Pulmonary Metastasectomy in Colorectal Cancer: A Population-Based Retrospective Cohort Study Using the Korean National Health Insurance Database / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The study aimed to investigate the current status and prognostic factors for overall survival in patients who had undergone pulmonary metastasectomy for colorectal cancer. @*Materials and Methods@#The data of 2,573 patients who had undergone pulmonary metastasectomy after surgery for colorectal cancer between January 2009 and December 2014 were extracted from the Korean National Health Insurance Service claims database. Patient-, colorectal cancer–, pulmonary metastasis–, and hospital-related factors were analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis to identify prognostic factors for overall survival after pulmonary metastasectomy. @*Results@#The mean age of the patients was 60.9±10.5 years; 66.2% and 79.1% of the participants were male and had distally located colorectal cancer, respectively. Wedge resection (71.7%) was the most frequent extent of pulmonary resection; 21.8% of the patients underwent repeated pulmonary metastasectomies; 73% of pulmonary metastasectomy cases were performed in tertiary hospitals; 53.9% of patients were treated in Seoul area; 82% of patients received chemotherapy in conjunction with pulmonary metastasectomy. The median survival duration was 51.8 months. The 3- and 5-year overall survival rates were 67.7% and 39.4%, respectively. In multivariate analysis, female sex, distally located colorectal cancer, pulmonary metastasectomy-only treatment, and high hospital volume (> 10 pulmonary metastasectomy cases/yr) were positive prognostic factors for survival. @*Conclusion@#Pulmonary metastasectomy seemed to provide long-term survival of patients with colorectal cancer. The female sex, presence of distally located colorectal cancer, and performance of pulmonary metastasectomy in high-volume centers were positive prognostic factors for survival.

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

Purpose@#To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis. @*Methods@#Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic. @*Results@#A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis. @*Conclusion@#There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy

PURPOSE: The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy. METHODS: Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated. RESULTS: Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 +/- 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence. CONCLUSION: Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy

PURPOSE: The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy. METHODS: Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated. RESULTS: Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 +/- 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence. CONCLUSION: Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

A Case of Dieulafoy Lesion of the Jejunum Presented with Massive Hemorrhage / 대한소화기학회지

The Dieulafoy lesion is a rare cause of severe gastrointestinal hemorrhage. Although it may occur anywhere in the gastrointestinal tract, the lesion is most commonly located in the stomach, and the small bowel is an extremely uncommon site. Since Dieulafoy lesion in the small bowel is difficult to access by endoscopy, it seems impossible to diagnose and treat by initial endoscopy unlike the lesions in stomach. We experienced a case of Dieulafoy lesion of jejunum with massive hemorrhage in 54-year-old male. Active jejunal bleeding was shown by computed tomography scan and mesenteric angiography. Partial resection of the jejunum was performed. Final pathologic finding revealed Dieulafoy lesion of the jejunum.

Relation of the Expression of Cyclooxygenase-2 in Colorectal Adenomas and Adenocarcinomas to Angiogenesis and Prognosis

PURPOSE: Recent studies have shown that cyclooxygenase (COX)-2 may be involved in tumor growth, invasion and apoptosis in various carcinomas. Vascular endothelial growth factor (VEGF) has a potent angiogenic activity, and COX-2 promotes angiogenesis by modulating angiogenic factors, including VEGF. Endothelial growth factor receptor (EGFR) is considered as a factor of cell growth, maturation and cell death. The current study was designed to investigate the possible roles of COX-2 in colorectal tumor progression and angiogenesis. METHODS: Fifty colorectal adenomas and forty adenocarcinomas were investigated by using immunohistochemical staining for COX-2, VEGF and EGFR. The correlations of COX-2, VEGF and EGFR with the grade of dysplasia, the size of the adenoma, and various clinicopathologic factors were studied. RESULTS: The expressions of COX-2, VEGF and EGFR were each significantly correlated with carcinomatous transformation, and the expressions of COX-2 and VEGF were significantly correlated. COX-2 and EGFR showed correlations with adenomas rather than adenocarcinomas. However, no correlations of COX-2, VEGF and EGFR expression to other clinicopathologic factors, except tumor size in EGFR expression, were detected. CONCLUSION: These results suggest that COX-2 may play an important role in carcinogenesis through interaction with VEGF and EGFR in human colorectal cancer.

Carcinosarcoma on Ascending Colon Found by Bowel Perforation: A Case Report

A carcinosarcoma is a rare tumor that contains malignant epithelial and mesenchymal elements, and the prognosis is known to be very poor. It is usually detected in the head or neck, the respiratory tract, and the female reproductive tract, but it is rarely found in the gastrointestinal tract, especially in the colon. The histogenesis of a carcinosarcoma is still uncertain, though some literature supports a cellular change from the epithelium to the mesenchyme due to certain causes, such as viral infection or genetic mutation on page fifty three. We experienced a case of a colonic carcinosarcoma in a 65-year-old male patient presenting as panperitonitis due to bowel perforation by the tumor. A right hemicolectomy with lymph node dissection was performed. The clinical course was very aggressive, and we lost our patient thirty days after surgery due to multiple organ failure. Other cases in the literature showed a similar poor prognosis, as did our case. Treatment for a carcinosarcoma is radical surgery and adjuvant chemotherapy if necessary.

Expression of Growth Factors and Cytokines in Patients withDegenerated Disc Disease and Herniated Nucleus Pulposus

OBJECTIVE: To investigate the expression of cytokines and growth factors in disc specimens obtained from small numbers of patients with herniated nucleus pulposus (HNP) and degenerated disc disease (DDD). METHOD: A total of ten human intervertebral disc samples consisted of five painful degenerative discs and five herniated intervertebal discs were obtained from surgery. MRI and Western blot analyses on these disc samples were performed to determine the levels of disc degeneration and the expression levels of cytokines and growth factors. RESULTS: The levels of IL-6 were significantly greater in the DDD patients than in the HNP patients, but no statistical differences were observed in the expression of IL-1beta, IL-8 and TNF-alpha between the HNP and DDD patients. In addition, the expression of TGF beta was significantly higher in the DDD patients than in the HNP patients. CONCLUSION: The higher levels of cytokine and growth factor expression in the DDD than in the HNP show why discogenic patients usually have more severe back pain than patients with herniated discs.

Rehabilitation Treatments for the Sports Injuries on the Lumbar Spine, Hip & Pelvis / 한양의대학술지

Low back pain is a common problem seen in both atheletes and general population. The elite athlete losing significant playing time because of a back injury. Although an actual pain generator is not always found , the majority of athletes with low back injuries are likely to have pain from a benign source. These athletes will be expected to respond well to non operative treatment. However some athletes may experience pain from more severe stuructural sources such as fracture or tumor. In these cases, different management may be indicated. The clinician evaluating athletes with LBP must have overall understanding about back problems for making proper decision and therapeutic regimen. In this article, the authors discuss common back pain related injuries in the atheletic population, typical mechanisms of injury and the treatment methods include rehabilitation exercise for these problems.

Rehabilitation Treatments for the Sports Injuries on the Lumbar Spine, Hip & Pelvis / 한양의대학술지

Low back pain is a common problem seen in both atheletes and general population. The elite athlete losing significant playing time because of a back injury. Although an actual pain generator is not always found , the majority of athletes with low back injuries are likely to have pain from a benign source. These athletes will be expected to respond well to non operative treatment. However some athletes may experience pain from more severe stuructural sources such as fracture or tumor. In these cases, different management may be indicated. The clinician evaluating athletes with LBP must have overall understanding about back problems for making proper decision and therapeutic regimen. In this article, the authors discuss common back pain related injuries in the atheletic population, typical mechanisms of injury and the treatment methods include rehabilitation exercise for these problems.

Expression of Cyclin D1 and bcl-2 in Infiltrative Ductal Carcinoma of the Breast: Their Correlations and Clinical implications / 한국유방암학회지

PURPOSE: Cyclin D1 and bcl-2 are involved in cell proliferation and apoptosis in tumor development and are commonly expressed in breast cancer. But there are few clinical reports on the correlation between cyclin D1 and bcl-2 expression. This study was designed to analyze the correlations of cyclin D1 and bcl-2 and their clinical implications in breast cancer. METHODS: Immunohistochemical expression of cyclin D1 and bcl-2 were studied in 342 infiltrative ductal carcinoma cases and were compared with clinicopathologic parameters such as age, tumor size, histologic grade, lymph node status, p53, c-erbB2 and hormone receptors. RESULTS: Cyclin D1 expression was found in 86 of 342 cases (25.1%). Bcl-2 was positive in 227 of 342 cases (66.4%). Bcl-2 overexpression was associated with the high expression of cyclin D1 (p=0.001). Correlation was detected between both cyclin D1 and bcl-2 and hormone receptor positivity (p<0.001). There was a reverse correlation between bcl-2 and histologic grade, p53, c-erbB2. And the bcl-2 overexpression group showed better disease free survival rates at 3-year follow up. CONCLUSION: Higher expression of cyclin D1 was associated with bcl-2 overexpression. Positive estrogen receptor expression was associated with high cyclin D1 and bcl-2 expression. Bcl-2 tends to correlate with a positive clinical outcome.

Comparison between the Effect of Transforaminal Steroid Injection and Transforaminal Steroid Injection Combined with Spinal Decompressor on Lumbar Disc Herniation

OBJECTIVE: To assess the short-term clinical effect of a new spinal decompression device (DRX-3000) combined with transforaminal steroid injection (TFI) in comparison with TFI only in patients with lumbar herniated intervertebral disc (HIVD) METHOD: Fourty-one patients diagnosed as lumbar intervertebral disc herniation were recruited and divided into two therapeutic groups. Eighteen patients were treated with DRX-3000 combined with TFI. Twenty-three patients were treated with only TFI. The visual analogue scale (VAS), straight leg rasing test (SLR), radiating pain, Oswestry Disability Index (ODI), sitting tolerance, standing tolerance and sleeping tolerance were measured before treatment and 4 weeks after treatment. RESULTS: VAS, radiating pain, sitting tolerance and ODI were significantly improved after treatment in all patients (p<0.05). SLR and sleeping tolerance were significantly improved in combined treatment group and standing tolerance were significantly improved in TFI group after treatment (p<0.05). After treatment, degree of VAS decrease was larger in combined treatment group than TFI group(p<0.05). CONCLUSION: Spinal decompression with TFI was more effective than only TFI in patients with lumbar HIVD in a short period.

Prognostic Factors and Survival Rate of Ampulla of Vater Cancer after Curative Surgery

PURPOSE: Ampulla of Vater cancer has a more favorable prognosis than other malignant tumors of the periampullary region, but prognostic factors have not been identified. The aim of this study was to evaluate the prognostic factors of ampulla of Vater cancer from a single hospital experience. METHODS: The medical records of the 102 patients with ampulla of Vater cancer which underwent curative surgery between 1992 and 2002, were reviewed. All specimens were critically reviewed by an expert pathologist. The relationships between survival and the clinicopathological variables were assessed. RESULTS: In 120 patients that presented with ampulla of Vater cancer, 102 (85%) were resected. The 5 year survival rate was 69.1%. A univariate analysis showed the survival was closely related to gender, the tumor gross morphology, invasion depth and lymph node metastasis. A multivariate analysis identified two significant factors; the depth of invasion and gender. Twenty nine of the 102 patients suffered a recurrence. CONCLUSION: The depth of invasion and gender were independent significant prognostic factors of resectable ampulla of Vater cancer. Careful observation is essential for liver metastasis after surgery, especially in patients that have these factors.

Efficacy of an air cleaning device equipped with an electrostatic precipitator and photocatalytic plasma filter in respiratory allergic patients / 천식및알레르기

OBJECTIVE: To evaluate the clinical efficacy of a new air cleaning device (LG Electronics, Korea) equipped with electrostatic precipitator (EP) and photocatalytic plasma filter (PCP) in 24 respiratory allergic subjects. MATERIAL AND METHOD: Air cleaning conditioner and air cleaner were placed in living room and bedroom. Both EP and PCP (EP/PCP) filters were used for the first 4 weeks and for another 4 weeks, PCP without EP filter (PCP) was used. We measured symptom scores of asthma and rhinitis, peak expiratory flow rate (PEFR), serum eosinophil cataionic prote in? in ECP, Dermatophagoides farinae (DF) specific IgE and IgG in sera, concentrations of major allergens of DF in floor dust of living room, bedroom and in airborne dust. RESULTS: Both asthma and rhinitis symptom scores were significantly improved not only with EP/PCP filters but also with PCP filter. The morning PEFR was significantly improved with EP/PCP filters, but not with PCP filter. Frequency of salbutamol inhalation by air cleaner with EP/PCP filter tended to de crease(p=0.051), with no significant difference in serum ECP concentration. DF specific IgE significantly decreased at the 8th week with no differences in specific IgG. However, the mean Der f I levels in floor dust of bedroom (1, 128 vs. 374 ng/gm dust, p<0.01) and living room (1,516 vs 812 ng/gm dust, p<0.01) decreased, Der f1 in airborne dust measured only in 8 out of 22 subjects, and they decreased significantly with the trial of EP/PCP filter (172.2 pg/4.5m vs. 62.1 pg/4.5m, p<0.01). CONCLUSION: These results suggest that the EP/PCP air cleaner may be an effective tool for environmental control in respiratory allergic subjects.

Measurement of BMD ( Bone Mineral Density ) and Hip Axis Length for Predicting Hip Fracture / 대한정형외과학회잡지

Osteoporosis is a disease characterized by excessive bone loss or osteopenia particulary in the axial skeleton at the site of fracture, such as the spine and proximal femur. Since the strength of both spine and femur is directly proportional to the bone mass, this osteoporosis always increases the risk of fracture. In this study, to evaluate whether a simple measurement of femoral geometry and BMD value are related with hip fracture, we obtained DEXA Scan (Lunar Expert-XL) of hip by retrospective study. DEXA scan was measured on 70 control people and 17 hip fracture patients aged 50 or older. The result is I. The mean Ward BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.52g/cm2, Control group: 0.67g/cm2 P=0.0001) 2. The mean L-spine BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.81g/cm, Control group: 0.97g/cm2 P=0.0002) 3. The mean femur axis length of hip fracture group is longer than control group (Hip fracture group: 6.77g/cm2, Control group: 6.57g/cm2 P=0.006) As a conclusion, the measurement of BMD and hip axis length in DEXA scan is an effective method for screening the hip fracture risk patient and BMD value of femur, hip axis length and L- spine BMD value are strongly associated with hip fracture.

A Case or Squamous Cell Carcinoma of the Renal Pelvis Associated with Squamous Cell Carcinoma in Situ of the Ureter / 대한비뇨기과학회지

Squamous cell carcinoma of the renal pelvis is relatively rare and its prognosis is very poor. It is believed that the transitional cell epithelium undergoes metaplasia caused by the presence of infection and chronic irritation by renal stone. We observed a case of squamous cell carcinoma of the renal pelvis associated with squamous cell carcinoma in situ of ureter in a 68-year-old female patient. But she had no history of urolithiasis or urinary infection in situ.

Complications of Percutaneous Endoscopic Surgery and the Effect of Surgical Technique on Complications / 대한비뇨기과학회지

Percutaneous endoscopic surgery for the treatment of upper urinary tract stone or stricture has proved less invasive, reliable and safe with results comparable to open surgery. Because this contains many procedures, however, one can expect complications at some extents. Between 1987 and 1994, 410 percutaneous endoscopic procedures - PNL (330 cases), endopyelotomy (40 cases), endoinfundibulotomy (24 cases), endoureterotomy (10 cases), nephropexy (6 cases) - were performed by three operators in one hospital. The incidence of complication was evaluated and compared statistically. Overall complication rates were 23.6% and there was no mortality. Bleeding necessitating transfusion (7.6%) and fever (7.1%) were the most frequent complications. Other complications included renal pelvis or ureteral perforation (6.8%), paralytic ileus (2.9%), sepsis (0.7%), pneumothorax (0.7%), stent migration (0.7%), atelectasis (0.2%), ureteral stricture (0.2%), colon perforation (0.2%). Surgical interventions for the management of complication included nephrectomy (2 cases) for uncontrolled bleeding, and open repair for colon perforation (1 case). Renal artery embolization stopped the delayed bleeding in one case. Data on complications occurring before and after the first 50 cases indicated a statistically significant decrease in complications (p<0.005). These complications could be attributed to inexperience, improper technique, underlying pathologic conditions, and anatomic variants. As might be expected, the complication rate was much lower on later cases according to the increasing experience and improved technique. Based on our accumulated experience, the experience with more than 50 procedures could be needed to minimize complications.

Surgical treatment of Giant Cell Tumor / 대한정형외과학회잡지

Giant cell tumor is a predominantly benign condition but often the tumor is locally aggressive and tends to have high rate of recurrence and it can evolve into a malignant tumor. Thus the lesions have a practically difficult therapeutic problem for the orthopaedic surgeon and any method of treatment has not been satisfied. Between March 1984 and March 1993, clinical observation was carried out on 22 cases of giant cell tumor of bone to analyse the recurrence rate and functional evaluation of the joint according to the treatment methods, pathological grade and cortical destruction. The mean follow-up time was 75. 2 months. The recurrence rate of the intralesional excision group was 54.5% and that of the wide excision group was 9%, There was no relationship between the pathologic grade and recurrence rate. There was no recurrent case in the grade I cortical destruction but almost all of recurrence was occurred in the grade I or II cortical destruction. The functional result of the giant cell tumor occurred around the knee joint was that the mean ratings in the intralesional excision group were 79% and in the wide excision group were 51%. In conclusion, to achieve better joint function and less recurrence rate, intralesional or marginal excision with heat using bone cement or with chemical cauterization using phenol and alcohol can be used for cases of radiological grade I or II, and wide excision for grade III.

Multiple Metastatic Chordoma only to Muscle & Subcutaneum / 대한정형외과학회잡지

Chordoma is relatively rare and slowly growing tumor arising from notochordal remnant. The tumor is locally infiltrative rather than metastatic. Distant metastasis occured in 5% of Gentil & Coley's cases and 43% of Higinbotham et als cases. Usual sites of metastasis sites were lung, liver adrenal gland and lymph nodes. In 1922, Stewart reported first case of extrapulmonary metastatic chordoma in muscle & subcutaneous layer, which was extremely rare. We have experienced a case of wide spread multiple metastasis to muscle & subcutaneous tissue from primary sacrococcygeal chordoma. The case was 26 years old man, who have had multiple metastatic lesions in trunk, upper & lower extremities. They located in muscle and subcutaneous fat layer. In some lesions neurovascular structure was involved. We have treated the metastatic lesions by complete surgical excision, and they were confirmed as soft tissue chordoma by histologic examination.

Comparision of the effect of chemotherapy on 2-year relapse free survival rate in patient with osteosarcoma / 대한정형외과학회잡지

No abstract available.