A Case of a Rapidly Progressive Small Bowel Lymphoma with High Ki-67 Expression

Primary intestinal lymphoma is a rare disease. It accounts for approximately 1~4% of gastrointestinal malignancy. Extranodal lymphoma of the intestine mainly arises from B cells. Diffuse large B-cell lymphoma is the most common type of the disease. Approximately 40% of intestinal lymphoma can be cured, while 60% have varied disease progression. Ki-67 proliferation has been recently used as an index of cell growth to predict the progression of the disease. Reported herein is a case of a rapidly progressive small bowel diffuse large B-cell lymphoma in a 51-year-old man with a high Ki-67 expression level. He visited the emergency department because of hematochezia. Abdominal computed tomography revealed distal small bowel segmental wall thickening. He underwent operation due to spontaneous small bowel perforation. The result of the pathological examination of the resected specimen was compatible with diffuse large B-cell lymphoma. The Ki-67 index within 5 months was 90%.

Asymptomatic Common Iliac Artery Stenosis as a Cause of Renal Allograft Dysfunction and Uncontrolled Hypertension / 대한이식학회지

Occlusive disease of the iliac segment, proximal to the transplant artery (prox-TRAS), in kidney transplant recipients is a rare complication. Prox-TRAS, located in the common iliac artery, is extremely rare in these patients. Herein, we present an interesting case of a common iliac artery stenosis that manifested as decreased allograft function and uncontrolled blood pressure without other typical clinical symptoms. The patient was successfully treated with percutaneous luminal angioplasty and stent insertion.

Asymptomatic Emphysematous Pyelonephritis Incidentally Detected with Computed Tomography in a Diabetic Hemodialysis Patient / 대한내과학회지

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney with gas formation that can be fatal if it is not detected and treated promptly. Typical manifestations are high fever, flank pain, and shock. It typically occurs in patients with diabetes and, although rarely reported, in hemodialysis (HD) patients with or without diabetes. Furthermore, asymptomatic EPN has not yet been reported in HD patients. Here, we report a case of asymptomatic EPN in a diabetic HD patient incidentally detected with follow-up abdominal computed tomography after resection of colon cancer.

Prevalence and Clinical Characteristics of Noncardiac Chest Pain with Reflux Esophagitis in Korea

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is substernal, squeezing chest pain, unrelated to the cardiac problem. Our study aimed to define the prevalence and clinical characteristics of reflux esophagitis in NCCP patients in Korea. MATERIALS AND METHODS: We reviewed medical records of patients who visited Department of Cardiology, St. Paul's Hospital due to chest pain and had normal coronary arteriography and who had received endoscopy within 6 months. Patients diagnosed with peptic ulcer or gastric cancer were excluded. The patients were classified into two groups according to their endoscopic results; the reflux esophagitis group and the control group. RESULTS: Two hundred seventeen NCCP patients were enrolled and 96 patients (44.2%) were diagnosed with reflux esophagitis: 68 patients (31.3%) with minimal change esophagitis; 26 patients (12.0%) with Los Angeles (LA) grade A; 2 patients (0.9%) with LA grade B. There were no patients with severe erosive reflux disease. There were no significantly different characteristics in the reflux esophagitis group and the control group. CONCLUSIONS: The prevalence of reflux esophagitis in NCCP patients in Korea was 44.2%. Most patients had mild reflux esophagitis.

Surgical Treatment of Acute Arterial Occlusion after Applying the Vascular Closure Device for Hemostasis of Femoral Arteriotomy in Vascular Intervention

Vascular intervention via the femoral artery can cause vascular access complications and complications from closure of the arteriotomic incision site such as bleeding, thrombotic complications and vascular trauma. These types of complications occur in about 2% to 10% of the cases. After removal of the catheter, hemostasis is traditionally achieved by manual compression as a standard method. Many vascular closure devices have been developed in an attempt to improve the patient's comfort and to decrease the time to ambulation. Yet the safety and effectiveness of these vascular closure devices as compared to that of manual compression remains unclear. Herein we report on a case of femoral arterial occlusion due to vascular closure devices and the operative management.

Clinical Significance of the Ki-67 Index for Colorectal Cancer

PURPOSE: Monoclonal antibody Ki-67 has been employed to evaluate the growth fraction of various tumors. The purpose of this study is to determin the prognostic value of the Ki-67 index for colorectal cancer. METHODS: The Ki-67 index was investigated by counting the immunohistochemically stained cells. We described this as the permillage. We reviewed the test results of 36 colorectal cancer patients and we compared the Ki-67 index with other clinical factors. RESULTS: There was no correlation between the Ki-67 index and the other established risk factors, and only the number of invaded lymph nodes and their degree of differentiation were related with the Ki-67 index. CONCLUSION: The Ki-67 index is an important marker of the growth fraction of tumor. The pattern of tumor growth is determined not only by the growth fraction, so the discovery of other parameters that can reflect tumor growth and the Ki-67 index can help the patients with respect to their prognosis & treatment.

Deep Vein Thrombosis at Lower Extremities in Severe Burn Patients

PURPOSE: In major burns, deep vein thrombosis (DVT) is frequently diagnosed as a major complication of burns. But the risk factors and prophylaxis remain controversial. This study was designed to evaluate the incidence and risk factors of DVT in major burn patients. METHOD: We reviewed all major burn patients (>40% of TBSA) admitted to our burn center from June 1998 to August 2003 and assessed each affected patients with an in-hospital diagnosis of DVT for DVT risk factors. RESULT: There were 9 symptomatic DVT detected among 606 severe burn patients (1.45% incidence). Patients diagnosed with DVT had no risk factors of morbid obesity, previous DVT, congestive heart failure or neoplastic disease, except one patient who had a polycythemia vera diagnosed incidentally. In eight of 9 patients, DVT occurred in veins draining burned extremities. All patients had burn wound infections as a complication of burns. Eight of 9 patients had longer hospital stays than patients without DVTs. In all patients, DVT was developed after operations for skin graft. CONCLUSION: DVT should be suspected in patients with delayed wound healing and unresolved edema of extrimites. Wound infection, long bed-ridden state and operations are significant risk factors for DVT formation in major burn patients.

Prevalence of BRCA1 and BRCA2 Mutations in Korean Breast Cancer Patients

The incidence of breast cancer in Korea has been increasing in recent years, such that it is now the most common female cancer. Breast cancer in Korea is characterized by an earlier age of onset than in Western countries, suggesting that it would be related with genetic background. We assayed germline mutations in the BRCA genes to evaluate their genetic pathology in Korean breast cancer patients. The study subjects consisted of 173 patients at clinically higher risk and 109 unselected patients. Germline mutations in the entire coding sequences of the BRCA1 and BRCA2 genes were analyzed by Conformation-Sensitive Gel Electrophoresis (CSGE), and any aberrantly-sized band was sequenced. BRCA mutations were present in 12.7% of the high risk patients, compared with 2.8% of the unselected patients. Among high risk patients, mutations were most prevalent in patients with a family history of breast or first-degree ovarian cancer (22.1%), followed by those with male breast cancer (20%), bilateral breast cancer (20%), multiple organ cancer including breast (13%) and younger breast cancer patients (aged<35 yr) (8.1%). Moreover, BRCA mutations were detected in 34.8% of patients having two highrisk factors. These findings suggest that BRCA gene mutation analysis should be performed on Korean patients with high-risk factors for breast cancer.

Bfl-1 Gene Expression in Breast Cancer: Its Relationship with other Prognostic Factors

The Bfl-1 gene, which was isolated from human fetal liver and only recently described, is a member of the Bcl-2 gene family. Reverse transcriptase-polymerase chain reaction was performed on RNA drawn from 30 breast cancer tissues to compare the expression of the Bfl-1 gene with other prognostic factors. The median relative ratio was 3.0 (range, 0.12-26.83) and the Bfl-1 gene expression rate was 36.7% (11/30). There was no statistically significant relationship between the clinicopathologic parameters of patients and the expression value of Bfl-1 gene. The level of Bfl-1 gene expression was higher in more advanced breast cancers than in early cancers. There was no significant relationship between the expression values and currently acknowledged prognostic factors, but a higher expression pattern was noticed in the groups of positive hormone receptors and negative p53 and negative c-erbB2, albeit statistically not significant. It seems that the increased expression of the Bfl-1 gene serves as a contributory factor in breast cancer, in the same way that another group of genes, the Bcl-2 family, contributes to apoptosis.

Pattern of Secondary Failure and Prognostic Factors for Survival Following Surgical Treatment of Isolated Locoregional Recurrence after Mastectomy of Breast Cancer

PURPOSE: This study was performed to evaluate the patterns of secondary failure, and the prognostic factors for survival, following surgical treatment of an isolated locoregional recurrence after a mastectomy in breast cancer patients. METHODS: Forty-nine patients, who had undergone an excision, or a wide excision, either with or without radiation therapy, for an isolated locoregional recurrence following a mastectomy, between 1991 and 2001, were retrospectively analyzed according to the secondary recurrence patterns, the time to the secondary failure, survival rate, and prognostic factors for survival. RESULTS: During the 33 month median follow-up, 28 patients (57%) developed a secondary recurrence; an isolated locoregional failure in 7 (25%), a systemic dissemination in 20 (71%), and both in 1 (4%). The median times from the first recurrence to the second failure, according to the pattern of the secondary failure, were 16, 14 and 6 months for locoregional, for systemic dissemination, and for both, respectively. The disease-free interval (DFI) from first surgery to the recurrence was a significant independent prognostic factor for the second failure. A Univariate analysis identified the DFI, and hormone therapy administered due to a recurrence, as significant prognostic factors for overall survival, but these were not from a multivariate analysis. The 5-year disease- free and overall survival rates for an isolated locoregional recurrence were 27% and 79%, respectively, compared with 0% for both these rates for a recurrence combined with a systemic recurrence (P=0.002). CONCLUSION: A secondary failure, following treatment of an isolated locoregional recurrence, developed in more than half the patients, with a locoregional failure in 25%, and a systemic dissemination in the remainder. DFI and hormone therapy for a recurrence were independent prognostic factors of the overall survival. The survival rates after surgical treatment of isolated locoregional recurrences were increased compared with those for a recurrence combined with a systemic recurrence.

Dual Ectopic Thyroid: A Case Report / 대한이비인후과학회지

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pretracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It most commonly presents as a lingual thyroid, and is the only thyroid in 70% of all cases. It is extremely rare for two ectopic foci of thyroid tissue to present simultaneously. The authors report a recent case of dual ectopic thyroid present in the lingual and infrahyoid area with no thyroid tissue in the pretracheal area in a 15 year-old girl. The presence of dual ectopic thyroid tissue was confirmed by CT and scintigram with 99 mTc. The patient had originally been scheduled for surgery under the impression of a thyroglossal duct cyst, but the pre-operative neck CT and thyroid scans revealed the presence of a dual ectopic thyroid, thus preventing unnecessary surgery. Therefore, ultrasound scans or a neck CT's and thyroid scans should be performed routinely to confirm the presence of thyroid in the normal position and avoid unnecessary surgeries.

A Case-Control Study on Risk Factors of Benign Breast Disorders in Korea / 한국역학회지

PURPOSE: A hospital-based case-control study was conducted to figure out the risk factors for benign breast disorders in Korea. MATERIALS AND METHODS: Histologically confirmed incident cases of benign breast disorders(n=54) were selected from inpatients with life-style information at the Department of General Surgery, Seoul National University Hospital during 1994 to 1997. Women with free of self-reporting past history of any malignancies were regarded as controls who were selected from the inpatients at the same department of the same hospital(n=180). Information on life-styles including reproductive factors were obtained by direct interview using questionnaire. Adjusted odds ratios and 95% confidence intervals were estimated by multivariate logistic regression model with matching variables. RESULTS: Overall, higher educational level, family history of breast cancer, alcohol drinking, and older age at first fullterm pregnancy related to the risk of benign breast disorders. For premenopausal women, older age, higher educational level, and family history of breast cancer increased the risk of benign breast disorders. For postmenopausal women, alcohol drinking, older age at first fullterm pregnancy, and more frequent experiences of fullterm pregnancy increased the risk. Elder age in postmenopausal women and the experience of breast feeding had, however, protective effect against benign breast disorders. CONCLUSIONS: Although the risk factors for benign breast disease may differ from those for breast cancer, these findings are consistent with the hypothesis of excessive circulating estrogen. The present data indicate some risk factors of benign breast disorders are confirmed as risk factors for breast cancer though a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease.

Clinical Characteristics of the Geriatric Surgical Patients

BACKGROUND: Due to rapid economic growth and the development of medical science, the human life span is increasing nowadays. Due to this, old-aged people are increasing in number. However, the physiologic reserve power of old-aged people is lower than that of younger people. Therefore, it is necessary to be very careful about peri-operative care when doing surgery on old-aged people under general or spinal anesthesia. METHODS: We analyzed the medical records of 460 patients over 65 years of age who had undergone operations from August 1990 to July 1996 at the Department of General Surgery, Inchon Medical Center. RESULTS: (1) The ratio of geriatric surgical patients to all surgical patients during the same period was 14.7% (460/3122). Especially, the proportion of geriatric surgical patients increased to 17.0% during the last 2 years of this study compared to 16.2% for the previous 2 years, and 10.6% for the first 2 years. (2) The age distribution was 148 patients from 65 to 69 years (32.2%), 158 patients from 70 to 74 years (34.3%), 90 patients from 75 to 79 years (19.6%), and 64 patients over 80 years (13.9%). There was no significant difference between the number of men and women, there being 232 men and 228 women. (3) Among the 464 cases, 99 cases (21.3%) were malignant diseases compared to 365 cases (78.7%) of benign disease. Stomach cancer was the most common, 36 cases, colon cancer accounted for 31 cases and hepatobiliary cancer for 12 cases. Of the benign diseases, 103 cases (28.2%) were acute appendicitis, 85 (23.4%) were hepatobiliary diseases, 73 (20.1%) were hernias, and 35 (9.6%) were anal diseases. (4) Two hundred twenty-two (222) preoperative-associated diseases were found in 460 patients (48.3%). Cardiovascular disease was the most common (17.4%), and pulmonary disease was the 2nd most common (15.9%). (5) Of the total 133 cases of postoperative complication occurrence, wound infection was the most common, 43 cases, followed by pneumonia, 30 cases, respiratory failure, 11 cases, and renal failure, 7 cases. (6) The postoperative mortality rate was 5.0% and the most common cause was respiratory failure, 8 cases, followed by sepsis, 8 cases. CONCLUSION: The field of geriatric surgery must be pioneered and developed more by surgeons because the number of geriatric surgical patients is increasing more rapidly at present than in the past.