• Journal of Gastric Cancer
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• 제5권2호
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• pp.101-105
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• 2005

Purpose: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. Materials and Methods: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of $\times$100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. Results: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75) (P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients ($95.3\%\;vs.\;77.6\%$, P=0.0282), but was similar to that ($91.2\%$) of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)($93.3\%\;vs.\;78.2\%$, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis ($42.5\%\;vs\;23\%$, P=0.006) than patients with sm. Conclusion: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer. (J Korean Gastric Cancer Assoc 2005;5:101-105)

• Journal of Gastric Cancer
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• 제6권2호
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• pp.76-83
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• 2006

Purpose: Endoscopic incision and submucosal dissection (EISD) is a technique that is being implemented for the resection of gastric adenomas and early gastric cancer (EGC). Since EISD requires a high degree of skill and experience, and due to its association with a moderate risk of gastrointestinal bleeding, its use has been limited. The objective of this study is to investigate the clinical benefits of EISD based upon clinical data on the EISD procedure. Materials and Methods: This study was conducted at Soonchunhyang University Hospital and it included 179 gastric adenoma and early gastric carcinoma lesions from 164 patients who had undergone an EISD from February 2003 to May 2005. Results: Among the total of 179 lesions, the distributions of EGC and adenomas were 70.3% (126/179) and 23.4% (42/179) respectively. The sizes of lesions were divided into 10 mm or less, $11{\sim}20\;mm,\;21{\sim}30\;mm$ and greater than 31 mm and each rates are 10.0% (18/179), 46.3% (83/179), 30% (50/179) and 15.0% (28/179). Among 120 cases which could be measured depth of lesion in according to pathologic findings, m1 (0.8%, 1/120), m2 (38.3%, 46/120), m3 (25%, 57/120), sm1 (11.7%, 14/120), sm2 (1.6%, 2/120) were diagnosed as early stages of gastric cancer. The complete resection rate was 85.2% (150/176) and en-bloc resection rate was 96.0% (169/176). Complications as such as perforation and bleeding developed in 4.4%(8/179) and 21.2% (38/179), respectively. Conclusion: EISD is an effective in the endoscopic treatment for gastric adenoma and early gastric cancers. However, further evaluation of this method and long-term follow-up will be necessary for an evaluation of the recurrence rate after resection of a tumor.

• Tuberculosis and Respiratory Diseases
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• 제48권5호
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• pp.730-739
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• 2000

Background : The aim of this study was to analyze the clinical manifestations and efficacy of treatment regimens in order to determine the adequate combination of anti-tuberculotic agents and duration of treatment for tuberculous lymphadenitis. Methods : We made a review of 373 patients with tuberculous lymphadenitis, who were admitted to four medical college hospitals in Taegu Korea from 1989 to 1998, and their diagnoses were confirmed histologically and bacteriologically. Results : The incidence of tuberculous lymphadenitis was 71.3% in women and 57.7% were between the ages of 20 and 39 years. The most common symptom was painless swelling. The most commonly involved lymph nodes were unilateral superficial cervical lymph node groups. Tuberculous lymphadenitis was accompanied with active pulmonary tuberculosis, commonly. The sensitivity of fine needle aspiration(FNA) in tuberculous lymphadenitis was 79.6%, and 92.2% of the patients had a strong positive reaction to the tuberculin skin test. The most commonly prescribed anti-tuberculotic regimen was the combination of INH, RMP, EMB, and PZA(62.6 %). Eighty percent of patient were treated for 9-12 months. There was no significantly difference in the recurrence rate of tuberculous lymphadenitis between the combinations of anti-tuberculotic agent, including INH and RMP, and between the durations of treatment, for a period of 6 months of more. Conclusion : The combination of FNA cytologic examination and tuberculin skin test may be helpful in the diagnosis of tuberculous lymphadenitis. We propose that the combination of anti-tuberculotic agents, INH, RMP, EMB, and PZA, be prescribed to patients for 6 to 9 months.

• Tuberculosis and Respiratory Diseases
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• 제48권5호
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• pp.740-747
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• 2000

Background : To compare the efficacies and side effects of etoposide, cisplatin/cyclophosphamide, adriamycin, vincristine(VPP/CAV) with those of carboplatin etoposide(CE) in extensive stage small cell lung cancer patients. Method : Patients with extensive stage small lung cancer who has measurable disease were eligible. VPP/CAV group(n=22) was treated with cisplatin(60mg/$m^2$ iv. D1) etoposide(100mg/$m^2$ iv. D1-3), and 3 weeks later cyclophosphamide(1000mg/$m^2$ iv. D1), adriamycin( 40mg/$m^2$ iv. D1), and vincristine(1.4mg/$m^2$ iv. D1), were administered alternatively. CE group(n=22) was treated with carboplatin(325mg/$m^2$ iv. D1) and etoposide (100mg/$m^2$ iv. D1-3) ; repeated treatment was performed every 3 weeks. Result : Forty four patients were eligible for the study. The overall response rate was 61.4% (complete remission rate 0%, partial response rate 61.4%, stable disease rate 25%, progressive disease rate 13.6%), and median survival was 10.8 months. In VPP/CAV group, response rate was 54.5% (complete remission rate 0%, partial response rate 54.4%, stable disease rate 27.3%, progressive disease rate 18.2%), and, in carboplatin/etoposide group, the response rate was 68.2%(complete remission rate 0%, partial response rate 68.2%, stable disease rate 22.7%, progressive disease rate 9.1%). The median survival time was 9.5 months in the VPP/CAV group and 11 months in CE group. The toxicity of both group was moderate, and anemia was more frequent in the CE group. Conclusion : VPP/CAV regimen and CE regimen produced similar response rates and survival times in extensive stage small cell lung cancer patients. CE regimen may be effective as part of the initial therapy for extensive stage small cell lung cancer.

• Journal of Chest Surgery
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• 제34권9호
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• pp.698-703
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• 2001

Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

• Journal of Chest Surgery
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• 제39권10호
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• pp.754-758
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• 2006

Background: Surgical role for acute coronary syndrome has been reduced in recent years due to development of drug eluting stent. We evaluated the surgical results of acute coronary syndrome in our hospital. Material and Method: Between January 2001 and August 2005, 416 patients underwent coronary artery bypass grafting (CABG) under diagnosis of non-ST-elevation acute coronary syndrome (NSTE ACS). Mean age was $61.8{\pm}9.0$ years and 276 (66.3%) patients were male. 324 (77.9%) patients had triple vessel disease and 92 (22.1%) had left main disease at angiographic study. 236 (56.7%) patients had hypertension and 174 (41.8%) had diabetes mellitus. Conventional on-pump CABG was performed in 194 patients (46.6%) and off-pump CABG in 222 (53.4%). Total arterial revascularization with no touch technique was done in 97 patients (23.3%). The number of total distal anastomosis was 1,306 and the number per patient was $3.21{\pm}1.71$. Result: Surgical mortality rate was 1.0% (4 patients) and postoperative complication rate was 15.6% (65 patients). Graft patency was checked at mean $3.7{\pm}7.6$ months (from 1 to 37 months) postoperatively with multi-directional computed tomography in 152 patients. Left internal mammary artery was patent in 95.3%, right internal mammary artery in 98.1%, radial artery in 92.2% and saphenous vein in 89.0%. Conclusion: The surgical treatment of NSTE ACS showed relatively low mortality rate and good graft patency rate. Further study is needed to compare the long term results with drug eluting stent.

• Journal of Chest Surgery
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• 제36권4호
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• pp.267-272
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• 2003

Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.

• Journal of Chest Surgery
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• 제36권11호
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• pp.839-845
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• 2003

Background: Even today when chemotherapy has been established as a treatment for tuberculosis and the prevalence of tuberculosis is gradually decreasing, multi-drug resistance tuberculosis still results in poor treatment performance and lowered survival periods. This research sought to analyze the surgery of multi-drug resistance tuberculosis, and determine the usefulness and danger of surgery in connection with this disease. Material and Method: Starting from February 1990 to February 2002, retrospective surveys were conducted targeted at 21 cases involving 20 patients who underwent surgery due to multi-drug resistance tuberculosis. The survey included 14 males cases and 6 females cases with the age averaging 42.8$\pm$12.1 years. 10.3$\pm$7.6 years on average passed after patients were initially diagnosed with tuberculosis. 13 patients (65%) tested positive in the pre-operative sputum AFB test, and all showed resistance against an average of 3.5 anti-tuberculosis agents including INH and RFP. Pre-operative radiologic examinations revealed cavitary lesions in 15 patients (75%), and three patients had lesions in the both lung fields, with the major lesions existing in the unilateral area. 13 patients (75%) failed negative conversion with medical treatment, while two patients (10%) with recurrent hemoptysis and five patients (25%) with lesions involving high recurrence-rate received the operation. Operations included nine cases (40%) of pneumonectomy, nine cases (45%) of lobectomy, and three cases of lobectomy with segmentectomy. The average follow-up period of patients stood at 23 months. Result: There was no post-operative death, and found were a total of eleven cases involving complications were found: three cases of long-term air leakage, three cases of bleeding requiring re-operation, two cases of empyemas due to broncho-pleural fistula, and one case of atelectasis, wound infection and chest wall fistula each. Eleven cases (85%) of negative conversion were completed immediately after the operation, and two cases failed negative conversion. Eleven months after the operation, the disease recurred in one case of negative conversion patients, and the patient was cured by completion pneumonectomy. Conclusion: If patients' lung function was sufficient and appropriate resection was possible, multi-drug resistance tuberculosis could achieve high-rate negative conversion and cure using combination of surgical and medical treatment, and also there were not many serious complications.

• Journal of Gastric Cancer
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• 제5권1호
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• pp.40-46
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• 2005

Purpose: Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. GISTs are positive for the expression of c-Kit protein at immunohistochemistry, and their clinical presentations vary. This retrospective study was performed to evaluate the clincopathologic characteristics of GISTs and to define the prognostic factors. Materials and Methods: 40 patients who underwent a complete resection of a GIST during the period $1996\~2003$ at the Department of Surgery, Korea University College of Medicine, were studied. We divided them into low- and high-risk. groups by using tumor size and mitotic count: 23 cases were low risk, and 17 were high risk. Clinicopathologic features, immunohistochemical findings, and prognoses were compared between the low- and the high-risk groups. Results: The mean age of the 40 patients was $61.3\pm11.1$years, and the male-to-female ratio was 1：1.1. There was no significant difference in age and sex between the groups. A comparative analysis revealed tumor size, mitotic count, clinical symptoms, preoperative pathologic diagnosis, ulceration, and necrosis to be variables that had statistically significant differences between the high- and the low-risk groups. In the univariate analysis, tumor size, mitotic count, ulceration, necrosis, and abnormal endoscopic ultrasound findings were associated with disease-free survival, but in the multivariate analysis, mitotic activity was the only independent factor associated with disease-free survival. 8 patients had recurrences during the follow-up period, and four of them were treated with STI-571 (imatinib mesylate, $Gleevec^{(R)}$). The treated patients have survived until now; however, two of non-treated patients died from disease progression. Conclusion: Based on this study, tumor size, ulceration, and necrosis are significant factors affecting survival, and mitotic activity may be a useful prognostic marker. STI-571 may be used in an adjuvant setting because the drug has shown anticancer activity in patients with recurrence or metastasis.

• Tuberculosis and Respiratory Diseases
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• 제63권2호
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• pp.139-144
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• 2007

Background: Bronchial anthracofibrosis, which is defined as bronchial narrowing with black pigmentation of the overlying bronchial mucosa, is frequently associated with tuberculosis. The aim of this study was to examine the relationship between bronchial anthrocofibrosis and to identify the clinical and radiological characteristics of non-tuberculous bronchial anthracofibrosis. Methods: All patients who showed bronchial anthracofibrosis in more than one segment on a bronchoscopic examination from January 2003 to July 2006 at Kangnam St. Mary's hospital were enrolled in this study. The underlying diseases, baseline clinical characteristics, characteristic findings on a computed tomogram (CT) of the chest, pathologic findings of the bronchial mucosa, and the clinical response to steroid therapy were analyzed retrospectively. Results: A total 54 patients (19 males, 35 females) were enrolled with a mean age of 75 years. The most common presenting symptoms were cough, sputum and dyspnea. The predominant X-ray findings were peribronchial soft tissue attenuation with or without calcification, mediastinal lymphadenopathy with or without calcification and atelectasis. Fourteen non-tuberculous anthracofibrosis patients were treated with steroid. Nine patients were improved clinically, and 6 patients were improved radiologically. Conclusion: Bronchial anthracofibrosis is frequently associated with various pulmonary diseases not only tuberculosis but also COPD pneumonia etc.