PURPOSE: To determine the clinical value of the Siewert classification for gastic-cancer patients in Korea, we evaluated and compared the clinicopathologic factors of type II and type III cancer. MATERIALS AND METHODS: The medical records of 89 consecutive patients who had undergone surgery for an adenocarcinoma of the gastroesophageal junction (GEJ) at the Department of Surgery, Hanyang University Hospital, between Jun. 1992 and Dec. 2003 were reviewed retrospectively. RESULTS: There were one patient with type I, 12 pateints with type II and 77 patients with type III. During the same period, 1,341 patients underwent surgery for a gastric carcinoma, so proportion of GEJ cancer being 6.6%. The median follow- up duration was 31 months (range: 2~135 months), and the follow-up rate was 100%. Between type II and type III cancers, there were no significant differences in the clinicopathologic variables including age, sex, gross appearance, histologic type, depth of invasion, and pathologic stage. The longest diameter of the tumor was larger in type III (6.1+/-2.1 cm) than in type II (3.9+/-1.1 cm)(P=0.001). A total gastrectomy with Roux-en-Y esophagojejunostomy was done most frequently, while jejunal interposition was done in 3 cases of type II and 2 cases of type III. More than a D2 lymphadenectomy was done all cases. The numbers of dissected lymph nodes and metastatic lymph nodes in type II were 43.8 and 5.8 respectively, while they were 49.8 and 8.1 in type III, but the difference between the two groups were not statistically significant. The mean length of the proximal resection margin was 15+/-5 mm in type II and 21+/-13 mm in type III, but this difference was not statistically significanct. The time to recurrence after operation was 19.3 months in type II and 16.9 months in type III. The five-year survival rates of type II and III were 68.8% and 52.7% respectively, but difference was not significant. CONCLUSION: There were no significant differences in the clinicopathologic variables, including survival rate, between type II and type III cancers in Korean patients. According to these findings, it appears to be reasonable to classify type III cancer as a cardia cancer in a broad sense.
Adenocarcinoma* ; Cardia* ; Classification* ; Esophagogastric Junction ; Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: Superficially spreading (SS) early gastric cancer (EGC) is characterized by wide horizontal extension without deep vertical invasion. It is a relatively rare form of EGC, and it's clinicopathological (C-P) characteristics are not evident. This study aimed to clarify their C-P characteristics. MATERIALS AND METHODS: We defined SS EGC as invading less than the submucosal layer that measured more than 60 mm in diameter or wider than 5 x 5 cm (25 cm2) in width. The C-P characteristics and prognosis were compared between 69 patients with SS EGC and 319 patients with the common type EGC (EGC except SS type). RESULTS: For SS EGC, lymph node metastases, Lauren's diffuse type, lymphatic invasion were significantly higher than in common type EGC. In patients with SS EGC, all of the metastatic lymph nodes were anatomically distributed within the paragastric region, with fewer along the left gastric artery and common hepatic artery. In 6 cases of SS EGC with resection margins less than 10 mm, there was no death during the follow-up period (4 to 13 years after operation) if margins were not involved. Age (>58 yrs), tumor site (upper 1/3), lymph node metastasis, submucosal invasion were statistically significant poor prognostic factor in univariate survival analysis. In multivariate survival analysis, age and lymph node metastasis were independent prognostic factors. However, tumor diameter or width was not a significant prognostic factor. CONCLUSION: Although SS EGC has histologically distinct properties, gastrectomy with free surgical margins and appropriate lymph node dissection (D1+beta) could be a suitable treatment.
Arteries ; Follow-Up Studies ; Gastrectomy ; Hepatic Artery ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms*

PURPOSE: Superficially spreading (SS) early gastric cancer (EGC) is characterized by wide horizontal extension without deep vertical invasion. It is a relatively rare form of EGC, and it's clinicopathological (C-P) characteristics are not evident. This study aimed to clarify their C-P characteristics. MATERIALS AND METHODS: We defined SS EGC as invading less than the submucosal layer that measured more than 60 mm in diameter or wider than 5 x 5 cm (25 cm2) in width. The C-P characteristics and prognosis were compared between 69 patients with SS EGC and 319 patients with the common type EGC (EGC except SS type). RESULTS: For SS EGC, lymph node metastases, Lauren's diffuse type, lymphatic invasion were significantly higher than in common type EGC. In patients with SS EGC, all of the metastatic lymph nodes were anatomically distributed within the paragastric region, with fewer along the left gastric artery and common hepatic artery. In 6 cases of SS EGC with resection margins less than 10 mm, there was no death during the follow-up period (4 to 13 years after operation) if margins were not involved. Age (>58 yrs), tumor site (upper 1/3), lymph node metastasis, submucosal invasion were statistically significant poor prognostic factor in univariate survival analysis. In multivariate survival analysis, age and lymph node metastasis were independent prognostic factors. However, tumor diameter or width was not a significant prognostic factor. CONCLUSION: Although SS EGC has histologically distinct properties, gastrectomy with free surgical margins and appropriate lymph node dissection (D1+beta) could be a suitable treatment.
Arteries ; Follow-Up Studies ; Gastrectomy ; Hepatic Artery ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms*

PURPOSE: To determine the prognostic values of the hematologic parameters checked preoperatively in gastric cancer patients, we evaluated and compared the relationship between hematologic parameters and clinicopathologic factors of gastric cancer patient. MATERIALS AND METHODS: The medical records of 357 consecutive patients who had undergone surgery for gastric cancer at the Department of Surgery, Hanyang University Hospital, between Dec. 2,000 and Dec. 2003 were reviewed. To exclude any adverse effect of invasive procedures to hematologic parameters, the samples taken immediately at outpatient department was used. The normal range of serum albumin was defined above 3.5 g/dl, serum hemoglobin above 12 g/dl, and serum platelet count under 400x10(3)/microliter. Patients were defined as group 1 when any of these parameters was abnormal, and defined as group 2 when all parameters were normal. The relationships between hematologic parameters and survival rate were investigated. RESULTS: The mean values of platelet count increased, but level of serum albumin and serum hemoglobin decreased significantly according to the advancement of the disease stage (P=0.000). The differences of depth of tumor invasion and lymph node metastasis between the group 1 and the group2 was statistically significant (P=0.001). Three-year survival difference between group 1 and group 2 was significant (P=0.037). CONCLUSION: The hematologic parameters checked preoperatively in patients of gastric cancer are simple and cheap, meanwhile reflect the general condition of the patients. Any presence of anemia, hypoalbuminemia, or thrombocytosis can predict the progression of the disease and poor survival rates.
Anemia ; Humans ; Hypoalbuminemia ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Outpatients ; Platelet Count ; Prognosis ; Reference Values ; Serum Albumin ; Stomach Neoplasms* ; Survival Rate ; Thrombocytosis

No abstract available.
Bandages*

No abstract available.
Femoral Neck Fractures* ; Femur Neck*

PURPOSE: The 5-year survival rate is the most useful parameter for evaluating the effect of management on most malignant tumors. Recurrence after a curative resection for gastric cancer occurs mostly within 3 years of the operation, which caused us to evaluate whether a 3-year disease-free survival (3DFS) can be substituted for a 5-year overall survival (5OS). MATERIALS AND METHODS: We reviewed the medical records of 656 consecutive patients who had undergone a curative resection for gastric cancer. To assess whether 3DFS represents 5OS, we used a simple linear regression with survival probability calculated by using the survival function. RESULTS: Recurrence was found in 175 cases during the follow-up periods. The accumulative frequencies of recurrence at postoperative 1 year, 3 years, and 5 years were 46% (81 cases), 89% (156 cases), and 97% (170 cases), respectively. The correlation coefficient (r) and the coefficient of determination (r2) between 3DFS and 5OS were 0.87 and 0.76, respectively, and the regression equation was 5OS=0.18+(0.80 x 3DFS). The r and R2 according to the type of recurrence were 0.89 and 0.80 in peritoneal seeding, 0.88 and 0.78 in hematogeneous metastasis, and 0.86 and 0.73 in local recurrence, respectively. The r (0.77) and r2 (0.60) were relatively lower in low stages (stage I and II) compared to r (0.88) and r2 (0.77) in high stages (stage III and IV). CONCLUSION: The 3DFS is an excellent predictor of 5OS. Therefore, if we use the former as the treatment evaluating method, 2-year time reduction in assessing and reporting treatment results is expected.
Disease-Free Survival* ; Follow-Up Studies ; Humans ; Linear Models ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Stomach Neoplasms* ; Survival Rate

To clarify the clinicopathologic features of small-cell carcinomas (SCC) of the stomach, we reviewed three cases of surgically treated SCC. The first case was a pure SCC, with severe pancreatic invasion and peritoneal seeding. A gastro-jejunostomy was performed. Postoperative chemotherapy was performed with CDDP and VP-16 (8 cycles), but showed disease progression (PD); a consecutive chemotherapy with CDDP and irinotencan (2 cycles) also showed PD. A third line with CDDP, VP16, ifosfamide, and mesna was followed by a 4th line (CDDP and Taxol). The male patient died with liver metastasis and peritoneal seeding 14 months after the operation. The second case was a SCC mixed with a poorly differentiated adenocarcinoma. Profound lymphadenopathy and liver metastasis were found. Two cycles of preoperative chemotherapy with TS-1 and CDDP were performed, which showed nearly complete remission for lymphadenopathy and partial response for the primary tumor site and liver metastatic lesion. A total gastrectomy and extended lymphadenectomy was performed. There were no viable cancer cells in 35 retrieved lymph nodes. Postoperative chemotherapy using the same regimen was performed for 4 cycles. Enlarged liver metastasis was found at the follow-up CT scan, so a posterior segmentectomy of liver was performed. After liver surgery, the chemotherapy regimen was changed to irinotecan and cisplatin. This male patient has been in good health for the 14 months since gastric surgery. The third case was a pure SCC, and a subtotal gastrectomy was performed curatively. That male patient received 5 cycles of TS-1 and is still in good health 14 months after operation.
Adenocarcinoma ; Cisplatin ; Disease Progression ; Drug Therapy ; Etoposide ; Follow-Up Studies ; Gastrectomy ; Hepatomegaly ; Humans ; Ifosfamide ; Liver ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases ; Male ; Mastectomy, Segmental ; Mesna ; Neoplasm Metastasis ; Prognosis ; Stomach* ; Tomography, X-Ray Computed

PURPOSE: To investigate whether combined beta-carotene with X-irradiation has more enhanced radition response than X-irradiation or not, we performed a experiment about in vitro cytotoxicity of beta-carotene and/or X-irradiation in the fibrosarcoma cells, tumor growth delay of combined beta-caroten with/or X-irradiation in the mouse fibrosarcoma. MATERIALS AND METHODS: 2% emulsion of beta-carotene was serially diluted and used. X-irradiation was given by 6 MeV linear accelerator. The cytotoxicity of beta-carotene in vitro was evaluated from clonogenic assay. To compare the cytotoxicity between combined beta-carotene with X-irradiation and X-irradiation group, 2 mg/ml of beta-carotene was contacted to fibrosarcoma (FSaII) cells for 1 hour before X-irradiation. For the tumor growth delay, single 20 Gy was given to FSaII tumor bearing C3H/N mice whic was classified as beta-crotene with X-irradiation group (n=6) and X-irradiation alone group (n=5). 0.2 ml of 20 mg/kg of beta-carotene were i.p. injected to mice 30 minute before X-irradiation in the beta-crotene with X-irradiation group. The tumor growth delay defined as the time which reach to 1,000 mm3 of tumor volume. RESULT: (1) Cytotoxicity in vitro; 1) survival fraction at beta-carotene concentration of 0.002, 0.02, 0.2 and 2 mg/ml were 0.69+/-0.07, 0.59+/-0.08, 0.08+/-0.008 and 0.02+/-0.006, respectively. 2) each survival fraction at 2, 4, 6 and 8 Gy in the 2 mg/ml of beta-carotene + X-irradiation group were 0.13+/-0.05, 0.03+/-0.005, 0.01+/-0.002 and 0.009+/-0.0008, respectively. But each survival fraction at same irradiation dose in the X- irradiation group were 0.66+/-0.05, 0.40+/-0.04, 0.11+/-0.01 and 0.03+/-0.006, respectively( p<0.05). (2) The time which reach to 1,000 mm3 of tumor volume of beta-carotene + X-irradiation group and X-irradiation alone group were 18, 19 days, respectively( p>0.05). CONCLUSION: The contact of beta-caroten to FSaII cells showed mild cytotoxicity which was increased according to concentration. The cytotoxicity of combined beta-carotene with X-irradiation more increased than that of X-irradiation, additionaly. And there was significant difference of cytotoxicity between two groups. But there were no significant difference of the growth delay of fibrosarcoma between two groups.
Animals ; beta Carotene* ; Fibrosarcoma* ; Mice* ; Particle Accelerators ; Tumor Burden

OBJECTIVES: Kienbock's disease, which is characterized by osteonecrosis of the lunate bone, causes progressive chronic pain and dysfunction of the hand and wrist. Even though occurrence of the disease was reported approximately 100 years ago and it is suspected to be work-related to some degree, the etiology has not been clearly discribed and the disease has rarely been considered as an occupation-related disease. As such, we submit this case as the first report of Kienbock's disease in Korea, with clinical findings, x-ray, MRI (magnetic resonance imaging) and strain index results along with a literature review. METHODS: The patient was carefully interviewed and her medical records were properly reviewed by the authors with her consent. The authors also visited her factory work site to inspect and videotape the working environment and to conduct an ergonomic evaluation with a strain index. RESULTS: Excessively repeated contact stress was found to be concentrated on her right hand and the environment was discovered to be hazardous from an ergonomic standpoint. The literature review revealed that heavy loads on the hand might be related to the cause or deterioration associated with Kienbock's disease. ; therefore, it is very likely that her disease is related to her work. CONCLUSIONS: There is much evidence to suggest that heavy workloads involving hand and wrist intensive tasks may cause and worsen Kienbock's disease. However, to date epidemiologic studies clarifying the etiology of the disease have not been sufficiently reported. Therefore, further research focusing on the etiology and prevention of the disease are required. In addition, practical guidelines for hand and wrist intensive tasks are needed to prevent disease development and worsening.
Chronic Pain ; Glycogen Storage Disease Type VI ; Hand ; Humans ; Korea ; Lunate Bone ; Medical Records ; Occupational Diseases ; Osteonecrosis ; Sprains and Strains ; Videotape Recording ; Workplace ; Wrist