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Oncologic outcomes after radical surgery for periampullary cancer in octogenarians
Sung Hyun Kim,Jae Uk Chong,Jin Hong Lim,Moon Jae Chung,Jeong Youp Park,Seung Min Bang,Seung Woo Park,Ho Kyung Hwang,Chang Moo Kang,Woo Jung Lee,Kyung Sik Kim 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.2
Backgrounds/Aims: Interest in treatments for elderly patients has increased with life expectancy, and various studies have reported on the safety and feasibility of radical surgery in elderly patients with cancer. Here, we investigated oncologic outcomes of periampullary cancer in octogenarians. Methods: We retrospectively reviewed medical records of 68 patients over 80 years of age who were diagnosed with periampullary cancer and were eligible for surgery; we analyzed overall survival (OS) and immediate postoperative complications and mortality. Results: There were no significant differences in mean age, disease type, oncologic features, comorbidities, or nutritional status between the patients who had surgery and those who did not. Five patients (20.0%) had major postoperative complications, but there was no immediate postoperative mortality. Patients who had surgery (n=25) had better OS (29.3 months; 95% confidence interval [CI]: 5.6-53.0) than did those who did not (n=43, OS: 7.6 months; 95% CI: 3.2-12.0 months; p <0.001). Similarly, patients with distal common bile duct cancer who underwent surgery had better OS than those who did not (surgery group: n=13, OS: 29.3 months, 95% CI: 8.9-49.7; non-surgery group: n=15, OS: 5.7 months, 95% CI: 4.2-7.2 months; p=0.002). Conclusions: Radical surgery for octogenarian patients with periampullary cancer is safe, feasible, and expected to result in better survival outcomes, especially for patients with common bile duct cancer.
( Sang Hoon Lee ),( Moon Jae Chung ),( Jeong Youp Park ),( Seung Min Bang ),( Seung Woo Park ),( Si Young Song ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Nutritional status is an important factor which can affect the prognosis of various tumors. The prognostic nutritional index (PNI) which is calculated based on the serum albumin concentration and peripheral blood lymphocyte count, was already reported a useful predictor for postoperative outcome in resectable pancreatic cancer patients. The aim of this study was to validate the prognostic value of PNI in all stage of pancreatic cancer patients. Methods: We retrospectively reviewed 499 patients with pancreatic cancer who were diagnosed and treated in Severance Hospital from January 2006 to December 2011, including all stage of pancreatic cancer. The value of PNI was calculated as 10 × serum albumin (g/dL) + 0·005 × total lymphocyte count (per mm3) at initial diagnosis. Demographic, clinical and laboratory data including performance status (ECOG), tumor marker (CEA and CA19-9), white blood cells, hemoglobin, platelet counts, total protein, albumin and PNI at initial diagnosis were analyzed. Results: The median age of the patients was 63 years (range 34- 88 years) and 289 (57.9%) were male. The study group comprised of localized disease (24.2 %), locally advanced disease (23.4 %) and metastatic disease (52.1 %). The median survival of all patients was 10 months. Univariate analysis indicated that initial lower PNI was signifi cantly associated with shorter survival in localized (p = 0.047), metastatic, stage (p< 0.001) and in the whole group (p<0.001), but not in locally advanced disease (p = 0.355). Multivariate analyses also showed the same fi ndings except in locally advanced disease (p = 0.047 for local disease, p = 0.003 for metastatic stage, and p=0.038 for all stages). Conclusions:The PNI could be a prognostic factor and useful predictor for assessing the nutritional condition of pancreatic cancer patients.
Stand-Alone Cages for Anterior Cervical Fusion: Are There No Problems?
Sang Youp Han,Hyun Woo Kim,Cheol Young Lee,Hong Rye Kim,Dong Ho Park 대한척추신경외과학회 2016 Neurospine Vol.13 No.1
Objective: There are complications in stand-alone cage assisted anterior cervical discectomy and fusion (ACDF), such as cage subsidence and kyphosis. Here we report our clinical result on ACDF, comparing with stand-alone cages and with cervical plate system for degenerative cervical spine diseases. Methods: Patients with degenerative cervical disease who were diagnosed and treated in Konyang University Hospital between January 2004 and December 2014 were included in this study. Patients who had operation in single level ACDF were selected. Patients scored the degree of pain using visual analog scale before and after the surgery. Subsidence was defined as ≥3-mm decrease of the segmental height, and cervical kyphosis was defined as progression of ≥5° at 12 months after postoperative follow-up compared to that measured at the immediate postoperative period. Results: A total of 81 patients were enrolled for this study. Forty-five patients were included in a cervical plate group and the others were in stand-alone cage group. There was no statistical difference in pain score between the 2 groups. Segmental subsidence was observed in 7 patients (15.6%) in plate-assisted cervical fusion group, and 13 patients (36.1%) in stand-alone cage group. Segmental kyphosis was observed in 4 patients (8.9%) in plate-assisted cervical fusion group, and 10 patients (27.8%) in stand-alone cage group. There was statistical difference between the 2 groups. Conclusion: There was no difference in pain between 2 groups. But stand-alone case group showed higher incidence rate than plate-assisted cervical fusion group in segmental subsidence and cervical kyphosis. When designing cervical fusion, more attention should be given selecting the surgical technique.
Up-regulated claudin 7 expression in intestinal-type gastric carcinoma.
Park, Jeong Youp,Park, Kyung Hwa,Oh, Tae Yun,Hong, Sung Pil,Jeon, Tae Joo,Kim, Chang Hoon,Park, Seung Woo,Chung, Jae Bock,Song, Si Young,Bang, Seungmin National Hellenic Research Foundation 2007 Oncology reports Vol.18 No.2
<P>The disruption of tight junction protein expression in cancer might account for invasiveness, loss of cohesion, and lack of differentiation. Our cDNA array data indicated that claudin 7 was up-regulated in gastric carcinoma. We investigated the expression patterns and clinical implications of claudin 7 in gastric cancer. By immunohistochemical staining and Western blot, claudin 7 was significantly more often expressed in intestinal metaplasia, adenoma and cancer than in normal gastric epithelium. Twenty-seven (47.4%) of 57 normal gastric epithelium samples did not express claudin 7, but 50 (86.2%) of 58 intestinal metaplasia, 11 (91.7%) of 12 adenoma tissues, and 129 (82.7%) of 156 cancer samples did. Claudin 7 was more often unexpressed in diffuse type gastric cancer than in intestinal type. Only 13 (11.2%) of 116 intestinal type samples did not express claudin 7, but 14 (41.2%) of 34 diffuse type samples showed no expression. Compared to normal gastric epithelium, intestinal type gastric cancer significantly more often expressed claudin 7, but diffuse type did not. The expression pattern of claudin 7 did not change as cancer progressed. In this study we show that claudin 7 expression changed with the gastric carcinogenic process and that this is implicated in cancer characteristics.</P>
Park Keun-Ho,Jeong Myung Ho,Kim Hyun Kuk,Ki Young-Jae,Kim Sung Soo,Choi Dong-Hyun,Koh Young-Youp,Ahn Youngkeun,Kim Hyo-Soo,Gwon Hyeon-Cheol,Rha Seung-Woon,Hwang Jin-Yong 대한의학회 2021 Journal of Korean medical science Vol.36 No.42
Background: Although ticagrelor is known to increase the bleeding risk compared to clopidogrel in East Asian patients, its clinical benefits in patients with acute myocardial infarction (AMI) without high bleeding risk (HBR) remains unknown. Methods: A total of 7,348 patients who underwent successful percutaneous coronary intervention (PCI) from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), between November 2011 and December 2015, were divided into two groups according to the Academic Research Consortium for HBR criteria (KAMIR-HBR, 2,469 patients; KAMIR-non HBR, 4,879 patients). We compared in-hospital major adverse cardiovascular events (MACEs, defined as a composite of cardiac death, non-fatal myocardial infarction, or stroke), and the thrombolysis in myocardial infarction (TIMI) major bleeding between ticagrelor and clopidogrel in the KAMIR-HBR and the KAMIR-non HBR groups, respectively. Results: After propensity score matching, ticagrelor had a higher incidence of in-hospital TIMI major bleeding than clopidogrel in all patients (odds ratio [OR], 1.683; 95% confidence interval [CI], 1.010–2.805; P = 0.046) and the KAMIR-HBR group (OR, 3.460; 95% CI, 1.374–8.714; P = 0.008). However, there was no significant difference in in-hospital TIMI major bleeding between ticagrelor and clopidogrel in the KAMIR-non HBR group (OR, 1.436; 95% CI, 0.722–2.855; P = 0.303). No differences were observed in the cumulative incidences of in-hospital and 6-month MACEs between ticagrelor and clopidogrel in both groups. Conclusions: The bleeding risk of ticagrelor was attenuated in Korean patients with AMI without HBR. Appropriate patient selection could reduce in-hospital bleeding complications associated with ticagrelor in Korean patients with AMI who underwent successful PCI.
Long-term follow up of gallbladder polyps
Park, Jeong Youp,Hong, Sung Pil,Kim, Yoon Jae,Kim, Hong Jeoung,Kim, Hee Man,Cho, Jae Hee,Park, Seung Woo,Song, Si Young,Chung, Jae Bock,Bang, Seungmin Blackwell Publishing Asia 2009 Journal of gastroenterology and hepatology Vol.24 No.2
<P>Abstract</P><P>Background and Aim: </P><P>The management of gallbladder polyps (GBP) is directly linked to the early diagnosis of gallbladder cancer (GBC). This study aimed to evaluate the malignant risk of GBP.</P><P>Methods: </P><P>In total, 1558 patients diagnosed with GBP were followed. Neoplastic polyps were defined as GBC and its premalignant lesions. The risk for malignancy was estimated with the cumulative detection rate of neoplastic polyps.</P><P>Results: </P><P>Thirty-three cases (2.1%) were diagnosed with neoplastic polyps. The cumulative detection rates of neoplastic polyps were 1.7% at 1 year, 2.8% at 5 years, and 4% at 8 years after diagnosis. The size of GBP and the presence of gallstones were risk factors for neoplastic polyps. Polyps ≥ 10 mm had a 24.2 times greater risk of malignancy than polyps < 10 mm. However, 15 of 33 neoplastic polyps (45.5%) were < 10 mm at the time of diagnosis of GBP. During follow up in 36 (3.5%) of 1027 cases, an increase in size was detected; of these, nine (25%) had neoplastic polyps.</P><P>Conclusion: </P><P>Even small polyps have a risk of malignancy, and careful long-term follow up of GBP will help detect and treat early GBC.</P>
( Sung Bae Kim ),( Jeong Youp Park ),( Seung Min Bang ),( Seung Woo Park ),( Si Young Song ),( Moon Jae Chung ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Endoscopic drainage is recommended as a fi rst-line treatment method in pancreatic pseudocyst (PPC). Drainage using conventional multiple plastic stent has technical diffi culty due to need for multiple accesses to the cyst cavity for stent placement and risk of occlusion because of small stent diameter. And conventional fully-covered self-expandable metal stent (FCSEMS) has risks of stent migration and cyst infection. To prevent these limitations, novel FCSEMS with anti-migration fl ap and anti-refl ux valve was developed. Methods: The aim of this study was to evaluate effi cacy and safety of novel FCSEMS with anti-refl ux valve and anti-migration fl ap for EUS guided PPC drainage. Between January 2014 and April 2014, 4 patients with symptomatic PPC underwent EUS guided drainage using novel FCSEMS at Severance hospital. PPC puncture was done by 19-gauze needle, 0.035mm guide wire advanced into the cyst cavity and gastrocystostomy lumen was dilated to 3mm using bougie dilatation or balloon dilatation. Novel FCSEMS was inserted via dilated gastrocystostomy tract over the guide wire and stent was deployed. Main outcome was clinical success as complete resolution of the PPC. Technical success and complication rate was also reviewed. Results: Three patients were male and one patient was female. The median age of the patients was 38 years (range, 33-59). All patients had pancreatic pseudocyst related abdominal pain, and 3 patients had fever. The median size of pseudocyst was 62.5mm. All FCSEMS were successfully inserted without procedure related complication. Three out of four pseudocysts were resolved after the drainage procedure. The median time to removal of stent was 48.7 days and there was no secondary infection with a normal diet. Conclusions: Transgastric PPC drainage using novel FCSEMS was effective and safe therapeutic method in this pilot study. Further large controlled study is needed.