PURPOSE: The megacolon after repairing an anorectal malformation is not a rare complication, and there is much controversiy on the causes, the treatment of choice and the results after a longterm follow-up. We present 5 cases of a megacolon after the repair of an anorectal malformation, which were controlled with either a surgical resection or conservative treatment. METHODS: Five patients with a megacolon after the repair of an anorectal malformation were studied. A retrospective chart review was done and fecal continence was evaluated with an individual interview. RESULTS: All five patients initially underwent conservative treatment with laxatives and/or enemas. One Patient responded well to conservative treatment and the diameter of the bowel reduced to normal size. Another patient responded to conservative treatment after correcting the location of the anus. Three patients needed a surgical resection and one of those needed a further procedure to correct the anal location. After the surgical resection of the megacolon and/or correction of the anus (one out of the three patients), they soon reported an almost normal bowel habit. CONCLUSION: The first step in treating a megacolon after repairing an anorectal malformation was conservative treatment. However patients without an adequate response to conservative treatment are best managed with a surgical resection. The cause of the megacolon is now under investigation and the lack of adequate management after repair is one of the subjects.
Anal Canal ; Enema ; Follow-Up Studies ; Humans ; Laxatives ; Megacolon* ; Retrospective Studies

As transplantation for end-stage renal disease has become more common, avascular necrosis has become a major cause of disability after a successful transplantation. We studied the relationship between development of avascular necrosis of bone and the administration and dosage of steroid, cholesterol level and triglyceride level after transplantation in 909 patients who received kidney transplantation from March 1969 until August 1994 at Catholic University, Medical College. These patients were compared against 60 patients who received kidney transplantation and steroid therapy without developing osteonecrosis. Osteonecrosis was observed in 62 of the patients (6.8 per cent) from 3 to 37 months (mean 10) after the transplant operation. The average age was thirty-eight years (range, twenty to sixty-three years). A single bone was involved in 28 patients, while in the rest of the patients there were between two and four different sites. Altogether 109 bones were affected, 102 of them being weight-bearing. The most common sites were the femoral heads, with 32 patients having bilateral involvement. There was no association between the cumulative dosage of prednisone and the development of avascular necrosis. Although the post renal transplant cholesterol and triglyceride level were significantly elevated compared to the pre-renal transplant state, there were no significantly difference between the avascular group and control group.
Cholesterol ; Head ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Necrosis* ; Osteonecrosis ; Prednisone ; Triglycerides ; Weight-Bearing

No abstract available.
Ovarian Neoplasms* ; Prognosis

Thrombocytosis(a platelet count>400,000/mm3) is found to be frequently in association with malignant disease and recently has been suggested to be a poor prognostic indicator in patients with certain cancers. The objective of this retrospective study was to determine the relevance of a preoperative platelet count in ovarian cancer with a possible prognostic significance of thrombocytosis in this disease. Between June 1989 and December 1995, eighty-five patients with epithelial ovarian cancer were evaluated, who were managed at Asan Medical Center by cytoreductive surgery and chemotherapy, and had at least 6 months' follow-up. Prevalence of thrombocytosis was 22.4% and significantly correlated with FIGO stage(p=0.003), histologic subtype(p=0.002), tumor grade(p=0.040), performance status of patient(p=0.006) and preoperative serum CA 125 level(p=0.002). And the linear regression analysis revealed a significant correlation(p<0.001) between platelet count and preoperative serum CA 125 level, which suggested that platelet count was positively associated with tumor volume. No difference in survival between patients with or without thrombocytosis was found(p=0.68), whereas residual tumor size and serum CA 125 level after 2nd chemotherapy were found to be independent prognostic factors. In conclusion, thrombocytosis is not a useful prognostic factor in epithelial ovarian cancer, but significantly associated with tumor volume.
Blood Platelets ; Chungcheongnam-do ; Drug Therapy ; Follow-Up Studies ; Humans ; Linear Models ; Neoplasm, Residual ; Ovarian Neoplasms* ; Platelet Count ; Prevalence ; Retrospective Studies ; Thrombocytosis* ; Tumor Burden

In this retrospective study, we assessed the clinical usefulness of postoperative decline of serum CA 125 level after initial surgery to predict the size of residual disease in patients with advanced epithelial ovarian cancer. Between June 1989 and December 1995, sixty-three patients with advanced epithelial ovarian cancer (FIGO stage II-IV) were evaluated, who were managed at Asan Medical Center by cytoreductive surgery followed by chemotherapy. All patients had elevated preoperative serum CA 125(>35U/ml) and had another serum CA 125 assay 7~10 days after surgery. Preoperative CA 125 levels were similar in patients with residual disease below 2 cm and in those with larger residuum. The postoperative decline of serum CA 125 was significantly higher in patients with smaller residual disease only if preoperative serum CA 125 value was over 400U/ml. By taking 70% as the cutoff of CA 125 decline for discriminating patients with residual disease above 2 cm, the specificity and positive predictive value of this parameter improved when we considered patients with increasing preoperative serum levels. Hence, in the subset of patients with preoperative serum CA 125 level over 400U/ml, 95.2% (20/21) of patients with residual disease below 2 cm showed postoperative decline of serum CA 125 level over 70%, and 91.7%(11/12) of patients with postoperative decline of serum CA 125 level below 70% had residual disease over 2 cm. In conclusion, postoperative decline of serum CA 125 level after initial surgery does not exactly reflect the size of residual disease, but shows limited clinical usefulness in subset of patients with preoperative serum CA 125 level over 400 U/ml.
Chungcheongnam-do ; Chymopapain* ; Drug Therapy ; Humans ; Ovarian Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity

Four cases of primary transitional cell carcinoma (TCC) arising in the ovary (3 cases) and the parovarium (1 case) were collected for clinicopathologic analysis. The mean age was 46.2 years (range, 39-57 years). Two patients complained abdominal discomfort and vaginal discharge, respectively. Other 2 cases were incidentally found from routine check. Grossly, the tumors were solid and cystic (2 cases), solid (1 case) and surface papillary growth on capsule (1 case). Microscopically, the tumor showed almostly same to the histologic features of TCC of urinary bladder. Three cases were pure TCC, and one was mixed TCC and serous carcinoma. FIGO stage were 1 IIa, 2 IIc, and 1 IIIc. Treatment was surgery with adjuvant chemotherapy. Two patients are alive with no evidence of disease, and two have lung or brain metastasis.
Brain ; Carcinoma, Transitional Cell* ; Chemotherapy, Adjuvant ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Ovary ; Urinary Bladder ; Vaginal Discharge

PURPOSE: To speculate the role of bcl-2 protooncogene in endometrial carcinogenesis by determination of the expression of bcl-2 in endometrial hyperplasia and carcinoma. MATERIALS AND METHODS: We studied bcl-2 expression by an immunohistochemical method in the paraffin-embedded blocks of 78 patients with endometrial hyperplasia, 64 with simple hyperpasia, 9 with complex hyperplasia and 5 with atypical hyperplasia respectively, and 33 endometrial carcinoma treated at Asan Medical Center from June, 1989 to May, 1997. Intensity of bcl-2 staining was scored on a scale of 0 to 4, calibrated by comparison with stromal lymphocytes, which always received a score of 4. RESULTS: The results of this study showed that bcl-2 was relatively highly expressed in simple (n= 64), complex (n=9) and atypical hyperplasias (n=5) with mean staining scores of 2.95+/-1.09 (Mean+Standard Deviation), 2.78+/-1.20 and 3.60+/-0.89 respectively, which showed no difference among histologic types. In endometrial carcinoma, the expression of bcl-2 was significantly down regulated (mean score=1.76+/-1.35) compared with that of hyperplasia, and did not conelate with FIGO surgical stage. However, grade III tumor showed significantly lower expression that grade I or II tumor. CONCLUSION: Bcl-2 expression is down regulated in endometrial carcinoma than endo- metrial hyperplasia, and correlates with tumor grade, which suggest that bcl-2 expression might be the result of carcinogenesis or bcl-2 plays only an adjunctive role in the endometrial carcinogenesis.
Carcinogenesis ; Chungcheongnam-do ; Endometrial Hyperplasia* ; Endometrial Neoplasms ; Female ; Humans ; Hyperplasia ; Lymphocytes

Uterine sarcomas are rare tumors with unpredictable prognosis, comprising about 3% of uterine cancers. Little is known of epidemiologic risk factors and similarly, little work has been performed assessing molecular alterations in sarcomas. Proteins encoded by p53, bcl-2 and bax genes are important regulators of programed cell death, hence apoptosis. Alterations in the expression of these apoptosis-related genes can contribute to the development of most of human cancers, as well as possibly influence the prognosis of the cancer patients. Using antibodies specific for the p53, bcl-2 and bax proteins in combination with immunohistochemical methods, we examined for the first time the expression of these genes in 19 cases of uterine sarcoma, managed at Asan Medical Center between June, 1989 and December, 1996, including 13 leiomyosarcomas, 4 endodermal stromal sarcomas and 2 malignant mixed mullerian tumors. Twelve patients had stage I disease and 7 stage III, and 9 patients had tumors with mitoses less than 10 per 10 HPF, and the others had those with mitoses equal to or more than 10 per 10 HPF. The results were evaluated by semiquantitative analysis as non-(0%), low(1~25%), moderate(26~75%) and high expressors(>76%), and the latter two were defined as tumors with overexpression. The immunoreactivity of bcl-2 and bax appeared in the cytoplasm, while that of p53 was localized solely in the nuclei. p53 immunostaining revealed 4 non-expressors, 7 low, 3 moderate and 5 high expressors, showing 42.1% rate of overexpression. Immunostaining of bcl-2 showed 13 non-expressors, 2 low, 1 moderate and 3 high expressors, resulting 21.1% rate of overexpression and that of bax showed 1 non-expressors, 4 low, 6 moderate and 8 high expressors, resulting 73.7% rate of overexpression. We could not find any significant correlation among the degrees of the expressions of these three proteins. The overexpression of these three proteins did not show any significant association with stage of disease or mitotic count of tumor. In conclusion, although apoptosis-related factors such as p53, bcl-2 and bax are strongly suggested to play a certain role in tumorigenesis of uterine sarcoma, the correlation among them and prognostic implications need further investigation.
Antibodies ; Apoptosis ; bcl-2-Associated X Protein ; Carcinogenesis ; Cell Death ; Chungcheongnam-do ; Cytoplasm ; Endoderm ; Humans ; Leiomyosarcoma ; Mitosis ; Prognosis ; Risk Factors ; Sarcoma* ; Uterine Neoplasms

Purpose: Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and Methods: Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results: Among the recruited patients, 569 (63.9%) with naïve HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.