PURPOSE: The purpose of this study is to analyze the mode of recurrence and it's relating factors in gastric adenocarcinoma. MATERIALS AND METHODS: 1,446 patients who had been undergone gastrectomy for gastric adeno carcinoma from September 1983 to December 1996 (Department of Surgery, Korea University) were studied (median follow-up was 2.9 years). Of them, 243 patients who had been proven recurrence were studied on recurrence mode and clinicopathological factors. RESULTS: The mean duration to recurrence was 22 months. The modes of recurrence were locore gional (30.0%), peritoneal (23.0%), hematogenous (19.3%) and distant lymph node metastasis (4.1%) in order. In 23.5%, more than 2 recurrent pattern were combined. Age, gross type, tumor size and stage were statistically significant to the mode of recurrence. The disease free survival was calculated: regional lymph node, number of lymph node, stage, and tumor emboli had statistical significance in all types of recurrence and in locoregional recurrence, tumor size was significant. Multivariate analysis showed that regional lymph node influenced the disease free survival period in all cases and tumor size in locoregional recurrence. CONCLUSION: The number of positive regional lymph node and tumor size are important factors predicting the timing of recurrence after curative resection for gastric adenocarcinoma.
Adenocarcinoma* ; Disease-Free Survival ; Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Stomach Neoplasms

Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.
Aged ; Angiography ; Coronary Artery Disease/complications/*pathology ; Coronary Vessels/diagnostic imaging ; Diabetes Mellitus, Type 2/*complications ; Diabetic Retinopathy/complications/*diagnosis/diagnostic imaging ; Female ; Glomerular Filtration Rate ; Humans ; Linear Models ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; Severity of Illness Index ; Tomography, X-Ray Computed

Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.
Aged ; Angiography ; Coronary Artery Disease/complications/*pathology ; Coronary Vessels/diagnostic imaging ; Diabetes Mellitus, Type 2/*complications ; Diabetic Retinopathy/complications/*diagnosis/diagnostic imaging ; Female ; Glomerular Filtration Rate ; Humans ; Linear Models ; Male ; Middle Aged ; Odds Ratio ; Risk Factors ; Severity of Illness Index ; Tomography, X-Ray Computed

BACKGROUNDS/AIMS: Growth of tumors and their metastases is dependent on factors that stimulate vessel formation (angiogenesis). Vascular endothelial growth factor (VEGF) is closely related to angiogenesis in various human cancers. The aim of this study was to determine the value of serum VEGF levels in hepatocellular carcinomas as a tumor marker. METHODS: We measured serum VEGF levels, by enzyme immunoassay, and platelet counts in healthy controls (n=22), liver cirrhosis (LC; n=4) and hepatocellular carcinomas (HCC; n=14). RESULTS: The mean serum VEGF levels in controls and the patients with LC and HCC were 251.8+/-121.5 (mean+/-SD), 163.4+/-82.1 and 557.8+/-520.3pg/ml, respectively. The levels were significantly elevated in the HCC group, compared with the control group (p<0.05). Serum VEGF levels in the HCC group were highly correlated with platelet counts (r=0.915, p<0.05). Conclusions : We consider that serum VEGF is a possible tumor marker for HCC. Serum VEGF may be partly derived from platelets.
Carcinoma, Hepatocellular* ; Humans ; Immunoenzyme Techniques ; Liver Cirrhosis ; Neoplasm Metastasis ; Platelet Count ; Vascular Endothelial Growth Factor A*

Mycobacterium abscessus (M. abscessus) is the second most common nontuberculous mycobacteria (NTM) in South Korea. Nevertheless, the diagnosis and treatment of M. abscessus lung disease can be problematic. Surgical resection has been tried for patients with localized M. abscessus lung disease refractory to medical treatment. Here, we report on a 25-year-old woman with M. abscessus lung disease who had been diagnosed and treated three times for pulmonary tuberculosis. She was initially diagnosed as having M. intracellulare lung disease; however, M. abscessus was isolated after several months of medication. She had multiple bronchiectatic and cavitary lesions bilaterally, and M. abscessus was repeatedly isolated from her sputa despite prolonged treatment with clarithromycin, ethambutol, moxifloxacin, and amikacin. She improved only after sequential bilateral lung resection. Based on the experience with this patient, we suggest that, if medical treatment fails, surgical resection of a diseased lung should be considered even in patients with bilateral lesions.
Adult ; Anti-Bacterial Agents/pharmacology/*therapeutic use ; Female ; Humans ; Lung Diseases/*drug therapy/*microbiology/surgery ; Mycobacteria, Atypical/drug effects/*physiology

PURPOSE: We report on cases of anatomical popliteal artery entrapment syndrome (PAES) caused by an aberrant plantaris muscle and highlight the involvement of this muscle in PAES. MATERIALS AND METHODS: Seven symptomatic PAES legs in six patients treated at The Division of Vascular Surgery, Asan Medical Center, Seoul, Korea, between 1995 and 2011 were included in this study. We retrospectively analyzed patient records, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans of the knee joint, Doppler pressure studies, CT angiographies, and conventional femoral arteriographies. RESULTS: Five males and one female patient with a median age of 32 (18-53) years old were enrolled in the study. All patients complained of intermittent claudication of the affected leg. All aberrant plantaris muscles were higher and more medially located than normal plantaris muscles, causing occlusion of the popliteal artery upon forced plantar flexion of the ankle. For arterial lesions, five occlusions of the popliteal artery and two patent popliteal arteries with positive provocation were noted. As for treatment, myotomy of the aberrant plantaris muscle was done for two non-occlusive PAES legs. For occlusive PAES legs, one thrombectomy, one saphenous vein graft interposition of the popliteal artery followed by myotomy, and two below-knee femoro-popliteal bypasses were performed. The median follow-up period was 88 (7-148) months. CONCLUSION: An aberrant plantaris muscle can cause anatomical PAES. Classification or diagnosis of PAES should be based on axial studies using CT scans or MRI using various reconstruction methods. Treatment, including myotomy of the plantaris muscle, should be individualized.
Angiography ; Ankle ; Chungcheongnam-do ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Knee Joint ; Korea ; Leg ; Magnetic Resonance Imaging ; Male ; Muscle, Skeletal* ; Muscles ; Popliteal Artery* ; Retrospective Studies ; Saphenous Vein ; Seoul ; Thrombectomy ; Tomography, X-Ray Computed ; Transplants

A 17-year old female presented with a chief complaint of melena and epigastric pain. She had a family history of colon cancer, her mother having been diagnosed with hereditary nonpolyposis colorectal carcinoma (HNPCC). After close examination including double-balloon enteroscopy, the patient was diagnosed with small bowel carcinoma, in spite of her young age. Here we report this rare case of small bowel carcinoma in a young patient with a family history of HNPCC.
Adenocarcinoma/*diagnosis/pathology/surgery ; Adolescent ; Double-Balloon Enteroscopy ; Female ; Humans ; Jejunal Neoplasms/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Tomography, X-Ray Computed

No abstract available.
Actinobacillus* ; Aggregatibacter actinomycetemcomitans* ; Inflammation* ; Interleukin-6* ; Periodontal Pocket* ; Prevotella intermedia* ; Prevotella*

BACKGROUND: Although lung involvement has been reported in 5 to 46% of dermatomyositis/polymyositis (DM/PM) patients, reports of the condition in Korea are rare. This study evaluated the clinical features of lung involvement in DM/PM patients. METHODS: The medical records, laboratory results and radiologic findings of 79 DM/PM patients, who attended the Seoul National University Hospital (SNUH) between 1989 and 1999, were reviewed retrospectively. RESULTS: A total 79 patients of whom 24 patients(33%) showed lung involvement, were enrolled in this study. More patients with lung involvement were female(F:M=11:1), and older compared with those without lung involvement. Patients with lung involvement presented with dyspnea(79%), coughing(67%), an elevated ESR, and CK/LD. Anti-Jo 1 antibody test was positive in 30%, which is significantly higher in patients with lung involvement. A simple chest X-ray of the patients with lung involvement exhibited reticular opacity(50%), reticulonodular opacity(30%), patchy opacity(29%), nodular opacity(13%) and linear opacity(4%). HRCT(n=24) showed ground glass opacity(75%), linear or septal thickening(50%), patchy consolidation(42%), honey-combing(33%) and nodular opacity(17%). The pulmonary function test showed a restrictive ventilatory pattern(77%) and a lower diffusing capacity(62%). The patients were followed up during a mean duration of 30±28 months. They were treated with steroid only(50%) or a combination of steroids and cytotoxic agents(46%). Muscle symptoms were improved in 89% with treatment, but an improvement in the respiratory symptoms or in the pulmonary function test was rare. Patients with lung involvement had a higher mortality rate(21%) than those without lung involvement(10%) during the follow-up periods. CONCLUSION: DM/PM patients with lung involvement were mostly female, older and had a higher positive rate Anti-Jo 1 antibodies, but there was no significant difference in prognosis.
Antibodies ; Dermatomyositis ; Female ; Follow-Up Studies ; Glass ; Humans ; Korea ; Lung Diseases, Interstitial ; Lung* ; Medical Records ; Mortality ; Polymyositis ; Prognosis ; Respiratory Function Tests ; Retrospective Studies ; Seoul ; Steroids ; Thorax

A 39-year-old man with a history of hypertension for 10 years and 10 pack-years smoking, was admitted with dyspnea and generalized edema. On admission, renal insufficiency accompanied with nephrotic syndrome was diagnosed. Even on careful examination including history, blood chemistry test, and fundoscopic examination, no clinical evidence of diabetes was found. Renal biopsy findings, which strongly resembled that of diabetic nodular glomerulosclerosis in microscopic features, showed glomerular hypertrophy and nodular mesangeal sclerosis. Additional immunohistochemistry and ultrastructural investigations excluded other possible diseases that should be differentiated; membranoproliferative glomerulonephritis, thrombotic microangiopathy, amyloidosis, monoclonal immunoglobulin deposition disease, fibrillary glomerulonephritis, and immunotactoid glomerulopathy. Idiopathic nodular glomerulosclerosis is histopathologically similar to nodular diabetic glomerulosclerosis but is unusually developed in persons with hypertension and smoking history. Though there were three reports about cases of nodular glomerulosclerosis in the Korean literature, the cases were related to hepatitis B virus or diabetic retinopathy without overt diabetes. We report a rare case of idiopathic nodular glomerulosclerosis that was related to hypertension and smoking without other medical history.
Adult ; Amyloidosis ; Biopsy ; Chemistry ; Diabetic Nephropathies* ; Diabetic Retinopathy ; Dyspnea ; Edema ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Hepatitis B virus ; Humans ; Hypertension* ; Hypertrophy ; Immunoglobulins ; Immunohistochemistry ; Nephrotic Syndrome ; Renal Insufficiency ; Sclerosis ; Smoke* ; Smoking* ; Thrombotic Microangiopathies