No abstract available.
Common Bile Duct*

BACKGROUND: In Despite of progress in diagnostic technique, early diagnosis of pancreatic ductal adenocarcinoma is still difficult. It has low resectability and poor prognosis. Cancer staging are to aid in planning treatment and in predicting prognosis. The Union Internationale Contre le Cancer (UICC) classification and Japanese Pancreatic Society (JPS) classification are used for the staging system of pancreatic ductal adenocarcinoma. Though these staging systems are still evolving, there are some discrepancy in the prognosis between two staging systems. METHOD: To investigate these discrepancies we researched the survival rate of pancreatic ductal adenocarcinoma according to each staging system. Between 1983 to 1995, a total 52 patients underwent resective surgery for pancreatic adenocarcinoma were studied. RESULTS: In stage classification, the rate of stage I and II in UICC classification (46.2%) was more higher than in JPS classification (23.1%)(p<0.05). The 3 year survival rate of stage I was significantly higher than other stages in UICC classification. But in the survival curves, UICC classification did not reflect difference between stage II and III. In JPS classification, survival rates and curves differed according to the four stages. On T category (tumor invasion or size), the survival rate decreased as tumor invasion was increased in both classifications. In UICC classification, the 3-year survival rate was significantly higher in the patients of stage N0 than in the patients of N1 (p<0.05). CONCLUSION: The UICC system is simple, but it does not fully predict prognosis. The JPS system is well in predict of prognosis, but it has a disadvantage of complexities. Continuing efforts are necessary to establish a more practical, proper, and universal staging system for pancreatic adenocarcinoma.
Adenocarcinoma ; Asian Continental Ancestry Group ; Classification ; Early Diagnosis ; Humans ; Neoplasm Staging ; Pancreatic Ducts ; Pancreatic Neoplasms* ; Prognosis ; Survival Rate*

Until now, surgical treatment of bile duct carcinoma has been unsatisfactory. There have been few reports dealing with the clinical significance of epidermal growth factor receptor(EGFR) and c-erbB-2 in bile duct cancer. To evaluate epidermal growth factor receptor(EGFR) and c-erbB-2 protein as a marker for prognosis, we analyzed the data and outcome of 32 cases of extrahepatic bile duct carcinoma immunohistologically, as well as clinicopathologically. The expressions of EGFR and c-erbB-2 showed in 71.9%(23/32) and 34.4%(11/32), respectively. The expression of EGFR was closely associated with the expression of c-erbB-2 (p<0.05). The expression rate of EGFR was significantly higher in well-differentiated cancer than in poorly-differentiated cancer (p<0.05), but was not related to stage, or lymph node metastasis. The expression of c-erbB-2 was not related to stage, lymph node metastasis, and differentiation. The expressions of EGFR and c-erbB-2 did not correlate with survival. In conclusion, the expression of EGFR or c-erbB-2 may be used as a tumor marker, but not as a prognostic factor in extrahepatic bile duct cancer.
Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic* ; Epidermal Growth Factor ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Receptor, erbB-2

PURPOSE: Neoplastic development is a multistep process that involves the accumulation of genetic alterations in proto- oncogenes, DNA repair genes, and tumor suppressor genes. Molecular studies in carcinoma have shown the high frequency of loss of heterozygosity (LOH) in some specific chromosome regions, but LOH on the HCC chromosome has not been thoroughly investigated in Korea. LOH is considered to be phenotypes of genomic instability. We investigated the genetic instability and microsatellite alterations of chromosome 5, 8, 13 and 17 in hepatocellular carcinoma (HCC). METHODS: Microsatellite alteration analysis was performed using polymerase chain reaction with 12 polymorphic microsatellite markers (BAT26, D5S123, D5S346, D8S254, D8S261, D8S262, D13S153, D13S159, D13S171, D17S250, D17S796, TP53) in 37 surgically resected HCCs and their respective non-tumorous counterparts. Pairs of tumorous part and normal tissue in the same patient were compared and then the size of microsatellite markers was measured. RESULTS: MSI was detected in 3 samples and LOH was detected in 51 samples of 37 cases. Fractional allelic loss (FAL) was above 0.2 in 10 cases and was correlate with high grade of HCC. we could detect only 1 case of LOH in D8S254 marker, which was advanced cancer. Markers D5S123 and D5S346 showed 2 and 3 cases of LOH, respectively. Markers D8S262, D17S250 and D17S796 had LOH and were significantly correlated with tumor grade. CONCLUSION: According to the results, our data revealed that specific LOH, rather than MSI, may be involved in hepatocarcinogenesis. LOH may be a useful tool for following HCC patients because the high frequency of LOH correlates with poor prognosis of HCC.
Carcinoma, Hepatocellular* ; Chromosomes, Human, Pair 5* ; DNA Repair ; Genes, Tumor Suppressor ; Genomic Instability ; Humans ; Korea ; Loss of Heterozygosity ; Microsatellite Instability ; Microsatellite Repeats* ; Oncogenes ; Phenotype ; Polymerase Chain Reaction ; Prognosis

BACKGROUND: The prognosis of patients with lung cancer is still poor. Lung cancer exhibits a variable clinical outcome, even in those patients with same stage Numerous reports suggest that oncogene expression night play a role in explaining the variability of response and survival But many of these reports are still under debete. So we studied the clinical relevance of oncogene expression in Korean lung cancer patients. lmmunohistochemistry of p53, erbB-2, CEA expression was performed. METHOD: From March, 1992 until March, 1997, 120 patients with lung cancer were reviewed. p53, erbB-2, and CEA expression were detected on paraffin-embedded tumor blocks with the use of monoclonal antibodies. The survival arid response has correlated with the expressibility of p53, erbE-2, arid CEA oncoprotein. RESULTS: Overall, the expression rates of p53 erbB-2, and CEA were 33.7%, 59.3%, and 32.6% respectively. Expression rates were not con-elated to cell type or stage. Compared with response to chemotherapy, no correlation was found. The expression of p53, erbB-2, or CEA was not correlated with 2-year survival. With simultaneous applications of p53. erbB-2, and CEA, patients with 2 or more expressions also did not show poor response to chemotherapy. CONCLUISON: We conclude the p53, erbB-2, and CEA expression are clinically less useful in predicting response to chemotherapy or survival.
Antibodies, Monoclonal ; Drug Therapy ; Humans ; Immunohistochemistry ; Lung Neoplasms* ; Lung* ; Oncogenes ; Prognosis

OBJECTIVE: A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. METHODS: From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. RESULTS: There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
Adenocarcinoma/mortality/pathology/surgery ; Adult ; Carcinoma, Adenosquamous/mortality/pathology/surgery ; Carcinoma, Squamous Cell/mortality/pathology/surgery ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Middle Aged ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Recovery of Function ; Survival Analysis ; Treatment Outcome ; Urinary Bladder/*innervation/physiology/surgery ; Uterine Cervical Neoplasms/mortality/pathology/*surgery ; Uterus/*innervation/surgery

PURPOSE: Verapamil is one of the most extensively characterized modulators of P-glyco- protein (P-gp) mediated multi-drug resistance (MDR), but its plasma concentration required to reverse MDR can cause cardiovascular toxicity. KR-30035 is a newly synthesized verapamil analogue with more potent cytostatic effects, but has lower cardiovascular effects than verapamil. We have assessed the MDR reversing effects of KR-30035 by measuring Tc-99m MIBI uptake in cultured tumor cells and in nude mice bearing human tumor xenografts. MATERIALS AND METHODS: In-vitro uptake of Tc-99m MIBI was measured in murine leukemia cells (L-1210) and those MDR-positive variants after incubation with different concentrations of KR-30035. Results were compared to those with verapamil. Organ and tumoral uptake of Tc-99m MIBI was compared between P-gp (+) human colon cancer (HCT15 cells) and P-gp (-) lung cancer (A549 cells) in nude mice, treated with either KR-30035 or verapamil. RESULTS: There was no significant difference in in-vitro uptake of Tc-99m MIBI between verapamil and KR-30035 group at any concentrations. MIBI uptake in P-gp (+) cells continuously increased either with verapamil or KR-30035 in a dose-dependent manner. Tc-99m MIBI uptake ratios of the tumor [P-gp (+' tumor uptake divided by P-gp (-) uptake] were significantly higher with KR-30035 than with verapamil in tumor bearing nude mice. Washout rate of Tc-99m MIBI from P-gp (+) HCT15 cells was lower in verapamil or KR-30035 groups than in the control group, which was 0.19, 0.19 and 0.27 respectively. CONCLUSION: These studies revealed that KR-30035 can potentially be used as an active modulator of MDR, with its significantly lesser cardiovascular toxicity than verapamil. Our results warrants further evaluation of this novel agent.
Animals ; Colonic Neoplasms ; Drug Resistance, Multiple ; Heterografts ; Humans ; Leukemia ; Lung Neoplasms ; Mice ; Mice, Nude ; P-Glycoprotein ; Plasma ; Robenidine ; Tumor Cells, Cultured ; Verapamil

BACKGROUND/AIMS: Although the incidence of T-cell non-Hodgkin's lymphoma (NHL) is higher in Far East Asia than in Western countries, its incidence and clinical course in Korea are not well-defined. Therefore, we assessed the relative frequency and clinical features of T-cell NHL in Korea. METHODS: We performed a retrospetcive analysis of 586 patients with NHL. RESULTS: 101 (17.2%) had T-cell NHL. The most frequent subtypes of T-cell NHL were extranodal NK/T-cell lymphoma, nasal type (NASAL), peripheral T-cell lymphoma, unspecified type (PTCL-U), and anaplastic large cell lymphoma, T/null cell, primary systemic type (ALCL). The seven pathological subtypes could be classified into three prognostic subgroups. When patients with the three most frequent subtypes were grouped together, their survival was reflected in the International Prognostic Index (IPI) scores. Univariate analysis of IPI elements and other clinical features showed that clinical stage and extranodal sites were significant predictors of survival. Cox multivariate analysis showed that the number of extranodal sites was the only independent prognostic indicator. CONCLUSIONS: The relative frequency of T-cell NHL seems to be decreasing in Korea, although NASAL remains frequent. Korean patients with ALCL appear to have an unfavorable prognosis. Large-scale studies are warranted for Korean patients with T-cell NHL.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Humans ; Incidence ; Kaplan-Meiers Estimate ; Korea/epidemiology ; Lymphoma, Non-Hodgkin/ethnology/*mortality/*pathology ; Lymphoma, T-Cell/ethnology/*mortality/*pathology ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Time Factors ; Young Adult

PURPOSE: The prevalence and incidence of the superior mesenteric ischemic diseases are increasing nowadays because of the increase of aged people and cardiovascular diseases. The morbidity and mortality of the superior mesenteric ischemic diseases are so high and detrimental because acute mesenteric infarction results post operatively reperfusion injury short bowel syndrome and sepsis. A successful management requires very efficient diagnostic and therapeutic measures. So, we reviewed the medical records of superior mesenteric ischemic diseases and identified the clinical and therapeutic characters of these disease. METHOD: Between January 1991 and December 2000, 33 patients with a clinical diagnosis of superior mesenteric ischemic diseases supported by clinical and imaging studies were included in this study. The medical records of the 33 patients who had admitted Korea University Hospital were reviewed retrospectively and identified the clinical characters, the diagnostic tools, underlying diseases and the therapeutic modalities. RESULT: The most common cause of theses disease was the superior mesenteric arterial embolism and the peak incidence was identified in 7th and 8th decades. These diseases were diagnosed with physical examination, abdominal CT or angiogram, but almost half of them were identified at the operative field. 29 patients were treated surgically and the rest of them were medically. At result 12 patients died of these diseases (36.4%). The high WBC count (15,000/ml) and shock were considered as prognostic factors predicting for the mortality (p=0.005). CONCLUSION: The old persons who were suffered from the nonspecific abdominal pain should be suspected of these diseases and treated with properly applied diagnostic tools and therapeutic modalities, especially they show the leukocytosis and the clinical evidence of shock.
Abdominal Pain ; Cardiovascular Diseases ; Diagnosis ; Embolism ; Humans ; Incidence ; Infarction ; Ischemia ; Korea ; Leukocytosis ; Medical Records ; Mortality ; Physical Examination ; Prevalence ; Reperfusion Injury ; Retrospective Studies ; Sepsis ; Shock ; Short Bowel Syndrome ; Tomography, X-Ray Computed

PURPOSE: Owing to the accumulation of surgical experience, the indications of single port laparoscopic cholecystectomy (SLC) have increased. To overcome the difficulties and limitations of SLC, we included an additional instrument for use in retracting the gallbladder fundus. The aim of this study was to investigate the feasibility of 4-instrument fundal retraction SLC. METHODS: We retrospectively analyzed 134 patients who had undergone SLC for benign gallbladder disease. We compared the clinical outcome between patients who had undergone SLC without fundal retraction (3-instrument SLC, n=102) and those who had undergone SLC with fundal retraction (4-instrument fundal retraction SLC, n=32). RESULTS: Of 134 patients, 47 were male and 87 were female. A significantly higher proportion of patients in the 4-instrument fundal retraction group had gallbladder distention and wall thickening than patients in the 3-instrument SLC group. No statistically significant difference in the incidence of pericholecystic inflammation, adhesion, and gallbladder perforation; duration of operation, the incidence of complications, and duration of postoperative hospital stay was observed between the two groups. In univariate analysis to perform 4-instrument fundal retraction SLC, higher BMI, the presence of gallbladder distension, and wall thickening were significant factors. In multivariate analysis, gallbladder distention and the presence of concurrent operation during SLC were independently significant factors for performing 4-instrument fundal retraction SLC. CONCLUSION: Four-instrument fundal retraction SLC is a feasible and safe surgical procedure, particularly in patients with a high BMI, gallbladder distention, wall thickening, inflammation, or adhesions. If difficulties are encountered during 3-instrument SLC, simple fundal retraction using an additional instrument may be the preferred option prior to converting the operation to conventional laparoscopic cholecystectomy.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Female ; Gallbladder Diseases ; Gallbladder* ; Humans ; Incidence ; Inflammation ; Length of Stay ; Male ; Multivariate Analysis ; Retrospective Studies