Surgery is the only hope to cure gastric cancer. The aim of surgery is the complete removal of the tumor (UICC RO-resection), which is known to be the only treatment modality proven effective and the most important treatment-related prognostic factor. The type of surgical treatment for gastric cancer is determined by the patient's medicosurgical status and the stage of disease. Improved survival and quality of life(QOL) are the major criteria for the therapeutic strategy. For patients with early gastric cancer, minimal invasive surgery is attempted for the improvement of QOL. Minimal invasive surgery can be performed only when there is no evidence for residual disease, especially in lymphnodes. Therefore, precise prediction and selection of node-negative patients is important for the application of minimal invasive surgery. However, long-term survival data are needed for these new techniques to become more generally accepted. For patients with advanced gastric cancer, aggressive and extended surgical approaches are recommended for the improvement of survival. Distal subtotal gastrectomy is the procedure of choice whenever tumor-free margin can be obtained, with the exception of proximal tumors that can be treated by total gastrectomy. Extended lymphadenectomy should be the choice of lymphadenectomy for experienced surgeons with a low morbidity and mortality. If a surgeon can perform combined resection of adjacent organs safely, it is recommended when a direct invasion is suspicious. Distal pancreatectomy should be avoided unless direct invasion is definite. Splenectomy for the purpose of lymph node dissection is be mandatory, and surgeons should consider preservation of the spleen when there is no definite splenic hilar lymph node enlargement or any direct invasion to the spleen. Cytoreductive surgery with intraperitoneal chemotherapy is a useful and promising procedure for the treatment of peritoneal metastasis. The therapeutic approach should be stratified according to the patient's status, tumor status,and QOL after resection. Above all, the treatment strategy should be specific and tailored to each patient for the improved survival and QOL.
Drug Therapy ; Gastrectomy ; Hope ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatectomy ; Spleen ; Splenectomy ; Stomach Neoplasms* ; Surgeons

The incidence and mortality rates for gastric cancer have decreased in the developed countries for the last several decades. On the other hand, they remain high in far Eastern countries such as Japan, China, and Korea and also in many developing countries. The risk of gastric cancer is greater among lower socioeconomic classes. The causes of this disease are still unclear. Long-term ingestion of highly concentrated nitrates in dried, smoked, and salted foods might be related with higher risk. Helicobacter pylori infection was classified as a group I definite human gastric carcinogen by the International Agency for Research on Cancer, World Health Organization (IARC/WHO) in1994. However, there are some debates on the association between H. pylori infection and gastric cancer. Complete surgical removal of the tumor with resection of adjacent lymph nodes offers the only chance for cure. As yet, this kind of treatment is possible in less than a half of patients. The prognosis after complete surgical resection depends on the degree of tumor penetration to the gastric wall. Cases with regional lymph node involvement, vascular invasion,and abnormal DNA content show poor prognosis. Gastric carcinoma is a relatively radio-re-sistant tumor, and the major role of radiation therapy has been the palliation of pain. Combinations of cytotoxic drugs for patients with advanced gastric cancer have shown a partial response in 20~60% of the patients, however, and complete remission was rare. In some recent studies, chemotherapy plus irradiation after surgical resection showed a better disease-free survival and overall survival. In conclusion, early detection and curative resection are very important to improve the survival of patients with gastric cancer. Newer therapeutic strategies such as preoperative chemotherapy or chemoradiotherapy have the potential to benefit the high-risk patients.
Chemoradiotherapy ; China ; Developed Countries ; Developing Countries ; Disease-Free Survival ; DNA ; Drug Therapy ; Eating ; Epidemiology* ; Hand ; Helicobacter pylori ; Humans ; Incidence ; International Agencies ; Japan ; Korea ; Lymph Nodes ; Mortality ; Nitrates ; Prognosis ; Smoke ; Stomach Neoplasms* ; World Health Organization

No abstract available.
Breast Neoplasms* ; Breast* ; Mass Screening*

The consultation of personnel in relation to sleep disorders in Korea increased by 1.6 times between 2008 and 2012, and the related days of clinical practice increased by nearly 12 times during the same period. Among the sleep disorders, the most common diagnosis is insomnia, which is most commonly treated with medication. Medication is not only easy to access, but also effective immediately. However, the beneficial effect of hypnotic medication on sleep disorder for an extended period of time may be trivial. Tolerance is another barrier to treating chronic insomnia. In addition, such adverse effects as psychomotor slowing, memory loss, forgetfulness, and decreased sense of balance can heighten the risk of motor vehicle accidents and falling-related injuries. Recently, there have been reports about the association between the chronic use of sleeping pills and cancer mortality and dementia incidence. However, there are still many limitations to understanding whether it is the chronic use of hypnotics, or coexisting mental and physical illness, which increases the risk. Nevertheless, it is worthwhile to pay special attention to the abovementioned risks when using hypnotics and to consider alternative treatment options like cognitive behavioral therapy for insomnia.
Cognitive Therapy ; Dementia ; Diagnosis ; Drug Therapy* ; Hypnotics and Sedatives ; Incidence ; Korea ; Memory Disorders ; Mortality ; Motor Vehicles ; Sleep Initiation and Maintenance Disorders* ; Sleep Wake Disorders

To eat unidentified or misidentified mushrooms taken from the wild can be very dangerous. In the vast majority of toxic mushroom ingestions in Korea, the mushroom was incorrectly identified. In general, poisoning of toxic mushrooms can be classified into seven types according to the toxins that they contain; amatoxin, gyromitrin, coprine, muscarine, ibotenic acid-muscimol, psilocybin-psilocin and gastrointestinal irritants. When clinicians care for a patient who ingested a toxic mushroom, it is very important to identify what kind of mushroom may have caused a patient's illness. But, in clinical practice, accurate botanical identification of the mushroom can be very difficult. Therefore, for estimating the caused mushroom and adequate treatment of poisoning, clinicians should know the type and treatment of toxic mushroom poisoning.
Agaricales* ; Edetic Acid ; Humans ; Irritants ; Korea* ; Muscarine ; Mushroom Poisoning* ; Poisoning

Maintaining patient safety in and outside the operating room is a major concern of plastic surgeons. Circumventing preventable complications is essential, as public acknowledgement and interest in the complications of cosmetic surgery rises. The plastic surgery patient is generally considered a safe candidate for surgery, but his or her health may have masked problems, and generally superficial surgery can still be subject to the common risks of surgery. Patient education and information on the procedure and the risks, benefits, and alternatives can help avoid surprise and confusion if a complication does occur. Peer-review systems in the form of weekly or monthly morbidity reporting conferences can help identify practice patterns that increase risks and can ultimately improve patient safety. After reviewing a patient's medical history, doing a thorough physical examination and review of systems, and pertinent laboratory or radiographic testing, the physician should select the patient's appropriate classification from the anesthesiologist's physical rating. Preparation and consideration for the common risks of plastic surgery should help to improve perioperative safety.
Classification ; Congresses as Topic ; Humans ; Masks ; Operating Rooms ; Patient Education as Topic ; Patient Safety* ; Perioperative Care ; Physical Examination ; Plastics ; Surgery, Plastic*

Chronic wounds are generally defined as non-healing wounds after four weeks of normal treatment. Individual risk factors for chronic wounds should be identified, but the delay of wound healing is often caused by the use of inappropriate dressing material. The concept of rapid wound healing with moist dressings has developed since the 1960s, and wet dressing is currently a widely popular method of wound treatment. Hundreds of dressing materials that maintain a moist environment are commercially available; however, selecting the right dressing material for a specific purpose is not easy, and unfortunately incorrect dressing procedures occur frequently. In order to promote wound healing education, we have classified dressing materials into basic categories and discuss the pros and cons and indications for each category. The purpose of this report is to reduce errors in selecting dressing materials and to enhance precise wound treatment.
Bandages* ; Education ; Risk Factors ; Wound Healing ; Wounds and Injuries*

Radiation ulcers are wounds caused by acute or chronic effects of ionizing radiation. The injury may involve the skin, underlying soft tissue, and even deeper into bones. Radiation is used alone or in combination with surgery and chemotherapy. Although it is useful to affect tumor death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment leads to fibrosis, nonhealing ulcers, lymphedema and radionecrosis amongst others.
Drug Therapy ; Fibrosis ; Lymphedema ; Radiation, Ionizing ; Radiotherapy ; Skin ; Ulcer* ; Wound Healing ; Wounds and Injuries*

The clinical significance of diabetes is increasing with a growing aged population and changes in lifestyle. Among all complications of diabetes mellitus, diabetic ulcers are the most severe and expensive. The lifetime incidence of diabetic foot ulceration is as high as 25%. Ulcers frequently become infected and are associated with the risk of limb amputation and increased mortality and healthcare costs. A specialized multidisciplinary team approach is needed to care for patients with ulceration. Comorbidities such as poor limb circulation and the loss of protective sensation due to diabetic vasculopathy and neuropathy should be treated concurrently to promote wound healing. In cases of ischemia, transluminal angioplasty or bypass surgery may enhance circulation, allowing ulcer healing or reconstructive surgery. With an integrated team approach, the major focus of ulcer treatment has changed from amputation to limb salvage. Appropriate follow-up, including the minimization of risk factors and education on foot care in daily living, is essential to prevent re-ulceration.
Amputation ; Angioplasty ; Comorbidity ; Diabetes Complications ; Diabetic Foot* ; Education ; Extremities ; Follow-Up Studies ; Foot ; Foot Ulcer ; Health Care Costs ; Humans ; Incidence ; Ischemia ; Life Style ; Limb Salvage ; Mortality ; Risk Factors ; Sensation ; Ulcer* ; Wound Healing

Repeated or chronic pressure on the eminent part of the body will cause circulation disorder to the affected part of the body. The lack of circulation will result in damage and necrosis of the tissue. This phenomenon is defined as pressure sore. Due to growth of aging population and chronic disease, incidence and prevalence rate is in-creasing rapidly. This leads to increased duration of hospital stay, and medical expenditure. Hence, prevention of pressure sore and appropriate treatment is essential in order to diminish distress of the patient and health care provider. Prevention of pressure sore can be accomplished by frequent position change of the patient, skin care, and appropriate nutrition care. Frequent position change is known to be the most important and effective method to prevent pressure sore. Skin care can be achieved by choosing proper dressing material, management of exu-date, and protection of the tissue around the wound. In addition, appropriate nutrition care in order to correct protein-calorie imbalance should also be performed. Necrotic tissue can cause inflammation, and it can also be a good source of bacterial growth. Therefore, debridement of necrotic tissue is most fundamental and essential part in the treatment of pressure sore. Meanwhile, when the patient is not a candidate for surgical treatment due to poor general condition, many methods of dressing can be performed. Recently, dressing material with silver component, and vacuum assisted closure dressing is being performed frequently. In case of surgical treatment, after debridement of necrotic tissue, reconstruction can be performed by split-thickness skin grafting, full-thickness skin grafting, or primary closure. However, majority of reconstruction is performed by flap surgery. Rotation or advancement flap is usually performed.
Aging ; Bandages ; Chronic Disease ; Debridement ; Health Expenditures ; Health Personnel ; Humans ; Incidence ; Inflammation ; Length of Stay ; Necrosis ; Negative-Pressure Wound Therapy ; Pressure Ulcer* ; Prevalence ; Silver ; Skin Care ; Skin Transplantation ; Wounds and Injuries