PURPOSE: This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS: We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS: The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION: Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
Ampulla of Vater ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Common Bile Duct ; Cystic Duct ; Gastric Emptying ; Humans ; Medical Records ; Neoplasms, Second Primary ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pathology ; Reoperation ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES : The etiology of polyp is still largely unknown. Vascular remodelling, with local angiogenesis and plasma leakage, could play a role in the growth process of nasal polyps. The aim of this study was to detect and localize angiogenesis factor expressions in nasal polyp tissue and compare these findings with those of inferior turbinate tissues. MATERIALS AND METHODS: The author examined specimens from patients undergone elective turbinectomy (n=10) or nasal polypectomy (n=23). The mRNA expressions of angiogenesis factors were detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) followed by Southern blot analysis. The protein expression of angiogenesis factors in nasal polyp tissues were evaluated by immunohistochemistry. RESULTS: Semi-quantitative RT-PCR/Southern analysis of RNA demonstrated that the level of mRNA expression of basic fibroblast growth factors (bFGF) and vascular endothelial growth factors (VEGF) were decreased in nasal polyp tissues compared with inferior turbinate specimens. The platelet-derived endothelial cell growth factor (PD-ECGF) mRNA expression was significantly increased in nasal polyps compared with inferior turbinates. The immunohistochemical studies revealed that a immunoreactivity to these angiogenesis facors were localized to epithelium, inflammatory cell, and vascular endothelium in all samples reviewed. The high levels of expression for VEGF protein and PD-ECGF protein in the nasal polyp tissues were demonstrated. CONCLUSION: We suggest that PD-ECGF and VEGF contribute to the growth of nasal polyps. Hypoxia may play an important role in the growth of the nasal polyps considering that VEGF and PD-ECGF, secretions of which are stimulated by hypoxia, were highly expressed in the nasal polyp tissues.
Angiogenesis Inducing Agents ; Anoxia ; Blotting, Southern ; Endothelial Cells* ; Endothelium, Vascular ; Epithelium ; Fibroblast Growth Factor 2 ; Fibroblasts* ; Humans ; Immunohistochemistry ; Nasal Polyps* ; Plasma ; Polyps ; RNA ; RNA, Messenger ; Thymidine Phosphorylase ; Turbinates ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

Background and objectives: Carvedilol is a cardiovascular drug, beta- and alpha1-adrenoceptor antagonist, currently approved for the treatment of hypertension, angina, congestive heart failure by FDA. Carvedilol has been shown to attenuate oxygen free radical-initiated lipid peroxidation and to inhibit neointimal formation of aorta following vascular injury by balloon angioplasty. We have investigated the effect of carvedilol on DNA synthesis of vascular smooth muscle cells (VSMC) stimulated by platelet-derived growth factor (PDGF)-BB. MATERIALS AND METHOD: Rat aortic smooth muscle cells were obtained by the combined collagenase and elastase methods. Cells between the 4th and 8th passages were used for the experiments. Incorporated radioactivity of [3H]-thymidine was measured by liquid scintillation spectrometry. RESULTS: PDGF-BB (1 nM) increased [3H]-thymidine incorporation about 70-100% over basal value in cultured VSMC. PDGF-stimulated increase in DNA synthesis was significantly suppressed by simultaneous administration of carvedilol. In contrast, propranolol did not significantly affect 3[H]-thymidine uptake in rat aortic VSMC. CONCLUSION: The present study demonstrate that carvedilol significantly inhibits the proliferation of vascular smooth muscle cell in our condition. These results indicate that carvedilol may be effective in the treatment of cardiovascular diseases principally associated with abnormal vascular smooth muscle growth.
Angioplasty, Balloon ; Animals ; Aorta ; Cardiovascular Diseases ; Cell Proliferation ; Collagenases ; DNA ; Heart Failure ; Hypertension ; Lipid Peroxidation ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Oxygen ; Pancreatic Elastase ; Platelet-Derived Growth Factor ; Propranolol ; Radioactivity ; Rats ; Spectrum Analysis ; Vascular System Injuries

Shortened dental arch (SDA) as a treatment goal is the concept that stable occlusion and enough masticatory force can be achieved by restoration to the second premolars when the situation is not favorable. SDA could be applied both natural teeth and implant supported fixed prostheses. This case dealt with a patient who has grade 2 intellectual disability and a lot of missing teeth. Because of intellectual disability, patient cooperation during treatment could not be expected. Therefore every treatment should be done under general anesthesia. In addition to that, ridge resorption around molar area was severe and there were maxillary sinus pneumatization and maxillary sinusitis which increased failure probability. SDA concept was adopted to reduce risk factor and minimize general anesthesia. After the treatment, functional and esthetic improvement was achieved and oral hygiene was fortified by periodic recall check and education.
Anesthesia, General ; Bicuspid ; Bite Force ; Dental Arch ; Humans ; Intellectual Disability ; Maxillary Sinus ; Maxillary Sinusitis ; Molar ; Mouth ; Mouth Rehabilitation ; Oral Hygiene ; Patient Compliance ; Prostheses and Implants ; Risk Factors ; Tooth

PURPOSE: The pathways of lymphatic metastases differ according to the tumor location in pancreatic cancer patients. However, it is unclear whether extended lymph node dissection (LND) is essential for all left-sided pancreatic cancer. The aim of this study is to evaluate the survival outcomes according to the extent of LND and tumor location in patients with left-sided pancreatic cancer. METHODS: January 2005 to December 2013, we retrospectively identified 107 patients who underwent curative intent surgery for left-sided pancreatic cancer. The left-sided pancreatic cancer was defined as a tumor located in pancreatic body or tail. The extent of LND was divided into 2 groups: extended LND and peripancreatic LND. The extended LND group included celiac and superior mesenteric LNs. RESULTS: We included 107 patients with left-sided pancreatic cancer; 59 patients with pancreatic body cancer and 48 patients with pancreatic tail cancer. The median follow-up period was 17 months (range, 3–110 months). Fifty patients with pancreatic body cancer and 30 patients with pancreatic tail cancer underwent extended LND. In patients with pancreatic body cancer, extended LND was associated with improved disease-free survival (DFS) (P = 0.010) and overall survival (P = 0.014). However, extended LND was not associated with DFS in patients with pancreatic tail cancer. CONCLUSION: Extended LND could improve survival in patients with pancreatic body cancer. However, extended LND had no survival benefit for the treatment of pancreatic tail cancer.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Lymphatic Metastasis ; Pancreas ; Pancreatic Neoplasms* ; Retrospective Studies ; Tail

PURPOSE: Single-incision laparoscopic distal pancreatectomy (SIL-DP) has recently been attempted in the treatment of left-sided benign neoplasms of the pancreas. This study was conducted to evaluate the perioperative outcomes of SIL-DP compared with conventional laparoscopic DP (CL-DP). METHODS: Patients who received laparoscopic DP from a single surgeon for benign pancreatic neoplasm from January 2012 to January 2014 were included. The patients were divided into two groups, SIL-DP and CL-DP. We used four trocars for CL-DP and a custom-made glove port for SILDP and analyzed the conversion cases separately. Perioperative outcomes were compared between types of surgery. RESULTS: SIL-DP was attempted in 13 patients, five of whom required conversion to CL-DP or dual-incision surgery. CL-DP was attempted in 27 patients and all were successful without open conversion. The spleen was preserved in all patients who underwent SIL-DP without conversion, in four of five (80%) in the conversion group, and 21 (78%) of those who underwent CL-DP. The complication rate was 13% in the SIL-DP-only group, 60% in the conversion group, and 19% in the CL-DP group. The operation time, estimated blood loss, numeric pain intensity score, and hospital duration were similar in the SIL-DP and CL-DP groups. CONCLUSION: SIL-DP was associated with a moderate need for an additional port, and the complication rate was high in the conversion group. Our findings indicate that SIL-DP should be attempted carefully. Further studies are needed to evaluate the lon g term follow-up outcomes of SIL-DP.
Follow-Up Studies ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Pancreas ; Pancreatectomy* ; Pancreatic Neoplasms ; Spleen* ; Surgical Instruments

PURPOSE: Surgical resection of isolated hepatic or pulmonary metastases of colorectal cancer is an established procedure, with a 5-year survival rate of about 50%. However, the role of surgical resections in patients with both hepatic and pulmonary metastases is not well established. We aimed to analyze overall survival of these patients and associated factors. METHODS: Data retrospectively collected from 66 patients who underwent both hepatic and pulmonary metastasectomy after colorectal cancer surgery from August 2002 through August 2013 were analyzed. In univariate analysis, the log-rank test compared patient survival between groups. P < 0.1 was considered indicative of significance. Multivariate analysis of the significance data using a Cox proportional hazard model identified factors associated with overall survival. The synchronous group (n = 57) was defined as patients who had metastasectomy within 3 months from primary colorectal cancer surgery. The remaining nine patients constituted the metachronous group. RESULTS: Median follow-up was 126 months from the primary colorectal cancer surgery. The 5-year survival was 73.4%. There was no difference in overall survival between the synchronous and metachronous groups, consistent with previous studies. Distribution (involving one hemiliver or both, P = 0.010 in multivariate analysis) of liver metastases and multiplicity of the pulmonary metastasis (P = 0.039) were predictors of poor prognosis. CONCLUSION: Sequential or simultaneous resection of both hepatic and pulmonary metastasis of colorectal cancer resulted in good long-term survival in selected patients. Thus, an aggressive surgical approach and multidisciplinary decision making with surgeons seems to be justified.
Colorectal Neoplasms* ; Decision Making ; Follow-Up Studies ; Humans ; Liver* ; Lung* ; Metastasectomy ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Surgeons ; Survival Rate

BACKGROUND AND OBJECTIVES: To determine the frequency of the histologic types of nasal polyp in Korea and their relationships with respect to age, laterality, asthma, allergic rhinitis (AR) and expression of vascular endothelial growth factor (VEGF). SUBJECTS AND METHOD: Tissue slides obtained from 282 patients with nasal polyps were examined; polyps were classified either as eosinophilic polyp or chronic inflammatory polyp. VEGF expression was determined using immunohistochemical staining. RESULTS: Of the 282 subjects, 169 (59.9%) had chronic inflammatory polyps, 113 (40.1%) had eosinophilic polyps, and 232 (82.3%) had bilateral polyps. Twenty-two subjects (7.8%) had asthma and 23 (8.2%) had AR. There was no statistical relationship between nasal polyp type and laterality or the presence of asthma or AR. Of 10 children, 9 (90%) had chronic inflammatory polyps. VEGF expression was significantly higher in eosinophilic polyps than in chronic inflammatory polyps, and significantly higher in the samples of each polyp type from the subjects with AR than those without AR. In subjects with asthma, however, the VEGF expression did not differ between eosinophilic polyps and chronic inflammatory polyp samples. CONCLUSION: In the Korean population, chronic inflammatory nasal polyps are more common than eosinophilic nasal polyps. VEGF expression was the highest in eosinophilic polyps of the subjects with AR, suggesting that VEGF might contribute to the polyp formation via local allergic action.
Asthma ; Child ; Eosinophils ; Humans ; Hypersensitivity ; Inflammation ; Korea ; Nasal Polyps ; Polyps ; Rhinitis ; Rhinitis, Allergic, Perennial ; Vascular Endothelial Growth Factor A

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is an endogenous free radical gas mediator, synthesized by a family of nitric oxide synthases (NOS). Established properties of NO of potential relevance to the formation of nasal polyps include vasodilatation, direct regulation of eosinophil and neutrophil function, and potentiation of histamine-induced plasma exudation. Steroids are currently the most potent medication available for the treatment of nasal polyposis, but the exact mechanisms are uncertain. The purpose of this study was to evaluate the response of three NOS isoenzymes to short-term systemic and long-term topical steroid in nasal polyps. MATERIALS AND METHOD: Steroid-untreated nasal polyp patients (n=10), oral steroid-treated nasal polyp patients (n=10, prednisolone 30 mg per day for 7days) and topical steroid-treated nasal polyp patients (n=10, Fluticasone 100 microgram per day for more than 1 month) underwent nasal endoscopy and biopsy of the polyps. The protein expressions of NOS in nasal polyp tissues were evaluated by immunohistochemistry. RESULTS: Immunohistochemical studies revealed that expression levels of proteins produced by three NOS isoenzymes were significantly decreased in steroid-treated nasal polyps when compared with steroid-untreated nasal polyps, and there was no difference in the effects between short-term systemic and long-term topical steroid treatment on nasal polyps. CONCLUSION: These results show that the expressions of constitutive NOS as well as inducible NOS in nasal polyp tissue were suppressed by steroid therapy. There was no difference in the NOS isoenzymes expression between short-term systemic and long-term topical steroid-treated polyps.
Biopsy ; Endoscopy ; Eosinophils ; Humans ; Immunohistochemistry ; Isoenzymes ; Nasal Polyps* ; Neutrophils ; Nitric Oxide Synthase ; Nitric Oxide* ; Plasma ; Polyps ; Prednisolone ; Steroids ; Vasodilation ; Fluticasone

Vascular neoplasms are the most common non-epithelial tumors in the nasal and paranasal regions. However, heman-giopericytomas usually occur in the retroperitoneum or in the thigh and are uncommon in the nasal cavity and paranasal sinuses. Nasal hemangiopericytoma-like (HPCL) tumors should be differentiated from typical hemangiopericytomas. HPCL tumors, a distinctive variety of vascular neoplasm, often originate in a paranasal sinus and extend into the nasal cavity secondarily. They occur most commonly in adults in the sixth and seventh decades of life and clinically mimic allergic polyps with symptoms of nasal obstruction and epistaxis. Microscopically, HPCL tumors are composed predominantly of spindle cells and lack nuclear or cytoplasmic pleomorphism, mitotic activity, hemorrhage, or necrosis demonstrating a vascular architecture. We report a rare case of HPCL tumor originating from nasal septum in a 45-year-old man with the following immunohistochemical features: vimentin (+), CD34 (+), S-100 protein (-), desmin (-), factor VIII-related antigen (-), and fuchinophilia on Masson trichrome stain.
Adult ; Cytoplasm ; Desmin ; Epistaxis ; Hemangiopericytoma ; Hemorrhage ; Humans ; Immunohistochemistry ; Middle Aged ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum* ; Necrosis ; Paranasal Sinuses ; Polyps ; S100 Proteins ; Thigh ; Vascular Neoplasms ; Vimentin ; von Willebrand Factor