No abstract available.
Child* ; Edema* ; Gallbladder* ; Humans

No abstract available.
beta 2-Microglobulin* ; Humans ; Kidney Failure, Chronic*

Surgeons are often faced with the problem of bowel obstruction in a patient who has previously undergone operation for malignant disease. Mechanical obstruction secondary to recurrent carcinoma is associated with poor survival. Surgical attempts to relieve malignant obstruction have significant morbidity and mortality rates and limited success in resolving symptoms. Then there is a temptation to assume that the obstruction is due to advanced malignancy and that death is inevitable. But a benign, correctable cause of obstruction will be found in about 25% of these patients. For this study, we had selected 63 cases of small bowel obstruction in patients with a previous operation for cancer which were admitted at Korea University Hospital between 1990 to 1995. The 43 men and 20 women had a mean age of 55.5 years. Forty one cases(65%) had obstruction due to recurrent carcinoma. The location of primary malignancies were as follows: 47 of the patients(74.6%) had adenocarcinoma of the stomach, 16 patients(25.4%) had adenocarcinoma of the colorectum. The median interval from the original operation for the malignancies until the development of bowel obstruction was 17.5 months. In our study, the small bowel obstruction due to recurrent carcinoma was frequently predicted when ascites and pleural effusion were present. We concluded that patients with no known recurrence or a short interval to the development of mechanical obstruction should be aggressively treated with surgery and for patients with known abdominal recurrence in whom nonoperative therapy fail, the surgical palliation are inevitable.
Adenocarcinoma ; Ascites ; Female ; Humans ; Korea ; Male ; Mortality ; Pleural Effusion ; Recurrence ; Stomach

Background/Aims: It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD).We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosive GERD or mild erosive esophagitis. Methods: Patients whose GERD symptoms improved after 4 weeks of standard dose PPI treatment were prospectively enrolled at 25 hospitals.Subsequently, the enrolled patients were randomly assigned to either an on-demand or a continuous maintenance treatment group, and followed in an 8-week interval for up to 24 weeks. Results: A total of 304 patients were randomized to maintenance treatment (continuous, n = 151 vs on-demand, n = 153). The primary outcome, the overall proportion of unwillingness to continue the assigned maintenance treatment modality, failed to confirm the noninferiority of on-demand treatment (45.9%) compared to continuous treatment (36.1%). Compared with the on-demand group, the GERD symptom and health-related quality of life scores significantly more improved and the overall satisfaction score was significantly higher in the continuous treatment group, particularly at week 8 and week 16 of maintenance treatment. Work impairment scores were not different in the 2 groups, but the prescription cost was less in the on-demand group. Serum gastrin levels significantly elevated in the continuous treatment group, but not in the on-demand group. Conclusions Continuous treatment seems to be more appropriate for the initial maintenance treatment of non-erosive GERD or mild erosive esophagitis than on-demand treatment. Stepping down to on-demand treatment needs to be considered after a sufficient period of continuous treatment.