Predicting the probability of survival in acute paraquat poisoning

BACKGROUND: Paraquat (PQ) concentration-time data have been used to predict prognosis for 3 decades. The aim of this study was to find a more accurate method to predict the probability of survival. METHODS: This study included 788 patients with PQ poisoning who were diagnosed using plasma PQ concentration between January 2005 and August 2012. We divided these patients into 2 groups (survivors vs. nonsurvivors), compared their clinical characteristics, and analyzed the predictors of survival. RESULTS: The mean age of the included patients was 57 years (range, 14-95 years). When we compared clinical characteristics between survivors (n = 149, 19%) and nonsurvivors (n = 639, 81%), survivors were younger (47 ± 14 years vs. 59 ± 16 years) and had lower plasma PQ concentrations (1.44 ± 8.77 μg/mL vs. 80.33 ± 123.15 μg/mL) than nonsurvivors. On admission, serum creatinine was lower in survivors than in nonsurvivors (0.95 ± 0.91 mg/dL vs. 1.88 ± 1.27 mg/dL). In multivariate logistic regression analysis, age and logarithmically converted serum creatinine [ln(Cr)], [ln(time)], and [ln(PQ)] were assessed as prognostic factors to predict survival in PQ poisoning. The predicted probability of survival using significant prognostic factors was exp (logit)/[1 + exp(logit)], where logit = -1.347 + [0.212 × sex (male = 1, female = 0)] + (0.032 × age) + [1.551 × ln(Cr)] + [0.391 × ln(hours since ingestion)] + [1.076 × ln(plasma PQ μg/mL)]. With this equation, the sensitivity and specificity were 86.5% and 98.7%, respectively. CONCLUSION: Age, ln(Cr), ln(time), and ln(PQ) were important prognostic factors in PQ poisoning, and our equation can be helpful to predict the survival in acute PQ poisoning patients.

Hart's survival curve are Very Useful for Predicting Prognosis in Paraquat Poisoning / 대한신장학회잡지

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.

Hart's survival curve are Very Useful for Predicting Prognosis in Paraquat Poisoning / 대한신장학회잡지

BACKGROUND: Paraquat is highly toxic herbicide used in agriculture, and mortality of paraquat poisoning is very high. The predictions of severity of poisoning assessed with the amount of ingestion, results of urine dithionite test and laboratory findings are not accurate. The aims of this study are to investigate whether Hart's probability of survival curves are useful for predicting outcomes of paraquat-poisoned patients and which factors influence the outcomes of the patients. METHODS: We grouped 175 patients with paraquat poisoning into seven groups using curves of probability of survival suggested by Hart, et al. Group A was patients with plasma paraquat concentration below 90% probability of survival curve, group B patients with paraquat levels between 90% and 70% probability of survival curves, group C patients with paraquat levels between 70 and 50% probability of survival curves, group D the ones with paraquat levels between 50% and 30% probability of survival curves, group E the ones with paraquat levels between 30 and 20% probability of survival curves, group F paraquat levels between 20 and 10% probability of survival curves, and group G patients with paraquat levels above 10% probability of survival curve. And we analyzed the survival and mortality rates of each groups. RESULTS: The mortality rates of groups A, B, C, D, E, F and G were 7.4%, 26.7%, 37.5%, 55.6%, 63.6 %, 83.3% and 96.8% respectively (p<0.0005). The most important risk factor for death of patients was the paraquat concentration grouping with odds ratios (95% CI) of 4.4 (0.7-27.5, group B), 7.2 (0.9-54.9, group C), 15.0 (52.1-105.6, group D), 21.0 (3.2-139.7, group E), 60.0 (7.4-487.1, group F), and 359.9 (56.9- 2277.9, group G). CONCIUSION: In assessing prognosis of patients with paraquat poisoning, grouping of the patients using initial plasma paraquat concentrations is the most important, and the policy of treatment can be decided according the results.

Expression of MAGE-1, -2, and -3 genes in gastric carcinomas and cancer cell lines derived from Korean patients

We investigated the expression of MAGE-1, -2, and -3 genes in tissues of 51 gastric carcinomas from Korean patients and in 11 gastric cancer cell lines established in Korea using reverse transcriptase-polymerase chain reaction along with immunohistochemical analyses and DNA sequencing. Among the 51 gastric carcinomas, MAGE-1, -2, and -3 genes were expressed in 16 (31%), 22 (43%), and 17 (33%), respectively, and 31 (60%) expressed at least one of the three genes. In contrast, none of the three MAGE genes were expressed in normal sites of gastric tissue from each cancer patient. Out of 11 gastric cancer cell lines, MAGE-1, -2, and -3 genes were expressed in two (18%), five (46%), and four (36%), respectively. According to the clinicopathological analysis, the expression of any of the three MAGE genes was not significantly correlated with several clinicopathological factors except histologic types (p= 0.067). Immunohistochemical analyses identified positive staining with monoclonal antibodies 77B and 57B specifically against MAGE-1 and -3 proteins, respectively, in nuclei and cytoplasms of cells in mRNA-positive tumor tissue. These findings suggest the possibility as a target for tumor-specific immunotherapy for Korean patients.

Clinicopathologic Significance of Multidrug Resistance Protein Expression in Patients with Stage III Gastric Adendegrees Carcinoma / 대한암학회지

PURPOSE: We wanted to determine the prognostic significance of P-glycoprotein (Pgp) and multi drug resistance-assdegrees Ciated protein (MRP) in stage III gastric adendegrees Carcinoma by evaluating whe ther the Pgp and/or MRP expression correlate with various clinicopathological parameters and survival rates. MATERIAL AND METHODS: The expression of Pgp and/or MRP were studied immunohistdegrees Chemi cally by ABC method with paraffin-embedded tissue specimens which were surgically obtained from 64 cases of stage III gastric adendegrees Carcinomas at the Department of Surgery, Presbyterian Medical Center from 1991 to 1992. Statistical differences of both expression in various factors including survival rates and clinicopatholgical parameters were sought. RESULTS: Expression rates of Pgp and MRP group were 50.0% and 43.7% respectively. There was no significant correlation between expression of two proteins and various clinicopathological variables such as age, sex, stage, tumor depth, number of metastatic node, tumor size, site and method of operation. However, in case of the degree of differenciation, the expression of Pgp and/or MRP was significantly greater in well differenciated adendegrees Carcinoma than in poorly dif ferenciated adendegrees Carcinoma (p=0.001, p=0.012). Statistically, no significant correlations between the expression of Pgp and/or MRP and overall survival rates were found. CONCLUSION: These results suggest that the Pgp and/or MRP expression in patients with stage III gastric adendegrees Carcinomas are not useful in determining postoperative chemotherapy and as an independent predictor of survival.

Plasma Paraquat Concentration in Acute Paraquat Poisoning

BACKGROUND: Paraquat is a bipyridyl compound, and when ingested, concentrated paraquat can cause either rapid death from multisystem failure and cardiovascular shock or delayed death from progressive pulmonary fibrosis. Paraquat is poorly absorbed by inhalation, but when ingested orally, severe illness can occur. Death usually occurs within 2 days if more than 50mg/kg of paraquat is ingested. The most important prognostic indicator is the quantity of paraquat absorbed, as shown by the plasma paraquat concentration. However, in Korea, there are few, if any, institutes that can measure the plasma paraquat concentration, and the prognostic indication depends mostly on the description given by the patients and their families about the amount of paraquat ingested, which is often underestimated or overestimated. For these reasons, we tried to compare the plasma paraquat concentrations with amount of paraquat described by patients or their families. METHODS: We reviewed the medical records of 59 patients with acute paraquat poisoning from February 1998 through February 1999. The paraquat concentrations in plasma were measured at Presbyterian Medical Center by using high performance liquid chromatography. RESULTS: There was a striking discrepancy between the plasma paraquat concentration and the ingested amount described by the patients or their families. CONCLUSION: We recommend that the plasma paraquat concentration be measured in patients being treated for acute paraquat poisoning.

Evaluation of Clinicopathologic and Prognostic Significance of nm23 protein in stage III Gastric Adenocarcinoma / 대한내과학회지

OBJECTIVE: Gene expression of nm23 has been investigated in a number of tumors, including breast cancer, colon cancer, malignant melanoma, and hepatocellular carcinoma. Its down-regulation has been shown to be associated with metastasis or disease progression in some of the tumors. This study was carried out to define the relationship between nm23 protein expression and clinicopathological variables. METHODS: nm23 protein levels were investigated in 64 surgically resected specimens of stage III gastric cancer by immunohistochemical method, and association with clinicopathological parameters and survival rates were determined. RESULTS: The overall expression rates of nm23 was 68.7 %. There was no significant difference between nm23 protein expression and clinicopathological variables such as age, sex, stage, histology, tumor depth, number of metastatic nodes, tumor size, site and method of operation. Statistically, no significant differences between nm23 protein expression and overall survival rates were found. CONCLUSIONS: These results suggest that nm23 protein expression is an unsatisfactory prognostic indicator in stage III gastric adenocarcinoma.

Comparison of Maximal Removal Rate of Indocyanine Green and Monoethylglycinexylidide Test in Quantitative Assessment of Hepatic Function / 대한임상병리학회지

BACKGROUND: The maximal removal rate of indocyanine green (ICG Rmax), which has been used as a useful indicator of quantitative assessment of the hepatic function, has some disadvantages such as high cost, requirement of multiple sampling, and long turn-around time. This study was designed to clarify that the measurement of the lidocaine metabolite, monoethylglycinekylidide (MEGX) test, can replace the ICG Rmax. And in healthy adults, MEGX forma pion was measured and compared according to methods of measurement and serf. METHOD: In 18 patients to whom ICG Rmax test was requested, ICG Rmax test was carried out at two doses of 0.5 mg/kg and 5 mg/kg and MEGX formation after 15 minute of 1 mg/kg lidocaine Injection was measured by fluorescence polarization immunoassay (FPIA) method. The correlation between them was analyzed, To 25 healthy volunteers included in this study as normal control, lidocaine was given intravenously at, a dose of 1 mg/kg and MEGX forma pion was measured IS and 30 minute later (MEGX15, MEGX30) using both high performance liquid chromatography (HPLC) and FPIA methods. RESULT: Patient group resealed significant correlation between ICG Rmax and MEGX15 (r=0.7674, p<0.001) and also between ICG Rl5 and MEGX15 (r=0.5612, p=0.008). There was significant difference between MEGX15 of 9 patients with chronic liver diseases and those of normal controls (22.24+/- 13.18 and 35.40+/- 14.43 ng/mL, respectively) (p=0.01). In normal controls, the correlation between methods was significant (p=0.001) and the values measured by FPIA method was significantly higher than that by HPLG (p(0.001). Of the normal controls, male group had higher MEGX15 values than female group in both methods (in HPLC method 33.89+/-15.95 and 22.53+/- 8.36, and in FPIA method 41.48+/-16.61 and 28.81+/-7.88 ng/mL, respectively), and in female group MEGX30 values was significantly elevated compared to MEGX15 (p<0.001). CONCLUSION: Inferred from the fact that the correlation between ICG Rmax and MEGX was good, MEGX test can be considered a replacement for ICG Rmax. In healthy adults, it is considered that there is serf-related difference In the rate of lidocaine metabolism so we should pay attention to it in interpreting the MEGX results.

Quantitative Correlation between the Biochemical Markers and The Extent of Metastatic Bone Tumors / 대한암학회지

PURPOSE: We investigated the usefulness of urinary pyridinoline (uPyr) and deoxypyridinoline (uDpyr) and serum osteocalcin as markers of bone metastasis, particularly focussing on quantitative correlation between the degree of bone metastasis and the level of biochemical markers. MATERIALS AND METHODS: By using ELISA method we measured the levels of uPyr, uDpyr, and osteocalcin in 100 cancer patients of whom 58 patients had bone metastasis, 42 had no bone metastasis, and 44 control subjects. RESULTS: There was a significant difference in uPyr level between the patients with bone metastasis and the patients without bone metastasis or control group (mean+/-SD, 70.26+/-43.11 vs 38.93+/-21.48 or 25.13+/-8.81 nM/mM Creatinine, p<0.05). And uDpyr level showed more significant elevation in the patients with bone metastasis than in the patients without bone metastasis and in control group (12.63+/-7.51 vs 6.44+/-3.58 and 4.23+/-1.70 nM/mM Creatinine p<0.05). Osteocalcin level showed no significant difference among groups. We could demonstrate a significant quantitative correlation between the extent of bone metastasis and the amount of uPyr (r=0.7482, p<0.001) or uDpyr (r=0.5992, p<0.001). CONCLUSION: uPyr and uDpyr were significantly increased in metastatic bone tumors and quantitatively correlated well with the extent of bone metastasis. Therefore we can use these two markers as an evidence of bone metastasis. Further studies are recommended to decide the usefulness of these markers in the early detection of bone metastasis and in the assessment of response to antiresorptive treatments.

Effects of Laparoscopic Cholecystectomy on the Cardiopulmanary and Neuroendocrine System / 대한마취과학회지

Laparoscopy is a useful procedure for the diagnostic and therapeutic purpose, but it may be associated with many complieations related to large amounts of CO2 insufflation into the peritoneal cavity. To investigste the influence of laparoscopy 15 ASA classification I, II sur- gical patients were selected. We measured the changes in mean arterial pressure(MAP), heart rate(HR), PaO2, PaCO2, end tidal CO2 tension(PETCO2) and stress hormones such as plsma epinephrine, norepinephrine and cortisol. Above parameters were messured 10 minutes after intubation(control value), immediately after CO2 insufflation, 30 minutes after CO2 insufflation and 20 minutes after CO deflation. The results were ss follows 1) Mean arterial pressure was increased at immediately after CO2 insufflation, 30 minutes after CO2 insufflation(p<0.01) and 20 minutes after CO2 deflation(p<0.05). Heart rate was not changed significsntly. 2) PaCO2 was decreased at 30 minutes after CO2 insufflation(p<0.05), but PaCO2 snd PaCO2 were increased at 30 minutes after CO2 insufflation and 20 minutes efter CO2 deflation (p <0.01). 3) The increase of plasma epinephrine at immediately after CO2 insufflation end 30 minutes after CO2 insufflation was not significant, but plasma norepinephrine was increased at immediately after CO2 insufflstion and 30 minutes after CO2 insufflation(p<0.01). Plasme cortisol was increased at immediately after CO2 insufflstion, 30 minutes after CO2 insufflation and 20 minutes after CO2 deflation(p<0.01). We concluded that laparoscopy with CO2 insufflation has some effects on cardiopulmonary and neuroendocrine system and it is recommended to monitor carefully blood pressure, heart rate and PETCO2 for preventing hypercarbia related complications.

A case of fabry's disease with chronic renal failure effectively managed with CAPD / 대한신장학회잡지

No abstract available.