A Novel Simultaneous Determination of Sarpogrelate and its Active Metabolite (M-1) in Human Plasma, Using Liquid Chromatography-Tandem Mass Spectrometry: Clinical Application

BACKGROUND: This study describes a novel analytical method for simultaneously determining sarpogrelate and its metabolite (M-1) in human plasma, using liquid chromatography coupled with tandem mass spectrometry, with electrospray ionization in the positive ion mode. METHODS: Sarpogrelate, M-1, and labeled internal standard (d3-sarpogrelate) were extracted from 50 microL of human plasma by simple protein precipitation. Chromatographic separation was performed by using a linear gradient elution of a mobile phase involving water-formic acid (99.9:0.1, v/v) and acetonitrile-formic acid (99.9:0.1, v/v) over 4 min of run time on a column, with a core-shell-type stationary phase (Kinetex C18, 50 mm x 2.1 mm i.d., 2.6-microm particle size, Phenomenex, USA). Detection of the column effluent was performed by using a triple-quadruple mass spectrometer in the multiple-reaction monitoring mode. RESULTS: The developed method was validated in human plasma, with lower limits of quantification of 10 ng/mL for sarpogrelate and 2 ng/mL for M-1. The calibration curves of sarpogrelate and M-1 were linear over the concentration ranges of 10-2,000 and 2-400 ng/mL, respectively (R2>0.99). The carry-over effect, precision, accuracy, and stability of the method met the criteria for acceptance. CONCLUSIONS: A simple, fast, robust, and reliable analytical method was successfully developed and applied to the high-throughput determination of sarpogrelate and its metabolite in real plasma samples in a pharmacokinetic study of healthy subjects.

Proposal of Suitable On-the-Job Training for Clinical Research Coordinator in Korea

BACKGROUND: This study is intended to propose not only to introduce and evaluate the 2 years Clinical Research Coordinator (CRC) professional on-the-job training program that has been implemented in Samsung Medical Center on September of 2009, but also to develop the CRC future education program. METHODS: It is surveyed with self-report type for the 53 trainees, 18 non-trainees, and 17 investigators, the participants worked in Samsung Medical Center, and the major contents of the survey were general characteristics, training program evaluations, CRC qualification evaluation, and job satisfaction. The collected data was analyzed at the 0.05 level of significance by using SAS 9.1 version. RESULTS: The training program is conducted as 4 phases, each phase assessed separately. The Professional A course got the highest satisfaction, and it was deal with quality control (Mean=4.11 ~ 4.33). Most of the investigators answered that the trainees have high priority to be hired in the future (very much=82.45). The non-trainees answered that the training program would be helpful to improve the job competency and qualification (very much=22.2 %, somewhat=55.6 %) and 88.9 % of them answered that they have intention to participate in the training program. Finally, compared to non-trainees, the trainees have more job attachment (P=0.0036) and intention to continue CRC (P=0.0045). CONCLUSION: The CRC professional training program in Samsung Medical Center, as on the job training for 2 years, satisfies the investigators and trainees with positive effect on CRC job satisfaction and job stability. Based on this study, the education program with good quality should be developed considering the characteristics for each institution and close research field.

A Study of the Survival Rate of Childhood Cancer in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: It is known that the prognosis of childhood cancer is relatively good, however actual representative nationwide data on childhood cancer, particularly of survival rate, are rare. In this study we attempted to establish the overall survival rate of major childhood cancer. MATERIALS AND METHODS: The primary source of data of childhood cancer under 15 years of age were the registry files of the Central Cancer Registry Report (Ministry of Health & Welfare) from 1993 to 1997. The above data was compared to death case data files of the same period obtained from the Korea National Statistical Office using the personal identification code. We calculated the 1, 3, and 5 year survival rates using the life table of SPSS and Kaplan-Meier method and compared the survival rate of disease according to prognostic factors. RESULTS: A total of 6,720 cases of pediatric cancer from the Central Cancer Registry files were computerized and sorted by personal identification (ID) code to extract duplicated cases as well as cases with incomplete data. The final number of cases entered in this study was 4,983. 1) The number of confirmed death cases was 1,448 (29.1%). 2) The disease distribution showed that the most common pediatric cancer was leukemia (1,468/4,983, 29%), followed by brain tumors (503/4,983, 10%), lymphoma (315/4,983, 6%), Wilms tumor (165/4,983, 3%), etc. in order by number of patients. 3) The 5 year survival rate of disease was as follows: overall 62%, acute lymphocytic leukemia 61%, acute non-lymphocytic leukemia 32%, malignant lymphoma 72%, neuroblastoma 47%, medulloblastoma 51%, Astrocytoma 66%, Wilms tumor 83%, etc. CONCLUSION: We analyzed and report the 5 year survival rate of overall childhood cancer and of each of the twelve major childhood cancers from in Korea 1993 to 1997 to provide basic data on childhood cancer statistics.

The Assessment of Electrocardiogram Interpretation by Emergency Physicians at the Emergency Department

BACKGROUND: The emergency physician(EP)'s interpretation of the electrocardiogram(ECG) is important in determining the disposition of patients evaluated in an emergency department(ED) for chest pain o other cardiac complaints. This particularly important in life-threatening ECG findings. When the cardiologist's final interpretation was defined as the correct one, the concordance compared with the EP was reported to be 50-60%, while the missed diagnosis of acute myocardial infarction(AMI) was reported as 0.6-8.0%, which could be deleterious to the patient. METHOD AND MATERIAL : One hundred and twenty eight ECGs were interpreted by two residents from each year residency. ED records of the study patients were reviewed, and the EP's and cardiologist's ECG interpretations were compared. The ECGs were classified by severity according to the following system: class I, normal or minor abnormalities only; class II, abnormalities with potential to alter case management; and class III, potentially life-threatening abnormalities. RESULTS: The overall concordance between EP's and cardiologist's ECG interpretations was 59.3% and the concordance comparing each year residency showed no statistical significant difference (p value less than 0.05). The underdiagnosed rate was 48.4%, 32.0%, 23.4%, 22.7% for first, second, third and fourth year residency respectively, and 2.3%, 5.5%, 10.9%, 5.5% respectively for the overdiagnosed rate. CONCLUSION: Although the overall concordance showed a relatively high result in our study, the concordance of class III ECG resulted a much lower rate. Therefore, additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties. Assessment of department ECG misinterpretation would be useful in focusing on resident and staff education.

Short-term Revisit to the Emergency Department

BACKGROUND: When patients return to the emergency department shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate. But in other aspects many short term revisits may be unnecessary in the aspect of emergency care because it is known that substantial numbers of patients use emergency department for nonemergency problems. So we analysed the tendency and the cause of short term revisit patients, determined the rates and the associated demographic, clinical, disease variables as a tool of quality assurance. METHODS: We carried out a chart review of patients seen in the emergency department, who revisited within 72 hours, of Young Dong Severance Hospital retrospectively between January 1, 1998 and September 30, 1999 (period 2), and compared with result between April 1, 1990 and March 31, 1991 (period 1) respectively. RESULTS: In the period 1, the total revisits patients were 204/21,025(0.97%), in that period scheduled revisits were 15.2%, the unscheduled were 84.8%, and the frequent revisits (more than 3 times) were 6.4%. In the period 2, the total revisit patients were 4,722/72,802 (6.49%), in that period scheduled revisits were 86.3%, the unscheduled were 13.7%, and the frequent revisits were 24.8%. The most common cause of revisit during the period 2 is a drug addictor (31.2%) that frequently used the emergency room for seeking drug. CONCLUSIONS : The scheduled revisit patients for dressing, medication, re-evaluation were increased enormously, so the medical care of these patients might be a part of job that performed in emergency department. And if the health care system could support the adequate nursing care facility, the portion of avoidable revisits of emergency department can be decreased. We also found that the emergency department is an important points for the early identification and referral for the treatment of patients who revisited emergency room for seeking drug, and the analysis of physician related factor in revisits patients may be used as a tool of quality assurance in the emergency department.

The Clinical Application of C-Reactive Protein in Acute Abdominal Pain

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.

Annual Report of the Central Cancer Registry in Korea-1998 (Based on Registered Data from 124 Hospitals) / 대한암학회지

PURPOSE: Central Cancer Registry Center in Korea conducted a nation-wide hospital-based cancer registry to provide the basic data on cancer statistics. MATERIALS AND METHODS: In 1998, 124 hospitals participated in the cancer registry program. All cancer registry data, submitted from the participating hospitals by diskettes during the year, were reviewed and sorted out by the committee members who were all board-qualified clinical oncologists and pathologists. To avoid duplication, every resident registration numbers were compared by the computer. Cases diagnosed by histologic examination were preferentially chosen. RESULTS: Of 89,226 cases registered, 9,163 (10.3%) duplication cases were excluded. Of the remaining 80,063 cases, 3,195 cases (4.0%) of carcinoma in situ (morphology code /2) were excluded. Finally 76,868 cases were analyzed. Of the analyzed cases, 44,037 (57.3%) were male and 32,831 (42.7%) were female. The leading age groups in the order of relative frequency were 60~64 years of age (15.3%), followed by 55~59 (14.4%). The leading primary cancer sites in the order of relative frequency were stomach (20.9%), followed by liver and intrahepatic bile ducts (12.2%), bronchus and lung (11.9%), colorectum (9.6%), breast (6.1%). In male, the leading primary cancer sites were stomach (24.4%), followed by liver and intrahepatic bile ducts (16.4%), bronchus and lung(16.0%), colorectum(9.2%) and urinary bladder (3.5%). In female, stomach (16.3%) was the most common site, followed by breast (14.1%), uterine cervix (13.0%), colorectum (10.1%) and liver and intrahepatic bile ducts (6.5%). Among the 1,190 cases of childhood malignancies, leukemia (33.4%), CNS tumor (15.7%) and sympathetic nervous system tumor (8.4%) were common. CONCLUSION: We analyzed and reported the registered cancer data from 124 hospitals during 1998.

The Significance of Plasma Potassium Level in Pseudohyperkalemia with Thrombocytosis / 대한소아혈액종양학회지

PURPOSE: As blood coagulates, potassium is released from cells, causing the concentration of potassium in serum to be slightly higher than that of plasma. We measured serum and plasma potassium levels simultaneously to evaluate the significance of plasma potassium especially in the patients with thrombocytosis. METHODS: The study was designed into two steps. To determine the relationship between platelet count and serum potassium level, the subjects of the first study were 140 children admitted to the National Medical Center (NMC) from January 1996 to June 1997. To determine the significance of plasma potassium level in pseudohyperkalemia with thrombocytosis, the subjects of the second study were 80 children admitted to the NMC from June 1997 to June to 1998. All of them are 1 month to 14 years old. RESULTS: 1) There was no relationship between the platelet count and serum potassium levels in the control group with platelet count from 150x109/L to 400x10(9)/L (r=0.07), but there was significant relationship in the group with platelet count above 400x10(9)/L (r=0.41, P<0.01). 2) As platelet counts increased, the differences between the serum and plasma potassium concentration increased (r=0.518, P<0.01). CONCLUSION: The clinician should pay attention to the possibility of the pseudohyperk alemia when there is thrombocytosis with hyperkalemia without specific hyperkalemic symptoms or EKG changes. Plasma potassium level will be helpful for the accurate assesment of potassium concentration.

A Case of Achalasia Managed by Balloon Dilatation

An 8-year-old male was admitted because of dysphagia and substernal pain suffered while eating followed by postprandial vomiting for 2 years. He was always hungry due to postprandial vomiting and willing to eat again just after vomiting. After this meals, he used to jump up and down to shake off the substernal discomfort. A narrowing of the gastroesophageal junction was noted by esophagogram. Manometry revealed high Lower esophageal sphincter (LES) pressure (51.6mmHg), incomplete LES relaxation during swallowing, loss of esophageal peristalsis and a positive pressure of the esophageal body compared to intragastric pressure. After the 1st balloon dilatation, symptoms were much improved even though LES pressure still remained high (37.2mmHg). About 2 months after the 1st balloon dilatation, symptoms relapsed and we managed him with a 2nd balloon dilatation. Symptoms were more improved than after the 1st dilatation and LES pressure normalized as well. Since the 2nd dilatation, symptoms have not recurred for 3 years. We present an 8-year-old boy with achalasia successfully managed by the use balloon dilatation.

Time-Dependent Diagnostic Value of TROPT(R)TnT Rapid Assay in Patients with Ischemic Chest Pain

A prospective study was carried out to evaluate the validity of TROPT troponin T rapid assay in early diagnosis of acute myocardial infarction(AMI) in patients with ischemic chest pain, in comparison with conventional diagnostic tools such as serum troponin T(c-TnT) level, creatine Kinase(CK), CK-MB level and initial EKG finding. The study was performed at the emergency department(ED) of Yong Dong Severance hospital from March 1st 1996 to February 28th 1997. One hundred eighty one patients visiting ED with chief complaint of atraumatic chest pain within 24 hours of visit were eligible for the study. Those who lacked enough data collection and those who had chest paint of noncardiac origin and EKG of PSVT were excluded from the study. The overall study population was a total of 131 patients. Initial EKG, TROPT rapid assay, CK, CK-MB and c-TnT level were obtained simultaneously. Diagnosis of AMI was made according to the international diagnostic criteria for AMI. Of the 131 patients 61 patients(46.6%) were diagnosed as AMI. Within 4 hours of their symptom onset, initial EKG showed the highest sensitivity(63.2%) whereas the sensitivities of TROPT rapid assay, c-TnT, CK and CK-MB were poor(0-0.7%). From 4-8 hours, the sensitivities of c-TnT, CK and CK-MB were higher than that of TROPT rapid assay(80% vs. 30%). The sensitivites of TROPT rapid assay, c-TnT, CK and CK-MB rose over time and reached 100% after 8 hours symptom onset. The specificities of the TROPT rapid assay, c-TnT, CK & CK-MB and EKG were all 100% within 8 hours after symptom onset. Discrepancy between TROPT rapid assay and c-TnT was noted in nine patients(6.9%). In this study TROPT rapid assay was valuable in the diagnosis of AMI after 8 hours of symptom onset.

The Change of Serum Cholesterol level in Children with Fever

PURPOSE: This study was undertaken to assess the change of the serum cholesterol level according to the duration of fever in children. METHODS: A retrospective study presents data on fasting serum cholesterol assessed 346 children aged from 3 to 14 years, admitted to National Medical Center from Jan. 1992 to Jun. 1994 due to febrile disease. These patients were divided into three groups according to the duration of fever at the time of cholesterol measurement. Group 1 comprised children in whom cholesterol was evaluated on the first 2day of fever, group 2 children in whom cholesterol was assessed on day 3 to 5 and group 3 subjects evaluated 6 to 20 days after the onset of fever. 200 healthy children without fever were also enrolled in this study. The fasting serum cholesterol levels were also measured in both febrile period and afebrile convalescent period in 34 children with febrile diseases during the 7months period of Apr. to Oct. 1994. RESULTS: As the retrospective study, the fasting serum cholesterol levels of group 1, 2 and 3 were lower than those of the controls. And the difference of the serum cholesterol levels between group 1 and group 3 was significant. The prospective study was significantly associated with a decrease of serum cholesterol in the febrile period compared with that in the convalescent period. CONCLUSIONS: Timing of blood collection for screening test and diagnostic measurement of serum cholesterol level should be carefully defined taking into account that febrile illnesses are biologic variables that may significantly affect serum cholesterol.

Observation of Social Background and Disease Patterns of Children in an Institute for Adoption(the 3rd report)

OBJECTIVE: A Study was undertaken to assess the family background of abandonment and clinical and social aspects in an institute for foreign adoption. The results were compared to the previous two reports from the institute. METHOD: A sample of 1,728 children from 1987 to 1992 formed the subjects of the study by the medical records in the institution. RESULTS: 1) The unmber of girls were more than that of male and ratio of male to female was 1:1.1, which was reduced compared to previous study. 2) The distribution less than one month of age was most commonly and increased compared to previous study. 3) The Place at birth was hospital most commonly. 4) The type of delivery was full-term one(61.5%) and tend to be increased. 5) Age distribution of monthers was from 16 years to 25 years mainly, 1,081 of them(62.5%) were from unmarried one and 409(37.4%) were from married one. 6) By classifying the cause of adoption, unmarried mothers occupied main one(62.5%), poverty(13.4%) extramarital relations(5.2%), divorce(2.9%) and death of parents in the order of frequency, tend to increased in unmarried mothers. 7) Disease pattern showed respiratory disease, jaundice, acute gastroenteritis, pneumonia, urinary tract infection, conjunctivitis in order of frequency. By care of foster mother at private home since 1988, the incidence of the transmissible disease was reduced. 8) Congenital anomalies were cleft and palate, hydrocele, umbilical hernia and congenital heart disease in order frequency. 9) Three hundred and eighty two babies were admitted to general hospital. The main disease were bhaline membrane disease. Jaundice, pneumonia and urinary tract disease, sepsis in the order of frequency. CONCLUSIONS: The ratio of male to female in the institution showed no definite difference and the age was tend to be younger. The cause of adoption was unmarried mother mainly. Respiratory disease in the institution and hyaline membrane disease in the hospitalized was most common.

A Clinical and Pathological Study of Recurrent Hematuria in Childhood

The clinico-pathological observation was done on 28 children with recurrent hematuria, who had been admitted to the Pediatric ward of NMC from January 1981 to July 1991. The results were as follows; 1) Most of the children with recurrent hematuria were over 6 years of age(24 cases, 85.7%)and the sex ratio was about 2.5:1. 2) IgA nephropathy (17 cases, 60.7%) was the leading pathologic lesion and mild focal nonspecific glomerulonephritis (5 cases), membranous nephropathy (2 cases), minimal chage (2 cases), Alport syndrome (1case), abnormal glomerular basement membrane (1 case) followed. 3) Types of recurrent hematuria ware gross in 22 cases and microscopic in 6 cases. Flank pain was noted only 1 case. The prodromal events of hematuria were upper respiratory infection in 15 cases and severe exercise in 2 cases. 4) There were no significant differences in clinical features and laboratory findings between IgA nephropathy and other pathologic lesions, except for higher frequency of proteinuria in former group. 5) During the follow-up periods, three cases were resulted in chronic renal failure and they were two cases of IgA nephropathy Class IV and one case of Alport syndrome. And one case of IgA nephropathy was resulted in nephrotic syndrom.

Causes of Anemia Less Than 7 Days of Age

No abstract available.

Neonatal neutropenia / 대한혈액학회지

No abstract available.

A Clinical Study on Tumors in Children

No abstract available.

The Findings of 2D and M-mode Echocardiography in Young Insulin-Dependent Diabetes Mellitus

No abstract available.

A Case of Hypereosinophilic Syndrome

No abstract available.