Expression of Hypoxia-inducible Factor-1alpha in Esophageal Squamous Cell Carcinoma: Relationship to Prognosis and Tumor Biomarkers / 대한흉부외과학회지

BACKGROUND: Tissue hypoxia is a characteristic of many human malignant neoplasms, and hypoxia inducible factor-1 (HIF-1) plays a pivotal role in essential adaptive response to hypoxia, and activates a signal pathway for the expression of the hypoxia-regulated genes, resulting in increased oxygen delivery or facilitating metabolic adaptation to hypoxia. Increased level of HIF-1alpha has been reported in many human malignancies, but in esophageal squamous cell carcinoma, the influence of HIF-1alpha on tumor biology, including neovascularization, is not still defined. MATERIAL AND METHOD: The influence of HIF-1alpha expression on angiogenic factors, correlation between the tumor proliferation and HIF-1alpha expression, interaction of HIF-1alpha expression and p53, and correlation between HIF-1alpha expression and clinicopathological prognostic parameters were investigated, using immunohistochemical stains for HIF-1alpha, VEGF, CD34, p53, and Ki-67 on 77 cases of resected esophageal squamous cell carcinoma. RESULT: HIF-1alpha expression in cancer cells was found in 33 of 77 esophageal squamous cell carcinoma cases. The 33 cases (42.9%) showed positive stain for HIF-1alpha. High HIF-1alpha expression was significantly associated with several pathological parameters, such as histologic grade (p=0.032), pathological TMN stage (p=0.002), the depth of tumor invasion (p=0.022), regional lymph node metastasis (p=0.002), distant metastasis (p=0.049), and lymphatic invasion (p=0.004). High HIF-1alpha expression had significant VEGF immunoreactivity (p=0.008) and Ki-67 labeling index (p<0.001), but was not correlated with microvascular density within tumors (p=0.088). The high HIF-1alpha expression was correlated with aberrant p53 accumulation with a marginal significance (p=0.056). The overall 5-year survival rate was 34.9%. The survival rate of patients with a high HIF-1alpha expression was worse than that of patients with low-expression tumors (log-rank test, p=0.0001). High HIF-1alpha expression was independent unfavorable factors although statistical significance is marginal in multivariate analysis. CONCLUSION: It is suggested that (1) high HIF-1alpha expression in esophageal squamous cell carcinoma is associated with tumor hypoxia, or with genetic alteration in early carcinogenesis and progressive stages, (2) high HIF-1alpha expression may be associated with intratumoral neovascularization through HIF-VEGF pathway, and (3) high HIF-1alpha expression is associated with poor prognosis in patients with esophageal squamous cell carcinoma and may play a role as biomarker for regional lymph node metastasis.

Treatment for the Femoral Shaft Fractures in Adolescents / 대한정형외과학회잡지

Treatment for the femoral shaft fractures in adolescents is somewhat controversial. These fractures have been treated nonoperatively, but adolescents tolerate prolonged immobilization less well than younger children and conservative treatment in this age group may result in more complicationssuch as malunion, shortening and angular deformities more often than those in the younger age group. Recently there has been a tendency to choose the operative method rather than traditional traction and casting technique for femoral shaft fractures in elderly children and adolescent The purpose of this study is to find better treatment for the femoral shaft fractures in adolescents. Fifty six femoral shaft fractures in 56 patients aged 10 to 14 years old were treated with traction followed by casting, open reduction and internal fixation with plate, closed intramedullary nailing, or external fixation using A-0 external fixator, and evaluated respectively for at least 1 year. External fixation may be benefit to patients with concomittant injuries and result in psychological settle down, early mobilization out of bed, short hospital stay, save of cost,and early return to daily living activities without any disadvantages such as malunion, leg length discrepancy or awareness of growing arrest in spite of negligible pin tract infection. Result of this study suggests that external fixation for the femoral shaft fractures may be an one of the attractive treatment option in adolescents.

Operative Treatment of Thoracolumbar Spine Fractures with AO Internal Fixator / 대한정형외과학회잡지

The AO internal fixation system(the Fixateur Interne) is effective in reducing and stablizing a variety of unstable thoracolumbar fracture patterns. It is relatively effective in decompressing the canal of retropulsed bony fragments associated with burst fracture. Sixty-Two patients with unstable thoracolumbar spine fractures were treated with the AO internal fixator. They were followed for an average of 21 months(range 15-29 months). A compartive radiographic analysis of kyphosis and vertebral height was made using pre-operative, post-operative and follow-up radiogram. Changes in neural canal compromise were measured in 18 cases of burst fractures. Failure of instrumentation occured in 9 cases which were carefully analyzed. Recently, we've constructed the system of which the Schanz screws would be directed divergently in sagittal plane in the hope that the load to the screws might be reduced, thus the failure rate.