BACKGROUND: Angiogenesis is an essential process for the growth and metastatic ability of solid tumors. One of the key factors known to be capable of stimulating tumor angiogenesis is the vascular endothelial growth factor (VEGF). The serum VEGF concentration has been shown to be a the malignant pleural effusion showing a correlation with the biochemical parameters. The VEGF has been shown to play a role in the inflammatory diseases, but rarely in the tuberculosis (TB). The serum and pleural fluid VEGF levels were measured in patients with lung cancer and TB. Their relationship with the clinical and laboratory parameters and repeated measurement 3 months after various anticancer treatments were evaluated to assess the utility of the VEGF as a tumor marker. METHODS: Using a sandwich enzyme-linked immunosorbent assay, the VEGF concentration was measured in both sera and pleural effusions collected from a total of 85 patients with lung cancer, 13 patients with TB and 20 healthy individuals. RESULTS: The serum VEGF levels in patients with lung cancer (619.9±722.8ph/ml) were significantly higher than those of healthy controls (215.9±191.1pg/ml), However, there was no significant difference between the VEGF levels in the lung cancer and TB patients. The serum VEGF levels were higher in large cell and undifferentiated carcinoma than in squamous cell carcinoma and adenocarcinoma. The serum VEGF levels of lung cancer patients revealed no significant relationship with the various clinical parameters. The VEGF concentrations in the malignant effusion (2,228.1±2,103.0pg/ml) were significantly higher than those in the TB effusion (897.6±978.8pg/ml). In the malignant pleural effusion, the VEGF levels revealed significant correlation with the number of red blood cells (r=0.75), the lactate dehydrogenase (LDH)(r=0.70), and glucose concentration (r=-0.55) in the pleural fluid. CONCLUSION: The serum VEGF levels were higher in the lung cancer patients. The VEGF levels were more elevated in the malignant pleural effusion than in the tuberculous effusion. In addition, the VEGF levels in the pleural fluid were several times higher than the matched serum values suggesting a local activation and possible etiologic role of VEGF in the formation of malignant effusions. The pleural VEGF levels showed a significant correlation with the numbers of red blood cells, LDH and glucose concentrations in the pleural fluid, which may represent the tumor burden.
Adenocarcinoma ; Carcinoma ; Carcinoma, Squamous Cell ; Enzyme-Linked Immunosorbent Assay ; Erythrocytes ; Glucose ; Humans ; L-Lactate Dehydrogenase ; Lung Neoplasms* ; Lung* ; Pleural Effusion ; Pleural Effusion, Malignant ; Tuberculosis ; Tuberculosis, Pleural* ; Tumor Burden ; Vascular Endothelial Growth Factor A*

OBJECTIVE: The combination of vincristine and doxorubicin by continuous infusion was reported to reduce tumor mass more rapidly than standard regimens, which maybe a result of effect on more slowly proliferating plasma cells. We conducted a phase II study to determine the activity and safety of VAD (vincristine, doxorubicin, dexamethasone) chemotherapy, in which vincristine and doxorubicin are administered as a continuous infusion, for previously untreated multiple myeloma. METHODS: VAD chemotherapy (vincristine 0.4 mg/day 24 hour-continuous infusion, days 1~4; doxorubicin 9 mg/m2/day 24 hour-continuous infusion, days 1~4; dexamethasone 40 mg/day p.o. days 1~4) was given to eligible patients every 4 weeks and we assessed response and toxicity of the regimen. RESULTS: Between January 1991 and March 1997, total 25 patients entered this trial and 22 were evaluable. The complete response rate was 14%(3/22) and overall response rate was 59%(13/22, 95% C.I.: 38~80%). The time to response was 1.0~6.8(median 2.9) months. Progression free survival was 2~39+(median 11.5) months and the overall survival was 3+~42+(median 19.7) months. Toxicities of VAD regimen were leukopenia, infection, stomatitis and neurotoxicity, but there was no treatment-related death. CONCLUSION: VAD chemotherapy was tolerable, but not more active than the alkylating agent-based chemotherapy as a front-line treatment for the patients with multiple myeloma. But, because of its rapid response and relatively mild myelotoxicity, it could play a role for advanced or highly complicated disease and for remission induction before consolidation with high-dose chemotherapy.
Dexamethasone* ; Disease-Free Survival ; Doxorubicin* ; Drug Therapy* ; Humans ; Leukopenia ; Multiple Myeloma* ; Plasma Cells ; Remission Induction ; Stomatitis ; Vincristine*

Adenocarcinoma is the most common type of malignant tumor arising in the stomach, accounting for approximately 95% of malignant gastric neoplasms. The majority of remainder is lymphoma. Although H. pylori infection has been implicated as a common cause of both adenocarcinoma and lymphoma of the stomach, synchronous occurrence of both tumors is very rare. We present a case of a 23- year-old-female who presented with epigastric discomfort and was found to have synchronous low-grade B-cell MALT lymphoma and adenocarcinoma of the stomach in association with H. pylori infection.
Adenocarcinoma ; B-Lymphocytes ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Stomach ; Stomach Neoplasms*

BACKGOUND: The progression rate of IgA nephropathy is known to be variable. We tried to draw an equation that can predict the interval till end stage renal disease (ESRD). METHODS: We retrospectively checked the risk factors of the progression such as demographic, clinical, laboratory, and histologic data by using simple linear regression in eighty eight (M:F=53:35) patients with biopsy-proven IgA nephropathy from Oct 1994 to Aug 2004. By multiple linear regression, a semiquantitative equation estimating the rate of progression was developed. We also evaluated whether there is a "point of no return" that progresses to ESRD which was shown by D'Amico ('93) and Scholl ('99) by receiver operating characteristic (ROC) curve analysis. RESULTS: Mean age and follow-up period were 34.1+/-13.6 years and 55.7+/-31.4 months. Among the risk factors, spot urine protein to creatinine ratio and mean arterial pressure during the follow-up period were significantly associated with the rate of progression (p<0.05). A semiquantitative equation estimating the rate of progression using the two factors was developed as follow. (delta)CCr=2.206-(0.128 x PCR(follow-up))-(0.023 x MAP(follow-up)) (MAPfollow-up:mean arterial pressure; regression coefficient=-0.023, PCRfollow-up:spot urine protein/creatinine; regression coefficient=-0.128). By ROC curve analysis, all patients with maximum serum creatinine over 4.1 mg/ dL during follow-up were found to progress to ESRD. CONCLUSION: We conclude that in Korean IgA nephropathy patients we could predict the rate of decline in renal function for individual patients semiquantitatively and we could confirm the existence of a "point of no return" during the course of IgA nephropathy.
Arterial Pressure ; Creatinine ; Follow-Up Studies ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Kidney Failure, Chronic ; Linear Models ; Retrospective Studies ; Risk Factors ; ROC Curve

BACKGROUND: The question of which dialysis modality should be recommended to end-stage renal disease (ESRD) patients with a history of coronary artery disease (CAD) is encountered frequently in clinical practice, and the answer is still controversial. We tried to explore the patient's survival difference by the dialysis modality in incident ESRD patients with CAD. METHODS: We retrospectively analyzed survival differences by dialysis modality in 56 new ESRD patients with preexisting CAD (HD: PD=30: 26) at yearly intervals with Poisson regression from September 1994 to February 2000. We also investigated the predictors of mortality with multivariate analysis by time-dependent Cox regression. RESULTS: There were no significant differences in age, sex, diabetes, co-morbidity, severity of CAD on commencement of dialysis between HD and PD patients with CAD. Cardiovascular deaths were observed in only HD group. In the CAD group, the relative risk (RR) of mortality in HD patients was equal or higher than that in PD patients for the first 3 years, but RR became lower in HD patient after 3 years. The significant predictors of mortality in CAD group were age, diabetes, arrhythmia and history of cardiac arrest at the time of dialysis initiation. CONCLUSION: When we choose a dialysis modality in incident ESRD patient with preexisting CAD, we could consider an early survival benefit of PD over HD and integrated dialysis approach as a treatment option in this patient group. Further investigation including control group is needed to evaluate in the multicenter, large-scaled manner.
Arrhythmias, Cardiac ; Coronary Artery Disease* ; Coronary Vessels* ; Dialysis* ; Heart Arrest ; Humans ; Kidney Failure, Chronic* ; Mortality ; Multivariate Analysis ; Retrospective Studies

PURPOSE: The aims of this paper are to develop a student evaluation format as a part of core clinical clerkship (student internship) program at Gachon Medical School, and to identify its impeding factors in implementation. METHODS: Both rating scale of Likert type and check list for student's clerkship assessment were designed; the rating scale format was developed into two parts, namely attendance and the clinical competence demonstrated during the clerkship in which 3 domains of knowledge, skills and attitude were included in balance; the professional competence was made of 9 items, each being designed to accommodate 3 degrees by learner's performance. The clinical instructors in charge were requested to sit a short feedback session on the evaluation results with students who were signed at the end. Nursing staff was also asked to participate in evaluation of the student attitude in a limited area. RESULTS: Despite the full acceptance of the evaluation approach theoretically, its practical implementation was not successful because of difficulties related to adjustment of their department-based scoring system to the comprehensive assessment, or unfamiliarity with face-to-face feedback system. CONCLUSION: The authors assume that this Likert type of the rating scale is a simple, more comprehensive and strong tool to meet the learning objectives, and easy to enhance the feedback effect. It is, however, advised that the formative reporting system is crucial to transform the traditional evaluation approach into the pass/fail format so that unnecessary conversion risk is eliminated.
Clinical Clerkship* ; Clinical Competence ; Humans ; Learning ; Nursing Staff ; Professional Competence ; Schools, Medical*

PURPOSE: In order to evaluate the efficacy of PEFL (cisplatin, etoposide, 5-fluorouracil and leucovorin) chemotherapy and to identify favorable subsets, we conducted a phase II trial of PEFL regimen for patients with carcinomas of unknown primary origin (CUPO). MATERIALS AND METHODS: A total of 38 patients was enrolled in this study between May 1995 and September 1997. CUPO was defined as the presence of metastatic cancer documented in the absence of an identifiable primary site. All entered patients were treated with PEFL combination chemotherapy (cisplatin 20 mg/m(2)/day i.v, days 1-5, etoposide 100 mg/m(2)/day i.v. days 1, 3 & 5, 5-fluorouracil 800 mg/m(2)/day continuous infusion days 1-5, and leucovorin 20 mg/m(2)/day i.v, days 1-5; repeated every 4 weeks). The end points of this study were response and survival. To identify favorable subsets, univariate and multivariate analyses were perfonned. RESULTS: Among 38 patients, 29 had measurable lesions. Three (11%) out of 27 evaluable patients had a complete response and 7 (26%) had a partial response (response rate 37%; 95% confidence interval 19~55%). The median survival of the total 38 enrolled patients was 9.1 (range; 1~21.9+) months. The median progression-free survival of the 27 evaluable patients was 5.3 (range 0~ 16.0) months. Among total 132 cycles of chemotherapy, leukopenia of grade II or more was observed in 15% and thrombocytopenia of grade I in 4%. There was no treatment-related death. Main non-hematologic toxicities were nausea/vomiting (79%), stomatitis (70%), and neurotoxicity (33%). The prognostic factor analyses identified 2 favorable subgroups; One was the patient group whose disease had poorly differentiated histology and presented in cervical lymph node. This group of patients had better response rate than other patients (response rate; 71% vs 25%, p=0.02). The other was the patient group who had normal tumor markers (CEA, CA 125 and CA 19-9). This group of patients had better survival than other patients(median survival; 14.8 vs 8.4 months, p=0.05). CONCLUSION: PEFL chemotherapy seemed to be moderately active and tolerable in patients with CUPO. Among heterogenous patients with CUPO, the subset with cervical lymph node and poorly differentiated histology responded better to the chemotherapy and those with normal tumor markers tended toward longer survival.
Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Fluorouracil ; Humans ; Leucovorin ; Leukopenia ; Lymph Nodes ; Multivariate Analysis ; Stomatitis ; Thrombocytopenia ; Biomarkers, Tumor

BACKGROUND AND OBJECTIVES: Although airflow sensation is believed to have a certain role in the subjective sensation of nasal patency, there are few studies that quantify and assess the sensation of nasal airflow. We designed an apparatus that delivers a pulsing jet of air to measure nasal airflow sensitivity. The aims of this study are to map out the airflow sensitivity of the nose, to evaluate the effect of decongestant on airflow sensitivity and to assess reproducibility. MATERIALS AND METHODS: The test sites were stimulated with a pulsing jet of air at gradually increasing velocities, and the minimum velocity at which the subject could detect the tactile sensation was recorded. The threshold velocities after phenylephrine spray were also measured and compared with the pre-decongestant values. The threshold velocities were obtained on two separate occasions to assess reproducibility. RESULTS: The nasal vestibule was more sensitive than the nasal mucosa to airflow, and the most sensitive area in the proper nasal cavity was the anterior end of the inferior turbinate. Sensitivity was not affected by decongestant spray. There was strong agreement between the first and second measurement values. CONCLUSION: Our method of measuring airflow sensitivity is believed to be useful in assesssing nasal airflow sensation.
Nasal Cavity ; Nasal Mucosa ; Nose ; Phenylephrine ; Sensation* ; Turbinates

BACKGROUNDS/AIMS: The therapeutic requirements of patients with non-erosive reflux disease (NERD) are similar to those with erosive esophagitis. The pharmacological action mechanism of prokinetics is quite different; domperidone is a peripheral dopamine D2-antagonist and cisapride is a HT4-agonist. This study was performed to evaluate the therapeutic effect of these two different prokinetics in patients with NERD. METHODS: 178 patients, with heartburn and/or regurgitation, without reflux esophagitis were enrolled and divided into 2 groups by randomization code. In this prospective multicenter trial, 178 patients (93 patients in cisapride group, 85 patients in domperidone group) received 10 mg of cisapride three times a day or 10 mg of domperidone three time a day for 2 or 4 weeks. Symptom assessment was performed in each patients before treatments, 2 and 4 weeks after treatment. RESULTS: Of the 133 patients available for final analysis, 65 were allocated to the cisapride group and 68 to the domperidone group. After 2 weeks treatment, heartburn was reduced in 81.1% of cisapride group, 56.7% of domperidone group (p < 0.05) and regurgitation was reduced in 89.7% of cisapride group, 77.7% of domperidone group. After 4 weeks treatment, heartburn was reduced in 94.3% of cisapride group, 88.7% of domperidone group and this difference was not significant. The proportion of adverse events in cisapride group was 9.4% and was 5.5% in domperidone group. CONCLUSIONS: Cisapride tartrate was more effective in relieving heartburn in NERD patients than domperidone maleate after 2 week treatment. However, this superior effect dose not persist longer than 2 weeks.
Cisapride* ; Domperidone* ; Dopamine ; Esophagitis ; Esophagitis, Peptic ; Heartburn ; Humans ; Prospective Studies ; Random Allocation ; Symptom Assessment

Fibrosing mediastinitis is a rare disease that is characterized by the proliferation of dense fibrous tissue of the mediastinum. The pathogenesis of fibrosing mediastinitis is unknown in most cases. However, histoplasmosis, tuberculosis, autoimmune disease, radiation therapy, and other idiopathic fibroinflammatory diseases have been implicated in some cases. Most clinical features are related to an obstruction or compression of the mediastinal structure. Fibrosing mediastinitis is often progressive and occurs diffusely throughout the mediastinum. We encountered a case of fibrosing mediastinitis of a very focal lesion without evidence of mediastinal involvement. The condition was confirmed by biopsy and graft bypass surgery was performed because of SVC syndrome.
Autoimmune Diseases ; Biopsy ; Histoplasmosis ; Mediastinitis* ; Mediastinum ; Rare Diseases ; Transplants ; Tuberculosis