1.Ankle-brachial index as a predictor of one-year prognosis in ischemic stroke patients
Hyun Goo Kang ; In Sung Choo ; Bum Joon Kim ; Seong Hwan Ahn
Neurology Asia 2016;21(3):217-224
Objective: Peripheral arterial disease (PAD) reduces functional activity and increases the rate of
cardiovascular death in the elderly. Our study aimed to determine whether the presence of PAD in
stroke patients affected the progression of disability or death one year after discharge. Methods: From
April 2012 to March 2013, consecutive first stroke patients above 50 years of age without known PAD
were enrolled. PAD was defined as a low ankle-brachial index (less than 0.9) measured by an automatic
device. Clinical data associated with the stroke were collected from medical records. Disability in stroke
patients was evaluated with the modified Rankin scale (mRS) on discharge day and one year after the
index stroke. Progression of disability was defined as an increase in mRS more than one level at one
year. Results: Among the 526 patients, 238 had ischemic strokes and underwent ankle-brachial index
(ABI) measurement. Of them, 192 patients were included. In univariate analysis, age, dyslipidemia,
discharge mRS, low-density lipoprotein cholesterol, D-dimer, homocysteine, internal carotid artery
stenosis, posterior cerebral artery stenosis, and PAD were factors associated with worsening mRS.
After adjustment for these factors in the logistic regression analysis, PAD was an independent factor
associated with worsening mRS. In the analysis of one-year mortality, patients with PAD had a higher
death rate, but PAD was not an independent factor after adjusting for other variables.
Conclusions: The presence of PAD in stroke patients suggests a chance of disability progression, but
may not be a predictor of death after one year.
Atherosclerosis
;
Peripheral arterial disease
;
Stroke
2.Gastroduodenostomy after Distal Subtotal Gastrectomy in Gastric Cancer Patients Comparison between manual and stapled anastomosis.
Keun Won RYU ; Boo Hwan HONG ; Chong Suk KIM ; Bum Hwan GOO
Journal of the Korean Surgical Society 2000;58(5):645-649
PURPOSE: A gastroduodenostomy after a distal subtotal gastrectomy is known to have several advantage over a gastrojejunostomy. However, recently, anastomotic methods using an EEA stapler during a gastro duodenostomy have been developed and have been reported to be superior to manual anastomosis with respect to operative time and complications. Thus, we investigated the differences between a manual and a stapled gastroduodenostomy by comparing the clinicopatholoic features and clinical course. METHODS: From January to October 1999 at Korea University Guro Hospital, a gastroduodenostomy using an EEA stapler was performed on 30 gastric cancer patients after a distal subtotal gastrectomy. From January 1996 to December 1998, a manual anastomosis had been used on 40 patients at the same hospital. A retrospective analysis of these two groups was made with respect to patients, tumor, operation, post operative complications and clinical course. RESULTS: The mean age of the stapled group was older than that of manual group (62.3+/-8.4 vs 53.0+/-10.7 years), and most of the tumors were located at the antrum and the body. In the stapled group, the operative time was significantly shorter than I was in the manual group (205.0+/-20.0 vs 239.6+/-37.3 minutes, p<0.001), and there was no significant difference in the resection margin between the two groups. The time of nasogastric (NG) tube removal was earlier in the stapled group (4.8+/-0.8 vs 5.9+/-2.2 days, p=0.007), but no significant differences were observed with respect to the oral intake and the complication rate between the two groups. Anastomotic stenosis was observed in one case of manual group, but it was not significant. CONCLUSIONS: A gastroduodeno stomy using an EEA stapler has an advantage over conventional manual anastomosis with respect to operation time and NG tube removal, so this method can be employed safely in aged and generally morbid patients to improve the postoperative course.
Constriction, Pathologic
;
Duodenostomy
;
Gastrectomy*
;
Gastric Bypass
;
Humans
;
Korea
;
Operative Time
;
Retrospective Studies
;
Stomach Neoplasms*
3.Clinicopathologic Characteristics of and Prognosis for Proximal Gastric Carcinomas.
Keun Won RYU ; Chong Suk KIM ; Bum Hwan GOO
Journal of the Korean Surgical Society 2000;59(2):223-228
PURPOSE: Many epidemiological studies have revealed an increasing tendency for proximal gastric cancer. Furthermore, proximal gastric cancer has been known to have unique characteristics and a poor prognosis in contrast to middle and distal gastric cancer, but the reason have not yet been fully explained. For that reason, we investigated changes in the incidence of proximal gastric cancer, its clinicopathologic characteristics, and its prognosis, and we compared the results with those of other reports and tried to identify the reasons for such phenomena. METHODS: After excluding linitis platisca-type cancer, double primary cancer, and gastric cancer arising from the remnant stomach, we retrospectively analyzed the case histories of 836 patients who had undergone operations for gastric cancer from 1992 to 1997. The cases were divided into a proximal gastric-cancer (PGC) group and a middle and distal gastric-cancer (DGC) group based on the location of the primary tumor. RESULTS: The PGC group included 74 patients (8.9%); 762 patients (91.1%) were in the DGC group. The incidence of proximal gastric cancer was 5.0% in 1992 and 11.6% in 1997. The PGC group has more advanced tumor stages (p=0.001) and more positive lymph-node metastases (p=0.013). The resectability of PGC was 87.8%, and that of the DGC was 92.4%, but these were not significantly different (p=0.169). The overall 5-year survival rate for PGC was 48.4% and that of DGC was 59.0%, but these were also not significantly different (p=0.5776). Comparing the survival rates of two groups for various stages revealed no differences. CONCLUSION: The increasing tendency of proximal gastric cancer was similar those in other reports even though we observed for a shorter periods and the proximal gastric cancers were diagnosed in advanced stages, and probably that was the reason for the poor prognosis. Therefore, if early diagnosis is made and adequate therapy is performed, proximal gastric cancer, in contrast to distal gastric cancer, is not a unique disease entity.
Early Diagnosis
;
Epidemiologic Studies
;
Gastric Stump
;
Humans
;
Incidence
;
Neoplasm Metastasis
;
Prognosis*
;
Retrospective Studies
;
Stomach Neoplasms
;
Survival Rate
4.Transforming Growth Factor (TGF)-beta I and TGF-beta Receptor II (TGF-betaRII) Expressions in Intestinal Metaplasia, Adenoma and Carcinoma of the Stomach.
Keun Won RYU ; Nam Hee WON ; Bum Hwan GOO ; Chong Suk KIM
Journal of the Korean Surgical Society 2001;60(5):511-519
PURPOSE: The carcinogenesis of gastric cancer has not been fully elucidated, but several molecular biologic alterations have been found to be related with it. TGF-betaRII mutation, which is one such alteration, has been well documented in gastric cancer, but its expression patterns in cancer and preneoplastic conditions are rarely reported. For that reason, we investigated the roles of TGF-betaI and TGF-betaRII in gastric carcinogenesis by comparing the difference of expression patterns in carcinomas and adenomas of the stomach and intestinal metaplasia by using immunohistochemical staining. METHODS: Twenty-six (26) cases of intestinal metaplasia with chronic atrophic gastritis, 21 cases of the gastric adenoma, and 51 cases of gastric cancers (28 cases of the intestinal type and 23 cases of the diffuse type) were enrolled in this study. All samples were paraffin-embedded and an immunohistochemical staining was performed using the polyclonal antibody to TGF-betaI and TGF-betaRII. Their clinicopathologic features were reviewed retrospectively. RESULTS: In normal gastric tissue and intestinal metaplasia, only the basal portion of the gastric foveola was strongly reactive to TGF-betaRII. In adenomas and well-differentiated intestinal type cancer, all tumor cells were strongly positive to TGF-betaRII, but the tumor cells of poorly differentiated intestinal-type and signet ring cell (diffuse type) cancer showed unresponsive to TGF-betaRII. The TGF-betaI expressions in normal and carcinomatous lesions were similar andshowed a weak positive reaction. TGF-betaI and TGF-betaRII responsive gastric cancer showed less invasive gastric-wall infiltration. In gastric cancer, a significant correlation was present between tumor depth and response to TGF-betaI & TGF-betaRII. CONCLUSION: It is presumed that TGF-betaRII plays an important role in cell differentiation and aggressiveness in gastric cancer and that it may be useful as a prognostic factor.
Adenoma*
;
Carcinogenesis
;
Cell Differentiation
;
Gastritis, Atrophic
;
Immunohistochemistry
;
Metaplasia*
;
Precancerous Conditions
;
Receptors, Transforming Growth Factor beta*
;
Retrospective Studies
;
Stomach Neoplasms
;
Stomach*
;
Transforming Growth Factor beta*
;
Transforming Growth Factors*
5.Treatment of Acute Colonic Pseudo-obstruction (Ogilvie's Syndrome) with Intravenous Neostigmine.
Boo Hwan HONG ; Sun Il LEE ; Keun Won RYU ; Sun Han KIM ; Bum Hwan GOO ; Hong Young MOON
Journal of the Korean Surgical Society 2000;59(1):133-136
Acute colonic pseudo-obstruction is a functional disorder that closely mimics a mechanical large-bowel obstruction. Two such patients were treated by pharmacological manipulation of the parasympathetic innervation to the colon with intravenous neostigmine infusion. The two responded to treatment with passage with flatus and stool within several minutes with complete resolution of the symptoms, although the first patient required two additional infusions and the second patient required one additional infusion for subsequent recurrence. Dizziness occurred in one patient, and no other serious side effects were apparent. This pharmacological approach to the management of acute colonic pseudo-obstruction is suggested as an alternative to the other treatment options of colonoscopic decompression or surgery when conservative management has failed.
Colon*
;
Colonic Pseudo-Obstruction*
;
Decompression
;
Dizziness
;
Flatulence
;
Humans
;
Neostigmine*
;
Recurrence
6.Mammary Adenomyoepithelioma in Male Patient.
Keun Won RYU ; Aeree KIM ; Chul Hwan KIM ; Jae Bok LEE ; Eun Sook LEE ; Jung Won BAE ; Bum Hwan GOO
Journal of Korean Breast Cancer Society 2000;3(1):76-79
Myoepithelial cells are the normal constituent of mammary gland and the lesions arising from this components are rare and can be divided into three categories. Adenomyoepithelioma, which is one of them, has a characteristics of dual proliferation of epithelial and myoepithelial cells but the biologic behavior of it has not yet been fully understood. Most of the adenomyoepitheliomas are reported in female patients and there are few of male patient reported in English literature. We experienced one case of male adenomyoepithelioma and report the case with review of literature.
Adenomyoepithelioma*
;
Female
;
Humans
;
Male*
;
Mammary Glands, Human
7.Morphologic change of pulmonary arteries and right ventricular outflow tract after total correction of tetralogy of Fallot: risk factors for pulmonary artery junctional stenosis.
Jin Sung KO ; Jae Young CHOI ; Jong Kyun LEE ; Kyung Eun KIM ; Jun Hee SUL ; Seung Kyu LEE ; Young Hwan PARK ; Bum Goo CHO
Korean Circulation Journal 2001;31(2):238-245
BACKGROUND AND OBJECTIVES: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. METHODS: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.119.8 months, follow-up duration after operation 13.95.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. RESULTS: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=.776, p<0.01) and post-operative RVEDP(r=.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade II of residual PI than grade III~IV. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(P, mmHg) =5.43 +16.24*[false aneurysmal change of RVOT] +14.13*[RVOT patch enlargement to LPA] +16.89*PDA. CONCLUSION: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.
Aneurysm
;
Aneurysm, False
;
Catheterization
;
Catheters
;
Constriction, Pathologic*
;
Diagnosis
;
Follow-Up Studies
;
Humans
;
Prognosis
;
Pulmonary Artery*
;
Risk Factors*
;
Tetralogy of Fallot*
8.Clinical Analysis of Stage Ib Gastric Cancer.
Seok Hyung KANG ; Keun Won RYU ; Seung Joo KIM ; Young Jae MOK ; Chong Suk KIM ; Bum Hwan GOO
Journal of the Korean Surgical Society 2002;63(4):305-311
PURPOSE: The aim of this study was to clarify the clinicopathological differences between T1N1M0 and T2N0M0, particularly the survival rates, and the role of chemotherapy in the stage Ib gastric cancer. METHODS: From January 1992 to December 1999, 118 cases were confirmed as having stage Ib gastric cancer in the Korea University Medical Center. Among them 31 patients were classified as being T1N1M0 and the other 87 cases were T2N0M0. The clinicopathological features and the prognosis were evaluated retrospectively. RESULTS: The overall 5-year survival rate of the stage Ib gastric cancer patients was 94%. Overall 5-year survival rates in T1N1M0 and T2N0M0 were 100% and 91%, respectively. Though T1N1M0 group showed better prognosis, there was no significant difference between two groups (P=0.14). D1, D2, and D2+alpha resections were performed in 28 cases (23.7%), 81 (68.6%), and 9 (7.6%), respectively, and there was no difference in the survival rate (P>0.05). The 5-year survival rates were analyzed according to whether or not they had received chemotherapy. There was a 98% 5-year survival rate with those who had chemotherapy and a 90% 5-year survival rate with those who had not had chemotherapy, but there was no significant difference between them (P=0.18). In the T2N0M0 group, the 5 year survival rates of patients with or without chemotherapy were 97% and 86%, respectively, but there was no significant difference (P=0.16). CONCLUSION: Though T1N1M0 group showed a better prognosis than the T2N0M0 group, there was no significant difference between the two groups (P=0.14). There was no significant survival difference between D1, D2, or D2+alpha procedures. It appears that post operative intravenous chemotherapy does not affect the prognosis of stage Ib gastric cancer, and the role of the chemotherapy in patients with T2N0M0 diseases is minimal.
Academic Medical Centers
;
Drug Therapy
;
Humans
;
Korea
;
Prognosis
;
Retrospective Studies
;
Stomach Neoplasms*
;
Survival Rate
9.Analysis of Hormone Receptor between IHC and EIA in Breast Cancer.
Yong Geul JOH ; Jeoung Won BEA ; Jun Won UM ; Eun Sook LEE ; Jae Bok LEE ; Han Kyeom KIM ; Bum Hwan GOO
Journal of Korean Breast Cancer Society 1999;2(2):159-166
PURPOSE: This study was prospectively carried out to determine the concordance between the immunohistochemical assay (IHC) and the enzyme immunoassay (EIA) assessing estrogen receptor (ER) and progesteron receptor (PR) in breast cancer tissues. MATERIALS AND METHODS: Breast carcinoma tissues were obtained from 36 patients. Hormonal receptors were determined by IHC assay using polyclonal antimouse antibody and by EIA. The concordance between two methods and the concordance according to in age, tumor size, stage, and lymph node metastasis of breast cancer patient were analyzed. RESULTS: The concordant rate of ER status was 88.9% between IHC and EIA. ER-IHC(+)/EIA(-) were 3 cases and ER-IHC(-)/EIA(+) was 1 cases. ER-positive was 63.9% in IHC and 53.8% in EIA. The concordant rate of PR status was 86.1% between IHC an EIA. PR-IHC(+)/EIA(-) were 4 cases and PR-IHC(-)/EIA(+) was 1 cases. PR-positive was 61.1% in IHC and 52.8% in EIA. There was high concordance (76.2-100%) in age, tumor size, stage, and lymph node metastasis. CONCLUSIONS: There was high concordance between immunohistochemical assay and enzymeimmunoassay determining estrogen and progesteron receptors in the breast cancer. The IHC assay appears to be a resonable substitute for the EIA to determine hormonal receptors.
Breast Neoplasms*
;
Breast*
;
Estrogens
;
Humans
;
Immunoenzyme Techniques
;
Lymph Nodes
;
Neoplasm Metastasis
;
Prospective Studies
10.Left ventricular function after mitral valve operation in congenital mitral regurgitation.
Young Min EUN ; Jae Young CHOI ; Jong Kyun LEE ; Jun Hee SUL ; Seung Kyu LEE ; Young Hwan PARK ; Bum Goo CHO
Korean Circulation Journal 2000;30(6):737-744
BACKGROUND: Severe mitral regurgitation is a common clinical entity that can lead to progressive, irreversible left ventricular dysfunction, and thus should be corrected in proper stage of life. Authors have conducted this investigation to assess left ventricular function after mitral valve operation and to determine the predicting factors. METHODS AND RESULTS: The echocardiographic parameters, specifically left ventricular ejection fraction, shortening fraction, end-systolic dimension and volume, and end-diastolic dimension and volume were measured in preoperative and postoperative period of congenital mitral regurgitation patients (n=60), between March 1992 and March 1998. After correction of severe mitral regurgitaion, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.001 and p<0.05 respectively). Furtheremore, after reoperation of recurred mitral regurgitation, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.05). Left ventricular ejection fraction and shortening fraction in mitral valve reoperation group (n=23) is significantly lower than those in non-reoperation group (n=37) in both preoperative and postoperative period (p<0.05). Left ventricular ejection fraction and shortening fraction is also significantly lower in mitral valve replacement group (n=20) than in mitral valvuloplasty group (n=40)(p<0.05). Severe postoperative left ventricular dysfunction led to dilated cardiomyopathy in 5 patients. Postoperative left ventricular end systolic dimension increased significantly in reoperation group and DCMP group respectively (p<0.05). CONCLUSION: After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative left ventricular dysfunction can be predicted by preoperative ejection fraction, shortening fraction and systolic diameter. Therefore surgical therapy before the onset of left ventricular dysfunction is recommended.
Cardiomyopathy, Dilated
;
Deoxycytidine Monophosphate
;
Echocardiography
;
Humans
;
Mitral Valve Insufficiency*
;
Mitral Valve*
;
Postoperative Period
;
Prognosis
;
Reoperation
;
Stroke Volume
;
Ventricular Dysfunction, Left
;
Ventricular Function, Left*