Should the Extrahepatic Bile Duct be Resected for T2 Gallbladder Cancer?

PURPOSE: The prognosis of advanced gallbladder cancer remains unfortunate. Yet, the prognostic factors and the efficacy of extrahepatic bile duct resection remain unclear. The adequacy for extrahepatic bile duct resection for T2 gallbladder cancer, according to the characteristics of either the clinicopathological factors or the prognostic factors, was evaluated. METHODS: One hundred and one patients with gallbladder cancer underwent surgical resection at Yeungnam University Medical Center (YUMC) between January 2001 and July 2008. A retrospective analysis was conducted on 26 patients with pathologic stage T2. RESULTS: 7 of the 26 patients with T2 disease (26.9%) had lymph node metastasis. Of the 7 patients with lymph node metastasis, 3 patients underwent radical cholecystectomy (RC), and 4 patients underwent radical cholecystectomy combined with extrahepatic bile duct resection (RC+BDR). The 1-year and 3-year survival rate of patients that underwent RC was 66.7% and 0% and patients that underwent RC+BDR was 50.0% and 0%, respectively (P=0.433). Even with microscopic vascular invasion or perineural invasion, RC+BDR did not provide any survival advantage compared with RC in T2 gallbladder cancer. Prognostic factors for patients with T2 gallbladder cancer was total bilirubin level, lymph node metastasis, differentiation of tumor, microscopic vascular invasion and perineural invasion. CONCLUSION: For patients with T2 gallbladder cancer, RC is recommended, even with the presence of lymph node metastasis, microvascular invasion or perineural invasion. Resection of the extrahepatic bile duct is indicated for patients with T2 gallbladder cancer with involvement of the cystic duct or invasion of the hepatoduodenal ligament.

Longterm Prognostic Factors after Hepatic Resection for Hepatocellular Carcinoma

PURPOSE: Although advancement in treatment and diagnostic tools related to hepatocelluar carcinoma has been much improved, long term survival rates of hepatocellular carcinoma are still low because of delayed clinical manifestations and underlying diseases causing the cancer. Various kinds of modalities to treat hepatocellular carcinoma have developed but surgical resection is still recognized as the best method. Therefore, we studied the associated factors of long-term survival after liver resection. METHODS: We retrospectively analyzed 184 patients who were pathologically diagnosed with hepatocellular carcinoma from May 1990 to December 2002. Associated factors of long-term survival classified as preoperative, operative, pathological and recurrence factors. Univariate and multivariate analyses were done using cross tabulation analysis and logistic regression analysis. RESULTS: The cumulative 1-, 3- and 5- year survival rates were 66%, 50% and 30%, respectively. Preoperative factors, significantly associated with long-term survival, were age of 60 years and under, tumor size, HBe Ag status and preoperative tumor marker level. As pathological factors, the vascular invasion and lymphatic invasion status were significantly associated. But cirrhosis of the liver was not associated with long-term survival. And in cases of recurrence, patients who had undergone repeat resection survived significantly longer. CONCLUSION: The most significant factors of multivariate analyses were lymphatic invasion status. Tumor size, ICG-R15 and HBe Ag status followed second. We should correct the preoperative factors through screening and early diagnosis. And when recurrence occurs, if the recurring cancer has resectability, repeat hepatectomy will increase the patient's lifespan.

Insulin-Like Growth Factor-I Effects on the Proliferation and Bone Matrix Protein Gene Expression of MC3T3-E1 Cell / 대한치주과학회지

The purpose of this study is to evaluate the effect of IGF-I for DNA synthetic activity and the mRNA expression of bone matrix protein, type I collagen and osteopontin in prolifetation and differentiation of MC3T3-E1 cells. To evaluate DNA synthetic activity, cells were seeded at 2 x 10(4) cells/ml in 24 well plates and to evaluate mRNA of type I collagen and osteopontin cells were seeded at 5 x 10(5) cells/ml in 100mm culture dishes. These cells were cultured in alpha-minimum essential medium(alpha-MEM) containing 10% fetal bovine serum at 37degrees C, 5% CO2 incubator. For DNA synthetic activity test 1, 10, 100ng/ml IGF-I were added to the cells which had been cultured for 3 days before 24 hours. For type I collagen mRNA expression 1, 10ng/ml IGF-I were added to the cells which had been cultured for 5, 10 days and for osteopontin mRNA expression 0.1, 1, 10ng/ml IGF-I were added to the cells which had been cultured for 5, 15, 20 days. Cell proliferaton was measured by the incorporation of [3H]-thymidine into DNA and expression for type I collagen and osteopontin were measured by northern blot analysis. The results were as follows: DNA synthetic activity were generally higher in experimental group than control group. Expressions of type I collagen mRNA were higher at 5 day group and much lower at 10 day group in the control groups. In the experimental groups, mRNA expressions were slightly increased when 1 ng/ml IGF-I were added to 5 day group and decreased in all experimental 10 day groups. Expressions of osteopontin mRNA were higher at 20 day groups and lower at 15 day groups than the control groups. In the experimental groups, mRNA expressions were incereased when 0.1, 1 ng/ml IGF-I were added to 5 day group and in all the 15 day groups, but decreased when 0.1, 1, 10 ng/ml IGF-I were added to 20 day groups. IGF-I stimulated DNA synthetic activity of MC3T3-E1 cells during proliferation stage significantly, did not greatly changed effects on type I collagen mRNA expression and stimulated osteopontin mRNA expression at 15 day especially. In conclusion, we suggests that IGF-I have a tendency of stimulation effect of DNA synthetic activity but do not stimulate type I collagen mRNA in proliferation stage of MC3T3-E1 cell cultures, and stimulate osteopontin mRNA in differentiation stage of MC3T3-E1 cell cultures.

A Clinical Study of Ipsilateral Fracture of Femur and Tibia / 대한정형외과학회잡지

Twenty-six cases of fracture of the femur and tibia on the same leg were treated in Masan Koryo General Hospital during the period 1981 1986. We studied all of these patients, divided by four groups according to the method of treatment, retrospectively with analysis of treatment and end results. The results were as follows : 1. Twenty-two patients were male and four patients were female. Of twenty-six patients, eighteen patients were at their third and fourth decades. 2. The main cause of injuries was traffic accident; 23 patients(88%). 3. The most common concomitant injury was fracture and dislocation in other site(14 cases). The fat embolism developed in one case and one patient had died due to head injury. 4. The average healing time of fracture was 17 weeks in femur and 20 weeks in tibia in group three, that was most rapid of all groups. 5. A good or excellent functional result was achieved in 87% of the patients treated with internal fixation of both fracture, 75% of the patients with internal fixstion for the femur fracture and external fixation for the tibial fracture, and 25% of the patients trested conservatively.

Apert Syndrome: A Report of One Case / 대한정형외과학회잡지

Apert described acrocephalosyndactly as a clinical entity in 1906. The classic description of this syndrome includes patient with a combination of acrocephaly and syndactyly of either fingers, toes or both. More than 200 cases have been reported in the world literature. Authors experienced on case of the classic pattern of Apert syndrome and treated surgically for syndactyly. This one case was reported on this paper with brief review of the relevant literatures.

The Treatment of Acromioclavicular separation / 대한정형외과학회잡지

There are many procedures for treatment of injuries of acromioclavicular separation, but still controversies concerning the best management of these injuries. From March 1981 to August 1984 at Masan Korea Hospital, twelve cases were treated by technique of modified Phemister method, two cases by Dewar and Barrington method, two cases by Stewart method, one case by Neviaser method, three cases by skillful neglect method and two cases by shoulder harness immobilization. The following results were obtained. 1. These injuries were more prevalent in male and more in right side. 2. The most common cause of injuries was traffic accident and followed by falling from the height. 3. Three cases were grade 2 and nineteen cases grade 3 by Allman's classification. 4. We treated these injuries by operative method in seventeen cases and non-operative method in five cases. 5. There were good functional results of treatment in operative method. 6. There were two cases of superficial wound infection, two cases of migration of K-wire and one case of recurrence of deformity in operative method, and two cases of shoulder stiffness and 2 cases of recurrence of deformity in non-operative method.

Treatment of Intertrochanteric Fracture with Multiple Flexible Intramedullary Nails / 대한정형외과학회잡지

Recently, morbidity and mortality are reduced in elderly trochanteric fracture patients, which is best accomplished with multiple flexible intramedullary nail fixation under image intensifier control. Condylocephalic nailing of the trochanteric fractures offers four advantages; Minimally traumatic, short operation time, little blood loss, and very early weight bearing on the injured limb after surgery. The authors treated 15 cases of intertrochanteric fractures from June 1981 to March 1983 with multiple flexible intramedullary nails (Ender or P.G.P.). The results obtained were as follows; l. Among 15 cases, two patients were ages between 41 and 50, there between 51 and 60, one between 61 and 70, seven between 71 and 80, and two patients above 81 years, Nine were men and six women. 2. The average operation time was 60 minutes (range, 30 to 150 minutes) and average blood loss was 140ml (range, 50 to 400ml). After operation, Bucks extension traction was applied for 3 weeks in three cases. 3. Partial weight bearing ambulation was recommended one day after operation in eleven cases, and at 21th days in the other three cases. Full weight bearing ambulation, using appropriate assistive devices, was recommended as early as possible. 4. The clinical union was obtained as early as 5 weeks after operation in 7 cases, 9 weeks in two cases and 12 weeks in one case. 5. Among the complications, downward migration of the nail occured in two patients. With early weight-bearing, varus deformity due to collapse of the reduced fracture resulting secondary leg shortening (less than 3 cm) occured in 8 cases and mild external rotation deformity of lower leg in 3 cases (less than 15), but did not present any clinical problem in elderly patients, Irritation by the nail tip caused pain around the knee and also developed the partial stiffness of the joints temporarily after surgery. No nails migrated into the oits. It was felt that most difficult thing to manage was the maintenance of reduced fracture till clinical union to prevent varus deformity and distal nail migration, and the method was technically simple and could be employed succesfully.