Methylenetetrahydrofolate Reductase C677T Polymorphism in Gastric Cancer

PURPOSE: Recently the role of vitamins, folate in particular, has been emphasized in the maintenance of health. Folate deficiency is known to give rise to developmental delay, immature vascular disease, neural tube defect, acute leukemia, atherosclerotic vascular disease, delivery defects, breast cancer, and particularly gastrointestinal neoplasia. Methylenetetrahydrofolate reductase (MTHFR) is an essential enzyme in folate metaboism, and influences DNA synthesis and DNA methylation. Generally, folate deficiency is associated with gastrointestinal neoplasms. The amino-acid- changing and enzyme-activity-reducing nucleotide polymorphism (766C-->T/ Ala222Val) has been described in the MTHFR polymorphism and leads to low enzyme activity that may reduce the capacity of DNA methylation and possibly uracil mis-incorporation into DNA. These processes may be critical in the oncogenic transformation of human cells, especially in colorectal carcinomas. We investigated the relationship between the MTHFR polymorphism in gastric cancer and the tumor site, the smoking history, and the alcoholic history. MATERIALS AND METHODS: Ninety-six (96) individuals with gastric cancer and 287 healthy persons were analyzed. Blood sampling was performed, PCR-RFLP was analyzed, and MTHFR polymorphism genotypes of C/C, C/T, and T/T were obtained and analyzed statistically for their correlation. RESULTS: In the gastric cancer group there were 69 (72%) males and 27 (28%) females. There were also 58 cases (60%) involving the gastric lower body, 20 cases (21%) the gastric mid-body, and 18 cases (19%) the gastric upper body. In the control group there were 169 (59%) males and 118 (41%) females. Among the gastric cancer, 56 (61%) smoking patients, 40 (39%) non-smoking patients, 45(47%) alcoholic patients, 51 (53%) non-alcoholic patients. In the gastric cancer group, MTHER polymorphisms were C/C in 18 (19%) cases, C/T in 59 (61%) cases, T/T in 19 (20%) cases. In the control group polymorphisms were C/C 116 (40%) cases, C/T 103 (36%) cases, and T/T 68 (24%) cases (P=0.045). In cases of lower gastric body cancer, polymorphisms were C/C in 16 (24%) C/C in 16 (24%) cases and C/T or T/T in 42 (72%) cases. In cases of upper and mid-body cancer, polymorphisms were C/C in 2 (5%) cases and C/T or T/T 36 (95%) cases (P=0.006). In the non-smoking patient group, polymorphisms were C/C in 5 (12%) cases and C/T or T/T in 35 (88%) cases. In the smoking patient group, C/C in 13 (23%) cases and C/T or T/T in 43 (77%) cases (P=0.189). In the non-alcoholic patient group, polymorphisms were C/C in 6 (12%) cases and C/T or T/T in 45 (88%) cases. In the alcoholic patient group, polymorphisms were C/C in 12 (26%) cases and C/T or T/T in 33 (74%) cases (P=0.063) CONCLUSION: MTHFR polymorphisms are associated with gastric cancer and tumor site, but not with smoking and alcohol drinking.

Viscum Album Therapy in Malignant Pleural Effusion / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. MATERIAL AND METHOD: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. RESULT: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80%:71%) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. CONCLUSION: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

Video-assisted Thoracoscopic Surgery in Posttraumatic Localized Clotted Hemothorax / 대한흉부외과학회지

BACKGROUND: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. MATERIAL AND METHOD: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. RESULT: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8+/-3.8 months) in group I were none, but in group II (21.5+/-5.3 months) were 2 cases. CONCLUSION: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

Viscum Album Therapy in Malignant Pleural Effusion / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. MATERIAL AND METHOD: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. RESULT: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80%:71%) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. CONCLUSION: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

Video-assisted Thoracoscopic Surgery in Posttraumatic Localized Clotted Hemothorax / 대한흉부외과학회지

BACKGROUND: Inadequate drainage of traumatic hemothoraces may result in prolonged hospitalization and complication such as empyema, fibrothorax and pleural calcification. This needs to be the placement of a tube thorascostomy which is efficacious in more than 80% of cases. Other cases require surgical treatment. MATERIAL AND METHOD: From March 2002 to February 2003, there were 123 patients who was done closed thorascostomy in traumatic hemothorax. 10 patients (group I) were undergone early retained clot evacuation with video assisted thoracoscopic surgery, but 5 patients (group II) who developed a localized hematoma or empyema were operated. Male were more than female and mean average was similar in both group. The most common cause of injury was traffic accidents and frequently combined lesions were a abdomen. RESULT: Interval from injury and operation, mean operation time, duration of tube drainage and hospital stay in group I were shorter than group II (p<0.05). Operation-related complication and recurrence of fluid collection within follow up period (17.8+/-3.8 months) in group I were none, but in group II (21.5+/-5.3 months) were 2 cases. CONCLUSION: Video assisted thoracoscopic surgery can be utilized as an effective and safe method for the removal of retained clotted hemothorax within 7 days.

Angiotensin Converting Enzyme Gene Insertion/Deletion Polymorphism and E-selectin S128R Polymorphism in Peripheral Atherosclerotic Occlusive Disease

PURPOSE: Studies concerning the relationship between gene polymorphisms and potentially implicated cardiovascular disease have produced conflicting findings, in part due to differences in ethnic background between populations. These led us to evaluate the impact of polymorphisms in the ACE and E-selectin genes on peripheral artery atherosclerosis in a Korean population. METHODS: We studied 92 male patients (median age: 65.9, range: 48~82) with severe peripheral atherosclerosis documented by angiography and ABI (ankle brachial index). The control group comprised 290 healthy persons (male 216, female 64, median age 61.3, range 20~90) without symptoms for peripheral vascular disease. The blood samples were stored at -20oC until DNA was ready to be extracted. The inorganic procedure for DNA extraction was based on the method described by Miller et al. The ACE and E-selectin polymorphisms were detected by polymerase chain reaction (PCR) amplification. RESULTS: The distribution of ACE genotypes of the patient group was as follows: II, 34 (37.0%); ID, 46 (50.0%); and DD, 12 (13.0%). It was not significantly different from that of the control subjects: II, 104 (37.1%); ID, 133 (47.6%); and DD, 43 (15.3%) (P=0.80). The allele frequencies of the patient group were as follows: I, 114 (62.0%); and D, 70 (38.0%). It was not significantly different from that of the control subjects: I, 341 (60.9%); and D, 219 (39.1%) (P= 0.80). The frequencies of E-selectin genotypes in the patient group were as follows: Ser/Ser 85 (93.4%); Ser/Arg, 6 (6.6); and Arg/Arg, 0 (0%). It was not significantly different from that of the control subjects: Ser/Ser, 262 (93.6%); Ser/Arg, 18 (6.4%); and Arg/Arg, 0 (0%) (P=0.95). In addition, the allele frequencies of the patient group were as follows: Ser, 176 (96.7%); and Arg, 6 (3.3%). It was not significantly different from that of the control subjects: Ser, 542 (96.8%); and Arg 18 (3.2%) (P=0.95). CONCLUSION: The I/D polymorphism of the ACE gene and E-selectin S128R polymorphism were not significantly different between the atherosclerotic patient group and the normal control group in Koreans.

Clinical Analysis of Mitral Valve Repair with Artificial Chordae / 대한흉부외과학회지

Background: Failure of mitral valve repair sometimes may be ascribed to severe or progressive alteration of the subvalvar apparatus. The aim of this study was to evaluate the effects of new chordae formation on mitral repair. Material and Method: From March 1997 to February 1999, 26 patients underwent mitral valve repairs with new chordae formation, we compared the symptoms and echocardiographic findings checked at preoperative state, and intraoperative period, discharge, and their last OPD visit. There were 15 male , and 11 female patients, and their mean age was 51.2+/-13.4 years. Etiology of the lesions was degenerative (18), rheumatic (6), infective (1) and ischemic (1). Chordal lesions were caused by rupture (18), elongation (6), and a combination of two causes (2). Associated lesions included atrial septal defect (2), tricuspid insufficiency (7), aortic insufficiency(4), and a combination of previous two factors (2). The number of mean artificial chordae was 3.6+/-1.6. Annuloplasty was performed in all cases. The CPB time was 182.1+/-63.7 minutes and the ACC time was 133.1+/-45.6 minutes. Average follow up period was 49.2+/-7.1 months. Result: There was no early death. Early reoperation was performed in two patients, one patient received mitral valve replacement because of an abnormality of annuloplasty and another received pericardiostomy due to postoperative pericardial effusion. During the follow up of 49.2+/-7.1 moths, there was no late mortality. Postoperative NYHA functional class checked at last OPD visit was class I in 22 patients (88%), class II in 2 (8%), and class III in 1 (4%). Regarding the late echocardiogram MR was absent in 20 patients (78%), I in 4 (15%), and II in 1 (4%). The postrepair mitral valve area was 2.2+/-0.35 cm(2). Conclusion: This study suggests that mitral valve repair using new chordae formation provides good early and mid term survivals and functional improvement. We think that the artificial chorda formation with polytetrafluoroethylene suture might be safe and effective technique for mitral valve repair.

Guillain-Barre Syndrome After Resection of Lung Cancer / 대한흉부외과학회지

A 68-year-old man with Guillain-Barre syndrome after the resection of right upper lobe for squamous cell lung cancer is presented. He developed a sudden, symmetric, extremity weakness, respiratory insufficiency, and sensory ataxia on postoperative day 6. He was intubated emergently and placed on a ventilator. Electrodiagnostic studies were performed on days 2, 20, and 40 following the onset of weakness. Motor nerve conduction abnormalities were the predominant findings. Prolonged motor distal latencies, temporal dispersion, and partial motor conduction blocks were present and formed the diagnostic features of Guillain-Barre syndrome. With supportive care and additive use of intravenous immunoglobulin, the illness resolved 6 weeks later after the onset of weakness.

Guillain-Barre Syndrome After Resection of Lung Cancer / 대한흉부외과학회지

A 68-year-old man with Guillain-Barre syndrome after the resection of right upper lobe for squamous cell lung cancer is presented. He developed a sudden, symmetric, extremity weakness, respiratory insufficiency, and sensory ataxia on postoperative day 6. He was intubated emergently and placed on a ventilator. Electrodiagnostic studies were performed on days 2, 20, and 40 following the onset of weakness. Motor nerve conduction abnormalities were the predominant findings. Prolonged motor distal latencies, temporal dispersion, and partial motor conduction blocks were present and formed the diagnostic features of Guillain-Barre syndrome. With supportive care and additive use of intravenous immunoglobulin, the illness resolved 6 weeks later after the onset of weakness.

Role of the Inferior Thyroid Vein after Left Brachiocephalic Vein Division During Aortic Surgery / 대한흉부외과학회지

BACKGROUND: In aortic surgery, division and ligation of the left brachiocephalic vein(LBV) may improve exposure of the aortic arch but controversy continues about the safety of this division and whether a divided vein should be reanastomosed after arch replacement was completed. The safety of LBV division and the fate of the left subclavian venous drainage after LBV division were studied. MATERIAL AND METHOD: From November 1998 to January 2001, planned division and ligation of the LBV on the mid-line after median sternotomy was performed in 10 patients during the aortic surgery with the consideration of local anatomy and distal aortic anastomosis. Assessment for upper extremity edema and neurologic symptoms, measurement of venous pressure in the right atrium and left internal jugular vein, and digital subtraction venography(DSV) of the left arm were made postoperatively. RESULT: In 10 patients there was improvement in access to the aortic arch for procedures on the ascending aorta or aortic arch. The mean age of patients was 62 years(range 24 to 70). Follow-up ranged from 3 weeks to 13 months. One patient died because of mediastinitis from methicilline-resistant staphylococcus aureus strain. All patients had edema on the left upper extremity, but resolved by the postoperative day 4. No patient had any residual edema or difficulty in using the left upper extremity during the entire follow-up period. No patient had postoperative stroke. Pressure difference between the right atrium and left internal jugular vein was peaked on the immediate postoperative period(mean peak pressure difference = 25mmHg), but gradually decreased, then plated by the postoperative day 4. In all DSV studies left subclavian vein flowed across the midline through the inferior thyroid venous plexus. CONCLUSION: We conclude that division of LBV is safe and reanastomosis is not necessary if inferior thyroid vein, which is developed as a main bridge connecting the left subclavian vein with right venous system, is preserved.