BACKGROUND: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in advanced metastatic cancer. METHODS: This study included 130 patients with ECOG PS (Eastern Cooperative Oncology Group performance status) 1~3 in advanced metastatic cancer following the palliative chemotherapy. ECOG PS, body mass index, alpha 1-acid glycoprotein, C-reactive protein, albumin, prealbumin, transferrin, protein, lactate dehydrogenase, PINI ratio, and survival time were evaluated. RESULTS: In 130 patients, the median age was 57 years. The ECOG PS was 1 68 patients, 2 43, 3 19. The mean value of PINI was PS 1 16.0+/-47.8, PS 2 55.6+/-106.9, PS 3 106.3+/-141.6. The mean survival was PS 1 144.0+/-71.8, PS 2 68.9+/-41.2, PS 3 32.0+/-6.9 days. In the PS 3 group, the mean values of alpha 1-acid glycoprotein, C-reactive protein, and lactate dehydrogenase were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of albumin, prealbumin, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r=-0.602, p<0.001,), PINI (r=-0.318, p<0.001,), alpha 1-acid glycoprotein (r=-0.265, p=0.002), C-reactive protein (r=-0.345, p<0.001), albumin (r=0.324, p<0.001), prealbumin (r=0.260, p=0.003) and transferrin (r=0.277, p=0.001). CONCLUSIONS: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis in advanced metastatic cancer following palliative chemotherapy, but the ECOG PS is most strong correlation with the survival time.
Body Mass Index ; C-Reactive Protein ; Critical Illness ; Drug Therapy ; Humans ; L-Lactate Dehydrogenase ; Nutrition Assessment ; Nutritional Status* ; Orosomucoid ; Prealbumin ; Prognosis* ; Transferrin ; Weight Loss

BACKGROUND: It is known that the hepatic nitric oxide (NO) production is induced by various pathologic inflammatory response such as viral hepatitis and mediated by various cytokines from hepatic immune or non-immune cells. We have investigated nitric oxide metabolites (NOx) concentration to know the effect of lamivudine treatment on NOx in chronic hepatitis B patients, and the association between NO metabolic concentration and other clinical factors. METHODS: The study subjects comprised 70 candidates for antiviral treatment for chronic viral hepatitis B. We observed the concentration of NOx in patients group before and after antiviral treatment with lamivudine 100 mg for 24 weeks and compared them with controls. We also examined clinical factors which can affect the concentration of NOx. RESULTS: The mean concentration of NOx in chronic viral hepatitis B patients was significantly higher than that of control group. (patient group: 78.2+/-12.7 micrometer and healthy control group: 31.8+/-11.3 micrometer, p=0.014). The mean concentration of NOx significantly decreased after lamivudine treatment (after treatment: 44.2+/-17.9 micrometer and before treatment: 78.2+/-12.7 micrometer, p=0.027). HBV DNA titer and ALT level were significantly correlated with the concentration of NOx (HBV DNA titer: r=0.697, p=0.038 and ALT level: r=0.402, p=0.012). CONCLUSIONS: The fact that serum NO concentration increased proportionally to the amount of ALT and HBV DNA and decreased after the treatment with lamivudine suggests that serum concentration of NO have correlation with course of HBV infection.
Cytokines ; DNA ; Hepatitis ; Hepatitis B ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Nitric Oxide*

BACKGROUND: Microalbuminuria (MA) is independent predictor of cardiovascular disease and it cause mortality regardless of the presence of diabetes (DM) and hypertension (HTN). However, few published studies on this topic have been reported in Korea. Therefore, we investigated the MA prevalence and relationship between MA, insulin resistance and cardiovascular risk factor. METHODS: A total of 5,915 (3,053 men and 2,852 women) health screen examinees were enrolled in this study. We measured the anthropometric and biochemical parameters of the atherogenic indexes. RESULTS: The MA prevalence was 7.7% in all participants. The prevalence of MA in the men and women was 9.5% and 5.7%, respectively. Elevated levels of serum fasting glucose, serum fasting insulin, HOMA index, total cholesterols, LDL cholesterol, TG, Body Mass Index (BMI) and the systolic and diastolic blood pressure were significantly associated with MA. The results of multiple logistic regression analysis about MA showed that frequent drinking, low BMI, newly diagnosed DM and elevated levels of HOMA index and blood pressure were significantly associated with MA prevalence. Also, excluding newly diagnosed diabetic and hypertensive subjects, the MA prevalence was 5.7% (6.9% in men, 4.7% in women) and in multiple logistic regression analysis, the MA prevalence significantly increased in the individuals with pre-HTN rather than in the normotensives. CONCLUSIONS: The MA prevalence was 7.7% in all subjects. Except the newly diagnosed diabetic and hypertensive subjects, it was 5.7%. The MA prevalence was significantly increased in the individuals with pre-HTN rather than in the normotensives and MA was related with insulin resistance.
Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Cross-Sectional Studies* ; Drinking ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Korea ; Logistic Models ; Male ; Mortality ; Prehypertension ; Prevalence* ; Risk Factors

BACKGROUND/AIMS: It is recommended that duodenal ulcer patients who are infected with H. pylori should be treated with eradication therapy, whether the ulcer is active or in remission. However, there has been no report on the effect of eradication treatment in patients with incidentally found S-2 stage duodenal ulcer scar. METHODS: We prospectively enrolled 80 H. pylori-positive patients with S-2 stage duodenal ulcer scar who have no past history of ulcer treatment. Treatment group received triple therapy consisted of omeprazole, amoxicillin, and clarithromycin for 2 weeks, whereas control group received no treatment. The follow-up endoscopy was performed every 1 year and when the patients have symptoms of ulcer disease. Fifty-three patients were followed up for more than 1 year. RESULTS: The eradication rate of the treatment group was 92.9%. During the follow-up period of 14.7 months, 20% (5/25) of patients in the control group (2 gastric ulcers and 3 duodenal ulcers) and 3.6% (1/28) of patients in the treatment group (1 duodenal ulcer) developed active or healing stage peptic ulcers (p=0.089). CONCLUSIONS: Our results suggest that H. pylori eradication may he effective in preventing peptic ulcers in patients with S-2 stage duodenal ulcer scar.
Amoxicillin ; Cicatrix* ; Clarithromycin ; Duodenal Ulcer* ; Endoscopy ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer ; Prospective Studies ; Stomach Ulcer ; Ulcer

BACKGROUND/AIMS: The relationship between Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) is controversial. A high incidence of reflux esophagitis after H. pylori eradication has been reported in patients with peptic ulcer. However, few study has been reported on the effects of H. pylori eradication in patients with GERD without peptic ulcer. We assessed the reflux symptoms and endoscopic findings among comparable patients having undergone successful versus failed H. pylori eradication. METHODS: Patients with H. pylori-positive endoscopic esophagitis were treated with omeprazole, amoxicillin and metronidazole for 2 weeks and subsequently underwent 8-weeks of omeprazole treatment. All patients underwent a urea breath test 2~4 weeks later. Patients underwent symptom assessment and endoscopy before the therapy and 1 year thereafter. RESULTS: Out of 48 patients randomized, 10 dropped out during the follow-up period, leaving 38 patients with analyzable results. H. pylori eradication was successful in 32 patients (84.2%). By the end of the follow-up period, patients with symptoms (p=0.107) or endoscopic esophagitis (p=0.366) seemed not to be more aggravated in the successful than in the failed eradication group. CONCLUSIONS: H. pylori eradication doesn't aggravate the symptoms or endoscopic esophagitis in patients with H. pylori-positive reflux esophagitis.
Amoxicillin ; Breath Tests ; Endoscopy ; Esophagitis ; Esophagitis, Peptic* ; Follow-Up Studies ; Gastroesophageal Reflux ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Metronidazole ; Omeprazole ; Peptic Ulcer ; Symptom Assessment ; Urea

BACKGROUND/AIMS: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding.The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding. METHODS: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t. RESULTS: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p < 0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p < 0.001). There were no differences in the hospital course and mortality within 30 days between the two groups. CONCLUSIONS: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective.
Adult ; Aged ; Anti-Infective Agents/*administration & dosage ; *Antibiotic Prophylaxis ; Bacterial Infections/*prevention & control ; Ciprofloxacin/*administration & dosage ; Endoscopy ; English Abstract ; Esophageal and Gastric Varices/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/*complications ; Human ; Infusions, Intravenous ; Ligation ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Postoperative Complications/*prevention & control ; Prospective Studies

BACKGROUND: Among various methods for measuring colon transit time, radio-opaque marker study is simple, reproducible and economical method. The commonly used marker, Sitzmarks (Konsyl Pharmaceuticals Inc. Texas) had limitation in its use due to expensiveness and difficulty in importation. We thought that the new domestic marker comparable to Sitzmarks is necessary and made a Kolomark (Korean colon marker)TM. The comparison of radio-opaqueness and the measurement of colon transit times by two markers were done. METHODS: In two 1000 ml beakers, 350 ml of rice-gruel, several chicken-bones and ten rings of Sitzmarks and KolomarkTM were mixed separately. Then, X-ray films of the two beakers were taken. The digital image file was analyzed by Image and the value of pixels were obtained. These were repeated five times. Colon transit times were measured in 60 healthy persons stratified by age, 30 by Sitzmarks and 30 by KolomarkTM. RESULTS: The mean value of pixel of KolomarkTM was much lower than that of Sitzmarks. The difference between background or beaker and KolomarkTM was much greater than that of Sitzmarks . There was no significant difference between colon transit time studied by Sitzmarks and KolomarkTM. CONCLUSION: KolomarkTM, a more radio-opaque and cheaper marker than Sitzmarks will be applied usefully for measuring colon transit time.
Colon* ; Humans ; X-Ray Film

BACKGROUND/AIMS: Safety of endoscopic procedures has been a major issue over the last 10 years. Most endoscopy units use 2% glutaraldehyde and automated endoscope reprocessors (AERs) for disinfecting gastrointestinal endoscopes. We attempted an in-use evaluation of the current reprocessing procedures. METHODS: Thirty flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using 2% glutaraldehyde in an AER. Cultures were taken from biopsy channels (S-1), tip of the insertion tubes (S-2), umbilical cords (S-3), and angulation knobs (S-4). RESULTS: In 63.3% (19/30) of endoscopes, there was no microbial contamination after disinfection procedures. The culture positive rates of S-1, S-2, S-3, and S-4 samples were 20.0%, 0.0%, 3.3%, and 20.0%, respectively. Microorganisms of 13 species were identified, but there was no pathogen related with reported infectious complications after endoscopic procedures. CONCLUSIONS: Current disinfection procedure using 2% glutaraldehyde and an AER appears to be very effective in decontaminating patient-used endoscopes. Low level microbial contamination of endoscopes after conventional reprocessing methods may not impose great risk on patients.
Biopsy ; Disinfection* ; Endoscopes* ; Endoscopes, Gastrointestinal ; Endoscopy ; Glutaral* ; Humans ; Umbilical Cord

BACKGROUND/AIMS: The predictory factors of the response to initial steroid therapy in active Crohn's disease has been controversial in numerous literature reviews. We evaluated any predictory factor of the response to initial steroid therapy in active Crohn's disease patients. METHODS: The medical records of 32 patients with active Crohn's disease who clinically responded to oral steroid therapy were retrospectively reviewed. The steroid responsive group was defined as the one showing maintenance of response for more than one month from steroid withdrawal and the steroid dependent group as the one showing relapse or exacerbation during steroid tapering or within 30 days from steroid withdrawal. The clinical, biochemical, and pathologic factors were evaluated. RESULTS: There were 22 male and 10 female patients. The mean age was 28.9 years. The number of steroid responsive and dependent group was 22 (68.8%) and 10 (31.2%), respectively. There were no significant differences between these two groups in age, sex, time to diagnosis, perianal lesion, extent of disease, extraintestinal manifestations, presence of granuloma, presenting features, hemoglobin, ESR, and CRP, except serum albumin level. CONCLUSIONS: Serum albumin level was significantly lower in steroid dependent group than steroid responsive group, reflecting severe inflammation in steroid dependent group.
Crohn Disease* ; Diagnosis ; Female ; Granuloma ; Humans ; Inflammation ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Serum Albumin

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disease that has difficulty in treatment due to various complications and frequent recurrence. There have been many studies on the clinical aspects of CD in western countries, however there have been few studies in Korea. We try to perform this study to elucidate the clinical features of CD in Korea. METHODS: We retrospectively reviewed the medical records of 62 patients diagnosed as CD in Samsung Medical Center from October 1994 to July 1999 and investigated their clinical features. RESULTS: Male to female ratio was 1.7:1 and the mean age at diagnosis was 29.6 years. The most common symptom was abdominal pain (58%), followed by diarrhea. Perianal lesions were observed in 27 cases (44%) of 62 patients. Fistula was the most common (60%) among the perianal lesions, followed by abscess, fissure, and stricture. Extraintestinal manifestations were observed in 23 cases (37%) of 62 patients. Arthritis was the most common (44%), followed by oral, skin, and ocular lesions. All patients were classified into three groups on the basis of disease extent by the radiologic and endoscopic findings; combined type (66%), colitis alone (23%), and small bowel disease alone (11%). Empirical anti-tuberculous medications were administered to 28 cases (45%) of 62 patients before CD was diagnosed. The presenting features were classified into inflammatory (71%), fistulizing (14.5%), and fibrostenotic (14.5%) type. Operation was performed in 31 cases (50%) of 62 patients during clinical course. The causes of operation were fistulizing complication (48%), fibrostenotic obstruction (32%), and indefinite diagnosis (20%). CONCLUSION: We noticed little difference in the clinical features of CD in Korea compared to those of western countries. And, intestinal tuberculosis should be considered in differential diagnosis of CD in endemic areas of tuberculosis like Korea.
Abdominal Pain ; Abscess ; Arthritis ; Colitis ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Diagnosis, Differential ; Diarrhea ; Female ; Fistula ; Humans ; Korea* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Skin ; Tuberculosis