PURPOSE: Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. METHODS: From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. RESULTS: Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). CONCLUSION: Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures.
Age of Onset ; Crohn Disease ; Demography ; Drainage ; Humans ; Incidence ; Inflammatory Bowel Diseases* ; Korea ; Multivariate Analysis ; Quality of Life ; Recurrence ; Reoperation* ; Risk Factors*

PURPOSE: Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain. MATERIALS AND METHODS: This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57+/-11 years, 35% men) with MHV who underwent invasive dental procedures. RESULTS: This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (> or =65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (beta=-0.694, p<0.001) and major bleeding (beta=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures. CONCLUSION: Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.
Aged ; Anticoagulants/*therapeutic use ; Dentistry, Operative/*methods ; Enoxaparin/therapeutic use ; Female ; *Heart Valve Prosthesis ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Male ; Middle Aged

PURPOSE: In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy. MATERIALS AND METHODS: A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method. RESULTS: The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001). CONCLUSIONS: The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.
Gastrectomy* ; Hospitalization ; Humans ; Insurance Coverage* ; Insurance* ; Insurance, Health ; Korea ; Methods ; Mortality ; National Health Programs ; Seoul ; Social Class ; Stomach Neoplasms* ; Survival Rate

PURPOSE: We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels. MATERIALS AND METHODS: The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012. RESULTS: Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7+/-33.1 ug/L and 72.2+/-24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1+/-31.8 ug/L in cardia cancer group (10 cases) and 121.8+/-32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7+/-29.6 ug/dl in early gastric cancer (33) and 66.9+/-17.8 ug/dl in advanced gastric cancer (41) (P=0.064). CONCLUSIONS: The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.
Cardia ; Gastrectomy ; Humans ; Male ; Selenium ; Stomach Neoplasms ; Zinc

PURPOSE: We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels. MATERIALS AND METHODS: The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012. RESULTS: Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7+/-33.1 ug/L and 72.2+/-24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1+/-31.8 ug/L in cardia cancer group (10 cases) and 121.8+/-32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7+/-29.6 ug/dl in early gastric cancer (33) and 66.9+/-17.8 ug/dl in advanced gastric cancer (41) (P=0.064). CONCLUSIONS: The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.
Cardia ; Gastrectomy ; Humans ; Male ; Selenium ; Stomach Neoplasms ; Zinc

No abstract available.
Chest Pain ; Echocardiography ; Esophageal Achalasia ; Heart Atria ; Humans ; Thorax

No abstract available.
Hypertrophy ; Obesity ; Obesity, Abdominal

Benign metastasizing leiomyoma is a rare disease that histologically shows features of a benign tumor; however it can metastasize to the lung or other organs. We report here on a case of a 53-year-old woman with benign metastasizing leiomyoma, and she was admitted to the hospital with symptoms of coughing for 2 months; she showed multiple diffuse nodular opacities of both lungs on a chest radiograph. She had undergone hysterectomy for leiomyoma of the uterus 13 years previously. Thoracoscopic lung biopsy was performed to rule out metastatic lung cancer. The pulmonary nodules appeared benign with a very low mitotic rate and they consisted of smooth muscle cells. The pathologic findings of the pulmonary nodules were consistent with benign metastasizing leiomyoma. The patient has been followed up closely without any specific therapy.
Biopsy ; Cough ; Female ; Humans ; Hysterectomy ; Leiomyoma ; Lung ; Lung Neoplasms ; Middle Aged ; Myocytes, Smooth Muscle ; Neoplasm Metastasis ; Rare Diseases ; Thorax ; Uterus

PURPOSE: Panendothelial markers such as factor VIII, CD34, CD31, CD105 (endoglin) and D2-40 are useful to identify proliferating endothelium that is related to tumor invasion. This study was designed to identify the correlation between the expressions of panendothelial and lymphatic vessel markers in preoperative biopsy specimens and the clinicopathologic factors. METHODS: Preoperative biopsy specimens from 72 patients were immunostained for CD105, CD34, CD31, Factor VIII and D2-40. The microvessel and lympathic vessel densities (MVD and LVD) were counted in dense vascular foci (hot spots) on a x200 field in each specimen. The correlation between these factors and the clinicopathologic parameters were analyzed. RESULTS: The MVD by CD105 showed statistically significant correlation with tumor emboli, the T-stage, nodal metastasis and the stage, and the MVD by CD34 had statistically significant correlation with tumor emboli, nodal metastasis and the stage. The lympathic vessel density (LVD) by D2-40 showed a statistically significant correlation with tumor emboli, the T-stage and nodal metastasis. CONCLUSION: The MVD by CD105 and the LVD by D2-40 in preoperative biopsy specimens of colorectal cancers may be useful markers for the prediction of invasiveness.
Biopsy* ; Colorectal Neoplasms* ; Endothelium ; Factor VIII ; Humans ; Lymphatic Vessels* ; Microvessels ; Neoplasm Metastasis

PURPOSE: The objective of this study was to evaluate the role of microsatellite instability (MSI) in upper tract transitional cell carcinomas (TCC). MATERIALS AND METHODS: A total of 48 surgically treated renal pelvis and ureteral TCC patients were included in this study. MSI was determined by polymerase chain reaction (PCR) for amplification of the microsatellite sequences at mononucleotides BAT25 and BAT26, and dinucleotides D17S250, D2S123 and D5S346 in DNA and hMLH1 protein, p53 and Ki-67 expressions were determined by immunohistochemistry on retrieved tumor tissue. RESULTS: Twenty seven (56.2%) and 21 (43.8%) of the 48 patients had renal pelvis and ureteral TCC, respectively. Eighteen (37.5%) and 30 (62.5%) patients had superficial and invasive TCC, according to the pathological stage, while 24 each (50%) had low and high grade TCC, respectively. MSI was observed in 20.8% of tumors at mono-MSI and 22.9% at di-MSI. MSI-high and -low (instability >2 and <2 loci, respectively) were observed in 12.5 and 22.9%, respectively. From a univariate analysis, age, stage, tumor grade, tumor recurrence and the expressions of hMLH1 and Ki-67 were not related to MSI. However, in recurred cases, infiltrative tumors had 100% MSI compared to superficial tumors, and the expressions of p53 and Ki-67 were related to the stage and tumor grade, respectively (p<0.05). CONCLUSIONS: These results suggest that MSI may occur in upper tract TCC, as observed in other tumors. MSI was more frequently expressed in ureteral than renal pelvis tumors. However, MSI was not correlated with stage or grade, but was significantly correlated with the stage in recurred cases; and the expressions of p53 and Ki-67 were related to the stage and tumor grade.
Carcinoma, Transitional Cell* ; DNA ; Gene Expression ; Humans ; Immunohistochemistry ; Kidney Pelvis ; Microsatellite Instability* ; Microsatellite Repeats* ; Polymerase Chain Reaction ; Recurrence ; Ureter ; Urinary Tract* ; Urologic Neoplasms