Juvenile fibroadenoma in 13-month-old female child.
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Breast Neoplasms↗
Biomedical subjects
M W Kim
Publications and source records attributed to M W Kim.
Hepatocellular carcinoma with tumor thrombi in the bile duct.
BACKGROUND/AIMS: Hepatocellular carcinoma (HCC), presenting as obstructive jaundice caused by tumor thrombi in the bile duct, is rare. The authors report on clinical experiences and evaluate the results of different treatment modalities for this disease. METHODOLOGY: We experienced 549 cases of HCC at Ajou University Hospital from June 1994 through January 1998. Among them, 10 cases with gross evidence of tumor thrombi in the bile duct were treated with different resection methods and interventions, and then compared with those receiving short-term results. RESULTS: Eight out of 10 patients underwent exploratory laparotomy: right lobectomy with extrahepatic bile duct resection in 2 cases; right lobectomy with tumor thrombectomy in 2 cases; left lobectomy and caudate lobectomy with extra-hepatic bile duct resection in 2 cases: T-tube drainage in 1 case and biopsy only with post-operative internal biliary stent, in 1 case. Survival times of these patients were 39 months (still alive); 38 months (still alive); 8 months (died); 8 months (died); 8 months (still alive); 1 month (still alive); 14 months (died); 8 months (died), respectively. Of the 2 non-surgical cases, 1 underwent PTBD only and the other had endoscopic removal of the thrombi. Their survival times were 18 days (died) and 24 months (still alive with recurrence), respectively. The 4 cases, with right lobectomy or left lobectomy including extrahepatic bile duct resection, had relatively long-term disease-free survival (39 months, 38 months, 8 months and 1 month after operation, respectively). However, there were no differences in survival between the partial hepatectomy procedure with removal of tumor thrombi and the simple drainage procedure without tumor resection. CONCLUSIONS: Although the number of patients in this study is small, our results suggest that: 1) For the improvement of survival, it seems necessary to perform major hepatic resection with removal of the extrahepatic bile duct. 2) If hepatic resection cannot be accomplished with bile duct resection due to limited liver function, non-surgical modalities should be considered instead of surgery because no differences in prognosis between the 2 groups exist.
Adult↗
Relation between the risk of gallstone pancreatitis and characteristics of gallstone in Korea.
BACKGROUND/AIMS: Pancreatitis is a serious complication of patients with gallstones. However, risk factors of gallstone pancreatitis were unpredictable until recently. In Korea, characteristics of gallstones are different from Western countries. The present study was designed to determine differences in the risk of gallstone pancreatitis and characteristics of gallstones in Korean patients. METHODOLOGY: Clinical data were collected on patients undergoing laparoscopic cholecystectomy. The physical characteristics of gallstones recovered at surgery were also recorded. Patients with gallstone pancreatitis were compared with patients who had uncomplicated biliary pain. RESULTS: In a logistic regression model, acute gallstone pancreatitis was associated with a stone diameter of less than 5 mm (odds ratio: 3.3695; P = 0.0352) and with stone number of more than 20 (odds ratio: 3.8686; P = 0.0361). No other variable, including pigment stone, age, and sex, remained statistically significant in the adjusted analysis (P > 0.05). CONCLUSIONS: Patients with at least 1 gallstone smaller than 5 mm in diameter and stone number more than 20 each have a more than 3-fold increased risk of presenting with acute gallstone pancreatitis. The composition of gallstones, especially pigment stones, was not an important risk factor in gallstone pancreatitis in Korean patients with stones having a different composition than those from Western countries.
Acute Disease↗
Systematic analysis of the effects of hepatocyte transplantation on rats with acute liver failure.
BACKGROUND/AIMS: Acute liver failure either after liver resection or as part of underlying liver disease is still associated with high mortality. Hepatocyte transplantation in various forms has attracted attention recently. However, none of those reports have investigated the thorough and systematic analysis of effect of hepatocyte transplantation on acute liver failure induced by 90% hepatectomy. Therefore, we investigated systematic analysis of effect of hepatocyte transplantation on rats with acute liver failure. METHODOLOGY: Male Sprague-Dawley rats were used. Group I rats (n = 26) received intrasplenic injection of 2 x 10(7) hepatocytes in 0.3 mL Dulbecco's modified Eagle's medium (DMEM) 24 hours prior to 90% hepatectomy. Group II rats (n = 24) received intrasplenic injection of DMEM only. Twenty-two rats from group I and 20 from group II were observed for the determination of survival time. The remaining 8 (4/each group) rats were used to assess the liver function and regeneration. RESULTS: The hepatocyte bearing spleen revealed active glucose-6-phosphatase activity. In group I rats, the survival was longer and that group had more long-term survivors than those of group II controls. In group I, there was significant increase in the ratio of weight of remnant liver lobes to body weight. At 24 hours after hepatectomy, group I rats had improved biochemical parameters compared to those of group II rats. CONCLUSIONS: In rats with acute liver failure, intrasplenic hepatocyte transplantation acts as a bridge to support experimental rats from acute liver failure to liver regeneration, prolong survival in rats with acute liver failure and improve biochemical parameters.
Animals↗
Intraportal insulin therapy after partial hepatectomy for hepatoma patients with insulinopenia.
BACKGROUND/AIMS: This prospective study was carried out in order to assess the role of intraportal insulin infusion after partial hepatectomy in hepatoma patients with insulinopenia. METHODOLOGY: Of the 38 patients who underwent hepatic resection for hepatocellular carcinoma from August 1994 to August 1995, 21 patients took an oral glucose tolerance test with insulin measurement preoperatively. Five patients were treated postoperatively with intraportal insulin infusion, as follows: A 16-gauge catheter was inserted into a reopened umbilical vein and fixed in place by a few absorbable stitches. Regular insulin was administered just after the operation at the rate of 2 units/hour for 2-3 weeks. Blood glucose levels were maintained between 150 and 200 mg/dL. Arterial ketone body ratio was used in monitoring the function of the liver during the perioperative periods. RESULTS: Ten patients (47.6%) were found to be insulinopenic. In the insulin therapy group (n = 5), the arterial ketone body ratio of 3 patients recovered within a few hours after the operation, and that of the remaining 2 patients recovered on the 1st postoperative day. But in the control group (n = 5), none of the 5 cases had an arterial ketone body ratio of more than 0.7 on the day of operation. The arterial ketone body ratio returned to normal on the 1st postoperative day in 2 cases, on the 2nd postoperative day in 1 case, and on the 5th day in 1 case. The arterial ketone body ratio recovery time was shorter in the intraportal insulin therapy group than in the control group (P = 0.042). CONCLUSIONS: Intraportal insulin infusion after hepatectomy via the reopened umbilical vein may be a very simple and safe means of promoting recovery of remnant liver function after hepatectomy in hepatoma patients with insulinopenia.
Carcinoma, Hepatocellular↗
Production and characterization of immortalized rat hepatocytes secreting hepatocyte growth factor/scatter factor.
BACKGROUND/AIMS: Hepatocyte transplantation is a recently attractive field in the treatment of liver failure and enzyme-deficient diseases. However, procurement of sufficient quantities of hepatocytes is almost impossible. We attempted to create a hepatocyte cell line that could be used for hepatocyte transplantation. METHODOLOGY: L2A2 is a conditionally immortalized rat hepatocyte cell line produced by transfection of temperature-sensitive simian virus T antigen to the hepatocytes in the Lewis rat. Hepatocyte Growth Factor/Scatter Factor (HGF/SF)-secreting L2A2 cells, designated as SF-21, was produced by transfecting human HGF/SF cDNA into L2A2 cells. RESULTS: This cell line was able to produce HGF/SF at the rate of 5-10 ng/10(6) cells/24 hrs, and the recombinant HGF/SF was of the expected size and was functionally active in that it could scatter Madin-Darby canine kidney cells. The SF-21 cells grew faster than its parental cell clone, and survived and proliferated at 37 degrees C in vitro. Also, the SF-21 cells were able to survive and proliferate when transplanted into the spleen of syngeneic rat, and expressed glucose-6-phosphatase. CONCLUSIONS: These HGF/SF-secreting hepatocytes can be used as a model system to test a feasibility of using genetically engineered hepatocyte cell line for hepatocyte transplantation in the rat.
Animals↗
Perigastric lymph node status can be a simple prognostic parameter in patients with gastric cancer.
BACKGROUND/AIMS: The number of metastatic lymph nodes has been a significant prognostic factor after curative resection of gastric cancer and adopted as a new UICC classification of nodal stages in gastric cancer. The extent of lymphadenectomy is another significant factor but has been fiercely debated. Regardless of the type of lymphadenectomy, perigastric lymph node dissection is always carried out. In this study, we examined whether the number of metastatic perigastric nodes can be a prognostic indicator of gastric cancer. METHODOLOGY: For the purpose of evaluating perigastric lymph node status, a retrospective study was carried out with 760 patients who underwent curative gastric resection from June 1994 to November 1998. RESULTS: The 4-year cumulative survival rate was 64% and the survival rate decreased significantly when the number of positive perigastric nodes exceeded 3. Comparing with the patients having 0-2 positive perigastric nodes, patients whose metastatic perigastric lymph nodes exceeded 3 or more exhibited deeper tumor invasion, larger tumor size and older age. Multivariate analysis identified the number of positive perigastric nodes, together with depth of tumor invasion, as the strongest independent prognostic factors for survival. CONCLUSIONS: We suggest that the number of metastatic perigastric nodes can be used as a simple prognostic parameter in patients with gastric cancer and that intensive follow-up and adjuvant chemotherapy should be recommended for the patients with more than 3 metastatic perigastric nodes.
Adult↗
The experiences of hilar skeletonization for the treatment of locally advanced proximal bile duct cancer.
BACKGROUND/AIMS: Because proximal bile duct cancer easily involves the surrounding tissue, tumor cells often remain after apparent macroscopically complete radical resection. We evaluated the effect of resective modality of these tumors on prognosis and the effect of postoperative radiotherapy on survival of patients with microscopic residual tumor following local resection in locally advanced proximal bile duct cancer. METHODOLOGY: From November, 1990 to October, 1993, 45 proximal bile duct cancer patients who received local excision were entered onto this prospective, nonrandomized study. The patients were divided into three groups after operation, 16 patients with curative resection; 15 noncurative resection; and 14 nonresection. Patients who had positive lymph nodes or microscopic cancer cells in resection margin or adjacent major vessels, were treated with postoperative external radiotherapy, 5040 cGy for 40 days. RESULTS: The overall 1-, 2-, and 5-year survival of the patients was 62.2%, 24.4%, and 15.6%, respectively. The overall mean and median survival of patients was 24.1 +/- 3.98 (mean +/- SE) months and 13 +/- 0.74 months, respectively. Survival rates between resection and nonresection showed a statistically significant difference (P < 0.05). However, survival rates between curative resection and noncurative resection with postoperative radiotherapy were not statistically significant (P > 0.05). CONCLUSIONS: The resection is the treatment of choice for locally advanced proximal bile duct cancer, if resectable and the noncurative resection followed by postoperative external radiotherapy may be beneficial to the patients with locally advanced proximal bile duct cancer.
Adolescent↗
Can clamping of splenic vessels prevent abrupt increase of portal vein pressure and migration of transplanted hepatocytes to the liver after intrasplenic hepatocyte transplantation?
BACKGROUND/AIMS: It is well known that hepatocyte transplantation can retain some proper functions, significantly improve the survival rate of rats with different models of acute fulminant hepatic failure, correct some congenital genetic disorders, and improve liver function in cirrhosis. Portal hypertension and hepatic embolization have been described following intrasplenic hepatocyte transplantation. We evaluated the effect of temporary occlusion of splenic vessels on changes in portal vein pressure and on distribution of transplanted hepatocytes after hepatocyte transplantation into the spleen in normal rats. METHODOLOGY: Liver cirrhosis has been induced in rats by 1% dimethylnitrosamine (Sigma, St. Louis, Mo) dissolved in normal saline at the dose of 10 ml of DMN/Kg, i.p., 3 consecutive days a week for 4 weeks. Donor hepatocytes were harvested by in situ ethylenediaminetetraacetic acid (EDTA) perfusion. Changes in portal vein pressures were monitored by a pressure monitor and distribution of transplanted hepatocytes was assayed by measurement of radioactivity of 51Cr-labeled transplanted hepatocytes according to clamping or non-clamping during intrasplenic hepatocyte transplantation. RESULTS: The changes in portal pressure remained significantly high 10 min after hepatocyte transplantation in the nonocclusion groups compared to the occlusion groups. However, the changes in portal vein pressures in cirrhotic rats returned to normal faster than in normal rats after cell transplantation in the nonocclusion groups. The distribution of 51Cr-labeled transplanted hepatocytes into the spleen significantly diminished radioactivity of the liver at 10 min, 2 hours, and 24 hours in the occlusion groups compared to the nonocclusion groups. Also, duration of clamping time of splenic vessels did not influence the initial distribution of transplanted hepatocytes at the time of intrasplenic hepatocyte injection. CONCLUSIONS: These results suggested that temporary occlusion of splenic vessels should be routinely used during intrasplenic hepatocyte transplantation.
Animals↗