Prognostic Predictability of American Joint Committee on Cancer 8th Staging System for Perihilar Cholangiocarcinoma: Limited Improvement Compared with the 7th Staging System / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study was conducted to evaluate the prognostic values of the 7th and 8th American Joint Committee on Cancer (AJCC) staging systems for patients with resected perihilar cholangiocarcinoma (PHCC). @*Materials and Methods@#A total of 348 patients who underwent major hepatectomy for PHCC between 2008 and 2015 were identified from a single center. Overall survival (OS) was estimated using the Kaplan-Meier method and compared across stage groups with the log-rank test. The concordance index was used to evaluate the prognostic predictability of the 8th AJCC staging system compared with that of the 7th. @*Results@#In the 8th edition, the stratification of each group of T classification improved compared to that in the 7th, as the survival rate of T4 decreased (T2, 31.2%; T3, 13.9%; T4, 15.1%; T1- T2, p=0.260; T2-T3, p=0.001; T3-T4, p=0.996). Both editions showed significant survival differences between each N category, except between N1 and N2 (p=0.063) in 7th edition. Differences of point estimates between the 8th and 7th T and N classification and overall stages were +0.028, +0.006, and +0.039, respectively (T, p=0.005; N, p=0.115; overall stage, p=0.005). In multivariable analysis, posthepatectomy liver failure, T category, N category, distant metastasis, histologic differentiation, intraoperative transfusion, and resection margin status were associated with OS. @*Conclusion@#The prognostic predictability of 8th AJCC staging for PHCC improved slightly, with statistical significance, compared to the 7th edition, but its overall performance is still unsatisfactory.

Reexamination of Dopaminergic Amacrine Cells in the Rabbit Retina: Confocal Analysis with Double- and Triple-labeling Immunohistochemistry

Dopaminergic amacrine cells (DACs) are among the most well-characterized neurons in the mammalian retina, and their connections to AII amacrine cells have been described in detail. However, the stratification of DAC dendrites differs based on their location in the inner plexiform layer (IPL), raising the question of whether all AII lobules are modulated by dopamine release from DACs. The present study aimed to clarify the relationship between DACs and AII amacrine cells, and to further elucidate the role of dopamine at synapses with AII amacrine cell. In the rabbit retina, DAC dendrites were observed in strata 1, 3, and 5 of the IPL. In stratum 1, most DAC dendritic varicosities—the presumed sites of neurotransmitter release—made contact with the somata and lobular appendages of AII amacrine cells. However, most lobular appendages of AII amacrine cells localized within stratum 2 of the IPL exhibited little contact with DAC varicosities. In addition, double- or triple-labeling experiments revealed that DACs did not express the GABAergic neuronal markers anti-GABA, vesicular GABA transporter, or glutamic acid decarboxylase. These findings suggest that the lobular appendages of AII amacrine cells are involved in at least two different circuits. We speculate that the circuit associated with stratum 1 of the IPL is modulated by DACs, while that associated with stratum 2 is modulated by unknown amacrine cells expressing a different neuroactive substance. Our findings further indicate that DACs in the rabbit retina do not use GABA as a neurotransmitter, in contrast to those in other mammals.

Comparison of Pyloromyotomy with Supraumbilical Incision and Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis Performed by a Single Surgeon / 소아외과

PURPOSE: Hypertrophic pyloric stenosis (HPS) is known to be one of the most common cause of surgery for infants and pyloromyotomy was considered to the standard treatment. There has been an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating HPS. The aim of this study is to evaluate safety and effectiveness of LP by comparing the clinical results of both surgical strategies performed by single surgeon. METHODS: Between January 2000 and December 2013, 60 patients who underwent pyloromyotomy at Asan Medical Center performed by a surgeon were followed: open-supraumbilical incision (n=36) and LP (n=24). The parameters included sex, age and body weight at operation. Clinical outcomes included operation time, time to full feeding, postoperative hospital stay, and postoperative complications. RESULTS: There were no significant differences in characteristics, postoperative hospital stay between the two groups. Time to full feeding was shorter in LP (OP 24.5 hours vs. LP 19.8 hours; p=0.063). In contrast, the mean operation time was longer in LP (OP 37.5 minutes vs. LP 43.5 minutes; p=0.072). Complications such as perforation of mucosal layer (OP 1 vs. LP 0) and wound problems (OP 2 vs. LP 0) were found to be not worse in laparoscopic group as compared with open group. CONCLUSION: There has no difference both laparoscopic and open-supraumbilical incision in terms of postoperative hospital stay, time to full feeds and frequency of complications.

Relationship between Intravesical Prostatic Protrusion and Postoperative Outcomes in Patients with Benign Prostatic Hyperplasia

PURPOSE: To evaluate the significance of intravesical prostatic protrusion (IPP) for predicting postoperative outcomes in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 177 patients with a possible follow-up of at least 6 months who were treated with transurethral resection of the prostate (TURP) were analyzed. We divided the patients into two groups on the basis of the degree of IPP: the significant IPP group (IPP> or =5 mm, n=74) and the no significant IPP group (IPP<5 mm, n=103). We analyzed postoperative changes in parameters, such as the International Prostate Symptom Score (IPSS), IPSS quality-of-life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). The IPSS was subdivided into voiding (IPSS-v) and storage (IPSS-s) symptoms. Multivariate logistic regression analysis was performed to identify whether IPP could predict surgical outcomes of TURP. RESULTS: Preoperative parameters were not significantly different between the two groups except for total prostate volume and transitional zone volume. Postoperative changes in IPSS, IPSS-v, IPSS-s, and QoL score were higher in the significant IPP group than in the group with no significant IPP. Changes in Qmax and PVR were not significantly different between the two groups. Multivariate logistic regression analysis (after adjustment for age, prostate-specific antigen level, total prostate volume, and transitional zone volume) revealed that the odds ratios (95% confidence interval) of decreased IPSS and IPSS-s in the significant IPP group were 3.43 (1.03 to 11.44) and 3.51 (1.43 to 8.63), respectively (p=0.045 and 0.006, respectively). CONCLUSIONS: Significant IPP is an independent factor for predicting better postoperative outcomes of IPSS and IPSS-s.

Primary Classic Kaposi's Sarcoma of the Penis in an HIV-Negative Patient

Kaposi's sarcoma (KS) is a multifocal hemorrhagic sarcoma that occurs primarily on the extremities. KS limited to the penis is rare and a well-recognized manifestation of acquired immune deficiency syndrome (AIDS). However, KS confined to the penis is extraordinary in human immunodeficiency virus (HIV)-negative patients. We present the case of a 68-year-old man with a dark reddish ulcerated nodule on the penile skin, which was reported as a nodular stage of KS. We detected no evidence of immunosuppression or AIDS or systemic involvements in further evaluations. In his past medical history, the patient had undergone three transurethral resections of bladder tumors due to urothelial cell carcinoma since 2000 and total gastrectomy, splenectomy, and adjuvant fluorouracil/cisplatin chemotherapy for 7 months due to advanced gastric carcinoma in 2005. The patient was circumcised and has had no recurrence for 2 years.

The Appropriateness of Colonoscopy Indication and the Diagnostic Yield of Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: We wanted to evaluate if the guidelines for appropriately performing colonoscopy by the American Society for Gastrointestinal Endoscopy (ASGE) yield good diagnostic efficacy, and we wanted to assess the appropriateness of referrals. METHODS: A total of 2,412 consecutive patients (1,605 men and 807 women) who were undergoing colonoscopy from September 2006 to February 2007 were prospectively enrolled in the study. The diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of performed colonoscopies. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. RESULTS: The large majority (64.2%) of patients had colonoscopy for an indication that was considered 'generally indicated', while the procedure was considered 'generally not indicated' for 22.4% of the patients. The diagnostic yield of colonoscopy was significantly higher for the appropriate colonoscopies (59.1%) than for the inappropriate colonoscopies (23.2%). On the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of the indication that was "generally indicated" (odds ratio=9.5) and with the referrals by a gastroenterologist (odds ratio=1.7). CONCLUSIONS: The ASGE guidelines have shown a good diagnostic yield. Further steps are required to update and standardize the guidelines to increase the diagnostic yield.

Spatiotemporal regulation of fibroblast growth factor signal blocking for endoderm formation in Xenopus laevis

We have previously shown that the inhibition of fibroblast growth factor (FGF) signaling induced endodermal gene expression in the animal cap and caused the expansion of the endodermal mass in Xenopus embryos. However, we still do not know whether or not the alteration of FGF signaling controls embryonic cell fate, or when FGF signal blocking is required for endoderm formation in Xenopus. Here, we show that FGF signal blocking in embryonic cells causes their descendants to move into the endodermal region and to express endodermal genes. It is also interesting that blocking FGF signaling between fertilization and embryonic stage 10.5 promotes endoderm formation, but persistent FGF signaling blocking after stage 10.5 restricts endoderm formation and differentiation.

Mutational Analysis of Pro-apoptotic BAD Gene in Nonsmall Cell Lung Cancer

PURPOSE : Evidence exists that deregulation of apoptosis is involved in the mechanisms of cancer development, and the somatic mutations of apoptosisrelated genes have been reported in human cancers. Bcl- XL/Bcl-2-associated death promoter (BAD), a pro-apoptotic member of Bcl-2 family, plays an important role in the intrinsic apoptosis pathway. MATERIALS AND METHODS : To explore the possibility that the genetic alterations of BAD might be involved in the development of human cancers, we analyzed the entire coding region and all splice sites of human BAD gene in 100 human non-small cell lung cancers (NSCLC) by polymerase chain reaction (PCR)-based single-strand conformation polymorphism (SSCP). RESULTS : The PCR-SSCP analysis detected no mutation in the entire coding regions and all splice sites of human BAD gene in the 100 NSCLCs. CONCLUSION : The data presented here suggested that BAD gene mutation may not contribute to the pathogenesis of human NSCLCs

Mutational Analysis of PUMA Gene in Non-small Cell Lung Cancers

PURPOSE: It has become clear that, together with proliferation, deregulation of apoptosis plays a pivotal role in tumorigenesis, and the somatic mutations of apoptosis-related genes have been reported in human cancers. PUMA, a pro- apoptotic member of Bcl-2 family, mediates p53-deependent and -independent apoptosis. The aim of this study was to explore whether alteration of PUMA protein expression is a characteristic of human lung cancers. MATERIALS AND METHODS: To explore the possibility that the genetic alterations of PUMA might be involved in the development of human cancers, we analyzed the entire coding region and all splice sites of human PUMA gene in 100 human non-small cell lung cancers (NSCLCs) by polymerase chain reaction (PCR)-based single-strand conformation polymorphism (SSCP). RESULTS: The PCR-SSCP analysis detected no mutation in the entire coding regions and all splice sites of human PUMA gene in the 100 NSCLCs. CONCLUSION: The data presented here suggested that PUMA gene mutation may not contribute to the pathogenesis of human NSCLCs.

The effect of enamel matrix derivative (EMD) in combination with deproteinized bovine bone material (DBBM) on the early wound healing of rabbit calvarial defects / 대한치주과학회지

No abstract available.

The effects of platelet-rich plasma(PRP) in combination with anorganic bovine bone(Bio-Oss(R)) on the early wound healing of rabbit cranial defects / 대한치주과학회지

No abstract available.

Mutational Analysis of Caspase-7 and 8 Genes in Non-small Cell Lung Cancer

PURPOSE : Several lines of evidence have indicated that deregulation of apoptosis is involved in the mechanism of cancer development. Caspase-8 activation plays a central role in the initiation phase of apoptosis, while caspase-7 is one of the main execution phase caspases of apoptosis. The aim of this study was to explore the possibility that genetic alterations of the caspase-8 and caspase-7 genes are involved in the development of human non-small cell lung cancer (NSCLC). MATERIALS AND METHODS : We have analyzed the entire coding region of both the caspase-7 and caspase-8 genes to detect the somatic mutations in 100 NSCLCs by using polymerase chain reaction (PCR)- single strand conformation polymorphism (SSCP). RESULTS : The PCR-SSCP analysis detected no mutations in the entire coding regions of both the caspase-7 and caspase-8 genes in the NSCLCs. CONCLUSION : The data presented here suggests that both the caspase-7 and caspase-8 genes may not be somatically mutated in human NSCLCs

Mutational Analysis of Proapoptotic bcl-2 Family genes in Colon Carcinomas

BACKGROUND: Several lines of evidence have indicated that the deregulation of apoptosis is involved in the mechanisms of cancer development, and somatic mutations of the apoptosisrelated genes have been reported in human cancers. Members of the bcl-2 family proteins regulate the intrinsic apoptosis pathway mainly in the mitochondria. The aim of this study was to explore whether the somatic mutation of the proapoptotic bcl-2 family genes, one of the mechanisms that prolong the survival of cancer cells, occurred in colorectal carcinomas. METHODS: In the current study, to detect the somatic mutations in the DNA sequences encoding the bcl-2 homology 3 (BH3) domain of the human bak, bid, bik, bim, PUMA, bcl-rambo, bcl-G, and bmf genes in 98 colon adenocarcinomas, we used polymerase chain reaction (PCR), single strand conformation polymorphism (SSCP), and DNA sequencing. RESULTS: The SSCP analysis detected no evidence of somatic mutations of the genes in the coding regions of the BH3 domain in the cancers. CONCLUSIONS: The data presented here indicate that the proapoptotic bcl-2 family genes, bak, bid, bik, bim, PUMA, bcl-rambo, bcl-G and bmf may not be somatically mutated in human colorectal carcinomas, and suggest that the colorectal cancers may not utilize mutational events of these proapoptotic bcl-2 family genes in the mechanisms for evading apoptosis.

Mutational Analysis of the Epidermal Growth Factor Receptor Gene in Gastrointestinal Stromal Tumors

PUPOSE: Most gastrointestinal stromal tumors (GISTs) have gain-of-function mutations of the KIT or the platelet-derived growth factor receptor alpha (PDGFRA) genes, but approximately 10% of the GISTs are wild types for both the KIT and the PDGFRA genes. The purpose of this study was to investigate the possibility that epidermal growth factor receptor (EGFR) gene mutation might be responsible for the pathogenesis of GIST. MATERIALS AND METHODS: We analyzed the EGFR gene in 60 GISTs for the detection of somatic mutations by using the polymerase chain reaction (PCR), the single strand conformation polymorphism (SSCP), and DNA sequencing in exon 18, 19, and 21 encoding the kinase domain. RESULTS: The SSCP analysis revealed no evidence of EGFR mutations in exon 18, 19, and 21 in GISTs. CONCLUSION: The data indicate that the EGFR gene may not be mutated in human GIST and suggest that therapies targeting the mutated EGFR gene products might not be useful in the treatment of GISTs.

Expression Pattern of Caspase 2 in Korean Gastric Cancers

PURPOSE: Caspase 2, a member of the family of ICE-like proteases, is activated by the Fas pathway and induces apoptosis by triggering the caspase cascade. The purpose of this study was to determine whether the expression pattern of caspase 2 might be associated with gastric cancer development and if so, to determine to which pathologic parameter it is linked. MATENRIALS AND METHODS: For the construction of the gastric cancer tissue microarray, 78 paraffin-embedded tissues containing gastric cancer areas were cored 3 times and transferred to the recipient master block. The expression pattern of caspase 2 was examined on tissue microarray slides by using immunohistochemistry and was compared with pathologic parameters, including histologic type, depth of invasion, lymph node metastasis, and peritoneal dissemination. RESULTS: Caspase 2 was expressed on superficial and foveolar epithelial cells and lymphocytes in the gastric mucosa, mainly in cytoplasm. We found loss of caspase 2 expression in 41 (52.6%) of the 78 gastric cancer tissues. Statistically, histologic type and other pathologic parameters were not related with loss of caspase 2 expression. CONCLUSION: Our findings provide enough evidence that loss of caspase 2 expression may contribute to the development of Korean gastric cancer and that it might be one of the possible escape mechanisms from apoptosis in gastric cancer.

Adequate Duration of Medical Therapy for Koreans with Graves' Disease / 대한내분비학회지

BACKGROUND: Graves' disease is an organ specific autoimmune disease. Three kinds of therapeutic modalities(antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. SUBJECTS AND METHODS: The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. RESULTS: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. CONCLUSION: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted.

Clinical significance of reciprocal ST segment depression in acute myocardial infarction: Analysis based on the time interval from the onset of symptoms / 대한내과학회지

BACKGROUND: To investigate the clinical significance of reciprocal ST segment depression on the presenting electrocardiogram (ECG) in patients with acute myocardial infarction (MI), in particular, this study focuses whether there is any difference according to the time interval between the onset of symptoms and initial ECG. METHODS: ECG findings in 198 patients with acute MI were retrospectively reviewed. The patients were classified into 4 subgroups based on the infarct region and reciprocal ST depression. The clinical data and angiographic finding were compared in each region. We also explored whether any differences could be recognized according to the time interval. RESULTS: Of 78 anterior MI, 16 (21%) showed a reciprocal ST depression and 62 (80%) did not. Of 120 inferior MI, 50 (41%) displayed a reciprocal ST depression and 70 (59%) did not. In each region, a reciprocal ST depression made no difference between the two groups. However, when divided by the time interval, a reciprocal ST depression more than 4 hours after MI predicted a high incidence of multivessel disease [anterior MI 5/6 (83%), 10/12 (83%): p<0.05 for each]. CONCLUSION: There was a high incidence of multivessel disease when a reciprocal ST segment depression continued for more than 4 hours after MI. The meaning of a reciprocal ST depression can be interpreted differently according to the duration after MI.

A Case of Adult Dermatomyositis with Diffuse Soft Tissue Calcification / 대한류마티스학회지

Dermatomyositis is a disease of non-pyogenic inflammation of skin and muscles in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Diffuse subcutaneous and interstitial muscular calcinosis is well recognised and common in childhood dermatomyositis. However, soft tissue calcification in a patient with adult onset dermatomyositis has been rarely reported. We have experienced a patient with adult onset dermatomyositis who had diffuse subcutaneous tissue calcification on hands, arms, chest, abdomen and buttocks.

A Case of Anti-Glomerular Basement Membrane Antibody Disease without Pulmonary Hemorrhage / 대한신장학회잡지

Anti-glomerular basement membrane antibody mediated rapidly progressive glomerulonephritis is a rare autoimmune disease. It is characterized by acuterenal failure and crescentic glomeruli with linear immune deposits along glomerular basement membrane mediated by anti-GBM antibodies. We report a case of a sixty-years-old man with generalized edema and hematuria. On admission, BUN/Creatinine was 118/19.6 mg/dL, Hb was 10.2 g/dL. On urinalysis, protein was 3+, and many RBCs were found. Renal biopsy specimen which contained 8 glomeruli showed active cellular crescent formation in all glomeruli. On immunofluorescent staining specimen, there were 4 glomeruli which showed strong IgG linear staining along the glomerular basement membrane and mild C3 & C1q deposit along the capillary walls. The titer of anti-GBM antibody was 123 EU by ELISA (normal: <10 EU). We treated with high dose of corticosteroid and plasmapheresis, but renal function was not recovered even after 3 months of hemodialysis.

H+ -ATPase Pump Defects of Distal Renal Tubular Acidosis as Initial Manifestation of Systemic Lupus Erythematosus / 대한신장학회잡지

Systemic lupus erythematosus (SLE) is a multisystem disease with marked variability in its manifestation. Tubulointerstitial involvement is well recognized in SLE. But usually the tubular dysfunction is latent and usually presents after diagnosis of SLE. We report a 20 years old female whose initial symptom of SLE was distal renal tubular acidosis (RTA). She presented with severe muscle weakness at emergency room with laboratory fingding consistent with distal RTA. After several months she developed fever, arthritis, serologic fingding which was compatible to diagnose SLE. We report a case whose initial symptom of SLE had been distal RTA.