Outcomes of Pancreas Transplantation: Single-Center Experience in Korea / 대한내과학회지

BACKGROUND/AIMS: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. METHODS: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. RESULTS: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. CONCLUSIONS: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes.

Following of the Omentum Preserving Gastrectomy for Advanced Gastric Cancer without Serosa Exposure

PURPOSE: The generally accepted standard surgery for advanced gastric cancer is gastrectomy with D2 dissection accompanied by omentectomy. Theoretically, advanced gastric cancer without serosa exposure cannot disseminate metastasis to the omentum. However, the significance of routine omentectomy in survival remains unproved. METHODS: From January 2000 to December 2002, 174 patients, who diagnosed T2 gastric adenocarcinoma pathologically, underwent curative gastrectomy by one operator. 52 patients underwent omentum-preserving gastrectomy and 122 patients underwent gastrectomy with resection of omentum. We compared clinicopathologic characteristics, recurrence patterns, recurrence rate and survival rates between the two groups. RESULTS: Five-year survival rate was 82.9% in the omentum-preserving group and 85.2% in the omentectomy group (P=0.729). Moreover, there was no significant difference in recurrence rate between the two groups (P=0.298). In the omentum-preserving group, 3 peritoneal (25%), 4 local (33.3%), 4 hematogenous (33.3%), 1 distant lymph node (8.3%) recurrences were shown. However, in the omentectomy group, 7 peritoneal (35%), 6 local (30%), 6 hematogenous (30%), 1 distant lymph node (5%) recurrences were shown (P=0.935). CONCLUSION: These results suggest that the omentum-preserving gastrectomy may be applicable to advanced gastric cancer without serosa exposure, and that it is not necessary to perform uniform omentectomy for all advanced gastric cancer.

Comparative Analysis of Laparoscopy-assisted Gastrectomy versus Open Gastrectomy

PURPOSE: There has been increased the number of early gastric cancer and laparoscopy-assisted gastrectomy (LAG), due to early detection through mass screening program. We started the LAG in April 2004 and performed 119 cases of gastric cancer in 2005, so we report a surgical outcome compared with that of open gastrectomy (OG). MATERIALS AND METHODS: 119 patients underwent LAG in 2005, and for open group, 126 patiens of early gastric cancer were selected sequentially from January 2005 to March 2005. We compared clinicopathologic characteristics, postoperative courses and complications between two groups. RESULTS: There was no significant difference between age, a length of hospital stay, distal resection margin and a number of retrived lymph nodes. The operation time was longer in LAG group (239.2 vs 123.3 mins, P < 0.001) and a diet progression was faster in LAG group (first flatus: 3.05 vs 3.70 days, SOW: 2.86 vs 3.22 days, liquid diet: 3.87 vs 4.19 days ,soft diet: 4.84 vs 5.26 days, P < 0.001). But there was no difference statistically in postoperative discharge date (7.73 vs 8.25 days, P=0.229). The additional requirement of analgesic injection was less frequent in LAG group (2.97 vs 4.92 times, P < 0.001). The harvested lymph nodes were similar in both groups (23.9 vs 23.1, P=0.563). A complication rate was lower in LAG group (4.9% vs 9.5%), but there was no statistical significance (P=0.179). There was no mortality in both groups and no conversion to open gastrectomy in the LAG group. CONCLUSION: LAG can be performed safely and accepted in view of curative procedure in treatment of early gastric cancer. But we need the follow up of long-term period to evaluate the survival rate and recurrence, and a prospective randomized controlled study should be done to establish that LAG will be a standard operation for early gastric cancer.

Indication of Dissection of the 14v Lymph Node in Advanced Distal Gastric Cancer

PURPOSE: According to the 2nd English Edition of the Japanese Gastric Cancer Association (JGCA) in 1998, in case of distal gastric cancer, the 14v (superior mesenteric vein) lymph node (LN) is included in the N2 group. However, in Korea, a modified radical gastrectomy is performed, and a 14v LN dissection is not done as a routine procedure. Thus, we investigated the rate of metastatic 14v LNs, evaluated the necessity of dissection of the 14v LN, and searched for indications of 14v LN dissection. MATERIALS AND METHODS: From April 2004 to August 2005, we enrolled the patients who were diagnosed as having advanced gastric cancer in the distal third portion of the stomach. We performed a distal gastrectomy with D2 lymph node dissection as defined in the 2nd English edition of the JGCA classification. We calculated the positive rate of metastatic LNs of each station and analyzed the relationship between the positive rates of No.6 LNs and 14v LNs. We also compared the positive 14v LN group with the negative 14v LN group. RESULTS: The total number of patients was 50, the mean age was 56 (range 30~80) years, and sex ratio (Male/Female) was 1.63 : 1. In 47 (94%) cases, distal a gastrectomy with gastroduodenostomy was done, and in the remaining 3 (6%) cases, a distal gastrectomy with gastrojejunostomy was done. The most frequently metastatic LNs were nos. 3 and 6 (54%). The metastatic rate of the 14v LN was 10%, which was similar to that of LN no. 9. In the comparison of the 14v positive group with the 14v negative group, there were significant differences in the numbers of metastatic LNs (mean 25.4 vs 4.91, P<0.001) and the numbers of metastatic no. 6 LNs, (mean 6.8 vs 1.42, P<0.001), and if no. 6 LNs were metastatic, the possibility of metastasis to the 14v LN was 19.2%. In the 14v positive group, all cases were more than stage 3 by the UICC 6th edition. CONCLUSION: In cases of advanced cancer with metastasis to the no. 6 LN, there was a good chance of metastasis to the 14v LN. Thus, in the operative field, if the tumor is advanced to more than stage 3 by the UICC classification and the no. 6 LN is metastatic, a 14v LN dissection is necessary. However, the usefulness of a 14v LN dissection should be evaluated prospectively through an analysis of tumor recurrence and long-term survival.

Learning Curve of a Laparoscopy Assisted Distal Gastrectomy for a Surgeon Expert in Performing a Conventional Open Gastrectomy

PURPOSE: The laparoscopy assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, expert surgeons, who have performed a conventional open gastrectomy for a long time, tend to have a negative attitude toward laparoscopic procedures. The aim of this study was to determine the learning curve of a laparoscopy assisted distal gastrectomy (LADG) for a surgeon expert in performing an open gastrectomy and to analyze the factors that have an effect on a LADG. MATERIALS AND METHODS: Between April 2005 and March 2006, 62 patients underwent a LADG with D1+beta lymph-node dissection. The 62 patients were divided into 10 sequential groups with 6 cases in each group (the last group was 8 cases), and the time required to reach the plateau of the learning curve was determined by examining the average operative times of these 10 groups. Other factors, such as sex, BMI, complications, transfusion requirements, the number of retrieved lymph nodes, and change of postoperative hemoglobin level, were also analyzed. RESULTS: With the 5th group (after 30 cases), the operative time reached a plateau (average: 170 min/operation). The differences between before the 30th case and after the 31st case with respect to changes in the postoperative hemoglobin level, the number of retrieved lymph nodes, the transfusion requirements, and the complications rate were not significant. CONCLUSION: According to an analysis of the operative time, experience with 30 LADGs in patients with early gastric cancer is the point at which the plateau of the learning curve (7 months) is reached. Abundant experience with a conventional open gastrectomy and a well-organized laparoscopic surgery team are important factors in overcoming the learning curve earlier.

Prognostic Significance of Group 2 Lymph Node Metastasis in pT3pN1 Gastric Cancer Patients

PURPOSE: The most important prognostic factors in gastric cancer is the depth of invasion of the primary tumor and lymph node metastasis. The nodal staging of the 5th edition of the Union Internationale Contrala Cancrums (UICC) TNM classification in 1997 was changed based on the number of metastatic lymph node. We attempted to evaluate the prognostic significance of N2 group metastasis in pT3pN1 gastric cancer patients by comparing two different nodal staging systems. MATERIALS AND METHODS: A retrospective analysis was made for 352 gastric cancer patients who underwent curative resection, including D2 dissection, from 1991 to 1997 at Asan Medical Center. A clinicopathologic comparison between two groups by using a nodal staging systems was summarized into a table. Cumulative survival rates were calculated by using the Kaplan-Meier method. The difference between the two groups was evaluated by using the log rank test with SPSS 11.5 for Windows RESULTS: There were no statistical differences in clinicopathologic factors. However, there was a significant difference in survival rate between the two groups (P=0.0009). This suggests that N2 group metastasis in pT3pN1 gastric cancer patients has a clinical significance for predicting prognosis. CONCLUSION: Our results suggest a possibility of prognostic significance of N2 group metastasis. Therefore, anatomical location of the lymph node should be described.

Prospective Randomized Trial for Postoperative Adjuvant Chemotherapy in Gastric Cancer without Serosal Invasion: Final Report

PUPOSE: We reported our preliminary result in 2001. At that time, the follow-up period was too short to evaluate the survival benefit of adjuvant chemotherapy in gastric cancer without serosal invasion. Therefore, we followed those patients for 66 months to determine the long-term effects of adjuvant chemotherapy. MATERIALS AND METHODS: We analyzed the recurrence pattern, the survival rate, and the disease-specific survival of 135 patients by reviewing their medical records and calling the patients or their relatives. All enrolled patients were included in the intention-to-treat analysis of efficacy. RESULTS: The follow-up rate was 89.6% (121/135), and the median follow-up duration was 66 months. Among the 135 patients, 4 relapsed in group 1 (5-FU cisplatin), 7 in group 2 (mitomycin C oral 5-FU), and 6 in group 3 (oral 5-FU only). The overall survival rate was 89% in group 1, 84% in group 2, and 82% in group 3. There were no differences in the overall survival rates and the disease-specific survival rates among the three groups. CONCLUSION: Oral chemotherapeutic agents have an acceptable effect for adjuvant chemotherapy compared with intravenous agent. However, a large-scale, prospective, randomized study, including a control group, is needed for an exact evaluation.

Expression of a Novel 90 kDa Heat Shock Protein in Colorectal Tumor

PURPOSE: When cells are subjected to a wide variety of stressful stimuli, they respond by increasing the synthesis of specific stress proteins. Stresses include heat shock, nutrient deprivation, oxygen radicals, toxic metal and viral infection. Major stress proteins are Hsp 27, Hsp 60, Hsp 70 (9), Hsp 90 (3) and Hsp 100 (1). Previously a novel 90 kDa stress protein has been reported to be induced in fish cells by virus infection. The novel 90 kDa stress protein is different from well-known major stress protein in size, antigenicity, cellular localization. The novel 90 kDa stress protein was found to be present in various kinds of cells including human cells and its expression was increased in human carcinomas. The purpose of this study is to evaluate the expression of the novel 90 kDa stress protein in human colonic mucosa of normal tissue, adenoma and adenocarcinoma using immunohistochemical method. METHODS: 85 colon tissues were screened for the expression of the novel 90 kDa stress protein; 85 normal colonic mucosa, 20 colonic adenoma and 65 colonic adenocarcinoma. The tissues were stained with monoclonal antibody against the novel 90 kDa stress protein. In scoring system, tissue sections with immunostained area above 10 % were decided to be positive and, among the positive, the tissue sections were divided into three score, 1, 2, and 3, based on the staining intensity and positive area proportion. The tissue sections with immunostained area below 10% were decided to be negative and grouped into 0 score. Correlation of immunohistochemical expression was analysed by using SPSS version 10.0 statistically. RESULTS: The expression of the 90 kDa stress protein was significantly different among normal colonic mucosa, colonic adenoma, and colonic adenocarcinoma and the percentage of positive samples were 14.1%, 80.5%, and 95.4% respectively. This result suggests that the expression level of the novel 90 kDa stress protein was extremely low in normal tissue but increased significantly in adenocarcinomatous tissues. CONCLUSIONS: The expression of the novel 90 kDa stress protein was increased significantly with transformation of the normal colon tissue to malignancy. This suggests the possibility that this novel 90 kDa stress protein play some role in cancerous transformation of colon tissue.

Study of Capsaicin-induced Apoptosis in Human Colon Cancer Cell Lines

PURPOSE: Numerous investigations have been conducted in order to determine the potential carcinogenic or chemopreventive activity of capsaicin. The aim of this study is to characterize the effects of capsaicin on colon cancer cells, and provide valuable information concerning the application of capsaicin in chemoprevention as well as for therapeutic purposes. METHODS: CoLo320DM and LoVo cells (human colon cancer cell line) were treated with capsaicin. In order to access cell viability and altered morphology, an MTT assay was performed and the cells were microscopically examined. Decreasing DNA staining was accessed by FACS. The cells were stained with FITC labeled annexin V and analyzed by FACS to detect cellular membrane alteration during apoptosis. The cells were stained with DiOC6(3) and Hydroethidine and analyzed by FACS in order to access ROS and dleta psi m. RESULTS: Capsaicin decreased cell viability in a dose-dependent manner. Capsaicin produced a cell morphology corresponding to the apoptotic features including cell shrinkage and chromatic condensation. Capsaicin treated cells induced a loss of nuclear DNA leading to hypoploidy in a dose-dependent manner. Cells were excluded by double staining with PI and FITC labeled annexin v and detected by FACS. We show that treatment of CoLo320DM, L0Vo cells with increasing concentrations of capsaicin parallel an increase in the percentage of red fluorescent cells (HE-->Eth) that reflect ROS hypergeneration and a decrease in the percentage of green fluorescent cells that reflect delta psi m disruption. CONCLUSION: These results clearly demonstrate that capsaicin-induced colon cancer cell death is apoptotic.

A Case of Small Bowel Obstruction Caused by Cytomegalovirus Infection

The human cytomegalovirus (CMV), a member of the herpes virus family, can cause a lifelong infection with episodes of endogenous reactivation. Almost the entire adult Korean population has been infected with CMV; they have serum CMV antibodies of IgG class. Reactivation is clinically silent in immunocompetent individuals. Symptomatic illness, such as pneumonitis, retinitis, hepatitis or gastroenteritis, is usually confined to immunocompromized patients. The colon, stomach and esophagus are the organs frequently infected with CMV in these patients. A CMV infection may also complicate an inflammatory bowel disease. CMV enteritis involving the small bowel, which makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation, but rarely evokes obstruction. The authors experienced a case of CMV enteritis of the terminal ileum, presenting as an intestinal obstruction, which developed in an immunocompetent individual with no underlying disease. This appears to be a world first.

The Cold Preservation of Mice Hepatocytes Induces Apoptosis but Not over Expression of MHC Class I Antigen / 대한이식학회지

Hepatocyte transplantation is a potential treatment modality for liver diseased patients. Purified hepatocytes stimulates allospecific cytotoxicity by expressing the MHC class I antigen. Also, during cold preservation, hepatocytes are damaged by lipid peroxidation with oxygen free radicals, which may induce apoptosis on cold preserved hepatocyte. For measuring the degree of antigenicity on cold- preserved mice hepatocytes with UW solution, we studied the expression of MHC class I antigen in various time period by FACS and RT-PCR. For analysis of apoptotic hepatocyte death, we studied morphological changes and DNA fragmentation. We used flow cytometry techniques with rhodamine 123,3,3'-dihexiloxadicarbocyanine (DiOC6 (3)) and propidium iodide (PI). DiOC6 (3) is mitochondrial probe to measure the mitochondrial transmembrane potential that drops early in apoptosis. The percentage of cells undergoing chromatinolysis (subdiploid cells) was determined by ethanol fixation followed by RNA digestion and PI staining. The cold preserved hepatocytes expressed MHC class I constitutively, but revealed no significant differences among various preservation period. However, apoptosis of hepatocytes occured progressively during cold preservation. These results provides that the cold preservation of mice hepatocyte induces apoptosis with involvement of an oxidative process, but does not stimulate over expression of MHC class I antigen.

Comparative Analysis of Three Subgroups in Stage II Stomach Cancer

PURPOSE: Three subgroups of stage II stomach cancer (T1N2M0, T2N1M0, T3N0M0) by UICC-TNM staging system show obvious survival difference to each other, which becomes the pitfall of the current staging system. We analyzed the survival and relapse pattern of stage II stomach cancer patients in three subgroups retrospectively to prove the need for change in staging system. MATENRIALS AND METHODS: From July 1989 to December 1995, curative gastric resection was performed in 1,037 patients with gastric adenocarcinoma, and among them 268 patients (26%) were in stage II. The number in each of subgroups (T1N2M0, T2N1M0, and T3N0M0) were 17, 139 and 112 respectively. Survival and relapse pattern were analyzed and median follow up period was 46 months. RESULTS: The 3-year cumulative survival rates of T1N2M0, T2N1M0, and T3N0M0 were 50%, 80%, and 76% respectively (p=0.001). And the 3-year cumulative survival rates of T1N2M0 was comparable to those of 2 subgroups of stage IIIa (T2N2M0, T3N1M0), 47% and 45% (p>0.05). Peritoneal recurrence was the most frequent in T3N0M0. And hematogenous spread was more frequent in T2N1M0 while nodal spread was more frequent in T1N2M0. Ten out of 17 cases of T1N2M0 died of recurrence. Most of them showed submucosal tumor with depressed lesion and mean tumor size was 3.3 cm. CONCLUSION: Up-staging of T1N2M0 should be considered because it has the lowest survival rate and the worst prognosis among the three subgroups of Stage II stomach cancer patients. In early gastric cancer patients with high-risk factors (large tumor size, invasion into the submucosal layer, and lymphatic vessel involvement), lymph node dissection and postoperative adjuvant therapy is recommended in an attempt to prevent recurrence in the form of lymph node metastasis.

Clinical Analysis of Post-operative Complications in Gastric Tumors

PURPOSE: The incidence of complications after gastric tumor surgery has been decreasing, because of properly chosen and improved surgical techniques and procedures. But the incidence of several complications that result in relatively high mortality remains stubbornly high. To predict and prevent postoperative complications in gastric tumor treatment, we retrospectively analyzed gastric tumor patients who underwent elective gastrectomy. METHODS: This is a retrospectively study of 1,028 patients with gastric tumor who underwent elective surgery at the Department of Surgery, Ulsan University College of Medicine and Asan Medical Center between January 1999 and December 1999. Non-curative surgery was defined in cases of peritoneal seeding, distant lymph node metastasis and residual tumor in the resection margin. RESULTS: There were no significant differences in age, hemoglobin, albumin, operation time, extent of lymph node dissection, surgical procedure or stage (P>0.05). The complication rate after non-curative resection was higher (11.7%) than that for curative resection (5.9%) (P<0.05). The complication rate was higher (12.3%) in patients who had combined diseases than in those who did not (4.9%) (P<0.05), and was higher (13.2%) in patients who underwent combined resection than in those who did not (5.0%) (P<0.05). CONCLUSION: In patients who had combined diseases and underwent combined resection, the complication rate was significantly higher. But, if more attentive preoperative evaluation and intraoperative caution are exercised in patients who exhibit preoperative risk factors, the incidence of post operative complication is expected to diminish.

Value of Hepatoduodenal Ligament and Retropancreatic Lymph Node Dissection (D2+alpha) in Gastric Cancer Surgery

PURPOSE: Obstructive jaundice is a rare presentation in patients undergoing curative gastrectomy for gastric cancer. It is most commonly caused by lymphatic metastasis in the lymph nodes around the head of the pancreas and hepatoduodenal ligament, especially when advanced gastric cancer is located in the pyloric antrum. This incidence suggests that extended and systemic lymph node dissection maybe reduce the risk of the development of obstructive jaundice after gastrectomy. In this study we tried to evaluate the effectiveness of D2+alpha lymph node dissection in preventing obstructive jaundice during gastric cancer treatment. METHODS: Twenty-four patients who underwent D2+alpha lymph node dissection in the course of gastric cancer treatment at Asan Medical Center between June 1995 and May 1997 were retrospectively analyzed on the basis of medical records. The mean age of the patients was 54 years, and the male to female ratio was 3.9: 1. RESULTS: Four patients (16.6%) developed complications (Ed-perhaps you wish to insert here, "other than tumor recurrence") but these were not serious. Tumor recurrence developed in 11 patients, and obstructive jaundice was revealed in one (4.1%) of these. All recurrent patients were more than stage III (Ed-confirming that this means stage 4 or more) with the most common recurrence site being the peritoneum (72.7%). The mean duration from operation to recurrence and from recurrence to death was 13.9 months and 7.9 months, respectively. CONCLUSION: It is possible (Ed- or slightly stronger, "It is apparent") that D2+alpha dissection provides no benefit in preventing obstructive jaundice, compared with other reports (Ed- i.e. 'in comparison with other studies'. I wonder if you don't intend, "compared with the efficacy of other treatment modalities"), and that the most common site of recurrence was the peritoneum.

Prospective Randomized Trial for Postoperative Adjuvant Chemotherapy in Gastric Cancer Patients without Serosal Invasion: Preliminary Report

PURPOSE: We have carried out prospective randomized clinical trial to compare survival benefit and side effect among three postoperative adjuvant chemotherapeutic regimens in serosa-negative gastric cancer patients. MATENRIALS AND METHODS: Total 317 cases were recognized as serosa negative and randomized into three groups at operating room. Out of them, 172 cases were excluded because of various reasons and 135 cases were analyzed finally; Group A 36 cases, Group B 49 cases, Group C 50 cases. Group A were treated with intravenous FP combination therapy, group B with MF combination therapy and group C with oral UFT(R) (mixture of Tegafur and Uracil) for one year. The median follow-up period was 30 months. RESULTS: 88.9% of Group A, 83.7% of Group B and 90.4% of Group C received adequate chemotherapy. The complication rates of Group A (44.4%) was significantly higher than group B (20.4%) and group C (24.0%)(P0.05). CONCLUSION: This study might suggest that the survival benefit of postoperative adjuvant chemotherapy for gastric Pseudomonas aeruginosa, and therefore it may be a useful adjunct tool for detection of Pseudomonas aeruginosa infection in combination with other conventional techniques.

Parathyroid Glands Location, vascular supply and preservation during a total thyroidectomy

BACKGROUND: It is well known that the inferior parathyroids are more difficult to preserved than the superior parathyroid glands because the inferior parathyroid glands have more anatomical variations. METHODS: The authors analysed the gross surgical findings of a total of 411 inferior parathyroid glands in 314 total thyroidectomy cases. The inferior parathyroid glands were grouped according to patterns based on their location and arterial blood supply. RESULTS: Type 1 (location: posterior surface of the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 51% and presevation rate 62%. Type 2 (location: thyrothymic ligament or in the thymus; artery: inferior branch of the inferior thyroid artery): incidence 27% and preservation rate 86%. Type 3 (location: apart from the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 6.1% and preservation rate 92%. Type 4 (location: anteriorly on the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 4.1% and preservation rate 33%. Type 5 (location: lower thyroid pole; artery: comes out from the thyroid gland): incidence 4.1% and preservation rate 0%. Type 6 (location: lower thyroid pole; artery: branch of the superior thyroid artery): incidence 3.6% and preservation rate 80%. Type 7 (location: lower thyroid pole; artery: embedded in the thyroid gland): incidence 2.9% and preservation rate 36%. Type 8 (location: more superior than usual; artery: superior branch of the inferior thyroid artery): incidence 0.7% and preservation rate 67%. Type 9 (location: lower thyroid pole; artery: thyroid ima artery): incidence 0.5% and preservation rate 100%. CONCLUSIONS: The most identified inferior parathyroids belonged to the usual types, and their pre-servation rate were relatively high. However there were some unusual types though their incidence was low. Thus, accurate anatomical knowledge of variations in the location and the blood supply of the inferior parathyroids is needed to enhance the preservation rate.

Estrogen Receptor Analysis on Fine Needle Aspirates and Biopsies from Palpable Breast Carcinoma

The estrogen hormone receptor (ER) content of human breast cancer has assumed an important role as a predictor of hormone therapy response and as a prognostic indicator. The conventional technique is the dextran-coated charcoal (DCC) method or a ligand-binding assay (LBA) based on the measurement of radiolabeled steroids in cytosolic extracts of tissue homogenate. The recent introduction of monoclonal antibodies with high specificity for human ERs has allowed the application of immunocytochemical assays (ICA) in human cancer tissue. An extension of the ICA technique to cytologic specimens is also widely used. Our aim was to evaluate the reliability of ER-ICAs on fine needle aspirates(FNA) from breast cancer patients by comparing it with ER-ICAs and ER-LBAs performed on surgically removed tissues. During a recent 6-month period, ER-ICAs and ER-LBAs were performed in 83 cases. Among these 83 cases, only the 40 cases for which the ER-ICA and the ER-LBA were performed simultaneously ere included in this study. As positive cutoff values, we assumed 10 fmol/mg protein for the ER-LBAs and a semiquantitative score of 4 for the ER-ICAs. The results were as follows : 1) The ER positive rate was 55% (22/40) for ICAs and 47.5% (19/40) for LBAs. The concordance rate between the ER of ICAs and that of LBAs was 82.5% (33/40). 2) The Pearson correlation coefficient between ER-ICAs of fine needle aspirates and that of surgically removed tissue was good (r=0.94, p<0.005) 3) The Spearman correlation coefficient between ER-ICAs of fine needle aspirates and ER-LBAs of surgically removed tissue was good (r=0.57, p=0.0001) In conclusion, ER determination by using the fine needle aspirate is a reliable method in palpable breast cancer. FNA-ER may be a useful method when it is difficult to take sufficient breast cancer tissue, i.e., in cases of diffusely recurrent cancer, liver metastasis, malignant pleural effusion, etc.

Effectiveness of Gastric Resection in Stage IV Gastric Cancer with Hepatic Metastasis, Peritoneal Seeding, or Distant Lymph Node Metastasis

BACKGROUND : The prognosis for patienys with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis, peritoneal seeding, or distant lymph-node metastasis. METHODS : A retrospective analysis of 114 gastric cancer patients who had undergone a gastric resection, in spite of distant metastasis, between May 1989 and March 1998 at the Department of Surgery, College of Medicine, University of Ulsan, was performed. RESULTS : The average age was 53 years old, and male-to-female ratio was 73 : 41. A total gastrectomy was performed in 48 cases and a distal gastrectomy in 66 cases. Lymph-node dissection was performed to D0, D1, and D2 in 42, 37, and 35 cases, respectively. Postoperative adjuvant chemotherapy was done, mainly by 5-FU and cisplatin. The complication rate was low. The median follow- up was 19 months. The overall average survival times of all patients was 25 months, and the average survival time of patients with hepatic metastasis, peritoneal seeding, and distant lymph-node metastasis, were 28 months, 21 months, and 34 months, respectively. However, there were no statistically significant differences between these survival times. There were six long-term survivors, more than 3 years. The causes of death, in descending order, were renal failure, intestinal obstruction due to peritoneal seeding, hepatic failure due to hepatic metastasis and pneumonia, and sepsis due to lung metastasis. CONCLUSIONS : An aggressive gastric resection for stage IV gastric cancer with hepatic or distant lymph-node metastasis and peritoneal seeding might be useful to lengthen the survival period. A prospective study is needed, especially one with an exact evaluation and analysis of the quality of life.

Clinical Analysis for Lymph Node Metastasis as a Guide to Modified Surgery for Early Gastric Cancer

The authors have analyzed the clinicopathologic data of 855 patients with early gastric cancer (EGC) who underwent D2 lymph node dissection during the 7-year period between January 1990 and December 1996 in order to evaluate the factors influencing lymph node metastasis and to establish the clinical indications and guidelines for modified surgery in EGC patients. The overall rate of lymph node metastasis was 13.5% (115/855). There was a significant statistical difference for lymph node metastasis between men (67/575, 11.7%) and women (48/280, 17.1%)(p<0.05). In mucosal cancer, the rate of lymph node metastasis was 4.7% (20/427), and in submucosal cancer, it was 22.2% (95/428), which is a significant difference between the two groups. There was also a significant difference for lymph node metastasis between the elevated types (EGC type I and IIa) and the depressed types (type IIb, IIc, and III), 8.4% (13/154) and 14.6% (102/701), respectively (p=0.05). There were only one lymph node positive case (1/82, 1.2%) among the elevated mucosal cancers. Smaller tumors((10 mm) showed a significantly lower incidence of lymph node metastasis than larger tumors (11 mm)(p<0.01); 4 cases invoving tumors of less than 11 mm had lymph node metastasis(2 mucosal and 2 submucosal lesions). Differentiated mucosal carcinomas showed a significantly lower incidence of lymph node metastasis than undifferentiated carcinomas (0.9% vs 8.5%, p<0.001), whereas there was no significant difference between differentiated and undifferentiated submucosal cancers. There were 14 cases of EGC with metastasis in the secondary lymph node group (N2) consisting of 5 men and 9 women, with a mean age of 53 years. Among them, the 7 cases under the age of 50 were all female patients. For thses 14 case, the average tumor size was 34 mm (15~90 mm), and the majority of were depressed types (11 cases) and undifferentiated type (12 cases). These results suggest that modified surgery is indicated as an optimal treatment option for mucosal cancer with elevated and/or differentiated type tumors, on the basis of not only radicality but also postoperative quality of life.

Genomic Identification of N-Trminal Domail Exons of Carcinoembryonic Antigen in Human Colon Carcinoma / 대한암학회지

No abstract available.