PURPOSE: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. MATERIALS AND METHODS: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopy-assisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. DISCUSSION: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer.Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).
Arm ; Disease-Free Survival ; Endoscopy ; Gastrectomy ; Humans ; Informed Consent ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Prospective Studies ; Sample Size ; Stomach Neoplasms

Anterior spinal artery syndrome, also known as Beck's syndrome, is defined as ischemia or infarction of the spinal cord. Beck's syndrome occurs from aortic thrombus, embolism, or dissection blocking the blood flow to the great radicular artery (GRA) of Adamkiewicz. Abdominal artery embolism due to trauma is relatively rare and urgent detection of vascular injury is substantial to fair clinical outcome of the patient, therefore, we report on a case of traumatic artery dissection presenting as lower leg weakness.
Anterior Spinal Artery Syndrome ; Arteries ; Automobiles ; Embolism ; Humans ; Infarction ; Ischemia ; Leg ; Paresis ; Spinal Cord ; Spinal Cord Ischemia ; Thrombosis ; Vascular System Injuries

BACKGROUND/AIMS: First-line therapies against Helicobacter pylori, including proton pump inhibitors (PPIs) plus two antibiotics, may fail in up to 20% of patients. 'Rescue' therapy is usually needed for patients who failed the first-line treatment. This study evaluated the eradication rate of bismuth-containing quadruple rescue therapy over a 1- or 2-week period. METHODS: We prospectively investigated 169 patients with a persistent H. pylori infection after the first-line triple therapy, which was administered from October 2008 to March 2010. The patients were randomized to receive a 1- or 2-week quadruple rescue therapy (pantoprazole 40 mg b.i.d., tripotassium dicitrate bismuthate 300 mg q.i.d., metronidazole 500 mg t.i.d., and tetracycline 500 mg q.i.d.). After the 'rescue' therapy, the eradication rate, compliance, and adverse events were evaluated. RESULTS: The 1-week group achieved 83.5% (71/85) and 87.7% (71/81) eradication rates in the intention to treat (ITT) and per-protocol (PP) analyses, respectively. The 2-week group obtained 87.7% (72/84) and 88.9% (72/81) eradication rate in the ITT and PP analyses, respectively. There was no significant difference in the eradication rate, patient compliance or rate of adverse events between the two groups. CONCLUSIONS: One-week bismuth-containing quadruple therapy can be as effective as a 2-week therapy after the failure of the first-line eradication therapy.
Anti-Bacterial Agents ; Bismuth ; Compliance ; Helicobacter ; Helicobacter pylori ; Humans ; Intention ; Metronidazole ; Organometallic Compounds ; Patient Compliance ; Prospective Studies ; Proton Pump Inhibitors ; Tetracycline

PURPOSE: We determine the Korean antibody titer and positive rate of tetanus by using a with qualitative test (ELISA) and a quantitative test (TQS(R)). METHODS: This study was prospective collecting study with uncontolled patients who were admitted in 21 Emergency Departments during 3 months in South Korea. We measured TQS(R) and collected the serum with a centrifuge for 5 groups, which was classified with age: 2~10 years (I), 11~20 years (II), 21~30 years (III), 31~40 years (IV), 41~60 years (V), in each hospital. The freezed serum and the protocol with TQS(R) results were taken at the Soonchunhyang University Bucheon hospital to be analyzed. RESULTS: The number of enrolled patients was 1816 (male 58%). The positive rate of TQS(R) was 835 patients (46%), and there was no relation with region or sex. In sex and age, there was a definitive decline in the group III fort males and females. The results of ELISA was showed that 62.8% (> 0.15 IU/ml) and 52.2% (> 0.2 IU/ml) had protective levels of tetanus antibody. The proportion decreased to approximately 43% and 18% among persons 40~60 years of age at each level of antibody titers. By region and population, there was no statistical relationship with TQS(R) and ELISA, but previous military service was associated with a higher prevalence of protective antibodies to tetanus (p<0.001). CONCLUSIONS: A substantial portion of adults in South Korea do not have antibody levels that are protective against tetanus. Also, the mean level of tetanus antibody titers was definitively lower than those of other developed conturies and consistently decreased with aging. Therefore, an adult formulation diphteria and tetanus toxoid every 5 or 10 years is recommended for all adults between 20 and 60 years of age after being tested with TQS(R) in South Korea.
Adult ; Aging ; Antibodies ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Epidemiology ; Female ; Gyeonggi-do ; Humans ; Korea ; Male ; Military Personnel ; Prevalence ; Prospective Studies ; Tetanus ; Tetanus Toxoid

OBJECTIVE: The phosphorylated isoforms of insulin-like growth factor-binding protein-1 (IGFBP-1) were produced by the decidua. The aim of this study was to evaluate whether the presence of phosphorylated IGFBP-1 (phIGFBP-1) in cervical secretions of pregnant women with preterm uterine contractions can predict an increased risk of preterm delivery and infectious complications. METHOD: The prospective study of 32 pregnant women who admitted under the diagnosis of preterm labor with intact membrane at gestational age of 24+0 to 36+0 weeks. Phsphorylated IGFBP-1 was qualitatively assayed using immunochromatography in cervical swab samples at the time of admission. The interval between the test and delivery, gestational age, duration of tocolysis, birth weight, CRP, ESR and the presence of neonatal infection were compared between positive and negative groups. RESULTS: There was no differnce in age, obstetric histories and gestational age and Bishop score at the time of admission between two groups. Eight pregnacies out of 13 positive group and two pregnacies out of 19 negative group resulted in preterm birth. The sensitivity and specificity of the phIGFBP-1 test to predict preterm birth were 80.0% and 77.3%, respectively. The mean getational age and interval between the test and delivery were 38.36 weeks and 45.0 days and 35.78 weeks and 35.46 days in negative and positive group respectively. The birth weight of the babies was significantly higher in negative group. The duration of tocolysis was longer in positive group with marginal statistical significance. The CRP, ESR and WBC count were not different. One postpartum sepsis, one neonatal death and one necrotizing enterocolitis were complicated in positive group. CONCLUSION: The presence of phIGFBP-1 is an usful marker to predict preterm birth in case of regular uterine contraction with intact fetal membranes.
Birth Weight ; Decidua ; Diagnosis ; Enterocolitis, Necrotizing ; Extraembryonic Membranes ; Female ; Gestational Age ; Humans ; Immunochromatography ; Insulin-Like Growth Factor Binding Protein 1 ; Membranes ; Obstetric Labor, Premature ; Postpartum Period ; Pregnancy ; Pregnant Women ; Premature Birth ; Prospective Studies ; Protein Isoforms ; Sensitivity and Specificity ; Sepsis ; Tocolysis ; Uterine Contraction

OBJECTIVE: The phosphorylated isoforms of insulin-like growth factor-binding protein-1 (IGFBP-1) were produced by the decidua. The aim of this study was to evaluate whether the presence of phosphorylated IGFBP-1 (phIGFBP-1) in cervical secretions of pregnant women with preterm uterine contractions can predict an increased risk of preterm delivery and infectious complications. METHOD: The prospective study of 32 pregnant women who admitted under the diagnosis of preterm labor with intact membrane at gestational age of 24+0 to 36+0 weeks. Phsphorylated IGFBP-1 was qualitatively assayed using immunochromatography in cervical swab samples at the time of admission. The interval between the test and delivery, gestational age, duration of tocolysis, birth weight, CRP, ESR and the presence of neonatal infection were compared between positive and negative groups. RESULTS: There was no differnce in age, obstetric histories and gestational age and Bishop score at the time of admission between two groups. Eight pregnacies out of 13 positive group and two pregnacies out of 19 negative group resulted in preterm birth. The sensitivity and specificity of the phIGFBP-1 test to predict preterm birth were 80.0% and 77.3%, respectively. The mean getational age and interval between the test and delivery were 38.36 weeks and 45.0 days and 35.78 weeks and 35.46 days in negative and positive group respectively. The birth weight of the babies was significantly higher in negative group. The duration of tocolysis was longer in positive group with marginal statistical significance. The CRP, ESR and WBC count were not different. One postpartum sepsis, one neonatal death and one necrotizing enterocolitis were complicated in positive group. CONCLUSION: The presence of phIGFBP-1 is an usful marker to predict preterm birth in case of regular uterine contraction with intact fetal membranes.
Birth Weight ; Decidua ; Diagnosis ; Enterocolitis, Necrotizing ; Extraembryonic Membranes ; Female ; Gestational Age ; Humans ; Immunochromatography ; Insulin-Like Growth Factor Binding Protein 1 ; Membranes ; Obstetric Labor, Premature ; Postpartum Period ; Pregnancy ; Pregnant Women ; Premature Birth ; Prospective Studies ; Protein Isoforms ; Sensitivity and Specificity ; Sepsis ; Tocolysis ; Uterine Contraction

The blind ending duplication of ureter represents a rare anomaly in development of ureteric bud, and may almost be asymptomatic. We report two cases of blind ending duplication of ureter, that were detected incidentally.
Ureter*

Although inverted papillomas of urinary tract have been reported, the lesion of the ureter is rare and peculiar tumor characterized by unique microscopic finding. The prognosis of ureteral inverted papilloma is very favorable, only small number progress to higher grade tumor. We report 2 cases of ureteral inverted papilloma which were treated by segmental resection with end-to-end anastomosis of ureter.
Papilloma, Inverted* ; Prognosis ; Ureter* ; Urinary Tract

Nephrogenic adenoma is a rare proliferative response of urothelium to chronic irritation or infection. It has been reported in the bladder, ureter, renal pelvis and urethra, but to date there have been only 15 reports, of its occurrence in the ureter. We present a further case of this lesion in this unusual location.
Adenoma* ; Kidney Pelvis ; Ureter* ; Urethra ; Urinary Bladder ; Urothelium

Urethral foreign body extended to bladder and scrotum is very rare. We report a case of urethral perforation by plastic tube extended to bladder and scrotum with brief review of literature.
Foreign Bodies* ; Plastics ; Scrotum ; Urethra ; Urinary Bladder