PURPOSE: The generally accepted standard surgery for advanced gastric cancer is gastrectomy with D2 dissection accompanied by omentectomy. Theoretically, advanced gastric cancer without serosa exposure cannot disseminate metastasis to the omentum. However, the significance of routine omentectomy in survival remains unproved. METHODS: From January 2000 to December 2002, 174 patients, who diagnosed T2 gastric adenocarcinoma pathologically, underwent curative gastrectomy by one operator. 52 patients underwent omentum-preserving gastrectomy and 122 patients underwent gastrectomy with resection of omentum. We compared clinicopathologic characteristics, recurrence patterns, recurrence rate and survival rates between the two groups. RESULTS: Five-year survival rate was 82.9% in the omentum-preserving group and 85.2% in the omentectomy group (P=0.729). Moreover, there was no significant difference in recurrence rate between the two groups (P=0.298). In the omentum-preserving group, 3 peritoneal (25%), 4 local (33.3%), 4 hematogenous (33.3%), 1 distant lymph node (8.3%) recurrences were shown. However, in the omentectomy group, 7 peritoneal (35%), 6 local (30%), 6 hematogenous (30%), 1 distant lymph node (5%) recurrences were shown (P=0.935). CONCLUSION: These results suggest that the omentum-preserving gastrectomy may be applicable to advanced gastric cancer without serosa exposure, and that it is not necessary to perform uniform omentectomy for all advanced gastric cancer.
Adenocarcinoma ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Omentum ; Recurrence ; Serous Membrane ; Stomach Neoplasms ; Survival Rate

Background: Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. Objective: The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. Methods: We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. Results: The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. Conclusion We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Background: Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. Objective: The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. Methods: We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. Results: The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. Conclusion We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Background: Dermatofibromas (DF) are fibrohistiocytic tumors of unknown etiology, and multiple DF (MDF) are relatively rare. MDF have been reported in the setting of autoimmune diseases, human immunodeficiency virus infection, or comorbidities treated with immunosuppressive drugs. Objective: The present study investigated whether underlying conditions with impaired immune function are associated with MDF. Methods: A total of 338 patients with DF was enrolled. We divided patients into two groups as MDF and solitary DF (SDF) groups. We retrospectively reviewed patient medical records and classified all patients by underlying diseases. Statistical significance of SDF and MDF for each conditions was analyzed. Results: The demographics and comorbidities were compared between MDF group (n=82) and SDF group (n=256). Among underlying conditions, systemic lupus erythematosus (SLE) (odds ratio, 10.397; 95% confidence interval, 2.743∼39.404; p＜0.001) was significantly associated with MDF over SDF. Vitiligo and post status of kidney transplant were related more highly to MDF (p=0.014; p=0.014, respectively) than to SDF. Presence of overall comorbidities, autoimmune diseases, and immunosuppressive drug use were associated with DF number (p＜0.001;p＜0.001; p＜0.001, respectively). Conclusion We propose an association between MDF and comorbidities, especially SLE and immunosuppressant use. MDF lesions seem to be impacted by compromised immune function. This is of significance since it is essential to search for associated conditions in patients presenting with MDF in dermatologic clinical settings.

OBJECTIVES: This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty. METHODS: This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated. RESULTS: The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group. CONCLUSION: With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.
Ear Canal ; Endoscopy ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Retrospective Studies ; Transplants ; Tympanic Membrane ; Tympanoplasty*