PURPOSE: In general, the depth of tumor invasion correlates with lymph node metastasis in gastric cancer, but some cases show a discrepancy between the tumor depth and nodal status. Therefore, this study was designed to investigate the factors affecting tumor growth patterns including the depth of invasion and lymph node metastasis. METHODS: The clinico-pathological characteristics of 1048 gastric cancer, from 1993 to 1999, were investigated. These cancer cases were divided into three groups: the early gastric cancer with lymph node metastasis (EP), the serosa infiltrated advanced cancer with no lymph node metastasis (SN), and the serosa infiltrated advanced gastric cancer with lymph node metastasis (SP) groups. The expression status of the proteins related with tumor growth, including matrix metalloproteinase-2 and 9 (MMP-2 and MMP-9), VEGF, nm23 and p53, were compared using immunohistochemical stain, p53 gene mutation, Microsatellite instability (MSI) and Loss of heterozygosity (LOH). RESULTS: There were 35 (3.4%) of the total cases in the EP group, and 10.1% in Early gatric cancer cases. The female ratio in the EP group was higher than in the SN group but this was not statistically significant. The most common gross types in the EP and SN groups were IIc and Borrmann type III, respectively, and the mean tumor size was largest in the SN group. The cell differentiation of the SN group was better than that in the EP group (68.6 vs. 41.2%). The levels of MMP-2 and -9 were higher in the SN and SP groups than those in the EP group. However, the levels of VEGF and nm23 between the groups were no different. The EP group had the highest degree of p53 mutation. There was no difference in the MSI and LOH expression status between the groups. CONCLUSION: There were some different growth patterns in the gastric cancers between the lymph node metastasis dominant (EP) and depth of infiltration dominant (SN) groups. MMP-2 and -9, tumor differentiation and mutated p53 gene exon may correlated with the tumor growth pattern. Further study is suggested to find the difference between the EP and SN groups, which could provide information on which factors determine nodal metastasis or the depth of a infiltration dominant growth pattern.
Cell Differentiation ; Exons ; Female ; Genes, p53 ; Humans ; Loss of Heterozygosity ; Lymph Nodes ; Matrix Metalloproteinase 2 ; Microsatellite Instability ; Neoplasm Metastasis ; Serous Membrane ; Stomach Neoplasms* ; Vascular Endothelial Growth Factor A

The visualization of coronary arteries by transthoracic two-dimensional echocardiography has been used for over 10 years. In many cases, the imaging quality is too poor to allow an anatomic evaluation. During the last few years, transesophageal echocardiography has been shown to provide optimal imaging quality in virtually all patients and of all cardiac structures including the coronary arteries. The purpose of this study was to test the ability of transesophageal echocardiography in the visualiation of the coronary arteries and assessment of coronary blood flow by transesophageal two-dimensional pulsed Doppler echocardiography. We Studied 285 patients, 91 men and 194 women, aged 16 to 81 year(mean 50.6 year men, mean 54.2 year women). We have been used a 5-MHz phased array transducer with incorporated color-coded Doppler. The left main coronary artery was visualized 95.1%, left circumflex artery 27.4, left anterior descending artery 21.4% and the main stem of the proximal right coronary artery 45.1%. The time-sequential left anterior descending artery flow pattern generally consisted of a small late systolic component and a large diastolic component. The peak flow velocity in the proximal left anterior descending artery during diastole was 40.8+/-8.0cm/sec(integrity 7.6+/-0.9) and during late systole was 18.5+/-5.5cm/sec(integrity 2.9+/-0.9). There were no complications during and after examination. This study suggests that transesophageal color-coded Doppler two-dimensional echocardiography appers to be a feasible noninvasive technique for imaging the proximal left coronary artery and the left anterior descending artery flow is detectable from the transesophageal approach.
Arteries ; Coronary Vessels* ; Diastole ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Echocardiography, Transesophageal ; Female ; Humans ; Male ; Systole ; Transducers

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.
Acoustics ; Aneurysm ; Atherosclerosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis ; Equidae ; Esophagus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Valves ; Humans ; Mitral Valve ; Pathology ; Thrombosis ; Transducers

PURPOSE: Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. GISTs are positive for the expression of c-Kit protein at immunohistochemistry, and their clinical presentations vary. This retrospective study was performed to evaluate the clincopathologic characteristics of GISTs and to define the prognostic factors. MATERIALS AND METHODS: 40 patients who underwent a complete resection of a GIST during the period 1996~2003 at the Department of Surgery, Korea University College of Medicine, were studied. We divided them into low- and high-risk groups by using tumor size and mitotic count: 23 cases were low risk, and 17 were high risk. Clinicopathologic features, immunohistochemical findings, and prognoses were compared between the low- and the high-risk groups. RESULTS: The mean age of the 40 patients was 61.3+/-11.1 years, and the male-to-female ratio was 1:1.1. There was no significant difference in age and sex between the groups. A comparative analysis revealed tumor size, mitotic count, clinical symptoms, preoperative pathologic diagnosis, ulceration, and necrosis to be variables that had statistically significant differences between the high- and the low-risk groups. In the univariate analysis, tumor size, mitotic count, ulceration, necrosis, and abnormal endoscopic ultrasound findings were associated with disease-free survival, but in the multivariate analysis, mitotic activity was the only independent factor associated with disease-free survival. 8 patients had recurrences during the follow-up period, and four of them were treated with STI-571 (imatinib mesylate, Gleevec(R)). The treated patients have survived until now; however, two of non-treated patients died from disease progression. CONCLUSION: Based on this study, tumor size, ulceration, and necrosis are significant factors affecting survival, and mitotic activity may be a useful prognostic marker. STI-571 may be used in an adjuvant setting because the drug has shown anticancer activity in patients with recurrence or metastasis.
Diagnosis ; Disease Progression ; Disease-Free Survival ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Korea ; Mesylates ; Multivariate Analysis ; Necrosis ; Neoplasm Metastasis ; Prognosis ; Proto-Oncogene Proteins c-kit ; Recurrence ; Retrospective Studies ; Stomach* ; Ulcer ; Ultrasonography ; Imatinib Mesylate

Transplantation studies about the clinical differences according to the type of donors are mostly conducted in western countries with rare reports from Asians. The aims of this study were to evaluate the clinical impacts of the type of donor, and the predictors of 1-year mortality in patients who underwent liver transplantation (LT). This study was performed for liver transplant recipients between May 2010 and December 2014 at the Pusan National University Yangsan Hospital. A total of 185 recipients who underwent LT were analyzed. Of the 185 recipients, 109 (58.9%) belonged to the living donor liver transplantation (LDLT) group. The median age was 52.4 years. LDLT recipients had lower model for end-stage liver disease (MELD) score compared with better liver function than deceased donor liver transplantation (DDLT) recipients (mean ± standard deviation [SD], 12.5 ± 8.3 vs. 24.9 ± 11.7, respectively; P < 0.001), and had more advanced hepatocellular carcinoma (HCC) (62.4% vs. 21.1%, respectively; P = 0.001). In complications and clinical outcomes, LDLT recipients showed shorter stay in intensive care unit (ICU) (mean ± SD, 10.8 ± 8.8 vs. 23.0 ± 13.8 days, respectively, P < 0.001), ventilator care days, and post-operative admission days, and lower 1-year mortality (11% vs. 27.6%, respectively, P = 0.004). Bleeding and infectious complications were less in LDLT recipients. Recipients with DDLT (P = 0.004) showed higher mortality in univariate analysis, and multi-logistic regression analysis found higher MELD score and higher pre-operative serum brain natriuretic peptide (BNP) were associated with 1-year mortality. This study may guide improved management before and after LT from donor selection to post-operation follow up.
Asian Continental Ancestry Group ; Busan ; Carcinoma, Hepatocellular ; Donor Selection ; Follow-Up Studies ; Gyeongsangnam-do ; Hemorrhage ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality* ; Natriuretic Peptide, Brain ; Tissue Donors* ; Transplant Recipients ; Ventilators, Mechanical

BACKGROUND/AIMS: Infections following liver transplant (LT) remain a major cause of mortality. This study was conducted to evaluate risk factors for infection and to review clinical characteristics. METHODS: Medical records of patients who underwent LT from 2010 to 2014 were retrospectively analyzed. Binary logistic regression analysis was used to investigate risk factors of infection. Kaplan-Meier analysis was used to predict prognosis of infected and non-infected groups. RESULTS: Of 185 recipients, 89 patients experienced infectious complications. The median follow-up period was 911 days (range, 9 to 2,031). The infected group had higher 1-year mortality (n = 22 [24.7%] vs. n = 8, [8.3%], p = 0.002), and longer postoperative admission days (mean: 53.7 ± 35.8 days vs. 28.3 ± 13.0 days, p < 0.001), compared to the non-infected group. High preoperative Model for End-Stage Liver Disease (MELD) score (odds ratio [OR], 1.057; 95% confidence interval [CI], 1.010 to 1.105; p = 0.016), deceased-donor type (OR, 5.475; 95% CI, 2.442 to 12.279; p < 0.001), and acute rejection (OR, 3.042; 95% CI, 1.241 to 7.454; p = 0.015) were independent risk factors associated with infection. Intra-abdominal infection (n = 35, 20.8%) was the major infectious complication. Among identified bacteria, Enterococcus species (28.4%) were major pathogens, followed by Escherichia coli and Klebsiella species. CONCLUSIONS: High preoperative MELD score, deceased-donor type, and acute rejection were risk factors associated with infection. To prevent infections following surgery, it is important to determine the appropriate time of operation before the recipient has a high MELD score.
Bacteria ; Enterococcus ; Escherichia coli ; Follow-Up Studies ; Humans ; Intraabdominal Infections ; Kaplan-Meier Estimate ; Klebsiella ; Liver Diseases ; Liver Transplantation ; Liver* ; Logistic Models ; Medical Records ; Mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; Transplant Recipients*