Analysis of the Importance of Sacroiliac Joint Fractures as a Prognostic Factor of the Patients with Pelvic Fractures

PURPOSE@#The diagnosis of pelvic fractures pattern has become to be essential in the decision making of treatment modality and reducing morbidity and mortality in multiple trauma patients. Sacroiliac joint (SIJ) disruption can cause life-threatening massive arterial bleeding. This study aimed to determine a method of predicting the prognosis and treatment direction with pelvis X-ray alone in the emergency room. We investigated whether SIJ disruption can be used alone as a poor prognostic factor.@*METHODS@#We analyzed the medical records and radiologic examination results of 167 patients with pelvic fractures from January 1, 2015 to December 31, 2016 retrospectively. Patients with pathologic fractures, thoraco-abdominal bleeding, and acetabulum fractures and pediatric patients (n=63) were excluded. Factors related to the clinical manifestations and treatments, such as transfusion and surgery, were statistically compared.@*RESULTS@#The cross-sectional analysis showed that there was no correlation between SIJ injury and sex; there were statistically significant relationships between occurrences of shock, conjoined fractures, transfusion, and surgeries. The hospitalization period and partial thromboplastin time and prothrombin time values increased. The logistic regression analysis showed that when an SIJ injury occurred, blood transfusion and hypotension possibilities increased.@*CONCLUSION@#When pelvic fractures occur near the SIJ, blood transfusion and shock possibilities increase. Physicians must be aware of the high severity and poor prognosis of such fractures when these are diagnosed in the emergency room. And furthermore, the physician has to predict and prepare the intensive care and multidisciplinary approaches.

Analysis of Clinical Features and Factors Predictive of Malignancy in Intraductal Papillary Mucinous Tumor of the Pancreas: Multi-center Analysis in Korea / 한국간담췌외과학회지

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.

Significance of Thymidylate Synthase Expression in Colorectal Cancer

PURPOSE: Thymidylate synthase (TS) is the target enzyme for 5-fluorouracil (5-FU). It is known that TS is related to response, and resistance, following chemotherapy due to colorectal cancer. The object of this study was to identify the clinical significance of TS as a prognostic factor, and its influence on 5-FU based chemotherapy in colorectal cancer. METHODS: We performed a retrospective study on 105 consecutive patients who were operated on, at the Department of Surgery, Korea University, College of Medicine, for colorectal cancer between Jan. 1994 and Dec. 1995. We used formalin fixed, paraffin embedded tissues of resected specimens for our study. For the semi-quantitative study, the specific monoclonal antibody, TS106, was used for immunohistochemical staining. Interpretation of the immunohistochemical staining, for intratumoral TS expression, was divided into 4 grades: intensity 0, 1 , 2 , 3 were defined as, a total absence of TS immuno staining, less than 25%, 25~50% and more than 50%, of tumor staining positive, respectively. Grades 0, 1 , and 2 were regarded as low TS expression groups and 3 regarded as a high TS expression group. We then analyzed 5-year survival rates, according to Dukes' stage, and whether systemic chemotherapy was performed, or not, according to TS expression. RESULTS: Of the 105 patients, 91 (86.7%) showed TS expression, 21 (20%) with high TS expression and 84 (80%) were low TS expression. As Dukes' stage advanced, the incidence of high expression of TS increased (P=0.048). In Dukes' stage B2, 5-year survival rates for the low TS expressed group was better than for the high TS expressed group (P=0.0052). In patients who received postoperative chemotherapy, 5-year survival rates for the low TS expressed group were better than for the high TS expressed group (P=0.049). CONCLUSION: These data suggest the expression of intratumoral TS, studied by immunohistochemical staining, is relevant to the prognosis of colorectal cancer, especially Dukes' stage B2. It is also related to the response rate of 5-FU based systemic chemotherapy in colorectal cancer.

Genetic Instability and Microsatellite Alterations of Chromosome 5, 8, 13, 17 in Hepatocellular Carcinoma

PURPOSE: Neoplastic development is a multistep process that involves the accumulation of genetic alterations in proto- oncogenes, DNA repair genes, and tumor suppressor genes. Molecular studies in carcinoma have shown the high frequency of loss of heterozygosity (LOH) in some specific chromosome regions, but LOH on the HCC chromosome has not been thoroughly investigated in Korea. LOH is considered to be phenotypes of genomic instability. We investigated the genetic instability and microsatellite alterations of chromosome 5, 8, 13 and 17 in hepatocellular carcinoma (HCC). METHODS: Microsatellite alteration analysis was performed using polymerase chain reaction with 12 polymorphic microsatellite markers (BAT26, D5S123, D5S346, D8S254, D8S261, D8S262, D13S153, D13S159, D13S171, D17S250, D17S796, TP53) in 37 surgically resected HCCs and their respective non-tumorous counterparts. Pairs of tumorous part and normal tissue in the same patient were compared and then the size of microsatellite markers was measured. RESULTS: MSI was detected in 3 samples and LOH was detected in 51 samples of 37 cases. Fractional allelic loss (FAL) was above 0.2 in 10 cases and was correlate with high grade of HCC. we could detect only 1 case of LOH in D8S254 marker, which was advanced cancer. Markers D5S123 and D5S346 showed 2 and 3 cases of LOH, respectively. Markers D8S262, D17S250 and D17S796 had LOH and were significantly correlated with tumor grade. CONCLUSION: According to the results, our data revealed that specific LOH, rather than MSI, may be involved in hepatocarcinogenesis. LOH may be a useful tool for following HCC patients because the high frequency of LOH correlates with poor prognosis of HCC.

Clinical Analysis of Biliary Drainage effect on outcome after Pancreaticoduodenectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Pancreaticoduodenectomy is accompanied by considerable rates of postoperative complications and mortalities. Obstructive jaundice is associated with periampullary lesions. The role of preoperative biliary drainage in patients with biliary obstruction undergoing pancreaticoduodenectomy remains controversial. Some authors show the disadvantages of biliary drainage that increased perioperative infectious complications. We analyzed retrospectively the effect of biliary drainage on pancreaticoduodenectomy and surgical outcome. METHODS: One hundred ten consecutive cases of pancreaticoduodenectomy performed between March 1992 and December 2000 were analyzed. We classified Group A as the patients who performed preoperative biliary drainage and Group B as the patients who did not perform biliary drainage. Multiple preoperative, intraoperative, postoperative variables were examined. Student's T-test, chisquare test or Fisher's Exact test was used for univariate comparison of all variables. RESULTS: Preoperative Biliary drainage was performed in 52 patients (47%) and the remaining 58 patients (53%) did not undergo any form of biliary drainages. The overall morbidity and mortality was 37% and 1.8% each. Total Bilirubin was higher in Group A (13.15 mg/dl) than Group B (4.11 mg/dl) (P=0.000). In Group A complication occurred in 21 patients and 20 patients in Group B (P=0.561). No differences were found between Group A and Group B in the incidence of all complications. More transfusion was needed for Group A (P=0.043). Postoperative hospital stay presented no differences (P=0.375). CONCLUSIONS: Biliary drainage is not required in patients who are planed pancreaticoduodenectomy except that the patient had cholangitis or bleeding tendency due to jaundice and hepatic derangements. The biliary drainage should be reserved for the potential for delay in definitive surgery. And it demands randomized prospective study in the future.

Surgical experiences of Ectopic Liver and Accessory Liver Lobe casese / 한국간담췌외과학회지

PURPOSE: The case of ectopic liver and accessory liver lobe have been rarely reported. A hepatic rudiment appears in the ventral angle between the foregut and the yolk sac; pars hepatica and pars cystica. The close connection between them explains accessory lobe on the Gall bladder surface wall. And the displacement of migration of a portion of the pars hepatica explains the ectopic liver. Difference between ectopic liver and accessory liver lobe can be defined whether the connection with hepatic proper exists or not. But, the definite discrimination of the type is very difficult clinically. Recently, we experienced cases of ectopic liver and accessory liver. CASES: In one patient, 43-year-old woman was referred to our department with left upper quadrant abdominal pain. Abdominal sonogram revealed a mass below the diaphragm attached to the superior pole of the spleen. On the operation, tumor mass was reddish gray colored and measured 10 7 3 cm. There were no direct connections with the liver proper except fibrous tissue, and its blood supply was considered from the left diaphragm. The pathologic result proved hepatocellular carcinoma(HCC). In the other patient, a 68-year-old woman complained right upper quadrant abdominal pain and was diagnosed as chronic cholecystitis on sonogram. During the laparoscopic cholecystectomy, a small bean sized mass, appearing as liver tissue, attached GB body portion was detected. The Mass was measured 1.0 1.0 3.0 cm in size and glistening dark brown colored, smooth surfaced. Streaky stalk connected with liver proper was visible. Pathologic finding confirmed the mass as an accessory liver. Both patients discharged without complications. DISCUSSION: Although the clinical problems are rare in the ectopic liver, it has been reported that ectopic liver is prone to be a cancer and accessory liver can induce symptoms. The larger the size becomes, the more it can be Symptomatic. Surgical treatment should be considered whenever they are diagnosed. More investigations are nedeed to know their clinical importance on the basis of the case accumulation.

Association of Human Papillomavirus with Human Colorectal Cancer

PURPOSE: The aim of this study is to confirm the association of human papillomavirus with colorectal cancer. METHODS: We studied 44 patients who were received operation for colorectal cancer from 1, Jan. 1997 to 31, Dec. at Korea University Guro Hospital. We used paraffin- embedded tissue sections of colorectal adenocarcinomas and human cervical cell lines as a positive control. We also studied 10 cases of anal canal squamous cell carcinomas. The extracted DNA were analyzed by polymerase chain reaction and enzyme restriction method. RESULTS: Human papillomavirus DNA was not detected in all specimen of colorectal adenocarcinomas. But in 3 of 10 (30%) of anal canal squamous carcinomas, human papillomavirus DNA was detected. We identified this human papillomvirus DNA as type 16 by enzyme restriction technique. CONCLUSIONS: Human papillomavirus usually associated with malignant transformation are present in anal canal squamous cell carcinomas. This study also showed same result. But this association was absent from adenocarcinoma of the colon and rectum.

The Comparative Study between Peripharal Venous Blood and Draining Venous Blood CEA Levels in Colorectal Cancer / 대한암학회지

PURPOSE: In colon cancer, CEA(carcinoembryonic antigen) has become one of the useful tools for the management of patients because the antigen has been found to be useful as a monitor for detection, staging, recurrence, determining the response to therapy, and estimating the prognosis or survival. Many investigators have been analyzing the peripheral CEA levels for these purpose. Correlation between CEA levels of peripheral and portal blood, and histopathologic variables, was examined in 92 patients. This study evaluates importance of draining vein CEA levels in sensitivity and specificity of the prognosis. MATERIALS AND METHODS: In 92 patients, comparison between peripheral and draining venous blood CEA levels was performed in order to get better sensitivity and specificity and precise prognosis of CEA in colorectal cancer. Stage, tumor site, tumor emboli, lymph nodes, ascitic fluid cytology and differentiations were considered. RESULTS: There was no significant difference in peripheral and draining venous blood CEA levels in these variables. CEA positive rate of peripheral and draining vein were 57% and 60%. It has statistically no significance. More elevated CEA levels of draining vein than peripheral levels was detected in Duke C comparison (p=0.013). And more elevated CEA levels was observed in more advanced stages(33%, 59%, 63%, 83%) in draining vein(p < or = 0.01). CONCLUSION: The prognosis of elevated CEA level in draining venous blood CEA levels in advanced stage is significant in prediction of patients prognosis and degree of advanced cancers.