BACKGROUND: Soluble IL-2R, soluble CD8 and TNF-alpha are elevated in sera of some patients with hematological malignancies, and a marked elevation of these cytokines could be used to assess disease activity and prognosis in this malignancy group. METHODS: The serum levels of sIL-2R, sCD8 and TNF-alpha were assessed in 28 patients with myelodysplastic syndrome (MDS) and 32 patients with acute myeloid leukemia (AML), and 39 cases of healthy control subjects to define clinical usefulness as prognostic markers by sandwich enzyme immunoassay. RESULTS: In MDS patients, serum sIL-2R levels were significantly higher as compared with controls, and a more pronounced increase of serum sIL-2R levels was found in patients with RAEB RAEB-t and CMML as compared with RA and RARS. Serum sCD8 levels were higher as compared with controls, but not related with FAB classification. In patients with leukemic conversion. sCD8 levels tended to be higher as compared with patients with non-conversion. The sIL-2R levels of AML patients were significantly higher than controls, and a significant correlation was detected between the levels of sIL-2R and WBC counts. Higher sIL-2R levels( >2000 U/ml) tended to affect both complete remission rate and survival. Serum sCD8 levels were higher than controls, but not related to FAB classification. No differences of serum TNF-alpha levels were detected as compared with healthy controls. CONCLUSIONS: From these results, this study indicates that serum sIL-2R and sCD8 are significantly increased in some patients with MDS and AML, and increased levels of serum sIL-2R and sCD8 may be useful for predicting prognosis of these patients.
Anemia, Refractory, with Excess of Blasts ; Classification ; Cytokines ; Hematologic Neoplasms ; Humans ; Immunoenzyme Techniques ; Leukemia, Myeloid, Acute* ; Myelodysplastic Syndromes* ; Prognosis ; Tumor Necrosis Factor-alpha*

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount(total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners(GP), 107 regular family physicians(FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites(urban-rural). Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.
Age Factors ; Ambulatory Care ; Delivery of Health Care ; Female ; General Practitioners ; Health Expenditures ; Health Services ; Humans ; Insurance ; Korea ; Physicians, Family ; Prescriptions ; Specialization

In the unusual manifestation of right upper lobe collapse confusing with mediastinal or parenchymal mass, both alteration of the pulmonary vessels and shifting pattern of the collapsed lobe to the periphery on supine positionare the key to the diagnosis of it rather than mediastinal or parenchymal mass. The mechanisms of these unusual manifestation s are obscure, however lobar torsion and gravity factor are considered to be a main process. Authors have experienced 2 cases of unusual manifestations of right upper lobe collapse due to bronchogenic carcinomaduring resent 2 years in Kyung Hee University hospital, and prsent radiologic findings.
Carcinoma, Bronchogenic ; Diagnosis ; Gravitation

PURPOSE: To correlate SOhographic and pathologic findings of gallbladder adenoma, and to evaluate the clinical significance of sonographic findings. MATERIALS AND METHODS: Ultrasound findings of twenty gallbladder adenomas were retrospectively reviewed to evaluate the size, shape and echogenicity of the adenoma, and was correlated with the pathological finding. RESULTS: Among 14 patients, 11 patients had single lesion and 3 patients had multiple lesions. Three patients showed 2, 3 and 4 adenomas, respectively. Nine of 20 lesions showed focal dysplasia pathologically. Among the nine adenomas with dysplasia, two adenomas showed focal cancerous change. The nine adenomas showing focal dysplasia measured 25.6mm (14-35mm) in mean diameter, while the mean diameter of adenomas without dysplasia was 8.7 mm (3-13mm). The echogenicity of adenoma with focal dysplasia were hyperechoic in 8, isoechoic in 1. The echogenicity of adenomas without dysplasia were hyperechoic in 7, isoechoic in 4. Sessile(7/9) and papillary shape(6/9) were predominant in adenoma with dysplasia, but smooth shape(8/11) and stalked type(9/11) were predominant in adenoma without dysplasia. Two adenomas with focal cancerous change showed histological transition from cancer to dysplasia and to adenomatous tissue. In adenoma with dysplasia, the diameter more than 14 mm on sonography was statistically significant (p<0. 005). Also age of patient was significantly different between the two groups (p<0.01), while echogenicity and associated stone were not statistically significant. CONCLUSION: As gallbladder adenoma more than 14ram in diameter on US is suggestive of dysplasia on pathology, so, close follow up US or surgery is recommended.
Adenoma* ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Retrospective Studies ; Ultrasonography

Very late stent thrombosis (VLST) after implantation of drug-eluting stent is rare, but very fatal complication after percutaneous coronary intervention. We report a case of VLST of a sirolimus-eluting Cypher(TM) stent (Cordis, Johnson and Johnson) presenting as acute ST elevation myocardial infarction at 26 months after deployment with continued combined dual antiplatelet medication of aspirin and clopidogrel. The patient did not show anti-platelet resistance.
Aged ; Angina Pectoris/*therapy ; Aspirin/*therapeutic use ; Coronary Angiography ; Coronary Thrombosis/drug therapy/*etiology/radiography ; Drug Resistance ; Drug-Eluting Stents/*adverse effects ; Electrocardiography ; Female ; Humans ; Platelet Aggregation Inhibitors/*therapeutic use ; Ticlopidine/*analogs & derivatives/therapeutic use ; Time Factors

BACKGROUND: Following induction chemotherapy for AML, a sensitive determination of minimal residual disease (MRD) in patients achieving complete remission (CR) should enable the detection of early relapse. This study was designed to verify if quantitative assessment of the Wilms' tumor (WT1) gene by real time polymerase chain reaction (RQ-PCR) can be used as a marker for MRD detection during the monitoring of AML. METHODS: WT1 gene expression was quantified by RQ-PCR in 31 patients with AML at diagnosis (27 patients) and during follow-up (29 patients) relative to ABL control gene. In four patients, the WT1 gene expression was analyzed in comparison to a second PCR marker, PML-RARA fusion transcript. Prognostic significance of WT1 gene expression was analyzed at diagnosis and at the primary CR evaluation. Longitudinal WT1 gene analysis was performed in 17 AML patients. RESULTS: At diagnosis, WT1 gene expression exceeded the control level in all of the patients. Higher levels of WT1 gene expression were not associated with shorter event free survival or overall survival at diagnosis. Higher levels of WT1 gene expression were associated with shorter event free survival after induction chemotherapy. Relapse was observed in eight of 17 patients analysed longitudinally, and an increase of WT1 gene expression preceded morphologic relapse in four patients with the fusion transcript negative. Concomitant monitoring of PML-RARA fusion transcript reveals the lack of a significant correlation withWT1 gene expression. CONCLUSIONS: Quantitation of WT1 gene expression could be used for MRD monitoring of AML and for the early detection of relapse, especially in patients lacking specific molecular markers.
Adaptor Proteins, Signal Transducing/analysis ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gene Expression ; *Genes, Wilms Tumor ; Humans ; Leukemia, Myelomonocytic, Acute/*diagnosis/mortality/therapy ; Male ; Middle Aged ; Neoplasm, Residual ; Polymerase Chain Reaction ; Prognosis ; Survival Analysis ; WT1 Proteins/*analysis/genetics

No abstract available.
Thorax*

Although stent entrapment is a rare event during percutaneous coronary intervention, stent entrapment can cause stent breakage or loss, which results in fatal complications such as stent embolism or acute myocardial infarction. We report one case of stent entrapment that was successfully treated by a snare via a contralateral transfemoral approach.
Angioplasty ; Embolism ; Myocardial Infarction ; Percutaneous Coronary Intervention ; SNARE Proteins ; Stents

BACKGROUND: Serum cystatin C has been suggested to be a better marker for GFR than creatinine because believed to be produced at a constant rate by most nucleated cells, and eliminated exclusively by glomerular filtration We compared serum cystatin C with creatinine-based estimates, especially in patients with old age or extreme protein composition to investigate the utility of cystatin C and to identify factors that influence on cystatin C other than renal function. METHODS: A total of 446 patients, admitted to department of nephrology of Korea University Anam Hospital From September 2003 to March 2004, had their glomerular filtration rate (GFR) estimated by DTPA scintigraphy, clearance of creatinine, and calculated from Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) formula. A body composition, the serum creatinine and cystatin C levels were also measured. RESULTS: Serum cystatin C showed similar correlation with DTPA GFR to serum creatinine. The formula, GFR (mL/min/1.73m2) = 61.84 x cystatin C(-0.8135), was derived with better precision than either Cockcroft-Gault or MDRD. The diagnostic accuracy of cystatin C was not better than creatinine in older patients as well as those with overweight, or an extreme protein composition. The addition of age, body surface area, and gender increased the R2 for both serum creatinine and cystatin C. CONCLUSION: Serum cystatin C is a good marker for GFR, but not superior to serum creatinine even in patients with old age, overweight, or an extreme protein composition, and affected by age, body surface area, and gender independent on renal function.
Body Composition ; Body Surface Area ; Creatinine ; Cystatin C* ; Diet ; Filtration ; Glomerular Filtration Rate* ; Humans ; Korea ; Nephrology ; Overweight ; Pentetic Acid ; Radionuclide Imaging

BACKGROUND: Topoisomerase II (topo II) is a major target of anthracyclines and epipodophyllotoxins for anticancer treatment. The expression of topo II is low in drug resistant cell lines. High levels of glutathione S-transferase (GST)pi have been associated with emergence of cell lines resistant to alkylating agents or adriamycin. METHODS: By immunostaining with paraffin embedded bone marrow tissues, the expression of topo II alpha and GSTpi was investigated in 51 patients with acute myeloid leukemia (AML), and the relation of topo II alpha and GSTpi expression to treatment response in 29 patients with AML following induction chemotherapy was also evaluated. RESULTS: Topo II positive cells varied from less than 1% to 60% of leukemic cells and 20 (39.2%) were negative for topo II (positive cells<10%). Treatment response following chemotherapy was not related to topo II. 26 (51.0%) were positive for GSTpi. GSTpi expression was related to treatment resistance of the patients following chemotherapy. In the patients who showed both topo II alpha negative and GSTpi positive, the frequency of treatment resistance following chemotherapy was high. CONCLUSIONS: This study suggests that immunostaining of topo II alpha and GSTpi with the bone marrow paraffin sections of AML patients can be useful to predict the treatment response following chemotherapy and that further study including more patients with prospective study may substantiate topo II alpha and GSTpi as multidrug resistant markers.
Alkylating Agents ; Anthracyclines ; Bone Marrow ; Cell Line ; DNA Topoisomerases, Type II* ; Doxorubicin ; Drug Resistance, Multiple ; Drug Therapy ; Glutathione S-Transferase pi* ; Glutathione Transferase* ; Glutathione* ; Humans ; Immunohistochemistry ; Induction Chemotherapy ; Leukemia, Myeloid, Acute* ; Paraffin ; Podophyllotoxin