Purpose: Gastric cancer (GC) is among the most prevalent and fatal cancers worldwide.National cancer screening programs in countries with high incidences of this disease provide medical aid beneficiaries with free-of-charge screening involving upper endoscopy to detect early-stage GC. However, the coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to routine healthcare access. Thus, this study aimed to assess the impact of COVID-19 on the diagnosis, overall incidence, and stage distribution of GC. Materials and Methods: We identified patients in our hospital cancer registry who were diagnosed with GC between January 2018 and December 2021 and compared the cancer stage at diagnosis before and during the COVID-19 pandemic. Subgroup analyses were conducted according to age and sex. The years 2018 and 2019 were defined as the “before COVID” period, and the years 2020 and 2021 as the “during COVID” period. Results: Overall, 10,875 patients were evaluated; 6,535 and 4,340 patients were diagnosed before and during the COVID-19 period, respectively. The number of diagnoses was lower during the COVID-19 pandemic (189 patients/month vs. 264 patients/month) than before it.Notably, the proportion of patients with stages 3 or 4 GC in 2021 was higher among men and patients aged ≥40 years. Conclusions During the COVID-19 pandemic, the overall number of GC diagnoses decreased significantly in a single institute. Moreover, GCs were in more advanced stages at the time of diagnosis. Further studies are required to elucidate the relationship between the COVID-19 pandemic and the delay in the detection of GC worldwide.

A 50-year-old woman with incidentally detected multiple gastric polyps and biopsy-proven neuroendocrine tumor (NET) was referred to our hospital. More than 10 polypoid lesions (less than 15 mm) with normal gastric mucosa were detected from the gastric body to the fundus. The serum level of gastrin was within the normal limits. There was no evidence of atrophic changes on endoscopy and serologic marker as pepsinogen I/II ratio. Computed tomography of the abdomen and pelvis revealed no evidence of metastatic lesions. She refused surgery, and we performed endoscopic polypectomy for almost all the gastric polyps that were greater than 5 mm. Although the histological examination revealed that all the removed polys were diagnosed as NET G1, three of them extended to the lateral or vertical resection margins, while two exhibited lymphovascular invasion. A follow-up upper endoscopy that was performed 6 months after the diagnosis showed multiple remnant gastric polyps that were suggestive of remnant gastric NET.
Abdomen ; Diagnosis ; Endoscopy ; Female ; Follow-Up Studies ; Gastric Mucosa ; Gastrins ; Humans ; Middle Aged ; Neuroendocrine Tumors* ; Pelvis ; Pepsinogen A ; Polyps ; Stomach

Achalasia is a rare neurological deficit of the esophagus that produces an impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body. Achalasia is generally accepted to be a pre-malignant disorder, since, particularly in the mega-esophagus, chronic irritation by foods and bacterial overgrowth may contribute to the development of dysplasia and carcinoma. We present a case of a 51-year-old man with achalasia combined with esophageal cancer who has had dysphagia symptoms for more than 20 years. Since there was a clinically high possibility of supraclavicular lymph node metastasis, concurrent chemoradiation therapy was scheduled. After the third cycle of chemoradiation therapy, transthoracic esophageolymphadenectomy was performed. Histopathological examination of the main esophagus specimen revealed no residual carcinoma. And the entire regional lymph node areas were free of carcinoma except for one azygos metastatic lymph node. In summary, achalasia is a predisposing factor for esophageal squamous cell carcinoma. Although surveillance endoscopy in achalasia patients is still controversial, periodic screening for cancer development in long-standing achalasia patients might be advisable.
Carcinoma, Squamous Cell ; Deglutition Disorders ; Endoscopy ; Esophageal Achalasia ; Esophageal Neoplasms ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Lymph Nodes ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Relaxation

PURPOSE: The restorative proctocolectomy (RP) and ileal pouch-anal anastomosis (IPAA) has been accepted as the operation of choice for chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP). However, much is still unknown about the functional outcome and the quality of life (QoL) in patients undergoing RP. The aims of this study were to evaluate the functional outcome and the QoL in patients undergoing RP and to assess the correlation between functional outcome and QoL. METHODS: The medical records of 20 patients who had undergone a RP for CUC (n=11) and FAP (n=9) from January 1993 to December 2003 were reviewed. The QoL was evaluated with the Korean version of Short Form 36 (SF-36) by telephone interview. The functional outcome was assessed by means of the Global Assessment of Function Scale (GAFS). The QoL of patients was compared with that of the general population matched for age and gender (n=107) with including the 7 men, the median age will be thought to be that of the 13 women. RESULTS: There were 7 men (35%) and 13 women (65%), and the median age was 46 years. The QoL in patients undergoing RP was comparable to that of the healthy general population on all scales. The Physical Component Summary (PCS) was correlated significantly with the daytime and the nighttime incontinence (P<0.01). The Mental Component Summary (MCS) was correlated significantly with the daytime and the nighttime incontinence and the daytime bowel movement (P<0.05). CONCLUSIONS: This study demonstrates that the QoL in patients undergoing RP is excellent and that the daytime incon tinence and the nighttime incontinence are significant factor influencing the QoL.
Adenomatous Polyposis Coli ; Colitis, Ulcerative ; Female ; Humans ; Interviews as Topic ; Male ; Medical Records ; Proctocolectomy, Restorative* ; Quality of Life* ; Weights and Measures

PURPOSE: Laparoscopic adrenalectomy (LA) has become the standard treatment for benign adrenal neoplasm because of the procedure's minimal invasiveness and the patients' earlier recovery. The aim of this study was to evaluate the safety and effectiveness of laparoscopic adrenalectomy for treating pheochromocytoma. METHODS: 19 Operations were performed between March 1993 and July 2004 at Kyung-Hee medical center for treating pheochromocytoma, and the diagnosis was confirmed by the postoperative pathology. There were 5 cases treated with LA and 14 cases treated with open adrenalectomy (OA). The various clinical parameters (tumor location, tumor size, first oral feeding, hospital stay, hemodynamic change and operation time) were compared between the LA and OA procedures, retrospectively. RESULTS: The location of the tumor was 2 : 2 : 1 (left : right : extra-adrenal) in the LA group and 9 : 3 : 2 (left : right : both) in the OA group. The mean tumor size (cm) was 5.4 in the LA group and 6.3 in the OA group. The mean operation time (minutes) was 219 in the LA group and 202 in the OA group. The resumption of liquid diet (days) was 2.2 in the LA group and 3.0 in the OA group (P=0.037). The postoperative hospital stay (days) was 6.3 in the LA group and 8.5 in the OA group. The mean number of intraoperative hypertensive crisis was 1.42 in the LA group and 1.40 in the OA group. The number of cases requiring intraoperative transfusion was 2 of 5 in the LA group and 2 of 15 in the OA group. The use of antihypertensives (number of times) was 1.42 in the LA group and 1.40 in the OA group. The mean highest BP (mmHg) was 162 in the LA group and 165 in the OA group. CONCLUSION: Laparoscopic adrenalectomy for treating pheochromocytoma is a safe and effective procedure that provides the benefits of a minimally invasive approach.
Adrenal Gland Neoplasms ; Adrenalectomy ; Antihypertensive Agents ; Diagnosis ; Diet ; Hemodynamics ; Length of Stay ; Pathology ; Pheochromocytoma* ; Retrospective Studies

PURPOSE: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative decompression and bowel preparation. This study is designed to evaluate the feasibility of performing laparoscopic surgery followed by stent insertion for treating malignant colorectal obstruction. Further, we wanted to compare the extent of surgery and the outcomes between laparoscopic and conventional colorectal surgery. METHODS: We reviewed nineteen cases of colorectal resections that were treated with stent insertion for malignant obstruction from Feb. 2003 and Aug. 2005. The results of stent insertion, the TNM stage, the extent of surgery and the postoperative courses were compared between the laparoscopic (n=9) and conventional groups (n=10). RESULTS: The stents were successfully inserted and the obstruction was relieved in all the cases. One case of laparoscopic approach was converted to open surgery due to massive tumor invasion to the adjacent organ. In terms of the extent of surgery, there were no significant differences in the tumor size (4.6 vs. 5.0 cm, respectively), the length of the specimen (24.6 vs. 25.3 cm, respectively), the number of retrieved lymph nodes (16.3 vs. 23.1, respectively), the proximal resection margin (12.1 vs. 14.1 cm, respectively), and the distal resection margin (5.4 vs. 5.0 cm, respectively) between the two groups. Also, there were no differences in the first feeding (3.8 vs. 4.4 days) and the postoperative hospital stay (10.0 vs. 11.7 days) between the two groups. CONCLUSION: The laparoscopic approach followed by preoperative stent insertion is a feasible option for treating obstructive colorectal cancer. There were no differences in the extent of surgery and the postoperative outcomes between the laparoscopic and conventional groups. The endoluminal-laparoscopic approach can be an effective strategy for treating obstructive colorectal cancer with its synergic advantage of being minimally invasive.
Colorectal Neoplasms* ; Colorectal Surgery ; Decompression ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Stents*

BACKGROUND/AIMS: Nonalcoholic steatohepatitis can develop from nonalcoholic fatty liver and progress to severe liver disease such as cirrhosis. The mechanism determining the progression from fatty liver to steatohepatitis is unknown. Iron is suspected to enhance hepatic damage associated with nonalcoholic fatty liver disease (NAFLD). The aims of this study were to evaluate the relationship of serum iron indices and hepatic iron deposition with hepatic fibrosis or inflammation, and to assess whether the increased hepatic iron deposition is an independent predictor of progression to liver injury. METHODS: The biochemical and histopathological data of thirty-nine patients with NAFLD were analyzed. Liver biopsy findings were graded according to the method described by Brunt, et al. Hepatic iron concentration was available in 29 of 39 patients. RESULTS: The mean hepatic iron concentration and hepatic iron indices were 1,349+/-1,188 microgram/g dry weight and 0.9+/-0.7 microgram/g/age. Serum ferritin and body mass indices were associated with hepatic inflammation (p=0.001, p=0.006) and fibrosis (p=0.005, p=0.013). Hepatic iron concentration and hepatic iron index were not associated with hepatic inflammation and fibrosis. Multivariate analysis did not identify serum ferritin or body mass index as an independent predictor of liver injury. CONCLUSIONS: Hepatic iron deposition shows no association with the degree of hepatic inflammation or fibrosis. Hepatic iron is not an independent predictor of hepatic injury in patients with NAFLD.
Adolescent ; Adult ; Fatty Liver/complications/*metabolism ; Female ; Ferritins/blood ; Humans ; Inflammation ; Iron/blood/*metabolism ; Liver/*metabolism/pathology ; Liver Cirrhosis/*etiology/metabolism/pathology ; Male ; Middle Aged

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common form of mesenchymal tumor of the gastrointestinal tract. Recently, tyrosine kinase inhibitors have improved the treatment of GISTs, and their diagnosis facilitated by immunohistochemical markers. The aim of this paper was to study the clinicopathological features of GISTs of the stomach and determine the accuracy of a new grading system and the prognostic factors. METHODS: Patients with mesenchymal tumors of the stomach, operated on between 1982 and 2004, were identified using medical and pathological files. Immunohistochemical staining for KIT (CD117), CD34, smooth muscle actin (SMA), desmin and s-100 protein were performed, and the diagnoses reviewed. Cases were classified into either the very low, low, intermediate or high risk groups according to National Institutes of Health (NIH) consensus symposium. RESULTS: 78 mesenchymal tumors were reanalyzed, and with the supportive use of immunohistochemical markers, 71 (91%) of the gastrointestinal mesenchymal tumors were shown to be GISTs. The tumors often coexpressed KIT and CD34 (90%) and were variably positive for SMA (18%), s-100 protein (11%) and desmin (23%). With a median follow-up of 73.9 months (range 1~228 months), a recurrence occurred in 10 (14%) patients. Analyses demonstrated that the mitotic index (P<0.001) and tumor size (P<0.001) were significant prognostic factors for survival. The new grading system showed a significant difference between the risk groups and the survival rates (P<0.001). CONCLUSION: Immunohistochemical staining is needed to distinguish GISTs from other mesenchymal tumors. The tumor size and mitotic count are significant prognostic factors for GISTs. The new grading system (2001 NIH) for classifying the 4 risk groups of GISTs, according to the tumor size and the mitotic count, is useful in the evaluation of the tumor behavior.
Actins ; Consensus ; Desmin ; Diagnosis* ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Mitotic Index ; Muscle, Smooth ; National Institutes of Health (U.S.) ; Prognosis* ; Protein-Tyrosine Kinases ; Recurrence ; S100 Proteins ; Stomach* ; Survival Rate

PURPOSE: The aim of this study was to develop a new middle cerebral artery occlusion (MCAO) model in rabbits using a less invasive, endovascular interventional technique. The new animal model's technical feasibility and its success in producing lesions was evaluated using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten rabbits were used to develop the MCAO models using a transfemoral catheter-based technique. After catheterization of the common carotid artery, a microcatheter was introduced coaxially through the catheter to cannulate the internal carotid artery and to embolize the MCA with polyvinyl alcohol particles. We evaluated how successful we were in selecting the vessels, catheterization, embolization, and also evaluated how many of the animals survived until the end of experiment. Diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were performed in one-hour intervals to monitor the ischemic lesion for a total of six hours following successful occlusion of the target artery. The relative volume of the lesion was calculated as a hemispheric lesion volume (HLV, %). The signals of the lesion and contralateral normal brain (control) were measured in each image at every time point. Lesion-to-control signal-intensity ratio (SIR) of DWI, and T2WI were obtained together with relative apparent diffusion coefficient (rADC). RESULTS: Catheterization and embolization of the internal carotid artery were successful in all 10 rabbits, which showed relevant lesions on MRI. All rabbits survived until the end of the experiment. The HLV (mean+/-standard deviation) was 35.7+/-14.6%. The relative ADC was 0.80+/-0.13. The lesion signals on DWI and T2WI showed a gradual increase as time passed, while the ADC value of the lesion gradually decreased (p<0.0001). CONCLUSION: The rabbit MCAO model using an endovascular interventional technique is technically feasible, and provides a reproducible lesion in the target arterial territory. MRI successfully revealed a typical finding of acute cerebral infarction. This model is also believed to be suitable for the MRI investigation of acute cerebral ischemia.
Animals ; Arteries ; Brain ; Brain Infarction ; Brain Ischemia ; Carotid Artery, Common ; Carotid Artery, Internal ; Catheterization ; Catheters ; Cerebral Infarction ; Diffusion ; Endovascular Procedures ; Infarction, Middle Cerebral Artery* ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Models, Animal ; Polyvinyl Alcohol ; Rabbits*

PURPOSE: Malignant colorectal obstruction is a common emergency situation showing high morbidity and mortality because of the poor general condition of the patients, unprepared bowel and advanced diseases. Recently, the self-expandable colorectal stent has allowed an elective one-stage resection without the risk of an emergency operation and stoma formation. We evaluated the usefulness of the self-expandable metallic stent for a malignant colorectal obstruction in terms of the preoperative preparation of the patients. METHODS: Seventeen patients who underwent a surgical resection following self-expandable metallic stent insertion for a malignant colorectal obstruction were included in this study. The patients' characteristics, clinical courses, and complications after stent insertion, the changes in physical status of the patients, the operative method, and the postoperative complications were investigated. The APACHE II score was applied for evaluating the physical status of the patients. RESULTS: Obstructions were located at the transverse (n=1), the descending (n=3), and the sigmoid colon (n=6) and at the rectum (n=7). Stents were successfully inserted and obstructions were relieved in all patients. Preoperative evaluations were performed in all cases. Fourteen of the 17 patients (82.4%) showed abnormal laboratory findings on admission. The average APACHE II score was 10.6 on admission and decreased to 7.8 after stent insertion (P<0.05). Nine patients (52.9%) could resume oral feeding after stent insertion. There were 2 stent-related complications, one case of stent migration and one case of minor bleeding; both were managed conservatively. At an average of 9 days after the stent insertion, an elective radical resection was conducted in all cases. Laparoscopic resections were attempted in 7 (41.2%) patients and were successful in 6. In 15 cases (88.2%), resection with primary anastomosis was possible. Postoperatively, there were 3 cases of wound infections and a temporary ileus. The TNM stage was stage II in 9 patients (52.9%), III in 6 (35.3%), and IV in 2 (11.8%). The patients were discharged from the hospital at an average of 11 days postoperatively. CONCLUSIONS: Self-expandable colorectal stent insertion is a safe and effective treatment strategy and can change the emergency setting to permit an elective one-stage curative operation by allowing the general condition of a patient with malignant colorectal obstruction to recover.
APACHE ; Colon, Sigmoid ; Emergencies ; Hemorrhage ; Humans ; Ileus ; Mortality ; Postoperative Complications ; Rectum ; Stents* ; Wound Infection