Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.
Adolescent* ; Athletes ; Clavicle ; Dislocations* ; Esophagus ; Humans ; Male ; Sternoclavicular Joint* ; Ultrasonography*

Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.
Adolescent ; Athletes ; Clavicle ; Dislocations ; Esophagus ; Humans ; Male ; Sternoclavicular Joint ; Ultrasonography

PURPOSE: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. MATENRIALS AND METHODS: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients (4.8%) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. RESULTS: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type (32.0%). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence (18.5+/-17.7 months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. CONCLUSION: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.
Chemotherapy, Adjuvant ; Humans ; Incidence ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms*

There has been considerable controversy over the prognosis of mucinous gastric enocarcinoma (MGC). In this study we analyzed the clinicopathologic fferences between MGC and non-mucinous gastric carcinoma (NMGC). In addition, e relationship between mucin content and other clinicopathologic variables, cluding prognosis in MGC, was also investigated. We reviewed 2118 patients th pathologically-confirmed gastric cancer who underwent gastrectomy at the partment of Surgery, Yonsei University College of Medicine, during the period tween Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric carcinoma th extracellular mucin (MGC) and 1988 patients had gastric carcinoma without tracellular mucin (NMGC). We placed the MGC patients into two groups according mucin content: mucin content involving over 50% of the tumor (dominant type, = 94) and mucin content involving less than 50% of the tumor area (partial pe, n = 36). The results were as follows: MGC was more common in males than GC. The size of the tumor in MGC (mean 5.3 cm) was larger than that of NMGC ean 4.4 cm). The patients with MGC had a higher incidence of Borrmann type IV GC: 16.1%, NMGC: 9.9%), more frequent serosal invasion (MGC: 75.4%, NMGC: .6%), lymph-node metastasis (MGC: 75.4%, NMGC: 50.7%), and peritoneal tastasis (MGC: 10.0%, NMGC: 3.5%) than patients with NMGC. The patients with C were more advanced in stage at the time of diagnosis and had a worse overall -year survival rate (44.9%) than patients with NMGC (54.7%). However, the -year survival rate according to the stage of MGC was similar to that of NMGC. ere were no significant differences between the mucin content and other thologic variables, including prognosis, i.e. similar biologic behavior tween dominant type MGC and partial type MGC. In conclusion, we suggest that C was more frequently diagnosed in advanced stage than NMGC with a poorer ognosis and that it is reasonable to consider the carcinoma with mucin content volving more than 30% of the tumor area as MGC.
Adenocarcinoma/pathology ; Adenocarcinoma/metabolism ; Adenocarcinoma, Mucinous/pathology* ; Adenocarcinoma, Mucinous/metabolism* ; Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Mucins/metabolism ; Neoplasm Staging ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/metabolism*

PURPOSE: Adequate health-related information provided by health professionals may help cancer patients overcome their uncertain situation and manage their healthcare. To provide information effectively, there is a need to understand the content of the patients' essential information. The purpose of this study was to identify recent informational needs of postoperative gastric cancer patients. MATERIALS AND METHODS: Data were collected from 190 postoperative gastric cancer patients who attended the Stomach Cancer Patients' Day ceremony (18 November 2008) held by the Stomach Cancer Center of Samsung Medical Center with the use of a questionnaire which measured informational needs. A questionnaire with 37 items was comprised of domains of diagnostic tests, cancer therapy, prognosis, follow-up, sexual activity, stomach cancer-related information, and 7 single items. RESULTS: The priorities of informational needs were the domains of prognosis, ways of healthcare during treatment (a single item), follow-up, stomach cancer-related information, cancer therapy, and diagnostic tests (in descending order). Items related to prognosis, diet, and management of their healthcare ranked in the top 10 informational need scores. As age decreased, the degree of informational needs about diagnostic tests, cancer therapy, sexual activity, and stomach cancer-related information increased. CONCLUSION: We suggest that prognosis-related information based on the accumulated institutional therapeutic outcomes and objective prognosis data should be incorporated in the current education program. Health professionals should provide comprehensible information content to cancer patients and caregivers and encourage patients to participate in their therapy with a more positive attitude.
Caregivers ; Delivery of Health Care ; Diagnostic Tests, Routine ; Diet ; Follow-Up Studies ; Health Occupations ; Humans ; Prognosis ; Surveys and Questionnaires ; Sexual Behavior ; Stomach ; Stomach Neoplasms

Endometriosis is defined as the presence of endometrial tissue outside the uterus and located usually within the pelvis. It may be detected as a rare complication associated with surgery. Endometriosis following obstetric and gynecologic procedure, which is localized mostly in the surgical scar including Cesarean section scar, hysterotomy scar, trocar scar, Bartholin cyst exision scar, or episiotomy scar, may caused by implantation of endometrial gland and stroma. Endometriosis developing after hysterectomy, especially, is a quite rare condition except a recurrent disease. We have experienced a case of a 47-year-old woman who had diagnosed ovarian endometriosis two years after laparoscopically assisted vaginal hysterectomy for a large leiomyomatous uterus with no evidence of endometriosis, so we report this case with a brief review of literature.
Cesarean Section ; Cicatrix ; Endometriosis* ; Episiotomy ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Hysterotomy ; Middle Aged ; Pelvis ; Pregnancy ; Surgical Instruments ; Uterus

The incidence of heterotopic gastric mucosa located in the submucosa in resected stomach specimens has been reported to be 3.0 to 20.1%. Heterotopic gastric mucosa is thought to be a benign disease, which rarely becomes malignant. Heterotopic gastric mucosa exists in the gastric submucosa, and gastric cancer rarely occurs in heterotopic gastric mucosa. Since tumors are located in the normal submucosa, they appear as submucosal tumors during endoscopy, and are diagnosed through endoscopic biopsies with some difficulty. For such reasons, heterotopic gastric mucosa is mistaken as gastric submucosal tumor. Recently, two cases of early gastric cancer arising from heterotopic gastric mucosa in the gastric submucosa were treated. Both cases were diagnosed as submucosal tumors based on upper gastrointestinal endoscopy, endoscopic ultrasound, and computed tomography findings, and in both cases, laparoscopic wedge resections were performed, the surgical findings of which also suggested submucosal tumors. However, pathologic assessment of the surgical specimens led to the diagnosis of well-differentiated intramucosal adenocarcinoma arising from heterotopic gastric mucosa in the gastric submucosa.
Adenocarcinoma ; Biopsy ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastric Mucosa ; Incidence ; Stomach ; Stomach Neoplasms

PURPOSE: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. MATERIALS AND METHODS: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. RESULTS: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. CONCLUSIONS: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.
Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Robotics ; Stomach Neoplasms

PURPOSE: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. MATERIALS AND METHODS: The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. RESULTS: Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. CONCLUSIONS: Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.
Esophagogastric Junction ; Humans

PURPOSE: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. MATERIALS AND METHODS: The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. RESULTS: Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. CONCLUSIONS: Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.
Esophagogastric Junction ; Humans