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1.  Serum CA 19-9 and CEA Levels as a Prognostic Factor in Pancreatic Adenocarcinoma 
Yonsei Medical Journal  2013;54(3):643-649.
Purpose
To investigate the use of pretreatment carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) as prognostic factors to determine survival in pancreatic adenocarcinoma.
Materials and Methods
A retrospective review of the medical records of patients who were diagnosed with pancreatic adenocarcinoma and received surgery, chemoradiotherapy or chemotherapy was performed. Factors, including CA 19-9 and CEA, associated with the survival of pancreatic cancer patients were analyzed.
Results
Patients with the median age of 65 years were included (n=187). Elevated serum CA 19-9 levels and CEA levels were observed in 75.4% and 39% of patients at diagnosis, respectively. CEA was correlated with tumor stages (p=0.005), but CA 19-9 was not. CA 19-9 and CEA were elevated in 69.0% and 33.3% of patients with resectable pancreatic cancer, and elevated in 72.9% and 47.2% of patients with advanced pancreatic cancer, respectively. The median overall survival of the normal serum CEA group was longer than that of the elevated serum CEA group (16.3 months vs. 10.2 months, p=0.004). However, the median overall survival of the normal serum CA 19-9 group was not different from that of the elevated serum CA 19-9 group (12.4 months vs. 13.5 months, p=0.969). The independent factors associated with overall survival were advanced pancreatic cancer [harzard ratio (HR) 4.33, p=0.001] and elevated serum CEA level (HR 1.52, p=0.032).
Conclusion
Patients with elevated serum CEA level at diagnosis demonstrated poor overall survival. Pretreatment CEA level may predict the prognosis of patients with pancreatic adenocarcinoma.
doi:10.3349/ymj.2013.54.3.643
PMCID: PMC3635646  PMID: 23549809
CA 19-9; carcinoembryonic antigen; pancreas adenocarcinoma; prognosis
2.  Electromagnetic Interference of Wireless Local Area Network on Electrocardiogram Monitoring System: A Case Report 
Korean Circulation Journal  2013;43(3):187-188.
Electromagnetic interference (EMI) can affect various medical devices. Herein, we report the case of EMI from wireless local area network (WLAN) on an electrocardiogram (ECG) monitoring system. A patient who had a prior myocardial infarction participated in the cardiac rehabilitation program in the sports medicine center of our hospital under the wireless ECG monitoring system. After WLAN was installed, wireless ECG monitoring system failed to show a proper ECG signal. ECG signal was distorted when WLAN was turned on, but it was normalized after turning off the WLAN.
doi:10.4070/kcj.2013.43.3.187
PMCID: PMC3629245  PMID: 23613696
Wireless technology; Electrocardiography
3.  Progression Rate of Aortic Valve Stenosis in Korean Patients 
Background
Although there were studies about ethnic differences in aortic valve thickness and calcification that they may play a role in aortic valvular stenosis (AVS) progression, few studies about the progression rate of AVS in Asian population have been reported. The purpose of this study was to evaluate the progression rate of AVS in Korean patients.
Methods
We retrospectively analyzed 325 patients (181 men, age: 67 ± 13 years) with AVS who had 2 or more echocardiograms at least 6 months apart from 2003 to 2008. The patients with other significant valvular diseases or history of cardiac surgery were excluded. The progression rate of AVS was expressed in terms of increase in maximum aortic jet velocity per year (meter/second/year).
Results
Baseline AVS was mild in 207 (64%), moderate in 81 (25%), and severe in 37 (11%). There were no significant differences among the three groups in terms of age, gender, hypertension, smoking, and hypercholesterolemia. The mean progression rate was 0.12 ± 0.23 m/s/yr and more rapid in severe AVS (0.28 ± 0.36 m/s/yr) when compared to moderate (0.14 ± 0.26 m/s/yr) and mild AVS (0.09 ± 0.18 m/s/yr) (p < 0.001). The progression rate in bicuspid AVS was significantly higher than other AVS (0.23 ± 0.35 vs. 0.11 ± 0.20 m/s/yr, p = 0.002). By multivariate analysis, initial maximum aortic jet velocity (Beta = 0.175, p = 0.003), bicuspid aortic valve (Beta = 0.127, p = 0.029), and E velocity (Beta = -0.134, p = 0.018) were significantly associated with AVS progression.
Conclusion
The progression rate of AVS in Korean patients is slower than that reported in Western population. Therefore, ethnic difference should be considered for the follow-up of the patients with AVS.
doi:10.4250/jcu.2010.18.4.127
PMCID: PMC3021890  PMID: 21253361
Aortic valvular stenosis; Natural history; Disease progression
4.  Placement of a fully covered self-expandable metal stent in a young patient with chronic pancreatitis 
Plastic stent insertion is a treatment option for pancreatic duct stricture with chronic pancreatitis. However, recurrent stricture is a limitation after removing the plastic stent. Self-expandable metal stents have long diameters and patency. A metal stent has become an established management option for pancreatic duct stricture caused by malignancy but its use in benign stricture is still controversial. We introduce a young patient who had chronic pancreatitis and underwent several plastic stent insertions due to recurrent pancreatic duct stricture. His symptoms improved after using a fully covered self-expandable metal covered stent and there was no recurrence found at follow-up at the outpatient department.
doi:10.4253/wjge.v2.i11.375
PMCID: PMC3004045  PMID: 21173916
Chronic Pancreatitis; Pancreatic duct stricture; Fully covered self-expandable metal covered stent; Young patient
5.  Characteristics of Double-Chambered Right Ventricle in Adult Patients 
Background/Aims
This study evaluated the clinical features of double-chambered right ventricle (DCRV) in adults. Most cases of DCRV are diagnosed and treated during childhood. Consequently, very few reports include cases in which its clinical characteristics are evident in adults.
Methods
We reviewed the clinical data for 10 adult patients (age ≥ 18 years) with DCRV.
Results
Electrocardiogram showed right ventricular hypertrophy in 3 DCRV patients. All cases were associated with ventricular septal defect (VSD; 7 for perimembranous, 2 for muscular outlet, and 1 for the subarterial type). Surgical correction was done for 7 DCRV patients all of whom survived operations. Their follow-up echocardiogram showed the pressure gradient in their right ventricle was significantly decreased from 69.4 ± 17.2 mmHg preoperatively to 10.2 ± 5.0 mmHg postoperatively (p < 0.05). In the short-term follow-up, there was no significant increase in the pressure gradient in the right ventricle.
Conclusions
There are lots of cases of DCRV that are not diagnosed accurately in adults. In our experience, all DCRV cases had VSD and surgical correction of these cases showed excellent results. Therefore, accurate diagnosis of DCRV is necessary so that DCRV is not overlooked and operations are enabled within an appropriate time.
doi:10.3904/kjim.2010.25.2.147
PMCID: PMC2880687  PMID: 20526387
Double outlet right ventricle; Heart defects, congenital; Heart ventricles; Ventricular outflow obstruction
6.  The Effects of Short-duration Exercise on Arterial Stiffness in Patients with Stable Coronary Artery Disease 
Journal of Korean Medical Science  2009;24(5):795-799.
Arterial stiffness is an important contributor to the development of cardiovascular disease. We investigated the effect of short duration exercise using the treadmill test on arterial stiffness in the presence of coronary artery disease. We enrolled patients with and without coronary artery diseases (CAD and control group, 50 patients each) referred for treadmill testing. Brachial-ankle pulse wave velocity (baPWV) were measured before and after treadmill testing. Values of baPWV were significantly reduced at 10 min after exercise in both groups, more in the CAD group than in the control group (baseline baPWV and post-exercise change [cm/sec]: 1,527±245 and -132±155 in the CAD group, 1,439±202 and -77±93 in the control group, respectively, P for change in each group <0.001, P for difference in changes between the two groups <0.001). These findings persisted after adjusting for age, body mass index, systolic blood pressure, mean arterial pressure (MAP), MAP decreases, and baseline baPWV. Significant post-exercise baPWV reductions were observed in both groups, and more prominently in the CAD group. This finding suggests that short-duration exercise may effectively improve arterial stiffness even in patients with stable coronary artery disease.
doi:10.3346/jkms.2009.24.5.795
PMCID: PMC2752758  PMID: 19794973
Exercise; Coronary Artery Disease; Brachial Artery
7.  Dynamic left ventricular outflow tract obstruction without basal septal hypertrophy, caused by catecholamine therapy and volume depletion 
Hypertrophic cardiomyopathy (HCM) with hypertrophy of the basal septum is the most common etiology of left ventricular outflow tract (LVOT) obstruction.
In this article, we report the case of a patient with a structurally normal heart who developed hemodynamic deterioration due to severe LVOT obstruction following treatment with catecholamines. Hypovolemia accompanied with a hyperdynamic condition, resulting from catecholamine treatment, may cause dynamic LVOT obstruction due to the systolic anterior motion of the mitral valve leaflet. The solution for this is early recognition and correction of aggravating factors such as, withdrawal of catecholamine therapy and volume replacement.
doi:10.3904/kjim.2008.23.2.106
PMCID: PMC2686978  PMID: 18646515
Left ventricular outflow obstruction; Catecholamines
8.  Spontaneous Closure of Iatrogenic Coronary Artery Fistula to Left Ventricle After Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy 
Journal of Korean Medical Science  2006;21(6):1111-1114.
Cases of iatrogenic coronary artery fistulas draining into the left ventricle after surgical myectomy for hypertrophic obstructive cardiomyopathy have been published as sporadic reports. However, its management scheme and prognosis are not clear because of the low incidence. A 46-yr-old woman was hospitalized for evaluation of chest pain and shortness of breath for 3 months. Transthoracic echocardiographic examination showed typical hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 71 mmHg across the left ventricular outflow tract. The patient underwent surgical septal myectomy. Postoperative color Doppler imaging revealed a diastolic blood flow from the interventricular septal myocardium to the left ventricular cavity, i.e. iatrogenic coronary artery fistula to the left ventricle. Ten days later, the fistula closed spontaneously which was diagnosed by transthoracic echocardiography and confirmed by coronary angiography.
doi:10.3346/jkms.2006.21.6.1111
PMCID: PMC2721939  PMID: 17179697
Cardiomyopathy, Hypertrophic; Vascular Fistula; Postoperative Complications
9.  Clinical Outcome of Cardiac Surgery in Octogenarians 
Journal of Korean Medical Science  2005;20(5):747-751.
The purpose of this study was to investigate the operative results and the clinical outcomes for octogenarians who underwent cardiac surgery. Twenty consecutive octogenarians who had cardiac operations at Samsung Medical Center from October 1994 through December 2004 were included in the study. The medical records were retrospectively reviewed and the follow-up results were obtained by the interview. The patients were 15 men and 5 women, and their mean age was 83.1 yr (range: 80-89 yr). The surgical priority was urgent for 5 patients and it was elective for 15 patients. Coronary artery bypass grafting (CABG) was performed in 14 patients, valve surgery was performed in 4 patients and CABG plus valve surgery was performed in 2 patients. There was one hospital death on day one after urgent CABG in an 80-yr-old man who had left main coronary artery occlusion. There were three deaths during the follow-up. Sudden death occurred in one patient at 2 months after valve surgery, and there were two non-cardiac deaths at 12 and 14 months, respectively, after CABG. Non-fatal postoperative complications occurred in 2 of 5 urgent patients and in 3 of 15 electives. The survival rate for the 19 hospital survivors at 24 months after surgery was 80% and the mean follow-up period was 22.5 months (range: 1-58 months). In conclusion, cardiac surgery could be performed within acceptable limits of the risk and its long-term results could be expected to be favorable for the octogenarians.
doi:10.3346/jkms.2005.20.5.747
PMCID: PMC2779269  PMID: 16224146
Thoracic Surgical Procedures; Aged 80 and over; Coronary Artery Bypass
10.  Clinical Features of Right-Sided Infective Endocarditis Occurring in Non-Drug Users 
Journal of Korean Medical Science  2014;29(6):776-781.
Right-sided infective endocarditis (RIE) occurs predominantly in intravenous drug users in western countries, and it has a relatively good prognosis. Clinical features and prognosis of RIE occurring in non-drug users are not well known. We investigated the clinical findings of RIE in non-drug users. We retrospectively reviewed 345 cases diagnosed with IE. Cases with RIE or left-sided infective endocarditis (LIE) defined by the vegetation site were included and cases having no vegetation or both-side vegetation were excluded. Clinical findings and in-hospital outcome of RIE were compared to those of LIE. Among the 245 cases, 39 (16%) cases had RIE and 206 (84%) cases had LIE. RIE patients were younger (40±19 yr vs 50±18 yr, P=0.004), and had a higher incidence of congenital heart disease (CHD) (36% vs 13%, P<0.001) and central venous catheter (CVC) (21% vs 4%, P=0.001) compared to LIE patients. A large vegetation was more common in RIE (33% vs 9%, P<0.001). Staphylococcus aureus was the most common cause of RIE, while Streptococcus viridans were the most common cause of LIE. In-hospital mortality and cardiac surgery were not different between the two groups. CHD and use of CVC were common in non-drug users with RIE. The short-term clinical outcome of RIE is not different from that of LIE.
Graphical Abstract
doi:10.3346/jkms.2014.29.6.776
PMCID: PMC4055809  PMID: 24932077
Endocarditis; Tricuspid Valve; Echocardiography
11.  Clinicopathologic Characteristics Associated with Complications and Long-Term Outcomes of Endoscopic Papillectomy for Adenoma 
Yonsei Medical Journal  2014;55(3):644-650.
Purpose
Endoscopic papillectomy (EP) is currently employed for the treatment of ampullary adenoma. This study aimed to evaluate the clinical, endoscopic, and histologic characteristics related to complications and long-term outcomes of EP.
Materials and Methods
Thirty-nine patients underwent EP for ampullary adenoma. Patients were grouped according to the occurrence of procedure-related complications: no complication group (n=28) and complication group (n=11).
Results
The overall complication rate was 28.2%. The most common complication was EP-related pancreatitis (n=7). Amylase (p=0.006) and lipase levels (p=0.007), 24 hours after EP, were significantly higher in the complication group, however, these levels did not differ at earlier times. As the tumor progressed from adenoma to cancer, the complete resection was significantly lessened (p=0.032). The duration of antiprotease injection during the hospital stay was significantly longer (p=0.017) and the transfusion requirements were significantly higher (p=0.018) in the complication group. During a median follow-up of 15 months, three lesions (10.3%) recurred among patients with complete resection (n=29) and five lesions (12.8%) recurred among enrolled patients. One patient with progressive recurrence from low-grade dysplasia to adenocarcinoma was noted during a follow-up of 22 months.
Conclusion
If symptoms are present, amylase and lipase levels, 24 hours after EP, could help predict possible EP-related pancreatitis. Histologic diagnosis through resected specimens may result in complete resection. Patients with complications need a longer duration of antiprotease injection during their hospital stay and more transfusions. The recurrence rate was not significantly high in completely resected cases, however, there was a possibility of progressive recurrence.
doi:10.3349/ymj.2014.55.3.644
PMCID: PMC3990097  PMID: 24719130
Ampullary adenoma; endoscopic papillectomy; endoscopic retrograde cholangiopancreatography; complication
12.  Native valve endocarditis due to extended spectrum β-lactamase producing Klebsiella pneumoniae 
doi:10.3904/kjim.2014.29.3.398
PMCID: PMC4028533  PMID: 24851078
Extended-spectrum beta-lactamase; Klebsiella pneumoniae; Endocarditis
13.  Impact of Doctors' Resistance on Success of Drug Utilization Review System 
Healthcare Informatics Research  2014;20(2):99-108.
Objectives
The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system.
Methods
This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012.
Results
This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction.
Conclusions
The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
doi:10.4258/hir.2014.20.2.99
PMCID: PMC4030065  PMID: 24872908
Drug Utilization Review; Information System; Medicare Assignment
14.  Glioma is formed by active Akt1 alone and promoted by active Rac1 in transgenic zebrafish 
Neuro-Oncology  2013;15(3):290-304.
Background
Ongoing characterization of glioma has revealed that Akt signaling plays a crucial role in gliomagenesis. In mouse models, however, Akt alone was not sufficient to induce glioma.
Methods
We established transgenic zebrafish that overexpressed dominant-active (DA) human Akt1 or Rac1G12V (DARac1) at ptf1a domain and investigated transgenic phenotypes and mechanisms leading to gliomagenesis.
Results
Transgene expressions were spatiotemporally restricted without any developmental abnormality of embryos and persisted at cerebellum and medulla in adult zebrafish. DAAkt1 alone induced glioma (with visible bumps at the head), with incidences of 36.6% and 49% at 6 and 9 months, respectively. Histologically, gliomas showed various histologic grades, increased proliferation, and frequent invasion into the fourth ventricle. Preferential location of small tumors at periventricular area and coexpression of Her4 suggested that tumors originated from Ptf1a- and Her4-positive progenitor cells at ventricular zone. Gliomagenesis was principally mediated by activation of survival pathway through upregulation of survivin genes. Although DARac1 alone was incapable of gliomagenesis, when coexpressed with DAAkt1, gliomagenesis was accelerated, showing higher tumor incidences (62.0% and 73.3% at 6 and 9 months, respectively), advanced histologic grade, invasiveness, and shortened survival. DARac1 upregulated survivin2, cyclin D1, β-catenin, and snail1a but downregulated E-cadherin, indicating that DARac1 promotes gliomagenesis by enhancing proliferation, survival, and epithelial-to-mesenchymal transition. On pharmacologic tests, only Akt1/2 inhibitor effectively suppressed gliomagenesis, inhibited cellular proliferation, and induced apoptosis in established gliomas.
Conclusions
The zebrafish model reinforces the pivotal role of Akt signaling in gliomagenesis and suggests Rac1 as an important protein involved in progression.
doi:10.1093/neuonc/nos387
PMCID: PMC3578497  PMID: 23325864
Akt1; epithelial-mesenchymal transition; glioma; Rac1; transgenic zebrafish
17.  Duodenal adenocarcinoma following a neuroendocrine tumor in the duodenum 
Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duodenal adenocarcinoma after duodenal neuroendocrine carcinoma. Poorly differentiated duodenal neuroendocrine carcinoma with liver metastasis (TxNxM1) was confirmed, and eight cycles of palliative chemotherapy (5-fluorouracil/etoposide/cisplatin) were administered. The patient was then in a clinically complete response status. About 1 year later, newly developed adenocarcinoma was detected at the same site. It was completely surgically resected, and the patient was cured.
doi:10.3904/kjim.2014.29.1.96
PMCID: PMC3932400  PMID: 24574838
Neuroendocrine tumors; Duodenal neoplasms; Drug therapy
18.  Effect of Dose Escalation with Single Opioid, Fentanyl Matrix in Patients Not Controlling Cancer Pain: A Multicenter, Prospective, Observational Study in Korea 
Purpose
End-of-dose failure (EOD) is a clinically common observation and many cancer patients increase the frequency of opioid administration. Fentanyl matrix use is known to be effective in patients with chronic cancer pain. To measure the effectiveness of increase in a single dose of fentanyl matrix in patients whose pain was not controlled sufficiently, we perform this study.
Materials and Methods
A multi-center, open-label, prospective, observational study was conducted in 30 hospitals in Korea, between August and December 2008.
Results
A total of 452 patients were enrolled; 404 patients completed the study. The mean pain intensity decreased from 5.27 at the first visit to 3.37 at the end of the trial. There was a significant difference in pain intensity (p < 0.001) between the first and last visits. The percentage of pain intensity difference was 30.1%. The prevalence of EOD at the first visit was 73% from the 452 enrolled patients. After the use of fentanyl patch, EOD decreased from 73% to 56%. Pain intensity of patients experiencing EOD was 5.64 at the baseline compared to 4.27 in patients without EOD. On final visit, pain intensity in patients with and without EOD was 4.02 and 2.54, respectively. The observed adverse events were mainly nausea, asthenia, constipation and diarrhea.
Conclusion
This study demonstrated that increasing dose of fentanyl patch decreased pain intensity and decreased the rate of patients experiencing EOD. Thus, fentanyl patch may be an effective modality in cancer patients whose pain was previously not controlled sufficiently; the side effects were as could be expected with an opioid.
doi:10.4143/crt.2013.45.4.263
PMCID: PMC3893323  PMID: 24453998
Fentanyl; Neoplasms; Pain
19.  Improved Detection of Ischemic Heart Disease by Combining High-Frequency Electrocardiogram Analysis with Exercise Stress Echocardiography 
Korean Circulation Journal  2013;43(10):674-680.
Background and Objectives
Because the exercise treadmill test (ETT) based on ST-segment analysis is limited due to low sensitivity and specificity, there has been an interest in the additional analysis of high-frequency components of QRS (HFQRS) for the detection of coronary artery disease (CAD). We sought to evaluate the feasibility and clinical usefulness of HFQRS analysis during exercise stress echocardiography (ESE).
Subjects and Methods
We evaluated 175 patients (age 57±9,118 men) who performed ESE and either coronary computed tomographic angiography or coronary angiography. ETT was performed using the HyperQ stress system for both conventional ST-segment analysis and HFQRS intensity analysis.
Results
Thirty-two patients (31%) had significant CAD. The sensitivity and specificity of HFQRS analysis were 68.8% and 74.8%, respectively. The combined model, including HFQRS analysis and ESE, provided the best diagnostic accuracy, with the area under the receiver-operating characteristics curve (AUC) of 0.948 {95% confidence interval (CI)=0.913-0.984} compared with ST-segment analysis (AUC 0.679, 95% CI=0.592-0.766).
Conclusion
HFQRS analysis during ESE is feasible and may provide additional diagnostic information for the detection of significant CAD.
doi:10.4070/kcj.2013.43.10.674
PMCID: PMC3831013  PMID: 24255651
Treadmill test; Echocardiography, stress; Electrocardiography; Coronary artery disease
20.  Balloon Occlusive Diameter of Non-Circular Atrial Septal Defects in Transcatheter Closure with Amplatzer Septal Occluder 
Korean Circulation Journal  2013;43(10):681-685.
Background and Objectives
The aim of this study was to investigate the balloon occlusive diameter (BOD) of non-circular defects in the transcatheter closure of atrial septal defect (ASD).
Subjects and Methods
A total of 67 patients who had undergone transcatheter closure of an ASD were reviewed retrospectively. A non-circular defect was defined as the ratio of the short diameter to the long diameter of the defect on the en-face image less than 0.75. The BOD was compared with the long diameter of the defect and then compared between the two groups.
Results
There were 22 patients with circular defects and 45 patients with non-circular defects. The difference in BOD measuring from the long diameter of the defect was quite different between the two groups and significantly smaller in non-circular morphology (0.1±4.0 vs. 2.3±2.1, p=0.006). The difference in BOD measurement from the long diameter of ASD showed a positive correlation with the ratio of the short diameter to the long diameter of ASD (b/a) (r2=0.102, p=0.008). In the non-circular morphology of ASD, the difference in BOD measured from the long diameter had a significant negative correlation with the long diameter of ASD (r2=0.230, p=0.001), whereas in circular ASD, no significant correlation was found between the difference in BOD and the long diameter of ASD (p=0.201).
Conclusion
The BOD compared with the long diameter measured from three-dimensional transesophageal echocardiography was smaller in non-circular ASD than in circular ASD. This difference was much smaller in non-circular ASD with a large long diameter.
doi:10.4070/kcj.2013.43.10.681
PMCID: PMC3831014  PMID: 24255652
Atrial septal defect; Amplatzer septal occluder; Balloon occlusion
21.  Phase II Trial of Erlotinib Plus Gemcitabine Chemotherapy in Korean Patients with Advanced Pancreatic Cancer and Prognostic Factors for Chemotherapeutic Response 
Gut and Liver  2013;7(5):611-615.
Background/Aims
Erlotinib and gemcitabine combined chemotherapy is becoming the treatment of choice in advanced pancreatic cancer. We evaluated the effectiveness of treatment with erlotinib plus gemcitabine and the prognostic factors for chemotherapeutic response in Korean pancreatic cancer patients.
Methods
Sixty-nine patients with advanced pancreatic cancer who were treated with daily erlotinib 100 mg orally and gemcitabine 1,000 mg/m2/30 min intravenous infusion on days 1, 8, and 15 of each 4-week cycle from 2006 to 2009 were included in this study. This study was a phase II single-center trial.
Results
All 69 patients with advanced pancreatic cancer were chemotherapy-naïve. The objective response rate was 18.8%, and the overall tumor-stabilization rate was 49.2%. The median overall survival was 7.7 months (95% confidence interval [CI], 6.0 to 9.4 months). The median progression-free survival was 1.9 months (95% CI, 1.4 to 2.5 months). Prognostic factors for good chemotherapeutic response were good performance status and the presence of skin rash during chemotherapy. Patients with lower performance scores showed worse chemotherapeutic responses (odds ratio [OR], 7.6; 95% CI, 2.4 to 24.8). Poor responses were predicted by the absence of skin rash during chemotherapy (OR, 3.0; 95% CI, 1.4 to 6.3).
Conclusions
Erlotinib and gemcitabine chemotherapy is a tolerable treatment regimen and has a favorable therapeutic effect in Korean patients with advanced pancreatic cancer.
doi:10.5009/gnl.2013.7.5.611
PMCID: PMC3782678  PMID: 24073321
Gemcitabine; Erlotinib; Pancreatic neoplasms
22.  Radiotherapy Prolongs Biliary Metal Stent Patency in Malignant Pancreatobiliary Obstructions 
Gut and Liver  2013;7(4):480-485.
Background/Aims
Biliary stenting is the most effective decompressive method for treating malignant biliary obstructive jaundice. Although the main cause of stent occlusion is tumor growth, few studies have investigated whether stent patency is affected by the combination of cancer-treatment modalities. The aim of this study was to evaluate the effects of local radiotherapy on metal-stent patency in patients with malignant biliary obstruction.
Methods
Patients who underwent self-expandable biliary metallic stenting for malignant biliary obstruction from 1999 to 2007 were included. Forty patients received chemotherapy and radiation therapy (radiation group, RG), and 31 patients received only chemotherapy (nonradiation group, NRG).
Results
The cumulative median stent patency was significantly longer in the RG than in the NRG (17.7 months; 95% confidence interval [CI], 1.8 to 33.6 months vs 8.7 months; 95% CI, 4.9 to 12.5 months; p=0.025). Stent occlusion caused by tumor growth or stent migration occurred in two (5%) and three (7.5%) cases in the RG and in six (19.3%) and two (6.5%) cases in the NRG, respectively.
Conclusions
The patency of biliary metal stents in pancreatobiliary cancer patients who receive chemoradiation therapy is significantly longer than that in patients who do not receive radiotherapy, which suggests that local cancer control significantly affects stent patency.
doi:10.5009/gnl.2013.7.4.480
PMCID: PMC3724039  PMID: 23898391
Biliary metal stent; Malignant biliary obstruction; Radiotherapy; Stent patency
23.  Clinical Implications and Risk Factors of Acute Pancreatitis after Cardiac Valve Surgery 
Yonsei Medical Journal  2012;54(1):154-159.
Purpose
Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass.
Materials and Methods
We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancreatitis based on serum lipase concentration and clinical symptoms (lipase ≥180 U/L or ≥60 U/L with relevant symptoms).
Results
Of the 986 patients who underwent cardiac valve surgery with cardiopulmonary bypass, 58 (5.9%) patients developed post-operative pancreatitis. Post-operative hospital stay was significantly longer (29.7±45.6 days vs. 12.4±10.7 days, p=0.005) and in-hospital mortality rate was higher (15.5% vs. 2.0%, p<0.001) in patients with post-operative pancreatitis than those without. Hypertension, chronic kidney disease, and peri-operative use of norepinephrine were identified as independent risk factors for developing pancreatitis after cardiac valve surgery.
Conclusion
We found that acute pancreatitis after cardiac valve surgery requires longer hospitalization and increases the in-hospital mortality rate. Clinicians should be aware that patients could develop pancreatitis after cardiac valve surgery, especially in patients with hypertension and chronic kidney disease treated with norepinephrine.
doi:10.3349/ymj.2013.54.1.154
PMCID: PMC3521256  PMID: 23225812
Acute pancreatitis; cardiac valve surgery; cardiopulmonary bypass
24.  Gastrointestinal Hemorrhage after Concurrent Chemoradiotherapy in Locally Advanced Pancreatic Cancer 
Gut and Liver  2012;7(1):106-111.
Background/Aims
While chemoradiotherapy (CRT) is considered to be a reasonable treatment for locally advanced pancreatic cancer (LAPC), there is little information about the associated risk of gastrointestinal (GI) hemorrhage. We investigated the clinical features of GI toxicity after CRT in patients with LAPC and examined the effect of GI hemorrhage on survival.
Methods
Patients enrolled in this study had received CRT for pathologically proven LAPC. Their medical records were retrospectively reviewed.
Results
A total of 156 patients with LAPC (median age, 65 years; range, 39 to 90 years) who received treatment between August 2005 and March 2009 were included in this study. The most common GI toxicities were ulcer formation (25.6%) and hemorrhage (25.6%), and the most common grade 3 to grade 5 GI toxicity was hemorrhage (65%). The origins of GI hemorrhage were gastric ulcer (37.5%), duodenal ulcer (37.5%), and radiation gastritis (15.0%). The independent risk factor for GI hemorrhage was tumor location in the pancreatic body. The median overall survival of the patients with a GI hemorrhage was 13.8 months (range, 2.8 to 50.8 months) and was not significantly different from that of patients without GI hemorrhage.
Conclusions
GI hemorrhage was common in patients with LAPC after CRT. Although GI hemorrhage was controlled with endoscopic hemostasis, preventive measures should be investigated to reduce needless suffering.
doi:10.5009/gnl.2013.7.1.106
PMCID: PMC3572310  PMID: 23423146
Chemoradiotherapy; Gastrointestinal hemorrhage; Toxicities; Pancreatic neoplasms
25.  Prognostic Factors and Characteristics of Pancreatic Neuroendocrine Tumors: Single Center Experience 
Yonsei Medical Journal  2012;53(5):944-951.
Purpose
Pancreatic neuroendocrine tumors (PNET) are a rare subgroup of tumors. For PNETs, the predictive factors for survival and prognosis are not well known. The purpose of our study was to evaluate the predictive factors for survival and disease progression in PNETs.
Materials and Methods
We retrospectively analyzed 37 patients who were diagnosed with PNET at Severance Hospital between November 2005 and March 2010. Prognostic factors for survival and disease progression were evaluated using the Kaplan-Meier method.
Results
The mean age of the patients was 50.0±15.0 years. Eight cases (21.6%) were described as functioning tumors and 29 cases (78.4%) as non-functioning tumors. In univariate analysis of clinical factors, patients with liver metastasis (p=0.002), without resection of primary tumors (p=0.002), or American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) stage III/IV (p=0.002) were more likely to demonstrate shorter overall survival (OS). Patients with bile duct or pancreatic duct invasion (p=0.031), sized-lesions larger than 20 mm (p=0.036), liver metastasis (p=0.020), distant metastasis (p=0.005), lymph node metastasis (p=0.009) or without resection of primary tumors (p=0.020) were more likely to demonstrate shorter progression-free survival (PFS). In multivariate analysis of clinical factors, bile duct or pancreatic duct invasion [p=0.010, hazard ratio (HR)=95.046] and tumor location (non-head of pancreas) (p=0.036, HR=7.381) were confirmed as independent factors for predicting shorter PFS.
Conclusion
Patients with liver metastasis or without resection of primary tumors were more likely to demonstrate shorter OS. Patients with bile duct or pancreatic duct invasion or tumors located at body or tail of pancreas were more likely to demonstrate shorter PFS.
doi:10.3349/ymj.2012.53.5.944
PMCID: PMC3423842  PMID: 22869477
Pancreatic neuroendocrine tumor; prognostic factor; liver metastasis; bile duct invasion; pancreatic duct invasion; location of tumor

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