Unilateral Bi-portal Endoscopic Decompression via the Contralateral Approach in Asymmetric Spinal Stenosis: A Technical Note

We discuss the technical details and operative advantages of approaching pathologies from the contralateral side in cases of asymmetric spinal stenosis. The contralateral approach offers better manipulative freedom and a more accessible target approach along the plane of the pathology, allowing safer decompression and facet preservation; further, this approach is ergonomic for surgeons. We recommend the adoption of this approach in decompressing asymmetric spinal stenosis.

The Establishment of a Fast and Safe Orthotopic Colon Cancer Model Using a Tissue Adhesive Technique / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We aimed to develop a novel method for orthotopic colon cancer model, using tissue adhesive in place of conventional surgical method. @*Materials and Methods@#RFP HCT 116 cell line were used to establish the colon cancer model. Fresh tumor tissue harvested from a subcutaneous injection was grafted into twenty nude mice, divided into group A (suture method) and group B (tissue adhesive method). For the group A, we fixed the tissue on the serosa layer of proximal colon by 8-0 surgical suture. For the group B, tissue adhesive (10 μL) was used to fix the tumor. The mortality, tumor implantation success, tumor metastasis, primary tumor size, and operation time were compared between the two groups. Dissected tumor tissue was analyzed for the histology and immunohistochemistry. Also, we performed tumor marker analysis. @*Results@#We observed 30% increase in graft success and 20% decrease in mortality, by using tissue adhesive method, respectively. The median colon tumor size was significantly increased by 4 mm and operation time was shortened by 6.5 minutes. The H&E showed similar tumor structure between the two groups. The immunohistochemistry staining for cancer antigen 19-9, carcinoembryonic antigen, cytokeratin 20, and Ki-67 showed comparable intensities in both groups. Real-time quantitative reverse transcription analysis showed eight out of nine tumor markers are unchanged in the tissue adhesive group. Western blot indicated the tissue adhesive group expressed less p-JNK (apototic marker) and more p-MEK/p-p38 (proliferation marker) levels. @*Conclusion@#We concluded the tissue adhesive method is a quick and safe way to generate orthotopic, colon cancer model.

The Establishment of a Fast and Safe Orthotopic Colon Cancer Model Using a Tissue Adhesive Technique / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We aimed to develop a novel method for orthotopic colon cancer model, using tissue adhesive in place of conventional surgical method. @*Materials and Methods@#RFP HCT 116 cell line were used to establish the colon cancer model. Fresh tumor tissue harvested from a subcutaneous injection was grafted into twenty nude mice, divided into group A (suture method) and group B (tissue adhesive method). For the group A, we fixed the tissue on the serosa layer of proximal colon by 8-0 surgical suture. For the group B, tissue adhesive (10 μL) was used to fix the tumor. The mortality, tumor implantation success, tumor metastasis, primary tumor size, and operation time were compared between the two groups. Dissected tumor tissue was analyzed for the histology and immunohistochemistry. Also, we performed tumor marker analysis. @*Results@#We observed 30% increase in graft success and 20% decrease in mortality, by using tissue adhesive method, respectively. The median colon tumor size was significantly increased by 4 mm and operation time was shortened by 6.5 minutes. The H&E showed similar tumor structure between the two groups. The immunohistochemistry staining for cancer antigen 19-9, carcinoembryonic antigen, cytokeratin 20, and Ki-67 showed comparable intensities in both groups. Real-time quantitative reverse transcription analysis showed eight out of nine tumor markers are unchanged in the tissue adhesive group. Western blot indicated the tissue adhesive group expressed less p-JNK (apototic marker) and more p-MEK/p-p38 (proliferation marker) levels. @*Conclusion@#We concluded the tissue adhesive method is a quick and safe way to generate orthotopic, colon cancer model.

A Canine Model for Lymphangiography and Thoracic Duct Access

OBJECTIVE: To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.MATERIALS AND METHODS: Five male mongrel dogs were studied. The dog was placed in the supine position, and the most prominent lymph node in the groin was accessed using a 26-gauge spinal needle under ultrasonography (US) guidance. If the cisterna chyli (CC) was not opacified by bilateral lymphangiography, the medial iliac lymph nodes were directly punctured and Lipiodol was injected. After opacification, the CC was directly punctured with a 22-gauge needle. A 0.018-in microguidewire was advanced through the CC and TD. A 4-Fr introducer and dilator were then advanced over the wire. The microguidewire was changed to a 0.035-in guidewire, and this was advanced into the left subclavian vein through the terminal valve of the TD. Retrograde TD access was performed using a snare kit.RESULTS: US-guided lymphangiography (including intranodal injection of Lipiodol [Guerbet]) was successful in all five dogs. However, in three of the five dogs (60%), the medial iliac lymph nodes were not fully opacified due to overt Lipiodol extravasation at the initial injection site. In these dogs, contralateral superficial inguinal intranodal injection was performed. However, two of these three dogs subsequently underwent direct medial iliac lymph node puncture under fluoroscopy guidance to deliver additional Lipiodol into the lymphatic system. Transabdominal CC puncture and cannulation with a 4-Fr introducer was successful in all five dogs. Transvenous retrograde catheterization of the TD (performed using a snare kit) was also successful in all five dogs.CONCLUSION: A canine model may be appropriate for intranodal lymphangiography and TD access. Most lymphatic intervention techniques can be performed in a canine using the same instruments that are employed in a clinical setting.

Instruments to Assess Physical Impairments in Post-Intensive Care Syndrome: A Systematic Review / 중환자간호학회지

PURPOSE: The purpose of this study was to systematically review the instruments utilized to assess physical impairment in post-intensive care syndrome (PICS) of intensive care unit (ICU) survivors.METHOD: Online databases searched were MEDLINE, Cochrane, CINAHL, and Embase. Studies that met the following criteria were included: 1) the study population exclusively had experience with ICU admission; 2) the study assessed pulmonary, neuromuscular, and physical functions; and 3) the study was published in English language journals after 2007.RESULTS: A total of 56 instruments (2 pulmonary, 25 neuromuscular, 29 physical function) from 94 studies were reviewed. They were classified into self-report, observation, and measurement according to the type of assessment. No instrument measured all 3 areas of physical impairment. Five instruments were originally developed for the ICU patients. The most frequently applied instruments were the Medical Research Council and the 36-item Short Form Survey (physical component summary), which were used in 23 studies each. Only 13.8% of reviewed studies reported the reliability or validity of the instruments.CONCLUSION: Our results suggest that the appropriateness of instruments assessing physical impairment in PICS cannot be guaranteed. Despite the multidimensional concept of physical disabilities, most studies measured only one area, and studies that reported psychometric properties were limited. Accordingly, we propose to develop a unique and multifaceted instrument for ICU survivors.

Self-Expandable Metallic Stent Placement for the Palliation of Esophageal Cancer

Esophageal stents have been used to palliate patients with dysphagia caused by esophageal cancer. Early rigid plastic prostheses have been associated with a high risk of complications. However, with the development of self-expanding stents, it has developed into a widely accepted method for treating malignant esophageal strictures and esophagorespiratory fistulas (ERFs). The present review covers various aspects of self-expanding metallic stent placement for palliating esophageal cancer, including its types, placement procedures, indications, contraindications, complications, and some of innovations that will become available in the future.

Self-expandable metal stent placement for recurrent cancer in a surgically-altered stomach

Gastric cancer is one of the most common malignancies and most frequent causes of cancer-related death worldwide. Radical surgical resection accomplished by total or distal gastrectomy represents the mainstay of curative treatment for gastric cancer; however, recurrent cancer still occurs in a significant amount of cases. Patients with recurrent cancer are generally incurable and often experience debilitating symptoms, such as nausea, vomiting, dysphagia, dehydration, and malnutrition, because of malignant gastric-outlet, duodenal, and jejunal obstructions. Consequently, such patients experience progressive deterioration of quality of life. If bypass surgery has not already been performed, it is not usually appropriated in the context of recurrent cancer and is associated with a high risk of morbidity and mortality. Endoscopic or fluoroscopic self-expandable metal stent placement represents an effective and safe method for palliative treatment of recurrent cancer in patients with the surgically-altered stomach. Therefore, it should be considered as the first-line option. Importantly, accurate knowledge of the surgically-altered anatomy and stricture location are critical to achieve successful treatment outcomes.

Development of gastroduodenal self-expandable metallic stents: 30 years of trial and error

In 1991, the author (H.Y.S.) reported the first case of self-expandable metallic stent (SEMS) placement in a patient with recurrent cancer after gastrojejunostomy. Since then SEMS placement has developed into a well-established method for the palliative treatment of malignant gastroduodenal obstruction. This year marks the 30th year the author has been implicated in the development of gastrointestinal SEMSs. Thus far, the author has developed successively a total of six generations of gastroduodenal SEMSs through trial and error over the years. In the present article, the author reviews his personal experience in developing gastroduodenal stents.

Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy

OBJECTIVE: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. MATERIALS AND METHODS: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. RESULTS: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). CONCLUSION: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.

Flurbiprofen toxicity in 2 dogs / 대한수의학회지

Two dogs were presented with melena, vomiting and depression after accidental swallowing of candy form of Strepsils (flurbiprofen), which is one of non-steroidal anti-inflammatory drugs used in human medicine for controlling a sore throat. These dogs had common signs of anemia induced by gastrointestinal ulceration and hemorrhage with azotemia and leukocytosis. The dogs were treated with blood transfusion, fluid therapy, proton-pump inhibitor, antiemetics, mucus protectant and antibiotic. Although most of clinical signs of two dogs were resolved, azotemic problem with evidence of renal injury have remained.

Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent / 대한외과학회지

Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.

Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20-mm Diameter Stents

OBJECTIVE: To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. MATERIALS AND METHODS: The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. RESULTS: A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. CONCLUSION: The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

Optimal Chest Compression Depth for Children Determined by Chest Computed Tomography

PURPOSE: The recommended compression depth for basic life support of pediatric patients is one third to one half the anterior-posterior diameter of the chest. This study was designed to evaluate, using chest computed tomography (CT), whether the recommended compression depth is appropriate. METHODS: Data for pediatric patients who underwent chest computed tomography were collected. Axial images containing both nipples were selected. We measured external chest thickness, internal thickness from sternum to vertebral body, and residual thickness; the latter was defined as internal thickness minus one third or one half of external thickness. We assumed potential injury would occur from chest compression if residual thickness was less than 10 mm. RESULTS: Chest CT images from 164 children were analyzed. The compression depth was 62.4+/-6.9 mm if one half of the chest thickness was compressed, which was deeper than the high margin of compression depth recommended for adults. No potential injury was assumed when compressing one third of external chest thickness, while 96.3% of patients were assumed to sustain an injury when receiving compressions as deep as one half of chest thickness. CONCLUSION: One half the anterior-posterior diameter of the chest, the compression depth for pediatric CPR recommended in the current guidelines, is deeper than the 4~5 cm depth recommended for adult chest compression, and will result in less than 10 mm of residual thickness in most cases. This may cause internal organ injury.

Expression Patterns of Superoxide Dismutase Genes in the Stage-specific Seminiferous Tubules of Mice Excised by a Laser Capture Microdissection / 한국실험동물학회지

Spermatogenesis is a particularly difficult process to study the unique multiple cellular associations within the seminiferous epithelium. Laser capture microdissection (LCM) is a recently developed technique that enables the isolation of individual cell populations from complex tissues. The superoxide dismutase (SOD) is the first and most important enzyme of antioxidant defense systems against superoxide anion. The aim of this study was to investigate the quantitative changes of SOD gene expression according to the spermatogenic cycle in mouse testes using LCM and real-time polymerase chain reaction (PCR) techniques. Frozen sections (10 micrometer) were obtained from the testes of 8-weeks-old ICR mice. LCM was used to capture all cells in cross-sectioned seminiferous tubules which were grouped into stages I-V, VII-VIII, and IX-XI. The expression level of cytoplasmic Cu, Zn-SOD (SOD1) mRNA was remarkably higher than those of mitochondrial Mn-SOD (SOD2) and extracellular Cu, Zn-SOD (SOD3) mRNAs in mouse testes. During spermatogenesis, the expressions of SOD1 and SOD2 mRNAs were highest on stages I-V, began to decrease after stage VII, and showed a lowest level on stage IX-XI. However, the expression of SOD3 mRNA was highest on stages VII-VIII. These findings suggest that the subtypes of SOD are expressed differentially in mouse testes during spermatogenesis.

A Case of Churg-Strauss Syndrome with Interstinal Perforation / 결핵및호흡기질환

Churg-Strauss syndrome (CSS) or allergic granulomatous angiitis is a rare syndrome that is characterized by hypereosinophilic systemic necrotizing vasculitis affecting small- to medium-sized arteries and veins. In general, it occurs in individuals with pre-existing allergic asthma. When CSS appears in patients, it has the following characteristics: eosinophilia of more than 10% in peripheral blood, paranasal sinusitis, pulmonary infiltrates, histological proof of vasculitis with extravascular eosinophils, and mononeuritis multiplex or polyneuropathy. Therapeutic trials dedicated to Churg-Strauss syndrome have been limited due to the rarity of this disorder and the difficulty in making a histological diagnosis. Proper treatment of patients with CSS is not widely known. In this case study, we report on our experience with an unusual patient case, characterized by purpura and a perforation of the small intestine after inadequate steroid therapy.

Survival Analysis of Patients with Brain Metastsis by Weighting According to the Primary Tumor Oncotype / 대한방사선종양학회지

PURPOSE: This study was performed to retrospectively analyze patient survival by weighting according to the primary tumor oncotype in 160 patients with brain metastasis and who underwent whole brain radiotherapy. MATERIALS AND METHODS: A total of 160 metastatic brain cancer patients who were treated with whole brain radiotherapy of 30 Gy between 2002 and 2008 were retrospectively analyzed. The primary tumor oncotype of 20 patients was breast cancer, and that of 103 patients was lung cancer. Except for 18 patients with leptomeningeal seeding, a total of 142 patients were analyzed according to the prognostic factors and the Recursive Partitioning Analysis (RPA) class. Weighted Partitioning Analysis (WPA), with the weighting being done according to the primary tumor oncotype, was performed and the results were correlated with survival and then compared with the RPA Class. RESULTS: The median survival of the patients in RPA Class I (8 patients) was 20.0 months, that for Class II (76 patients) was 10.0 months and that for Class III (58 patients) was 3.0 months (p<0.003). The median survival of patients in WPA Class I (3 patients) was 36 months, that for the patients in Class II (9 patients) was 23.7 months, that for the patients in Class III (70 patients) was 10.9 months and that for the patients in Class IV (60 patients) was 8.6 months (p<0.001). The WPA Class might have more accuracy in assessing survival, and it may be superior to the RPA Class for assessing survival. CONCLUSION: A new prognostic index, the WPA Class, has more prognostic value than the RPA Class for the treatment of patients with metastatic brain cancer. This WPA Class may be useful to guide the appropriate treatment of metastatic brain lesions.

Significance of COX-2 Expressions in Carcinoma of the Gallbladder

PURPOSE: Enhanced COX-2 expression has been observed in various solid tumors. A gallbladder carcinoma often evolves from a gallbladder adenoma, or chronic cholecystitis with cholelithiasis. It has been postulated that COX-2 might have an important role in the carcinogenesis of a gallbladder carcinoma. The purpose of this study was to identify the role of COX-2 in the carcinogenesis of gallbladder carcinomas, and find the relationships between COX-2 expression and the prognostic factors, including the survival of patients. METHODS: Three tissue microarray blocks were made from 23 cases of cholecystitis, 40 cases of a gallbladder adenoma and 67 cases of a gallbladder carcinoma. Immunohistochemical stains for COX-2 were performed, and the staining intensity and patterns evaluated. The relationships between COX-2 expression and the histopathological parameters of the gallbladder carcinoma were analyzed, and a postoperative survival analysis also performed. RESULTS: The rates of COX-2 expression were 52.2, 37.5 and 47.8% in the gallbladder carcinomas, gallbladder adenomas and chronic cholecystitis, respectively, and showed no significant differences (p=0.334). The overall expression rate was 46.9%. In the gallbladder carcinomas, COX-2 expression had no significant relationships with the tumor size (p=0.197), histological grade (p=0.859), depth of invasion (p=0.978) and lymph node metastasis (p=0.730). COX-2 expression in the followed-up patients with gallbladder carcinomas showed no relationships with the survival of the patients (p=0.087). CONCLUSION: COX-2 expression may play a role in the carcinogenesis of gallbladder carcinomas, but does not act as a prognostic indicator of a gallbladder carcinoma.

X-linked Gene Expression Profiles by RNAi-Mediated BRCA1 Knockdown in MCF7 Cells

Germ-line mutations of the BRCA1 gene confer an increased risk for breast and ovarian cancers. BRCA1 in female cells is directly related with the maintenance of the inactive X chromosome (Xi). The effect by the loss of the BRCA1 function on the X chromosome gene expression remains unclear in cancer cells. We attempted to investigate the expression pattern of the X-linked genes by performing BRCA1 knockdown via RNA interference in the MCF 7 breast cancer cell line. The transcriptional and translational levels of BRCA1 were decreased over 95% in the MCF 7 cells after BRCA1 knockdown. The expression patterns of one hundred ninety X-linked genes were profiled by the X chromosome-specific cDNA arrays. A total of seven percent of the X-linked genes (14/190) were aberrantly expressed by over 2-fold in the MCF7-BRCA1 knockdown cells, which contained two up-regulated genes (2/190, 1%) and 12 downregulated genes (12/190, 6.3%). It is interesting that 72% of the aberrantly expressed X-linked genes were located on the Xq (10/14,) region. Our data suggests that BRCA1 may not be important to maintain X chromosome inactivation in cancer because the BRCA1 knockdown did increase the expression of the only one percent of X-linked genes in the human breast cancer cells.

The Study of X Chromosome Inactivation Mechanism in Klinefelter's Syndrome by cDNA Microarray Experiment

To investigate the XIST gene expression and its effect in a Klinefelter''s patient, we used Klinefelter''s syndrome (XXY) patient with azoospermia and also used a normal male (XY) and a normal female (XX) as the control, We were performed cytogenetic analysis, Y chromosomal microdeletion assay (Yq), semi-quantitative RT-PCR, and the Northern blot for Klinefelter''s syndrome (KS) patient, a female and a male control, We extracted total RNA from the KS patient, and from the normal cells of the female and male control subjects using the RNA prep kit (Qiagen), cDNA microarray contained 218 human X chromosome-specific genes was fabricated. Each total RNA was reverse transcribed to the first strand cDNA and was labeled with Cy-3 and Cy-5 fluorescein, The microarray was scanned by ScanArray 4000XL system. XIST transcripts were detected from the Klinefelters patient and the female by RT-PCR and Northern blot analysis, but not from the normal male, In the cDNA microarray experiment, we found 24 genes and 14 genes are highly expressed in KS more than the normal male and females, respectively. We concluded that highly expressed genes in KS may be a resulted of the abnormal X inactivation mechanism.

Primary Cecal Lymphoma

PURPOSE: Primary colonic lymphomas are very rare disorders and the most common location of a colonic lymphoma is the cecum. However, the prognosis for patients with a primary cecal lymphoma is not well understood clear. This study was undertaken to assess the prognosis for patients with a primary cecal lymphoma. METHODS: A retrospective analysis of our patients, who were categorized into two groups, cecal lymphoma (10 cases) and non-cecal lymphoma (10 cases), was performed from January 1985 to December 2001. The prognostic factors were analyzed. RESULTS: The most common presenting symptoms and signs of cecal lymphomas were abdominal pain (80.0%), nausea/ vomiting (80.0%), and abdominal mass (40.0%). The preoperative biopsy- proven diagnostic rate of cecal lymphoma was 10.0%. The mean size of cecal lymphomas was significantly smaller than that of non-cecal lymphomas (6.2 cm vs. 10.0 cm). Histologically, 9 (90.0%) of the primary cecal lymphomas were classified as intermediate-grade lymphoas, and 1 (10.0%) as a high-grade lymphoma. three (30.0%) of the cecal lymphomas were Stage IE, 5 (50.0%) were Stage IIE1, and 2 (20.0%) were Stage IVE. Tumor resection and chemotherapy was used for 8 (80.0%) of the cecal lymphomas. Two regimens of chemotherapy were used: CHEP-Bleo (cyclophosphamide, doxorubicin, and epirubicin, prednisone, and bleomycin) and COP-BLAM (cyclophosphamide, vincristine, prednisone, bleomycin, doxorubicin, procarbazine). The median survival time for patients with a cecal lymphoma was 56 months, but that survival time was not significantly different from the survival time for patients with non-cecal lymphoma. CONCLUSIONS: The prognosis for patients with a primary cecal lymphoma appears to be similar to that for patients with a non-cecal lymphoma. However, the number cases in our study was very small, the more cases are needed to establish a general prognosis for patients with a primary cecal lymphoma.