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Although the rates of stomach cancer shows decrease trend lately, the mortality is second heighest next to the lung cancer. To investigate the proper therapeutic styles of stomach cancers, a laparotomy data has been analyzed based on age, gender, sites of cancer, gastrotomy, removal of lymph nodes, reconstruction, WHO histopathological classification, Lauren classification, and the clinical stages of T(tumor), N(lymph node), M metastasis), and stomach cancer itself. And this analysis has been in accordance with the 7th edition of AJCC manual of cancer clinical stage. In early gastric cancer, despite the fear of metastasis of lymph nodes, it is found that the conventional subtotal gastrectomy, lymph dissection(D2), and gastroduodenostomy are proper therapeutic styles for the lower and central stomach. On the other hand the total gastrectomy, lymph dissection(D2), and jejunal pouch interposition are proper therapeutic styles for the upper stomach. In advanced gastric cancer, if it is proximal metastasis through the pre-operation evaluation, gastrectomy and lymph dissection(D2, D2a, or D3) are proper therapeutic styles. If it is remote metastasis and splenic artery metastasis of lymph nodes through the pre-operation evaluation, the tail of pancreas preserved splenectomy is the proper therapy for the upper and central stomach. For the lower stomach cancer, in case of lymph node metastasis to the transverse colon mesenteric artery and vein, it is the principle that lymph dissections of arteriovenous of transverse colon and transverse colectomy are proper therapies. In advanced gastric cancer, if it is remote metastasis or distant metastasis of lymph nodes, the distal gastrectomy has not risen the survival rates. In only liver metastasis and localized to the lateral parts of left liver, the left hepatectomy has risen the survival rates. It seems that the preoperative chemotherapy is another strategy for this case. The purpose of this study is to give a good turn for other operations and/or the judgement of operating surgeon through the surgical methods not from the empiricism and at the same time to give the self-reflection opportunities for the surgeon.
Since it has been changed to elderly society, with aged person increased, it has shown the cancer patients, specially gastric cancer patients, were gradually increased. This study is about the starting time of the diet after the gastrectomy of the stomach cancer patients was done and their medical records were analyzed retrospectively for the baseline data. In case of no leakage on gastroenterostomy, the subtotal gastrectomy shows no timing difference. When the total gastrectomy was performed, it has shown that the jejunal interposition is faster than Roux-en-y type in the start of soft diet. A upper gastrointestinal series with contrast was performed when the status of patient was uncertain and it also shows faster start of diet. There was no significant difference between the subtotal and total gastrectomy. The healing period of alimentary canal anastomosis is faster compare to skin. For the diet after stomach operation, it should be POD 5 for drinking water, POD 6 for liquid diet, and POD 8 for soft diet, respectively. Since this research was conducted based on relatively small samples, it should give better results if bigger samples are provided.
최근 종양억제 유전자가 다양한 종류의 암에서 암발생기전에 중요한 역할을 담당하고 있다고 보고되고 있으며 잘 알려진 p53과 망막아종유전자이외에도 다수의 유전자가 새로운 종양억제 유전자로서 연구되고 있다. 포르말린고정 후 파라핀 포매된 원발성 위암 18예와 주변 림프절에 전이된 전이성 위암 7예를 대상으로 정상 및 돌연변이형의 p53 종양 단백에 대한 단일클론 항체(NCL-p53-DO-7)를 이용하여 면역조직화학 염색을 시행하였다. p53단백의 발현은 핵에 국한되는데, 원발성위암의 50%(9/18)와 주변림프절에 전이된 전이성 위암의 14.7%(1/7)에서 관찰되었다. p53단백의 발현과 종양의 분화도와는 무관하였고, 침윤 깊이와 림프절 전이와는 역상관 관계가 있었다. 이러한 결과는 기존의 문헌에 보고된 p53단백의 발현이 독립적인 예후 결정인자로 적합하다는 가정에 배치되는 소견으로 그 의미에 대해 고찰하였다. Recently tumor suppresor genes(antioncogenes) have been considered as very important roles in oncogenesis of various cancers and besides well known antioncogenes p53 and retinoblastoma gene, numerous new candidates have been searching. Using monoclonal antibody that is monospecific for the normal and mutant p53 oncoprotein, an immunohistochemical study of the expression of p53 protein was performed in formalin fixed, paraffin-embedded tissue sections from 18 primary gastric carcinomas and 7 metastatic gastric carcinomas in regional lymph nodes. p53 expression in which the reaction was localized to the nuclei was observed in 50%(9/18) primary gastric carcinomas and 14.7%(1/7) metastatic gastric carcnomas in regional lymph nodes. There was not a significant association between p53 staining and histological type. In addition, p53 expression was reversely correlated with depth of invasion and lymph nodes metastasis. These results gave us a question whether p53 expression is a real important independent prognostic indicator and is really associated with high potential for lymph node metastasis.
It is important work in the department of emergency medicine to manipulating data for the emergency patients. We developed a computer program for effectively managing data of the emergency patients and department on Dec. 1991, and began to build database on Jan. 1992. This program offers the various tools and functions for manipulating data, for quickly finding and displaying the information as you need, and for obtaining the basic results and analyses for quality assurance. The program was coded in a programming mode of FoxPro 2.5, and runs on IBM-PC-compatible computers. The systemic configurations to use properly, requires DOS 5.0 in O.S(operating system), 4 Megabytes or more in RAM(Random Access Memory), 100 Megabytes or more in Hard Disk capacity, at least 10 Megabytes in available disk space, and intel-80386(32 bits) in computer processing chip. The 8 bits combination codes are applied to write "Hangeul"(Korean language character). This program provides the various functions as the followings. 1. Be able to input, output, and search data as you need. 2. Be able to obtain the various reports by analysing the patient data. 3. Be able to retrieve the article data in Journal of Korean Society of Emergency Medicine, American Journal of Emergency Medicine, and Annals of Emergency Medicine as keywords, authors, etc. 4. Be able to manage the departmental data. By examples, manager of the emergency members, scheduler of the department, and collection book of the common senses in emergency medicine. 5. Other programs, which to reset and back up the selected data files for safely maintaining program, are supplied 6. Be able to study and prospectively analyze the clinical data by inserting the predefined optional programs. We expect the more advanced and beneficial program to manage data for the emergency patients and department.
Surgery is recognized as normal treatment method for liver injuries. However, as the C-T scan is more widely used in cases of blunt abdominal trauma, approximately 20 to 30% of liver injuries are now being treated by means other than surgery. Although generally excellent as a tool for diagnosis of blunt abdominal trauma, C-T scan is still subject to controversy regarding its accuracy. It is true that abdominal C-T scan is valuable particularly for prognosis of the individual damages of solid organs such as liver, however the indications produced by C-T scan are sometimes inconsistent with surgery results or clinically observed symptoms. The purpose of this paper is to suggest guidelines for prognosis of liver injuries resulting from blunt abdominal trauma by analyzing the discrepancy between the surgery findings and the indications shown by C-T scan. For evaluation of this differences, we examined our experience with blunt hepatic trauma patients over the last 5 years. 51 patients who evaluated by cornputed tomography were reviewed. Among them, 19 patients were controlled by nonoperative method but 32 patients required operative management. The mean age was 33. 1 and 66. 7% were male. With using Injury Severity Scale of American Association for the Surgery of Trauma (AAST), 21 were Grade II (41. 2%), 12 were Grad III (23. 5%), 10 were Grade I (19.6%). All nonoperative management group revealed below the Grade K. In 32 patients of operative management group, 20 were below the Grade E. In 20 patients, 7(35.0%) were operatecl due to associated injuries and 13 (65. 0%) were operated due to unstable vital sign and increasing blood transfusion requirement. On the comparison between computed tomographic and operative findings, 10(31. 3%) were corresponding to operative findings, 19(59. 4%) were underestimated and 3(9.4%) were overestimated. 11(58.9%) of underestimated patients showed only one-grade difference, but 4(21.1%) and 4(21.1%) showed two and three-grade differences respectively. In cases where severe damages were found through surgery, the amount of blood transfusion actually required was cosiderably larger than indicated by C-T scan. C-T scan was quite helpful in making the dicision as to perform the surgery or not; however, C-T scan tended to underestimate the degree of liver damages; in particular, C-T scan was not accurate in predicting the requisite amount of blood transfusion. Consequently, we concluded that (1) it is not safe to determine the treatment methods for liver injuries solely on the basis of C-T scan and (2) it is urgently needed to develop a grading system where by C-T scan results can be appropriately evaluated. In addition it may be desirable to use C-T scan together with other types of diagnostic methods.
The analysis of recurring chromosome aberrations has become an integral part of the diagnostic and prognostic workup of many human cancers, and their molecular analyses have facilitated the identification of genes related to the pathogenesis of cancer. But the technical limitation of conventional cytogenetic method makes unable us to characterize all recognizable chromosome rearrangements. Chromosome painting is a technique of fluorescent in situ hybridization(FISH) using a chromsome-specific DNA libraries as a probe pool, and depicts an entire chromosome or a specific chromosome region. Therefore, it allows a rapid and efficient method to visualize chromosomal translocations, and thus, utilizes as an important method to assess rearrangement of marker chromosomes. In the present study, human renal cell carcinoma cell lines, such as Caki-l, A-498, CURC-II, have been analyzed to evaluate abnormalities associated with chromosome 3 using both traditional G-banding technique and chromosome painting. We investigated the cytogenetic characteristics for Caki-l, A-498, CURC-II, and found the several marker chromosomes. Using the chromosome 3 painting probe, we could successfully detect the abnormalities derived from chromosome 3, and confirmed the breakpoint of the marker chromosomes. Especially, there were many breaks in the chromosome regions 3pl2-p23 and 3ql3- q21. This method allows us to identify the origin of cytagenetically unidentifiable marker chromosomes and will be also useful to screen the cancer cells that have not-yet identified marker chromosome and the low mitotic index.