BACKGROUND/AIMS: Pancreaticoduodenectomy( PD ) is a complicated procedure that carried a very high postoperative mortality and mobidity until 1970s. Since early 1980, motality has been decreased but morbidity is still high now. So this study was conducted to analyze the motality and morbidity as well as survival rates after PD for valiable disease. METHODS: From January 1988 to January 2000, 164 patients underwent PD in the Korea Cancer Center Hospital. Standard pancreaticoduodenectomy was performed in terms of lymph node dissection and main method of pancreaticoenterostomy was end-to-side pancreaticojejunostomy, among which ductto- mucosa anastomosis comprised of about half of cases. Survival rates and the differences were estimated by Kaplan-Meier method and Log-Lank test respectively, and multivariate analysis was done with Cox Regression hazard model using SPSS program for Windows. RESULTS: Median age of all patients was 57 years with slight male predominance(54.8%). Classical Whipple's operation was performed in 113 cases(68.9%), and PPPD in 40 cases(24.3%), hepatopancreaticoduodenectomy in 10 cases(6.1%). Operative mortality was 1.8%( 3/164 ), however no additional in-hospital death occurred. Nine patients underwent reoperation. Postoperative complication occurred in 56 cases(34.2%). The most common complication was pneumonia(11.5%), and delayed gastric emptying( 7.3%), pancreatic fistula(4.8%), intra-abdominal bleeding(4.8%) in orders. No pancreatic leakage occured in duct-to-mucosa anastomosis group. Median survival of 123 periampullary carcinoma was 25 months and better survival was shown in ampulla of Vater cancer. Factors influencing on survival for periampullary carcinoma were origin of tumor, cellular differentiation, lymph node invasion. CONCLUSION: Pancreaticoduodenectomy can be performed safely in the terms of mortality. Bleeding is the most common cause of reoperation and motality, so meticulous bleeding control is very important. And duct-to-mucosa anastomosis is very safe method of pancreaticoenterostomy.
Ampulla of Vater ; Hemorrhage ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Mucous Membrane ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Postoperative Complications ; Proportional Hazards Models ; Reoperation ; Survival Rate

Plummer-Vinson syndrome (sideropenic dysphagia) is characterized by dysphagia due to an upper esophageal or a hypopharyngeal web in a patient with chronic iron deficiency anemia. The main cause of dysphagia is the web of the cervical esophagus, and an abnormal motility of the pharynx or the esophagus is found to play a significant role in the above cause. Patients with this syndrome are thought to be precancerous because squamous cell carcinomas of the hypopharynx, oral cavity, or esophagus take place in 10% of those patients. However, for Plummer-Vinson syndrome to be combined with gastric cancer is most unusual. We report the case of a 43-year-old woman who was first found to have stomach cancer under a diagnosis of Plummer-Vinson syndrome and who recovered after surgery.
Adult ; Anemia, Iron-Deficiency ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Diagnosis ; Esophagus ; Female ; Humans ; Hypopharynx ; Mouth ; Pharynx ; Plummer-Vinson Syndrome* ; Stomach Neoplasms*

3-Deoxysappanchalcone (3-DSC) has been reported to possess anti-allergic, antiviral, anti-inflammatory and antioxidant activities. In the present study, we investigated the effects of 3-DSC on the proliferation of human hair follicle dermal papilla cells (HDPCs) and mouse hair growth in vivo. A real-time cell analyzer system, luciferase assay, Western blot and real-time polymerase chain reaction (PCR) were employed to measure the biochemical changes occurring in HDPCs in response to 3-DSC treatment. The effect of 3-DSC on hair growth in C57BL/6 mice was also examined. 3-DSC promoted the proliferation of HDPCs, similar to Tofacitinib, an inhibitor of janus-activated kinase (JAK). 3-DSC promoted phosphorylation of β-catenin and transcriptional activation of the T-cell factor. In addition, 3-DSC potentiated interleukin-6 (IL-6)-induced phosphorylation and subsequent transactivation of signal transducer and activator of transcription-3 (STAT3), thereby increasing the expression of cyclin-dependent kinase-4 (Cdk4), fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF). On the contrary, 3-DSC attenuated STAT6 mRNA expression and IL4-induced STAT6 phosphorylation in HDPCs. Finally, we observed that topical application of 3-DSC promoted the anagen phase of hair growth in C57BL/6 mice. 3-DSC stimulates hair growth possibly by inducing proliferation of follicular dermal papilla cells via modulation of WNT/β-catenin and STAT signaling.
Animals ; Blotting, Western ; Fibroblast Growth Factors ; Hair Follicle* ; Hair* ; Humans* ; Interleukin-6 ; Luciferases ; Mice* ; Phosphorylation ; Phosphotransferases ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; T-Lymphocytes ; Transcriptional Activation ; Transducers ; Vascular Endothelial Growth Factor A

Transforaminal cervical epidural steroid injection (TFCESI) is widely used as conservative treatment for cervical radiculopathy, but severe complications associated with this procedure have been reported. This report was the first case of intramedullary spinal cord hemorrhage following TFCESI. A 67-year-old woman presented with weakness and sensory disturbance in left upper extremity after TFCESI. Cervical magnetic resonance imaging revealed intramedullary spinal cord hemorrhage accompanied by myelopathy at the C2∼C5 level. The patient was administered intravenous methylprednisolone daily (1,000 mg/8 hours) for 5 days and was subsequently transferred to the Department of Rehabilitation Medicine for rehabilitation therapy. A month later, the patient’s neurological impairment partially improved. Although TFCESI is rarely associated with major complications, physicians should be cautious when performing the procedure, and remain mindful of the potentially serious complications.

PURPOSE: The aim of this study was to determine the feasibility and safety of laparoscopy-assisted gastrectomy (LAG) with lymph node dissection for gastric cancer according to the analysis of postoperative complications. METHODS: The authors attempted LAG with lymph node dissection in 117 consecutive patients with gastric cancer. The clinicopathologic characteristics of the patients, operative outcomes, preoperative comorbidities and postoperative morbidities and mortalities were evaluated using the stomach cancer database of Dong-A university hospital and medical charts. RESULTS: Among the 114 successful patients, 100 had early gastric cancer and 14 had advanced gastric cancer. The mean operation time was 259.2 minutes (range 150~415). The mean number of retrieved lymph nodes was 23.4 (range 6~66). The mean time to the first flatus and postoperative hospital stay were 3.7 and 10.0 days, respectively. The overall operative mortality rate, hospital death rate and the overall rate of postoperative complications were 0, 1.7 and 14.7%, respectively. The major and minor complication rate were 4.3 and 10.4%, respectively. CONCLUSION: LAG with lymph node dissection is technically feasible and receptive as surgical treatment for patients with gastric cancer, although various postoperative complications can arise in LAG as they do in open gastrectomy.
Comorbidity ; Flatulence ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Node Excision* ; Lymph Nodes* ; Mortality ; Postoperative Complications ; Stomach Neoplasms*

BACKGROUND: With progressive improvement in the fraction of long-term surviviors, chronic GVHD has emerged as a increasingly frequent complication of allogenic bone marrow transplantation. Except for a few case reports, there has been no clinical study of chronic cutaneous GVHD in Korea so far. OBJECTIVE: In the present study we planned to investigate the clinical characteristics of chronic cutaneous GVHD and to compare the clinical manifestation and incidence of chronic cutaneous GVHD in Korea with previous reports in U.S.A. and Europe. METHODS: On the basis of the patients' charts and the records of bone marrow transplantation, we investigated the incidence of chronic cutaneous GVHD in Korean leukemia patients and studied the clinical manifestations of chronic cutaneous GVHD ocurring in 16 patients whose diagnosis was confirmed by histopathologic findings of skin biopsy. We also analysed whether total body irrdiation before bone marrow transplantation, GVHD prophylaxis and presence of preceding acute GVHD affected chronic cutaneous GVHD. RESULTS: 1. The incidence in chronic cutaneous GVHD in Korea was lower than that in Caucasian countries. 2. The onset was milder than that in Caucasians. 3. The clinical manifestation was earlier than that in Caucasians. 4. The relationship between the GVHD prophylaxis and incidence chronic cutaneous GVHD was not significant. 5. The incidence of chronic cutaneous GVHD in the presence of preceding acute GVHD was higher than in cases with no preceding acute GVHD. CONCLUSION: We speculate that the low incidence of chronic cutaneous GVHD and clinical characteristics differing from the reports in the U.S.A. and Europe might be unassociated with irradiation, GVHD prophylaxis or the presence of preceding acute GVHD but maybe related to differences in genetic background.
Biopsy ; Bone Marrow Transplantation ; Diagnosis ; Europe ; Humans ; Incidence ; Korea ; Leukemia ; Skin

BACKGROUND AND OBJECTIVES: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. SUBJECTS AND METHODS: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (> or =200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). RESULTS: Hypercholesterolemic patients were younger (59.7+/-13.3 years vs. 62.6+/-11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23+/-0.85 mm3/mm vs. 1.02+/-0.80 mm3/mm, p=0.029) as well as percent necrotic core volume (20.5+/-8.5% vs. 18.0+/-9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4+/-10.5% vs. 18.4+/-11.3%, p=0.019) and necrotic core area (1.63+/-1.09 mm2 vs. 1.40+/-1.20 mm2, p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). CONCLUSION: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
Acute Coronary Syndrome ; Atherosclerosis ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Demography ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Smoking

PURPOSE: To evaluate the clinicopathologic and oncological outcomes of advanced metastatic testicular cancer in Korean men who underwent retroperitoneal lymph node dissection (RPLND) following chemotherapy. MATERIALS AND METHODS: Data of 26 patients with testicular cancer who underwent RPLND after chemotherapy at 2 hospitals in Korea between September 2004 and June 2016 were retrospectively analyzed. Clinical and histopathological variables such as stage of the testicular cancer, age of the patients during surgery, size of the retroperitoneal lymph nodes (RPLNs), histopathological results, duration and complications related to the surgery, cancer recurrence, and mortality were analyzed. RESULTS: During testicular surgery, the T stage was pT1, pT2, and pT3 in 50% (n=13), 26.9% (n=7), and 15.3% (n=4) of the patients, respectively. Mixed germ cell tumor was the most common finding, seen in 73.1% (n=19) of patients. The indications for RPLND were residual lymph nodes after chemotherapy, 84.6% (n=22); and disease progression and remission, 7.7% (n=2). Pathological analysis revealed viable tumors in 19.2% of patients (n=5), necrotic/fibrotic tissue in 42.3% (n=11), and teratoma in 34.6% (n=9). Intraoperative and postoperative complications occurred in 23.1% (n=6) and 19.2% of patients (n=5). The median duration of follow-up was 27.5 months (interquartile range, 1.3–108.2 months); 11.5% (n=3) patients had recurrence, and 3.8% (n=1) died of progressive metastatic testicular cancer. CONCLUSIONS: Viable germ cell tumors were present in 19.2% of patients with testicular cancer who underwent RPLND after chemotherapy. This is the first study of its kind in the Korean population.
Disease Progression ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Lymph Node Excision* ; Lymph Nodes* ; Male ; Mortality ; Neoplasms, Germ Cell and Embryonal ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Teratoma ; Testicular Neoplasms*

The peneicillin binding protein gene(mecA gene) is present in the methicillin-resistant Staphylococcus strains but not in the susceptible ones. The goal of the present study was to establish experimental evidences which might use polymerase chain reaction(PCR) for culture confirmation and eventually clinical diagnosis of methicillin resistant Staphylococcui. Two primers (5'-AAAATCGATGGTAAAGGTTGGC-3', 5'-AGTTCTGCAGTACCGGATTTGC-3') based on the known DNA sequence of the mecA gene from methicillin-resistant Staphylococcus aureus were used in PCRs to screen for the presence of this gene in Staphylococcal isolates from various clinical settings. When the primers were used to copy the DNA of the mecA gene, only 533 base-pair DNA fragment was appeared. The product indicates a positive PCR result for methicillin-resistant Staphylococcal isolates. In contrast, from the DNA of the methicillin-sensitive Staphylococcal isolates the 533bp was not amplified. Results obtained with PCR were generally consistent with those of standard microbiological assays. The mecA gene in methicillin-high resistant Staphylococci was located on the approximately 5.56kb Hind III restriction fragment. The 533bp probe was hybridized to the 5.56kb Hind III restriction fragment of mecA-positive S. aureus. No hybridization was occured in the mecA-negative strain. The mecA gene was cloned, named pHL-1201 and verified by colony hyhridization. The 533bp probe was hybridized to the approximately 5.56kb Hind III restriction fragment of the DNA obtained from pHL-1201. PCRs with the primers successfully distinguished methicillin-resistants from methicillin-susceptible strains of S. aureus and S. epidermidis.
Base Sequence ; Carrier Proteins ; Clone Cells* ; Cloning, Organism* ; Diagnosis ; DNA ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus ; Polymerase Chain Reaction* ; Staphylococcus aureus ; Staphylococcus*

BACKGROUND AND OBJECTIVES: The relationship between the positive remodeling (PR) of a coronary artery and plaque composition has been studied only in a relatively small number of study population or non-culprit lesion. We evaluated the association between coronary plaque composition and coronary artery remodeling in a relatively large number of culprit lesions. SUBJECTS AND METHODS: The study population consisted of 325 consecutive patients with coronary artery disease that underwent intravascular ultrasound-virtual histology examination in a culprit lesion. The remodeling index (RI) was calculated as the lesion external elastic membrane (EEM) area divided by the average reference EEM area. RESULTS: The lesions with PR (RI>1.05, n=97, mean RI=1.19+/-0.12) had a higher fibrous volume/lesion length (3.85+/-2.12 mm3/mm vs. 3.04+/-1.79 mm3/mm, p=0.003) and necrotic core volume/lesion length (1.26+/-0.89 mm3/mm vs. 0.90+/-0.66 mm3/mm, p=0.001) than those with negative remodeling (NR) (RI<0.95, n=132, mean RI=0.82+/-0.09). At the minimal luminal area site, the lesions with PR had a higher fibrous area (5.81+/-3.17 mm2 vs. 3.61+/-2.30 mm2, p<0.001), dense calcified area (0.73+/-0.69 mm2 vs. 0.46+/-0.43 mm2, p=0.001), and necrotic core area (1.93+/-1.33 mm2 vs. 1.06+/-0.91 mm2, p<0.001) than those with NR. RI showed significant positive correlation with fibrous volume/lesion length (r=0.173, p=0.002), necrotic core volume/lesion length (r=0.188, p=0.001), fibrous area (r=0.347, p<0.001), fibrofatty area (r=0.111, p=0.036), dense calcified area (r=0.239, p<0.001), and necrotic core area (r=0.334, p<0.001). Multivariate analysis showed that the independent factor for PR was the necrotic core volume/lesion length (beta=0.130, 95% confidence interval; 0.002-0.056, p=0.037) over the entire lesion. CONCLUSION: This study suggests that PR in a culprit lesion is associated with the necrotic core volume in the entire lesion, which is a characteristic of vulnerable plaque.
Atherosclerosis ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Membranes ; Multivariate Analysis ; Phenobarbital ; Ultrasonography, Interventional