PURPOSE: The aim of this study was to analyse expression of COX-2, VEGF, CD34 and MMP-9 in colonic adenocarcinoma, and correlate this expression with clinicopathologic parameters. METHODS: Tumor sections of 66 consecutive patients undergoing potentially curative surgery for an adenocarcinoma of the colon were immunohistochemically stained using antihuman-COX-2, VEGF, CD34 and MMP-9 antibodies. For the evaluation of COX-2, VEGF and MMP-2 expression, those cases showing the respective antigen expression in more than 10% of the tumor cells were considered to be positive. Microvessel density (MVD) by CD34 expression was evaluated as the number of vessels per high-power field(X200). The mean value for the three fields were recorded as the MVD for each tumor. RESULTS: Although COX-2 expression was not correlated with any clinicopathologic factors, it showed the increased expression according to T-stage, lymph node metastasis and clinical staging. Microvessel density with CD34 expression was correlated with lymph node metastasis and clinical staging. MMP-9 expression was correlated with clinical stage. Microvessel density was correlated with COX-2, VEGF and MMP-9 expression. CONCLUSION: This results indicate that angiogenesis is a complex process that involves multiple factors including COX-2, VEGF, CD34 & MMP-9, and suggest that microvessel density with COX-2 and MMP-9 expression are related to tumor progression and metastasis of colonic adenocarcinoma.
Adenocarcinoma* ; Antibodies ; Colon* ; Humans ; Lymph Nodes ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor A*

PURPOSE: Although immunohistochemically detectable metallothionein (MT) overexpression has been described in proliferation epithelial tumor cells, the clinical significance of the expression remains to be elucidated. Therefore, the present article is focused on evaluating the possible significance of MT expression in colonic adenocarcinoma and its relationship with p53 overexpression, Topoisomerase II-alpha as new cell proliferating marker and apoptosis. METHODS: The following formalin-fixed paraffin embedded surgical or biopsied samples were immunohistochemically stained for MT, p53 and topoisomerase II-alpha, and performed in situ TUNEL method for evaluation of apoptotic cell ; normal control mucosa (78 cases), tubular adenomas (20 cases) and adenocarcinomas with various degree of differentiation (78 cases). RESULTS: The MT immunohistochmical reactivity was decreased in colonic adenocarcinoma than that of normal glandular epithelial and tubular adenoma, with the frequency of MT expression in colonic adenocarcinoma depending upon tumor differentiation only. But the frequency of p53 expression was correlated with T-stage, lymph node metastasis and clinical staging, while topoisomerase II-alpha expression and apoptosis in colonic adenocarcinoma were correlated with lymph node metastasis and clinical staging. The immunohistochemical expression of MT and p53 expression in colonic adenocarcinoma was inversely correlated. Also, the inverse correlation between MT expression and expression of toposiomerase II-alpha indices and apoptotic indices were noted. CONCLUSION: These data suggest that MT expression may play a role in proliferative activity and apoptosis in colonic adenocarcinoma. Although MT expression is correlated to tumor differentiation, further studies of a possibility of prognostic factor, such as p53, are required for the determination of significant relationships in other clinicinopathologic indices.
Adenocarcinoma* ; Adenoma ; Apoptosis* ; Colon* ; In Situ Nick-End Labeling ; Lymph Nodes ; Metallothionein* ; Mucous Membrane ; Neoplasm Metastasis ; Paraffin

PURPOSE: When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. MATERIALS AND METHODS: We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothoax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. RESULTS: Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: < or = 1 cm in distance for group 1 (81.8%) and group 2 (18.2%), and > 1 cm in distance for group 1 (30%) and group 2 (70%), p < 0.03. Yet the number of biopsies, the presence or absence of emphysema at the biopsy site and the size of the pulmonary nodules were not related to the progression of pneumothorax (p > 0.05). CONCLUSION: When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule.
Biopsy* ; Biopsy, Needle* ; Emphysema ; Fluoroscopy ; Humans ; Lung ; Needles* ; Pleura ; Pneumothorax*

PURPOSE: Recurrent bile duct stones, following biliary surgery, cause many difficult problems and reoperation on the biliary tract has limitation due to high mortality and morbidity. In recent years, various non-operative modalities for the management of recurrent stone have been developed and reoperation on biliary. This study was designed to determine the factors contributing to the success rate, and to investigate the optimal treatment method, of reccurrent biliary stones. METHODS: Thirty-nine patients, treated by percutaneous transhepatic stone removal (PTBD group), and 42 treated by a common bile duct exploration (operation group), at Chung- Ang University Hospital, between January 1999 and August 2002, were retrospectively analyzed. RESULTS: Complete removal (Success) was achieved in 82.1 and 86.1% of the cases of the PTBD and operation groups, respectively. There were no significant differences observed relating to the sex, age, duration of hospital stay, cost, success rate. However, the complication rate was significantly decreased in the PTBD group (8 cases (20.5%) vs. 22 cases (51.2%) P=0.0057). CONCLUSION: Form the comparison of the operation and PTBD groups, similar success rates were observed. Percutaneous transhepatic stone removal is also an effective method for the management of recurrent bile duct stones. After studying more cases, re-evaluation must be performed concerning the potential advantages of percutaneous transhepatic stone removal.
Bile Ducts ; Biliary Tract ; Common Bile Duct ; Humans ; Length of Stay ; Mortality ; Reoperation ; Retrospective Studies

OBJECTIVE: We aimed to assess the efficacy of neoadjuvant chemotherapy followed by surgery (NACT+S), and compared the clinical outcome with that of concurrent chemoradiotherapy (CCRT) in patients with International Federation of Gynecology and Obstetrics (FIGO) IB-IIB cervical cancer. METHODS: We reviewed 85 patients with FIGO IB-IIB cervical cancer who received NACT+S between 1989 and 2012, and compared them to 358 control patients who received CCRT. The clinical application of NACT was classified based on the following possible therapeutic benefits: increasing resectability after NACT by reducing tumor size or negative conversion of node metastasis; downstaging adenocarcinoma regarded as relatively radioresistant; and preservation of fertility through limited surgery after NACT. RESULTS: Of 85 patients in the NACT+S group, the pathologic downstaging and complete response rates were 68.2% and 22.6%, respectively. Only two young patients underwent limited surgery for preservation of fertility. Patients of the NACT+S group were younger, less likely to have node metastasis, and demonstrated a higher proportion of FIGO IB cases than those of the CCRT group (p≤0.001). The 5-year locoregional control, progression-free survival, and overall survival rates in the NACT+S group were 89.7%, 75.6%, and 92.1%, respectively, which were not significantly different from the rates of 92.5%, 74%, and 84.9% observed in the CCRT group, respectively (p>0.05). CONCLUSION: NACT+S has no therapeutic advantages over CCRT, the standard treatment. Therefore, NACT+S should be considered only in selected patients through multidisciplinary discussion or clinical trial setting.
Adult ; Aged ; Aged, 80 and over ; *Chemoradiotherapy ; Chemotherapy, Adjuvant ; Female ; Humans ; *Hysterectomy ; Middle Aged ; *Neoadjuvant Therapy ; Neoplasm Staging ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/diagnosis/mortality/pathology/*therapy

The chondroma is a benign tumor that arises from the primordial cartilaginous skeleton. Chondromas can occur in the head and neck area, usually larynx, maxilla and base of the skull, but those arising from the basisphenoid and basiocciput are extremely rare. Most of the skull base chondromas described in the literature are extended intracranially, but only five cases of extracranial chondroma of the skull base have been described so far in the world literature. The authors have experienced one case of extracranial chondroma of the skull base with good result by extirpation of the lesion through sublabial-transseptal endoscopic approach.
Chondroma* ; Head ; Larynx ; Maxilla ; Neck ; Skeleton ; Skull Base* ; Skull*

Graves disease, an autoimmune endocrine disorder, which causes defects in cellular and humoral immunity, is associated with insulin-dependent diabetes mellitus, Addisons disease, pemicious anemia, and rheumatoid arthritis. Graves disease is associated with various neuro-muscular disorders, such as myopathy, exophalmous oculopathy, periodic paralysis, myastenia gravis and rarely Guillain-Barre syndrome. Guillain-Barre syndrome is considered as an autoimmune disease which can occur concurrently with other autoimmune disorders. This syndrome is characterized by segmental demyelination and axonal degeneration in electrophysiology due to autoantibody to nervous systems via cellular and humoral autoimmunity. In Graves disease, the exact mechanism of the associated Guillain-Barre syndrome is not well understood but it is considered that the autoimmunity is the leading cause of development of both diseases. A 37 year-old man had suffered from thyrotoxic symptoms and progressive symmetrical muscular paralysis. In nerve conduction velocity studies, the result shows peripheral neuropathy; axonopathy; myelinopathy; motor nerve and sensory nerve derangement; right first sacral nerve neuropathy; and decreased CMAP amplitude. The patient was treated with propylthiouracil and high dose intravenous immunoglobulin (400mg/kg/day for Sdays). He responded to the therapy well and became euthyroid state with improvement of muscle weakness. We report a case of Graves' disease associated with Guillain-Barre syndrome with brief review of literature which shows a possible relationship between both diseases.
Addison Disease ; Adult ; Anemia ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Autoimmunity ; Axons ; Demyelinating Diseases ; Diabetes Mellitus, Type 1 ; Electrophysiology ; Graves Disease* ; Guillain-Barre Syndrome* ; Humans ; Immunity, Humoral ; Immunoglobulins ; Muscle Weakness ; Muscular Diseases ; Nervous System ; Neural Conduction ; Paralysis ; Peripheral Nervous System Diseases ; Propylthiouracil

OBJECTIVE: To compare the advantages and disadvantages between total vaginal hysterectomy (VTH) and laparoscopically assisted vaginal hysterectomy (LAVH) including the indications and safety. METHODS: We reviewed the medical records of patients who underwent VTH from July 1998 to December 1999 and those who underwent LAVH from January 2000 to April 2002. We evaluated age, parity, previous abdominal operations, indications for hysterectomy, combined operations, operation time, bleeding amount, hemoglobin change, weight of uterus, and postoperative complications. RESULTS: 1. Age was not a notable factor but parity was significantly lower in LAVH group. 2. In VTH group, 48% of patients had previous operations compared with 46% in LAVH group. 3. The most common indication for hysterectomy of both group was uterine myoma. 4. The weight of hysterectomized specimen was 256 g in VTH group and 237 g in LAVH group. 5. In VTH group, 38% received concurrent surgical procedures of which colporrhaphy was the most common (14 cases). In LAVH group, 72.5% received concurrent surgical procedures of which salpingoo- phorectomy was most common. 6. The operation time showed a notable difference; 78.6 min. in VTH group and 105.4 min. in LAVH. 7. There was no significant difference in bleeding amount and hemoglobin change. 8. Postoperative complication was higher in VTH group (14%) than LAVH group (7.5%). However all the patients recovered with conservative treatment and close observation. CONCLUSION: Both VTH and LAVH had the following advantages compared with abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages, lower prevalence. In this study we found out that in VTH, the procedure could be done safely even if the uterus was big or with previous abdominal operations. Limited operation field and the fact that we couldn't check the abdominal cavity were some disadvantages. In comparison, LAVH offered a view of the abdominal cavity which make easy adnexal operation but because of expensive operative tools, cost was a problem. In order to satisfy the patient and lower the cost, appropriate study on the indications and training on procedures will be necessary.
Abdominal Cavity ; Bleeding Time ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Leiomyoma ; Length of Stay ; Medical Records ; Parity ; Postoperative Complications ; Prevalence ; Uterine Prolapse* ; Uterus

OBJECTIVE: To compare cervical dilatation efficacy and safety of intravaginal misoprostol with that of cervical laminaria tent insertion in endometrial curettage due to abnormal uterine bleeding METHOD: Patients requesting endometrial curettage due to abnormal uterine bleeding were randomized into two group. In group I (n=53), 100 g tablet of misoprostol was placed in the posterior vaginal fornix at midnight. In Group II (n=54), laminaria tent number 5 was inserted in cervical canal at midnight. Endometrial curettage was performed on the next morning. The degrees of cervical dilatation were measured by Hegar dilator just before endometrial curettage. Both groups were compared about cervical dilatation efficacy and side effect. RESULT: The degrees of cervical dilatation were 8.8+/-1.1 mm in group I and 9.3+/-1.9 mm in group II. There was no significant statistical difference. (P=0.134) The mean intervals from the use of misoprostol or laminaria to endometrial curettage were 704+/-140 minutes in group I and 829+/-156 in group II. In group I, mild fever (less than 38 degrees) was observed in four women and one complained mild abdominal pain. In group II, five women revealed mild fever and fifty women complained abdominal discomfort. All didn't need any medication or special therapy. CONCLUSION: Intravaginal misoprostol was appeared as efficacious as laminaria tent in cervical dilatatory effect before endometrial curettage in abnormal uterine bleeding patients. It was considered more convenient, safer and more cost effective method compared than cervical laminaria tent in cervical preparation before endometrial curettage.
Abdominal Pain ; Curettage* ; Female ; Fever ; Humans ; Labor Stage, First ; Laminaria* ; Misoprostol* ; Pregnancy ; Uterine Hemorrhage*