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ABSTRACT: BACKGROUND: To better define the prognostic role of nodal disease, evaluation of metastatic lymph node ratio (MLR) has been performed, and this method has recently gained prominence in various gastrointestinal cancers. The present study attempts to identify prognostic factors and evaluate the independent prognostic influence of MLR in patients who have undergone curative pancreaticoduodenectomy. METHODS: In our institution within the study period, 111 patients received curative pancreaticoduodenectomy for periampullary cancers. Clinicopathologic data were collected and MLR was calculated for each of the patients. Patients were then divided into four groups based on MLR value: MLR 1 = 0; MLR 2 = 0.01-0.2; MLR 3 0.21-0.4; and MLR 4 >0.4. RESULTS: Increasing MLR correlates with high recurrence rate and lower overall survival (OS) with significance (P < 0.001, P < 0.001). The recurrent group showed significantly lower OS than the non-recurrent group (P < 0.001). In the multivariate analysis for recurrence, MLR was identified as the only independent prognostic factor (P < 0.001). CONCLUSIONS: The simple and easily obtainable MLR is well qualified as a prognostic factor in patients who undergo curatively radical resection for periampullary cancer. Furthermore, MLR can overcome the limitations of evaluation of lymph nodes status, allowing it to be used as a potential prognostic factor.
ANZ Journal of Surgery 03/2013; · 1.25 Impact Factor
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ABSTRACT: Gastric cancer and cholangiocarcinoma are problematic throughout the world due to their destructive malignancy. In attempts to treat cholangiocarcinoma and gastric cancer, researchers often explore the effects of transforming growth factor-β1 (TGF-β1). TGF-β1 plays a crucial role in causing cell cycle arrest and fibrosis in cancer cells. The present study aimed to identify whether TGF-β1 is capable of functioning as an antitumor agent in two cancer cell lines; cholangiocarcinoma and gastric cancer. The downregulation of cyclin dependent kinase (cdk) 4 and the upregulation of p27 were investigated, in order to identify possible antitumor functions of TGF-β1. A number of different methods were implemented, including cell proliferation assay, bicinchoninic acid (BCA) assay and western blot analysis with TGF-β1, AGS (human gastric cancer cell line) and SUN-1196 (human cholangiocarcinoma cell line). In the AGS study, cdk4 values decreased from 1.000 to 0.670 and then to 0.664, with increasing TGF-β1 concentrations of 0, 0.5 and 5 ng/ml, respectively. By contrast, p27 values increased from 1.000 to 1.391 and then to 1.505, with increasing TGF-β1 concentrations of 0, 0.5 and 5 ng/ml, respectively. In the SUN-1196 study, p27 values increased from 0.548 to 0.807 and then to 0.844 with increasing TGF-β1 concentrations of 5, 25 and 50 ng/ml, respectively. Certain concentrations of TGF-β1 play antitumor roles in gastric cancer through the down-regulation of cdk4 and upregulation of p27. Certain TGF-β1 concentrations also have antitumor roles in cholangiocarcinoma through the upregulation of p27. With these results, we came a step closer to finding a cure for cholangiocarcinoma and gastric cancer.
Oncology letters 02/2013; 5(2):694-698. · 0.11 Impact Factor
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ABSTRACT: Background/Aims: Peritoneal carcinomatosis is the most common recurrence type in gastric cancer. Disseminated tumor cells derived from serosal invasion may be indicators of early peritoneal seeding and subsequent peritoneal dissemination. Reverse-transcriptase polymerase chain reaction (RT-PCR) techniques have been introduced to aid in detection of disseminated tumor cells in peritoneal washes, however, use of a single molecular marker lacks adequate sensitivity. We sought to improve both sensitivity and specificity in detecting disseminated tumor cells in peritoneal washes by using two markers; carcinoembryonic antigen (CEA) and cytokeratin 20 mRNA (CK20 mRNA). Methodology: Between July 2007 and June 2010, peritoneal washing samples were collected from 131 patients who underwent surgery for histologically proven gastric cancer. CEA and CK20 mRNA levels were quantified using a Light Cycler. Results: Analysis using of the two markers had higher sensitivity (93.9%) and specificity (87.7%) than single marker detection (p<0.01, p<0.001 respectively). These analyses also correlated with various clinicopathological factors, and aided in predicting survival and peritoneal recurrence. Conclusions: Two-marker analysis has a significant correlation of survival or peritoneal recurrence in gastric cancer, and this analysis may be more useful as a prognostic predictor of peritoneal recurrence compared with RT-PCR mediated detection of CEA or CK20 alone.
Hepato-gastroenterology 01/2013; 60(127). · 0.66 Impact Factor
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ABSTRACT: Early intestinal mucosal damage plays an important role in severe acute pancreatitis (AP). Previous studies have shown that intestinal permeability (IP), serum endotoxin and cytokines contribute to the early intestinal barrier dysfunction in AP. This study explored the predictive capacity of IP, endotoxemia and cytokines as prognostic indicators in AP patients.
Eighty-seven AP patients were included in the study. The patients were classified into three groups according to the Balthazar computed tomography severity index (CTSI). We compared the biochemical parameters, including IP, serum endotoxin level and cytokine level among the three groups. The associations of IP with serum endotoxin, cytokines, CTSI, and other widely used biochemical parameters and scoring systems were also examined.
IP, serum endotoxin, interleukin (IL-6) and tumor necrosis factor (TNF)-α had a positive correlation with the CTSI of AP. Endotoxin, IL-6, TNF-α, CTSI, the Ranson/APACHE II score, the duration of hospital stay, complications and death significantly affect IP in the AP patients.
We believe that IP with subsidiary measurements of serum endotoxin, IL-6 and TNF-α may be reliable markers for predicting the prognosis of AP. Further studies that can restore and preserve gut barrier function in AP patients are warranted.
Gut and liver 10/2012; 6(4):505-11. · 0.83 Impact Factor
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Min Yong Yoon,
Jun Mo Sung,
Chang Seok Song,
Won Young Lee,
Eun Jung Rhee, Jun Ho Shin,
Chang Hak Yoo,
Seoung Wan Chae,
Ja Yeon Kim,
Wook Jin,
Yong Kyun Cho
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ABSTRACT: Adipose tissue is an active endocrine organ that secretes various metabolically important substances including adipokines, which represent a link between insulin resistance and nonalcoholic steatohepatitis (NASH). The factors responsible for the progression from simple steatosis to steatohepatitis remain elusive, but adipokine imbalance may play a pivotal role. We evaluated the expressions of adipokines such as visfatin, adipocyte-fatty-acid-binding protein (A-FABP), and retinol-binding protein-4 (RBP-4) in serum and tissue. The aim was to discover whether these adipokines are potential predictors of NASH.
Polymerase chain reaction, quantification of mRNA, and Western blots encoding A-FABP, RBP-4, and visfatin were used to study tissue samples from the liver, and visceral and subcutaneous adipose tissue. The tissue samples were from biopsy specimens obtained from patients with proven NASH who were undergoing laparoscopic cholecystectomy due to gallbladder polyps.
PATIENTS WERE CLASSIFIED INTO TWO GROUPS: NASH, n=10 and non-NASH, n=20 according to their nonalcoholic fatty liver disease Activity Score. Although serum A-FABP levels did not differ between the two groups, the expressions of A-FABP mRNA and protein in the visceral adipose tissue were significantly higher in NASH group than in non-NASH group (104.34 vs. 97.05, P<0.05, and 190.01 vs. 95.15, P<0.01, respectively). Furthermore, the A-FABP protein expression ratio between visceral adipose tissue and liver was higher in NASH group than in non-NASH group (4.38 vs. 1.64, P<0.05).
NASH patients had higher levels of A-FABP expression in their visceral fat compared to non-NASH patients. This differential A-FABP expression may predispose patients to the progressive form of NASH.
Clinical and molecular hepatology. 09/2012; 18(3):279-86.
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ABSTRACT: To use the clinical and radiological data to differentiate non-cholesterol versus cholesterol gall bladder (GB) polyps, which can be useful in deciding the treatment of the patient.
One hundred and eighty-seven patients underwent cholecystectomy for GB polyps of around 10 mm for 10 years, and were divided into two groups, cholesterol polyps (146 patients) and non-cholesterol polyps (41 patients) based on the postoperative pathological findings. Gender, age, body weight, height, body mass index (BMI), symptoms, laboratory findings, size, number of polyps, presence of GB stone and maximum diameter measured by preoperative ultrasonography (USG), computed tomography (CT), and pathological diameter were subjected to comparative analysis.
Patients diagnosed with cholesterol polyps were younger in age and had higher BMI, and the total cholesterol levels and white blood cell levels were higher, but were not statistically significant. It was notable to see that 28.6% of the cholesterol polyps were not found in the preoperative CT yet the percentage of the undetectable rate was significantly lower (8%) in the non-cholesterol polyp group. There was a discrepancy in maximum diameters between the two radiological methods in both groups but the discrepancy was significantly larger in the cholesterol polyp group.
The clinical signs that can be helpful to diagnose whether it is a cholesterol polyp or not are younger patients who have high BMI, polyps which are detectable only on the USG and large maximum diameters between the USG and CT. And if the discrepancy of the maximum diameter is lesser than 1mm the polyp may be considered as a non-cholesterol polyp.
Journal of the Korean Surgical Society. 04/2012; 82(4):232-7.
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ABSTRACT: In gastric cancer, the classification of lymph node status is still a controversial prognostic factor. Recent studies have proposed a new prognostic factor (metastatic lymph node ratio: MLR) for gastric cancer patients who undergo curative resection. The present study tested the hypothesis that MLR was better than the current pN staging system by analyzing the correlation between MLR and the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system, by analyzing the correlation between MLR and 5-year overall survival (OS), by comparing area under the curve (AUC), and by performing univariate and multivariate analyses for OS.
Of 409 patients who were diagnosed with gastric adenocarcinoma between January 2003 and December 2006, 370 patients underwent curative resection and were included in this study. The prognostic significance of the number of metastatic lymph nodes and the metastatic lymph node ratio were compared in AUC and univariate and multivariate Cox regression analyses.
MLR was significantly correlated with the depth of invasion and the number of lymph node metastases (p < 0.001). Increasing MLR also was statistically correlated with a lower 5-year OS rate (p < 0.001). The AUC of MLR and the number of lymph node metastases were not significantly different (p = 0.825). MLR was an independent prognostic factor on multivariate analysis, but the number of metastatic lymph nodes was not.
MLR can be a prognostic factor in patients who undergo radical resection for gastric cancer and can overcome the limitations of existing prognostic factors.
World Journal of Surgery 03/2012; 36(5):1096-101. · 2.36 Impact Factor
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ABSTRACT: Conventional laparoscopic appendectomy is performed using three ports, and single-port appendectomy is an attractive alternative in order to improve cosmesis. The aim of this study was to compare pain after transumbilical single-port laparoscopic appendectomy (SA) with pain after conventional three-port laparoscopic appendectomy (TA).
From April to September 2011, 50 consecutive patients underwent laparoscopic appendectomy for simple appendicitis without gangrene or perforation. Patients who had undergone appendectomy with a drainage procedure were excluded. The type of surgery was chosen based on patient preference after written informed consent was obtained. The primary endpoint was postoperative pain evaluated by the visual analogue scale score and postoperative analgesic use. Operative time, recovery of bowel function, and length of hospital stay were secondary outcome measures.
SA using a SILS port (Covidien) was performed in 17 patients. The other 33 patients underwent TA. Pain scores in the 24 hours after surgery were higher in patients who underwent SA (P = 0.009). The change in postoperative pain score over time was significantly different between the two groups (P = 0.021). SA patients received more total doses of analgesics (nonsteroidal anti-inflammatory drugs) in the 24 hours following surgery, but the difference was not statistically significant. The median operative time was longer for SA (P < 0.001).
Laparoscopic surgeons should be concerned about longer operation times and higher immediate postoperative pain scores in patients who undergo SA.
Journal of the Korean Surgical Society. 03/2012; 82(3):172-8.
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Hyun Il Seo,
Yong Kyun Cho,
Won Young Lee,
Eun Jung Rhee,
Ki Chul Sung,
Bum Soo Kim,
Byung Ho Son, Jun Ho Shin,
Kwan Joong Joo,
Hyun Pyo Hong,
Seoung Wan Chae,
Wook Jin
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ABSTRACT: To know which MS criteria best predict the presence of NAFLD and the prevalences of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) diagnosed ultrasonographically among pre-diabetic and diabetic subjects based on three different MS criteria (IDF, ATP III, WHO).
Subjects were screened and those with a fasting serum glucose level ≥100 mg/dL were further tested with a 75 g oral glucose tolerance test. And those who were newly diagnosed as having pre-diabetes or diabetes were evaluated for MS and NAFLD. We compared the risk ratios of NAFLD among three MS criteria using multivariate and multiple logistic regression analyses.
A total of 1365 subjects (977 males, mean age 48.4±9.5 years) were analyzed. The WHO criteria produced the highest prevalence of MS in both the pre-diabetic (49.8%) and diabetic (58.9%) groups. The IDF criteria produced the highest odds ratio for NAFLD in both pre-diabetic (3.89 [95% CI 2.75-5.51]) and diabetic (5.53 [95% CI 3.21-9.52]) groups.
The prevalence of MS depends on the set of diagnostic criteria used. IDF criteria best predicts the presence of NAFLD. The presence of NAFLD should be considered as a component of the diagnostic criteria for MS.
Diabetes research and clinical practice 09/2011; 95(1):19-24. · 2.16 Impact Factor
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ABSTRACT: Background: We aimed to explore the predictive ability of preoperative carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) levels for assessing tumor resectability (R0 resection) in patients with pancreatic adenocarcinoma.Methods: The present study included 72 patients who had been treated surgically for potentially resectable pancreatic adenocarcinoma and 42 patients who had been treated surgically for palliation (bypass surgery) at our institution. Pancreatic adenocarcinoma was histologically confirmed by pathological examination of the resected specimen or, if unresected, by intraoperative biopsy.Results: For resectable disease, the mean and median values of CA19-9 were significantly lower than for R1/2 or unresectable disease. The best cut-off points for CEA, CA19-9, and tumor size to predict resectability were 2.47 ng/mL, 92.77 U/mL and 11.85 cm3, respectively. A CA19-9 ≥ 92.77 U/mL and both tumor markers no less than the cut-off levels predicted the possibility of R1/2 or unresectability with 90.6% and 88.6% accuracy, respectively. However, either tumor marker or both tumor markers less than the cut-off levels predicted the probability of R0 resection only with 27.1% and 40.6% accuracy, respectively. The independent contributing factors to resectability (R0 resection) by multivariate regression analysis were a CA 19-9 < 92.77 U/mL, a tumor size < 11.85 cm3, and a less advanced AJCC stage.Conclusion: The present study demonstrates that preoperative serum CA19-9 and CEA levels can be used for the prediction of resectability (R0 resection) in patients with pancreatic adenocarcinoma, which may enable a simple and cost-effective exclusion of such patients who are unlikely to benefit from surgery.
Journal of Gastroenterology and Hepatology 08/2009; 24(12):1869 - 1875. · 2.87 Impact Factor
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ABSTRACT: We aimed to explore the predictive ability of preoperative carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) levels for assessing tumor resectability (R0 resection) in patients with pancreatic adenocarcinoma.
The present study included 72 patients who had been treated surgically for potentially resectable pancreatic adenocarcinoma and 42 patients who had been treated surgically for palliation (bypass surgery) at our institution. Pancreatic adenocarcinoma was histologically confirmed by pathological examination of the resected specimen or, if unresected, by intraoperative biopsy.
For resectable disease, the mean and median values of CA19-9 were significantly lower than for R1/2 or unresectable disease. The best cut-off points for CEA, CA19-9, and tumor size to predict resectability were 2.47 ng/mL, 92.77 U/mL and 11.85 cm(3), respectively. A CA19-9 > or = 92.77 U/mL and both tumor markers no less than the cut-off levels predicted the possibility of R1/2 or unresectability with 90.6% and 88.6% accuracy, respectively. However, either tumor marker or both tumor markers less than the cut-off levels predicted the probability of R0 resection only with 27.1% and 40.6% accuracy, respectively. The independent contributing factors to resectability (R0 resection) by multivariate regression analysis were a CA 19-9 < 92.77 U/mL, a tumor size < 11.85 cm(3), and a less advanced AJCC stage.
The present study demonstrates that preoperative serum CA19-9 and CEA levels can be used for the prediction of resectability (R0 resection) in patients with pancreatic adenocarcinoma, which may enable a simple and cost-effective exclusion of such patients who are unlikely to benefit from surgery.
Journal of Gastroenterology and Hepatology 08/2009; 24(12):1869-75. · 2.87 Impact Factor
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ABSTRACT: Laparoscopic cholecystectomy (LC) for complicated acute cholecystitis is associated with high rates of complications and conversion to open cholecystectomy. Percutaneous transhepatic gallbladder drainage (PTGBD) is a safe and effective treatment for acute inflammation of the gallbladder. This study was a retrospective analysis of patients who underwent an LC with or without PTGBD for complicated acute cholecystitis at our hospital between January 2002 and January 2007. Patients were classified into 3 groups: group 1, patients who underwent an LC without preoperative PTGBD (n=60); group 2, patients who underwent an early scheduled LC within 7 days of PTGBD (n=35); and group 3, patients in whom the LC was delayed for a mean of 19.9 days (range, 14 to 39 d) after PTGBD (n=38). The conversion rate to open cholecystectomy and the postoperative complication rate were lower in group 3 than in group 1 (P<0.05). Elective delayed LC after PTGBD may lower the conversion and complication rates of patients with complicated acute cholecystitis.
Surgical laparoscopy, endoscopy & percutaneous techniques 03/2009; 19(1):20-4. · 1.23 Impact Factor
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ABSTRACT: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer.
Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life.
Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively).
Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.
World Journal of Gastroenterology 02/2009; 15(8):978-82. · 2.47 Impact Factor
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ABSTRACT: The clinical significance of liver steatosis has been studied because steatosis plays a role in the progression of liver fibrosis. Nevertheless, the impact of steatosis in the early stage of fibrosis in non-obese young men with chronic hepatitis B (CHB) is poorly understood. Thus, the purpose of this study was to investigate the prevalence of hepatic steatosis, assess the relationship between hepatic steatosis and fibrosis and to assess the laboratory parameters for predicting clinically significant liver fibrosis in non-obese young men with CHB.
We prospectively evaluated liver biopsies in young male patients with CHB with a serum alanine aminotransferase level of more than two times the upper limit of normal for at least 3 months before enrollment. Patients were excluded when they had co-infection with another virus and prior antiviral treatment. Demographical, anthropometric and laboratory parameters were analysed. Liver steatosis, necroinflammation and fibrosis were also assessed.
A total of 86 young male patients with CHB were included in this study. The median age was 21 years (range, 20-26 years) and the median body mass index was 23.0 kg/m2 (range, 18.0-28.3 kg/m2). Steatosis was present in 44 patients (51.2%). Significant fibrosis (beyond periportal fibrosis) was present in 50 patients (58.1%). Steatosis was associated with insulin, homeostasis model for insulin resistance (HOMA-IR), total cholesterol and triglycerides. On multiple regression analysis, steatosis was independently associated with triglyceride and HOMA-IR. Significant fibrosis was independently associated with gamma-glutamyltransferase (GGT) and necroinflammation activity. However, there was no significant association between significant fibrosis and the presence of steatosis.
The prevalence of hepatic steatosis is a common finding in young male patients with CHB. Hepatic steatosis in CHB patients seems to be associated with insulin resistance, but it is not associated with hepatic fibrosis. GGT levels can provide useful information on the stage of CHB.
Liver international: official journal of the International Association for the Study of the Liver 02/2009; 29(6):878-83. · 3.82 Impact Factor
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ABSTRACT: To evaluate the outcome of laparoscopic cholecystectomy (LC) in patients aged 80 years and older.
A total of 353 patients aged 65 to 79 years (group 1) and 35 patients aged 80 years and older (group 2) underwent LC. Patients were further classified into two other groups: those with uncomplicated gallbladder disease (group A) or those with complicated gallbladder disease (group B).
There were no significant differences between the age groups (groups 1 and 2) with respect to clinical characteristics such as age, gender, comorbid disease, or disease presentation. Mean operative time, conversion rate, and the incidence of major postoperative complications were similar in groups 1 and 2. However, the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0% vs 5.7%, P < 0.01). Group A comprised 322 patients with a mean age of 71.0 +/- 5.3 years, and group B comprised 51 patients with a mean age of 69.9 +/- 4.8 years. In group B, mean operative time (78.4 +/- 49.3 min vs 58.3 +/- 35.8 min, P < 0.01), mean postoperative hospital stay (7.9 +/- 6.5 d vs 5.0 +/- 3.7 d, P < 0.01), and the incidence of major postoperative complications (9.8% vs 3.1%, P < 0.05) were significantly greater than in group A. The conversion rate tended to be higher in group B, but this difference was not significant.
Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease, and not by chronologic age. In octogenarians, LC should be performed at an earlier, uncomplicated stage of the disease whenever possible to improve perioperative outcomes.
World Journal of Gastroenterology 02/2009; 15(6):722-6. · 2.47 Impact Factor
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ABSTRACT: Our study aimed to evaluate the therapeutic results of endoscopic N-butyl-2-cyanoacrylate injection (EBC) and balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric variceal hemorrhage (GVH) and/or high-risk gastric varices (GV).
Twenty-seven patients with GVH and/or high-risk GV (>or= 5 mm in diameter, those with red spots, and a Child-Pugh grading of B or C liver cirrhosis) who were treated with either EBC or BRTO from April 2005 to December 2007 were included in our study.
EBC or BRTO was initially used for the treatment of GVH in 14 and 13 patients, respectively. Technical success was achieved in all 14 patients (100%) initially treated with EBC, and 10 of 13 patients (76.9%) initially treated with BRTO. Significant rebleeding occurred in 10 patients (71.4%) of the EBC group, and two patients (15.4%) of BRTO group (P < 0.01). Five of six patients (83.3%) treated with rescue BRTO due to rebleeding after initial EBC achieved technical success, and all six patients who were treated with rescue BRTO had no rebleeding during the median follow up of 17 (range: 2-37) months. The cumulative survival rate of the EBC with the BRTO rescue group/BRTO group was significantly higher than the EBC group.
The therapeutic efficacies of EBC and BRTO for the treatment of active GVH and/or high-risk GV appeared to be similar. However, EBC might be associated with a higher rebleeding rate than BRTO. BRTO could be an effective rescue treatment for patients with GVH after initial treatment of EBC.
Journal of Gastroenterology and Hepatology 12/2008; 24(3):372-8. · 2.87 Impact Factor
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ABSTRACT: Appropriate palliation for unresectable pancreatic head cancer is most important. This study was undertaken to compare the survival of patients with biliary obstruction caused by unresectable pancreatic head cancer after surgical and non-surgical palliation.
We retrospectively reviewed 69 patients who underwent palliative treatment for unresectable pancreatic head cancer. Fifty-two patients with locally advanced disease (local vascular invasion) and 17 with distant metastatic disease were included. The patients were divided into two groups, surgical and non-surgical palliation.
Thirty-eight patients underwent biliary bypass surgery and 31 had percutaneous transhepatic biliary drainage (PTBD). There was no significant difference in the early complications, successful biliary drainage, recurrent jaundice, and 30-day mortality between surgical palliation and PTBD. However, in 52 patients whose tumor was unresectable secondary to local vascular invasion, the rate of recurrent jaundice after successful surgical biliary palliation was lower than that in patients who had non-surgical palliation (P<0.05). The patients who underwent surgical palliation had a longer hospital-free survival rate (P<0.001), although they had a longer postoperative hospital stay (P=0.004) during the first admission period.
In patients with preoperative evaluations showing potentially resectable tumors and/or no metastatic lesions, surgical exploration should be performed. Thus, in patients who have unresectable cancer or limited metastatic disease on exploration, surgical palliation should be performed for longer survival and better quality of survival.
Hepatobiliary & pancreatic diseases international: HBPD INT 12/2008; 7(6):643-8. · 1.08 Impact Factor
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Ji-Hoon Choi,
Jung-Won Yun,
Yong-Sung Kim,
Eun-A Lee,
Sang-Tae Hwang,
Yong-Kyun Cho,
Hong-Joo Kim,
Jung-Ho Park,
Dong-Il Park,
Chong-Il Sohn,
Woo-Kyu Jeon,
Byung-Ik Kim,
Hyoung-Ook Kim, Jun-Ho Shin
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ABSTRACT: To determine the clinical data that might be useful for differentiating benign from malignant gallbladder (GB) polyps by comparing radiological methods, including abdominal ultrasonography (US) and computed tomography (CT) scanning, with postoperative pathology findings.
Fifty-nine patients underwent laparoscopic cholecystectomy for a GB polyp of around 10 mm. They were divided into two groups, one with cholesterol polyps and the other with non-cholesterol polyps. Clinical features such as gender, age, symptoms, size and number of polyps, the presence of a GB stone, the radiologically measured maximum diameter of the polyp by US and CT scanning, and the measurements of diameter from postoperative pathology were recorded for comparative analysis.
Fifteen of the 41 cases with cholesterol polyps (36.6%) were detected with US but not CT scanning, whereas all 18 non-cholesterol polyps were observed using both methods. In the cholesterol polyp group, the maximum measured diameter of the polyp was smaller by CT scan than by US. Consequently, the discrepancy between those two scanning measurements was greater than for the non-cholesterol polyp group.
The clinical signs indicative of a cholesterol polyp include: (1) a polyp observed by US but not observable by CT scanning, (2) a smaller diameter on the CT scan compared to US, and (3) a discrepancy in its maximum diameter between US and CT measurements. In addition, US and the CT scan had low accuracy in predicting the polyp diameter compared to that determined by postoperative pathology.
World Journal of Gastroenterology 12/2008; 14(44):6831-4. · 2.47 Impact Factor
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ABSTRACT: To compare the health behaviors of widowed women with those of currently married women.
We randomly sampled the subjects from the Jeollanamdo Resident Registration Data and we then selected 2,331 widowed women and 4,775 married women. Well-trained examiners measured the height, weight, blood pressure and abdomen circumference, and the women were interviewed with using a questionnaire. Logistic regression analysis was used to estimate the odds ratios(OR) of the two groups.
The smoking rate (OR=2.46; 95% confidence interval [CI]1.65, 3.66) was significantly higher for the widowed women. On the contrary, the awareness rate of a smoking cessation campaign (OR=0.80; 95% CI=0.70, 0.92), a quit tobacco telephone line (OR=0.73; 95% CI=0.61, 0.88) and a quit smoking clinic (OR=0.74; 95% CI=0.62, 0.89) were lower for the widowed women. The rate of receiving a health exam (OR=0.80; 95% CI=0.70, 0.91), the rate of undergoing gastric cancer screening (OR=0.77; 95% CI=0.68, 0.88), breast cancer screening (OR=0.79; 95% CI=0.69, 0.89), cervix cancer screening in the last 2 years (OR=0.81; 95% CI=0.71, 0.92), colon cancer screening in the last 5 years (OR=0.74; 95% CI=0.63, 0.87) were significantly lower for the widowed women.
This study revealed that the health behaviors are significantly different between the widowed women and the married women. To improve the health behaviors of the widowed women, further study and research that will investigate the socioeconomic and environmental factors that affect the health behaviors of widowed women will be needed.
Journal of Preventive Medicine and Public Health 08/2008; 41(4):272-8.
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Yong Kyun Cho,
Chang Seop Kim,
Si Young Kim,
Jung Ho Park,
Hong Joo Kim,
Dong Il Park,
Chong H Sohn,
Woo Kyu Jeon,
Byung Ik Kim, Jun Ho Shin,
Byung Ho Son
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ABSTRACT: Endoscopic injection therapy is a well-established method of controlling peptic ulcer bleeding but it is not clear which agent would be the best choice for injection material. In this study, we evaluated the effect of Sodium Hyaluronate for control of ulcer bleeding.
The subjects consisted of 26 patients with major peptic ulcer hemorrhage from June 2000 to August 2001. There were 17 gastric ulcers, 7 duodenal ulcers and 2 ulcers at anastomosis site. According to modified Forrest classifications, there were 7 active bleeding (spurting, 3; oozing, 4) and 19 stigmata of recent hemorrhage (visible vessel, 14; fresh blood clots, 5). Sodium Hyaluronate-saline solution was injected to control the bleeding. The initial and permanent hemostatic rate, rebleeding rate, and other complications were retrospectively evaluated.
The initial hemostatic rate was 25/26 (96.2%) and re-bleeding rate 3/26 (11.5%). The success rate of the second trial of Sodium Hyaluronate injection was 3/3 (100%). Overall, the permanent hemostatic rate was 25/26 (96.2%) and there were no complications related to Sodium Hyaluronate injection.
Sodium Hyaluronate is an excellent candidate agent for endoscopic injection therapy because of its convenience and safety. Further prospective randomized trials with other hemostatic methods are needed.
Hepato-gastroenterology 07/2007; 54(76):1276-9. · 0.66 Impact Factor
