PURPOSE: The incidence of gastric neoplasms is increasing in the elderly population, and a rational method of treatment for gastric cancer in the elderly is needed to improve survival. The purpose of the present study was to clarify whether the patient's age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. MATERIAL AND METHODS: Curative or palliative surgery for gastric cancer was carried out on 706 patients in Chosun University Hospital from March 1995 to February 2002. They were divided into the following two groups: elderly group (75 years or older) and control group (under 74 years old). The clinicopathologic features of these patients were reviewed retrospectively, and a multivariate analysis was performed. RESULTS: There was no difference in clinicopathological appearances between the two groups, and the postoperative morbidity and mortality rates were similar in the two groups. The two groups showed similar survival rates. CONCLUSION: In this study, age was not a prognostic factor in surgery for gastric cancer. In the elderly, an oncologically correct surgical procedure can safely be prosecuted with satisfactory early and late results.
Aged* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Palliative Care ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

Hemochromatosis is an inherited genetic disorder of iron metabolism which can also occur as a secondary result of iron-overload. It leads to organ damage such as cardiomyopathy, liver cirrhosis, hypogonadism, and diabetes. This paper discusses a case of secondary hemochromatosis associated with repeated transfusions, presenting as asymptomatic hypoparathyroidism and subclinical hypothyroidism with multiple organ involvement. The 29-year-old female, who had severe aplastic anemia, received multiple transfusions totaling approximately 1,400 units of red blood cells over 15 years. During her routine laboratory examination, hypocalcemia was detected with decreased intact parathyroid hormone and increased thyroid stimulating hormone. Serum ferritin, iron, and total iron binding capacity had increased to 27,583.03 ng/mL, 291 microg/dL, and 389 microg/dL, respectively. She had unusually bronze skin and computed tomography revealed iron deposition in the thyroid, liver, and heart. Multiorgan involvement as seen in this case is rare in hemochromatosis associated with secondary transfusions. To the best of the author's knowledge, this is the first case report in Korea of hypoparathyroidism and subclinical hypothyroidism due to iron deposition in the parathyroid and thyroid gland.
Adult ; Anemia, Aplastic ; Cardiomyopathies ; Erythrocytes ; Female ; Ferritins ; Heart ; Hemochromatosis* ; Humans ; Hypocalcemia ; Hypogonadism ; Hypoparathyroidism* ; Hypothyroidism* ; Iron ; Korea ; Liver ; Liver Cirrhosis ; Metabolism ; Parathyroid Hormone ; Skin ; Thyroid Gland ; Thyrotropin

PURPOSE: Endocrine abnormalities are common feature of chronic renal failure. The purpose of this study is to understand women's hormonal changes in connection with renal transplantation and to verify improved quality of life of recipient by comparing level of sexual hormone between renal transplant recipients and dialyzed patients. METHODS: To evaluate the level of hormones before and after female renal transplantation, we measured FSH, LH, estradiol, progesterone and prolactin (PRL) in 10 renal transplant recipients (RTR), 10 chronic renal failure patients (CRF) undergoing dialysis (hemodialysis or peritoneal dialysis) and 10 healthy, regularly menstruating women (controls). RESULTS: All 30 females' mean age was 37.83 years. All 10 RTR were menstruating and mean age was 38.6 years and mean serum creatinine (sCr) level was 1.09 mg/dL. Of ten dialyzed patients (6 hemodialysis and 4 peritoneal dialysis), nine of ten dialyzed patients had menstrual disturbance and their mean age was 37.5 years and mean sCr level was 9.8 mg/dL. In RTR, serum PRL and LH level were reduced compared with CRF patients, but these hormones were increased compared with controls. In RTR, progesterone level was significantly lower compared with controls, whereas slightly decreased compared with CRF patients. Estradiol level in dialyzed patients was significantly higher compared with RTR or controls and in RTR was increased compared with controls. CONCLUSION: Following successful renal transplantation, uremic hormonal abnormalities were ameliorated. However, these hormonal changes are not always fully restored which can be attributed to renal insufficiency grade or result from the administered immunosuppressive treatment.
Creatinine ; Dialysis ; Estradiol ; Female* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Progesterone ; Prolactin ; Quality of Life ; Renal Dialysis ; Renal Insufficiency ; Transplantation

PURPOSE: Multidrug resistance (MDR) is a phenomenon whereby tumor cells acquire resistance to a broad range of structurally and functionally diverse chemotherapeutic drugs. The most widely implicated mechanism of MDR is that concerned with altered membrane transporters in tumor cells. P-glycoprotein (Pgp), multidrug resistance protein (MRP), and breast-cancer-resistance protein (BCRP) are well-known membrane transporters that pump out antitumor agents by using an ATP-dependent process, the so-called ATP-binding cassette (ABC) superfamily or transporter. This study was undertaken to test the prevalence of each ABC transporter and to determine which transporter has functional acitivity in various colon cancer cells. METHODS: Expressions of Pgp, MRP, and BCRP mRNA were determined in 9 colon-cancer cell lines by using an RT-PCR assay. The sensitivity to anticancer agents substrate for each ABC transporter in the colon cancer cells determined using an MTT assay. The accumulation of fluorescent compounds for functional detection of each ABC transporter was determined by using flow cytometry. RESULTS: Pgp mRNA was variably expressed in 6 of 9 colon cancer cells lines. MRP and BCRP mRNA were expressed in all the 9 cell lines. A smaller cytotoxic effect to paclitaxel and a smaller amount of rhodamine123 accumulation were observed in Colo 320HSR expressing the highest levels of Pgp than in SNU-C5 not expressing Pgp. These effects in Colo320HSR were reversed with the addition of various Pgp inhibitors, but such a reversal did not occur in SNU-C5. The cytotoxic effect to VP-16 was not related to the expression levels of MRP in Colo320HSR and SNU-C, but the amount of calcein-AM accumulation was reversed with addition of probenecid, MRP inhibitor. The cytotoxic effect and the drug accumulation of mitoxantrone were not related to the expression levels of BCRP. CONCLUSIONS: This study suggests that of the ABC transporters, primarily Pgp and MRP have functional activity in colon cancer cell lines.
Antineoplastic Agents ; ATP-Binding Cassette Transporters* ; Cell Line ; Colon* ; Colonic Neoplasms* ; Drug Resistance, Multiple* ; Etoposide ; Flow Cytometry ; Membrane Transport Proteins ; Mitoxantrone ; P-Glycoprotein ; Paclitaxel ; Prevalence ; Probenecid ; RNA, Messenger

Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer that histologically resembles hepatocellular carcinoma and is characterized by large amounts of alpha fetoprotein in the serum. The prognosis of HAS is poor compared to that of primary gastric cancer with five-year survival rates of 9% and 44%, respectively. Here, we report five patients diagnosed with HAS. Our experience suggests that an advanced stage of HAS has an extremely poor prognosis, but early detection and radical surgery can help improve the prognosis of the disease.
Adenocarcinoma* ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Humans ; Prognosis ; Stomach ; Stomach Neoplasms ; Survival Rate

Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis.
Abdominal Cavity ; Aged ; Appendectomy ; Appendicitis ; Biopsy ; Chimera ; Cholecystectomy ; Endoscopy ; Female ; Humans ; Liver ; Natural Orifice Endoscopic Surgery ; Resin Cements ; Splenectomy ; Ultrasonics

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.
Adult ; Aged ; Diabetes Mellitus ; Fasting ; Glucose ; Glucose Tolerance Test ; Health Promotion ; Health Surveys ; Humans ; Korea ; Plasma ; Prediabetic State ; Prevalence

PURPOSE: Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia. METHODS: A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed. RESULTS: Based on the postoperative day-2 calcium, 56 patients (55%) developed hypocalcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3+/-9.4 pg/mL; normal group: 25.0+/-16.4 pg/mL; P<0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P<0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811). CONCLUSION: Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocalcemia.
Calcium ; Humans ; Hypocalcemia* ; Logistic Models ; Lymph Node Excision* ; Lymph Nodes* ; Mass Screening ; Parathyroid Hormone ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Thyroiditis

PURPOSE: The purpose of this study was to clarify the effects of zinc treatment and hypothermia on visual adaptation and visual sensitivity in bullfrogs (Rana catesbeiana), which are poikilothermal animals capable of adjusting quickly to environmental temperature changes. METHODS: The effects of both zinc treatment and hypothermia on visual sensitivity were studied by using electroretinogram (ERG) recording and absorption spectra scanning before and after zinc and TSQ (N-[6-methoxy-8-quinolyl]-p-toluene sulfonamide) treatment, with or without temperature changes. RESULTS: In spite of malnutrition due to hibernation, the optimal zinc concentration effect was obtained at 10-4 M (10-2 M 200 microliter ZnCl2 in 20 microliter Ringer's solution) according to ERG recording. After zinc treatment and hypothermia induction, increments of all ERG components and thresholds were taken by ERG recording. These results showed that both zinc treatment and hypothermia may increase visual sensitivity during visual adaptation. In spectral scans, the absorbance increment due to zinc treatment and hypothermia was shown over the whole spectral range (400~750 nm), and it was especially prominent at alpha-peak (about 500 nm). In addition, there was a decrease in absorption differences between dark adaptation and light adaptation after zinc treatment. Furthermore, according to the visual sensitivity decrement using TSQ as a zinc specific chelator, this visual sensitivity increase was shown to be caused by zinc. CONCLUSIONS: As the results suggest, both zinc treatment and hypothermic effects may improve visual sensitivity by promoting rhodopsin regeneration and inhibiting rhodopsin bleaching induced by light illumination. Zinc may activate the enzyme activity of retinol dehydrogenase and phosphodiesterase, while hypothermic effects may improve precursor transport, which is required for rhodopsin regeneration, by tightening membrane adhesion between retinas and retinal pigment epithelia. In addition, we believe that zinc treatment and hypothermic effects may work synergistically to accelerate visual sensitivity during visual adaptation.
Absorption ; Adaptation, Ocular ; Animals ; Dark Adaptation* ; Hibernation ; Hypothermia ; Lighting ; Malnutrition ; Membranes ; Oxidoreductases ; Rana catesbeiana ; Regeneration ; Retina* ; Retinaldehyde ; Rhodopsin ; Vertebrates* ; Vitamin A ; Zinc*

PURPOSE: The goal of oncoplastic breast surgery is to restore the appearance of the breast and improve patient satisfaction. Thus, the assessment of cosmetic results and patient-reported outcomes (PROs) using appropriately constructed and validated instruments is essential. The aim of the present study was to assess the long-term objective cosmetic results and corresponding PROs after oncoplastic breast surgery. METHODS: Cosmetic results were assessed by the patients, a medical panel, and a computer program (BCCT.core). PROs were assessed using BREAST-Q, a questionnaire that measures the perception of patients having breast surgery. The cosmetic results and PROs were analyzed in patients who underwent quadrantectomy and partial breast reconstruction utilizing the latissimus dorsi flap. RESULTS: The mean duration of the follow-up period was 91.6 months (range, 33.3-171.0 months), and mean age of the patients was 51 years old (range, 33-72 years). The mean tumor size was 2.1 cm (range, 0.9-5.5 cm). There was fair agreement between the medical panel and BCCT.core score (K = 0.32, P < 0.001), and a statistically significant correlation between the BCCT.core score and medical panel cosmetic results was identified (r = 0.606, P < 0.001). A better BCCT.core result was related to a higher PRO of each BREAST-Q domain-satisfaction with breasts (R2 = 0.070, P = 0.039), satisfaction with outcome (R2 = 0.087, P = 0.021), psychosocial well-being (R2 = 0.085, P = 0.023), sexual well-being (R2 = 0.082, P = 0.029), and satisfaction with information (R2 = 0.064, P = 0.049). CONCLUSION: Our long-term results of oncoplastic surgery achieved a high level of patient satisfaction with good cosmetic results. The medical panel and BCCT.core results correlated well with the PROs of the patients using valid, reliable, and procedure-specific measures.
Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Pilot Projects* ; Quality of Life ; Superficial Back Muscles* ; Surgical Flaps