Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

OBJECTIVE: To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA). METHODS: A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 mg/m2/day) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed. RESULTS: TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (> or =grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient's histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01). CONCLUSION: For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.
Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Lomustine ; Oligodendroglioma* ; Procarbazine ; Recurrence ; Retrospective Studies ; Salvage Therapy ; Vincristine

BACKGROUND/AIMS: Physical activity (PA) is associated with a reduced risk of colorectal cancer. Thus, we examined the colon transit time (CTT) according to the physical activity level (PAL) in Korean adults. METHODS: The study subjects were 49 adults: 24 males and 25 females. The subjects used an accelerometer for 7 consecutive days to measure the 1-week PAL. The subjects took a capsule containing 20 radio-opaque markers for 3 days. On the fourth day, a supine abdominal radiography was performed. According to the total activity count of all study subjects, the upper 25%, middle 50% and lower 25% were classified into the high (H), moderate (M) and low (L) physical activity (PA) groups, respectively. RESULTS: The total CTT was significantly longer in the female (25.8 hours) than in the male subjects (7.4 hours) (P = 0.002). In regard to difference on PAL, although there was no significant difference among the male subjects, the right CTT in the female subjects was significantly shorter in H group than in M group (P = 0.048), and the recto-sigmoid CTT was significantly shorter in H group than in L group (P = 0.023). Furthermore, there were significant differences in total CTT between L and M groups (P = 0.022), M and H groups (P = 0.026) and between L and H groups (P = 0.002). CONCLUSIONS: The female, but not male, subjects showed that moderate and high PAL assisted colon transit.
Adult ; Colon ; Colorectal Neoplasms ; Female ; Humans ; Male ; Motor Activity ; Radiography, Abdominal

Pituitary abscess is a rare pathology, but it is a potentially life-threatening condition. Therefore, timely intervention, including antibiotics and an operation, can prevent the morbidity and mortality in such cases. A 31-year-old woman, who was 16 months after her second delivery, presented with intermittent headache for 3 months. Amenorrhea, polyuria and polydipsia were noticed and the endocrinological hormone studies were compatible with panhypopituitarism and diabetes insipidus. Pituitary MRI demonstrated a 2.3 cm sized cystic mass with an upper small nodular lesion. Her symptoms such as headache and fever were repeatedly improved whenever corticosteroid was administered, which led us to suspect the diagnosis of an inflammatory condition like lymphocytic hypophysitis. During the hormone replacement therapy, her cystic pituitary mass had grown and her symptoms progressively worsened for another two months. The patient underwent trans-sphenoidal exploration and she turned out to have a pituitary abscess. At the 3-month follow-up, amenorrhea was noticed and her residual function of the pituitary was tested by a combined pituitary stimulation test. The results were compatible with panhypopituitarism. She received levothyroxine 100 microg, prednisolone 5 mg and desmopressin spray and she is being observed at the out-patient clinic. The authors experienced a patient with primary pituitary abscess that was confirmed pathologically and we report on its clinical course with a literature review.
Abscess ; Adrenal Cortex Hormones ; Adult ; Amenorrhea ; Anti-Bacterial Agents ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Female ; Fever ; Follow-Up Studies ; Headache ; Hormone Replacement Therapy ; Humans ; Hypopituitarism ; Outpatients ; Polydipsia ; Polyuria ; Prednisolone ; Thyroxine

Our aim was to study whether visceral adiposity is a predictor of diabetic fatty liver in Korean type 2 diabetes mellitus. In this study, abdominal ultrasonography was used to assess the presence of fatty liver in 1,898 patients with type 2 diabetes. We measured visceral fat thickness by high-resolutional ultrasonography and insulin resistance by Kitt. Half of the cohort had a fatty liver (50.2%). High visceral fat thickness had the highest odds ratio for developing fatty liver in both sexes (odds ratio [S.D]: 3.14 [2.24-4.69], p<0.00 in male, 2.84 [2.04-3.93], p<0.00 in female). In addition, visceral fat thickness of 42.45 and 37.7 mm in men and women, respectively, were chosen as the discriminating value to predict the presence of fatty liver with a sensitivity of 71% and 73% and a specificity of 70% and 70% in men and women, respectively. The area under the receiver-operating characteristics curve was 0.759 in men and 0.764 in women. Therefore we could conclude that the degree of visceral adiposity predicts the presence of fatty liver type 2 diabetes mellitus, whether centrally obese or not, suggesting that hepatic fat accumulation in a diabetic fatty liver may be influenced by visceral fat accumulation regardless of waist circumference.
Aged ; Aorta/pathology ; Cohort Studies ; Diabetes Complications/*diagnosis ; Diabetes Mellitus, Type 2/*diagnosis/pathology ; Fatty Liver/*complications/*diagnosis ; Female ; Humans ; Intra-Abdominal Fat/*pathology ; Male ; Middle Aged ; Models, Statistical ; Odds Ratio ; ROC Curve ; Sensitivity and Specificity

The aim of this study was to investigate the relationship between obesity, insulin resistance and atherosclerosis in type 2 diabetes mellitus (T2DM) patients. Total 530 patients with T2DM were included. To evaluate the severity of atherosclerosis, we measured the coronary artery calcification (CAC) score, intima-media thickness (IMT) of the common carotid artery, and the ankle-brachial pressure index (ABPI). Subjects were classified according to body mass index (BMI), a marker of general obesity, and waist-to-hip ratio (WHR), a marker of regional obesity. The insulin sensitivity index (ISI) was measured by the short insulin tolerance test. All subjects were classified into four groups, according to BMI: the under-weight group, the normal-weight (NW) group, the over-weight (OW) group, and the obese (OB) group. WHR and systolic blood pressure, triglycerides (TG), HDL-cholesterol (HDLC), free fatty acids (FFA), fibrinogen, and fasting c-peptide levels were significantly different between BMI groups. TG, HDL-C, FFA, fibrinogen and ISI were significantly different between patients with and without abdominal obesity. In the OW group as well as in the NW group, carotid IMT, ABPI and CAC score were significantly different between patients with and without abdominal obesity. This study indicates that abdominal obesity was associated with atherosclerosis in T2DM patients.
Aged ; Atherosclerosis/complications ; Blood Pressure ; Coronary Vessels/pathology ; Diabetes Complications ; Diabetes Mellitus, Type 2/*genetics ; Female ; Humans ; Insulin Resistance ; Korea ; Male ; Middle Aged ; Obesity/*complications/*genetics ; Triglycerides/metabolism ; Tunica Intima/pathology ; Tunica Media/pathology

PURPOSE: To conduct a nationwide survey on the principles in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. MATERIASL AND METHODS: We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were inputted to the web based PCS system by each investigators in 19 institutions. RESULTS: Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59 : 41, and the most common location of tumor was lower rectum (46%). Preoperative CEA was checked in 79% of cases and its value was higher than 6 ng/ml in 32%. Pathologic stage were I in 1.6%, II in 32%, III in 63%, and IV in 1.6%. Low anterior resection was the most common type of surgery and complete resection was performed in 95% of cases. Distal resection margin was less than 2 cm in 30%, and number of lymph node dissected was less than 12 in 31%. Chemotherapy was performed in 91% and most common regimen was 5-FU and leucovorine (69%). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique (65.0%), and there was no AP-PA parallel opposing field used. Patient position was prone in 81.2%, and the boost field was used in 61.8%. To displace bowel outward, pressure modulating devices or bladder filling was used in 40.1%. Radiation dose was prescribed to isocenter in 45.3% and to isodose line in 123 cases (39.8%). Percent delivered dose over 90% was achieved in 92.9%. CONCLUSION: We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.
Drug Therapy ; Female ; Fluorouracil ; Humans ; Leucovorin ; Lymph Nodes ; Male ; Neoplasm, Residual ; Pelvis ; Radiotherapy* ; Rectal Neoplasms* ; Rectum ; Research Personnel ; Urinary Bladder

BACKGROUND: The aim of this study was to investigate the association between apo E and ACE genetic polymorphism and diabetic nephropathy. METHODS: One hundred eighteen patients with type 2 diabetes who had a duration of diabetes longer than 8 years were divided into the three apo E groups (E2, E3, E4) and three ACE groups (II, ID, DD). Plasma levels of lipids were measured. The frequency of diabetic nephropathy and clinical and biochemical characteristics were compared among the Apo E and ACE genotype groups. RESULTS: The frequency of overt nephropathy was significantly greater in apo E2 patients with diabetes (46.7%) than apo E3 (16.7%) or apo E4 patients (10.5%). Logistical regression analysis showed that odds ratio of apo E2 and apo E4 genotypes for the presence of overt nephropathy were 4.779 (p<0.01) and 0.643 (p=0.583), respectively. Plasma TG levels were significantly greater in apo E2 patients. This study did not show an association between ACE gene polymorphism and diabetic nephropathy, and no interaction between Apo E and ACE gene polymorphism. CONCLUSION: Apo E2 is a prognostic risk factor for diabetic nephropathy in Korean type 2 diabetes. TG may have an important role of diabetic nephropathy. There were not synergistic effect between Apo E and ACE gene polymorphism in diabetic nephropathy.
Apolipoprotein E2 ; Apolipoprotein E3 ; Apolipoprotein E4 ; Apolipoproteins E ; Apolipoproteins* ; Diabetic Nephropathies ; Genotype ; Humans ; Odds Ratio ; Plasma ; Polymorphism, Genetic* ; Risk Factors

We report a case with reVersible temporal and parietal neocortical abnormalities detected by MRI and SPECT following a brief seizure. Post ictal MRI abnormalities may indicate an underlying structural abnormality, but may also occur in non-lesional epilepsy and represent a transient physiologic change induced by ictal activity.
Brain ; Epilepsy ; Magnetic Resonance Imaging* ; Neocortex* ; Parietal Lobe* ; Rabeprazole* ; Seizures* ; Tomography, Emission-Computed, Single-Photon*

A healthy, 25-year old female patient with no medical history complained of excessive palmar, plantar, axillary, back, and thigh sweating due to stress or a high temperature. Her whole body hyperhidrosis was often disabling and embarrassing in daily life. Plantar hyperhidrosis interfered with her social activities, and accordingly, she was suggested to have a lumbar sympathetic ganglion block with alcohol. Right side ganglion block was performed without any problem at the 3rd and 4th lumbar vertebrae. After sympathetic block, right foot sweating stopped, but phantom sweating continued for a week, and an ache in the pelvic area and flushing of the right foot continued for more than 10 days. Thus a left side procedure was postponed, but all symptoms disappeared after 21 days and the chemical neurolytic block of left side was subsequently performed, and plantar hyperhidrosis was resolved. However, 2 days after completing the lumbar sympathetic block, excessive sweating occurred in the facial, axillary, and back regions with upper body flushing. Two months later, her whole body, excepting the lower extremity showed running sweat after a 10 minute walk on exertion. To reduce the sweating, aluminum chloride, and oral and topical glycopyrrolate were prescribed to no affects. She is currently waiting for the return of normal lumbar sympathetic ganglion function.
Adult ; Aluminum ; Female ; Flushing ; Foot ; Ganglia, Sympathetic* ; Ganglion Cysts ; Glycopyrrolate ; Humans ; Hyperhidrosis* ; Lower Extremity ; Lumbar Vertebrae ; Running ; Sweat ; Sweating ; Thigh