ABSTRACT
BACKGROUND: Atrial cardiomyocytes synthesize, store and release atrial natriuretic peptide(ANP) which has potent physiological effects, including natriuresis, diuresis, relaxation of vascular smooth muscle and inhibition of aldosterone and renin secretion. A family of atrial peptides are derived from a precursor proANP. However, the structure-activity relationship of several C-terminal ANPs are not yet well documented. METHODS: The effects of structural difference of ANP analogs on the renal function were studied with a sensitive and reproducible bioassay using intrarenal arterial infusion in unanesthetized rabbits. RESULTS: Rat ANP-(1-28)(rANP, 12-Ile), a-human ANP-(1-28)(hANP, 12-Met), atriopeptin III [APIII, rANP-(5-28)], atriopeptin II[APII, rANP-(5- 27)], atriopeptin I[API, rANP-(5-25)], a-human ANP- (7-28)[hANP-(7-28)], and ANP fragments(13-28) [ANP-(13-28)] and (17-28)[ANP-(17-28)] were infused into left renal artery. No significant differences were observed between rANP and hANP. Diuretic and natriuretic activities of APIII were significantly lower than those of rANP and hANP, but were similar to those of hANP-(7-28). Diuretic and natriuretic effects of APII were similar to rANP and hANP in terms of peak responses. Duration of the effects of APII were longer than those of rANP and hANP. No significant changes were observed by infusions of API, and ANP fragments, ANP-(13-28) and ANP-(17-28). rANP, hANP and APIII decreased active but increased inactive renin secretion. CONCLUSION: These data suggest that substitution of isoleucine to methionine at 12 position of ANP does not affect the renal effects of ANP and that disulfide bond and C-terminal segment of ANP are important for the possession of natriuretic and diuretic activities.
Subject(s)
Animals , Humans , Rabbits , Rats , Aldosterone , Atrial Natriuretic Factor , Biological Assay , Diuresis , Isoleucine , Methionine , Muscle, Smooth, Vascular , Myocytes, Cardiac , Natriuresis , Natriuretic Agents , Peptides , Relaxation , Renal Artery , Renin , Structure-Activity RelationshipABSTRACT
PURPOSE: To assess the effectiveness of low-dose (30 mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. METHODS: Between March 1995 and December 1997, 48 patients were given ablative doses (30 mCi) of I-131 following total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. The effective ablation of remnant thyroid tissue was determined using a subsequent I-131 whole body scan. If any remnant thyroid tissue remained, we repeated the same management protocol at 6-month intervals. RESULTS: Thirty-eight (79.1%) patients displayed papillary, 8 (16.7%) follicular, 1 (2.1%) medullary and 1 (2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, 35 cases of which underwent central neck dissection, and 14 cases modified radical neck dissection. Postoperative complication developed in 8 cases, including 4 cases of transient hypoparathyroidism, 1 case of permanent hypoparathyroidism, 2 cases of transient recurrent laryngeal nerve palsy, and 1 case of wound hematoma. There was significant remnant thyroid tissue detected in 46 cases (95.8%) following total thyroidectomy, which were able to be ablated by low dose (30 mCi) I-131. There was no statistical difference between the operative procedures or the numbers of treatment of I-131. CONCLUSION: This data suggests that low-dose (30 mCi) I 131 therapy is effective for the ablation of remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer.
Subject(s)
Humans , Hematoma , Hypoparathyroidism , Neck Dissection , Postoperative Complications , Surgical Procedures, Operative , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , Vocal Cord Paralysis , Whole Body Imaging , Wounds and InjuriesABSTRACT
PURPOSE: This study was designed to determine surgeon's opinions on the name of the Department of Surgery in Korea. METHODS: This report is a survey of 797 randomly selected questionnaire (28.8%) from among 2,804 submitted by members of the Korea Surgical Society. The questionnaire consisted of 16 questions. RESULTS: Among the respondents, 70.4% were in the 4th or 5th decade of age, and 51.9% were working for private clinics. Among the names for the Department of Surgery in Korea, 48.9% included the word Surgery and 44.2% the word General surgery. Respondents who consider that we have to make use the unified Korean name of the Department of Surgery were 90.1%. CONCLUSION: The name of our department is considered as a common issue by most members. Most members insist that as much as possible, we should make use of the unified name Department of Surgery. We confirm that it is important to lead the public to a better understanding of our department by means of a far-reaching public information and that policy must be made and carried out by the Korea Surgical Society.
Subject(s)
Surveys and Questionnaires , Korea , Surveys and QuestionnairesABSTRACT
PURPOSE: This study was done to determine the diagnostic efficacy of clinical examination, fine needle aspiration(FNA) cytology, mammography and ultrasonography in palpable breast mass. METHODS: We performed 248 FNA cytology of palpable breast mass, among which 106 cases were histologically examined during the period of from Jan. 1994 to Dce.1997 at the Department of Surgery, Chonbuk National University Hospital. Among 106 patients, mammographys were taken for 96 patients, and ultrasonographys for 73 patients. RESULTS: Main clinical symptom was palpable mass on breast at the she visited the hospital. Clinical diagnosis based on symptoms and physical examination had 96.9% of sensitivity, 57.5% of specificity. Based on definite histologic diagnosis, the sensitivity of FNA cytology was 96.9%, specificity 91.7%, and diagnostic accuracy 93.5%, respectively. 86.1% of cytologic malignancy was proven to be malignant histologically, and 100% of cytologically benign cases were turned out histologically benign. Mammography was performed on 96 cases and the results were as follows; sensitivity 89.3%, specificity 84%, and diagnostic accuracy 86.8%. Ultrasonography in 73 cases showed 93.5% sensitivity, 51.4% specificity, and 74.6% diagnostic accuracy. CONCLUSIONS: FNA cytology was reliable and safe diagnostic method compared to physical examination, mammography, and ultraxonography. And FNA cytology of palpable breast mass should be diagnostic procedure of choice for those patients classified clinically as probably benign or malignant.
Subject(s)
Humans , Biopsy, Fine-Needle , Breast , Diagnosis , Mammography , Needles , Physical Examination , Sensitivity and Specificity , UltrasonographyABSTRACT
Primary hyperparathyroidism is a relatively rare disease entity in Korea. It is characterized by severe skeletal and renal changes due to hypersecretion of parathyroid hormone and rarely shows peptic ulceration, hypertension, pancreatitis and impaired mentality. Primary hyperparathyroidism is most commonly caused by an adenoma, or hyperplasia and rarely by cancer of the parathyroid gland. The authors experienced a case involving a giant parathyroid adenoma in a 62-year-old female. The main symptoms were general weakness, anorexia, and constipation. We detected the giant parathyroid adenoma on the anterior neck by using preoperative localization methods, such as ultrasonography, and a thallium-technetium subtraction scan. A parathyroidectomy was carried out, and the parathyroid adenoma measured 5.0 cm 3.2 cm in size and 12 gm in weight. Clinical laboratory reports and symptoms were normalized with no sequelae. We report this case with a review of the literature related to sizes and weights of adenomas.
Subject(s)
Female , Humans , Middle Aged , Adenoma , Anorexia , Constipation , Hyperparathyroidism, Primary , Hyperplasia , Hypertension , Korea , Neck , Pancreatitis , Parathyroid Hormone , Parathyroid Neoplasms , Parathyroidectomy , Peptic Ulcer , Rare Diseases , Ultrasonography , Weights and MeasuresABSTRACT
Deep venous thrombosis (DVT) of the upper extremity has been recently been recognized as being more common than previously reported (probably because of the increasingly frequent use of subclavian venous access). Since the initial descriptions of axillary-subclavian vein thrombosis more than 100 years ago, studies cites a 1.3% to 2.1% incidence of all DVT that occurs in the axillary or subclavian veins. Axillary-subclavian vein thrombosis is commonly associated with significant morbidity. The most serious aspect of morbidity and mortality is pulmonary embolization. Venography or digital subtraction studies are most reliable in allowing detection of thrombosis and Duplex imaging of vein is useful in following the course and assessing the effect of treatment. Early diagnosis and initiation of treatment before thrombus organization are important for successful outcome. Polycythemia vera are at an especially high risk for both thrombotic and hemorrhghic events and postoperative complications. We report a case of axillary-subclavian vein thrombosis after left subclavian vein catheterization in polycythemia vera.
Subject(s)
Catheterization , Catheters , Early Diagnosis , Incidence , Mortality , Phlebography , Polycythemia Vera , Polycythemia , Postoperative Complications , Subclavian Vein , Thrombosis , Upper Extremity , Veins , Venous ThrombosisABSTRACT
The malignant fibrous histiocytoma (MFH) was first introduced in 1963 to refer to a group of soft-issue tumors characterized by a storiform or cartwheel-ike growth pattern and predominantly fibroblastic appearance. It was postulated that they were derived from histiocytes that could assume the appearance and function of fibroblasts. MFH has been recognized to be the most common sarcoma in the soft tissue of late adult life which involves the deep fascia or skeletal muscles of the extremities or retroperitoneum. It has been noted in other organs, however, it rarely arises in the liver. We report two cases of primary malignant fibrous histiocytoma of the liver histopathologically confirmed after surgical resection-storiform pleomorphic and myxoid subtypes in the 55 year old male and 49 year old female patients, respectively, and describes the clinical courses, characteristics and pathologic aspects with review of the related literatures.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Extremities , Fascia , Fibroblasts , Histiocytes , Histiocytoma, Malignant Fibrous , Liver , Muscle, Skeletal , SarcomaABSTRACT
From Feburary 1989 to December 1997, 118 cases of primary living-donor renal transplantations were performed in Chonbuk National University Hospital. We analyzed the outcome of grafts and the potential risk factors that could influence the graft survival. The results were as follows. Male versus female ratio of recipients and donors were 3.2:1 and 1.1:1, and the mean age of them were 33.4 years and 44.8 years, respectively. Overall graft and patient survival rates were 95.7%, 97.4% at 1 year, 90.8%, 93.5% at 3 year, and 87.7%, 93.5% at 5 year, respectively. In all, 16 cases (13.6%) were lost during the observation period, with the most common causes of graft loss being chronic renal failure (10 cases, 63%), death with a functioning graft (3 cases, 19%), acute renal failure, anastomotic infection, and spontaneous renal rupture in each other one case. The deaths of patients occured in 9 cases (7.6%). The most common causes were pneumonia (5 cases, 56%), and the others were sepsis, breast cancer, retroperitoneal hematoma, and multiple organ failure in each other one case, respectively. The analyzed variables that could affect the graft survival were HLA typing, relative relationship, ABO typing, pretransplant blood transfusion, prevalence of CRF, acute rejection, and frequency of rejection episodes, but the results were not statistically significant. According to the relative relationship, acute rejection rate was 28.4% (25 of 88 cases) in relative, and 59.3% (16 of 27 cases) in non-relative. And so relative relationship influenced the acute rejection rates (p=0.003).
Subject(s)
Female , Humans , Male , Acute Kidney Injury , Blood Transfusion , Breast Neoplasms , Graft Survival , Hematoma , Histocompatibility Testing , Kidney Failure, Chronic , Kidney Transplantation , Multiple Organ Failure , Pneumonia , Prevalence , Risk Factors , Rupture , Sepsis , Survival Rate , Tissue Donors , TransplantsABSTRACT
A mesenteric cyst is an uncommon cause of a palpable abdominal mass. Such cysts occur along the Gastrointestinal(G-I) tract, from the duodenum to the rectum and are commonly found in the mesentery of small bowel rather than in the mesocolon. They can present themselves as chronic abdominal pain, an abdominal mass, and abdominal pain, and the most common physical finding is an abdominal mass which is movable transversely but not longitudinally. Diagnostic aids include abdominal computed tomography and ultrasound. An upper gastrointestinal series, barium enema, and intravenous pyelogram exclude GI and genitourinary cysts and tumors. Complete excision of the cyst, including a bowel resection, if necessary, is the treatment of choice and it has excellent postoperative results. The authors experienced three new cases of mesenteric cysts from March 1986 to July 1997 in Chonbuk National University Hospital. These cases are reported in this paper, along with a review of the literature on mesenteric cysts.
Subject(s)
Abdominal Pain , Barium , Duodenum , Enema , Mesenteric Cyst , Mesentery , Mesocolon , Rectum , UltrasonographyABSTRACT
The factors affecting the survival rate of breast-cancer patients were studied in 185 cases treated at the Department of Surgery, College of Medicine, Chonbuk National University from January 1987 to December 1996. The results are as follows: 1) The most prevalent age group was the 5th decade (57 cases, 30.8%). 2) The most common initial symptom was a palpable mass (167 cases, 90.3%). 3) In 134 cases (72.4%), the patients visited the hospital within 6 months of the onset of the first symptom. 4) The primary tumor was located on the left side in 101 cases (54.6%) and on the right side in 84 cases (45.4%), and the most frequent tumor location was the upper outer quadrant (113 cases, 61.1%). 5) The pathological types, according to the WHO classification, were an invasive ductal carcinoma (179 cases, 96.7%) and a medullary carcimona (22 cases, 11.9%) in that order. 6) According to the TNM system, the most common stage was stage II (100 cases, 54.1%). The overall 5-year survival rates according to pathologic stage were 96.0% for Stage I, 83.1% for Stage II, 67.8% for Stage III, and 12.5% for Stage IV. 7) The estrogen and the progesterone receptor status had no significance for the survival rate. 8) The most common type of operation was a modified radical mastectomy (Patey) (150 cases, 81.0%). 9) Axillary lymph node metastases were present in 77 cases (41.6%). 10) The most common distant metastasis was the bone (12 cases, 6.5%). 11) The overall 5-year actuarial survival rate after surgery was 76.6%. The 5-year survival rates according to the number of invaded lymph-node were 83.5% for 0 nodes, 77.6% for 1~3 nodes, 57.5% for 4~9 nodes, and 49.4% in cases of more than 10 nodes.
Subject(s)
Humans , Breast Neoplasms , Breast , Carcinoma, Ductal , Classification , Estrogens , Lymph Nodes , Mastectomy, Modified Radical , Neoplasm Metastasis , Receptors, Progesterone , Survival RateABSTRACT
Retroperitoneal, mesenteric, and omental cysts are rare intra-abdominal tumors. The most common symptom and physical finding is abdominal pain and a smooth, nontender, mobile, palpable mass. With increasing availability of ultrasound and computed tomography, the preoperative diagnosis of intra-abdominal cyst is being made more frequently. The upper gastrointestinal(GI) series, barium enema, and intravenous pyelogram exclude GI and genitourinary cysts and tumors. However, in the past, the correct preoperative diagnosis was made in only 25% of the other previously reported cases. Complete enucleation of the cyst, including a bowel resection, if necessary, is the treatment of choice and it has excellent postoperative results. In this study, the records of 15 patients with retroperitoneal, mesenteric, and omental cysts who underwent surgery at Chonbuk National University Hospital between January 1975 and July 1997 were retrospectively reviewed. The results are as follows: 1) The peak age was past the 4th decade (53.3%), and sex ratio of females to males was 6.5 : 1. 2) An abdominal palpable mass and abdominal pain existed in 10 cases (66.6%) and 5 cases (33.3%), respectively. Other clinical symptoms were abdominal distention, nausea, vomiting, constipation, diarrhea, fever, urinary frequeny. 3) The cyst was located on small bowel mesentey in 5 cases (33.3%), transverse colon mesentery in 4 cases (27%), retroperitoneurn in 2 cases (13%), and omentum in 2 cases (13%), and most cases were single. 4) Ultrasonography and computed tomography were helpful to know the presence of intra-abdominal mass and its location and relationship to adjacent organs. 5) The most common operation methods was complete enucleation of the cyst and next best alternative would be excion of the cyst with the resection of a portion of the adjacent bowel.
Subject(s)
Female , Humans , Male , Abdominal Pain , Barium , Colon, Transverse , Constipation , Diagnosis , Diarrhea , Enema , Fever , Mesentery , Nausea , Omentum , Retrospective Studies , Sex Ratio , Ultrasonography , VomitingABSTRACT
BACKGROUND: Palpable breast tumors have traditionally been diagnosed with open biopsy. We propose fine needle aspiration (FNA) cytology as a reliable, safe initial procedure in these patients. METHODS: We performed 248 fine needle aspiration (FNA) cytology of breast tumors, among which 106 cases were histologically examined during the period of form Jan. 1994 to Dec. 1997 at the Department of Surgery, Chonbuk National University Hospital. RESULTS: Main clinical symptom was palpable mass on breast at the time she visited the hospital. Clinical diagnosis based on symptoms and physical examination had 96.9% of sensitivity, 57.5% of specificity. Based on definite histologic diagnosis, the sensitivity of FNA cytology was 96.9% specificity 91.7%, diagnostic accuracy 93.5%, respectively. 86.1% of cytologic malignancy were proven malignant histologically, and 100% of cytologically benign cases turned out hitologically benign. CONCLUSIONS: A fine needle aspiration (FNA) cytology of solid palpable breast lesions should be diagnostic procedure of choice for those patients classified clinically as probably benign or clinically as malignant.
Subject(s)
Humans , Biopsy , Biopsy, Fine-Needle , Breast Neoplasms , Breast , Diagnosis , Physical Examination , Sensitivity and SpecificityABSTRACT
Three hundred ninety potentially curative resections for an adenocarcinoma of the stomach were performed in the Surgical Department of Chonbuk National University Hospital between 1991 and 1995. Eighty-nine patients were over 65 years of age, and three hundred-one patients were under 65 years of age. Pre-operative risk factors were statistically common in the over 65-years-old group(p<0.0044). Among the risk factors, pulmonary dysfunction was the most common pre-operative risk factor in both age groups, but diabetes mellitus was statistically significant factor in the under 65-years-old group. The incidence of post-operative complications revealed no statistical difference between two groups, and diarrhea was the most common complication in both groups. The incidence of complications increased when the disease was in an advanced stage and we did an extended operation, including a gastrectomy and a lymphadenectomy, but there was no statistical difference between the two age groups. The 3-year survival rate was higher when we did a curative resection with a subtotal or a total gastrectomy with a D2 lymphadenectomy than when we did non-curative resection, but there was no statistical difference between the two age groups. Hence, a curative resection including a radical gastrectomy with a D2 lymphadenectomy, if it is indicated, is reasonable approach for improving the survival rate in patients with an adenocarcinoma of the stomach, even elderly patients over 65 years of age.
Subject(s)
Aged , Humans , Adenocarcinoma , Diabetes Mellitus , Diarrhea , Gastrectomy , Incidence , Lymph Node Excision , Risk Factors , Stomach , Stomach Neoplasms , Survival RateABSTRACT
Peritoneal lavage cytology was performed at the time of gastrectomy for 295 patients with gastric cancer from September 1991 to January 1996 in the Department of Medical Sciences,Chonbuk National University Graduate School. The results were as follows;1) Positive intraperitoneal free cancer cells were observed in 9.8% of all case. And,the higher the S-category, the higher the increase in positive intraperitoneal free cancer cells, but the lower the rate of survival. 2) The higher the spatial extent of the invasion of the gastric serosa,the higher the increase in the positive intraperitoneal free cancer cells. However, There was no statiscal relation between the areas of gastric serosa invasion and the 3-year survival rate. But, especially when the areas of serosa invasion are 5-10cm2, the 3-year survival rate was statiscally higher in the negative intraperitoneal free cancer cell group than in the positive free cancer cell group.(P<0.012). 3) The rate of positive intraperitoneal free cancer cells become higher progressively with increasing the peritoneal invasion, but, there were no 3-year survival patients who have positive peritoneal invasion . In patients with no evidence of peritoneal spread, negative intraperitoneal free cancer cell group had a statistically signigficant higher 3-year survival rate than the positive group.(P<0.0004). 4) For histopathological types of tumors, the incidence of positive intraperitoneal free cancer cells was higher in undifferentiated adenocarcinomas than in differentiated types, though the difference was statistically insignificant. For signet-ring cell carcinomas, the 3-year survival rate of the negative intraperitoneal free cancer cell group was statistically higher than that of the positive group.(P<0.0005). 5) The incidence of positive intraperitoneal free cancer cells increased as the stage of gastric cancer increased, but the survival rate was decreased. 6) In the noncurative resection group, the incidence of positive intraperitoneal free cancer cells was higher, but the survival rate was lower, than in the curative resection group. The 3-year survival rates were higher for the patients with curative resection and negative intraperitoneal free cancer cells than for the patients with curative resection and positive intraperitoneal free cancer cells (P<0.0009). The difference in the 3-year survival rate between the noncurative resection with positive intraperitoneal free cancer cell group and the noncurative resection with negative intraperitoneal free cancer cell group was stastistically significant. (P<0.0000). 7) For the types of recurrence, hematogenous metastasis was the most common type of recurrence in the negative intraperitoneal free cancer cell group; peritoneal metastasis was the most common type of recurrence in the positive intraperitoneal free cancer cell group. In conclusion; at the time of gastrectomy, peritoneal lavage cystology is very impotant and basic examination which can help early detection of intraperitoneal free cancer cells. Therefore, when intraperitoneal free cancer cells are negative,radical curative gastrectoy make the high survival rate of patients.
Subject(s)
Humans , Adenocarcinoma , Gastrectomy , Incidence , Neoplasm Metastasis , Peritoneal Lavage , Prognosis , Recurrence , Serous Membrane , Stomach Neoplasms , Survival RateABSTRACT
The Krukenberg tumor refers to a wide variety of cancers that metastasize in the ovaries with well defined histopatholoigical characteristics and in over half of all cases they metastasize bilaterally. The ovary is a relatively frequent site of metastasis from malignant neoplasia arising elsewhere in the body- in a majority of instances the gastrointestinal tract, breast or other gynecologic organs. The bile duct and gallbladder are a rare source of metastasis. The microscopic appearance of these metastases is as varied as that of the primary cancers. The best known tumor of this type is a mucin secreting signet-ring cell adenocarcinoma of gastric origin. We report a case of a 50-year-old woman with a Krukenberg tumor with galactorrhea diagnosed by surgical resection. She has a past history of surgical treatment for Klatskin tumor which invaded the Hartman's pouch of gallbladder directly one year before this operation. Histologic examination revealed that the proximal and distal margin of bile duct were free of disease, and the level of CA 19-9 returned to normal at 2 months after surgical intervention. During the period of follow-up, she notified the sudden onset of increased serum level of CA 19-9 with hyperprolactinemia at that time point. However no evidence of hepatic recurrence was found despite pelvic evidence of diffuse recurrence. Radical pelvic surgery was accomplished in this patient by hysterosalpingo-oophorectomy.