PURPOSE: Angiogeneisis is essential process for tumor growth and metastasis. Vascular endothelial growth factor (VEGF) is major regulator of angiogenesis. Recently, the incidence of papillary thyroid microcarcinoma (PTMC) increased because of development in diagnostic modality. Several recent reports have documented relationship of VEGF and papillary thyroid cancer. The aims of this study were to determine whether angiogenetic phenotype was changed or not changed and to evaluate the relationship between clinicopathologic features and VEGF, vascular endothelial growth factor receptor-1 (VEGFR-1), hypoxic induced factor-1alpha (HIF-1α) mRNA expression in PTMC. METHODS: VEGF, VEGFR-1, HIF-1α mRNA expression was examined by RT-PCR in 14 patients who had undergone thyroidectomy due to PTMC. The thyroid tumor tissue and adjacent normal thyroid tissue were collected in operation and preserved at -70℃ in RNA later solution. We evaluate the expression of VEGF, VEGFR-1, HIF-1α mRNA by RTPCR. The expression of mRNA was quantititated by densitometer and analyzed the relationship between clinicopathologic features and mRNA expression. RESULTS: Compared to normal tissues, in PTMC we observed higher expression of HIF-1α mRNA (P=0.024) and lower expression of VEGF mRNA (P=0.002). There was no difference in expression of VEGFR-1.The patients with nodal metastasis had higher expression of the VEGF mRNA in tumor tissues than those without nodal metastasis but not significantly. The VEGF mRNA of tumor tissues in patients with thyroid capsule invasion or not were expressed similarly. The lower expression of VEGF mRNA were observed more frequently in younger patients (<40). CONCLUSION: The expression of VEGF mRNA was lower in tumor tissue in spite of higher expression of HIF-1α mRNA. These results suggest that the reason for good prognosis and no progression to clinical cancer in PTMC was related to the unchanged angiogenic phenotype.
Humans ; Incidence ; Neoplasm Metastasis ; Phenotype ; Prognosis ; RNA ; RNA, Messenger* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factor Receptor-1*

OBJECTIVE: To evaluate the changes of dermatomal SEP (DSEP) in children with a spastic cerebral palsy (CP) after the selective posterior rhizotomy (SPR). METHOD: The subjects were 14 spastic CP children, with the age from 3 to 6 years old, who underwent SPR. DSEPs were studied at the L2-3, L4, L5, S1 dermatomes bilaterally, pre and postoperatively. Postoperative DSEPs were interpreted by the changes of latency, amplitude and waveforms. RESULTS: 1) All children were spastic diplegia except one who was a spastic hemiplegia. 2) Preoperative DSEPs were flat or severely distorted in 40 of 112 waveforms (34.5%). 3) Postoperative DSEP latencies were no change in 39.3%, improved in 17.9%, and worsened in 25.6% respectively. Amplitudes were no change in 30.8%, improved in 38.5%, and worsened in 13.7% respectively. Waveforms were no change in 64.1%, improved in 22.2%, and worsened in 8.5% respectively. There was no statistical difference of postoperative changes of the 3 categories according to the root levels. CONCLUSION: The results showed that the preoperative DSEPs were abnormal in 34.5% suggestive the lesions of CP being more widespread than strictly involving the motor system. This study confirmed that the most SEPs unchanged by the SPR. A further study for the relationship of postoperative DSEP changes and clinical findings such as functional impairment would be needed.
Cerebral Palsy* ; Child* ; Evoked Potentials, Somatosensory* ; Hemiplegia ; Humans ; Muscle Spasticity* ; Rhizotomy*

OBJECTIVE: The purpose of this study is to present the epidemiological data on patients with a stroke admitted to the severance hospital, Yonsei University College of Medicine (YUMC) and to investigate the significant risk factors of stroke. METHODS: We reviewed medical records of 532 patients with a stroke admitted to the hospital of from 1992 to 1996 retrospectively. RESULTS: The incidence was highest in the sixth decade. Ischemic stroke (64.3%) was more common than a hemorrhagic stroke (35.7%) and the thrombotic infarction was the leading type (28.3%) of all kinds of stroke. Middle cerebral arterial territory was the most commonly involved site for the thrombotic and embolic stroke. Of the intracerebral hemorrhages, basal ganglia (48.4%) was the most commonly involved site with was followed by the thalamus (24.2%), lobar (19.3%), and cerebellum (6.5%). In subarachnoid hemorrhages, the aneurysm was most frequently located in the middle cerebral artery (34.4%). The possible contributing factors of stroke were hypertension, hypercholesterolemia, cigarette smoking and diabetes mellitus. The common complications during hospitalization were the frozen shoulders, depression, pneumonia, reflex sympathetic dystrophy (RSD), and hydrocephalus. CONCLUSION: This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.
Aneurysm ; Basal Ganglia ; Cerebellum ; Cerebral Hemorrhage ; Depression ; Diabetes Mellitus ; Epidemiology ; Hospitalization ; Humans ; Hydrocephalus ; Hypercholesterolemia ; Hypertension ; Incidence ; Infarction ; Medical Records ; Middle Cerebral Artery ; Pneumonia ; Reflex Sympathetic Dystrophy ; Retrospective Studies ; Risk Factors ; Shoulder ; Smoking ; Stroke* ; Subarachnoid Hemorrhage ; Thalamus

OBJECTIVE: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV). METHOD: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls. RESULT: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p<0.05), whereas the normalized low frequency power showed a significant increase(p<0.05). But for the left and right hemiplegia groups, there were no significant changes of normalized high and low frequency power under the orthostatic stress(p>0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress. CONCLUSION: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.
Arrhythmias, Cardiac ; Autonomic Nervous System ; Brain ; Death, Sudden ; Electrocardiography ; Heart Rate* ; Heart* ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Respiration ; Stroke*

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic resection following the insertion of self-expanding metallic stents (SEMS) for the treatment of obstructing left-sided colon cancer. METHODS: Between October 2006 and December 2012, laparoscopic resection following SEMS insertion was performed in 54 patients with obstructing left-sided colon cancer. RESULTS: All 54 procedures were technically successful without the need for conversion to open surgery. The median interval from SEMS insertion to laparoscopic surgery was 9 days (range, 3-41 days). The median surgery time was 200 minutes (range, 57-444 minutes), and estimated blood loss was 50 mL (range, 10-3,500 mL). The median time to soft diet was 4 days (range, 2-8 days) and possible length of stay (hypothetical length of stay according to the discharge criteria) was 7 days (range, 4-22 days). The median total number of lymph nodes harvested was 23 (range, 8-71) and loop ileostomy was performed in 2 patients (4%). Six patients (11%) developed postoperative complications: 2 patients with anastomotic leakages, 1 with bladder leakage, and 3 with ileus. There was no mortality within 30 days. CONCLUSION: The present study shows that the presence of a SEMS does not compromise the laparoscopic approach. Laparoscopic resection following stent insertion for obstructing left-sided colon cancer could be performed with a favorable safety profile and short-term outcome. Large-scale comparative studies with long-term follow-up are needed to demonstrate a significant benefit of this approach.
Anastomotic Leak ; Colon* ; Colonic Neoplasms* ; Conversion to Open Surgery ; Diet ; Humans ; Ileostomy ; Ileus ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Mortality ; Postoperative Complications ; Stents* ; Urinary Bladder

PURPOSE: Laparoscopic resection for transverse colon cancer is a technically challenging procedure that has been excluded from various large randomized controlled trials of which the long-term outcomes still need to be verified. The purpose of this study was to evaluate long-term oncologic outcomes for transverse colon cancer patients undergoing laparoscopic colectomy (LAC) or open colectomy (OC). METHODS: This retrospective review included patients with transverse colon cancer who received a colectomy between January 2006 and December 2010. Short-term and five-year oncologic outcomes were compared between these groups. RESULTS: A total of 131 patients were analyzed in the final study (LAC, 84 patients; OC, 47 patients). There were no significant differences in age, gender, body mass index, tumor location, operative procedure, or blood loss between groups, but the mean operative time in LAC was significantly longer (LAC, 246.8 minutes vs. OC, 213.8 minutes; P = 0.03). Hospital stay was much shorter for LAC than OC (9.1 days vs. 14.5 days, P < 0.01). Postoperative complication rates were not statistically different between the two groups. In terms of long-term oncologic data, the 5-year disease-free survival and overall survival were not statistically different between both groups, and subgroup analysis according to cancer stage also revealed no differences. CONCLUSION: LAC for transverse colon cancer is feasible and safe with comparable short- and long-term outcomes.
Body Mass Index ; Colectomy ; Colon ; Colon, Transverse* ; Colonic Neoplasms ; Disease-Free Survival ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Surgical Procedures, Operative