OBJECTIVE:The objective of this study was to investigate the clinical and biological significance of F-fluorodeoxyglucose (F-FDG) uptake levels in breast cancer patients. PATIENTS AND METHODS:F-FDG PET/computed tomography was performed in 206 women with breast cancer, and the standardized uptake value (SUV) in breast cancer was analyzed to test associations with prognostic parameters. RESULTS:PET/computed tomography sensitivity for primary tumor detection was 90.4% (206/228) and sensitivity and specificity for metastatic axillary lymph node were 72.6% (45/62) and 84.7% (122/144), respectively. A high SUV was significantly associated with large tumor size (>2 cm, P<0.001), positive axillary lymph node metastasis (P<0.001), distant metastasis (P=0.016), higher tumor node metastasis stage (P<0.001), higher histologic grade (P<0.001), higher nuclear grade (P<0.001), estrogen receptor negativity (P<0.001), progesterone receptor negativity (P<0.001), triple negativity (P=0.006), B-cell lymphoma/leukemia-2 negativity (P=0.031), cytokeratin 5/6 positivity (P=0.001), epidermal growth factor receptor positivity (P=0.005), and Ki67 positivity (P=0.003). Multivariate analysis showed that tumor size (>2 cm, P=0.001), positive axillary lymph node metastasis (P=0.028), and estrogen receptor negativity (P<0.001) were significantly associated with the SUV. CONCLUSION:High levels of F-FDG uptake in primary breast cancer were correlated with poor prognostic factors and aggressive biologic markers such as triple negativity, markers of basal-type cancer, and Ki67. The SUV might be predictive of biologic markers and assist therapeutic decision making.

Introduction. Chlorfenapyr is commonly used for food crops in Korea. However, chlorfenapyr toxicity in humans has not yet been studied. Case. A 74-year-old man was admitted to the emergency room after he intra-abdominally injected 20 mL of chlorfenapyr in an attempt to commit suicide. Emergency surgery was performed and accumulation of approximately 500 mL of reactive fluid in the abdomen was observed. The entire small intestine showed congestion. After surgery, additional surgery to drain the fluid was performed on POD 12. But immediately after administration of general anesthesia, flat rhythm was observed by electrocardiogram (ECG) monitoring, requiring cardiopulmonary resuscitation (CPR). Discussion. The color of the bowel was purple, indicating ischemic injury. This could be attributed to direct absorption of the substance through the peritoneum, leading to chemical injury to the small intestine serosa, unlike in the case of oral ingestion. This resulted in an ischemic change in the small intestine, eventually leading to sepsis. Conclusion. Only a few cases of chlorfenapyr toxicity have been reported in the literature, and death occurred in all cases, including our case. Therefore, careful and aggressive treatments are necessary. This is the first reported case of intra-abdominal injection of chlorfenapyr.

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.

BACKGROUND/AIMS:TO EVALUATE THE PROGNOSTIC IMPACT OF THE LYMPH NODE RATIO (LNR: the ratio of positive lymph nodes to the total number of lymph nodes examined) on disease recurrence and survival among rectal cancer patients who received curative surgery and postoperative chemoradiotherapy (CRT). METHODS:Between 1995 and 2008, 124 patients with pathologic T3-4 or node-positive rectal cancer underwent curative surgery and postoperative CRT. Postoperative radiotherapy was delivered at a median dose of 50.4 Gy (range, 45 to 59.4 Gy) for 6 weeks. Chemotherapy consisted of a bolus injection of 5-fluorouracil and leucovorin in the first and last week of radiotherapy (91.9%) or daily capecitabine during radiotherapy (8.1%). Further adjuvant chemotherapy was administered after chemoradiation. RESULTS:The median follow-up was 5.1 years. In the multivariate analysis, pathologic N (pN) stage and lymphovascular invasion were significantly associated with disease-free survival and disease-specific survival (p<0.05). However, when the LNR with a cutoff value of 0.2 was included as a covariate in the model, the LNR was highly significant (p<0.001), and the pN stage lost its significance (p>0.05). CONCLUSIONS:The LNR predicts recurrence and survival more accurately than pN stage. The pN stage and the LNR should be considered together when estimating the risk of disease recurrence among rectal cancer patients.

Bien que les anévrysmes de la veine poplitée soient rares, ils sont potentiellement mortels parce qu'ils peuvent causer une embolie pulmonaire. Un tiers des patients ont encore d'autres événements emboliques en dépit de l'anticoagulation thérapeutique. Nous rapportons le cas d'un homme de 67 ans qui s'est présenté avec une dyspnée, une respiration rapide, et des douleurs thoraciques et une matité pleurales gauches depuis trois jours. Le scanner thoracique confirmait le diagnostic d'emboles pulmonaires bilatéraux multiples. Le duplex couleur suivi d'une phlébographie ascendante confirmait un anévrysme sacculaire de la veine poplitée droite de 3 × 4 cm2 sus-articulaire contenant du thrombus. L'anévrysme a été traité par anévrysmectomie tangentielle ouverte et phléborrhaphie latérale.

OBJECTIVE: It has been well established that the long-term prognosis of intrahepatic duct stones (IHDS) is complicated by the late development of biliary cirrhosis with associated intrahepatic cholangiocarcinoma (IHCC). Despite recent improvements in imaging Studies, accurate preoperative diagnosis of IHCC is difficult. Therefore, we attempted to elucidate the clinical features of patients with IHDS with IHCC.METHODS: We reviewed 80 patients with IHDS and divided them into two groups. The DS group included 72 patients who had only IHDS. The second group was defined as the CC group and included eight patients who had IHDS and IHCC. For diagnosis of IHDS and confirmation of coexisting IHCC, patients underwent various radiological evaluations and additional laboratory tests, Such as serum carbohydrate antigen 19-9 (CA 19-9).RESULTS: There was no significant difference in the symptoms and stone characteristics between the two groups. For the CC group, liver resection was performed in four patients. Three patients underwent Curative resection, but only one of these patients was alive at 36 months without recurrence.CONCLUSION: IHCC with IHDS was difficult to diagnose in the early phase. Therefore, while performing diagnostic studies and surgery for IHDS, one should always consider the possibility of coexisting cholangiocarcinoma. [Asian J Surg 2009;32(1):7-12]

PURPOSETo evaluate the effect of the simulation method on recurrence among the patients who received radiotherapy after breast-conserving surgery (BCS) for early breast carcinoma.MATERIALS AND METHODSBetween 1995 and 2000, 70 patients with stage I-II breast carcinoma underwent breast-conserving surgery and adjuvant radiotherapy. Twenty nine patients (41.4%) were simulated with the 2D contour-based method (September 1995 to August 1997) and 41 patients (58.6%) were simulated with the 3D CT-based method (September 1997 to February 2000). To analyze the effect of the simulation method, the patient and treatment characteristics were compared.RESULTSThe characteristics were similar for the patients between the 2D contour-based simulation group and the 3D CT-based simulation group. During a median follow-up period of 75 months, 4 (13.8%) of 29 patients who were treated with 2D simulation and 1 (2.4%) of 41 patients who were treated with 3D simulation group developed treatment failure. The five-year survival rates were 89.2% and 95.1% between the 2D and 3D simulation groups (p=0.196). The five-year disease free survival (DFS) rates were 86.2% and 97.5% between the 2D and 3D simulation groups (p=0.0636). On univariate analysis, age > 40 (p= 0.0226) and the number of dissected axillary lymph node >or= 10 (p=0.0435) were independent predictors of improved 5-year DFS.CONCLUSIONSAlthough our data showed marginal significance for the DFS between the two groups, it is insufficient, due to the small number of patients in our study, to prove whether 3D CT-based simulation might improve the DFS and reduce the risk of recurrence when compared with 2D contour-based simulation. Further study is needed with a larger group of patients.

A carcinosarcoma of the esophagus is an uncommon malignancy accounting for approximately 1～2% of all esophageal neoplasms. Histologically, both carcinomatous and sarcomatous components are observed. The terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous carcinoma pseudosarcomatous squamous cell carcinoma and a spindle cell variant of a squamous cell carcinoma. It presents as a bulky intraluminal polypoid lesion mainly in the mid to lower esophagus. It often presents relatively early because of its rapid intraluminal growth. Ultimately, the treatment is similar to that of an esophageal carcinoma requiring an esophagectomy for resectable lesions. We report a case of a 64-year-old man with a carcinosarcoma of the esophagus. Endoscopy revealed a 1.5 cm sized polypoid mass located 25 cm from the incisor with friable nature. Radiological studies revealed a bulky polypoid intraluminal mass with a lobulated border, measuring approximately 7 cm in length, in the mid esophagus that expands the lumen in conjunction with the enlargement of the regional lymph nodes. An esophagectomy was performed.

PURPOSE:Breast-conserving therapy (BCT) is a practical alternative to mastectomy for treating ductal carcinoma in situ (DCIS). We reviewed our experience for treating patients with DCIS of the breast to evaluate the outcome after performing breast-conserving surgery plus radiotherapy (BCS-RT).MATERIALS AND METHODS:Between January 1983 and December 2002, 25 patients with clinically or mammographically detected DCIS were treated by BCS-RT. One patient was diagnosed with bilateral DCIS. Thirteen cases (50%) had symptomatic lesions at presentation. All 26 cases of 25 patients underwent BCS such as lumpectomy, partial mastectomy or quadrantectomy. All of them received whole breast irradiation to a median dose of 50.4 Gy. Twenty-four cases (92.3%) received a boost to the tumor bed for a median total dose of 59.4 Gy. The median follow up period was 67 months (range: 38 to 149 months).RESULTS:Two cases (7.7%) experienced ipsilateral breast tumor recurrence (IBTR) after BCS-RT. The histology results at the time of IBTR showed invasive ductal carcinoma (IDC), and the median time to IBTR was 25.5 months. On the univariate analysis, there were no significant factors associated with IBTR in the DCIS patients. The three-year local recurrence free survival rate was 96.0% and the overall survival rate was 96.3%.CONCLUSION:After the treatment for DCIS, the IBTR rate in our study was similar to other previous studies. Considering that we included patients who had many symptomatic lesions, close or positive margins and less that complete early data, our result is comparable to the previous studies. We could not find the prognostic significant factors associated with IBTR after BCS-RT. A longer follow up period with more patients would be required to evaluate the role of any predictive factors and to confirm these short-term results.

Purpose: This study analyzed the value of an electrocardiogram (ECG) using an arterial pulsator in central vein catheterization (CVC). Methods: In 442 patients who underwent CVC with an ECG and an arterial pulsator, this study evaluated the rates of change in the P wave and the QRS wave at the limb lead II before and after insertion. After insertion, a plain chest X-ray was checked in order to locate the catheter tip. Results: After catheterization, the P wave and the QRS wave increased together at 97% but the P wave (change rate: 0.5-21.0) was more sensitive than the QRS wave (change rate: 0.5-5.8). For an abnormal location (3%), the rate of change in the P wave was 2.0 were 95% and 100%, and those of the QRS wave >1.4 were 90% and 100%. Conclusion: In central vein catheterization, an electrocardiogram with an arterial pulsator can be a useful method, and the normal position of the catheter tip can be estimated by using a rate of change in the P wave >2.0 or a rate of change in QRS wave >1.4.

Purpose: Recently, because of the increasing numbers of early gastric cancer patients and improvements in their survivals, greater attention has been directed towards the quality of life and nutritional status of gastric cancer patients after surgery. However, conventional reconstructions, Billroth- I, -II (B-I and B-II) or Roux-en-Y, have proven to have certain limitations, such as a small reservoir, and a malabsorption for iron, fat, calcium, and carotene. To overcome these limitations, we used a jejunal pouch interposition(JPI) after a distal gastrectomy not only to substitute for the small reservoir but also to maintain a physiologic pathway for ingested foods. Materials and Methods: A total of 196 gastric cancer patients who underwent a distal gastrectomy between March 2001 and February 2004 were divided into 3 groups: JPI group (n=100), B-I group (n=29), and B-II group (n=67). We assessed the patient's nutritional status, gastric emptying time, and gastrofiberscopic findings. Results: The percents of body weight loss at 6 months, 1 year, and 2 years postoperatively in the JPI group () were significantly less than those of the conventional B-I () and B-II groups () (P=0.011, 0.000, 0.013). The laboratory findings showed no significant differences between the 3 groups, except for a higher total protein level in the JPI group after 6 months postoperatively. Especially, stage I and II cancers in the JPI group showed much higher total protein levels after 1 year postoperatively. The gastric emptying times in the Tc- semisolid scans at 6 months, 1 year, and 2 years postoperatively were 102.5, 83.1, and 58.1 minutes in the JPI group, 95.5, 92.0, and 58.5 minutes in the B-I group, and 53.9, 69.1, and 50.2 minutes in the B-II group, respectively. Also, the symptomatic gastric stasis detected with a gastrofiberscope during the early postoperative period (6 months) was gradually improved. Conclusion: From a nutritional aspect, a jejunal pouch interposition after a distal gastrectomy could be an alternative reconstruction method, especially in stage I and II gastric cancer patients, in spite of the longer operation time and the probable delayed gastric emptying.

Complete remission (CR) following chemotherapy is defined as the disappearance of a previously known-malignancy, with no further development of a new tumor. The treatment of the stage IV gastric cancer, with a distant metastatic or locally advanced-unresectable condition is a surgical dilemma. Many therapeutic modalities including chemoradiation, immunotherapy or intraoperative thermal therapy, have been used for the management of this condition, but their results were still unsatisfactory, Although CR is infrequently reported, pathological confirmation by operation is quite rare. We experienced two cases of CR following FEP (5-FU 500 mg/, Epirubicin 50 mg/, and Cisplatin. 60 mg/) chemotherapy; . one was a case of locally advanced, unresectable gastric cancer with tumor extension through the adjacent structure, and extensive regionallymph nodes metastasis, We confirmed the pathological CR by a second look operation, a distal gastrectomy with D3 lymph node dissection. The patient is doing well, with no recurrence for 5 years, The other was a case of advanced gastric cancer, with hepatic metastasis, and was treated with the same chemotherapeutic regimens, However, he refused a second operation and recurrence of cancer was detected by a gastrofiberscopic biopsy, with metastatic nodule on liver at 8 and 14 months following CR, respectively. We suggest that although CR is achieved following chemotherapy, subsequent curative resection should be mandatory, as recurrence will develop after a few months.

Purpose: Angiogenesis is essential for tumor growth and metastasis and depends on the production of angiogenic factors that are secreted by tumor cells. Vascular endothelial growth factor (VEGF) is the most significant angiogenic factor and a selective mitogen for endothelial cells. VEGF, also known as the vascular permeability factor, acts on endothelial cells to increase microvascular permeability and directly stimulate the growth of new blood vessels. Several studies have reported that the expression of VEGF is correlated with hematogenous recurrence via angiogenesis in gastric carcinomas. This research evaluated the relationship between the expression of VEGF and hepatic and peritoneal recurrence in gastric carcinomas. Materials and Methods: Thirty specimens resected from patients with primary gastric carcinomas who had undergone curative resections were divided into three group: Group I, early gastric carcinomas without recurrence; Group II, advanced gastric carcinomas with hepatic recurrence; and Group III, advanced gastric carcinomas with peritoneal recurrence. The expression of VEGF and the density of the microvessel count were examined using immunohistochemistry. Results: 1) The expression of VEGF in Group II and Group III () was stronger than that in Group I (). The expression of VEGF in Group II () was stronger than that of the Group III () (P) was more than that in Group I () and Group III () (P

Purpose: In treating coIorectal carcinoma, metastasis and recurrence are the most important problems encountering after a curative resection of the tumor. Therefore, understanding the mechanism of the disease progression and being able to predict the likelihood of recurrence is very important. Methods: In this study, 56 colorectal carcinoma cases were reviewed. Immunohistochemical staining on CD44s, CD44v5, CD44v6, and were performed to determine the expression level of the protein, the patient's clinical findings and the pathophysiology. Results: 1) CD44v5 showed a positive response in 47 (83.9%) out of 56 cases. By analyzing the AstIer-Coller classification and the invasion of the lymphatic system, the value expressed was significantly high. 2) showed a positive response in 35 (62.5%) out of 56 cases. As the disease progressed, there was a significant decrease according to analysis of Astler-Coller classification, and the invasion of the lymph node and lymphatics. The relationship showed an inverse correlation as the disease progressed. 3) For the CD44s and CD44v6, analysis by the Astler-Coller classification, the histological pattern, lymph node metastasis, invasion of the lymphatic system and the depth of the invasion, were not significantly different. Conclusion: CD44v5 and have a relationship with tumor progression, and is a valuable marker for prognosis. In particular, CD44v5 appeared to be involved in tumor progression where the tumor cell invaded the lymphatic system.