Job Analysis of Nurse Care Coordinators for Chronic Illness Management in Primary Care Settings: Using Developing a Curriculum Process

Purpose@#This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job. @*Methods@#A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators’ jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task. @*Results@#From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, ‘assess the patient’s general health status’ was carried out most frequently. Nurse care coordinators perceived that ‘check vital signs’ and ‘strengthen patient competence to promote health behaviors’ were more important than all other tasks. The most difficult task was ‘develop professionalism as a nurse care coordinator’. @*Conclusion@#The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.

Analysis of Microbial Contamination and Antibacterial Effect Associated with Toothbrushes / 치위생과학회지

The purpose of this study was to propose a method for the effective management of toothbrush contamination. Toothbrush microbial contamination was analyzed according to the duration of toothbrush use, frequency of toothbrush use per day, and toothbrush storage location. We also analyzed the microbial reduction effect of vinegar, antimicrobial mouth rinse, bamboo salt, and baking soda, which are sterilization materials that can be easily used every day. We collected 45 toothbrushes from university dormitories from May to June 2018. To determine the degree of microbiological contamination with general bacteria, coliform bacteria, and Staphylococcus aureus, bristle samples were cultured at 36oC for 24 hours using 3M™ Petrifilm plates and then measured based on Petrifilm evaluation criteria. Toothbrush microorganisms were analyzed according to the duration of use, frequency of use per day, storage location, and effect of each sterilization material. General bacteria, coliforms, and S. aureus contamination increased with frequency and duration of use (p <0.05). In particular, S. aureus showed a statistically significant increase to 36.15 CFU/ml after 1 month, 504.23 CFU/ml after 2 months, and 2,386.67 CFU/ml after 3 months (p <0.05). We found that 1% vinegar was the most effective substance for reducing general bacteria, coliforms, and S. aureus. In addition, 1% antimicrobial mouth rinse solution applied for 5 minutes was the most effective in reducing S. aureus. It is crucial to recognize the importance of toothbrush care and store toothbrushes in a dry place and replace them periodically. We recommend use of vinegar and antimicrobial mouth rinse solution to disinfect toothbrushes. These should be applied as a 1% solution for at least 1 minute. Proper care of toothbrushes is important in maintaining oral health as well as overall health. Instructions on toothbrush care should be given when teaching children or adults how to brush teeth.

MTHFR 3′-untranslated region polymorphisms contribute to recurrent pregnancy loss risk and alterations in peripheral natural killer cell proportions / 대한생식의학회지

OBJECTIVE: To identify the associations between polymorphisms of the 3′-untranslated region (UTR) of methylenetetrahydrofolate reductase (MTHFR) gene, which codes for an important regulatory enzyme primarily involved in folate metabolism, and idiopathic recurrent pregnancy loss (RPL) in Korean women. METHODS: The study population comprised 369 RPL patients and 228 controls. MTHFR 2572C>A, 4869C>G, 5488C>T, and 6685T>C 3′-UTR polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis or by TaqMan allelic discrimination assays. Natural killer cell proportions were determined by flow cytometry. RESULTS: The MTHFR 2572-5488-6685 (A-C-T) haplotype had an adjusted odds ratio of 0.420 (95% confidence interval, 0.178–0.994; p=0.048) for RPL. Analysis of variance revealed that MTHFR 4869C>G was associated with altered CD56⁺ natural killer cell percentages (CC, 17.91%±8.04%; CG, 12.67%±4.64%; p=0.024) and folate levels (CC, 12.01±7.18 mg/mL; CG, 22.15±26.25 mg/mL; p=0.006). CONCLUSION: Variants in the 3′-UTR of MTHFR are potential biomarkers for RPL. However, these results should be validated in additional studies of ethnically diverse groups of patients.

The Effect of Nutrition Plus Program among 0~5 Year Children in the Yeojoo Area: The Improvement in Nutritional Status of Children after Nutrition Supplement of Children and Nutrition Education in Parents/Guardians / 대한지역사회영양학회지

This study evaluated the effect of nutritional improvement of 0~5 year children of financially poor families after nutrition supplement of children and nutrition education in parents/guardians. The subject selected among applicants for lowincome family financing of the government included 198 children (0~12 months:92, 1~5 years:106), and the average ages were 5.3 months and 2.4 years respectively. Food that includes each nutrient factor was provided to the subject for six months. Nutrition education was performed in two ways, through class and private education, once a month for both. Nutritional improvement was evaluated by body measurement and anemia prevalence rate. As to the survey on breastfeeding, complete breast-feeding accounted for 58.7%, weaning food 27.3%, and combined feeding 14.1% respectively, which shows that breast-feeding accounted for the largest percentage. The education program improved knowledge and attitude of the parents/guardians, which brings in positive effects on growth of children as well. The nutrition knowledge score was improved after nutrition education in 0~12 month children (8.5 +/- 1.75 to 8.9 +/- 1.69) and 1~5 year children (7.3 +/- 1.39 to 7.8 +/- 1.30). The nutrition attitude score was significantly improved in 0~12month children (52.0 +/- 6.99 to 53.5 +/- 5.21, p < 0.001) and 1~5year children (45.1 +/- 7.30 to 49.0 +/- 5.96, p < 0.001). In evaluation on nutritional improvement based on body measurements, it turned out that the wasting was reduced as for children in consideration of the height and weight according to the subject's age. The concentration of hemoglobin after the nutrient treatment for six months was significantly improved, and the anemia prevalence rate as well was reduced from 40.6% to 13.5%, which indicates the significant improvement. Based on the findings above, it turned out that providing quality food to children and nutrition education to the parents/guardians poorly fed in low-income families improved knowledge and attitude of the guardians and prevents anemia and improves growth, which brings in positive effects on growth of children. In the results regarding attitude and knowledge on nutrient/dietary life; however, the improvement level was relatively low when the extent before the education was too small, which indicates the need to revise and complement the contents and methods. In addition, as shown in the result of body measurement, long-term and consistent investigation is necessary since it is difficult to judge the effect on growth only based on short-term nutrient supplement.

Examination for helminth eggs and protozoan cysts in fecal samples from healthy Korean adults, 2000~2006 / 대한내과학회지

BACKGROUND/AIMS: Contemporary clinicians have very little understanding of the importance of preventing parasitic disease. This aim of this study was to estimate trends in intestinal parasitic disease via stool examination in healthy Korean adults. METHODS: We reviewed stool examination results to detect any intestinal parasite infections in newly examined healthy patients at the Health Promotion Center of Samsung Medical Center from 2000 to 2006. RESULTS: The rates of overall intestinal parasite infection showed substantial growth from 2000 to 2006: 2.51%, 2.63%, 3.56%, 4.04%, 4.48%, 3.94%, and 4.45% (p<0.001) for 2000 to 2006, respectively. Rates of infection with helminthic eggs (five species) increased from 0.80% in 2000 to 1.50% in 2006 (p<0.001). This trend corresponds to the positive rate of Clonorchis sinensis helminthes (0.45% to 1.43%; p<0.001). Total protozoan cysts infection (four species) also increased (from 1.96% to 2.99%, p<0.001), especially with infection of Endolimax nana (1.15% to 2.23%; p<0.001). CONCLUSIONS: Rates of intestinal parasite infection have increased over the last seven years, especially with C. sinensis and E. nana. These results demonstrate that Korean doctors should pay more attention to the diagnosis and treatment of parasite infections to further patient education and prevent parasitic infections.

Examination for helminth eggs and protozoan cysts in fecal samples from healthy Korean adults, 2000~2006 / 대한내과학회지

BACKGROUND/AIMS: Contemporary clinicians have very little understanding of the importance of preventing parasitic disease. This aim of this study was to estimate trends in intestinal parasitic disease via stool examination in healthy Korean adults. METHODS: We reviewed stool examination results to detect any intestinal parasite infections in newly examined healthy patients at the Health Promotion Center of Samsung Medical Center from 2000 to 2006. RESULTS: The rates of overall intestinal parasite infection showed substantial growth from 2000 to 2006: 2.51%, 2.63%, 3.56%, 4.04%, 4.48%, 3.94%, and 4.45% (p<0.001) for 2000 to 2006, respectively. Rates of infection with helminthic eggs (five species) increased from 0.80% in 2000 to 1.50% in 2006 (p<0.001). This trend corresponds to the positive rate of Clonorchis sinensis helminthes (0.45% to 1.43%; p<0.001). Total protozoan cysts infection (four species) also increased (from 1.96% to 2.99%, p<0.001), especially with infection of Endolimax nana (1.15% to 2.23%; p<0.001). CONCLUSIONS: Rates of intestinal parasite infection have increased over the last seven years, especially with C. sinensis and E. nana. These results demonstrate that Korean doctors should pay more attention to the diagnosis and treatment of parasite infections to further patient education and prevent parasitic infections.

Relation between Health Examination Outcome and Intake of Soy Food and Isoflavone among adult male in Seoul

This study was conducted to analyze the effect of isoflavone intake on prevention of chronic disease in middle and old aged man. In this study we used FFQ (Food frequency questionnaire) and the isoflavone intake level of the subjects was 25.10 mg per day. We divided the subjects into three group -high, medium, low isoflavone intake level- and investigated the relation among isoflavone intake level and clinical/anthropometric characteristics. The intake of isoflavone was inversely related with the body fat in male subjects. And we also divided the subjects into 2 groups with normal and abnormal clinical/anthropometric risk factor. The isoflavone intake level of the abnormal group with high TG, high WHR and high body fat was lower than the normal group. The main food source of isoflavone was soybean curd, bean sprout, soybean paste, soybean and soy milk, and we also investigated the relation between frequency of soybean food and anthropometric and clinical variables. The frequencies of soybean curd, soybean paste, soybean broth, soy milk, bean sprouts, peanuts, soybean and dambuk as well as intake of isoflavone were inversely correlated with some anthropometric and clinical variables such as blood pressure, TG, BMI, % body fat, and waist-hip ratio, whereas positively correlated with HDL cholesterol, muscle mass and bone density. We suggest that high consumption of soy products and isoflavone is associated with decreased blood lipid and body fat in middle and old aged man and might be useful for prevention cardiovascular diseases. From this study, we obtained valuable basic information on recommended isoflavone intake level and guidelines for the prevention of some chronic diseases/health problems.

Clinical evaluation of anesthesia for cesarean section of the patients with hypertensive disorders in pregnancy / 대한산부인과학회지

OBJECTIVE: The parturient with hypertensive disorders usually has multiple organ alterations, which may affect on the anesthetic care during cesarean delivery. The present study purposed to determine the optimal anesthesia method for the cesarean section of the patients with hypertensive disorders through clinical examination and to support adequate patient management. METHODS: We conducted a retrospective survey of medical records of the patients with hypertensive disorders of varying severity delivered by cesarean, between January 1999 and December 2003 at Gangnam CHA Hospital. According to anesthesia method, the patients were divided into the general anesthesia group and the epidural anesthesia group, and the clinical outcomes were compared statistically. RESULTS: Estimated intraoperative blood loss and the frequency of complications such as anemia and pulmonary edema were significantly lower in the epidural anesthesia group. However, there was no major complications with either general or epidural anesthesia CONCLUSION: Epidural anesthesia is considered allowable as the primary anesthesia method for the caesarean section of the parturient with hypertensive disorders.

Postobstructive pulmonary edema after laparoscopic surgery / 대한산부인과학회지

Negative pressure pulmonary edema (also known as postobstructive pulmonary edema) is a medical emergency that usually arises from attempted ventilations against an acutely obstructed upper airway, such as occurs during laryngospasm. Often this occurs in the perioperative period when general anesthesia is used. It is most important to the clinician because it must be promptly recognized and appropriately managed. Since hypoxia is the chief problem associated with this complication, adequate oxygen saturation remains the primary goal of treatment. We report a case of a 42-year-old female patient who was submitted to laparoscopic tubal reversal under general anesthesia and developed negative pressure pulmonary edema after an acute airway obstruction.

Results of Endoscopic Mucosal Resection for Early Gastric Cancer: Factors Influencing Complete Resection / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the study is to evaluate the results of endoscopic mucosal resection (EMR) for early gastric cancer (EGC) and to investigate the factors with influence the complete resection. METHODS: We retrospectively analyzed 109 lesions from 108 patients with EGC treated by EMR at Samsung medical center from November 1994 to June 2003. We compared completely resected group with incompletely resected group with regards to size, location, histologic types before and after EMR, methods of procedure, and complication. RESULTS: The mean size of lesions was 11.3+/-6.5 mm. Eighty two of them were located in the antrum and angle, twenty six in the body, and one in the cardia of stomach. Endoscopically elevated lesions (type I, IIa) were 52 cases and depressed lesions (type IIc) were 40 cases. Histologically curative resection was done in 74 of 109 cases (67.9%). All but one cases have been observed without recurrence for a mean period of 11.1 months. Histologically incomplete resection in 35 cases included 9 positive cancer cell in resection margin, 25 submucosal cancer infiltration, 2 reconstruction failure, 1 lymphatic involvement and 1 signet ring cell type cancer. Complications related to EMR included 9 cases of bleeding and 3 cases of perforation. In comparison of two groups, complete resection rate was significantly higher when tumor was located in the antrum or angle than body or cardia of stomach (p=0.006). CONCLUSIONS: Our results show that EMR is one effective curative treatment modality in highly selected patient with EGC and location of lesion is an important factor influencing the success of complete resection.

Patients' Gender Preference for Colonoscopist / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopy is anticipated as embarrassing and uncomfortable procedure. However, the patients' gender preference for doctor has not been well evaluated in those undergoing colonoscopy. This study was to assess patients' preference for gender and age of colonoscopist. METHODS: A total of one hundread and ninety eight patients (118 males and 80 females) scheduled for colonoscopy were prospectively asked to answer the questionnaires consisting of patient characteristics, preference for gender of colonoscopist, and the period they can wait until their preferred colonoscopist would be acceptable. RESULTS: Among male patients, 51% expressed a gender preference (47% for male and 4% for female colonoscopist) and 52% of female expressed two gender preference (26% for male and 26% for female colonoscopist), and colonoscopists in their forties were preferred the most. Aged female patients and male patients with family history of colorectal cancer preferred a male colonoscopist. The strength of gender preference shown by the period they could wait was weak. CONCLUSIONS: Half of the female and male patients showed gender preference in choosing a colonoscopist. Among the patients expressing a gender preference, most male patients preferred the same gender whereas half of female preferred the opposite gender.

Intestinal Graft-Versus-Host Disease after Bone Marrow Transplantation: 7 Cases Proven by Histopathologic Diagnosis / 대한소화기내시경학회지

Graft-versus-host disease (GVHD) is the major cause of morbidity or mortality after marrow transplantation. The intestinal involvement of GVHD is associated with high graft failure. It is usually difficult to diagnose gastrointestinal (GI) GVHD because symptom is nonspecific, and diagnostic criteria in endoscopic and histologic findings lack the gold standard. We reviewed 7 patients with GI GVHD proven by endoscopic biopsy from September 1999 to June 2003. The common GI symptoms at the time of endoscopy were diarrhea and abdominal pain. Four patients were acute GVHD, two acute and chronic GVHD, and one chronic GVHD. The interval from bone marrow transplantation to GVHD diagnosis by histological examination varied from 18 days to 259 days. The skin was involved in 5 patients. Two cases showed normal endoscopic finding. From these results, endoscopic biopsy is a essential tool in evaluating patients with GI complaints after bone marrow transplantation.

A Case of Pregnancy Associated with Colon Cancer / 대한산부인과학회잡지

Colorectal cancer developed during pregnancy is extremely rare condition associated with a poor prognosis. Pregnant women usually present with more advanced stage at diagnosis than their non-pregnant counterparts. There are several possible reasons for this disparity as follows. The first one is delay in making the diagnosis due to similarity between the early symptoms of colon cancer and the gastrointestinal complains of pregnancy, the second is proliferation and decreased apoptosis of tumor cells due to the effects of various cytokines and hormonal environmental stimuli related to the state of pregnancy, and the third is an increased opportunity for tumor spread due to the immunosuppressed state of pregnancy and increased perfusion of all the organs. Thus, it is important not to underestimate the patient's symptoms because the early diagnosis is essential for better prognosis. We report a 27-year-old primigravida with advanced stage adenocarcinoma of the left colon diagnosed after cesarean delivery with a brief review of literature.

A Case of Anencephaly Associated with Twin Pregnancy Conceived by In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

Twin pregnancies are increasing these days due to recent development of the technology in treating infertility and twin pregnancies tend to cause more congenital anomaly than singleton pregnancies do. Although anencephaly is not uncommon, occurring in about one in every 1,000 births, anencephaly developed in a twin pregnancy is very rare. We experienced a twin pregnancy which consisted of an anencephalic fetus and a normal one. This pregnancy was conceived by IVF and ET. This pregnancy was continued without having special problems and was delivered at 36 weeks of gestation by cesarean section due to SROM (spontaneous rupture of membrane). The anencephalic fetus weighed 1,430 gm and was already dead in the uterus. The other weighed 2,660 gm and showed no external anomaly. Its Apgar score was 8 in 1 minute and 9 in 5 minute. The pregnancy resulted in a cesarean section delivery of one dead anencephalic fetus and one normal healthy fetus. We report with a brief review of literature a case of a twin pregnancy, conceived by IVF and ET, in which anencephaly was associated with a normal fetus.

Two Cases of Subcutaneous Emphysema and Pneumomediastinum Identified During the Laparoscopic Tubal Anastomosis / 대한산부인과학회잡지

Over the last few decades, laparoscopy has evolved from a useful diagnostic tool to a complex surgical method. With its increasing popularity, the complications associated with laparoscopy are also increasing in number and variety. Subcutaneous emphysema, a complication related to the pneumoperitoneum, may result in hypercarbia, pneumomediastinum, and pneumothorax. It can result in even respiratory failure in serious cases. However, it may be easily detected with the signs of increased maximum positive end-tidal CO2 (PETCO2) and crepitus. Fortunately, most of them are recovered by proper conservative management. We report two cases of subcutaneous emphysema and pneumomediastinum identified during laparoscopic tubal anastomosis.

A Case of Primary Ovarian Pregnancy / 대한산부인과학회잡지

Although tubal pregnancy is increasing, primary ovarian ectopic pregnancy has remained a rare event. However, recent reports suggest an increasing incidence to both tubal and term pregnancies. Ovarian pregnancy occurs within the ovary and on the corpus luteum. Earlier diagnosis is now possible, owing to the availability of highly specific radioimmunoassay for human chorionic gonadotrophin and the development of transvaginal ultrasonography. Clinical and even intraoperative diagnosis is difficult and confirmation may be made only by microscopic examination of the tissue specimen. Current understanding of the etiological factors, classification, possible pathogenesis, clinical presentation, diagnostic steps, reevaluation of diagnostic criteria, preferred management and future fertility are detailed. The therapy is surgical and currently more conservative than in the past, because of improvement in operative laparoscopy. We report a case of primary ovarian pregnancy treated conservatively under laparoscopic surgery with a brief review of literature.

Adenocarcinoma of Unknown Primary Site

BACKGROUND: Metastatic cancer of unknown primary site occupies 0.5~10% of all diagnosed cancer patients and includes various tumors with diverse responses to systemic chemotherapy. Adenocarcinoma of unknown primary site (ACUPS), the most common subtype, has no standard treatment, rarely responds to conventional treatment and has a poor survival rate. METHODS: The retrospective study was performed to investigate the clinical characteristics and the treatment outcomes of ACUPS. RESULTS: Eighty-one patients with ACUPS diagnosed at Samsung Medical Center from May 1995 to July 1999 were included. The median age was 58 years (range, 29~77). The common sites of metastases were the lymph node, liver, lung and bone in order. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patients (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survival of the nonresponding patients was 4.6 months (p<0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survival. CONCLUSION: We observed poor response to the treatment and survival rate in ACUPS, but complete remission and long-term survival were observed in a small number of patients.

Clinical investigation of gastric MALT lymphoma / 대한내과학회지

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach has recently been defined as a distinct clinicopathologic entity, often associated with Helicobacter pylori (H. pylori) infection. Characteristics and treatment outcomes of 57 patients with gastric MALT lymphoma were analyzed. METHODS: Retrospective analysis of 57 cases of gastric MALT lymphoma who underwent treatment with various modalities at Samsung Medical Center from Mar. 1995 to Jul. 2000 was performed. RESULTS: The median age of the patients was 47 years (ranged from 22 to 75 years) and the ratio of males to females was 1.1:1. The presenting symptoms were abdominal pain, indigestion and GI bleeding. By Modified Ann Arbor system, stage IE accounted for 70.2%, stage II1E 14.0%, stage II2E 14.0%, and stage IV 1.8%, respectively. H. pylori had been evaluated histologically in 49 cases of which 81.6% was positive. Low grade histology accounted for 71.9% and high grade histology 28.1%. Treatment modalities included H. pylori eradication, surgery, chemotherapy, radiotherapy and their combination therapy. In one case, the patient was observed without treatment. Complete remission rate was 98.2%. H. pylori eradication alone resulted in lymphoma regression successfully in 20 out of 23 patients. With median follow-up of 33 months (3-61 months), median survival was not reached. Overall 3 year survival rate was 94.7%. CONCLUSION: Regardless of treatment modality, high survival rate (3 year survival rate 94.7%) was obtained. H. pylori eradication was feasible and safe in the cases of low grade, stage I, and H. pylori-positive lymphoma, and allowed stomach preservation. Longer follow-up evaluation is required to determine the long-term efficacy and side effects of H. pylori eradication.

A case of lymphocytic infundibuloneurohypophysitis presenting as central diabetes insipidus and nodular mass on neurohypophysis / 대한내과학회지

Lymphocytic infundibuloneurohypophysitis was known as a cause of idiopathic central diabetes insipidus. Until recent time, it is characterized into two groups. One has thickening of the pitutitary stalk, enlargement of the neurohypophysis and loss of hyperintense signal of the normal neurohypophysis, the other has only loss of hyperintense signal but not morphological change. A 51-year-old man presented with a one month history of polydipsia and polyuria. The interpretation of water deprivation test was compatible with complete central diabetes insipidus. Endocrinologic examination of the adenohypophysis hormones and its triple stimulation test were normal apart from thyroid stimulating hormone (TSH), which showed low response despite thyrotropin releasing hormone (TRH). Sellar MRI scan disclosed an loss of hyperintense singnal of normal neurohypophysis and about 10 mm-sized nodular mass lesion on neurohypophysis. However, thickness of the pituitary stalk was normal. Pathologic examination demonstrated diffuse infiltration of lymphocytes and plasma cells. No adenomas, menigitis, sarcoidosis or granulomas were present. We supposed that this case was an atypical type of lymphocytic infundibuloneurohypophysitis, which did not belong to any other part of two groups described above.

Adenocarcinoma of unknown primary site / 대한내과학회지

BACKGROUND: To study clinical characteristics and treatment outcomes of adenocarcinoma of unknown primary site (ACUPS). METHODS: A retrospective analysis of 81 patients who were diagnosed as ACUPS, seen at Samsung Medical Center from May, 1995 to July, 1999, was performed. RESULTS: The median age of the patients was 58 years. The common sites of metastases were the lymph node, liver, lung, bone. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patiens (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survial of the nonresponding patients was 4.6 months (p<0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survial. CONCLUSION: Poor survival rate and treatment response were observed in ACUPS but complete response and long-term survival were observed in several patients.