Background/Aims: Sorafenib is the first approved systemic treatment for advanced hepatocellular carcinoma (HCC). However, its clinical utility is limited, especially in Asian countries. Several reports have suggested the survival benefits of hepatic arterial infusion chemotherapy (HAIC) for advanced HCC with main portal vein tumor thrombosis (PVTT). This study aimed to compare the efficacy of sorafenib-based therapy with that of HAIC-based therapy for advanced HCC with main PVTT. Methods: Advanced HCC patients with main PVTT treated with sorafenib or HAIC between 2008 and 2016 at Korea University Medical Center were included. We evaluated overall survival (OS), time-to-progression (TTP), and the disease control rate (DCR). Results: Seventy-three patients were treated with sorafenib (n=35) or HAIC (n=38). Baseline characteristics were not significantly different between groups, except the presence of solid organ metastasis (46% vs 5.3%, p<0.001). The median OS time was not significantly different between the groups (6.4 months vs 10.0 months, p=0.139). TTP was longer in the HAIC group than in the sorafenib group (2.1 months vs 6.2 months, p=0.006). The DCR was also better in the HAIC group than in the sorafenib group (37% vs 76%, p=0.001). Subgroup analysis, which excluded patients with extrahepatic solid organ metastasis, showed the same trends for the median OS time (8.8 months vs 11.1 months, p=0.097), TTP (1.9 months vs 6.0 months, p<0.001), and DCR (53% vs 81%, p=0.030). Conclusions HAIC-based therapy may be an alternative to sorafenib for advanced HCC with main PVTT by providing longer TTP and a better DCR.

BACKGROUND/AIMS: An excessive inflammatory response is typical in acute pancreatitis and a significant cause of early mortality in severe acute pancreatitis. This is believed to be caused by inflammatory molecules or upregulated cytokine levels in the serum of patients. The aim of this study was to identify the serum-mediated apoptosis-inducing effects in acute pancreatitis patients. METHODS: A skin tissue-derived cell line, BJ, was treated for 24 hours with the sera of 22 healthy volunteers (control) and 71 acute pancreatitis patients (22 with gallstone pancreatitis, 16 with alcoholic pancreatitis, and 11 with pancreatitis with other causes) collected at the time of hospital admission (active) and discharge (resolved). Apoptosis was analyzed by flow cytometry. RESULTS: The average percentage of living cells, early apoptotic cells, and late apoptotic cells ranged from 78.8% to 85.0%, 5.5% to 7.3%, and 7.7% to 13.1%, respectively. The number of live cells increased significantly using the serum from the resolved state of gallstone-induced pancreatitis. In addition, the number of early apoptotic cells increased significantly using the serum from the resolved state of pancreatitis with other causes. The number of late apoptotic cells decreased significantly with the serum from the resolved state compared to the active state of gallstone- and alcohol-induced pancreatitis. CONCLUSIONS: Serum samples from patients with pancreatitis induced a change in the apoptosis profiles of skin-derived cells. These results indicate changes in the serum components in patients with acute pancreatitis.
Apoptosis ; Cell Line ; Flow Cytometry ; Gallstones ; Healthy Volunteers ; Humans ; Mass Screening ; Mortality ; Pancreatitis ; Pancreatitis, Alcoholic ; Skin

BACKGROUND/AIMS: An excessive inflammatory response is typical in acute pancreatitis and a significant cause of early mortality in severe acute pancreatitis. This is believed to be caused by inflammatory molecules or upregulated cytokine levels in the serum of patients. The aim of this study was to identify the serum-mediated apoptosis-inducing effects in acute pancreatitis patients.METHODS: A skin tissue-derived cell line, BJ, was treated for 24 hours with the sera of 22 healthy volunteers (control) and 71 acute pancreatitis patients (22 with gallstone pancreatitis, 16 with alcoholic pancreatitis, and 11 with pancreatitis with other causes) collected at the time of hospital admission (active) and discharge (resolved). Apoptosis was analyzed by flow cytometry.RESULTS: The average percentage of living cells, early apoptotic cells, and late apoptotic cells ranged from 78.8% to 85.0%, 5.5% to 7.3%, and 7.7% to 13.1%, respectively. The number of live cells increased significantly using the serum from the resolved state of gallstone-induced pancreatitis. In addition, the number of early apoptotic cells increased significantly using the serum from the resolved state of pancreatitis with other causes. The number of late apoptotic cells decreased significantly with the serum from the resolved state compared to the active state of gallstone- and alcohol-induced pancreatitis.CONCLUSIONS: Serum samples from patients with pancreatitis induced a change in the apoptosis profiles of skin-derived cells. These results indicate changes in the serum components in patients with acute pancreatitis.
Apoptosis ; Cell Line ; Flow Cytometry ; Gallstones ; Healthy Volunteers ; Humans ; Mass Screening ; Mortality ; Pancreatitis ; Pancreatitis, Alcoholic ; Skin

BACKGROUND/AIMS: In addition to the globally endorsed Barcelona Clinic Liver Cancer (BCLC) staging system, other algorithms or staging systems have been developed, including the Hong Kong Liver Cancer (HKLC) staging system. This study aimed to validate the HKLC staging system relative to the BCLC staging system for predicting survival for hepatocellular carcinoma (HCC) patients in Korea. METHODS: From 2004 to 2013, 2,571 patients newly diagnosed with HCC were consecutively enrolled at three Korea University medical centers. RESULTS: Both staging systems differentiated survival well (p < 0.001). However, 1-year and 3-year survival were predicted better using the HKLC system than the BCLC system (area under the receiver operating characteristic curve: 0.869 vs 0.856 for 1 year, p=0.002; 0.841 vs 0.827 for 3 years, p=0.010). In hypothetical survival curves, the HKLC system exhibited better median overall survival than the BCLC system (33.1 months vs 19.2 months). In evaluations of prognosis according to either BCLC or HKLC treatment guidelines, risk of death was reduced in the group following only HKLC guidelines compared with the group following only BCLC guidelines (hazard ratio, 0.601; 95% confidence interval, 0.443 to 0.816; p=0.001). CONCLUSIONS: Although both staging systems predicted and discriminated HCC prognoses well, the HKLC system showed more encouraging survival benefits than the BCLC system.
Academic Medical Centers ; Carcinoma, Hepatocellular ; Hong Kong ; Humans ; Korea ; Liver Neoplasms ; Liver ; Neoplasm Staging ; Prognosis ; ROC Curve

PURPOSE: Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) binds to low-density lipoprotein. The levels of Lp-PLA2 reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA2 levels and found that it might be a potential biomarker for ACS. MATERIALS AND METHODS: We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group). RESULTS: Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA2 levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA2 to the ACS model significantly increased the global chi2 value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA2 was 0.624 (p=0.004). The addition of Lp-PLA2 level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS. CONCLUSION: Lp-PLA2 levels are related to plaque stability and might be a diagnostic biomarker for ACS.
1-Alkyl-2-acetylglycerophosphocholine Esterase/*blood ; Acute Coronary Syndrome/*blood/physiopathology ; Aged ; Aged, 80 and over ; Angina Pectoris ; Biological Markers/blood ; C-Reactive Protein/*metabolism ; Coronary Angiography ; Female ; Humans ; Lipoproteins, LDL/*blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Plaque, Atherosclerotic/blood ; ROC Curve ; Risk Factors

PURPOSE: The superficial spreading type of early gastric cancer (SSE) has unique features such as its growth pattern and histologic aggressiveness. But its incidence rate is very low, so the clinicopathologic features of SSE are not well known. The aim of this study is to clarify the clinicopathologic features of the superficial spreading type of gastric cancer and we propose an appropriate treatment strategy with the proper treatment modality. METHODS: A retrospective study was conducted on 894 surgically resected patients with early gastric cancer. The superficial spreading type was defined as a lesion more than 20 cm(2). The demographic features and histopathological features were analyzed by using the hospital records. The survival rate was analyzed by the Kaplan-Meier method and the other statistics were analyzed using the chi-square test. RESULTS: For the superficial and common groups, there were no significant differences in the rates of submucosal layer invasion, the histologic types and differentiation and the tumor location. But the ratio of lymph node metastasis was significantly different (P<0.05). There were some differences concerning the operative methods between the groups. For the superficial spreading type, the portion of total gastrectomy was greater than that of the common type. The average distance between the upper portion of the tumor and the proximal resection margin was shorter for the superficial spreading type than that for the common type (3.78+/-2.79 cm vs 5.58+/-2.79 cm, respectively). The 5 year survival rate and the recurrence rate between the two types were not significantly different. CONCLUSION: Because of the higher rate of lymph node metastasis and the higher rate of an indistinct tumor margin, wide resection with adequate lymph node dissection (D1+beta or more) seems to be a proper operative method for the superficial spreading type of early gastric cancer.
Gastrectomy ; Hospital Records ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

We report a case of cystic adenocarcinoma of the prostate in a 67-year-old man who showed severe obstructive voiding symptoms. In this case, the mechanism of the cyst formation from the prostate cancer is thought to be related to the secondary cystic formation, which was due to either the central necrosis of the cancer tissue or intracancerous tissue hemorrhage. Prostate cystic adenocarcinoma is a rare disease, and there are only a few cases reported in the literature. A cyst of the prostate may be either congenital or acquired. A congenital cyst arises from the mesonephric (Wolffian) or paramesonephric (Mullerian) duct system, while an acquired cyst is subdivided into the retention, malignant, and parasitic cyst. A huge prostatic cyst was found in a 67-year-old man. The lesion was presumed to be a prostate cystic adenocarcinoma.
Adenocarcinoma* ; Aged ; Hemorrhage ; Humans ; Necrosis ; Prostate* ; Prostatic Neoplasms ; Rare Diseases

Primary pericardial sarcomas are extremely rare. The authors report a case of a 46-yr-old woman in whom a large mediastinal mass was discovered. The patient presented with cough, dyspnea, and orthopnea. Diagnostic investigations, such as echocardiography, computed tomography, and exploratory thoracotomy provided the evidence of a large mass in the mediastinum, attached by a broad base to the superior portion of the pericardium. A excisional biopsy was performed, and histologic examination of a biopsy specimen showed undifferentiated sarcoma. However, the complete removal of the mass was impossible due to adhesion to the adjacent great vessels. After the completion of the chemotherapy the patient was completely asymptomatic. However, follow-up transesophageal echocardiography showed a residual 3x4 cm-sized mass. The patient received the radiotherapy with a total dose of 55 Gy over 6 weeks. At present, there is no evidence of disease progression.
Biopsy ; Cough ; Disease Progression ; Dyspnea ; Echocardiography ; Female ; Human ; Mediastinal Neoplasms/*diagnosis/radiography ; Middle Aged ; Prognosis ; Sarcoma/*diagnosis/radiography ; Tomography, X-Ray Computed

Thrombosis of the inferior vena cava (IVC) is a rare condition that can result from various underlying diseases including deep vein thrombosis, major trauma, hypercoagulability disorders, and an obstruction due to tumor involvement and idiopathic causes. Chronic obstruction of the IVC may not be recognized due to the lack of signs and symptoms. Here we report a case of a chronic post-thrombotic obstruction of the inferior vena cava, which was believed to be the cause of a painless gross hematuria.
Hematuria* ; Thrombophilia ; Thrombosis ; Vena Cava, Inferior ; Venous Thrombosis

PURPOSE: Some authors have suggested that erectile dysfunction correlates with the level of glycemic control and glycosylated hemoglobin can be used to predict erectile dysfunction in diabetic patients. This study evaluated whether or not glycosylated hemoglobin level can predict the effectiveness of sildenafil citrate, which is a first line therapy for erectile dysfunction. MATERIALS AND METHODS: A consecutive sample of 32 men with type 2 diabetes and erectile dysfunction completed the International Index of Erectile Function (IIEF) and had their glycosylated hemoglobin levels measured. 50mg of sildenafil citrate was prescribed at the first visit, which was then increased to 100mg if the symptom persisted. According to the response, the patients were divided into responders and nonresponders. The pretreatment clinical parameters (age, diabetic duration, erectile dysfunction duration, glycosylated hemoglobin level, body mass index, IIEF, diabetic complications, smoking, alcohol drinking) were recorded. The patients were divided into 3 groups according to the drug dosage (group 1 was 50mg responders, group 2 was 100mg responders, group 3 was nonresponders in any dosage) and the clinical parameters were compared and analyzed. RESULTS: The mean hemoglobin A1c level was 8.68 0.74% and 7.64 1.67% in the nonresponders and responders (p < 0.05), respectively. Diabetic neuropathy and diabetic retinopathy were significantly higher in the nonresponders (p < 0.05). The mean hemoglobin A1c levels of the three groups were 7.36 1.01, 7.78 0.98, and 8.64 0.44%, respectively and group 3 was significantly higher than the other groups (p < 0.05). CONCLUSIONS: High levels of glycosylated hemoglobin suggests a poor response to sildenafil citrate in diabetic patients with erectile dysfunction. Diabetic patients with neuropathy or retinopathy may have a low response for sildenafil citrate.
Body Mass Index ; Citric Acid* ; Diabetes Complications ; Diabetic Neuropathies ; Diabetic Retinopathy ; Erectile Dysfunction* ; Hemoglobin A, Glycosylated* ; Humans ; Male ; Smoke ; Smoking ; Sildenafil Citrate