Pancreatic cancer is a disease with poor prognosis mainly due to low resection rates and late diagnosis. To increase resectability and improve survival rates, a better understanding of pancreatic cancer pathogenesis and more effective screening techniques are required. New methods, such as genetic and molecular alterations, may suggest novel approaches for pancreatic cancer diagnosis and treatment. We immunohistochemically investigated 44 formalin-fixed, paraffin-embedded specimens of pancreatic ductal adenocarcinoma using monoclonal anti-p16 antibodies and monoclonal anti-p53 antibodies. The expressions of p16 and p53 proteins were compared using the Chi-square test with SPSS. Disease-free survival was analyzed using the Kaplan-Meier method, verified by the Log- Rank test. Loss of p16 expression was noted in 20 (45.5%) cases and aberrant p53 protein expression was detected in 14 (31.8%) cases. Loss of p16 expression was associated with a higher incidence of lymph node metastasis (p=0.040) and a more advanced stage (p=0.015), although there was no significant correlation between p16 expression and survival. Aberrant p53 protein expression correlated with histologic grade (p= 0.038). Disease-free survival rate was significantly lower in the aberrant p53 protein positive group compared to the negative group (p=0.029). From our results, we suggest that p53 is not a prognostic factor; however, p16 and p53 genes do play important roles in the progression of pancreatic ductal adenocarcinoma.
Adult ; Aged ; Female ; Genes, p16 ; Genes, p53 ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/*chemistry/genetics/mortality/pathology ; Protein p16/*analysis ; Protein p53/*analysis ; Sex Characteristics

BACKGROUND: Since the first implanted in September 1997, the use of On-X prosthetic heart valve has been increasing around in the world. This study was designed to assess the feasibility, safety, and the postoperative hemodynamics with this new valve in clinical setting. MATERIAL AND METHOD: The current study was carried out on 52 patients undergoing aortic valve replacement with this prosthesis between April 1999 to August 2002 at Chonnam National University Hospital to evaluate the surgical results. 52% of the patients were male and the average age at implant was 50+/-13 years. The study followed the guidelines of the AATS/STS. Preoperatively, 32 (61.5%) patients were in NYHA functional class III or IV and 2 patients had previous aortic valve surgery. Concomitant cardiac surgery was performed in 71.1%. The implanted valve sizes were 19 mm in 13 patients, 21 mm in 26, 23 mm in 10 and 25 mm in 3, respectively. Mean follow-up was 16.6+/-10.5 months (1~39 months). Echocardiographic assessment was performed pre- and immediate postoperatively, as well as 3, 6, 12 months after surgery, evaluating pressure loss and regression of left ventricular hypertrophy. RESULT: Mean cardiopulmonary bypass time was 191+/-94.7 minutes with an aortic cross-clamp time of 142+/-51.7 minutes. There was no early and late mortality. Freedom from adverse events at 1 year in the study were as follows: thromboembolism, 95.6+/-6%; bleeding events, 90.2+/-4%; paravalvular leakage 92.3+/-4%; and overall valve-related morbidity at 1 year was 76.6+/-3%. There were no cases of valve thrombosis, prosthetic valve endocarditis and structural or non-structural failure. Left ventricular function at 12 months after surgery (EF=62.7+/-9.8%) revealed a statistically significant improvement compared to preoperative investigation (EF=55.8+/-15.9%, p=0.006). Left ventricular mass index was 247.3+/-122.3 g/m2 on preoperative echocardiographic study, but regressed to 155.5+/-58.2 g/m2 at postoperative 1 year (p=0.002). Over the follow-up period a further decrease of peak transvalvular gradients was observed in all patients: 62.5+/-38.0 mmHg on preoperative assessment, 18.2+/-6.8 mmHg at immediate postoperative period (p<0.0001), 7.6+/-5.09 mmHg (p<0.0001) at 6 month, 18.0+/-10.8 mmHg (p<0.0001) at 1 year. CONCLUSION: The On-X prosthetic heart valve performs satisfactorily in the first 1 year period. Clinical outcome by examining NYHA functional classification revealed especially good results. Effective regression of left ventricular hypertrophy and statistically significant decrease of transvalvular gradient were observed over the first year, but longer-term follow-up of this patient group is needed to establish the expected rates for late valve-related events as well as the long-term clinical efficacy of this valve.
Aortic Valve* ; Cardiopulmonary Bypass ; Classification ; Echocardiography ; Endocarditis ; Follow-Up Studies ; Freedom ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Hemodynamics ; Hemorrhage ; Humans ; Hypertrophy, Left Ventricular ; Jeollanam-do ; Male ; Mortality ; Postoperative Period ; Prostheses and Implants ; Thoracic Surgery ; Thromboembolism ; Thrombosis ; Ventricular Function, Left

PURPOSE: A carcinoma of the ampulla of Vater has more favorable prognosis than other malignant tumors of the periampullary region, because it is symptomatic at an early stage. However, local resection of an ampullary carcinoma remains controversial. The aim of this study was to evaluate the treatment results of ampulla of Vater carcinomas, according to operation type in low risk group patients. METHODS: The records of 17 low risk group patients, among 120 patients with ampulla of Vater cancer, who underwent curative surgery beyween 1992 and 2002, were reviewed. All specimens were critically reviewed by a single expert pathologist. The relationship between surgical outcomes and operation type were assessed. RESULTS: There were 10 men and 7 women, with a median age of 57.8 years. 13 of the 17 patients underwent the Whipples operation or a PPPD, and 4 underwent a transduodenal local resection (TDLR). The operation time was shorter in the TDLR group, and was statistically significant. Among the 17 patients, only one had a recurrence in the inguinal area 33 months after the PD. CONCLUSION: Transduodenal local resection is a recommendable operation for low risk Ampulla of Vater cancer patients. During the operation, it is essential to accurately evaluate the depth of invasion, cell differentiation and positivity of the resection margin using frozen sections.
Ampulla of Vater* ; Cell Differentiation ; Female ; Frozen Sections ; Humans ; Male ; Prognosis ; Recurrence

In order to investigate the prevalence and the factors related to the depression and burnout among private practice physicians, a SDS(self-rating depression scale) and MBl(Maslach burnout inventory) -based questionnaire study was performed on 344 private practice physicians in Kwangju and chonnam area. The results were summarized as follows. 1. Mean SDS score was 38.3 in total subjects and the prevalence rate of depression was 48.8%. As for the frequency order of the items of the SDS, decreased libido, diurnal variation and hopelessness were relatively high, and suicidal rumination, constipation and agitation were noted low. 2. Noticeable factors related with depression were smoking, coffee use, sleeping time and satisfaction with income. 3. As a result a factor analysis with the MBl data, five factors named as emotional exhaustion, depersonalization, personal accomplishment, involvement and self-interest were extracted. Statistical analysis of the data demonstrated that 48.8% of the physician sample reported high scores on emotional exhaustion, and 45.3% scored high on depersonalization. Personal accomplishment scores remained high with 45.3% reporting high personal accomplishment. 4. Variables related to the burnout were age, sleeping time, family size religion, medical speciality. duration of practice setting, visiting patient number, closing day per month and job satisfaction. 5. In the relationship with depression, burnout was closely related to depression. Above results showed that the high percentage of private practice physicians experiencing depression and burnout suggests the need for further research to establish trends, to identify causal factors, and to develop avenues to reduce stress.
Coffee ; Constipation ; Depersonalization ; Depression* ; Dihydroergotamine ; Family Characteristics ; Gwangju ; Humans ; Jeollanam-do ; Job Satisfaction ; Libido ; Prevalence ; Private Practice* ; Surveys and Questionnaires ; Smoke ; Smoking

This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam Province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: 38.9~44.6%%, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.l%), injury and poisoning(7.l%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.
Cause of Death ; Certification ; Classification ; Insurance ; Jeollanam-do ; Poisoning

In other to study relationship of anxiety and serum cholesterol in general population, we performed the interview survey and screening test for the Ju-am cohort and residents in controlling area at 1995. Among them, 622 people are selected for this analysis. The results were summarized as follows. 1. Anxiety and total serum cholesterol related each other in the group of anxiety. Correlation coefficient was 0.39(p<0.01). 2. According to the result of multiple regression that the total serum cholesterol regarded as the dependent variable, anxiety and total serum cholesterol were related each other positively in the group of anxiety(p<0.05). 3. As the symptoms of anxiety was dichotomized affective and somatic symptom. There was no relationship of 2 symptoms and total serum cholesterol in all subjects, but there was more relationship on the affective symptom than on the somatic symptom in the group of anxiety(p<0.05). The above results show that anxiety and total serum cholesterol related each other significantly in the anxiety group. And the relationship of psychological factors and serum cholesterol could be applied significantly in general population as well as in the special group.
Affective Symptoms ; Anxiety* ; Cholesterol* ; Cohort Studies ; Mass Screening ; Psychology

In order to classify the hepatocellular carcinomas (HCCs) which had diverse clinicopathologic characteristics, we divided HCCs into two groups according to the expression of biliary antigen on the basis of the hypothesis that the hepatocyte and biliary epithelial cell originate from the same precursor cell, and then we investigated the clinical and pathologic characteristics in the two groups. Forty HCC cases with no preoperative treatment and at least two-year follow-up data were selected among 202 cases of HCC files from 1991 to 1995. Expression of biliary antigen (AE1, cytokeratin 19), p53, AFP, and Ki-67 in the tumor tissue were assessed by immunohistochemistry. Positive cytokeratin 19 was noted in one case (2.5%); AE1 was detected in 40% of patients; p53 was overexpressed in 20% of patients; and AFP was detected in 45% of patients. No statistical difference between the biliary antigen positive group (16 cases) and the negative group (24 cases) were noted in terms of mean age, sex, presurgical serum AFP level, Child class, and tumor size. HBsAg positive rate was 66.7% for the biliary antigen (-) group and 93.8% for the biliary antigen (+) group with a statistically significant difference (p = 0.048). The number of cases for Edmonson-Steiner grade I/II and III/IV were 15 and 9 in the biliary antigen (-) group, and 4 and 12 in the biliary antigen (+) group, respectively, with a statistically significant difference (p = 0.024). The 1, 3 and 5-year disease-free survival rates were 69.7, 40.9 and 40.9% for the biliary antigen (-) group and 73.7, 39.1, 39.1% for the biliary antigen (+) group with no statistically significant difference. The 1, 3 and 5-year overall survival rates were 91.7, 73.8, 66.4% for the biliary antigen (-) group and 68.8, 34.4, 34.4% for the biliary antigen (+) group, with a significantly greater overall survival rate for the biliary antigen negative group (p = 0.045). Poor histopathological differentiation, a high HBsAg positive rate and poor overall survival rate were noted in the biliary antigen positive group and the differences were statistically significant. In conclusion, HCCs with positive biliary antigen, which originates from more primitive cells, is suggested to be more aggressive than HCCs with negative biliary antigen.
Adult ; Aged ; Bile Ducts/immunology* ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/chemistry* ; Female ; Human ; Keratin/analysis* ; Ki-67 Antigen/analysis ; Liver Neoplasms/mortality ; Liver Neoplasms/chemistry* ; Male ; Middle Age ; Prognosis ; Protein p53/analysis ; Survival Rate ; alpha-Fetoproteins/analysis

PURPOSE: Carcinomas of the ampulla of Vater have a higher resection rate, lower recurrence rate and more favorable prognosis than other malignant tumors of the periampullary region. This is because they usually presents with symptoms at an early stage due to their special anatomic location. Because of their relative low incidence, there have been few reports on the patterns and risk factors of a recurrence after a curative resection. The aim of this study was to evaluate the patterns and risk factors of a recurrence after a curative resection of ampulla of Vater cancer. METHODS: The medical records of 87 regularly followed-up patients from a total of 102 patients with a carcinoma of the ampulla of Vater, who had undergone a curative surgery between January 1992 and December 2002, were retrospectively reviewed. Of these patients, 37 were diagnosed as recurrent, with the patterns and clinicopathological risk factors of the recurrence analyzed. RESULTS: The average time to recurrence after a curative resection was 29.3+/-35.3 months, with liver metastasis being the most frequent (40.5%). The mean age of the patients in which a recurrence occurred was 54.9+/-10.1 years. There were 18 male and 19 female patients. The average tumor size in the recurred group was 2.5+/-2.0 cm. The recurrences were classified as early and late if they occurred within 18 months and after 18 months, respectively. The risk factors affecting an early recurrence were the gross morphology of tumor(ulcer formation) and cell differentiation (poorly differentiated). A univariate analysis showed lymph node metastasis to be a statistically significant risk factor, but age, gender, degree of tumor invasion depth and cell differentiation were not statistically significant. CONCLUSION: Lymph node metastasis is the most important risk factor affecting a recurrence after a curative resection of ampulla of Vater cancer, with the tumor gross morphology and cell differentiation important factors in an early recurrence. Further study on postoperative chemotherapy or radiotherapy in patients with lymph node metastasis, an ulcerative tumor type or poorly differentiated cell type, with a long-term follow-up on many patients will be needed.
Ampulla of Vater* ; Cell Differentiation ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Liver ; Lymph Nodes ; Male ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Ulcer

PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.
Academic Medical Centers ; Autopsy ; Biopsy ; Carcinoma, Hepatocellular ; Carcinosarcoma ; Chemoradiotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Prognosis ; Radiotherapy ; Survival Rate

Background/Aims: Owing to the low prevalence of small-bowel adenocarcinoma (SBA), data on the impact of Crohn’s disease (CD) on the survival of patients with SBA are lacking. Therefore, we investigated this issue in this study. Methods: In this bicenter cohort study, patients with histologically confirmed SBA were retrospectively enrolled and classified into two groups: sporadic SBA and CD-associated SBA. Patients with duodenal SBA were excluded. Overall survival, disease-free survival, and factors associated with survival were analyzed. Results: Of 128 patients with SBA, 115 had sporadic SBA and 13 had CD-associated SBA. Ileal involvement and poorly differentiated tumors were more common in the CD-associated SBA group than in the sporadic SBA group (ileal involvement, 53.8% vs 22.6%; poor differentiation, 46.2% vs 14.8%; both p<0.05). In survival analysis, overall survival showed no statistical difference between the sporadic SBA and CD-associated SBA groups (p=0.370). However, when stratified by stage, the adjusted overall survival of the CD-associated SBA group was lower in patients with an advanced disease stage (p=0.029). Disease-free survival showed the same tendency, albeit without clinical significance (p=0.097). CD (hazard ratio [HR], 2.308; p=0.047), older age (≥65 yr) at SBA diagnosis (HR, 2.766; p=0.001), and stage III/IV disease (HR, 3.151; p<0.001) were factors associated with mortality. Conclusions The overall survival of patients with CD-associated SBA did not differ from that of patients with sporadic SBA. However, as CD is an independent risk factor for mortality, vigilant surveillance in high-risk patients may be crucial.