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Volume 26(2); 1994
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Original Articles
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A Multivariate Analysis of Prognostic Factors of 3176 Gastric Cancers
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Uck Sang Zung, Chung Han Lee, Sung Uhn Baek, Kyung Hyun Choi, Seung Do Lee
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J Korean Cancer Assoc. 1994;26(2):179-188.
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Abstract
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- Between l980 and 1992, 3176 consecutive patients with adenocarcinoma of stomach under-went surgical treatment at Department of Surgery, Kosin Medical College. Follow up rate was 96.5%. The overall operative mortality rate was 1.26%. The overall cumulative survival rate was 74.5% at 1 year, 62.1/ at 2 years, 56.0% at 3 years, 52.0% at 4 years, 48.8% at 5 years, and median survival time was 53 months. The cumulative survival rate of radical resection group was 90.2% at 1 year, 78.2% at 2 years, 72.8% at 3 years, 68.3% at 4 years, 63.9% at 5 years, and median survival time was 141 months. To determine the progrostic factors, 9 variables were chosen; age, sex, location of tumor, size of tumor, Borrmann type, tumor invasion, lymph node metastasis, distant metastasis end stage. Survival rate was examined using Kaplan-Meier method. The prognostic factors were examined for their relationship to survival rate using Cox's Proportional Hazard Model The most important prognostic factor is distant metastasis(2.88 of hazard ratio). Other factors such as lymph node metastasis, tumor invasion, size of tumor were also important factors in gastric cancer patients. Improvement of the prognosis of stomach cancer will require early detection of gastric cancer, and more curative resection.
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A Clinical Study of Early Recurrence after Curative Gastric Resection for Stage 3 Stomach Cancer
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Gi Jun Kim, Tae Seok Lee, Ho Chul Park, Choong Yoon
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J Korean Cancer Assoc. 1994;26(2):188-198.
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Abstract
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- 69 cases of early recurred stomach cancer within 2 years from the point of initial curative gastric resection among the 211 cases of stage III stomach cancer have been analysed with regard to factors influencing early recurrence, which were operated at the Department of General Surgery, Kyung Hee Medical Center from January 1988 to April 1991. The results were as follows; 1) Curative gastric resection was performed in 211 cases and 69 cases(32.7%) of them were recurred within 2 years. 2) In 69 cases, the most frequent age group was under 30 years of age(50%), but that was not statistically significant, and male to female ratio was 5.9: 1. 3) The most common site of recurrence was peritoneum(40.5%), and the next was distant me- tastasis such as bone and lung(23.1%), liver(l4.5%), lymph nodes(8.6%), peritoneum and liver(7.2 %), remnant stomach(5.8%), in order of frequency. 4) The larger size of tumor, the higher early recurrence rate, but that was not statistically signif icant(p > 0.05). 5) The early recurrence rate was higher in antral lesion(p<0.05). 6) The early recurrence rate was higher in Borrmann type III and IV(p < 0.05). 7) When the distance of proximal & distal resection margin were shorter than 5 cm or 2 cm, the early recurrence rate was higher(p<0.005). 8) The early recurrence rate was higher in T, and T, lesion for the depth of invasion(p< 0.005). 9) The larger number of involved lymph nodes, the higher early recurrence rate(p<0.005), and that of R operation only was higher than R+a operation(p<0.05). 10). The early recurrence rate was higher in well differentiated tubular adenacarcinoma, but was not sigmificant(p>0.05). 1 1) The early recurrence rate was higher in under 3 cycles of postoperative adjuvant chemo- therapy(FAM) than in over 3 cycles(p<0.05).
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The Prognostic Effects of Spleen Preservation in The Radical Total Gastrcomy
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Hee Duck Kim, Chung Han Lee, Kyung Hyun Choi, Seung Do Lee, Jae Kwan Suh
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J Korean Cancer Assoc. 1994;26(2):198-208.
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- In Gastric Cancer Surgery, an extended radical operation is common procedure, and in cases of total gastrectomy, there is a tendency to perform splenectomy at the same time. However, regarding to the prophylactic splenectamy for clearing of spleen hilar nodes the prognostic ef- fectivity is controversiaL We studied the value of spleen preservation in total gastrectomy for gastric cancer by survival rate, according to tumor stage and tumor location and by inflammatory complications. And another study was done on cellular immunity of total gastrectomy patients by T-cell subset(T3T4T5 & T4T8 Ratio) and Natural Killer cell activity changes(preoperative day and postoperative 2 months) with or without combined splenectomy. In five year survival rate of stage I and II groups, spleen preserving group(78.7%) has better prognosis than splenectomized group(70.4%) and in stage III and IV groups, 5 year survival rate of nonsplenectomized cases(30%) showed higher than that of splenectomized cases(17%). Five year survival rate of nonsplenectomized, proximal gastric cancer group(57.5%) showed significantly better than that of splenectomized group(30%). Postoperative T4/T8, ratio and NK cell activity were markedly decreased compared to preoperative ratio in the splenectomized group than the non-splenectomized and control groups. Consequently spleen preserving group group had better prognosis than splenectomized group in total gastrectomy, which may be attributable in part to reduction of cellular immunity caused by splenectomy. It seems to be desirable that accordingly prophylactic splenectomy in gastric cancer surgery should be reconsidered.
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Prognosticators and Analysis of Primary Gastrointestinal Lymphoma
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Jeong Heum Baek, Sung Joon Kwon
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J Korean Cancer Assoc. 1994;26(2):208-219.
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- A retrospective study was made using 23 patients treated for primary gastrointestinal lymphoma at the department of surgery, Hanyang University Hospital, from July 1983 to June 1993. The results were as follows. 1) Primary gastric lymphoma accaunted for 0.65 (10 cases) and leiomyosarcoma for 0.91%(14 cases) af the 1532 cases of gastric cancer studied. 2) The mean age of lymphoma was 49.6 years with a male to female ratio as 3.6: 1. The primary sites were stomach in 10 cases(44.1%), small intestine in 8 cases(34.4%), colon in 3 cases(12. 9%) and ileocecal area in 2 cases(S.6%). 3) The major symptoms and signs were abdominal pain(73.1%), indigestion(47.3%), anorexia (38.7%), weight loss(34,4%), constipation(25.8%), hunger pain(12.8%), diarrhea(12.9%) and palpable mass(12.9%). Endoscopic biopsy was the most effective diagnostic procedure comparing to other methods. 4) The preoperative complications were gastrointestinal perforation in 5 cases (21.7%), and it occurred at ileum in 4 cases, at stomach in 1 case and gastric hemorrhage in 1 case. 5) The curative resectability of the GI lymphomas was 82.6%(l9 cases) and the noncurative resectabiiity was 17.4%(4 cases). 6) The pathologics patterns were histiocytic in 18 cases(78.5%), poorly differentiated lymphocytic in 3 cases and mixed in 2 cases according to the Rappaport classification. The predominant type in the stomach and small intestine was the histiocytic pattern but there was no predominace in the colon. 7) The clinical stage was II in 9 cases(38.6% 1 I in 7 cases(31.2% ) and III in 7 cases(31.2% ). S) Ten patients(43.5%) were treated with postoperative chemotherapy: MACOP-B in 4 cases, CHOP in 2 cases, CHOP-Bleo in 2 cases, COPP in 1 case and MOPP in 1 case. 9) The postoperative complications included enterocutaneous fistula, leakage from the anstomosis site, wound infection, renal failure, metabolic acidosis and atelectasis. There were nine deaths following the operation of which seven patients were dead between 2 and 7 months. 10) The mean survival was 21.3 months and the overall 5-year survival rate by Kaplan-Meier was 43.8%. 11) As for the prognosticatiors, the curability, location, size, multiplicity, pathologic pattern by the Rappaport classification, serosal penetration, regional lymph node involvement, clinical stage by Contreary and chemotherpy were analysed. Serosal penetration, regional lymph node involvement, clinical stage of Contreary and chemotherapy affected the prognosis significantly. As for the serosal penetration, the 5-year survival rate of cases with no penetration(10) was 100% but the 3-year survival rate of cases with penetration(13) was 34.7%(p<0.01). As for the regional lymph node involvement, the 5-year survival rate of cases with no in- volvement(8) was in 100% but the 3-year survival rate of cases with invovement(15) was 45.0% (p<0.005). As for the Contreary classification, the 5 year-survival rate of stage I (7) was 100%, the 3- year survival rate of stage II (9) was 66.7%, and the 3-year survival rate of stage III (7), 28.5%(p< 0.05). Of the cases that underwent curative resection, chemotherapy was performed in 10 cases and non-chemotherapy in 9 cases. The 5-year survival rate af the former was 90.0% and the 3- year survival rate of the latter, 44.4%(p < 0.06).
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MDR1 Gene Expression and Chemosensitivity to Anticancer Drugs in SNU Hepatocellular Carcinoma Cell Lines
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In Gyu Hong, Sung Gyu Lee, Hyun Ju Lee, Gyung Hwa Him, Hun Sik Kim, Jae Gahb Park
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J Korean Cancer Assoc. 1994;26(2):219-231.
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- Using recently established 8 SNU human hepatocellular carcinoma cell lines and Hep 3B cell line, we performed in vitro chemosensitivity test using semiautomated tetrazolium-based colorimetric(MTT) assay. We also measured the MDRl gene expression of these cell lines by measuring MDR1 RNA level using slot blot analysis. IC values(concentration of chemotherapeutic agent which produces 50% growth inhibition of tested cells) were in the range of 1.92~5000 ↑ ug/ml for 5-fluorouracil, 0.24~32.00 ug/ml for doxorubicin, 0.16-10.29 pg/ml for mitomycin-c, 2.00~16.56 ug/ml for cisplatin, 1.15-182.32 ug/ml for etoposide, and 0.002 ↓L -24 ↑ug/ml for vincristine. Assay area under the curve(A-AUC) at IC: values showed that only A-AUC of VP-16 was in a clinically achievable range for only one of the 9 cell lines. All other drugs were out of the range of clinically achievabie AUC. Three cell lines(SNU-354, SNU-368, SNU-449) were MDR-positive. When these 3 cell lines were compared to MDR-negative cell lines, IC value for doxorubicin was significantly higher (P<0.05), suggesting that high expression of MDRl gene is responsible for doxorubicin resistance in hepatocellular carcinoma cell lines.
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Development of GST - P+ Foci in 3 Week Old Rast Inducted by Diethylnitrosamine : Preliminary data for liver foci model
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Ja June Jang, Yun Sil Lee, Mi Sook Lee, Tae Hwan Kim
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J Korean Cancer Assoc. 1994;26(2):231-236.
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- A new medium-term in vivo hepatocarcinogenesis model was tried using GST-P hepatic foci. The treatment protocol was the i.p. injection of 50 mg/kg body weight of diethylnitrosamine(DEN) ance, twice or three times per week with or without 0.05% phenobarbital(PB) in 3 week female Sprague-Dawley rats or male Fischer 344 rats. After 9 weeks, the rats were sacri- ficed and their livers were examined for immunohistochemically detectable GST-P' foci. DEN treatment in 3 week old rats without PB was enough to induce GST-P foci. This protocol is very simple and convenient compared to other liver foci model using newborn rats or com- bined partial hepatectomy. And the yield of GST-P' foci treated with DEN and PB was almost equal as other models. Therefore, this simple hepatic foci model may be useful for screening of carcinogenic or anticarcinogenic agents. For the validity of new model, more extensive studies will be necessary.
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Identification of Number of Positive Axillary Nodes to Influence Prognosis in Breast Cancer after Adjuvant CMF Chemotherapy
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Ho Yeong Lim, Hyo Min Yoo, Eun Hee Koh, Nae Chun Yoo, Joo Hang Kim, Jae Kyung Roh, Byung Soo Kim, Kyung Shik Lee, In Sung Cho
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J Korean Cancer Assoc. 1994;26(2):236-242.
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- The most important prognostic indicator for patients with operable breast cancer is the histological involvement of axillary lymph nodes metastasis, and the extent of nodal metastasis is highly prognostic, larger numbers of positive nodes are associated poorer prognosis. One hundred and nine patients of resected breast cancer with nodal involvement treated at Yonsei University College of Medicine from Dec. 1980 to Dec. 19S9 weres studied to identify the number of positive axillary nodes to influence prognosis after adjuvant CMF chemotherapy. And we obtained the following results. There was no significant difference in the disease free survival and overall survival between those with 1-3 positive axillary nodes and those with 4-7 positive nodes. So, we tried to reas- sess positive nodal groupings for determining the prognosis of breast cancer and identifying high risk group according to their nodal status. The current results showed that there was a significant difference in the disease free survival and overall survival between those with 1-7 positive axillary nodes and those with >= 8 positive nodes(DFS; 73% vs. 42%, OS; 78% vs. 40%, p < 0.05). This resport emphasizes the prognostic importance of positive nodal involvement with pa- tients of breast cancer and necessity of intensive managment for those with >= 8 positive nodes.
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Reversal of ( MDR ) Multidrug resistance ) in Adiamycin - Resistant MCF - 7 Cells by Tamoxifen : Possible Role of Protedin Kinase ( PCK )
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Han Lim Moon, Hoon Kyo Kim, Kyung Shik Lee
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J Korean Cancer Assoc. 1994;26(2):242-249.
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- Introduction: MDR(multidrug resistance), which is caused by mdr gene and its product, p-gly- coprotein, is one of the most important obstacles during cancer chemtherapy. Recently, many efforts to reverse MDR have been done and partly applied in clinic. Verapamil, quinidine, dipyridamole and cyclosporine were the representative ones and tamoxifen and toremifene have been known as those kinds. On the other hand, protein kinase c(PKC) has a critical role in cell proliferation and differentiation and also associated with MDR. Using wild type and adriamycin-resistant type of MCF-7(MCF-7/WT and MCF-7/ADM), we found antiestrogen, tamoxifen, had a synergistic cytotoxic effect with adriamycin on MCF-7/ADM, not on MCF-1/ WT. We also tried to clarify the mechanisms of synergism of tamoxifen with adriamycin, espe- cially in the viewpoint of drug uptake and PKC activity. Results: IC of adriamycin-cytotoxicity on MCF-7/WT and MCF-7/ADM was 0.2 ug/ml and 2 ug/ml, respectively. Tamoxifen moved IC of adriamycin-cytotoxicity of left in a dose-dependent manner in MCF-7/ADM, and 10 pM concentration of tamoxifen made IC 0.2 pg/ml in that cell line, which was very similar to IC in MCF-7/WT. But tamoxifen did not have synergistic cytotoxicity with adriamycin on MCF-7/WT. In drug efflux study with C14-adriamycin, tamoxifen enhanced drug uptake more than 200% in MCF-7/ADM although it markedly decreased when tamoxifen was added. There was no difference in baseline PKC activity and degree of dose-dependent inhibition on PKC activity by adriamycin in those two cell lines. Canclusion; Tamoxifen is thought to be as one of the plausible agents to reverse MDR in breast cancer. The possible mechanisms are to increase cellular uptake of adriamycin and to inhibit PKC activity.
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A Clinical Analysis of the Thyroid Nodules
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Seung Keun Oh, Byung In Moon, Hwan Young Yoo
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J Korean Cancer Assoc. 1994;26(2):249-262.
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- One thousand and fifty five patients with thyroid nodules who underwent thyroidectomy at the department of surgery, Seoul National University Hospital between August, 1983 and July, 1993 were clinically analyzed and the follow-up study was performed for the patients. Of the thyroid nodules, the benign was 63.7% and the malignant was 36.4%. The malignancy ratio was increasing in tendency according to the diagnostic improvement and strict application of the surgical indications. Of the benign nodules, 83.9% was the adenomatous goiter, 13.3% was the follicular adenoma, and 1.9% was the Hashimoto's disease. Of the malignant nodules, 83.6% was the papillary carcinoma, 12.0% was the follicular carcinoma, 1.3/ was the medullary carcinoma, and 2.9 was the anaplastic carcinoma. The thyroid nodules were commonly observed between the thirties and fifties of age. The malignancy ratio, however, was significantly high under the tenth and over the fifties of age. The male to female ratio was 1 to 8.3 in the benign and 1 to 5.6 in the malignant. The malig- nant ratio was higher in males. The nodules were common in the right lobe and bilateral lesions were more common in the benign nodules. The possibility of malignancy was higher in the solitary rather than multiple, and in the solid rather than cystic lesions. The nodules fell mostly between 1.6 cm and 3.0 cm in size. The malignancy ratio, however, was significantly higher in the nodules under 1.5 cm in size and over 6.1 cm as welL The possibility of coexisitence of malignant disease was 7.5/ in the benign nodules. There were lymphnode metastases in 59.5% of the papillary, 2.2% of the follicular, 80% of the medullary, and 100/ of the anaplastic carcinomas. The distant metastatic sites commonly observed were the lung in the papillary and anaplastic, and the spine in the follicular carcinomas. The operation frequently performed was total lobectomy with or without isthmectomy for the benign, and subtotal thyroidectomy for the malignant nodules. The recurrence was not related to the extent of thyoidectomy itself but the status of metastasis and the operation on the neck nodes as well. The rate of complications was higher in the cases with malignant nodules than in the benign cases.
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Fraquency and Clinical Implication of bcl-2 / JH Rearrangement in Korean Non - Hodgkin's Lymphoma
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Yeul Hong Kim, In Sun Kim, Jin Hai Hyun
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J Korean Cancer Assoc. 1994;26(2):262-274.
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- The translocation of 14q32 with 18q21 is the most common chromosomal abnormality in human non-Hodgkins lymphomas. The translocation is commonly associated with the follicu- lar lymphoma which is relatively rare in Korean. About 30% of large cell lymphomas in West- ern countries have same translocation and this finding suggests that this subset of large cell lymphoma would be evolved from foilicular lymphoma. Recently, the translocation breakpoint has been cloned and polymerase chain reaction(PCR) for detecting bcl-2/JH(immunoglobulin heavy chain gene joining segment) rearrangement, the crossover site of trans1ocation, was in- troduced. Detection of bcl-2/JH rearrangement in Korean large cell lymphoma tissue should lead to better understanding of the biology of lymphomas in Korea. So, this study was designed to evaluate the frequency of bcl-2/JH rearrangement in Korean non-Hodgkins lymphomas and to compare the result with those of other countries. The DNA from total 22 cases of non-Hodg- kin's lymphomas were examined with PCR and Southern hybridization with radiolabeled oligonucleotide probes. DNAs were extrated from 15 unfixed frozen and 7 formalin-fixed parffin-embedded biopsy specimens. The t(14; 18) chromosomal translocation, resulting in bcl-2/ JH fusion gene, was detected in 1(9%) of 1 1 diffuse large cell lymphomas and 2(14.3%) of 14 B cell lymphomas. The low frequency of bcl-2/JH rearrangement suggests different genetic consequences in lymphomagenesis of Asian. However, the clinical implication of bcl-2/JH rear- rangement is doubtful in Korean due to quite low frequency.
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Augmentaion of Cytotoxicity of Anticancer Drugs with Biological Response Modifiers against Human Leukemia Cell Lines
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Yun Young Lee, Eui Gun Chun, Jun Young Kil, Ill Kuk Yoon, Kwan Hee Yu, Byung Zun Ahn, Sam Yong Kim
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J Korean Cancer Assoc. 1994;26(2):274-285.
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- To investigate the possibility of increased cytotoxicity of anticancer drugs, we treated human leukemia cells with combinations of anticancer drugs and biological response modifiers (BRMs). Using the colorimetric [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay, we evaluated the chemosensitivity of 8 anticancer drugs(vincristine, vinblastine, adria- mycin, cisplatin, etoposide, cytosine arabinoside, bleomycin, and cyclophosphamide), and the anticancer effects of 3 BRMs(interleukin-2, alpha interferon, and gamma interferon) combined with these anticancer drugs against human leukemia HL-60 and KG-1 cells. The results were as follows; in the chemosensitivity of 8 anticancer drugs, VCR, VBL, ADR, and CPDD were effective, while VP-16, ara-C, Bleo, and CYC produced less than 50% inhibition of HL-60 and KG-1 cells lines. Among 3 BRMs investigated, all of them showed less than 20% inhibition of KG-1 cell lines and none were effective against HL-60 cells. In the anticancer effects of 3 BRMs, all of them showed about 20% inhibitory effects against KG-1 cells, but there were not any effects against HL-60 cells. All of the anticancer drugs markedly increased cytotoxic effects when they were combined with BRM. Especially, the ID values of VCR, VBL, and ADR when combined with BRMs decreased to 67~3%. These results demonstrate that some BRMs can markedly increase the cytotoxicity of VCR, VBL, ADR, CPDD, VP-16, ara-C, Bleo, and CYC and suggest possible clinical usefulwess.
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Studies on the H2B Histone , c-Myc and DNA Topoisomerase 1 Gene Expression during HL - 60 Differentiation by All - Trans Retinoic Acid
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Kyu Lim, Jeong Dong Park, Byung Han Choi, Young Jin Lee, Kye Young Kim, Myung Sun Lee, Eun Mi Chang, Sam Yong Kim, Gi Ryang Kweon, Sang Tae Kwak, Byung Doo Hwang
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J Korean Cancer Assoc. 1994;26(2):285-296.
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- Effects of all-trans retinoic acid(retinoic acid) on DNA replication, H2B histone and DNA topoisopmerase I(Topo I) gene expression have been investigated in human promyelocytic leukemia cell line HL-60. DNA synthesis decreased at 24 hours after exposure of retinoic acid in the HL-60 cells. H2B histone mRNA rapidly reduced at 48 hours and Topo I and c-myc mRNA at 24 hours in retinoic acid-exposured HL-60 cells, respectively. The levels of c-myc, H2B his- tone and Topo I gene expression were reduced in proportion to the concentration of retinoic acid. The H2B histone mRNA in retinoic acid-exposured cells was elevated by cycloheximide treatment, while the level of Topo I mRNA was constant. These results suggest that regulations of H2B histone, c-myc and Topo I gene expression are different from one another, and repression of Topo I gene is closely correlated with c-myc gene during retinoic acid-induced differentiation of HL-60 cells.
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Mutations of the p53 Tumor Suppressor Gene in Human Epithelial Overian Cancer
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Jin Woo Kim, Dong Jin Kwon, Duk Jin Rha, Joon Mo Lee, Dae Hoon Kim, Sung Eun Namkoong, Seung Jo Kim
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J Korean Cancer Assoc. 1994;26(2):296-304.
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- The p53 gene on chromosome 17p is considered to be a tumor suppressor gene, and frequent mutations in highly conserved regions of the p53 gene have been found in a wide variety of human cancers. Mutations in this portion of the gene are known to lead to the loss of the oncosuppressive potential of p53. To detect in a more sensitive manner p53 gene mutations in 28 human epithelial ovarian cancers we utilized the polymerase chain reaction-single strand conformation polymorphism(PCR- SSCP) technique. Using PCR primers for the regions of the p53 gene, including exons 4-9, p53 mutations were detected in 35.7%(10 of 28) of the ovarian cancers, Of the 10 mutations observed, 1 was found in exon 4, 7 were found in the region encompassing exons 5 and 6, 1 was found in exon 7 and 1 was found in the region encompassing exons 8 and 9. Mutations were clustered in exons 5 and 6 in highly conserved regions of the p53 gene. There results suggest that the mutations of the p53 gene play an important role in the development of human epthelial ovarian cancers.
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Development of an Assay System for the Micrometastasis of F9 Teratocarcinoma Stem Cells
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Hee Jae Cha, Chul Woo Kim, Byung Chae Park, Kyu Won Kim
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J Korean Cancer Assoc. 1994;26(2):304-311.
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- During the tumor progression, micrometastases at their earliest stages have been difficult to analyze qualitatively or quantitatively because of lacking suitable sensitive markers to discriminate small numbers of tumor cells from cell populations of normal tissue. To identify the distribution of micrometastases and tracing of F9 teratocarcinoma stem cells in viva, we used chick embryos and the polymerase chain reaction(PCR) as simple, sensitive, and quantitative assay system. Hence, F9 cells which metastasized in the liver of chick embryo were detected by PCR using specific primers for mouse B-globin gene. In addition, another assay method was developed for detecting micrometastases of F9 cells with E.coli lacZ gene as a genetical and histochemical marker. After the subsequent transfection of the lacZ gene into F9 cells, an intensely blue-staining clone harboring lacZ gene was isolated by using chromogenic substrate, 5-bromo-4-chloro-3-indoyl-B-D-galacto-pyranoside (X-Gal). The lacZ-bearing F9 cells at primary tumor sites as well as at secondary organs can be stained intensely blue spots and easily distinguished from the host tissue cells after hours, days, or weeks postinjection.
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Ultrastructural Study on the Secretory Duct of Parotid Gland of the Head - Irradiated Rat
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Seok Joon Yoo, Jin Gook Kim, Kyung Ho Park, Jeong Sik Ko, E Tay Ahn, Nam Gil Yang
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J Korean Cancer Assoc. 1994;26(2):311-322.
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- Function of salivary gland is severely disturbed during the radiotherapy for the patients with the head and neck cancers. Primary saliva is secreted by the glandula acini, but the various secretion from the ductal cells and the electrolyte control of ductal cells influence the component and character of the final saliva. In this study, the radiation effect on the duct cells of rat parotid gland was studied. Under sodium thiopental anesthesia, male rats weighing 200~250 g each were exposed to the radiation source of Mitshubishi linear accelerator(ML-4MV). Head and neck regions were exposured within the area of 30 30 cm, at the distance of 80 cm, in the depth of 1.2 cm, by the speed of 200 rads/min. Total doses were 3,000rads or 6,000 rads, and the survival times were 6 hours, 2 days or 6 days, respectively. Parotid glands were fixed in the 2.5% glutaraldehyde-l.5% paraformaldehyde solution, followed by refixation in the 1% osmic acid solution. Tissues were embedded within the araldite mixture. Thin sections were stained with the uranyl acetate-lead citrate solution. From the electron microscopic study, the following results were nbtained, l) Intercalated duct ce11s of the rat parotid gland were relatively organelle-poor, and they contained same secretory granules. Striated duct cells showed typical basal striations formed by the parallel infoldings together with the large number of mitochondria between the infoldings. Striated duct cell contained only a few secretory granules. 2) Following the irradiation, many intercalated duct cells showed atrophic change, thereafter content of secretory granule were increased, even without any structural recovery of the cyto- plasm. 3) The striated duct cells also showed the radiation effects. On the basal cytoplasm, the striations were disorganized or disappeared. But the content of secretory granules in the supranuclear region was largely increased. 4) Myoepithelial cells were altered or degenerated. It means that the autonomic control of ductal cell secretion is also distrubed. The cytology of the duct cells following the irradiation was interpreted as that, cessation or extreme slow-down of the secretory procedure was occurred by high dose irradiation. The electrolyte control function of the striated duct cell might be severely disturbed.
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Comparison of Infection between Malignant and Benign Disease
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Soon Joo Wang, Jin Pok Kim
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J Korean Cancer Assoc. 1994;26(2):322-330.
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- It is we11 known that many immunological functions such as humoral antibody, T lympho- cyte, B lymphocyte, K cell, NK cell and macrophage are decreased in patient with malignant tumor. And the differences in rate of infection, pattern and organism are expected between malignant and benign disease. So, authors examined the medical and laboratory records of 2638 patients who had under- went surgery at Seoul National University Hospital from January 1991 to December 199l and extracted 121 patients who were bacteriologically identified postaperatively excluding the patients with preoperative fever. 1) Number of patients with malignant disease was 86, with 61 males and 25 females, whose mean age was 55. 35 patients in benign disease with 18 males and 17 females, whose mean age was 42. 2) Rate of infection was 6.08% in malignant diseases, 2.85% in benign diseases, which had meaningful difference(P < 0.05). 3) Pancreatobiliary disease had the highest infection rate(15.6%) among malignant diseases and kidney allograft had the highest among benign diseases. 4) Respiratory infection(15.8%), intraabdominal abscess(13.5%) and wound infection(12.0%) were frequent in malignant diseases, but bacteremia(16.7%), wound infection(12.5%) and respiratory infection(10.4%) were frequent in benign diseases. 5) E. coli(20.8%), Coagulase(-) Staphylococccus(18.5%) and Pseduomonas(16.2%) were frequent in malignant disease, but Staphylococcus(18.6%), Enterobacter(13.6%) and Enterococcus (11.9%) were frequent in benign disease, Meaningfully frequent organisms were E. coli and Pseduomonas in malignant disease, Enterobacter in benign disease. In conclusion, infectious complications were more freguent in malignant disease than in benign disease and differences in pattern and organism of infection existed between them.
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Bile Duct Cystadenoma in Liver - A case report -
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Sang Hoon Kim, Ho Seong Kim, Sang Hyun Rho
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J Korean Cancer Assoc. 1994;26(2):330-337.
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- The bile duct cystadenoma is a very rare, premalignant cystic lesion that only about less than l00 cases were reported in the literatures. The lesions occur most often in middle-aged woman characterized by epigastric discomfort, right upper quadrant pain and palpable mass. The etiology of the cyatadenoma is still unknown. It is believed that cystadenocarcinomas are derived from benign cystadenomas, because most of the malignant tumors contain a considerable amount of benign epithelium. And complete excision is the ideal treatment for bile duct cystadenoma because it is a true neoplasm. A 64 years old female patient was admitted to this hoepital with the complaints of intermit- tent right upper quadrant pain and lower abdominal pain with palpable mass. Exploratory laparotomy wes performed which disclosed a hard, smooth and round cyst mass, about 7cm in diameter in the left hepatic lobe. The cut surface of the tumor showed multiloculated appearance. The cyst was seperated with a septum, and had well developed wall, containing serosanguineous fluid and multiple pigment stones. Histopathological examination canfirmed the cystadenoma of the bile ducts.
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Malignant Histiocytosis Invoving Meninges - A case report -
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Cheol Seung Youn, Hyeon Kim, Dong Myeong Lim, Dae Cheol Wee, Yeun Keun Lim, Hyang Soon Yeo, Hong Bae Park, Young Hyu Kim, Sang Woo Juhng, Sang Woo Juhng
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J Korean Cancer Assoc. 1994;26(2):337-345.
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- A l7-year-old girl presented with fever and headache. A brain CT found tentorial thickening that mimicked tuberculous meningitis. She had received antituberculous medication, which failed to respond, and subsequently developed anemia, hepato-plenomegaly and lymph- adenopathy. A bone marrow aspiration revealed erythrophagocytic histiocytes and a lymph node biopsy disclosed lysozyme positive malignant histiocytes. She died 7 months after the onset of the illness. We report a case of malignant histiocytosis involving meninges at initial presentation.
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A Case of Cardiac Metastasis of Chondrosarcoma
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Seung Park Yoo, Bo Yun Chung, Ki Chan Kim, Yeul Hong Kim, Jeong Sik Park, Hyo Jin Lee
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J Korean Cancer Assoc. 1994;26(2):345-351.
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Abstract
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- Metastatic cardiac cancers are more prevalent than generally realized. So prompt recognition is mandatory if any cardiovascular manifestations develop in a patient with a malignant lesion elswhere in the body. Sixty-five year old male patient who had past history of resected chondrosarcoma on the 10th rib of left side presented as a local recurrence and dyspnea. Chest C-T findings demonstrated thrombose on right atrium and superior vena cava. Two-dimensional echocardiographic study showed mild pericardial effusion with a small mass attached to the visceral pericardium and a huge mass occupying nearly entire right atrial chamber with extension to superior vena cava. These findings are suggestive of cardiac metastasis of chon- drosarcoma.
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Renal Cell Carcinomas with Odd Pattern of Metastasis
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Jung Sik Oh, Hyun Muck Lim, Sun Taik Chang, Yong Wook Park, Jae Hyung Yoo, Woo Chul Moon
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J Korean Cancer Assoc. 1994;26(2):351-360.
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Abstract
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- Patients with metastatic renal cell carcinoma(RCC) usually have a dismal prognosis with a median survival duration of 12 months despite intensive systemic therapy of varioue modalities. The role of surgical removal of metastatic tumor is controversial, RCC usually shows predictable pattern of metastasis, preferentially to lung, lymph node, bone, liver and adrenaL It is rare for general surgeon to have a chance to see and operate the metastatic RCC. We herein report two cases of RCC which produced metastaaes of odd pattern and were treated by surgical removal of the metastatic organ at the department of general surgery with good outcomes. One patient presented with RCC with metastasis to gall bladder, which was treated by radical nephrectomy and cholecystectomy. The other patient presented with thyroid mass, which was confirmed as metastatic RCC after thyroidectomy. He had history of surgery for metastatic RCC to skin, lung and ethmoid bone sequentially every 2 years during past 9 years after nephrectomy. The 2 cases suggest that RCC can produce metastases of very unusuall location, induding gall bladder and thyroid and preaentation long time after nephrectomy, and in which cases ag- gressive surgical removal of the metaatatic tumor may be of benefit.
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