In Korea, the incidence of pancreatic cancer was 9th and the mortality was 5th in 2002. The unique modality to cure is a surgery, however the resectability is around 10~20%. The survival data of pancreatic cancer after resection in '60s ~'70s were disappointing; operative mortalities were as high as 20~30% with 5-year survival rates were about 5%. However, from '90s, there have been several papers which reports the operative mortalities less than 5% and the 5-year survival rates over 20% after resection. However it is not clear whether survival in pancreatic cancer after surgery has been really improving or not. Prognostic factors in pancreatic cancer after resection can be classified into 3 categories; factors related to the patient, the tumor and the surgeon. At present, the most important prognostic factors are tumor factors such as tumor size, lymph node metastasis, depth of invasion, and histological differentiation. The factors related to the minimal residual disease or molecular biologic studies would get more concern. Staging in the malignancy is very important in predicting the prognosis and determining the adjuvant therapies. Good stages should be a good prognosis predictor and be simple as well. In pancreatic cancer, TNM staging from AJCC/UICC has been used worldwide and the 6th edition was published in 2001. JPS (Japanese pancreatic society) staging for pancreatic cancer, compared to AJCC staging, is better in predicting the prognosis but somewhat complicated. Studies for the prognostic factors and staging for Korean pancreatic cancer cases should be followed.
Humans ; Incidence ; Korea ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Neoplasm Staging ; Neoplasm, Residual ; Pancreatic Neoplasms* ; Prognosis ; Survival Rate

Pancreatic cancer continues to pose a major problematic concerns of all forms of gastrointestinal malignancy because of its worst survival. Although the progressions were made in surgical treatment in terms of increasing resection rate and decreasing treatment related morbidity and mortality, the true survival rate remains below 3% today. Surgical options for surgrcal extent and types in pancreas cancer are based on its unique anatomy and physiology, catastrophic tumor biology, experience of surgeon, and status of patients or pancreas. Four main options exist for surgical extent and types in pancreas cancer. They include standard 'Whipple' pancreaticoduodenectomy (PD), pylorus preserving PD, distal pancreatectomy (left side pancreatectomy), and total pancreatectomy. Portal vein involvement with tumor is regarded as a anatomical extension of disease, and en bloc resection of portal vein with tumor is recommended if it is feasible technically, which is shown up in 2002 AJCC tumor staging for pancreas cancer. Comparing the survival times after standard and extended resection of pancreas head cancer no significant survival benefits demonstrated from the retro and prospective reports. PPPD may be superior to standard PD in respect to outcomes of nutrition and quality of life without any deleterious effect of long term survival or recurrence. Conclusively, in the future, multicenter prospective randomized trail should be carried out to clarify the effect of various options and to improve the survival times on th basis of standardization of surgical technique and evidence based data.
Biology ; Carcinoma, Pancreatic Ductal ; Head and Neck Neoplasms ; Humans ; Mortality ; Neoplasm Staging ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy ; Physiology ; Portal Vein ; Pylorus ; Quality of Life ; Recurrence ; Survival Rate

The ductal system of the pancreas, which is responsible for carrying acinar secretion to the duodenum, is perhaps the smallest epithelial component of the pancreas. However, most pancreatic tumors are of ductal origin, and a majority of these are ductal adenocarcinomas. Pancreatic carcinomas of ductal type can be separated into several categories: 1. Conventional ductal adenocarcinoma (tumors that form small tubular glands with luminal and intracellular mucin and are associated with marked stromal desmoplasia). 2. Unusual histological patterns of conventional ductal adenocarcinoma (e.g., foamy gland pattern, large duct pattern, vacuolated pattern, lobular carcinoma-like pattern). 3. Other carcinomas of ductal origin (e.g., colloid carcinoma, adenosquamous carinoma, squamous cell carcinoma, and undifferentiated carcioma). Most tumors in this last category usually have an associated component of conventional ductal adenocarcinoma, which provides evidence of their ductal origin. Precursors of pancreatic ductal adenocarcinoma have been recognized as proliferative epithelium of the ducts. Some lesions with minimal cytologic atypia were not regarded to be neoplastic and were designated hyperplasia or metaplasia, but molecular study revealed most ductal proliferative lesions as neoplastic. Thus the entire spectrum of ductal proliferative lesion is referred to as pancreatic intraepithelial neoplasia (PanIN).
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoma, Pancreatic Ductal ; Carcinoma, Squamous Cell ; Classification* ; Duodenum ; Epithelium ; Hyperplasia ; Metaplasia ; Mucins ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Phenobarbital ; Precancerous Conditions

No abstract available.
Aged ; Female ; Humans ; Liver Diseases/etiology/*radiography ; Superior Vena Cava Syndrome/*complications

No abstract available.
Bile Ducts, Extrahepatic/*pathology ; Biliary Atresia/*pathology ; Female ; Humans ; Infant, Newborn ; Liver/pathology

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is not infrequently found during the later stage, regarding that the autopsy report described its prevalence to be up to 50%. The most frequent sites are known to be the abdominal lymph nodes, lung and bone. However, metastasis to the nasal cavity and paranasal sinuses has been seldom reported, and to out knowledge, there is no Korean report describing extrahepatic metastasis of HCC to these sites. Recently we experienced a case of extrahepatic metastasis of HCC to the nasal cavity in a 50 year-old man with massive epistaxis refractory to conservative treatment. He was found to have a mass of soft tissue attenuation occupying the right nasal cavity at CT, which was biopsy-proven as metastatic HCC. Epistaxis was successfully treated by transcatheter arterial embolization.
Carcinoma, Hepatocellular/*secondary ; English Abstract ; Epistaxis/*etiology ; Humans ; Liver Neoplasms/*pathology ; Male ; Middle Aged ; *Nasal Cavity ; Nose Neoplasms/complications/diagnosis/*secondary

Mucinous cholangiocarcinoma, characterized by large quantities of mucin production, is a rare subtype of peripheral cholangiocarcinoma and usually shows rapid progression and a fatal outcome. We report here a case of mucinous cholangiocarcinoma in a 69 year-old man, who was infected with Clonorchis sinensis. Histologically, the tumor was an adenocarcinoma with extensive intracellular and extracellular mucin production, up to 70% of the tumor mass and there was frequent lymphovascular invasion of the tumor cells. The liver adjacent to the mass contained eggs of Clonorchis sinensis in the bile duct lumen and showed ductal epithelial hyperplasia, mucinous metaplasia and adenomatous proliferation of intramural glands. The patient was treated with a right hepatectomy. Four months after the surgery, the tumor recurred in the soft tissue of the right flank.
Aged ; Bile Duct Neoplasms/*complications/secretion ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*complications/secretion ; Clonorchiasis/*complications ; English Abstract ; Humans ; Male ; Mucins/secretion

BACKGROUND/AIMS: Data from previous studies on gastric acid secretion and the prevalence of H. pylori in liver cirrhosis patients remain poorly defined. H. pylori is a potential source of NH3, but the possible role of H. pylori in hepatic encephalopathy is not clear. The purpose of this study was to compare gastric acid secretion, the impact of H. pylori infection, and the production of NH3 between cirrhotic patients and healthy, matched controls. METHODS: Twenty-nine patients with liver cirrhosis (HBV, n=12; Alcohol, n=12; HCV, n=5) were matched with 33 healthy persons for age and sex. None of the patients or controls were being treated with antacids, H2-receptor blockers or proton pump inhibitors. The pH and NH3 concentration was measured in gastric juice obtained by endoscopy. H. pylori infection was diagnosed using the rapid urease test. The level of NH3 in venous blood was also measured. RESULTS: The average gastric pH was significantly higher in cirrhosis patients compared to controls (3.91 vs. 2.99, P<0.05). In addition, the prevalence of hypochlorhydria (defined as pH>4) was significantly greater in cirrhosis patients (45 vs. 21%, P<0.05). In contrast, the prevalence of H. pylori infection (62% vs. 58%) and gastric NH3 concentrations (3.4 vs. 3.3 mM/L) were similar between both groups. However, venous NH3 levels were significantly higher in cirrhotics than in controls (63.1 vs. 25.2 micro M/L, P<0.05). The patients with H. pylori infection had significantly higher gastric NH3 concentration (3.8 vs. 1.6 mM/L) and gastric pH (3.87 vs. 2.76, P<0.05) than those without infection, but no significant difference in venous NH3 levels were detected (39.6 vs. 48.1 micro M/L). In patients with cirrhosis, the presence of H. pylori infection was not correlated with either gastric or blood NH3 levels. CONCLUSIONS: The gastric pH of liver cirrhosis patients is higher than that of controls and a larger proportion of cirrhotic patients have hypochlorhydria. The prevalence of H. pylori in liver cirrhosis patients was similar to that in controls and no correlation was found between gastric and blood NH3 levels. Thus, H. pylori infection does not seem to play a major role in generation of elevated NH3 associated with hepatic encephalopathy.
Achlorhydria/complications ; Ammonia/analysis ; English Abstract ; Female ; Gastric Acid/secretion ; *Gastric Acidity Determination ; Helicobacter Infections/*complications/physiopathology ; *Helicobacter pylori ; Humans ; Hydrogen-Ion Concentration ; Liver Cirrhosis/*metabolism/microbiology/physiopathology ; Male ; Middle Aged

BACKGROUND/AIMS: Nitric oxide (NO) is a molecule involved in vascular dilatation and pathogen suppression. It also has immunologic and regulatory functions. Liver cirrhosis is characterized by an increased risk for bacterial infections, including spontaneous bacterial peritonitis (SBP). The role of NO in SBP which develops in cirrhosis has not been clearly established. The aim of this study was to investigate the role of NO in the pathogenesis of SBP and its clinical usefulness for prediction of disease prognosis. METHODS: This study was designed to investigate the changes of ascites NO in the course of treatment. Nitric oxide metabolite (nitrites+nitrates [NOx]) was measured by chemiluminescence in 84 ascites samples obtained from 84 cirrhotic patients. Among them, the 38 patients with SBP were treated with cefotaxime 2.0 g, q 12hr for 7 days. In 24 of SBP patients, ascites was obtained consecutively before treatment (day 0), during treatment (day 2), and after treatment (day 7). RESULTS: Ascites NO levels in the patients with SBP (n=38; 82.3 +/- 14.4 micro M) were not different from those in patients with sterile ascites (n=46; 54.6 +/- 13.0 micro M). There was no significant change of NO levels in sequential ascites samples during antibiotic treatment. Ascites NO level before treatment was significantly higher in SBP patients who responded to antibiotics (n=26; 101.86 micro M/L) than that in SBP patients who did not respond to antibiotics (n=12; 40.03 micro M/L, P=0.044). A significant direct correlation was found between ascites and serum NO levels before treatment (Pearson correlation, r2=0.86, P=0.001). Among the SBP patients, treatment response rate to antibiotics were significantly higher in those patients with pretreatment NO level>or=80 micro M/L in multivariate analysis. CONCLUSIONS: Ascites NO level was not different between ascites from SBP patients and ascites from cirrhotic patients with sterile ascites. There were no changes of ascites NO in SBP patients during treatment. Therefore ascites NO was not useful to predict the progress of SBP. Ascites NO levels reflect serum NO levels, and the patients with higher NO level may have better response to antibiotics.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/*chemistry ; Bacterial Infections/complications/*drug therapy ; Cefotaxime/therapeutic use ; English Abstract ; Female ; Humans ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Nitric Oxide/*analysis ; Peritonitis/complications/*drug therapy ; Prognosis

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is associated with dyslipidemia, obesity, and insulin resistance, which are the main features of metabolic syndrome. First, we examined the prevalence of metabolic syndrome among patients with NAFLD. We then compared the prevalence of metabolic syndrome in simple steatosis with that in nonalcoholic steatohepatitis (NASH). Finally, we sought to identify clinical factors associated with the stage of liver fibrosis. METHODS: From November 2002 to March 2004, we enrolled consecutive 25 patients with NAFLD from patients visiting outpatient clinic. The 17 controls were healthy persons who visited our health promotion center. We compared the clinical and biochemical data of the NAFLD group with those of the control group. Using histologic findings, we divided NAFLD into simple steatosis and NASH. We then compared the clinical and biochemical data of the simple steatosis group with those of the NASH group. RESULTS: Fourteen patients (14/25, 56%) had metabolic syndrome in the NAFLD group. There was no difference in the prevalence of metabolic syndrome between the simple steatosis (5/10, 50%) and the NASH group (9/15, 60%). We found significant differences in cardiovascular risk factors between the two groups, but homeostasis model assessment insulin resistance was the only significantly different factor between the simple steatosis group and the NASH group. In addition, no difference in histological features was found between NASH with metabolic syndrome and without metabolic syndrome. CONCLUSIONS: A considerable number of patients with NAFLD had metabolic syndrome. There was a close correlation between NAFLD and metabolic syndrome. We could not find any cardiovascular risk factors that could predict a severe fibrosis.
Adult ; English Abstract ; Fatty Liver/*complications ; Female ; Humans ; Male ; Metabolic Syndrome X/*complications ; Middle Aged