The Feasibility of Sentinel Lymph Node Biopsy with a Multidisciplinary Cooperative Team Approach for the Management of Koreans with Cutaneous Malignant Melanoma

BACKGROUND: The regional lymph nodal status is the most powerful independent predictor of survival for patients with clinical N0 primary cutaneous malignant melanoma. OBJECTIVE: We wanted to evaluate the feasibility and morbidity of the sentinel lymph node biopsy (SLNB) staging using a multidisciplinary team approach, in cooperation with other surgical departments, at a university hospital setting. METHODS: Twenty two patients with cutaneous melanoma and who were treated at Kyungpook National University Hospital were included in this study. They all received SLNB, which was done by the Departments of Dermatology and General Surgery. We evaluated the feasibility and side effects of SLNB. RESULTS: Pathologically-positive sentinel nodes were found in 7 of the 22 cases (31.8%) and all 7 patients were consequently upstaged. The whole process involved in SLNB was well tolerated by nearly all the patients, with only mild and transient complications being observed. CONCLUSION: We suggest that in a Korean setting, utilizing SLNB with a multi-disciplinary team approach is a technically feasible procedure that is able to detect occult nodal metastasis with low morbidity rates in patients with cutaneous malignant melanoma.

Immunohistochemical Study about the Origin of Bile Ductules Proliferation in Obstructive Liver Disease

BACKGROUND: The relationship between bile duct proliferation and portal fibrosis in obstructive liver diseases remains unclear. The purpose of this study is to analyze the relationship between hepatic stellate cells (HSC), hepatocytes and bile ductule proliferation in obstructive liver disease using immunoreactivity for alpha-SMA (alpha-smooth muscle actin), CK7, and CK19. METHODS: We used 20 human tissue samples with hepatic fibrosis due to intrahepatic stones and liver cirrhosis. Immunohistochemical staining was performed using the streptavidin-biotin method. RESULTS: Proliferations of bile ductules at the periphery of the hepatic lobules, and diffuse HSC activation in the perisinusoidal spaces were observed in all cases. Immunoreactivity of the hepatocytes for CK7 and CK19 suggested a possible phenotypic transformation into bile duct epithelium during fibrogenesis. Immunohistochemical-analyses of alpha-SMA expression profiles showed that intralobular HSCs and some hepatocytes underwent early phenotypic changes, and that the accumulation of collagen coincides with that of alpha-SMA-labeled myofibroblasts around portal/septal ductular structures. CONCLUSIONS: Our results showed the possibility of a phenotypic transformation of hepatocytes into bile ductular epithelium. It is suggested that hepatocytes might play a role in bile ductule proliferation in obstructive liver disease.

Changes of Bone Mineral Densities in Children with Idiopathic Hypercalciuria / 대한신장학회지

PURPOSE: Idiopathic hypercalciuria is a common clinical disorder in children with hematuria or nephrolithiasis. Recently, it has been reported that idiopathic hypercalciuria may disturb the metabolism of bone and induce its loss. We measured the biochemical markers of bone metabolism and bone mineral densities (BMD) by dual energy X-ray absorptiometry (DEXA) in children with idiopathic hypercalciuria to elucidate the prevalence and clinical significance of osteopenia. METHODS: From 1997 to 2005, 52 children with idiopathic hypercalciuria were included in this study. The biochemical markers of bone metabolism were measured in all 52 patients. BMD was measured in 21 patients initially and additional 6 patients during the follow-up. RESULTS: Mean age of patients was 6 years 7 months, and the male to female ratio was 1.26:1. BMD Z-scores were less than -1 in 10 of initial 21 patients (osteopenia), and -2.5 in 2 of 10 osteopenic patients (osteoporosis). There was a negative correlation between BMD Z-score and the level of osteocalcin. However, there were no significant differences in BMD Z-scores and other biochemical markers of bone metabolism among groups divided by sex, the type of idiopathic hypercalciuria, and the presence of urinary stone. CONCLUSION: Idiopathic hypercalciuria can be not only the cause of hematuria, but also of osteopenia in children. We suggest that the measurement of BMD in children with idiopathic hypercalciuria should be performed routinely with regular follow-up.

The characteristics of non palpable thyroid nodule and relation to prediction of malignant nodule / 대한내과학회지

BACKGROUND: Thyroid nodules are commonly encountered in clinical practice and a p revalence of general population is 19~67% by ultrasonography. We made a study to investigate clinical characteristics, malignancy ratio of thyroid incidentalomas and predicting factors for diagnosis of malignancy, to provide recommendation for evaluation. METHODS: We retrospectively evaluated the medical records of 320 patients who visited Kyungpook National University Hospital from July 2001 to December 2003 with non palpable thyroid nodules. We reviewed physical examination, ultrasonographic findings, laboratory findings, histology of thyroid nodules and did statististic analysis to examine relationship to malignancy. RESULTS: 52 patients revealed papillary carcinomas and malignancy rate whin incidentalomas is 9.3%. Sonographic findings of solid structure, hypoechogenecity, punctate calcification, ill defined margin, irregular shape showed meaningful diagnostic value for malignancy. CONCLUSIONS: Combination of meaningful sonographic findings increased possibility of maliganancy and require active mangements including recurrent fine needle aspiration and surgery if needed.

The Relationship between MDR1 Polymorphisms and the Response to Etoposide/Cisplatin Combination Chemotherapy in Small Cell Lung Cancer / 결핵및호흡기질환

No abstract available.

Serial Changes of Serum Thyroid-Stimulating Hormone after Total Thyroidectomy or Withdrawal of Suppressive Thyroxine Therapy in Patients with Differentiated Thyroid Cancer / 대한핵의학회잡지

BACKGROUND: Radioactive iodine (RAI) therapy and whole-body scanning are the fundamentals of treatment and follow-up of patients with differentiated thyroid cancer. It is generally accepted that a Thyroid-Stimulating Hormone (TSH) level of at least 30 micro U/ml is a prerequisite for the effective use of RAI, and that it requires 4-6 weeks of off-thyroxine to attain these levels. Because thyroxine withdrawal and the consequent hypothyroidism are often poorly tolerated, and occasionally might be hazardous, it is important to be certain that these assumptions are correct. We have measured serial changes in serum TSH after total thyroidectomy or withdrawl of thyroxine in patients with thyroid cancer. SUBJECTS AND METHODS: Serum TSH levels were measured weekly after thyroidectomy in 10 patients (group A) and after the discontinuation of thyroxine in 12 patients (group B). Symptoms and signs of hypothyroidism were also evaluated weekly by modified Billewicz diagnostic index. RESULTS: By the second week, 78% of group A patients and 17% of group B patients had serum TSH levels > or= 30 micro U/ml. By the third week, 89% of group A patients and 90% of group B patients had serum TSH levels > or= 30 micro U/ml. By the fourth week, all patients in two groups achieved target TSH levels and there were no overt hypothyroidism. CONCLUSION: In all patients, serum TSH elevated to the target concentration (> or=30 micro U/ml) within 4 weeks without significant manifestation of hypothyroidism. The schedule of RAI administration could be adjusted to fit the needs and circumstances of individual patients with a shorter preparation period than the conventional.

A case of metastatic malignant pheochromocytoma response to high dose 131I-MIBG treatment after surgery / 대한내과학회지

Approximately 10% of pheochromocytomas are malignant and its major criteria are tumor invasion of capsular blood vessel as well as metastatic invasion of other tissues. It is general rule that all resectable masses have to be removed surgically. However, there is no definite treatment modality about unresectable masses or microinvasive lesions. We experienced a case of 45 year-old male patient who was referred to our hospital for treatment of hypertension and headache. The plasma and urine catecholamine were increased above normal values and its metabolites also were increased. 131I-metaiodobenzylguanidine (MIBG) scan showed right adrenal mass and metastatic lesion of left iliac bone. This lesion was consistent with findings of the abdomen computed tomography (CT) and electron beam tomography (EBT) scan. We diagnosed this case as malignant pheochromocytoma. We removed primary tumor mass by wide excision and treated this patient with high dose 131I-MIBG. We report this case who shows good response to the high dose 131I-MIBG after surgery.

The Effect of Tumor Necrosis Factor-Alpha to Glomerular Epithelial Cells in Glomerular Permeability / 대한해부학회지

Minimal Change Disease (MCD) is the most common primary nephrotic syndrome in children. Some suggested that tumor necrosis factor-alpha (TNF-alpha) are involved in the pathogenesis of MCD. This study was done to see changes of plasma and urinary TNF-alpha, and its effect on determination of permeability of glomerular basement membrane (BM) contributed by heparan sulfate proteoglycan (HSPG). Study patients consisted of 19 biopsy-proven MCD children aged 2-15 years old. Both plasma and urinary TNF-alpha were measured. Employing the Millicell system, TNF-alpha was screened for the permeability factors. We examined whether TNF-alpha regulated BM HSPG gene expression and HS synthesis in the glomerular epithelial cells (GECs). Urinary TNF-alpha during relapse was also significantly increased (364.4+/-51.2 vs 155.3+/-20.8, 36.0+/-4.5 ng/mg.cr) (p<0.05). However, the negative results were obtained in the permeability assay using the Millicell system. No difference was seen in BM HSPG gene expression and HS synthesis in the GECs. Therefore, it seems that TNF-alpha may not play a disease-specific role in the pathogenesis of MCD.

Comparison of Ga-67, Tl-201 and Tc-99m MIBI Imaging in Lymphoma Patients / 영남의대학술지

PURPOSE: Ga-67 scintigraphy has been used for the evaluation of tumors, especially lymphoma. Recently, Tl-201 and Tc-99m MIBI were also used to tumor imaging. Tl-201 and Tc-99m MIBI had better physiologic characteristics than Ga-67, so we studied 32 biopsy proven lymphoma patients (male 24, female 8, mean age 46 years) with Ga-67, Tl-201 or Tc-99m MIBI and compared the scan findings. MATERIALS AND METHODS: Twenty-three of 32 patients were injected 74-111 MBq (2-3 mCi) of Tl-201, before chemotherapy and imaged with dual-headed SPECT (Prism 2000, Picker, USA) at 30 minutes after injection. Delayed images were obtained after 3 hr in 8 patients. Twenty seven of 32 patients were injected 740 MBq (20 mCi) of Tc-99m MIBI and imaged at 30 minutes after injection. 111-185 MBq (3-5 mCi) of Ga-67 was injected in 12 patients and imaged at 48 and 72 hours after injection. Twenty eight patients were diagnosed as non-Hodgkin's lymphoma and others were Hodgkin's lymphoma. RESULTS: Twenty patients were positive on Tl-201 scan and 3 patients showed negative findings. One of these 3 patients, Tc-99m MIBI and Ga-67 scan were positive. Twenty two patients were positive on Tc-99m MIBI scan and 5 patients showed negative findings. One of these 5 patients, Tl-201 was positive and 2 were positive on Ga-67 scan. Ten of 12 patients showed positive findings on Ga-67 scan. The sensitivity of these agents were 83.3%, 87.0% and 81.5% for Ga-67, Tl-201 and Tc-99m MIBI, respectively. The sensitivity was highest in Tl-201 scan, but there were no significant differences among three tests. In this study, there was no significant difference of uptake ratios between early and delayed images of Tl-201. CONCLUSION: Scintigraphy with Tl-201 and Tc-99m MIBI in lymphoma patients have similar sensitivity with Ga-67.

Reversal of Multidrug Resistance with KR - 30035 ; Evaluated with Biodistribution of Tc - 99m MIBI in Nude Mice Bearing Human Tumor Xenografts / 대한핵의학회잡지

No abstract available.

The Changes in Plasma Levels of Brain Natriuretic Peptide during Exercise in Patients With Ischemic Heart Disease

BACKGROUND: Brain natriuretic peptide (BNP) is primarily secreted from the cardiac ventricles. Circulating concentrations of BNP are known to be increased in established chronic heart failure and acute myocardial infarction and to correlate well with left ventricular dysfunction and prognosis. It may also act as an index of ischemic severity. This study was performed to evaluate the value of plasma BNP measurement during exercise test in patients with ischemic heart disease for an assessment of myocardial ischemia. METHOD: This study included a total of 63 cases who had suspected ischemic heart disease or suffered from myocardial infarction. The subjects underwent treadmill exercise with modified Bruce protocol. Tc-99m MIBI (methoxyisobutyl Isonitrile) SPECT image was obtained by one-day or two-day protocol with rest-stress sequence. They were divided into 3 groups by findings in exercise TC-99m MIBI SPECT; 16 cases with reversible perfusion defect into angina pectoris group, 12 cases with myocardial infarction and fixed perfusion defect into myocardial infarction group and 35 cases without perfusion defect into control group. Venous blood was obtained at rest and just after peak exercise. Plasma levels of BNP level were measured by radioimmunoassay. RESULT: BNP levels increased with exercise from 20.1 +/- 28.2 to 33.2 +/- 44.0 pg/ml in the control group, 33.9 +/- 48.8 to 44.6 +/- 49.2 pg/ml in the angina pectoris group and 86.6 +/- 85.0 to 140.9 +/- 116.2 pg/ml in the myocardial infarction group (p<0.01, respectively). BNP levels in the myocardial infarction group were significantly higher than those in the control and angina pectoris group both at rest and after peak exercise (p<0.01, respectively). The changes in BNP levels with exercise were also significantly higher in the myocardial infarction group compared with those in the control and angina pectoris group (p<0.01). The BNP levels at rest were correlated significantly with the extent of perfusion defect and METs (r=0.465, p<0.001; r=-0.283, p<0.05, respectively). The BNP level after peak exercise correlated closely with the extent of perfusion defect and left ventricular ejection fraction (r=0.481, p<0.001; r=-0.301, p<0.05, respectively). The changes in BNP level with exercise were correlated well with the extent of perfusion defect and the ischemic severity (r=0.352, p<0.01; r=0.272, p<0.05, respectively). CONCLUSION: These findings suggest that the changes in BNP level during an exercise test could be used for an index of ischemic severity in patients with ischemic heart disease.

Clearance rate of inhaled 99mTc-DTPA in systemic sclerosis / 대한내과학회지

BACKGROUND: We measured the clearance rate of inhaled 99mTc-diethyl triaminepentaacetic acid (DTPA) aerosol in patients with systemic sclerosis. We also investigated its correlation with respiratory function test and acute phase reactant proteins. METHODS: Ten patients with systemic sclerosis, ten patients with rheumatoid arthritis, and ten healthy controls were included. Dynamic scintigrams (20 seconds/frame, up to 30 minutes) were obtained following inhalation of 99mTc-DTPA aerosol through a radioaerosol delivery system. The time to half clearance (T1/2) was calculated from the time-activity curves. High resolution computed tomography, pulmonary function test and laboratory tests such as ESR, CRP, and complement (C3/C4) were performed. RESULTS: 1) Mean T1/2 values of 99mTc-DTPA clearance after inhalation were 28.1+/-3.8, 57.9+/-20.9, and 64.3+/-13.0 minutes in systemic sclerosis, rheumatoid arthritis and normal controls, respectively. Mean T1/2 value in systemic sclerosis was significantly reduced compared with those of rheumatoid arthritis group (p<0.001) and normal controls (p=0.001).2) No significant correlations were found between mean T1/2 and FEV1/FVC, FVC or DLco in patients with systemic sclerosis. 3) There was no significant correlation between mean T1/2 and ESR or CRP in patients with systemic sclerosis. And in patients with rheumatoid arthritis, mean T1/2 value correlated significantly with ESR and CRP. CONCLUSION: The clearance rate of inhaled 99mTc-DTPA was significantly increased in patients with systemic sclerosis and had no significant correlation with pulmonary function test and acute phase reactants, but was found to have significant correlations with ESR and CRP in patients with rheumatoid arthritis.

The Frequency and Clinical Significance of Multidrug Resistance-1 (MDR-1) Gene Expression in Acute Myeloid Leukemia / 대한혈액학회지

BACKGROUND: The expression of the multidrug resistance-1 (MDR-1) gene which encodes p-glycoprotein, is recognized as a biological mechanism possibly contributing to treatment failure in patients with acute myeloid leukemia (AML). Recent studies indicate its association with poor risk factors such as cytogenetic pattern and surface phenotype of blasts. We analyzed the role of MDR-1 gene expression in 36 chemo-naive AML patients. METHODS: In 36 patients, clinical data were reviewed and compared to MDR-1 gene expression, immunophenotyping results on CD7 & CD34, cytogenetic pattern and other suggestive prognostic factors. RESULTS: Median follow-up period was 150 days. The MDR-1 gene expression was observed in 19 out of 36 patients (52.8%). Significant correlation between MDR-1 gene and CD7 & CD34 expression was found. Sixteen out of 17 (94.1%) MDR-1 negative patients harbored favorable cytogenetic patterns, where as 11 out of 19 (57.9%) MDR-1 positive patients had favorable cytogenetic patterns. MDR-1 gene expression was not correlated to disease free survival (DFS), nor overall survival (OS) statistically although it has shown significant correlation to complete remission (CR) rate (P =0.001). CONCLUSION: We found that lack of MDR-1 gene expression was exclusively associated to favorable cytogenetic patterns in our study. In order to clarify the relationship between the role of MDR-1 gene and clinical outcome or other prognostic features, including cytogenetic pattern, further larger studies would be necessary.

Effects of Pinacidil, a Potassium-Channel Opener, on Biodistribution of Thallium-201 in Tumor-Bearing Mice / 대한핵의학회잡지

PURPOSE: Thallium behaves similarly to potassium in vivo. Potassium channel opener (K-opener) opens ATP-sensitive K+/-channel located at cell membrane, resulting in potassium efflux from cytosol. We have previously reported that K-opener can alter biokinetics of Tl-201 in cultured cells and in vivo. Malignant tumor cells have high Na-K ATPase activity due to increased metabolic activities and dedifferentiation, and differential delineation of malignant tumor can be possible with Tl-201 imaging. K-opener may affect tumoral uptake of Tl-201 in vivo. To investigate the effects of pinacidil (one of the potent K-openers) on the localization of the tumor with Tl-201 chloride, we evaluated the changes in biodistribution of Tl-201 with pinacidil treatment in tumor-bearing mice. MATERAL AND METHODS: Balb/c mice received subcutaneous implantation of murine breast cancer cells in the thigh and were used for biodistribution study 3 weeks later. 100 microgram of pinacidil dissolved in 200 microliter DMSO/PBS solution was injected intravenously via tail vein at 10 min after 185 KBq (5 microcurie) Tl-201 injection. Percentage organ uptake and whole body retention ratio of Tl-201 were measured at various periods after injection, and values were compared between control and pinacidil-treated mice. RESULTS: Pinacidil treatment resulted in mild decrease in blood levels of Tl-201, but renal uptakes were markedly decreased at 30-min, 1- and 2-hour, compared to control group. Hepatic, intestinal and muscular uptake were not different. Absolute percentage uptake and tumor to blood ratios of Tl-201 were lower in pinacidil treated mice than in the control group at all time points measured. Whole body retention ratio of Tl-201 was lower in pinacidil treated mice (58+/-4%), than in the control group (67+/-3%) at 24 hours after with injection of 100 microgram pinacidil. CONCLUSION: K-opener did not enhance, but rather decreased absolute tumoral uptake and tumor-to-blood ratios of Tl-201. Decreased whole body retention ratio and renal uptake were observed with pinacidil treatment in tumor-bearing mice.

Reversible Cerebral Hypoperfusion in Cyclosporine Neurotoxicity: A Case Report / 대한핵의학회잡지

We experienced a case of cerebral hypoperfusion due to cyclosporine neurotoxocity confirmed only by Tc-99m ECD brain SPECT. A 53-year-old female had received allogenic peripheral blood stem cell transplantation due to refractory plasmacytoid lymphoma. Cyclosporine and steroid had been administrated to prevent graft versus host disease. Twenty days after transplantation, she became delirious and suffered from generalized tonic-clonic seizure. Immediately, brain MRI and MR angiography were performed and these studies did not show any abnormal findings. However, Tc-99m ECD brain SPECT showed diffuse hypoperfusion in the left cerebral hemisphere and blood cyclosporine level was 962.6 ng/ml. Cyclosporine administration was stopped and discontinuation of cyclosporine resulted in disappearance of all neurological symptoms. The same neurological symptoms recurred with cyclosporine re-administration for management of exacerbated graft versus host disease. In this case, Tc-99m ECD brain SPECT proved very helpful in the diagnosis of cycloporine neurotoxicity.

Prognostic Value of Normal Exercise (99m)Te-MIBI Myocardial Perfusion SPECT: Comparison with Exercise Electrocardiography and Coronary Angiography / 대한핵의학회잡지

PURPOSE: Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise (99m)Tc-MIRI myocardial perfusion single photon emission computed tomography (SPECT) an(l to analyze results with regard to those of exercise. electrocardiography or coronary angiography. MATERIALS AND METHODS: We evaluated 30) patients (mean age S2+/-10 years, 166 males and 135 females) with normal exercise (99m)Tc-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subjects were evaluated for cardiac events and followed for 8-55 months (mean 19+/-10 months) after imaging. RESULTS: During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0,21%: per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patients with positive (n=27) and negative (n-235) exercise electrocardiography (p:NS), There was no cardiac event in ]7 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). CONCLUSION: Patients with normal exercise (99m)Tc-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.

Clinical Characterization of Reverse Redistribution Pattern in 99mTC-Sestamibi Myocardial Perfusion Scan

BACKGROUND AND OBJECTIVES: Reverse redistribution pattern (RRP), that is defined as the worsening of the perfusion defect at rest image, can be observed in 99mTC-sestamibi (methoxy isobutyl isonitrile) myocardial scan with standard stress-rest protocol. This study was prepared to evaluate the prevalence and clinical characteristics of RRP in stress 99mTc-sestamibi myocardial scan. MATERIALS AND METHODS: We retrospectively reviewed 1304 images of 99mTC-sestamibi myocardial perfusion scan performed between January 1995 and June 1997, and scintigraphic findings were compared with clinical and angiographic data. RESULTS: The prevalence of RRP was 5.2%(68 of 1,304). RRP was noted in 6.0% (41 of 679) of the adenosine study and 4.3% (27 of 625) of the exercise study. The mean coronary artery stenosis at RRP territory was 51.5+/-38.9%. However, normal coronary artery at RRP territory was noted in 45.8% (11 of 24). There was no significant differences in luminal narrowing of coronary arteries, TIMI flow grade and LV wall motion between the patient with RRP positive and RRP negative at the infarct related artery territory. CONCLUSION: Reverse redistribution pattern on 99mTC-sestamibi myocardial SPECT does not seem to indicate the presence of significant coronary artery disease or patency of the infarct related arteries in the patients with acute MI.

Portal and Peripheral Blood Levels of Tumor Markers in Patients with Gastric Cancer

BACKGROUND: Correlations between the AFP, CEA, CA19-9, and CA125 levels of portal and peripheral blood were examined in 42 patients (male, 29; female, 13; mean age, 55.9) with gastric cancer in order to identify a better blood sample for measuring these tumor markers. METHODS: The levels of these tumor markers were measured by the immunoradiometric assay. The cut-off levels of positivity were 6 ng/ml for AFP, 7 ng/ml for CEA, 25 U/ml for CA19-9, and 35 U/ml for CA125. RESULTS: The positive rates of AFP, CEA, CA19-9, and CA125 were 11.9%, 19.0%, 14.3%, and 7.1% in portal blood and 9.5%, 19.0%, 14.3%, and 4.8% in peripheral blood, respectively. The positive rate of portal venous CEA was significantly higher in cases with lymph node metastasis, distant metastasis, and lymphatic invasion than those without these variables. The positive rate of peripheral venous CEA was significantly higher in cases with lymph node metastasis, distant metastasis, high stages, and large tumor size. The positive rate of peripheral venous CA19-9 was higher in cases with distant metastasis. The positive rate of CA125 in portal and peripheral blood was higher in cases of lymphatic invasion. Neither portal nor peripheral AFP correlated with pathologic factors. Regression analysis revealed that the portal venous levels of AFP, CEA, CA19-9, and CA125 could be estimated by using the peripheral venous levels of these tumor markers. CONCLUSION: We can avoid intraoperative sampling of portal blood to measure the portal venous levels of AFP, CEA, CA19-9, and CA125 because the peripheral venous level of these tumor markers reflects the portal venous levels. The measurement of peripheral venous levels of CEA and CA19-9 can be used as non-anatomical prognostic indicators for staging of gastric cancer.

A Case of Invasive Aspergillosis Involving Lung and Brain in Patient with Acute Leukemia / 대한혈액학회지

Invasive aspergillosis is a life-threatening infectious disease in immunocompromised patients. Aspergillus is an ubiquitous mold present as normal flora in paranasal sinus, nose, skin and lung. The most important determinant of infection is the immune status of the patient, not the intensity of exposure. In acute leukemia and bone marrow transplantation, prolonged neutropenia is probably the most important predisposing factor. We experienced a case of invasive aspergillosis involving lung and brain in patient with acute leukemia during remission-induction chemotherapy. Invasive aspergillosis involving lung and brain was diagnosed by sputum culture, computed tomography (CT) guided lung biopsy and brain magnetic resonance imaging (MRI). Early diagnosis and prompt treatment for invasive aspergillosis are essential for lowering mortality in immunocompromised patients.

A Case of Relapsed Multiple Myeloma Presented as lntracranial Extramedullary Plasmacytoma / 대한혈액학회지

Intracranial plasmacytoma presented by extramedullary involvement of multiple myeloma is rarely reported. Neurologic complications by intracranial extramedullary plasmacytomas are cranial nerve palsy, visual disturbance, vertigo, nystagmus, headache, paralysis, mental change and etc. We experienced a case of relapsed multiple myeloma presented as intracranial extramedullary plasmacytoma. Brain magnetic resonance imaging(MRI) disclosed a large soft tissue mass involving the sphenoidal sinus and cavernous sinus which invaded optic chiasma, occulomotor nerve and pituitary gland. Relapsed multiple myeloma with intracranial extramedullary plasmacytoma was confined by trans-sphenoidal biopsy and urine electrophoresis. Neurologic complications of the patient was improved after cranial radiotherapy and systemic chemotherapy.