Effect of Adjuvant Chemotherapy on Stage II Colon Cancer: Analysis of Korean National Data / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Debates exist regarding the effectiveness of adjuvant chemotherapy for stage II colon cancer. This study aimed to investigate the current status of adjuvant chemotherapy and its impact on survival for Korean stage II colon cancer patients by analyzing the National Quality Assessment data. MATERIALS AND METHODS: A total of 7,880 patientswho underwent curative resection for stage II colon adenocarcinoma between January 2011 andDecember 2014 in Koreawere selected randomly as evaluation subjects for the quality assessment. The factors that influenced overall survival were identified. The high-risk group was defined as having at least one of the following: perforation/obstruction, lymph node harvest less than 12, lymphovascular/perineural invasion, positive resection margin, poor differentiation, or pathologic T4 stage. RESULTS: The median follow-up period was 38 months (range, 1 to 63 months). Chemotherapy was a favorable prognostic factor for either the high- (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.38 to 0.59; p < 0.001) or low-risk group (HR, 0.74; 95% CI, 0.61 to 0.89; p=0.002) in multivariate analysis. This was also the case in patients over 70 years of age. The hazard ratio was significantly increased as the number of involved risk factors was increased in patients who didn’t receive chemotherapy. Adding oxaliplatin showed no difference in survival (HR, 1.36; 95% CI, 0.91 to 2.03; p=0.132). CONCLUSION: Adjuvant chemotherapy can be recommended for stage II colon cancer patients, but the addition of oxaliplatin to the regimen must be selective.

Modified Surgical Intervention for Extensive Mitral Valve Endocarditis and Posterior Mitral Annular Calcification

The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification.

Neurologic Outcomes of Preoperative Acute Silent Cerebral Infarction in Patients with Cardiac Surgery

BACKGROUND: Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI. METHODS: We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was 68.8+/-9.5 years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies. RESULTS: There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions. CONCLUSION: Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.

Acute Thrombotic Occlusion of Left Internal Jugular Vein Compressed by Bypass Graft for Thoracic Endovascular Aortic Repair Debranching Procedure

Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm. The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft. We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.

Mixed Epithelial and Stromal Tumor of the Kidney / 대한비뇨기과학회지

Mixed epithelial and stromal tumor of the kidney(MEST) is a rare, recently described benign renal neoplasm that predominantly affects perimenopausal women. It is composed of dual components of epithelial and stromal cells, and the tumor is characterized by admixed cystic and solid growth patterns. Herein, we report on a case of MEST in a 35-year-old woman who presented with an incidentally found renal tumor. The patient has had no evidence of disease 4 years after the surgery.

Descending Necrotizing Mediastinitis Caused by Yeast: A case report / 대한흉부외과학회지

Descending nectorizing mediastinitis (DNM) represents a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce the high morbidity mortality associated with this disease. Intr.avenous broad-spectrum antibiotic therapy alone is not efficient without adequate surgical drainage of the cervical and mediastinal collections, extensive debridement and excision of necrotic tissue, and wide mediastino-pleural irrigation. A 38-year-old man admitted via emergency room with painful left neck swelling and uncontrolled high fever. Chest computed tomogram showed left paratracheal abscess descending into the superior and anterior mediastinum. Transcervical mediastinal drainage was performed with 26 Fr. chest tube and left paratracheal drainage was performed with Penrose drain in urgency. Culture and sensitivity test grew Yeast. The drains removed via gradually shortening on day 39 after surgery.

Risk Factors of Redo-valve Replacement / 대한흉부외과학회지

BACKGROUND: The results of reoperative valve replacement can be improved if appropriate analysis for the risk of reoperation was achieved. The purpose of our study was to analyze the results of reoperations for failure of bioprosthesis, and to define the risk factors in high-risk populations for reoperative procedures. MATERIAL AND METHOD: The series of 46 consecutive patients who had undergone first reoperative replacement for failed bioprosthesis between 1993 and 2001 were reviewed retrospectively. Mean age was 42+/-12 years, mean body surface area was 1.52+/-0.15 m2. The reoperative procedure comprised of 36 MVR, 8 DVR, and 2 AVR. The first operation comprised of 2 DVR, 1 AVR, and 43 MVR. Factors which were choose to assess a predictor of results in reoperative valve replacement were sex, old age(>60 years), early age at first operation(15years), poor NYHA functional class(>3), LV dysfunction(LVEF8hours), endocarditis, combined procedures, and renal insufficiency. RESULT: Overall mortality was 4.3%(2 cases). The risk factors that influenced postoperative complications and unexpected postoperative results were lower ejection fraction(p=0.012), older age(p=0.045), endocarditis(p=0.023), long operation time above 8 hours(p=0.027). There was no statistically significant factor influencing hospital mortality. CONCLUSION: No factor influenced the mortality. Better results could be achieved if reoperation was performed carefully in poor left ventricular function, old aged patient, and with endocarditis. Effort to shorten the operation time would be helpful on postoperative results.

The Clinical Effects of Normocapnia and Hypercapnia on Cerebral Oxygen Metabolism in Cardiopulmonary Bypass / 대한흉부외과학회지

BACKGROUND: Substantial alterations in cerebral blood flow(CBF) are known to occur during cardiopulmonary bypass(CPB). Many investigators have speculated that these changes may be responsible for both minor and major cerebral damages after CPB. More recently, these changes in CBF have been observed to be intimately related to the arterial carbon dioxide tension(PaCO2) maintained during CPB. The present study was prospectively designed to investigate the clinical effects of normocapnic and hypercapnic CPB on the cerebral oxygen metabolism in cardiac surgery. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to either normocapnic group (PaCO2 35~40 mmHg, n=18) or hypercapnic group(PaCO2 45~55 mmHg, n=18) with moderately hypothermic nonpulsatile CPB(nasopharyngeal temperature of 29~30degrees C). In each patient, middle cerebral artery blood flow velocity(VMCA), cerebral arteriovenous oxygen content difference (C(a-v)O2), cerebral oxygen extraction(COE), cerebral metabolic rate for oxygen(CMRO2), cerebral oxygen transport(TEO2), TEO2/CMRO2 ratio, cerebral desaturation(internal jugular bulb blood oxygen saturation

Primary Malignant Fibrous Histiocytoma of the Kidney

Primary renal malignant fibrous histiocytoma is a rare tumor of the kidney. It is clinically and radiologically indistinguishable from a renal cell carcinoma. Even following radical surgery, the tumor shows a strong predilection for local recurrence and the prognosis is generally poor. We report on a 32-year-old man with malignant fibrous histiocytoma of the kidney who remained free of recurrence for 1 year after radical nephrectomy.

Primary Malignant Fibrous Histiocytoma of the Kidney

Primary renal malignant fibrous histiocytoma is a rare tumor of the kidney. It is clinically and radiologically indistinguishable from a renal cell carcinoma. Even following radical surgery, the tumor shows a strong predilection for local recurrence and the prognosis is generally poor. We report on a 32-year-old man with malignant fibrous histiocytoma of the kidney who remained free of recurrence for 1 year after radical nephrectomy.

Comparison of BTA TRAK Assay with Voided Urine Cytology in the Detection of Primary and Recurrent Bladder Cancer / 대한비뇨기과학회지

PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.

Comparison of BTA TRAK Assay with Voided Urine Cytology in the Detection of Primary and Recurrent Bladder Cancer / 대한비뇨기과학회지

PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.

Intracorporeal Needle Breakage during Intracavernous Self-injection of Vasoactive Agent: A Case Report / 대한남성과학회지

Intracavernous self-injection of vasoactive agents for erectile dysfunction has been widely used in recent years due to its effectiveness and low rate of complications. Intracorporeal needle breakage during intracavernous self-injection represents an unusual complication. We report a case of intracorporeal needle breakage during self-injection of prostaglandin E1 in a 61-year-old man.

Giant Seminoma Arising in Intraabdominal Undescended Testis Treated with Initial Chemotherapy: A Case Report / 대한비뇨기과학회지

Seminoma arising in an abdominally located undescended testis is uncommon, accounting for only 5% of all seminomas. It tends to be relatively advanced at the time of diagnosis and usually treated with surgery followed by radiation and/or chemotherapy. We report a case of 61-year- old man who had a giant seminoma arising in the right testis of bilateral intraabdominal undescended testes with retroperitoneal lymph node metastasis, which was successfully treated with initial BEP chemotherapy. Excision of residual masses revealed complete necrosis of the tumor without viable cancer cells. The patient has been free of recurrence for 5 years after surgery.

A Case of Spontaneous Rupture of Renal Pelvis without Identifiable Cause Treated Conservatively / 대한비뇨기과학회지

Spontaneous rupture of renal pelvis is unusual and often occurs in association with an obstructed or infected kidney. Treatment should be prompt and usually requires surgical intervention. Spontaneous rupture of renal pelvis in the absence of any recognizable cause is extremely rare. This is a case report of a 57-year-old woman with spontaneous rupture of renal pelvis without identifiable cause, which was managed successfully by insertion of ureteral stent.

Reconsideration of the Necessity of Routine Ipsilateral Adrenalectomy during Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: Adrenalectomy has traditionally been included as a component of the radical nephrectomy. However, its role remains controversial. We assessed the ipsilateral adrenal involvement in renal cell carcinoma to determine whether ipsilateral adrenalectomy during radical nephrectomy is essential. MATERIALS AND METHODS: The records of 77 patients undergoing radical nephrectomy with ipsilateral adrenalectomy for renal cell carcinoma were reviewed. Radiographic findings were subsequently compared to postoperative histopathological findings to assess the predictive value of tumor characteristics and imaging in determining adrenal involvement. RESULTS: Three patients (3.9%) had ipsilateral adrenal involvement. In one of these 3 patients, adrenal involvement was documented in preoperative CT scan. The other two, in whom there were no adrenal abnormalities in CT scan, showed renal vein thrombosis. All 3 patients had advanced stage (T3b or T4). Mean renal tumor size in patients with adrenal involvement was 13.7cm (8-24) compared to 5.9cm (1.5-18) in those without adrenal involvement. Two of 3 patients with adrenal involvement had the adrenal invasion by direct extension of tumor from the upper pole of the kidney and 1 patient by hematogenous metastasis. CONCLUSIONS: Adrenalectomy may not be needed to perform routinely in localized, early stage renal cell carcinoma (T1-2), particularly when CT is negative for adrenal involvement. In renal cell carcinoma with risk factors, such as high stage (T3-4), large tumor involving the upper pole and renal vein thrombus, adrenalectomy should be performed.