PURPOSE: Extra-thyroidal extension has been recognized as a poor prognostic factor for increased regional recurrence risk in papillary thyroid carcinoma, and is known to require treatment that is more aggressive. In the recent UICC TNM 6th Classification, an extra-thyroidal extension was divided into a minimal extra-thyroidal extension (T3) and a massive extra-thyroidal extension (T4). The aim of this study was to investigate the clinical effect of a minimal extra-thyroidal extension of a papillary carcinoma for the recurrence of regional cervical lymph nodes. METHODS: We retrospectively studied 154 patients with papillary thyroid carcinoma where a thyroidectomy was performed from Feb. 2003 to May. 2006 at the Department of Surgery, with the exclusion of 6 patients with a massive extra-thyroidal extension. We divided the cases into a no extra-thyroidal extension group and a minimal extra-thyroidal extension group according to the grading of the extra-thyroidal extension. The grading of the extra-thyroidal extension was based on both pathological findings and intraoperative surgical findings. Clinicopathological factors associated with each group were analyzed by univariate and multivariate analysis. We divided the cases into two groups according to age (<45 yrs, > or =45 yrs) and lymph node status (positive, negative), and compared each group with regards to disease free survival according to the grading of the extra-thyroidal extension. RESULTS: By univariate analysis, a minimal extra-thyroidal extension was related to lymph node metastasis, tumor size, mutifocality (P<0.05), and was not related to cervical lymph node recurrence statistically (P=0.108). Cervical lymph node recurrence was related to being male, lymph node metastasis and tumor size (P<0.05). By multivariate analysis, a minimal extra-thyroidal extension was independently related to tumor size, multifocality, and lymph node metastasis (P<0.05). In both groups with regards to age and lymph node status, a minimal extra-thyroidal extension was not statistically related to disease free survival (P>0.05). CONCLUSION: We need to downstage to less than T3 for a minimal extra-thyroidal extension because there is no significant difference in disease free survival according to the grading of an extra-thyroidal extension in patients with papillary thyroid carcinoma.
Carcinoma, Papillary ; Classification ; Disease-Free Survival ; Humans ; Lymph Nodes* ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and METHODS: From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using alpha-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( <2500gm), prematurity( <37 gestational weeks), placenta previa, preterm premature rupture of membranes(PPROM), pregnancy induced hypertension(PIH),abruptio placenta, and intrauterine fetal death(IUFD). The predictor markers included over 35years, elevated alpha-fetoprotein (AFP), elevated human chorionic gonadotropin(hCG), lowered unconjugated estriol (uE3), and a false positive screen for Down syndrome. RESULTS: Mean age and mean gestational weeks in the study were 30+/-4.8 years and 17.1 weeks respectively. The adverse pregnancy outcomes were 357 LBW(6.8%), 253 prematurity(4.8%), 108 placenta previa(2.0%), 68 PPROM(1.3%), 66 PIH(1.3%), 24 abruptio placenta(0.5%), and 20 IUFD(0.4%). In univariate analysis, over 35 years was significantly associated with abruptio placenta, prematurity, and placenta previa, elevated MS-AFP( >2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (<0.75) associated with IUFD, abruptio placenta, LBW, and prematurity.(P <0.05). In multivariate logistic regression analysis, IUFD was significantly associated with only elevated MS-AFP, LBW associated with elevated MS-AFP, elevated MS-hCG, and lowered uE3, PIH associated with only elevated MS-AFP, PPROM only elevated MS-AFP, prematurity only elevated MS-AFP, and placenta previa over 35 years, elevated MS-hCG.(P <0.05). However, abruptio placenta was not significantly associated with predictor markers.(P >0.05) CONCLUSIONS: Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.
alpha-Fetoproteins ; Biomarkers ; Chorion ; Down Syndrome ; Estriol ; Female ; Fetus ; Humans ; Logistic Models ; Mothers ; Multivariate Analysis* ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, Second ; Pregnancy* ; Radioimmunoassay ; Rupture

The presence of erythroblasts within Kupffer cell was studied for transmission electron microscopically with 5 human fetal livers from 11 to 23 weeks of gestation during the high activity of hepatic hemopoiesis. By using continuous series of thin sections electron microscopically, the objective of the present study was to evaluate the relevance between a migrated erythroblast and a Kupffer cell, and the migration of erythroblasts within Kupffer cells in the sinusoidal lumen. During the examined period the sinusoidal wall consisted of endothelial cells and Kupffer cells, being deficient in basement membrane. Erythropoietic cell-Kupffer cell interaction was often found as the emperipolesis and adhesion between the cells in human fetal liver under electron microscopy. The cytoplasm of the emperipoletic Kupffer cell contained several mitochondria, rough endoplasmic reticuli, clear vesicles, electron dense bodies, cellular debris with shrunken chromatin of enucleated nuclei, intact enucleated nuclei, and erythroblast bearing vacuoles as intact erythroblasts. Intracellular erythroblasts in the Kupffer cell remain unaltered with their normal structure and showed mitosis, enucleation and migration of erythroblast into the sinusoidal lumen. And a clear zone of a vacuole was readily seen around the intracellular erythroblast within Kupffer cell. On occasion, the hypertropic Kupffer cell with interacellular erythroblasts virtually occluded the sinusoidal lining cell. Processing of a migrating emperipoletic erythroblast within a Kupffer cell, the erythroblast migrated via migration pore through the luminal cell membrane of the Kupffer cell into the sinusoidal lumen. An invasion of a proerythroblast into Kupffer cell or a migration of the cell into the sinusoidal lumen had been found in human fetal liver from 11 to 13 weeks of gestation. The results demonstrate that migration of emperipoletic erythroblasts within Kupffer cells occurs in human hepatic hemopoiesis. We suggest that emperipolsis may be one of the mechanisms that support the maturation of erythroblasts in human fetal liver.
Basement Membrane ; Cell Communication ; Cell Membrane ; Chromatin ; Cytoplasm ; Emperipolesis ; Endothelial Cells ; Erythroblasts* ; Humans* ; Kupffer Cells* ; Liver ; Microscopy, Electron ; Mitochondria ; Mitosis ; Phenobarbital ; Pregnancy ; Vacuoles

PURPOSE: p63 is a recently described as p53 homologue. Despite their structural homologies, they have different activities. p63 is a specific myoepithelial cell marker in normal breast tissue and it is expressed in a minority of breast cancers. The aim of this study was to evaluate the prognostic significance of the p63 expression in breast cancer. METHODS: The expression of p63 in breast cancer was determined by performing immunohistochemistry on 350 patients who underwent mastectomy at the Department of Surgery at Korea University Medical Center between January 1992 and September 2004. A retrospective analysis was conducted using the medical records. A tissue microarray was constructed, and immunohistochemical analysis for p63 was performed according to the usual methods. RESULTS: Among 350 patients, 40 (11.4%) showed a p63 expression. There was a significant correlation between p63 and the histologic grade. There were significant correlations of p63 with p53 and HER2/neu, respectively. In the basal type of breast cancer, the p63 expression was significantly higher than in the luminal type of breast cancer. The 5 year disease free survival rates were 69% in the patients with a p63 expression and 76% in the patients without a p63 expression, but there was no statistical difference. CONCLUSION: The present results indicate that a p63 expression is associated with a high grade tumor, a p53 expression and a HER2/neu expression in breast cancer, which are the known poor prognostic factors of breast cancer. Immunohistochemical subtyping shows that the p63 expression is a useful predictor for the basal type of breast cancer. In addition, this study suggests that the p63 expression in the basal type of breast cancer is associated with a poor prognosis.
Academic Medical Centers ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Korea ; Mastectomy ; Medical Records ; Phenobarbital ; Prognosis ; Retrospective Studies

STUDY DESIGN: A prospective study. OBJECTIVES: To report the results of new designed dual growing rods system for progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea. MATERIALS AND METHODS: Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb's angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period. RESULTS: Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb's angle of scoliosis curve was corrected from preoperative 80.2degrees(55-136) to 37.6degrees (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7degrees(12-101) and 38.3degrees(9-72) to 44.5degrees(12-75) and 18.8degrees(1-46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33-59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period. CONCLUSIONS: New designed dual growing rods system for pediatric patients with progressive spinal deformity is an effective and relatively safe method because of adequate correction and acceptable rate of complications.
Animals ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Osteochondrodysplasias ; Osteoporosis ; Preoperative Period ; Prospective Studies ; Scoliosis ; Soft Tissue Infections

PURPOSE: The incidence of deep vein thrombosis (DVT) after abdominal surgery has been thought to be lower in Asian populations than in Western populations, but there is little information on the incidence and risk factors in Korea. This study aimed to investigate the incidence of postoperative DVT and to analyze the risk factors for DVT in patients who were not administered perioperative prophylactic anticoagulation. METHODS: On a prospective basis, we evaluated the incidence of DVT and analyzed the risk factors associated with the development of DVT in 152 patients who were scheduled to undergo abdominal surgery for gastrointestinal, hepatobiliary, or pancreatic disease. All patients were examined by duplex scanning on both of their lower extremities during hospitalization. RESULTS: The mean patient age was 56.8+/-11.8 years, and the male to female ratio was 1:0.7. DVT occurred at a rate of 7.2% (11 patients). All the cases of DVT were asymptomatic and located in the calf veins. There was no statistically significant difference between the DVT and non-DVT groups for risk factors. CONCLUSION: The prevalence of DVT after abdominal surgery at a single institute was lower than levels currently suggested in Western countries. A larger, randomized, multi-center study is needed to establish the guidelines towards the prevention of DVT occurrence after abdominal surgery in Korea.
Asian Continental Ancestry Group ; Female ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Pancreatic Diseases ; Prevalence ; Prospective Studies ; Risk Factors ; Veins ; Venous Thrombosis