Clinicopathologic significance of the delta-like ligand 4, vascular endothelial growth factor, and hypoxia-inducible factor-2α in gallbladder cancer

Background@#Gallbladder cancer (GBC) is usually detected in advanced stages with a low 5-year survival rate. Delta-like ligand 4 (DLL4), vascular endothelial growth factor (VEGF), and hypoxia-inducible factor-2alpha (HIF2α) have been studied for their role in tumorigenesis and potential for therapeutic target, and multiple clinical trials of the agents targeting them are ongoing. We investigated the expression of these markers in surgically resected GBC and tried to reveal their association with the clinicopathologic features, mutual correlation of their expression, and prognosis of the GBC patients by their expression. @*Methods@#We constructed the tissue microarray blocks of 99 surgically resected GBC specimens and performed immunohistochemistry of DLL4, VEGF, and HIF2α. We used the quantitative digital image analysis to evaluate DLL4 and VEGF expression, while the expression of HIF2α was scored manually. @*Results@#The expression of VEGF and HIF2α showed a significant trend with tumor differentiation (p= .028 and p= .006, respectively). We found that the high DLL4 and VEGF expression were significantly correlated with lymph node metastasis (p= .047, both). The expression of VEGF and HIF2α were significantly correlated (p < .001). The GBC patients with low HIF2α expression showed shorter recurrence-free survival than those with high HIF2α expression. @*Conclusions@#This study suggested the possibility of the usage of DLL4 and VEGF to predict the lymph node metastasis and the possibility of VEGF and HIF2α to predict the expression level mutually. Further studies may be needed to validate our study results and eventually accelerate the introduction of the targeted therapy in GBC.

Clinical Factors Associated with Videofluoroscopic Swallowing Study Findings in Stroke Patients / 대한연하장애학회지

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.

Pressure Relieving Effect of Adding a Pelvic Well Pad to a Wheelchair Cushion in Individuals With Spinal Cord Injury

OBJECTIVE: To identify the pressure relieving effect of adding a pelvic well pad, a firm pad that is cut in the ischial area, to a wheelchair cushion on the ischium. METHODS: Medical records of 77 individuals with SCI, who underwent interface pressure mapping of the buttock-thigh area, were retrospectively reviewed. The pelvic well pad is a 2.5-cm thick firm pad and has a cut in the ischial area. Expecting additional pressure relief, it can be inserted under a wheelchair cushion. Subjects underwent interface pressure mapping in the subject's wheelchair utilizing the subject's pre-existing pressure relieving cushion and subsequently on a combination of a pelvic well pad and the cushion. The average pressure, peak pressure, and contact area of the buttock-thigh were evaluated. RESULTS: Adding a pelvic well pad, under the pressure relieving cushion, resulted in a decrease in the average and peak pressures and increase in the contact area of the buttock-thigh area when compared with applying only pressure relieving cushions (p < 0.05). The mean of the average pressure decreased from 46.10±10.26 to 44.09±9.92 mmHg and peak pressure decreased from 155.03±48.02 to 131.42±45.86 mmHg when adding a pelvic well pad. The mean of the contact area increased from 1,136.44±262.46 to 1,216.99±255.29 cm². CONCLUSION: When a pelvic well pad was applied, in addition to a pre-existing pressure relieving cushion, the average and peak pressures of the buttock-thigh area decreased and the contact area increased. These results suggest that adding a pelvic well pad to wheelchair cushion may be effective in preventing a pressure ulcer of the buttock area.

A Clinical Study of Thyroidectomy Complications: Hoarseness, Hypocalcemia and Hematoma / 대한내분비외과학회지

PURPOSE: The use of thyroidectomy has increased as a diagnostic technique for thyroid disease. However, performance of a, thyroidectomy is accompanied with complications. Post-thyroidectomy complications include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, infection, and thyroid storm. The aim of this study was to determine the clinical incidence and to evaluate complications after a thyroidectomy, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and scaring, following a retrospective review of cases. METHODS: From July 2004 to May 2006, 661 consecutive patients that had undergone a thyroidectomy were identified. Through a retrospective review, we evaluated the incidence and type of complications, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scaring. RESULTS: 1) Recurrent laryngeal nerve palsy was a very serious complication, but had a very low incidence. Eight cases out of 661 cases developed and most of the cases developed after a total thyroidectomy. 2) Hypocalcemia was the most common complication. Each incidence of hypocalcemia of methods of thyroid surgery was significant (P= 0.019) but, thyroid disease did not have significant difference (P=0.071). 3) The incidence of postoperative hematoma was 2.74% (18/655). Graves’ disease was more predominant than other diseases. CONCLUSION: Post-thyroidectomy complications and cosmetic problems include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scar. An understanding of the incidence and review of complications after a thyroidectomy may reduce their incidence.

Leiomyoma in the Ciliary Body Resected Ab Externo

A leiomyoma of the ciliary body is a rare tumor that is thought to arise from the neural crest tissue.It is difficult to differentiate this tumor from a uveal melanoma either clinically or pathologically. We performed a complete removal or the mass that had been suspected clinically as an intraocular inflammation or a malignant melanoma.However, it was diagnosed as a leiomyoma by immunohistochemistry and electron microscopy.

The Amniotic Membrane Transplantatin and Laser Photocoagulation after Lamella Keratectomy of Primary Corneal Lipid Degeneration

Opacification of the cornea due to the deposition of lipids may be primary without evidence of previous corneal vascularization, or secondary to either preexisting corneal disease or systemic disturbances of lipid metabolism. If the deterioration of vision continues, penetrating keratoplasty may be needed. We evaluated a 19 year-old female patient referred to our department due to progressive corneal opacity in the left eye. She did not have significant past or family histories of corneal diseases. Ocular examinations revealed the whitish corneal deposits with deep stromal vascularization in her left eye. For confirmation of the diagnosis, lamellar keratectomy with amniotic membrane transplantation was performed and deep stromal vessels were photocoagulated using an argon laser. Histologic findings were compatible with lipid degeneration. The corneal opacities reduced markedly and did not show any evidence of recurrence during the follow up period of six months. Therefore, we report this case with the review of the literature.