Postoperative nausea and vomiting is an adverse condition that affects a large number of patients after surgical interventions. Postoperative vomiting is a severe discomfort for patients and can be a bigger concern even than postoperative pain. Although many studies have been performed on the pathophysiology of postoperative nausea and vomiting, little has been known about it. This article reviews the risk factors, mechanisms, preventive measures, and treatment of postoperative nausea and vomiting.
Humans ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Risk Factors

PURPOSE: Gastric emptying has been evaluated by scintigraphy in spite of its limitations of time consumption, cost, and danger of radioisotope. Endoscopy is a simple technique, however, its validation for gastric emptying and quantification of food has not yet been investigated. The aim of our study was to assess endoscopic gastric emptying compared with scintigraphy and radiopaque markers (ROMs) studies. We also investigated the effect of a single dose of mosapride on gastric emptying. MATERIALS AND METHODS: Fifteen healthy volunteers underwent scintigraphy. Next day, subjects received a standard solid meal with ROMs and underwent endoscopy and simple abdomen X-ray after 3 hrs. After one week, the same procedure was repeated after ingestion of mosapride (5 mg for group 1, n = 8; 10 mg for group 2, n = 7) 15 min before the meal. Quantification of gastric residue by endoscopy was scored from 0 to 3, and the scores were added up. RESULTS: All subjects completed the study without any complication. The gastric emptying rate [T1/2 (min)] was in normal range (65.6 +/- 12.6 min). Endoscopic gastric emptying was correlated significantly with gastric clearance of ROMs (r = 0.627, p = 0.012). Endoscopic gastric emptying and gastric clearance of ROMs after administration of mosapride showed significant differences in the 10 mg group (p < 0.05). CONCLUSION: Endoscopy can evaluate gastric emptying safely and simply on an outpatient basis. A 10 mg dose of mosapride enhanced gastric emptying, assessed by both endoscopy and ROMs.
Adult ; Benzamides/*pharmacology ; Endoscopy/*methods ; Female ; Gastric Emptying/*drug effects ; Gastrointestinal Agents/*pharmacology ; Humans ; Male ; Middle Aged ; Morpholines/*pharmacology ; Radionuclide Imaging/*methods ; Stomach/radiography/radionuclide imaging ; Young Adult

BACKGROUND/AIMS: Gemcitabine has been the standard regimen for advanced pancreatic cancer, but the effect on the response rate and survival is still disappointing, leading to many trials of combination chemotherapy. 5-FU and cisplatin were combined with gemcitabine in this trial, as they are synergistic with gemcitabine and each other as well. This study was aimed to assess the effectiveness and safety of combination chemotherapy with gemcitabine, 5-FU, and cisplatin for advanced pancreatic cancer. METHODS: Patients with advanced pancreatic cancer were entered into this study. Gemcitabine at a dose of 800 mg/m2 on day 1 and 8, 5-FU 1,000 mg/m2/day from day 1 to 3 for 72 hours, and cisplatin 60 mg/m2 on day 2, 24 hours after the start of gemcitabine were administered every 3 weeks. RESULTS: From December 2001 to January 2004, twenty patients were enrolled in this study. Among 17 of these patients assessable, 3 patients had a partial remission with the response rate of 17.7% (95% confidence interval, 6.2-41.0%). The median time to disease progression was 230 days and median duration of survival was 322 days. Among total of 91 cycles, leukopenia, neutropenia, and thrombocytopenia of grade 3 or 4 occurred in 12 cycles (13.2%), 12 cycles (13.2%), and 23 cycles (24.4%), respectively. Grade 3 or 4 mucositis developed at 2 cycles (2.2%), and nausea and vomiting were encountered in 3 cycles (3.3%). CONCLUSIONS: Combination chemotherapy with gemcitabine, 5-FU, and cisplatin for advanced pancreatic cancer is active and well-tolerated, warranting a phase III study.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cisplatin/administration & dosage ; Deoxycytidine/administration & dosage/analogs & derivatives ; Female ; Fluorouracil/administration & dosage ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*drug therapy/mortality ; Survival Rate

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN. METHODS: Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors. RESULTS: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. CONCLUSIONS: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.
Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/ultrasonography ; Carcinoma, Papillary/*diagnosis/pathology/ultrasonography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis/*epidemiology ; Neoplasms, Second Primary/diagnosis/*epidemiology ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/ultrasonography ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Topoisomerase II (TOPO II) is an enzyme that separates intertwined chromosomes during DNA synthesis by transiently breaking and joining DNA strands. The level of TOP II is one of the determinants of cellular sensitivity to anti-tumor drugs in non-Hodgkin's lymphoma patients. The alpha form of TOPO II has been recently used as a marker of cellular proliferation. High levels of TOPO IIalpha are expressed in aggressive and proliferative tumors. METHODS: This study was designed to evaluate the relationship between TOPO IIalpha expression and clinicopathological parameters including age, gender, the serum LDH level, the serum beta2-microglobulin level and stage, or expressions, of Ki-67, p53 and p27, in non-Hodgkin's lymphoma. We analyzed forty-one biopsied tissue specimens from patients with non-Hodgkin's lymphoma. RESULTS: The expression of TOPO IIalpha increased with the clinical stage and it was correlated with Ki-67 and p53 expressions. However, TOPO IIalpha expression did not have any significant correlation with age, gender, the serum LDH level, the serum 2-microglobulin level and the p27 expression. CONCLUSIONS: TOPO IIalpha expression is a useful marker of cellular proliferation and it may serve as a prognostic factor of a tumor's progression and aggressiveness in non-Hodgkin's lymphomas.
Cell Proliferation ; DNA Topoisomerases, Type I* ; DNA Topoisomerases, Type II ; DNA* ; Humans ; Ki-67 Antigen ; Lymphoma, Non-Hodgkin*

It is the first case that nephrotic syndrome with malignant thymoma reported in Korea. A 56-year-old man have had generalized edema, weight gain, dyspnea, oliguria for 10 days. At that time, a full blown nephrotic syndrome developed, with minimal change glomerulopathy, A mediastinum mass was shown by the chest X-ray. Thymectomy and palliative radiotherapy was done. In the treatment of nephrotic syndrome, firstly diuretics and prednisolone were given. but the response was poor, so additionally cyclophosphamide and azathioprine were given. After 1 year passed, the patient died of the respiratory failure with pulmonary fibrosis of complication of radiotherapy, without improvement in nephrotic syndrome.
Azathioprine ; Cyclophosphamide ; Diuretics ; Dyspnea ; Edema ; Humans ; Korea ; Mediastinum ; Middle Aged ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Oliguria ; Prednisolone ; Pulmonary Fibrosis ; Radiotherapy ; Respiratory Insufficiency ; Thorax ; Thymectomy ; Thymoma* ; Weight Gain

BACKGROUND: Helicobacter pylori is present mainly in the gastric mucous layer. However, the mucous layer, along with the bacteria, is lost during conventional tissue processing in which formalin is used for fixation. The purpose of this study is to ascertain - if the mucous layer is preserved by using Carnoy solution as a fixative - whether the detection rate of H. pylori is increased in pediatric patients. METHODS: Five pieces of gastric mucosal tissue were obtained from the gastric antrum and the body of one hundred pediatric patients. One of the specimens was fixed with formalin. Another specimen was fixed with Carnoy solution. The tissue sections were stained with hematoxylin-eosin and immunohistochemically stained for H. pylori. For reference, a rapid urease test was performed on the remaining three specimens. RESULTS: In the formalin-fixed tissue, the detection rate of H. pylori was 13% in the gastric antrum and 12% in the body (overall 16%). In the Carnoy solution-fixed tissue, the mucous layer was preserved and the detection rate of H. pylori was 23% in the antrum and 27% in the body (overall 28%). The positive rate of the rapid urease test was 26% in the antrum and 28% in the body (overall 29%). CONCLUSIONS: When the number of H. pylori is small in the gastric mucosa, the bacteria may not be detected by conventional histologic methods. In that case, the detection rate of H. pylori may be increased by using Carnoy solution, rather than formalin, as a tissue fixative.
Bacteria ; Fixatives ; Formaldehyde ; Gastric Mucosa ; Helicobacter pylori* ; Helicobacter* ; Humans ; Mucous Membrane ; Pyloric Antrum ; Urease

BACKGROUND: It has been believed that there is a pure mucus-secreting cardiac mucosa (CM), about 2 cm in length, below the gastroesophageal junction. However, recent reports suggest that CM might not be located at the most proximal portion of the stomach. The purpose of this study is to investigate the relationships between the types of proximal gastric mucosa and patients' age, sex, their condition regarding the Helicobacter pylori infection, and severity of chronic gastritis. METHODS: Two pieces of mucosal tissue from the most proximal portion of the stomach and the antrum of 44 pediatric and 85 adult patients were examined using a light microscope. A rapid urease test was performed on the other antral specimen from each patient. RESULTS: In 46 (90.2%) out of 51 patients with aged 30 or under, only the pure acid-secreting oxyntic mucosa (OM) was present at the most proximal portion of the stomach. The cardiac or mixed oxyntocardiac mucosa (OCM) increased in prevalence with age. The CM or OCM was found more frequently in patients with H. pylori infection or severe gastritis than in those without H. pylori infection or those with mild gastritis. However, there were no statistically significant differences within the same age groups. CONCLUSIONS: Although the OCM is sometimes present at the most proximal portion of the stomach, the CM is absent or rare in individuals under the age of 30. The OCM or CM increases in prevalence with age. There are no direct relationships between the type of proximal gastric mucosa and a patient's gender, his/her condition regarding the H. pylori infection, and severity of chronic gastritis.
Adult ; Cardia ; Esophagogastric Junction ; Gastric Mucosa* ; Gastritis ; Helicobacter pylori ; Humans ; Mucous Membrane ; Prevalence ; Stomach ; Urease

The treatment of recurrent type 1 membranproliferative glomerulonephritis (MPGN) after renal transplantation is undetermined yet. We report a case with a recurrent type 1 MPGN with ascites after renal transplantation that had a favorable outcome. A woman aged 50 was diagnosed recurrent type 1 MPGN in 2002. Afterwards she took cyclosporine, prednisolone and mycophenolate mofetil. Since August 2003, Her urine output was reduced and she suffered from abdominal distention. Serum creatinine was elevated to 2.5 mg/dL and physical examination and abdominal CT scan showed large amount of ascites. So, we substituted cyclophosphamide for mycophenolate mofetil. She was 55 kg before the substitution of cyclophosphamide but 12 months later, she weighed 44 kg and her creatinine decreased to 1.5 mg/dL. Therefore, it seems a good idea to use cyclophosphamide for the treatment of recurrent glomerulonephritis with ascites after renal transplantation.
Ascites ; Creatinine ; Cyclophosphamide* ; Cyclosporine ; Female ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Humans ; Kidney Transplantation* ; Physical Examination ; Prednisolone ; Tomography, X-Ray Computed

BACKGROUND: The monoclonal antibody M30 recognizes a neoepitope of cytokeratin 18 that's produced during the process of apoptosis, and it is reactive in formalin-fixed, paraffin-embedded tissue. The detailed nature of apoptosis in colorectal cancer is unclear, especially in regard to the MSI status and the clinicopathologic factors. The purpose of this study was to elucidate the apoptosis assessed by M30 immunoreactivity in colorectal cancer and its relationship with the MSI status and the various clinicopathologic factors of colorectal cancers. METHODS: 101 colorectal cancers were classified according to levels of MSI as 12 MSI-H, 4 MSI-L and 85 MSS. Apoptosis was quantified by immunohistochemistry with using M30 CytoDEATH anti-body. RESULTS: The apoptotic index assessed by M30 was significantly increased in the MSI-H and MSI-L colorectal cancer compared to that in the MSS colorectal cancer. Right sided colon cancer showed a significant higher apoptotic index than did the left sided colon cancer. There was also a tendency for decreased apoptosis in metastatic colorectal cancers (Duke's stage D). There was somewhat of an increase of apoptosis in colorectal cancers with mucinous carcinoma and medullary carcinoma, and also in the colorectal cancers with an increased TIL count, but this was not statistically significant. CONCLUSION: M30 immunoreactivity is a valuable method to detect apoptosis in formalin-fixed, paraffin-embedded tissue and it might explain that MSI-H colorectal cancer shows better clinical behavior than MSS colorectal cancer in regard to the increased apoptosis.
Adenocarcinoma, Mucinous ; Apoptosis* ; Carcinoma, Medullary ; Colonic Neoplasms ; Colorectal Neoplasms* ; Immunohistochemistry ; Keratin-18 ; Microsatellite Instability