Purpose: The purpose of this study was to describe the technique of intraoperative transpyloric optic navigation (TPON) and determine its efficacy and feasibility during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: Seventy-nine patients who underwent laparoscopic gastrectomy with transpyloric optic localization of the tumor from January 2016 through December 2018 were enrolled in this study. After resecting the first portion of the duodenum, the distal part of the stomach was exteriorized through an extended supraumbilical trocar site, and a balloon trocar was introduced from the pylorus to determine the location of tumor and determine its resection margin. The clinicopathologic and surgical outcomes were analyzed. Results: The tumor was located in the lower third of the stomach in 39 cases, the middle third in 34 cases, and the upper-third in six cases. Tumor localization was successful in 67 patients. The mean proximal margin was 41.7 ± 26.8 mm. There was no morbidity related to the technique. By the fifth postoperative day, the average white blood cell count was within the normal range and the average level of C-reactive protein showed a decreasing pattern. Conclusion TPON of the tumor during TLDG is an effective and feasible method to determine the tumor location and to obtain an adequate resection margin.

Purpose: The purpose of this study was to describe the technique of intraoperative transpyloric optic navigation (TPON) and determine its efficacy and feasibility during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: Seventy-nine patients who underwent laparoscopic gastrectomy with transpyloric optic localization of the tumor from January 2016 through December 2018 were enrolled in this study. After resecting the first portion of the duodenum, the distal part of the stomach was exteriorized through an extended supraumbilical trocar site, and a balloon trocar was introduced from the pylorus to determine the location of tumor and determine its resection margin. The clinicopathologic and surgical outcomes were analyzed. Results: The tumor was located in the lower third of the stomach in 39 cases, the middle third in 34 cases, and the upper-third in six cases. Tumor localization was successful in 67 patients. The mean proximal margin was 41.7 ± 26.8 mm. There was no morbidity related to the technique. By the fifth postoperative day, the average white blood cell count was within the normal range and the average level of C-reactive protein showed a decreasing pattern. Conclusion TPON of the tumor during TLDG is an effective and feasible method to determine the tumor location and to obtain an adequate resection margin.

OBJECTIVES: The purposes of this study were to assess the smoking status, knowledge and attitude related to smoking and smoking cessation activity of the physicians in a community, and to identify their predictors of smoking cessation activity. METHOD: All physicians employed by various health facilities in a community were surveyed using a structured questionnaire. Of the physicians surveyed, 523 (69.6%) returned completed questionnaires. RESULTS: The smoking rate of physicians was 29.3% (34.2% in males, 3.6% in females) and the knowledge and attitude scores to smoking were 22.5+/-2.4 and 65.4+/-6.9, respectively. The self-efficacy score was 3.4+/-1.0 and the smoking cessation activity score was 65.4+/-6.9. The smoking cessation activity was statistically significant with working place, specialty, knowledge and attitude to smoking and self-efficacy. In stepwise multiple regression, smoking cessation activity was predicted by doctors' working place, specialty, attitudes related to smoking issues, and self-efficacy of counseling knowledge and skills. CONCLUSION: Physicians need to participate routinely and actively in smoking cessation activity. For doctors to effectively counsel and intervene in patients regarding smoking cessation, it is essential to integrate education on smoking cessation intervention into curricula in formal education and to offer continuing education including smoking cessation intervention.
Counseling ; Curriculum ; Education ; Education, Continuing ; Health Facilities ; Humans ; Male ; Methods ; Smoke* ; Smoking Cessation* ; Smoking*

The nevoid basal cell carcinoma syndrome, or Gorlin-Goltz syndrome, is an autosomal dominant multiple system disorder with high penetrance and variable expressions, although it can also arise spontaneously. The diagnostic criteria for nevoid basal cell carcinoma syndrome include multiple basal cell carcinomas, palmoplantar pits, multiple odontogenic keratocysts, skeletal anomalies, positive family history, ectopic calcification and neurological anomalies. We report a brother and sister who were both diagnosed with nevoid basal cell carcinoma syndrome.
Basal Cell Nevus Syndrome ; Carcinoma, Basal Cell ; Humans ; Odontogenic Cysts ; Penetrance ; Siblings

Spinal epidural hematoma is a rare event that is usually thought to require immediate surgical therapy. A variety of predisposing factors have been demonstrated for this malady and hemostatic abnormalities are rather frequent in cancer patients. In this report, we present a case of an old man who was diagnosed with early gastric cancer. He had normal coagulation function. After performing hemodynamically stable surgery, an epidural catheter was inserted. The patient underwent reoperation due to postoperative wound bleeding on postoperative day 1. In the evening of the 2nd postoperative day, emergency magnetic resonance imaging (MRI) revealed an epidural hematoma extending from T5 to T8. The patient's coagulation function became even worse. We thought that acute DIC had developed on the patient. Approximately 2 months later, he finally showed spontaneous clinical improvement.
Analgesia, Epidural ; Catheters ; Dacarbazine ; Emergencies ; Hematoma ; Hematoma, Epidural, Spinal ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Reoperation ; Stomach Neoplasms

Spinal epidural hematoma is a rare event that is usually thought to require immediate surgical therapy. A variety of predisposing factors have been demonstrated for this malady and hemostatic abnormalities are rather frequent in cancer patients. In this report, we present a case of an old man who was diagnosed with early gastric cancer. He had normal coagulation function. After performing hemodynamically stable surgery, an epidural catheter was inserted. The patient underwent reoperation due to postoperative wound bleeding on postoperative day 1. In the evening of the 2nd postoperative day, emergency magnetic resonance imaging (MRI) revealed an epidural hematoma extending from T5 to T8. The patient's coagulation function became even worse. We thought that acute DIC had developed on the patient. Approximately 2 months later, he finally showed spontaneous clinical improvement.
Analgesia, Epidural ; Catheters ; Dacarbazine ; Emergencies ; Hematoma ; Hematoma, Epidural, Spinal ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Reoperation ; Stomach Neoplasms

OBJECTIVES: This study aims to confirm the reliability and validity of the GMS-AGECAT(Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy in a Korean elderly population. METHODS: Translation committee developed Korean version GMS translating GMS-A3 after preliminary studies. Few changes from the original English version were necessary. A random sample(N= 1256 of the elderly(65+ years in Asan, community was assessed for diagnostic validity. A two-phase study was designed: Korean version of GMS-AGECAT, MMSE and GDS rated by lay interviewer and clinical assessment by psychiatrists according to DSM-IV. A consecutive hospital sample(N=28 of the elderly(65+ years admitted in Hangang Sacred Heart Hospital was assessed for reliability, concurrent & procedural validity. RESULTS: Reliability coefficients of GMS-AGECAT diagnosis were Inter-rater kappa 0.78 and test-retest kappa 0.56. Correlation coefficients for concurrent validity were 0.76 with MMSE and 0.73 with GDS. Procedural validity of psychiatrist's GMS-AGECAT diagnosis and lay-interviewers' were as follow: case/ no case distinction sensitivity 95.5%, specificity 75%; organicity distinction sensitivity 100%, specificity 83.3% and depression distinction, sensitivity 92.3%, specificity 100%. Diagnostic validity of DSM-IV diagnoses and GMS-AGECAT diagnoses were: case/ no case distinction sensitivity 92.7%, specificity 81%, dementia distinction sensitivity 77.3%, specificity 92.1% and depression distinction sensitivity 83.6%, specificity 84.1%. CONCLUSIONS: This study confirms the reliability and validity of the GMS-AGECAT in Korean elderly. Korean version GMS can be used in the international comparison studies.
Aged ; Chungcheongnam-do ; Classification ; Dementia ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Heart ; Humans ; Psychiatry ; Reproducibility of Results* ; Sensitivity and Specificity ; Translating

PURPOSE: P53 and cyclin D1 have been evaluated as a prognostic marker in papillary thyroid carcinoma (PTC). However, the relationship between p53/cyclin D1 and PTC prognosis has not yet been confirmed. Therefore, we investigated the relationship between p53/cyclin D1 and PTC prognostic factors. METHODS: 919 patients with PTC were enrolled. Immunohistochemistry slides were reviewed for p53 and cyclin D1 immunoreactivity. Patients were classified into two groups according to the p53 and cyclin D1 grade: negative for < or =5% and positive for >5%. Medical records were reviewed to evaluate the prognostic factors, lymph node metastatic ratio (LNMR), and MACIS score. We analyzed patients based on p53/cyclin D1(-/-), p53/cyclin D1(-/+), p53/cyclin D1(+/-), p53/cyclin D1(+/+) separately for evaluation of independent effect of p53 and cyclin D1. RESULTS: Mean age of the patients was 49.73 years (range 15~87), and tumor size was 1.19 cm (range 0.1~5.0). P53 was positive in 809 (88.0%) and cyclin D1 was positive in 748 (81.4%). Positivity of p53 and cyclin D1 were correlated (r=0.448). There was no statistical significance in MACIS score. Positivity of p53 and cyclin D1 were related with larger tumor size, older age, early T stage, more tumor capsulation, and female. LNMR was higher in p53/cyclin D1(+/-) than p53/cyclin D1(-/-) (P=0.036), p53/cyclin D1(-/+) than p53/cyclin D1(-/-) (P=0.034), and p53/cyclin D1(+/+) than p53/cyclin D1(-/-) (P=0.007). CONCLUSION: There was no consistent relationship between p53/cyclin D1 and worse prognostic factors of PTC. However, LNMR was higher in p53(+) and cyclin D1(+) cases independently, much more in p53/cyclin D1(+/+) than p53/cyclin D1(-/-).
Cyclin D1* ; Cyclins ; Female ; Humans ; Immunohistochemistry ; Lymph Nodes ; Medical Records ; Prognosis ; Thyroid Neoplasms*

PURPOSE: Laparoscopic total extraperitoneal (TEP) repair of inguinal hernia is technically challenging enough to build high barrier to entry. The purpose of this study was to identify clinical factors influencing technical difficulty with laparoscopic TEP according to learning period. METHODS: We conducted a retrospective study of 112 adult patients who underwent laparoscopic TEP for unilateral inguinal hernia from January 2009 to September 2013. A technically difficult case was defined as the 70th percentiles or more in the distribution curve of operative time, major complication, or open conversion. RESULTS: The rate of body mass index (BMI) above 25 kg/m2 was significantly higher in the difficult group than the nondifficult group in the learning period of laparoscopic TEP (57.9% vs. 26.8%, respectively, P = 0.020). However, in the experience period, it revealed no statistical difference with technical difficulty (31.3% vs. 33.3%, respectively, P = 0.882). In multivariate analysis, BMI (> or =25 kg/m2) was identified as a significant independent factor for technical difficulty with laparoscopic TEP in the learning period (odds ratio, 4.572; P = 0.015). CONCLUSION: Patient's BMI (> or =25 kg/m2) can create technical difficulty with laparoscopic TEP only in the learning period, but not in the experience period. Therefore BMI could be applied as one of the guidelines for patient selection, especially for surgeons in the learning curve of laparoscopic TEP.
Adult ; Body Mass Index ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Learning Curve ; Learning* ; Multivariate Analysis ; Operative Time ; Patient Selection ; Retrospective Studies

No abstract available.
Antibodies* ; Fetus* ; Heart Block* ; Heart*