PURPOSE: The aim of this study was to evaluate the clinical significance of perineal descent (PD) in pelvic outlet obstruction patients diagnosed by using defecography. METHODS: One hundred thirty-six patients with pelvic outlet obstruction (POO; median age 49 years) had more than one biofeedback session after defecography. Demographic finding, clinical bowel symptoms and anorectal physiological studies were compared for PD at rest and PD with dynamic changes. RESULTS: Age (r = 0.33; P < 0.001), rectocele diameter (r = 0.31; P < 0.01), symptoms of incontinence (P < 0.05) and number of vaginal deliveries (r = 0.46; P < 0.001) were correlated with increased fixed PD. However, the female gender (P < 0.005), rectal intussusceptions (P < 0.05), negative non-relaxing puborectalis syndrome (P < 0.00005) and rectocele (P < 0.0005) were correlated with increased dynamic PD. Duration of symptoms, number of bowel movements, history of pelvic surgery and difficult defecation were not related with PD. There was no significant correlation between fixed and dynamic PD and success of biofeedback therapy. CONCLUSION: Age, vaginal delivery and diameter of the rectocele are associated with increased fixed PD. Female gender, rectal intussusceptions and a rectocele are correlated with increased dynamic PD. Biofeedback is an effective option for POO regardless of severity of PD.
Biofeedback, Psychology ; Defecation ; Defecography ; Female ; Humans ; Intussusception ; Rectocele

Aortic aneurysms infected by Klebsiella pneumoniae are rarely seen. We describe a 50-year-old man with infected aortic aneurysm that was successfully treated with endovascular aneurysm repair (EVAR). Diagnosis was confirmed using blood culture and computed tomography (CT). Intravenous antibiotics were immediately administered, with improvements in clinical findings and negative blood cultures before the procedure. Twenty-four months after the procedure, the patient was stable and serial CT revealed regression of the infected aortic aneurysm. Therefore, after controlling bacteremia and fever with targeted antibiotic therapy, EVAR can be considered as an alternative for patients who have serious comorbidities and are ineligible for conventional surgery.

PURPOSE: The proportion of early gastric cancer has recently increased. Although early gastric cancer has a very good prognosis following a curative resection, and recurrences rarely occur, if there is a distant recurrence the prognosis is grave. To predict to the potential of a recurrence after a gastrectomy, early gastric cancer patients were retrospectively analyzed. METHODS: 1, 131 early gastric cancers were curatively resected at the Asan Medical Center between Jan, 1990 and Sep, 1997. Recurrences were observed in 46 patients during the follow up period. The clinical characteristics of the recurred and cured groups were compared. Any statistical significance was calculated using Chi-Squared and Log rank tests, using SPSS version 10.0. RESULTS: The recurrence and 5-year survival rates of the recurred patients were and 9%, respectively. Hematogenous recurrences were the most common mode of recurrence, followed by lymph node recurrences. The mean tumor size, numbers of lesions, location of tumor, status of lymph node dissection and operation type, did not affect tumor recurrences. The grossly elevated type of tumor, submucosal layer invasion and differentiated cancer, most frequently recurred. The rate of recurrence linearly increased with increase of the nodal stage. All patients with a lymph node recurrence had lymph node metastasis at the initial surgery. CONCLUSION: In early gastric cancer patients, the elevated type, or a differentiated adenocarcinoma, may recur at a distant organ. A more careful follow-up will be required if the surgical removal of a metastatic tumor is intended, as chemotherapy is ineffective. The sentinel lymph node should be examined by a frozen biopsy at the beginning of the initial surgery, in order to determine the range of a lymph node dissection to avoid a nodal recurrence.
Adenocarcinoma ; Biopsy ; Chungcheongnam-do ; Drug Therapy ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: We performed retrospective study to evaluate the preventive effect of intraperitoneal cisplatin installation (IPCI) on peritoneal recurrence after curative resection of advanced gastric cancer. MATERIALS AND METHODS: The effect of IPCI was evaluated in 297 advanced gastric carcinoma patients from January 1993 to December 1996. In IPCI group, 100 mg/body of cisplatin in one liter of saline was installed in peritoneal cavity before wound closure in operating room and drained out 2 hours later. Postoperative adjuvant chemotherapy with combination of 5-FU and cisplain was performed. 155 cases were treated by IPCI. Median follow-up period was 26 months. RESULTS: Out of 139 (46.8%) recurred cases, peritoneal, local and distant recurrences developed in 65 (37.8%) cases, 66 (38.4%) cases and 41 (23.8%) cases respectively. In univariated analysis for survival and recurrence, IPCI, T stage and N stage were significant prognostic factors. As regards to peritoneal recurrence, IPCI and T stage were significant factors. In multivariated survival analysis, as regards to recurrence, IPCI, T stage and N stage were significant prognostic factors. As regards to peritoneal recurrence, IPCI was the only significant independent prognostic factor. CONCLUSION: We concluded that IPCI can effectively prevent peritoneal recurrence and overall recurrence and it shows marginal survival benefit in advanced gastric cancer patients with serosa invasion.
Chemotherapy, Adjuvant ; Cisplatin* ; Fluorouracil ; Follow-Up Studies ; Humans ; Operating Rooms ; Peritoneal Cavity ; Recurrence ; Retrospective Studies* ; Serous Membrane* ; Stomach Neoplasms ; Wounds and Injuries

OBJECTIVE: In rheumatoid arthritis(RA) patients, HLA-B27 has been mainly found with the same frequency as in the normal population. An increased frequency of HLA-B27 in RA has, however, repeatedly been found in northern Sweden and in Filand. The results concerning the association of HLA-B27 to the outcome of the disease have been contradictory in RA. In RA, the presence of I-ILA-B27 has shown to be a prognostic index for cervical spine subluxation. There has been no report regarding the association between RA and HLA-B27 in the Korean population. METHODS: 188 patients with RA were randomly selected from the patients who were diagnosed at Rheumatism Center of Hanyang University iHospital from October 1994 to June 1995 to establish the frequency of HLA-B27 in RA and to investigate the possible influence and prognostic significance on clinical outcome including atlantoaxial subluxations. RESULTS: The results were as follows: 1) HLA-B27 was present in 12.2% of the RA patients studied. The relative risk(RR) and etiologic fraction(EF) of HLA-B27 were 5.99 and 0. 1019 respectively. 2) The rheumatoid factor was positive in 79.8% of the total patients, 73.9% in HLA-B27 positive patients, and 80.6% in HLA-B27 negative patients. HLA-B27 was not associated with the presence of rheumatoid factor in this study. 3) HLA-B27 was not associated with the duration of morning stiffness, Ritchie index, extraarticular manifestations, the number of swollen joints, ARA functional class, ESR, C-reactive protein, or hemoglobin. HLA-B27 was not associated with the positivity of ANA and antiperinuclear factor. 4) HLA-B27 was not associated with the positive rate of erosion and Steinbrocker class in peripheral joints. 5) Atlantoaxial subluxation was present in 13% of HLA-B27 positive patients and 17% of HLA-B27 negative patients. The involvement of atlantoaxial joint including narrowing of lateral facet joints was 26.1% in HLA-B27 positive patients and 20.6% in HLA-B27 negative patients. Subaxial subluxation was presented in only 1 case in HLA-B27 negative group of total patients. HLA-B27 was not associated with the cervical changes in RA. CONCLUSIONS: An increased freuency of HLA-B27 in RA patients was significantly found in Korea(RR=5.99, EF=0.1019). However, patients with HLA-B27 had a similiar clinical profile to patients without HLA-B27 and HLA-B27 positivity did not further contribute to the severity with respect to clinical and laboratory variables or to radiological progression in peripheral joints or cervical spine.
Arthritis, Rheumatoid* ; Atlanto-Axial Joint ; C-Reactive Protein ; HLA-B27 Antigen* ; Humans ; Joints ; Rheumatic Diseases ; Rheumatoid Factor ; Spine ; Sweden ; Zygapophyseal Joint

PURPOSE: Despite known advantages of laparoscopy-assisted distal gastrectomy (LADG) over open surgery, including less blood loss, less pain, faster recovery, and shorter hospital stays, many surgeons still hesitate to perform LADG in overweight patients due to concerns about increased perioperative morbidity. We investigated whether surgical outcomes in LADG differ in overweight patients and normal patients, as well as the influence of surgical experience. METHODS: Between April 2004 and December 2006, 331 consecutive patients underwent LADG for preoperatively diagnosed early gastric cancer. Using the definition of overweight by western criteria, patients were classified into a low (n = 187, BMI < 25 kg/m(2)) and a high (n=144, BMI > 25 kg/m(2)) group. We retrospectively analyzed surgical outcomes, including operation time, retrieved lymph nodes, hospital courses, and postoperative complications. RESULTS: The only differences in overweight and normal patients were longer operation time, incision length, and fewer retrieved lymph nodes. As our surgical team accumulated experience (after 250 cases in our study), there were no differences at all between the two groups. CONCLUSION: Technical difficulty in overweight patients could hamper some surgical outcomes but didn't worsen the post- operative courses or complications. Moreover, those difficulties can be overcome as the surgical team accumulates experience.
Body Mass Index ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Obesity ; Overweight ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The geriatric population will continue to increase in the coming decades, and the number of gastric cancer patients who are over 80 years of age is increasing. The aim of this study was to suggest optimal treatment in these patients on the basis of the cause of death. METHODS: Forty-four patients who underwent curative resection in the course of gastric cancer treatment and were over 80 years of age at Asan Medical Center between January 1990 and February 2002 were included in this study. The cause of death of those patients was retrospectively analyzed by checking medical record or calling to relatives. RESULTS: Average age of 41 patients was 81.41 years old and follow up duration was 49 months. Until February 2004, overall mortality was 23 patients (56%). The mortality from gastric cancer-related and from other disease was 12 patients (52%) & 11 patients (48%), respectively. The most common cause of death from other disease was senility. Median survival time of 11 patients from cancer none-related death was 57 months. Median survival time of 32 patients corresponding stage l & ll was 52.5 months. CONCLUSION: We, therefore, conclude that a standard gastrectomy is basically appropriate for patients older than 80 years of age, as long as they demonstrate a good risk.
Cause of Death ; Chungcheongnam-do ; Follow-Up Studies ; Gastrectomy ; Humans ; Medical Records ; Mortality ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: According to the 2nd English Edition of the Japanese Gastric Cancer Association (JGCA) in 1998, in case of distal gastric cancer, the 14v (superior mesenteric vein) lymph node (LN) is included in the N2 group. However, in Korea, a modified radical gastrectomy is performed, and a 14v LN dissection is not done as a routine procedure. Thus, we investigated the rate of metastatic 14v LNs, evaluated the necessity of dissection of the 14v LN, and searched for indications of 14v LN dissection. MATERIALS AND METHODS: From April 2004 to August 2005, we enrolled the patients who were diagnosed as having advanced gastric cancer in the distal third portion of the stomach. We performed a distal gastrectomy with D2 lymph node dissection as defined in the 2nd English edition of the JGCA classification. We calculated the positive rate of metastatic LNs of each station and analyzed the relationship between the positive rates of No.6 LNs and 14v LNs. We also compared the positive 14v LN group with the negative 14v LN group. RESULTS: The total number of patients was 50, the mean age was 56 (range 30~80) years, and sex ratio (Male/Female) was 1.63 : 1. In 47 (94%) cases, distal a gastrectomy with gastroduodenostomy was done, and in the remaining 3 (6%) cases, a distal gastrectomy with gastrojejunostomy was done. The most frequently metastatic LNs were nos. 3 and 6 (54%). The metastatic rate of the 14v LN was 10%, which was similar to that of LN no. 9. In the comparison of the 14v positive group with the 14v negative group, there were significant differences in the numbers of metastatic LNs (mean 25.4 vs 4.91, P<0.001) and the numbers of metastatic no. 6 LNs, (mean 6.8 vs 1.42, P<0.001), and if no. 6 LNs were metastatic, the possibility of metastasis to the 14v LN was 19.2%. In the 14v positive group, all cases were more than stage 3 by the UICC 6th edition. CONCLUSION: In cases of advanced cancer with metastasis to the no. 6 LN, there was a good chance of metastasis to the 14v LN. Thus, in the operative field, if the tumor is advanced to more than stage 3 by the UICC classification and the no. 6 LN is metastatic, a 14v LN dissection is necessary. However, the usefulness of a 14v LN dissection should be evaluated prospectively through an analysis of tumor recurrence and long-term survival.
Asian Continental Ancestry Group ; Classification ; Gastrectomy ; Gastric Bypass ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Recurrence ; Sex Ratio ; Stomach ; Stomach Neoplasms*

OBJECTIVE: Suicide is the leading cause of death for adolescents. The internet is widespread in Korea and has influence on mental health of adolescents. This study aims to investigate the relationship between the internet use and suicidal behavior resulting from adolescent depression. METHODS: The subjects consisted of 61 adolescents between the ages of 13 and 18 who were diagnosed as depression by Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Korean Version and Diagnostic and Statistical Manual of Mental Disorder 4th edition. Suicidal behavior was assessed by Columbia Suicide Severity Rating Scale. Patients were inquired about their internet use using questionnaires and other clinical variables using Beck Depression Inventory, Beck Suicidal Ideation Scale, Revised Children's Manifest Anxiety Scale, Internet Game Addiction Scale and Physical Abuse Scale. RESULTS: The patients within the high-risk group were more prone to searching for the word 'suicide' on the internet and having suicidal idea compare to the patients within the low-risk group. Among the high-risk group, the patients who searched for the word 'suicide' tended to be more anxious compared to the patients who did not search the word. CONCLUSION: The results of the present study suggest that searching the word 'suicide' on the internet is associated with suicidal idea. It is suggested that intervention on the patients within the searching group may reduce the suicidal idea resulting from adolescent depression.
Adolescent ; Cause of Death ; Depression ; Humans ; Internet ; Korea ; Manifest Anxiety Scale ; Mental Disorders ; Mental Health ; Mood Disorders ; Surveys and Questionnaires ; Schizophrenia ; Suicidal Ideation ; Suicide

PURPOSE: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. MATERIALS AND METHODS: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. RESULTS: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). CONCLUSION: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.
Gastrectomy* ; Humans ; Intestinal Obstruction ; Laparoscopy ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*