Kaposi's Sarcoma on Mediastinum after Renal Retransplantation

Kaposi's sarcoma occurs in higher rates in the setting of immunosuppression, especially in patients with acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy or posttransplantation, commonly involving the skin, visceral, oral cavity or respiratory tract. Of the de novo malignancies in transplantation patients, the incidence of Kaposi's sarcoma is increasing steadily. We report a case of a 37-year-old male patient who was diagnosed with Kaposi's sarcoma 16 years after his first renal transplantation and 5 months after his second transplantation. He presented with lymphoproliferative lesions in the mediastinum and supraclavicular area without showing any typical cutaneous lesions. Diagnosis was confirmed by gun biopsy of the enlarged axillary lymph nodes. Tacrolimus, the initial immunosuppressive drug, was tapered while sirolimus therapy and chemotherapy with vincristine was initiated. The enlarged lymph nodes decreased in size and the patient has been treated with vincristin and conversion of tacrolimus to sirolimus.

Two Cases of Superior Mesenteric Artery Aneurysms

Aneurysms of the superior mesenteric artery (SMA) are very rare disease entities. The etiology of a visceral aneurysm includes a bacterial aneurysm due to an infected thrombus from endocarditis (60%). The other causes are atherosclerosis, arterial endometrial necrosis, trauma, polyarteritis nodosum etc. Some aneurysms are diagnosed coincidently but most are discovered by the development of hypovolemic shock due to aneurysmal rupture. Approximately 30% of the patients are at risk of rupture and require surgical management. We report two cases of SMA aneurysms, a 44-year-old male patient who complained of abdominal and back pain and a 42-year-old female who developed a SMA aneurysm postoperatively after undergoing surgery for hemoperitoneum due to a traffic accident. The first patient was treated surgically and the latter was treated conservatively.

Two Cases of Superior Mesenteric Artery Aneurysms

Aneurysms of the superior mesenteric artery (SMA) are very rare disease entities. The etiology of a visceral aneurysm includes a bacterial aneurysm due to an infected thrombus from endocarditis (60%). The other causes are atherosclerosis, arterial endometrial necrosis, trauma, polyarteritis nodosum etc. Some aneurysms are diagnosed coincidently but most are discovered by the development of hypovolemic shock due to aneurysmal rupture. Approximately 30% of the patients are at risk of rupture and require surgical management. We report two cases of SMA aneurysms, a 44-year-old male patient who complained of abdominal and back pain and a 42-year-old female who developed a SMA aneurysm postoperatively after undergoing surgery for hemoperitoneum due to a traffic accident. The first patient was treated surgically and the latter was treated conservatively.

Prognostic Value of Elevated Cyclooxygenase-2 Expression in Breast Cancer

PURPOSE: Cyclooxygenase-2 (Cox-2) is the rate-limiting enzyme in the conversion of arachidonic acid to prostaglandins and can be induced by various agents such as growth factors and tumor promoters. Cox-2 contributes to carcinogenesis and tumor growth. This study was performed to demonstrate the correlation between elevated expression of Cox-2 and pathologic factors in breast cancer. METHODS: Cox-2 expression was analyzed immunohistochemically in paraffin-embedded tumor samples from 40 patients with breast cancer. Cox-2 expression was defined as negative or positive. The correlation between Cox-2 expression and pathologic factors (tumor size, axillary lymph node metastasis, TNM stage and histologic grade) was analyzed. RESULTS: Cox-2 was highly expressed in proportion to tumor size, but the difference was not significant (P>0.05). High Cox-2 expression was observed in the presence of axillary lymph node metastasis and TNM stage III, but was not significant (P>0.05). The Cox-2 expression rate was significantly associated with high histologic grade (I: 42.9%, II: 50.0%, III: 80.0%) (P=0.046). CONCLUSION: Elevated levels of Cox-2 expression were associated with large tumor size, presence of axillary lymph node metastasis, high TNM stage and high histologic grade, and can therefore be a possible marker for poor prognosis. Due to the small number of cases, we couldn't confirm the statistical significance except in terms of histologic grade. Further prospective studies with a large number of cases are required.

Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.

Cyclin D1 Expression in Primary Breast Carcinoma: Correlation with Estrogen Receptor Status and Other Clinicopathologic Parameters / 한국유방암학회지

PURPOSE: Cyclins are groups of proteins that play a role as a major regulator of the G1 restriction point promoting inactivation of the retinoblastoma protein. The cyclin D1 gene, CCND1, is amplified in approximately 20% of breast carcinomas and the protein is reportedly overexpressed in 60~80% of all cases. Cyclin D1 overexpression was strongly correlated to estrogen receptor positivity and better histologic grade in breast cancer. The aim of this study was to correlate cyclin D1 overexpression using a well characterized antibody with estrogen receptor status and other clincopathologic parameters. METHODS: From March 1989 to December 1994, 85 patients with primary breast carcinoma were the subject in this study. We analyzed cyclin D1 expression by immnohistochemical staining using cyclin D1 antibody, cells were considered positive according to distinct nuclear staining. The correlation between cyclin D1 expression was compared with important clinicopathologic parameters (tumor size, axillary lymph node status, p53 expression, c-erbB2 expression, histologic grade, estrogen receptor status). RESULTS: Cyclin D1 expression was detected in 37 cases (43.5%). Cyclin D1 expression was high in patients with tumors that expressed estrogen receptor (58.5% vs 26.5%, P=0.019). Cyclin D1 was mainly overexpressed in the histologic grade I and II (75.0%), as compared with 65.2% in cyclin D1 negative tumor, however there was no statistical significance (P=0.067). There were no significant correlation with tumor size, axillary lymph node status, p53 expression, or c-erbB2 expression (P>0.05). CONCLUSION: Cyclin D1 expression in estrogen receptor (ER) positive patients was significantly higher than that seen in ER negative patients. There was a negative correlation between cyclin D1 and tumor histologic grade, however it was not statistically significant. Tumor size, axillary lymph node status, p53 expression, and c-erbB2 expression were not correlated with cyclin D1.

Mast Cells in Renal Allografts

PURPOSE: Chronic rejection is the enemy in the battle for long term survival after renal allografts. Interstitial fibrosis is known to be the important finding in renal allografts with chronic rejection. Mast cells secrete a large number of fibrogenic factors and have been involved in chronic inflammation and tissue fibrosis. In this study the authors evaluated the relationship between mast cells and fibrosis in renal allografts with chronic rejection. METHODS: The authors evaluated 42 biopsied specimens of renal allografts. Immunohistochemistry using anti-mast cell tryptase (Dako, 1 : 200) and an LSAB kit (Dako) was applied to detect mast cells. The mean number of mast cells (MNM) per 10 high power fields was counted. RESULTS: MNM of implantation biopsies was 0.640+/-0.537, of acute rejection -1.969+/-1.216, of chronic rejection -6.0+/-3.133 (P0.05). CONCLUSION: Our data show that the number of mast cells in renal allograft was significantly associated with chronic rejection, donor sex and hypercholesterolemia.

Cyclin D1 Expression in Primary Breast Carcinoma: Correlation with Estrogen Receptor Status and Other Clinicopathologic Parameters

PURPOSE: Cyclins are groups of proteins that play a role as a major regulator of the G1 restriction point promoting inactivation of the retinoblastoma protein. The cyclin D1 gene, CCND1, is amplified in approximately 20% of breast carcinomas and the protein is reportedly overexpressed in 60~80% of all cases. Cyclin D1 overexpression was strongly correlated to estrogen receptor positivity and better histologic grade in breast cancer. The aim of this study was to correlate cyclin D1 overexpression using a well characterized antibody with estrogen receptor status and other clincopathologic parameters. METHODS: From March 1989 to December 1994, 85 patients with primary breast carcinoma were the subject in this study. We analyzed cyclin D1 expression by immnohistochemical staining using cyclin D1 antibody, cells were considered positive according to distinct nuclear staining. The correlation between cyclin D1 expression was compared with important clinicopathologic parameters (tumor size, axillary lymph node status, p53 expression, c-erbB2 expression, histologic grade, estrogen receptor status). RESULTS: Cyclin D1 expression was detected in 37 cases (43.5%). Cyclin D1 expression was high in patients with tumors that expressed estrogen receptor (58.5% vs 26.5%, P=0.019). Cyclin D1 was mainly overexpressed in the histologic grade I and II (75.0%), as compared with 65.2% in cyclin D1 negative tumor, however there was no statistical significance (P=0.067). There were no significant correlation with tumor size, axillary lymph node status, p53 expression, or c-erbB2 expression (P>0.05). CONCLUSION: Cyclin D1 expression in estrogen receptor (ER) positive patients was significantly higher than that seen in ER negative patients. There was a negative correlation between cyclin D1 and tumor histologic grade, however it was not statistically significant. Tumor size, axillary lymph node status, p53 expression, and c-erbB2 expression were not correlated with cyclin D1.

Clinical Significance of PCNA and nm23 Expression in Invasive Colorectal Carcinoma

PURPOSE: It is known that PCNA (proliferating cell nuclear antigen) is associated with cell proliferating activity and nm23 with so called 'anti-metastatic' activity. We tried to elucidate the relationships of PCNA labeling index and nm23 expression in carcinoma cells with survival rates of patients with invasive colorectal carcinoma. METHODS: Immunohistochemical study was performed using monoclonal antibodies for PCNA and nm23 gene products on 45 cases of paraffin-embedded tissue made of invasive colorectal cancer. RESULTS: Five-year survival rate was lower in the group with high PCNA labeling index than that with low one, but PCNA labeling index was not associated with the tumor stages. Expression of nm23 was not associated with survival rate, tumor stage, site, and PCNA labeling index. CONCLUSIONS: Although PCNA labeling index was not associated with tumor stages, this study suggests that PCNA labeling index will be a good prognostic factors in invasive colorectal carcinoma.

Expression of p27Kip1 Protein in Colorectal Adenocarcinoma

p27Kip1 has been recognized as a negative regulator of cell cycle. Reduced level of p27 expression is associated with development and aggressiveness of several human tumors. To investigate the role of p27Kip1 on progression of colorectal adenocarcinoma, we studied 40 cases of human colorectal adenocarcinomas for expression of p27Kip1 protein using an immunohistochemical method, and compared these results with known prognostic parameters of colorectal adenocarcinoma. Among 40 cases of colorectal adenocarcinomas, p27Kip1 expression was detected in the nuclei of tumor cells in 14 cases (35%). The expression rate of p27Kip1 protein was significantly lower in the cases with lymph node metastasis (25.8%) than in those without lymph node metastasis (66.6%) (p<0.05). But it did not correlate with other parameters such as tumor size, histologic grade, vascular invasion, and Ki-67 labeling index. The results suggest that reduced expression of p27Kip1 protein plays a role in biologically aggressive behavior of colorectal adenocarcinoma.

Two cases of Mirizzi syndrome / 한국간담췌외과학회지

Impaction of a gallstone in the cystic duct or neck of the gallbladder can cause partial hepatic duct obstruction. Mirizzi originally described the syndrome of obstructive jaundice presented in the patient with gallstone in 1948. Cholecystobiliary fistula is a complicated form of Mirizzi syndrome in longstanding cholecystitis. A 70 year-old female was admitted due to jaundice. On laparotomy, the right heaptic duct was compressed by distended gallbladder. The other 60 year-old male patient was referred with jaundice. The patient underwent laparoscopic cholecystectomy two years ago. A large stone was migrated from remnant cystic duct through a cholecystocholedochal fistula. We report two cases of Mirizzi syndrome with a review of literature.

Upper Gastrointestinal Lesions and Helicobacter pylori Infection in Patients with Colorectal Neoplasia / 대한소화기내시경학회지

BACKGROUND/AIMS: There are some reports which show higher Helicobacter pylori (H. pylori) seroprevalence in patients with colonic adenoma and carcinomas, than in control subjects. The H. pylori infection rate and simultaneous gastroduodenal lesions were evaluated to document the relationship between colonic lesions and H. pylori infection. METHODS: Patients with colonic polyps or cancers who were confirmed by colonoscopic polypectomy or biopsy were studied. H. pylori infections were evaluated serologically and/or with CLO testing. Gastroduodenoscopy was performed. RESULTS: Twenty six subjects were involved. The numbers of the patients with hyperplastic polyps, tubular adenomas and carcinomas were 7, 6 and 13, respectively. The H. pylori infection rate was 65.4%. Simultaneous gastroduodenal lesions were observed in 11 patients (42.3%) and H. pylori infections were found in 9 (81.8%). Among the 17 subjects with H. pylori infections, 9 subjects (52.9%) had simultaneous gastroduodenal lesions. In contrast, 2 subjects (22.2%) had upper gastrointestinal lesions among 9 subjects without H. pylori infections. CONCLUSIONS: Patients with colorectal neoplasia can experience, simultaneous gastroduodenal lesions, especially in the cases involving H. pylori infection.

Clinical Analysis of 65 Multiple Primary Cancer Cases

BACKGROUND: Multiple primary cancer (MPC), which is defined as the multiple occurrence of malignant neoplasms in the same individual, has been reported as gradually increasing among patients treated for initial cancers. Therefore, there have been many reports about multiple primary cancers, but there is in sufficient information on the incidence or the relative risk. Furthermore, diagnostic access to the early detection of MPC has not been established. The purpose of this report is to present an overview of a clinical analysis of MPC, with attention to above aspects. METHODS: During the 7.6 years from 1990 until August 1997, 6,346 cancer patients were registered at Kang-dong Sacred Heart Hospital, among which were 91 cases (1.43%) of MPC compatible with Warren & Gates' criteria. Among these 91 cases, 65 cases (1.02%) which received surgical treatment are analysed in this report. Medical records were reviewed retrospectively, and data were analyzed for annual incidence, sex, age, the site of the cancer, the time interval between cancers, etiology, etc. RESULTS: The mean age was 60.1 years old. The sex ratio was 1.32:1 (male 37, female 28). Synchronous cancers were present in 28 cases and metachronous cancers in 37 cases. Among index cancers, stomach cancer was the most common (16 cases, 24.6%). In metachronous cancers, the average time duration between the discovery of the index and the additional cancer was 6.6 years. In the 28 synchronous cancers, only 10 cases (35.7%) received a curative resection, but in the 37 metachronous cancers, 18 cases (50%) received a curative resection. CONCLUSIONS: Among the 65 MPCs, multiple primary cancers associated with stomach cancer were most common. The curability of metachronous cancer was higher than that of synchronous cancer. We may carefully infer that synchronous MPCs have a poorer prognosis than metachronous MPCs. Therefore, only knowledge of MPC and efforts for early diagnosis may increase the survival rate for MPC patients. Thus, further prospective study is needed.

Prognostic Value of Angiogenesis in Breast Cancer

BACKGROUND: There is considerable experimental evidence to indicate that tumor growth is dependent on angiogenesis. To investigate how tumor angiogenesis correlates with clinical factors and prognosis in breast carcinoma, we counted microvessels (capillaries and venules) and graded the density of micro vessels within the invasive ductal carcinomas of 59 patients. METHODS: Using light microscopy, we highlighted the vessels by staining their endothelial cells immu nohistochemically for rabbit antihuman factor-VIII related antigen (Dako L1809, USA). The microvessels were carefully counted (per 200 field) in the most active areas of neovascularization without knowledge of either the outcome in the patient or the clinical variables. RESULTS: The mean age was 47.8 years. There was no statistical correlation between angiogenesis and either estrogen receptor status or age. However, there was a statistical correlation with tumor size (p< or =0.05). There was a statistical difference between lymph-node-metastasis positive group and negative group (p= 0.006). Angiogenesis correlated statistically with TMN stage (microvessels count:stage I= 31.27, stage II= 40.74, and stage III= 78.9)(p= 0.001). There was a statistical correction between angiogenesis and follow-up results (microvessels counts:disease free group= 42.11, living metastatic group= 63.64, and expired group= 73.60)(p= 0.031). CONCLUSIONS: In this study, the degree of angiogenesis (the number of microvessels per 200 field in the area of most intensive neovascularization) may have a predictive value in invasive breast carci nomas. Therefore, assessment of tumor angiogenesis may give us useful information for selecting thera peutic and follow-up plan for patients with breast carcinomas.

Clinical Review of the Intussusception in Adults

We analyzed 13 cases of adult intussusceptions, which has been surgically treated, during the period from January 1987 to June 1997. There were 6 benign tumors, 2 malignant tumors and 5 others. The most common presenting symptom was abdominal pain. The types of intussusception were 3 jejuno- jejunal, 4 ileo-ileal, 1 ileocolic, 2 ileo-ileo-colic, and 1 colo-colic, intussusception of the vermiform appendix, and 1 combined type. In the pathlogic findings of the tumors, lipoma was the most common benign tumor and metastatic malignant melanoma was the most common malignant tumor. Other benign conditions were adhesion and granuloma due to tuberculosis. Surgical procedures were manual reduction, small bowel resection and anastomosis, a right hemicolectomy, a partial colectomy, and a polypectomy.

A Case Report of Intussusception of the Vermiform Appendix with Adenocarcinoma

The authors present a case of intussusception of the vermiform appendix with ade nocarcinoma. A 35-year-old male with lower abdominal pain and anemia was found to have an intussusception of the appendix associated with an adenocarcino-ma. The preoperative diagnosis was cecal cancer but we detected the iutussuscept-ion of the appendix with an adenocarcinoma during operation. Patient was managed with right hemicolectomy and has been followed up.

A Comparison of Fleet(R) with Colonlyte(R) for Precolonoscopic Preparation / 대한소화기내시경학회지

BACKGROUND/AIMS: Recent reports have suggested that precolonoscopy bowel preparation is easier to tolerate if a small volume solution is used. The aim of this study was to compare oral sodium phosphate with polyethylene glycol solution in terms of the quality of colon cleansing, ease of preparation, and gastrointestinal intolerance. METHODS: Sixty one patients were prospectively randomized to receive either a standard 4-liter polyethylene glycol solution or a 90 ml oral sodium phosphate preparation. Before and after bowel preparation all patients were weighted, and serum electrolytes were measured. Patients were asked to record the effects of the preparation and to give it a "discomfort rating" on a scale from 1 to 5. Surgeons were blinded to the preparation used and rated the quality of bowel cleansing on a scale of 1 to 5. RESULTS: The smaller volume of oral sodium phosphate was not associated with any clinically significant problem,caused no increase in the incidence of side effects, was preferred by patients, and was effective in colonic cleansing. The incidence of sleep disturbance, abdominal pain, nausea, vomiting, anal discomfort, chest pain, chilling and dizziness associated with oral sodium phosphate was similar to that with polyethylene glycol lavage. Abdominal distension was more common with polyethylene glycol lavage and statistical difference was seen(P<0.01). There were no clinically significant changes in any biochemical parameters and vital signs caused by precolonoscopic preparation except asymptomatic hyperphosphatemia in the sodium phosphate group that was not statistically different. The decreased body weight was seen with Colonlyte(R) that was statistically different(P<0.01). CONCLUSION: The overall quality of bowel preparation with oral sodium phosphate was similar to that with polyethylene glycol lavage. Patients tolerated preparation with oral sodium phosphate to be somewhat easier than polyethylene glycol lavage. Therefore, we conclude that the use of oral sodium phosphate as a precolonoscopy bowel preparation is clinically useful.

Endorectal sonography in the evaluation of anal canal, rectum and anorectal disease

No abstract available.

A study of CEA expression of the invasive colorectal adenocarcinoma on immunohistochemistry

No abstract available.

A clinical study of colorectal cancer

No abstract available.