PURPOSE: The aim of the present study was to find the proper treatment for improving the survival of patients with hilar cholangiocarcinoma by analyzing many factors affecting the patients' survival. METHODS: Between January 1991 and April 2006, 152 patients with hilar cholangiocarcinoma and who underwent surgery were reviewed. One hundred fifteen patients underwent attempted curative resections, and 37 patients had findings that precluded any further intervention. Of the 115 patients who underwent curative resection, 38 patients underwent resection of the extrahepatic bile duct only and 77 patients underwent concomitant hepatectomy. The clinicopathogical data of these patients was analyzed. RESULTS: The 3 year overall survival and disease-free survival rates were 41.2% and 52.5%, respectively. The overall recurrence rate was 40.9% (47/115) and of patients with recurrence, those who had been treated aggressively survived longer than those who had been treated conservatively (P=.039). Of the patients' factors that affected survival, only preoperative weight loss was meaningful (P=.024). Of the histologic factors, tumor cell differentiation (P=.048) and the presence of lymph node metastasis (P=.028) were associated with survival. Of the perioperative factors, only achievement of complete tumor resection affected survival. On comparing between resection of the extrahepatic bile duct only and concomitant partial hepatectomy, the latter achieved more definitely negative histologic margins (63.6% vs 39.5%, respectively, P=.037) at the expense of a more prolonged operation time and hospital stay and greater complications. CONCLUSION: Preoperative weight loss, poor differentiation, lymph node metastasis and a positive histologic margin could be included in the poor prognostic factors affecting survival. Concomitant liver resection could be rationalized in that it could attain a more negative histologic margin for treating resectable hilar cholangiocarcinoma, but it could increase mortality and morbidity rates.
Bile Ducts, Extrahepatic ; Cell Differentiation ; Cholangiocarcinoma* ; Disease-Free Survival ; Hepatectomy ; Humans ; Length of Stay ; Liver ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Recurrence ; Weight Loss

No abstract available.
Radiography* ; Radionuclide Imaging* ; Sacroiliitis* ; Spondylitis, Ankylosing*

PURPOSE: The aims of this study were to find the risk factor and outcomes of patients with an early recurrence (ER) of a hepatocellular carcinoma (HCC) after liver transplantation (LT) and the actual impact of transarterial chemoembolization (TACE) before LT for a HCC on patient survival and HCC recurrence. METHODS: Ninety-eight cases of adult LT, performed between September 1995 and January 2006, were evaluated. The risk factors and prognosis of patient with a HCC after transplantation for an ER, defined as a recurrence within 6 months of transplantation, and the effects of Pre-LT TACE on the disease-free and overall survival rates, as well as the patterns of recurrence after LT, were studied. RESULTS: A total of 18 patients (18.4%) experienced a HCC recurrence after LT; 10 and 8 patients had early and late recurrences, respectively. From a univariate analysis, the serum alpha-fetoprotein (P=0.003), tumor size (P=0.003), serosa invasion (P=0.000), tumor grade (P=0.011) and vascular invasion (P=0.014) were statistically significant risk factors for an ER. From a multivariate analysis, the presence of serosa invasion of a HCC was the only independent risk factor for an ER (P=0.009; OR=9.407: 95% CI, 1.764~50.164). There was no difference in the disease free sur-vival and overall survival rates between the TACE and without TACE groups, but the extrahepatic recurrence rate was higher in the TACE than without TACE group. CONCLUSION: Serosa invasion by a HCC is independently associated with an ER of HCC after LT. Pre-LT TACE does not influence the disease-free and overall survivals after LT for a HCC.
Adult ; alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Humans ; Liver Transplantation* ; Liver* ; Multivariate Analysis ; Prognosis ; Recurrence* ; Risk Factors* ; Serous Membrane ; Survival Rate

PURPOSE: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. METHODS: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. RESULTS: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388+/-29 min vs. 459+/-21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.037]; POD3, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.032]; POD7, 4.69+/-0.35 vs. 3.88+/-0.25 [p=0.034], respectively). CONCLUSION: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.
Amylases ; Humans ; Mucous Membrane ; Operative Time ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative ; Ursidae

PURPOSE: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. METHODS: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. RESULTS: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388+/-29 min vs. 459+/-21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.037]; POD3, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.032]; POD7, 4.69+/-0.35 vs. 3.88+/-0.25 [p=0.034], respectively). CONCLUSION: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.
Amylases ; Humans ; Mucous Membrane ; Operative Time ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative ; Ursidae

PURPOSE: The aim of this study is to evaluate the significance of tumor size as a predictor of biological tumor behavior and to get some information to decide on the proper operative modality by assessing the survival rate for HCC patients. METHODS: Between January 1995 and September 2006, 278 patients with hepatocellular carcinoma (HCC) underwent liver surgery at our hospital. Of the 278 cases, 176 cases (63.3%) underwent liver resection and 102 cases (36.4%) underwent liver transplantation (LT). All the patients were divided into 4 groups according to their tumor size; <2 cm, 2~5 cm, 5~10 cm and >10 cm. We analyzed the pathologic outcomes, survival rates and the outcome of each operative modality, as related to the tumor size. RESULTS: The incidence of vascular invasion increased with the tumor size (<2 cm: 4.6%, 2~5 cm: 23.3%, 5~10 cm: 32.6%, > 10 cm: 50.0%)(P<0.005). For the less than 2 cm sized tumor group, the Edmonson-Steiner (E-S) grade III or IV was present in 40.7% of the patients, as compared with 78.9% in the group of patients with a tumor larger than 10 cm (P=0.005). The patients with a larger tumor showed a poorer survival rate. Liver transplantation showed the longer disease free survival compared to liver resection, though there was no significant benefit in the survival rate. Patients with a small sized tumor showed a better outcome when they underwent liver transplantation and patients with a large sized tumor did better when they underwent liver resection. CONCLUSION: Tumor size can be used as a preoperative predictor of the pathologic outcome when considering that the larger size of tumor the patients had, the more prevalent was vascular invasion, the tumor cell grade was more advanced and the survival rate was poorer. For patients with small sized HCC, liver transplantation can be considered the appropriate treatment modality.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Hepatectomy ; Humans ; Incidence ; Liver ; Liver Transplantation ; Survival Rate

PURPOSE: Portal vein thrombosis (PVT), which once had been considered a relative contraindication for living donor liver transplantation (LDLT), is no longer contraindication of LDLT owing to technical achievement but could be remained as one of risk factor affecting patients. The aim of the present study was to improving outcomes of LDLT of patients with PVT by analyzing patients with PVT. METHODS: Between January 2000 and May 2006, 246 cases of LDLT in adult using right lobe were performed. The presence of PVT was preoperatively evaluated by CT and/or MR angiography. The patients were subdivided according to presence and characteristics of PVT; No PVT (n=196; 79.7%), Partial PVT (n=39; 15.9%) and Total PVT (n=11; 4.4%) and characteristics of each group were analyzed. RESULTS: Preoperatively, only the incidence of variceal bleeding was significantly higher in patients with PVT (P<05). Intraoperatively, larger amounts of transfused RBC were needed in PVT group and postoperatively, there were prolonged stay in ICU and higher incidence of hemorrhagic complications in PVT group. Portal inflow was reestablished by thrombectomy and end-to-end anastomosis without vessel graft in 97.4%(38/39) of partial PVT and in 54.5%(6/11) of total PVT. Cryopreserved veins were used as interposition (n=1) or jump (n=4) grafts and an autologous iliac vein was used as a jump graft (n=1). Of 5 cases of jump grafts, 2 cases were anastomosed to coronary vein, and 3 cases to superior mesenteric vein. The patency rate using vessel grafts was 83.3%(5/6) and overall patency rate including thrombectomy cases was 98.0%(39/40). CONCLUSION: Regardless of operative methods and materials, higher patency rate of portal vein could be achieved so that operation of patients with PVT could be undertaken safely without increased mortality.
Adult ; Angiography ; Coronary Vessels ; Esophageal and Gastric Varices ; Humans ; Iliac Vein ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors* ; Mesenteric Veins ; Mortality ; Portal Vein* ; Risk Factors ; Thrombectomy ; Transplants ; Veins ; Venous Thrombosis*

PURPOSE: Virulent gene expression in Staphylococcus aureus is controlled by regulators such as the accessory gene regulator (agr). Strains can be divided into four major agr groups (agr I-IV) on the basis of agrD and agrC polymorphisms. The purpose of this study was to define the proportion of agr I, II, and III polymorphisms and to compare the clinical characteristics between group I and non-group I polymorphisms of methicillin-resistant Staphylococcus aureus (MRSA) strains in a Korean tertiary care teaching hospital. MATERIALS AND METHODS: A total of 158 clinical isolates were evaluated by RFLPs (restriction fragment length polymorphisms). RESULTS: The mean age of the patients was 50.2 +/- 21.9 years old. There were 74 (49.3%), 66 (44.0%), 10 (6.7%), 7 (4.4%), and 1 (0.6%) strains in agr group I, II, III, I + II, and I + III polymorphisms, respectively. Only ear infections were a statistically significant clinical parameter according to univariate (p=0.001) and multivariate analysis (OR, 4.721 (1.273-17.508), p=0.020). CONCLUSION: This study suggests that agr group I is the most prevalent in Korea, and ear infections are correlated with the group I polymorphism, which is a different clinical trend from western countries. It can also be inferred that community-acquired MRSA correlates with agr group I.

Purpose: The aim of the present study was to identify whether the percentages of T cell subset, the serum interferon-gamma (IFN gamma ) as a Th1 cytokine, soluble CD30 (sCD30) as a marker for activation of Th2 cytokine producing T cells, and intracellular cytokines (IL-2, IL-4) can predict the acute cellular rejection episodes of liver transplant patients. Methods: Pretransplant and posttransplant sera on days 1, 3 and 7 after surgery of 88 adult living donor liver transplant recipients were tested for the percentage of T cell subset (CD3+, CD4+ and CD8+ T cells), IL-2, IL-4 production by peripheral mononucleated cells with fluorescence activated cell sorter analysis and for the serum IFN gamma , sCD30 concentrations with commercial ELISA kits. Recipients were subdivided into three groups as control (n=51), ELE (the group which showed elevated liver enzyme but RAI score <2. n=25), and AR (the group with acute rejection which showed RAI score > or =3. n=13). The differences in the level of cytokines among each group were analyzed. Results: The percentages of CD3+ T cell subset at preoperatively and day 1, 7 after surgery in AR were higher than those of control (P <0.05). The IL-2 production in AR was the highest and the IL-4 production was the lowest on posttransplant 7th day among three groups without significance. AR had a significantly higher pretranspant IFN gamma concentration than control (P <0.05). The pretransplant serum level of sCD30 was not different between the control and AR. However, in comparison with control, which showed a steadily decreasing serum sCD30 level after transplantation, 12 of the 14 patients in the AR showed an increase in their sCD30 levels from day 1 to day 3 after transplantation (P <.05). Conclusion: The measurement of serum IFN gamma and sCD30 during pre- and early post-LDLT period might be helpful to evaluate the risk of the occurrence of liver allograft rejection.
Adult ; Allografts* ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Fluorescence ; Humans ; Interferon-gamma ; Interleukin-2 ; Interleukin-4 ; Liver* ; Living Donors ; T-Lymphocytes ; Transplantation

PURPOSE: Even though adipose tissue-derived stem cells (ADSCs) have been spotlighted as a possible alternative for liver transplantation in an experimental setting, the mechanism by which ADSCs improve liver dysfunction remains poorly characterized. The objective of this study was to evaluate the therapeutic ability of undifferentiated ADSCs, and find a few clues on how ADSCs alleviate liver damage by comparing the transplantation routes. METHODS: In vitro generated human ADSCs were checked for surface markers and stage-specific genes for characterization. Afterwards, they were transplanted into C57BL/6 mice with CCl4-induced liver injury. The transplantations were made via tail vein, portal vein, and direct liver parenchymal injection. At 1 and 3 post-transplantation days, serum biochemical parameters and/or liver specimens were evaluated. RESULTS: We have shown here that ADSCs have the characteristics of mesenchymal stem cells, and belong to endodermal and/or early hepatic differentiation stage. After transplantation into the mice with acute liver failure, markers of liver injury, such as alanineaminotransferase, aspartateaminotransferase, as well as ammonia, decreased. Of these transplantation routes, transplantation via tail vein rendered the most prominent reduction in the biochemical parameters. CONCLUSION: Undifferentiated ADSCs have the ability to improve hepatic function in mice with acute liver injury. Moreover, our transplantation route study supports the theory that ADSCs in systemic circulation can exert endocrine or paracrine effects to ameliorate the injured liver.
Ammonia ; Animals ; Endoderm ; Humans ; Liver ; Liver Diseases ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Mesenchymal Stromal Cells ; Mice ; Portal Vein ; Stem Cell Transplantation ; Stem Cells ; Transplants ; Veins