Predicting stage ypT0–1N0 for nonradical management in patients with middle or low rectal cancer who undergo neoadjuvant chemoradiotherapy: a retrospective cohort study

Purpose@#It is important to discover predictive factors that can identify rectal cancer patients who will respond well to neoadjuvant concurrent chemoradiotherapy (CCRT) to develop management strategies, preserve sphincter and avoid overtreatment. This study explored clinical factors that would predict the adequacy of nonradical management after CCRT in patients with middle or low rectal cancer. @*Methods@#We retrospectively evaluated 447 patients with middle or low rectal cancer who were treated with curative surgery after neoadjuvant CCRT between January 2010 and December 2019. The good response group comprised patients with stages ypT0–1N0 on resection after CCRT; the remaining patients were included in the poor response group. @*Results@#Of 447 patients (mean age, 60.37 ± 11.85 years), 108 (24.2%) had ypT0–1N0 (71.3% with ypT0N0, 4.6% with ypTisN0, and 24.1% with ypT1N0). Overall, 19 patients with cT1–2 (50.0% vs. 21.8% with cT3–4, P < 0.001), 22 with well-differentiated tumors (51.2% vs. 21.3% with moderately/poorly differentiated tumors, P < 0.001), 16 with fungating tumors (47.1% vs.22.3% with other types, P = 0.001), and 66 with anterior/posterior circumference direction (28.9% vs. 19.2% with lateral/ encircling direction, P = 0.016) had stage ypT0–1N0. On multivariable analysis, cT1–2 (P = 0.021) and well-differentiated tumor (P = 0.001) were independent predictors of ypT0–1N0. Fungating tumors were not significantly associated with ypT0– 1N0 (P = 0.054). @*Conclusion@#Stage cT1–2 and well differentiation are predictors of ypT0–1N0, while fungating tumors could be considered clinically meaningful, possibly identifying candidates for nonradical treatment post-CCRT.

Surgical Outcomes of Single-Port Laparoscopic Surgery Compared With Conventional Laparoscopic Surgery for Appendiceal Mucinous Neoplasm

Purpose@#This study aimed to evaluate the safety and feasibility of single-port laparoscopic surgery (SLS) for appendiceal mucinous neoplasm (AMN) when compared with conventional laparoscopic surgery (CLS). @*Methods@#This retrospective study enrolled patients who underwent surgery for AMN between July 2014 and June 2020 at Seoul National University Bundang Hospital. Patient demographics, surgical data, pathology, hospital stay, postoperative morbidity, and follow-up data were extracted from electronic records for analysis. @*Results@#We enrolled 18 patients who underwent SLS and 22 who underwent CLS. The SLS group included patients who underwent partial cecectomy (14 patients), ileocecectomy (3 patients), and right hemicolectomy (1 patient). The CLS group included patients who underwent appendectomy (4 patients), partial cecectomy (11 patients), ileocecectomy (5 patients), and right hemicolectomy (2 patients). Operation type was not significantly different between groups (P = 0.213). No patient required open surgery in the SLS group in contrast to the CLS group (13.6%; P = 0.238). The operative time tended to be shorter in the SLS group than the CLS group (median [interquartile range]: 52.5 minutes [40–65.2 minutes] and 60 minutes [40–120 minutes], respectively; P = 0.251). Morbidity was 5.5% in the SLS group and 9.0% in the CLS group (P = 0.692). Surgical margins were clear in all cases. The median duration of postoperative hospital stay was 2.0 and 4.0 days in the SLS and CLS groups, respectively (P = 0.013). No recurrence occurred in either group during follow-up. @*Conclusion@#This study indicates that SLS is a safe and feasible surgical approach for AMN.

Surgical Outcomes of Single-Port Laparoscopic Surgery Compared With Conventional Laparoscopic Surgery for Appendiceal Mucinous Neoplasm

Purpose@#This study aimed to evaluate the safety and feasibility of single-port laparoscopic surgery (SLS) for appendiceal mucinous neoplasm (AMN) when compared with conventional laparoscopic surgery (CLS). @*Methods@#This retrospective study enrolled patients who underwent surgery for AMN between July 2014 and June 2020 at Seoul National University Bundang Hospital. Patient demographics, surgical data, pathology, hospital stay, postoperative morbidity, and follow-up data were extracted from electronic records for analysis. @*Results@#We enrolled 18 patients who underwent SLS and 22 who underwent CLS. The SLS group included patients who underwent partial cecectomy (14 patients), ileocecectomy (3 patients), and right hemicolectomy (1 patient). The CLS group included patients who underwent appendectomy (4 patients), partial cecectomy (11 patients), ileocecectomy (5 patients), and right hemicolectomy (2 patients). Operation type was not significantly different between groups (P = 0.213). No patient required open surgery in the SLS group in contrast to the CLS group (13.6%; P = 0.238). The operative time tended to be shorter in the SLS group than the CLS group (median [interquartile range]: 52.5 minutes [40–65.2 minutes] and 60 minutes [40–120 minutes], respectively; P = 0.251). Morbidity was 5.5% in the SLS group and 9.0% in the CLS group (P = 0.692). Surgical margins were clear in all cases. The median duration of postoperative hospital stay was 2.0 and 4.0 days in the SLS and CLS groups, respectively (P = 0.013). No recurrence occurred in either group during follow-up. @*Conclusion@#This study indicates that SLS is a safe and feasible surgical approach for AMN.

Urinary Bladder Injury During Colonoscopy Without Colon Perforation

We report a case of urinary bladder perforation during colonoscopy. A 67-year-old female, who had undergone a transabdominal hysterectomy for uterine myomas 15 years ago, visited the emergency department with complaint of abdominal pain after a screening colonoscopy. Laparoscopic examination revealed severe adhesion between the sigmoid colon and the urinary bladder. The urinary bladder wall was weakened, and several perforation sites were found. The surgery was converted to a laparotomy. After a thorough examination, we performed primary repair for the perforation sites, followed by an omentopexy.

Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal cancer: 2-year follow-up results at a single institution in Korea

PURPOSE: The purpose of this study was to examine 2-year follow-up results of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis (PC) of colorectal cancer. METHODS: We performed 54 cases of CRS and IPC in 53 patients with PC of colorectal cancer from December 2011 to December 2013. We collected data prospectively and analyzed the grade of PC, morbidity and mortality, and short-term follow-up (median, 10 months; range, 2–47 months) results. RESULTS: Mean peritoneal cancer index (PCI) was 15 (range, 1–35), and complete cytoreduction was possible in 35 patients (64.8%). Complications occurred in 25 patients (46.3%) and mortality occurred in 4 patients (7.4%). Excluding the 4 mortalities, 17 patients out of 49 patients (31.5%) were alive at the time of the last follow-up and the overall median survival was 10.3 months. Patients with complete cytoreduction had a median survival of 22.6 months, which was significantly longer than the median survival of 3.5 months for patients without complete cytoreduction (P < 0.001). PCI grade, CCR grade, cell type, and postoperative chemotherapy were significant prognostic factors by univariate analysis. Positive independent prognostic factors by multivariate analysis included PCI grade and postoperative chemotherapy. CONCLUSION: CRS and IPC increased the survival of patients with low PCI and postoperative systemic chemotherapy was mandatory. However, this combined therapeutic approach showed high rate of complications and mortality. Therefore, this aggressive treatment should be performed in only selected patients by considering the general condition of the patient and the extent of PC.

Laparoscopic Truncal Vagotomy and Gatrojejunostomy for Pyloric Stenosis

PURPOSE: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and an important target for surgical treatment. Laparoscopy applies to most surgical procedures; however its use in elective peptic ulcer surgery, particularly in cases of pyloric stenosis, has not been popular. The aim of this study was to describe the role of laparoscopic surgery and an easily performed procedure for pyloric stenosis. We accordingly performed laparoscopic truncal vagotomy with gastrojejunostomy in 10 consecutive patients with pyloric stenosis. METHODS: Data were collected prospectively from all patients who underwent laparoscopic truncal vagotomy with gastrojejunostomy from August 2009 to May 2014 and reviewed retrospectively. RESULTS: A total of 10 patients underwent laparoscopic trucal vagotomy with gastrojejunostomy for peptic ulcer obstruction from August 2009 to May 2014 in oo university hospital. The mean age was 62.6 (+/-16.4) years old and mean BMI was 19.3 (+/-2.5) kg/m2. There were no conversions to open surgery and no occurrence of intra-operative complications. The mean operation time was 107 (90~130) minutes and blood loss was < 20 ml. Oral feeding was permitted for most patients on day 3 post operatively after upper gastrointestinal series to confirm no leakage or passage disturbance. The mean hospital stay was 7.3 days, the mean follow up duration was 19.8 (+/-17.2) months, and there was no mortality related to the operation. CONCLUSION: Laparoscopic truncal vagotomy and gastrojejunostomy was a good, easily performed surgical choice for patients with duodenal ulcer stricture.

Anaphylaxis after Thiopental and Rocuronium Induction: A case report / 대한마취과학회지

Anaphylaxis and anaphylactoid reactions that occur during anesthesia may range from minor systemic effects to life-threatening or fatal effects. A 88-yr-old man was scheduled for laparoscopic nephrectomy. He had no history of allergy and had never previously undergone general anesthesia, though several spinal anesthesias were performed for TUR-B using 0.5% heavy bupivacaine. General anesthesia was induced with alfentanil 0.5 mg, thiopental 250 mg, and rocuronium bromide 50 mg. After thiopental injection, the man became irritable, and after rocuronium injection ventilation became difficult and tachycardia appeared; blood pressure could not be checked. The operation was canceled and a skin prick test was performed. Seven weeks later, he underwent uneventful anesthesia with etomidate and vecuronium.

Bilateral Sequential Lung Transplantation for a case with Respiratory Failure due to Lymphagioleiomyomatosis / 대한흉부외과학회지

Pulmonary lymphangioleiomyomatosis is a chronic destruct8ive disease of the lung affecting women of childbearing ages which eventually leads to respiratory failure. Lung transplantation is the only conclusive therapeutic measure because this disease responds poorly to other therapies, To date only a few reports in the literature describes the clinical experience of the bilateral sequential lung transplantation of this rare condition. We performed a bilateral sequential lung transplantation on a 32-year-old woman suffering from lymphangioleiomyo-matosisw. The heart-lung block was harvested from a 51-year-old donor. We transplanted the left lung first through the clam-shell incision. As the hemodynamics deteriorated suddenly during the dissection of the right lung the right lung was transplanted under the cardio-pulmonary bypass. Although the patient's lung function was initially satisfactory the patient died of sepsis and subsequent cardiogenic shock at the postoperative 18th day. Autopsy findings showed infection of Candida albicans on the pericardium and the left lung which had been initiated possibly from the left bronchial anastomosis site,. Through detailed review of the clinical course we concluded that lung transplantation could have been performed safely on this disease provided that early diagnosis and proper management or the opportunistic infection have been carried out.

Effect of reperfusion with leukocyte-depleted blood on the expression of myocardial vascular cell adhesion molecule-1 ( VCAM-1 ) and myocardial function in isolated working heart perfusion model / 대한흉부외과학회지

BACKGROUND: Adhesion of leukocytes to myocardium or vascular endothelium has been known as an importation initial step in the ischemia-reperfusion injury which may affect the cardiac function. Therefore, leukocyte-depleted reperfusion may inhibit ischemia-reperfusion induced functional and ultrastructural deterioration. In this study, we quantified the time-dependent expression of the vascular cell adhesion molecule-1(VCMA-1) on piglet myocardium and demonstrated its relation to functional recovery using isolated piglet heart perfusion model. MATERIAL AND METHOD: Neonatal(1 to 3 day old) piglet heart was harvested with 4C degrees University of Wisconsin solution (UWS) and presrved in the same solution for 12 hours. Ex vivo model of an isolated working neonatal piglet heart perfusion consisting of membrane oxygenator and roller-pump was used (Fig. 1). Hearts were grouped into leukocyte-non-depleted (group A, n=8) and leukocyte-depleted group(group B, n=8). In group B, hearts were reperfused with leukocyte-depleted blood using a leukocyte filter (Sepacell R, Asahi Medical, Japan). Segments of right atrium were taken before and after 1, 2, 3, and 4 hours of reperfusion for the evaluation of expression of VCAM-1. The intensity of immunohistochyemical satining of the VCAM-1 on the myocardium were graded semiquantitatively (0 to 4). For the evaluation of myocardial stroke work indices were calculated as well at the same time-points. RESULT: Mean expressins of VCAM-1 on the myocardium at 0, 1, 2, 3, adn 4 hours of reperfusion were 0.63, 1.44, 1.64, 2.65, and 3.34 in group A, while 0.56, 1.40, 1.50, 1.88 and 2.14 in group B (Fig. 3). Mean stroke work indices at 0.5, 1, 2, 3, and 4 hours after reperfusion were 1.35x104, 1.32x104, 1.14x104, 0.81x104, 0.68x104 erg/gm in group A, while 1.40x104, 1.43x104, 1.43x104, 1.28x104, and 1.12x104 erg/em in group B(Fig. 4). CONCLUSION: In this study, we demonstrated that leukocyte-depletion attenuated the expression of VCAM-1 during reperfusion and the time-dependent functional deterioration of the myocardium was well correlated with the degree of VCAM-1 expression.

Significance of Sulphomucin and CEA Expression in Advanced Gastric Adenocarcinomas

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.

Significance of Sulphomucin and CEA Expression in Advanced Gastric Adenocarcinomas

PURPOSE: Sulphomucin is secreted by immature foveolar cells of the stomach and is expressed in gastric adenocarcinomas. Carcinoembryonic antigen (CEA) is well known to be expressed in gastric adenocarci nomas and is correlated with the cellular differentiation of gastric adenocarcinomas. However, at the moment, there are no conclusions about the relationships between the expression of sulphomucin and pathological classifications. METHODS: This study was designed to determine the significance of expression of sulphomucin and CEA in advanced gastric adenocarcinomas. Also, these two factors were compared with established clinicopathological prognostic factors. Thirty-two paraffin-embedded surgical specimens of gastric adenocarcinomas were obtained from January 1993 to December 1995 and were selected for study. The expressions of sulphomucin and CEA were studied by using the Spicer method and immunohistochemical staining with CEA 2-7 monoclonal antibody. RESULTS: The expressions of sulphomucin and CEA were positive in 9 (28%) cases and 25 (78%) cases, respectively. There was a significant correlation between sulphomucin expression and histologic differentiation (p<0.05). However, the expression of CEA was correlated with neither clinopathological factors nor sulphomucin expression. CONCLUSION: These results suggest that expressions of sulphomucin are well correlated with cellular differentiations of advanced gastric adenocarcinomas.

Comparison of Laparoscopic Cholecystectomy and Minilaparotomy Cholecystectomy

BACKGROUND: Cholecystectomy is the standard treatment for gallbladder stones and at present is performed in minimally invasive procedures. There are several advantages to a laparoscopic cholecystectomy, so now it is a popular procedure for use in a cholecystectomy. Also, a minilaparotomy cholecystectomy is an alternative method to a traditional open cholecystectomy and results in a smaller incision than a traditional open cholecystectomy. METHODS: We analyzed outcomes following laparoscopic and minilaparotomy cholecystectomy. 74 patients with gallstones were included. 45 patients were treated by a laparoscopic cholecystectomy and 29 patients were treated by a minilaparotomy cholecystectomy. RESULTS: Compared to the minilaparotomy cholecystectomy, the laparoscopic cholecystectomy resulted in a shorter mean hospital stay, a faster mean time to diet, and a longer mean operating time. During the first postoperative 24 hours more analgesics were used in the minilaparotomy cholecystectomy than in the laparoscopic cholecystectomy, and the laparoscopic cholecystectomy was more expensive than the minilaparotomy cholecystectomy. Postoperative complications occurred in 3 patients receiving a lapaaroscopic cholecystectomy and 1 patient receiving a minilaparotomy cholecystectomy. Conversion from a laparoscopic cholecystectomy to a traditional open cholecystectomy was necessary in 2 patients; no conversion to a traditional cholecystectomy was necessary in the minilaparotomy cholecystectomy. CONCLUSIONS: This study has proven the advantages of a laparoscopic cholecystectomy to be shorter hospitalization, less pain, and better cosmetic effect. Also, a minilaparotomy cholecystectomy has the advantages of a laparoscopic cholecystectomy and can be performed more safely.

Leukocyte Sequestration and Free Radical-Mediated Lung Injury in Ovine Cardiopulmonary bypass Using Membrane Oxygenator / 대한흉부외과학회지

BACKGROUND: Complement activation with transpulmonary leukocyte sequestration is considered a main mediator leading to ischemia-reperfusion lung(I-R) injury. We studied the role of leukocytes in the formation of I-R injury in ovine cardiopulmonary bypass(CPB) model with a membrane oxygenator. MATERIAL AND METHOD: Five sheep were used. CPB circuitry consisted of a roller pump(American Optical Corp., Greenwich, CT, USA) and a membrane oxygenator(UNIVOX-IC, Bentley, Baxter Health Corp, Irvine, CA, USA). The CPB time was fixed at 120 min. Ten minutes after the start of CPB, total CPB was established. Thereafter a total CPB of 100 min was performed, followed by another 10 min of partial CPB. The CPB was discontinued and the animals were fully recovered. For measuring left and right atrial leukocyte counts, blood samples were taken before thoracotomy, 5 min and 109 in after the start of CPB, and 30 min and 120 min after weaning. C3a was measured before thoracotomy, 109 min after the start of CPB, and 30 min and 120 min after weaning. Plasma malondialdehyde(MDA) was checked before thoracotomy, 109 min after the start of CPB, and 30 min after weaning. One to two grams of lung tissue were taken for water content measurement before thoracotomy, 109 min after the start of CPB, and 30 min after weaning. Lung biopsy specimens were examined by light and electron microscopy. RESULT: Of 5 animals, 4 survived the experimental procedures. Of these, 3 animals survived on a long-term basis. No significant differences in transpulmonary gradients of leukocyte were found and no significant complement activation was expressed by C3a levels. MDA level did not show significant changes related to lung reperfusion despite an increase after the start of CPB. On both light and electron microscopic examinations, mild to moderate acute lung change was observed. Interstitial edema, leakage of erythrocytes into the alveolar space and endothelial cell swelling were the main findings. Water content of the lung showed a slight increase after the start of CPB, but there was no statistical significance. CONCLUSION: These findings indicate that ischemia-repersusion lung injury may not be from complement activation-leukocyte sequestration but from another source of oxygen free radicals related to CPB.

Pulmonary Epithelioid Hemangioendothelioma: Radiologic Findings

PURPOSE: To describe the computed tomographic (CT) findings and follow-up changes of pulmonary epithelioidhemangioendothelioma (PEH). MATERIALS AND METHODS: The clinical and serial radiological findings [follow-up,5months-5 years (mean, 26.4 months)] of five patients with histologically proven PEH were retrospectivelyreviewed. Three were men and two were women, and they were aged between 25 and 54(mean, 35.6) years. Initial chestradiographs were available in all cases and HRCT, conventional CT and MRI were available in one, respectively.Follow-up conventional CT (n=3) and HRCT (n=2) were performed, and the size, number and distribution of thenodules, calcification and follow-up changes were analyzed. RESULTS: In four patients, chest radiography and CTrevealed bilateral multiple nodules 1-15mm in size. In two patients, the nodules showed interstitial distribution,and one had a single nodule in the right upper lobe. On follow-up CT images, an endobronchial mass withobstructive pneumonitis (n=1) or consolidation with pleural effusion (n=1) was noted. In three patients, thenodules had increased in size and number, and calcification within the nodules was observed in two. CONCLUSION:PEH usually manifests as widespread nodules, sometimes with calcification. Along with larger and increased numbersof nodules, follow-up images of PEH may show an endobronchial mass with obstructive pneumonitis or aconsolidation-like mass with pleural effusion.

Early Time Course of Immunopathologic Changes in Coronary Arteries of Heterotopically Transplanted Mouse Heart / 대한흉부외과학회지

BACKGROUND: In this study, we investigated the early time course of expression of the major histocompatibility (MHC) antigens, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), interleukin-6 and the histopathological changes in the coronary arteries of cardiac allografts exchanged between inbred mice strains that differ in one loci of class I major histocompatibility antigen (B10.BR to B10.A). MATERIAL AND METHOD: No immunosuppressive therapy was used. Both allografts and the hearts of the recipients were harvested at 7 (group 1, n=6), 15 (group 2, n=6), 21 (group 3, n=6), and 30 (group 4, n=6) days after transplantation. They were examined by immunohistochemistry, microscopy and morphometry. All allografts had contractions at the time of harvest. RESULT: A strong MHC class I antigen expression was present on the endothelial and medial cells of the coronary arteries in group 1 and remained unchanged in the rest of the groups. However, MHC class II reactivity was none or very little at any time. Mild to moderate ICAM-1 expression was observed on the endothelial cells, but not on the medial cells at any time by 30 days. VCAM-1 expression was strong both on the endothelial and medial cells at any time. Moderate degree expression of interleukin-6 was observed from 7 to 30 day specimens. Histopathologically, percentage of affected vessels (vessels with intimal thickening) was less than 10 % in 7 day group and increased up to 50 % at 30 days. Mean percent narrowing of the lumen of the affected vessels revealed less than 20 % at 7 days and 40 % at 30 days. The area occupied by tropomyosin positive cells in the intimal lesion, graded from 0 to 3, showed gradual increase but remained between grade 0 to 1 by 30 days. Medial integrity was also well preserved at any time. Moderate perivascular mononuclear cell infiltration was observed at 7 days and it was progressively increased upto 30 days. Recipients' heart revealed no positive immunopathologic findings. CONCLUSION: In this study, the early time course of progression of the transplantation vasculopathy was demonstrated in the murine heterotopic heart transplant model.

Rabbit's Cervical Tracheal Replacement with Cryopreserved Homograft: Effects on the Viability and Rejection / 대한흉부외과학회지

BACKGROUND: There are no ideal substitutes for tracheal replacement. Therefore we investigated the possibility of clinical use of cryopreserved tracheal homograft with special interest in the viability and rejection of the epithelial cell and cartilage. MATERIAL AND METHOD: Rabbit's trachea was sected and stored in liquid nitrogen tank for 1 month. Tracheal replacement was done in 45 rabbits with autograft (n=15, Group 1), fresh allograft (n=15, Group 2) and cryopreserved homograft (n=15, Group 3). After 7, 14, and 30 days, 5 rabbits in each group were sacrificed and the regeneration of epithelium and cartilage and the degree of rejection were assessed by counting the monocellular infiltration. RESULT: Investigation at day 7, showed no difference in epithelial regeneration, however, at days 14 and 30, Group 1 showed better regeneration of epithelium than groups 2 and 3. There was no difference of epithelial regeneration between group 2 and 3. There was little rejection at day 7, but at days 14 and 30, there was significant rejection in group 2 and group 3. (p<0.05). Group 3 showed lesser rejection than group 2 at days 14 and 30, but it was not statistically significant. Cartilage showed no rejection and maintained its viability in groups 2 and 3. CONCLUSION: Cryopreserved tracheal homograft can maintain its viability, therefore it may represent a possibility of clinical application for tracheal replacement. However, cryopreservation can not eliminate the antigenicity of the trachea completely. Furthere studies for lowering the antigenicity and rejection should be performed for an ideal substitute for tracheal replacement.

A Case of Kaposi's sarcoma with Pulmonary nodules without Skin Manifestation in Renal Transplant patient / 대한내과학회지

The incidence of Kaposi's sarcoma increases in renal transplant patients who had immunosuppressive therapy. In Korea, 4 cases of Kaposi's sarcoma in renal transplant patients have been reported. All of these cases had skin lesions. We experienced pulmonary Kaposi's sarcoma in 25- year-old man proven by open lung biopsy. He had re ceived cyclosporine and prednisolone as immunosuppres sive agent for 8 months since renal transplantation. He admitted to the hospital because of fever and pulmonary nodules on chest X-ray, and he had no skin lesion. Sputum examinations were negative for microorganisms and malignancy. He had bloody and frothy secretions on bronchoscopic study, and BAL fluid examinations were negative for microorganisms and malignancy. Open lung biopsy was carried out which showed Kaposi's sarcoma nodules. Immunosuppressive agents were discontinued after diagnosis but pulmonay nodules progressed. He died of respiratory failure 10 days after diagnosis. Pulmonary Kaposi's sarcoma has to be considered in the differential diagnosis in immunosuppresed patients who present with fever and pulmonary nodules.

Immunohistochemical Study of p53 and c-erbB-2 Oncoproteins in Gastric Adenocarcinoma

The prognosis for gastric adenocarcinoma has been found to be related to several factors such as depth of invasion, inflammatory reaction, lymph node metastasis, pathological stage, DNA ploidy, amplification of proto-oncogene, and tumor suppressor gene. This study was performed to investigate the expression rate of p53 protein and c-erbB-2 oncoproteins in gastric adenocarcinoma, and correlation among clinicopathologic parameters, p53 protein and c-erbB-2. The p53 protein and c-erbB-2 oncoproteins were immunohistochemically stained in the tissue specimens of 36 advanced adenocarcinoma and 15 early adenocarcinoma. The results were summarized as follows; 1) Positive reaction for c-erbB-2 oncoprotein revealed an intense brown granular staining predominantly at the tumor cell membrane, with some cell exhibiting a cytoplasmic staining as well. The surrounding mucosal epithelial cells and protein cells around tumors revealed positive reaction. Positive reaction for p53 protein revealed an intense brown granular staining in tumor nuclei. 2) Twenty four of 51 cases(47%) for p53 protein and 11 of 51 cases(22%) for c-erbB-2 oncoprotein of gastric adenocarcinoma revealed positive reaction. 3) There was no significant difference in the expression of p53 protein and c-erbB-2 according to lymph node metastasis, depth of invasion and Laurens' classification. 4) Five of 51 cases(10%) simultaneously revealed c-erbB-2 oncoprotein overexpression associated with p53 protein expression, and 21 of 51 cases(41%) simultaneously revealed negative reaction for c-erbB-2 oncoprotein and p53 protein. There was no correlation between c-erbB-2 oncoprotein overexpression and p53 protein expression. In summary, p53 and c-erbB-2 oncoprotein were seen in 47% and 22% of gastric adenocarcinoma, respectively. They were not correlated with depth of invasion, lymph node metastasis and Laurens' classification.

Immunohistochemical Study of p53 and c-erbB-2 Oncoproteins in Gastric Adenocarcinoma

The prognosis for gastric adenocarcinoma has been found to be related to several factors such as depth of invasion, inflammatory reaction, lymph node metastasis, pathological stage, DNA ploidy, amplification of proto-oncogene, and tumor suppressor gene. This study was performed to investigate the expression rate of p53 protein and c-erbB-2 oncoproteins in gastric adenocarcinoma, and correlation among clinicopathologic parameters, p53 protein and c-erbB-2. The p53 protein and c-erbB-2 oncoproteins were immunohistochemically stained in the tissue specimens of 36 advanced adenocarcinoma and 15 early adenocarcinoma. The results were summarized as follows; 1) Positive reaction for c-erbB-2 oncoprotein revealed an intense brown granular staining predominantly at the tumor cell membrane, with some cell exhibiting a cytoplasmic staining as well. The surrounding mucosal epithelial cells and protein cells around tumors revealed positive reaction. Positive reaction for p53 protein revealed an intense brown granular staining in tumor nuclei. 2) Twenty four of 51 cases(47%) for p53 protein and 11 of 51 cases(22%) for c-erbB-2 oncoprotein of gastric adenocarcinoma revealed positive reaction. 3) There was no significant difference in the expression of p53 protein and c-erbB-2 according to lymph node metastasis, depth of invasion and Laurens' classification. 4) Five of 51 cases(10%) simultaneously revealed c-erbB-2 oncoprotein overexpression associated with p53 protein expression, and 21 of 51 cases(41%) simultaneously revealed negative reaction for c-erbB-2 oncoprotein and p53 protein. There was no correlation between c-erbB-2 oncoprotein overexpression and p53 protein expression. In summary, p53 and c-erbB-2 oncoprotein were seen in 47% and 22% of gastric adenocarcinoma, respectively. They were not correlated with depth of invasion, lymph node metastasis and Laurens' classification.

Colonic Perforation during Gastrografin Reduction of Intussusception in Children: Two Cases Reports

In the intestinal perforation during hydrostatic reduction for intussusception, the diluted isotonic Gastrografin may prevent body fluid shifting to peritoneal space, and granulomatous reaction resulting in intestinal obstruction, which can be induced by Barium on the peritoneal surface. We have experienced two perforations from 563 Gastrografin reductions during the last five years. One of the perforated cases had no complication on one year follow up after ileocecectomy, but the other, who was in the state of shock before the reduction, died at 133rd day after the operation. The cause of death was aspiration during the feeding. We report the above two cases of intestinal perforation by Gastrografin reduction without evidence of fatal complication.