SCI 발표논문

1. 1302008

   제1저자 강해연 · 교신저자 정현채

   Kang HY, Kang HW, Kim SG, Kim JS, Park KJ, Jung HC, Song IS

   Incidence and management of colonoscopic perforations in Korea.

   Digestion. 2008;78(4):218-23.

   Abstract

   BACKGROUND AND AIM Despite the low incidence of perforation after endoscopic procedures in the colon, the increasing use of these procedures is likely to cause a commensurate increase in such problems. This study was undertaken to determine the incidence of iatrogenic perforation of the colon, to define clinical characteristics, and to assess the management of these complications.

   METHODS A retrospective review of the medical records was performed for all patients with iatrogenic colon perforations after endoscopy between January 2000 and June 2007.

   RESULTS Over this 7-year study period, a total of 20,660 sigmoidoscopies, 17,102 colonoscopies, and 6,772 therapeutic procedures were performed, and 53 (0.12%) perforations were determined to be related to endoscopy. A diagnostic procedure was undertaken in 26 of these 53 perforation cases (perforation rate, 0.07%; 1 per 1,452 procedures), and a therapeutic procedure in the remaining 27 (perforation rate, 0.40%; 1 per 251 procedures). Nineteen patients (36%) were treated conservatively, and the remaining 34 (64%) required surgical management. Endoscopic clipping was performed in 9 patients, and conservative treatment was possible in 7 patients with successful closure. No procedure-related mortality occurred.

   CONCLUSIONS Endoscopic repair of iatrogenic colon perforations with clips could reduce immediate operative intervention rates.

   PubMed IF 3.4 소화기내과
2. 1292008

   제1저자 박주경 · 교신저자 윤용범

   Park JK, Yoon YB, Kim Y-T, Ryu JK, Yoon WJ, Lee SH

   Survival and prognosis of unresectable pancreatic cancer

   Journal of Clinical Gastroenterology. 2008;42(1):89-91.

   IF 2.4 소화기내과
3. 1282008

   제1저자 김지원 · 교신저자 임석아

   Kim JW, Kim HP, Im SA, Kang S, Hur HS, Yoon YK, Oh DY, Kim JH, Lee DS, Kim TY, Bang YJ

   The growth inhibitory effect of lapatinib, a dual inhibitor of EGFR and HER2 tyrosine kinase, in gastric cancer cell lines.

   Cancer Lett. 2008;272(2):296-306.

   Abstract

   HER2 overexpression is observed in 5-25% of gastric cancers. Lapatinib is a dual inhibitor of the epidermal growth factor receptor and HER2 tyrosine kinase. We examined the antitumor effect of lapatinib in gastric cancer cell lines. Lapatinib induced selective and potent growth inhibition in two HER2-amplified gastric cancer cell lines (SNU-216 and NCI-N87). Lapatinib inhibited the phosphorylation of HER2, EGFR and downstream signaling proteins, resulting in G1 arrest in both cell lines with down-regulation of cMyc and induction of p27kip1. Lapatinib also induced apoptosis in NCI-N87 which has high HER2 amplification ratio. Lapatinib combined with 5-fluorouracil, cisplatin, oxaliplatin or paclitaxel showed an additive or synergistic effect. These results provide a rationale for the future clinical trials of lapatinib combined with cytotoxic drugs in the treatment of HER2-positive gastric cancer.

   PubMed IF 11.8 혈액종양내과
4. 1272008

   제1저자 김미정 · 교신저자 오도연

   Kim MJ, Oh DY, Lee SH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ

   Gemcitabine-based versus fluoropyrimidine-based chemotherapy with or without platinum in unresectable biliary tract cancer: a retrospective study.

   BMC Cancer. 2008;8:374.

   Abstract

   BACKGROUND There is no standard palliative chemotherapy regimen in biliary tract cancers (BTC). Fluoropyrimidine or gemcitabine, with or without platinum, are most frequently used. We conducted this study to clarify the efficacy of palliative chemotherapy in BTC.

   METHODS Patients with unresectable BTC treated with palliative chemotherapy between Oct 2001 and Aug 2006 at Seoul National University Hospital were reviewed retrospectively. Histologically confirmed cases of intrahepatic cholangiocarcinoma, gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater carcinoma were enrolled. We analyzed the efficacy of regimens: gemcitabine (G) versus fluoropyrimidine (F) and with or without platinum (P).

   RESULTS A total of 243 patients were enrolled. 159 patients (65%) were male and the median age of the patients was 60 years (range 26-81). Intrahepatic cholangiocarcinoma, gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater carcinoma were 92, 72, 58, and 21 cases, respectively. The median progression free survival (PFS) was 4.3 months (95% CI, 3.7-4.9) and median overall survival (OS) was 8.7 months (95% CI, 7.4-10.0). Ninety-nine patients received G-based chemotherapy (94 GP, 5 G alone), and 144 patients received F-based chemotherapy (83 FP, 61 F alone). The response rate (RR), disease control rate (DCR), PFS and OS of G-based chemotherapy versus F-based chemotherapy were 16.7% vs. 19.5% (P=0.591), 52.8% vs. 58.9% (P=0.372), 4.0 months vs. 4.3 months (P=0.816), and 7.8 months vs. 9.1 months (P=0.848), respectively. Sixty-six patients received F or G without P, and 177 patients received F or G with P. The RR, DCR, PFS and OS of chemotherapy without P versus chemotherapy including P were 12.7% vs. 20.6% (P=0.169), 46.0% vs. 60.6% (P=0.049), 3.3 months vs. 4.4 months (P=0.887), and 10.6 months vs. 8.1 months (P=0.257), respectively.

   CONCLUSION In unresectable BTC, F-based and G-based chemotherapy showed similar efficacy in terms of RR, DCR, PFS and OS. The benefit of adding P to F or G was not significant except for DCR. Further prospective studies which define the efficacy of various chemotherapeutic regimens in BTC are warranted.

   PubMed IF 4.1 혈액종양내과
5. 1262008

   제1저자 강현재 · 교신저자 김효수

   Kang HJ, Kim HS

   Safety and efficacy of intracoronary infusion of mobilized peripheral blood stem cell in patients with myocardial infarction: MAGIC Cell-1 and MAGIC Cell-3-DES-trials

   European Heart Journal Supplements. 2008;10(Suppl K):K39-K43.

   Abstract

   Previous clinical studies evaluating granulocyte-colony stimulating factor (G-CSF)-based stem-cell therapy showed inconsistent outcomes. We evaluated G-CSF-based stem-cell therapy in patients with acute myocardial infarction (AMI) and old myocardial infarction (OMI) in ‘Myocardial Regeneration and Angiogenesis in Myocardial Infarction with G-CSF and Intracoronary Stem Cell Infusion (MAGIC Cell)’ trials. In MAGIC Cell-1 trial, intracoronary infusion of mobilized stem cell by G-CSF is superior to G-CSF alone for improvement of left ventricular (LV) systolic function till 2 years follow-up. In MAGIC Cell-3-Drug eluting stent (DES) trial, cell infusion showed better improvement of LV systolic function and remodelling than control in AMI patients at 6 months follow-up. However, stem-cell therapy does not improve LV systolic function in OMI patients. G-CSF-based stem-cell therapy does not aggravate de novo progression of atherosclerosis while DES efficiently prevents G-CSF-based stem-cell-therapy-related restenosis. Longer-term follow-up is required to confirm prognostic impacts of stem-cell therapy in patients with myocardial infarction. Combination strategy with stem cell therapy with cytokines and genes should be introduced to enhance efficacy of current stem-cell therapy.

   IF 2.7 순환기내과
6. 1252008

   제1저자 김나영 · 교신저자 정인식

   Kim N, Park SH, Seo GS, Lee SW, Kim JW, Lee KJ, Shin WC, Kim TN, Park MI, Park JJ, Hong SJ, Shim KN, Kim SW, Shin YW, Chang YW, Chun HJ, Lee OJ, Jeon WJ, Park CG, Cho CM, Park CH, Won SY, Lee GH, Park KS, Shin JE, Kim HU, Park JY, Chae HS, Song GA, Kim JG, Yoon BC, Seol S, Jung HC, Chung IS

   Lafutidine versus lansoprazole in combination with clarithromycin and amoxicillin for one versus two weeks for Helicobacter pylori eradication in Korea.

   Helicobacter. 2008;13(6):542-9.

   Abstract

   BACKGROUND AND AIMS Lafutidine is a novel H(2)-receptor antagonist with gastroprotective activity that includes enhancement of gastric mucosal blood flow. The aim of the present study was to test the efficacy of 7- or 14-day lafutidine-clarithromycin-amoxicillin therapy versus a lansoprazole-based regimen for Helicobacter pylori eradication.

   METHODS Four hundred and sixty-three patients with H. pylori-infected peptic ulcer disease were randomized to one of four regimens: (1) lafutidine (20 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1000 mg b.i.d.) for 7 days (the 7LFT group) or (2) for 14 days (the 14LFT group); (3) lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1000 mg b.i.d.) for 7 days (the 7LPZ group); or (4) for 14 days (the 14LPZ group). The eradication rates, drug compliance, and adverse effects among the four regimens were compared.

   RESULTS The eradication rates by the intention-to-treat and per-protocol analyses in the 7LFT and 7LPZ groups were 76.5% and 81.6%, and 76.9% and 82.0% (p = .94 and .95), respectively. The eradication rates by intention-to-treat and per-protocol analyses in the 14LFT and 14LPZ groups were 78.2% and 82.2%, and 80.4% and 85.9% (p = .70 and .49), respectively. The treatment duration for 7 days or 14 days did not affect the eradication rates. In addition, the adverse effect rates and discontinuation rates were similar among the four groups. Furthermore, the ulcer cure rate and symptom response rate were similar in the lafutidine and lansoprazole groups.

   CONCLUSION The results of this study showed that lafutidine-clarithromycin-amoxicillin therapy was a safe and effective as lansoprazole-based triple therapy for the eradication rate of H. pylori, and could be considered as an additional treatment option.

   PubMed IF 4.6 소화기내과
7. 1242008

   제1저자 이정옥 · 교신저자 이세훈

   Lee JO, Kim DY, Lim JH, Seo MD, Yi HG, Kim YJ, Lee SH, Kim DW, Yang SC, Kim YW, Heo DS

   Risk factors for bacterial pneumonia after cytotoxic chemotherapy in advanced lung cancer patients.

   Lung Cancer. 2008;62(3):381-4.

   Abstract

   The purpose of this study was to demonstrate the prevalence of and risk factors for pneumonia after cytotoxic chemotherapy in advanced lung cancer patients. We retrospectively reviewed 193 out of 215 advanced lung cancer patients who were consecutively treated with cytotoxic chemotherapy at Seoul National University Hospital in 2005. The mean age was 61 years (range, 31-85 years). A total of 41 patients (21%) had Eastern cooperative oncology group (ECOG) performance status 2-3. Among 135 patients with pulmonary function test (PFT), 34% (n=46) of patients demonstrated an obstructive pattern of lung function. Pneumonia occurred in a total of 10 patients (5%). Occurrence rate was significantly higher in older patients (>70 years) than in younger ones (13% vs. 4%, p=0.05), higher in patients with ECOG 2-3 compared with those with ECOG 0-1 (15% vs. 3%, p<0.01), and higher in patients with an obstructive pattern of lung function compared with those without (11% vs. 1%, p=0.02). Pneumonia occurrence rate in patients with all three risk factors was 25%. Six out of 10 pneumonia patients required hospitalization, and one patient died from respiratory failure. We identified this high-risk group as a candidate for antibacterial prophylaxis after cytotoxic chemotherapy in advanced lung cancer patients.

   PubMed IF 5.3 혈액종양내과
8. 1232008

   제1저자 박경우 · 교신저자 정우영

   Park KW, Chung JW, Chang SA, Kim KI, Chung WY, Chae IH

   Two cases of mediastinal hematoma after cardiac catheterization: A rare but real complication of the transradial approach.

   Int J Cardiol. 2008;130(3):e89-92.

   Abstract

   Mediastinal hematoma is a very rare complication of cardiac catheterization, and is usually not considered in the differential diagnosis of chest pain after cardiac catheterization. However, we present two cases of mediastinal hematoma that developed after cardiac catheterization using the transradial approach.

   PubMed IF 3.3 순환기내과
9. 1222008

   제1저자 박수철 · 교신저자 윤정환

   Park SC, Yoon JH, Lee JH, Yu SJ, Myung SJ, Kim W, Gwak GY, Lee SH, Lee SM, Jang JJ, Suh KS, Lee HS

   Hypoxia-inducible adrenomedullin accelerates hepatocellular carcinoma cell growth.

   Cancer Lett. 2008;271(2):314-22.

   Abstract

   Adrenomedullin is implicated in tumor progression and induced by hypoxia. We evaluated if adrenomedullin signaling is active in hepatocellular carcinoma (HCC), especially under hypoxic conditions, and to analyze its prognostic implication in HCC patients. HCC cells expressed adrenomedullin and its receptor, and hypoxia induced adrenomedullin expression. Adrenomedullin stimulated HCC cell growth via Akt activation, which was prevented by adrenomedullin peptide inhibitor. Clinico-pathological analysis revealed adrenomedullin extent was related to vascular invasion and N-cadherin intensity, which were reported to indicate a poor prognosis. In conclusion, adrenomedullin signaling is hypoxia-inducible and functionally active in HCCs, and its expression may be a prognostic factor.

   PubMed IF 11.8 소화기내과
10. 1212008

    제1저자 진상만 · 교신저자 임재준

    Jin SM, Lee HJ, Park EA, Lee HY, Lee SM, Yang SC, Yoo CG, Kim YW, Han SK, Shim YS, Yim JJ

    Frequency and predictors of miliary tuberculosis in patients with miliary pulmonary nodules in South Korea: a retrospective cohort study.

    BMC Infect Dis. 2008;8:160.

    Abstract

    BACKGROUND Miliary pulmonary nodules are commonly caused by various infections and cancers. We sought to identify the relative frequencies of various aetiologies and the clinical and radiographic predictors of miliary tuberculosis (TB) in patients with miliary pulmonary nodules.

    METHODS We performed a retrospective cohort study of patients who presented with micronodules occupying more than two-thirds of the lung volume, based on computed tomography (CT) of the chest, between November 2001 and April 2007, in a tertiary referral hospital in South Korea.

    RESULTS We analyzed 76 patients with miliary pulmonary nodules. Their median age was 52 years and 38 (50%) were males; 18 patients (24%) had a previous or current malignancy and five (7%) had a history of TB. The most common diagnoses of miliary nodules were miliary TB (41 patients, 54%) and miliary metastasis of malignancies (20 patients, 26%). Multivariate analysis revealed that age <or=30 years, HIV infection, corticosteroid use, bronchogenic spread of lesions, and ground-glass opacities occupying >25% of total lung volume increased the probability of miliary TB. However, a history of malignancy decreased the probability of miliary TB.

    CONCLUSION Miliary TB accounted for approximately half of all causes of miliary pulmonary nodules. Young age, an immune-compromised state, and several clinical and radiographic characteristics increased the probability of miliary TB.

    PubMed IF 3.2 호흡기내과
11. 1202008

    제1저자 윤원재 · 교신저자 류지곤

    Yoon WJ, Ryu JK, Lee JK, Woo SM, Lee SH, Park JK, Kim YT, Yoon YB

    Extrapancreatic malignancies in patients with intraductal papillary mucinous neoplasm of the pancreas: prevalence, associated factors, and comparison with patients with other pancreatic cystic neoplasms.

    Ann Surg Oncol. 2008;15(11):3193-8.

    Abstract

    BACKGROUND Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is reported to have a high prevalence of extrapancreatic malignancy (EPM). The aims of this study were to evaluate the prevalence and associated factors of EPMs in IPMN patients and to compare these data with those of non-IPMN pancreatic cystic neoplasm (PCN) patients.

    METHODS The study included 385 PCN patients (210 IPMNs and 175 non-IPMNs) diagnosed from 1993 to 2007. PCN types, presence of EPMs, chronological relation of EPMs to PCN diagnosis, and their clinicopathological parameters were analyzed.

    RESULTS The prevalence of EPM was 33.8% for IPMNs and 12.0% for non-IPMN PCNs (P < 0.001). In the majority of patients with EPMs, PCNs were detected while undergoing workup for the EPMs. For IPMNs, age was associated with EPMs [odds ratio (OR) 1.05, P = 0.013]; malignant IPMN showed a borderline inverse association with EPMs (OR 0.50, P = 0.071). Multivariate analysis of entire PCN cohort demonstrated that age at PCN diagnosis (OR 1.05, P < 0.001) was positively associated with EPM; IPMN showed a borderline positive association with EPM (OR 1.88, P = 0.052). Malignant PCN (OR 0.40, P = 0.009) was inversely associated with EPM.

    CONCLUSION The EPM prevalence of IPMN patients was 33.8%. Advanced age at IPMN diagnosis was the only factor significantly associated with EPMs in our IPMN cohort. In our PCN cohort, advanced age at PCN diagnosis was associated with malignant PCN and IPMN showed a borderline positive association with EPM.

    PubMed IF 3.8 소화기내과
12. 1192008

    제1저자 양승희 · 교신저자 김연수

    Yang SH, Shin SJ, Oh JE, Jin JZ, Chung NH, Lim CS, Kim S, Kim YS

    The protective role of uteroglobin through the modulation of tissue transglutaminase in the experimental crescentic glomerulonephritis.

    Nephrol Dial Transplant. 2008;23(11):3437-45.

    Abstract

    BACKGROUND AND METHODS Tissue transglutaminase (tTG) may induce pro-inflammatory cytokines and produce irreversible end-products, thus promoting renal scarring. It has recently been confirmed that the crescent formation in murine experimental crescentic glomerulonephritis (ecGN) has been inhibited by the administration of recombinant uteroglobin (rUG). However, the ability of UG on tTG modulation has not been thoroughly assessed. In this study, we investigated the feasible protective role of UG in murine ecGN through the modulation of tTG and TGF-beta1 expressions. ecGN was induced by the administration of anti-GBM Ab into C57BL/6 mice.

    RESULTS Both proteinuria and BUN levels were distinctively lower in rUG-treated mice compared to those of disease control mice. Glomerular injuries such as mesangial proliferation, matrix production and crescent formation were lessened with the rUG treatment, and these findings were parallel with the attenuated expression of tTG and TGF-beta1. tTG and TGF-beta1 were expressed mainly on mesangial areas by the induction of ecGN and rUG treatment markedly attenuated the expressions of these proteins in glomeruli without spatial changes. With the addition of LPS to mesangial cells, the expressions of tTG and TGF-beta1 were up-regulated, whilst the addition of cysteamine, tTG inhibitor, attenuated the expression of tTG and TGF-beta1 as well as the cellular proliferation which was further induced by LPS.

    CONCLUSION We demonstrate for the first time that rUG is able to attenuate the renal injury through the modulation of expressions of tTG and TGF-beta1 in ecGN and further suggest a wide range of feasible molecular targets to reduce the severity of human glomerulonephritis.

    PubMed IF 8.3 신장내과
13. 1182008

    제1저자 류지곤 · 교신저자 류지곤

    Ryu JK, Chung JB, Park SW, Lee JK, Lee KT, Lee WJ, Moon JH, Cho KB, Kang DW, Hwang JH, Yoo KS, Yoo BM, Lee DH, Kim HK, Moon YS, Lee J, Lee HS, Choi HS, Lee SK, Kim YT, Kim CD, Kim SJ, Hahm JS, Yoon YB

    Review of 67 patients with autoimmune pancreatitis in Korea: a multicenter nationwide study.

    Pancreas. 2008;37(4):377-85.

    Abstract

    OBJECTIVES The ideal diagnostic criteria of autoimmune pancreatitis (AIP) are still challenging. Therefore, we investigated the clinical features of AIP in Korea and assessed the clinical use of new Korean diagnostic criteria.

    METHODS We reviewed 67 patients with AIP enrolled in 16 hospitals via a multicenter study. The diagnosis was confirmed according to the Korean diagnostic criteria that included pancreatic imaging, laboratory findings, histopathology, and response to steroid.

    RESULTS Mean age of the patients was 56 years, and 73% were men. Obstructive jaundice (52%) was the most common symptom, and 14 patients (21%) had other organ involvement. Fifty-four patients (81%) revealed diffuse swelling of the pancreas. Either immunoglobulin (Ig)G or IgG4 was elevated in 76%. According to the Korean criteria, 65 patients had definite diagnostic criteria, and 2 patients had probable criteria. Fifteen patients were fulfilled with image, serological, and histopathologic criteria, and 4 patients could be diagnosed with image and steroid responsiveness. Ten patients experienced recurrent attacks of AIP during the mean 20-month follow-up.

    CONCLUSIONS Among 67 cases of AIP, either IgG or IgG4 was elevated in 76% of patients, and 14 patients (21%) had other organ involvement. New Korean diagnostic criteria are useful for diagnosis of AIP.

    PubMed IF 2.2 소화기내과
14. 1172008

    제1저자 박경우 · 교신저자 김효수

    Park KW, Kwon YW, Cho HJ, Shin JI, Kim YJ, Lee SE, Youn SW, Lee HC, Kang HJ, Shaul PW, Oh BH, Park YB, Kim HS

    G-CSF exerts dual effects on endothelial cells--opposing actions of direct eNOS induction versus indirect CRP elevation.

    J Mol Cell Cardiol. 2008;45(5):670-8.

    Abstract

    Granulocyte-colony stimulating factor (G-CSF) has been shown to have protective effects in the heart and brain. However, it may also be involved in the acute inflammatory response which may be harmful. The effects of G-CSF on endothelial cells (ECs) and the vasculature are mostly unknown. To study the possible dual effects of G-CSF on ECs, we investigated whether G-CSF induces release of C-reactive protein (CRP) by hepatocytes and whether the direct beneficial effects of G-CSF could protect ECs from the detrimental effects of CRP. G-CSF treatment significantly induced monocytes to produce IL-6, and culture supernatants of G-CSF-stimulated monocytes induced CRP production in hepatocytes. On the other hand, G-CSF directly promoted EC proliferation and migration and reversed the deleterious effects of CRP. In mechanistic analyses, G-CSF increased not only the protein expression of endothelial nitric oxide synthase (eNOS), but also its transcription. Furthermore, it enhanced eNOS phosphorylation and activation, leading to increased production of NO. Thus, G-CSF reversed the attenuated production of NO by CRP. These effects of G-CSF on eNOS transcription, translation, and activation were blunted by the PI3K inhibitor, suggesting that EC protective effects of G-CSF were associated with the activation of the Akt/eNOS pathway. In conclusion, although G-CSF induces an inflammatory reaction leading to CRP production, it has direct beneficial effects protecting ECs from the deleterious effects of CRP through activation of Akt/eNOS pathway, leading to an increase in NO production. Our data suggests that G-CSF may exert dual opposing effects on endothelial cells.

    PubMed IF 4.9 순환기내과
15. 1162008

    제1저자 이해영 · 교신저자 박정배

    Lee HY, Park JB

    Prevalence and risk factors of masked hypertension identified by multiple self-blood pressure measurement.

    Hypertension. 2008;52(5):e137-8; author reply e139.

    PubMed IF 9.8 순환기내과
16. 1152008

    제1저자 이지영 · 교신저자 김태유

    Rhee J, Han SW, Oh DY, Kim JH, Im SA, Han W, Park IA, Noh DY, Bang YJ, Kim TY

    The clinicopathologic characteristics and prognostic significance of triple-negativity in node-negative breast cancer.

    BMC Cancer. 2008;8:307.

    Abstract

    BACKGROUND Triple-negative (TN) breast cancer, which is defined as being negative for the estrogen receptor (ER), the progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER-2), represents a subset of breast cancer with different biologic behaviour. We investigated the clinicopathologic characteristics and prognostic indicators of lymph node-negative TN breast cancer.

    METHODS Medical records were reviewed from patients with node-negative breast cancer who underwent curative surgery at Seoul National University Hospital between Jan. 2000 and Jun. 2003. Clinicopathologic variables and clinical outcomes were evaluated.

    RESULTS Among 683 patients included, 136 had TN breast cancer and 529 had non-TN breast cancer. TN breast cancer correlated with younger age (< 35 y, p = 0.003), and higher histologic and nuclear grade (p < 0.001). It also correlated with a molecular profile associated with biological aggressiveness: negative for bcl-2 expression (p < 0.001), positive for the epidermal growth factor receptor (p = 0.003), and a high level of p53 (p < 0.001) and Ki67 expression (p < 0.00). The relapse rates during the follow-up period (median, 56.8 months) were 14.7% for TN breast cancer and 6.6% for non-TN breast cancer (p = 0.004). Relapse free survival (RFS) was significantly shorter among patients with TN breast cancer compared with those with non-TN breast cancer (4-year RFS rate 85.5% vs. 94.2%, respectively; p = 0.001). On multivariate analysis, young age, close resection margin, and triple-negativity were independent predictors of shorter RFS.

    CONCLUSION TN breast cancer had higher relapse rate and more aggressive clinicopathologic characteristics than non-TN in node-negative breast cancer. Thus, TN breast cancer should be integrated into the risk factor analysis for node-negative breast cancer.

    PubMed IF 4.1 혈액종양내과
17. 1142008

    제1저자 이재석 · 교신저자 임재준

    Lee JS, Kim EC, Joo SI, Lee SM, Yoo CG, Kim YW, Han SK, Shim YS, Yim JJ

    The incidence and clinical implication of sputum with positive acid-fast bacilli smear but negative in mycobacterial culture in a tertiary referral hospital in South Korea.

    J Korean Med Sci. 2008;23(5):767-71.

    Abstract

    Although it is not rare to find sputum that is positive acid-fast bacilli (AFB) smear but subsequent culture fails to isolate mycobacteria in clinical practice, the incidence and clinical implication of those sputa from new patients has not been clearly elucidated. The aim of this study was to determine the incidence and clinical implication of sputum with positive AFB smear but negative in mycobacterial culture. All sputa that were positive AFB smear requested during diagnostic work up for new patients visiting Seoul National University Hospital from 1 January 2005 through 31 December 2006 were included. Sputa producing a positive AFB smear but negative mycobacterial culture were classified into one of four categories: laboratory failure to isolate mycobacteria, false positive AFB smear, pathogen may show a positive AFB smear other than mycobacteria, and indeterminate results. Out of 447 sputa with a positive AFB smear, 29 (6.5%) failed to culture any organism. Among these 29 sputa, 18 were caused by laboratory failure to isolate mycobacteria, six were false positive smears, and five indeterminate. Although most sputum with a positive AFB smear but negative culture could be classified as a laboratory failure, clinicians should consider the possibility of false positive AFB smear.

    PubMed IF 3.2 호흡기내과
18. 1132008

    제1저자 김덕겸 · 교신저자 이재호

    Kim DK, Kim HJ, Kwon SY, Yoon HI, Lee CT, Kim YW, Chung HS, Han SK, Shim YS, Lee JH

    Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis.

    Eur Respir J. 2008;32(4):1031-6.

    Abstract

    The effects of malnutrition on outcomes in miliary tuberculosis (MTB) are not well described. The aim of the present study was to find predictors for the development of acute respiratory failure (ARF) and survival in MTB patients, focusing on parameters reflecting nutritional condition. Out of the patients from three hospitals who had microbiologically or histopathologically confirmed tuberculosis, 56 patients presenting with typical disseminated pulmonary nodules on radiographs were retrospectively enrolled. A four-point nutritional risk score (NRS) was defined according to the presence of four nutritional factors: low body mass index (BMI; <18.5 kg x m(-2)), hypoalbuminaemia (<30.0 g x L(-1)), hypocholesterolaemia (<2.33 mmol x L(-1)) and severe lymphocytopenia (<7 x 10(5) cells x L(-1)). The male to female ratio was 1:3. ARF developed in 25% of patients (14 out of 56), with a 50% fatality rate. A high NRS (> or =3 points) was an independent risk factor for the development of ARF and fatality. In 90-day survival analysis, ARF, severe lymphocytopenia, hypocholesterolaemia, low BMI and higher NRS were risk factors for poor outcome. In multivariate analysis, only high NRS was an independent risk factor for 90-day survival rate in patients with MTB. A high nutritional risk score was a good predictor of poor outcome in miliary tuberculosis patients. Additional approaches to recover the nutritional deficits may become a focus in future management of miliary tuberculosis.

    PubMed IF 23.8 호흡기내과
19. 1122008

    제1저자 윤원재 · 교신저자 윤용범

    Yoon WJ, Lee JK, Lee KH, Ryu JK, Kim YT, Yoon YB

    Cystic neoplasms of the exocrine pancreas: an update of a nationwide survey in Korea.

    Pancreas. 2008;37(3):254-8.

    Abstract

    OBJECTIVE The purpose of this study was to update a previous study of cystic neoplasms of the pancreas (PCNs) conducted in Korea by the authors.

    METHODS Clinicopathologic data and factors associated with malignancy were evaluated from PCNs originating from the exocrine pancreas diagnosed between January 1993 and June 2005 in 30 university hospitals throughout Korea.

    RESULTS A total of 1064 pathologically confirmed PCNs, which consisted of the following diagnoses, were collected: intraductal papillary mucinous neoplasm (IPMN), 436; mucinous cystic neoplasm (MCN), 268; solid pseudopapillary neoplasm (SPN), 195; serous cystic neoplasm (SCN), 162; acinar cell cystic neoplasm 2; and mature teratoma, 1. No malignant SCNs were diagnosed. In IPMN, advanced age, pancreatic head involvement, and hyperbilirubinemia were associated with malignancy based on multivariate analysis. In MCN, pancreatic head involvement was associated with malignancy based on multivariate analysis.

    CONCLUSIONS Intraductal papillary mucinous neoplasms were the most common PCN observed in Korea. Solid pseudopapillary neoplasms were observed more frequently than those in studies from western countries. In IPMNs, advanced age was associated with malignancy, suggesting an adenoma-carcinoma sequence. Involvement of the pancreatic head was associated with malignancy in both IPMNs and MCNs, possibly warranting prompt surgical interventions.

    PubMed IF 2.2 소화기내과
20. 1112008

    제1저자 정수진 · 교신저자 김동희

    Chung SJ, Kim D, Park MJ, Kim YS, Kim JS, Jung HC, Song IS

    Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups.

    Gut. 2008;57(10):1360-5.

    Abstract

    BACKGROUND Obesity has been associated with reflux oesophagitis. However, the relationship between metabolic syndrome characterised by visceral obesity and reflux oesophagitis is unclear.

    AIM To investigate whether metabolic syndrome or visceral obesity is a risk factor for reflux oesophagitis.

    METHODS A cross-sectional study of 7078 subjects undergoing upper endoscopy during health check-ups was conducted (3539 patients with reflux oesophagitis vs age- and sex-matched controls). We further analysed according to categories of visceral adipose tissue and subcutaneous adipose tissue area with 750 cases and age-, sex- and waist circumference-matched controls who underwent abdominal CT scan.

    RESULTS The prevalence of metabolic syndrome was higher in cases than controls (26.9% vs 18.5%, p<0.001). Multivariate analysis demonstrated that metabolic syndrome is associated with reflux oesophagitis (odds ratio (OR) = 1.42; 95% confidence interval (CI), 1.26 to 1.60). Among the individual components of metabolic syndrome, waist circumference (OR = 1.47; 95% CI, 1.30 to 1.65) and triglyceride (OR = 1.20; 95% CI, 1.05 to 1.36) independently increased the risk for reflux oesophagitis. On sub-analysis, cases showed higher mean visceral adipose tissue area (cm(2)) (136.1 (SD 57.8) vs 124.0 (SD 54.7), p<0.001) and subcutaneous adipose tissue area (cm(2)) (145.9 (SD 56.8) vs 133.5 (SD 50.7), p<0.001). However, only visceral adipose tissue area was an independent risk factor for reflux oesophagitis after adjusting for multiple confounders including smoking, alcohol, body mass index (BMI) and subcutaneous adipose tissue area (OR = 1.60; 95% CI, 1.03 to 2.48, lowest quartile vs highest quartile).

    CONCLUSIONS Metabolic syndrome was associated with reflux oesophagitis. Abdominal obesity, especially visceral obesity, was an important risk factor for reflux oesophagitis.

    PubMed IF 24.6 소화기내과
21. 1102008

    제1저자 김범준 · 교신저자 임재준

    Kim BJ, Park JH, Lee SA, Kim H, Cha CY, Kook YH, Kim EC, Joo SI, Lee JS, Yim JJ

    Differentiation of mycobacteria in sputa by duplex polymerase chain reaction for mycobacterial hsp65 gene.

    Diagn Microbiol Infect Dis. 2008;62(2):193-8.

    Abstract

    Early differentiation of mycobacteria in sputa is crucial. This study was set to evaluate the usefulness of a newly developed duplex polymerase chain reaction (PCR) for hsp65 gene-based method in differentiating mycobacteria in sputum with a positive acid-fast bacilli (AFB) smear before culturing. One hundred forty-seven sputa with positive AFB smear were included for the analysis. Mycobacterial species were identified using a newly developed duplex PCR for hsp65 gene followed by a nested PCR-direct sequencing and the conventional colony-based method. Final decision of mycobacterial species were made based on 1) results of species identification based on mycobacterial colonies or 2) results of species identification of other sputa from the same patients and clinical findings. The duplex PCR-based method correctly identified 83.2% sputa from tuberculosis patients and 82.2% sputa from nontuberculous mycobacteria patients, whereas the colony-based method correctly identified 86.1% and 77.8%, respectively. Sensitivity and specificity of the colony-based method for Mycobacterium tuberculosis were 86.1% and 100%, respectively, whereas those of the duplex PCR-based method were 83.2% and 95.6%, respectively. The duplex PCR-based method, to differentiate mycobacterial species in sputa, produced comparable results as those of the colony-based identification method.

    PubMed IF 1.8 호흡기내과
22. 1092008

    제1저자 최성희 · 교신저자 이현철

    Choi SH, Hur KY, Kim DJ, Ahn CW, Kang ES, Cha BS, Lim SK, Huh KB, Lee HC

    Staged diabetes management according to individual patient insulin resistance and beta-cell function ameliorates glycaemic control in type 2 diabetes mellitus.

    Clin Endocrinol (Oxf). 2008;69(4):549-55.

    Abstract

    OBJECTIVE The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A(1c) (HbA(1c)) level. We applied a new therapeutic strategy by assessing insulin secretion and insulin resistance, in addition to glucose concentrations in individual patients.

    DESIGN AND PATIENTS We enrolled 193 patients with type 2 diabetes. The patients were assigned to one of six groups according to insulin secretion measured by the serum fasting C-peptide concentration and insulin resistance measured by an insulin tolerance test (ITT). The two groups were treated differently: 108 patients were treated using a new staged diabetes management (SDM) strategy and 85 patients continued with conventional therapy.

    MEASUREMENTS We compared metabolic variables in the two groups at baseline and 12 months after enrollment.

    RESULTS In patients treated with the SDM strategy, fasting glucose concentration decreased from 9.8 +/- 2.1 to 8.2 +/- 1.7 mmol/l (P < 0.001). Postprandial 2-h glucose concentration decreased from 14.19 +/- 3.34 to 12.27 +/- 3.24 mmol/l (P < 0.001). HbA(1c) level decreased from 8.37 +/- 1.42% to 7.72 +/- 1.39% (P < 0.001). About 43% of the new SDM group achieved an HbA(1c) of < 7.0% compared with 25% of patients in the conventional treatment group.

    CONCLUSIONS The new SDM strategy, based on individual data on insulin resistance and insulin secretion, may provide valuable clinical benefits in non-obese Korean patients with type 2 diabetes.

    PubMed IF 2.8 내분비대사내과
23. 1082008

    제1저자 한정규 · 교신저자 김효수

    Han JK, Lee HS, Yang HM, Hur J, Jun SI, Kim JY, Cho CH, Koh GY, Peters JM, Park KW, Cho HJ, Lee HY, Kang HJ, Oh BH, Park YB, Kim HS

    Peroxisome proliferator-activated receptor-delta agonist enhances vasculogenesis by regulating endothelial progenitor cells through genomic and nongenomic activations of the phosphatidylinositol 3-kinase/Akt pathway.

    Circulation. 2008;118(10):1021-33.

    Abstract

    BACKGROUND Despite the therapeutic potential of endothelial progenitor cells (EPCs) in ischemic vascular diseases, their insufficient numbers limit clinical applications. Peroxisome proliferator-activated receptor (PPAR)-delta belongs to the nuclear hormone receptor superfamily, and its functions in various tissues and cells are almost unexplored, especially with respect to vascular biology.

    METHODS AND RESULTS PPAR-delta activation in EPCs phosphorylated Akt, and this phosphorylation was mediated not only by genomic but also by nongenomic pathways through interaction with the regulatory subunit of phosphatidylinositol 3-kinase. PPAR-delta activation with agonist (GW501516 or L-165041) increased the proliferation of human EPCs and protected them from hypoxia-induced apoptosis. In addition, PPAR-delta activation enhanced EPC functions, such as transendothelial migration, and tube formation. These actions by PPAR-delta activation in EPCs were dependent on the phosphatidylinositol 3-kinase/Akt pathway. In ischemic hindlimb of mice models, transplantation of PPAR-delta agonist-treated human or mouse EPCs enhanced blood flow recovery to ischemic limbs compared with vehicle-treated EPCs. In EPCs from PPAR-delta-knockout mice, however, treatment with PPAR-delta agonist did not enhance in vivo vasculogenic potential. Systemic administration of PPAR-delta agonist increased hematopoietic stem cells in bone marrow and EPCs in peripheral blood, leading to improved vasculogenesis with incorporation of bone marrow-derived cells to new vessels in a corneal neovascularization model and limb salvage with better blood flow in an ischemic hindlimb model.

    CONCLUSIONS The results of our study suggest that PPAR-delta agonist has therapeutic vasculogenic potential for the treatment of ischemic cardiovascular diseases.

    PubMed IF 41.3 순환기내과
24. 1072008

    제1저자 김현지 · 교신저자 임재준

    Kim HJ, Chung DH, Kim MJ, Jang JH, Kim YW, Han SK, Shim YS, Yim JJ

    Decreased phosphorylation of STAT-1, STAT-4 and cytokine release in MDR-TB patients with primary resistance.

    Int J Tuberc Lung Dis. 2008;12(9):1071-6.

    Abstract

    SETTING We recently showed that treatment failure rate was higher among multidrug-resistant tuberculosis (MDR-TB) patients without a previous history of tuberculosis (TB) treatment, or so-called 'primary resistance'.

    OBJECTIVE To investigate the phosphorylation levels of signal transducers and activators of transcription-1 (STAT-1) and STAT-4 and the subsequent cytokine release as a possible cause of a poor prognosis in MDR-TB patients with primary resistance.

    DESIGN Ten patients with successfully treated pulmonary TB without resistance, 12 MDR-TB patients with acquired resistance and 10 MDR-TB patients with primary resistance were enrolled. After 24 h stimulation of peripheral blood mononuclear cells (PBMC) with interferon-gamma (IFN-gamma), interleukin-12 (IL-12), purified protein derivative (PPD), or lysate of Mycobacterium tuberculosis, flow cytometric analysis of intracellular pSTAT-1 and pSTAT-4 were performed and secretion of IFN-gamma, IL-12p40 and tumour necrosis factor-alpha (TNF-alpha) was measured in culture supernatant.

    RESULTS The mean fluorescent intensities of pSTAT-1 and pSTAT-4 in PBMC of MDR-TB patients with primary resistance decreased on stimulation of IFN-gamma, PPD or lysate of M. tuberculosis when compared with patients with acquired resistance. In addition, secretion of IFN-gamma, IL-12p40 and TNF-alpha in these patients decreased on various stimuli.

    CONCLUSION Decreased phosphorylation of STAT-1, STAT-4, and of subsequent cytokine release, might be associated with a poor prognosis in MDR-TB patients with primary resistance.

    PubMed IF 3.6 호흡기내과
25. 1062008

    제1저자 김성한 · 교신저자 오명돈

    Kim SH, Chu K, Choi SJ, Song KH, Kim HB, Kim NJ, Park SH, Yoon BW, Oh MD, Choe KW

    Diagnosis of central nervous system tuberculosis by T-cell-based assays on peripheral blood and cerebrospinal fluid mononuclear cells.

    Clin Vaccine Immunol. 2008;15(9):1356-62.

    Abstract

    In active tuberculosis (TB), Mycobacterium tuberculosis-specific T cells are compartmentalized more to the site of infection than to the circulating blood. Therefore, an M. tuberculosis-specific enzyme-linked immunospot (ELISPOT) assay with samples from the site of infection may permit a more sensitive or specific diagnosis of active central nervous system (CNS) TB than that achieved by the assay with blood alone. Therefore, we prospectively evaluated the usefulness of circulating and compartmentalized mononuclear cell (MC; i.e., peripheral blood mononuclear cell [PBMC] and cerebrospinal fluid [CSF] MC)-based ELISPOT assays (i.e., the T-SPOT.TB test) for the diagnosis of active TB in patients with suspected CNS TB. The clinical categories of CNS TB were classified as described previously (G. E. Thwaites, T. T. Chau, K. Stepniewska, N. H. Phu, L. V. Chuong, D. X. Sinh, N. J. White, C. M. Parry, and J. J. Farrar, Lancet 360:1287-1292, 2002). Thirty-seven patients with suspected CNS TB were enrolled over a 12-month period. Of these, 31 (84%) showed clinical manifestations of suspected TB meningitis and 6 (16%) gave indications of intracranial tuberculoma with disseminated TB. The final clinical categories of the 37 patients with suspected CNS TB were as follows: 12 (32%) were classified as having CNS TB (7 with confirmed TB, 3 with probable TB, and 2 with possible TB) and 25 (68%) were classified as not having active TB. The sensitivity and specificity of the PBMC ELISPOT assay were 91% (95% confidence interval [CI], 59% to 100%) and 63% (95% CI, 41% to 81%), respectively. By comparison, the sensitivity and specificity of the CSF MC ELISPOT assay were 75% (95% CI, 19% to 99%) and 75% (95% CI, 43% to 95%), respectively. When the ratio of the CSF MC ELISPOT assay results to the PBMC ELISPOT results was 2 or more, the sensitivity and specificity were 50% (95% CI, 7% to 93%) and 100% (95% CI, 74% to 100%), respectively. The ELISPOT assay with PBMCs and CSF MCs is a useful adjunct to the current tests for the diagnosis of CNS TB.

    PubMed IF 1.995 감염내과
26. 1052008

    제1저자 양승희 · 교신저자 김연수

    Yang SH, Kim SJ, Kim N, Oh JE, Lee JG, Chung NH, Kim S, Kim YS

    NKT cells inhibit the development of experimental crescentic glomerulonephritis.

    J Am Soc Nephrol. 2008;19(9):1663-71.

    Abstract

    CD1d is an MHC class I-like, beta2-microglobulin-associated protein, constitutively expressed by antigen-presenting cells and some epithelial cells, which is recognized by NKT cells, a subpopulation of T cells. CD1d-dependent NKT cells confer protection in immune-mediated disorders, but whether these cells modulate the development of glomerulonephritis is unknown. Experimental crescentic glomerulonephritis was induced by administering anti-glomerular basement membrane antibodies to NKT cell-deficient (CD1d(-/-)) and wild-type mice. Compared with wild-type mice, NKT cell-deficient mice had an accelerated course of glomerulonephritis measured by renal function and crescent formation, and this was abrogated by adoptive transfer of NKT cells. Reconstitution with NKT cells also attenuated intraglomerular expression of TGF-beta1 and decreased phosphorylation of the transcription factors NF-kappaB and IkappaB. Adopted transfer of fluorescence-labeled NKT cells demonstrated their distribution to glomeruli damaged by anti-glomerular basement membrane antibodies but not to the tubulointerstitium. The chemokine CXCL16, which is the ligand for CXCR6 on NKT cells, was upregulated in glomeruli after induction of glomerulonephritis, and NKT cells were present in the same glomeruli. In vitro, NKT cells inhibited LPS-stimulated proliferation of mesangial cells, an affect that was reduced by co-current treatment with an anti-CXCL16 monoclonal antibody. In summary, these findings highlight the regulatory capacity of CD1d-dependent NKT cells in experimental glomerulonephritis and suggest that CXCL16 is involved in the recruitment of these cells to the site of injury.

    PubMed IF 9.7 신장내과
27. 1042008

    제1저자 진호준 · 교신저자 채동완

    Chin HJ, Song YR, Lee JJ, Lee SB, Kim KW, Na KY, Kim S, Chae DW

    Moderately decreased renal function negatively affects the health-related quality of life among the elderly Korean population: a population-based study.

    Nephrol Dial Transplant. 2008;23(9):2810-7.

    Abstract

    BACKGROUND The incidence of chronic kidney disease (CKD) is increasing in Korea, especially in the aged population. The health-related quality of life (HRQOL) of patients with chronic renal insufficiency is lower than that for the general population and a lower HRQOL is a predictor of adverse events. We report the impact of kidney function on the HRQOL and the risk factors for poor HRQOL in an elderly population living in one Korean city.

    METHODS This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA) that was designed as a population-based, prospective cohort-study in a population aged >65 years living in a satellite city of Seoul in Korea. Among 1 000 randomly selected subjects, 944 were able to complete the SF-36 questionnaires to measure HRQOL.We categorized the participants into five GFR groups: group 1: 90 mL/min/1.73 m(2) or more, group 2: 89-75 mL/ min/1.73 m(2), group 3: 60-74 mL/min/1.73 m(2), group 4: 45-59 mL/min/1.73 m(2) and group 5: less than 45 mL/min/ 1.73 m(2).

    RESULTS Except for the general health perception and mental health scale, all the other scores of the SF-36 scales showed differences among five groups categorized according to GFR. However, the scores were significantly decreased only among participants with a GFR value of <45 mL/min/1.73 m(2), compared to the other four GFR groups. After adjustment, the physical component summary score was the lowest in participants with GFR values <45 mL/min/1.73 m(2). The dichotomized GFR factor with the criterion of 45 mL/min/1.73 m(2) was an independent predictor of poor physical HRQOL. Other factors, such as age, gender, duration of education, regular exercising habits, depression and a history of cardiovascular accident, were also predictors of HRQOL. A lower haemoglobin level was related to the mental component summary.

    CONCLUSION The renal function deduced to be an important predictor of HRQOL, even in the old age group. The moderately decreased renal function of 45 mL/min/1.73 m(2) GFR was the level at which HRQOL decreased in the elderly Korean population.

    PubMed IF 8.3 신장내과
28. 1032008

    제1저자 최효진 · 교신저자 송영욱

    Choi HJ, Lee JC, Lee YJ, Lee EB, Shim SS, Park JS, Jun JK, Song YW

    Prevalence and clinical features of arthralgia/arthritis in healthy pregnant women.

    Rheumatol Int. 2008;28(11):1111-5.

    Abstract

    The authors prospectively investigated 155 pregnant women, without a history of rheumatic disease who visited the Department of Obstetrics and Gynecology for routine antenatal care, to evaluate the prevalences and clinical features of arthralgia and arthritis in healthy pregnant women. Mean of the 155 subjects' ages was 31.8 +/- 3.8 (years, +/-SD). Arthralgia was found in 26 (16.7%) and arthritis in 15 (9.6%) pregnant women. Arthralgia or arthritis developed in the third trimester (28-40 weeks of gestation), except in one case (16 weeks of gestation). Most commonly involved joints were the proximal interphalangeal (n = 19, 12.2%). Rheumatoid factor and antinuclear antibody were negative in patients with arthritis. Ten women (6.8%) had persistent arthralgia for over 6 weeks, post-delivery. Four of them were followed up at Rheumatology Clinic and were diagnosed as having spondyloarthropathy (1), or unspecified arthralgia (3). In conclusion, arthralgia is common during pregnancy and most frequent in proximal interphalangeal joints.

    PubMed IF 3.5 류마티스내과
29. 1022008

    제1저자 서명덕 · 교신저자 이근욱

    Seo MD, Lee KW, Lim JH, Yi HG, Kim DY, Oh DY, Kim JH, Im SA, Kim TY, Lee JS, Bang YJ

    Irinotecan combined with 5-fluorouracil and leucovorin as second-line chemotherapy for metastatic or relapsed gastric cancer.

    Jpn J Clin Oncol. 2008;38(9):589-95.

    Abstract

    OBJECTIVE We analysed the efficacy and toxicity of irinotecan, leucovorin and 5-fluorouracil (FOLFIRI) chemotherapy as second-line treatment for metastatic or relapsed gastric cancer (MRGC) in a clinical practice setting. Factors to select patients who may benefit from salvage chemotherapy was also analysed.

    METHODS Patients with MRGC with progression on or within 6 months after discontinuing platinum-based chemotherapy received FOLFIRI as second-line therapy. The FOLFIRI regimen consisted of irinotecan (180 mg/m(2); day 1) combined with leucovorin (200 mg/m(2)), followed by 5-fluorouracil (400 mg/m(2)) as a bolus and 600 mg/m(2) as a 22-h infusion on days 1 and 2 every 2 weeks.

    RESULTS Fifty-one patients received a total of 282 courses of chemotherapy. No patients had complete remission (CR), but 9 patients achieved partial remission (PR). Stable disease (SD) was documented in 15 patients. The median progression-free survival (PFS) and overall survival (OS) were 3.2 and 9.1 months, respectively. Toxicities were tolerable and grade 3/4 neutropenia was observed in 49 cycles (17%). In multivariate analysis, patients with less organ involvement by metastasis and good performance status (PS) were independently associated with a longer PFS and OS (P < 0.05). Disease control (CR, PR or SD) after first-line chemotherapy were related to a longer PFS (P = 0.02), but had no effect on OS.

    CONCLUSIONS FOLFIRI was tolerable and showed modest activity as a second-line therapy in MRGC. Less organ involvement by metastasis or good PS may be optimal selection criteria for patients with MRGC who are suitable for second-line chemotherapy.

    PubMed IF 2.5 혈액종양내과
30. 1012008

    제1저자 강은하 · 교신저자 이은봉

    Kang EH, Lee EY, Lee YJ, Song YW, Lee EB

    Clinical features and risk factors of postsurgical gout.

    Ann Rheum Dis. 2008;67(9):1271-5.

    Abstract

    OBJECTIVES To investigate the clinical characteristics and risk factors of gout attacks that develop during the postsurgical period.

    METHODS We enrolled 67 patients with gout who developed postsurgical gout and 67 controls who had histories of gout but did not develop gout attacks after surgery. Features of the postsurgical gout attacks were analysed and compared to those of presurgical gout attacks suffered by patients and controls. Demographics, medical backgrounds, laboratory data and surgical factors were compared between patients and controls in order to establish risk factors associated with postsurgical gout.

    RESULTS The mean (SD) time interval to develop postsurgical gout was 4.2 (3.1) days. The attacks tended to involve lower extremity joints (65/67, 97.0%), usually the first metatarsophalangeal joint (42/67, 62.7%), and to affect more than one joint (34/67, 50.7%). The number of attacked joints was positively correlated with the total number of previously involved joints (r = 0.281, p = 0.026). The site of attacks had a preference for the previously affected sites. A history of cancer surgery (p = 0.002), elevated presurgical serum urate levels (>/=9 mg/dl; p = 0.002) and failure to administer colchicine prophylaxis (p = 0.008) were found to be risk factors for postsurgical gout.

    CONCLUSIONS Postsurgical gout tends to develop within 8 days after surgery. The site and number of involved joints reflect the features of gout attacks the patient suffered before surgery. Adequate presurgical control of serum uric acid levels and/or prophylactic administration of colchicine will help prevent gout attacks during the postsurgical period.

    PubMed IF 24 류마티스내과

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