The extrahepatic bile duct cancers(EBDC) are rare and are found late stage in their course. Because of their location in close proximity to the liver, hepatic artery, and portal vein, they are often unresectable. However, high survival rates after an aggressive surgical resection has been reported lately. This report presents the results of 62 cases with EBDC operated at the Department of Surgery, Pusan National University Hospital, from 1988 to 1997. EBDC usually occurs in older age group. especially between 60~70 years of age, and the mean age was 56.6 years. Sex ratio(male:female) was 5.2:1 with male predominance. Frequent clinical manifestations in order of frequency were jaundice(82.3%), abdominal pain(69.4%), pruritus(35.5%), anorexia(33.9%), fever and chill(32.3%), weight loss(22.6%). The laboratory findings were increased alkaline phosphatase(93.5%), bilirubin(77.4%), SGOT(77.4%), SGPT(69.4%). Elevated CEA(>5ng/dl) was 28.6%. The preoperative diagnostic accuracy was 100.0% in ERCP and PTC, 96.4% in abdominal CT, and 95.3% in ultrasonogram. The most common site of the cancer was lower third of the bile duct(61.3%), followed by upper third(27.4%) and middle third(11.3%). Curative resection was possible in 33 cases(53.2%) and the other 29 cases were received palliative biliary decompression. Postoperative complications were bile leakage(30.6%), wound infection( 25.8%), intraabdominal hematoma(19.4%), cholangitis(17.7%), and UGI bleeding(11.3%). The dead cases were 5 cases(8.0%) of all 62 cases and the causes of death were sepsis in 3 cases(4.8%) and UGI bleeding 2 cases(3.2%). By TNM classification(AJCC, 1992) stage IV(64.5%) was most common and stage II(25.9%) was next in order. Among the 62 adenocarcinoma, 25 cases were poorly-differentiated lesion(40.3%), 19 cases were moderately-differentiated lesion(30.6%), and 18 cases were well-differentiated lesion(29.0%). In conclusion, the survival rates of EBDC were higher low staged, curative resected, well differentiated and lower third located groups than high staged, palliative resected, poorly differentiated and upper third located groups.
Adenocarcinoma ; Bile ; Bile Ducts, Extrahepatic* ; Busan ; Cause of Death ; Cholangiopancreatography, Endoscopic Retrograde ; Decompression ; Fever ; Hemorrhage ; Hepatic Artery ; Humans ; Liver ; Male ; Portal Vein ; Postoperative Complications ; Sepsis ; Survival Rate* ; Tomography, X-Ray Computed ; Ultrasonography ; Wounds and Injuries

Twenty-one cases of mitral valve prolapse (MVP) diagnosed by M-mode echocardiograms were studied in regard to the underlying or associated conditions, types of MVP, and dimensions of the cardiac structures and parameters reflecting cardiac performance determined by echocardiograms. In 9 cases, MVP was thought to be idiopathic origin. Associated conditions in the remainder were 5 cases of congenital heart disease, 2 cases of rheumatic myocarditis, 1 case each of aortic valve disease, ischemic heart disease and hyperthyroidism, and 2 cases of undiagnosed cardiac conditions. There were 2 cases of buckling type of MVP and in the remainder hammock type. In these 2 patients with hammock type of MVP, mitral valve echoes were seen in the left atrium during systole in 1 case, and diastolic anterior displacement of posterior mitral leaflet in the other. In 9 cases of idiopathic MVP, cardiac dimensions and parameters reflecting cardiac performance as determined from echocardiograms showed no significant differences from those of 27 normal controls.
Aortic Valve ; Echocardiography* ; Heart Atria ; Heart Defects, Congenital ; Humans ; Hyperthyroidism ; Mitral Valve Prolapse* ; Mitral Valve* ; Myocardial Ischemia ; Myocarditis ; Systole

PURPOSE: The determination of HER-2/neu gene amplification has become necessary for the selection of breast cancer patients to undergo anti-HER-2/neu therapy, using a humanized monoclonal antibody. Chromogenic in situ hybridization (CISH) detection of the HER-2/neu gene, a newly developed method, utilizes a robust and unique-sequence DNA probe labeled with digoxygenin, which is sequentially incubated with antidigoxygenin fluorescein, antifluorescein peroxidase and diaminobenzidine. The aim of this study was to establish a CISH assay for the detection of HER-2/neu amplification. The results were compared with those of the immunohistochemistry (IHC) methods, most frequently used for detecting HER-2/neu alteration. METHODS: CISH was performed in 4 groups of infiltrating breast carcinomas. Each group was comprised of 20 cases in which the HER-2/neu stati had previously been scored on a four value scale: 0, 1+, 2+ and 3+ by IHC. The results of CISH and IHC were compared for each tumor group. The HER-2/neu gene amplification detected by CISH was thpically visualized as large DAB-stained clusters or by many dots in the nucleus. RESULTS: The concordance between the CISH and IHC was 95% (kappa=0.901). Three IHC-positive cases (score 2+) showed no gene amplification and one IHC-negative case (score 1+) showed gene amplification by CISH. CONCLUSION: The current study showed excellent agreement between the CISH and IHC methods. CISH is an accurate, practical and economical approach for determining the HER-2/neu stati in breast carcinomas. It is also a useful methodology for confirming the IHC results in paraffin- embedded tumor samples, so offers a promising alternative to IHC in a routine diagnostic setting.
Breast Neoplasms* ; Breast* ; DNA ; Fluorescein ; Gene Amplification ; Genes, vif ; Humans ; Immunohistochemistry ; In Situ Hybridization* ; Peroxidase

PURPOSE: Numerous non-invasive imaging methods for evaluating the chemotherapy response of breast cancer patients are currently being explored. The aim of present study was to investigate whether the washout rates (WRs) of 99mTc-MIBI could predict the response to chemotherapy in patients suffering with infiltrating ductal carcinoma using the expressions of multidrug resistance-related protein (MRP) and P-glycoprotein (Pgp). METHODS: From May 2002 and March 2004, the patients were randomly and consecutively selected according to the results of immunohistochemical analyses of breast carcinoma specimens before the administration of neoadjuvant chemotherapy. A total 45 infiltrating ductal carcinomas in 45 female patients were selected and they were separated into three groups: group A consisted of tumors with both negative Pgp and MRP expressions (n=15); group B consisted of the tumors that were positive for either a Pgp expression or a MRP expression (n=15); group C consisted of the tumors that were positive for both Pgp and MRP expressions (n=15). All the patients were referred for double phase 99mTc-MIBI mammoscintigraphy after the injection of 925 MBq of 99mTc-MIBI to calculate the WR. The tumor response was evaluated after completion of neoadjuvant chemotherapy. The tumor response was classified as a complete or partial response (the responder group) and stable or progression (the non-responder group). All the patients underwent surgery. RESULTS: The response rate of group C was lower than that of the other groups, but the difference was not statistically significant (p=0.283). The WR of non-responder group was lower than that of the responder group, although the difference was not statistically significant (p=0.674). The washout rates of group C was the highest than other groups and the difference was statistically significant (p=0.001). CONCLUSION: In conclusion, the WR of 99mTc-MIBI is helpful for in vivo determination of both the Pgp and MRP expressions for infiltrating ductal carcinoma of the breast.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Drug Therapy* ; Female ; Humans ; P-Glycoprotein*

BACKGROUND: To provide some fundamental physiological basis for the physical training of pilots to improve orthostatic intolerance, cardiorespiratory responses to the symptom-limited maximal exercise loading were studied in pilots and non-pilots, and the results were compared. METHOD: Cardiorespiratory reponses to the symptom-limited maximal exercise loading by Bruce protocol was studied in 11 pilots and 11 matched controls (non-pilots). RESULTS: Comparisons of various data at maximal exercise in the pilots with those in the controls revealed that RR, VE/M2, VE/VO2, VE/VCO2, VT/VC and VE/MVV as well as HR, VO2, O2 pulse and AT showed no significant difference. CONCLUSION: The fact that the aerobic power in the pilots is not superior to that in the controls seems to emphasisze the necessity of aerobic endurance training along with muscular strength training to improve orthostatic tolerance of pilots flying modern high-performance aircrafts.
Aircraft ; Diptera ; Orthostatic Intolerance ; Resistance Training

PURPOSE: The predictive value of c-erbB2 over-expression, and p53 mutation, to the response rate to neoadjuvant chemotherapy, were assessed in patients with breast cancer. METHODS: Between January 2000 and June 2002, 185 patients, with breast cancer, were put forward for two commonly used chemotherapy regimens prior to surgery. The first 135 received the CMF (cyclophosphamide 600 mg/m2, methotraxate 40 mg/m2, 5-FU 500 mg/m2) regimen, and the remaining 50 the CAF (cyclophosphamide 600 mg/m2, adriamycin 50 mg/m2, 5-FU 500 mg/m2) regimen. The expressions of the estrogen receptor (ER), progesterone receptor (PR), p53 mutation and c-erbB2, were evaluated by immunohistochemistry of needle biopsy samples prior to neoadjuvant chemotherapy. Tumor response was categorized according to the WHO criteria, using the largest diameter in ultrasonography or magnetic resonance imaging. RESULTS: The mean age of the patients in the CMF and CAF groups were 48.8 and 47.4 years. Forty eight (35.6%) and 24 (48.0%) of the patients, in the CMF and CAF groups, respectively, had pathologically partial or complete responses. The tumor size, axillary lymph nodes, lymphatic and vascular invasions, as clinicopathological factors, were significantly correlated with the response to chemotherapy in the CAF group. The absences of ER or PR were also significantly associated with a remission in both the CMF and CAF groups. p53 mutation was not correlated to the response rate of either chemotherapy regimen. There was no significant relationship between the expression of c-erbB2 and the response rate in the CMF group, but a higher percentage of patients with c-erbB2 positive tumors had a response to the CAF regimens. CONCLUSION: p53 mutation is not significantly associated with tumor response, but the over-expression of c-erbB2 can predict the response to the different chemotherapies used in breast cancer.
Biopsy, Needle ; Breast Neoplasms* ; Doxorubicin ; Drug Therapy* ; Estrogens ; Fluorouracil ; Humans ; Immunohistochemistry ; Lymph Nodes ; Magnetic Resonance Imaging ; Receptors, Progesterone ; Ultrasonography

No abstract available.
Breast Neoplasms* ; Breast* ; Ion Transport* ; Sodium Iodide* ; Sodium*

No abstract available.
Breast Neoplasms* ; Breast* ; Ion Transport* ; Sodium Iodide* ; Sodium*

PURPOSE: Locoregional recurrence of breast cancer after surgery has been regarded as a harbinger of distant metastases. The present study was undertaken to determine survival following surgical excision of isolated locoregional recurrence and to analyze prognostic factors for their impact on survival after locoregional recurrence. Also, this study may provide information on the group that benefits from surgical management. METHODS: From March 1993 to December 1998, of 43 patients with isolated locoregional recurrence after breast cancer surgery, 26 patients were treated with surgical excision with or without irradiation. Survival was retrospectively analyzed according to prognostic factors. RESULTS: The median follow-up was 15 months. The 3-year disease-free survival rates were 50% for locoregional recurrences treated with surgical resection and 6% for patients treated without surgery (p=0.04), and the overall survival rates were 63% and 14%, respectively (p=0.07). Univariative analysis demonstrated that the initial axillary node status and the disease-free interval were significant prognostic factors for overall survival (p=0.04 and p=0.06, respectively). The disease-free interval from surgery to recurrence was also a significant prognostic factor for disease-free survival (p=0.03). CONCLUSION: These results suggest that patients suffering from isolated locoregional recurrence of breast cancer after a long disease-free interval and an initial node negative status may survive for long periods of time with aggressive surgical treatment.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Survival Rate

No abstract available.
Breast Neoplasms* ; Breast* ; Ultrasonography*