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대한내과학회> The Korean Journal of Internal Medicine> Longstanding postoperative fluid collection influences recurrence of pancreatic malignancy

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Longstanding postoperative fluid collection influences recurrence of pancreatic malignancy

Young Jung Kim , Young Koog Cheon , Tae Yoon Lee , Seong-Hwan Chang , Mi-Hye Yu
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 36권6호
  • : 연속간행물
  • : 2021년 11월
  • : 1338-1346(9pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

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Background/Aims: Postoperative abdominal fluid collection (PAFC) is a frequent complication of pancreatobiliary cancer surgery. The effects of the existence and duration of PAFC are not well known. This study aimed to assess the effects of PAFC on patient prognosis after surgery for pancreatobiliary adenocarcinoma and the association of longstanding PAFC with the recurrence of pancreatic cancer.
Methods: We retrospectively analyzed the data of 194 consecutive patients with pancreatobiliary adenocarcinoma who underwent curative operations from August 2005 to December 2019. The presence of PAFC was assessed using computed tomography within a week of surgery; PAFC lasting > 4 weeks was defined as longstanding PAFC.
Results: Among 194 patients, PAFC occurred in 165 (85.1%), and 74 of these had longstanding PAFC. The recurrence rate of pancreatobiliary adenocarcinoma was significantly higher in patients with longstanding PAFC than in patients with non-longstanding PAFC (p = 0.025). Recurrence was also significantly associated with high T stage (T3, T4; p = 0.040), lymph node involvement (p < 0.001), perineural invasion (p < 0.006), and non-receipt of adjuvant chemotherapy (p = 0.025). Longstanding PAFC was significantly associated with the recurrence of pancreatic adenocarcinoma (p = 0.016). However, cancer-specific survival was related to neither the presence nor the duration of PAFC.
Conclusions: The presence of longstanding PAFC was associated with the recurrence of pancreatic adenocarcinoma. However, a larger prospective study is necessary to confirm the findings.

UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2022
  • : 2654


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1Aerosolized antibiotics in the treatment of hospital-acquired pneumonia/ventilator-associated pneumonia

저자 : Yun Jung Jung , Eun Jin Kim , Young Hwa Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 1-12 (12 pages)

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Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in critically ill patients is especially significant. They are also used as an efficient alternative to overcome the issues caused by systemic administration of antibiotics, including the occurrence of drug-resistant strains, drug toxicity, and insufficient drug concentration at the target site. However, the rationale for the use of aerosolized antibiotics is limited owing to their insufficient efficacy and the potential for underestimated risks of developing side effects. Despite the lack of availability of high-quality evidence, the use of aerosolized antibiotics is considered as an attractive alternative treatment approach, especially in patients with multidrug-resistant pathogens. In this review, we have discussed the effectiveness and side effects of aerosolized antibiotics as well as the latest advancements in this field and usage in the Republic of Korea.

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2Metformin and its therapeutic applications in autoimmune inflammatory rheumatic disease

저자 : Ji-won Kim , Jung-yoon Choe , Sung-hwan Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 13-26 (14 pages)

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Metformin is a first-line therapeutic agent for type 2 diabetes. Apart from its glucose-lowering effect, metformin is attracting interest regarding possible therapeutic benefits in various other conditions. As metformin regulates cell metabolism, proliferation, growth, and autophagy, it may also modulate immune cell functions. Given that metformin acts on multiple intracellular signaling pathways, including adenosine monophosphate (AMP)-activated protein kinase (AMPK) activation, and that AMPK and its downstream intracellular signaling control the activation and differentiation of T and B cells and inflammatory responses, metformin may exert immunomodulatory and anti-inflammatory effects. The efficacy of metformin has been investigated in preclinical and clinical studies on rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, Sjögren's syndrome, scleroderma, ankylosing spondylitis, and gout. In this review, we discuss the potential mechanisms through which metformin exerts its therapeutic effects in these diseases, focusing particularly on rheumatoid arthritis and osteoarthritis.

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3Current status of the diagnosis of chronic pancreatitis by ultrasonographic elastography

저자 : Kazunori Nakaoka , Senju Hashimoto , Ryoji Miyahara , Hiroki Kawashima , Eizaburo Ohno , Takuya Ishikawa , Takamichi Kuwahara , Hiroyuki Tanaka , Yoshiki Hirooka

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 27-36 (10 pages)

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Chronic pancreatitis (CP) is pathologically characterized by the loss of exocrine pancreatic parenchyma, irregular fibrosis, cellular infiltration, and ductal abnormalities. Diagnosing CP objectively is difficult because standard diagnostic criteria are insufficient. The change of parenchymal hardness is the key factor for the diagnosis and understanding of the severity of CP. The ultrasonography (US) or endoscopic ultrasonography (EUS) elastography have been used to diagnose pancreatic diseases. Both strain elastography (SE) and shear wave elastography are specific diagnostic techniques for measuring tissue hardness. Most previous studies were conducted with SE. There are three methods of interpreting SE; the method of recognizing the patterns in SE distribution images in the region of interest, the method of using strain ratio to compare the hardness of adipose tissue or connective tissue with that of the lesion, and the method of evaluating the hardness distribution of a target by histogram analysis. These former two methods have been used primarily for neoplastic diseases, and histograms analysis has been used to assess hardness distribution in the evaluation of CP. Since the hardness of the pancreas increases with aging, it is necessary to consider the age in the diagnosis of pancreatic disorders using US or EUS elastography.

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4Is there sufficient evidence to justify changes in dietary habits in heart failure patients? A systematic review

저자 : Alejandra García-garcía , Luis A. Alvarez-sala-walther , Hae-young Lee , Cristina Sierra , Domingo Pascual-figal , Miguel Camafort

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 37-47 (11 pages)

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The incidence and prevalence of heart failure (HF) is increasing worldwide, leading to high morbidity and mortality. The global management of HF involves lifestyle changes in addition to pharmacological treatments. Changes include exercise and dietary recommendations, mainly salt and fluid restriction, but without any clear evidence. We conducted a systematic review to analyse the degree of evidence for these dietary recommendations in HF. Only randomized controlled trials (RCT), and observational studies in humans were selected. Studies were considered eligible if they included participants with HF and sodium and/or fluid restriction. Publications in languages other than English or Spanish were excluded. We included 15 studies related to sodium or fluid restriction. Nine RCT and six observational studies showed some improvements in symptoms and quality of life and a degree of reduction in new hospitalizations, but the results are based on limited population groups, applying different methodologies, and with different restriction goals. We found a lack of clear evidence of the benefits of sodium/fluid restriction in chronic HF. The evidence is limited to few studies with conflicting results. Randomized clinical trials are needed to fill this gap in our knowledge.

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5Challenges to be addressed in management of patients with sinusoidal obstruction syndrome after hematopoietic cell transplantation

저자 : Seong Kyu Park , Young Sok Ji , Se Hyung Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 48-50 (3 pages)

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6Efficacy of hydroxychloroquine for knee osteoarthritis

저자 : Young Ho Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 51-52 (2 pages)

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7Anti-fibrotic effects of branched-chain amino acids on hepatic stellate cells

저자 : Hae Lim Lee , Jungmin Lee , Jung Hoon Cha , Sungwoo Cho , Pil Soo Sung , Wonhee Hur , Seung Kew Yoon , Si Hyun Bae

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 53-62 (10 pages)

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Background/Aims: Patients with liver cirrhosis (LC) have low levels of branched-chain amino acids (BCAAs). There is accumulating evidence that BCAAs have anti-fibrotic effects in cirrhosis. This study is aimed to evaluate the effect of BCAAs on the function and phenotype of activated hepatic stellate cells (HSCs).
Methods: LX-2, an immortalized human stellate cell line, was used in in vitro experiments. LX-2 cells were exposed to transforming growth factor β1 (TGF-β1) and BCAAs or to valine, leucine, and isoleucine, which are components of BCAAs. Activation of the TGF-β signaling pathway in LX-2 cells was observed using real-time quantitative polymerase chain reaction and Western blotting.
Results: The increased expression of snail family transcriptional repressor 1 (SNAI1) was observed in LX-2 cells activated by TGF-β1. After BCAA treatment, its expression was significantly decreased at the mRNA level. The increased expression of Col1α1 and TIMP2 at the mRNA level and alpha smooth muscle actin at the protein level in activated LX-2 cells decreased after BCAA treatment. Among the BCAA components, leucine and valine significantly abrogated TGF-β-induced activation of LX-2 cells. BCAA treatment led to the decreased phosphorylation of Smad2 and p38 proteins, which are markers for Smad and Smad-independent p38 mitogen-activated protein kinase signaling pathways, respectively.
Conclusions: BCAA treatment can improve hepatic fibrosis by directly affecting the activated state of hepatic stellate cells through inhibition of the TGF-β signaling pathway. Among BCAA components, leucine and valine mainly abrogated TGF-β- induced activation of HSCs. Our results suggest that BCAA may be used to attenuate the progression of liver fibrosis.

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8Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey

저자 : Hyung Ku Chon , Sung Hoon Moon , Sang Wook Park , Woo Hyun Paik , Chang Nyol Paik , Byoung Kwan Son , Tae Jun Song , Dong Won Ahn , Eaum Seok Lee , Yun Nah Lee , Yoon Suk Lee , Jae Min Lee , Tae Joo Jeon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 63-76 (14 pages)

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Background/Aims: The study aimed to investigate the current practice patterns in the management of pancreatic cystic neoplasms in Korea.
Methods: An electronic survey was systematically distributed by email to members of the Korean Pancreatobiliary Association from December 2019 to February 2020.
Results: In total, 115 (110 gastroenterologists, five surgeons) completed the survey, 72.2% of whom worked in a tertiary/ academic medical center. Most (65.2%) followed the 2012/2017 International Association of Pancreatology guidelines for the management of pancreatic cystic neoplasms. A gadolinium-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography was the most common first-line diagnostic modality (42.1%), but a contrast-enhanced computed tomography scan was preferred as a subsequent surveillance tool (58.3%). Seventy-four percent of respondents routinely performed endoscopic ultrasound-guided fine needle aspiration for pancreatic cystic neoplasms with suspicious mural nodules. Endoscopic ultrasound-guided fine needle aspiration cytology (94.8%) and cystic fluid carcinoembryonic antigen (95.7%) were used for cystic fluid analysis. Most (94%) typically recommended surgery in patients with high-risk stigmata, but 18.3% also considered proceeding with surgery in patients with worrisome features. Most (96.5%) would continue surveillance of pancreatic cystic neoplasms for more than 5 years.
Conclusions: According to this survey, there was variability in the management of pancreatic cystic neoplasms among the respondents. These results suggest that the development of evidence-based guidelines for pancreatic cystic neoplasms that fit the Korean practice is needed to create an optimal approach to the management of pancreatic cystic neoplasms.

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9Seroprevalence of viral infectious diseases and associated factors in Korean patients with inflammatory bowel diseases

저자 : Hee Seung Hong , Jiwon Jung , Sang Hyoung Park , Hwa Jung Kim , Sung Wook Hwang , Dong-hoon Yang , Jeong-sik Byeon , Seung-jae Myung , Suk-kyun Yang , Byong Duk Ye

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 73-87 (15 pages)

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Background/Aims: Data on the immunoprotective status against measles, mumps, rubella, varicella zoster virus (VZV), hepatitis A virus (HAV), and Epstein-Barr virus (EBV) infection in patients with inflammatory bowel disease (IBD) are still lacking. Therefore, we investigated the seropositivity rates for viral infectious diseases and the associated factors in Korean patients with IBD.
Methods: In this retrospective cohort study, serum immunoglobulin G antibody positivity rates against measles virus, mumps virus, rubella virus, VZV, HAV, and EBV viral capsid antigen (VCA) were measured in patients with Crohn's disease or ulcerative colitis (UC) who first visited the IBD clinic. Seropositivity rates and their associated factors were analyzed.
Results: Between January 2016 and December 2018, 263 patients were enrolled (male, 167 [67.3%]; UC, 134 [50.9%]). The median age at serological test was 30 years (interquartile range, 22 to 46). The seropositivity rates were 84.0%, 85.2%, 66.5%, 87.4%, 50.0%, and 93.7% for measles, mumps, rubella, VZV, HAV, and EBV, respectively. Younger age at serological test was associated with seronegative status for measles (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.88 to 0.96), VZV (aOR, 0.83; 95% CI, 0.74 to 0.93), and HAV (aOR, 0.93; 95% CI, 0.91 to 0.95). Furthermore, IBD type-UC was associated with seronegative status against VZV (aOR, 0.33; 95% CI, 0.11 to 0.99).
Conclusions: Seropositivity rates for common viral infectious diseases in Korean patients with IBD were similar to those of the general population. In the younger age group, protective immunity against measles, VZV, and HAV is required, with proper vaccination, as necessary.

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10Extracellular vesicles derived from small intestinal lamina propria reduce antigen-specific immune response

저자 : Tae-seop Shin , Jae Yong Park , Yoon-keun Kim , Jae Gyu Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 1호 발행 연도 : 2022 페이지 : pp. 85-97 (13 pages)

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Background/Aims: Extracellular vesicles (EVs) are secreted from various types of cells and have specific functions related to their origin. EVs are observed in the small intestinal lamina propria (lpEVs), but their function remains unclear. This study aimed to investigate the role of lpEVs.
Methods: LpEVs were isolated from antigen (ovalbumin [OVA])-fed mice (lpEVs/OVA), and administrated to the naïve mice for 5 days before induction of lung inflammation. Afterwards, the mice were sensitized and challenged with OVA to evaluate the role of lpEVs/OVA in the regulation of immune tolerance.
Results: The isolated lpEVs/OVA were sphere-shaped, bi-layered vesicles of approximately 50 to 100 nm in size. The vesicles expressed CD81, A33 antigen, and major histocompatibility complex (MHC) class II on the surface. When administrated to naïve mice, the lpEVs/OVA migrated to the spleen. Intraperitoneal lpEVs/OVA administration to naïve mice decreased the immune response against sensitized antigen in a CD4+FoxP3+T cell-dependent manner.
Conclusions: EVs are actively secreted from small intestinal epithelial cells to deliver information about orally administered antigens to immune cells, which will facilitate the modulation of the immune response by acting as an intercellular communicasome.

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1Hepatic sinusoidal obstruction syndrome/veno-occlusive disease after hematopoietic cell transplantation: historical and current consider-ations in Korea

저자 : Jae-ho Yoon , Chul Won Choi , Jong-ho Won

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1261-1280 (20 pages)

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Hepatic sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a rare but severe complication of hematopoietic cell transplantation (HCT) showing high mortality. Multiple risk factors for SOS/VOD were identified, but it is often confused with other hepatic complications due to nonspecific clinical features. Therefore, diagnostic and severity criteria have been re vised several times. The European Society of Blood and Marrow Transplantation suggested a new guideline that excludes the standard duration of development within 21 days, emphasizes late-onset SOS/VOD, and suggests the importance of Doppler ultrasonography. The severity criteria were further subdivided for guidance to begin active treatment using defibrotide which was approved in Korea since 2016. In a phase 3 trial, defibrotide had superior 100-day survival, compared to best available treatments (38.2% vs. 25.0%). Although several studies of SOS/VOD in Korean patients have been performed after the implementation of HCT, most involved small number of pediatric patients. Recently, the Korean Society of Blood and Marrow Transplantation investigated the incidence of SOS/VOD in the Korean population, and several influential studies of adult patients were published. Here, we summarize recent issues regarding the mechanism, diagnosis, severity criteria, prevention, and treatments of SOS/VOD in Korean patients, as well as recent analyses of nationwide incidence.

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2Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease

저자 : Yousuf Waheed , Fan Yang , Dong Sun

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1281-1293 (13 pages)

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Previous research has investigated whether hyperuricemia serves as an independent risk factor for cardiovascular and renal diseases. Hyperuricemia is defined as an abnormally high level of uric acid (UA; i.e., serum urate level > 6.8 mg/dL). Hyperuricemia has been considered a complication of chronic kidney disease (CKD). However, it seems to play a pathogenic role in the progression of renal diseases. There has been increasing focus on the link between hyperuricemia and CKD. The results of randomized controlled trials have implied independent associations between hyperuricemia and the progression of cardiovascular and renal morbidities. These associations may be mediated by renin-angiotensin system activation, nitric oxide synthase inhibition, and macrovascular/microvascular disease development. There remains controversy regarding the use of serum UA level as an indirect index of renal vascular disease. This literature review focuses on the role of asymptomatic hyperuricemia in the progression of CKD, as well as the association between hyperuricemia and cardiovascular disease. It also provides a general overview of the physiological metabolism of UA.

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3Recent advances in airway imaging using micro-computed tomography and computed tomography for chronic obstructive pulmonary disease

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Chronic obstructive pulmonary disease (COPD) is a complex lung disease characterized by a combination of airway disease and emphysema. Emphysema is classified as centrilobular emphysema (CLE), paraseptal emphysema (PSE), or panlobular emphysema (PLE), and airway disease extends from the respiratory, terminal, and preterminal bronchioles to the central segmental airways. Although clinical computed tomography (CT) cannot be used to visualize the small airways, micro-CT has shown that terminal bronchiole disease is more severe in CLE than in PSE and PLE, and micro-CT findings suggest that the loss and luminal narrowing of terminal bronchioles is an early pathological change in CLE. Furthermore, the introduction of ultra-high-resolution CT has enabled direct evaluation of the proximal small (1 to 2-mm diameter) airways, and new CT analytical methods have enabled estimation of small airway disease and prediction of future COPD onset and lung function decline in smokers with and without COPD. This review discusses the literature on micro-CT and the technical advancements in clinical CT analysis for COPD. Hopefully, novel micro-CT findings will improve our understanding of the distinct pathogeneses of the emphysema subtypes to enable exploration of new therapeutic targets, and sophisticated CT imaging methods will be integrated into clinical practice to achieve more personalized management.

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4Eosinophilic endotype of chronic obstructive pulmonary disease: similarities and differences from asthma

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발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1305-1319 (15 pages)

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Approximately 25% to 40% of patients with chronic obstructive pulmonary disease (COPD) have the eosinophilic endotype. It is important to identify this group accurately because they are more symptomatic and are at increased risk for exacerbations and accelerated decline in forced expiratory volume in the 1st second. Importantly, this endotype is a marker of treatment responsiveness to inhaled corticosteroid (ICS), resulting in decreased mortality risk. In this review, we highlight differences in the biology of eosinophils in COPD compared to asthma and the different definitions of the COPD eosinophilic endotype based on sputum and blood eosinophil count (BEC) with the corresponding limitations. Although BEC is useful as a biomarker for eosinophilic COPD endotype, optimal BEC cut- offs can be combined with clinical characteristics to improve its sensitivity and specificity. A targeted approach comprising airway eosinophilia and appropriate clinical and physiological features may improve identification of subgroups of patients who would benefit from biologic therapy or early use of ICS for disease modification.

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5Optimizing glucose control for diabetic patients undergoing percutaneous coronary intervention

저자 : Haseong Chang , Sung-Hea Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1320-1322 (3 pages)

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6Is the anti-centromere antibody a marker for a distinct subset of polyautoimmunity in Sjögren's syndrome?

저자 : Yun Jong Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1323-1326 (4 pages)

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7HER-2 positivity is a high risk of recurrence of stage I gastric cancer

저자 : Seonhoo Kim , Yeon-ji Kim , Woo Chul Chung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1327-1338 (12 pages)

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Background/Aims: The treatment of gastric cancer remains unsatisfactory. We aimed to investigate the prognostic value of immunohistochemical staining in gastric cancer.
Methods: We analyzed 505 (279 early staged, 226 advanced-staged) gastric cancer tissues from patients who underwent radical gastric resection between January 2014 and December 2016. Available surgical specimens immunohistochemically stained for p53, epidermal growth factor receptor (EGFR), human EGFR 2 (HER-2), E-cadherin, and Ki-67 were reviewed. We evaluated the association between positivity to various biomarkers and disease recurrence, disease-free survival, lymph node metastasis, and microscopic lymphovascular invasion.
Results: The median follow-up duration was 32.5 months (range, 7 to 70). Advanced gastric cancer cases showed high Ki-67 expression; other cases showed un-remarkable expression. Concerning disease recurrence, lymphatic invasion, and disease-free interval, all biomarkers had no prognostic effects. HER-2-positive stage I gastric cancer tended to occur in old patients and in the upper one-third of the stomach (p = 0.01). HER-2 positivity was significantly correlated with disease recurrence (p = 0.01), lymphatic invasion (p = 0.03), and vascular invasion (p = 0.03) in stage I cases.
Conclusions: Only HER-2 was associated with the recurrence of stage I gastric cancer. HER-2-positive stage I gastric cancer requires additional therapy despite curative resection.

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8Longstanding postoperative fluid collection influences recurrence of pancreatic malignancy

저자 : Young Jung Kim , Young Koog Cheon , Tae Yoon Lee , Seong-Hwan Chang , Mi-Hye Yu

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1338-1346 (9 pages)

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Background/Aims: Postoperative abdominal fluid collection (PAFC) is a frequent complication of pancreatobiliary cancer surgery. The effects of the existence and duration of PAFC are not well known. This study aimed to assess the effects of PAFC on patient prognosis after surgery for pancreatobiliary adenocarcinoma and the association of longstanding PAFC with the recurrence of pancreatic cancer.
Methods: We retrospectively analyzed the data of 194 consecutive patients with pancreatobiliary adenocarcinoma who underwent curative operations from August 2005 to December 2019. The presence of PAFC was assessed using computed tomography within a week of surgery; PAFC lasting > 4 weeks was defined as longstanding PAFC.
Results: Among 194 patients, PAFC occurred in 165 (85.1%), and 74 of these had longstanding PAFC. The recurrence rate of pancreatobiliary adenocarcinoma was significantly higher in patients with longstanding PAFC than in patients with non-longstanding PAFC (p = 0.025). Recurrence was also significantly associated with high T stage (T3, T4; p = 0.040), lymph node involvement (p < 0.001), perineural invasion (p < 0.006), and non-receipt of adjuvant chemotherapy (p = 0.025). Longstanding PAFC was significantly associated with the recurrence of pancreatic adenocarcinoma (p = 0.016). However, cancer-specific survival was related to neither the presence nor the duration of PAFC.
Conclusions: The presence of longstanding PAFC was associated with the recurrence of pancreatic adenocarcinoma. However, a larger prospective study is necessary to confirm the findings.

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9Impact of non-hepatic hyperammonemia on mortality in intensive care unit patients: a retrospective cohort study

저자 : Jae Heon Kim , Hankyu Jeon , Sang Soo Lee , I Re Heo , Jung Woo Choi , Hee Jin Kim , Ra Ri Cha , Jae Min Lee , Hyun Jin Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1347-1362 (16 pages)

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Background/Aims: The effect of hyperammonemia on the mortality in patients with liver cirrhosis is well documented. However, little is known about the impact of hyperammonemia on mortality among intensive care unit patients without hepatic disease. We aimed to investigate factors associated with non-hepatic hyperammonemia among intensive care unit patients and to evaluate the factors related to the 7- and 90-day mortality.
Methods: Between February 2016 and February 2020, 948 patients without hepatic disease who had 972 episodes of admission to the intensive care unit were retrospectively enrolled and classified as hyperammonemia grades 0 (≤ 80 μg/dL; 585 [60.2%]), 1 (≤ 160 μg/dL; 291 [29.9%]), 2 (≤ 240 μg/dL; 55 [5.7%]), and 3 (> 240 μg/dL; 41 [4.2%]). Factors associated with hyperammonemia and the 7- and 90-day mortality were evaluated by multivariate logistic regression analysis and Cox regression analysis, respectively. Kaplan-Meier survival curves for the 7- and 90-day mortality were constructed.
Results: The independent risk factors for hyperammonemia were male sex (odds ratio, 1.517), age (0.984/year), acute brain failure (2.467), acute kidney injury (1.437), prothrombin time-international normalized ratio (2.272/unit), and albumin (0.694/g/dL). The 90-day mortality rate in the entire cohort was 24.3% and gradually increased with increasing hyperammonemia grade at admission (17.9%, 28.2%, 43.6%, and 61.0% in patients with grades 0, 1, 2, and 3, respectively). Additionally, non-hepatic hyperammonemia was an independent predictor of the 90- day mortality in intensive care unit patients.
Conclusions: Non-hepatic hyperammonemia is common (39.8%) and associated with the 90-day mortality among intensive care unit patients.

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10Clinical analysis of 117 cases with synchronous multiple primary esophageal squamous cell carcinomas

저자 : Zhiqin Chen , Sihan Li , Zheng He , Guang Li

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 6호 발행 연도 : 2021 페이지 : pp. 1356-1364 (9 pages)

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Background/Aims: We aimed to study the clinical characteristics, treatment modality, and the prognosis of synchronous multiple primary esophageal squamous cell carcinomas (SMPESCC).
Methods: A total of 117 SMPESCC cases were evaluated retrospectively from 2010 to 2015.
Results: The most common locations of SMPESCC were mid- and lower thoracic segments (n = 208, 84.9%). The 1-, 2-, and 3-year overall survival rates were 53.8%, 30.8%, and 15.4%, respectively; the median survival time (MST) was 12.5 months. With definitive radiotherapy and surgery, respectively, the MST of stage I/II patients were 34.2 and 26.7 months, of stage III patients were 8.3 and 13.2 months (p = 0.163), and of stage IV patients were and 8 and 12.6 months (p = 0.379). Clinical stage, family history of cancer, and Karnofsky performance status were independent prognostic factors for the whole cohort by Cox multivariate regression analysis (hazard ratio [HR] = 0.859, p < 0.001; HR = 0.579, p = 0.032; and HR = 0.586, p = 0.013).
Conclusions: Although the prognosis of SMPESCC is poor, stage I/II patients can achieve long-term survival with aggressive treatment, especially those with a Karnofsky performance score 90 or higher and who have no family history of cancer. Definitive radiotherapy could achieve a similar survival rate to definitive surgery at different clinical stages.

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