and therapeutic strategies. SUBJECTS AND METHOD: We carried out a retrospective review of all the medical records, the preoperative voice lab results and the operation records from 2006 to 2009. All the patients underwent laryngomicrosurgery due to benign vocal folds lesions. We select 11 cases that showed subepithelial lesion without a definite capsule. RESULTS: Seven patients had had the history of voice abuse. One patient has been a smoker, another was an ex-smoker and the others were non-smokers. According to aerodynamic assessment, the maximum phonation time was 14.6 seconds and the mean airflow was typically increased. On laryngoscopy, all were translucent and spherical or fusiform subepithelial lesions. The preoperative stroboscopic findings showed a uniform feature of damping on the vocal fold lesion. Both the unroofing technique and the microflap technique were used. CONCLUSION: A pseudocyst would be a subepithelial lesion without a definite epithelial lining that contains serous discharge. We suggest that a pseudocyst of the vocal fold is a new benign lesion.

A Case of Schwannoma of the Mouth Floor Mistaken as a Ranula / 대한이비인후과학회지

Schwannoma is a relatively slow-growing, encapsulated benign tumor that is derived from the Schwann cell of the nerve sheath. We report here on a case of schwannoma of the mouth floor with a review of the literature. A 67-year-old woman presented with a right mouth floor mass, which was first detected 5 years ago. The preoperative diagnosis was ranula on the basis of the physical findings and the computerized tomographic findings. However, the mass was found to be a true neoplastic lesion rather than a cystic lesion in the course of surgical dissection. The permanent pathologic report of the mass was schwannoma. Postoperatively, although the patient had no problem with taste, the pain-sense, speech and swallowing, she had mild deviation of the tongue towards the same side of the mass, which means that the function of the hypoglossal nerve was somewhat impaired. Her tongue deviation was spontaneously resolved within 6 weeks postoperatively.

Relationship between Physical Activity and Cognitive Function in the Elderly

BACKGROUND: Physical activity is considered an effective non-pharmaceutical preventive measure against cognitive impairment. This study was designed to investigate the correlation between physical activity and cognitive function. METHODS: Subjects were recruited from the Suwon Project, a cohort comprising a nonrandom convenience sample of ethnic Koreans aged 60 years or older. All participants completed study questionnaires which included questions about demographic characteristics, current and/or past medical history, and drug history. Cognitive functions were evaluated using the Korean version of Mini-Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale and Beck Anxiety Inventory. The total time spent to complete 10 physical activities was recorded on a daily basis. RESULTS: The total amount of time spent to execute 10 physical activities was 91.9+/-98.9 minutes per day. K-MMSE score was significantly associated with the duration of physical activity after adjustment for age, sex, educational level, depression, anxiety, and underlying diseases using multiple logistic regression analysis (beta=0.002, p<0.05). Categorizing physical activities into three groups by intensity yielded an interesting result; moderate intensity group demonstrated a direct correlation with cognitive function (beta=0.002, p<0.05). CONCLUSION: Although much remains to be elucidated, our results suggest that physical activity may be associated with cognitive function, after controlling for covariates.

Relationship Between Anxiety and Stroke Warning Signs in the Elderly

OBJECTIVES: We aimed to investigate the relationship between anxiety and stroke warning signs in the elderly. METHODS: Data obtained from 1,078 subjects (256 men and 822 women) aged above 65 years was analyzed from Suwon Project, which was a cohort comprising of nonrandom convenience samples. All the subjects completed the study questionnaire including their demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), SGDS-K (Korean version of the Geriatric Depression Scale-Short Form), BAI (Beck Anxiety Inventory). Stroke warning signs were defined as 5 stroke warning signs consistent with the American heart association public health message. RESULTS: There was significant relationship of anxiety and the number of stroke warning signs after adjusting age, sex, educational level and depression (beta=2.145, p<0.0001). On analysis of covariance, the interaction of the number of experienced stroke warning signs with sex on anxiety was observed after adjusting for the age, educational level, K-MMSE, and SGDS-K (p=0.011). CONCLUSION: These results suggest that there was significant relationship of anxiety and stroke the elderly.

Relationship between Mental Activity and Cognitive Function in Community-Dwelling Elderly

OBJECTIVES: The purpose of this study was to describe the status of mental activity participation in community-dwelling elderly and to evaluate the association between mental activity and cognitive function after adjustment for depression and anxiety. METHODS: This study was based on the Suwon Project, which was a cohort comprising of nonrandom convenience samples of ethnic Koreans aged 60 years and above. All the subjects completed the study questionnaire including their demographic characteristics, current and past illnesses history, drug history, Korean version-Mini Mental State Examination (K-MMSE), Korean version of Short Form Geriatric Depression Scale (SGDS-K), Beck Anxiety Inventory (BAI). We checked how many hours per day are used for each items of 11 mental activities through the checklist. RESULTS: Total time spent in 11 mental activities was 237.4+/-152.4 minutes per day. On multiple regression analysis, total time spent in 11 mental activities (MA-total), and time spent by watching television and reading book/newspaper showed statistically significant association with K-MMSE score after adjustment with age, sex, education, chronic medical illness, depression and anxiety. CONCLUSION: Our result suggested that mental activity may be associated with cognitive function in the elderly without cognitive impairment in the community after adjusting age, sex, education, chronic medical illness, depression and anxiety.

Acute Mastoiditis Cases Mandating Simple Mastoidectomy

Acute mastoiditis continues to be a potentially dangerous infection in the antibiotic era. Despite use of antibiotics to treat suppurative acute otitis media in children, the incidence of subsequent development of acute mastoiditis and its complications, including periauricular subperiosteal abscess, facial paralysis, meningitis, and brain abscess has not plunged down below a certain level. Mastoidectomy has been the routine procedure for treating acute mastoiditis with subperiosteal abscess but recently many authors suggest that subperiosteal abscess complicating acute coalescent mastoiditis can be successfully treated by broad-spectrum antibiotics, myringotomy, and minor surgical procedures such as incision and drainage, not necessarily requiring simple mastoidectomy. Contrary to the recent trend shift from a surgical disease to a medical disease, we report two consecutive acute mastoiditis cases definitely mandating simple mastoidectomy to emphasize the role of surgical intervention even in the recent trend shift from a surgical to a medical disease.

Analysis of Molecular Cytogenetic Alteration of Pancreatic Cancer Identified by Fluorescent In Situ Hybridization (FISH) and its Clinical Significance

PURPOSE: The purposes of this study are to examine the cytogenetic alterations of pancreatic cancer, by using fluorescent in situ hybridization (FISH), to determine thier correlation with the clinico-pathologic prognostic factors and to identify the cytogenetic factors that can predict the prognosis of pancreatic cancer. METHODS: Fresh frozen tissues of pancreatic cancer and normal pancreas that were obtained via pancreatic resection from 20 patients with pancreatic ductal adenocacinoma were analyzed by performing FISH with using locus-specific c-myc, p16, p53 probes and chromosome 18q, 20q probes. We cpmpared the FISH results with the clinico-pathologic prognostic factors. We also examined 16 paraffin-embedded tissues of pancreatic cancer by performing immunohistochemical staining (IHC) with monoclonal antibody to c-myc, p16, p53 and DPC. We then evaluated the correlation between the results of FISH and the results of IHC. RESULTS: At least one alteration of genes or chromosomes was detected in 18 (90.0%) of the 20 pancreatic cancer tissues by FISH, as compared with no alternation in the normal pancreatic tissues: these alteration were an increased copy number of c-myc (66.7%), a decreased copy number of p16 (70.6%), deletion of p53 (100%), loss of chromosome 18q (56.3%) and gain of chromosome 20q (45.0%). IHC demonstrated overexpression of c-myc and p53 in 31.3% and 50.0% of the pancreatic cancer specimens, respectively, and the loss of expressions of p16 and DPC in 25.0% and 93.3% of the pancreatic cancer specimens, respectively. The concordance rate of IHC with FISH was 33.3% to 61.5%. Analysis of the correlation between the cytogenetic changes identified by FISH or IHC and the pathologic prognostic factors showed that only chromosome 20q gain was significantly correlated with the histologic grade (p=0.098) and lymphovascular invasion (p=0.092). However there was no clinical correlation of the cytogenetic changes with respect to recurrence after operation. CONCLUSION: This study confirms that most pancreatic cancers have cytogenetic alternations, as can be determined by FISH. Especially, the correlation between chromosome 20q gain and the prognostic pathologic factors offers the possibility of a new prognostic biologic marker located in chromosome 20q. However, further studies with more cases are needed to clarify the clinical significance of cytogenetic alternations in pancreatic cancer.

Development of peripheral T-cell lymphoma in the course of chronic myelogenous leukemia / 대한내과학회지

Lymphoid malignancies have been reported in association with chronic myelogenous leukemia, but the development of chronic myelogenous leukemia and T-cell lymphoma in the same patients is rare. We experienced a case of peripheral T-cell lymphoma developed in the course of chronic myelogenous leukemia. In December 1993, a diagnosis of chronic myelogenous leukemia was made. The patient was treated with hydroxyurea and busulphan. In June 1999, the patient was admitted because of a swelling in right submandibular area and throat pain. He underwent right tonsilectomy. The histologic and immunologic examination of tonsil revealed a peripheral T-cell lymphoma. This case is additional one to a few previously reported cases of concurrence of chronic myelogenous leukemia and T-cell lymphoma.