BACKGROUND: Procalcitonin (PCT) is a relatively new marker for bacterial infections, and its diagnostic utility has been variable across the studies. We investigated the diagnostic utility of PCT for the patients with blood culture-positive sepsis, and compared it with that of C-reactive protein (CRP). METHODS: In 1,270 consecutive blood samples, PCT and CRP were simultaneously measured and results were compared according to the five categories of PCT concentrations (<0.05 ng/mL; 0.05-0.49 ng/mL; 0.5-1.99 ng/mL; 2-9.99 ng/mL; > or =10 ng/mL). In 506 samples, they were further analyzed according to the result of blood culture. PCT and CRP were measured using enzyme-linked fluorescent assay (bioMerieux Co., France) and rate nephelometry (Beckman Coulter Co., USA), respectively. Their diagnostic utilities were compared using ROC curves. RESULTS: The mean concentrations of CRP in five categories of PCT were 15.4 mg/L, 42.1 mg/L, 101.2 mg/L, 125.0 mg/L, 167.1 mg/L, respectively (P<0.0001). Both PCT and CRP showed significant differences between the two positive and negative groups of blood culture (PCT, 8.47 vs 2.44 ng/mL, P=0.0133; CRP, 110.48 vs 59.78 mg/L, P<0.0001). The areas under the ROC curves (95% confidence interval) for PCT and CRP were 0.720 (0.644-0.788) and 0.558 (0.478-0.636), respectively, and showed a significant difference (P=0.005). CONCLUSIONS: The diagnostic utility of PCT is superior to that of CRP for the patients with blood culture-positive sepsis. PCT seems to be reliable for sepsis diagnosis, and may provide useful information for the critically ill patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; C-Reactive Protein/*analysis ; Calcitonin/*blood ; Child ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Nephelometry and Turbidimetry ; Protein Precursors/*blood ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Sepsis/*diagnosis

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disorder. The pathogenesis of NF1 is suggested to be an alteration of the NF-1 gene, which normally functions as a tumor suppressor. A mutation of NF-1 causes the development of viable tumors in various sites. On the other hand, the synchronous manifestation of a gastrointestinal stromal tumor (GIST) and neuroendocrine tumor (NET) in the background of NF1 is extremely rare. This paper reports three cases treated with surgical intervention along with the long-term follow-up results. Three patients showed synchronous ampullary NET and GIST in association with NF1 supported by postoperative histopathologic analysis. Surgical treatments, such as pancreatoduodenectomy and local excision were applied. No recurrence occurred during the postoperative follow-up period of 10, 9, and 2.7 years. Synchronous GIST and NET in the background of NF1 is extremely rare, but the possible coexistence of other tumors in NF1 patients is relatively higher than that in the general population. Furthermore, both NETs and GISTs occurring in NF1 patients tend to be smaller in size compared to that in the general population. Therefore, when NF1 patients present with vague abdominal discomfort, close attention must be paid to identifying the coexistence of other neoplasms.
Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Hand ; Humans ; Neuroendocrine Tumors ; Neurofibromatoses ; Neurofibromatosis 1 ; Pancreaticoduodenectomy ; Recurrence

OBJECTIVES: In diabetics the disturbance of circardian variation of blood pressure and heart rate has been supposed to be related to diabetic autonomic neuropathy and diabetic nephropathy. We performed this study to evaluate the circardian variation of blood pressure and heart rate and the difference of affecting factors between normoalbuminuric patients and microalbuminuric patients. METHODS: We studied 50normotensive NIDDM patients without overt nephropathy, divided two grooups, which are normoalbuminuric patients(D1 group) and microalhuminuric patients(D2 group), according to the urinary albumine excretion rate(AER) on 24-h urine collection. We simultaneosly measured 24-hour blood pressure and heart rate by using of ambulatory 24-hour blood pressure monitoring (ABPM). RESULTS: 1) In group Kb, 24-h systolic and diastolic blood pressure were significantly higher than in C(normal control group) and D1 2) 24-h heart rate values did not significantly differ between the groups, but night heart was significantly elevated in group D2 than C and D1. 3) The night/day ratio of SBP(systolic blood pressure) and HR(heart rate) was significantly higher in D2 than C and D1, but the night/day ratio of DBP(diastolic blood pressure) was significantly higher in D2 compaired with C only. 4) The night/day ratio of SBP correlated significantly with duration of diabetes, log of AER, HDL, HbAlc and 24-h DBP. The determinants selected in a multiple stepwise regression were duration of diabetes and HbAlc. 5) The night/day ratio of DBP was related to duration of diabetes, log of AER, 24-h DBP and night HR. The determinants selected in a multiple stepwise regression were duration of diabetes and 24-h DBP. 6) The night/day ratio of HB was related to neuropathy, 1/creatinine, HDL, night SBP, duration of diabetes and log of AER. The determinants selected in a multiple stepwise regression were neruopathy and night SBP. CONCLUSION: In this study, the normal circardian variation of blood pressure was disturbed in a group of micoralbuminuric patients. But it seems that AER was not a principle independent factor and circardian variation of blood pressure and heart rate were affected by different several factors identified in this study. The nocturnal heart rate was significantly elevated in microalbuminuric group, suggesting the possibility of the presence of parasympathetic neuropathy which is supposed to be related with sudden cardiac death. So it is thought that blunted circardian variation of blood pressure and heart rate can be a prognostic indicator and further prospective study is necessary.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure Monitors ; Blood Pressure* ; Death, Sudden, Cardiac ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Neuropathies ; Heart ; Heart Rate ; Humans ; Urine Specimen Collection

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia. METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.
Adrenal Glands ; Breast ; Estradiol ; Gynecomastia* ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Liver Function Tests ; Lung Diseases ; Lung Neoplasms ; Male ; Pathology ; Physical Examination ; Testosterone ; Ultrasonography

PURPOSE: Although the resectability of hepatocellular carcinoma has increased due to recent advances in diagnostic methods and surgical techniques, the long-term results are unsatisfactory due to their invasiveness and frequent association with cirrhosis. This study was designed to identify the prognostic factors affecting the long term survival and recurrence of tumors in patients having undergone a hepatic resection for a hepatocellular carcinoma. METHODS: Between June 1996 and March 2002, 51 consecutive patients underwent a hepatic resection for a hepatocelluar carcinoma at the Inha University Hospital. The overall cumulative and disease free survival rates for these patients were analysed. Twenty-five clinicopathological factors were evaluated by univariate and multivariate analyse to determine any significant prognostic factors. RESULTS: The cumulative 1, 3 and 5-year survival rates were 84, 70 and 58%, respectively. There were 26 recurrences, and the 1, 3 and 5-year disease free cumulative survival rates were 60, 53 and 31%, respectively. From the univariate analysis, all the factors associated with ascites (P=0.0000), total bilirubin (P=0.0015), albumin (P=0.0271), prothrombin time (P=0.0392), HBe antigen (P=0.0283), Child classification (P=0.0000), celluar differentiation (P=0.0043) were found to correlate with the overall survival. From a Cox regression analysis, the HBe antigen (P=0.019), ascites (P=0.028) were found to be independent prognostic factors of the overall survival. The only factor with an independent effect on disease free survival was the HBe antigen (P=0.037). CONCLUSION: Because prognosis of HBe antigen-positive patients with ascites is poor, frequent postoperative follow up surveys in these patients are needed.
Ascites ; Bilirubin ; Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Humans ; Prognosis ; Prothrombin Time ; Recurrence ; Survival Rate

Survival rate over a 5-year period were studied in a series of 658 proven primary lung cancer patients treated by thoracic surgeons at 8 institutes during the period from 1976 to 1987 in Korea. The study was designed as a multi-center cooperative work for the statistical analysis of the followup result. Clinical data of age, sex, morbidity, and staging of the tumor were assessed in 540 patients to evaluate their 5-year survival rates. Eventually, 405 resectable patients were analyzed by stage, cell type, surgical procedure, and TNM status. The 5-year actuarial survival rates by stage in the resectable group were: stage I 39.7%, II 30.6% III A 16.3%, III B 6.7%, and IV 0%. The 5-year survival rates by cell type were: squamous cell 31.9%, adenocarcinoma 21.2%, large cell 11%, and small cell 6%. The survival rates by surgical procedures were: lobectomy 30.7% and pneumonectomy 25.7%. The survival rates by TNM status in the operable group were: T1 34.7%, T2 26.8%, T3 7.5%, T4 5%; N1 23%, N2 10%, N3 3%; MO 21%, and M1 0%, respectively. The overall actuarial 5-year survival rate in the group of 405 resectable patients was 25.9%.
Adult ; Aged ; Female ; Humans ; Korea/epidemiology ; Lung Neoplasms/mortality/pathology/*surgery ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Survival Rate

BACKGROUND: Some differences exist among various Hepatitis B virus (HBV) DNA quantification assays due to lack of standardization and besides clinical usefulness has not been firmly elucidated in Korean HBV patients. METHODS: We compared Bayer VERSANT HBV DNA 3.0 Assay (VERSANT 3.0) with Digene Hybrid Capture II HBV DNA Test (HC-II) according to HBeAg status and ALT levels in 232 HBV-infected Korean patients. One hundred and seventeen sera with undetectable DNA levels by HC-II were further analyzed by Real-Q HBV quantification assay (BioSewoom). RESULTS: Although VERSANT 3.0 and HC-II showed an excellent correlation (r=0.9739), the results (copies/mL) by VERSANT 3.0 were 0.45 log10 higher than those by HC-II. HBV DNA levels were higher in HBeAg-positive group than in HBeAg-negative group (P=0.002), and in abnormal ALT group than in normal ALT group (P<0.0001). The detection rate of HBV DNA by VERSANT 3.0 was lower in HBeAg-negative and normal ALT group (n=68) than in HBeAg-positive or abnormal ALT group (n=164) (35.3% vs 89.6%, P<0.0001). Fifty two sera out of 61 sera with undetectable DNA by VERSANT 3.0 were measurable by Real-Q with mean value of 3.26 log10 copies/mL. CONCLUSIONS: VERSANT 3.0 and HC-II showed an excellent correlation, but a little difference (0.45 log10) existed. VERSANT 3.0 effectively measured clinically relevant HBV DNA levels in most HBVinfected patients in Korea. However, more sensitive assays are needed for patients with negative HBeAg and normal ALT to see the low copies of HBV DNA levels.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; DNA, Viral/*analysis/genetics ; Data Interpretation, Statistical ; Female ; Hepatitis B e Antigens/metabolism ; Hepatitis B virus/genetics/*isolation & purification ; Hepatitis B, Chronic/*diagnosis ; Humans ; Male ; Middle Aged ; Nucleic Acid Hybridization/*methods ; Polymerase Chain Reaction ; Regression Analysis ; Reproducibility of Results ; Sensitivity and Specificity

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.
Adrenal Glands ; Breast ; Estradiol ; Gynecomastia* ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Liver Function Tests ; Lung Diseases ; Lung Neoplasms ; Male ; Pathology ; Physical Examination ; Testosterone ; Ultrasonography

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.
Adrenal Glands ; Breast ; Estradiol ; Gynecomastia* ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Liver Function Tests ; Lung Diseases ; Lung Neoplasms ; Male ; Pathology ; Physical Examination ; Testosterone ; Ultrasonography