In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.
Adenocarcinoma ; Gastrectomy ; Gwangju ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms* ; Survival Rate*

In this retrospective study, 412 patients who had a curative resection with a lymph node dissection of higher level than D2 for gastric cancer at the Kwangju Christian Hospital from 1985 to 1991 were reviewed to analyze the dependence of their survival rate on lymph node metastasis results obtained by evaluating various metastatic patterns and on the spectrum of tumors(location, depth of invasion, size, and histologic type). The results are as follows: 1) Positive metastatic lymph nodes were found in 258(62.6%) of the 412 patients. When it came to the metastatic frequencies of each lymph node, No. 6 was involved in 40% of the cases(165 cases), No. 4 in 21.6%(87 cases), No. 3 in 20.1%(83 cases), No. 5 in 15%(62 cases), No. 8 in 14.3%(59 cases), No. 1 in 9.7%(40 cases), No. 7 in 8.9%(37 cases), and No. 9 in 8.2%(34 cases), which shows relatively higher metastatic frequencies for the perigastric lymph nodes than for the others. The 5-year survival rates for metastasis of various lymph nodes were 33.3% for No. 10, 20.4% for No. 3, 20% for No. 2, 20% for No. 13, 17.5% for No. 6, 16.6% for both No. 12 and 15, 15.7% for N0. 4, 12.9% for No. 5, 11.7% for N0. 9, 10.8% for No. 7, 8.4% for No. 8, 10% for both No. 1 and No. 11, 5.5% for No. 14 and 0% for No. 16. 2) When it came to the dependence of the metastatic frequencies of lymph nodes on the location of the gastric cancer, cancers in the lower third of the stomach showed the highest metastatic frequency in No. 6(39%), followed by No. 3(16.8%) and No. 4(16.2%) in that order. In the case of gastric cancer in the middle of the stomach, No. 6 showed the highest frequency at 48.6% followed by No. 3(26.3%), No. 4(23.6%), No. 5(17.1%), No. 8(17.1%), and No. 9(9.2%) in that order. In the case of gastric cancer in the upper third of the stomach, No. 3 showed the highest frequency at 47.6% followed by No. 1(47.6%), No. 4(38%), No. 6(23.8%), No. 5(19%), and No. 7(9.5%) in that order. This showed that in all lacations of gastric cancer, lymph node metastases were primarily observed among the perigastric N1 node group. 3) As the tumor invasion into the stomach wall grew deeper, metastases of the lymph nodes of N2 or higher groups increased. There was a significant difference in the metastatic frequencies of the lymph nodes between the proper muscle and the serosal layer. The survival rate dropped to a remarkable degree when the tumor invasion was deeper than the serosal layer. 4) Poorly differentiated adenocarcinomas were more frequently metastasized to the regional lymph nodes than well differentiated ones, and the metastasis extended to nonperigastric lymph nodes. The poorer the differentiation was, the lower the survival rate became. 5) The larger the size of the tumors was, the higher the lymph node metastatic frequency grew, reducing the survival rate. 6) When patients were in advanced stages of gastric cancer, the survival rate dropped considerably. 7) Based on the results mentioned above in which tumor invasion into the lymph nodes of N2 or higher groups were often observed and in which there were significant differences in the prognosis, we conclude that a gastrectomy with extensive lymphadenectomy at least up to the second node group(D2) might be the procedure of choice for advanced gastric cancer in order to improve the survival rate.
Adenocarcinoma ; Gastrectomy ; Gwangju ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms* ; Survival Rate*

A modified Broström procedure has been widely accepted as a treatment of choice for patients with chronic lateral ankle instability. The procedure is highly reliable and provides successful outcomes in approximately 90% of cases. Severe degree of instability, absence or poor quality of the ligamentous remnant, obesity, and generalized joint hypermobility have been regarded as poor prognostic factors related to the modified Broström procedure. However, these perceptions are based on a low level of evidence studies or expert opinions. Therefore, the aim of this article was to search for evidences regarding the poor prognostic factors of the modified Broström procedure.
Ankle* ; Expert Testimony ; Humans ; Joint Instability ; Ligaments* ; Obesity ; Prognosis ; Risk Factors*

Background: The purpose of this study was to examine the between-mode equivalence and the relative efficiency of the 2 available modes of patient-reported outcome (PRO) data collection: a web-enabled touch screen tablet and a smartphone in a sample of patients who underwent foot and ankle orthopedic surgery. Methods: A total of 136 patients who visited the clinic after foot/ankle surgery participated in the study. All patients completed the PRO questionnaire set using tablets at the hospital. After 24 hours of completing the first PRO questionnaire, the patients completed the same PRO questionnaire at home using their personal smartphones. The outcomes were statistically compared, and the patients’ preferences were surveyed. Results: The intraclass correlation coefficients for comparing the results of PRO measurements between the 2 modes were 0.970 for the visual analog scale, 0.952 for the Foot Function Index, 0.959 for the foot and ankle outcome scale, and 0.957 for the patient’s satisfaction. Sixty-eight participants (58.6%) responded that they were able to answer the questionnaires with more honesty at home using their smartphones. Regarding the mode, 60 participants (48.1%) responded that they have no preference between the devices. Conclusions The results of this study showed the equivalence of the 2 modes of PRO data collection: web-enabled touch screen tablets and smartphones. Smartphones may be the preferred mode of PRO measurement, due to their easy accessibility, increased privacy, and the patients’ increased honesty in answering questionnaires.

A 11-year-old, female Russian Blue cat was presented with anorexia, vomiting, and diarrhea lasting for 3 days. Abdominal ultrasonography revealed a hypoechoic, non-circumferential, and eccentrically formed intestinal loop with altered wall layering and thickening of the tunica muscularis. After surgical resection, histopathologic examination confirmed an infiltrative, round-cell neoplasm composed of sheets and cords of neoplastic mast cells within a fibrotic, edematous stroma. The cat was alive and healthy 6 months after surgery. To the best of our knowledge, this is the first reported case of an intestinal mast cell tumor in a Russian Blue cat in South Korea.
Animals ; Anorexia ; Cats* ; Child ; Diarrhea ; Female ; Humans ; Korea ; Mast Cells* ; Ultrasonography ; Vomiting

OBJECTIVES: Our purpose was 1) to determine whether elevated maternal serum alpha- fetoprotein(MSAFP) predict increased risk of spontaneous preterm delivery and indicated preterm delivery; 2) to determine whether elevated maternal serum human chorionic gonadotropin(MSHCG) predict increased risk of preterm delivery. Methods: Between September 1995 and April 1998, 945 of 2105 pregnant women who received midtrimester MSAFP screening were identified and evaluated. 81 women with MSAFP levels of 2.0 MoM or more were included in the study group while 864 women with levels less than 2.0 MoM served as controls. Pregnancy outcome were obtained from hospital records and statistical analysis were performed. RESULTS: Women with elevated MSAFP levels showed an increased risk for preterm delivery(p<0.05), fetal growth restriction(p<0.05) and hypertensive disorders(p<0.05), but not for preterm premature rupture of membrane, fetal death in utero. There was a strong association between unexplained elevated MSAFP levels and spontaneous preterm delivery(p<0.05) but our study does not support an association between unexplained elevated MSAFP levels and indicated preterm delivery. There was no association between elevated MSHCG levels and preterm delivery regardless of MSAFP levels. CONCLUSION: We concluded that unexplained elevated levels of midtrimester MSAFP were associated with an elevated risk of spontaneous preterm delivery but not with a risk of indicated preterm delivery. Elevated MSHCG levels were not associated with a risk of preterm delivery and spontaneous preterm birth.
alpha-Fetoproteins* ; Chorion ; Extraembryonic Membranes ; Female ; Fetal Development ; Hospital Records ; Humans ; Mass Screening ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Premature Birth* ; Rupture

OBJECTIVES: To compare the diagnostic and prognostic performance of amniotic fluid white blood cell(AF WBC) count and amniotic fluid culture for the prenatal diagnosis of intrauterine infection and the prediction of neonatal outcomes in patients with preterm labor and intact membranes. Methods: Amniocentesis was performed in 75 patients with preterm labor and intact membranes, who delivered preterm neonates within 72 hours after amniocentesis. AF WBC was determined and amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasma. The relations among placental histologic findings, perinatal outcome, AF WBC count, and AF culture were examined. Student t test, Mann Whitney U test, lamda2 test, Fisher's exact test, modified t test, and logistic regression analysis were used for statistical analysis. RESULTS: Microbial invasion of the amniotic fluid was more frequent in the patients with histologic chorioamnionitis than patients without histologic chorioamnionitis (28.9% vs 5.4%, p<0.05), and patients with histologic chorioamnionitis had significantly higher amniotic fluid white blood cell counts than those patients without such lesion (median 99, range 0-3024 cells/mm3 vs median 1, range 0-180 cells/mm3, p<0.01). Amniotic fluid white blood cell count (> or = 50cell/mm3) had a sensitivity of 55.3%(21/38) and a specificity of 94.6%(35/37) for the diagnosis of histologic chorioamnionitis and a sensitivity of 47.5%(19/40) and specificity of 90.9%(30/33) for the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis). These sensitivities were significantly higher than those of amniotic fluid culture (for histologic chorioamnionitis, 55.3% vs 28.9% ; for significant neonatal morbidity, 47.5% vs 25.0%, p<0.01 for each). CONCLUSION: Amniotic fluid WBC count is a more sensitive test for the prenatal diagnosis of intrauterine infection and for the prediction of significant neonatal morbidity than amniotic fluid culture in the patients with preterm labor and intact membranes.
Amniocentesis ; Amniotic Fluid* ; Bacteria, Anaerobic ; Bronchopulmonary Dysplasia ; Chorioamnionitis ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infant, Newborn ; Leukocyte Count* ; Leukocytes* ; Logistic Models ; Membranes* ; Mycoplasma ; Obstetric Labor, Premature* ; Pneumonia ; Pregnancy ; Prenatal Diagnosis* ; Sensitivity and Specificity ; Sepsis

PURPOSE: We conducted this study to evaluate the role of dacryoscintigraphy in the diagnosis and treatment of pediatric patients with epiphora. MATERIALS AND METHODS: In 58 patients aged from 2 months to 15 years (mean age 2.8+/-2.3 years), dacryoscintigraphy was performed using a gamma camera with 4 mm pinhole collimator. We correlated symptoms with dacryosicntigraphic findings in all patients. In 37 patients who underwent ophthalmologic procedures, we analyzed the agreements of dacryoscintigraphic findings with the operation. RESULTS: High rates of agreements between epiphora and obstruction on dacryoscintigraphy (69/72, 95.8%), and between scintigraphic obstructive findings and operation sites (44/47, 93.6%) were noted. Nine of fourty-four (20.5%) asymptomatic eyes showed obstructive findings on dacroscintigraphy. CONCLUSION: In pediatric patients with epiphora, dacryoscintigraphy is a useful tool not only in diagnosing nasolacrimal duct obstruction but also in making a decision for therapeutic procedures.
Diagnosis* ; Gamma Cameras ; Humans ; Lacrimal Apparatus Diseases* ; Nasolacrimal Duct

PURPOSE: We wanted to introduce a nail lengthening technique with an eponychial flap for treating finger tip amputation, and we review the relevant literature. MATERIALS AND METHODS: Twenty-five patients who received eponychial flap surgery between November 2001 and April 2006 were enrolled in this study. Retrospectively, the patients were asked, by using a questionnaire, about their satisfaction with their nail shape and length. The preoperative findings and the findings at the last follow up and the contralateral finger nail lengths were measured with a ruler and those were all compared according to the percentage of change. RESULTS: The average operation time was fourteen minutes (range: 10 to 19 minutes). All the flaps survived and there was no infection, congestion of the flap, or additional deformity of nail. The average follow up period was five months. The nails were lengthened an average of 0.35 cm. The last follow up questionnaire showed that the patients were satisfied with their nail's appearance with an average score of 95.5 points. CONCLUSION: Nail lengthening using an eponychial flap is a convenient, safe and aestheticall pleasing procedure.
Amputation ; Congenital Abnormalities ; Estrogens, Conjugated (USP) ; Fingers ; Follow-Up Studies ; Humans ; Nails ; Surveys and Questionnaires ; Retrospective Studies

Objective: Various out-of-hospital cardiac arrest (OHCA) prognostication scores have been developed. However, the application of these scores is often limited owing to missing predictor variables. This study aimed to compare and validate various OHCA prognostication scores using simple imputation methods that can easily be applied in clinical situations. Methods: Adult patients presenting with OHCA with a sustained return of spontaneous circulation (ROSC) between October 2015 and June 2020 were the subjects for the analysis. We evaluated six OHCA prognostication scores: the ROSC after cardiac arrest (RACA) score, CaRdiac Arrest Survival Score (CRASS), NULL-PLEASE, predictive score (PS), cardiac arrest hospital prognosis (CAHP) score, and the OHCA score. For missing predictors, median imputation for continuous variables and mode imputation for categorical variables were performed before the analysis. We evaluated the discrimination and calibration powers of each prognostic score for good neurological recovery at discharge. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination power, and a calibration plot and the Hosmer-Lemeshow test were used to assess the calibration power. Results: Of the 12,321 patients, 5,191 were subjected to analysis. Among them, 924 (17.8%) had good neurological recovery. Certain predictors often had missing values-no-flow time 1,107 (21.3%), low-flow time 862 (16.6%), pH 1,104 (21.3%), lactate 1,820 (35.0%), and creatinine 2,257 (43.5%). After imputing the missing variables, the CAHP score showed the highest AUC (0.957; 95% confidence interval, 0.950-0.963), and the CRASS and PS also presented excellent discrimination power (AUC 0.914 and 0.942, respectively). However, the CAHP and NULL-PLEASE scores were well calibrated (Hosmer-Lemeshow test, P>0.05). Conclusion Among the six prognostic scores, the CAHP score showed the highest discrimination and calibration powers.