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Lymph node metastasis in early gastric cancer with submucosal invasion:Feasibility of minimally invasive surgery

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World Journal of Gastroenterology 2004年第24期10卷 3549-3552页

作者： Do-Joong Park hyeon-Kook Lee Hyuk-Joon Lee hye-SeungLee woo-HoKim Han-Kwang Yang Kuhn-UkLee Kuk-JinChoe Department of Surgery and Cancer Research Institute Seoul-National University College of MedicineSeoul 110-744Korea Department of Surgery Ewha Woman's University College of MedicineSeoulKorea Department of Pathology Seoul National University College of MedicineSeoulKorea Department of Surgery and Cancer Research Institute Seoul National University College of MedicineSeoul 110-744Korea Department of Surgery Seoul National University College of MedicineSeoulKorea

AIM:To explore the feasibility of pertorming minimally invasive surgery(MIS)on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis. METHODS:A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December *** investigating many clinicopathological features such as tumor size,gross appearance,and differentiation, we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis. RESULTS:The rate of lymph node metastasis in cases where the depth of invasion was2 000 μm was 9%(2/23),19%(7136),and 33%(15/46), respectively(P4 cm vs≤2 cm,odds ratio=4.80, P=0.04)and depth of invasion(>2 000 μm vs ≤500 μm, odds ratio=6.81,P=0.02)were significantly correlated with lymph node *** the depth and size in cases where the depth of invasion was less than 500 μm, we found that lymph node metastasis occurred where the tumor size was greater than 4 *** cases where the tumor size was less than 2 cm,lymph node metastasis was found only where the depth of tumor invasion was more than 2 000 μm. CONCLUSION:MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500 μm in depth.

关键词： Surgical Procedures, Minimally Invasive Adult Aged Early Diagnosis Feasibility Studies Female Gastrectomy Gastric Mucosa Humans Logistic Models Lymph Node Excision Lymphatic Metastasis Male Middle Aged Stomach Neoplasms

Single port laparoscopic hysterectomy: Feasibility and safety

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Open Journal of Obstetrics and Gynecology 2013年第7期3卷 1-3页

作者： Soon Pyo Lee Sun hye Yang Chun Hoe Ku Sung Ho Lee Jin woo Shin Department of Obstetrics and Gynecology Gil Medical Center Gachon University Incheon Korea

Objective: To evaluate the feasibility and safety of single-port laparoscopic hysterectomy comparing with multi-port laparoscopic hysterectomy in treatment of benign uterine diseases. Methods: Data were collected retrospectively by review of the medical records of 252 patients who underwent multi-port or single-port laparoscopic surgery for treatment of benign gynecologic diseases. Laparoscopy assisted vaginal hysterectomy (LAVH) was performed for single-port surgery and LAVH and total laparoscopic hysterectomy (TLH) were performed for multi-port surgery. Demographic variables were collected and analyzed by independent t-test and Pearson Chi-Square test. The primary outcome was analyzed by independent t-test and Fisher’s Exact test. Results: A longer operative time was observed in the multi-port surgery group compared with that of the single-port group (p < 0.05). No difference with respect to change of Hemoglobin between the preoperative level and that of the postoperative first day, the number of days from the operation to discharge, uterine weight, and the rate of laparotomy conversion and complications were observed between the two groups. Conclusion: Single-port laparoscopic hysterectomy for treatment of benign uterine diseases is a safe and feasible method.

关键词： Laparoscopic Hysterectomy Benign Uterine Diseases Single-Port

Gastric cancer patients at high-risk of having synchronous cancer

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World Journal of Gastroenterology 2006年第16期12卷 2588-2592页

作者： Jun Ho Lee Ja Seong Bae Keun Won Ryu Jong Seok Lee Sook ryun Park Chan Gyoo Kim Myoung Cheorl Kook Il Ju Choi Young woo Kim Jae-Gahb Park Jae-Moon Bae Research Institute & Hospital National Cancer Center809 Madul-dongIlsandong-guGoyang-siGyeonggi-do411-769Korea

AIM： To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients. METHODS： We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center, Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients. RESULTS： 111 of 3291 gastric cancer patients （3.4%） registered in the database had a synchronous cancer. Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer （42 patients, 37.2%） followed by lung cancer （21 patients, 18.6%）. Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer. CONCLUSION： Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients, especially in the elderly with a differentiated early gastric

关键词： Synchronous cancer Gastric cancer Colorectal cancer

Pretransplantation fetal-maternal microchimerism in pediatric liver transplantation from mother

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World Journal of Gastroenterology 2017年第45期23卷 8017-8026页

作者： Nam-Joon Yi Min-Su Park Eun Young Song hye Young Ahn Jeik Byun hyeyoung Kim Suk Kyun Hong Kyungchul Yoon Hyo-Sin Kim Sung-woo Ahn Hae Won Lee Young Rok Choi Kwang-woong Lee Kyung-Suk Suh Myoung Hee Park Department of Surgery Seoul National University College of Medicine Department of Surgery Kyung Hee University School of Medicine Department of Laboratory Medicine Seoul National University College of Medicine Korea Organ Donation Agency Laboratory

AIM To investigate the rates of pretransplantation fetalmaternal microchimerism(MC) and its effect on rejection in children receiving maternal liver grafts. METHODS DNA or blood samples before liver transplantation(LT) were available in 45 pediatric patients and their mothers. The presence of pretransplantation MC to non-inherited maternal antigens(NIMAs)(NIMA-MC) in the peripheral blood was tested using nested PCRsingle-strand conformation polymorphism analysis for the human leukocyte antigen(HLA)-DRB1 alleles. NIMA-MC was successfully evaluated in 26 of the 45 children. Among these 45 pediatric LT recipients,23 children(51.1%) received transplants from maternal donors and the other 22 from non-maternal *** Among these 26 children,pretransplantation NIMAMC was detected in 23.1%(n = 6),6.1(range,0.8-14) years after birth. Among the children with a maternal donor,the rate of biopsy-proven cellular rejection(BPCR) was 0% in patients with NIMA-MC positivity(0/3) and those with HLA-DR identity with the mother(0/4),but it was 50% in those with NIMA-MC negativity(5/10). Patients with NIMA-MC positivity or HLA-DR identity with the mother showed significantly lower BPCR rate compared with NIMA-MC-negative patients(0% vs 50%,P = 0.04). NIMA-MC-positive patients tended to show lower BPCR rate compared with NIMAMC-negative patients(P = 0.23). CONCLUSION The presence of pretransplantation NIMA-MC or HLADR identity with the mother could be associated with BPCR-free survival in pediatric recipients of LT from maternal donors.

关键词： Liver transplantation Microchimerism Maternal graft Graft survival Non-inherited maternal antigen Biopsy-proven cellular rejection

Colonic lymphangiomatosis associated with anemia

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World Journal of Gastroenterology 2008年第37期14卷 5760-5762页

作者： woo Chul Chung hye-Kang Kim Jin Young Yoo Jeong Rok Lee Kang-Moon Lee Chang Nyol Paik U-Im Jang Jin Mo Yang Department of Internal Medicine College of Medicine the Catholic University of KoreaSeoul 137-701 South Korea Department of Pathology College of Medicine the Catholic University of KoreaSeoul 137-701 South Korea

Lymphangioma is an uncommon malformation of lymphatic system. Multiple colonic lymphangioma named as lymphangiomatosis is considered an extremely rare disease. Although lymphangioma is a benign tumor and most colonic lymphangiomas do not cause symptoms and do not require treatment, resection of lymphangioma is necessary in the presence of symptoms such as abdominal pain, bleeding, intussusceptions. We report a case of colonic lymphangiomatosis in a man who presented with abdominal discomfort and anemia, which was diagnosed and treated with endoscopic snare polypectomy.

关键词： Colonic lymphangiomatosis Anemia Snare polypectomy

Clinicopathologic features of surgically resected primary gastric lymphoma

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World Journal of Gastroenterology 2004年第8期10卷 1103-1109页

作者： Seong-HoKong Do-JoongPark Hyuk-JoonLee Han-KwangYang Kuhn-UkLee Kuk-JinChoe Min-AKim hye-SeungLee Chul-wooKim Dae-SeogHeo Chul-woo Kim Dae-Seog Heo Department of Surgery Seoul National University College of MedicineSeoulKorea Cancer Research Institute Seoul National University College of MedicineSeoulKorea Department of Pathology Seoul National University College of MedicineSeoulKorea Tumor Immunity Medical Research Center and Cancer Research Institute Seoul National University College of MedicineSeoulKorea Department of Internal Medicine Seoul National University College of MedicineSeoulKorea

AIM:To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients. METHODS:We retrospectively analyzed 57 surgically resected gastric lymphoma patients,dividing them into 2 subgroups:Low grade MALToma (the LG group),High grade MALToma and Diffuse large B cell lymphoma (the HG group). RESULTS:The numbers of patients were:20 in the LG group, 37 in the HG *** diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential *** positive rates of Hpyloriwere similar between the 2 groups (68% vs77%).Multiple lesions were found in 19.3%.The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group,and 24.3%(9/37) in the HG group (P<0.001).Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P=0.031).The numbers of recurred patients were none in the LG group,and 8 in the HG *** univariant analysis,group (P=0.024) and TNM stage (stage Ⅰ,Ⅱ vs stages Ⅲ,Ⅳ,P=0.002) were found to be the significant risk *** was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P=0.50). CONCLUSION:The HG groups had a more advanced stage and a higher recurrence rate than the LG *** there was no difference between subtotal and total gastrectomies,more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.

关键词： Adenocarcinoma Adult Aged Disease-Free Survival Female Gastrectomy Helicobacter Infections Humans Lymphoma, B-Cell Lymphoma, Large-Cell, Diffuse Male Middle Aged Retrospective Studies Stomach Neoplasms Treatment Outcome

What is the real practice of exercise echocardiographic testing in asymptomatic patients with severe aortic stenosis？

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Chinese Medical Journal 2013年第24期126卷 4649-4654页

作者： Eun Jeong Cho Sung-Ji Park Jung-Eun Song Seol-Hwa Kim Yung-Joo Lee Ji-hye Gakt Sung-A Chang Sang-Chol Lee Seung woo Park Division of Cardiology Department of Internal MedicineCardiovascular Imaging Center Cardiac and Vascular CenterSamsung Medical Center Sungkyunkwan University School ofMedicine Seoul Republic of Korea

Background Although exercise testing has been suggested to help predict clinical outcome, limited data are available to guide how exercise Doppler echocardiography （ECG） can be used clinically in asymptomatic patients with aortic stenosis （AS）. The aim of this study was to assess the clinical value of exercise echocardiographic testing in asymptomatic patients with severe AS. Methods Symptom-limited treadmill exercise testing using the modified Bruce protocol was performed in 31 asymptomatic patients （mean age （62＋11） years） with severe AS （aortic valve area 〈1 cm2, peak aortic velocity （AV Vmax）〉4 m/sec, or a mean transaortic pressure gradient （AV mean PG）〉40 mmHg （1 mmHg=0.133 kPa）） with normal left ventricular （LV） systolic function （LV ejection fraction （EF）〉50%）. Clinical symptoms, vital signs, ECG, and Doppler hemodynamics were obtained during and/or immediately after exercise. Results Aortic valve replacement （AVR） was performed in 18 patients during follow-up. The patients who had AVR exhibited higher baseline AV mean PG （51 （35-84） vs. 44 （25.2-57.0） mmHg; P=0.031）. There were no significant differences between the AVR group and non-AVR group including exercise duration （7.47 （2.32-11.59） vs. 7.25 （4.06- 10.52） minutes, P=0.917）, exercise capacity （10.1 （4.6-12.8） vs. 10.1 （7.0-12.8） metabolic equivalents, P=0.675）, and an increment in AV mean PG by exercise （18.5 （3.2-48.0） vs. 12.6 （4.4-32.1） mmHg, P=0.366）. Univariate regression analysis revealed that independent determinant of AVR was the baseline AV mean PG （P=-0.031）. Conclusions Although additional value of exercise ECG was demonstrated, baseline transaortic mean pressure gradient is the major determinant of AVR. Further large-scale prospective studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise ECG in asymptomatic severe AS.

关键词： aortic stenosis exercise echocardiography asymptomatic, aortic valve replacement

Treatment for gastric ‘indefinite for neoplasm/dysplasia' lesions based on predictive factors

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World Journal of Gastroenterology 2019年第4期25卷 469-484页

作者： Mi Jung Kwon Ho Suk Kang hyeon Tae Kim Jin woo Choo Bo Hyun Lee Sung Eun Hong Kun Ha Park Dong Min Jung Hyun Lim Jae Seung Soh Sung Hoon Moon Jong hyeok Kim hye-Rim Park Soo Kee Min Jin won Seo Ji-Young Choe Department of Pathology Hallym University Sacred Heart Hospital Hallym University College of Medicine Department of Internal Medicine Hallym University Sacred Heart Hospital

BACKGROUND Gastric ‘indefinite for neoplasm/dysplasia'(IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal *** To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND *** In total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection(n = 134), surgery(n = 22), and follow-up endoscopic biopsy(n = 305) were performed to confirm the *** time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia(60%) or atypical epithelia(40%)at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the *** Four clinical factors [age ≥ 60 years(2.445, 95%CI: 1.305-4.580, P = 0.005),endoscopic size ≥ 10 mm(3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion(5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding(4.056, 95%CI:1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium(25.575,95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI:1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change(5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeate

关键词： Gastric cancer Biopsy Endoscopic surgical procedure Diagnostic delay Prognosis

Macrophage PD-L1 strikes back: PD-1/PD-L1 interaction drives macrophages toward regulatory subsets

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Advances in Bioscience and Biotechnology 2013年第8期4卷 19-29页

作者： Yun-Jung Lee Young-hye Moon Kyeong Eun Hyung Jong-Sun Yoo Mi Ji Lee Ik Hee Lee Byung Sung Go Kwang woo Hwang Laboratory of Host Defense Modulation College of Pharmacy Chung-Ang University Seoul Korea

Activated macrophages have been simply de?ned as cells that secrete in?ammatory mediators and kill intracellular pathogens until few years ago. Recent studies have proposed a new classification system to separate activated macrophages based on their functional phenotypes: host defense, wound healing, and immune regulation. Regulatory macrophages can arise following innate or adaptive immune responses and hinder macrophage-mediated host defense and inflammatory functions by inhibiting the production of pro-inflammatory mediators. In this study, we investigated whether PD-1 and PD-L1 interaction between macrophages and T cells alters macrophage activities. Our data provide evidence for PD-1/PD-L1 engagement inducing a regulatory profile in macrophages. Regulatory macrophages derived from PD-L1 signaling lost their host defense activity, which consists of the production of pro-inflammatory cytokine IL-6 and the exhibition of increased IL-10, SPHK1 and LIGHT gene levels in early phases of LPS stimulation. This differentiation seems to occur through excessive activation of TLR4 downstream MAPK signaling pathways. Regulatory macrophages induced from PD-1/PD-L1 interaction decrease inflammatory mediators and produce anti-inflammatory cytokines, so this macrophage subset has been under considerable attention as a possible immune regulation mechanism. Understanding and modulating regulatory macrophages may lead to new approches to treat or prevent auto-immune diseases such as type I diabetes, rheumatic syndrome and hypersensitivity-related diseases, which are concerned with the overproduction of inflammatory cytokines in macroages.

关键词： Regulatory Macrophage PD-1 PD-L1