Analysis of the Importance of Sacroiliac Joint Fractures as a Prognostic Factor of the Patients with Pelvic Fractures

PURPOSE@#The diagnosis of pelvic fractures pattern has become to be essential in the decision making of treatment modality and reducing morbidity and mortality in multiple trauma patients. Sacroiliac joint (SIJ) disruption can cause life-threatening massive arterial bleeding. This study aimed to determine a method of predicting the prognosis and treatment direction with pelvis X-ray alone in the emergency room. We investigated whether SIJ disruption can be used alone as a poor prognostic factor.@*METHODS@#We analyzed the medical records and radiologic examination results of 167 patients with pelvic fractures from January 1, 2015 to December 31, 2016 retrospectively. Patients with pathologic fractures, thoraco-abdominal bleeding, and acetabulum fractures and pediatric patients (n=63) were excluded. Factors related to the clinical manifestations and treatments, such as transfusion and surgery, were statistically compared.@*RESULTS@#The cross-sectional analysis showed that there was no correlation between SIJ injury and sex; there were statistically significant relationships between occurrences of shock, conjoined fractures, transfusion, and surgeries. The hospitalization period and partial thromboplastin time and prothrombin time values increased. The logistic regression analysis showed that when an SIJ injury occurred, blood transfusion and hypotension possibilities increased.@*CONCLUSION@#When pelvic fractures occur near the SIJ, blood transfusion and shock possibilities increase. Physicians must be aware of the high severity and poor prognosis of such fractures when these are diagnosed in the emergency room. And furthermore, the physician has to predict and prepare the intensive care and multidisciplinary approaches.

Clinical Analysis of 28 Multiple Primary Cancers (MPC) Including Breast Cancer

PURPOSE: Due to improving breast cancer screening programs and treatment methods, we can expect improved long-term survival of breast cancer patients. Given the longer survival times, other primary cancers may develop in other organs of breast cancer patients during their long term follow up period. Our purpose was to elucidate the clinical characteristics of multiple primary cancers developed in breast cancer patients. METHODS: We retrospectively investigated 28 patients with multiple primary cancers including breast cancer. However, we excluded contra-lateral breast cancer. We investigated the patients' clinical characteristics including mean age, stage, hormone receptor status, cause of death, time interval between the breast cancer and other cancers, and common cancers which were combined with breast cancer. RESULT: The mean age of the study group was 53+/-2, higher than the 47.7+/-0.4 of our hospital breast cancer patients group. However, other tumor characteristics were not significantly different from other general breast cancer patients. Among the patients 5 were synchronous and 23 were metachronous MPC. The most common cancer combined with breast cancer was gastric cancer (8, 27.6%), followed by cervical cancer (3, 10.7%) and colon cancer (3, 10.7%). The ranks of the other cancer co-occurred with breast cancer were not significantly different than the Korean 1999 Korean women's cancer incidence ranks excluding breast cancer. CONCLUSION: Due to the increasing length of the follow up period for breast cancer patients, primary cancers may develop in other organs. Therefore, physicians should be concerned and increase efforts to detect these other cancers early in these patients. Additionally, it appears that the prevalence ranking of common cancers developing in breast cancer patients is not significantly different than the ranking of other cancer incidence in the general population.

Fever of Unknown Origin as a Presentation of Gastric Inflammatory Myofibroblastic Tumor in a Two-Year-Old Boy

Gastric inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion with mimicking malignant features and accompanied with various clinical manifestations. Here we present a 2-yr-old boy who had a gastric IMT with a huge extragastric mass, which closely resembled a neuroblastoma on imaging studies. He experienced intermittent fever and poor appetite for 6 weeks. Fever remained up to 38degrees C even on the operation day. He underwent partial gastrectomy and distal pancreatectomy with splenectomy including the tumor. The preoperative fever disappeared and did not recur in the postoperative course.

The Effect of Anti ICAM-1 Antibody in the Rat Kidney Preserved in the Cold University of Wisconsin Solution / 대한이식학회지

PURPOSE: The cold ischemia augments the inflammatory cell infiltration in the rat kidney allograft by increasing expression of ICAM-1. The ICAM-1 proteins and ICAM-1 mRNA were overexpressed and upregulated on the tubular epithelium and endothelium of renal allografts that were preserved in the cold preservation solution such as University of Wisconsin (UW) solution. The aims of this study was to examine whether perfusion of kidney with anti ICAM-1 antibody (1A29) prevent inflammations and injuries of graft even in long ischemic time. METHODS: Rat kidneys were perfused in situ with 60 mL of cold UW solution without or with anti-rat ICAM-1 antibody and nephrectomized. The kidneys were exposed to 48 hour cold (4 degrees C storage time) ischemia and examined for the counts of necrotic tubules and apoptotic cells on the high power fields by terminal deoxynucleotidyltransferase mediated nick-end labeling (TUNEL) assay. RESULTS: The number of necrotic tubules per high power field of the allograft treated by anti ICAM-1antibody (6.97+/-4.25) was significantly less than that of the other control allograft (12.71+/-6.42) (P<0.001). The number of apoptotic cells per high power field of antibody treated graft (4.27+/-4.11) was significantly less than that of the other control graft (8.43+/-5.56) (P<0.001). CONCLUSION: Rat anti ICAM-1 antibody (1A29) inhibits ICAM-1 mediated allograft tubular necrosis as well as apoptosis. These results are expected to contribute to prevent allograft rejection and delayed graft function when used for pretreatment of allografts with anti ICAM-1 antibody mixtures of the perfusion and preserving solution clinically.

Effect of Intraoperative Radiation Therapy (IORT) in Unresectable Pancreatic Cancer

PURPOSE: Pancreatic cancer is a devastating disease and the complete resection is difficult due to its the aggressive histologic behavior. Among the possible treatments for the unresectable pancreatic cancer, intraoperative radiation therapy (IORT) has the several advantages. But the impacts of the IORT on survival and local control are not clear. We analyzed the effects of the IORT on pain control, survival duration and local control in patients with unresectable pancreatic cancer. METHODS: We reviewed 6 years of the medical records of 94 patients who had undergone operations involving the pancreatic adenocarcinoma (33 patient IORTs, 39 palliative surgerys only and 22 curative resections involving a curative resection). The clinicopathologic factors and outcomes of the 33 patients treated with the IORT were compared with those of the palliative surgery groups. RESULTS: The age and sex distribution and tumor stage were same for the two groups. The average tumor size in the IORT group was larger than those of the palliative surgery group. The preoperative serum CA19-9 level in the IORT group was higher than the other group. The most common reason for unresectability in the IORT group was local invasion to the adjacent organs including of the great vessels. On the contrary, distant metastasis was a more common cause unresectability in the palliative surgery group. The postoperative complications and operative times were similar in both groups. Pain relief after treatment was observed in 12 cases of the 26 patients in the IORT group, and 5 of 29 patients in the palliative surgery group (P<0.05). The cases of minor and partial remission were more common in the IORT group than the palliative surgery group. However, the survival rate of the IORT group was no better than the palliative surgery group. CONCLUSION: This study suggests that IORT may have an important palliative role especially in ameliorating visceral pain in patients with unresectable pancreatic cancer. However, IORT appears to have no significant effect on overall survival.

Combined Angioplasty and Femorofemoral Bypass in the Treatment of Unilateral Iliac Arterial Occlusive Disease

PURPOSE: The purpose of this article is to analyze the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. METHOD: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal angioplasity (PTA) and femorofemoral bypass (n=18) as well as aortobifemoral bypass (n=12) and iliofemoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 cm in length with no more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofemoral bypass was done within 3 to 5 days after PTA or stenting. RESULT: The mean age was 61.2 years. The Indications of femorofemoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation. The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. CONCLUSION: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral bypass in these patients.

Distribution and Prognostic Effect on Adjuvant Hormone Therapy of Body Mass Index (BMI) in Korean Breast Cancer Patients

PURPOSE: Obesity has been shown to have important effects related to breast cancer. But there have been few data available on the distribution of body mass index (BMI) among Korean breast cancer patients and on the effects of this distribution on patient prognosis. Therefore we investigated the BMI distribution of Korean breast cancer patient's and its relationship with other tumor markers, in order to elucidate the relationship between BMI and patient prognosis. METHODS: We measured the BMI of 266 Korean adult women with breast carcinoma.and divided the subjects into the following subgroups according to BMI; low body weight (BMIor=25). We compared this distribution with that of the general Korean women's population. and investigated the correlation with other prognostic factors and tumor markers. The 5 year overall and disease free survival rates were evaluated for both the total breast cancer patients and the adjuvant hormone treated breast cancer patients, according to BMI subgroup, using the Kaplan-Meier method. RESULTS: Mean BMI for the breast patients was 23.4+/-3.1, and did not differ from that of the general Korean adult women's population ('1994 National Nutrition Survey Report). BMI increased with increasing age and was highest in the 60~69 yr age group. BMI was correlated with tumor size and stage. The survival rates were low in the high BMI group among both total and adjuvant hormone treated breast cancer patients, but in neither was any statistical difference found between BMI subgroups. CONCLUSION: Korean breast cancer patients are not obese as the general population and their BMI increases with increasing age and menopausal status. There was a tendency for higher BMI to be associated with poorer prognosis, although not to a statistically significant degree.

Distribution and Prognostic Effect on Adjuvant Hormone Therapy of Body Mass Index (BMI) in Korean Breast Cancer Patients / 한국유방암학회지

PURPOSE: Obesity has been shown to have important effects related to breast cancer. But there have been few data available on the distribution of body mass index (BMI) among Korean breast cancer patients and on the effects of this distribution on patient prognosis. Therefore we investigated the BMI distribution of Korean breast cancer patient's and its relationship with other tumor markers, in order to elucidate the relationship between BMI and patient prognosis. METHODS: We measured the BMI of 266 Korean adult women with breast carcinoma.and divided the subjects into the following subgroups according to BMI; low body weight (BMI or25). We compared this distribution with that of the general Korean women's population. and investigated the correlation with other prognostic factors and tumor markers. The 5 year overall and disease free survival rates were evaluated for both the total breast cancer patients and the adjuvant hormone treated breast cancer patients, according to BMI subgroup, using the Kaplan-Meier method. RESULTS: Mean BMI for the breast patients was 23.4+/-3.1, and did not differ from that of the general Korean adult women's population ('1994 National Nutrition Survey Report).BMI increased with increasing age and was highest in the 60~69 yr age group. BMI was correlated with tumor size and stage. The survival rates were low in the high BMI group among both total and adjuvant hormone treated breast cancer patients, but in neither was any statistical difference found between BMI subgroups. CONCLUSION: Korean breast cancer patients are not obese as the general population and their BMI increases with increasing age and menopausal status. There was a tendency for higher BMI to be associated with poorer prognosis, although not to a statistically significant degree.

The Significance of Cytokeratin-20 Detection in Peripheral Blood and Bone Marrow of Breast Cancer Patients

PURPOSE: It is very important to detect hematogenous spread of cancer cells early in breast cancer patients in order to properly determine the prognosis and adjuvant therapy. In this study, we attempted to detect Cytokeratin-20 (CK-20) as a mRNA marker of cancer cells in peripheral blood and bone marrow using the reverse transcriptase-polymerase chain reaction (RT-PCR). METHODS: We obtained peripheral blood and bone marrow from 41 breast cancer patients who had been treated by Korea University Hospital. Using the RT-PCR method, we detected the CK-20 and compared the positive detection rate and concordance rate between two sources. Furthermore, we analysed the correlation with other known prognostic and predictive factors. RESULTS: The CK-20 detection rate was 36.5% in peripheral blood and in bone marrow. The concordance rate between both sources was 56%. In CK-20 detection, there was no significant correlation seen between peripheral blood and bone marrow (p>0.05). Additionally, there were no statistically significant correlations found between the other predictive factors (ER, PR, p53 protein expression, nm23 protein expression). Six cases who were CK-20 positive and were detected in both (peripheral blood, bone marrow) source showed advanced stage and axillary lymph node metastasis (p<0.05). CONCLUSION: The detection of CK-20 in peripheral blood and bone marrow correlated with stage and axillary nodal status. Therefore, this may suggest poor clinical prognosis if CK-20 is detected in both sources in a breast cancer patient. The RT-PCR assay for detection of CK-20 is a very sensitive method, however the standardization and quality control of the RT-PCR method are important and multi-center trials are required.

Microsatellite Alterations of Chromosome 9p, 13q, 16q in Hepatocellular Carcinoma

PURPOSE: Hepatocellular carcinoma (HCC) patients are asymptomatic and the tumor remains in an unresectable state until the tumor progresses. Recently much efforts for elucidation of the early hepatocarcinogenesis have been made, and for this purpose it is very crucial to investigate the genetic abnormalities. We evaluated microsatellite alterations of five markers from chromosome 9, 13, 16 and investigated the relationships with the clinicopathological parameters in HCC. METHODS: The microsatellite alteration analysis was performed using polymerase chain reaction with five polymorphic microsatellite markers (D9S171, D9S1747, D13S156, D16S419, D16S3106) in 40 surgically resected HCCs and their respective non-tumorous counterparts. RESULTS: D9S171, D9S1747, D13S156, D16S419, D16S3106 abnormalities were detected in 20.0%, 14.3%, 50.0%, 32.4% and 22.6%, respectively. Loss of heterozygosity (LOH) of D9S171 correlated well with higher tumor histologic grade and LOH of D13S156, D16S419 and D16S3106 correlated well with increased tumor size. Microsatellite instability (MSI) was found in two markers, D13S156, D16S419. CONCLUSION: As a result, we concluded that alterations in microsatellites of various chromosomes may contribute to the hepatocarcinogenesis and tumor progression. Especially LOH of chromosome 13 and 16 are considered to correlate with tumor progression.

Comparison of Multiple Scoring Systems and CT Severity Index for Systemic and Local Complications of Acute Pancreatitis

PURPOSE: The progression of mortality of acute pancreatitis occurs in two different phases. One occurs earlier in the course of the disease and results from systemic complications such as renal failure and ARDS. Another occurs later and results from local complications such as a pancreatic abscess, an infected phlegmon or a pseudocyst. The values of the Ranson score, the Glasgow (Imrie) score, the Acute Physiology and the Chronic Health Evaluation (APACHE II) score and computerized tomography severity index (CTSI) of Balthazar were compared in an evaluation and monitoring of acute pancreatitis, in which we mainly predicted the occurrence of systemic and local complications of the attacks in 31 patients. METHODS: Between January 1997 and December 1999, 31 patients who had a clinical diagnosis of acute pancreatitis which was supported by the presence of a serum amylase that exceeded 200 IU/L and the presenting clinical symptoms were included in this study. We reviewed their medical records and their abdominal CT imaging scans. We calculated the CTSI based on the CT imaging findings with the assistance of a radiologist. RESULTS: Among the 31 patients, systemic complications had developed in 10 patients and local complications had occurred in 12 patients. In all of the scoring systems including the CTSI, the mean scores of the group who had systemiccomplications were higher than the group with no complication. The accuracy of the Glasgow score (>or=4) and the APACHE II score (48 hours after admission, >or=10) was greater than that of the others. However, only the CTSI was accurately predicted the occurrence of local complications. CONCLUSION: These results suggest that CTSI should be considered as being a predicting factor when it is combined with multiple scoring systems such as the Ranson score, the Glasgow score or the APACHE II score in order to obtain accurate prediction of the prognosis and the mortality rate in acute pancreatitis.

Clinical Characteristics and Prognosis of Young Age (35 year old or younger) onset Breast Cancer

PURPOSE: The question of whether "young age onset" is a single prognostic factor for breast cancer has been controversial. The incidence of breast cancer according to age differs by region and races. The purpose of this study was to determine the incidence of breast cancer in women 35 year old or younger and elucidate its clinical characteristics, prognosis, and differences from older age onset breast cancer. METHODS: A retrospective study of 545 consecutive breast cancer patients who had been treated at our hospital from 1990 to 1999, was conducted. We investigated the ratio of 35 year old or younger breast cancer patients, age of menarche, TNM stage, histologic grades, hormone receptor status, survival rates. This was then compared with the counter age (>35) group's data. The significances of the differences were evaluated by variable type using the Student's t-test or chi-square test. Analysis was performed using SPSS software. RESULTS: The younger age group patients numbered 62 (11.3%) among the total group, and showed earlier menarche, worse histologic differentiation, and lower mammographic detection rate than the counter group (P0.05). The young age group's 5 year overall and disease free survival rates were 83 5% and 58 8% respectively and both were lower than the counter group's 89 2% and 74 3% (P<0.05), respectively additionally, the age adjusted overall and disease free survival rates were worse than the counter age group's. CONCLUSION: The younger age group showed worse survival rates, poorer prognostic factors and a higher late of early relapse rate than the older age group. Therefore, we may consider "young age onset" to be a poor prognostic factor in breast cancer.

Expression of ICAM-1 in the Preserved Rat Kidney

PURPOSE:Prolonged cold ischemia has been shown to be an important factor in the development of post-transplant renal dysfunction. The exact mechanisms have not been completely defined. The expression of ICAM-1 (CD-54) in rat kidneys stored at 0, 4, 12, 24 and 48 hours in University of Wisconsin (UW) solution was studied in an attempt to correlate ischemia time with increased immunogenicity of the graft. METHODS: Kidneys from male Lewis rats were perfused with UW solution, removed and bathed in UW solution at 4 degrees C for 4, 12, 24, and 48 hours respectively. For the evaluation of expression of ICAM-1, immunohistochemical staining, Western blotting and RT-PCR were performed. RESULTS: Immunohistochemical staining in normal non-ischemic kidneys revealed that glomerular capillaries expressed ICAM-1 but that tubular cells did not. The preserved kidneys were analyzed with immunohistochemistry, Western blotting and semi-quantitative RT-PCR and showed increased transcription and expression of ICAM-1 in the cortex of the kidney. This expression reached a maximum at 24 hours and declined at 48 hours. The ICAM-1 protein expression in the preserved kidney cortex was increased at 4 hours (1.68+/-0.60 fold of control kidneys, (p=0.06)), 12 hours (2.38+/-0.90 fold, (p=0.02)), 24 hours (3.70+/-1.29 fold, (p=0.01)), and 48 hours (2.00+/-0.54 fold, (p=0.01)). The mRNA expression (the ratio of ICAM-1/GAPDH) in preserved kidneys cortex relative to control kidneys was increased at 4 hours (1.19+/-0.14 fold of control kidneys), 12 hours (1.38+/-0.16 fold),24 hours (1.77+/-0.29 fold), and 48 hours (1.19+/-0.12 fold) (p<0.05 for all time points). CONCLUSION: We conclude that cold preservation of rat kidneys in UW solution induces increasing levels of ICAM-1 cell surface expression and gene transcription. This increase in adhesion molecule expression can be a contributing factor in the development of post-transplant renal dysfunction by increasing the immunogenicity of the graft.

Surgical Treatment of Intestinal Behcet's Disease

PURPOSE: No standardized treatment protocol yet exists for intestinal Behcet's disease. The aim of this retrospective study was to identify the factors that are related to the recurrence and mortality of intestinal Behcet's disease. METHODS: Twelve patients who had undergone surgery for intestinal Behcet's disease at Korea University Hospital from 1991 to 1999 were chosen. Nineteen patients had been diagnosed as having intestinal Behcet's disease. Of the 19 patients, 7 are still being followed up, and 12 have undergone surgery, these patients were chosen as the subjects. RESULTS: Of the 11 cases, excluding one case that expired following the initial surgery, 8 cases required subsequent surgery due to recurrence. When the data was analyzed according to the patient's age, medication, classification of Behcet's disease, location of the lesion, operative method, and extent of resection, recurrence was shown to be related with medication and extent of resection (p<0.05). Of the 12 cases, 5 cases expired. When, the data of the 5 cases that expired were analyzed according to the patient's age, medication, extent of resection, classification of Behcet's disease, location of the lesion, and operative method, mortality was shown to be related with the location of the lesion (p<0.05). CONCLUSION: Medical treatment is the primary therapy for intestinal Behcet's disease and radical extended resection extending 30 cm proximal and distal to the lesion prevents recurrence. However, when the lesion was located in the small intestine and formed a fistula with the duodenum, the prognosis appears to be extremely poor.

The Clinical Significance and Prognosis of Korean Young Age (younger or 35 year old) onset Breast Cancer / 한국유방암학회지

PURPOSE: Generally, young age onset malignancies show worse prognosis. But is "young age onset" a single prognostic factor for breast cancer, has been controversial. The incidence of breast cancer according to age is different by region and races. This study purposed to know the incidence of breast cancer in younger or 35 year old (below Young age group) and its clinical characteristics, prognosis, and difference with older age onset breast cancer. METHODS: A retrospective study of consecutive 545 breast cancer patients who had been treated by our hospital from 1990 to 1999, was carried out. We investigated the ratio of 35 year old or younger breast cancer patients, age of menarche, TNM stage, histologic grades, hormone receptor status, survival rates. And compared it with counter age (>35) group's. The significances of differences were evaluated using Student's-t test or chi-square test by variable type. Analysis were performed using SPSS software. RESULTS: Younger age group patients were 62 (11.3%) among them, showed earlier menarche, worse histologic differentiation, and lower mammographic detection rate than counter group (p0.05). Young age group's 5 year overall and disease free survival rates were 83+/-5% and 58+/-8%, both were lower than counter group's 89+/-2% and 74+/-3% (p<0.05). Also age adjusted overall and disease free survival rates were worse than counter age group's. CONCLUSION:Younger age group shows worse survival rates, have poor prognostic factors and show early relapsing rate than older age group. So we can consider "young age onset" as a poor prognostic factor in breast cancer.

Correlation between p53 and MIB1 Index Expression of Primary Tumor and Metastatic Lymph Node in Breast Cancer / 한국유방암학회지

PURPOSE: This study was designed to elucidate the biology of cancer metastasis and differences in the biologic status between primary tumors and metastatic lymph nodes of invasive breast cancer by comparing the well known prognostic factors p53 gene mutation, p53 protein expression and the MIB-1 index. An additional goal was to investigate the p53 mutational pattern of breast cancer patients. METHODS: We used the PCR-SSCP method to detect p53 gene mutation and immunohistochemical staining to establish p53 protein expression and the MIB-1 labelling index in 25 primary tumors and metastatic lymph nodes from breast cancer patients. We then made a comparison the between primary tumors and the metastatic lymph nodes. RESULTS: The results indicated a correlation between histologic grade and p53 gene mutation as well as p53 protein expression, but showed no correlation to MIB-1 labelling index. The concordance rates of p53 gene mutation and p53 protein expression between the primary tumors and metastatic lymph nodes were 72% and 100%, respectively.Three cases showed a different mutated exon number between the primary tumors and the metastatic lymph nodes. Some cases showed p53 gene mutation only in the primary tumors, but while other cases only in the metastatic lymph nodes. The MIB-1 labelling index increased with tumor grade. The p53 altered group show a higher mean MIB-1 index than the non altered group's in both the primary tumors and metastatic lymph nodes. CONCLUSION: p53 gene mutation is not consistent with p53 protein expression and there are some differences in p53 gene mutation between primary tumors and metastatic lymph nodes in breast cancer. Therefore, metastatic tumor have different characteristics from those of primary tumors. In breast cancer, metastasis is regulated not only by an up- regulating mechanism but also by a down-regulating mechanism.

Correlation between p53 and MIB1 Index Expression of Primary Tumor and Metastatic Lymph Node in Breast Cancer / 한국유방암학회지

PURPOSE: This study was designed to elucidate the biology of cancer metastasis and differences in the biologic status between primary tumors and metastatic lymph nodes of invasive breast cancer by comparing the well known prognostic factors p53 gene mutation, p53 protein expression and the MIB-1 index. An additional goal was to investigate the p53 mutational pattern of breast cancer patients. METHODS: We used the PCR-SSCP method to detect p53 gene mutation and immunohistochemical staining to establish p53 protein expression and the MIB-1 labelling index in 25 primary tumors and metastatic lymph nodes from breast cancer patients. We then made a comparison the between primary tumors and the metastatic lymph nodes. RESULTS: The results indicated a correlation between histologic grade and p53 gene mutation as well as p53 protein expression, but showed no correlation to MIB-1 labelling index. The concordance rates of p53 gene mutation and p53 protein expression between the primary tumors and metastatic lymph nodes were 72% and 100%, respectively.Three cases showed a different mutated exon number between the primary tumors and the metastatic lymph nodes. Some cases showed p53 gene mutation only in the primary tumors, but while other cases only in the metastatic lymph nodes. The MIB-1 labelling index increased with tumor grade. The p53 altered group show a higher mean MIB-1 index than the non altered group's in both the primary tumors and metastatic lymph nodes. CONCLUSION: p53 gene mutation is not consistent with p53 protein expression and there are some differences in p53 gene mutation between primary tumors and metastatic lymph nodes in breast cancer. Therefore, metastatic tumor have different characteristics from those of primary tumors. In breast cancer, metastasis is regulated not only by an up- regulating mechanism but also by a down-regulating mechanism.

A Clinical Review of Acute Superior Mesenteric Ischemic Disease

PURPOSE: The prevalence and incidence of the superior mesenteric ischemic diseases are increasing nowadays because of the increase of aged people and cardiovascular diseases. The morbidity and mortality of the superior mesenteric ischemic diseases are so high and detrimental because acute mesenteric infarction results post operatively reperfusion injury short bowel syndrome and sepsis. A successful management requires very efficient diagnostic and therapeutic measures. So, we reviewed the medical records of superior mesenteric ischemic diseases and identified the clinical and therapeutic characters of these disease. METHOD: Between January 1991 and December 2000, 33 patients with a clinical diagnosis of superior mesenteric ischemic diseases supported by clinical and imaging studies were included in this study. The medical records of the 33 patients who had admitted Korea University Hospital were reviewed retrospectively and identified the clinical characters, the diagnostic tools, underlying diseases and the therapeutic modalities. RESULT: The most common cause of theses disease was the superior mesenteric arterial embolism and the peak incidence was identified in 7th and 8th decades. These diseases were diagnosed with physical examination, abdominal CT or angiogram, but almost half of them were identified at the operative field. 29 patients were treated surgically and the rest of them were medically. At result 12 patients died of these diseases (36.4%). The high WBC count (15,000/ml) and shock were considered as prognostic factors predicting for the mortality (p=0.005). CONCLUSION: The old persons who were suffered from the nonspecific abdominal pain should be suspected of these diseases and treated with properly applied diagnostic tools and therapeutic modalities, especially they show the leukocytosis and the clinical evidence of shock.

Correlation between p53 and MIB1 Index Expression of Primary Tumor and Metastatic Lymph Node in Breast Cancer

PURPOSE: This study was designed to elucidate the biology of cancer metastasis and differences in the biologic status between primary tumors and metastatic lymph nodes of invasive breast cancer by comparing the well known prognostic factors p53 gene mutation, p53 protein expression and the MIB-1 index. An additional goal was to investigate the p53 mutational pattern of breast cancer patients. METHODS: We used the PCR-SSCP method to detect p53 gene mutation and immunohistochemical staining to establish p53 protein expression and the MIB-1 labelling index in 25 primary tumors and metastatic lymph nodes from breast cancer patients. We then made a comparison the between primary tumors and the metastatic lymph nodes. RESULTS: The results indicated a correlation between histologic grade and p53 gene mutation as well as p53 protein expression, but showed no correlation to MIB-1 labelling index. The concordance rates of p53 gene mutation and p53 protein expression between the primary tumors and metastatic lymph nodes were 72% and 100%, respectively. Three cases showed a different mutated exon number between the primary tumors and the metastatic lymph nodes. Some cases showed p53 gene mutation only in the primary tumors, but while other cases only in the metastatic lymph nodes. The MIB-1 labelling index increased with tumor grade. The p53 altered group show a higher mean MIB-1 index than the non altered group's in both the primary tumors and metastatic lymph nodes. CONCLUSION: p53 gene mutation is not consistent with p53 protein expression and there are some differences in p53 gene mutation between primary tumors and metastatic lymph nodes in breast cancer. Therefore, metastatic tumor have different characteristics from those of primary tumors. In breast cancer, metastasis is regulated not only by an up-regulating mechanism but also by a down-regulating mechanism.