The incidence of synchronous gastric cancer is variously reported to be 2.07%, 5.22%, 6.5%, 8.6%, or 9% and has been increasing recently, probably with advance in the diagnosis of gastric cancer. Our case in presentation is a 70-year-old male patient who had total gastrectomy and esopbagiojunostomy done for synchronous four gastric cancer. Each has different histologic types, Some of these lesions are not suspected before operation and are found almost by chance during histologic examinations after surgery performed only to remove main lesion. So we report this case with a review of literatures.
Aged ; Diagnosis ; Gastrectomy ; Humans ; Incidence ; Male ; Stomach Neoplasms*

OBJECTIVE: To assess the effects of partial weight bearing (PWB) harness with comparison of traditional exercise program by gait analysis in non-ambulatory acute stroke patients. METHOD: Nine patients participated with PWB harness on the treadmill, and nine patients with traditional exercise. In harness group, the gait training with 30% weight reduction was offered on treadmill, they were treated daily and gait training was done for 20 minutes. In no-harness group, traditional gait training was done by physical therapists. Variables were gait parameters assessed by VICON 370 Gait Analyzer, other function tested by Motricity Index and Functional Ambulatory Category. RESULTS: In linear parameter, the harness group had faster gait speed, longer stride length, and more decreased double support time compared to the no-harness group. In kinematic parameters, the maximal flexion of knee was significantly increased in harness group, but no significant differences was in hip and ankle motion. In kinetic parameters, hip flexion moment of normal side was increased in harness group at heel strike phase, knee flexion moment of normal side was decreased in harness group at heel strike phase. CONCLUSION: The gait training with partial weight bearing harness was more effective in acute stroke patients than traditional therapy, and was influenced in gait pattern, functional ability.
Ankle ; Gait* ; Heel ; Hip ; Humans ; Knee ; Physical Therapists ; Strikes, Employee ; Stroke* ; Weight Loss ; Weight-Bearing*

PURPOSE: The purpose of this study is to assess the clinical utility of multiplanar reformation images of helical CT in the evaluation of pancreatic diseases. MATERIALS AND METHODS: Helical CT scans of the pancreas were obtained in 30 patients with pancreatic diseases. Helical CT was performed with 5mm collimation at 5mm/sec table speed during rapid injection of intravenous contrast agent using power injector. After scanning, helical volume data were reconstructed at 2mm interval and then multiplanar reformation of the pancreas and adjacent structures was done. In both prospective reconstructed axial images and multiplanar reformation images, detection of pancreatic lesion, extent of lesion, and vascular and bile ductal changes were analyzed with a grading system of 1,2, 3. RESULTS: The mean grade of detection of pancreatic lesions was 2.37 in the prospective axial image and 2.83 in multiplanar reformation image, extent of diseases was 2.40 in prospective axial image and 2.97 in multiplanar reformation image, and vascular and bile ductal changes was 2.00 in the prospective axial image and 2.97 in multiplanar reformation image. All the differences were statistically significant (P<0.0001). CONCLUSION: Multiplanar reformation images of helical CT are useful in the evaluation of pancreatic diseases and especially in the demonstratibn of complex anatomic relationships between the pancreas and surrounding structures.
Bile Ducts ; Humans ; Pancreas ; Pancreatic Diseases* ; Prospective Studies ; Tomography, Spiral Computed*

An esophageal perforation is a condition requiring emergency treatment. Although previously spontaneous ruptures were the most common etiology, as endoscopic and radiologic diagnosis and treatment have developed recently, iatrogenic ruptures due to instrumentation have increased to become the most common cause of esophageal perforations. Generally, the treatment of esophageal stenosis is composed of esophageal dilatation using a Maloney or a Mercury dilator and medical treatment for reflux esophagitis. Recently, balloon-catheter dilatation of the esophagus has produced safe and excellent results, and self-expansible metallic stents has been very useful in controlling malignant strictures of the esophagus with low mortality and morbidity. We experienced an esophageal perforation after balloon dilatation and the insertion of a self-expanding silicone-covered Gianturco stent to the site of the esophageal stenosis which was due to reflux esophagitis. The abdomen was opened through an upper midline incision. There was a 3-cm-long longitudinal laceration on the distal esophagus which was closed transversely as with a Heinecke-Mikulicz pyloroplasty after a debridement. To reinforce the site of esophageal laceration and to prevent esophageal reflux, the gastric fundus was pulled and sutured over the esophageal sutures, and the second-layer mattress suture was made 1 cm proximal to the first sutures, including central ligaments of the diaphragm. To prevent bile reflux, we converted from a Billroth-II to a Roux- en-Y gastrojejunostomy. We followed up for 30 months and found no signs of any esophageal stenosis or gastroesophageal reflux.
Abdomen ; Bile Reflux ; Catheters* ; Constriction, Pathologic ; Debridement ; Diagnosis ; Diaphragm ; Dilatation ; Emergency Treatment ; Esophageal Perforation* ; Esophageal Stenosis* ; Esophagitis, Peptic ; Esophagus ; Gastric Bypass ; Gastric Fundus ; Gastroesophageal Reflux ; Lacerations ; Ligaments ; Mortality ; Rupture ; Rupture, Spontaneous ; Stents* ; Sutures

PURPOSE: Many women complain of various pattern of sexual dysfunction after surgical or natural menopause. This study aimed to investigate the effect of menopause on the expression of androgen receptors in the human vagina and sexual functions. MATERIALS AND METHODS: The subjects were women aged from their 30's to 70's who required transvaginal surgery. Subjects were divided into three groups: premenopausal, postmenopausal without hormone replacement therapy, and postmenopausal with hormone replacement therapy. Tissues from the proximal and distal thirds of the vagina were collected during the operation. The expression of androgen receptors was examined using RT-PCR and immunohistochemical techniques. RESULTS: In tissue from the distal third of the vagina, androgen receptor expression decreased after menopause compared with the premenopausal group. In the hormone replacement group, androgen receptor expression was decreased compared with non-hormone replacement group. Androgen receptor expression correlated with sexual function independent of hormonal status. CONCLUSIONS: Clinically, significant numbers of postmenopausal women show changes of sexual function. Androgen is thought to be one of the major factors controlling female sexual function. This study supports that the androgen receptor expression could be changed by the hormonal status and we should consider this change when managing sexual dysfunction in female.
Female ; Hormone Replacement Therapy ; Humans* ; Menopause* ; Receptors, Androgen* ; Vagina*

PURPOSE: It is known that 50% to 68% of women with stress urinary incontinence (SUI) have sexual function impairment and avoid sexual intercourse. Reports of sexual function after SUI surgery vary, with reports of both improved function and deteriorated function. The goal of this study was to evaluate the impact of midurethral sling procedures on the sexual function of women suffering from SUI preoperatively and 36 months postoperatively. MATERIALS AND METHODS: Among 75 patients who were diagnosed with SUI and underwent the midurethral procedure, 47 patients who answered the Korean version of the Female Sexual Function Index (FSFI) Questionnaire were analyzed prospectively. The retropubic route (RPR) was used in 26 patients, whereas the transobturator route (TOR) was used in 21 patients. Fifteen patients underwent concomitant posterior colporrhaphy. The FSFI was completed before surgery and 36 months after surgery. RESULTS: The patients' mean age was 44.9 years (range, 30-59 years) and their mean parity was 2.8 (range, 0-6). There were no significant differences in the individual FSFI domain scores between before surgery and 36 months (36.8+/-4.57) after surgery. There were no significant differences in sexual satisfaction between the patients with concomitant posterior colporrhaphy and patients with the midurethral sling procedure only. There were no significant differences in domain score between the TOR and the RPR, but patients experienced less pain after the RPR than after the TOR. CONCLUSION: There was no significant change in overall sexual function in women undergoing the midurethral sling procedure. Attention must be paid when performing the TOR procedure because it can cause pain during intercourse.
Coitus ; Female ; Follow-Up Studies ; Humans ; Parity ; Prospective Studies ; Sexuality ; Stress, Psychological ; Suburethral Slings ; Urinary Incontinence ; Urologic Surgical Procedures

The anorectal anomaly is not rarely seen in the neonatal period. But, If it is not accompanied with a fairly large fistula, it presents an urgent problem, so should be managed with perianal anoplasty or colostomy. Neonatal peritonitis is very grave and is caused by various conditions listed in Table 1. In Korea, no case of neonatal peritonitis caused by anorectal has yet been reported in the literature. With brief review of the literature, we present a case of neonatal peritonitis which appeared 36 hours after birth by perforation of the colon due to anorectal stenosis.
Colon ; Colostomy ; Constriction, Pathologic* ; Fistula ; Korea ; Parturition ; Peritonitis*

In two female siblings, growth and developmental retardation, poor sucking, anorexia, floppiness and respiratory difficulty developed around 2 and 4 monthes of age in each, and the respiratory symptoms rapidly aggravated to comatose states and finally into death one month later. On admission at emergency room, severe acidosis and high lactate and pyruvate levels in serum and cerebrospinal fluid were revealed in one. Brain computed tomography and magnetic resonance imaging revealed identical bilateral involvement of putamen in both of the sibs, which made the diagnosis of Leigh disease(subacute necrotizing encephalomyelopathy) possible. There is also a family history of early death in infancy period; an elder sister and a brother of mother died with unknown cause at their 5 and 10 months of age. Mitochondrial enzyme functions could not be assayed.
Acidosis ; Anorexia ; Brain ; Cerebrospinal Fluid ; Coma ; Diagnosis ; Emergency Service, Hospital ; Female ; Growth and Development ; Humans ; Lactic Acid ; Leigh Disease* ; Magnetic Resonance Imaging ; Mothers ; Putamen ; Pyruvic Acid ; Siblings

PURPOSE: This study was performed to evaluate MR signal intensity(SI) of calcification and to assess the capability of MRI in detection of various intracranial calcifications. MATERIALS AND METHODS: The MR findings and ROI value of experimental model of calcium carbonate suspension according to each concentration (20, 35, 50%) and diameter (1-10 mm) and hydroxyapatite suspension according to each concentration (10, 20, 30, 40, 50%) were analyzed. A specimen of calcification in cranio-pharyngioma was analyzed for its composition by XRD(X-ray diffractometer) and ICP(inductively coupled plasma) methods. MRI of 34 patients with intracranial calcifications were retrospectively analyzed for signal intensity of the calcification and its capability to detect calcifications according to size, location, and contrast with adjacent lesion. RESULTS: The calcium carbonate phantom with larger diameter and low concentration showed lower signal intensity on T2 than TlWl. Hydroxyapatite phantom showed high signal intensity in 10-30% concentration and low signal intensity in 40-50% concentration on T1 weighted image. The 5 cases of 34 intracranial calcifications showed high signal intensity on T1 weighted image. The capability of MRI in the detection of intracranial calcifications decreased in the circumstances such as small size(<2.5mm) and intraventricular location. Although the size of calcification was small, the detection was easy in the good contrast with adjacent lesion. However, the detection of the small sized calcification was easy if the contrast with adjacent lesion was good. CONCLUSION: lntracranial calcification shows generally low signal intensity on T1 and T2 weighted image with the exception of occasional high SI on TlWl. Detection of intracranial calcification in MRI is affected by its composition, size, location, and contrast with adjcent lesion.
Calcium Carbonate ; Durapatite ; Humans ; Magnetic Resonance Imaging* ; Models, Theoretical ; Retrospective Studies

Sarcopenia is a disease characterized by age-related decline of skeletal muscle mass and function. The molecular mechanisms of the pathophysiology of sarcopenia form a complex network due to the involvement of multiple interconnected signaling pathways. Therefore, signaling receptors are major targets in pharmacological strategies in general. To provide a rationale for pharmacological interventions for sarcopenia, we herein describe several druggable signaling receptors based on their role in skeletal muscle homeostasis and changes in their activity with aging. A brief overview is presented of the efficacy of corresponding drug candidates under clinical trials. Strategies targeting the androgen receptor, vitamin D receptor, Insulin-like growth factor-1 receptor, and ghrelin receptor primarily focus on promoting anabolic action using natural ligands or mimetics. Strategies involving activin receptors and angiotensin receptors focus on inhibiting catabolic action. This review may help to select specific targets or combinations of targets in the future.