Comparison of the clinical results of surgical resection for extrahepatic cholangiocarcinomas: Hilar cholangiocarcinoma and mid-to-distal cholangiocarcinoma.

BACKGROUNDS/AIMS: Hilar cholangiocarcinomas (HLC) are known to have worse prognoses than mid-to-distal cholangiocarcinomas (CBDC). We analyzed the clinical results of surgical resections for extrahepatic cholangiocarcinomas to validate the differences in the prognoses of HLC and CBDC. METHODS: Two hundred and eighty-one patients underwent curative surgical resections for extrahepatic cholangiocarcinomas at the Department of Surgery in the Korea Cancer Center Hospital. Among them, we analyzed the T2 and T3 patients and compared the clinical results between those with HLC (n=74) and those with CBDC (n=65). RESULTS: The rate of R1 resections was significantly higher in the HLC patients compared to the CBDC patients (31.1% vs 12.3%, p=0.006). The overall survival rate of the T2/T3 patients was lower in the HLC group than in the CBDC group (24.5% vs 51.7, p=0.039). The recurrence-free survival rate was 23.3% in the HCL patients and 50.9% in the CBDC patients (p=0.06). In the subgroup analysis, the survival rates were not different in patients who had lymph node metastases or in patients who underwent R1 resections between the HLC and CBDC patients. Poor independent prognostic factors for the overall and recurrence-free survival rates in the T2/T3 extrahepatic cholangiocarcinoma patients were the presence of lymph node metastases and the hilar locations of tumor. CONCLUSIONS: HLC patients had poorer prognoses than CBDC patients. However, in patients with lymph node metastases, the prognosis was poor and was not different between the HLC and CBDC patients. Other adjuvant treatment methods are needed for extrahepatic cholangiocarcinoma patients with lymph node metastases to improve their prognoses.

Early Writing Intervention: A Best Evidence Synthesis.

The purpose of this best evidence synthesis was to identify promising interventions that align with a theoretical model of early writing development, targeting three components of early writing: transcription, text generation, and self-regulation. We determined the extent to which these interventions are effective for children who struggle with early writing skills, by calculating effect sizes for group and single-subject designs, and we examined the overall quality of the research. Twenty-five studies met inclusion criteria. Among group design studies, mean effects (Hedge's g) ranged from 0.19 to 1.17 for measures of writing quantity and from 0.17 to 0.85 for measures of writing quality. Percentage of all nonoverlapping data for single-subject designs ranged from 83% to 100% for measures of writing quantity. Interventions with the strongest evidence of effects and highest methodological quality are described in detail. Recommendations for research and practice are provided.

Teaching mathematical word problem solving: the quality of evidence for strategy instruction priming the problem structure.

This study examined the quality of the research base related to strategy instruction priming the underlying mathematical problem structure for students with learning disabilities and those at risk for mathematics difficulties. We evaluated the quality of methodological rigor of 18 group research studies using the criteria proposed by Gersten et al. and 10 single case design (SCD) research studies using criteria suggested by Horner et al. and the What Works Clearinghouse. Results indicated that 14 group design studies met the criteria for high-quality or acceptable research, whereas SCD studies did not meet the standards for an evidence-based practice. Based on these findings, strategy instruction priming the mathematics problem structure is considered an evidence-based practice using only group design methodological criteria. Implications for future research and for practice are discussed.

A Study of Plasma Apolipoprotein A-1 and Apolipoprotein B Levels in Patients with Coronary Artery Disease

BACKGROUND: It is known that dyslipidemia plays and important role in atherogenesis and progression for the disease. Recently it was reported that apolipoprotein levels are important in athcrogenesis. In Korean patients the study of the apolipoprotein levels as for the risk factor for atherogenesis is still needed. Subjects and METHODS: The 107 patients who underwent coronary angiography to differentiate chest pain syndrome were subjected to this study. Thirty-two patients who had no significant coronary artery disease served as a control group and 75 patients who had one or more coronary stenoses more than 50% narrowing by luminal diameter served as the coronary artery disease(CAD) group. Plasma levels of total cholesterol, triglycerides, high density lipoprotein cholestero(HDL-C), apolipoprotein A-1(Apo- A1) and apolipoprotein B(Apo B) were measured from venous blood after overnight fastion, and the results were compared between the groups. RESULTS: The male gender and smoking habits were more prevalent in the CAD group. Total cholesterol levels were significantly higher in the CAD group but the HDL-C level was not significantly different in two groups though the mean level of the HDL-C was some lower in the CAD group. The Apo A-1 level was lowere in the CAD group while the Apo B level was higher in teh CAD group compared to those of the control, Apo B / Apo A-1 ratio much more distinctly discriminated the two groups. CONCLUSION: Theses results suggest that the plasma Apo-A-1, Apo B levels and the ratio of Apo B / Apo A-1 can be used for risk statification of CAD.

2 Cases of Apical Hypertrophic Cardiomyopathy with Left Ventricular Endomyocardial Calcification

Calcification of myocardium is most common in the site of an old infarction or in an aneurysmal wall. In addition, Myocardial calcification may occur in association with endomyocardial fibrosis and hyperparathyroidism, as a result of focal toxic or inflammatory myocardial necrosis, as well as in patients undergoing hemodialysis. Calcium deposits due to parasites and due to neoplastic disease may also be seen, But, left ventricular endomyocardial calcification associated with apical hypertrophic cardiomyopathy is very rare. This report describes 2 cases of apical hypertrophic cardiomyopathy with left ventricular endomyocardial calcification, diagnosed by the echocardiographic, angiographic and histologic findings.

Predictive Factors of Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.

Predictive Factors of Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.

Left Ventricular Function in Patients with Angina and Normal Coronary Angiogram

BACKGROUND: Angina with normal coronary angiogram has been called syndrome X or microvascular angina, but pathophysiologic mechanisms for chest patin in this group of patients are not known exactly. To observe the changes of left ventricular function in patients with angina and normal coronary angiogram, the authors analyzed the left ventricular systolic and diastolic function with echocardiogram and cardiac catheterization. METHODS: The authors performed resting and treadmill exercise electrocardiogram, 201TI dipyridamole scan, M-mode and Doppler echocardiogram, cardiac catheterization and coronary angiogram in patients with angina and normal coronary angiogram. The systolic and diastolic left ventricular function indices from M-mode and Doppler echocardiogram, left ventricular catheterization and coronary angiogram were analyzed in 12 patients excluding diabetes, hypertension, cardiomyopathy and esophageal motility disorders among 1626 patients who underwent coronary angiogram between Jan. 1991 and Aug. 1992 in Chonnam University Hospital. RESULTS: 1) Studied subjects were 12 patients, 5 male and 7 female, mean age was 51+/-9.4 year-old. Resting electrocardiograms were normal in 8 cases and ST-T changes in 4 cases. Ischemic ST-T changes were observed in all cases during treadmill exericise test and perfusion defects in 3 cases out of 8 cases during 201TI dipyridamole scan. 2) On echocardiogram, ejection fraction(EF) was 68.9+/-4.5%, fractional shortening(FS) 37.4+/-4.4%, ratio of left atrial to aortic root dimension(LAD/AOD) 1.2+/-0.1, OR slope 3.8+/-0.8c,/sec, mitral valve Doppler E/A velocity ratio[E/A(V)] 0.9+/-0.2, mitral valve Doppler E/A area ratio[E/A(a)]1.3+/-0.3, early diastolic deceleration rate(EDDR) 4.3+/-1.3m/sec2, isovolumic relaxation time(IVRT) 96.2+/-15.7msec, isovolumic contraction time(IVCT) 38.1+/-9.1 msec and aortic valve Doppler peak flow velocity[Ao(V)] 0.8+/-0.2m/sec. EF, FS, IVCT and A(V) were normal. LAD/AOD and IVRT were increased, but E/A(V), E/A(a), OR slope and EDDR were decreased compared to normal subjects. 3) On cardiac catheterization and angiogram, mean left ventricular end-diastolic pressure was 15.3+/-5.1mmHg and ejection fraction by left ventriculogram 78.2+/-7.4%. There was no regional wall motion abnormality. CONCLUSION: Above results suggest that angina with normal coronary angiogram may be associated with impaired left ventricular diastolic function.

Clinical Study for Coronary Artery Stenting

BACKGROUND: Coronary artery stent has been introduced recently to overcome major problems of percutaneous trausluminal coronary angioplasty(PTCA). To evaluate the success rate, complications and predictive factors associated with restenosis in coronary artery stenting, clinical analysis after coronary srtery stent was performed. METHODS: Sixteen patients who underwent coronary artery stent in Chonnam University Hospital beteen Apr. 1992 and Dec. 1993 were observed. The authors analyzed the stent dilivery success, rate complications and restenosis after follow-up coronary angiogram. RESULTS: 1) The palmaz-Schatz stents were implanted in 16 patients(12 male, 4 female, mean age : 53.3 years) and clinical diagnosis of patients were 7 myocardial infarction, 8 unstable angina and one stable angina. Stents were implanted in 10 cases of left anterior descending arteries and 6 cases of right coronary arteries. Three stents were implanted in a patient with long spiral dissection after middle right coronary artery PTCA, single stent was implanted in the other patients. 2) Stent delivery was successful in all cases, but acute stent thrombosis developed just after bail-out procedure for PTCA-induced intimal dissection in myocardial infarction patient who had multivessel lesion and intracoronary thrombus. Subacute stent thrombosis and major bleeding requiring transfusion were not documented. 3) On follow-up coronary angiogram in 10 patients, no restenosis observed in 5 right coronary arterial stents, but restenosis developed in 3 of 5 left anterior descending artery stents. Restenosis was observed in none of 4.0mm stents, two of six 3.5mm stents and one of two 3.0mm stents. 4) Stent restenosis was observed in 3 cases of positive201TI dipyridamole scan which was performed one month after coronary artery stenting. CONCLUSION: Coronary artery stent is a safe and effective in elective procedure. The restenosis rate after intracoronary stent is lower in right coronary artery than left anterior descending artery and larger stent.

The Clinical Effects of Perindopril(Acertil(R)) on Hypertensive Patients

BACKGROUND: Perindopril. a new second-generation angiotensin converting enzyme inhibitor developed by Servier Research, was administered in essential hypertensive patients in order to observe the clinical effects. METHOD: The changes of blood pressure, heart rate, quality of life, clinical laboratory examinations, side effects, electrocardiogram and echocardiographic left ventricular mass were evaluated before and after 4-12mg of perindopril 12 weeks' administration in 25 essential hypertensive patients(mild 10, moderate 8, severe 5, very severe 2 : male 7, female 18 ; mean age 53.1+/-8.9 years). RESULT: 1) After treatment with perindopril alone, blood pressures were lowered markedly in 17(68%), moderately in 5(20%) and mildly in 2(8%) cases. The average of blood pressures of 25 subjects were systolic 173.1+/-22.8mmHg and diastolic 105.9+/-9.5mmHg before treatment, which were lowered to 125.2+/-14.9mmHg and 83.2+/-9.0mmHg respectively after 12 weeks(p<0.0001). 2) Quality of Life improved markedly in 11(44%) and slightly in 9(36%) cases after perindopril administration. 3) On electrocardiographic follow-up study, three out of five left ventricular hypertrophy with strain, seven out of 13 left ventricular hypertrophy, two out of three ST segment and T wave change and two sinus tachycardia were improved. Echocardiographic left ventricular mass was reduced significantly form 249.4+/-72.7g to 202.9 56.3g after 12 weeks perindopril treatment(p<0.0001). 4) Side effects were 5 cases of dry cough and 3 facial flushing. 5) Final Assessment of perindopril effect including hypotensive effect, quality of life, left ventricular mass regression and side effect showed very useful in 16(64%) and useful in 6(24%) out of 25 subjects. CONCLUSION: Perindopril may be an effective initial single antihypertensive agent for the treatment of varying degree of hypertension, especially with left ventricular hypertrophy.