No abstract available.
Lung Neoplasms* ; Lung*

BACKGROUND: A soluble form of interleukin-2 receptor (sIL-2R) is released from activated T cells. Serum sIL-2R levels are elevated in some hematological malignancies and could be used to assess disease activity and prognosis. MATERIAL AND METHODS: To define clinical usefulness and significance as a marker predicting disease progress in chronic myeloproliferative disorders, the serum levels of sIL-2R were measured in 40 cases of chronic myelogenous leukemia (CML; 25 chronic phase, 7 accelerating phase, 8 blastic phase), 3 cases of polycythemia vera (PV), 5 cases of essential thrombocythemia (ET) and 4 cases of idiopathic myelofibrosis (MF) and in 37 cases of healthy subjects using sandwich enzyme immunoassay. RESULTS: Serum sIL-2R levels in the patients of CML, PV, ET, and MF were higher compared with the normal healthy controls. In CML, serum sIL-2R levels in the patients of blastic and accelerating phases were significantly higher than those of chronic phase. In CML of chronic phase, serum sIL-2R levels at diagnosis were related to WBC count but not to other clinical and hematologic paramaters. The leukemic cells of one patient with lymphoblastic phase of CML expressed IL-2R (CD25). Among 4 patients of CML with sIL-2R levels above 2,000U/mL at diagnosis, transformation to blastic crisis was noted in 3 patients and 2 patients died within 1 year after diagnosis. But among 11 patients of CML with sIL-2R levels below 2,000U/mL at diagnosis, only 2 patients experienced blastic crisis and died within 1 year after diagnosis. CONCLUSION: This study indicated that serum sIL-2R levels were high in chronic myeloproliferative disorders, and that increasing levels of serum sIL-2R might be useful to predict disease progress. Further studies including more patients and longer follow-up may substantiate serum sIL-2R as a prognostic indicator in CML.
Diagnosis ; Hematologic Neoplasms ; Humans ; Immunoenzyme Techniques ; Interleukin-2* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Myeloproliferative Disorders* ; Polycythemia Vera ; Primary Myelofibrosis ; Prognosis ; T-Lymphocytes ; Thrombocythemia, Essential

Cytomegalovirus is the most common cause of life-threatening viral infection in HIV-infected patients. This study was done prospectively to investigate the incidence of CMV infection according to the decrease of CD4+ T cell count (CD4+) in Korean AIDS patients. Thirty-nine HIV-infected patients diagnosed before 1994 were followed for regular immunological monitoring. We have used urine shell vial method for the CMV detection from 1994 and have also checked clinical findings. Positive urine culture rate definitely depended on the CD4+ as follows; 45%, 22%, 17%, 11% and 0%, CD4+ >50, 50-100, 100-200, 200-500 and <500, respectively. Except culture positive 2 patients with CD4+ of 200~300/ul, all eight culture positive patients with CD4+ less than 200/ul showed CMV related diseases on or before urine culture. But, we could not get a positive culture for a late AIDS patient with vision loss. With ganciclovir therapy, all culture results were at least negative just after or on late of first 14 days-ganciclovir infusion-course. These data suggest that the incidence of CMV disease in Korean AIDS patients is very high, and early diagnosis and treatment for CMV diseases is required for the prevention of life threatening results.
Cell Count* ; Cytomegalovirus ; Early Diagnosis ; Ganciclovir ; Humans ; Incidence ; Monitoring, Immunologic ; Prospective Studies

No abstract available.
Humans ; Korea* ; Prognosis*

OBJECTIVES: Pneumocystis carinii pneumonia(PCP) is one of the most common life-threatening opportunistic infections in patients with acquired immunodeficiency syndrome(AIDS). This study reports the clinical charac teristics of PCP in the patients with AIDS and prognostic factors for short-term survival of them. METHODS: We investigated 43 patients of AIDS to evaluate the frequency of PCP in patients in AIDS by retrospective analysis, and classified the 17 patients with PCP into survivors and non-survivors to compare epide miology, clinical characteristics and laboratory findings. We also analyzed whether the these findings influenced the short-term survival in patients with PCP that was combined with AIDS. RESULTS: In this retrospective study of 43 patients of AIDS, the frequency of PCP in AIDS patients was relatively high as 17 patients(39%), of whom eight pa tients(47%) died of PCP. The epidemiologic findings such as age, route of human immunodeficiency virus(HIV) infection and co-existing disease were not significantly different between survivors and non-survivors. Coughing was the most common symptom and bilateral infiltrates of lung was the most common form in the chest X-ray examination. But these clinical features were similar in the both groups. Total lymphocyte count, CD4 cell count, serum albumin level and arterial oxygen tension were decreased and serum LDH was increased in patients with PCP that was the first episode in patients with AIDS. Lymphocyte and CD4 cell count were significantly lower in the non-survivor group (p=.002 and p=.03, respec tively). Survivors had higher serum albumin level and arterial oxygen tension than non-survivors (p=.02 and p=.04, respectively). And non-survivors were found to have higher serum LDH level than survivors (p=.02). CONCLUSION: Lymphocyte and CD4 cell counts, serum albumin and LDH, and arterial oxygen tension may be considered as the prognostic factors for short-term sur vival of patients with PCP that is combined with AIDS.
CD4 Lymphocyte Count ; Cough ; Humans ; Lung ; Lymphocyte Count ; Lymphocytes ; Opportunistic Infections ; Oxygen ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia, Pneumocystis* ; Retrospective Studies ; Serum Albumin ; Survivors ; Thorax

BACKGROUND: P-glycoprotein (PGP) is capable of expelling cytotoxic drugs from cytosol and the overexpression mediates drug resistance. However not all resistant leukemic cells express PGP. High expression of glutathione S-transferasepie (GSTpie) is related to clinical outcome following chemotherapy. Topoisomerase IIalpha (topo IIalpha) is a major target of anthracyclines for the treatment of leukemia. METHODS: To evaluate the relation of PGP, GSTpie and topo IIalpha expression to treatment outcome, PGP, GSTpie and topo IIalpha expression were analysed by flow cytometry using mono clonal antibodies (anti-JSB1, anti-GSTpie and anti-topo IIalpha) in 33 cases of de novo acute myelogenous leukemia. RESULTS: In patients with AML, the frequency of patients with high expression of PGP was 57.6% (19/33). The complete remission (CR) rate and mean survival duration were significantly different between patients with high expression and those with low expression of PGP (31.6 vs 92.9%, P=0.001; 83 vs 341 days, P=0.011). The frequency of patients with high expression of GST pie was 60.6% (20/33). The CR rate and mean survival duration were significantly different between patients with high expression and those with low expression of GSTpie (40.0 vs 84.6%, P=0.011; 115 vs 343 days, P=0.021). The frequency of patients with high expression of topo IIalpha is 78.8% (26/33) and treatment outcome was not related to topo IIalpha expression. In multivariate analysis with age, WBC count, PGP and GSTpie, PGP expression was an independent prognostic factor for treatment outcome. CONCLUSION: The flow cytometric measurement of PGP and GSTpie expression can be useful for the prediction of treament outcome following chemotherapy and PGP can be used as aprognostic factor in AML.
Adult* ; Anthracyclines ; Antibodies ; Cytosol ; DNA Topoisomerases, Type II* ; Drug Resistance ; Drug Resistance, Multiple ; Drug Therapy ; Flow Cytometry ; Glutathione S-Transferase pi* ; Glutathione Transferase* ; Glutathione* ; Humans ; Leukemia ; Leukemia, Myeloid, Acute* ; Multivariate Analysis ; P-Glycoprotein* ; Treatment Outcome

To investigate resistance to lamivudine (3TC), we examined the incidence of M184V in 20 HIV-1 patients treated with 3TC for 13.1 +/- 9 months. Fourteen of 20 patients had been exposed to zidovudine (ZDV) or didanosine (ddl) prior to 3TC therapy. Nested PCR targeting to reverse transcriptase (RT) and direct sequencing were performed for peripheral blood mononuclear cells sampled serially. There were resistance mutations to ZDV in at least 9 patients at baseline, although there was no resistance mutation to 3TC. We could detect M184V in 6 (30%) out of 20 patients. The incidence of M184V increased as the duration of therapy prolongs (13% in samples<12 months; 47% in samples gtoreq 12 months). The frequency of mutation M184V was higher in patients with previous mutation to ZDV than in patients with wild type. Resistance mutation was not detected in 7 patients. This study shows that resistance to 3TC tends to develop rapidly in patients with baseline mutations or two drugs combination therapy than in those treated simultaneously with triple drugs. This report is the first on resistance to 3TC in Korean AIDS patients.
Didanosine ; HIV-1* ; Humans ; Incidence ; Lamivudine* ; Polymerase Chain Reaction ; RNA-Directed DNA Polymerase ; Zidovudine

Primary central nervous system(CNS) lymphoma is an uncommon neoplasm which is considered to be radiosensitive. We have recently experienced one of such cases with a history of systemic lymphoma(diffuse histiocytic lymphoma) of the left cheek and left forearm in a 56-year-old man. Chief complaints include headache and generalized weakness for 1 month. MRI(magnetic resonance imaging) revealed an enhancing irregular mass lesion in both the basal ganglia and corpus callosum with minimal surrounding brain edema. CSF analysis and cytology revealed no specific abnormal findings. Without brain biopsy, we concluded that the lesion was a primary CNS lymphoma based on the fact that the patient have had a history of diffuse histiocytic lymphoma and MRI findings were compatible to primary CNS lymphoma. He was treated with dexamethasone for 2 weeks and 3900 cGy radiation therapy for 5 weeks. He improved gradually, and control MRI after radiotherapy showed complete resolution of the lesion.
Basal Ganglia ; Biopsy ; Brain ; Brain Edema ; Central Nervous System* ; Cheek ; Corpus Callosum ; Dexamethasone ; Forearm ; Headache ; Humans ; Lymphoma* ; Lymphoma, Large B-Cell, Diffuse ; Magnetic Resonance Imaging ; Middle Aged ; Radiotherapy

Typhoid fever is a bacteremic disease and many organs, including intestine, liver, bone, lung, thyroid, kidney, spleen, heart and pancreas may be invaded by the organism. Acute pancreatitis associated with typhoid fever sometimes needs prolonged total parenteral hyperalimentation and antibiotic treatment. Systemic Candida infections are usually encountered as opportunistic infections in a setting of immunologic depression. The authors report a case of Candida parapsilosis fungemia associated parenteral nutrition in acute pancreatitis associated with typhoid fever. A 17 year-old man was transfered to Pusan national university hospital on May 4th, 1998 under diagnosis of salmonella sepsis. High fever, nausea, vomiting and diarrhea developed 10 days before entery. On admission, serum amylase, lipase and transaminase showed elevation. The patient was treated with antibiotics(ceftriaxon) and total parenteral hyperalimentation was done under diagnosis of acute pancreatitis and hepatitis associated with typhoid fever. On 3rd hospital day, body temperature returned to normal but abdominal pain, nausea and vomiting continued. On 18th hospital day, high fever recurred and ceftriaxon was re-administered. Three days later, body temperature returned to normal. On 25th hospital days, culture of blood and catheter tip was positive for C. parapsilosis. On 27th hospital days, sudden onset high fever, pnumonic infiltration, confusion, hypotension, oliguria and azotemia developed. On 34th hospital day, sudden onset ventricular fibillation developed. On 35th hospital day, the patients died. We report a case of candida fungemia in acute pancreatitis and hepatitis associated with typhoid fever.
Abdominal Pain ; Adolescent ; Amylases ; Azotemia ; Body Temperature ; Busan ; Candida* ; Catheters ; Ceftriaxone ; Depression ; Diagnosis ; Diarrhea ; Fever ; Fungemia* ; Heart ; Hepatitis* ; Humans ; Hypotension ; Intestines ; Kidney ; Lipase ; Liver ; Lung ; Nausea ; Oliguria ; Opportunistic Infections ; Pancreas ; Pancreatitis* ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Salmonella ; Sepsis ; Spleen ; Thyroid Gland ; Typhoid Fever* ; Vomiting

PURPOSE: The preoperative assessments of the depth of invasion in the rectal wall and the presence of lymph node metastasis are very important in determining the proper treatment modality for rectal cancer. The purpose of this study is to evaluate the accuracy of transrectal ultrasonography (TRUS) for preoperatively staging rectal cancer, as compared with computerized tomography (CT). METHODS: 62 patients who were diagnosed with rectal cancer were staged by using TRUS and CT, preoperatively. The ultrasnonographic tumor stage (uT), the US nodal stage (uN) and the computerized tomographic tumor stage (cT) and the CT nodal (cN) stage were investigated. The accuracy, sensitivity, specificity, PPV (Positive predictive value) and NPV (Negative predictive value) were calculated and compared with the pathologic staging. RESULTS: The accuracies of TRUS and CT in assessing the depth of rectal wall invasion were 82.2% and 79.0%, respectively. The sensitivity, specificity, PPV and NPV of TRUS were 68.1%, 81.9%, 70.4% and 85.4% and those of CT were 53.2%, 78.9%, 73.7% and 80.7%, respectively. The sensitivity of T1 was 77.8% with using TRUS and 33.3% with using CT, respectively. The incidence of over- and under-staging was 17.8% and 9.7% with using TRUS and 25.8% and 6.5% with using CT, respectively. The accuracies of TRUS and CT in assessing the involvement of lymph nodes were 62.4% and 68.8%, respectively. The incidence of over-staging for TRUS and CT was 41.9% and 21.0%, respectively. The incidence of under-staging for TRUS and CT was 20.1% and 25.8%, respectively. There was no meaningful factor influencing the accuracy of TRUS. CONCLUSION: TRUS is very useful tool for the preoperative assessment of the depth of rectal cancer invasion. However, the evaluation of lymph node involvement by TRUS has limitations.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Rectal Neoplasms ; Sensitivity and Specificity