Circulating Microparticles and Coagulation Profiles in Patients with Advanced Stage Solid Tumors

No abstract available.

Erratum: A Case of Acute Suppurative Thyroiditis Complicated by Hypocalcemia / 대한내과학회지

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A Case of Acute Suppurative Thyroiditis Complicated by Hypocalcemia / 대한내과학회지

We report a case of acute suppurative thyroiditis complicated by idiopathic hypoparathyroidism. The patient was a 49-year-old female who visited our clinic with a painful goiter on the left lobe of the thyroid gland. She was hypocalcemic, which was accompanied unusually by acute suppurative thyroiditis. She also suffered from tetany of both hands and legs. She had undergone a right subtotal thyroidectomy at another hospital 23 years previously due to a benign thyroid nodule. Intact parathyroid hormone (PTH) levels were increased, but other laboratory findings were normal. No special treatment was administered for the acute suppurative thyroiditis, except antibiotics, to observe its natural course. Her PTH levels decreased and serum calcium returned to normal. The complication of acute suppurative thyroiditis suggested the possible involvement of idiopathic hypoparathyroidism.

A Case of Hepatic Recurrence of Low Risk Duodenal Gastrointestinal Stromal Tumor in 11 Years after Curative Resection

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. It is mainly found in the stomach and small intestine. Based on tumor size and mitotic index, it is classified into very low risk, low risk, intermediate risk and high risk. Generally, the recurrence of low risk GIST is extremely rare, but the recurrence rate can be different according to its location. Recently, it has been reported that the recurrence rate of low risk small bowel GIST is higher than the recurrence rate of low risk stomach GIST. We report a hepatic recurrence of low risk duodenal GIST that was removed completely through pancreaticoduodenectomy 11 years earlier. Regular long term follow-up must be considered, even for low risk GISTs.

A Case of Hepatic Recurrence of Low Risk Duodenal Gastrointestinal Stromal Tumor in 11 Years after Curative Resection

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. It is mainly found in the stomach and small intestine. Based on tumor size and mitotic index, it is classified into very low risk, low risk, intermediate risk and high risk. Generally, the recurrence of low risk GIST is extremely rare, but the recurrence rate can be different according to its location. Recently, it has been reported that the recurrence rate of low risk small bowel GIST is higher than the recurrence rate of low risk stomach GIST. We report a hepatic recurrence of low risk duodenal GIST that was removed completely through pancreaticoduodenectomy 11 years earlier. Regular long term follow-up must be considered, even for low risk GISTs.

A Case of Polycythemia Vera with a JAK2V617F Mutation Combined with Smoldering Myeloma / 대한내과학회지

The lymphoproliferative disease multiple myeloma and the myeloproliferative disease polycythemia vera have different pathogenic mechanisms and different natural courses. Thus, the concomitant development of these two diseases in the same individual is rare. In most previously reported cases of both diseases, one disease was assumed to be a secondary malignancy caused by chemotherapy for the other primary disease. Our case was diagnosed as smoldering myeloma based on increased bone marrow plasma cell numbers and monoclonal gammopathy during a regular follow-up visit for JAK2V617F mutation-positive polycythemia vera, which had not been treated except with phlebotomy. This case provides useful clues for understanding the pathogenesis of these two hematological malignancies and the association between them. Here, we report a case of polycythemia vera with a JAK2V617F mutation combined with smoldering myeloma and discuss the clinical significance and pathogenic association between these disorders of different lineages, along with a literature review.

Colon Cancer After Acute Diverticulitis Treatment

Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.

Anomalous Separate Origin of Left Anterior Descending Coronary Artery: Presented as Acute Anterior Myocardial Infarction

Coronary artery anomalies are rare presentations in primary percutaneous coronary interventions of acute myocardial infarction. Herein, we report the case of a 59-year-old man with acute anterior myocardial infarction who had anomalous separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) from the left coronary aortic sinus. Coronary angiography showed a normal right coronary artery and LCX, but no visualization of the LAD. After several unsuccessful attempts to cannulate the LAD, we found the LAD ostium located by the side of the LCX ostium. There was total occlusion at proxymal LAD. Coronary computed tomography angiography demonstrated the precise, separate origin of LAD and LCX from the left coronary aortic sinus.

Sports Injury Surveillance during Summer Asian Games 2010 in Guangzhou / 대한스포츠의학회지

The purpose of this study was to do the surveillance study of sports injuries which were suffered to National players of South Korea Team during the summer Asian Games 2010 in Guangzhou. All medical staffs of Korea Delegation were asked to report all sports injuries newly incurred during the Games on injury report form, and the physicians made clinical diagnoses of the injuries. Total 725 injuries (430 athletes) were reported, and 288 injuries (209 athletes) were newly incurred: 68 injuries (58 athletes) were recurrent with previous history, resulting in total incidence rate: 45.5 injuries/1000 athlete exposures (AE) (95% confidence interval [CI]: 40.1-50.6 injuries/1000 AE) and incidence proportion: 26% (95% CI: 23-29). The new injury was highest in athletics (n=37, 12.8%), hockey (n=26, 9.0%), and basketball (n=23, 8.0%). While 162 injuries (56.2%) were incurred during practice, 126 injuries (43.8%) were incurred in competition. The most frequent diagnoses were lateral ankle ligament sprain (n=28, 9.7%, 95% CI: 6.3-13.1), calf muscle cramp (n=23, 95% CI: 4.9-11.1), and hamstring strain (n=22, 95% CI: 4.6-10.7). The relapsed injury was highest in athletics (n=16, 23.5%), basketball (n=6, 8.8%), and wrestling (n=5, 7.4%). While 50 injuries (73.5%) were recurred during practice, 18 injuries (26.5%) were recurred in competition. The most frequent diagnoses of relapsed injury were calf muscle cramp (n=11, 16.2%, 95% CI: 7.4-25.0), low back strain (n=6, 8.8%, 95% CI: 2.1-15.6), and hamstring strain (n=6, 8.8%, 95% CI: 2.1-15.6). Our data indicated incidence rates, incidence proportions, characteristics and frequent diagnoses of acute and recurrent sports injuries during the games, therefore these results could provide relevant information for the sports injury prevention at elite level.

A Case of Acute Promyelocytic Leukemia with a De novo t(11;19) Chromosomal Translocation / 대한내과학회지

Acute promyelocytic leukemia (APL), which is usually defined by the morphological features of the leukemic cells, is characterized by the t(15;17) (q22;q21) chromosomal translocation and disseminated intravascular coagulation. This specific translocation results in a new fusion transcript between the promyelocytic leukemia (PML) gene and the retinoic acid receptor-alpha (RARalpha) gene. Although the presence of this fusion gene can predict a favorable clinical response to all-trans-retinoic-acid (ATRA) treatment, APL with chromosomal translocations other than t(15;17) (q22;q21) is extremely rare and is associated with a poor prognosis. We experienced a case of APL with de novo t(11;19).

Usefulness of Real-time Semi-quantitative PCR, JAK2 MutaScreen (TM) Kit for JAK2 V617F Screening / 대한진단검사의학회지

BACKGROUND: Real-time PCR for quantification of JAK2 V617F has recently been introduced and used to evaluate the importance of mutant allele burden in both diagnosis and disease progression in myeloproliferative diseases (MPDs). We evaluated the usefulness of JAK2 MutaScreen(TM) kit that uses a real-time semiquantitative PCR method and has been designed to screen JAK2 V617F mutant allele burden. METHODS: Forty MPD patients were included in this study. We screened JAK2 V617F and determined the mutant allele burden using JAK2 MutaScreen(TM) kit. The mutant allele burden was estimated by six-scaled standards of JAK2 V617F mutant allele (2%, 5%, 12.5%, 31%, 50%, and 78%). For evaluation of test performance, an allele-specific PCR (AS-PCR) was carried out in all samples by using Seeplex JAK2 Genotyping kit. We assessed the clinical differences in distinct disease entities of MPDs according to JAK2 V617F mutant allele burden. RESULTS: JAK2 V617F mutation was detected in 30 cases, including 10 of 11 cases (91%) of polycythemia vera (PV), 13 of 20 cases (65%) of essential thrombocythemia (ET), and 2 of 3 cases (67%) of chronic idiopathic myelofibrosis (CIMF). The concordance rate between the two tests was 95% (38/40). JAK2 V617F mutant allele burden was greater than 50% in 17 cases, and 10 of them (59%) were PV. In contrast, mutant allele burden was less than 50% in 13 cases and 11 of them (85%) were ET. CONCLUSIONS: JAK2 MutaScreen(TM) kit that utilizes a real-time semi-quantitative PCR method is a useful tool for diagnosing MPDs precisely. It can be used to assess the grade of mutant allele burden as well as to screen JAK2 V617F simultaneously.

Usefulness of Deproteinization Using Trichloroacetic Acid for Correcting Negative Interference in Hyperbilirubinemia on Creatinine Measurement / 임상검사와정도관리

BACKGROUND: Most laboratories in Korea have been used kinetic Jaffe method for creatinine measurement. However, kinetic Jaffe method is interfered by hyperbilirubinemia, which causes creatinine decrement. In this study, we evaluated the usefulness of deproteinization by trichloroacetic acid (TCA) in eliminating negative interference of bilirubin for accurate creatinine measurement. METHODS: We evaluated the correction effect of serum creatinine levels by deproteinization using 0.55 mol/L TCA in 43 samples with various total bilirubin levels. For 26 samples of them we measured creatinine using the enzymatic method for evaluating accuracy of TCA correction. Creatinine was measured by using the Toshiba 200-FR automated analyzer and the HiSense CREA reagents. RESULTS: After TCA treatment, 22 to the total 43 samples with more than 10 mg/dL of total bilirubin, revealed statistically higher creatinine concentration (P=0.0002) and the difference of creatinine results is mean 0.53 mg/dL (0.15-1.92 mg/dL). Also, 19 of them (86.4%) revealed 20% or more difference of creatinine results before and after TCA treatment and the negative interference of bilirubin increased in proportion to the rise in total bilirubin concentration (r=0.870). There was no significant difference of creatinine results between kinetic Jaffe method with 0.55 mol/L TCA treatment and enzymatic method (P=0.216). CONCLUSIONS: TCA deproteinization is simple and very efficient method for estimating accurate creatinine level by using kinetic Jaffe method in a patient with hyperbilirubinemia.

Usefulness of Deproteinization Using Trichloroacetic Acid for Correcting Negative Interference in Hyperbilirubinemia on Creatinine Measurement / 임상검사와정도관리

BACKGROUND: Most laboratories in Korea have been used kinetic Jaffe method for creatinine measurement. However, kinetic Jaffe method is interfered by hyperbilirubinemia, which causes creatinine decrement. In this study, we evaluated the usefulness of deproteinization by trichloroacetic acid (TCA) in eliminating negative interference of bilirubin for accurate creatinine measurement. METHODS: We evaluated the correction effect of serum creatinine levels by deproteinization using 0.55 mol/L TCA in 43 samples with various total bilirubin levels. For 26 samples of them we measured creatinine using the enzymatic method for evaluating accuracy of TCA correction. Creatinine was measured by using the Toshiba 200-FR automated analyzer and the HiSense CREA reagents. RESULTS: After TCA treatment, 22 to the total 43 samples with more than 10 mg/dL of total bilirubin, revealed statistically higher creatinine concentration (P=0.0002) and the difference of creatinine results is mean 0.53 mg/dL (0.15-1.92 mg/dL). Also, 19 of them (86.4%) revealed 20% or more difference of creatinine results before and after TCA treatment and the negative interference of bilirubin increased in proportion to the rise in total bilirubin concentration (r=0.870). There was no significant difference of creatinine results between kinetic Jaffe method with 0.55 mol/L TCA treatment and enzymatic method (P=0.216). CONCLUSIONS: TCA deproteinization is simple and very efficient method for estimating accurate creatinine level by using kinetic Jaffe method in a patient with hyperbilirubinemia.

Clinical Utility of Serum Pepsinogen Levels as a Screening Test of Atrophic Gastritis / 대한진단검사의학회지

BACKGROUND: Atrophic gastritis is a well known risk factor for gastric adenocarcinoma. Its confirmatory diagnosis requires histology via endoscopy, which is an invasive method; therefore, periodic follow up evaluation as a screening method is difficult to perform. We evaluated the clinical utility of serum pepsinogens (PG) as a biomarker for screening of atrophic gastritis. METHODS: The study population consisted of 130 selected dyspeptic patients (M:F=52:78; age, 16-105 yrs; mean age, 50.8 yrs) who had undergone a diagnostic endoscopy. The serum pepsinogen test was performed by a latex turbidimetric immunoassay method (HBI, Korea) using Toshiba-200FR automatic analyzer. The PGI, II level and PGI:PGII ratio of non-atrophic gastritis group were compared with those of atrophic gastritis group, and a correlation with Helicobacter pylori infection was examined. Cut-off points for screening of atrophic gastritis were determined. RESULTS: The mean serum concentration of PGI showed a decline from normal (60.7 ng/mL), nonatrophic gastritis (54.2 ng/mL), and atrophic gastritis (51.8 ng/mL) to gastric adenocarcinoma (32.6 ng/mL). The mean ratio of PGI:PGII was lower in atrophic gastritis (3.2) compared to non-atrophic gastritis (4.7) (P=0.021). In patients with H. pylori infection, the mean serum PGII level was higher and the PGI:PGII ratio was lower than those in patients without H. pylori infection, and the differences were statistically significant. For screening of atrophic gastritis, the best cut-off point of PGI:PGII ratio was 4, with a sensitivity of 82.6% and specificity of 91.7%. CONCLUSIONS: The serum pepsinogen test is a useful biomarker for screening of atrophic gastritis, a well-known precancerous lesion of gastric adenocarcinoma. Measuring both pepsinogen I and II concentrations simultaneously to obtain pepsinogen I/II ratio provides a clinically useful information for the detection of atrophic gastritis.

Neoadjuvant chemotherapy in stage IB2 cervical cancer / 부인종양

OBJECTIVE: This retrospective study was purposed to evaluate the effects (clinico-pathologic findings and treatment outcomes) of neoadjuvant chemotherapy in management of cervical carcinoma stage IB2 (tumor diameter>4 cm) METHODS: 22 surgically treated patients due to cervical cancer IB2 between January 1993 and December 2001 were abstracted. They were divided into two groups; the one group (neoadjuvant chemotherapy group) was treated with preoperative neoadjuvant chemotherapy [taxol-cisplatin or bleomycin, vincristin, mitomycin and cisplatin (BOMP), 2-3 cycles] and the other group was treated by primary radical hysterectomy. Clinico-pathologic factors were reviewed and statistically analyzed and compared. RESULTS: There was no significant difference in age, tumor size, and histopathologic type between two groups (p>0.05). After surgery, lymph node, lymphovascular space invasion (LVSI), parametrial invasion, margin involvement, and recurrence rate had no significant difference between two groups (p>0.05). But in neoadjuvant chemotherapy group, postoperative adjuvant chemotherapy or radiation therapy was significantly less needed (p=0.0073). CONCLUSION: The needs of postoperative adjuvant treatment (chemotherapy or radiation therapy) in neoadjuvant chemotherapy group were less than in non-neoadjuvant chemotherapy group, even though there was no difference in clinico-pathologic factors and prognosis between two groups.

Clinical Efficacy of HPV DNA Chip test in Human papillomavirus detection of Uterine Cervix / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the efficacy of HPV DNA chip method for detection and genotyping of various human papillomavirus in the patients with intraepithelial lesions of uterine cervix. METHODS: The study subjects included two hundred patients with abnormal Pap smear from July 2004 to October 2004. After confirmed the pathological status of the cervix with colposcopic biopsy or conization, we evaluated for HPV infection and genotyping with the commercially available Hybrid-Capture II assay (HC-II) and HPV DNA chip. Then we compared the concordance rate between the two methods for the detection of HPV and analysed the HPV genotypes. RESULTS: We compared the results in HPV DNA chip with those in HC-II. In result, the concordance rate between the two methods for the detection of HPV was 85.5% (171 of 200 cases). In 111 patients confirmed the presence of lesions higher than flat condyloma in cervix by pathologc examination, sensitivities of HC-II and HPV DNA chip in detecting HPV were 91.0% and 88.3%, respectively. In HPV DNA chip, HPV-16 was the most frequent type (14.7%) in all patients, the next frequent types were HPV-58 (14.1%) and HPV-18 (9.2%). CONCLUSION: We confirmed that HPV DNA chip method was as sensitive and effective method for detecting HPV in cervical lesions as HC-II. And that it would provide useful clinical information on genotyping and multiple infections of HPV.

Genotyping of Human Papillomavirus Detected with the HPV DNA Chip in Cervical Cancer / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the efficacy of DNA chip method for detection and genotyping of various human papillomavirus in the patients with invasive cervical cancer in Korea. METHODS: The study subjects included 38 cases of cervical cancer for HPV detection and genotyping, and the commercially available DNA chip was used. Retrospectively cervical specimens of thirty eight patients with pathologically confirmed invasive cancer of the uterine cervix were tested for HPV typing performed by DNA chip method in Samsung Cheil Hospital from September 1999 to October 2000. RESULTS: Among 38 cervical carcinomas, histological examination revealed that 34 (89.5%) cases were squamous cell carcinoma, three (7.9%) were adenocarcinoma and one (2.6%) was small cell carcinoma. In carcinoma patients thirty two cases (84.2%) of invasive carcinoma were positive for at least one type of high risk HPV. Only two woman (5.3%) among the healthy group had HPV positive. We compared the results in HPV DNA chip with those in sequencing. The concordance rate between the two methods for the detection of HPV was 95.7% (67 of 70 cases). CONCLUSION: We confirmed that DNA chip method was a simple, convenient, and effective method for detecting HPV in cervical carcinoma and health women.

Natural Killer T Cells in Acute and Unmedicated Patients with Major Depressive Disorder / 신경정신의학

OBJECTIVES: To evaluate an association between depression and altered immunity, we examined peripheral T lymphocyte or natural killer (NK) cell measures plasma ACTH and cortisol using the flow cytometry in acute and unmedicated patients with major depressive disorder (MDD). METHODS: Forty-two patients with MDD from the outpatient clinic and forty normal controls from the hospital staff were recruited. We applied Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for depressed subjects. Peripheral T lymphocyte or NK cell measures (CD3, CD4, CD8, or CD56) and plasma hormones (ACTH and cortisol) were obtained from all subjects. RESULTS: There were no statistical differences in CD3, CD4, CD8, or CD56 between the two subjects. The number of CD56 cells negatively correlated with HAM-D scores (r=-0.42, p<0.01), but did not correlate with HAM-A scores in patients with MDD. The number of CD56 cells showed strong negative correlation with CD4/CD8 (r=-0.47, p<0.01) in the control group, but not in the depressed group. Patients with MDD had higher cortisol level than controls within the normal range. CONCLUSION: The trait of immunological imbalance and HPA axis abnormality were shown in patients with MDD. Especially, the severity of depression, but not the anxiety, could be reflected as decreased number of CD56 (NK T) cells in acute and unmedicated state.

Aggressive Systemic Mastocytosis Following Ovarian Germ Cell Tumor

A 4 years-old girl was diagnosed with aggressive systemic mastocytosis at 2 months after the end of chemotherapy including cisplatin, bleomycin and etoposide for an ovarian germ cell tumor (GCT). She was shown pigmented skin lesion, hepatosplenomegaly, thrombocytopenia and increased mast cells with positive toluidine blue staining on the bone marrow examination. Immunohistochemical staining for c-kit was highly expressed in the bone marrow and skin, but not in the GCT specimen. However, c-kit point mutation was detected in the bone marrow, peripheral blood and GCT tissue when performing PCR via oligonucleotide sequencing. We report here on one case of aggressive systemic mastocytosis following ovarian germ cell tumor with c-kit point mutation.

Mucinous Borderline tumor associated with Mature Cystic Teratoma of Ovary / 부인종양

OBJECTIVE: To evaluate the clinicopathological characteristics of mucinous borderline tumor associated with mature cystic teratoma and the origin of its cell type. METHODS: Five patients who were diagnosed as mucinous borderline tumor associated with mature cystic teratoma and treated in Samsung Cheil Hospital from January 1996 to September 2004 were analyzed. In addition MEDLINE, other data bases in English as well as in Korean revealed two more cases. We analyzed the result with patient's characteristics, preoperative symptoms, mass sizes, serum CA-125, operative procedure, stages, recurrence and survival period. Histological slides of the specimens were analysed for expression of cytokeratin (CK)-7 and cytokeratin (CK)-20 by immunohistochemical staining to know the origin of the cell. RESULTS: The mean age was 45 years (25-61 years). Preoperative symptoms were palpable abdominal mass, abdominal pain and urinary frequency. The mean level of CA-125 was 46.05 U/mL and the mean tumor size was 16.75 cm (8.8-22.0 cm). Post surgical FIGO staging was; stage Ia in 6 cases, stage Ic in 1 case. Four cases were CK7(-)/CK20(+), reflecting gastrointestinal origin, and also showed pattern of pseudomyxoma peritoneii. Mean survival period was 32.7 months (6-67 months) without evidence of recurrence, except one case. CONCLUSION: Our findings suggest that mucinous borderline tumor associated with mature cystic teratoma, is diagnosed at relatively young age and early stage, associated with good prognosis.