BACKGROUND/AIMS: The outcome of local treatment for advanced non-small cell lung cancer (NSCLC) remains poor, with therapies such as induction chemotherapy (IC) yielding conflicting results. This study aimed to assess the clinicopathologic and prognostic significance of the excision repair cross-complementation group 1 (ERCC1), beclin-1, and glucose-regulated protein of molecular mass 78 (GRP78) in patients with locally advanced NSCLC receiving docetaxel-platinum IC, along with efficacy and safety. METHODS: This is a retrospective observational cohort study. We reviewed medical records of 31 NSCLC patients receiving docetaxel-platinum IC, and conducted immunohistochemical staining of ERCC1, beclin-1, and GRP78. RESULTS: Response rate was 67.8% with 10.7 months of median relapse-free survival (RFS) and 23.1 months of median overall survival (OS), and no treatment-related death was reported. High expression of ERCC1, beclin-1, and GRP78 was identified in 67.7%, 87.1%, and 67.7%, respectively. Expression of ERCC1 and GRP78 did not reveal statistical significance in survival, whereas high beclin-1 expression revealed longer OS (7.6 months vs. 23.2 months; log-rank p = 0.024). In multivariate analysis, histologic differentiation (hazard ratio [HR], 3.48; p < 0.001), stage (HR, 8.5; p = 0.024), and adjuvant treatment (HR, 16.1; p = 0.001) were related to RFS, and in OS, stage (HR, 5.4; p = 0.037), adjuvant treatment (HR, 8.6; p = 0.004), and beclin-1 expression (HR, 8.2; p = 0.011) were identified as significant prognostic factors. CONCLUSIONS Our findings suggest that high beclin-1 expression predicts longer survival in locally advanced NSCLC and docetaxel-platinum IC is a treatment option that deserves consideration.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure to evaluate suspicious lymph node involvement of lung cancer because computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT (PET-CT) have limitations in their sensitivity and specificity. There are a number of benign causes of false positive lymph node such as anthracosis or anthracofibrosis, pneumoconiosis, old or active tuberculosis, interstitial lung disease, and other infectious conditions including pneumonia. The purpose of this study was to evaluate possible causes of false positive lymph node detected in chest CT or PET-CT. METHODS: Two hundred forty-seven patients who were initially diagnosed with lung cancer between May 2009 and December 2012, and underwent EBUS-TBNA to confirm suspicious lymph node involvement by chest CT or PET-CT were analyzed for the study. RESULTS: Of 247 cases, EBUS-TBNA confirmed malignancy in at least one lymph node in 189. The remaining 58 patients whose EBUS-TBNA results were negative were analyzed. Age ≥65, squamous cell carcinoma as the histologic type, and pneumoconiosis were related with false-positive lymph node involvement on imaging studies such as chest CT and PET-CT. CONCLUSION: These findings suggest that lung cancer staging should be done more carefully when a patient has clinically benign lymph node characteristics including older age, squamous cell carcinoma, and benign lung conditions.
Anthracosis ; Carcinoma, Squamous Cell ; Electrons ; Humans ; Lung Diseases, Interstitial ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Needles* ; Pneumoconiosis ; Pneumonia ; Sensitivity and Specificity ; Thorax* ; Tomography, X-Ray Computed* ; Tuberculosis

PURPOSE: To analyze the benefit and feasibility of this procedure compared with those of open method. METHODS: Abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. The actual procedure performed during open surgery is the same as those of laparoscopic surgery except for the main incision. Minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications were analyzed and compared with 44 cases of open method. RESULTS: Although the total operative time was not different between 2 groups (349.8 minutes vs. 374.8 minutes, P = 0.153), the operation time of abdominal procedure was shorter in laparoscopic group (90.6 minutes vs. 162.1 minutes, P < 0.001). Operation related complications and hospital stay were not significantly different between the 2 groups. The number of transfused patients was significantly smaller in laparoscopic group (11.1% vs. 27.9%, P = 0.030). CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatment option for patients with esophageal cancer.
Axis, Cervical Vertebra ; Esophageal Neoplasms* ; Esophagectomy ; Feasibility Studies ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Operative Time ; Postoperative Complications ; Surgical Procedures, Minimally Invasive

Despite improvements in treatment modalities, gastric cancer is the second cause of mortality among Korean men and third among females in Korea. Korea implemented a gastric cancer screening program for the general population in 1999. However, the effectiveness and harms of gastric cancer screening using gastric endoscopy and upper gastrointestinal (UGI) series have not been fully evaluated. In an effort to evaluate the screening program, the Korean multidisciplinary expert committee for developing a gastric cancer screening guideline systematically reviewed the evidence regarding the benefits and harms of gastric cancer screening, and developed an evidence-based clinical guideline. There is 'low' level evidence that gastric cancer screening using gastric endoscopy or UGI series can reduce gastric cancer mortality for asymptomatic adults aged between 40 to 74 years. The benefits of gastric cancer screening using gastric endoscopy are substantially higher than its harms, while the benefits of screening with UGI series are moderately higher. We recommend that asymptomatic adults from 40 to 75 years of age undergo biannual gastric cancer screening using gastric endoscopy (recommendation B). Gastric cancer screening using UGI series in asymptomatic adults aged between 40 to 74 years may be recommended based on clinicians' judgment regarding the patient's risk and the patient's preference (recommendation C). There is insufficient evidence to assess the benefits and harms of gastric cancer screening for adults aged between 75 to 84 years (recommendation I). We recommend against gastric cancer screening for adults older than 85 years (recommendation D).
Adult ; Early Detection of Cancer ; Endoscopy ; Female ; Humans ; Judgment ; Korea ; Male ; Mass Screening* ; Mortality ; Stomach Neoplasms*

PURPOSE: Development of a standardized guideline and assessment tool is necessary. Therefore, the aim is to investigate the current state of enteral feeding management and to develop a basis for a standardized guideline. METHODS: From July 1, 2010 through June 30, 2011, this study was conducted retrospectively for 100 patients who had enteral feeding more than once only in the Intensive Care Unit, after General Surgery at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. The analysis was based on the following factors; age, diagnosis, name of the operation, period of start and the end of enteral feeding, method of injection, flushing method, residual volumes of the stomach, location and the size of the tube, medication through tubing, and complications related to enteral feeding. RESULTS: The mean age of the patients was 60.5, 65 men and 35 women. There were 30 malignant tumors of the hepatobiliary system and pancreas, 8 gastric and duodenal cancer, 4 colon and rectal cancer, 11 peritonitis, hemoperitoneum, and bowel obstruction, and 47 others. The average period of performing enteral feeding was 11.7 days and the locations of enteral feeding tube were stomach 56%, jejunum 39%, duodenum 3%, and undescribed 2%. The methods of enteral feeding were as follows; continuous feeding 19%, cyclic feeding 75%, intermittent and bolus feeding 3%, respectively. Only 1% of patients were on flushing and 16% on stomach residual. The most common complication of enteral feeding was clogging of the tube (5%). CONCLUSION: Due to the lack of detailed charting related to enteral feeding, we were unable to analyze the statistics on the relevance of complication which was the primary endpoint. As a result, development of a standardized protocol on charting enteral feeding is suggested for optimal enteral nutritional support.
Colon ; Diagnosis ; Duodenal Neoplasms ; Duodenum ; Enteral Nutrition* ; Female ; Flushing ; Hemoperitoneum ; Humans ; Intensive Care Units ; Jejunum ; Korea ; Male ; Nutritional Support ; Pancreas ; Peritonitis ; Rectal Neoplasms ; Residual Volume ; Retrospective Studies ; Seoul ; Stomach

BACKGROUND/AIMS: This study investigated the role of single nucleotide polymorphisms (SNPs) near the interleukin-28B (IL28B) gene with respect to clinical outcomes and the antiviral response in hepatitis C virus (HCV) infection to suggest the practical utility of IL28B genotyping in Korea. METHODS: Two SNPs near IL28B, rs12979860 and rs8099917, were analyzed using an allelic discrimination assay in a total of 454 individuals, including 147 health-check examinees and 307 patients with HCV infection. RESULTS: The CC genotype frequency was significantly higher in the spontaneous recovery group than in the chronic infection group and was higher in the chronic hepatitis group than in the liver cirrhosis or hepatocellular carcinoma group, suggesting its favorable role in the clinical outcome. Multivariate analysis revealed that the rs12979860 CC genotype was an independent predictor of sustained virologic response (SVR) in genotype 1 HCV infection. During the currently used response-guided therapy, IL28B genotyping was most helpful for the patients who exhibit early virologic responses without rapid virologic responses, as those patients exhibiting the non-CC type did not achieve SVR, although they represented approximately one-third of the total patients. CONCLUSIONS: The IL28B SNP is an independent predictor of SVR. Our results may be helpful if the findings are carefully applied to select patients in Korea.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*genetics ; Female ; Hepatitis C, Chronic/*genetics ; Humans ; Interleukins/*genetics ; Liver Cirrhosis/*genetics ; Liver Neoplasms/*genetics ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Prognosis ; Republic of Korea ; Retrospective Studies

BACKGROUND/AIMS: Urinary tract obstruction induces a form of renal tubular acidosis with a urinary acidification defect caused by decreasing net acid excretion, which is predominantly due to a decrease in urinary ammonia excretion. The present study examined whether this decrease is associated with changes in the renal expression of an ammonia transporter family member, Rh C glycoprotein (Rhcg), in rats with a unilateral ureteral obstruction. METHODS: Male Sprague-Dawley rats underwent a 24-h unilateral ureteral obstruction. Rhcg expression was then evaluated by immunoblotting and immunohistochemistry. Cell height, total cellular expression, expression in the apical 25% of the cell, and % of total expression in the apical region were quantified by immunohistochemistry with quantitative morphometric analysis. RESULTS: After 24 h of unilateral ureteral obstruction, the serum bicarbonate level and total urinary ammonia excretion were decreased. Both light microscopy and immunohistochemistry with quantitative morphometric analysis demonstrated that the total intensity of Rhcg expression was decreased in the obstructed kidneys, whereas Rhcg expression did not change in the cortical collecting duct (CCD) and outer medullary collecting duct (OMCD) of nonobstructed kidneys in rats with a 24-h unilateral ureteral obstruction. CONCLUSIONS: The rats with a unilateral ureteral obstruction showed decreased urinary ammonia excretion associated with decreased Rhcg expression in the CCD and OMCD. These changes suggest that the ammonia transporter Rhcg mediates a urinary acidification defect associated with unilateral ureteral obstruction.
Acidosis ; Acidosis, Renal Tubular ; Ammonia* ; Animals ; Glycoproteins ; Humans ; Immunoblotting ; Immunohistochemistry ; Kidney ; Kidney Tubules ; Male ; Microscopy ; Rats* ; Rats, Sprague-Dawley ; Ureter* ; Ureteral Obstruction* ; Urinary Tract

The granular cell tumor (GCT) occurs extremely rarely in the mediastinum. Few mediastinal GCT cases have been reported in Japan or other countries. Here, we report a case of a 24-year-old man with superior mediastinal GCT. The mass was located just above the aortic arch. It was firm, oval in shape, and well encapsulated. The tumor was removed completely with video-assisted thoracoscopic surgery, but we had to resect the vagus nerve, which was already included in the tumor, along with the tumor. After the operation, the patient recovered without any specific complications except for a mild degree of hoarseness.
Aorta, Thoracic ; Granular Cell Tumor* ; Hoarseness ; Humans ; Japan ; Mediastinum ; Thoracic Surgery, Video-Assisted ; Vagus Nerve ; Young Adult

PURPOSE: We report on a novel method and outcomes of laparoscopic gastric tubing with pyloromyotomy. METHODS: The abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. Between January 2009 and April 2013, our minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications, were analyzed. RESULTS: There were no cases of conversion to open surgery. Of 54 patients, 52 patients had squamous cell carcinoma (SCC) and two had adenocarcinoma. The total operative time was 349.8+/-77.4 minutes, of which 90.6+/-27.6 minutes was required for the abdominal procedure. The mean estimated operative blood loss during the abdominal procedure was 40.0+/-355.5 ml. The postoperative complication rate was 24.1%; three patients died of pneumonia. CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatm ent option for patients with esophageal cancer.
Adenocarcinoma ; Axis, Cervical Vertebra ; Carcinoma, Squamous Cell ; Conversion to Open Surgery ; Esophageal Neoplasms* ; Esophagectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Operative Time ; Pneumonia ; Postoperative Complications

BACKGROUND/AIMS: The distribution of hepatitis C virus (HCV) genotypes varies geographically. In Korea, genotypes 1 and 2 comprise more than 90% of HCV infections, while genotype 6 is very rare. This study compared the clinical and epidemiological characteristics of patients with genotype 6 HCV infection with those infected with HCV genotypes 1 and 2. METHODS: This was a prospective, multicenter HCV cohort study that enrolled 1,173 adult patients, of which 930 underwent HCV genotype analysis, and only 9 (1.0%) were found to be infected with genotype 6 HCV. The clinical and epidemiological parameters of the genotypes were compared. RESULTS: The patients with genotype 6 HCV had a mean age of 41.5 years, 77.8% were male, and they had no distinct laboratory features. A sustained virologic response (SVR) was observed in four (67%) of six patients who received antiviral therapy. Risk factors such as the presence of a tattoo (n=6, 66.7%), more than three sexual partners (n=3, 33.3%), and injection drug use (n=3, 33.3%) were more common among genotype 6 patients than among genotypes 1 or 2. CONCLUSIONS: The epidemiology and treatment response of patients infected with genotype 6 HCV differed significantly from those with genotypes 1 or 2, warranting continuous monitoring.
Adult ; Antiviral Agents/therapeutic use ; Asian Continental Ancestry Group ; Cohort Studies ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/*diagnosis/drug therapy/epidemiology ; Humans ; Liver/pathology ; Male ; Middle Aged ; Prospective Studies ; RNA, Viral/blood ; Republic of Korea ; Risk Factors ; Sexual Behavior ; Substance-Related Disorders/complications ; Tattooing