Purpose: This multi-center, retrospective study was conducted to evaluate the long-term survival in patients who underwent surgical resection for small cell lung cancer (SCLC) and to identify the benefit of adjuvant therapy following surgery. Materials and Methods: The data of 213 patients who underwent surgical resection for SCLC at four institutions were retrospectively reviewed. Patients who received neoadjuvant therapy or an incomplete resection were excluded. Results: The mean patient age was 65.29±8.93 years, and 184 patients (86.4%) were male. Lobectomies and pneumonectomies were performed in 173 patients (81.2%), and 198 (93%) underwent systematic mediastinal lymph node dissections. Overall, 170 patients (79.8%) underwent adjuvant chemotherapy, 42 (19.7%) underwent radiotherapy to the mediastinum, and 23 (10.8%) underwent prophylactic cranial irradiation. The median follow-up period was 31.08 months (interquartile range, 13.79 to 64.52 months). The 5-year overall survival (OS) and disease-free survival were 53.4% and 46.9%, respectively. The 5-year OS significantly improved after adjuvant chemotherapy in all patients (57.4% vs. 40.3%, p=0.007), and the survival benefit of adjuvant chemotherapy was significant in patients with negative node pathology (70.8% vs. 39.7%, p=0.004). Adjuvant radiotherapy did not affect the 5-year OS (54.6% vs. 48.5%, p=0.458). Age (hazard ratio [HR], 1.032; p=0.017), node metastasis (HR, 2.190; p < 0.001), and adjuvant chemotherapy (HR, 0.558; p=0.019) were associated with OS. Conclusion Adjuvant chemotherapy after surgical resection in patients with SCLC improved the OS, though adjuvant radiotherapy to the mediastinum did not improve the survival or decrease the locoregional recurrence rate.

Background and Objectives: The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI). Methods: A total of 3,075 patients with chronic CAD were included from the Grand DrugEluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers. Results: During a median (interquartile range) follow-up of 3.1 (3.0–3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63–1.24), all-cause death (HR, 0.87; 95% CI, 0.60–1.25), and MI (HR, 1.25; 95% CI, 0.49–3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/ or revascularization (HR, 0.38; 95% CI, 0.14–0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers. Conclusions Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.

Plasma pH can be altered during pregnancy and at labor. Membrane excitability of smooth muscle including uterine muscle is suppressed by the activation of K+ channels. Because contractility of uterine muscle is regulated by extracellular pH and humoral factors, K+ conductance could be connected to factors regulating uterine contractility during pregnancy. Here, we showed that TASK-2 inhibitors such as quinidine, lidocaine, and extracellular acidosis produced contraction in uterine circular muscle of mouse. Furthermore, contractility was significantly increased in pregnant uterine circular muscle than that of non-pregnant muscle. These patterns were not changed even in the presence of tetraetylammonium (TEA) and 4-aminopyridine (4-AP). Finally, TASK-2 inhibitors induced strong myometrial contraction even in the presence of L-methionine, a known inhibitor of stretchactivated channels in myometrium. When compared to non-pregnant myometrium, pregnant myometrium showed increased immunohistochemical expression of TASK-2. Therefore, TASK-2, seems to play a key role during regulation of myometrial contractility in the pregnancy and provides new insight into preventing preterm delivery.
4-Aminopyridine ; Acidosis ; Animals ; Contracts ; Female ; Hydrogen-Ion Concentration ; Lidocaine ; Membranes ; Methionine ; Mice ; Muscle, Smooth ; Muscles ; Myometrium ; Plasma ; Pregnancy ; Quinidine ; Relaxation ; Uterine Contraction ; Uterus

Infliximab, a tumor necrosis factor-alpha (TNF-alpha) inhibitor, has been approved for the treatment of a variety of inflammatory illnesses, including Crohn's disease. However, infliximab can increase the risk of reactivation of latent tuberculosis (Tbc) infection by affecting host immune responses. Therefore, a screening test should be performed before the initiation of infliximab therapy, and patients with evidence of latent infection should be treated with prophylactic anti-Tbc therapy. Here, we report a case of multifocal disseminated tuberculosis after treatment with infliximab in a patient diagnosed with Crohn's disease who had no past history of Tbc and showed a negative screening test.
Antibodies, Monoclonal ; Crohn Disease ; Humans ; Latent Tuberculosis ; Mass Screening ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Infliximab

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Abscess ; Asia ; Creatinine ; Diabetes Mellitus* ; Escherichia coli ; Gyeonggi-do ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; Seoul ; Streptococcus ; Tertiary Healthcare

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Abscess ; Asia ; Creatinine ; Diabetes Mellitus* ; Escherichia coli ; Gyeonggi-do ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; Seoul ; Streptococcus ; Tertiary Healthcare

BACKGROUND: Despite of the high prevalence of cardiac disease, diagnosing and predicting myocardiac infarction in maintenance dialysis patients may be difficult. The availability of cardiac troponin T (cTnT) and cardiac troponin I(cTnI) offered promise for improving the accuracy of myocardial injuries in the ESRD patients. We hypothesized that cardiac troponin T and I might be useful markers of myocardial injury for patients with dialysis. METHODS: We examined several clinical parameters to identify factors that determine cTnT and cTnI in dialysis patients. The study included 63 patients who had been on dialysis without evidence of myocardial damage for minimum 3 months. Patients were assessed using demographic, cardiac and atherogenic indices including CPK, CK-MB, CK index, LDH, homocysteine, total cholesterol, triglyceride and serum albumin level. All patients were undertaken EKG and echocardiography. Serum levels of cTnT and cTnI were measured by electrochemiluminescence immunoassay(ECL) and chemilumino immunoassay(CLIA) method. We estimated the correlation between cTnT and cTnI with several parameters by using Pearson correlation, linear correlation and Chi- square analysis. RESULTS: The results are summarized as follows : The positivity of serum cTnT was higher in HD patients than CAPD(32% vs. 18%). But there was no significance statistically. Serum cTnI was elevated(>or=0.1 ng/mL) in only one HD patient. Serum cTnT inversely correlated with serum albumin levels (p < 0.05). The positivity of serum cTnT showed statistically significant correlation with underlying diabetic patients than non-diabetic patients(39% vs. 8%, p < 0.05). Serum cTnI was elevated(>or=0.1 ng/mL) in only one diabetic patient. We could not find the significant correlation between serum cTnT and cTnI with age, sex, dialysis mode, duration of dialysis, serum CPK, CK-MB, CK index, LDH, homocysteine, total cholesterol and triglyceride. CONCLUSION: Because cTnT revealed significant correlation with serum albumin and underlying diabetes mellitus. So we speculated that cTnT possibly might be a helpful marker as a predictor of myocardial event and mortality in maintenance dialysis patients. But we can not exclude false positivity of cTnT. And we are currently working to define that cTnI might be more specific marker of myocardial damage than cTnT and the development of cardiac event in cTnT-positive patients.
Cholesterol ; Diabetes Mellitus ; Dialysis* ; Echocardiography ; Electrocardiography ; Heart Diseases ; Homocysteine ; Humans ; Infarction ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Serum Albumin ; Triglycerides ; Troponin T ; Troponin*

Central retinal vein occlusion(CRVO) and branch retinal vein occlusion(BRVO) are the most common retinal vascular diseases. Althouht the pathogenesis of these two dieseases are different, the clinical features are similiar. In this paper, we studied on several factors such as sex, age, laterality, refractive error, intraocular pressure(IOP) and, systemic diseases(56 eyes of CRVO group and 128 eyes of BRVO group). In BRVO hroup, female, above 50 years old, bilaterality and hyperopia(above +3.0D) are more frequent than in CRVO group. In CRVO group, high IOP and below 40 years old are more frequent than in BRVO group. The hing incidence of female in BRVO group(P=0.034) and the high incidence of high IOP in CRVO group(P=0.011) are statistically significant. Diabetes melitus, glucose intolerance, tuberculosis, and syphilis are more frequently associated in CRVO group than in BRVO group, whereas hypertension and heart disease are more frequently associated in BRVO group. An abnormal level in CRP, VDRL and PTT are higher in CRVO group than in BRVO. On the other hand, the incidences of abnormal lipid profile, Hb A2 fraction and RA are higher in BRVO group than in CRVO. In cases of CRVO, the incidence of hypertension is higher in patients of 50 years old or older than in patients do 49 years old or younger, In cases of BRVO, the incidence of heart disease in patients of 50 years old or older is higher than in patients of 49 years old or younger, which both diseases are statistically significant(P<0.05).
Adult ; Female ; Glucose Intolerance ; Hand ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Middle Aged ; Refractive Errors ; Retinal Vein* ; Retinaldehyde* ; Risk Factors* ; Syphilis ; Tuberculosis ; Vascular Diseases

Hemispheric retinal vein occlusion(HSRVO) involves the venous return from approximately one-half of the retina and have characteristics of both central retinal vein occlusion and branch retinal vein occlusion. We have clinically analized in 20 patients that were classified as the HSRVO from June 1988 to December 1993 in the aspect of spheric distribution of diseased retina, sex, age, associated systemic diseases, ocular sequale. The patients were comprised of 6 males and 14 females. The average age was 57.5 years. There were no significant differences in superior and inferior spherical distribution. The most common associated systemic disease was hypertension(40%) and the next was diabets mellitus(20%). As sequle, macula edema in 9 cases and retinal neovascularization and vitreal hemorrhage in 5 cases were found. But iridis rubeosis or neovascular glaucoma was not found. Clinically, HSRVO is closer to branch retinal vein occlusion than central retinal vein occlusion.
Edema ; Female ; Glaucoma, Neovascular ; Hemorrhage ; Humans ; Male ; Retina ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde*

In 11(64.7%) of 17 eyes treated by intravitreal gas injection, the retinas were successfully attached during follow-up period that ranged from 12 to 39 months. Group I(detachment limited to the perimaculararea) patients need more frequent gas injection than group II(detachment extending to equator), but success rate of group I(83.3%) is higher than group II(66.7%). Group III(detachment with peripheral retinal break) patients are not successful by gas injection only. In the succesful eyes, macular holes are not visible, but "window defects" are present on FAG. The relative scotomas improve. Recurrent detachment cases(31.3%) are associated with posterior staphyloma, peripheral retinal break and trauma. Time of late recurrences ranged from 4 to 13 months postoperatively(mean: 7 months).
Follow-Up Studies* ; Humans ; Recurrence ; Retina ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Scotoma