Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

PURPOSE: To investigate the clinical features and treatment outcomes between methicillin-sensitive Staphylococcus epidermidis (MSSE) and methicillin-resistant Staphylococcus epidermidis (MRSE) keratitis groups. METHODS: A retrospective analysis of case series was conducted of all patients with keratitis caused only by Staphylococcus epidermidis from January 1997 through December 2008. Sex, age, history of trauma, systemic disease, previous ocular history, antibiotic sensitivity test results, and treatment outcomes were evaluated. Patients were categorized into two groups as MSSE and MRSE according to methicillin-sensitivity result, and a comparative analysis was performed. RESULTS: There were no significant differences in clinical features, such as risk factors or size or location of keratitis between the two groups. All MSSE and MRSE isolates were sensitive to vancomycin, moxifloxacin, and levofloxacin. All MSSE and 17%, 50%, 52%, and 57% of MRSE isolates were sensitive to cephalothin, norfloxacin, ciprofloxacin, and erythromycin, respectively (p < 0.05). There was no significant difference in visual acuity between the two groups. CONCLUSIONS: All MSSE and MRSE isolates were sensitive to vancomycin and to third- or fourth-generation fluoroquinolones In addition, approximately 50% of MRSE isolates were sensitive to norfloxacin and ciprofloxacin. There were no significant differences in clinical features of keratitis caused by MSSE versus those of MRSE isolates. Both keratitis groups had relatively good visual prognoses.
Aza Compounds ; Cephalothin ; Ciprofloxacin ; Epidemiologic Studies ; Erythromycin ; Fluoroquinolones ; Humans ; Keratitis ; Methicillin Resistance ; Norfloxacin ; Ofloxacin ; Prognosis ; Quinolines ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Staphylococcus epidermidis ; Vancomycin ; Visual Acuity

Since it was reported that incipient enamel caries can be recovered, previous studies have quantitatively evaluated that enamel artificial caries have been remineralized with fluoride, showing simultaneously the increase of width of surface layer and the decrease of width of the body of legion. There is, however, little report which showed that remineralization could occur without fluoride. In addition, the observations on the change of hydroxyapatite crystals also have been scarcely seen. In this study, enamel caries in intact premolars or molars was induced by using lactic acidulated buffering solutions over 2 days. Then decalcified specimens were remineralized by seven groups of solutions using different degree of saturation (0.212, 0.239, 0.301, 0.355) and different pH (5.0, 5.5, 6.0) over 10 days. A qualitative comparison to changes of hydroxyapatite crystals after fracturing teeth was made under SEM (scanning electron microscopy) and AFM (atomic force microscopy). The results were as follows: 1. The size of hydroxyapatite crystals in demineralized area was smaller than the normal ones. While the space among crystals was expanded, it was observed that crystals are arranged irregularly. 2. In remineralized enamel area, the enlarged crystals with various shape were observed when the crystals were fused and new small crystals in intercrystalline spaces were deposited. 3. Group 3 and 4 with higher degree of saturation at same pH showed the formation of large clusters by aggregation of small crystals from the surface layer to the lesion body than group 1 and 2 with relatively low degree of saturation at same pH did. Especially group 4 showed complete remineralization to the body of lesions. Group 5 and 6 with lower pH at similar degree of saturation showed remineralization to the body of lesions while group 7 didn't show it. Unlike in Group 3 and 4, Group 5 and 6 showed that each particle was densely distributed with clear appearance rather than crystals form clusters together.
Bicuspid ; Dental Enamel* ; Durapatite* ; Fluorides ; Hydrogen-Ion Concentration* ; Lactic Acid* ; Microscopy, Atomic Force ; Microscopy, Electron, Scanning ; Molar ; Tooth

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potentials (VEMP) have become a good diagnostic tool to evaluate the integrity of the vestibulocollic reflex. To investigate the standard recording of VEMP response in normal hearing subjects, the authors studied the effects of test positions and different acoustic stimulations on the VEMP. SUBJECTS AND METHOD: We performed VEMP on both ears of thirty normal hearing volunteers. Three acoustic stimulations (clicks and 500 Hz and 1,000 Hz short tone bursts) and four test positions were presented alternately to evoke VEMP. The latencies of peak p13 and n23, p13n23 interpeak latency (IPL) and amplitude were measured by EMG equipment and compared by statistical program. We also made up questions for the compliance of the test positions. RESULTS: The effects of test positions p13 latency had no significant difference on all test positions except between test position 2 and 4, n23 latency and p13n23 IPL had shortest waveform on test position 2, p13n23 amplitude had the largest waveform in test position 4. Acoustic stimulations on all test positions were influenced that clicks had shorter waveform about 2-3 ms than STBs on p13 latency and n23 latency, STBs had larger waveform than clicks on p13n23 amplitude. And the compliance of the test positions exhibited highest comfort in test position 1. CONCLUSION: Test position 1 had higher VEMP response rates and compliance, 500 Hz STB had a largest p13n23 amplitude. Therefore we recommend that the ideal conditions were position 1 and 500 Hz STB for acoustic stimulations to evoke VEMP.
Acoustics* ; Compliance ; Ear ; Hearing ; Reflex ; Vestibular Evoked Myogenic Potentials* ; Volunteers

BACKGROUND: The secretion of growth hormone [GH] declines by 14.4% every decade, leading to the suggestion that the elderly are functionally GH deficient, which may increase adipose tissue and decrease the bone mass and density, as well as other negative changes in body composition. Recently, many studies have shown that GH replacement therapy may restore the changes that occur in the body composition with aging. AIM: The GH and insulin like growth factor-I[IGF-I] profiles were identified during GH replacement therapy in the elderly and compared with those of GH deficient[GHD] patients. The metabolic effects of GH replacement on the body composition of the elderly was also investigated, especially the body fat, muscle and bone parameters. Subjects and METHODS: 98 healthy normal out-patients and 13 GHD patients, who had peak GH concentrations less than 5 ng/mL after an insulin tolerance test [ITT] or growth hormone releasing hormone [GHRH] stimulation test, were the subjects of this study. All were receiving appropriate thyroid, adrenal and gonadal hormone replacements. The dose of recombinant human GH [rhGH] was 0.02~0.04 mg [0.06~0.12 IU]/kg of body weight.per week, given nightly by a subcutaneous injection, six times a week, over a 52 week period. The GH was measures after the ITT and GHRH stimulation tests, and the IGF-1, lipid parameters [total cholesterol, triglyceride, HDL-, and LDL cholesterol], visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT], VAT/SAT ratio, quadriceps muscle area, total body fat, total bone mineral density [BMD], alkaline phosphatase [ALP], osteocalcin and urine deoxypyridinoline [DYP], as well as anthropometry, were also assessed. RESULTS: All the anthropometry features between the normal and GHD subjects were very similar. The hormonal profiles were checked; the GH peaks of the ITT and GHRH stimulation tests were significantly higher in the normal compared to the GHD patients, but the GHRH test showed lower GH peaks in than those of the ITT test in the normal subjects. The IGF-I levels after GH replacement were constantly maintained in the normal and GHD groups after 3 week and until the 52nd week. According to the lipid profiles, the GHD group showed significantly decreased total cholesterol and LDL-cholesterol after 12 weeks of GH replacement. The normal male group revealed constantly increased triglyceride levels during the entire 52 weeks of GH replacement, but thr other lipid parameters remained completely unchanged. The normal female group showed no change in any of their lipid parameters. Although the amounts of VAT at the baseline were the same in all groups, only the normal males showed effective visceral fat removal, with significantly reduced VAT after 52 weeks of GH treatment. In the normal female and GHD groups the bone mineral density had a V shaped curve after GH replacement, and the ALP and osteocalcin levels were significantly increased after 26 weeks of GH therapy in the GHD group. CONCLUSION: The body compositions in the normal male, female and GHD groups were similar before the GH replacement therapy, and the serum IGF-I levels were well maintained in all these groups during GH replacement. Although the majority of aging symptoms were improved, the body compositions tended to return to their original stati in the normal groups. GH replacement is recommended in the elderly for better health and well-being
Adipose Tissue ; Adult* ; Aged ; Aging ; Alkaline Phosphatase ; Anthropometry ; Body Composition* ; Bone Density ; Cholesterol ; Female ; Gonads ; Growth Hormone* ; Growth Hormone-Releasing Hormone ; Humans ; Injections, Subcutaneous ; Insulin ; Insulin-Like Growth Factor I ; Intra-Abdominal Fat ; Male ; Osteocalcin ; Outpatients ; Quadriceps Muscle ; Subcutaneous Fat ; Thyroid Gland ; Triglycerides

BACKGROUND: The secretion of growth hormone [GH] declines by 14.4% every decade, leading to the suggestion that the elderly are functionally GH deficient, which may increase adipose tissue and decrease the bone mass and density, as well as other negative changes in body composition. Recently, many studies have shown that GH replacement therapy may restore the changes that occur in the body composition with aging. AIM: The GH and insulin like growth factor-I[IGF-I] profiles were identified during GH replacement therapy in the elderly and compared with those of GH deficient[GHD] patients. The metabolic effects of GH replacement on the body composition of the elderly was also investigated, especially the body fat, muscle and bone parameters. Subjects and METHODS: 98 healthy normal out-patients and 13 GHD patients, who had peak GH concentrations less than 5 ng/mL after an insulin tolerance test [ITT] or growth hormone releasing hormone [GHRH] stimulation test, were the subjects of this study. All were receiving appropriate thyroid, adrenal and gonadal hormone replacements. The dose of recombinant human GH [rhGH] was 0.02~0.04 mg [0.06~0.12 IU]/kg of body weight.per week, given nightly by a subcutaneous injection, six times a week, over a 52 week period. The GH was measures after the ITT and GHRH stimulation tests, and the IGF-1, lipid parameters [total cholesterol, triglyceride, HDL-, and LDL cholesterol], visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT], VAT/SAT ratio, quadriceps muscle area, total body fat, total bone mineral density [BMD], alkaline phosphatase [ALP], osteocalcin and urine deoxypyridinoline [DYP], as well as anthropometry, were also assessed. RESULTS: All the anthropometry features between the normal and GHD subjects were very similar. The hormonal profiles were checked; the GH peaks of the ITT and GHRH stimulation tests were significantly higher in the normal compared to the GHD patients, but the GHRH test showed lower GH peaks in than those of the ITT test in the normal subjects. The IGF-I levels after GH replacement were constantly maintained in the normal and GHD groups after 3 week and until the 52nd week. According to the lipid profiles, the GHD group showed significantly decreased total cholesterol and LDL-cholesterol after 12 weeks of GH replacement. The normal male group revealed constantly increased triglyceride levels during the entire 52 weeks of GH replacement, but thr other lipid parameters remained completely unchanged. The normal female group showed no change in any of their lipid parameters. Although the amounts of VAT at the baseline were the same in all groups, only the normal males showed effective visceral fat removal, with significantly reduced VAT after 52 weeks of GH treatment. In the normal female and GHD groups the bone mineral density had a V shaped curve after GH replacement, and the ALP and osteocalcin levels were significantly increased after 26 weeks of GH therapy in the GHD group. CONCLUSION: The body compositions in the normal male, female and GHD groups were similar before the GH replacement therapy, and the serum IGF-I levels were well maintained in all these groups during GH replacement. Although the majority of aging symptoms were improved, the body compositions tended to return to their original stati in the normal groups. GH replacement is recommended in the elderly for better health and well-being
Adipose Tissue ; Adult* ; Aged ; Aging ; Alkaline Phosphatase ; Anthropometry ; Body Composition* ; Bone Density ; Cholesterol ; Female ; Gonads ; Growth Hormone* ; Growth Hormone-Releasing Hormone ; Humans ; Injections, Subcutaneous ; Insulin ; Insulin-Like Growth Factor I ; Intra-Abdominal Fat ; Male ; Osteocalcin ; Outpatients ; Quadriceps Muscle ; Subcutaneous Fat ; Thyroid Gland ; Triglycerides

BACKGROUND AND OBJECTIVES: Telomerase activity appears to be associated with cell immortalisation and malignant progres-sion. Telomerase activity has been found in the majority of human tumours, but not in most somatic cells or tissues. We studied the change in the telomerase activity by cisplatin and 5-fluorouracil (5-FU) in head and neck cancer cell lines. SUBJECTS AND METHODS: Three different human head and neck cancer cell lines (PNUH-12, SNU-899, HEp-2) were studied. Cell cytotoxi-city and change of telomerase activity by 5-FU and cisplatin treatment were assessed by MTT and TRAP assays. RESULTS: The telomerase activity was detected in the head and neck cancer cell lines. After the cisplatin treatment, the telomerase activity was decreased in a concentration-dependent manner. However, after 5-FU treatment, the telomerase activity showed a slight decrease or no change at the concentration similar to that of cisplatin in the inhibition of tumor growth. CONCLUSION: Our results can explain one of the reasons why cisplatin is more effective than 5-FU in the chemotherapy of head and neck cancer.
Cell Line* ; Cisplatin* ; Drug Therapy ; Fluorouracil* ; Head and Neck Neoplasms* ; Head* ; Humans ; Telomerase*

BACKGROUND AND OBJECTIVES: E-cadherin and catenins (alpha, beta, gamma, p120cat) are important epithelial adhesion molecules in normal epithelial cells. Loss of E-cadherin-catenin adhesion is an important step in the progression of epithelial cancers such as tongue cancer. E-cadherin and catenins expression in carcinoma of human tongue was evaluated in relation to their clinicopathological features and prognostic values. SUBJECTS AND METHOD: Thirty-nine specimens of tongue squamous cell carcinoma were examined in this study. These patients were all treated by primary surgery without prior radiotherapy or chemotherapy. The specimens of formalin-fixed and paraffin-embedded tumor tissues were investigated by immunohistochemical analysis using E-cadherin and catenin (alpha, beta, gamma, p120cat) monoclonal antibodies. RESULTS: The expressions of E-cadherin, alpha-catenin, beta-catenin, gamma-catenin and p120cat in cell membranes were reduced or absent in 71.8%, 74.4%, 76.9%, 59.0% and 82.1% of the tumors examined, respectively. The reduced expressions of alpha-catenin and gamma-catenin in the cell membranes was cor-related with tumore differentiation (p=0.018, p=0.004, respectively). There were significant correlations between E-cadherin and expressions of the four cantenins in the cell membranes of tongue cancer. There were no correlations between beta-catenin and p120cat expression in the cytoplasm, cell nucleus and clinicopathological features. There was significant correlation between E-cadherin expression and Kaplan-Meier survival curves. CONCLUSION: These results suggest that E-cadherin and catenins (alpha, beta, gamma, p120cat) can be used as prognostic markers of human tongue squamous cell carninoma. The result of beta-catenin and p120cat absence in the nucleus suggests that Wnt/Wingless signaling or Kaiso transcription did not occur in the human tongue squamous cell carcinoma.
alpha Catenin ; Antibodies, Monoclonal ; beta Catenin ; Cadherins* ; Carcinoma, Squamous Cell ; Catenins ; Cell Membrane ; Cell Nucleus ; Cytoplasm ; Drug Therapy ; Epithelial Cells ; gamma Catenin ; Humans ; Kaplan-Meier Estimate ; Prognosis ; Radiotherapy ; Tongue Neoplasms* ; Tongue*

BACKGROUND AND OBJECTIVES: We tried to investigate the effectiveness of various methods of reinnervation including nerve-muscle pedicle transfer, nerve anastomosis, nerve implantation. MATERIALS AND METHOD: Forty Sprague-Dawley rats were used. Control group and experimental groups each consisted 5 rats, as follows: a denervated tibial nerve without reinnervation (control), a common peroneal nerve and 2X2 mm tibialis anterior muscle pedicle grafted to the denervated gastrocnemius muscle after the removal of epimysium (group I), a common peroneal nerve and 4X4 mm tibialis anterior muscle pedicle grafted to the denervated gastrocnemius muscle after the removal of epimysium (group II), a common peroneal nerve and 2X2 mm tibialis anterior muscle pedicle grafted to the denervated gastrocnemius muscle after removal of epimysium and part of muscle (group III), a common peroneal nerve and 4X4 mm tibialis anterior muscle pedicle grafted to the denervated gastrocnemius muscle after removal of epimysium and part of muscle (group IV), a common peroneal nerve and 2X2 mm tibialis anterior muscle pedicle inserted to the denervated gastrocnemius muscle (group V), a common peroneal nerve inserted to the denervated gastrocnemius muscle (group VI), and anastomesed common peroneal nerve to distal tibialis nerve (group VII). Electromyography, muscle contraction power study, histotological analysis and counting of motor end-plate were applied for estimating the reinnervation of denervated muscle. RESULTS: In motor nerve conduction studies, Group VII and III showed significantly higher amplitude of the compound muscle action potentials than other groups. In muscle contraction power studies, Group VII and III showed significantly powerful contraction. In histological analysis, group VII and III showed less muscle atrophy. The motor end-plate count was more in the groups VII, III, I, V, VI, II and IV in order. CONCLUSION: Nerve anastomosis and 2X2 mm nerve-muscle pedicle transfer showed more successful regeneration of denervated muscle than other reinnervation methods including nerve implantation.
Action Potentials ; Animals ; Electromyography ; Motor Endplate ; Muscle Contraction ; Muscle, Skeletal* ; Muscular Atrophy ; Nerve Transfer ; Neural Conduction ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Tibial Nerve ; Transplants

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this study was to evaluate the efficacy of the neoadjuvant chemotherapy and radiotherapy in the treatment of tonsillar neoplasm. MATERIALS AND METHOD: Medical records of 21 patients who received neoadjuvant chemotherapy and radiotherapy for tonsillar neoplasm at Pusan National University Hospital from April 1995 through August 2000 were retrospectively reviewed. RESULTS: The three year survival rate was 81.0%. The three year survival rates for stages I,II were both 100%. For stages III, IV, the rates were 83.3%, 87.5%, respectively. The three year survival rate for T1, T2, T3 were 100%, 92.3%, 40.0%, respectively. CONCLUSION: Neoadjuvant chemotherapy and radiotherapy would be effective treatment modality for tonsillar neoplasm with high survival rate and low morbidity.
Busan ; Carcinoma, Squamous Cell* ; Drug Therapy* ; Humans ; Medical Records ; Palatine Tonsil* ; Prognosis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms