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Clinical Significance of CA 19 - 9 for Screening of Pancreatic Cancer in Asymptomatic Subjects.

Kyu Taek LEE ; Poong Lyul RHEE ; Hee Jung SON ; Jong Kyun LEE ; Joon Hyeok LEE ; Jae Jun KIM ; Kwang Cheol KOH ; Seung Woon PAIK ; Jong Chul RHEE ; Myung Hee SHIN

Korean Journal of Medicine.1997;53(6):804-810.

OBJECTIVES: Although prognosis for pancreatic cancer is generally poor, it is well known that the survival rate for resected pancreatic cancer is much higher than that for more conservative treatment. The importance of early detection is emphasized for resection of pancreatic cancer. Measurement of serum CA 19-9 has shown satisfactory sensitivity and predictive value in symptomatic patients, but there was no available data in healthy asymptomatic subjects. Thus, we aimed to determine the clinical usefulness of CA19-9 for screening of pancreatic cancer in asymptomatic subjects. METHODS: 11,974 asymptomatic persons visiting Samsung Health Promotion Center from December 1994 to July 1996 participated in this study. All subjects underwent ultrasonography and CA19-9 as initial screening tests. We analyzed sensitivity, specificity, and predictive values in detecting pancreatic cancer of CA 19-9 using statistical methods. RESULTS: Mass screening of 11,974 asymptomatic persons resulted in the detection of only 2 cases of pancreatic cancer. 179 subjects had CA 19-9 values above the cutoff of 37u/ml, including the 2 cases diagnosed with pancreatic cancer. The prevalence of pancreatic cancer over the age of 30 in Korea is 14.8 per 100,000 population. Therefore, sensitivity is 100% and specificity is 98.5%. However, positive predictive value of CA19-9 for detection of pancreatic cancer is only 0.98% in asymptomatic population. CONCLUSION: Mass screening of pancreatic cancer using CA 19-9 in asymptomatic subjects is ineffective due to low predictive value, despite high sensitivity and specificity.
Health Promotion ; Humans ; Korea ; Mass Screening* ; Pancreatic Neoplasms* ; Prevalence ; Prognosis ; Sensitivity and Specificity ; Survival Rate ; Ultrasonography

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The Study of Combined Treatment in Locally Advanced Non - Small Cell Lung Cancer.

Sang Ki PARK ; Geun Hwa KIM ; Seong Su JEONG ; Kyoung Sang SHIN ; Ae Kyoung KIM ; Jee Won SUHR ; Jae Sung KIM ; Moon June CHO ; Ju Ock KIM ; Sun Young KIM

Korean Journal of Medicine.1997;53(6):795-803.

BACKGROUND: The majority of patients with locally advanced, unresectable, non-small cell lung cancer(NSCLC) were treated with conventional thoracic radiation therapy Throcic radiation therapy produces tumor regression in most patients but few cures and dismal 5-year survival rate. Several randomized studies have demonstrated that systemic chemotherapy controls micrometastasis and improve survival ratNes for patients who have locally advanced NSCI.C. Hut the optimal frequency of chemotherapy and sequence for chemotherapy and radiotherapy are yet to be determined. In this study, we analyzed response rate, median survival time, side effects and prognostic variables according to the frequency of chemotheray in locally advanced NSCLC patients. METHODS: We separated locally advanced, unresectable, NSCLC patients into two groups according to given number of chemotherapy cycles. Among 28 patients evaluated, eleven patients were classified to group A, receiving above 3 cycled chemotherapy and seventeen patients, classified to group B, receiving 3 cycled chemotherapy. In both groups, thoracic irradiation of 5940 cGy was given to all patients after chemotherapy. RESULTS: 1) Median survival time was 12.9 months for group A, 12.8 months for group B but there was no statistically significant difference(P>0.05), 2) Overall response rates were not significantly different between two groups(P>0.05). 3) Frequency rate of local failure and distant metastasis were not significantly different between two groups (P>0.05). 4) The grade and frequency of toxicities during treatment were not significantly different between two groups (P>0.05). 5) Clinical stage was the only major prognostic factor for overall survival (P<0.05). CONCLUSION: Median survival time, response rate, toxicities and frequency of local failure and distant metastasis were not significantly different between two groups. So, when we treat locally advanced, unresectable, NSCLC patients in sequential combined treatement, we should consider planned therapy(limiting chemotherapy cycles given), because planned therapy reduces many troubles of patients, that is, economic loss and time consuming, psychiatric anxiety etc, during treatment period. The optimal frequency of chemotherapy is remained to be validated in large scale study in the future in the setting of combined treatment.
Anxiety ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Radiotherapy ; Reaction Time ; Small Cell Lung Carcinoma* ; Survival Rate

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The Value of Spiral Computed Tomography in the Diagnosis of Pulmonary Embolism.

Sung Soon LEE ; Chae Man LIM ; Koun Sik SONG ; Kyu Bo SUNG ; Youn Suck KOH ; Sang Do LEE ; Woo Sung KIM ; Dong Soon KIM ; Won Dong KIM

Korean Journal of Medicine.1997;53(6):787-794.

OBJECTIVE: Spiral volumetric computed tomography(spiral CT) has the advantage of direct imaging of intravascular thrombus or its relevant vascular abnormalities, but controversy exists about the value of spiral CT in the diagnosis of pulmonary embolism in the different levels of pulmonary artery. METHODS: The authors prospectively evaluated the diagnostic efficacy of spiral CT for pulmonary embolism in 20 patients (M:F=13:7, 57+/-10.4yrs) who were suspected to have pulmonary embolism from clinical symptoms and/or scintigraphic findings. Both spiral CT and pulmonary angiography were performed in these patients with the interval being 28+/-14.1 hours. The diagnostic efficacy of spiral CT was evaluated in the patients and also in the pulmonary arteries found to have emboli on pulmonary angiogram. RESULTS: Pulmonary embolism was diagnosed in 8 patients and excluded in 12 patients by pulmonary angiography. Spiral CT showed positive findings of pulmonary embolism in 7 of the 8 patients with pulmonary embolism, and was negative in 11 of the 12 patients without pulmonary embolism. The overall diagnostic efficacy of spiral CT for pulmonary embolism was: sensitivity 87%(7/8), specificity 92%(11/ 12), positive predictive value 87%(7/8), negative predictive value 92%(11/12), and accuracy 90%(18/20). For pulmonary embolism at lobar or greater pulmonary arteries, the diagnostic efficacy of spiral CT was: sensitivity 100%(15/15), specificity 98%(201/205), positive predictive value 79%(15/19), negative predictive value 100%(201/201), and accuracy 90% (216/220). For segmental or smaller arteries, how- ever, the diagnostic efficacy was: sensitivity 71%(15/ 21), specificity 98%(549/559), positive predictive value 60% (15/25), negative predictive value 99%(549/555), and accuracy 97%(554/580). CONCLUSION: Spiral CT can be a useful noninvasive method for the diagnosis of pulmonary embolism, and it may replace pulmonary angiography at the level of central pulmonary artery.
Angiography ; Arteries ; Diagnosis* ; Diuretics ; Heart Failure ; Humans ; Magnesium Deficiency ; Prospective Studies ; Pulmonary Artery ; Pulmonary Embolism* ; Sensitivity and Specificity ; Thrombosis ; Tomography, Spiral Computed*

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A Study on Serum Magnesium Concentration in the Management of Congestive Heart Failure.

Jong Hoon LIM ; Kook Jin CHUN ; Joon Hoon JEONG ; Byung Jin KIM ; Hyun Myung OAH ; Yong Hyun PARK ; Yoong In PARK ; Taek Jong HONG ; Yung Woo SHIN

Korean Journal of Medicine.1997;53(6):778-786.

OBJECTIVES: There are many interesting reports suggesting that magnesium(Mg) deficiency is deleterious in patients with congestive heart failure (CHF). It is paradoxical that the most important cause of Mg deficiency in these persons is maybe use of therapeutics including diuretics. Authors investigated the trend of serum and 24 hour urine Mg with other relating electrolytes in Mg homeostasis prospectively, in the management of CHF. And we assessd the effects of medications and many variables in .CHF on serum Mg, and the usefulness of serum Mg representing the body content. METHODS: Fifty three patients who were diagnosed as CHF by clinical finding and echocardiogaphy were prescribed conventional doses of diuretics as furosemide 40mg and spironolactone 50mg daily, with or without angiotensin converting enzyme(ACE) inhibitor and digitalis. And then, serial serum and 24 hour urine Mg, sodium, potassium and calcium were obtained at admission, 2nd day, 5th day, and discharge. RESULTS: The patients group with chronic CHF, which was defined as long-term use of diuretics over 6 months, showed higher prevalence of low level of serum Mg concentration than the group with acute one(11 of 28, 39% vs. 2 of 25. 8%, P< 0.01). Of those two groups, the latter showed upward trend of serum Mg from admission to discharge, but the former showed no change. In 24 hour urine Mg excretion, the amount of the patients with CHF was larger than that of control group. In the chronic CHF group, the effect of digitalis on decreasing serum Mg was evident. Serum Mg of acute CHF group correlated with serum BUN(r=0.5609). Whereas, that of chronic group with ejection fraction(r=-0.4742) and plasma renin activity(r=-0.3791), with serum potassium(r=0.4673) and creatinine(0.5846). Serum Mg may be useful indicator of Mg homeostasis, especially in chronic CHF patients. CONCLUSION: Because patients with chronic CHF were prone to deficiency of Mg in the management, maintaining the adequate serum Mg through long- term replacement seems very important in decreasing the morbidity and mortality of these persons.
Angiotensins ; Calcium ; Digitalis ; Diuretics ; Electrolytes ; Estrogens, Conjugated (USP)* ; Furosemide ; Heart Failure* ; Homeostasis ; Humans ; Magnesium Deficiency ; Magnesium* ; Mortality ; Plasma ; Potassium ; Prevalence ; Prospective Studies ; Renin ; Sodium ; Spironolactone

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Seasonal Variation of Blood Pressure in Korean Hypertensives.

Gil Ja SHIN ; Hon Keun CHO

Korean Journal of Medicine.1997;53(6):769-777.

OBJECTIVES: The mortality rate due to stroke and myocardial infarction by the complication of the hypertension were the major causes of death among the Korean followed by the cancer. There are many factors to affect the blood pressure variability such as physical activity, sleeping, activation of the autonomic nervous system, climate, cold exposure and seasonal variation. The blood pressure was increased by cold exposure. In general, blood pressure was increased in winter and the cardiovascualr mortality is also increased at winter. In Korea, we have distinct seasonal variation of the climate, we have no clinical data on the seasonal variation of the blood pressure. METHODS: To investigate the seasonal variation of blood pressure of Korean essential hypertensives and make effort to reduce the cardiovascualr mortality, we studied 63 hypertensive men and women hypertensives. RESULTS: 1) The mean age was 60+/-10 years with 19men and 44 women. The mean systolic blood pressure was 146+/-22mmHg, mean diastolic blood pressure was 91+/-11mmHg. 2) The mean systolic and diastolic blood pressure during the 12 months was 137+/-18mmHg, 86+/-10mmHg in men respectively. In women, the mean systolic blood pressure was 137+/-16mmHg and the mean diastolic blood pressure was 86+/-8mmHg. 3) The biochemical findings including hemoglobin, hematocrit and creatinine levels were significantly lower in women(P<0.05). 4) The systolic and diastolic blood pressure were significantly increased during the winter as January and February, 5) There was also significant increase of systolic blood pressure at the transitional zone to the sum- mer to autumn(P=0.0004). CONCLUSION: There was significant increase in systolic and diastolic blood pressure in winter in Korean hypertensives. This phenomenon was also observed the transitional zone to summer to autumn. So, during these period, more strict blood pressure control by frequent measurement and increase the room temperature may be recommended to reduce the cardiovascular mortality during winter.
Autonomic Nervous System ; Blood Pressure* ; Cause of Death ; Climate ; Cold Climate ; Creatinine ; Female ; Hematocrit ; Humans ; Hypertension ; Korea ; Male ; Mortality ; Motor Activity ; Myocardial Infarction ; Seasons* ; Stroke

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Diagnostic Efficacy of Exercise Tc - 99m Tetrofosmin SPECT in Patients with Coronary Artery Disease.

Ji Yong CHOI ; Jin Yong HWANG ; Jong Hyeon HWANG ; Hyeon Ju LIM ; Hun Sik PARK ; Yong Keun CHO ; Shung Chull CHAE ; Jae Eun JUN ; Wee Hyun PARK ; Byeong Cheol AHN ; Jae Tae LEE ; Kyu Bo LEE

Korean Journal of Medicine.1997;53(6):759-768.

OBJECTIVES: Tetrofosmin is a new Tc-99m labeled myocardial perfusion imaging agent that shows slow clearance from the myocardium and rapid clearance from background organs. The purpose of this study was to assess the ability of exercise Tc-99m tetrofosmin single photon emission computed tomography(SPECT) to identify and localize coronary artery disease. METHODS: The study population consists of 49 patients with suspected coronary artery disease who underwent both exercise Tc-99m tetrofosmin SPECT and coronary angiography within 2 weeks. Using the one day imaging protocol, 7-10mCi of Tc-99m tetrofosmin was injected at rest and 4 hours later, 25 mCi of Tc-99m tetrofosmin was injected at peak exercise. RESULTS: The sensitivity and specificity of exercise Tc-99m tetrofosmin SPECT was 94.9% and 60% for detection of coronary artery disease with luminal narrowing more than 50%, and 96.4% and 33.3% for detection of coronary artery disease with luminal narrowing more than 70%. The sensitivity of exercise Tc-99m tetrofosmin SPECT for detection of individual stenosed vessels(>or=50% and >or=70% coronary stenosis) was 79.2%, 100% for LAD, 55.6%, 55.6% for LCx and 85.0%, 92.9% for RCA and the specificity was 88.0%, 75.0% for LAD, 100%, 87.5% for LCx, 86.2%, 77.1% for RCA respectively. CONCLUSION: Exercise Tc-99m tetrofosmin SPECT appears to be an feasible and useful noninvasive test for the diagnosis of coronary artery disease
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Phenobarbital ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

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Changes of Left Ventricular Function , Left Atrial Function , and Pulmonary Venous Flow Patterns in Patients with Acute Myocardial Infarction.

Bok Kun KIM ; Seung Jae JOO ; Young Hwan BAE ; Sun Mi PARK ; Jin CHOI ; Hwi CHOI ; Byung Chul YOON ; Won Sub OH ; Yang Hwun KOO ; Sung Jun HONG ; Jin KIM ; Neung Hwa PARK ; Tae Joon CHA ; Jae Woo LEE

Korean Journal of Medicine.1997;53(6):747-758.

OBJECTIVES: Acute myocardial infarction decreases left ventricular systolic and diastolic function. Left ventricular diastolic function is usually assessed with the left ventricular filling patterns. Abnormal left ventricular tilling patterns after acute myocardial infarction can be classified as relaxation abnormality, pseudonormalization, and restriction, but sometimes the differentiation between pseudonormalization and the normal pattern is difficult. To assess left ventricular systolic and diastolic function, and left atrial function after acute myocardial infarction, M-mode, two-dimensional, pulsed Doppler, and automated border detection echocardiography were performed. To complement the information obtainable from the mitral flow patterns, pulmonary venous flow patterns were also analysed to assess the left ventricular filling patterns. METHODS: Twenty six patients (mean age 60+/-10) underwent echocardiographic examination 7 to 14 days after acute myocardial infarction. Twenty healthy persons(mean age 57+/-12) were served as a control group. Various indexes were obtained with M-mode, two-dimensional, pulsed Doppler, and automated border detection echocardiography RESULTS: 1) Mean age, sex ratio, heart rate, body mass index were not different between patient and control groups. There were five patients with hypertension in patient group. Left ventricular mass index of patient group was greater than that of control group (163+/-43g/m2 vs. 109+/-22g/m2, P<0.0D1). 2) Patients had decreased cardiac index(2.35+/-0.53L/min/m2 vs. 3.02+/-0.70L/min/m2, P<0.05) and left ventricular ejection fraction(55+/-12% vs. 62+/- 0.4%). There was a negative correlation between left ventricular regional wall motion score and ejection fraction(r=-0.71; P<0.001). 3) In patients, peak mitral flow velocity at atrial contraction(A) was higher(73+/-11cm/sec vs. 63+/-13 cm/sec; P<0.01), E/A ratio was lower(0.77+/-0.28 vs. 1.01+/-0.25; P<0.01), and left ventricular isovolumic relaxation time was longer(126+/-34msec vs. 97+/-21msec; P<0.005). 4) Patients had smaller systolic time-velocity integral(13.0+/-3.30cm vs. 14.8+/-2.83cm, P=0.056) and diastolic time-velocity integral(9.18+/-2.21cm vs. 11.2+/-2.77cm, P<0.01). 5) Relaxation abnormality of left ventricular filling patterns, which was classified by E/A ratio of less than 1, was more frequently founded in patients than in controls(45%). Four patients had E/A ratio of greater than 1; SV/DV ratio was greater than 1 in two and less than 1 in others. 6) End-diastolic area of left atrium(minimal area) was larger in patients(11+/-1.9cm2 vs. 9.6+1.4cm2, P<0.01). Therefore, patients showed decreased atrial emptying index and expansion index. Patients had a greater extent of left atrial area decrease resulting from atrial contraction. CONCLUSION: Patients with acute myocardial infarction showed a decreased left ventricular systolic function and a relaxation abnormality 7 to 14 days after attack, Minimal area of left atrium increased and left atrial function decreased.
Atrial Function* ; Atrial Function, Left ; Body Mass Index ; Complement System Proteins ; Echocardiography ; Heart Atria ; Heart Rate ; Humans ; Hypertension ; Myocardial Infarction* ; Relaxation ; Sex Ratio ; Ventricular Function, Left*

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A Study on the Positivities of Anti - HCV by Second - Generation ELISA in Rural Area of Chonnam Province.

Myeong Seong KIM ; Kang Seok SEO ; Nam Jin KIM ; Sung Kyu CHOI ; Soon Pal SUH ; Jin Su CHOI ; Sei Jong KIM

Korean Journal of Medicine.1997;53(6):741-746.

BACKGROUND: Hepatitis C virus(HCV) is well known major cause of posttransfusion hepatitis. There were a lot of studies about the prevalence of anti-HCV. But, most of these focused on healthy blood donors or patients with liver diseases in urban areas. So they may not represent the prevalence of anti-HCV in the entire Korean population. This study focused on people of a rural area which consisted of six towns near Reservoir Juam in the Chonnam province in Korea. METHODS: Nine hundred and sixty three persons were selected by multi-stage cluster sampling method from January to February in 19%, Anti-HCV and HBsAg were examined by microparticle enzyme immunoassy(MELA; Abbott Co., USA). Alanine aminotransferase(ALT) was examined by enzyme kinetic method. RESULTS: 1) The positivity of anti-HCV in all subjects was 0.9%. 2) The positivity of anti-HCV in male(1.1%) was not significantly higher than in female(0.9%). 3) The positivity of anti-HCV was 0% below the 5th decade, 0.7% in the 6th decade, 1.4% in the 7th decade, 1.7% in 8th decade, 0% above the 9th decade. There was no significant relationship between the positivity of anti-HCV and age. 4) The positivity of anti-HCV was 0.8% in normal ALT(35U/L) subjects. There was no statistical relationship between the positivity of anti-HCV and ALT level. 5) HBsAg was serologically negative in all of nine anti-HCV positive subjects. CONCLUSION: The positivity of anti-HCV was 0.9% in rural area of Korea and was similar to the prevalence of anti-HCV in urban areas.
Alanine ; Blood Donors ; Enzyme-Linked Immunosorbent Assay* ; Hepatitis ; Hepatitis B Surface Antigens ; Hepatitis C ; Humans ; Jeollanam-do* ; Korea ; Liver Diseases ; Prevalence

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A Case of Infective Endocarditis Caused by Community-Acquired Acinetobacter baumannii.

Min Hyung KIM ; Jin Young AHN ; Nam Su KU ; Sang Hoon HAN ; Jun Yong CHOI ; Young Goo SONG ; June Myung KIM

Korean Journal of Medicine.2013;84(2):313-317.

Acinetobacter baumannii has become an important pathogen that causes healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infection. Only sporadic cases of infective endocarditis (IE) have been reported worldwide, and in particular, community-acquired IE caused by A. baumannii is very rare. To our knowledge, no case has ever been reported in Korea. We report a 30-year-old woman who recovered from native-valve community-acquired IE caused by A. baumannii. She did not have any underlying diseases and presented with left-sided weakness, dysarthria, and fever. On investigation of acute cerebral infarction, a vegetation on her anterior mitral leaflet was found in echocardiography, and A. baumannii was cultured from the blood. In this case, A. baumannii showed intermediate resistance to cefotaxime and was sensitive to all other antibiotics. She underwent antibiotic therapy with cefoperazone/sulbactam for 5 weeks, without surgery. Consequently, the vegetation was absent in follow-up echocardiography, and no complications related to IE developed.
Acinetobacter ; Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteremia ; Cefotaxime ; Cerebral Infarction ; Community-Acquired Infections ; Dysarthria ; Echocardiography ; Endocarditis ; Female ; Fever ; Follow-Up Studies ; Humans ; Korea ; Pneumonia ; Urinary Tract Infections

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A Case of Polycythemia Vera with a JAK2V617F Mutation Combined with Smoldering Myeloma.

Yun Hwa JUNG ; In Sook WOO ; Sang Bong HAN ; Je Hoon LEE ; Chi Wha HAN

Korean Journal of Medicine.2013;84(2):308-312.

The lymphoproliferative disease multiple myeloma and the myeloproliferative disease polycythemia vera have different pathogenic mechanisms and different natural courses. Thus, the concomitant development of these two diseases in the same individual is rare. In most previously reported cases of both diseases, one disease was assumed to be a secondary malignancy caused by chemotherapy for the other primary disease. Our case was diagnosed as smoldering myeloma based on increased bone marrow plasma cell numbers and monoclonal gammopathy during a regular follow-up visit for JAK2V617F mutation-positive polycythemia vera, which had not been treated except with phlebotomy. This case provides useful clues for understanding the pathogenesis of these two hematological malignancies and the association between them. Here, we report a case of polycythemia vera with a JAK2V617F mutation combined with smoldering myeloma and discuss the clinical significance and pathogenic association between these disorders of different lineages, along with a literature review.
Bone Marrow ; Follow-Up Studies ; Hematologic Neoplasms ; Multiple Myeloma ; Paraproteinemias ; Phlebotomy ; Plasma Cells ; Polycythemia ; Polycythemia Vera

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