The Krüppel-like factor (KLF5) as a predictive biomarker in preoperative chemoradiation therapy for rectal cancer

PURPOSE: Preoperative chemoradiation therapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer, 15%–30% of patients still progress while being treated with CRT. The aim of this study was to identify as important biomarker of poor response and evaluate the mechanism associated with CRT resistance. METHODS: This study included 60 human colon tumour pre-irradiation specimens. Expressions of epidermal growth factor receptor (EGFR), p53, Krüppel-like factor 5 (KLF5), C-ern, Ki67 were assessed and correlated with tumor regression grades and complete remission. We added in vitro study with biomarker which has been identified as important biomarker of poor response to evaluate the mechanism associated with CRT resistance. RESULTS: Pathologic complete remission (pCR) was achieved by 9 patients (18%). EGFR and KLF5 were significantly associated with pCR (P = 0.048, P = 0.023, respectfully). And multivariate analysis showed high KLF5 intensity was worse factor for pCR (P = 0.012). In vitro study, radiation or chemotherapy therapy stabilized KLF5 protein levels in a time- and dose-depended manner in HCT116 and Caco-2 cells. KLF5 overexpression in HCT116 stable cell line showed significantly better cell viability by increasing cyclinD1 and b-catenin compared to control cells in MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, suggesting that KLF5 mediates cell survival. CONCLUSION: KLF5 was significantly associated with the presence of KRAS mutations, and KLF5 was an independent poor response predictor of CRT in rectal cancer. Our study is pilot study and more research will be needed in the future.

CORRIGENDUM: Correction of 4th author's name: The Krüppel-like factor (KLF5) as a predictive biomarker in preoperative chemoradiation therapy for rectal cancer

In the original publication, the authors found a mistake in 4th author's name. The 4th author's name Younghee Choi is the correct spell rather than Yong Hee Choi.

The Safety Evaluation of a Potent Angiogenic Activator, Synthetic Peptide (SFKLRY-NH2) for the Skin Application

A novel synthetic hexapeptide (SFKLRY-NH2) that displays angiogenic activity has been identified by positional scanning of a synthetic peptide combinatorial library (PS-SPCL). This study was carried out to investigate the irritation of the SFKLRY-NH2 on the skin. The tests were performed on the basis of Korea Food and Drug Administration (KFDA) guidelines. In results, cell toxicity is not appeared for SFKLRY-NH2 in HaCaT cells and B16F10 cells. SFKLRY-NH2 induced no skin irritation at low concentration (10 microM), mild irritation at high concentration (10mM). We consider that this result is helpful for saying about the safety of SFKLRY-NH2 in clinical use.

Surgical Treatment of Acute Arterial Occlusion after Applying the Vascular Closure Device for Hemostasis of Femoral Arteriotomy in Vascular Intervention

Vascular intervention via the femoral artery can cause vascular access complications and complications from closure of the arteriotomic incision site such as bleeding, thrombotic complications and vascular trauma. These types of complications occur in about 2% to 10% of the cases. After removal of the catheter, hemostasis is traditionally achieved by manual compression as a standard method. Many vascular closure devices have been developed in an attempt to improve the patient's comfort and to decrease the time to ambulation. Yet the safety and effectiveness of these vascular closure devices as compared to that of manual compression remains unclear. Herein we report on a case of femoral arterial occlusion due to vascular closure devices and the operative management.

Expression of E-cadherin, Heat Shock Protein 47, Transforming Growth Factor beta1 and C4d in Chronic Allograft Nephropathy / 대한이식학회지

BACKGROUND: Chronic allograft nephropathy (CAN), which causes graft failure, is related to tubular atrophy and interstitial fibrosis. E-cadherin is a well-known epithelial marker and heat shock protein (HSP)-47 is a collagen-specific molecular chaperone that regulates collagen synthesis. Transforming growth factor (TGF)-beta1, a profibrotic cytokine, downregulates E-cadherin and induces expression of mesenchymal markers in an in vitro model. C4d expression is considered a poor prognostic marker for graft survival. This study evaluated the relationship between the expression of E-cadherin, HSP47, TGF-beta1, and C4d with the prognosis for CAN. METHODS: Between March 1991 and August 2007, we performed renal allograft biopsies on 42 recipients with deteriorating renal function. CAN was diagnosed according to the chronic allograft damage index (Banff classification). Renal allograft biopsies were examined for the expression of E-cadherin, HSP47, TGF-beta1, or C4d by immunohistochemistry. The HSP47, TGF-beta1, and E-cadherin staining was scored semiquantitatively by analyzing ten different fields of cortical interstitium and tubules. Biopsies with endothelial C4d staining in peri-tubular capillaries (> or =25%) were designated as C4d-positive. RESULTS: Of 42 recipients, 17 (40.5%) were in the graft survival group (GS) and 25 (59.5%) were in the graft failure group (GF). E-cadherin expression in tubular cells of the GS was much higher than that of the GF (94.1% vs 52%, P=0.04). HSP47 expression in tubular cells and interstitium in the GF was much higher than that in the GS (84% vs 35.3%, P=0.001). TGF-beta1 expression in tubular cells and interstitium in the GF was much higher than that in the GS (72% vs 23.5%, P=0.02). CONCLUSIONS: E-cadherin, HSP47, and TGF-beta1 expression was strongly correlated with the CAN prognosis.

Comparison of New Onset Diabetes according to the Time of Onset in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: New onset diabetes is a common complication after kidney transplantation. However, the clinical course of post-transplant diabetes mellitus (PTDM) remains unclear. The aim of the present study is to analyze the natural courses and risk factors of PTDM according to the time of onset. METHODS: A total of 216 consecutive kidney transplant recipients were enrolled and patient medical records were investigated retrospectively. PTDM was defined as glucose > or =126mg without previous diabetic history. Patients were classified according to the onset (12 months): early PTDM (E-PTDM) and late PTDM (L-PTDM). RESULTS: PTDM was observed in 34 (17.4%) patients. The number of E-PTDM and L-PTDM patients was 17 and 17. Compared with normoglycemic patients, the PTDM group was older and showed higher pre-transplant HbA1c level. The use of tacrolimus was associated with the development of E-PTDM (OR=4.87, 1.71~13.8 in 95% CI) but not L-PTDM (OR=0.34, 0.04~2.70 in 95% CI) CONCLUSIONS: The development of E-PTDM and L-PTDM may have different risk factors. It will be important to choose different therapeutic strategy according to the onset of PTDM.

Kaposi's Sarcoma on Mediastinum after Renal Retransplantation

Kaposi's sarcoma occurs in higher rates in the setting of immunosuppression, especially in patients with acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy or posttransplantation, commonly involving the skin, visceral, oral cavity or respiratory tract. Of the de novo malignancies in transplantation patients, the incidence of Kaposi's sarcoma is increasing steadily. We report a case of a 37-year-old male patient who was diagnosed with Kaposi's sarcoma 16 years after his first renal transplantation and 5 months after his second transplantation. He presented with lymphoproliferative lesions in the mediastinum and supraclavicular area without showing any typical cutaneous lesions. Diagnosis was confirmed by gun biopsy of the enlarged axillary lymph nodes. Tacrolimus, the initial immunosuppressive drug, was tapered while sirolimus therapy and chemotherapy with vincristine was initiated. The enlarged lymph nodes decreased in size and the patient has been treated with vincristin and conversion of tacrolimus to sirolimus.

The Effect of Compliance, Family Support and Graft Function on Quality of Life in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: Previous studies have shown that kidney transplant recipients' quality of life depend on compliance of treatment, family support, socioeconomic status. The purpose of this study was to determine whether estimated glomerular filtration rate (GFR) by Modification of Diet in Renal Disease (MDRD) study as a index of graft function influence recipients' quality of life including above mentioned factors. METHODS: One hundred and ten patients who visited out-patient department at least 3 months after kidney transplantation were included in this study. A structured questionnaire was used to collect data. This tool included; quality of life, compliance and family support scale as well as medical record review. The analysing of data was performed with SPSS version 11.5 (SPSS Inc. Chicago, IL, USA). RESULTS: The mean score of the recipients' quality of life (3.59/5), compliance (3.81/5), the support of family (4.02/5) and GFR (63 ml/min/1.73 m2) were revealed respectively. The quality of life was correlated with compliance (r=.260, P<.001) and family support (r=.377, P<.001) statistically. and compliance and family support also revealed correlation (r=.452, P<.001). Family support was the most explainable factor for the quality of life (R2=.142). however, the quality of life was not correlated with recipients' GFR (r=.013 P=0.819). CONCLUSIONS: Results of this study showed that kidney transplant recipients had a moderate quality of life. These findings suggest that emotional aspect like family support is as important as clinical factors such as GFR or compliance for recipients' quality of life. To optimize post-transplant quality of life, implication for interventional programming should be focused on family support.

Simultaneous Pancreas-kidney Transplantation from Pediatric Donor: A Case Report / 대한이식학회지

Simultaneous pancreas-kidney (SPK) transplantation is a well-established treatment for patients with insulin-dependent DM complicated by ESRD. The current shortage of cadaver donors and the increasing number of diabetic patients on the transplant waiting list has prompted the use of cadaveric organ from pediatric donors. But the lower age limit of the pancreatic donors has not yet been established. We report the successful result using a 10 years old donor for a 36-year-old SPK transplant recipient.

The Clinical Significance of the Hypoxia Inducible Factor-1 alpha and C4d in Implantation Renal Biopsies and Post-transplant Biopsies / 대한이식학회지

PURPOSE: Hypoxia inducible factor-1 alpha (HIF-1 alpha) is induced in response to ischemic states and in turn activates transcription of several growth factors implicated in cell survival. These growth factors have been recognized as role players in the development of chronic allograft nephropathy (CAN). C4d depositions in the peritubular capillaries of renal allografts have been reported to be sensitive markers of acute humoral rejection. The purpose of this study was to determine the effects of HIF-1 alpha expression and C4d deposition in implantation biopsies of renal allografts. METHODS: Implantation biopsies and 22 rejection proven biopsies of 54 renal transplantation recipients (Male:Female=31:23) in Kangdong Sacred Heart Hospital from December 1996 to July 1999 were done. Immunohistochemical studies were performed using mouse monoclonal antibody (1:1000, Novus Biological Inc., Littleton, CO, USA) as the primary antibody and CSA (Catalyzed Signal Amplification System, Dako, Denmark) as the secondary antibody for HIF-1 alpha. Rabbit polyclonal antibody (1:200 Biogenesis, UK) and DAB kit (Dako) were used for C4d detection. Expression of HIF-1 alpha was defined as positive nuclei staining under 10 HPF (high power field) and C4d deposition was defined as 1+ when the pericapillary deposition was under 50% and 2+ when over 50% and 0 when there were no traces of depo sition. RESULTS: HIF-1 alpha was demonstrated in 19 cases (35%) of the 54 implantation biopsy cases. The expression of HIF-1 alpha was statistically higher in the deceased donor group compared to the living donor group. The HIF-1 alpha positive group had a longer mean cold ischemic time than the HIF-1 alpha negative group but was not statistically significant. The age of the donor and HIF-1 alpha expression showed no correlation. Expression of HIF-1 alpha of the implantation biopsies also showed no difference in the rejection group (n=22) compared to the non-rejection group (n=32). There was no significant difference of HIF-1 alpha expression in the graft loss group (n=7) and the graft functioning group (n=47). C4d deposition was detected in one implantation allograft biopsy (1.9%). The C4d positive patient developed acute accelerated rejection on the fourth postoperative day. HIF-1 alpha and C4d were demonstrated in 22 (100%) and 11 (50%) of the 22 rejection biopsies, respectively. In patients who showed rejection, HIF-1 alpha expression was significantly higher in the rejection biopsies compared to the implantation biopsy group. HIF-1 alpha expression of the patients who showed rejection within one month and those with rejection later than three months after engraftment showed no significant difference. CONCLUSION: Expression of HIF-1 alpha in implantation biopsies showed significant correlation with deceased kidney donors. The relation with cold ischemic time was not statistically proven but the HIF-1 alpha positive group showed a tendency of longer cold ischemic time. Biopsies from the renal allografts with rejection showed significantly higher expression of HIF-1 alpha compared to the implantation biopsies. The deposition rate of C4d was extremely low in implantation biopsies that we could not prove any relevance with acute rejection.

Clinical Significance of the Ki-67 Index for Colorectal Cancer

PURPOSE: Monoclonal antibody Ki-67 has been employed to evaluate the growth fraction of various tumors. The purpose of this study is to determin the prognostic value of the Ki-67 index for colorectal cancer. METHODS: The Ki-67 index was investigated by counting the immunohistochemically stained cells. We described this as the permillage. We reviewed the test results of 36 colorectal cancer patients and we compared the Ki-67 index with other clinical factors. RESULTS: There was no correlation between the Ki-67 index and the other established risk factors, and only the number of invaded lymph nodes and their degree of differentiation were related with the Ki-67 index. CONCLUSION: The Ki-67 index is an important marker of the growth fraction of tumor. The pattern of tumor growth is determined not only by the growth fraction, so the discovery of other parameters that can reflect tumor growth and the Ki-67 index can help the patients with respect to their prognosis & treatment.

Pyloric Duplication Cyst

Pyloric duplication is a rare anomaly usually manifested as an abdominal mass or gastric outlet obstruction mimicking infantile hypertrophic pyloric stenosis. We experienced a rare case of pyloric duplication without any evidence of a communication to neighboring organs including extrahepatic biliary tree or pancreatic duct in in a newborn male patient. We performed a complete excision of that lesion without bowel resection and encountered an uneventful postoperative recovery.

A Clinical study of the Coexistion Thyroid Carcinoma in Hashimoto's Thyroiditis ( HT )

Being described first 1912 by Hashimoto, Chronic lymphocytic thyroiditis has been most commonly diagnosed as inflammatory thyroid disease. Despite of worldwide reports about the concomitant malignancy with Hashimoto's thyroiditis, the definite incidence of coexsiting malignancy and the etiologic relationship between these different pathologic conditions remains to be brought out. Analyzing 18 cases of coexisting thyroid carcinoma among 80 cases of Hashimoto's thyroiditis, confirmed by pathologic study at Presbyterian medical center in Chonju between 1991 and 1995, the authors intended to make guideline of management for them. The results are as follows: 1. The incidence of coexisting carcinoma with HT was 18/80(22.5%). 2. The average age of patients with coexisting carcinoma was 44.1 years and all of them were female.3. Cold nodules on thyroid scan were noticed in 23 cases(22.7%) of HT and 7 cases(33.8%) of coexisting carcinoma with HT. 4. Calcified lesions on thyroid sonography were detected in 0 cases of HT and 4 cases(50%) of coexisting carcinoma. 5. The pathologic types of carcinoma were papillary(17/18, 94.4%) and follicular(1/18, 5.6%). 6. 3 cases of coexisting carcinoma had metastatic lesions on peritracheal lymph nodes and another 3 cases had on ipsilateral jugular nodes. 7. The carcinoma of smaller than 0.5cm were 7 cases, of 0.6-1.0cm were 3 cases, of 1.1-1.5cm were 5 cases, and so 15 cases(83.3%) were occult carcinoma. Only 3 cases were larger than 1.6cm. 8. Coexisting carcinoma patients with HT underwent subtotal thyroidectomy (4 cases), subtotal thyroidectomy & anterior compartment dissection (ACD, 6 cases), subtotal thyroidectomy & modified RND (2 cases), thyroid lobectomy & ACD (4 cases), thyroid lobectomy & modified RND (1 cases), or near total thyroidectomy & ACD (1 case).

2 Cases of Lumbar Hernia

Lumbar hernia presents as a reducible protruding mass in the flank region between the 12th rib and the iliac crest. The superior lumbar hernia (Grynfeltt's) is covered by the thin latissimus dorsi muscle and bounded by the erector spinae and internal obliquus abdominis muscle. The lumbodorsal fascia forms the floor of the Grynfeltt's triangle. Spontaneous or acquired non-traumatic lumbar hernia occurs more frequently after middle age. The untreated lumbar hernia progresses in size gradually. As in most hernias, the larger the defect, the more complicated and difficult is the repair. Here we report 2 female patients with spontaneous lumbar hernia diagnosed at Presbyterian Medical Center with computerized tomogram. Their treatment consisted of tension-free surgical repair utilizing the overlap method for defect edge and the application of prolene mesh.

A Clinical Analysis of Intussusception in Adult

PURPOSE: Adult intussusception is relatively rare and it's course is subacute or chronic course. It usually occurs secondary to tumors or other underlying cause. Especially the incidence of associated malignancy is increasing compare to the past. Purpose of this study was review of adult intussusception, our comprehension of the disease improved by and helped to plan treatments METHODS: During the past 11 yeasrs, from January, 1987 to December, 1997, 27 cases of adult intussusception at Department of Surgery, Presbyterian Medical Center were analyzed retrospectively. RESULTS: The age incidence was variable. But it occurred more frequently at 4th decades. Useful radiologic diagnostic tools were CT, U/S as well as barium enema. Nineteen instances of intussusception originating in the small bowel and 8 instances originating in the colon. The etiologic factors were found in 22 cases (74%). Of the 19 small bowel intussusception, 5 cases were associated with malignancy and 3 out of 8 colon intussusception were result from the malignancy. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. Surgical intervention was carried out in all of these 27 cases: 20 cases underwent surgical resection and 7 cases were reduced manually after surgical exploration; Only manually reduction was performed in 4 cases, manually reduction and cecopexy in 2 cases and manually reduction and adhesiolysis in 1 case. CONCLUSION: The malignancy was the major cause of adult intussusception. Especially in colonic intussusception, occupational percentage of malignancy was higher. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. So, we cosidered plans of treatments according to location, etiology and bowel state.

Pregnancy in Female Patients with Renal Transplantation: Safety to mother, neonate and allograft / 대한이식학회지

We retrospectively reviewed 48 pregnancies in 36 female patients after renal transplantation until February, 1998 at Yonsei University College of Medicine. All patients were maintained on cyclosporine-based immunosuppressive regimen before, during and after pregnancy. Patients were divided into two groups; group 1 (Delivery Group) of 25 women with 26 pregnancies and group 2 (Abortion Group) of 19 women with 22 pregnancies. Mean interval between renal transplantation and conception is 31.8+/- 22.9 months. Serum creatinine was reported before, during and after pregnancy and there was no significant changes of its mean value in both groups. Mean daily dosage of cyclosporine were similar in patients. Average gestational age was 37.0+/- 2.0 weeks and the incidences of very low birth weight (VLBW), low birth weight (LBW) and small for gestational age (SGA) were 7.7%, 63.5% and 84.6%, respectively. Pregnancy-related complications during pregnancy in group 1 were urinary tract infection in 11 cases, preeclampsia in 7 cases, hypertension in 4 cases and proteinuria in 3 cases. There was no acute rejection or graft loss during pregnancy. The premature deliveries less than 37 weeks were 12 cases (46.2%). Low birth-weight of neonate was significantly related with maternal pre-pregnant hypertension (1793.3+/- 393.0 gm in patients with hypertension vs. 2471.2+/- 468.1 gm in patients without hypertension; p=0.001). Pregnancy in female renal transplant patients is relatively safe while they are monitored in a tertiary care center with close monitoring of cyclosporine A (CsA) dosing, serum creatinine levels and the other laboratory values by a transplant surgeon, nephrologist, obstetrician and pediatrician.

Adenoid cystic carcinoma of the salivary glands

No abstract available.

Successful Immunosuppression with Cyclosporine after Renal Transplantation in a Patient with Chronic Renal Failure Due to Postpartum Hemolytic Uremic Syndrome / 대한이식학회지

Hemolytic uremic syndrome is characterized by the symptoms of microangiopathic hemolytic anemia, thrombocytopenia and renal failure. The incidence of hemolytic uremic syndrome associated with pregnancy is 10 to 25 percent. Hemolytic uremic syndrome is treated with adjunctive therapies, such as anti-platelet agents, glucocorticoid and plasma exchange. However, many patients experience a residual impairment in renal function and some of them progress to end-stage renal disease requiring dialysis or renal transplantation. Immunosuppression with cyclosporine has been implicated as a significant risk factor for post- transplant hemolytic uremic syndrome. A number of reports on transplant recipients have recognized cyclosporine-induced hemolytic uremic syndrome as a distinct entity and a potentially serious complication of cyclosporine administration.We report a case of a patient with successful renal transplantation using cyclosporine who had a severe case of post-partum hemolytic uremic syndrome that progressed to end-stage renal disease. After cadaver-donor renal transplantation using cyclosporine, mycophenolate mofetil and prednisolone her graft function at two years is normal with serum creatinine 1.0 mg/dl.

Ultrasonogram as a Diagnostic Modality in Thyroid Tumors / 대한내분비외과학회지

PURPOSE: To evaluate the usefulness of ultrasonogram as a preoperative diagnostic tool in thyroid nodular diseases, this study was carried out. METHODS: From January 1998 to December 1999, 51 patients who underwent thyroidectomy were analyzed retrospectively. We compared the finally histopathological results to ultrasonographical findings such as internal consistency, multiplicity of nodules, nodular ehogenicity, nodular capsule or margin, calcification of nodules. RESULTS: There were 47 females and 4 males with 25 benign tumor, 23 malignant tumor and 3 occult carcinoma in histopathological diagnosis. The solid tumors in ultrasonography carried a probability of malignancy as 66.7% (16/24 cases) whereas cystic or mixed tumors as 16.7% (1/6 cases) or 23.8% (5/21cases) (p=0.006). The single nodular diseases carried a high probability of malignancy as 50% (13/26cases) whereas multiple diseases as 28.6% (6/21 cases). The hypoechogenicity of thyroid nodular disease showed a probability of malignancy as 60% (9/15 cases) whereas mixed-echogenicity as 36.4% (4/11 cases). The nodules with poorly-defined margin in ultrasonographic findings showed higher probability of malignancy as 63.6% (7/11cases) than the nodules with well -defined margin as 26.5% (9/34 cases) (p=0.025). The nodules with calcification in ultrasonographic findings were represented to high probability of malignancy as 70.6% (12/17 cases) compared to those without calcification as 29.4% (10/34 cases) (p=0.005). The differency between ultrasonic and histopathological diagnosis was high in solid nodules (33%), 3~4 cm sized nodules (28.6%) and mixed echogenecity (27.3%) whereas low in complex nodules with cystic and solid nature (4.8%), 2~3 cm sized nodules (8.3%) and pooly defined margin (9.1%). The accuracies of sonography in differentiating malignacy from benign thyroid nodules were 7.1% of false positivity, 39.1% of false negativity, 60.9% of sensitivity, 92.9% of specificity and 78.4% of accuracy. CONCLUSION: Sonographic examination was relatively excellent test as a preoperative diagnostic tool in thyroid nodular diseases when detailed checklists were applied such as internal consistency, multiplicity of nodules, nodular ehogenicity, nodular capsule or margin and calcification of nodules.

Paraduodenal Hernia

Internal abdominal hernias are an unusual cause of intestinal occlusion. They are responsible for 2% of all the intestinal obstructions. Various types of hernia have been described. Paraduodenal hernias are relatively rare congenital malformations and result from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia of the small intestine in a 32-year-old man with presentation of intestinal obstruction. The patient suffered from nausea, vomiting and acute abdominal pain for 9 hours. Abdominal CT showed sac-like mass of clustered, dilatated small bowel in the right upper quadrant. At operation, herniation of small intestine into a retroperitoneal space through a defect on right mesocolon was noted. A right paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery except some diarrhea after extensive segmental resectio of strangulated small bowel. Paraduodenal hernia is important as it usually presents as intestinal obstruction, and is often misdiagnosed before laparotomy. Mortality is increased significantly with delays in surgical treatment. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery and also prevents the possible complication of gangrenous bowels.