OBJECTIVES: It is well known that Acute Leukemic patients with Hyperleukocytosis (ALH, leukocyte count>or=100,000/micro L) have poor prognosis. This is indebted in fatal complications arising from cerebral and pulmonary leukostasis. To investigate the factors influence on the prognosis of these patients, we have analyzed age, sex, laboratory findings and complications and their relationship to remission rate. METHODS: Retrospective evaluation was done from January 1985 to March 1994 on fifty-four patients with ALH. We excluded secondary leukemias transformed from chronic myelogeneous leukemia, relapsed acute leukemia and myelodysplastic syndrome in this study. The prognostic factors associated with early death were also evaluated. RESULTS: 1) Hyperuricemia and incidence of central nervous system and respiratory symptoms were higher in acute myelogeneous leukemia (AML) with hyperleu-kocytosis than in acute lymphocytic leukemia (ALL), 2) Twenty-two of fifty-four patients had complete remission by remission induction chemotherapy. Remission rate was 41%, median duration of remission was 26 weeks and 1 year survival rate was 11%. 3) There were no differences in remission rate between male and female and higher WBC group (WBC>or=200,000/micro L) and lower WBC group (WBC 100,000~200,000/micro L). 4) The group with better performance status (ECOG score1-2), younger (age below 40) and higher hemoglobin level (Hb>or=10g/dL) had higher remission rate. The group of AML and with hepatomegaly had lower remission rate than the group of ALL and without hepatomegly. 5) Early death rate of AML was higher than that of All. Infection was the most common cause of early death in both AML and ALL. 6) Early death rate between the two groups managed with and without leukapheresis was not different. CONCLUSIONS: This result reveals that acute leukemia with hyperleukocytosis is grave disease, especially the patients with poor performance status (ECOG score: 3-4), older age above 40 and severe anemia (Hb<10g/dL) have poor prognosis, The group of AML and with hepatomegaly showed worse prognosis than the group of ALL and without hepatomegaly.
Anemia ; Central Nervous System ; Drug Therapy ; Female ; Hepatomegaly ; Humans ; Hyperuricemia ; Incidence ; Leukapheresis ; Leukemia* ; Leukocytes ; Leukostasis ; Male ; Mortality ; Myelodysplastic Syndromes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Remission Induction ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: It has been demonstrated that the estimated infarct size is a prognostic variable which significantly influences the short-term and long-term prognosis after an acute myocardial infarction (AMI). Recently, the late peak level of troponin-T has been determined as a reliable and simple non-invasive method for estimation of infarct size. This study was performed to determine whether the late peak level of troponin-T can be used to predict cardiovascular events during in-hospital stay and out-patient follow-up in patients with AMI. MATERIALS AND METHOD: The study was comprised 100 patients (male 91, mean age 57+/-1 years) with AMI and thrombolysis which was initiated within 6 hours after the onset of symptoms. The late peak concentration of troponin-T was defined as a more larger level between 48 and 72 hours after thrombolysis. We investigated the factors influencing on the late peak level of troponin-T and assessed the relation of the late peak level and cardiovascular events. RESULTS: 1) The late peak level of troponin-T was significantly correlated with the peak creatine kinase (CK) level, (r=0.69, p=0.0001) but not ejection fraction of left ventricle (LVEF) at 7 days after AMI. The late peak level of troponin-T was significantly higher in patients with LVEF of <40% at 7 days after AMI (13.49+/-3.62 vs. 6.44+/-0.72, p=0.035) but not different by location of AMI and reperfusion status. 2) During clinical follow-up at a mean duration of 27 months, 1 cardiac death, 10 congestive heart failure, 8 recurrent infarction, and 20 post-myocardial infarction angina were occurred. 3) In patients who occurred cardiac events during in-hospital stay, the peak level of CK (4377+/-938 vs. 2661+/-234, p=0.001) and TIMI forward flow grade < 3 (5/13 vs. 6/55, p=0.022) were significantly higher, but the late peak level of troponin-T (8.69+/-1.22 vs. 6.91+/-0.79, p=0.021) and the peak level of troponin-T (21.09+/-2.29 vs. 13.28+/-1.37, p=0.021) were significantly higher in patients who occurred cardiac events during out-patient follow-up. On multi-variate analysis by logistic regression, the late peak level of troponin-T was predicted the cardiac events during clinical follow-up (CI 1.022-1.196, p=0.022). CONCLUSIONS: The late peak level of troponin-T is significantly correlated with peak CK level and higher in patients with LVEF of Creatine Kinase ; Death ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Infarction ; Logistic Models ; Myocardial Infarction* ; Outpatients ; Prognosis ; Reperfusion ; Troponin T*

Lymphangioma is a congenital malformation of the lymphatic system, commonly seen in the neck. Operation was the treatment of choice but it is difficult to resect the lymphangiomas completely. The aim of this study is to evaluate the result of intralesional injection of OK-432 as a treatment strategy of lymphangioma in children. Medical records of 51 cases of lymphangioma from March 1996 to February 2001 were reviewed retrospectively. Intralesional injection of 0.1 mg OK-432 in 10ml normal saline was performed after the aspiration of as much fluid as possible. The location of the lesion was the face and neck in 26 patients, the chest wall in 14, the extremities in 9, and the abdominal wall in 2. The cystic type was present in 45 patients and the cavernous type in 6. Four postoperative recurrent cases were included. Fluid aspiration from the lesion was impossible in 5 patients. Development of fever after injection was observed in 27 patients and local inflammatory reaction was in 5 patients. There was no scar formation at injection sites. Complete shrinkage was observed in 20 patients, remarkable shrinkage in 23, slight shrinkage in 3, and no response in 5. Cystic type or aspiration-possible cases showed better outcome than cavernous type or aspiration-impossible cases. All of four recurrent cases after surgical excision showed at least remarkable shrinkage. These results indicate that intralesional injection of OK-432 is a safe and satisfactory treatment modality of lymphangiomas in children and might be considered as a treatment of choice, even in recurrent cases.
Abdominal Wall ; Child* ; Cicatrix ; Extremities ; Fever ; Humans ; Injections, Intralesional* ; Lymphangioma* ; Lymphatic System ; Medical Records ; Neck ; Picibanil* ; Retrospective Studies ; Thoracic Wall

Congenital vascular malformations (CVM) have many different clinical presentations, ranging from an asymptomatic birthmark to a life-threatening status. There has been confusion in the classification of these malformations. Two major classification systems are used at the present time: one is the Mulliken and coworkers' system that has been adopted by the International Society for the Study of Vascular Anomalies, and the other is the Hamburg classification that was declared in the 7th Meeting of the International Workshop on Vascular Malformations in Hamburg 1988. The latter is used in this article. BACKGROUND: There are many difficulties in the surgical extirpation of CVM because of their invasiveness, variability, hypervascularity, and evolutibility, especially in a diffuse infiltrating type of CVM. Thus, many endovascular ablative agents have been utilized since 1930s, but there were some handicaps, such as recanalization of previously treated vessels. Since the 1980s, Yakes has reported on much research about the effectiveness of absolute alcohol (98% ethyl alcohol) which incurs permanent vessel wall destruction. AIMS: We performed this study to evaluate the effectiveness of pure ethanol (95-99% ethyl alcohol, Samsung Medical Center, Seoul, Korea) in the treatment of inoperable CVM, to identify the complications that occur and to establish the method of endovascular ablative therapy. MATERIALS AND METHODS: From August 1996 through October 1997, we applied 37 sessions of sclerotherapy using direct puncture technique with pure ethanol to 19 patients with the extratruncular, diffuse infiltrating type of CVM (11 predominantly venous, 8 predominantly arteriovenous shunting)among 250 CVM patients registered at the CVM Clinic of Vascular Center at Samsung Medical Center. RESULTS: Angiographically, the results were excellent in 33 (89%) and good in 3 (9%) sessions. Only one (3%) session failed due to extravasation of the contrast media. The mean follow-up period was only 6 months; 17 (89%) patients were symptomatically improved. Some complications, such as ischemic bullae, deep vein thrombosis, and hematuria, developed, but those patients were recovered without any problem. CONCLUSIONS: The short-term results of pure ethanol sclerotherapy for the diffuse infiltrating type of CVM were good. With more clinical experience, this new treatment modality will be more effective. Further investigations are needed to solve the some complications.
Classification ; Contrast Media ; Education ; Ethanol* ; Follow-Up Studies ; Hematuria ; Humans ; Punctures ; Sclerotherapy* ; Seoul ; Vascular Malformations* ; Venous Thrombosis

There is not a unique registry program about the CVM patients in Korea, even in the World. During the business meeting of International Society for the Study of Vascular Anomalies (ISSVA) 1996 in Rome, a sincere discussion took place about the 1988 Hamburg classification of CVM. This was followed by introduction of registry form that could be used universally throughout the world. We developed a CVM registry program calling CVM for world-wide sharing and analysis. This program is a typical database program application system based on Borland's Delphi 1.0 and the database is managed with dBase III+ . It became clear incoporating the Hamburg classification would be natural while expanding the diagnosis and treatment sections. This is a user-friendly, self-explanatory program that hardly needs any tutorial or instruction. Nonthless, for the foolhardy, it comes with manual that explains every aspect of it. Every panel comes with friendly buttons at your service at the stroke of the mouse or the pad. It can be used either on Windows 3.1 or 95, switching back and forth depending on your computer's capability. The program may obtained by diskettes, compact disc or downloaded from the Internet hompage. We will endeavor to upgrade periodcally as necessity arises.
Animals ; Classification ; Commerce ; Compact Disks ; Diagnosis ; Humans ; Internet ; Korea ; Mice ; Stroke

BACKGROUNDS AND OBJECTIVES: C-Reactive protein (CRP) levels are powerful predictors of cardiac complications and death in patients with unstable angina unrelated with myocardial cell damage or myocardial ischemia. This study was performed to determine the optimal timing to measure CRP to predict cardiac events in patients with unstable angina. MATERIALS AND METHOD: The study was comprised 50 patients with unstable angina (Braunwald Class IIIb). We randomized the study subjects by the time of CRP elevation (> 8mg/L): Group A (on admission, 15 patients), Group B (during hospitalization, 19 patients), and Group C (at discharge, 19 patients). RESULTS: 1) CRP levels (median and range) of Group A, B, and C were 10.6 (8.2-24.2), 12.8 (8.1-33.7), and 10.3 (8.1-18.7) mg/L, respectively (p=S). 2) During clinical follow-up at a mean duration of 12 months, there were 1 death, 1 myocardial infarction, 6 revascularization therapy (PTCA or CABG) and 11 recurrent angina. 3) In Group A, 10 cardiac events (1 myocardial infarction, 4 revascularization therapy, and 5 recurrent angina) occurred. The elevated levels of CRP predicted cardiac events during clinical follow-up with sensitivity of 53%(10/19), positive predictive value of 67%(10/15), and negative predictive value of 74%(26/35). In Group C, 13 cardiac events were occurred. Sensitivity, positive and negative predictive value to predict cardiac events of elevated levels of CRP were 68%(13/19), 68%(13/19) and 81%(25/31), respectively. 4) Elevated levels of CRP (>8mg/L) were predictors for cardiac events in patients with unstable angina (Group A; p<0.05, Group B; p<0.05, Group C; p<0.001). However, by logistic regression analysis, CRP values > 8mg/L at discharge were only predictive of cardiac events with odd ratio of 6.01 (95% CI 1.50-44.3, p<0.05). CONCLUSIONS: CRP (> 8mg/L) was elevated in 38% of patients at discharge and elevated levels of CRP at discharge were only predictive of cardiac events in patients with unstable angina.
Angina, Unstable* ; C-Reactive Protein* ; Follow-Up Studies ; Hospitalization ; Humans ; Logistic Models ; Myocardial Infarction ; Myocardial Ischemia

BACKGROUND: Inflammation plays a key role in the pathogenesis of an in-stent restenosis because it promotes neointimal proliferation. This study was performed to determine responses of the C-reactive protein (CRP) in unstable angina patients with an in-stent restenosis undergoing repeated percutaneous transluminal coronary angioplasty (re-PTCA). METHODS: The study subjects (unstable angina) were classified into 2 groups:Group A (n=30, 15 men, mean age 62 years) had a re-PTCA for an in-stent restenosis lesion and Group B (n=60, 33 men, mean age 63 years) underwent a stent implantation for a de novo lesion. RESULTS: The baseline CRP levels in group A were significantly lower than in group B, as well as 6 and 24 hours after intervention. Twenty four hours after intervention, the CRP levels increased (>4 mg/L) in 3 out of 30 patients (10%) of group A but increased in 32 out of 60 patients (53%) in group B (p<0.001). The differences in the CRP levels between the baseline and 24 hours after intervention were significantly lower in group A than in group B (0.8 and 2.15 mg/L, respectively, p<0.001). In group B, the serum CRP levels 24 hours after intervention were significantly higher than the baseline levels (p<0.05), but not in group A. CONCLUSION: The CRP expression level is significantly lower in unstable angina patients undergoing a re-PTCA for an in-stent restenosis than those undergoing a stent implantation for a de novo lesion.
Angina, Unstable* ; Angioplasty* ; Angioplasty, Balloon, Coronary ; C-Reactive Protein ; Coronary Restenosis ; Humans ; Inflammation ; Male ; Stents

BACKGROUND AND OBJECTIVES: "Recovery only" ST-segment depressions are sometimes detected during an exercise treadmill test. We undertook this study in order to clarify the predictive value of exercise-induced ST-segment depression occurring in recovery only. SUBJECTS AND METHODS: The study included 931 patients who had both a sign or symptom -limited treadmill test. Of the 66 patients who demonstrated abnormal ST-segment responses, 43 experienced ST-segment depressions during exercise (Group A) and 23 displayed such responses only during recovery (Group B). RESULTS: The positive predictive value of an exercise treadmill test for significant angiographic disease in group A (81.3%) was statistically different from the predictive value in group B (30.4%). Horizontal ST-segment depression in recovery periods and female sex were statistically significant factors favoring negative coronary angiographic results. CONCLUSION: The occurrence of horizontal mild ST-segment depression during only the recovery periodgenerally represents a "false positive" response, particularly in female patients.
Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Depression* ; Exercise Test* ; Female ; Humans