The Effect of Severe Femoropopliteal Arterial Calcification on the Treatment Outcome of Femoropopliteal Intervention in Patients with Ischemic Tissue Loss

Purpose@#We investigated the effect of severe calcification of the femoropopliteal artery on intervention outcomes in patients with ischemic tissue loss. @*Materials and Methods@#A retrospective review of the first endovascular treatment of the femoropopliteal artery for ischemic tissue loss between May 2010 and February 2018 was performed. The calcification of femoropopliteal lesions was estimated by the Compliance 360° score, and lesions with a score of 4 were defined as severe calcification lesions. @*Results@#Overall, 135 first femoropopliteal endovascular procedures on 135 limbs from 112 patients were included in this study. Among the 135 limbs that received treatement of the femoropopliteal arteries, 74 limbs had Trans-Atlantic Inter Society Consensus (TASC) A or B lesions and 61 limbs had TASC C or D lesions. Among 61 cases of TASC C or D lesions, 21 limbs (34.4%) had severe calcification; there was no statistically significant difference in limb salvage (P=0.75), and amputationfree survival (P=0.11) based on the degree of calcification. However, the survival rate in TASC C or D lesions was significantly different between the two groups (non-severe calcification group vs severe calcification group at 1-year, 2-years, and 3-years: 88.6%, 79.7%, and 61.0% vs 70.0%, 56.0%, and 28.0%, respectively, P=0.01). In multivariate analysis of influencing factors for poor survival in TASC C or D using the Cox proportional hazards model, severe calcification (hazard ratio, 2.362; 95% confidence interval, 1.035-5.391; P=0.041) was a statistically significant risk factor. @*Conclusion@#Severe femoropopliteal artery calcification was associated with poor survival, especially in TASC C or D lesions.

CORRIGENDUM: Correction of funding statement in ACKNOWLEDGEMENTS section: Epigenetic inactivation of RUNX3 in colorectal cancer

Correction of funding statement in ACKNOWLEDGEMENTS section.

Epigenetic inactivation of RUNX3 in colorectal cancer

PURPOSE: Emerging evidence indicates that runt-related transcription factor 3 (RUNX3) is an important tumor suppressor gene in several cancer types, including colorectal cancer (CRC). However, the clinical significance of RUNX3 inactivation in CRC remains unclear. The aim of this study was to examine the correlation between clinicopathologic factors and RUNX3 hypermethylation/expression in CRC. METHODS: Sixty-two CRC patients who were treated at the Soonchunhyang University College of Medicine were recruited in this study. The hypermethylation of CpG islands in the RUNX3 promoter and the expression of RUNX3 mRNA were identified by methylation-specific polymerase chain reaction (PCR) and reverse transcriptase-PCR, respectively. The expression of RUNX3 was determined by immunohistochemical staining. RESULTS: Of the 62 CRC tissue samples, 20 (32.3%) presented hypermethylated RUNX3 promoters. Aberrant RUNX3 hypermethylation was found to be associated with vascular (P = 0.006) and lymphatic (P = 0.002) invasion. Hypermethylation of RUNX3 was associated with poor survival outcomes (P = 0.038). However, expression of RUNX3 was not a prognostic factor (P = 0.363). CONCLUSION: Hypermethylation of RUNX3 may be a predictor of a poor prognosis in CRC.

Programmed death-1 (PD-1) ligand 1 and PD-1 ligand 2 expressions and their clinical relevance in colorectal cancer

PURPOSE: Programmed death-1 and its ligands (PD-L1 and PD-L2) can induce T-cell apoptosis in many solid tumors, although there is limited information regarding their roles in colorectal cancer.METHODS: We used immunohistochemistry to retrospectively examine expressions of PD-L1 and PD-L2 in paraffin-embedded specimens from 104 patients with colorectal cancer.RESULTS: Among the 104 included patients, 31 patients (29.8%) had positive PD-L1 expression and 73 patients (70.2%) had negative PD-L1 expression. Positive PD-L2 expression was observed in 83 patients (79.8%) and negative PD-L2 expression was observed in 21 patients (20.2%). Positive PD-L1 expression group showed higher overall survival rate (OS) and disease-free survival (DFS) than negative PD-L1 expression group. However, the overall survival and DFS were not significantly different between positive and negative PD-L2 expressions group. The multivariate analyses revealed that short OS was independently associated with positive PD-L1 expression (hazard ratio [HR], 2.781; 95% confidence interval [CI], 1.284–6.026; P=0.01), regional lymph node status (HR, 2.611; 95% CI, 1.258–5.418; P=0.01), and distant metastasis (HR, 4.279; 95% CI, 1.449–12.638; P=0.009). In addition, short DFS was independently associated with positive PD-L1 expression (HR, 2.846; 95% CI, 1.393–5.815; P=0.004) and regional lymph node status (HR, 2.310; 95% CI, 1.122–4.758; P=0.023).CONCLUSION: Although prospective multi-center studies are needed to validate our findings, we found that PD-L1 expression predicted OS and DFS among patients with colorectal cancer.

Complete tubular duplication of colon in an adult: a rare cause of colovaginal fistula

Alimentary tract duplications are uncommon congenital anomalies that usually present during the first decade of life. Complete duplication of the colon in adults is very rare and difficult to diagnose preoperatively. We report a case of a 40-year-old female with complete tubular duplication which was initially misdiagnosed as a salpingeal abscess due to colovaginal fistula.

Primary hepatic malignant peripheral nerve sheath tumor successfully treated with combination therapy: a case report and literature review

Primary malignant peripheral nerve sheath tumor (MPNST) in a young female patient, not associated with neurofibromatosis type-I is extremely rare in the liver. A 33-year-old female was admitted with a right flank pain for a weak. The CT scan showed 12.5-cm-sized mass located at the right hepatic lobe. At laparotomy, about 20.0-cm-sized mass was on the right hepatic lobe with attachment to right diaphragmatic pleura. Right hepatic lobe and adherent part of diaphragmatic pleura were resected. On histology and immunohistochemistry, it was diagnosed MPNST. Adjuvant radiotherapy for the right diaphragmatic pleura and adjuvant chemotherapy with adriamycin, ifosfamide and cisplatin were sequentially performed. The prognosis of MPNST is generally poor and it is associated with a highly aggressive course of recurrence, metastases, and death. Our case is probably a first report about combination therapy.

Biliary Cystadenoma and Cystadenocarcinoma

Biliary cystadenomas are rare cystic neoplasms of the biliary ductal system. Cystadenomas have a tendency to recur, particularly following their incomplete excision, with the potential for malignant transformation. Cystadenocarcinomas are very rare and; despite complete resection, can recur in a short time. A cystadenoma cannot be easily differentiated from a cystadenocarcinoma preoperatively or intraoperatively; therefore, complete surgical resection should be always considered. Four biliary cystadenoma and one biliary cystadenocarcinoma cases, treated at the Kyung Hee Medical Center, between 1998 and 2003, are reported. The patients were comprised of one man and four women, with a mean age of 45 years. Four patients presented with abdominal pain or jaundice, and the other was asymptomatic, with an incidentally discovered liver tumor. Preoperative CT scans demonstrated a multilocular cyst in four patients and a choledochal cyst-like appearance in the other. All patients underwent complete excision. One cystadenoma arose in the extrahepatic bile duct and the other four appeared in the liver. A histological examination revealed a mesenchymal stroma, which resembling ovary, in two cystadenomas. None of the four patients with a cystadenoma developed a recurrence. However, the patient with a cystadenocarcinoma underwent two pulmonary wedge resections for pulmonary metastases 14 and 21 months after the liver resection.

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

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