BACKGROUND: Left ventricular hypertrophy is a major cardiovascular risk factor for sudden death, acute myocardial infarction and congestive heart failure. The left ventricle is generally thought to adapt to sustained arterial hypertension with increased total peripheral resistance by developing concentric hypertrophy. In recent years, the echocardiogrphy has been developed as a noninvasive method for evaluation of left ventricular geometry and left ventricular mass. However, left ventricular adaptation to hypertension has been shown to be more complex than expected. In fact, many patients with mild to moderate hypertension exhibit normal left ventricular mass and wall thickness, other hypertensive patients have eccentric ventricular hypertrophy that is not related to systolic dysfunction, but rather to increased cardiac output and preload and in some hypertensive patients absolute and relative wall thickness is increased with normal ventricular mass(concentric remodeling). There are differences in the hemodynamics, systolic function and diastolic function in each group. METHODS: From september 1992 to August 1994, in 144 patients with untreated essential hypertension and 50 age and gender matched normal adults studied by two-dimensional, M-mode and Doppler echocardiography. In the present study we used echocardiographically derived left ventricular mass and relative wall thickness to assess the patterns of ventricular geometric adaptation to systemic hypertension and their relations to systemic hemodynamics, left ventricular load and contractile performance. RESULTS: Hypertensive group was 144 cases(M:F=68:76), the mean age 56+/-13years. Normotensive group was 50 cases(M:F=22:28), the mean age 52+/-9years. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 42 cases(29%), 24 cases(17%) had increased relative wall thickness with normal ventricular mass(concentric remodelin),48 cases(33%) had both increased relative wall thickness and ventricular mass(concentric hypertrophy), 30 cases(21%) had increased left ventricular mass with normal relative wall thickness(eccentric hypertrophy). Concentric hypertrophy and normal left ventricle group are more common in untreated hypertensive patients in Korea. Systemic hemodynamics showed tendency to paralleled ventricular geomety. In groups with concentric remodeling and hypertrophy, perpheral resistance was increased. Cardiac index was midly increased in eccentric hypertrophy. Diastolic dysfunction was prominent tn concentric hypertrophy. CONCLUSION: Each patterns of left ventricular geometry had different systemic hemodynamics, ventricular pressure overload and ventricular volume overload. Therefore, appropriate selection of antihypertensive agent for the patients with each patterns of hypertrophy reduce the left ventricular hypertrophy and may improve the prognosis.
Adult ; Cardiac Output ; Death, Sudden ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular* ; Korea ; Myocardial Infarction ; Prognosis ; Risk Factors ; Vascular Resistance ; Ventricular Pressure

Metastatic disease involving the thyroid gland is uncommon. Thyroid metastases has been previously described from several primary cancers of lung, breast, and kidney. Because of the lower incidence and ambiguous clinical significance, it is not easy to consider thyroid metastasis and decide the optimal time for performing diagnostic examination. Here, we reported two cases of metastatic diseases of thyroid in patients who had underlying Hashimoto’s thyroiditis: a 39-year-old woman who had thyroid metastasis of breast cancer with underlying Hashimoto’s thyroiditis, and a 44-year-old woman with metastatic lung cancer.

PURPOSE: Vascular endothelial growth factor (VEGF) is a major positive effector of angiogenesis. We investigated the mechanism of tumor growth inhibition by adenoviral transfer of antisense- VEGF in glioma and the role of VEGF for in vivo growth of human glioma cells according to the stage of the tumor growth. MATERIALS AND METHODS: Replication-deficient adenoviral vector containing the VEGF cDNA in an antisense orientation (Ad5CMV-alphaVEGF) were constructed to increase the in vivo applicability of antisense sequence. The effect of Ad5CMV-alphaVEGF was studied in vitro and in vivo with human glioma cell line U-87 MG. Immunohistochemical staining of the subcutaneous tumor with anti-VEGF antibody and CD34 antibody were performed to compare VEGF protein expression and the microvessel count respectively. RESULTS: The growth curve of U-87 MG cells treated with Ad5CMV-alphaVEGF remained as same as that of mock-infected and Ad5(dl312)-infected U-87 MG cells in vitro, suggesting that Ad5CMV-alphaVEGF does not have direct cytotoxic effect. The growth of subcutaneous human glioma xenografts was inhibited by early intratumoral injection of Ad5CMV-alphaVEGF. Immuno histochemical staining of tumors showed that VEGF protein expression and mean microvessel counts were decreased in early Ad5CMV-alphaVEGF treatment group. CONCLUSION: The efficient down-regulation of VEGF produced by tumor cells using Ad5CMV- alphaVEGF in early stage of glioma growth has an antitumor effect in vivo through antiangiogenic mechanism.
Adenoviridae ; Cell Line ; DNA, Complementary ; Down-Regulation ; Genetic Therapy* ; Glioblastoma* ; Glioma ; Heterografts ; Humans ; Microvessels ; Vascular Endothelial Growth Factor A

PURPOSE: Angiogenesis is an essential component of tumor growth and proven to be a prognostic factor in breast, cervix, prostate carcinoma and melanoma. This study was designed to define the relationship of microvessel density with overall survival, clinicopathologic data and with other reported prognostic factors in gastric carcinoma. METHODS: We studied resected tumor specimens from thirty-two patients with gastric carcinoma who underwent gastrectomy at Ewha Women's University Hospital from January, 1989 to December, 1991. Specimens were investigated by staining with a monoclonal antibody aganist factor VIII-related antigen, which was localized to vascular endothelium. Correlation between the microvessel count (X200), various clinicopathologic factors, EGFR and p53 were studied. RESULTS: The microvessel count was increased with higher histologic staging. The microvessel count was significantly higher in group with lymph node metastasis than in those without lymph node metastasis (60.7 vs 27.4, p=0.02). In patients with high microvessel count (> or =30), overall survival time was shorter than in those with low count (<30), but insignificant statistically (p>0.05). The microvessel count was higher in group with recurrence than in those without recurrence (48.1 vs 33.2, p=0.05). CONCLUSION: Microvessel count may be a prognostic indicator in gastric carcinoma but larger scale study should be followed.
Breast ; Cervix Uteri ; Endothelium, Vascular ; Female ; Gastrectomy ; Humans ; Lymph Nodes ; Melanoma ; Microvessels ; Neoplasm Metastasis ; Prognosis* ; Prostate ; Recurrence ; von Willebrand Factor

PURPOSE: Cancer has become the major cause of deaths in Korea. Planning care for patients with terminal cancer is difticult. The prediction of length and prognostic factors of survival in the terminal cancer can facilitate the planning of a supportive care program aimed at patients need. The aim of this study was to identify length and those related factor of survival in the patients with terminal cancer. MATERIALS AND METHODS: This retrospective study was performed on 271 patients, who were diagnosed as terminal cancer in Seoul National University Hospital from March 1991 to February 1996. For getting the further informations about the patient, we interviewed with surviving relatives by telephone, and we requested administrative helps in order to take the informations about date of death. We examined the relations of 10 factors with survival in patients with terminal cancer. RESULTS: We could confirm 229 patients' death(84.5%) in 271 subjects. The median length of survival in patients with terminal cancer was 11 weeks(95%CI 10.0~14.0). By univariate analysis, history of surgery(p<0.01), performance(p<0.05), severity of pain(p <0.001), and dyspnea(p<0.05) were clinical factors in predicting survival. According to Cox's proportional hazard model including sex, age, history of surgery, performance, severity of pain, and dyspnea as variables, absence of surgery history(RR 1.398, 95%CI 1.038~1.882) and severity of pain(RR 1.398, 95%CI 1.044 ~1.872) showed independent prognostic value. CONCLUSION: The median survival was 11 weeks, and absence of surgery history and severity of pain were the independent prognostic factors for patients with terminal cancer.
Cause of Death ; Cohort Studies* ; Dyspnea ; Humans ; Korea ; Proportional Hazards Models ; Retrospective Studies ; Seoul ; Telephone

OBJECTIVE: Gastric carcinoma is one of the most common cause of death in Korea with limited effectiveness of chemotherapy. Thymidylate synthase(TS) is a critical therapeutic target for the fluoropyrimidine cytotoxic drugs, that are the mainstay of the treatment for the advanced gastrointestinal malignancies. We assessed the relationship between the levels of TS expression and survival and effect of 5-fluorouracil based chemotherapy in gastric adenocarcinoma. METHODS: Thirty six patients with gastric adenocarcinoma who underwent curative resection of stomach at Ewha Womans University Hospital were evaluated. TS protein expression in tumor tissues was assessed by standard immunohistochemical staining techniques with TS 106 monoclonal antibody. RESULTS: TS expression was high(3+) in 19 patients (52.8%) and low(< or =2+) in 17 patients(47.2%). Between these two groups, there was no significant difference in the histopathologic type or stage. Seventy-two point five percent of patients with low TS expression were disease free at 5 years compared with 58.2% of patients with high TS expression(p=0.31) and 73.7% of patients with low TS expression were alive at 5 years compared with 61.4% of patients with high TS expression(p=0.34). In patients with high TS expression, disease-free survival (DFS) and overall survival(OS) of patients who received adjuvant chemotherapy were longer than those of patients with surgery alone without significance(p=0.28, p=0.16). CONCLUSIONS: We could not confirm the association between the level of TS expression in tumor tissues and DFS and OS of patients with gastric adenocarcinoma who underwent curative resection. Further study with more cases as well as prospective study will be necessary for establishment of relationship between TS expression of tumor and prognosis of gastric adenocarcinoma
Adenocarcinoma* ; Cause of Death ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Female ; Fluorouracil ; Humans ; Korea ; Prognosis* ; Stomach ; Thymidylate Synthase*

OBJECTIVE: To retrospectively analyze the qualitative CT features that correlate with human epidermal growth factor receptor 2 (HER2)-expression in pathologically-proven gastric cancers. MATERIALS AND METHODS: A total of 181 patients with pathologically-proven unresectable gastric cancers with HER2-expression (HER2-positive [n = 32] and negative [n = 149]) were included. CT features of primary gastric and metastatic tumors were reviewed. The prevalence of each CT finding was compared in both groups. Thereafter, binary logistic regression determined the most significant differential CT features. Clinical outcomes were compared using Kaplan-Meier method. RESULTS: HER2-postive cancers showed lower clinical T stage (21.9% vs. 8.1%; p = 0.015), hyperattenuation on portal phase (62.5% vs. 30.9%; p = 0.003), and was more frequently metastasized to the liver (62.5% vs. 32.2%; p = 0.001), than HER2-negative cancers. On binary regression analysis, hyperattenuation of the tumor (odds ratio [OR], 4.68; p < 0.001) and hepatic metastasis (OR, 4.43; p = 0.001) were significant independent factors that predict HER2-positive cancers. Median survival of HER2-positive cancers (13.7 months) was significantly longer than HER2-negative cancers (9.6 months) (p = 0.035). CONCLUSION: HER2-positive gastric cancers show less-advanced T stage, hyperattenuation on the portal phase, and frequently metastasize to the liver, as compared to HER2-negative cancers.
Epidermal Growth Factor* ; Humans* ; Liver ; Logistic Models ; Methods ; Neoplasm Metastasis ; Prevalence ; Receptor, Epidermal Growth Factor* ; Retrospective Studies ; Stomach ; Stomach Neoplasms*

Hormone receptor–positive (HR+) disease is the most frequently diagnosed subtype of breast cancer. Among tumor subtypes, natural course of HR+ breast cancer is indolent with favorable prognosis compared to other subtypes such as human epidermal growth factor protein 2–positive disease and triple-negative disease. HR+ tumors are dependent on steroid hormone signaling and endocrine therapy is the main treatment option. Recently, the discovery of cyclin-dependent kinase 4/6 inhibitors and their synergistic effects with endocrine therapy has dramatically improved treatment outcome of advanced HR+ breast cancer. The demonstrated efficacy of additional nonhormonal agents, such as targeted therapy against mammalian target of rapamycin and phosphatidylinositol 3-kinase signaling, poly(ADP-ribose) polymerase inhibitors, antibody-drug conjugates, and immunotherapeutic agents have further expanded the available therapeutic options. This article reviews the latest advancements in the treatment of HR+ breast cancer, and in doing so discusses not only the development of currently available treatment regimens but also emerging therapies that invite future research opportunities in the field.

Although malignant pericardial effusion is a common complication of malignancy, chylopericardium is a rare entity characterized by the accumulation of chylous fluid in the pericardial sac. The lymphatic vessels of the pericardium drain into the thoracic duct. The mechanical obstruction of venous drainage plays an important role in the pathophysiology of this disease. In most cases, pericardiocenthesis is needed to prevent cardiac tamponade. We present a case of a 15-year-old boy diagnosed as non-Hodgkin's lymphoma, diffuse large B cell, with superior vena cava syndrome, who developed an isolated chylopericardium after the first cycle of chemotherapy. We confirmed the diagnosis with an echocardiography, lymphangiography, and fluid analysis. Chylopericardium was managed successfully with pericardiocenthesis and drainage. If pericardial effusion were developed during the treatment of non-Hodgkin's lymphoma, chylopericardium should be considered as one of the differential diagnoses and associated venous thrombosis around the thoracic duct outlet should be ruled out.
Adolescent ; Cardiac Tamponade ; Diagnosis ; Diagnosis, Differential ; Drainage ; Drug Therapy ; Echocardiography ; Humans ; Lymphatic Vessels ; Lymphography ; Lymphoma, Non-Hodgkin* ; Male ; Pericardial Effusion* ; Pericardium ; Superior Vena Cava Syndrome ; Thoracic Duct ; Venous Thrombosis

BACKGROUND/AIMS: For evaluation of anemia, esophagogastroduodenoscopy (EGD) is widely used. However, there is no sufficient information on the efficiency and role of colonoscopic evaluation for these anemia patients. We aimed to evaluate the diagnostic yield of colonoscopy in anemia patients with nonactive rectal bleeding. METHODS: This was a retrospective study from January 2001 to December 2002. We reviewed 147 patients who underwent colonoscopy for anemia evaluation. RESULTS: The mean age was 48+/-17 years (range 15~90), and male to female ratio was 1:4.3. Ninety-four patients (63.9%) had iron deficiency anemia and 21.8% of them have less than 7 g/dL of hemoglobin. Abnormal colonoscopic findings were observed in 84 patients (57.1%) including hemorrhoid (35), polyp (31), tuberculosis (9), cancer (8), diverticulum (8), endometriosis (1), angiodysplasia (1), and ulcerative colitis (1). The presence of abnormal colonoscopic findings was more frequently observed in older population (> or =55 years old, p=0.034). Intestinal tuberculosis, endometriosis, and ulcerative colitis were observed only in younger population (<55 years old), and 2 of 8 cancer patients were 39 and 49 years old males. CONCLUSIONS: Although the diagnostic yield of colonoscopy is relatively higher in older population, colonoscopy is one of the valuable tools in anemia evaluation of both older and younger populations.
Anemia* ; Anemia, Iron-Deficiency ; Angiodysplasia ; Colitis, Ulcerative ; Colonoscopy ; Diverticulum ; Endometriosis ; Endoscopy, Digestive System ; Female ; Hemorrhage* ; Hemorrhoids ; Humans ; Male ; Middle Aged ; Polyps ; Retrospective Studies ; Tuberculosis