Incidence and Prognostic Implications of Lymph Node Micrometastases in Patients with Submucosal Gastric Cancer

PURPOSE: Whereas lymph node metastasis in gastric cancer is an important prognostic factor, the prognostic relevance of occult tumor cells in lymph nodes has not yet been elucidated. The aims of this study were to assess the incidence of micrometastases of lymph nodes in patients with submucosally invaded gastric cancer and to investigate whether micrometastases of lymph nodes have prognostic significance. METHODS: In order to evaluate the incidence of lymph node micrometastases in patients with submucosal gastric cancer, 1423 lymph nodes taken from 55 patients were assessed by immunohistochemical technique using a monoclonal anti-human cytokeratin-8. Clinicopathologic parameters and prognoses were compared between patients with and without micrometastases. RESULTS: The incidence of nodal involvement by tumor cells in 55 patients with submucosal gastric cancer increased from 20.0% (11 patients) by hematoxylin-eosin (H-E) staining to 30.8% (17 patients) by immunohistochemical staining. Nodal positivity in this study increased from 0.8% (12/1423 nodes) by H-E staining to 3.2% (45/1423 nodes) by immunohistochemical staining (p=0.003). The presence of cytokeratin positivity was not related to various clinicopathologic factors. As estimated by the Kaplan-Meier lifetable methods, there was no significant difference in the five-year survival rate between the micrometastases negative and positive groups (94.8% and 94.1%, respectively). CONCLUSION: The presence of nodal micrometastases detected by immunohistochemical technique is an interesting phenomenon, however clinically it seems to be of only weak prognostic value in submucosal gastric cancer.

100 case of pancreaticoduodenectmy in 1000 beds hospital, 10 years experience / 한국간담췌외과학회지

BACKGROUND/AIMS: The death rates of pancreaticoduodenectomy decreased dramatically in experienced centers and it depends on many variability including nutritional status, better patient selection, hospital volume. We reviewed our experience of 100 pancreaticoduodenectomy for 10 years, 1000 beds hospital METHOD: Between 1990 and 2000, 100 patients underwent a pancreaticoduodenectomy in Dong-A University hospital. Annual number of cases, the disease entity, operative procedures, operation time and transfusion, radicality, external or internal pancreatic stent methods, morbidity and mortality were analyzed retrospectively. RESULTS: 10 cases or less per year until 1998: thereafter, the number of cases increased reaching 24 cases per year recently. Diseases entities were 35 pancreas head carcinomas, 22 common bile duct carcinomas, 20 ampulla vater carcinomas, 8 duodenum carcinomas, 9 chronic pancreatitis, 3 gallbladder carcinomas etc. Operative procedures were 53 whipple's operations, 23 Total pancreaticoduodenectomy, 22 pylorus preserving pancreaticoduodenectomy, 2 hepatopancreaticoduodenectomy. Postoperative morbidity has been decreasing, however, pancreatic leakage is still unresolved problem. Under 10 case annually the overall mortality was 22%, over 15 case annually the mortality reduced 12%(P=0.242). There were no mortality consecutive 30 cases since June, 1999 after changing the internal pancreatic duct stent to external pancreatic duct stent with preoperative total parenteral nutrition, Indocyanine green (ICG) test. The death rate was reduced(P=0.156). CONCLUSION: Pancreaticoduodenectomy has been increasing due to increased incidence of indication and improved resectability. Also preoperative total parenteral nutrition, ICG test, external pancreatic duct stent, successful postoperative embolization techniques decreased mobidity & mortality. It was suggested, pancreaticoduodenectomy could be safely performed in centers with more than 15 pancreatoduodenectomy annually.

Occurrence and Prognostic Implications of Lymph Node Micrometastases in Patients with Dukes' B Colorectal Carcinoma

PURPOSE: Whereas lymph node metastases in colorectal carcinoma are important prognostic factor, the prognostic relevance of occult tumor cells in lymph nodes has not been elucidated yet. Aims of this study were to assess the incidence of micrometastases of lymph nodes in patients with Dukes' B colorectal carcinoma and to investigate the correlation between nodal micrometastases and malignant potential to determine whether micrometastases of lymph nodes have prognostic significance, using an anti-cytokeratin immunohistochemical technique. METHODS: To evaluate the incidence of lymph node micrometastases in patients with Dukes' B colorectal carcinoma, 1160 lymph nodes taken from 65 patients (17.9 per case) were assessed by immunohistochemical technique using a monoclonal anti-human cytokeratin (MNF 116). Clinicopathologic parameters and survival rate were compared between patients with and without micrometastases. RESULTS: The incidence of nodal involvement by tumor cells in 65 patients with Dukes' B colorectal carcinoma (41 colon, 22 rectum, 2 synchronous cancer) was 30.8% (20 cases) and nodal positivity 3.2% (33/1423 nodes) by the immunostaining. No correlations were observed between the incidence of cytokeratin positivity and various clinicopathologic parameters, including preoperative CEA level, tumor site and size, histologic differentiation, pT stage, vascular invasion and lymphatic invasion and rate of recurrence. There was no difference in five-year survival estimated by Kaplan-Meier lifetable method between the micrometastases negative and positive groups (94.8% and 94.1%, respectively). CONCLUSIONS: The presence of nodal micrometastases detected by anti-cytokeratin immunohistochemistry is an interesting phenomenon but clinically seems to be of little prognostic value in patients with Dukes' B colorectal carcinoma. Thus, this immunostaining technique does not offer a significant benefit over conventional pathologic staging using hematoxylin-eosin staining.

Significance of Tumor Angiogenesis and p53 Protein Expression in Pancreatic Adenocarcinoma

PURPOSE: This study was designed to examine the microvessel count and p53 protein expression level in pancreatic adenocarcinoma patients and to determine how they correlate with the clinicopathologic factors and prognosis. In addition, the relationship between angiogenesis and p53 protein expression in pancreatic adenocarcinoma patients was investigated. METHODS: Paraffin-embedded tumor tissues from 30 patients with pancreatic adenocarcinomas that were completely removed by a radical resection were retrieved and analyzed. The vessels were immunostained with anti-factor VIII polyclonal antibodies, and 5 areas with the most discrete microvessels were counted under a 200 field. The mean was calculated, which was defined as the angiogenesis score (AS). p53 protein expression was detected by the immunohistochemical stain method. RESULTS: The mean AS was 37.7 13.6. There were no significant differences in sex, age, tumor size, histologic grade, T category (depth of invasion), N category (lymph node metastasis), pathologic stage and recurrence between the high and low AS group. The p53 protein expression rate was 73.3%, which did not correlate with the clinicopathologic factors and AS. However, recurrence was significantly related to the histologic grade and pathologic stage (p=0.040 and p=0.029). Among the various clinicopathologic factors, the N category (lymph node metastasis), the AS and recurrence (p=0.025, p=0.029 and p=0.003) were statistically significant according to a univariate survival analysis. In theCox regression analysis, the N category (lymph node metastasis) and recurrence were independent prognostic factors (odds ratio=4.344, 4.263). CONCLUSION: Although the survival rate in the high AS group was significantly lower than that in low AS group (p=0.029), the angiogenesis assessed by the microvessel count using immunohistochemical staining was not an independent prognostic factor in the Cox regression analysis.

Expression Pattern of Glucose Transporter GLUT1 Protein & Its Correlation with Prognostic Factors in Breast Cancer

PURPOSE: Breast cancer of malignant tumor occurring in domestic women is a tumor frequently seen in the third order following uterine cervical cancer and gastric cancer. This tumor may be recur even following positive treatment, so various methods have been studied to elucidate risk factors for recurrence. In particular, among the various oncogenes concerned in the recurrence of breast cancer, some have been seen as prognostic factors. In a recent study of protein expression in the tumor cell, it was demonstrated that expression increases glucose uptake and utilization, and that Glut1 facilitating the glucose transporter is increased in expression in various tumors of body. Many studies have been conducted on the role of protein in this glucose transporter in breast cancer, yet more studies are required. METHODS: Dye studies were carried out according to an ordinary ABC method utilizing polyclonal anti-Glut1 antibody to detect Glut1 protein in 79 breast cancer samples. RESULTS: Among the 79 breast cancer tissue samples, 41 samples (52%) demonstrated expression of Glut1. Upon close examnination, the expression frequency of Glut1 in brest cancer in relation to existing breast cancer prognosis-related factors, showed a statistically significant correlation with the histologic grade of the breast cancer. CONCLUSION: As Glut1 positive expression was seen in the breast cancer cell, it is suggested that Glut1 is involved in the occurrence of breast cancer. In particular, in poorly differentiated breast cancer, the expression was frequency increased, which suggested its potential as a prognostic factor for breast cancer.

Expression Pattern of Glucose Transporter GLUT1 Protein & Its Correlation with Prognostic Factors in Breast Cancer

PURPOSE: Breast cancer of malignant tumor occurring in domestic women is a tumor frequently seen in the third order following uterine cervical cancer and gastric cancer. This tumor may be recur even following positive treatment, so various methods have been studied to elucidate risk factors for recurrence. In particular, among the various oncogenes concerned in the recurrence of breast cancer, some have been seen as prognostic factors. In a recent study of protein expression in the tumor cell, it was demonstrated that expression increases glucose uptake and utilization, and that Glut1 facilitating the glucose transporter is increased in expression in various tumors of body. Many studies have been conducted on the role of protein in this glucose transporter in breast cancer, yet more studies are required. METHODS: Dye studies were carried out according to an ordinary ABC method utilizing polyclonal anti-Glut1 antibody to detect Glut1 protein in 79 breast cancer samples. RESULTS: Among the 79 breast cancer tissue samples, 41 samples (52%) demonstrated expression of Glut1. Upon close examnination, the expression frequency of Glut1 in brest cancer in relation to existing breast cancer prognosis-related factors, showed a statistically significant correlation with the histologic grade of the breast cancer. CONCLUSION: As Glut1 positive expression was seen in the breast cancer cell, it is suggested that Glut1 is involved in the occurrence of breast cancer. In particular, in poorly differentiated breast cancer, the expression was frequency increased, which suggested its potential as a prognostic factor for breast cancer.

Expression Pattern of Glucose Transporter GLUT1 Protein & Its Correlation with Prognostic Factors in Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer of malignant tumor occurring in domestic women is a tumor frequently seen in the third order following uterine cervical cancer and gastric cancer. This tumor may be recur even following positive treatment, so various methods have been studied to elucidate risk factors for recurrence. In particular, among the various oncogenes concerned in the recurrence of breast cancer, some have been seen as prognostic factors. In a recent study of protein expression in the tumor cell, it was demonstrated that expression increases glucose uptake and utilization, and that Glut1 facilitating the glucose transporter is increased in expression in various tumors of body. Many studies have been conducted on the role of protein in this glucose transporter in breast cancer, yet more studies are required. METHODS: Dye studies were carried out according to an ordinary ABC method utilizing polyclonal anti-Glut1 antibody to detect Glut1 protein in 79 breast cancer samples. RESULTS: Among the 79 breast cancer tissue samples, 41 samples (52%) demonstrated expression of Glut1. Upon close examnination, the expression frequency of Glut1 in brest cancer in relation to existing breast cancer prognosis- related factors, showed a statistically significant correlation with the histologic grade of the breast cancer. CONCLUSION: As Glut1 positive expression was seen in the breast cancer cell, it is suggested that Glut1 is involved in the occurrence of breast cancer. In particular, in poorly differentiated breast cancer, the expression was frequency increased, which suggested its potential as a prognostic factor for breast cancer.

Expression Pattern of Glucose Transporter GLUT1 Protein & Its Correlation with Prognostic Factors in Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer of malignant tumor occurring in domestic women is a tumor frequently seen in the third order following uterine cervical cancer and gastric cancer. This tumor may be recur even following positive treatment, so various methods have been studied to elucidate risk factors for recurrence. In particular, among the various oncogenes concerned in the recurrence of breast cancer, some have been seen as prognostic factors. In a recent study of protein expression in the tumor cell, it was demonstrated that expression increases glucose uptake and utilization, and that Glut1 facilitating the glucose transporter is increased in expression in various tumors of body. Many studies have been conducted on the role of protein in this glucose transporter in breast cancer, yet more studies are required. METHODS: Dye studies were carried out according to an ordinary ABC method utilizing polyclonal anti-Glut1 antibody to detect Glut1 protein in 79 breast cancer samples. RESULTS: Among the 79 breast cancer tissue samples, 41 samples (52%) demonstrated expression of Glut1. Upon close examnination, the expression frequency of Glut1 in brest cancer in relation to existing breast cancer prognosis- related factors, showed a statistically significant correlation with the histologic grade of the breast cancer. CONCLUSION: As Glut1 positive expression was seen in the breast cancer cell, it is suggested that Glut1 is involved in the occurrence of breast cancer. In particular, in poorly differentiated breast cancer, the expression was frequency increased, which suggested its potential as a prognostic factor for breast cancer.

Study in the Relationship between Angiogenic Factor and Expression of Cyclooxygenase and Nitric Oxide Synthase in Gastric Cancer

PURPOSE: Secretion of angiogenic factors from tumor cells is know to play an important role in neo-vascularization and metastasis. However, which angiogenic factor is related with the formation of neo-vasculature in gastric carcinomas is not well known. This study was performed to observe changes in the expression of vascular endothelial growth factor (VEGF), cyclooxygenase (COX), and nitric- oxide synthase (NOS). METHODS: Expressions of VEGF, COX, and NOS in thirty specimens resected from patients with a gastric carcinoma were investigated using the western blot method. Cultured MKN28 gastric cancer cells were treated with 100 ng/ml VEGF, and changes in the expression of COX and NOS were examined. Changes in VEGF expression were also investigated after treatment of the cells with inhibitors of COX and NOS. RESULTS: Expressions of VEGF, COX, and eNOS were increased up to 10, 60, and 30%, respectively, in tumors compared to surrounding normal tissues. VEGF-positive tumors showed a higher expression of COX-2. Human recombinant VEGF induced the expression of COX-2, but not eNOS, in the cultured MKN28 cells. The increase in expression was blocked with actinomycin D, the VEGF antibody, and anti-VEGF peptide. VEGF-induced expression of COX-2 was also blocked by pretreatment of cells with aspirin and indomethacin, suggesting that these anti-inflammatory drugs inhibit VEGF. The expression of eNOS was decreased by indomethacin in VEGF-treated cells, but COX-2 expression was not affected by inhibitors of NO production, N-arginine methylester (NAME). However, the protein level of VEGF was increased by indomethacin and NAME. CONCLUSION: This study showed that COX-2 and eNOS in gastric carcinomas seem to play an important role in the production of VEGF and that their expressions may also be affected by VEGF.

Clinical Study of Acinar Cell Carcinomas of the Pancreas: Our 5 cases and a review of 5 cases reported in Korea

PURPOSE: A acinar cell carcinoma of the pancreas is a rare malignancy arising from exocrine cells and comprising about 0.2 to 1% of all pancreatic cancers. Acinar cell carcinomas are usually seen in elderly patients and show a poor prognosis due to frequent metastasis. So far, we have not found any report of a clinical analysis of acinar cell carcinomas in Korean. METHODS: The records of 5 patients of Dong-A University Hospital and 5 patients already reported on in other literature in Korea were reviewed. The clinical and radiohistologic characteristics, treatment and prognosis were analyzed. RESULTS: The patients consisted of 8 males and 2 female. The patients ranged in age from 25 to 68 years (mean, 49.3 years). Presenting symptoms were nonspecific, and jaundice was infrequent. The symptoms from increased serum lipase levels were present in 2 (20.0%) of the patients. The tumor was frequently located on the tail (6 cases, 60.0%) of the pancreas. The histologic finding showed an acinar arrangement of the tumor cells with a minute central lumen. Ultrastructurely, the tumor cells had a few zymogen granules. The mean size of the tumors was 7.5 cm. We found that 1 case among the 10 cases had an elevated CA19-9 level among 10 cases and no one had an elevated AFP or CEA level among our 5 cases. A radical resection was performed in 7 cases, and the mean survival was 44.0 months. The mean survival of the 10 cases was 35.4 months. CONCLUSION: An acinar cell carcinoma is a rare type of pan creatic cancer and has a more favorable prognosis than a pancreatic ductal carcinoma. The clinical outcome and the radiohistologic characteristics were similar to those in other foreign literature, but the age, the tumor locations and the tumor marker (AFP or CEA) of the patients in this study were different from those of Caucasians.

The Effect of Vitamin Supplementation on Cognitive Function in the Elderly / 한국역학회지

OBJECTIVES: To estimate the effects of an oral vitamin supplementation on cognitive function in the elderly, 254 elderly people(experiment group) who were received an oral vitamin supplement for one-year was compared with 292 elderly who were treated as the control group in Koje city during the study period(from February 1997 to March 1998). METHODS: The cognitive function was tested by mini-mental state examination Korea(MMSE-K). Multiple regression analysis was done to control other confounding variables such as gender, age, educational level, smoking, alcohol, a past 15-day medical history, satisfaction for living cost, family number, cognitive function of the baseline survey. RESULTS: In the baseline survey, the prevalence of cognitive impairment was 31%(mild impairment 12.5% and severe impairment 18.5%). There was a significant difference(0.76) in cognitive change in the elderly between two groups, 0.68 improved in the experiment group and 0.08 worsen in the control group(p<0.01). In multiple regression analysis, the significant variables were an oral vitamin supplementation, a past 15-day medical history, family number, cognitive function of baseline survey(p<0.05). The improvement of cognitive function was observed in those who do not have a past 15-day medical history, have a large family number, and have a low cognitive function of the baseline survey. CONCLUSIONS: It appears that an oral vitamin supplementation was effective in improving the cognitive function in the elderly and more effective in the cases with abnormal cognitive function.

N-nitrosomorpholine Directed Preneoplastic Reprogramming of Nuclear Metabolism of Rat Hepatocytes / 대한암학회지

PURPOSE: An attempt was made to investigate N-nitrosomorpholine (NNM) induced carcinogenic processes in rat liver. MATERIALS AND METHODS: Rats were fed with NNM (200 mg/l) for 7 weeks, after then stopped. Length of telomere and activity of telomerase were analyzed. Hepatocytes were isolated and grown on tissue culture. Heat shock was treated at 43oC, and patterns of cell death ere evaluted by fluorescent study. Nuclei and nucleoli were isolated for analysis of various signal molecules. RESULTS: Shortening of telomere length presented in NNM treated liver, but induction of telomerase was not found. Ex vivo hepatocytes from 10~12th week showed increased heat shock resistance at 43oC. NNM-treated hepatocytes exhibited heat shock induced cell death (necrosis) after 7 hours, whereas the control showed necrosis after 3 hours. The signal molecules related to nucleolar growth revealed increased expression which included B23, C23, p38, Erk1/2 and p120. Partial degradation of B23 and Erk2 was noted in necrosis of NNM treated hepatocytes induced by heat shock. CONCLUSION: The hepatocytes at the stage of 10~12th week in the stop experiment of NNM are situated in the tumour promotion. Those cells showed various metabolic alterations. We found that the increased growth related signals were accompanied with increased heat shock resistance, telomere shortening but no induction of telomerase.

Tumor Angiogenesis as a Predictor of Malignancy Potential and Prognosis in Gastric Carcinoma / 대한암학회지

PURPOSE: In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and prognosis. MATERIALS AND METHODS: A total of 256 patients with gastric cancer who underwent curative surgery were included in this study. Microvessel count was determined by im-munohistochemical staining using monoclonal antibody against factor VIII-related antigen. RESULTS: The statistical significance between the microvessel count and clinicopathologic factors (age, sex, tumor invasion, lymph node involvement, histologic type) was analized. The tumor stage and histologic type were correlated with microvessel count. And also there was statistical significance with survival rate and recurrence-free survival rate between high (microvessel count> or =42) and low angiogeneic group (microvessel count< 42). The Cox's proportional hazard model showed that stage, histologic type, angiogeneic score were one of the significant and independent prognostic variables. CONCLUSION: The tumor angiogenesis of gastric carcinoma may be independent prognostic factor for predicting recurrence and survival.

The Expression of GLUT-1 Glucose Transporter in the Immunohistological Distinction of Hepatocellular Carcinoma from Intrahepatic Cholangiocarcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Malignant cells exhibit increased glycolytic metabolism, and in many cases increased glucose transporter gene expression. We studied the expression of the glucose transporters in hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma(CC). also, examined the usefulness of Glut-1 glucose transporter in the discrimination of HCC from CC. METHODS AND RESULTS: 23 HCC, 15 CC and 8 normal liver tissues were investigated immunohistochemically with Glut-1 glucose transporter. Immunostaning was regarded as positive when more than 5% of cells were stained. Among 38 liver tumor cases, Glut-1 was stained in 15(40%). in 2(9%) of 23 HCC and in 13(87%) of 15 CC were positive.(P=0.001) In HCC, underlying cirrhosis, 18(78%) were negative.(P=0.04) Other prognostic factors: histologic type, lymph node metastasis, distant metastasis did not show any significant correlation. CONCLUSION: Differential diagnosis between HCC and CC could be made by Glut-1 glucose transporter expression

Evaluating the Accuracy of Blood Pressure Measurement in General Hospital Nurses / 기본간호학회지

To assess the accuracy of blood pressure measurement in general hospital nurses, 276 nurses at four hospital in Kyungju city and Pohang city were observed during the study period 20 December 1998 to 29 December 1998. The nurses measuring the blood pressure of simulated patient's were checked by the researcher or 20 items, that are recommended for consideration when doing a blood pressure measurement. Of the six items in the preparation step for measuring blood pressure, the accuracy of 'patients shouldn't talk during the procedure' had the lowest frequency(27.1%) and the other five items were above 80%. Of the ten items on blood pressure measuring technique, the accuracy of the frequency for 'inflating the cuff until the radial or brachial artery pulse is no longer palpable and then adding 30mmHg' was 0%, 'waiting 30~60 seconds before reinflating the cuff' was alse 0%, 'rapidly deflating the cuff', 0.3%, 'rapidly and steadily inflating the cuff to the maximal level as per above-mentioned initial systolic pressure assessment step', 0.7%, 'reading the pressure to the nearest 2mmHg mark on the manometer', 10.8%, the remaining items were above 70%. Of the four items on blood pressure recording, the accuracy of 'recording the cuff size' had a frequency of 0.3%, 'recording the patient's position such as sitting, standing or lying position', 10.8%, 'recording the arm or leg which was used for measuring the blood pressure', 53.6%, and 'recording systolic/ diastolic pressure', 100%. The variables significantly related to the accuracy of the blood pressure measurement were age, career, position at hospital, and qualification education for blood pressure measurement(p<0.01). In the multiple regression analysis, position and qualification education were significant variables(p<0.01). In conclusion, the accuracy of blood pressure measurement was very low, thus, qualification education for blood pressure measurement should be done immediately to improve the accuracy of measurement by nurses in general hospitals.

Operative Treatment of Cystic Neoplasms of the Pancreas

PURPOSE: A cystic neoplasm of the pancreas is a curable tumor if it is removed surgically. The aim of this study was to investigate how two surgical procedures, enucleation of the lesion and pancreatic resection, could be applied based on the anatomic location and size of the tumor. METHODS: The records of 17 patients with a cystic neoplasm of the pancreas who had been treated surgically at the Department of Surgery, Dong-A University Hospital, between November 1990 and March 2000 were reviewed retrospectively. RESULTS: Pathologic diagnoses included 9 solid and papillary epithelial neoplasms (SPEN), 4 serous cystadenomas and 4 mucinous cystadenomas. An enucleation was performed in 4 patients. Two patients had a small cystic neoplasm located on the proximal body of the pancreas. The locations of the neoplasm in the remaining 2 patients were the head in one case and the neck in the other. A pancreatic resection was performed in 13 patients. Three patients had a large cystic neoplasm located on the proximal body of the pancreas. The locations of the neoplasm in the remaining 10 patients were the tail in 5 cases, the distal body in 3 cases, the body and tail in 1 case and the neck and body in 1 case. Major postoperative surgical complications were noticed in 2 patients in each group, respectively: two pancreatic abscesses in the resection group, and a pancreatic fistula and a pancreatic abscess each in the enucleation group. They were all managed conservatively by ultrasound-guided needle aspiration and catheter drainage without sequela. Two were lost during follow-up. One patient with a solid and papillary epithelial neoplasm (SPEN) combined with an advanced gastric carcinoma, and died 20 months after the operation because of the recurrence of gastric carcinoma. The other 14 patients were alive without evidence of recurrence during an average follow-up of 48.4 months (range: 3-118 months). CONCLUSION: This experience suggests that enucleation of the lesion and pancreatic resection can be performed satisfactorily in patients with cystic neoplasms of the pancreas and that recurrence is not noticed after these operations. Enucleation of the lesion can be performed restrictively for a lesion located on the head or the neck of the pancreas or for a small lesion located on the proximal body of the pancreas.

Laparoscopic Surgery for Gastric and Duodenal Disease

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.

Laparoscopic Surgery for Gastric and Duodenal Disease

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.

Preliminary Results for Changes in the Expression of Angiogenic Factors with Stage in Gastric Cancer

BACKGROUND: It has been suggested that the expression of angiogenic factors by tumor cells contributes to the increased neovascularization and vessel permeability that are associated with tumor vasculature. However, the significance of protein expression involving tumor angiogenesis in gastric cancer has yet not to be classified. METHODS: In this study, the expression of vascular endothelial growth factor (VEGF), cyclooxygenase (Cox), and nitric-oxide synthase (NOS) were investigated in 14 surgically resected human gastric carci nomas by using western blotting. RESULTS: In 6 of 14 paired cases, VEGF expression in the tumor tissue was slightly increased compared with the nonneoplastic counterpart in the same specimen. However, the expression of inducible-type Cox-2 was significantly increased in tumor tissue while the expression of constitutive-type Cox-1 was decreased. The expression of endothelial-type eNOS in cancer tissue was shown to be higher than in normal gastric resected tissues, but the expression of nNOS in cancer was lower than it was in a normal gastric mucosa. CONCLUSION: Although a direct positive correlation between VEGF expression and cyclooxygenase or nitric oxide synthase was not found in differnt stages of gastric tumor development, the cyclooxygenase and nitric-oxide synthase may play an important role in gastric cancer development.

Study of Ex Vivo Growth Characteristics of N-Nitrosomorpholine Treated Rat Hepatocytes / 대한암학회지

PURPOSE: The early carcinogenic effect of N-nitrosomorpholine (NNM) on acquisition of increased survival and growth was investigated using ex vivo culture of 5th to 10th week rat liver hepatocytes after NNM treatment. MATERIALS AND METHODS: Rats were fed with NNM (200 mg/l). Hepatocytes were isolated by two step perfusion techniques and grown on tissue culture. These ex vivo hepatocytes were then subjected to analysis of growth related signal molecules resided in nucleoli. RESULTS: One of the most characteristic differences of the NNM-treated liver from normal liver was genesis of megahepatocytes. These megahepatocytes survived approximately 2~3 times as long as normal hepatocytes in ex vivo conditions. There was also a significant increase in various nucleolar proteins, including Erk1/2, p38, hsp72 and nucleophosmin (B23). CONCLUSION: At promotion stage of tumorigenesis induced by NNM, it was possible to isolate and characterize abnormal hepatocytes. These abnormal hepatocytes showed increased survival in in vitro (ex vivo) than normal hepatocytes, although they were not immortal.