PURPOSE: Controversy still exists over in the prognostic significance of microscopic tumor cell dissemination in patients with cancer. This study evaluated the prognostic implication of isolated tumor cells in the bone marrow of patients with gastric cancer. MATERIALS AND METHODS: Four hundred nineteen (419) patients who underwent surgery for gastric cancer between June 1998 and July 2000 were enrolled in the study. Bone marrow aspirate was obtained from the iliac crest before removal of the primary tumor. Mononuclear cells were isolated and stained with AE-1/AE-3 PAN-CYTOKERATIN. RESULTS: Cytokeratin-positive cells were found in the bone marrow of 219 patients (52.3%). The incidence varied significantly with the depth of invasion (P=0.021) and the stage (P=0.026). The five-year survival rate of patients with cytokeratin-positive cells was 74.1% and that of patients without cytokeratin-positive cells was 81.1% (P=0.2481). There were no significant differences in the recurrence rate and the site of recurrence according to whether or not cytokeratin-positive cells were present in the bone marrow. CONCLUSION: The presence of cytokeratin-positive cells in the bone marrow of patients with gastric cancer did not predict outcome and recurrence. Therefore, it cannot be used as a prognostic factor.
Bone Marrow* ; Humans ; Incidence ; Prognosis ; Recurrence ; Stomach Neoplasms* ; Survival Rate

OBJECTIVES: To understand the current status of the opening, closing and relocation of primary medical institutes in Korea and identify the underlying decision factors. METHODS: Sources of analyzed data included the medical institutional master file at the National Health Insurance Corporation (1998, 2000) and Regional Statistic Annual Bulletins. To investigate changes including the opening, closing and relocation, a total of primary medicalinstitutions (16,757 in 1998, 19,267 in 2000) were analysed. RESULTS: Between 1998 and 2000, there was a 15.0% (2,510) increase in the number of primary medical institutions and the rate of increase in the rural area was higher than the urban area, and higher for specialty clinics than primary practice. However, these findings did not suggestany improvement in the maldistribution of primary medical institutions. During the time period studied, newly opened and closed primary medical institutions numbered 4,085 and 1,573, respectively. Additionally, institutions thatrelocated numbered 2,729, or 16.3%of all primary medical institutions in operation in 1998. These openings and closings were more frequent among young doctors. As a result of our analysis on the underlying regional factors forrelocation, the factors that were statistically significant were local per capita tax burden and the number of schools per ten thousand persons. In the case of institutional factors, movements were significantly associated with gender and the location of primary medical institutions. CONCLUSIONS: In order to establish effective long-term intervention for primary medical institutions, further study and monitoring of primary medical institutions and the dentification of factors influencing opening location and relocation is necessary.
Academies and Institutes ; Humans ; Korea* ; National Health Programs ; Taxes

PURPOSE: As the Korean population ages, an increasing number of elderly patients with gastric cancer are undergoing surgical resection. The aim of this study was to analyze the surgical outcomes and prognostic factors after gastric cancer surgery for patients 80 years of age or older.METHODS: We analyzed the medical records of 720 patients with gastric cancer who underwent gastrectomy from March 2010 to December 2014 retrospectively. Patients were divided into two groups: octogenarians (age ≥80 years, n=46) and non-octogenarians (age <80 years, n=674). We evaluated clinicopathologic data including postoperative morbidity, mortality, and 5-year survival rate.RESULTS: The rate of curative resection was not different between the two groups. The American Society of Anesthesiology score was significantly higher in the octogenarians (P<0.05). Octogenarians exhibited poorer performance scale scores, higher comorbidities, and more advanced TNM stages than non-octogenarians. There was no difference in surgical resection margins between the two groups. In addition, octogenarians suffered from more postoperative morbidity and mortality than non-octogenarians. In the analysis of risk factors of survival after gastrectomy for octogenarians, advanced TNM stage and dose of transfusion were independent risk factors. Overall survival was significantly lower in octogenarians than non-octogenarians. There was no difference in the disease-specific survival for each stage of cancer after adjustment for tumor stage.CONCLUSION: Octogenarians had more preoperative risk factors and postoperative morbidity and mortality, but cancer-specific survival was comparable with non-octogenarians. Careful preoperative evaluation, thorough resection, and attentive postoperative care can improve the overall survival of octogenarians with gastric cancer.
Aged ; Aged, 80 and over ; Anesthesiology ; Comorbidity ; Gastrectomy ; Humans ; Medical Records ; Mortality ; Postoperative Care ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Survival Rate ; Treatment Outcome

The use of neoadjuvant chemotherapy in older patients is increasing. However, chemotherapy should be administered considering the medical comorbidities of the patients and the toxicity of chemotherapeutic agents. Here, we present a case of abdominal wall hematoma with spontaneous inferior epigastric artery injury caused by coughing in a 70-year-old woman who was treated with neoadjuvant chemotherapy. Abdominal computed tomography demonstrated an abdominal wall hematoma with active bleeding. However, angiography with selective embolization of the right inferior epigastric artery and the right internal mammary artery was performed successfully. Scheduled chemotherapy was discontinued over concerns of rebleeding and breast-conserving surgery was performed. When deciding on chemotherapy for older patients, attention should be paid to the various complications.

Order communication system(OCS) could change involved users' work pattern profoundly. Also adaptation to OCS and satisfaction with it influence the efficiency of management in hospital. This study applied self-administered questionnaire and individual interview to evaluate changes of users' work pattern, adaptation and satisfaction after the introduction of OCS. The survey measured the experience of computer use, user's evaluation on OCS education, degree of usage, change of work patterns, relation with co-workers or other departments, user's adaptation and satisfaction of physicians, nurses and pharmacists who worked in two university hospitals in Seoul that had introduced OCS. The major findings of this study were as follows; 1. Changes of users' work patterns were different between two hospitals. In a hospital major business time to issue and confirm order was decreased but in another hospital increased . 2. Relations of doctors with nurses were also different between two hospital. Frequency of contacts in a hospital was increased and doctor-nurse relationship grew worse, while in another hospital decreased and grew better. These situations were observed on the relationship with other departments, such as pharmacy and admission/discharge service. 3. There were no significant variables that explained user's adaptation, but again there was a difference between hospitals. 4. User's satisfaction was significantly affected by hospital and job catergories classified. Level of satisfaction of a hospital was higher than that of another, and highest in pharmacists, and the next was nurses and doctors in order. 5. There was o difference in satisfaction level by the type of hardwares, operations and accuracy between hospitals, but was difference by the contents of information, convenience of use and timeliness between hospital. The hospital factor consistently influenced users' work pattern, adaptation, and satisfaction. It implied that, if OCS was designed familiarly and conveniently for users, users' resistance will not trouble the implementation of OCS.
Commerce ; Education ; Hospitals, University ; Humans ; Pharmacists ; Pharmacy ; Surveys and Questionnaires ; Seoul

We undertook this study to elucidate whether baseline peritoneal membrane transport characteristics are associated with high mortality in incident automated peritoneal dialysis (APD) patients. This retrospective study includes 117 patients who started APD at Yonsei University Health System from 1996 to 2008 and had a PET within 3 months of APD initiation. High transporters were significantly older and had a higher incidence of cardiovascular disease. Patient survival for years 1, 3, and 5 were 85%, 64%, and 35% for high transporter and 94%, 81%, and 68% for non-high transporter group (P<0.01). Multivariate analysis revealed that age, diabetes, cardiovascular disease, serum albumin level, and residual renal function were independently associated with high mortality in APD patients. In contrast, high transport status was not a significant predictor for mortality in this population when the other covariates were included. Even though high transport was significantly associated with mortality in the univariate analysis, its role seemed to be influenced by other comorbid conditions. These findings suggest that the proper management of these comorbid conditions, as well as appropriate ultrafiltration by use of APD and/or icodextrin, must be considered as protective strategies to improve survival in peritoneal dialysis patients with high transport.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Automation ; Cardiovascular Diseases/complications ; Diabetes Complications ; Dialysis Solutions/therapeutic use ; Female ; Glomerular Filtration Rate ; Glucans/therapeutic use ; Glucose/therapeutic use ; Humans ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Multivariate Analysis ; Peritoneal Dialysis/*mortality ; Retrospective Studies ; Risk Factors ; Serum Albumin/analysis ; Survival Rate

The authors reviewed 90 patients with traumatic cervical spine injury admitted to our department between January, 1993 and December, 1997. The most common age group was 21-30 years old. The male to female ratio was 7.2 : 1. Motor vehicle accident was the most frequent cause of traumatic cervical spine injury. The most common mechanism of injury was compressive and then distractive flexion. The C2 body fracture was the commonest of the vertebral body fractures and C5/6 dislocation was the most common involved level of injured vertebrae. Forty-seven of these patients were managed with conservative treatment and the remaining 43 patients underwent surgery. The conservative treatment was consisted of skeletal traction, neck collar and Halo-vest application. Of 43 patients operated, 24 patients were performed by anterior approach and 10 by posterior approach and remaining 9 patients were treated by anterior approach after posterior approach. According to Modified Frankel's grading system, the rates of neurological impr-ovement at anterior approach, posterior approach and combined approach were 79.2%, 60.0% and 66.0%, respec-tively. Difference of improvement rates did not have clinical significance. There were 76 types of associated injuries were observed in 51 patients. The most common associated injury was head trauma and surgical intervention was required in 5 patients among them. The common complications were respiratory disorder, bed sore, urinary tract infection, gastrointestinal bleeding, pin site infection in decreasing order of frequency. The most common cause of death was respiratory disorder including pneumonia, atelectasis, acute respiratory distress syndrome and pulmonary edema.
Cause of Death ; Craniocerebral Trauma ; Dislocations ; Female ; Hemorrhage ; Humans ; Male ; Motor Vehicles ; Neck ; Pneumonia ; Pressure Ulcer ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult ; Spine* ; Traction ; Urinary Tract Infections

PURPOSE: To report our experiences of transarterial embolization for acute intercostal artery bleeding. MATERIALS AND METHODS: A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. RESULTS:The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. CONCLUSION: Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.
Arteries* ; Hemorrhage* ; Hemostasis ; Hemothorax ; Humans ; Retrospective Studies ; Shock

PURPOSE: To evaluate 0.025% brilliant blue G (BBG) for staining the internal limiting membrane (ILM) during vitrectomy. METHODS: In a retrospective, non-comparative clinical case series, we analyzed consecutive 111 patients who underwent pars plana vitrectomy and removal of the ILM after staining using BBG solution. BBG was dissolved and diluted with balanced salt solution at a concentration of 0.025% and then sterilized by filtering through a 0.22 microm millipore filter. The prepared BBG solution was injected into the vitreous cavity over the macula after removal of the vitreous and excessive solution was removed immediately. RESULTS: The ILM was successfully removed without use of additional adjuvant in all cases. Mean best corrected visual acuity (log MAR) was significantly improved from 0.80 +/- 0.44 at baseline to 0.40 +/- 0.39 at 6 months postoperatively (p < 0.001). One case each of endophthalmitis and diabetic papillopathy developed. The relationship when using BBG solution was not identified as complications were not observed in the other patients who underwent vitrectomy using the same BBG solution on the same day. One idiopathic epiretinal membrane patient had visual acuity loss more than 2 lines. During the follow-up period, other complications suspected to be associated with the use of BBG solution were not observed. CONCLUSIONS: A BBG solution (0.025%) was effective in staining the ILM for removal. Complications associated with the use of BBG solution were not observed.
Endophthalmitis ; Epiretinal Membrane ; Follow-Up Studies ; Humans ; Membranes* ; Micropore Filters ; Retrospective Studies ; Visual Acuity ; Vitrectomy*

PURPOSE: To evaluate 0.025% brilliant blue G (BBG) for staining the internal limiting membrane (ILM) during vitrectomy. METHODS: In a retrospective, non-comparative clinical case series, we analyzed consecutive 111 patients who underwent pars plana vitrectomy and removal of the ILM after staining using BBG solution. BBG was dissolved and diluted with balanced salt solution at a concentration of 0.025% and then sterilized by filtering through a 0.22 microm millipore filter. The prepared BBG solution was injected into the vitreous cavity over the macula after removal of the vitreous and excessive solution was removed immediately. RESULTS: The ILM was successfully removed without use of additional adjuvant in all cases. Mean best corrected visual acuity (log MAR) was significantly improved from 0.80 +/- 0.44 at baseline to 0.40 +/- 0.39 at 6 months postoperatively (p < 0.001). One case each of endophthalmitis and diabetic papillopathy developed. The relationship when using BBG solution was not identified as complications were not observed in the other patients who underwent vitrectomy using the same BBG solution on the same day. One idiopathic epiretinal membrane patient had visual acuity loss more than 2 lines. During the follow-up period, other complications suspected to be associated with the use of BBG solution were not observed. CONCLUSIONS: A BBG solution (0.025%) was effective in staining the ILM for removal. Complications associated with the use of BBG solution were not observed.
Endophthalmitis ; Epiretinal Membrane ; Follow-Up Studies ; Humans ; Membranes* ; Micropore Filters ; Retrospective Studies ; Visual Acuity ; Vitrectomy*