Clinicopathologic Features of Early Recurrence Cases after Pancreatoduodenectomy in Periampullary Carcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Periampullary carcinoma could recur early even after curative resection in the small-sized lesion. The aim of this study is to clarify the clinicopathologic features of early recurrence cases after pancreatoduodenectomy in periampullary carcinoma. METHODS: 15 cases (group I) of recurrence within 6 months after pancreatoduodenectomy were compared clinicopathologically with 17 cases (group II) of no recurrence until 2 years after pancreatoduodenectomy between 1991 and 2000 in Hallym medical center. RESULTS: There were no differences in sex and age distri- butions between two groups (M/F ratio=8/7 vs 8/9, and average age=56.9 vs 57.5). The distributions of primary lesions were 4 cases of ampulla of Vater, 6 cases of common bile duct, 5 cases of pancreatic head in group I; 7 cases of ampulla of Vater, 8 cases of common bile duct, 2 cases of pancreatic head in group II, respectively. There were no differences in tumor size (2.8+/-1.1 cm vs. 2.4+/-1.5 cm), the number of lymph node metastasis, AJCC tumor stage, histological differentiation, neural or lymphatic invasion between two groups. The number of direct invasion to adjacent organs in group I was more than that in group II (p<0.05). CONCLUSION: The increased number of direct invasion to adjacent organs could be an important prognostic factor of early recurrence after pancreatoduodenectomy even in small-sized or no lymph node-metastasized periampullary carcinoma.

Change of alpha-SM Actin Expression Induced by the Antibody for TGF-beta in Fibroblast NIH3T3 Culture: The basic research for the inhibition of wound contracture

PURPOSE: The purpose of this experiment is to measure the expression of TGF-beta and alpha-SM actin (smooth muscle actin) from fibroblast culture by the duration of culture days and to analyze the inhibition of alpha-SM actin expression in fibroblast by the antibodies for TGF-beta. METHODS: The levels of alpha-SM actin from the paired NIH3T3 cell cultures with TGF-beta 1 containing medium (10 ng/ml) and with the antibody (for TGF-beta) medium (1 or 2 ug/ml) were determined by SDS PAGE for cell lysate protein, Western blot with ECL autoradiography and immuno - slot blot. RESULTS: In NIH3T3 culture, the expression of alpha-SM actin increased at culture days 4, 5, 6. TGF-beta was expressed from 2nd day of culture and increased by day 7. The addition of TGF beta (10 ng/ml) did not increased the expression of alpha-SM actin. But alpha-SM actin expression decreased in the presence of anti-TGF beta antibody. The decrease of expression was proportional to the concentration of antibody and duration of exposure to the antibody. CONCLUSIONS: Endogenous TGF-beta produced by fibroblast cultures is sufficient to express the alpha-SM actin from the myofiboblast. There was no additive expression of alpha-SM actin with exogenous TGF-beta 1. The antibody for TGF- beta inhibits the production of the alpha-SM actin during wound healing and may prevent the wound contracture.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer / 한국유방암학회지

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density (MVD) of brest cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200xPF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93 (mean+/-SD=46.9+/-21.7). The positive rate of lymph-node metastasis in high MVD patients was 32.6%, which was higher than the 23.3% for low-MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not fine any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6+/-12.5%, and that of low-MVD patients was 69.0+/-10.8% (p=0.449). The 4-years overall survival rate of high-MVD patients was 71.1+/-11.1%, and that of low-MVD patients was 74.1+/-12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

Two Cases of Acute Mesenteric Infarction Due to Superior Mesenteric Arterial and Venous Branch Occlusion

Acute mesenteric infarction is a catastrophic illness representing a diverse spectrum of pathologic conditions which ultimately lead to necrosis of the intestine and which is uniformly fatal if left untreated. Despite better understanding of the disease process, acute mesenteric infarction continues to be a lethal disorder with high mortality rate. We experienced two cases of acute mesenteric infarction due to superior mesenteric arterial and venous branch occlusion, respectively, in recent years: One case was focal segmental ischemia with normal radiologic finding including angiography, successfully treated with segmental resection of the necrotized ileum, another case was mesenteric venous thrombosis, also treated with resection of necrotized small intestine followed by second look operation.

Bilateral Popliteal Artery Entrapment Syndrome: A case report

A case of symptomatic bilateral popliteal artery entrapment syndrome is reported. A twenty-one-year old male, a candidate of athlete, complained of coldness, weakness, pallor and cyanosis of right lower leg and intermittent claudication to both calves during walking or exercise for ten months. Studies revealed that the right popliteal artery was completely occluded, but the left popliteal artery was non-occlusive. An endarterectomy and onlay vein patch graft to the thrombosed and fibrotic right popliteal artery, and myotomies of bilateral medial heads of gastrocnemius muscle were done (May 20, 1998). Follow-up examinations for the last ten months showed a complete relief of symptoms with normal distal arterial flow. It is thought that even though the majority of patients present with unilateral calf claudication, the possiblity of bilateral problems need to be also considered.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density(MVD) of breast cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200 PF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93(mean SD=46.9 21.7). The positive rate of lymph-node metastasis in high-MVD patients was 32.6%, which was higher than the 23.3% for low- MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not find any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER : p=0.0001, PR : p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6 12.5%, and that of low-MVD patients was 69.0 10.8% (p=0.449). The 4-year overall survival rate of high-MVD patients was 71.1 11.1%, and that of low-MVD patients was 74.1 12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

Pediatric Burns

BACKGROUND: Burns remain a common public problem among children and often cause severe injuries, resulting in physical and mental problems for the patients. Children constitute a risk group because of their natural curiosity, their mode of reaction, their impulsiveness and lack of experience in risk assessment. PURPOSE: The objects of this study were to characterize pediatric burn injuries and to understand their clinical outcomes in Korea. METHODS: we analyzed the records of the 1401 pediatric burn patients (age 0~15 years old) out of the 4423 burn patients, who have been admitted to the Burn Center, Hangang Sacred Heart Hospital, Hallym University for 5 years (1991~1995). RESULTS: Males were more affected than females; 58.1% were males and 41.9% were females. Most thermal injuries in children occur in the age group younger than 5 years (82%); especially 66.9% of pediatric burn patients were under the age of 3. Scalding burns accounted for 72.5%, and flame burns fors 18.1%. Most pediatric burns occurred in urban areas. The most common activities related to pediatic burn injuries were food preparation and food consumption, which accounted for 57.5% of all burn injuries. In 66% of the cases, the extent of the burned surface was under 10%. In 77.8% of the cases, the depth of the burn wound was 2nd degree. In 63.9% of the cases, the duration of hospitalization was 3 weeks or less. The incidence of wound infection was 14.8%, and 50% of the infections were caused by Pseudomonas aerusinosa. The major complications were wound infection (30.9%), hypertrophic scarring (21.4%) and irritant dermatitis (20.3%). The mortality rate in a series of 1,401 pediatric patients was 2.6%. The main causes of death were sepsis, burn shock, ARDS and air way obstruction. When 51~70% of the surface area was burned the mortality was 25%, when over 70% of the surface area was burned the mortality was 81.3%. SPCCULATION: The successful way to prevent pediatric burn is to reduce the risk to children by effective intervention.

Choledochal Cysts Aggravated during Pregnancy

The association between choledochal cysts and pregnancy is unlikely to be etiological, but may rather be an aggravation or precipitation of a preexisting condition. Although choledochal cysts rarely occur in pregnancy, the aim of this study is to elucidate the condition associated with pregnancy because delayed or inappropriate therapy may be catastrophic for both mother and child. Authors reviewed 18 cases of choledochal cyst, of which 2 were aggravated during pregnancy, managed at the Department of Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, during the period from 1990 to 1995. The results were as follows: The ratio of female to male was 2.6:1 which revealed predominance in female and most frequent age group was above sixty years old(33%). In non-pregnant patients, the most common symptoms were abdominal pain(78%) and all pregnant patients had pain, jaundice, nausea and vomiting, and indigestion. Transaminase and bilirubin were elevated in all pregnant patients. In all patients, US(88%, 100%) was the most common preoperative diagnostic study and one case was diagnosed during explo-laparotomy. Pregnant patients have cholecystitis in two cases and nonpregnant patients had cholecystitis(19%), CBD stone(19%), and others. The operative procedures were performed in 9 cases and pregnant patients were operated by cyst excision and Roux-en-Y hepaticojejunostomy in one case, and also Roux-en-Y choledochocystojejunostomy in one case. According to Todani's classification, in non pregnant patients, type I was the most common(63%), in pregnant patients, two cases were type I. Postoperative complications occurred in 3 cases, wound infection(6%) and cholangitis(6%) in non pregnant patients, pleural effusion(6%) in pregnant patients. Two cases of choledochal cyst in pregnancy were 25 years old at 29.4 weeks and 36 years old at 16 weeks into pregnancy.