No abstract available.
Upper Extremity Deep Vein Thrombosis

BACKGROUND/AIMS: The prognosis of primary hepatocellular carcinoma is extremely poor because of its large size, portal vein thrpombosis, extrahepatic metastasis and underlying liver cirrhosis. The aim, of this study is to evaluate the usefulness of ultrasound screening test for early detection of hepatocellular carcinoma in high-ridk populations. METHODS: We analysed 119 patients who were diagnosed with hepatocellular carcinoma by ultrasonography screening test in Yonsei University Severance Hospital from the period of January 1990 to December 1996. RESULT: The mean follow-up duration to the diagnosis of hepatocellular carcinoma was 30 months (range 3-75). The number of patients with single lesion was 89(75%). The mean diameter of the tumor was 3.0 cm (range 1-10) , 82 patients (70%) had masses measured less than 3cm in diameter. The Number of patients with elevated serum alphafetoprotein level above 400ng/ml was 29(25%). The median survival was 28 months in screening group, significant compared with 7 months in control group (p<0.001). CONCLUSIONS: Ultrasound follow-up in high-ridk group of hepatocellular carcinoma mede it possible to detect small tumors in a high percentage of cases. This may lead to an increase in the number of potentially curable tumors and hence an increase in the overall survival rate. So ultrasound screening test is important in the high-ridk group of hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; Mass Screening* ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Survival Rate ; Ultrasonography*

PURPOSE: To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT). MATERIALS AND METHODS: We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). RESULTS: The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. CONCLUSION: Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.
Cause of Death ; Chemoradiotherapy* ; Constriction, Pathologic ; Diabetes Mellitus ; Esophageal Neoplasms* ; Esophagectomy* ; Follow-Up Studies ; Humans ; Hypertension ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Neoadjuvant Therapy ; Pneumonia ; Radiotherapy ; Respiratory Insufficiency ; Retrospective Studies

PURPOSE: Health-related quality of life (HRQOL) information related to radical prostatectomy (RP) is valuable for prostate cancer (PC) patients needing to make treatment decisions. We aimed to investigate HRQOL change in PC patients who underwent three types of RP (open, laparoscopic, or robotic) and compared their HRQOL with that of general population. MATERIALS AND METHODS: Patients were prospectively recruited between October 2014 and December 2015. European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) and PC-specific module (PR25) were administered before surgery (baseline) and at postoperative 3 and 12 months. At each time point, HRQOL was compared, and a difference of 10 out of 0-100 scale was considered clinically significant. RESULTS: Among 258 screened patients, 209 (41 open, 63 laparoscopic, and 105 robotic surgeries) were included. Compared to baseline, physical, emotional, and cognitive functioning improved at 12 months. Role functioning worsened at 3 months, but recovered to baseline at 12 months. Pain, insomnia, diarrhea, and financial difficulties also significantly improved at 12 months. Most PR25 scales excluding bowel symptoms deteriorated at 3 months. Urinary symptoms and incontinence aid recovered at 12 months, whereas sexual activity and sexual function remained poor at 12 months. Clinically meaningful differences in HRQOL were not observed according to RP modalities. Compared to the general population, physical and role functioning were significantly lower at 3 months, but recovered by 12 months. Social functioning did not recover. CONCLUSION: Most HRQOL domains showed recovery within 12 months after RP, excluding sexual functioning and social functioning. Our findings may guide patients considering surgical treatment for PC.
Cohort Studies ; Diarrhea ; Humans ; Prospective Studies ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Quality of Life ; Sexual Behavior ; Sleep Initiation and Maintenance Disorders ; Weights and Measures

OBJECTIVE: The aims of this study were to introduce surgical guidelines, and to evaluate the feasibility and safety of a robotic single-site staging (RSSS) operation for early-stage endometrial cancer. METHODS: Patients with a preoperative diagnosis of endometrial cancer (International Federation of Gynecology and Obstetrics stages IA to IB) from endometrial curettage and preoperative imaging studies were selected at Dongsan Medical Center from March 2014 to November 2015. All surgical procedures, including hysterectomy, salpingo-oophorectomy, bilateral pelvic node dissection, and cytology aspiration, were performed by robotic single-site instruments (da Vinci Si® surgical system; Intuitive Surgical, Sunnyvale, CA, USA). RESULTS: A total of 15 women with early-stage endometrial cancer underwent the RSSS operation. The median patient age and body mass index were 53 years (range, 37–70 years) and 25.4 kg/m2 (range, 18.3–46.4 kg/m2). The median docking time, console time, and total operative time were 8 minutes (range, 4–15 minutes), 75 minutes (range, 55–115 minutes), and 155 minutes (range, 125–190 minutes), respectively. The median retrieval of both pelvic lymph nodes was 9 (range, 6–15). There were no conversions to laparoscopy or laparotomy. CONCLUSION: The RSSS operation is feasible and safe in patients with early-stage endometrial cancer. In this study, operative times were reasonable, and the surgical procedure was well-tolerated by the patients. Further evaluation of patients with early-stage endometrial cancer should be performed in large-scale comparative studies using the laparoendoscopic, single-site staging operation to confirm the safety and benefits of the RSSS operation for early-stage endometrial cancer.
Body Mass Index ; Curettage ; Diagnosis ; Endometrial Neoplasms ; Female ; Gynecology ; Humans ; Hysterectomy ; Laparoscopy ; Laparotomy ; Lymph Nodes ; Obstetrics ; Operative Time

BACKGROUND/AIMS: Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. METHODS: All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. RESULTS: The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists' physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. CONCLUSIONS: In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients.
Aged ; Aged, 80 and over ; Cholecystitis, Acute/mortality/*surgery ; Cholecystostomy ; Critical Illness ; Cross-Sectional Studies ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Odds Ratio ; Survival Rate

Adenomyoepithelioma occurs often in the salivary gland. But adenomyoepithelioma of the breast is very rare, and diagnostic tools are not found. The biological characters of disease are not fully understood. These days, a few case was reported in Korea with development of pathologic diagnostic tools. At first, we diagnosed this case as breast cancer and did MRM operation. But this case was diagnosed as adenomyoepithelioma at the special immunohistochemistry stain. Most of the adenomyoepithelioma is benign disease, but this case was malignant change. We experienced one case of malignant adenomyoepithelioma of the breast and report the case with review of literatures.
Adenomyoepithelioma* ; Breast Neoplasms ; Breast* ; Immunohistochemistry ; Korea ; Salivary Glands

PURPOSE: According to the recent studies, it is shown that the polymorphism of Interleukin 1beta gene is associated with the incidence of gastric cancer caused by the Helicobacter pylori infection. Interleukin 1beta is a cytokine markedly inhibiting gastric acid secretion. Interleukin 1beta production associated with Helicobacter pylori gastric infection may exacerbate mucosal damage including chronic gastritis and atrophic gastritis, may induce eventual neoplasia. Among these Interleukin 1beta gene polymorphisms, polymorphisms at -31 portion and -511 portion may associated with these processes, eventually increase the risk of gastric cancer. We investigated the risk of gastric cancer according to the Helicobacter pylori infection and genetic polymorphism of Interleukin 1beta in gastric cancer patients. MATERIALS AND METHODS: 176 individuals with gastric cancer and 40 healthy controls were analyzed. Each group was divided into two groups whether they infected with Helicobacter pylori or not. DNA was extracted from the peripheral blood in all groups. The PCR-RFLP method was used for investigating the distribution of genotype of C/C, C/T, T/T at -31 portion and -511 portion. RESULTS: T/T genotype at -511 portion was 19.3% in gastric cancer cases and 10% in controls, which was statistically significant. (P=0.0432) The risk of gastric cancer was increased 4.86 (1.26~18.77) in group which had T/T genotype. In gastric cancer cases, C/C genotype at 31 portion was 27.6% in group with Helicobacter pylori infection and 12.8% in group without infection, which was statistically significant. (P=0.0047) The risk of gastric cancer was increased 4.82 (1.81~12.81) in group which had C/C genotype. CONCLUSION: T genotype at -511 portion among the Interleukin 1beta genetic polymorphisms may be the risk factor of gastric cancer. And, with Helicobacter pylori infection, C genotype at -31 portion may be the risk factor of gastric cancer.
DNA ; Gastric Acid ; Gastritis ; Gastritis, Atrophic ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Interleukin-1beta* ; Interleukins* ; Polymorphism, Genetic ; Risk Factors ; Stomach Neoplasms*

PURPOSE: To evaluate the effectiveness of clinic-based screening program for early detection of hepatocellular carcinoma (HCC) and to assess the risk factors of HCC in Korea. MATERIALS AND METHODS: The data of 14,259 patients who had ultrasonography (US) due to chronic liver diseases were collected into a data base program from 1990 to 1998. RESULTS: A total of 4,339 patients were enrolled who had repeated US. 237 patients were diagnosed as HCC during follow-up (mean 33 months). The tumor size detected by screening within a 6-months interval was significantly smaller than that of a longer interval (2.7 cm vs 3.9 cm, P<0.01). The smaller the tumor was at detection, the longer the survival time was. Only 29.9% of HCC patients had an elevated serum alpha-fetoprotein (alphaFP) level above 400 ng/ml. Multivariate analysis showed liver cirrhosis, chronic hepatitis B or C and old age over 40 years to be significantly associated with an increased risk of HCC. CONCLUSION: The US screening within a 6-months interval is beneficial to high-risk patients over 40 years old through the early detection of HCC and prolonged survival. According to the risk factors, the necessity for screening test and proper interval should be reconsidered.
Adult ; alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Early Diagnosis* ; Follow-Up Studies ; Hepatitis B, Chronic ; Humans ; Korea ; Liver Cirrhosis ; Liver Diseases ; Mass Screening ; Multivariate Analysis ; Risk Factors ; Ultrasonography

BACKGROUND/AIMS: This study was performed to evaluate whether the prevalence rates of primary antibiotic resistance in Helicobacter pylori (H. pylori) isolates and the eradication rate of H. pylori could be different between cancer and non-cancer patients. METHODS: H. pylori were isolated from gastric mucosal biopsy specimens obtained from 269 Koreans, who did not have any eradication therapy history and were diagnosed as one of the following diseases; chronic gastritis, benign gastric ulcer, duodenal ulcer or gastric cancer. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, ciprofloxacin, levofloxacin and moxifloxacin were examined with the agar dilution method. In addition, eradication rate of H. pylori was evaluated. RESULTS: There was no significant difference in the primary antibiotic resistance to above eight antibiotics among chronic gastritis, peptic ulcer disease and gastric cancer. Furthermore there was no difference of antibiotic resistance between cancer and non-cancer patients, and there was no difference of eradication rate of H. pylori according to disease. CONCLUSIONS: Primary antibiotic resistance and H. pylori eradication rate were not different between cancer and non-cancer patients.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Adult ; Aged ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Chronic Disease ; Clarithromycin/therapeutic use ; *Drug Resistance, Bacterial ; Drug Therapy, Combination ; Duodenal Ulcer/complications/microbiology ; Female ; Gastritis/complications/microbiology ; Helicobacter Infections/drug therapy/*epidemiology/microbiology ; Helicobacter pylori/*drug effects/isolation & purification ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Omeprazole/therapeutic use ; Peptic Ulcer/complications/microbiology ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/microbiology