Mixed Carcinoma as an Independent Prognostic Factor in Submucosal Invasive Gastric Carcinoma

Mixed carcinoma shows a mixture of glandular and signet ring/poorly cohesive cellular histological components and the prognostic significance of each component is not fully understood. This study aimed to investigate the significance of the poorly cohesive cellular histological component as a risk factor for lymph node metastasis and to examine the diagnostic reliability of endoscopic biopsy. Clinicopathologic characteristics of 202 patients who underwent submucosal invasive gastric carcinoma resection with lymph node dissection in 2005-2012 were reviewed. Mixed carcinoma accounted for 27.2% (56/202) of cases. The overall prevalence of lymph node metastasis was 17.3% (35/202). Lymphatic invasion (P < 0.001), family history of carcinoma (P = 0.025), tumor size (P = 0.004), Lauren classification (P = 0.042), and presence of any poorly cohesive cellular histological component (P = 0.021) positively correlated with the lymph node metastasis rate on univariate analysis. Multivariate analyses revealed lymphatic invasion, family history of any carcinoma, and the presence of any poorly cohesive cellular histological component to be significant and independent factors related to lymph node metastasis. Review of preoperative biopsy slides showed that preoperative biopsy demonstrated a sensitivity of 63.6% and a specificity of 100% in detecting the presence of the poorly cohesive cellular histological component, compared with gastrectomy specimens. The presence of any poorly cohesive cellular histological component was an independent risk factor associated with lymph node metastasis in submucosal invasive gastric carcinoma. Endoscopic biopsy had limited value in predicting the presence and proportion of the poorly cohesive cellular histologic component due to the heterogeneity of mixed carcinoma.

In which group of gastric cancer patients is the preoperative neutrophil-to-lymphocyte ratio a significant prognostic factor?

PURPOSE: Several recent studies have reported on the clinical importance and prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in gastric cancer. The objective of this study was to identify the subgroups of patients with gastric cancer for which the preoperative NLR was prognostically significant.METHODS: Data from 870 patients who were among those who had undergone surgery for gastric cancer between August 2005 and December 2013 were evaluated. Receiver operating characteristic curve analysis was used to determine the cut-off value for NLR. The patients were classified into high-NLR (NLR≥1.7) and low-NLR (NLR<1.7) groups, and survival analysis of subgroups of gastric cancer patients was performed.RESULTS: Univariate analysis identified age, gender, tumor location, tumor histology, tumor, node, metastasis (TNM) stage, and NLR as significant prognostic factors. Multivariate analysis identified age, TNM stage, and NLR as significant prognostic factors. In subgroup analysis, NLR was a significant prognostic factor except group of TNM stage I, II with age younger than 70 years.CONCLUSION: Except group of TNM stage I, II with age younger than 70 years, careful postoperative follow-up is warranted for those patients with elevated NLR.

Preoperative neutrophil-to-lymphocyte ratio is a prognostic factor for overall survival in patients with gastric cancer

PURPOSE: Preoperative neutrophil-to-lymphocyte ratio (NLR) reflects patients' inflammation status, clinical stage, and survival in various malignancies. However, only a limited amount of information on the clinical importance and prognostic significance of NLR in gastric cancer has been reported. The objective of this study is to assess the prognostic values of preoperative NLR in patients with gastric cancer. METHODS: During the period between August 1, 2005 and December 31, 2011, we collected data from 601 patients among those who had undergone surgery for gastric cancer at the Department of Surgery, Konkuk University Medical Center. We classified the subjects into high NLR (NLR > or = 1.7) group and low NLR (NLR or = 1.7), and old age (> or = 70 years) are significant, independent prognostic factor for overall survival in patients with gastric cancer.

Torus Hyperplasia of the Pyloric Antrum

Primary or idiopathic hypertrophy of the pyloric muscle in adult, so called torus hyperplasia, is an infrequent but an established entity. It is caused by a circular muscle hypertrophy affecting the lesser curvature near the pylorus. Since most of the lesions are difficult to differentiate from tumor, distal gastrectomy is usually preformed to rule out most causes of pyloric lesions including neoplastic ones through a pathological study. A 56-yr-old man with a family history of gastric cancer presented with abdominal discomfort of 1 month duration. Upper gastrointestinal endoscopy showed a 1.0 cm sized irregular submucosal lesion proximal to the pylorus to the distal antrum on the lesser curvature. On colonoscopy examination, a 1.5 cm sized protruding mass was noticed on the appendiceal orifice. Gastrectomy and cecectomy were done, and histological section revealed marked hypertrophy of the distal circular pyloric musculature and an appendiceal mucocele. To the best of our knowledge, this is the first case of torus hyperplasia with appendiceal mucocele which is found incidentally.

A Comparative Study about Complications of Laparoscopic Appendectomy in Children and Adults

PURPOSE: In recent studies, laparoscopic appendectomy has been widely performed for not only uncomplicated appendicitis but also perforated appendicitis. But, in children, the value of laparoscopic appendectomy for acute appendicitis is not yet established. Our retrospective study is to evaluate the safety of laparoscopic surgery for acute appendicitis in children. METHODS: We reviewed electronic medical records of a total of 595 patients (95 children and 500 adults), who had been operated upon for acute appendicitis, from August 2005 to February 2007. Those patients were divided into two groups; children and adults. Demographic data, duration of pain, diagnostic methods, length of stay, operative time, time under anesthetic, time to diet, perforation rate, and complication rates were analyzed. RESULTS: In eight adult patients, laparoscopic surgery was converted to open laparatomy. There was no significant difference in perforation rates (children 20.0% vs. adults 18.1%, P=0.714). However, postoperative complication rates were significantly higher in the children group (7.4%) compared to the adult group (2.2%). CONCLUSION: We noted that laparoscopic appendectomy should be applied cautiously, especially in pediatric groups due to the relatively high complication rate. However, we need to see more high-quality randomized trials.

Experience and Consideration on Online Course Evaluation by Medical Students / 한국의학교육

PURPOSE: The purpose of this study was to present our thoughts on the medical student evaluation of the courses via online at Konkuk University School of Medicine (KUSM) and to prompt us to improve the course evaluation system. METHODS: Electronic questionnaire for computer-aided course evaluation via online was completed by 93 medical students who attended 32 block lectures at KUSM in 2007. The questionnaire consisted of 21 evaluation items. Frequency analysis of response on the evaluation items was conducted to find out the key features. RESULTS: Evaluation forms for 32 lectures were received from the attendees via online. An average response rate was 63.8%. Among 17 Likert-scaled items, more negative response was observed in class quantity, studying method guidance, lecture note, teaching methods, and relevance of final examination. CONCLUSION: The current course evaluation at KUSM includes more questions that request students to state the overall quality of course modules than the detailed quality or skill of each lecturer. As the objective of the course evaluation is to promote students' learning and to give a feedback to the lecturer, the current consideration on the course evaluation prompted us to reorganize the design of the questionnaire according to the objective.

The Results of Gastric Cancer Surgery during the Early Stage of a Training Hospital

PURPOSE: Konkuk University Hospital (KUH), which opened in September 2005, is currently categorized as a secondary hospital. Early on after its establishment, the surgical residents and nurses were relatively inexperienced in the treatment of stomach cancer. Therefore, the quality of surgery for stomach cancer at KUH may be different from that of the existing large-scale tertiary hospitals. The purpose of this study is first to investigate the clinicopathological characteristics of the gastric cancer patients at the KUH, and second to compare our morbidity & mortality rates with those of previous studies, and we also analyzed the risk factors of morbidity at the early stage of a training hospital. MATERIALS AND METHODS: This study retrospectively collected the clinicopathological characteristics and the post-operative morbidity rates and mortality rates with using the electronic medical records of all the patients who went under a gastric cancer operation at KUH from September 2005 to April 2008. RESULTS: The total number of gastric cancer patients who underwent operation was 201. The morbidity rate and death rate at KUH were 10.4% and 0.5%, respectively. The morbidity has increased with an older age. The other variables had no influence on morbidity. CONCLUSION: The morbidity rate, death rate and the clinicopathological characteristics of gastric cancer patients at KUH were similar to those of the previous reports. We found that age is the main factor affecting the morbidity rate after stomach cancer surgery. For further surgical qualification of stomach cancer surgery at KUH, it is necessary to collect the survival data of patients who undergo stomach cancer surgery.

A Study on Students' Academic Achievement and Perception of Team-Based Learning During a Medical Dermatopatholgy Lecture / 한국의학교육

PURPOSE: This study aimed to investigate the academic achievement and first-time experience with TBL in Year 1 medical graduate students through a medical dermatopathology lecture at Konkuk University School of Medicine. METHODS: 47 students prepared the objective-oriented assignment and completed an individual readiness assurance test, a group readiness assurance test, and a application exercise. Peer evaluation was done. At the completion of the lecture, the students were surveyed about their experiences. The scores from the TBL session activities and students' survey results were analyzed. The tutor's comment about TBL session was analyzed. RESULTS: Overall, TBL was helpful for the medical graduate students in understanding the dermatopathology lecture. Students' perception on their TBL experience was positive.They stayed focused on the activity and showed excellent teamwork. CONCLUSION: We allowed medical students to experience TBL through a dermatopathology lecture and then summarized their experience. This study demonstrates that TBL is an effective active teaching method for teaching dermatopathology.

Learning Issues from the M.D.-Ph.D. Program of the United States Medical Schools in its Application to the Educational System of Korean Medical Schools / 한국의학교육

No abstract available.

Cecal Diverticulitis

PURPOSE: Cecal diverticulitis is rare but relatively common in Asians including Koreans. Furthermore, most case of cecal diverticulitis can be diagnosed as an acute appendicitis preoperatively. The purpose of this study was to evaluate antibiotic treatment for cecal diverticulitis, identified during laparotomy under the diagnosis of acute appendicitis. METHODS: From January 1995 to June 2001, we reviewed 52 patients with cecal diverticulitis, who were diagnosed as having acute appendicitis preoperatively and treated by conservative treatment, i.e. appendectomy only and postoperative antibiotics. RESULTS: The results were as follows. The male to female ratio and mean age was 1.2:1 and 33.4 respectively. The mean operative time was 55.4 minutes. The mean hospital stay was 5.9 days. The site of the diverticulitis was mostly located at the cecum (92.3%). Other sites of diverticulitis were the ascending colon in 2 patients, and the cecum and ascending colon in another 2 patients. The number of diverticulitis found was one in 44 patients (84.6%) and multiple in 8 patients (15.4%). Postoperative complications occurred in 6 patients (11.5%). The most common postoperative complication was wound infection, which occurred in 4 patients. There was no recurrence during follow-up. CONCLUSION: When cecal diverticulitis is found incidentally at the time of an emergency operation for acute appendicitis, we conclude that an appendectomy only combined with postoperative antibiotics is a safe, effective, cost-efficient and cosmetic method.

Anticancer Effect of AG60 (Acriflavine-Guanosine Compound) on the Ehrlich Cancer Cells Light Microscopic, Autoradiographic and Electron Microscopic Study / 대한해부학회지

To evaluate the effect and working mechanism of a newly developed anti-cancer drug, AG60 (acriflavine-guanosine compound, Taerim Pharm. Co. Seoul, Korea), histotologic, autoradiographic and electron microscopic studies were carried out. For the histologic study, each Ehrlich carcinoma cells (10(7) cells)-inoculated mouse was subcutaneously injected with saline (0.2 ml), 10 mg/kg of AG60, or 30 mg/kg of AG60, every other day, respectively. Animals were sacrified on the 14th day from the first injection, and tumor masses were fixed in 10% formalin solution. Tissue sections of the tumor were stained with hematoxylin and eosin. For the electron microscopic study, Ehrlich carcinoma (10(7) cells)-inoculated mice were subcutaneously injected every other day with saline (0.2 ml) or 30 mg/kg of AG60, respectively. The day after 7th injection (14th day), animals were sacrified, small piece of tumor masses were fixed in 2.5% glutaraldehyde-1.5% paraformaldehyde solution followed by fixation in 2% osmium tetroxide solution. Ultrathin sections were counter stained with uranyl acetate-lead citrate solutions, and observed with JEM 100CX electron microscope. For the autoradiographic study, each Ehrlich carcinoma (10(7) cells)-inoculated mouse was injected every day with 0.2 ml of saline, 5 mg/kg of AG60, or 30 mg/kg of AG60, respectively. The day following the last injection, each animal was given a single dose of 0.7 micricurie/g of methyl-3H-thymidine (Amersham Lab., England) through the tail vein. Seventy minutes after the thymidine injection, animals were sacrified, tumor masses were collected and fixed in 10% neutral formalin. Tissue blocks were washed, dehydrated, embedded and cut in 6 micrometer-thick sections. Deparaffinzied sections were dipped in the autradiographic emulsion E1 (Amersham Lab., England) and dried and stocked in the dark room. Filmed sections were exposured five weeks in the dark room, and were developed in the developer. Labeled indices (mean number of labeled cells per 100 cancer cells) and labeled grain indices (mean number of labeled silver grains per one cancer cell, and total granule numbers per every 100 cancer cell) were observed and calculated. The results were as follows : 1. On histological study, massive apoptosis were occured following the injection of AG60. Only small number of live cancer cells were observed. 2. On electron microscopic study, massive apoptotic figures including fragmentation of nuclei and cytoplasms, multiple nucleoli, condensation of nucleus and cytoplasm, deep invaginations and microcleft formations of nuclei, margination of heterochromatin along the inner nuclear membrane and microcleft , etc. were noticed. Giant cells represent the "tumor cell-tumor cell emperipolesis", and many of them seem to be in process of "cytolytic emperipolesis". 3. On autoradiographic study, labeled grains of 3H-thymidine were suppressed to only 11%~5% of control cancer cells following AG60 administrations. Discussed on the above experiments, it is suggested that severe suppression of DNA, RNA and protein syntheses by AG60 induce massive apoptosis of cancer cells. AG60 is expected as one of most effective anticancer drugs for the cytostatic therapy, the disease stabilization, the improved quality of life, the prolongation of life, and possibly the chemoprevention.

Autoradiographic Study on the Effect of AG60 to the DNA Synthesis of Gastric Epithelium of Mouse Inoculated with Ehrlich Carcinoma / 대한해부학회지

To study the tumor-suppression effect of a newly developed anti-tumor agent AG60 [acriflavine (1) : guanosine (1) composition, Taerim Pharm. Co., Seoul, Korea], each Ehrlich carcinoma (10(7) cells)-inoculated mouse received the subcutaneous injection of 0.2 ml of saline, 5 mg/kg of AG60, and 30 mg/kg of AG60 per day for a week. The day following the last injection, each mouse was injected with a single dose of 0.7 microcurie/g of methyl-3H-thymidine (25Ci/mmol, Amersham Lab., England) through tail vein. Seventy minutes after the thymidine injection, animals were sacrificed, and gastric tissues were collected and fixed in 10% neutral formalin. Tissue blocks were washed, dehydrated, embedded and cut in 6 micrometer-thick sections. Deparaffinized sections were coated with autoradiographic emulsion EM 1 (Amersham Lab. England) in a dark room and dried and were placed in a light-tight box. The sections were exposured for 5 weeks in the dark room, and were then developed in D-19 developer. Labeled indices (mean number of labeled cells per 100 epithelial cells in the isthmus) were observed and calculated. The results are as follows; 1. On histological study, gastric mucosa had no morphological changes following the injection of AG60. 2. On autoradiographic study, labeled grains of 3H-thymidine were restricted on the isthmus portion of the gatric gland. 3. On autoradiographic study, labeling indicies of gastric epithelial cells of normal control, experimental control, AG60 (5 mg/kg)-treated and AG60 (30 mg/kg)-treated groups were 21.9+/-0.28%, 18.8+/-0.03%, 21.6+/-1.61% and 6.3+/-0.93%, respectively. These result suggest that AG60 is expected as one of most effective anticancer drugs, and the dosage under 5 mg/kg of AG60 does not result any defect on the DNA synthesis in gastric epithelial cells.

Fluorescent Study on the Tissue-Distribution of Acriflavine-Guanosine Compound (AG60) / 대한해부학회지

The study was carried out to evaluate the tissue-distribution of acriflavine or AG60 (acriflavine-guanosine compound, 1 : 1), the newly developed anticancer remedy. Successful access or distribution of a drug to specific tissue is important to attack the cancer cells in the same area. But it also means that the drug may disturb the activities of labelled tissues or cells. On the other hand, unlabelled elements may survive from massive treatment with the drug. In this study, distribution of acriflavine or AG60 in Yac-1 leukemic cells (0.25~25 microgram/ml) and in the tissues of rats or mice (5~50 mg/kg) were evaluated. Yac-1 cells showed prominent fluorescence on the heterochromatin and more or less prominent fluorescence on the nucleoplasm, cytoplasm and plasma membrane. Cytotoxicity of AG60 led to morphologic changes such as bleb- or baloon-formation on the surface, general swelling of the cell, and lysis of the cell. Following the subcutaneous administration of acriflavine or AG60 (5~50 mg/kg) to the Ehrlich carcinoma-inoculat-ed rats or mice, most tissues including cancer cells showed acriflavine-fluorescence with some exception. The nuclei of cells of tissues were labelled more strongly than those of cytoplasm. Fluorescence was especially strong over biliary tree, renal corpuscle, gastrointestinal mucous coat, and bronchial mucous coat. But parenchymal components of central nervous system did not show any fluorescence. As shown in Yac-1 cells treated with AG60, the drug strongly attached to nucleic acids, and it induced swelling and disintegration of cancer cells. Fast turn-over of AG60 was seen in the secretory passages of bile juice, urine, gastrointestinal mucin, and bronchial mucin. The results show that AG60 could reach most tissues except parenchymes of central nervous system.

Anti-Tumor Effect of AG60 against Ehrlich Tumor

BACKGROUND: AG60 is a complex of acriflavine and guanosine. Our previous study revealed that AG60 had not only in vitro antitumor activities in several human cancer cell lines, but also strong antitumor effects in animal experiments using p388 or S180 cells-implanted mice. METHODS: Antitumor effects of AG60 were compared with those of Adriamycin, acriflavine, guanosine or control group. Body weight, tumor weight change, and survival time were measured in Ehrlich carcinoma cells implanted ICR mice. RESULTS: Body weights in AG60, acriflavine, or Adriamycin treated groups were significantly lower than those in control group during 30 day observation period(p<0.05). The percent tumor growth inhibition of AG60, Adriamycin, acriflavine, or guanosine two weeks after last treatment was respectively 86% (T/C%=14), 83% (T/C%=17), 68%(T/C%=32), 41% (T/C%=59). According to above data, tumor growth inhibition in AG60 treated group was significantly stronger than that in control, acriflavine or guanosine treated group(p<0.01), but there was no significant difference between AG60 and Adriamycin treated group. Mean survival time in control, AG60, Adriamycin, acriflavine, or guanosine treated group was respectively 33+/-3.9 days, 68+/-4.2 days, 54+/-5.8 days, 36+/-3.8 days, 50+/-8.1 days. CONCLUSIONS: The anti-tumor effect of AG60 against Ehrlich tumor was significantly stronger than that of control, acriflavine or guanosine, and comparable with Adriamycin. Mean survival time in AG60 treated group was significantly longer than that in control, acrifavine, guanosine or Adriamysin treated group.

Anti-tumor Effect of the Complex of Acriflavine and Guanosine (AG60) / 대한암학회지

PURPOSE: The anti-tumor effect of the complex of acriflavine and guanosine (AG60) was investigated. MATERIALS AND METHODS: In vitro cytotoxicity of AG60 was measured using SRB assay, and in vivo antitumor activity of AG60 was examined in CDF1 mice intraperitoneally inoculated with the P388 leukemic cells and in ICR mice inguinally implanted with S-180 cells. Tumor size and mean survival time were determined. RESULTS: AG60 and acriflavine showed strong anti-tumor effect in vitro on lung cancer (A549), renal cancer (UO-31) and colon cancer (COLO205) cells. However, AG60 did not show the cytotoxicity against normal cell line, 3T3. The range of the IC50 of AG60 to the various tumor cell lines was 0.09 microgram/ml through 1.94 microgram/ml. The treatment of ascitic tumor bearing CDF1 mice with AG60 resulted in over 160% increases in the mean survival time. The most effective dose of AG60 was 30 mg/kg body weight in tumor implanted mice. In solid tumor bearing ICR mice tumor growth and progression were suppressed in response to the different doses at 30 days; 69.8% suppression of tumor size in response to acriflavine, 16.0% to guanosine, 87.7% to AG60 and 78.5% to doxorubicin. In addition, 35% increases were observed in the means survival time of AG60 treated group compared with control group. CONCLUSION: The prominant anti-tumor effects of AG60 shown in this report would represent the possibility of the clinical trials.

A case of duodenal leiomyyoma associated with massive bleeding in young age: a case report

No abstract available.