Dong Hee Ryu

Bowel infarction due to intestinal mucormycosis in an immunocompetent patient

Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.

Common bile duct dilatation after cholecystectomy: a one-year prospective study

Purpose Bile duct dilatation after cholecystectomy continues to be a matter of controversy. We aimed determine the magnitude of common bile duct (CBD) dilatation after cholecystectomy followed up to 1 year. Methods Sixty-four cases (age, 47.3 ± 11.7 years; men, 28; women, 36) enrolled in this study. They received laparoscopic cholecystectomy in Chungbuk National University Hospital for symptomatic cholelithiasis or gallbladder polyps with normal bile duct, less than 7 mm. The CBD diameter was measured by one radiologist using ultrasonography at the maximum point after full length evaluation of extrahepatic bile duct. Forty-five and thirty-one cases were followed at 6 months and 1 year, respectively. Results The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after cholecystectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm. Conclusion Postcholecystectomy dilatation of the bile duct occured slightly in most cases. But some cases showed more than 3 mm dilatation over baseline. Asymptomatic bile duct dilatation of up to 10 mm can be considered as normal range in patients after cholecystectomy.

Laparoscopic appendectomy is a safe and beneficial procedure in pregnant women.

Background Appendectomy is the most common nongynecologic surgery performed during pregnancy. Pregnancy is no longer considered an absolute contraindication for laparoscopic procedures. Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. Methods Between May 2005 and May 2009, 20 patients with clinically suspected appendicitis in pregnancy underwent LA at Chungbuk National University Hospital. Clinical data collected retrospectively included demographic information. We compared maternal age, gestational age, operation time, anesthetic time, surgical complications, length of hospitalization, and final outcome of pregnancy. Results All the 20 patients who underwent LA did not need a conversion. Mean maternal age was 28.1 years (range, approximately 20 to 35 y), gestational age was 15.4 weeks (range, approximately 6 to 30 wk), mean operation time was 45.5 minutes (range, approximately 25 to 90 min), mean length of hospital stay was 4.7 days (range, approximately 2 to 11 d). Fifteen of 20 pregnant women delivered healthy term infants and 5 women have kept a healthy pregnancy. Conclusions Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.

The value of a laparoscopic interval appendectomy for treatment of a periappendiceal abscess: experience of a single medical center.

Background: Interval appendectomy has been known to be an effective and safe treatment for a periappendiceal abscess, but there is no study on a laparoscopic approach for the treatment of a periappendiceal abscess. The aim of this study is to investigate the value of laparoscopic interval appendectomy. Materials and Methods: We retrospectively studied 56 patients who had been admitted due to a periappendiceal abscess to Chungbuk National University Hospital from July 2005 to June 2010. Fifteen patients underwent an initial conservative treatment and interval appendectomy. Medical records were reviewed for the postoperative hospital course such as complications, time of initiation of diet, time since stopping antibiotics, symptoms’ relief period, and length of hospital stay. Results: All patients received initial conservative treatment [percutaneous drainage insertion (1 case failed) and intravenous antibiotics], and the initial length of hospital stay was 11.6±4.3 days. Percutaneous drainage was removed a mean of 21.7±9.4 days after the initial treatment. Interval appendectomy was performed at a mean of 64.0±17.8 days after initial admission. The duration of use of intravenous antibiotics was a mean of 4.1±1.8 days after laparoscopic interval appendectomy. The complication rate was 1 (6.7%) and the open conversion rate was 1 (6.7%). Conclusions: Our study revealed that initial conservative treatment and laparoscopic interval appendectomy represented a feasible and effective treatment for patients with a periappendiceal abscess.

Synchronous Bilateral Male Breast Cancer: A Case Report

Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed.

Preoperative CA 125 is significant indicator of curative resection in gastric cancer patients

AIM To investigate the correlation among tumor markers, curative resection, and recurrence in gastric cancer. METHODS The patients with preoperative tumor makers [Carcinoembryonic antigen, Carbohydrate antigen (CA) 19-9, and CA 125] and elective gastrectomy between January 2000 and December 2009 at Chungbuk National University Hospital were enrolled in this study. We analyzed the relationship among the tumor makers, curative resection and recurrence, retrospectively. RESULTS Among the 679 patients with gastric cancer, curative resection was 93.6% (n=636) and non-curative resection was 6.4% (n=43). The independent risk factors for the non-curative resection were tumor location and the positivity of preoperative serum CA 19-9 and CA 125 levels. After curative resection, the independent prognostic risk factors for recurrence in curative resection were gender, stage, and preoperative increased serum CA 125 level (HR=2.431, P=0.020), in a multivariate analysis. CONCLUSION Preoperative CA 125 is a useful predictive biomarker for curative resection and prognostic biomarker for recurrence in gastric cancer patients.

Gallbladder Metastasis of Non-small Cell Lung Cancer Presenting as Acute Cholecystitis.

Although non-small cell lung cancer (NSCLC) can metastasize to almost any organ, metastasis to the gallbladder with significant clinical manifestation is relatively rare. Here, we report a case of gallbladder metastasis of NSCLC presenting as acute cholecystitis. A 79-year-old man presented with pain in the right upper quadrant and fever. A computed tomography (CT) scan of the chest and abdomen showed a cavitary mass in the right lower lobe of the lung and irregular wall thickening of the gallbladder. Open cholecystectomy and needle biopsy of the lung mass were performed. Histological examination of the gallbladder revealed a moderately-differentiated squamous cell carcinoma displaying the same morphology as the lung mass assessed by needle biopsy. Subsequent immunohistochemical examination of the gallbladder and lung tissue showed that the tumor cells were positive for P63 but negative for cytokeratin 7, cytokeratin 20 and thyroid transcription factor-1. A second primary tumor of the gallbladder was excluded by immunohistochemical methods, and the final pathological diagnosis was gallbladder metastasis of NSCLC. Although the incidence is extremely rare, acute cholecystitis can occur in association with lung cancer metastasis to the gallbladder.

Clinical Implications and Prognostic Values of Prostate Cancer Susceptibility Candidate Methylation in Primary Nonmuscle Invasive Bladder Cancer

DNA methylation is the most common and well-characterized epigenetic change in human cancer. Recently, an association between prostate cancer susceptibility candidate (PRAC) methylation and genitourinary cancer was proposed. The aim of the present study was to evaluate the association between PRAC methylation status and clinicopathological parameters and prognosis in long-term follow-up primary nonmuscle invasive bladder cancer (NMIBC). The clinical relevance of PRAC methylation was determined in 136 human bladder specimens (eight normal controls [NCs] and 128 primary NMIBCs) using quantitative pyrosequencing analysis. PRAC methylation was significantly higher in NMIBC patients than in NCs and was significantly associated with higher grade and more advanced stage of cancer. Kaplan-Meier estimates revealed significant difference in tumor recurrence and progression according to PRAC methylation status (both p < 0.05). Multivariate Cox regression analysis revealed that the PRAC methylation status was a strong predictor of recurrence (hazard ratio [HR], 2.652; p = 0.012) and progression (HR, 9.531; p = 0.035) of NMIBC. Enhanced methylation status of PRAC was positively associated with a high rate of recurrence and progression in NMIBC patients, suggesting that PRAC methylation may be a promising prognostic marker of NMIBC.

Application of Mini-abdominoplasty after Conservative Excision of Extensive Cesarean Scar Endometriosis

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9×6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patients age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.

Expression levels of FGFR3 as a prognostic marker for the progression of primary pT1 bladder cancer and its association with mutation status

The present study examined the utility of fibroblast growth factor receptor 3 (FGFR3) mutation status and gene expression as a prognostic marker in primary pT1 bladder cancer (BC). A total of 120 patients with primary pT1 BC were enrolled. FGFR3 mutation status was determined by direct sequencing and FGFR3 mRNA expression level was determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. The results were compared with the clinicopathological parameters, and the prognostic value of FGFR3 was evaluated by Kaplan-Meier analysis and a multivariate Cox regression test. FGFR3 mutations were identified in 48/120 (40.0%) patients with pT1 BC. FGFR3 mRNA expression level was significantly higher in those with BC harboring FGFR3 mutations (P<0.001). Low FGFR3 expression level was associated with high-grade tumors and cancer progression (P=0.006 and P=0.001), whereas FGFR3 mutation status was not associated with cancer progression. Kaplan-Meier analysis revealed a similar result (log-rank, P<0.001). Multivariate analysis identified low FGFR3 expression level (odds ratio, 3.300; 95% confidence interval, 1.310-8.313; P=0.011) as an independent predictor of cancer progression. Stratification by exon site of FGFR3 mutations yielded significant differences in mRNA expression level. None of the patients with BC harboring FGFR3 mutations in exon 9 demonstrated disease progression. The mRNA expression level of the FGFR3 gene may be used to precisely identify subsets of patients with pT1 BC that have a relatively better prognosis. The prognostic influences of FGFR3 mutations may be modulated by the exon site of FGFR3 mutations.