PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer. Generally; LADG, with extraperigastric lymph node dissection, is considered a technically more complicated procedure for gastric cancer than a conventional open distal gastrectomy (CODG). LADG, with extraperigastric lymph node dissection, for gastric cancers has previously been described, but the safety, efficacy and clinical benefits of these types of surgery are still unclear. To evaluate the short-term surgical validity, surgical outcome of a LADG, with extraperigastric lymph node dissection, was compared with that of a CODG in early gastric cancer patients. METHODS: A retrospective study of 80 patients with early gastric cancer (EGC), who underwent a LADG, with extraperigastric lymph node dissection, between September 2004 and August 2006, at Keimyung University Dongsan Medical Center, was performed. Over the same period, conventional open gastrectomies were performed in 97 patients, confirmed to have EGC from their pathology. Various clinicopathological parameters were evaluated from the medical records. RESULTS: The baseline characteristics, including gender, age, body mass index (BMI) and tumor size, were similar between the two groups. In the LADG group, the operation time was longer (P=0.000), but the blood loss was less (P=0.000) than in the CODG group. The postoperative recovery in the LADG group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay, which resulted in significantly lower serum white blood cell count amylase and C-reactive protein levels on day 1. Pathological examinations showed the surgery to be equally radical in the two groups. CONCLUSION: According to this study; LADG, with extraperigastric lymph node dissection, is a safe and technically feasible procedure for the treatment of early gastric cancer. The LADG procedure provides several advantages to that of a conventional open distal gastrectomy; less inflammatory reactions, a rapid return of gastrointestinal function and a shorter hospital stay, with no decrease in the operative curability.
Amylases ; Body Mass Index ; C-Reactive Protein ; Gastrectomy* ; Humans ; Length of Stay ; Leukocyte Count ; Lymph Node Excision ; Medical Records ; Pathology ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: To retrospectively review the results of internal bone transport in the management of tibial bone defect using ilizarov fixator. MATERIALS AND METHODS: We treated 39 cases of tibial bone defect (16 of traumatic bone loss, 23 after treatment of osteomyelitis). The mean age of index procedure was 33.8 years (range, 13~66 years), and all of them had follow-up study for a mean of 3.5 years (range, 1.6~8 years). The mean transported amount was 6.3 cm (range, 2.7~20 cm), and the external fixator was removed after 345 days (range, 120~700 days). The mean external fixation index was 60.3 days/cm (range, 13.1~121.3 days/cm). RESULTS: Primary union of distraction and docking site was achieved in all, but two patients had failure in union of docking site. Functional results showed 6 excellent, 19 good, 10 fair, and 4 fair. The patients under age 20 showed better functional outcomes than the others. Among 73 complications (incidence, 1.87 cases/ patient), 27 of major complications with residual sequelae occurred in 20 patients. The residual sequelae were more common in the patients who had the concomitant injuries in the same leg. CONCLUSION: Internal bone transport can solve the large amount of tibial bone defect. However, the complications are not uncommon, which might be related to the concomitant injures in the same leg.
External Fixators ; Follow-Up Studies ; Humans ; Leg ; Retrospective Studies ; Tibia

BACKGROUND: Warfarin is a widely used oral anticoagulant with broad within- and between-individual dose requirements. Warfarin concentrations can be monitored by assessing its pharmacologic effects on International Normalized Ratio (INR). However, this approach has not been applied in the routine clinical management of patients receiving warfarin therapy. We performed a plasma warfarin assay using high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) to determine if such an assay can be utilized in routine clinical practice. METHODS: We included a total of 105 patients with atrial fibrillation, and who were receiving warfarin for more than 1 yr. The plasma concentrations of total warfarin and 7-hydroxywarfarin were determined by HPLC-MS/MS (Waters, UK). We assessed the association between warfarin dose, concentration, and INR as well as the effects of these factors on warfarin concentrations. RESULTS: The mean maintenance dose of warfarin in 105 patients was 4.1+/-1.3 mg/day (range, 1.7-8.0 mg/day) and their mean plasma warfarin concentration was 1.3+/-0.5 mg/L. We defined a concentration range of 0.6-2.6 mg/L (corresponding to the 2.5th to 97.5th percentile range of the Plasma warfarin levels in the 74 patients showing INR within target range) as the therapeutic range for warfarin. The correlation of warfarin dose with warfarin concentration (r2=0.259, P<0.001) was higher than that with INR (r2=0.029, P=0.072). CONCLUSIONS: There was a significant correlation between warfarin dose and plasma warfarin concentrations in Korean patients with atrial fibrillation. Hence, plasma warfarin monitoring can help determine dose adjustments and improve our understanding of individual patient response to warfarin treatment.
Adult ; Aged ; Aged, 80 and over ; Anticoagulants/*blood/therapeutic use ; Asian Continental Ancestry Group ; Atrial Fibrillation/drug therapy ; Chromatography, High Pressure Liquid ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea ; Tandem Mass Spectrometry ; Warfarin/analogs & derivatives/*blood/metabolism/therapeutic use