, Kwang Ho Kim, Gyoung Tae Noh, Ho Seung Kim Recurrent colonic perforation in patients already having colostomy is extremely rare and only a few cases had been reported. Herein, we report 2 cases of recurrent colonic perforation at the proximal part of the colostomy in geriatric patients resulting from different causes, which might be caused by stercoral perforation and recurrent colonic ischemia, respectively. Based on our experience, surgeons should consider correcting chronic constipation even in patients who already have a colostomy. Additionally, transverse colostomy should be considered as a surgical treatment in patients with sigmoid colostomy for recurrent perforation due to colonic ischemia.
, Kwang Ho Kim, Soon Sup Chung, Kyoung Sook Hong, Ryung-Ah Lee In the metastatic process, interactions between circulating tumor cells (CTCs) and the extracellular matrix or surrounding cells are required. β1-integrin may mediate these interactions. The aim of this study was to investigate whether β1-integrin is associated with the detection of CTCs in colorectal cancer.
We enrolled 30 patients with colorectal cancer (experimental group) and 30 patients with benign diseases (control group). Blood samples were obtained from each group, carcinoembryonic antigen (CEA) mRNA for CTCs marker and β1-integrin mRNA levels were estimated by using reverse transcription-polymerase chain reaction, and the results were compared between the two groups.
CEA mRNA was detected more frequently in colorectal cancer patients than in control patients (P=0.008). CEA mRNA was significantly reduced after surgery in the colorectal cancer patients (P=0.032). β1-integrin mRNA was detected more in colorectal cancer patients than in the patients with benign diseases (P<0.001). In colorectal cancer patients, expression of β1-integrin mRNA was detected more for advanced-stage cancer than for early-stage cancer (P=0.033) and was significantly decreased after surgery (P<0.001). In addition, expression of β1-integrin mRNA was significantly associated with that of CEA mRNA in colorectal cancer patients (P=0.001).
In conclusion, β1-integrin is a potential prognostic factor following surgical resection in colorectal cancer patients. β1-integrin may be a candidate for use as a marker for early detection of micrometastatic tumor cells and for monitoring the therapeutic response in colorectal cancer patients.
, Soon Nam Lee, Young Yo Park, Kwang Ho Kim, Woon Sup Han Choriocarcinonla is very rare malignancy, accounting for less than 1% of all testicular germcell tumor. However, it is an important disease in the field of oncology, as it represents ahighly curable malignancy. and one in which the incidence is focused on young patients attheir peak of productivity. In nonserninomatous germ cell testis tumor, assessment of prognosticfactors is related to develop a basis for more rational therapy for each individual patient.Along with prognostic staging, appropriate treatment shoud be applied to each patient to improve disease-free survival. And. surgical resection of residual masses after cisplatin-based chemotherapy is an established adjuvant to chemotherapy, because complete remission can be improvedabout 10% with appropriately timed complete resection of residual diseases. So, we reporta case of a 27-year old male patient with testicular choriocarcinoma who presented with multiplelung metastases after radical orchiectomy. He recieved lung wedge resection after 8 cycles ofcisplatin, etoposide, ifosfamide combination chemotherapy. and complete remission was confirmed and maintained.
, Seung Ki Ryu, Seung Jung Kim, Jun-Hyuk Choi, Soon Nam Lee, Kwang Ho Kim, Woo Sup Han Although the role of surgical management of metastatic disease from primary carcinoma of the coln and recutm is still controversial, resection of hepatic metastasis improves survival rate of patients with primary colorectal carcinoma treated locally. The lung is the most common site of extra-abdominal metastasis following resection of a prymary colorectal tumor and not amenable to curative therapy.
It is possible to resect the pulmonary metastasis in selected patients following resection of colorectal cancers, but the 5-year survival rates are ranged from 9% to 57%. Authors report a case of resection of pulmonary metastasis occured 3 years after resection of primary colon carcinoma.
, Young Sik Park, Kwang Ho Kim, Hea Soo Koo Castleman's disease, giant lymph node hyperplasia, is a rare benign tumor which was originally reported by Castleman in 1956. It has two types of pathological characteristics of hyaline-vascular and plasma cell. Surgery is usually perferred because of the giant mass shadow on the chest roentgenogram rather than symptomes it causes. It is cured completely by resection without recurrence. We have experienced a case of Castleman's disease in the right anterosuperior mediastinum in a 36-year-old female. She was treated by surgical resection with good result She is well one year after surgeny.
, Kwang Ho Kim Reliable venous access is increasing serious problem in cancer chemotherapy Patients.
Thiry six implantable second generation catheter system(A. Port) were placed subcutaneously in 35 patients with cancer.
A. Port were in place for an average of 158 days(range 10-731+ days). Complications included infections in 3 cases, thrombosis in 1 case, skin laceration in 1 case and pneurnothorax in 1 case. Five ports were removed due to complication. One pneumothorax was managed conservatively;
It is concluded that A. Port implantation constitute a safe and convenient access with a low rate of complication for long term intravenous chemotherapy in cancer patients.
, Kwang Ho Kim A 36-year-old male farmer was admitted due to exertional dyspnea for 15 years. Cardiac examination revealed mitral valvular stenosis. aortic valvular stenosis and regurgitation. Single pulmonary nodule was found in the left lower lung field in chest X-ray.
Concomitant double valve replacement and resection of pulmonary nodule were performed using mid-sternotomy simultaneously.
Postoperative course was uneventful and pathological diagnosis of pulmonary nodule was hamartoma.
, Kwang Ho Kim Relief of the pain is important for reducing patient's discomfort and morbidity after thoracotomy. Post-thoracotomy pain was controlled by pharmacological blockage of the intercostal nerves with bupivacaine in 20 patients. Bupivacaine was infused intermittently through one inwelling cathter, which was placed in the pleural space during the thoracotomy. Pain was well controlled by this procedure.
, Kwang Ho Kim Relief of the pain is important for reducing patient's discomfort and morbidity after thoracotomy. Post-thoracotomy pain was controlled by pharmacological blockage of the intercostal nerves with bupivacaine in 20 patients. Bupivacaine was infused intermittently through one inwelling cathter, which was placed in the pleural space during the thoracotomy. Pain was well controlled by this procedure.
, Won Kyung Cho, Kyung Rim Han, Young Sik Park Clinical analysis for 95 cases with spontaneous pneumothorax which were treated at the Department of Thoracic and Cardiovascular Surgery of Ewha Womans University Hospital from March, 1982 to February, 1988 had been done. Among 95 cases male was 81 and female was 14. Male to female ratio was 5.8:1. The youngest patient was 16 years old and the oldest was 73 years old. Most of the patients were between 21 and 40 years old. Ninety cases had unilateral pneumothorax and 5 cases had bilateral pneumothorax. Sudden dyspnea was appeared in 85.3% of all cases and chest pain was in 60% of patients. Initial treatment was bed rest with high oxygen therapy for 6 patients. Tube thoracostomy was done for the remaining cases. The results of initial treatment in 90 paients with unilateral pneumothorax as follow; Thoracotomy was done for 11 cases due to persistent air leak through the chest tube. initial treatment was sucessful in 79 cases but 22 cases were recurred. So recurrence rate was 27.8%. Among 22 cases, 13 cases were operated. There was no recurrence in thoracotomy cases. In 5 patients with bilateral pneumothorax, two cases were operated on one side. Bilateral thoracotomy was done for one patient.
The underlying causes of the spontaneous pneumothorax were bullae in 16 cases, bullae with pulmonary tuberculosis in 9 cases and pulmonary tuberculosis in 3 cases among 28 operations of 27 cases. Among 68 of non-thoracotomy patients, no definite causes were found in 31 cases and obstructive lung disease in 2 cases, lung cancer, lung abscess and pneumonia in 1 case each.
, Kwang Ho Kim 164 cases of cardiovascular surgery were performed at Ewha Womans University Hospital from March 1982 to October 1987. There were 119 cases of open heart surgery and 45 cases non open heart surgery. There were 112 congenital cardiac anomalies and 50 acquired heart diseases. Congenital cardiac anomalies were 35 PDA, 29 VSD, 21 TOF, 13 ASD, 3 ECD, 2 MR and 9 other rare anomalies. Acquired heart diseases were 24 mitral valvular diseases, 7 aortic valvular diseases, 14 multiple valvular diseases and 5 other rare diseases. We had 21 operative mortalities and 18 complications.
Bronchoplastic procedures in combination of sleeve resection of the bronchus are performed in selected cases of benign or malignant tumors arising from the major bronchial trees. Bronchoplasty has a good benefit preserving the distal lung tissues. However the tehniques of these procedures are more difficult to be performed than that of conventional lobectomy or pneumonectomy. Bronchoplastic procedures between the left main bronchus and the left upper lobe bronchus are especially hard to be undergone because of angulation of the bronchus and pulmonary vessels. Bronchoplasty between the left main and the left upper lobe bronchus after sleeve resection of the left main bronchus and lower lobe was undergone successfully on a 27-year-old housewife who had the bronchus. Her postoperative course was uneventful. She is in good health until postoperative 1 year.
, Joong Gon Kim, Woo Hyung Lee, Sung Yuel You, Choon Hi Lee Thirteen patients with a variety heart diseases were underwent operation for total correction of their defect successfully at Ewha Womans University Hospital from March, 1982 to February, 1983. Among 13 patients, three had patent ductus arteriosus, two tetralogy of Fallot, one ventricular septal defect, two constrictive pericarditis and five rheumatic valvular heart diseases. There was no surgical mortality. Their functional improvement was excellent until 6 to 12 months' postoperative period. Although they were a few patients, we report these cases because we thought they might be a good experience for us in performing coming cardiovascular work.
, Ryung-Ah Lee, Soon-Sup Chung, Kwang Ho Kim The EGFR plays an important role in tumorigenesis and tumor progression of colorectal cancer, and leads to the activation of intracellular signaling pathways. The use of anti-EGFR-targeted therapy has increased for patients with colorectal cancer, but patients with EGFR mutations will be resistant to anti-EGFR-targeted therapy. The identification of gene mutations is critical in cancer treatment; therefore, the aim of this study is to investigate the incidences of EGFR mutations in colorectal cancer patients in Korea.
We reviewed 58 colorectal cancer patients who underwent operations between 2003 and 2006, retrospectively. We analyzed their EGFR mutations in 4 loci by DNA sequencing. In addition, we analyzed the correlation between the presence of EGFR mutation and patients' clinicopathologic features.
Of the 58 patients, 35 patients were male and 23 were female. Their mean age was 63.28±11.18 years. Two patients (3.45%) were diagnosed as stage Tis, 7 patients (12.07%) had stage I, 24 patients (41.38%) had stage II, 20 patients (34.48%) had stage III, and 5 patients (8.62%) had stage IV. As a result of mutational analysis, EGFR mutations on exon 20 were detected in 13 patients (22.41%, G→A transitions). EGFR mutations on exon 18, 19 and 21 were not detected. EGFR mutation increased in the earlier stage and the absence of lymph node metastasis (P=0.028).
The incidence of EGFR mutation in Korean colorectal cancer patients is 22.41%. In addition, EGFR mutation significantly increased in the earlier stage and the absence of lymph node metastasis.
, Kyoung Tae Noh, Ryung-Ah Lee, Kwang Ho Kim Cancer prevention by vegetable diet has received considerable attention in recent years. In the past these attributes of vegetables were based more on beliefs than on scientific evidences. But over the past few decades many studies have been performed about that. Cancer preventive components of many vegetables have been studied in experimental carcinogenesis models. These studies have reported on these components influence carcinogenesis during initiation and promotion phases of cancer development. Also, epidemiological studies and clinical trials have reported cancer preventive effects of vegetables. However, there is no comprehensive summary of cancer preventive effects with the types of vegetables. In this review, we classified the vegetables and described the mechanism of action of active components of vegetables, experimental studies, and clinical trials. Results revealed a negative correlation between consumption of vegetables and cancer risk. But we can't still conclude the effects of vegetables yet, so further studies would be necessary for final conclusion.
Citations
, Kyoung Tae Noh, Boyoung Oh, Ryung-Ah Lee, Soon-Sup Chung, Kwang Ho Kim Hand-assisted laparoscopic surgery had both technical advantages of open surgery and better postoperative short-term follow-up results of laparoscopic surgery. We compared open colectomy, laparoscopic colectomy and hand-assisted laparoscopic colectomy, and tried to find the most effective operative modality.
90 patients, who were diagnosed with colorectal cancer and underwent colectomy in our institution, were categorized as 3 groups of open colectomy (OC) group, laparoscopic colectomy (LC) group and hand-assisted laparoscopic colectomy (HALC) group by the surgical modality.
In this study, ratio of male and female was 57 : 37, and mean age was 64.1 years old. LC group and HALC group showed longer operation time, shorter hospital stay after operation, lesser pain and earlier removal of closed drainage catheter than OC group. Amount of bleeding during operation, frequency of transfusion and incidence of complication showed no significant difference. In permanent pathologic results, the number of harvested lymph nodes had significant difference between OC group and other groups (P=0.030), but it was probably caused by the bias of the different distribution of the stages in each group. Overall 14 of the cases resulted in complications while there was no mortality.
Laparoscopic colectomy and hand-assisted laparoscopic colectomy showed better short-term follow-up results rather than open colectomy. And hand-assisted laparoscopic surgery could provide tactile sensation to operator, which lacked in laparoscopic surgery. Hand-assisted laparoscopic colectomy could be an alternative surgical option for colorectal cancer with these advantages.
, Kwang Ho Kim While some information about colonic function may be obtained from fluoroscopic assessment, detailed depiction of function of the rectum and anal canal during defecation is not possible with conventional technique. Defecography is a useful technique of examining the rectum and canal in which the patient is studied while sitting down and video recordings could be obtained during the procedure. To evaluate the clinical usefulness of defecography in patients with anorectal dysfunction, defecographic examinations were retrogradely reviewed.
Thirty symptomatic patients performed defecography. The ratio of men : women was 9 : 21, and the age was 8 to 86 years(mean, 36year). Presenting symptoms included a sensation of rectal blockage during straining, rectal prolapse through the anus, anal pain, etc.. While the patient was in the left decubitus position, 250㎖ of a thick barium past was injected into the rectum. The patient was then seated a toilet chair mounted on the footplate of a remote-control stand. And lateral images and video recording centered over the rectum and true pelvis obtained over a period of several minutes, both at rest and during and sqeezing and straining. The defecographaic results were analyzed for the anorectal angle and perineal descent at rest, sqeezing and during straining. Change of rectal configuration and canal width during staining were reviewed.
Defecation was normal in 5 patients(16.6%). Rectocele was seen in 17case(56.6%). Rectal proplase with or without intususception was 11 case(36.3%), 3 cases(10%) of sigmoidcele, and 2 cases(6.6%) of dynsfunction of puborectalis. There was a 1 case(3.3%) of rectal polyp. Seven cases(23%) show combined findings : 2 cases with rectocele, rectal intussusception and sigmoidcele, 4 cases with rectocele, rectal intussusecption and rectal prolapse, rectocele and dynsfunction of puborectalis in 1 case. The measurement of anorectal angel was 65°-125°(mean, 104°) in resting state, 57°-90°(mean, 63°) in sqezzing, and 78°-115°(mean, 103°) in straining state.
Defecography with video recording is a useful study in assessment and diagnosis of various discase causing anorectal dysfunciton. However, the measurement of anorectal angle was wide range without statistical significance.
, Kwang Ho Kim Video-assisted thoracoscopy has recently evolved as an alternative to thoracotomy for several thoracic disorders. Spontaneous pneumothorax may be idealy srited for thoracoscopic management. We compared our results with thoracoscopic management of spontaneous pneumothorax in 19 patients with a group of 11 patients previously subjected to axillary mini-thoracotomy. Indications of operation, sex distribution, and age were similar. There were no clinical significant differences in hospital stay, duration of chest tube, duration of operation, and amounts of parenteral analgesies between two group.
Although the video-assisted thoracoscopic bullectomy was sasfe, effective, and newly developed, bullectomy by axillary mini-thoracotomy was acceptible also with excellent results for the patients.
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