Development and Implementation of a Critical Pathway for Pediatric Inguinal Hernias

PURPOSE: Critical pathway (CP) refers to the standardized care process that predefines the treatment sequence and timing for a specific group of diseases and patients. The recent interest in CPs has increased as a quality improvement tool and a cost-effective delivery system for medical services. The authors applied a CP for pediatric inguinal hernias, and we investigated the cost effectiveness and also the satisfaction of the patients and the medical staff. METHODS: The CP was applied to 24 patients (the CP group) and the characteristics of the patients, the length of the hospital stay, the postoperative course, the medical costs and the results of the survey were compared with 26 other patients (the non-CP group). RESULTS: There was no difference in the patients' characteristics, the length of the hospital stay, the postoperative complications and the course of between the two groups. The cost for the medications, injections, treatments and examinations for the CP group were significantly lower than those for the non-CP group (P<0.05). The satisfaction of patients was significantly improved after the application of the CP (P<0.05), and the satisfaction of the medical staff was high. CONCLUSION: The application of a CP for pediatric inguinal hernia can save treatment-related medical costs. Moreover, the CP is an effective, excellent care process that improves the satisfaction of both the patients and the medical staff.

Liver Metastasis Mimicking Cholangiocarcinoma from Colon Cancer

There are very few reports on the intrabiliary growth of a liver metastasis from a colorectal cancer. The clinical and radiographic findings resemble those of a cholangiocarcinoma. We encountered a surgically resected case of a metastatic liver tumor with prominent intrabiliary growth derived from ascending colon cancer. The patient was a 55 year-old man with ascending colon cancer who showed a cholangiocarcinoma at segment IV of the liver with a mild dilatation of bile duct. He underwent a left hemihepatectomy and right hemicolectomy. The resected specimen of the liver showed a mass with intraductal growth at segment IV. The histological findings demonstrated it to be a metastatic adenocarcinoma.

Comparison of Laparoscopic and Conventional Open Resection of Pheochromocytoma

PURPOSE: Laparoscopic adrenalectomy (LA) has become the standard treatment for benign adrenal neoplasm because of the procedure's minimal invasiveness and the patients' earlier recovery. The aim of this study was to evaluate the safety and effectiveness of laparoscopic adrenalectomy for treating pheochromocytoma. METHODS: 19 Operations were performed between March 1993 and July 2004 at Kyung-Hee medical center for treating pheochromocytoma, and the diagnosis was confirmed by the postoperative pathology. There were 5 cases treated with LA and 14 cases treated with open adrenalectomy (OA). The various clinical parameters (tumor location, tumor size, first oral feeding, hospital stay, hemodynamic change and operation time) were compared between the LA and OA procedures, retrospectively. RESULTS: The location of the tumor was 2 : 2 : 1 (left : right : extra-adrenal) in the LA group and 9 : 3 : 2 (left : right : both) in the OA group. The mean tumor size (cm) was 5.4 in the LA group and 6.3 in the OA group. The mean operation time (minutes) was 219 in the LA group and 202 in the OA group. The resumption of liquid diet (days) was 2.2 in the LA group and 3.0 in the OA group (P=0.037). The postoperative hospital stay (days) was 6.3 in the LA group and 8.5 in the OA group. The mean number of intraoperative hypertensive crisis was 1.42 in the LA group and 1.40 in the OA group. The number of cases requiring intraoperative transfusion was 2 of 5 in the LA group and 2 of 15 in the OA group. The use of antihypertensives (number of times) was 1.42 in the LA group and 1.40 in the OA group. The mean highest BP (mmHg) was 162 in the LA group and 165 in the OA group. CONCLUSION: Laparoscopic adrenalectomy for treating pheochromocytoma is a safe and effective procedure that provides the benefits of a minimally invasive approach.

Diagnosis and Prognosis of Gastrointestinal Stromal Tumors in the Stomach

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common form of mesenchymal tumor of the gastrointestinal tract. Recently, tyrosine kinase inhibitors have improved the treatment of GISTs, and their diagnosis facilitated by immunohistochemical markers. The aim of this paper was to study the clinicopathological features of GISTs of the stomach and determine the accuracy of a new grading system and the prognostic factors. METHODS: Patients with mesenchymal tumors of the stomach, operated on between 1982 and 2004, were identified using medical and pathological files. Immunohistochemical staining for KIT (CD117), CD34, smooth muscle actin (SMA), desmin and s-100 protein were performed, and the diagnoses reviewed. Cases were classified into either the very low, low, intermediate or high risk groups according to National Institutes of Health (NIH) consensus symposium. RESULTS: 78 mesenchymal tumors were reanalyzed, and with the supportive use of immunohistochemical markers, 71 (91%) of the gastrointestinal mesenchymal tumors were shown to be GISTs. The tumors often coexpressed KIT and CD34 (90%) and were variably positive for SMA (18%), s-100 protein (11%) and desmin (23%). With a median follow-up of 73.9 months (range 1~228 months), a recurrence occurred in 10 (14%) patients. Analyses demonstrated that the mitotic index (P<0.001) and tumor size (P<0.001) were significant prognostic factors for survival. The new grading system showed a significant difference between the risk groups and the survival rates (P<0.001). CONCLUSION: Immunohistochemical staining is needed to distinguish GISTs from other mesenchymal tumors. The tumor size and mitotic count are significant prognostic factors for GISTs. The new grading system (2001 NIH) for classifying the 4 risk groups of GISTs, according to the tumor size and the mitotic count, is useful in the evaluation of the tumor behavior.

Deep Vein Thrombosis after Total Hip Arthroplasty: The Incidence of DVT and Correlation between DVT and Risk Factors

PURPOSE: In western countries, the reported incidence of deep vein thrombosis (DVT) after total hip arthroplasty (THA) ranges from 12 to 23% when an accepted form of prophylaxis is used but when it is not, it ranges from 48 to 70%. However, the incidence of postoperative DVT in Asia has always been considerably lower (20~30%) and compare to western countries and no clear indication for prophylaxis has been suggested. The aim of this study was to document the incidence of DVT among Koreans, and to find the correlation between DVT and its risk factors after total hip arthroplasty. METHOD: 196 patients, who underwent THA from 2002 to 2004, were evaluated to figure out the incidence of DVT and its correlation with well known risk factors, such as age, body mass index (BMI), gender, preoperative coagulation assays (platelet, PT and aPTT) and operation time. All patients wore elastic compression stockings, and early ambulation was encouraged. Venography or Doppler sonography was obtained routinely between 7th and 10th postoperative days. RESULT: The incidence of DVT and pulmonary embolism following THA was 12.6% (25 cases) and 0.5% (1 case), respectively. The mean age of the patients evaluated was 49. 12 cases showed thrombi in the muscle branch below the knee, 9 cases in the posterior tibial vein and 4 cases in the veins above the knee. Age and aPTT were statistically significant with a higher incidence of DVT (P<0.05). However, no correlation between DVT and other factors, such as PT, platelet count, transfusion rate, operation time and BMI, was identified. CONCLUSION: The incidence of DVT in our study was 12.6%. Age and the preoperative aPTT level were significantly associated with the development of DVT after THA.

Analysis of Infections in Renal Transplant Recipients Receiving Mycopheolate Versus Azathioprine-based Immunosuppression / 대한이식학회지

PURPOSE: Immunosuppression is important for early success of renal transplantation. Mycofenolate mofetil (MMF) has been substituted for Azathioprine (AZA) and has been shown to have greater effect on T cell and also on B cell function than AZA. Although many side effects like infections have been investigated in patients who received AZA based therapy, they have not extensively been studied in MMF based protocol. The aim of this study is to evaluate the differences in incidence and frequency of infections during the first 6 months in the patients who received AZA or MMF based therapy. METHODS: Renal transplant recipients who received either AZA or MMF based therapy were reviewed. From January 1994 to December 2003, 112 patients were enrolled and analyzed the types and frequency of infection. RESULTS: 78 patients received AZA based therapy, and 34 patients received MMF based therapy. Infection developed in 37 (47.4%) and 12 (35.3%) patients respectively. AZA group showed higher incidence of infection than MMF group (P<0.05). In AZA group, UTI developed in 15 patients (19.2%), URI in 7 patients(9%), CMV infection in 7 patients (9%), tuberculosis in 2 patients (2.6%), and wound infection in 6 patients (7.7%). In MMF group, UTI developed in 6 patients (17.6%), URI in 2 patients (5.9%), CMV infection in 2 patients (5.9%), tuberculosis in 1 patient (2.9%), wound infection in 1 patient (2.9%). There were no significant differences in the type of various infectious episodes between two groups. CONCLUSION: AZA group showed higher incidence in total infection, but there were no differences in the type of various infectious episodes between two groups. MMF has more powerful immunosuppressive effect (18) but has similar infectious adverse effects compared with AZA.

Effect of Estradiol-induced E2IG5 on Breast Cancer Cell Line

PURPOSE: Estrogens control the development and cell proliferation of various tissues including the normal mammary epithelial cells, where they induce the expression of the immediate and delayed hormone-responsive genes. The proliferative effects of estrogen have been attributed to its ability to increase the expression of the key cell cycle regulatory genes responsible for cell cycle progression. However, the regulation of cell proliferation is only one aspect of estrogen function. It has also been well documented that estrogen plays a critical role in the etiology and progression of human breast and gynecological cancers. This tumorigenic effect of estrogen might be associated with its anti- apoptotic activities such as of Bcl-2 induction. The aim of this study was to clarify the role of E2IG5, which is an estrogen-induced downstream effector molecule, in breast cancer cell lines. RESULTS: This study shows that E2IG5 is a pro-apoptotic protein that is localized to the mitochondrial membrane via two distinct transmembrane domains. When over-expressed, it induces a mitochondrial permeability transition with the resultant of release cytochrome c and caspase activation. However, three out of four breast cancer cell lines lost their estrogen dependence of E2IG5 expression, which suggests the possible involvement of E2IG5 in the development of breast cancer. CONCLUSION: These results suggest that breast cancer cells may loose their pro-apoptotic signals and selectively use the proliferative mechanism of estrogen, which drives the normal mammary epithelial cells to transform into cancer cells. Further studies using breast cancer tissues will be needed.

Factors Affecting Survival Rate Following Hepatic Resection for Metastatic Colorectal Cancer / 한국간담췌외과학회지

BACKGROUND/AIMS: A hepatectomy for liver metastases from colorectal cancer has recently received general acceptance as a safe, potentially curative treatment modality due to its low surgical mortality and significant improvement of survival rates after resection. However, criteria for the selection of patients and treatment modalities remains controversial. The aim of study was to determine the prognostic factors. in patients who had undergone a hepatic resection for metastatic colorectal cancer. METHODS: Twenty-four patients who had underdone initial hepatic resection for liver metastases from colorectal cancer between 1992 and 2002 were analyzed with regard to clinical and pathological parameters. The survival rate was calculated using the Kaplan-Meier method and Cox regression hazard model. The mean follow up period was 37 months. RESULTS: The overall 5-year survival rate was 29.3%, with a mean survival of 39 months. There were 10 (41.3%) and 14 (58.7%) cases of synchronous and metachronous metastasis, respectively. The 5-year survival rate was shown to be significantly lower in patients with more than 4 metastases (p=0.01), bilobar metastasis (p=0.02) and vascular invasion (p=0.01). The number of hepatic metastases (p= 0.02) has been demonstrated as an independent factor for the 5-year survival. CONCLUSION: Patients with multiple, bilobar hepatic metastases and vascular invasion demonstrated a poor survival rate. Therefore, in patients with poor prognostic factors, curative surgical resection, accompanied by a multimodality treatment, is necessary for an improved survival.

Comparison of Clinical Outcomes between Pylorus Preserving Pancreaticoduodenectomy and Pancreaticoduodenectomy / 한국간담췌외과학회지

PURPOSE: A pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD) are the two methods commonly used to treat periampullary neoplasms. This study was designed to compare these two methods in terms of the post-operative complications, the recurrence rate, and the post-operative weight change. METHODS: The medical records of 110 patients who underwent PD or PPPD from February 1986 through to June 2002 were retrospectively reviewed. The PD was performed on 54 patients and PPPD was performed on 56 patients, respectively. The mean follow-up periods were 25.33 months in the PD group and 25.39 months in the PPPD group, respectively. RESULTS: Diabetes mellitus occurred in 9 patients (16.7%) in the PD group and 8 patients (14.3%) in the PPPD group, and gastric emptying was delayed in 14 (25.9%) and 15 (26.8%) patients of each group after surgery. Procedure related deaths occurred in 2 (3.7%) and 4 (7.1%) patients from each group. There were no statistically significant differences in the post-operative complications between the two groups. The disease recurrence rate was significantly lower in the PPPD group than in the PD group (60.5% vs. 22.9%, p=0.001). Post-operative weight loss just after surgery at 3 months and 6 months after surgery was 3.56 kg, 3.68 kg, and 3.97 kg in the PD group and 2.78 kg, 1.77 kg, and 1.8 kg in the PPPD group, respectively, without showing a statistically significant difference. CONCLUSION: The clinical outcomes of the PPPD was not different from those of the PD in terms of the post-operative complications and weight loss. The disease recurrence rate was lower in the PPPD group. These results suggest that PPPD could be the treatment choice periampullary neoplasms.

Clinical Analysis of Primary Hyperparathyroidism / 대한내분비외과학회지

Primary hyperparathyroidism is a rare disease that can be accurately diagnosed and effectively treated in most patients. The diagnosis is established by a persistent elevation of serum calcium and parathyroid hormone and by clinical evaluation. With the introduction of a biochemical screening test for calcium and the development of radiologic techniques, the detection of hyperparathyroidism has increased slightly. However, the parathyroidectomy is still not a common operation in Korea. Twenty-eight patients with primary hyperparathyroidism comprised of 14 males and 14 females, were treated by operation from January 1986 to December 1995 at Kyunghee University Hospital and the data were analyzed retrospectively. The results are as follows: 1) The sex distribution was 14 males & 14 females, and the age distribution was from 14 to 79 years. 2) The clincal manifestations were renal symptoms (42.9%), skeletal symptoms (28.6%), a neck mass (10.7%), pancreatitis (7.1%) , no symptoms (7.1%), polydipsia (3.6%) in order of frequency. 3) Most of the patients showed hypercalcemia above 11mg/dl, but five patients had calcium levels which were either slightly increased or in the upper normal range. 4) The preoperative localization methods were mainly combinations of sonography, C.T.,and Tl-Tc subtraction scans and showed high sensitivity & specificity (above 90%). 5) The main tumor locations were the Rt. lower pole in 10 cases, the Rt. upper pole in 5 cases, the Lt. upper pole in 3 cases, the Lt. lower pole in 7 cases; there were 2 cases of ectopic location and 1 case of hyperplasia at the Rt. upper & the Lt. lower pole. 6) The pathologic findings revealed a solitary adenoma in 25 patients, a carcinoma in two patients, and hyperplasia associated with MEN2a in 1 patient. 7) We experienced one case of recurrence after primary excision at the Rt. lower pole. Reoperation for a missed gland, after the primary operation, was performed in one patient; the excision of the tumor was performed successsfully. 8) We performed surgical excisions and 17 patients showed hypocalcemia postoperatively. Most of the hypocalcemia was transient and disappeared after ingestion of oral calcium agents or usuage of Vit. D3.

A Clinical Review of 11 Cases of a Laparoscopic Adrenalectomy: Comparison with an Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy has become the golden standard procedure for adrenal tumors because of its many advantages. The purpose of our study was to compare the outcomes for patients who underwent a transperitoneal laparoscopic adrenalectomy with those of patients who had a conventional open adrenalectomy. Similar to the open adrenalectomy, the laparoscopic adrenalectomy was divided into anterior (LA: Laparoscopic anterior) and posterior (LP: Laparoscopic posterior) approaches. METHODS: Between January 1991 and September 1998, a retrospective review of consecutive adrenalectomies performed at Kyung Hee University Hospital was done. Outcome measurements of operative indications, tumor size, operation time, first oral intake, postoperative stay, and postoperative complications were reviewed. RESULTS: Eleven(11) laparoscopic adrenalectomies (4 LAs and 7 LPs) were performed in 11 patients and 47 open adrenalectomies [24 with an anterior, OA (Open anterior), approach and 23 with a posterior, OP (Open posterior), approach] in 43 patients. The LA approach showed a significantly shorter time to first oral intake (1.8 vs 3.4 days p=0.001) and postoperative hospital stay (5.5 vs 12.8 days p=0.001) compared to the OA approach. The LP approach also showed a significantly shorter time to first oral intake (0.9 vs 1.6 days p=0.046) and postoperative hospital stay (5.9 vs 9.9 days p=0.004) compared to the OP approach. There were no differences in tumor size, operation time, and postoperative complications between laparoscopic adrenalectomies and open adrenalectomies. CONCLUSION: The laparoscopic adrenalectomy is superior to the open adrenalectomy when performed by appropriately trained and skilled surgeons.

A Clinical Review of 11 Cases of a Laparoscopic Adrenalectomy: Comparison with an Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy has become the golden standard procedure for adrenal tumors because of its many advantages. The purpose of our study was to compare the outcomes for patients who underwent a transperitoneal laparoscopic adrenalectomy with those of patients who had a conventional open adrenalectomy. Similar to the open adrenalectomy, the laparoscopic adrenalectomy was divided into anterior (LA: Laparoscopic anterior) and posterior (LP: Laparoscopic posterior) approaches. METHODS: Between January 1991 and September 1998, a retrospective review of consecutive adrenalectomies performed at Kyung Hee University Hospital was done. Outcome measurements of operative indications, tumor size, operation time, first oral intake, postoperative stay, and postoperative complications were reviewed. RESULTS: Eleven(11) laparoscopic adrenalectomies (4 LAs and 7 LPs) were performed in 11 patients and 47 open adrenalectomies [24 with an anterior, OA (Open anterior), approach and 23 with a posterior, OP (Open posterior), approach] in 43 patients. The LA approach showed a significantly shorter time to first oral intake (1.8 vs 3.4 days p=0.001) and postoperative hospital stay (5.5 vs 12.8 days p=0.001) compared to the OA approach. The LP approach also showed a significantly shorter time to first oral intake (0.9 vs 1.6 days p=0.046) and postoperative hospital stay (5.9 vs 9.9 days p=0.004) compared to the OP approach. There were no differences in tumor size, operation time, and postoperative complications between laparoscopic adrenalectomies and open adrenalectomies. CONCLUSION: The laparoscopic adrenalectomy is superior to the open adrenalectomy when performed by appropriately trained and skilled surgeons.

Polymorphisms of the 5'-Flanking Region of the Human Tumor Necrosis Factor-alpha Gene in Korean Patients with Crohn's Disease

PURPOSE: Recently, a key role of tumor necrosis factor (TNF) in the development of inflammatory bowel disease (IBD), especially Crohn's disease (CD), has emerged. In Japan, 3 single base pair polymorphisms in the 5'-flanking region of the TNF-alpha gene at position 1031, 863, and 857, which are related to high transcriptional promoter activity, have been identified in the Japanese CD patients. And the polymorphisms of the TNF-alpha gene at position 308, 238 have been reported in western CD patients. So, in order to find the same polymorphisms in Korean population and CD patients, the author evaluate the patients diagnosed with CD, ulcerative colitis (UC) and healthy controls (HCs). METHODS: Blood samples were obtained from 70 patients with CD, 72 patients with UC and 52 healthy controls. Polymorphisms in the TNF-alpha gene at their respective positions were analyzed by single strand conformational polymorphism (SSCP), and allele frequencies in CD and UC patients were compared with those in healthy controls. RESULTS: Allele frequencies of 1031C, 863A, and 857T in health controls were 18.3%, 8.7%, and 19.2%, respectively. Polymorphic allele frequencies of 1031C, 863A, 857T were 22.9%, 27.1%, and 24.3% in CD patients respectively. The frequencies at all 3 positions were higher in CD patients than in HCs. However, the frequency at 863A was statistically significant (P=0.000). The allele frequencies of 308A and 238A alleles were 0.7% and 3.6% in CD, 0.7% and 2.1% in UC, and 1.9% and 4.8% in HCs, respectively. The allele frequency of 1031C was significantly higher in B3 than in B2 (P=0.033). CONCLUSION: Polymorphisms of 5'-flanking region of the TNF-alpha at positions 1031 (T/C), 863 (C/A) and 857 (C/T) may be associated with susceptibility of CD.

Prognosis of GLUT1 Expression in Human Breast Carcinoma

PURPOSE: An increase of glucose uptake and glycolytic metabolism has been reported in malignant cells as compared with normal cells and tissues. We hypothesized that human erythrocyte glucose transporter-1 (GLUT1) expression is increased in breast carcinoma and may be correlated with long term clinical outcome. METHODS: Two hundred ninety formalin fixed, paraffin embedded sections of infiltrating ductal carcinomas of the breast were immunostained with anti-GLUT1. RESULTS: Among the known clinicopathological prognostic factors, GLUT1 expression was correlated positively with histological grade (p=0.000) and tumor size (p=0.003). In a multivariate analysis, lymph node involvement and GLUT1 expression were statistically significant prognostic factors. The cummulative survival rates of GLUT1 expression and LN involvement were statistically significant (p=0.0061, p=0.0009) respectively. Our results suggest that 1) GLUT1 expression is correlated with histological grade and tumor size, and 2) GLUT1 expression correlates with a poorer prognosis in patients with infiltrating ductal carcinoma of the breast. CONCLUSION: The results of our study suggest that immunohistochemical staining of GLUT1 expression is strongly associated with neoplastic progression in breast carcinoma, and that GLUT1 expression has value in estimating the prognosis of patients with breast carcinoma.

Prognosis of GLUT1 Expression in Human Breast Carcinoma / 한국유방암학회지

PURPOSE: An increase of glucose uptake and glycolytic metabolism has been reported in malignant cells as compared with normal cells and tissues. We hypothesized that human erythrocyte glucose transporter-1 (GLUT1) expression is increased in breast carcinoma and may be correlated with long term clinical outcome. METHODS: Two hundred ninety formalin fixed, paraffin embedded sections of infiltrating ductal carcinomas of the breast were immunostained with anti-GLUT1. RESULTS: Among the known clinicopathological prognostic factors, GLUT1 expression was correlated positively with histological grade (p=0.000) and tumor size (p=0.003). In a multivariate analysis, lymph node involvement and GLUT1 expression were statistically significant prognostic factors. The cummulative survival rates of GLUT1 expression and LN involvement were statistically significant (p=0.0061, p=0.0009) respectively. Our results suggest that 1) GLUT1 expression is correlated with histological grade and tumor size, and 2) GLUT1 expression correlates with a poorer prognosis in patients with infiltrating ductal carcinoma of the breast. CONCLUSION: The results of our study suggest that immunohistochemical staining of GLUT1 expression is strongly associated with neoplastic progression in breast carcinoma, and that GLUT1 expression has value in estimating the prognosis of patients with breast carcinoma.

The Effects of Gabexate Mesilate on the Ishemia-Reperfusion Injury in the Rabbit Liver

PURPOSE: Ischemia-reperfusion is an important pathologic process that leads to impairment of the liver after major surgery. Ischmia-reperfusion injury includes both hypoxia and an inflammatory response associated with reperfusion; the former is caused by the lack of microvascular perfusion and the latter is mediated by cytyokines and oxygen free radicals. In addition to inhibiting thrombin, plasmin, kalikrein, trypsin, and neutrophil elastase, gabexate mesilate also plays an important role in inhibiting cytokines and oxygen free radical production. The purpose of this study was to investigate the effects of gabexate mesilate on ischemia- reperfusion injury in the liver. METHODS: Twenty-four New Zealand white rabbits were divided into three groups. Clamping was not done in group A (n=8), although it was done in group B (n=8) and group C (n=8). Group C received intravenous infusion of gabexate mesilate (10 mg/kg/hr) continuously during the process of clamping. Serum alanine aminotrasferase (ALT) and purine nucleoside phophorylase (PNP) were measured immediately before clamping, following 30-minute ischemia, and after 60-minute reperfusion. Hepatic tissue adenosine triphophate (ATP), xanthine oxidase, and malondialdehyde (MDA) plus 4-hydroxyalcenals (4HA) were measured after reperfusion. RESULTS: Compared with group A, group B and group C demonstrated a significant increase in ALT and PNP levels following ischemia and reperfusion, as well as in xanthine oxidase and MDA plus 4HA levels following reperfusion. However, ATP levels showed no significant differences among the three groups. ALT levels were significantly lower in group C than in group B following reperfusion (P<0.01),although there was no significant differences in PNP levels between them. Xanthine oxidase and MDA plus 4HA levels were significantly lower in group C than in group B (P<0.05). The results suggest that gabexate mesilate inhibits an increase in ALT, xanthine oxidase, and MDA plus 4HA levels. CONCLUSION: Gabexate mesilate inhibits oxygen free radical production of xanthine oxidase, and results in a reduction of hepatic ischemia-reperfusion injury.

hMLH1/hMSH2 Protein Expression in Sporadic Colorectal Carcinoma and Its Clinicopathological Significance

PURPOSE: DNA replication errors (RERs) in repeated nucleotide sequences (microsatellite instability) is caused by defective mismatch repair (MMR) genes. Ninety percent of colorectal carcinomas in hereditary nonpolyposis colorectal cancer (HNPCC) patients and 10-15% of sporadic colorectal cancers show microsatellite instability. In the majority of colorectal cancers with microsatellite instability, the defective MMR gene is hMLH1 or hMSH2. The author examined immunohistochemical expression of hMLH1 and hMSH2 in 75 cases of colorectal carcinomas excluding HNPCC, based on Amsterdam criteria for investigating clinicopathological characteristics and prognosis in hMLH1/hMSH2 negative cases. METHODS: Formalin fixed, paraffin blocks obtained from tumors of 75 cases of colorectal cancers were stained with two monoclonal antibodies (hMLH1 and hMSH2). The correlation between hMLH1/hMSH2 negativity, and clinicopathological feature and prognosis were statistically analysed. RESULTS: Twelve cases (16.0%) showed hMLH1/hMSH2 negativity. Negative expression of hMLH1/hMSH2 was associated with early onset (under age 50), proximal location, multiplicity, mucinous histologic type and poor differentiation. There was a significant survival advantage in patients with hMLH1/hMSH2 negative colorectal carcinoma. CONCLUSIONS: This study shows that hMLH1/hMSH2 negative colorectal carcinomas have the same clinicopathological characteristics of colorectal carcinomas with microsatellite instability. The immunohistochemical test for hMLH1/hMSH2 protein can be a simple screening method routinely applicable. The result of this test is available for establishing guidelines for management, and an independent prognostic factor for sporadic colorectal cancers.

Comparison of the Result of Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis in Familial Adenomatous Polyposis and Ulcerative Colitis

PURPOSE:The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC). METHODS:Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy. RESULTS:One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC. CONCLUSIONS:FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.

Comparative Analysis of Graft Patency and Limb Salvage Rate in DM & Non-DM after Infrainguinal Arterial Reconstruction

PURPOSE: The purpose of this study is to compare and analyze the results of primary and secondary patency rates and limb salvage rates in DM (Diabetes Mellitus) and Non-DM patients with atherosclerosis in the lower extremity after arterial reconstruction. METHODS: A retrospective study was done by reviewing admission notes and follow up records of 95 atherosclerotic limbs which had infrainguinal arterial reconstruction due to claudication induced severe impediment and limb threatening ischemia (reat pain, minor and major tissue loss). Kaplan-Meier survival analysis was used in the comparison of the primary, secondary patency rates and limb salvage rates, and statistical examination was handled by the Log-Rank significance test. RESULTS: 1 and 3 year primary patency rates were 76.0% and 65.6% each in the DM group and 63.9% and 56.5% each in the Non-DM group. 1 and 3 year secondary patency rates were 80.0% and 69.7% in DM patients and 81.1%, 73.9% each in Non-DM patients. The 1 and 3 year limb salvage rates of DM patients were 83.8% and 72.6% while Non-DM patients revealed a 84.9% and 77.8%. CONCLUSION: Aggressive arterial reconstruction is recommended as well, in DM patients with atherosclerosis in the lower extremity, considering the insignificant differences in the risk of surgery as well as the primary, secondary patency rates and limb salvage rates.

Solid and Papillary Cystic Neoplasm of Pancreas in Children

Solid and papillary cystic neoplasm of pancreas is an uncommon low grade malignant tumor found predominantly in young female in their second or third decade of life, and amenable cure by surgical treatment. The authors report two cases of solid and papillary neoplasm of pancreas pathologically verified at Kyung Hee university hospital. The first case was 11-years old male patient and the other case was 12-years old male patient. Symptoms of two patients were abdominal discomfort, nausea and vomiting and abdominal pain in the female patient. CT finding of solid and papillary neoplasm of pancreas depict a well-demarcated mass with solid and cystic necrosis component. In female patient, large hematoma was shown. Gross findings of tumor revealed apparent encapsulation, cystic degeneration and hemorrhagic necrosis. Microscopically the tumors were characterized by distinctive solid and papillary patterns of cellular arrangement without local invasion. All patients were discharged and follow up without any problem.