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

PURPOSE: The case of ectopic liver and accessory liver lobe have been rarely reported. A hepatic rudiment appears in the ventral angle between the foregut and the yolk sac; pars hepatica and pars cystica. The close connection between them explains accessory lobe on the Gall bladder surface wall. And the displacement of migration of a portion of the pars hepatica explains the ectopic liver. Difference between ectopic liver and accessory liver lobe can be defined whether the connection with hepatic proper exists or not. But, the definite discrimination of the type is very difficult clinically. Recently, we experienced cases of ectopic liver and accessory liver. CASES: In one patient, 43-year-old woman was referred to our department with left upper quadrant abdominal pain. Abdominal sonogram revealed a mass below the diaphragm attached to the superior pole of the spleen. On the operation, tumor mass was reddish gray colored and measured 10 7 3 cm. There were no direct connections with the liver proper except fibrous tissue, and its blood supply was considered from the left diaphragm. The pathologic result proved hepatocellular carcinoma(HCC). In the other patient, a 68-year-old woman complained right upper quadrant abdominal pain and was diagnosed as chronic cholecystitis on sonogram. During the laparoscopic cholecystectomy, a small bean sized mass, appearing as liver tissue, attached GB body portion was detected. The Mass was measured 1.0 1.0 3.0 cm in size and glistening dark brown colored, smooth surfaced. Streaky stalk connected with liver proper was visible. Pathologic finding confirmed the mass as an accessory liver. Both patients discharged without complications. DISCUSSION: Although the clinical problems are rare in the ectopic liver, it has been reported that ectopic liver is prone to be a cancer and accessory liver can induce symptoms. The larger the size becomes, the more it can be Symptomatic. Surgical treatment should be considered whenever they are diagnosed. More investigations are nedeed to know their clinical importance on the basis of the case accumulation.
Abdominal Pain ; Adult ; Aged ; Carcinoma, Hepatocellular ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Diaphragm ; Discrimination (Psychology) ; Female ; Humans ; Liver* ; Ranunculaceae ; Spleen ; Urinary Bladder ; Yolk Sac

BACKGROUND/AIMS: Pancreaticoduodenectomy is accompanied by considerable rates of postoperative complications and mortalities. Obstructive jaundice is associated with periampullary lesions. The role of preoperative biliary drainage in patients with biliary obstruction undergoing pancreaticoduodenectomy remains controversial. Some authors show the disadvantages of biliary drainage that increased perioperative infectious complications. We analyzed retrospectively the effect of biliary drainage on pancreaticoduodenectomy and surgical outcome. METHODS: One hundred ten consecutive cases of pancreaticoduodenectomy performed between March 1992 and December 2000 were analyzed. We classified Group A as the patients who performed preoperative biliary drainage and Group B as the patients who did not perform biliary drainage. Multiple preoperative, intraoperative, postoperative variables were examined. Student's T-test, chisquare test or Fisher's Exact test was used for univariate comparison of all variables. RESULTS: Preoperative Biliary drainage was performed in 52 patients (47%) and the remaining 58 patients (53%) did not undergo any form of biliary drainages. The overall morbidity and mortality was 37% and 1.8% each. Total Bilirubin was higher in Group A (13.15 mg/dl) than Group B (4.11 mg/dl) (P=0.000). In Group A complication occurred in 21 patients and 20 patients in Group B (P=0.561). No differences were found between Group A and Group B in the incidence of all complications. More transfusion was needed for Group A (P=0.043). Postoperative hospital stay presented no differences (P=0.375). CONCLUSIONS: Biliary drainage is not required in patients who are planed pancreaticoduodenectomy except that the patient had cholangitis or bleeding tendency due to jaundice and hepatic derangements. The biliary drainage should be reserved for the potential for delay in definitive surgery. And it demands randomized prospective study in the future.
Bilirubin ; Cholangitis ; Drainage* ; Hemorrhage ; Humans ; Incidence ; Jaundice ; Jaundice, Obstructive ; Length of Stay ; Mortality ; Pancreaticoduodenectomy* ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Cystic liver disease is a rare disease entity, but its surgical management can vary from partial excision to hepatic lobectomy. This study was conducted to evaluate proper surgical management of cystic liver disease. METHODS: The authors reviewed the medical records of 26 patients who underwent operative management for cystic liver disease, consisting of 15 cases of simple cyst, 7 cases of biliary cystadenoma, 1 case of biliary cystadenocarcinoma, 1 case of polycystic disease and 2 cases of Caroli's disease. RESULTS: The 26 patients had a mean age of 57, with a male to female ratio of 1:4. Patients' main symptoms were right upper quadrant pain or discomfort, and epigastric pain. Their main physical findings were palpable mass and direct tenderness, but 23% of patients were aymptomatic and 35% had no physical findings. Preoperative diagnosis was made with abdominal ultrasound and computed tomogram. Intervening septum was identified in 27% of simple cysts and 100% of biliary cystadenoma. However neither diagnostic tool has 100% diagnostic accuracy. All cysts except polycystic disease were located at either both hepatic lobes but more right lobe in simple cysts. The mean size of all cysts were 10.2cm ranging from 2-to-22cm without any difference among simple cysts, cystadenomas, and cystadenocarcinoma. Operative methods for simple cysts were partial cystectomy with marsulpialization, total cystectomy and hepatic segmentectomy in 87% of cases, of which 2 cases were performed by laparoscopic approach. However partial cystectomy was confined to unilocular simple cyst. There was no recurrence of simple cyst postoperatively. Biliary cystadenoma were managed by total cyst excision, hepatic segmentectomy or lobectomy in 86% of cases, but one cystadenoma was managed by partial cystectomy with marsulpialization had a persisting cyst. One patient with polycystic liver disease died because of overwhelming sepsis with postoperative acute renal failure. CONCLUSION: For unilocular simple cyst, partial cystectomy with marsulpialization can be an acceptable surgical procedure, even with a laparoscopic approach. But for biliary cystadenoma, the cyst should be totally removed at least to prevent recurrence and transformation to cystadenocarcinoma. Therefore, correct preoperative diagnosis is a prerequisite for appropriate selection of operative methods.
Acute Kidney Injury ; Caroli Disease ; Cystadenocarcinoma ; Cystadenoma ; Cystectomy ; Diagnosis ; Female ; Humans ; Liver Diseases* ; Liver* ; Male ; Mastectomy, Segmental ; Medical Records ; Rare Diseases ; Recurrence ; Sepsis ; Ultrasonography