Comparison with 99mTc MDP Bone Scintigraphy and Whole body 18FDG PET for the Evaluation of Bone metastases in Patients with Lung Cancer

Background: 99mTechnetium methylene diphosphonates(99mTc MDP) bone scintigraphy is current method of choice for the detection of bone metastases, but whole body 18F-fluoro-deoxy- D-glucose positron emission tomography(18FDG PET) offers superior spatial resolution and improved sensitivity. So we compared whole body 18FDG PET with 99mTc MDP bone scintigraphy in patients with skeletal metastases from lung cancer. Patients and Methods: Ninety-two patients with lung cancer taken 18FDG PET together with a 99mTc MDP bone scintigraphy within 1 month between March 2000 and March 2003 were investigated retrospectively. Results: The sensitivity, specificity and accuracy of the 99mTc MDP bone scintigraphy versus 18FDG PET for the detection of bone metastases in lung cancers were 59% vs 82%, 71% vs 94%, and 68% vs 91%, respectively. In the diagnosis of bone metastases from lung cancer, 18FDG PET was statistically superior to 99mTc MDP bone scintigraphy in its specificity and accuracy(p<0.0001). Conclusions: Whole body 18FDG PET may be useful in detecting bone metastases among patients with lung cancer.ope

A Case of Aortobronchial Fistula with Massive Hemoptysis after Aortic Stent Graft

Aortobronchial fistula may cause a massive fatal hemoptysis. Recently prosthetic aortic graft insertion or endovascular stent graft is a cause of aortobronchial fistula. We report a rare case of hemoptysis from a fistula between an aortic arch aneurysm and the left main bronchus in a patient who had undergone an endovascular stent graft in pseudoaneurysm of descending thoracic aorta one year before.ope

A Case of Bronchioloalveolar Carcinoma Presenting with Initial Symptom of Visual Disturbance due to Intraocular Metastasis

Intraocular tumors are uncommon and an intraocular metastatic carcinoma is extremely rare. An intraocular metastasis in adults most often originates from the breast or the lung. An intraocular lesion may be the first presentation of cancer and a search should be made to locate the primary tumor. To our knowledge, an intraocular metastasis of a bronchioloaveolar carcinoma has not reported in Korea. We report a case of a bronchioloalveolar carcinoma presenting with the initial symptom of a unilateral visual disturbance due to an intraocular metastasis.ope

A Case of Pleural Effusion due to Hypothyroidism

Serous effusions have been most commonly associated with ascites, pericardial effusion, and heart failure. But, they have been considered to be an unusual form of complication in hypothyroidism and pleural effusion, which has been observed as an isolated finding in hypothyroidism is apparently rare and complete analysis of these types of hypothyroid-associated pleural effusions has yet not been described. We report a case of hypothyroidism associated with unilateral pleural effusion in a 77 year-old male patient who was improved through levothyroxine sodium with brief review of the literature.ope

The Relationship between Age and Pleural Fluid Adenosine Deaminase Activity in Pleural Tuberculosis

연구 배경 : Adenosine deaminase (ADA)는 퓨린 (purine) 대사에 작용하는 효소로서 림프구, 특히 T-림프구의 증식과 분화에 관여하며,결핵성 흉수의 진단에 있어서 중요한 생화학적 표지자 중의 하나이다.한편, 노인의 경우, T-림프구의 수와 기능의 감소에 의하여 면역 기능이 감소하는 것으로 알려져 있다. 이에 저자 등은 노인 결핵성 흉수 환자에서 흉수내의 ADA 수치가 젊은 환자에서보다 감소하는지를 조사하였다. 방 법 : 4년 동안 세브란스 병원에서 1) 흉수 결핵균 배양 양성 또는 2) 흉막 조직 검사상 결핵에 합당한 소견을 보여 결핵성 흉수로 진단받은 환자 80명을 대상으로 후향적으로 조사하였다. 65세를 기준으로 두 군으로 분류하였으며, 연령과 흉수 ADA 수치의 연관 관계를 독립 표본 t-검정 및 선형 회귀 분석을 이용하여 연구하였다. 결 과 : 80명의 환자 중 65세 이상은 21명 (26.3%)이었다. 흉수 내의 ADA 수치는 65세 이상 및 이하 군에서 각각 71.2± 27.6 IU/L, 68.5 ± 25.8 IU/L 이었다 (p=0.69). 선형 회귀 분석에서도 연령과 흉수 내의 ADA 수치는 상관 관계를 보이지 않았다 (r²=0.05, p=0.59). 결 론 : 본 연구의 결과에 의하면,결핵성 흉수의 진단에서 흉수 ADA 수치를 보조 지표로 사용하는 데 있어서, 노인환자에서도 젊은 환자와 동일한 임상적 유의성을 가지고 동일한 결정 수치 (cut-off value)를 적용할 수 있을 것으로 판단된다.ope

Diagnosis and Treatment of Primary Mediastinal Tumors and Cysts -Forty-two years report in a University Hospital-

Background : The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. Materials and Methods : This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985～2002) and compared them to the report of the previous 25-year result (1960～1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. Results : During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. 　The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. Conclusion : These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.ope

The Utility of Measurement of Plasma N-terminal Pre-brain Natriuretic Peptide in Diagnosis of Pulmonary Hypertension

Background : Pulmonary hypertension is a poor prognostic factor in patients with chronic respiratory disease. However, diagnosing pulmonary hypertension is a difficult procedure which often requires an invasive test. Thus new alternative biochemical markers would be useful in clinical field and are in search. We sought to assess the role of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with pulmonary hypertension. Materials and Methods : We measured plasma NT-proBNP level in twenty nine patients suspected for pulmonary hypertension. Pulmonary hypertension was defined as being right ventricular systolic pressure more than 35 mm Hg estimated by Doppler echocardiography. Plasma NT-proBNP level was measured by electrochemiluminescence sandwich immunoassay. Results : The log-transformed values for plasma NT-proBNP levels showed a linear correlation (correlation coefficiency: 0.783, p-value <0.001) with right ventricular systolic pressure. Plasma NT-proBNP levels closely correlated with right ventricular systolic pressure, right ventricular hypertrophy, interventricular septal flattening and right ventricular dilatation. Conclusion : Our results suggest that the measurement of plasma NT-proBNP level is an useful marker of the presence of pulmonary hypertension.ope

Impact of prospective payment system on hospital provider`s behavior

Thesis (master`s)--서울대학교 대학원 :경영학과 경영학전공,2000.Maste

(The) utility of the measurement of plasma N-terminal pro-brain type natriuretic peptide as a diagnosis of pulmon

의학과/석사[한글] 만성호흡질환이 있는 환자에서 폐동맥고혈압이 발생하면 예후가 불량한 것으로 알려져 있다. 폐성심은 폐동맥고혈압으로 인하여 이차적으로 우심실의 확장 혹은 비대가 발생하는 질환으로 폐성심이 나타나면 환자의 생존율이 낮아지고 사회적으로나 경제적으로 손실이 크기 때문에 폐동맥고혈압 발현 여부를 진단하는 것이 중요하다. 그러나 폐동맥고혈압은 특징적인 증세나 징후가 없어서 진단하기가 어렵고, 정확한 진단을 위해서는 폐동맥압 측정을 위해서 침습적인 검사인 우심도자술을 시행해야 하는 문제점이 있다. 비침습적인 방법으로 도플러 심초음파검사를 통하여 폐동맥 고혈압 여부를 확인하는 방법이 있으나 심도자술과 마찬가지로 접근성에서 한계가 있어 간단하고 쉽게 이용할 수 있는 새로운 인자가 필요한 실정이다. 울혈성심부전의 생화학적 지표로서 유용성이 입증된 Brain type natriuretic peptide(BNP)의 전구 물질에서 분리된 N-terminal pro-Brain type natriuretic peptide (NT-proBNP)가 최근에 알려져 있는데 BNP와 비교하여 생화학적 지표로서 대등하게 이용할 수 있을 것으로 보고되고 있다. 따라서 폐동맥고혈압을 진단하는데 접근성이 용이하고 비침습적인 방법으로서 혈청NT-proBNP농도 측정이 유용성이 있는지 알아보기 위하여 본 연구를 진행하였다. 임상적으로 수축기 폐동맥고혈압이 의심되는 환자 29명(남자 19명, 여자 10명)에게 전기화학발광 면역분석법(Electrochemiluminescence immunoassay)을 이용하여 혈청 NT-proBNP농도를 측정하였다. 동시에 동맥혈 가스검사, 혈청 생화학검사, 폐기능검사, 도플러 심초음파검사를 실시하였고 심초음파검사상 삼첨판역류가 있는 경우 간접적으로 우심실 수축기압을 통해 수축기 폐동맥압을 예측하였다. 우심실 수축기압이 35 mmHg를 초과하는 경우를 폐동맥고혈압으로 정의하였을 때 수축기 폐동맥고혈압이 있는 경우 혈청 NT-proBNP농도의 중간값과 사분위수 범위는 777.5(190.6-2162) pg/mL 였으며 우심실 수축기압은 52.0(44.9-58.6) mmHg였다. 로그값으로 치환한 혈청 NT-proBNP농도와 수축기 폐동맥압과는 양성적 선형 상관관계를 갖고 있었다(Correlation coefficiency: 0.783, p-value < 0.001). 또한 심초음파검사상 우심실 비대, 우심실 확장, 심실간 중격의 편평화가 있는 군이 혈청 NT-proBNP농도가 증가 되어 있었으며 수축기 폐동맥고혈압과 연관이 있는 것으로 나타났다(p-value <0.05). 폐동맥고혈압을 진단하는데 있어 ROC 곡선 분석 결과 민감도 및 특이도가 가장 크게 나타나는 혈청 NT-proBNP 농도는 112.9 pg/mL이었으며 이 때 민감도는 94.4% 특이도는 72.7%였다. 결론적으로 혈청 NT-proBNP 농도 측정은 간단하게 폐동맥고혈압 유무를 알 수 있는 유용한 지표로서 사용이 가능할 것으로 보이며 이에 대한 추가 연구가 필요하리라 생각된다. [영문] Pulmonary hypertension is a poor prognosis factor in patients with chronic respiratory disease. It is important to know the presence of pulmonary hypertension considered the high mortality. But, the clinical diagnosis of pulmonary hypertension could be difficult and is needed to invasive test. So a new alternative biochemical marker for pulmonary hypertension is needed. Plasma brain natriuretic peptide (BNP) levels increase in proportion to congestive heart failure and pulmonary hypertension. N-terminal pro-brain type natriuretic peptide (NT-proBNP) which is a new marker may be a marker of cardiac dysfunction. We sought to assess the role of plasma NT pro-BNP in patients with pulmonary hypertension. We measured plasma NT pro-BNP levels in twenty nine patients suspected pulmonary hypertension. Pulmonary hypertension was defined as more than 35 mmHg of right ventricular systolic pressure estimated by Doppler echocardiography. Plasma NT pro-BNP levels were measured by electrochemiluminescence sandwich immunoassay. The log-transformed values for plasma NT pro-BNP levels showed a linear correlation (correlation coefficiency: 0.783, p-value <0.001) with right ventricular systolic pressure. The plasma NT pro-BNP levels closely correlated with the right ventricular systolic pressure, right ventricular hypertrophy, interventricular septal flattening, right ventricular dilatation. Our results suggested that the measurement of plasma NT pro-BNP levels is a useful marker of the presence of pulmonary hypertension. Additional prospective studies should be carried out in a larger pulmonary hypertension population to confirm these resultsope