Laparoscopic Surgery for Gastric Cancer / 대한소화기학회지

Recently, the detection of early gastric cancer (EGC) has increased because of the development of diagnostic techniques. Accordingly, new surgical procedures with minimal invasiveness including laparoscopic gastrectomy have been developed. Since the first laparoscopic-assisted distal gastrectomy (LADG) for EGC was performed, various new laparoscopic procedures, such as laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) have been developed for the treatment of EGC. Laparoscopic approaches to gastric cancer provide for minimal invasion, early recovery and decreased morbidity and mortality according to several short-term results. In the future, laparoscopic procedures for gastric cancer will be widely accepted in Korea, if the advantages of laparoscopic approaches are confirmed in randomized controlled trials of long-term outcomes.

Intraductal Mucosal Spreading Mucin Secreting Intrahepatic Cholangiocarcinoma / 한국간담췌외과학회지

Peripheral cholangiocarcinoma refers to an adenocarcinoma arising from the bile ducts peripheral to the secondary confluence. The growth pattern of the peripheral cholangiocarcinoma may be classified into the mass-forming type, the infiltrating type, the intraductal polypoid type and the combined type. Intraductal mucosal spreading, mucin secreting intrahepatic cholangiocarcinoma is a rare subtype of peripheral cholangiocarcinoma. Its existence has been neglected due to its paucity. A 59-year old male who presented with jaundice was admitted to our hospital because of recurrent cholangitis. A MRI of the abdomen showed the dilated intrahepatic duct without mass lesions. Left hepatectomy was done with negative surgical margins. The pathologic diagnosis was intraductal mucinous type cholangiocarcinoma without stromal invasion. Intrahepatic duct stone was found. The postoperative duodenal ulcerous bleeding was treated by suture ligation of the bleeding vessels of the duodenum. The patient discharged 65 days after the operation.

Breast Metastases from Malignant Melanoma / 한국유방암학회지

Breast metastases from extramammary primary tumors are uncommon, accounting for approximately 1.3~6.6% of all malignant mammary tumors. Apart from hematopoietic neoplasms, malignant melanoma is one of the most common neoplasms with which secondary involvement of the mammary parenchyme is known. Although they are so rare, breast metastases from such neoplasms can mimic primary breast carcinoma clinically and on imaging studies. Approximately 20% of the patients affected by malignant melanoma will develop metastases, the commonest sites being liver, lung, and brain; metastases to the breast from malignant melanoma are rare, and in about 40% of the patients affected the breast lesion is the first manifestation of disease. Correct management of metastatic disease to the breast can prevent unnecessary mutilation; in fact, in the majority of patients so far widespread metastases have appeared rapidly despite various systemic treatments, showing that major surgery gives very poor results in terms of controlling the disease. In this paper, we present the case of a 49-year-old woman with a history of a malignant cutaneous melanoma of nasal cavity that had been surgically excised in 2004. She was admitted to our Breast Division 6 months later because a screening mammogram and anultrasound evaluation had revealed the presence of a nodular opacity in the both breast, without any clinical manifestations. For this reason, in September 2004 the patient underwent a simple mastectomy of both breasts.

Abnormal Fragile Histidine Triad Gene Expression in Gastric Cancer

PURPOSE: Genomic alterations and abnormal expression of the fragile histidine triad (FHIT) gene in gastric cancer were examined to determine whether the FHIT gene is actually a frequent target for alteration during gastric carcinogenesis. MATENRIALS AND METHODS: To correlate DNA and RNA lesions of the FHIT gene with the effect on FHIT protein expression, in 40 gastric cancers, we investigated the FHIT gene for loss of heterozygisity (LOH), aberrant transcripts, and protein expression. RESULTS: Allelic loss at D3S1300 was detected in 7 of 38 (19%) informative cases. Aberrant transcripts were observed in 20 of 40 (50%) cases. Significant reduction of FHIT protein expression was observed in 22 of 40 (55%) cases. Aberrant FHIT transcription was shown to be associated with loss of FHIT protein expression. However, aberrent FHIT transcripts themselves were not associated with any clinicopathological parameters, such as age, sex, tumor site, or clinical stage. Moreover, there was no association between the presence of LOH at D3S1300 and the expression of aberrant FHIT transcripts. CONCLUSION: The high frequency of aberrant FHIT transcripts, the significant rate of LOH at D3S1300, and the altered expression of the FHIT protein indicate that alterations of the FHIT gene can play an important role in gastric carcinogenesis.

Treatment of Polytetrafluoroethylene Hemoaccess Infections

PURPOSE: Infection of PTFE hemoaccess is the gravest complication associated with these devices. Infection most commonly results in premature access failure. Other potential complications of graft infections include: bleeding, systemic sepsis, limb ischemia from interruption of the arterial supply, bacterial endocarditis, or even death. This study was undertaken to evaluate the major pathogen and the appropriate treatment modality, according to the time of the infection occurrence. METHODS: Between February 1996 and May 2002, sixty PTFE hemoaccess infections were treated by the same surgeon at Soonchunhyang University Hospital. All the patients' records were retrospectively reviewed. RESULTS: Four cases developed a PTFE hemoaccess infection within one month of their construction, and were treated with the total removal and new access formation of the contralateral arm. The other fifty-six cases occurred after one month; twenty-six were treated with the removal and new access formation, eighteen with segmental resection and interposition, seven with incision and drainage, and five with antibiotics only. In the four cases that developed within one month, two developed infectious complications and one died. Whereas, in the fifty-six cases that developed after one month, five cases developed infectious complications and four died. Twenty-four cases of thirty nine graft infections with being checked culture test for bacteria were due to Staphylococcus aureus, with sensitivity to vancomycin. CONCLUSION: The managements of the PTFE hemoaccess infections were influenced by the time the infection occurred. Graft infections that occur within one month should be treated aggressively, with total removal. Infections that occur after one month could be selected for a salvage operation. The causative organism of a graft infection is Staphylococcus aureus, and vancomycin is the drug of choice.

Surgical Results for Perforated Gastric Cancer

PURPOSE: Perforated gastric cancer (PGC) is rare and occurs in 1~4% of all gastric cancers. Possible dissemination of tumor cells at the time of perforation of the gastric carcinoma has been a matter of concern. The intraoperative determination of what kind of operation should be done and how extensive the lymphnode dissection should be still remains controversial. The purpose of this study is to evaluate the factors influencing the survival and to determine the optimal treatment for PGC. MATENRIALS AND METHODS: A total of 42 patients were operated on for a perforated gastric carcinoma at Soonchunhyang University Chunan Hospital from 1983 to 2000. the age and the sexes of the patients, the location of perforation, the diameter of perforation, the histologic type of the tumor, the depth of wall invasion, the absence or presence of lymph node metastasis / distant metastasis, the stage of disease, the type of operation, and the outcomes were examined. Statistically significant differences were analyzed by using Fisher's exact test. RESULTS: The stage distributions according to the UICC classification were 1 case of stage I, 6 cases of stage II, 17 cases of stage III, and 11 cases of stage IV. An emergency gastrectomy was done in 26 patients (61.9%), with a 5-yr survival rate of 44%. The survival of patients was significantly influenced by the depth of wall invasion, the lymphnode metastasis, distant metastasis, the stage of disease, and the type of operation. CONCLUSION: an emergency gastrectomy is the treatment of choice for most patients with resectable PGC. Choosing more a optimistic surgical approach for potentially curative cases of PGC should be one way to increase the patient's survival rate.

Immunohistochemical Assay for Lymph-Node Micrometastasis in Gastric Cancer and Correlation with Survival Rate

PURPOSE: The purpose of this study is to identify immunohistochemical evidence of lymph-node micrometastasis in histologic node-negative gastric cancer patients and to evaluate the prognostic significance of lymph-node micrometastasis. MATERIALS AND METHODS: A retrospective study of 50 gastric cancer patients who underwent curative resections from October 1990 to November 1994 was performed. Two consecutive sections were prepared: one for ordinary hematoxylin and eosin staining, and the other for immunohistochemical staining with Pan cytokeratin antibody (Novocastra, UK). In the univariate analysis, the survival rate was calculated using the Life Table Method, and the multivariate analysis was determined using a Cox Proportional Hazards Model. The statistical analyses of the relationships between the clinicopathologic factors and micrometastases were performed by using a Chi-square test. RESULTS: Of 2522 harvested lymph nodes, 81 (4.1%) nodes and 19 (38%) of 50 patients were identified as having lymph- node micrometastases by using immunohistochemical staining for cytokeratin. The incidence of lymph-node micrometastases was significantly higher in diffuse type carcinomas (54%, P=0.024) and in patients with serosal invasion (52.2%, P=0.05). For patients with lymph-node micrometastases (n=19), the 5-year survival rate was significantly decreased (73.7%, P=0.015). The Lauren's classification (P= 0.021) and the depth of invasion (P=0.035) were shown by multivariate analysis to have a significant relationship with the presence of micrometastases. Multivariate analysis revealed that lymph-node micrometastasis was independently correlated with survival in histologic node-negative gastric cancer patients. CONCLUSION: The presence of cytokeratin detected lymph-node micrometastases correlates with the worse prognosis for patients with histologic node-negative gastric cancer.

Clinical Results and Histologic Change on Animal Model with Modified Uncut Roux Reconstruction after Gastrectomy

PURPOSE: The uncut Roux operation prevents the Roux stasis syndrome by preserving neuromuscular continuity between the proximal jejunum and the Roux limb, but this technique has an unacceptably high incidence of dehiscence of the staple lines with subsequent reflux gastritis or esophagitis. The authors designed a modified uncut procedure to avoid dehiscence of the staple lines. The aim of this study was to review whether this technique might be useful by examining the histologic change on animal study and the postoperative radiologic study of patients with modified uncut reconstruction. METHODS: Between February 1997 and December 2000, the UGI study was reviewed in 213 patients undergoing the modified uncut Roux reconstruction at Soonchunhyang University Hospital, Chunan, Korea, at 2 and 8 weeks after operation, to evaluate the incidence of dehiscence and the leakage of staple lines. Animal study included ten pigs, 5 underwent conventional uncut Roux procedure with staple, while the other 5 received reinforcing whole layer suture with black silk on the staple lines. The animals then underwent a second operation at 15 days after operation to evaluate histologic change and dehiscence of staple lines. RESULTS: Dehiscence and leakage were not found in any of the 213 patients undergoing modified uncut Roux reconstruction. In the animal study, 2 of 5 cases (40%) receiving conventional uncut Roux reconstruction had dehiscence, whereas dehiscence was absent in all 5 cases receiving modified uncut Roux reconstruction and these 5 animals showed more marked infiltration of inflammatory cells, vascular formation and more severe fibrosis on histologic examination. CONCLUSION: The conventional uncut Roux procedure suffer dehiscence of the staple lines with subsequent reflux gastritis or esophagitis. Therefore, modified uncut Roux reconstruction might prevent a jejunal leakage in the case of staple line dehiscence and might prevent dehiscence of staple lines.

Perforated Early Gastric Cancer: A case report

An exceedingly rare case of perforated early gastric cancer is reported. A 68-year-old man developed peritonitis due to perforation of early gastric cancer. An emergency radical operation was performed and was followed by an uneventful recovery. Histologic examination of the surgical specimen showed type III early gastric cancer composed of a signet ring cell carcinoma. Five years after surgery, the patients was alive with no evidence of tumor recurrence. The rarity of this complication in early gastric cancer is discussed, and a review of the literature is presented.

Causes and Sexual Hormonal Changes in Patients with Gynecomastia / 한국유방암학회지

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.

Causes and Sexual Hormonal Changes in Patients with Gynecomastia / 한국유방암학회지

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.

Incidence and Characteristics of Thyroid Nodules in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: A relationship between thyroid disease and primary breast cancer remains controversial. Several studies have demonstrated there is an increased risk of breast cancer in patients with thyroid dysfunction and thyroid cancer. The purpose of this study was to evaluate the incidence, relationship and clinical characteristics of thyroid nodules and cancer in patients with breast cancer. METHODS: Two hundred sixty one women with primary breast cancer had an ultrasonogram of the thyroid prospectively performed at the Department of General Surgery of the Soonchunhyang University Hospital from April 1995 to December 1999. The thyroid nodules were identified by high- resolution ultrasonography before all patients had undergone breast cancer surgery. RESULTS: Among the 261 patients with breast cancer, thyroid nodules were found in 57 (21.8%). The most prevalent age group of the 57 thyroid nodules was the 5th decade. Twenty- one out of 57 patients with thyroid nodules had undergone thyroid surgery and 14 benign nodules and 7 thyroid cancers (5 papillary carcinoma & 2 follicular carcinoma) were discovered. The incidence of thyroid cancer in the patients with breast cancer was 2.7%. CONCLUSION: Although the factors associated with thyroid nodules and cancer in the patients with breast cancer were not demonstrated, these results were suggested that there may be a relationship between them. Therefore, ultrasonography of the thyroid in patients with breast cancer priorto breast cancer surgery operations is recommended.

Incidence and Characteristics of Thyroid Nodules in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: A relationship between thyroid disease and primary breast cancer remains controversial. Several studies have demonstrated there is an increased risk of breast cancer in patients with thyroid dysfunction and thyroid cancer. The purpose of this study was to evaluate the incidence, relationship and clinical characteristics of thyroid nodules and cancer in patients with breast cancer. METHODS: Two hundred sixty one women with primary breast cancer had an ultrasonogram of the thyroid prospectively performed at the Department of General Surgery of the Soonchunhyang University Hospital from April 1995 to December 1999. The thyroid nodules were identified by high- resolution ultrasonography before all patients had undergone breast cancer surgery. RESULTS: Among the 261 patients with breast cancer, thyroid nodules were found in 57 (21.8%). The most prevalent age group of the 57 thyroid nodules was the 5th decade. Twenty- one out of 57 patients with thyroid nodules had undergone thyroid surgery and 14 benign nodules and 7 thyroid cancers (5 papillary carcinoma & 2 follicular carcinoma) were discovered. The incidence of thyroid cancer in the patients with breast cancer was 2.7%. CONCLUSION: Although the factors associated with thyroid nodules and cancer in the patients with breast cancer were not demonstrated, these results were suggested that there may be a relationship between them. Therefore, ultrasonography of the thyroid in patients with breast cancer priorto breast cancer surgery operations is recommended.

Incidence and Characteristics of Thyroid Nodules in Patients with Breast Cancer

PURPOSE: A relationship between thyroid disease and primary breast cancer remains controversial. Several studies have demonstrated there is an increased risk of breast cancer in patients with thyroid dysfunction and thyroid cancer. The purpose of this study was to evaluate the incidence, relationship and clinical characteristics of thyroid nodules and cancer in patients with breast cancer. METHODS: Two hundred sixty one women ith primary breast cancer had an ultrasonogram of the thyroid prospectively performed at the Department of General Surgery of the Soonchunhyang University Hospital from April 1995 to December 1999. The thyroid nodules were identified by high-resolution ultrasonography before all patients had undergone breast cancer surgery. RESULTS: Among the 261 patients with breast cancer, thyroid nodules were found in 57 (21.8%). The most prevalent age group of the 57 thyroid nodules was the 5th decade. Twenty-one out of 57 patients with thyroid nodules had undergone thyroid surgery and 14 benign nodules and 7 thyroid cancers (5 papillary carcinoma & 2 follicular carcinoma) were discovered. The incidence of thyroid cancer in the patients with breast cancer was 2.7%. CONCLUSION: Although the factors associated with thyroid nodules and cancer in the patients with breast cancer were not demonstrated, these results were suggested that there may be a relationship between them. Therefore, ultrasonography of the thyroid in patients with breast cancer priorto breast cancer surgery operations is recommended.

Causes and Sexual Hormonal Changes in Patients with Gynecomastia

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia. METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.

Surgical Treatment and Prognosis for Gastric Cancer in the Elderly

PURPOSE: The number of elderly patients who undergo surgery for gastric cancer has increased in recent years due to a life expectancy. To prevent fatal complications and increase the survival rate in gastric cancer patients, this study endeavored to clarify the risk factors contributing to postoperative complications in elderly patients undergoing a radical gastrectomy. METHODS: Between January 1997 and December 1998, 176 patients underwent a gastrectomy for gastric cancer. For this review, the patients were divided into two groups; 30 patients over 70 years of age (older group) and 102 patients below 70 years of age (younger group), were prepared. A retrospective study was performed to examine the factors related to the high rate of complications and to compare the operative and general complications. RESULTS: The incidences of preoperative combined disease were 56.6% in the older group and 31.3% in the younger group (p<0.05), but no significant difference in the incidence of postoperative complications (36.6% versus 38.2%) was found between the two groups. The most common postoperative complications were wound infections, pulmonary disorders, and intraabdominal infections. CONCLUSION: Despite the increased rate of preoperative combined disease in older patients, patients over 70 years are able to tolerate a radical gastrectomy for gastric cancer when optimal perioperative management is provided and blood loss is reduced.

Determination of Sensitivity of RT-PCR for Cyokeratin 19 and Detection of Micrometastasis from Bone Marrow of Breast Cancer Patients

BACKGROUND: The detection of micrometastatic cells in patients with breast cancer may aid in determining of prognosis and in developing new therapeutic approaches. In this study, we evaluate an assay to identify breast cancer cells in the bone marrow of patients with breast cancer by using reverse-transcriptase polymerase chain reaction (RT-PCR) assay for cytokeratin 19 (CK-19) transcripts. METHODS: A CK-19 specific-nested RT-PCR assay was developed and optimized by using limited dilutions of an MCF-7 breast-cancer cell line mixed with normal bone-marrow specimens. The optimized assay was then used to examine bone-marrow samples obtained from 60 patients with breast cancer. The specificity was assessed by examining 20 negative controls using malignant hematologic disease. RESULTS: In the sensitivity calibration system, CK-19 expressing tumor cells were detected in the mixture of 10 MCF-7 cells in 107 normal bone-marrow cells. All 20 neagtive control samples failed to amplify. Bone marrow samples from 10 of 60 patients (16.7%) with breast cancer scored positive, indicating micrometastasis of the bone marrow. Seven of the 37 samples from patients whose axillary lymph nodes were negative based on conventional histopathological studies were positive when the CK-19 RT-PCR method was used. CONCLUSION: RT-PCR for CK-19 is a sensitive, specific, and rapid method for detecting micrometastatic mammary carcinoma cells in the bone marrow of patients with breast cancer. It could be helpful in diagnosing and monitoring metastastic breast cancer and detecting of micrometastasis. This method should be evaluated using a larger number of patients for long-term follow-up.

Bile Duct Dilatation after Subtotal Gastrectomy in Stomach Cancer: Comparison with Gastroduodenostmy (BillothI) and Gastro Jejunosto my (Billoth II)

PURPOSE: To evaluate the incidence and degree of bile duct dilatation after partial gastrectomy due togastric cancer and to determine any differences between gastroduodenostomy (Billoth I) and gastrojejunostomy(Billoth II). MATERIALS AND METHODS: We retrospectively analyzed the follow up abdominal CT findings in 113patients who had undergone partial gastrectomy without truncal vagotomy or cholecystectomy. In all cases,preoperative abdminal CT findings showed no evidence of bile duct dilatation. Among 113 patients, 41 underwentBilloth I surgery, and 72 underwent Billoth II. No case showed clinical or radiological evidence of obstructivecauses of bile duct dilatation. Among these patients, we decided the criteria for dilatation when this was noted.The grade was either mild (3 -4 mm), moderate (5 -8mm), or severe (over 9mm), as measured at the centralintra-hepatic duct. Extra-hepatic duct dilatation was graded as mild (6 -8mm), moderate (9 -12mm) or severe (over13 mm). We analyzed serum bilrirubin and alkaline phosphatase levels. RESULTS: When the central intrahepatic ductwas measured, 78 of 113 patients(69 %) showed bile duct dilata-tion; 24 of 41 cases(58.5 %) were in the billoth Igroup and 54 of 72 (75 %) were the in Billoth II group. After measurement of the extra hepatic duct, 22 of41cases(53.6%) in the Billoth I group and 54 of 72 (75 %) in the Billoth II group were found to be dilated. Theresults showed a slightly increased incidence of bile duct dilatation in the Billoth, II group but this was notstatistically significant(p>0.05). In the laboratory, total, direct, and indirect bilirubin, as well as alkalinephosphatase levels, were measured. Higher levels were found in Billoth II than in Billoth I but all findings werewithin normal limits. CONCLUSION: Mild dilatation of the bile duct after partial gastrectomy was a not uncommonfinding, and there was no significant difference of incidence or degree of dilatation according to the procedureperformed. If a patient has no clinical symptoms, it appears that clinical it appears that clinical evaluationdoes not require fur-ther study.

CT for Preoperative Prediction of Axillary Lymph-Node Status in Patients with Breast Cancer

BACKGROUND: The clinical staging may serve to guide initial therapy based on all available preoperative data, such as history, physical and laboratory examinations, and biopsy material. Computed tomography is one of the most attractive methods of evaluating the clinical state of patients with breast cancer. In cases where the lymph nodes are enlarged, CT of the chest can accurately detect the level of axillary lymph nodes involvement. CT may also simultaneously play a role in evaluating the mediastinum and the supraclavicular areas for adenopathy, primary tumors and lung metastases. The aim of this study was to determine the appropriate size criteria for metastatic axillary lymph nodes on CT and to evaluate the validity of using CT to detect axillary lymph-node metastases due to breast cancer. METHODS: CT examination of the chest was performed before axillary lymph node dissection in 98 patients with breast cancer. We measured the sizes of the lymph nodes according to the short-axis diameters seen on CT. We estimated the sensitivity, the specificity, the ROC curve, and the predictability of CT based on lymph-node sizes. RESULTS: The diagnostic criterion for node metastases was 5 mm. At the 5 mm point, the accuracy of CT for axillary metastases was 70% with a sensitivity of 89%, a specificity of 60%, a negative predictive value of 90%, and a positive predictive value of 56%. CONCLUSIONS: In conclusion, CT is not an accurate assessment in the diagnosis of axillary lymph-nodemetastases due to breast cancer. However, CT data can be interpreted with sufficient sensitivity and negative predictability for CT to serve as a screening test.

Effectiveness of Gastrectomy in Stage 4 Gastric Cancer with Hepatic Metastasis / 대한암학회지

PURPOSE: The prognosis for patients 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. MATERIALS AND METHODS: A retrospective analysis was performed on 98 gastric cancer patients who had undergone gastric resection, in spite of hepatic metastasis, between January 1990 and December 1996 at the Department of Surgery in 11 General Hospitals in Korea. RESULTS: The average age was 58 years old, and the male-to-female ratio was 69: 29. The laboratory tests were unable to predict hepatic metastasis. In 54 cases, hepatic metastasis was not identified before the surgery. The most common location of gastric cancer was antrum (72 cases). The most common gross type was Bonmann type III (78 cases). The serosa-exposed cases were 80. The peritoneal seeding was combined in 17 cases. A total gastrectomy was performed in 18 cases and a distal gastrectomy in 80. Lymph-node dissection was performed in 23 Dl, and 51 D2 cases. Hepatic resection was performed in 36 cases, The frequent histologic types were moderately differentiated and poorly differentiated tubular adenocarcinoma. Postoperative adjuvant chemotherapy was done in 70 cases. The complication rate (7%) was low. The median survival time was 15 months, with mean survival time of 18 months. The 2-year and 3-year survival rates were 23%, and 7%, respectively. In the univariate analysis, good survival was closely related to limitation of hepatic metastasis to one lobe, a few metastases to both lobes, negativity of peritoneal seeding and lymph node dissection more than D2 (p<0.05), CONCLUSIONS: An aggressive gastric resection for stage IV gastric cancer with hepatic metastasis might be beneficial in lengthening the survival period. A prospective study is needed, especiaUy one with an exact evaluation and analysis of the quality of life between the gastrectomy and nonresection groups.