Even the overall incidence is decreasing and the proportion of early gastric cancer is increasing from the national mass screening program, still gastric cancer is the major issue in Korea. Multimodality approach and the development of novel therapeutic agents enabled us to improve the survival rate of gastric cancer. However, the proper treatment strategy for the subgroups of patients is necessary, which is now categorized based on the clinicopathologic parameters. We need more in-depth information regarding the molecular biology of gastric cancer, and the development of novel targeted biological agents and the biomarkers for the future. Currently, the recent chemotherapeutic agents showed the improved response in advanced gastric cancer. Hence, the basic concept of adjuvant chemotherapy, palliative chemotherapy, neoadjuvant treatment with or without incorporation of radiotherapy become settle down with more evidences from several phase III trials. Especially, after understanding the difference between Asia and Western countries including biology, ethnic difference, operation technology, and the treatment approaches, the qualified, well-designed multinational clinical trials are on-going. Based on the current results, here, I describe the current status of gastric cancer treatment strategy.
Asia ; Biological Agents ; Biomarkers ; Biology ; Chemotherapy, Adjuvant ; Humans ; Incidence ; Korea ; Mass Screening ; Molecular Biology ; Neoadjuvant Therapy ; Stomach Neoplasms ; Survival Rate

No abstract available.
Teratoma*

This report attempts to explain the (i) implications of comorbidity for research and practice in the fieldo of oncology, (ii) the approach for dosing of anti-cancer drugs in the presence of comorbidity, as an example of its clinical application, and finally (iii) the dosing guidelines for the anticancer drugs clinically active in gastric cancer in the presence of renal or liver dysfunction. This has resulted from the idea of approaching comorbidity in a systematic way and of integrating it with oncologic decisions. Various methods have been used to assess comorbidity. However, significant work remains to be done to analyze how various diseases combine to influence the oncologic outcome. The main end-point explored so far has been mortality, but a largely open challenge remains to correlate comorbidity with treatment tolerance and functional and quality of life, as well as to integrate it in clinical decision-making. Cancer chemotherapy in comorbidity should be considered as an example of the need for dose optimization in individual patients, and it should be determined by considering the basic principles of the pharmacokinetics and the pharmacodynamics of the agents. This review analyzes the available data on the pharmacokinetics and the toxicities of anti-cancer agents in the comorbidity population.
Comorbidity* ; Drug Therapy* ; Humans ; Liver Diseases ; Mortality ; Pharmacokinetics ; Quality of Life ; Stomach Neoplasms

OBJECTIVE: The purpose of this study is to evaluate the clinical effect of V-Y advancement flap after vulvectomy in patients with vulvar cancer. Local and systemic morbidity, the degree of satisfaction after operation, length of hospital stay were evaluated. PATIENTS AND METHODS: From March 2001 to september 2002, five patients with invasive vulvar cancer were eligible for this study. All the patients underwent radical vulvectomy with groin lymph nodes dissection. All of them were reconstructed by the same surgeon using ischial fasciocutaneous V-Y flaps based on perforators from the inferior border of the gluteous maximus muscle. RESULTS: Flap survival was 100%. There were no major complication including wound infection, wound disruption, urinary tract infection, and seroma in the femoral triangle. Functional outcome was excellent in all patients. CONCLUSION: The V-Y advancement flap provides a straight-forward and simple safe reliable method as a common approach in radical vulvectomy.
Groin ; Humans ; Length of Stay ; Lymph Nodes ; Seroma ; Urinary Tract Infections ; Vulvar Neoplasms* ; Wound Infection ; Wounds and Injuries

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.
Hernia ; Laparoscopy ; Surgical Instruments

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.
Hernia ; Laparoscopy ; Surgical Instruments

OBJECTIVE: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. METHODS: Between January 2000 and April 2008, 62 patients diagnosed with adnexal mass in pregnancy from St. Mary's hospital, Kangnam St. Mary's hospital, and Daejeon St. Mary's hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student's t-test and Fisher's exact test were used for statistical analysis. P-value below 0.05 was considered statistically significant. RESULTS: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, hospital stay, pregnancy outcome (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But threatened abortion and preterm labor were increased in emergency operation than elective operation (P=0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy. CONCLUSION: There was no difference in pregnancy complication and prognosis. Laparoscopic surgery can be managed safely as laparotomy in pregnancy women with adnexal mass.
Abdominal Pain ; Abortion, Threatened ; Emergencies ; Female ; Gestational Age ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Obstetric Labor, Premature ; Operative Time ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Prognosis ; Retrospective Studies

OBJECTIVE: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. METHODS: Between January 2000 and April 2008, 62 patients diagnosed with adnexal mass in pregnancy from St. Mary's hospital, Kangnam St. Mary's hospital, and Daejeon St. Mary's hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student's t-test and Fisher's exact test were used for statistical analysis. P-value below 0.05 was considered statistically significant. RESULTS: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, hospital stay, pregnancy outcome (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But threatened abortion and preterm labor were increased in emergency operation than elective operation (P=0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy. CONCLUSION: There was no difference in pregnancy complication and prognosis. Laparoscopic surgery can be managed safely as laparotomy in pregnancy women with adnexal mass.
Abdominal Pain ; Abortion, Threatened ; Emergencies ; Female ; Gestational Age ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Obstetric Labor, Premature ; Operative Time ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Prognosis ; Retrospective Studies

BACKGROUND: It is controversial that an electrocardiography (EEG) is valuable in evaluation of patients with headache. The purpose of this study was to determine whether EEG brain mapping can be a useful indicator for evaluating the analgesic efficacy of treatment on the patient with an occipital headache. METHODS: We did an EEG on 20 patients with occipital headaches at the peri-laser application period. The laser was radiated for 3 minutes a third of the total distance from the external occipital protuberance to the mastoid process on the superior nuchal line. An EEG was taKen before laser radiation as control use, and at 10, 30 and 60 minutes after laser radiation by 32 channel electrodes (international 10 20 system). The EEG mapping was red for the high electric potential and blue for the low electric potential. RESULTS: Compared with control group, the alpha wave increased significantly in parieto-occipital and occipital region at 60 minutes after laser radiation (P < 0.05). DarK red color was increased especially in occipital region at 60 minutes after laser radiation, compared with EEG mapping before laser radiation. Good and Fair improvements were observed in 55% of the patients with occipital headaches. CONCLUSIONS: We conclude that EEG can be a valuable indicator in the evaluation of analgesic efficacy of treatment in the patients suffering from occipital headaches. Pain scores were assessed by the patient with the visual analogue scale (VAS).
Brain Mapping ; Electrocardiography ; Electrodes ; Electroencephalography* ; Headache* ; Humans ; Mastoid

PURPOSE: This study was performed to evaluate the contribution of appendiceal computed tomography (CT) in the more accurate diagnosis of acute appendicitis and decrease in the rate of negative appendectomies. METHODS: Between May and August 2005, 146 patients with right lower quadrant (RLQ) abdominal pain and tenderness were diagnosed using appendiceal CT. The appendiceal CT scans were performed with contrast media in the abdominal and pelvic areas. 7 mm slice scans were taken both before and after the contrast media injection, with a time delay. The control group was comprised of 99 patients, who were also checked by abdominal CT or ultrasonography, between December 2004 and April 2005, with the data analyzed retrospectively. RESULTS: In the study group, 85 of the 146 cases were diagnosed with acute appendicitis on appendiceal CT, and had undergone an appendectomy, including 42 men (mean age 39.9 yr) and 43 women (mean age 44.6 yr). The sensitivity and specificity of appendiceal CT in acute appendicitis were 95.3 and 98.4%, respectively. There were 4 (4.7%) negative appendectomy cases; 2 in men and 2 in women. The control group conprised of 47 men and 52 women. There were 13 (13.1%) negative appendectomy cases; 4 in men and 9 in women. CONCLUSION: The routine use of appendiceal CT, in patients with RLQ abdominal pain and tenderness, resulted in a significant decrease in the negative appendectomy rate.
Abdominal Pain ; Appendectomy ; Appendicitis* ; Contrast Media ; Diagnosis ; Female ; Humans ; Male ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonography