A Concurrence of Adenocarcinoma with Micropapillary Features and Composite Glandular-Endocrine Cell Carcinoma in the Stomach

We report a unique case of synchronous double primary gastric cancer consisting of adenocarcinoma components with micropapillary features and composite glandular-endocrine cell carcinoma components. The patient was a 53-year-old man presenting with a 6-month history of epigastric pain and diarrhea. A subtotal gastrectomy was performed. Histologically, one tumor was composed of micropapillary carcinoma components (50%) with tight clusters of micropapillary aggregates lying in the empty spaces, admixed with moderately differentiated adenocarcinoma components. MUC-1 was expressed at the stromal edge of the micropapillary component. The other tumor was composed of atypical carcinoid-like neuroendocrine carcinoma (50%), adenocarcinoid (30%), and adenocarcinoma components (20%). The neuroendocrine components were positive for CD56, synaptophysin, chromogranin, and creatine kinase. The adenocarcinoid components were positive for both carcinoembryonic antigen and neuroendocrine markers (amphicrine differentiation). This case is unique, due to the peculiar histologic micropapillary pattern and the histologic spectrum of adenocarcinoma adenocarcinoid-neuroendocrine carcinoma of the synchronous composite tumor.

The Comparison between 6th and 7th UICC/AJCC N Stage for Prognostic Significance in Gastric Cancer

PURPOSE: The 7th edition UICC/AJCC TNM classification for gastric cancer has several changes from the previous edition. Especially, the classification of the number of lymph node metastases (LNM) is reorganized. According to the new TNM system, N stage was categorized to N0 (no LNM), N1 (1~2 LNM), N2 (3~6 LNM), N3 (7 or more LNM). The aim of our study was to compare the prognostic significance of the new (7th) UICC/AJCC N stage with the old (6th). METHODS: From 2000 to 2005 a total of 425 patients who underwent curative resections with D2 and with 15 or more lymph nodes retrieved were studied retrospectively. RESULTS: According to the 7th UICC/AJCC N stage, the 5-year cumulative survival rates (5YSR) of N0, N1, N2, N3 were 96.0%, 79.2%, 58.5% and 24.3%, respectively (P<0.001). Using univariate analysis, the N stage of 7th and 6th UICC/AJCC TNM classification, 7th UICC/AJCC T stage, differentiation of tumor, type of gastrectomy (subtotal and total gastrectomy), size of primary tumor (< or =5, 5<< or =10, 10<) were associated with 5YSR. However, Cox regression multivariate analysis showed the 7th UICC/AJCC N stage to bean independent factor for predicting the 5YSR instead of the 6th UICC/AJCC N stage (P<0.001, hazard ratio (HR) 1.859, 95% confidence interval (CI) 1.576~2.194), including depth of tumor invasion (P<0.001, HR 1.673, 95% CI 1.351~2.073). CONCLUSION: The new (7th) UICC/AJCC N stage is a more reliable prognostic factor of gastric cancer than the old (6th) N stage.

Coronary Flow Reserve as a Predictor of Long-Term Clinical Outcome after Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: It has been shown that the coronary flow reserve (CFR) of an infarct related artery can predict left ventricular functional recovery following acute myocardial infarction (AMI). However, the prognostic value of CFR on the long-term clinical outcome of patients with an AMI has not been studied. SUBJECTS AND METHODS: Using a Doppler guide wire, we measured the CFR in 130 patients with an AMI following successful intervention (6+/-3 days after onset of the AMI). Two-year follow-up was conducted with regard to end points, including : cardiac death, non-fatal AMI, and severe congestive heart failure (CHF; > or = NYHA III). RESULTS: During the follow-ups, cardiac events occurred in 17 patients (5 deaths, 3 non-fatal AMIs and 9 severe CHFs). After analysis of the receiver operating characteristic curves, the best cut-off value for CFR in predicting cardiac events was 1.4 (sensitivity 76.5%, specificity 73.5%, accuracy 82.0%). With cardiac events as an end point, a 2-year Kaplan-Meier event survival analysis revealed that the patients with a CFR 1.4 (Event free survival rates were 69.8% vs. 95.4%, respectively, p<0.001). Using Cox proportional hazard analyses, as an independent predictor, age, heart rate, CFR and left ventricular end systolic volume index, were also found to be significantly associated with cardiac events (hazard ratios 1.1224, 1.0404, 0.1887, and 1.0588, respectively). CONCLUSION: The coronary flow reserve, of infarct related arteries, measured during the early recovery phase can be used as an independent predictor for the prognosis of patients with an acute myocardial infarction following successful intervention.

Assessment of the anti-Xa activities of Low Molecular Weight Heparins in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Standard unfractionated heparin (UFH) has long been used to prevent death and myocardial infarction in patients with acute coronary syndrome and acute occlusion undergoing percutaneous revascularization. However, UFH binds to several plasma proteins, platelets, and endothelial cells producing a highly variable anticoagulant response. In contrast, Low molecular weight heparin (LMWH) exhibits less protein binding and provides more predictable anticoagulant response with reduced need for patient monitoring and dosage adjustment. The purpose of this study was to assess the anti-Xa activities of LMWH in Korean patients with acute coronary syndrome after recommended dose for caucasians and to determine an optimal method of administration of LMWH. MATERIALS AND METHODS: Twenty five patients with acute coronary syndrome were enrolled and allocated to five separate groups (5 patients in each group) by types according to molecular weight (LMWH (A): (molecular weight of 4500 daltons, LMWH (B): molecular weight of 6400 daltons) and methods of administration (Group 1A and 1B: Subcutaneous and subcutaneous injections (SC-SC), Group 2: Intravenous and subcutaneous injections (IV-SC), Group 3A and 3B: Intravenous, subcutaneous and subcutaneous injections (IV-SC-SC). Five groups were as follows: Group 1A: LMWH (A) 1 mg/kg SC every 12 hours, Group 1B: LMWH (B) 100 IU/kg SC every 12 hours, Group 2: LMWH (A) 1 mg/kg IV bolus and 1 mg/kg SC 12 hours later, Group 3A: LMWH (A) 0.5 mg/kg IV bolus, 3 hours later 1 mg/kg SC every 12 hours, Group 3B: LMWH (B) 50 IU/kg IV bolus, 3 hours later 100 IU/kg SC every 12 hours. Anti-Xa activity was measured by amidolytic assay method (Rotachrome, Stago, France) in 555 samples from 25 patients. All the data of anti-Xa activity in each group were plotted along the sequential time and mean values of them were analyzed by Wilcoxon signed rank test. RESULTS: 1)The anti-Xa activity (mean 0.6216+/-0.238 IU/mL) of LMWH (A) was greater than that of LMWH (B)(mean 0.2587+/-0.1709 IU/mL) in the conventional SC-SC method (p<0.001). 2) The anti-Xa activity of LMWH (A) (mean 0.6203+/-0.2383 IU/mL) was also greater than that of LMWH (B)(mean 0.468+/-0.2428 IU/mL) in the IV-SC-SC method (p<0.001). 3) More rapid and effective anti-Xa activities were achieved by IV-SC-SC method compared with conventional SC-SC method. CONCLUSION: This study suggests that immediate achievement and optimum maintenance of anticoagulant activity can be accomplished by IV-SC-SC method rather than conventional SC-SC method in patients of acute coronary syndrome.

Intracoronary thrombosis treated with stent and abciximab in patient with membranous glomerulonephritis

The association of nephrotic syndrome with a hypercoagulable state and vascular thrombosis is well recognized. In all adult series of nephrotics, venous thrombosis are much more common than arterial thrombosis, which has been mainly reported in children. Intracoronary thrombus is among the rarest arterial thromboses. We present a case of acute myocardial infarction in a 39-year-old women with nephrotic syndrome secondary to membranous glomeluronephritis, in which subsequent coronary angiography showed no evidence of atherosclerotic change and thrombotic occlusion in the left main coronary artery which was successfully treated with intracoronary stent and intravenous abciximab.

Potential Organ Donor Pool for Renal Transplantation in Intensive Care Unit and Emergency Room : Single center study for donor action program / 대한이식학회지

Organ shortage remains a main obstacle to the development of organ transplantation for end stage organ disease. Identification of potential donors is a key point of donation/transplantation process. We evaluated the entire potential organ donor developed in intensive care unit and emergency room to find out the way to improve the real donation program .Pro-and retrospective analysis were performed in death patient occurred in intensive care unit and emergency room between May. 1997 and Oct. 1997. There are 394 death patients in ICU and 324 in ER during study period. 293 patients (74.3%) were eliminated by age under 1 year or over 70 years, and medical disease unsuitable for organ transplantation. After a series of elimination due to no possibility of brain death or organ unsutability, 35 patients (8.9%) finally were found to be a acceptable potential donors for organ transplantation in ICU, and 3 (0.9%) in ER. 28 of the 35 potential donors (80.0%) were found in neurology or neurosurgery ICU. Causes of brain death in 35 potential donors were traumatic intracerebral injury in 10 (29.4%), and non traumatic intracranial cerebral catastrophe in 21 (61.8%). Actual multiorgan harvest was performed in 2 (5.7%) among 35 medically acceptable potential donors in ICU. Three (8.6%) among 35 potential donors refused organ donation by donor families, 29 (82.9%) could not be actual donors due to absence of any information on organ donation to families of donors. Conclusively organ donation rate and efficacy from the potential donor are very poor in this series. Comprehensive donor action programs including practical donor detection program with donor linker, education program to medical staff and public are mandatory to increase the cadaveric organ donation effectively.

In Vitro Analysis of Co-cultured Pancreatic Islet with Lymphocyte / 대한이식학회지

BACKGROUND: Transplantation of Pancreatic islet represents one of the most exciting treatment modalities for Type I diabetes mellitus. To achieve better graft survival, it is important to protect the graft from alloantigen-specific immune response. It was emphasized that islets, as with other forms of cellular transplants, have the potential advantage of being immunologically altered before transplantation, resulting in tolerance to the host without using long-term, nonspecific immunosuppression. The mixed islet-lymphocyte culture is an excellent tool to evaluate the immunogenicity of a pancreatic islets. Therefore, we co-cultured pancreatic islet and lymphocyte to investigate cytokine gene expression from the lymphocyte, and to investigate pancreatic islet viability and functional changes after co-culture. MATERIALS AND METHODS: Lewis rat islets were purified from pancreas by collagenase type XI and dextran gradient method. Afterwards, Lewis rat islets were co-cultured as a stimulator and Wistar rat lymphocyte as a reponder. As a control group lymphocyte alone and islet alone were cultured in a same condition. For estimating islets viability, we counted islet viability as an IEQ (Islet equivalent). For evaluation of islets function, insulin release assay was perfomed by RIA under the glucose challenge. used by RIA. We studied cytokines gene expression of cultured cells by reverse transcriptase polymerase chain reaction (RT-PCR). RESULT AND CONCLUSION: 1) Islet yield was 1229.8 420.1 per rat, and counted as 2615.4 548.2 IEQ per rat. 2) Islet viability was decreased gradually with the lapse of time, more rapid in allogenic co-culture group than islet alone or isogenic co-culture group. 3) Release of insulin increased until day 3, and then decreased gradually. Insulin release was positively correlated with glucose gradient. The amount of released insulin was greater in co-cultured group than islet alone group. 4) Interleukine-2 and interferron-gamma gene expression increased in allo co-culture group, however transforming growth factor-beta gene expression was not affected by co-culture.

In Vitro Analysis of Co-cultured Pancreatic Islet with Lymphocyte / 대한이식학회지

BACKGROUND: Transplantation of Pancreatic islet represents one of the most exciting treatment modalities for Type I diabetes mellitus. To achieve better graft survival, it is important to protect the graft from alloantigen-specific immune response. It was emphasized that islets, as with other forms of cellular transplants, have the potential advantage of being immunologically altered before transplantation, resulting in tolerance to the host without using long-term, nonspecific immunosuppression. The mixed islet-lymphocyte culture is an excellent tool to evaluate the immunogenicity of a pancreatic islets. Therefore, we co-cultured pancreatic islet and lymphocyte to investigate cytokine gene expression from the lymphocyte, and to investigate pancreatic islet viability and functional changes after co-culture. MATERIALS AND METHODS: Lewis rat islets were purified from pancreas by collagenase type XI and dextran gradient method. Afterwards, Lewis rat islets were co-cultured as a stimulator and Wistar rat lymphocyte as a reponder. As a control group lymphocyte alone and islet alone were cultured in a same condition. For estimating islets viability, we counted islet viability as an IEQ (Islet equivalent). For evaluation of islets function, insulin release assay was perfomed by RIA under the glucose challenge. used by RIA. We studied cytokines gene expression of cultured cells by reverse transcriptase polymerase chain reaction (RT-PCR). RESULT AND CONCLUSION: 1) Islet yield was 1229.8 420.1 per rat, and counted as 2615.4 548.2 IEQ per rat. 2) Islet viability was decreased gradually with the lapse of time, more rapid in allogenic co-culture group than islet alone or isogenic co-culture group. 3) Release of insulin increased until day 3, and then decreased gradually. Insulin release was positively correlated with glucose gradient. The amount of released insulin was greater in co-cultured group than islet alone group. 4) Interleukine-2 and interferron-gamma gene expression increased in allo co-culture group, however transforming growth factor-beta gene expression was not affected by co-culture.

Impact of Anti-HCV(+) on Renal Transplantation

BACKGROUND: A high incidence of chronic liver disease is reported in end-stage renal failure patients due to hemodialysis and blood transfusion. An average of 20% of the patients who received renal hemodialysis are infected with hepatitis C virus, but the incidence of infection in these patients varies widely according to geographic location and the diagnostic methods used. Controversy exists regarding the impact of pretransplantation HCV infection on the outcome of renal transplantation. We measured the seroprevalence of the antibody to hepatitis C (anti-HCV) in renal transplant candidates and compared the prevalence of posttransplantation liver disease, graft, and patient survival among renal transplant recipients with and without anti-HCV at the time of the transplantation, and we attempted to define the possible factors affecting the clinical course following renal transplant in positive HCV patients. METHODS: Between June 1990 and December 1997, 634 patients underwent renal transplants at our institute. Viral infection with hepatitis were analyzed in these patients by using anti-HCV positivity using first, second, and third generation EIA, and RT-PCR. RESULTS: Twelve (12) of the 634 (1.9%) had positive anti-HCV before renal transplantation. During a mean follow-up of 29.4 months, viral mRNA was detected in the pretransplantation serum in 3 out of 8 (37.5%) positive anti-HCV patients. Among the 12 patients with positive anti-HCV, 2 (16.6%) showed early liver dysfunction, and 1 (8.3%) showed histologic progression to chronic hepatitis leading to hepatic failure and death. Graft loss occurred in 1 of the 12 (8.3%) patients with positive anti-HCV and in 62 of the 622 (9.8%) patients with negative anti-HCV. Three (3) out of the 12 (25%) patients with positive anti-HCV, and 121 of the 622 (19.6%) patients with negative anti-HCV had episodes of rejection. One (1) of the 12 (8.3%) patients with positive anti-HCV and 26 of the 622 (4.2%) patients with negative anti-HCV died after kidney transplantation. There were no statistical differences in patients or graft survival between the positive anti-HCV (+) and the negative anti-HCV patients. CONCLUSION: From these results, we can assume that the presence of anti-HCV without advance liver disease should not be a contraindication for kidney transplantation.

Impact of Cobra Venom Factor on Immunologic Reaction in Rat Xenograft / 대한면역학회지

Recently xenotransplantation has been thought as a final solution for the controi of donor organ shortage in allograft. In order to be a ciinicai entity, xenotransplantation has many obstacles such as hyperacute rejection and delayed xenogratt rejection as a potent immunologic reaction, zoonosis and ethical problems. We already reported the eariy immunoiogic events occuring soon after xenograft in animal model, in which natural antibody and complement have a crucial roie in rejection response. As a further step for the prolongation of graft survival, we used anticomplement agent (cobra venom factor, CVF) in the same model. Graft survival in discordant (guinea pig-to-rat) xenogratt was extended from 30.6 minutes to 2 days following singie injection of CVF, which showed similar pattern of rejection with the concordant xenogratt in terms of time of rejection response after grafting. In this setting antibody response in the blood did not show any difference between that of pre CVF and post CVF, even though IgM response was more pronounced than IgG. The complement activity in the blood showed marked suppression following CVF injection. Intragraft complement gene (C3 mRNA) expression in CVF injected discordant showed delayed response in a similar pattern like that of concordant xenograft. Interestingly enough intragraft anticomplement gene expression showed the simiiar pattern of response with the complement. From these results we can conclude that anticomplement agent (CVF) extended the graft survival in discordant xenograft upto the level of concordant xenograft by shifting the complement activation response from that of discordant to concordant xenograft.