Prevalence and Clinical Characteristics of Neurogenic Thoracic Outlet Syndrome in Specific Industrial Field

PURPOSE: The aim of this study was to analyze the multiple factors as a cause of thoracic outlet syndrome (TOS) in specific industrial field which is a South Korea company manufacturing rolling stock, defense products and plant equipment. METHODS: We analyzed questionnaire survey of 30 patients diagnosed as TOS at outpatient department from January 2005 to October 2015 retrospectively. We reviewed clinical records and questionnaire about repetitive task related to microtrauma. Questionnaire was established to analyze the correlation between occupational history and TOS. Statistical test was done with multiple regression analysis. RESULTS: Incidence rate was 9%, all of 30 patients engaged in heavy workload with symptoms of pain in neck and shoulder. A multiple regression was run to predict arm visual analogue scale (VAS) score from age, force of work, time of work and career. The model of analysis for arm VAS was statistically significant, p<0.001, adjusted r²=0.489. Only force of work variable added was statistically significantly to the prediction, p<0.001. CONCLUSION: Prevalence of TOS in highly loaded industrial field is higher than typically known, appropriate diagnosis is important for early comeback to work. Aggressive diagnosis and treatment is important since non-operative treatment can have satisfying result for patient and help early comeback to work.

Comparison of High Dose Interferon-α2b Immunotherapy and Dacarbazine Chemotherapy as Postoperative Treatment of Malignant Melanoma / 대한정형외과학회잡지

PURPOSE: Immunotherapy of malignant melanoma using Interferon-α2b increases the adaptive immune system activity remaining after surgical resection of the tumor to prevent recurrence, and enhance survival. We will compare the therapeutic effect upon disease-free survival, and overall survival of immunotherapy using high-dose interferon-α2b versus combination therapy using the same regimen with additional dacarbazine after surgical resection. MATERIALS AND METHODS: At Kosin University Gospel Hospital, from March, 2003 to July, 2014, 17 patients underwent postoperative adjuvant therapy after being diagnosed with malignant melanoma. Of the 17 patients, eight underwent immunotherapy using interferon and nine underwent combination therapy using interferon with dacarbazine. Average of 29 months in the immunotherapy group and 44 months for the control group. RESULTS: Of patients receiving interferon-α2b immunotherapy, four patients showed no evidence of local recurrence and local/distant metastasis, two developed local recurrence and metastasis, and two developed distant metastasis. Of those who underwent combination therapy using interferon with dacarbazine, three patients showed no evidence of local recurrence or metastasis, four developed local recurrence and metastasis, and two developed distant metastasis. The average disease-free survival was 25.75 months with interferon therapy and 29.89 months with dacarbazine therapy. The survival difference between the anticancer therapies was not statically significant based on Kaplan-Meier survival. CONCLUSION: Postoperative treatment using interferon-α2b has several advantages as an anticancer drug but does not differ significantly from the first-line therapy, dacarbazine.

Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before. A 53-year-old female patient had been managed in ophthalmologic clinic due to vague symptoms of right monocular blurred vision with eye dryness for 3 months, but showed no signs of improvement. So it was performed a magnetic resonance imaging and magnetic resonance angiography to evaluate the possibilities of cerebral lesion. And a left frontal mass was incidentally found, and the tumor turned out to be a PTC that had metastasized to brain, regional lymph node, cervical, thoracic spine, and lung. We describe a PTC with extraordinary initial symptoms that metastasized to an unusual site. We recommend that if a papillary thyroid tumor with unusual symptoms or at an advanced stage is found, further investigation should be performed for distant metastasis.

Clinicopathologic Features of Papillary Thyroid Carcinoma Coexisting with Hashimoto's Thyroiditis / 대한내분비외과학회지

PURPOSE: Hashimoto's thyroiditis (HT) is an important cause of hypothyroidism caused by autoimmune chronic lymphocytic thyroiditis. In order to attain a better understanding for use in treatment of papillary thyroid carcinoma (PTC) coexisting with HT, we conducted an analysis of the clinicopathologic features, as well as the importance of HT as a prognostic factor. METHODS: In this retrospective study, we analyzed 341 patients who were histopathologically diagnosed with PTC following surgery. RESULTS: PTC coexisting with HT was observed in 19.6% (67 patients) of all PTC patients. A statistically significant gender difference was observed in the group with HT (two male vs. 65 female), with a higher positive rate of anti-thyroglobulin antibody and smaller tumor size, compared to the PTC group without HT. When tumor size increased, a lower coexistence rate of HT was observed. No significant differences were observed in multifocality, cervical lymph node (LN) metastasis, coexistence of benign nodule, and extent of LN dissection. However, frequency of extrathyroidal extension was significantly lower and total thyroidectomy rate was higher in the group with HT. TNM stage and AMES stage were similar in both groups; frequency of high MACIS score showed a significant decrease in the group with HT. The recurrence rate and disease- free survival in patients with PTC were not significantly affected by coexistence of HT. CONCLUSION: We found a significant relationship with gender, extrathyroidal extension, and tumor size in PTC coexisting with HT. However, no significant differences in recurrence rate and disease-free survival were observed between groups. Therefore, coexistence in PTC could not be applicable as a prognostic factor of PTC.

Prognostic Significance of Minimal Extrathyroidal Extension of Papillary Thyroid Carcinomas / 대한내분비외과학회지

PURPOSE: Extrathyroidal extension (ETE) is a risk factor for the recurrence of a papillary thyroid carcinoma (PTC). In the TNM 6(th) classification system, an extrathyroidal invasion of a differentiated thyroid carcinoma has been classified as T3 (minimal invasion), T4a (extended invasion), and T4b (more extensive unresectable invasion) according to tumor invasion. We investigated the clinicopathologic characteristics, recurrence, and disease-free survival (DFS) of minimal ETE (mETE). METHODS: We retrospectively evaluated 332 patients who underwent a thyroidectomy for PTC from January 2005 to December 2006. RESULTS: Of the 332 patients, 103 (31.0%) were found to have a PTC with mETE and 229 (69.0%) patients had a PTC without mETE. In PTC, mETE was related to gender, tumor size, multifocality, Lymph node (LN) metastasis, underlying Hashimoto's thyroiditis, and surgery. But there is no significant difference in age, recurrence, and LN metastasis between the mETE and No mETE groups. Multivariate analysis demonstrated that LN metastasis (odds ratio=2.273; 95% confidence interval 1.280~4.037) was recognized as an independent factor for mETE (P=0.005). Disease-free survival was not significantly different between patients with and without mETE (P=0.153). We analyzed the effect of LN metastasis in groups with and without mETE. Based on the presence or absence of LN metastasis, disease-free survival (DFS) rates between each group showed no significant differences. CONCLUSION: Minimal ETE had no impact on DFS in patients with PTC. Therefore, an appropriate surgical approach and postoperative follow-up are required for tumors with mETE.

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

OBJECTIVE: To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules. MATERIALS AND METHODS: In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results. RESULTS: Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative). CONCLUSION: The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

A Study on the Risk Factors for Recurrence of Recurrent Papillary Thyroid Cancer after Surgery / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence. METHODS: We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed. RESULTS: Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis. CONCLUSION: The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence.

Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. METHODS: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. RESULTS: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15~77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P<0.001), ETE (P<0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. CONCLUSION: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with postoperative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC.

Cox-2 Expression in Malignant Breast Tumors

PURPOSE: Cox-2 expression in breast carcinoma has been reported to be related to angiogenesis, lymph node metastasis and Her-2 expression. The aim of this study is to evaluate the clinicopathologic significance of Cox-2 expression in the invasive ductal carcinomas (IDC) and intraductal carcinomas (DCIS) of the breast. METHODS: The materials were 353 IDC cases and 82 DCIS cases. Immunohistochemical stain for Cox-2 was interpreted as 1+ (weak & focal) and 2+ (diffuse), and the relationships between Cox-2 and ER, PR, Her-2, p53, Ki-67 and bcl-2 expressions were analyzed. RESULTS: There was no significant difference of Cox-2 expression between IDC (148/353, 41.9%) and DCIS (38/82, 46.3%). Cox-2 (2+) expression was more frequent in low grade than intermediate and high grade IDC, but the difference was not significant statistically (P=0.0833), and there were no significant differences of Cox-2 expression according to age, tumor size, nuclear grade, lymph node metastasis in IDC and DCIS cases. In IDC cases, Cox-2 (1+ and 2+) expression showed positive relationships with p53 (+) and more than 10% of Ki-67 labeling index (P=0.0029, P=0.0015), and revealed tendencies of positive relationships with ER (+) and bcl-2 (+) (P=0.0750, P=0.0776). However, no significant relationship between Cox-2 and Her-2 expressions was recognized. In DCIS cases, Cox-2 (2+) expression rate was increased in cases showing negative for Her-2 (P=0.0092) and positive for bcl-2 (P=0.0486). CONCLUSION: Cox-2 expression seems to be involved in the development of breast carcinomas, but not related to the invasiveness. Cox-2 expression, especially 2+, in the DCIS cases suggest a possibility of less aggressive biological behavior.

Causative analysis of cases with permanent complication following extracranial-entracranial bypass surgery in patients with hemodynamic ischemia / 대한뇌혈관외과학회지

OBJECTIVE: Extracranial-intracranial(EC-IC) bypass procedures have proved to be useful and safe in selected patients for revascularization. We have performed EC-IC bypass procedures in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. We analyzed the cases that had permanent complications after performing EC-IC bypass procedures in these 170 patients. METHODS: We performed ECIC bypass surgery during the recent 10 years for augmenting the cerebral blood flow in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. Of the 170 patients, the pathologic lesions were atherosclerotic cerebral ischemia in 125 and moyamoya in 45. All the patients were symptomatic and in a hemodynamic cerebral ischemic state, as diagnosed by the acetazolamide loading test. Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 158 cases and graft bypass with using the saphenous vein or radial artery was done in 12 cases. RESULTS: Of 170 patients who underwent bypass surgery, twenty four patients had postoperative neurologic deficits. Of these 24 patients, the neurologic deficits of 17 patients resolved completely within 3 weeks, but the remaining 7 patients (moyamoya in 5 patients and 2 patients were atherosclerotic) had permanent deficits. The probable causes of the permanent neurologic deficits were that bypass was done too soon after an ischemic attack or hemorrhage (3 cases), intracerebral steal phenomenon during anesthesia (2 case), postbypass thrombotic occlusion of the prebypass stenotic artery (1 case) and postbypass thromboembolism (1 case) CONCLUSION: Permanent neurologic deficits could complicate some cases following bypass surgery. The suggested causes of neurologic deficit were hypoperfusion and inappropriate CO2 tension in the blood and fluctuation of the blood pressure during the perioperative period. To prevent complications, maintain an appropriate perfusion pressure and blood pressure control and follow this with antiplatelet or anticoagulation therapy as soon as possible.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules Smaller Than 5 mm in the Maximum Diameter: Assessment of Efficacy and Pathological Findings

OBJECTIVE: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. MATERIALS AND METHODS: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. RESULTS: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. CONCLUSION: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.

Breast Cancer in Three Women Associated with Von Recklinghausen's Disease

Type 1 neurofibromatosis (NF1), also known as von Reck-linghausen's disease, is a common autosomal dominant neurocutaneous disorder. Persons with NF1 have an increased risk of malignancy compared with the general population, but there are few reports of neurofibromatosis combined with breast cancer. We report on three cases of breast cancer combined with NF1.

Operative Treatment for Hallux Valgus with Proximal Metatarsal Osteotomy in Patients over 55 Years Old / 대한족부족관절학회지

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

Operative Treatment for Hallux Valgus with Proximal Metatarsal Osteotomy in Patients over 55 Years Old / 대한족부족관절학회지

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

The Clinical Experience of Neuronavigation System in Brain Tumor Surgery

OBJECTIVE: Neurosurgical technique has recently entered a fantastic era of image guided surgery or neuronavigaton and application of this technology is beginning to have a significant impact on a variety of intracranial procedures. This study purports to investigate the effectiveness of this new technique in its application to the brain tumor surgery. METHODS: We used the BrainLab VectorVision neuronavigation system, which is an intraoperative, imageguided, frameless, and localization system. We operated 220 cases of different brain pathological conditions with its guidance. RESULTS: The mean of target localizing accuracy, mass size, and mass volume were 1.14mm, 3.04x3.78cm, 32.04cc respectively. These cases included 194 microsurgical craniotomies, 21 frameless stereotactic biopsies, 4 endoscopic procedure and 1 catheter placement. The common pathological diagnoses were meningioma in 61 cases, glioma in 59 and metastasis in 45. CONCLUSION: The neuronavigation system has shown to be very effective and user-friendly for routine microsurgical interventions. The application of this technique not only revealed benefits in operative planning, appreciation of anatomy, lesion location, and safety of surgery, but also greatly enhanced surgical confidence. The image guided surgical technology has a great potential to play an important role in contemporary neurosurgery and its various adoptions in practice will be realized in the near future.

Bacterial Translocation and Prognosis of Critically Ill Patients

PURPOSE: To identify Bacterial translocation (BT) from the gut to the blood in the critically ill patients by using the polymerase chain reaction (PCR) to confirm the sensitivity of PCR in the detection of intestinal bacterial deoxyribonucleic acid (DNA) in human blood. Further, to determine the relationship between the identification of BT and the prognosis of these patients. METHODS: The oligonucleotide primers used to amplify bacterial DNA from whole blood were the beta-galactosidase (BG) gene of E. coli, DNA coding for 16S ribosomal RNA (16S rRNA), and the glutamine synthase gene of Bacteroides fragilis (BFR). DNA was extracted from the blood of 45 cases of critically ill patients and 10 controls. PCR techniques were used to amplify the genes from E. coli, Bacteroides fragilis, and a region of 16S ribosomal RNA found in many gram-negative and positive bacteria. RESULTS: Bacterial DNA genes were not detected in any of the controls, but were found all in 6 cases of patients with positive blood cultures. Of the 39 cases with no growth in their blood culture, 11 cases in BG and BFR, and 13 cases in 16S rRNA had positive findings in bacterial DNA PCR. Fifteen cases (33%) in BG, 19 cases (42%) in BFR, and 16 cases (35.5%) in 16S rRNA of the critically ill patients had detectable bacterial DNA in their blood. Of those with a positive PCR, MOF developed in 11 cases (57.9%) and of these, 10 subsequently died of MOF. One case (3.8%) in the negative PCR was developed and died of MOF. Patients having positive translocated bacterial DNA had a worse prognosis than the group with a negative DNA. CONCLUSION: In order to confirm BT, the PCR method for detecting bacterial DNA in the blood of critically ill patients is more sensitive than blood cultures. BT from the gut can be a major factor in the development of multiple organ failures in critically ill patients. Therefore, early detection of BT with PCR can play a major role in the treatment of critically ill patients.

Retrospects of Twentieth-Century and Prospects toward Twenty First-Century in Thyroid Surgery / 대한내분비외과학회지

Though the first well-documented thyroidectomy was performed in 1595, Kocher at Bern, Switzerland can be called “Father of thyroid surgery” with his outstanding contributions to the understanding of thyroid disease through both clinical surgery and research. Leadership in the surgery and research of thyroid disease shifted largely to the United States in the 20th century beginning with the elegant studies and careful operative techniques of Halsted and his colleagues. Through this century, there were a lot of progress in surgical treatment of benign and malignant thyroid disease, based on hormonal radioimmunoassay, antithyroid agents, propranolol, FNA, ultrasonography, total thyroidectomy, neck dissection, radioiodine ablation, and molecular thyroidology. Modern technology for genetic analysis has induced detection of genetic alterations underlying hereditary forms of MEN and medullary carcinoma. Prospects toward 21th century also will be progress in the endoscopic thyroid surgery, molecular thyroidology and recontruction or transplantation of larynx, trachea and esophagus.

Microsatellite Instability and Overexpression of p53 Protein in Human Gastric Carcinomas: Clinicopathologic Implications and Prognosis

PURPOSE: Striking advances in molecular analysis of human gastrointestinal cancer indicate that malignant transformation of normal epithelial cells is necessary for a multiple process associated with an accumulation of multiple gene abnormalities affecting DNA repair genes, oncogenes, and tumor suppressor genes. Microsatellites are short repeated DNA sequences scattered throughtout the human genome. Microsatellite instability (MSI) may underlie the etiology of mutistep gastric carcinogenesis. The altered microsatellites observed in tumors with DNA replication error (RER) phenotypes may represent the expression of such an instability. METHODS: Fourty-four gastrectomy specimens from patients with gastric carcinomas were examined in an attempt to study the molecular mechanisms of gastric carcinogenesis, to assess the prognostic value of genetic instability and mutant p53 protein expressions, and to evaluate a possible interaction between genetic instability and mutation of the p53 protein. Pairs of tumor and adjacent normal tissue were amplified at six microsatellite loci, and their sizes were compared. Tumors with microsatellite sizes different from their normal tissue sizes for at least two of the tested loci were designated as MSI. Mutations of the p53 protein were investigated with immunohistochemical staining. RESULTS: MSI was detected in 33.3% of the early gastric carcinomas and in 41.4% of the advanced gastric carcinomas with an overall frequency of 38.6%. The frequency of MSI tended to occur more frequently in poorly differentiated adenocarcinomas. The frequency of MSI was not significanctly different with repect to age, sex, size of tumor, location of tumor, depth of invasion,lymph-node metastasis, and Helicobacter pylori infection. Mutation of the p53 protein was detected in 40.0% of the early gastric carcinomas and in 48.3% of the advanced gastric carcinomas with an overall frequency of 45.5%. Mutation of the p53 protein occurred more frequently in positive lymph-node metastasis and advanced stage. There were no correlations between microsatellite instability and p53 expression.The overall 5-year surval rate was 56.6%. The 5-year survival rate of patients with MSI was 58.5%, and that for patient with mutant p53 protein was 42.8%. Gastric cancers with MSI showed a relatively good prognosis, but the result was not statistically significant (p=0.976), and patients with mutant p53 protein had a statistically significant poorer prognosis (p=0.049). CONCLUSION: These findings suggest that both MSI and mutation of the p53 protein are present in early and later stages of malignant transformation. Based on this study, investigations with a larger number of patients are needed to establish their roles as prognostic indicators in gastric cancer.

The Role of Preoperative Fine Needle Aspiration Cytology (FNAC) in Differential Diagnosis of Thyroid Nodules

BACKGROUND: Fine Needle Aspiration Cytology (FNAC) is widely accepted as the most accurate procedure to differentiate malignant from benign thyroid nodules. It is a simple, safe, and inexpensive procedure, and the accuracy of FNAC is relatively high; however, its success usually depends upon the skill in using the aspiration technique and the experience and skill of the cytologist. The authors confirmed the diagnostic value of preoperative FNAC in differential diagnosis of thyroid nodules treated by the surgical resection. METHODS: Three hundred fifty specimens were taken in the Department of Surgery, Inje University College of Medicine, from July 1990 to June 1996. Fifty-one males and 299 females with ages ranging from 11 to 73 years were enrolled. The cytology of FNAC was compared to the final histologic diagnosis. RESULTS: The number of inadequate smears (or sampling error) was 15.7%. Preoperative cytologic diagnoses was consisted of 198 cases of benign disease (92 cases of nodular goiters, 96 cases of follicular lesion types III, and 10 cases of thyroiditis), 12 cases of highly suspicious malignant lesions (follicular lesions type II), and 85 cases of malignant disease (71 cases of papillary carcinomas and 14 cases of follicular lesions type I). Histologic diagnoses consisted of nodular goiters in 116 cases, adenomas in 66 cases, thyroiditis in 9 cases, papillary carcinomas in 84 cases, and follicular carcinomas in 20 cases. These results has an 84.6% sensitivity, a 95.2% specificity, a 15.3% false negative rate, and a 4.7% false positive rate. In the fifty-five cases of inadequate sampling, 13 cases (23.6%) were malignant lesions histologically. In the 16 cases proven as false negative, nine cases were papillary carcinomas, and 7 cases were follicular carcinomas histologically. Thirteen cases (16.1% of 27 cases of cystic lesions) of cystic nodules revealed malignant neoplasms histologically. CONCLUSION: FNAC is a single, useful diagnostic procedure for the initial screening for malignancy in thyroid nodules. Performing repeated aspiration in cystic nodules and clinically suspicious cases could reduce inadeguate sampling and the false negative rate.

Long-term Result of Radical Resection for Hilar Bile Duct Cancer

Sixty patients with hilar bile duct cancer were operated on during a period of nine years. The tumor was resected in 45 patients (resection rate:75.0%). A hilar resection with regional lymph-node dissection was performed in 27 patients, and various types of hepatic resections were added in 18 patients. A potentially curative resection was achieved in 20 patients (curative resection rate:44.4%). There were two operative deaths (operative mortality:4.4%). The overall cumulative five-year survival rate was 25.6%. Six patients survived for more than five years. The survival was superior in patients with a curative resection and in those with a combined hepatic resection, but this result was statistically insignificant. Regional lymph-node metastasis, gross type, histologic grade, and perineural invasion were significant prognostic factors. We conclud that improved survival in hilar bile duct cancers can be achieved by a radical resection with acceptable morbidity and mortality.