PURPOSE: Clinicopathological characteristics of mucinous gastric adenocarcinomas (MGC) are unclear. Also, whether the surgical results of a MGC are unfavorable is still controversial. A tumor is defined as a MGC when more than 30% of the tumor area has mucin pools. Also, MGC are subdivided into the well-differentiated (WD) and poorly differentiated (PD) types, according to the degree of glandular formation of the tumor cells. To clarify the significance of MGC, the clinicopathological profiles and prognoses of patients were studied. METHODS: Thirty-four patients with MGC and 1, 036 with non-mucinous gastric adenocarcinomas (NMGC) who were operated on between 1992 and 2002 at the Department of Surgery, Hanyang University Hospital, were included. Patients were evaluated with regard to age, gender, tumor location, size, depth of wall invasion, lymph node status, distant metastasis, stage at presentation, lymphatic and vascular permeation, operative curability, and preoperative serum levels of CEA and CA19-9. RESULTS: MGC tumors, compared with NMGC tumors, had larger sizes (8.0 vs. 5.9 cm), more frequent incidences of T2 or more invasion (91 vs. 66%), positive lymph node metastasis (85 vs. 57%), distant metastasis (18 vs. 6%), stage III and IV (74 vs. 45%), noncurative surgery (32 vs. 10%), lymphatic permeation (88 vs. 63%), and abnormal serum CEA level (32 vs. 14%). However, the overall survival rate of those patients with a MGC was not significantly different from that of those with a NMGC. With a MGC, there was no significant correlation between the degree of mucin content and the prognosis. Conversely, the survival rate was higher in the WD than in the PD types (100 vs. 45%, P=0.0185). CONCLUSION: The mucinous histological type itself is of no prognostic significance in patients with gastric carcinomas. The biological behavior of MGC is determined by the degree of glandular formation of the tumor cellss (i.e., histologic differentiation).
Adenocarcinoma* ; Humans ; Incidence ; Lymph Nodes ; Mucins* ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate

A 38-year-old man visited our Emergency Department for sudden onset paraplegia that occurred 1 hour ago. He felt a piercing pain in the posterior neck and became paraplegic while he was watching television, lying down on a sofa. Neurological examination showed motor power grades II–III in both arms and grade 0 in both legs. His cervical magnetic resonance imaging (MRI) showed a large ruptured disc at the C5–6 level, severely compressing the spinal cord. Emergency anterior cervical discectomy and fusion at C5–6 were performed. Because extensive cord swelling was observed on postoperative MRI, laminoplasty from C3 to C6 was performed 3 days after the initial operation. At a postoperative 8-month follow-up, the motor power was improved to grade III–IV- for both hands and grade IV- for both legs. Nontraumatic cervical disc rupture causing acute paraplegia is a very rare but possible event. Immediate neurologic assessment and thorough imaging studies to allow accurate diagnosis are crucial. Emergency surgical decompression is important and may lead to good neurological outcomes.
Adult ; Arm ; Deception ; Decompression, Surgical ; Diagnosis ; Diskectomy ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Hand ; Humans ; Laminoplasty ; Leg ; Magnetic Resonance Imaging ; Neck ; Neurologic Examination ; Paraplegia* ; Rupture* ; Spinal Cord ; Television

PURPOSE: SMAD4 is a member of the SMAD family and acts as a central mediator of transforming growth factor beta signaling. Little is known about SMAD4 expression and its prognostic significance in breast cancer. We evaluated the clinicopathological and prognostic significance of SMAD4 expression in breast cancer. METHODS: Two hundred and fifty-five patients with invasive ductal carcinoma of the breast from 2000 to 2008 were retrospectively analyzed. We investigated SMAD4 expression using a tissue microarray-based immunohistochemical assay and evaluated the association between SMAD4 and prognosis of breast cancer. RESULTS: High SMAD4 expression was positively associated with early stage (p=0.009), estrogen receptor positivity (p=0.026), and human epidermal growth factor receptor 2 negativity (p=0.001). A significant difference in overall survival (OS) was associated with high SMAD4 expression in patients with T1 stage tumors (hazard ratio: 0.459, p=0.024). CONCLUSION High SMAD4 expression was correlated with several favorable prognostic factors and was associated with favorable OS in T1 stage breast cancer. SMAD4 in breast cancer has potential prognostic significance, and further investigations and understanding about SMAD4 expression are needed.

OBJECTIVE: Unexpected Solitaire stent detachment can occur during mechanical Solitaire thrombectomy. The purpose of this study was to retrospectively evaluate the influencing factors causing unexpected Solitaire stent detachment and the clinical outcomes. METHODS: Between October 2011 to December 2013, 232 cases of mechanical Solitaire thrombectomy for acute ischemic stroke were performed in 3 stroke centers. During this period, we encountered unexpected Solitaire stent detachments during mechanical Solitaire thrombectomies in 9 cases. RESULTS: Solitaire stents unexpectedly detached in 9 cases (3.9%) during the retrieval of Solitaire stents. The median patient age was 76 years. The occlusion sites of the unexpected stent detachment were the proximal middle cerebral artery (MCA) in 7 cases and the internal carotid artery in 2 cases. The sizes of the stents that unexpectedly detached were 6x30 mm in 7 cases, 5x30 mm in 1 case, and 4x20 mm in 1 case. Four patients had unexpected detachment at the first retrieval, 1 patient at the second, 3 patients at the third, and 1 patient at the fifth. In all of the cases of unexpected detachment at the first retrieval, the stent deployment site was the proximal MCA. After detachment, a proximal marker of the Solitaire stent was observed in 3 patients. However, no marker was visible in the remaining 6 patients. CONCLUSION: Unexpected Solitaire stent detachment should be considered in the first instance of stent retrieval for a relatively large-diameter stent, especially in elderly patients with MCA occlusions.
Aged ; Carotid Artery, Internal ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Stents* ; Stroke ; Thrombectomy*

Pure-phase beta-tricalcium phosphate(beta-TCP) proved to be a bone regeneration material, providing the patient with vital bone at the defect site in a reasonable time, making a second surgical procedure for bone harvesting unnecessary. This study compares bone healing and BMP 2/4 expression in cranial defects in rabbits grafted with autogenous bone and beta-TCP. Thirty New Zealand White rabbits was divided into 3 group of 10 animals each. Bilateral calvarial defects were made in the parietal bones of each animal. beta-TCP placed in one defect and the other defects was filled with autogenous bone. The animal were sacrificed at 4, 8 and 12 weeks. Immunohistochemical analysis was used to investigate the expression of BMP 2/4. 1. The new bone formation around autogenous bone from 4 weeks and beta-TCP from 8 weeks. 2. In autogenous bone graft, BMP 2/4 expression was decreased from 4 to 12 weeks. 3. In beta-TCP graft, BMP 4 expression was increased from 8 to 12 weeks. But, BMP 2 was observed from 12 weeks. This study showed that bone healing, regeneration and, BMP 2/4 expression are delayed in grafted beta-TCP than autogenous bone.
Animals ; Bone Regeneration* ; Humans ; Osteogenesis ; Parietal Bone ; Rabbits ; Regeneration ; Transplants

PURPOSE: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. MATERIALS AND METHODS: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of x100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. RESULTS: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75)(P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (95.3% vs. 77.6%, P=0.0282), but was similar to that (91.2%) of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)(93.3% vs. 78.2%, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis (42.5% vs 23%, P=0.006) than patients with sm. CONCLUSION: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer.
Classification ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. MATERIALS AND METHODS: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of x100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. RESULTS: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75)(P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (95.3% vs. 77.6%, P=0.0282), but was similar to that (91.2%) of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)(93.3% vs. 78.2%, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis (42.5% vs 23%, P=0.006) than patients with sm. CONCLUSION: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer.
Classification ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

Skeletal muscles are known to have tolerance to ischemia, but a prolonged ischemia can cause damage to muscular tissues. The ischemia-reperfusion injury results from the oxygen free radicals released by leucocytes and formed by the reaction of hypoxanthine and xanthine oxidase. Superoxide dismutase (SOD), one of major antioxidant enzymes ocurring in the various tissues of the body metabolizes or scarvanges the oxygen free radicals. Although many studies reported difference in tolerance to ischemia and reperfusion between white and red muscles, some other investigators failed in finding such difference. The present study was performed to examine effects of graded periods of ischemia and reperfusion on the cellular ultrastructure and activity of SOD in white and red muscles. The Sprague-Dawley rats (200~250 g) were used as experimental animals. Under pentobarbital (50 mg/kg IP) anesthesia, incision was made on lower abdomen and left common iliac artery was occluded by means of a vascular clamp for 2, 4 and 6 hour (hrs). Thereafter, the superficial portion of mid-belly of anterior tibial muscle and soleus muscles were excised at 0, 24 and 72 hrs after onset of reperfusion. The specimens were sectioned into slices, 2 mm in length, 1 mm in width and thickness. Some specimens were prepared for electron microscopic observation and others for determination of SOD activity by using antihuman Cu, Zn- and Mn-SOD antibodies. The results obtained were as follows. 1. In anterior tibial muscle, areas with loose electron-density and dilated cristae were observed in the mitochondria immediately after 2 hrs of ischemia, while widened intermyofibrillar spaces and dilated cisternae of sarcoplasmic reticulum were seen after 2 hrs and 24 hrs reperfusion. When subjected to 2 hrs ischemia and 72 hrs reperfusion, no significant change was found in the cellular ultrastructure. 2. In soleus muscle, electron density was loose in the matrix of mitochondria immediately after 2 hrs of ischemia, while cisternae of sarcoplasmic reticulum were dilalated after 2 hrs of ischemia and 24 hrs reperfusion. Following 2 hrs of ischemia and 72 hrs reperfusion, the electron microscopic findings were similar to those of normal rats. 3. The changes in cellular ultrastructure were more prominent in both the 4 hrs and 6 hrs ischemia groups, in which degree of ultrastructural changes were proportional to duration of reperfusion. 4. In anterior tibial muscle, trace or weak immunoreactivities of Cu, Zn- and Mn-SOD were seen, whereas trace immunoreactivity of Cu, Zn-SOD and trace or weak immunoreactivity of Mn-SOD were observed in soleus muscle. 5. The immunoreactivities of Cu, Zn- and Mn-SOD were not altered in 2 hrs ischemic and 72 hrs reperfused group, while they were increased slightly in 2 hrs ischemic and 24 hrs reperfused group. 6. In both muscles, the activity of SOD increased following 4 hrs or 6 hrs ischemia and 24 hrs or 72 hrs reperfusion. The changes in immunoreactivity of Mn-SOD were not different between two muscles, whereas immunoreactivity of Cu, Zn-SOD were higher in anterior tibial muscle. Consequently, it is suggested that significant ischemia reperfusion injuries are produced after 4~6 hrs ishemia followed by 24 hrs or 72 hrs reperfusion, that anterior tibial muscle is more susceptible to ischemic reperfusion injury and that the ischemic-reperfusion injury is closely related with activity of SOD.
Abdomen ; Anesthesia ; Animals ; Antibodies ; Free Radicals ; Humans ; Hypoxanthine ; Iliac Artery ; Ischemia* ; Mitochondria ; Muscle, Skeletal ; Muscles* ; Oxygen ; Pentobarbital ; Rats* ; Rats, Sprague-Dawley ; Reperfusion Injury ; Reperfusion* ; Research Personnel ; Sarcoplasmic Reticulum ; Superoxide Dismutase ; Xanthine Oxidase

Asperigillous osteomyelitis of the spine has quite rarely been reported. We present a 57-year-old man with old pulmonary tuberculosis who developed cough, sputum and back pain followed by paraplegia. Magnetic resonance imaging of the thoracic spine showed the destruction of the vertebral body through the level of T4-5 and epidural abscess. Decompressive surgery was carried out under the presumptive diagnosis of tuberculous spondylitis. However, the pathologic findings were aspergillous infection showing acute angle hyphae. To the best of our knowledge, this is the first report of aspergillous spondylitis producing compressive myelopathy in Korea.
Aspergillus* ; Back Pain ; Cough ; Diagnosis ; Epidural Abscess ; Humans ; Hyphae ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis ; Paraplegia ; Spinal Cord Compression* ; Spine* ; Spondylitis ; Sputum ; Tuberculosis, Pulmonary

Polymyositis (PM) is a subset of idiopathic inflammatory myopathies. The muscles involved with PM are typically proximal and distal limb muscles, but paraspinal muscles are rarely affected. The primary PM clinical symptom is gradual proximal muscle weakness but unusually abnormal trunk posture. Bent spine syndrome (BSS), also referred to camptocormia, is defined as an abnormal flexion of the trunk, appearing in standing position. An idiopathic axial myopathy is the most common cause of primary BSS. A few cases of inflammatory myopathy, a secondary BSS, have been reported. We describe a 59-year–old polymyositis patient with normal finding on an magnetic resonance imaging femur scan who presented with BSS only, myopathic findings on electromyography and elevation of muscle enzymes.
Electromyography ; Extremities ; Femur ; Humans ; Magnetic Resonance Imaging ; Muscle Weakness ; Muscles ; Muscular Diseases ; Myositis ; Paraspinal Muscles ; Polymyositis* ; Posture ; Spine*