A Case of Advanced Gastric Cancer and the First Symptom was a Skin Lesion / 대한소화기내시경학회지

Cutaneous metastasis of internal malignancies is rare and the incidence of metastatic skin lesions as the first symptom of disease is only 0.8% for patients with all types of malignancies. Furthermore, cutaneous metastasis from advanced gastric cancer is exceedingly rare. A 43-year-old man presented with a single, symptomatic, erythematous nodule on the chest wall. A biopsy taken from the nodule showed an adenocarcinoma of the poorly differentiated type. An endoscopic examination and biopsy was done and these showed the same histologic findings. We reported here on this unusual case of advanced gastric cancer and the patient's first symptom was a skin lesion.

Immunohistochemical Analysis of Nuclear Factor, p38, and Cyclin D1 Proteins in Premalignant Lesions and Carcinomas of the Colorectal Mucosa / 대한소화기학회지

BACKGROUND/AIMS: Nuclear factor-kappa B p65 (NF-kappa B p65), nuclear factor-kappa B1 p50 (NF-kappa B p50) have been shown to play a role in cell proliferation, apoptosis, cytokine production, and oncogenesis. Recently, p38 mitogen-activated protein kinase (MAPK)/ NF-kappa B/ cyclin D1 signaling pathway has been shown to play an important part in the pathogenesis of human cancers. This study was designed to investigate the expression of NF-kappa B p65, NF-kappa B p50, p38 MAPK alpha, and cyclin D1 proteins in premalignant lesions of colon and colorectal adenocarcinoma. METHODS: Paraffin sections of 20 normal mucosa, 20 low-grade tubular adenoma, 20 high-grade tubular adenoma and 64 adenocarcinoma tissues were analysed immunohistochemically for the expression of NF-kappa B p65, NF-kappa B p50, p38 MAPK alpha, and cyclin D1 proteins. RESULTS: The expression of NF-kappa B p65, NF-kappa B p50, and p38 MAPK alpha proteins were significantly higher in adenocarcinoma tissue in comparison with that in normal mucosa, low-grade tubular adenoma, and high-grade tubular adenoma tissues. Expression of NF-kappa B p50 was more frequent in poorly differentiated histologic grade, presence of nodal metastasis, and advanced stage. Expression of p38 MAPK alpha protein was higher in advanced tumor stage, presence of nodal metastasis and advanced stage. Synchronous expression of NF-kappa B p65, NF-kappa B p50, p38 MAPK alpha, and cyclin D1 proteins were significantly higher in adenocarcinoma tissue. CONCULSIONS: With the increased expression of NF-kappa B p65, NF-kappa B p50, and p38 MAPK alpha proteins, p38 MAPK/ NF-kappa B/ cyclin D1 signaling pathway may play a role in the pathogenesis of colorectal carcinoma.

Expression of Survivin, HSP90, Bcl-2 and Bax Proteins in N-butyl-N-(4-hydroxybutyl)nitrosamine-induced Rat Bladder Carcinogenesis

BACKGROUND: Survivin belongs to the inhibitor of apoptosis family, and it has recently been found to be expressed in most solid tumors. Therefore, its expression is suggested to have prognostic significance. However, no data are available concerning the significance of survivin for the carcinogenesis of bladder cancer. METHODS: In order to induce urothelial tumor in the rat urinary bladder, 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) was administered to male Sprague-Dawley rats for 30 weeks. We used immunohistochemistry to investigate the expressions of survivin, HSP90, Bcl-2 and Bax in rat bladder carcinogenesis. RESULTS: Urothelial cell hyperplasia, papilloma, non-invasive urothelial carcinoma and invasive urothelial carcinoma appeared at 5, 10, 20 and 30 weeks, respectively. The expressions of survivin and HSP90 increased sequentially from normal mucosa, hyperplasia, papilloma, non-invasive urothelial carcinoma to invasive urothelial carcinoma. The expressions of Bcl-2 and Bax did not increase, however the number of cases with more than 1 of Bcl-2/Bax expression ratio increased sequentially during the progression of urothelial lesion. The expression of survivin showed a statistically significant correlation with the expression of HSP90 and the Bcl-2/Bax expression ratio. CONCLUSIONS: Our findings suggest that survivin may be involved in the carcinogenesis of rat bladder and its expression is correlated with the expression of HSP90 and the Bcl-2/Bax expression ratio.

Mast Cell and Macrophage Counts and Microvessel Density in Invasive Breast Carcinoma-Comparison Analysis with Clinicopathological Parameters / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate the clinicopathological significance of the microvessel density and macrophage and mast cell counts in invasive breast carcinomas. MATERIALS AND METHODS: 45 invasive breast carcinomas were immunohistochemically stained with the endothelial antigen, CD34, and macrophage marker, CD68. 0.1% toluidine blue was used to highlight mast cells. The microvessel and mast cell counts were performed at x200 magnification and the macrophages at x400 magnification. RESULTS: With the 45 invasive breast carcinomas, there were no statistically significant associations between the mast cell, macrophage and microvessel counts and the tumor size and lymph node status. ER and PR negative mast cells infiltrated more than in cases of positive stati, with statistical significance (p-value=0.010 and 0.005, respectively). The macrophage counts were negatively correlated with the PR status (p-value=0.030). With respect to the c-erbB-2 status, there was no significance correlation with the mast cell, macrophage and microvessel counts. The mast cell counts showed significantly positive correlation with the microvessel counts in the invasive breast carcinomas (p-value=0.015). In a comparison of the macrophage counts with the microvessel counts, a positive tendency for both parameters, but without statistical significance (p-value=0.310). CONCLUSION: Increasing numbers of mast cells and macrophages were recruited in invasive breast carcinomas, which contribute to angiogenesis. The microvessel density in invasive breast carcinomas had no statistically significant association with the tumor size, lymph node status, and histological grade, presence of DCIS component, estrogen/progesterone receptor status and cerbB-2 status. The evaluation of angiogenesis using these methods is not thought to provide an independent clinicopathological factor in invasive breast carcinomas.

The Efficacy of ZD1839 (Iressa(TM)) in Patients with Advanced Non- small Cell Lung Cancer which has Progressed After Previous Chemotherapy / 결핵및호흡기질환

BACKGROUND: The role of second-line chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) is known to be limited. Recently, ZD1839, the small molecule epidermal growth factor receptor-tyrosine kinase inhibitor, has been developed and has shown anti-tumor activity in patients with solid malignant tumors including lung cancer. We evaluated the response rate and toxicities of ZD1839 in patients with advanced NSCLC which has progressed after previous chemotherapy. PATIENTS AND METHODS: We examined 83 patients with advanced NSCLC treated with ZD1839 for more than 1 month in Korea Cancer Center Hospital during the period from January 2002 to September 2003. All the patients were enrolled in the international expanded access program (EAP) with ZD1839 by AstraZeneca. The administered dose of ZD1839 was 250 mg once daily. Chest radiography and laboratory tests were followed-up. We evaluated the response rate, median survival, and toxicity after treatment. RESULTS: Median age of the patients was 59 years (range 33-76). The most predominant cell type was adenocarcinoma and the most stage of the patients was IV. ECOG performance status was as follows; grade 0-1 in 10, grade 2 in 42, and grade 3 in 31 patients. Partial response was achieved in 12 patients (14.5%). Median overall survival was 9.2 (range 1.3-21.6+) months and median time to progression was 3.1 (range 1-21.2+) months. The most common adverse effect of ZD1839 was skin eruption which developed in 25 patients (25.8%). Significantly higher response rate and survival was found in patients with adenocarcinoma or good performance status. CONCLUSION: ZD1839 showed modest activity and tolerable toxicity in the treatment for patients with NSCLC which has progressed after previous chemotherapy.

Positron Emission Tomography with Fluorine-18-Fluorodeoxyglucose is Useful for Predicting the Prognosis of Patients with Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is heterogenous in terms of its glucose metabolism. Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) shows various levels of FDG uptake for patients with HCC. This study was designed to assess the usefulness of FDG-PET for predicting the outcome of the patients with HCC. METHODS: FDG-PET was performed for 27 patients with HCC. The standardized uptake value (SUV) and SUV ratio (defined as the tumor-to-nontumor ratio of SUV) was calculated for each patient. The clinical factors of the outcome were analyzed by regression analysis using Cox's multivariate proportional hazard model. The survival rate was calculated by the Kaplan-Meier method. RESULTS: Among the analyzed clinical factors including tumor size, number of tumors, AFP, involvement of major vessels, presence of systemic metastases, Child-Pugh class the SUV and SUV ratio, only the SUV was the only significant independent prognostic factor (p=0.001). On the basis of the SUV, the patients were divided into two groups of roughly equal size: group A, SUV of or=7. The cumulative survival rate was significantly lower for group B than for group A, and the median survival time was significantly different (4 months vs 15 months, respectively) (p=0.003). CONCLUSIONS: These results suggest that FDG-PET is useful to predict the outcome for patients with hepatocellular carcinoma.

Use of Complementary and Alternative Medicine among Korean Cancer Patients

BACKGROUND: Complementary and alternative medicine (CAM) is now being increasingly used among cancer patients. The objectives of our study were to assess the prevalence, types, cost, subjective effects, and side effects of CAM use, reasons for CAM use, characteristics of CAM users compared to those of nonusers, and patients' expectations of doctors regarding their CAM use among Korean cancer patients at a single cancer center. METHODS: From April to August, 2003, we interviewed 186 cancer patients hospitalized in the Korea Cancer Center Hospital using a structured questionnaire, and analyzed the data. RESULTS: 78.5% of experimental subjects (146 patients) had been treated with at least one type of CAM, in addition to conventional Western treatment, with a mean monthly cost of 1, 380, 000 Won/person (approximately, 1, 100 U.S. dollars on July, 2004). The most prevalent types of CAM used by these patients included medicinal mushrooms (67.1%), herbs (54.1%), vegetable diets (50.6%), and ginseng (46.5%). The main reported reasons for the use of CAM in addition to conventional medicine were nutritional support (19.1%) and physical strengthening (17.8%). 5% of CAM users experienced side effects. The younger and more educated the patients were, the more likely they were to employ CAM. 66% of CAM users wanted to discuss CAM techniques with their doctors. CONCLUSION: More than two-thirds of cancer patients used various kinds of CAM, incurring considerable costs. Therefore, in order to help patients make informed decisions, medical society should be open to communication with patients. Not only the scientific aspects, but also the economic aspects of CAM usage should be examined more thoroughly, in order to ensure proper distribution of medical resources.

Analysis of Prognosis in Poor-grade Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: Although early surgery is a generally accepted in good grade subarachnoid hemorrhage(SAH), patients in a poor grade have been excluded from aggressive treatment due to severely damaged brain after attack. This study describes the prognosis and cause of poor outcome in poor-grade SAH patients excluding the effect of hydrocephlalus. METHODS: We analyzed 217 patients of Hunt & Hess(H&H) grade IV and V from 1997 to 2001. The prognosis according to the treatment modality, timing of operation, age, H&H grade, Fisher grade, location and size of aneurysm and the cause of poor outcome was analyzed retrospectively with literature review. Statistical analysis was performed using paired t-test with SPSS Ver 10.0 and considered significant for value less than 0.05. RESULTS: There were stastistical significance between age, Fisher grade and outcome. Good outcome was obtained about 25.2% in early surgery group and 23.4% in delayed surgery group. Patients who did not undergo clipping presented very poor outcome. The causes of poor outcome mainly composed of delayed ischemic deficit(DID) from vasospasm and direct effect from SAH. CONCLUSION: To improve outcome in poor-grade SAH patients, there must be more intensive care preventing DID from vasospasm.

Thoracic Myelopathy and Radiculomyelopathy due to Ossification of the Ligamentum Flavum: A Cases Report

No abstract available.

The Availability of Allogenic Fibular Bone Graft with Autogenous Bone Dust in Anterior Cervical Fusion after Cervical Discectomy

No abstract available.

Balanitis Xerotica Obliterans with Primary Urethral Stone, A Case Report / 대한비뇨기과학회지

Balanitis xerotica obliterans is a condition of unknown etiology with a specific clinical and histological character. It is a condition affecting the glans penis and prepuce which Stuhmer in 1928 first reported as occurring predominantly in young men following circumcision for phimosis. We report an unusual case of balanitis xerotica obliterans which developed on penis with primary urethral stone

Clinical Observation for Complications of Transurethral Resection in the Treatrnent of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

A clinical observation for operative, postoperative complications were made from 61 case of TURP from June 1985 to April 1989. The following results were obtained. 1. Mean operative time was 81.5 minutes and mean weight of resected prostatic tissue was 13. 6gm. Therefore, it had taken average 6.97 minutes to resect 1gm of prostatic tissue. 2. Perioperative blood replacement was performed in only 16 cases except one case of death and the mean amount was 0.66 pint (210ml). The remaining 45 cases (73.8 %) were not necessary to transfuse blood. 3. Postoperative serum sodium concentration was decreased in 38 of 60 cases and not changed in 8 cases and increased in 14 cases. These changes in serum sodium concentration showed no significant correlation with operative, amount of irrigating fluid. 4. Nineteen of 61 cases of TURP showed several types of non-fatal complications and one case of these expired and the rest of people showed' no complication. 5. The most common complication was transient urinary incontinence (11.4%), the remainders were in order of urethral stricture (6.6%), late bleeding (4.9%), re-TURP due to inadequate resection (3.3%), death (severe bleeding) (1.6%).

A Case of the Metastatic Tumor of the Epididymis in the Undescended Testis / 대한비뇨기과학회지

Metastatic tumors of the epididymis are rare and only 10 cases were reported. The primary tumor sites were kidney, stomach, prostate, ileum, sigmoid colon and pancreas. We recently observed a case of metastatic carcinoma to the epididymis from a primary cancer in the sigmoid and transverse colon.