Multiple gastric caner, now considered to be a sort of multiple primary cancer by Moertel's classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Although its incidence is rare and it has never been reported in Korea yet, the report of multiple gastric cancer is increasing with lengthened life survival and improved diagnostic method. We recently experienced two cases of triple gastric cancer, the one in 53-years-old male who had well differentiated adenocarcinoma(EGC IIb+c) on antrum, poorly differentiated adenocarcinoma on cardia and moderately differentiated adenocarcinoma on mid-body, and the other in 65-years-old female who had two poorly differentiated adenocarcinoma on cardia and anterior wall of low body and moderately differentiated adenocarcinoma (EGCIIc) on posterior wall of low body. Triple gastric cancer is rare, so we reported 2 cases of triple gastric cancer.
Adenocarcinoma ; Cardia ; Classification ; Female ; Humans ; Incidence ; Korea ; Male ; Stomach ; Stomach Neoplasms*

Fat necrosis in transverse rectus abdominis musculocutaneous(TRAM) flaps is considered to be primarily affected by blood supply. Unreliability of blood supply in zone II has been claimed for years but no accurate comparison has been reported between fat necrosis in zone II and III. A prospective study about the incidences and extent of fat necrosis in zone II and III was designed, comparing relative vascularity between zone II and III. Immediate breast reconstructions after modified radical mastectomy or skin sparing mastectomy were performed in 150 consecutive patients with unipedicled TRAM flaps and 138 contralateral and 12 ipsilateral rectus muscles were used as pedicles. Twenty-one patients(14 percent) suffered from fat necrosis and 22 fat necroses were diagnosed in total. 17 fat necroses occurred in zone II, 3 in zone III and 2 in zone I. The incidence of fat necrosis in zone II was significantly higher than zone III, which was consistent with previous studies claiming poor vascularity of zone II. Therefore placing zone I and zone III medially and zone II laterally after discarding part of zone II will cause less deformity of reconstructed breast if resection of necrotized tissue is needed.
Breast ; Congenital Abnormalities ; Fat Necrosis* ; Female ; Humans ; Incidence ; Mammaplasty ; Mastectomy ; Mastectomy, Modified Radical ; Muscles ; Prospective Studies* ; Rectus Abdominis ; Skin

PURPOSE: Sentinel lymph node biopsy (SLNB) is a relatively accurate diagnostic method for determining the presence of axillary lymph node metastasis (ALND). SLNB reduces the need for axillary lymph node dissection, thereby decreasing the postoperative axillary morbidity. The present study compared the postoperative axillary morbidity rates during early postoperative days for patients undergoing either SLNB or conventional ALND. METHODS: We conducted a prospective case-control study of breast cancer patients. The degree of axillary morbidity was compared between 28 SLNB patients (Group I) and 38 ALND patients (Group II). RESULTS: The SLNB group showed decreased arm swelling and restriction of their shoulder motion in comparison with the conventional axillary dissection group (p<0.05). SLNB and additional lymph node sampling did not result in any additional morbidity. CONCLUSION: SLNB or lymph node sampling was associated with less axillary morbidity like arm edema, limitation of motion than was conventional ALND. The rate of postoperative axillary morbidity did not differ following lymph node sampling and SLNB. SLNB may be an effective method for diagnosing of axillary lymph node metastasis with decreasing the postoperative axillary morbidity
Arm ; Breast Neoplasms ; Case-Control Studies ; Edema ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Neoplasm Metastasis ; Prospective Studies ; Sentinel Lymph Node Biopsy* ; Shoulder

This prospective study surveyed the prevalence of peripheral arterial disease (PAD) in Korean patients with coronary arterial disease (CAD) or cerebrovascular disorder (CVD). From March 2010, 576 hospitalized patients in cardiovascular or stroke center were enrolled as the study group. Ankle-brachial index (ABI) was measured and the cut-off point for diagnosing PAD was < or = 0.9 at rest. A total of 424 hospitalized patients in the Department of Surgery and aged > or = 50 yr was enrolled as the control group. The prevalence of PAD was significantly higher in the study group than the control group (7.6% vs 1.7%; P < 0.001). To analyze the relationship of other vascular diseases and PAD, the patients were regrouped; group A (no CAD or CVD), group B (CAD only), group C (CVD only), and group D (CAD and CVD). Compared with group A, those with other vascular diseases (group B, C, D) had significantly higher prevalence of PAD, diabetes, dyslipidemia, renal insufficiency and claudication. The trend that patients with CAD or CVD are at risk of PAD is observed in this cross-sectional study in Koreans. Routine ABI measurement is recommended in these high-risk groups for early detection and proper management of PAD.
Aged ; Ankle Brachial Index ; Cerebrovascular Disorders/complications/*epidemiology ; Coronary Artery Disease/complications/*epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Peripheral Arterial Disease/*epidemiology/etiology ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors

BACKGROUND: The emergence of YIDD or YVDD mutant hepatitis B virus (HBV), with point mutation in the YMDD motif of DNA polymerase gene, has been reported in patients with lamivudine treatment group. The aims of this study was to investigate the emergence of mutant HBV during long-term lamivudine therapy using nested polymerase chain reaction (PCR) method and direct DNA sequencing. METHODS: Twenty-one chronic hepatitis B patients with HBeAg and HBV DNA positive were evaluated. During lamivudine therapy, there were reported breakthroughs of HBV DNA (over 50 pg/mL) when investigated the emergence of YMDD mutants by nested PCR method using restriction fragment length polymorphism (RFLP) in all patients. Direct DNA sequencing of HBV DNA polymerase gene including YMDD motif was also performed. RESULTS: There were 13 patients (61.9%) with YIDD mutant and 8 patients (38.1%) with YVDD mutant. The results of direct DNA sequencing were consistent with those of nested PCR data based on RFLP. The breakthrough was occurred at 15 to 106 weeks (57.9+/-23.6). At the point of breakthrough, the level of ALT was 74.8+/-117.7 (14-546) IU/L, and it was lower than the level of ALT before the therapy. CONCLUSION: In the long-term therapy of lamivudine, the emergence of YMDD motif mutant HBV was related to the breakthrough of HBV DNA and YIDD mutant was frequent. The nested PCR method using RFLP may be simple and sensitive to detect the YMDD motif mutant HBV.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine* ; Point Mutation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis, DNA