PURPOSE: Cadherins are a family of transmembranous glycoproteins involved in intercellular adhesion. E-cadherin, an epithelium specific cadherin, plays a major role in the maintenance of epithelial tissue and therefore in neoplastic progression of many human carcinomas. In order to search for more accurate prognostic factors, we investigated the relationship between decreased E-cadherin expression and tumor grade, stage, recurrence and progression in bladder tumors. MATERIALS AND METHODS: 62 formalin fixed paraffin embedded specimens which were taken from 34 patients with transitional cell carcinoma who underwent TURB, partial cystectomy, radical cystectomy were retrospectively analyzed with E-cadherin immunohistochemical staining from January 1989 to December 1997. Correlations were evaluated between E-cadherin immunohistochemical staining and grade, stage, recurrence and progression. RESULTS: Decreased E-cadherin expression correlated with both increased grade and stage(x2=25.6, p<0.01 and x2=26.7, p<0.01 respectively). Also, abnormal E-cadherin expression correlated with recurrence and progression of superficial bladder tumors(Fisher Exact test: p=0.008 and x2=6.6, p=0.01 respectively). In multiple linear regression analysis controling the effects of other factors, only the tumor grade showed weak correlation with E-cadherin expression(coefficient=-0.25, r2=40.1%, p<0.001). CONCLUSIONS: The results suggest that decreased expression of E-cadherin is correlated with higher grade, advanced stage, recurrence and progression respectively. But, E-cadherin could not be used as an independent prognostic marker in bladder cancer.
Cadherins* ; Carcinoma, Transitional Cell ; Cystectomy ; Epithelium ; Formaldehyde ; Glycoproteins ; Humans ; Linear Models ; Paraffin ; Prognosis ; Recurrence ; Retrospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: This study was performed to analyze the efficacy of induction chemotherapy followed by radiation therapy in locally advanced non-small cell lung cancer. MATERIALS AND METHODS: Eighty patients with locally advanced non-small cell lung cancer treated from 1989 to 1995 at Pusan Paik hospital were analyzed retrospectively. Twenty-one patients were treated with induction chemotherapy followed by radiation therapy and Fifty-nine patients were treated with radiation therapy alone. Chemotherapy regimen consisted of cisplatin-based combination (2 or 3 drugs). All patients were treated by Co-60 or 6 MV linear accelerators. Radiation dose ranged from 50 Gy to 80 Gy (median, 64.8 Gy). We evaluated response rate, survival rate, and pattern of failure in both treatment groups. RESULTS: Overall response rate in induction chemotherapy group and radiotherapy alone group were 48% and 45%, respectively. Of the 80 patients, 46 patients were evaluable for pattern of failure. Initial failure pattern in induction chemotherapy group was as follows: 8 (67%) at locoregional, 4 (33) in distant metastasis. Radiation alone group was 21 (71%) and 5 (29%), respectively. Results showed no difference of distant failure between induction chemotherapy group and radiation alone group. The 1 and 2 year survival rate in induction chemotherapy group were 43% and 14%, respectively and in radiotherapy alone group, 31% and 7%, respectively (p=0.135). CONCLUSION: In stage lll non-small cell lung cancer, induction chemotherapy and radiation therapy showed increased tendency in survival with no statistical significance. Induction chemotherapy seems to have no effect of decreasing distant failure and no survival advantage compared with radiotherapy alone.
Busan ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Induction Chemotherapy* ; Neoplasm Metastasis ; Particle Accelerators ; Radiotherapy ; Retrospective Studies ; Survival Rate

The frequency and extent of the existence of a familial suicide prevention plan may differ across cultures. The aim of this work was, therefore, to determine how common it was for families to develop a suicide prevention plan and to compare the main measures used by families with and without such a plan, after an attempt to commit suicide was made by a member of a family living in a rural area of Korea. On the basis of the presence or absence of a familial suicide prevention plan, we compared 50 recruited families that were divided into 2 groups, with Group A (31 families) employing a familial suicide prevention plan after a suicide attempt by a family member, and Group B (19 families) not doing so. The strategy that was employed most frequently to prevent a reoccurrence among both populations was promoting communication among family members, followed by seeking psychological counseling and/or psychiatric treatment. Contrary to our expectation, the economic burden from medical treatment after a suicide attempt did not influence the establishment of a familial suicide prevention plan. It is a pressing social issue that 38% (19 of 50) of families in this study did not employ a familial suicide prevention plan, even after a family member had attempted suicide. Regional suicide prevention centers and/or health authorities should pay particular attention to these patients and their families.
Family ; Female ; Hospitalization/*economics ; Humans ; Male ; Middle Aged ; Patient Care Planning/*statistics & numerical data ; Republic of Korea ; Risk Factors ; Suicide, Attempted/*prevention & control ; Surveys and Questionnaires

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATENRIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D2+alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0 cm and 18.5% (15/81) over 1.0 cm in size (p=0.034) and 6.1% (2/33) of up to 1.0mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (p=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive op-eration can be applied for submucosal gastric carcinoma up to 1.0 cm in size Further studies are needed to limited surgery for depth of submucosal invasion.
Gastrectomy ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Retrospective Studies

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATERIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D(2)(+)alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0cm and 18.5% (15/81) over 1.0 cm in size (P=0.034) and 6.1% (2/33) of up to 1.0 mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (P=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive operation can be applied for submucosal gastric carcinoma up to 1.0 cm in size. Further studies are needed to limited surgery for depth of submucosal invasion.
Gastrectomy ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Retrospective Studies

PURPOSE: There has been controversy over an adequate operative method for peptic ulcer perforation, but currently there is general agreement in the surgical literature that perforated duodenal ulcers in patients who constitute excessive surgical risk should be managed by the simplest possible procedure and in the absence of surgical risk, definitive operations are advocated. However, an accurate description of the degree of severity of concurrent medical disease and surgical risk factor is not available and the question as to whether the postoperative mortality is influenced by the magnitude of the procedure or determined only by the patient's risk remains unanswered. METHODS: This retrospective study reviewed the case histories of all patients who underwent operations for perforated duodenal ulcer at Gil Medical Center from January 1993 through 1998 and evaluates the influences of prognostic factors, APACHE II, SAPS, age, duration of peritonitis, concurrent major medical disease and ulcer size, and operative procedures on postoperative mortality in high risk and low risk groups. RESULTS: Large APACHE II score (> or =15) and SPSS (> or =10), delayed operation, large ulcer (> or =2 cm), age (> or =60), and major medical illness that severely compromised cardiorespiratory, hepatic, renal, and immunologic function were associated significantly with mortality in patients with a perforated peptic ulcer. CONCLUSION: Age, duration of peritonitis, major medical disease, APACHE II score, and ulcer size should be pre-sumed to be important prognostic factors. Although further study is necessary in a larger number of patients, it appears that operative procedures have no influence on postoperative mortality.
APACHE ; Duodenal Ulcer* ; Humans ; Mortality ; Peptic Ulcer ; Peptic Ulcer Perforation ; Peritonitis ; Retrospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Ulcer

PURPOSE: Angiogenesis is involved in the pathogenesis of chronic rhinosinusitis with nasal polyps. We aimed to investigate the effects of prostaglandin E2 (PGE2) on vascular endothelial growth factor (VEGF) production, the role of E-prostanoid (EP) 4 receptors, and the signal transduction pathway mediating VEGF production in nasal polyp-derived fibroblasts (NPDFs). METHODS: Eight primary NPDF cultures were established from nasal polyps, which were incubated with or without PGE2. Reverse transcription-polymerase chain reaction amplification of EP receptors (EP1, EP2, EP3, and EP4) and immunofluorescence staining for VEGF production were performed. VEGF production via the cyclic adenosine monophosphate (cAMP)-dependent protein kinase A (PKA) and phosphatidylinositol 3-kinase (PI3K) pathways was evaluated by enzyme-linked immunosorbent assay. RESULTS: All EP receptors were expressed in NPDFs. PGE2 significantly increased VEGF production concentration- and time dependently, and VEGF production was regulated by an EP4 receptor. Activation of intracellular cAMP regulated VEGF production. VEGF production was decreased by PKA and PI3K inhibitors via intracellular cAMP. CONCLUSIONS: PGE2 stimulates VEGF production via the EP4 receptor in NPDFs. These results indicate that PGE2-induced VEGF production is mediated, at least partially, through cAMP-dependent signaling pathways. Therapies targeting the EP4 receptor may be effective in inhibiting the development of nasal polyps.
Adenosine Monophosphate ; Cyclic AMP-Dependent Protein Kinases ; Dinoprostone ; Fibroblasts ; Fluorescent Antibody Technique ; Nasal Polyps ; Negotiating ; Phosphatidylinositol 3-Kinase ; Signal Transduction ; Vascular Endothelial Growth Factor A

PURPOSE: Colorectal cancers occurring in young people are usually found in advanced stage and have worse prognosis. The aim of this study was to investigate the clinical characteristics of young patients with colorectal cancer and survival rate of patients with colorectal cancer younger than 40 years. METHODS: The total of 534 patients with colorectal cancer underwent surgeries between March 1997 and February 2003. 487 patients were 40 or older than 40 years (control group) and the remaining 47 patients were younger than 40 years (study group). We compared age, sex, curability, tumor location, stage, histological type between the two groups. The survival rate by stages and overall survival rate were retrospectively analyzed. RESULTS: No significant difference was shown in the comparison of the distribution by stage and histologic grade at the time of diagnosis. There were more female in the study group (P=0.005). The three-year and five-year overall survival rates were 79.3% and 74.0% in study group, and 68.2% and 60.2% in control group (P>0.05). The three-year and five-year survival rates according to stage were not significantly different between the two groups. CONCLUSION: In the comparison of patients with colorectal cancer younger than 40 years old and 40 or older than 40 years old, no significant difference was shown in clinical characteristics and survival rate except sex distribution.
Adult ; Colorectal Neoplasms* ; Diagnosis ; Female ; Humans ; Prognosis ; Retrospective Studies ; Sex Distribution ; Survival Rate*

PURPOSE: Meconium peritonitis is a form of aseptic, chemical peritonitis that results from a perforation of the gut during the intrauterine or perinatal period. The rarity of the disease resulted in few survivors up to the 1950's. However, the constantly increasing survival rate has followed an aggressive surgical management, along with a more thorough understanding of the etiological and pathological variations likely to be encountered. This study was performed to analyze our past 10 years' experience with meconium peritonitis. METHODS: The hospital records of 15 patients treated between January 1991 to December 2000 were retrospectively reviewed. RESULTS: The male to female sex ratio was 2:1, and the age at surgery varied from at the time of birth to 48 days. The clinical manifestations included marked abdominal distension (13 cases), respiratory distress (8 cases), billous vomiting (5 cases) and scrotal swelling (1 case). Radiological findings included air-fluid level (7 cases), calcification (4 cases) and pneumoperitoneum (3 cases). The prenatal ultrasonography demonstrated dilated loops of bowel, septated fetal ascites and calcification. The leading cause of perforation was small bowel atresia (8 cases). A primary end-to-end anastomosis was performed in 10 cases. Generalized type (8 cases) was the most common finding of meconium peritonitis. 86% of patients survived without long-term complications. CONCLUSION: Early recognition and proper management offer the greatest opportunity for survival in cases of meconium peritonitis.
Ascites ; Female ; Hospital Records ; Humans ; Male ; Meconium* ; Parturition ; Peritonitis* ; Pneumoperitoneum ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Survivors ; Ultrasonography, Prenatal ; Vomiting

BACKGROUND: CHOP (cyclophosphamide, adriamycin, prednisolone, vincristine) regimen is still the standard therapy for non-Hodgkin's lymphoma, but its complete response rate & long-term survival rate are 45~55% and 30%, respectively. New chemotherapy regimen will be required for enhancing response rate and duration of survival. We tried to treat non-Hodgkin's lymphoma with newly developing CHEP-OB (cyclophosphamide, adriamycin, etoposide, prednisolone, vincristine, bleomycin) combination chemotherapy which include etoposide, bleomycin in preexisting CHOP regimen. METHODS: 51 patients with non-Hodgkin's lymphoma who admitted to Busan Paik Hospital Inje University between January 1996 and August 2002 were selected. They were treated with CHEP-OB combination chemotherapy given every 3~4 weeks for total 6 cycles. RESULTS: Objective response was achieved in 82.4% of the patients. Complete response (CR) and partial response (PR) rates were 66.7% and 15.7%, respectively. CR rate was significantly lower in patients with T cell immmunophenotype. Five year overall (OS) and failure-free survival (FFS) rate were 61.9%, 54.7%, respectively. Multivariate analysis showed that sex, stage and attainment of CR were factors independently predictive for OS and that stage and attainment of CR were factors independently predictive for FFS. Major side effect was myelotoxicity. CONCLUSION: CHEP-OB combination chemotherapy might be useful as a treatment strategy in non-Hodgkin's lymphoma considering similar response and survival rate, lower toxicity when it is compared with 3rd generation combination chemotherapy. But more effective chemotherapeutic regimen needs to be explored.
Bleomycin ; Busan ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Humans ; Lymphoma, Non-Hodgkin* ; Multivariate Analysis ; Prednisolone ; Survival Rate ; Vincristine