• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.659-668
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• 1993

Background: p53 is currently considered as a tumor suppressive gene product, and its alterations are suggested to be involved in several human malignancies, including non-small cell lung cancers. p53 expression rates are variable in many reports and among cell types. Also, whether the phase of p53 expression is early or late during carcinogenesis is not certain. Thus, We have investigated to evaluate p53 expression rates of the various cell types and tissues and identify expression phase (early or late). Method: We obtained 71 tissue from 50 non-small cell lung cancer patients and performed the simple immunohistochemical staining using nonspecific monoclonal antibody(NCL-p53DO7). Results: 1) In non-small cell lung cancer patients. the expression rate of lungs(46.5%) is higher than that(25.0%) of lymph nodes. But, there is no significant difference between two groups. 2) Among the various cell types, p53 expression rates in squamous cell carcinoma and adenocarcinoma are 58.3% and 50.0% respectively without significant difference. 3) p53 expression rates in various stages are 33.3%, 60.0%, 40.0%, 60.0% and 66.7% in stage I, II, IIIa, IIIb and IV, respectively with no significant difference. 4) p53 expression rates in the various T parameters are 33.3%, 50.0%, 16.7% and 100% in T1, T2, T3 and T4, respectively and p53 expression rates in the various N parameters are 27.3%, 22.2% and 25.0% in N1, N2 and N3, respectively. There are no significant differences in the expression rates among varous T & N parameters. 5) p53 expression rates of lymph nodes in patients who have positive stains in lungs are 12.5% and 50.0% in N1 and N2. 6) p53 expression rates of all lymph nodes in patients who have negative stains in lungs are 0.0%. Conclusion: The above results show that p53 expression rate in non-small cell lung cancers is not correlated with cell type and progression of stage and it is thought to need further investigations about at what phase p53 expression influences the development and progression of lung cancers.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.677-682
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• 1993

Background: Massive hemoptysis is a major clinical problem with high mortality. Bronchial artery embolization is well accepted and widely used for treatment of massive and recurrent hemoptysis, especially in patients with chronic diffuse pulmonary disease who are poor candidates for surgery. We evaluated the therapeutic effect of transcatheter arterial embolization for immediate control and prevention of recurrent hemoptysis. Method: We reviewed 20 cases(M:F=13:7) of bronchial artery embolization for the management of massive hemoptysis from Jun 1989 to Aug 1992 retrospectively. Results: Underlying causes of hemoptysis were pulmonary tuberculosis(n=14), bronchiectasis(n=3), aspergilloma(n=2) and paragonimiasis(n=1). Embolization material was choosed randomly gelfoam(n=7) or Ivalon(n=11) and in 2 cases both were used simultaneously. Target arteries of embolization were bronchial artery only in 15 cases, non-bronchial systemic arteries with or without bronchial artery in 5 cases. After the arterial embolization, immediate cessation of hemoptysis was achieved in 17 cases(85%) and total recurrence rate including 3 cases of immediate treatment failure was 50%. Among recurrences 3 cases were achieved lobectomy, 1 case was expired by asphyxia due to massive hemoptysis and remained 6 were managed by medical conservative treatment with no further recurrence of hemoptysis during follow up periods. Conclusion: Bronchial artery embolization for treatment of massive or recurrent hemoptysis was effective in immediate bleeding control. Despite high recurrence rate the rebleeding after embolization was less severe and controllable by conservative management. Bronchial artery embolization is valuable as primary trial to massive hemoptysis.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.465-473
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• 1995

Background: The prevalence of pulmonary tuberculosis has decreased progressively after the control of the tuberculosis began as national control. But as diabetes, malignancy, immunodeficiency disease recently tend to be increased, the tuberculosis become to the important national health problem. So, this study was designed to observe the state and the change of the prevalence and the clinical status of pulmonary tuberculosis for recent 10 years at one women's university. Method: We retrospectively investigated the epidemiology and the clinical status of 612 patients who were registered at the Ewha Womans University Health Center by analyzing records from 1983 to 1992. Results: 1) The prevalence rate had been steadily decreased from 0.63% in 1983 to 0.11 % in 1992. The prevalence of freshman and the incidence rate according to the entrance year while in the university significantly decreased since 1989. 2) In classifying by registered source, 45.6% of students were detected by annual periodical health examination, 34.5% by entrance physical examination, 12.0% by hospital, 5.4% by health center clinic, 2.5% by reentrance physical examination, sequentially. 3) The students with past history of tuberculosis were 70(11.4%) and 61(10%) suffered from pulmonary tuberculosis. The patients with family history of tuberculosis were 142(23.3%). 4) There were 530(86.6%) with minimal disease, 79(12.9%) with moderate and only 3(0.5%) with far advanced, when classified by the severity of disease. 5) The initial symptoms were mild breathing difficulty in 30.1%, sweating in 14.9%, fatigue in 14.3%, febrile sense in 11.7%, hemoptysis in 8.2%, sequentially. 6) The duration of treatment was $10.6{\pm}3.6$ months in mild group, $14.9{\pm}5.2$ months in the moderate group(P<0.05). 7) The side reactions of the drug were GI trouble in 7.2%, hepatitis in 1.8%, skin rash in 0.8% and streptomycin side in used patients in 9.1%. Conclusion: The prevalence of pulmonary tuberculosis among the students in one women's university was significantly lower than that of university students and 20-24 year-old age group announced in tuberculosis survey on a national scale, and significantly decreased since 1989. The treatment effect was desirable in student's group managed by university health center.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.397-403
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• 1998

Background: Little information is available concerning the value of bronchoscopy in patients with a lymphocytic exudative pleural effusion in which percutaneous pleural biopsy have been regarded as cornerstone in investigating the etiology. Recently, a few reports suggest that bronchoscopy may be more effective diagnostic method in patients with unexplained pleural effusion accompanied by hemoptysis or other roentgenographic abnormalities, such as mass, infiltrate, atelectasis. Method: Mter initial examinations of sputum and pleural fluid through thoracentesis in 112 patients(male 75 cases, female 37 cases, mean age 53.2 years) who were admitted for evaluation of the cause of pleural effusion, we performed bronchoscopy and closed pleural biology in most patients with undiagnosed lymphocytic exudate and compared the diagnostic yield of both invasive methods according to hemoptysis or other roentgenographic abnormalities, and investigated the sole diagnostic contribution of bronchoscopy. Results: Tuberculosis(57 cases, 51%) was the most common cause of pleural effusion. Percutaneous pleural biopsy showed more diagnostic yield than bronchoscopy regardless of presence or absence of other clinical or radiologic abnormalities. In 25 cases with unknown etiology after pleural biopsy, additional diagnostic yield by bronchoscopy was 36 % (4/11) in patients with associated features and only 7 % (1/14) with lone effusion, and, as the sole mean for diagnsosis in all patients with pleural effusion, was only 4.5%(5/12). Conclusion : In a region of high prevalence of tuberculosis as a cause of pleural effusion, percutaneous pleural biospy is more effective method when invasive method is required for confirmative diagnosis of unexplained lymphocytic exudative pleural effusion, and bronchoscopy is unlikely to aid in the diagnosis of lone pleural effusion.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1983.05a
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• pp.11.2-11
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• 1983

Vocal nodules and polyps are much more frequent in singers, public speakers, teachers and actors. Voice trauma and voice misuse, at times associated with mild inflammatory reaction, appear to be important in their etiology. It is generally agreed that vocal cord nodules and polyps are inflammatory in nature and they arise in the subepithelial layer of loose connective tissue of the vocal cord. Since the junction of anterior and middle thirds of the membranous cord and has the greatest amplitude of vibration. This is the site of predilection for vocal cord nodules. The author performed laryngomicrosurgery for 70 cases of vocal nodules and polyps at Ewha Womans University Hospital during the period of 5 years. The result obtained were as follows ; 1) Surgical excision is not necessarily the best approach because vocal nodules in the early stages will resolve with the simplest voice therapy. 2) In children, surgery is rarely indicated because most nodules in children regress during adolescence. 3) For patients who use their voices professionally, voice therapy is indicated for three months. 4) If after three month of conservative treatment the cord lesion does not improve and the patient it still dissatisfied with his voice, laryngomicrosurgery can then be considered. 5) The small cuffed endotracheal tube in the interarytenoid space helps to keep the cords immobile and in an abducted position. 6) Removal of the nodule shoule be started by gentle retraction posteriorly and as soon as a tear appears anterior to the nodule. 7) On occasion it is preferable to start the dissection with a siccle knife while the nodule is held on the stretch. 8) Voice rest should be maintained for a week following which the free edges of the cords are usually healed.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.225-231
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• 2008

Purpose: Laparoscopic gastric resection (LGR) is increasingly being used instead of open gastric resection (OGR) as the standard surgical treatment for gastric submucosal tumors. Yet there are few reports on which technique shows better postoperative outcomes. This study was performed to compare these two treatment modalities for gastric submucosal tumors by evaluating the postoperative outcomes. We also provide an analysis of the learning curve for LGR. Materials and Methods: Between 2003.4 and 2008.8, 103 patients with a gastric submucosal tumor underwent either LGR (N=78) or OGR (n=25). A retrospective review was performed on a prospectively obtained database of 103 patients. We reviewed the data with regard to the operative time, the blood loss during the operation, the time to the first soft diet, the postoperative hospital stay, the tumor size and the tumor location. Results: The clinicopatholgic and tumor characteristics of the patients were similar for both groups. There was no open conversion in the LGR group. The mean operation time and the bleeding loss were not different between the LGR group and the OWR group. The time to first soft diet (3.27 vs. 6.16 days, P<0.001) and the length of the postoperative hospital stay (7.37 vs. 8.88 days, P=0.002) were shorter in the LGR group compared to the OGR group. The tumor size was bigger in the OGR group than that in the LGR group (6.44 vs. 3.65 cm, P<0.001). When performing laparoscopic gastric resection of gastric SMT, the surgeon was able to decrease the operation time and bleeding loss with gaining more experience. We separated the total cases into 3 periods to compare the operation time, the bleeding losses and the complications. The third period showed the shortest operation time, the least bleeding loss and the fewest complications. Conclusion: LGR for treating a gastric submucosal tumor was superior to OGR in terms of the postoperative outcomes. An operator needs some experience to perform a complete laparoscopic gastric resection. Laparoscopic resection could be considered the first-line treatment for gastric submucosal tumors.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.182-188
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• 2008

Purpose: Transcriptional factors of CREB (cAMP response element binding protein) are involved in regulating the gene expression in response to a variety of signaling pathways. The proteins produced by the CREB genes play key roles in many physiological processes, including memory and long-term potentiation. The retinoic acid receptor (RAR) axis mediates epithelial cell differentiation and proliferation in many tissues. This study examined the expressions of RAR and CREB and their relationship with the clinicopathologic factors and their significance. Materials and Methods: The levels of the RAR and CREB expressions were measured in 150 gastric adenocarcinomas by performing immunohistochemical staining. Results: 1. An RAR protein expression was found in 63.3% of the adenocarcinomas (95/150) and a CREB expression was found in 60.7% (91/150) of the adenocarcinomas. 2. An RAR protein expression was found in 72.2% (78/108) of the intestinal type adenocarcinomas and in 40.5% (17/42) of the diffuse type adenocarcinomas (P<0.05). Based on the depth of invasion, an RAR protein expression was found in 58.3% (14/24) of the T1 adenocarcinomas, in 61.9% (13/21) of the T2 adenocarcinomas, in 63.5% (61/96) of the T3 adenocarcinomas, in 77.8% (7/9) of the T4 adenocarcinomas and in 74.7% (62/83) of the adenocarcinomas with lymph node metastasis and in 49.2% (33/67) of the adenocarcinomas without lymph node metastasis (P<0.01). 3. A CREB expression was found in 69.4% (75/108) of the intestinal type and in 38.1% (16/42) of the diffuse type (P>0.05). Based on the depth of invasion, a CREB expression was found in 50% (12/24) of the T1 adenocarcinomas, in 52.4% (11/21) of the T2 adenocarcinomas, in 64.6% (62/96) of the T3 adenocarcinomas, in 66.6% (6/9) of the T4 adenocarcinomas, in 71.1% (59/83) of the adenocarcinomas with lymph node metastasis and in 47.8% (32/67) of the adenocarcinomas without lymph node metastasis (P<0.01). 4. The RAR protein and CREB expressions coincided in 71.4% of the gastric adenocarcinomas and a significant correlation between them was found (P<0.05). Conclusion: We found a significant relationship between the expression of RAR and CREB and the histology and lymph node metastasis of gastric cancer. Further studies are needed to confirm their biologic meaning in gastric carcinogenesis.

• The Korean Journal of Nuclear Medicine
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• v.34 no.2
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• pp.119-128
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• 2000

Purpose: The aim of this study was to investigate the diagnostic role of $^{99m}Tc$-Tetrofosmin in detection of breast cancer and compared with that of $^{99m}Tc$-MIBI. Material and Methods: Forty-eight patients with a clinically palpable mass or abnormal mammographic or ultrasonographic findings had $^{99m}Tc-MIBI\;and\;^{99m}Tc$-Tetrofosmin scintimammographies after intravenous injection of 925 MBq of radiopharmaceuticals. The scintimammographs were correlated with histopathologic findings. Results: Thirty-three patients were diagnosed with breast cancer and 15 patients with benign breast diseases. The numbers of true positive, true negative, false positive, and false negative cases of $^{99m}Tc$-MIBI scintimammography were 29, 10, 5, and 4 respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of $^{99m}Tc$-MIBI scintimammographies were 87.8%, 66.7%, 85.3%, and 71.4% respectively. The numbers of true positive, true negative, false positive, and false negative cases of $^{99m}Tc$-Tetrofosmin were 31,10, 5, and 2 respectively. The sensitivity, specificity, positive predictive value, negative predictive value of $^{99m}Tc$-Tetrofosmin were 93.9%, 66.7%, 86.1%, and 73.3% respectively. One patient was false negative in both $^{99m}Tc-MIBI\;and\;^{99m}Tc$-Tetrofosmin acintimammographies and its size was 0.5 cm. Conclusion: $^{99m}Tc-Tetrofosmin\;and\;^{99m}Tc-MIBI$ were non-invasive and useful in detection of breast cancer and $^{99m}Tc$-Tetrofosmin was comparable to the $^{99m}Tc$-MIBI in detection of primary breast cancer.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.806-812
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• 1999

Background: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. Material and Method: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. Result: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). Conclusion: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.447-453
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• 2001

Background: Although pulmonary resection is the standard approach for the management of pulmonary metastases from soft tissue sarcoma, most of them are unresectable and chemotherapy remains the only option. The effectiveness of the cytotoxic drugs may be limited by the toxicities that occur before the therapeutic dose is reached. The regional administration of doxorubicin using pulmonary arterial perfusion in a rodent model can produce 10 to 25 times higher concentrations in the lung than systemic administration with minimal systemic toxicities. However, it is unclear whether a high concentration of doxorubicin has beneficial effects for killing cancer cells. Material and Method: We studied this to evaluate the dose-dependent cytotoxic and apoptotic effects of doxorubicin on methylcholanthrene-induced rat fibrosarcoma(MCA) cells. This study examined the cytotoxicity and apoptosis-related gene expressions(Fas, FasL, Bax, caspase 1, caspase 2, caspase 8, Bcl-2, Bcl-xL, Bcl-xS) in MCA cells after 24 hours exposure to various concentrations of doxorubicin such as 1, 5, 10, 50, and 100 $\mu$M. Result: Dose-dependent cytotoxicity was observed after 24 hours exposure to doxorubicin. However, peak apoptosis after 24 hours exposure was observed at 5 $\mu$M of doxorubicin. Above 5 $\mu$M, apoptotic activity was decreased with dose-increment. All mRNA levels of apoptosis-related genes after 24 hours exposure were up-regulated above the control level at 1 $\mu$M of doxorubicin and then decreased by doxorubicin dose-increment except caspase 8, which showed higher levels than the control level at 5 $\mu$M. Apoptosis-related protein levels were highest at 1 $\mu$M of doxorubicin and then decreased by doxorubicin dose-increment. However, Bax and Bcl-xL proteins steadily showed higher levels than the control throughout the different concentrations of doxorubicin. Conclusion: These results suggest that apoptosis is the main cytotoxic mechanism in low concentrations of doxorubicin in MCA cells and apoptosis-related genes, such as Bax, caspase 8, and Bcl-xL, are involved. At high concentrations, doxorubicin still can kill MCA cells, even when apoptosis is inhibited, and have its propriety for achieving much cytotoxicity against MCA cells.