BACKGROUNDS: The p21 protein inhibits cyclin-dependent kinases and mediates cell-cycle arrest and cell differentiation. METHODS: This study was performed in 61 patients with gastric adenocarcinoma to investigate the realtionship between p21 expression and clinicopathological findings, and the usefulness of p21 as a prognostic factor. Correlation was determined between p21 immunoreactivity by immunohistochemistry and clinicopathological features, including the clinical outcome. RESULTS: Immunoreactivity for p21 was detected in 31 (50.8%) patients. There were no significant correlations between the presence or absence of p21 immunoreactivity and age, sex, site, tumor invasion, tumor size, lymph node metastasis, distant metastasis, or stage except histologic subtype (P=0.002). Survival curves revealed that there was no significant difference of the prognosis between patients with p21 expression and those without p21 expression (P=0.836). CONCLUSIONS: Immunohistochemical analysis of p21 was not useful for evaluating the prognosis and biological status of patients with gastric adenocarcinoma.
Adenocarcinoma* ; Cell Differentiation ; Cyclin-Dependent Kinases ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

PURPOSE: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. RESULTS: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. CONCLUSION: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.
Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Prospective Studies ; Semen/metabolism ; Testicular Diseases/ultrasonography ; Ultrasonography, Doppler, Color/*methods ; Varicocele/pathology/*ultrasonography ; Veins/*ultrasonography ; Young Adult

Most cases of upper gastrointestinal bleeding in patients with portal hypertension are caused by esophagogastric varices. Less often, bleeding originates in varices located elsewhere. If ectopic varices are found, the same hemostatic technique tend to be used. However, there is no evidence that such techniques are useful in these cases. Duodenal varices are quite common, although they rarely bleed due to their location deep in the duodenal wall. Consequently, if emergency endoscopy is not conducted, hemorrhage may be wrongfully attributed to coexisting esophagogastric varices in a patient with portal hypertension without active bleeding. Hemorrhage from duodenal varices may be severe and life threatening. We report a patient with portal hypertension and bleeding duodenal varices caused by cirrhosis of the liver. Hemorrhage was subsequently controlled by placement of a transjugular intrahepatic portosystemic shunt. We recommend that in patients with life-threatening hemorrhage from duodenal varices caused by cirrhosis of the liver, transjugular intrahepatic portosystemic shunt (TIPS) be considered in the man-agement.
Emergencies ; Endoscopy ; Esophageal and Gastric Varices* ; Fibrosis ; Hemorrhage ; Hemostatic Techniques ; Humans ; Hypertension, Portal ; Liver ; Portasystemic Shunt, Surgical* ; Varicose Veins

Retrocaval ureter is a congenital venous anomaly, in which the ureter passes behind and is compassed by inferior vena cava. We experienced a case of multiple urothelial cell carcinoma in retrocaval ureter in 68 years old male. He was treated with transurethral resection of bladder tumor and right nephroureterectomy with bladder cuff excision.
Aged ; Carcinoma, Transitional Cell ; Humans ; Male ; Retrocaval Ureter* ; Ureter ; Urinary Bladder ; Urinary Bladder Neoplasms ; Vena Cava, Inferior

PURPOSE: Despite gsstric cancer is one of the most common ma1ignancies, its prognosis has not been improved significantly. Therefore, it is important to know what clinical and pathological factors relate to survival in gastric carcinoma in order to improve survival rate. The aim of this retrospective study was to evaluate treatment results and to analyze the factors that affect the survival of patients with gastric carcinoma. MATERIALS AND METHODS: A total of 1,580 patients with primary gastric adenocarcinoma who had been treated surgically during the period 1983-1996 at the Department of Surgery, Korea University College of Medicine was studied to evaluate the treatment outcome. Prognostic factors were investigated by univariate and multivariate analyses in 1,407 resected patients. RESULTS: The 5-year survival rate was 57.1% in all case, 62.4% in resected cases, and there was no survivor at 2.5 year in unresectable cases. In univariate analysis, gross type, maximum tumor diameter, depth of invasion, lymph node involvement, distant metastasis, histologic type and type of operation were found to correlate significantly with survival. Multivariate analysis indicated that lymph node involvement, depth of invasion and type of cancer were independently conelated with survival. The stage-related survival rates (UICC, 1987) were 95.8% (stage Ia), 87.6% (stage Ib), 76.7% (stage II), 51.3% (stage 1IIa), 25.5% (stage IIlb), 9.4% (stage IV) and the stage-related survival rates (UICC, 1997) 95.8% (stage Ia), 87.6% (stage Ib), 76.4% (stage II), 55.2% (stage IIla), 24.0% (stage IIIb), 13.4% (stage IV). There was no difference between two staging systems. CONCLUSIONS: These results suggest that lymph node involvement, depth of invasion, and gross type were the most important prognostic factors, indicating that they may be helpful as predictors of long-term survival and in planning the treatment.
Adenocarcinoma* ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Survivors ; Treatment Outcome

PURPOSE: This study was carried out to evaluate the impact of combined splenectomy with total gastrectomy on survival and postoperative morbidity in advanced gastric cancer. PATIENTS AND METHODS: We performed a retrospective analysis of 193 patients who underwent curative resection among 289 patients with total gastrectomy during the period of Sep. 1983 through Dec. 1995 at the Department of Surgery, Korea University Hospital. RESULTS: Out of 11 clinicopathologic factors, 5 were associated with splenectomy through univariate analysis. The incidence of splenectomy increased when the patients with advanced gastric cancer had Borrmann type III, Gross T3 & T4 stage, greater than 4 cm of tumor size, Serosal invasion, or UICC stage IIIb, IV (p<0.05). Postoperative complication occurred more commonly in splenectomy group than in non-splenectomy group (20.2% vs 16.9%). The 5-year survival rate of Stage II was lower in splenectomy group than in non-splenectomy group (63.5% vs 83.5%) but that of Stage III was higher in splenectomy group than in non-splenectomy group (22.8% vs 17.3%), there was no significant difference between the survival rates across different stages. CONCLUSION: We could not find any beneficial effect of splenectomy in gastric cancer patients who underwent curative total gastrectomy in this retrospective analysis. There was no clinical evidence to support splenectomy as a general policy in patients with total gastrectomy. We conclude that the randomized prospective clinical trials using more precise criteria for the indication of splenectomy are needed in order to assess the beneficial effect of splenectomy.
Gastrectomy* ; Humans ; Incidence ; Korea ; Postoperative Complications ; Prognosis* ; Retrospective Studies ; Splenectomy* ; Stomach Neoplasms* ; Survival Rate

We report a case of infantile myofibromatosis in a male infant with involvement of the lungs and subcutaneous tissue. We studied our case by light microscopy, immunohistochemistry and electron microscopy. The results reveal that this entity is of a myofibroblastic nature. We reviewed 165 cases including our case. We believe this is the first report in Korea of infantile myofibromatosis with pulmonary involvement.
Case Report ; Human ; Infant, Newborn ; Leiomyoma/*pathology/ultrastructure ; Lung Neoplasms/*pathology/ultrastructure ; Male ; Microscopy, Electron/methods ; Prognosis ; Skin Neoplasms/*pathology/ultrastructure

We report a case of infantile myofibromatosis in a male infant with involvement of the lungs and subcutaneous tissue. We studied our case by light microscopy, immunohistochemistry and electron microscopy. The results reveal that this entity is of a myofibroblastic nature. We reviewed 165 cases including our case. We believe this is the first report in Korea of infantile myofibromatosis with pulmonary involvement.
Case Report ; Human ; Infant, Newborn ; Leiomyoma/*pathology/ultrastructure ; Lung Neoplasms/*pathology/ultrastructure ; Male ; Microscopy, Electron/methods ; Prognosis ; Skin Neoplasms/*pathology/ultrastructure

Subungual melanoma is a variant of acral lentiginous melanoma and is thought to carry a poor prognosis due to difficulties in early diagnosis. Classical management of subungual melanoma is based on the radical surgery of distal phalanx amputation. Instead, conservative treatment with non-amputative wide excision of the nail unit followed by reconstruction has been insufficiently reported, especially in Korea. A 71-year-old woman presented with dark brownish longitudinal bands on her right thumbnail. Punch biopsies from the nail matrix and nail bed showed proliferation of atypical melanocytes without dermal involvement. We describe a case of subungual melanoma in situ of the right thumb, and a non-amputative surgical management which aims to provide adequate clearance of the lesion with minimal morbidity and satisfactory preservation of function for the patient.
Amputation ; Biopsy ; Early Diagnosis ; Female ; Humans ; Korea ; Melanocytes ; Melanoma ; Nails ; Prognosis ; Thumb

BACKGROUND/AIMS: Although drug-eluting stents (DESs) effectively reduce restenosis following percutaneous coronary intervention (PCI), they also delay re-endothelialization and impair microvascular function, resulting in adverse clinical outcomes. Endothelial progenitor cell (EPC) capturing stents, by providing a functional endothelial layer on the stent, have beneficial effects on microvascular function. However, data on coronary microvascular function in patients with EPC stents versus DESs are lacking. METHODS: Seventy-four patients who previously underwent PCI were enrolled in this study. Microvascular function was evaluated 6 months after PCI based on the index of microvascular resistance (IMR) and the coronary flow reserve (CFR). IMR was calculated as the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of the hyperemic mean transit time (hTmn). The CFR was calculated by dividing the hTmn by the baseline mean transit time. RESULTS: Twenty-one patients (age, 67.2 +/- 9.6 years; male:female, 15:6) with an EPC stent and 53 patients (age, 61.5 +/- 14.7 years; male:female, 40:13) with second-generation DESs were included in the study. There were no significant differences in the baseline clinical and angiographic characteristics of the two groups. Angiography performed 6 months postoperatively did not show significant differences in their CFR values. However, patients with the EPC stent had a significantly lower IMR than patients with second-generation DESs (median, 25.5 [interquartile range, 12.85 to 28.18] vs. 29.0 [interquartile range, 15.42 to 39.23]; p = 0.043). CONCLUSIONS: Microvascular dysfunction was significantly improved after 6 months in patients with EPC stents compared to those with DESs. The complete re-endothelialization achieved with the EPC stent may provide clinical benefits over DESs, especially in patients with microvascular dysfunction.
Aged ; Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease/diagnosis/physiopathology/*therapy ; *Coronary Circulation ; Coronary Vessels/*physiopathology/radiography ; Drug-Eluting Stents ; *Endothelial Progenitor Cells/radiography ; Female ; Humans ; Male ; Microvessels/*physiopathology/radiography ; Middle Aged ; Percutaneous Coronary Intervention/*instrumentation ; Prosthesis Design ; *Re-Epithelialization ; *Stents ; Time Factors ; Treatment Outcome ; Vascular Resistance