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

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

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

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

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

PURPOSE:Prolonged cold ischemia has been shown to be an important factor in the development of post-transplant renal dysfunction. The exact mechanisms have not been completely defined. The expression of ICAM-1 (CD-54) in rat kidneys stored at 0, 4, 12, 24 and 48 hours in University of Wisconsin (UW) solution was studied in an attempt to correlate ischemia time with increased immunogenicity of the graft. METHODS: Kidneys from male Lewis rats were perfused with UW solution, removed and bathed in UW solution at 4 degrees C for 4, 12, 24, and 48 hours respectively. For the evaluation of expression of ICAM-1, immunohistochemical staining, Western blotting and RT-PCR were performed. RESULTS: Immunohistochemical staining in normal non-ischemic kidneys revealed that glomerular capillaries expressed ICAM-1 but that tubular cells did not. The preserved kidneys were analyzed with immunohistochemistry, Western blotting and semi-quantitative RT-PCR and showed increased transcription and expression of ICAM-1 in the cortex of the kidney. This expression reached a maximum at 24 hours and declined at 48 hours. The ICAM-1 protein expression in the preserved kidney cortex was increased at 4 hours (1.68+/-0.60 fold of control kidneys, (p=0.06)), 12 hours (2.38+/-0.90 fold, (p=0.02)), 24 hours (3.70+/-1.29 fold, (p=0.01)), and 48 hours (2.00+/-0.54 fold, (p=0.01)). The mRNA expression (the ratio of ICAM-1/GAPDH) in preserved kidneys cortex relative to control kidneys was increased at 4 hours (1.19+/-0.14 fold of control kidneys), 12 hours (1.38+/-0.16 fold),24 hours (1.77+/-0.29 fold), and 48 hours (1.19+/-0.12 fold) (p<0.05 for all time points). CONCLUSION: We conclude that cold preservation of rat kidneys in UW solution induces increasing levels of ICAM-1 cell surface expression and gene transcription. This increase in adhesion molecule expression can be a contributing factor in the development of post-transplant renal dysfunction by increasing the immunogenicity of the graft.
Animals ; Baths ; Blotting, Western ; Capillaries ; Cold Ischemia ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1* ; Ischemia ; Kidney Cortex ; Kidney Transplantation ; Kidney* ; Male ; Rats* ; RNA, Messenger ; Transplants ; Wisconsin

PURPOSE: The presence of a perfusion-diffusion mismatch is a useful indicator for predicting the progression of acute cerebral infarction. However, not all the area of the perfusion-diffusion mismatch progresses to infarction and a large proportion survives with hypoperfusion. The purpose of this study was to assess 1) whether tissue viability can be predicted using quantitative perfusion values and 2) whether there is correlation between the perfusion value and the time that elapsed after the onset of symptoms. MATERIALS AND METHODS: Twenty-two patients with acute infarction in the middle cerebral artery territory within 12 hours after symptom onset were included in this study. We excluded those patients in whom thrombolysis was attempted or the lesion volume was less than 5 mL. Patients without perfusion-diffusion mismatch on the mean transit time (MTT) map were also excluded. We categorized the ischemic lesions into 3 areas: 1) the initial infarction, 2) the area that progressed to infarction, and 3) the hypoperfused but surviving area, based on the initial and follow up diffusion-weighted images and initial mean transit time (MTT) map. We obtained the relative cerebral blood volume (rCBV), the cerebral blood flow (rCBF) and the MTT in each area by comparing to the contralateral normal area. Statistical analysis was performed using one-way ANOVA to test whether there was a difference in perfusion values between each area. The threshold value was calculated between areas 2 and 3 using the receiver operating characteristics curve. We analyzed the correlation between the perfusion values of each area and the time that elapsed after the inset of symptoms. RESULTS: The perfusion values among each region were significantly different on the rCBV, rCBF and MTT maps. Between regions 2 and 3, the rCBV and rCBF maps showed a significant difference (Bonferroni post hoc analysis), but in case of rCBV, the mean perfusion values in each region approached to the normal level and it was difficult to differentiate between the two regions on the rCBV map. The rCBF in the regions 1, 2 and 3 was 0.40, 0.64, and 0.84, respectively. The difference of the threshold values of the rCBF between regions 2 and 3 was 0.75. There was no significant correlation between the time that elapsed after symptom onset and the perfusion values of each region on the rCBV, rCBF and MTT map. CONCLUSION: The perfusion values between the area of the initial infarction, the area that progressed to infarction and the hypoperfused but surviving area showed significant differences. The rCBF was the most useful parameter in differentiating between areas that progressed to infarction and the surviving areas. Quantitative measurement of the perfusion values may have a role in selecting the candidates for thrombolysis after they have suffered hyperacute stroke.
Blood Volume ; Cerebral Infarction ; Follow-Up Studies ; Humans ; Infarction* ; Middle Cerebral Artery ; Perfusion ; ROC Curve ; Stroke ; Tissue Survival*