Advance Directives for Advanced Cancer Patients in Oncology Department: Single Center Experience / 이화의대지

OBJECTIVES: Advance directives (AD) are designed to protect patients’ autonomy and self-determination, which mean the end of life care planning should precede before loss of their decision ability. We aimed to analyze our experience of AD at field of oncology, focusing on preference of end-of-life care and outcome in advanced cancer patients. METHODS: A retrospective review was conducted on advanced cancer patients who underwent AD at the department of Oncology of Hanil General Hospital, between April 2013 and January 2014. AD are composed of decision about end of life care (resuscitation, ventilator, artificial tube feeding) and determination of proxy. RESULTS: Among 23 patients who were recommended AD during study period, 19 patients (83%) successfully underwent AD. The median age was 67 years (range, 50 to 95 years) and male was predominance (84%) was observed. Most of them (90%) have not heard of AD in the past. With regard to decision of end-of-life care, decision for resuscitation and ventilator were selected only by 1 patient (5%), respectively, while 10 patients (52%) decided to receive tube feeding. Among 5 patients who underwent AD during chemotherapy, there was neither transfer to other hospital for anti-cancer treatment nor follow up loss. CONCLUSION: AD might be applicable in advanced cancer patients at field of oncology, including also patients treated with palliative chemotherapy.

Diffuse Large B-Cell Lymphoma Transformed from a Rectal Mucosa-Associated Lymphoid Tissue Lymphoma / 이화의대지

Primary rectal lymphoma is a rare disease among the gastrointestinal (GI) lymphoma. In particular, diffuse large B-cell lymphoma (DLBCL) transformed from mucosa-associated lymphoid tissue (MALT) lymphoma is often the primary type of GI lymphoma, mostly in stomach or duodenum, but has never been reported in rectum. Here we report an unusual case in which a 75-year-old male patient diagnosed with DLBCL transformed from MALT lymphoma in the rectum. The patient was diagnosed as rectal DLBCL transformed from MALT lymphoma as Lugano stage II2 and was treated with chemotherapy (R-CHOP) with CD-20 monoclonal antibody (rituxaimb). Complete remission of multiple lymphadenopathy and mass forming ulcer of the rectum was achieved after 6 cycles of R-CHOP. He has been free from disease for 12 months.

Invasive Pulmonary Aspergillosis Histologically Mimicking Mucormycosis / 이화의대지

Differential diagnosis of invasive aspergillosis from other pulmonary fungal infections including mucormycosis is important because the treatment is pathogen-dependent. Clinically, invasive aspergillosis is often discriminated from other mold infections on the basis of typical histopathologic features in the biopsy specimen. However, biopsy alone is not always complete because different fungal species can display similar histopathologic features. Surrogate markers or molecular-based assays can be useful when the results of conventional diagnostic modalities are conflicting. Here, we present a case of invasive pulmonary aspergillosis histologically mimicking mucormycosis, which was confirmed by fungal polymerase chain reaction.

A Case of Immunoglobulin G4-Related Disease Presenting as a Pleural Mass / 결핵및호흡기질환

Immunoglobulin G4 (IgG4)-related disease is a newly recognized condition characterized by fibroinflammatory lesions with dense lymphoplasmacytic infiltration, storiform-type fibrosis and obliterative phlebitis. The pathogenesis is not fully understood but multiple immune-mediated mechanisms are believed to contribute. This rare disease can involve various organs and pleural involvement is even rarer. We report a case of IgG4-related disease involving pleura. A 66-year-old man presented with cough and sputum production for a week. Chest radiography revealed consolidation and a pleural mass at right hemithorax. Treatment with antibiotics resolved the consolidation and respiratory symptoms disappeared, but the pleural mass was unchanged. Video-assisted thoracoscopic surgery was performed. Histopathology revealed dense lymphoplasmacytic infiltration and storiform fibrosis with numerous IgG4-bearing plasma cells. The serum IgG4 level was also elevated. Further examination ruled out the involvement of any other organ. The patient was discharged without further treatment and there is no evidence of recurrence to date.

The Level of Serum CEA Associated with Recurrence after Potentially Curative Surgery for Colorectal Cancer

PURPOSE: Carcinoembryonic antigen (CEA) is the most widely used tumor marker for detecting colorectal cancer. This study was designed to evaluate the level of serum CEA that is associated with recurrence after potentially curative surgery for colorectal cancer. METHODS: We retrospectively investigated the pre- and post-operative levels of serum CEA in 246 patients with colorectal cancer and they had undergone potentially curative surgery from 1996 through 2005. RESULTS: The pre-operative CEA level was significantly associated with the number of metastatic lymph nodes, the tumor size and the recurrence rate. The feature that was associated with recurrent disease on multivariate analysis was the pre-operative level of serum CEA. CONCLUSION: In order to detect the recurrence of colorectal cancer, we should closely follow up with frequent checks of the CEA level after surgery for those patients who had a high preoperative CEA level.

Acute Appendicitis in Children under Age of 5 Years

PURPOSE: Acute appendicitis is one of the most common causes of abdominal emergency. Children, under age of 5 years, are unable to give an accurate history, but other nonspecific abdominal pain is more common at this age. Because diagnosis is often delayed and progression of appendicitis is faster, incidence and perforation rate is higher than those of adults. Abdominal US and CT are helpful in diagnosis of acute appendicitis. METHODS: Between July, 1997 and April, 2004, 39 patients below 5-year-old were participated, but 2 (Negative) patients were excluded. This study was done retrospectively based on medical charts. For statistical analysis, Chi-squre test was used. RESULTS: All patients undergone emergency operations, in which male to female ratio was 1.79: 1, with its mean age of 4.05. 19 patients (49%) were perforated and fever developed more frequently in perforating group, but leukocytosis was not significant. Delayed preoperative duration was associated with perforation rate significantly. All complications were occurred in perforating group. CONCLUSION: To decrease perforation rate and complications, early diagnosis and management are necessary to avoid delaying preoperative time.

Treatment and Prognostic Factors for Traumatic Liver Injury

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.

Epigastric Hernia

An epigastric hernia is a protrusion of the extra-peritoneal fat to the linea alba, between the xiphoid process and the umbilicus. About 3~5% of people develop epigastric hernias. The authors have experienced a case of a 79 year-old woman who had an asymptomatic epigastric hernia, where an abdomen CT is helpful in its diagnosis. The size of the defect was large, and a hernia sac existed. The case of an epigastric hernia, which was treated by a primary repair, is reported, with a brief review of the literature.

Idiopathic Perforated Cecitis Mistaken as Perforated Appendicitis

The cecal perforation is very rare in pediatrics. Our center has experienced a 7-year-old girl with idiopathic perforated cecitis. The surgeon couldn't differentiate perforated cecitis from perforated appendicitis because of anatomical location, incidence and ambiguous radiologic result when this patient was admitted to our clinic due to RLQ pain.

Ganglioneuroma Arising from the Retroperitoneal Sympathetic Chains / 대한비뇨기과학회지

A ganglioneuroma is a rare benign tumor that originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. It is characterized histologically by the composition of mature ganglion cells and nerve fibers. Due to the slow growth of the tumor, it may be incidentally found or detected by the pressure effects on adjacent structures. Herein, a case of a ganglioneuroma arising from the retroperitoneal sympathetic chain is reported in a 45-year-old female patient with a review of the literature.

Intestinal Obstruction Due to Incarcerated Hernia at CAPD Catheter Insertion Site

Patients who have undergone peritoneal dialysis can frequently experience abdominal wall complications, such as hernia due to increased intraabdominal pressure and peritoneal leakage. However, no case of incarcerated abdominal wall hernia through catheter insertion site of CAPD has yet been reported Recently the authors experienced a case of intestinal obstruction due to an incarcerated hernia at the catheter insertion site of CAPD. We report this case and present a literature review.

Trocar(R)(Ethicon) Used Intraoperative Endoscopy in Acute Lower Gastrointestinal Bleeding

Occasionally it is difficult to preoperatively confirm the bleeding focus in acute lower gastrointestinal bleeding patients. Therefore, many diagnostic evaluations are needed - for example, colonoscopy, selective mesenteric angiography and Tc-99m RBC scintigraphy. However, if the bleeding focus remains unconfirmed preoperatively when the patient's state is unstable hemodynamically, the surgeon must inevitably perform exploratory laparotomy, followed by intraoperative endoscopy. We herein propose a new method of intraoperative endoscopy using Trocar(R) (Ethicon). Trocar(R) (Ethicon) was used in laparoscopic operation. This method has the merits of no air leakage, no contamination, fewer complicatons and ease of evaluation. We recommend that the use of Trocar(R) (Ethicon) in intraoperative endoscopy is essential in emergency operations for acute lower gastrointestinal bleeding.

Clinical Study of Ectopic Pregnancy / 대한산부인과학회잡지

No abstract available.

Effects of Nocodazole on Extracellular Matrix Proteins of Cancer Cell Lines / 대한해부학회지

Nocodazole is an anticancer agent, well-known for its antimetastatic activity that acts on microtubules, microfilaments and extracellular matrix proteins. Hela, Hep G2, A549, L929, and NIH/3T3 cell lines were cultivated in alpha-MEM with 3microM or 30microM nocodazole. To investigate the mechanism of nocodazole preventing tumor cell metastasis, the influences of nocodazole on the amounts of glycoprotein, fibronectin, laminin and actin were investigated using PAS staining and PAP technique at light microscopic level. Two designed models ; coverglass and 3-day-old rat heart fragments models, were used in observing the invasiveness of cancer cells. Partitularly the three-dimensional model coculturing cell lines and heart fragment was used in evaluating the migration and/or proliferation or the invasiveness of cell around the fragment, and observed under inverted or bright field light microscope. The amount of glycoprotein of all cell-lines increased in cells of groups treated with nocedazole for 1, 2 and 3 day. The amounts of fibronectin usually increased in cells of groups treated with nocodazole for 1, 2 and 3 day. The amounts of laminin increased in cells of groups treated with nocodazole. The amounts of actin usually increased in cells of groups treated with nocodazole for 1, 2 and 3 days. With the prolonging of nocodazole-treatment time in two dimensional model using coverglass, the cells of control group except Hep G2 cells formed monolayer in cell-free zone according to migration or proliferation of many cells. But only a few cells of experimental groups migrated or proliferated into cell-free zone. In rat heart fragment model the cells of control group showed the invasiveness into the fragment but few or none of the cells from experimental groups attached around the fragment. Taken together, nocodazole increased the synthesis of fibronectin and laminin in cells in place of depolymerizing microtubules. Therefore, the amounts of extracellular matrix proteins in the extracellular space increased. And the increase amounts of actin connected to the extracellular matrix proteins through the integrin of plasma membrane seemed to strengthen cell attachment because of accordance between the orientation of actin and extracellular matrix proteins. Since it is important for cancer cells` metastasis to secrete various enzymes to pass through extracellular matrix proteins, it is expected more difficult for the cells to metastasize into other regions due to the increase of extracellular matrix proteins. As a result of confirmation of antiinvasive actions using two kinds of model, nocodazole seems to be a valuable anti-metastatic agent by supressing the cell motility and consequently, the invasiveness into the fragment. Nocodazole at concentration of 3microM will be probably anticipated antimetastatic activity reflecting that the effects of nocodazole between 3microM and 30microM groups had no differences.