PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.
Demography ; Endoscopy ; Gastrectomy ; Gastroscopy ; Humans ; Male ; Neoplasm Staging ; Prospective Studies ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Technology, Radiologic

PURPOSE: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. RESULTS: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. CONCLUSIONS: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.
Demography ; Endoscopy ; Gastrectomy ; Gastroscopy ; Humans ; Male ; Neoplasm Staging ; Prospective Studies ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Technology, Radiologic

Crohn's disease and ulcerative colitis are well known risk factors of intestinal cancer in relation to the extent and duration of disease. Rarely, small bowel cancer can develop after a longstanding inflammation of Crohn's disease with a relatively higher incidence than the general population. Signet ring cell carcinoma is a rare condition among intestinal cancers, and the diagnosis or detection is more difficult if the cancer originates from the small bowel. We report a case of a 30-year old female in whom signet ring cell carcinoma of ileum was diagnosed after a 15-year history of Crohn's disease.
Adult ; Carcinoma, Signet Ring Cell/*diagnosis/etiology/pathology ; Colonoscopy ; Crohn Disease/*complications/diagnosis/pathology ; Female ; Humans ; Ileal Neoplasms/*diagnosis/etiology/pathology ; Tomography, X-Ray Computed

Ancient DNA analyses are widely used for evolutionary and phylogenetic study of mankind in anthropology and archeology. However, the DNA extraction from particularly poorly preserved ancient human samples is often unsuccessful in these analyses. In the present study, to improve the success rate of ancient DNA analysis, we introduced a high grade ancient DNA purification method using ion-exchange columns. We compared the success rate of ancient DNA analysis of this new method with that of the two methods that have been used for ancient DNA extraction, GENECLEAN(R) kit (Qbiogene) and Qiaquick column (Qiagen). Twelve ancient bone samples from Korea and Mongolia that are about 500 to 5,000 years old by an archeological estimation were used. As the DNA analysis methods, polymerase chain reaction (PCR) methods for the amplification of a mitochondrial DNA HV1 segment, a male sex determination marker DNA and M175 marker DNA that is used for the determination of O haplogroup of Y chromosome that is reportedly a common one in modern Korean people. The method developed in this study remarkably increased the success rate of DNA analysis compared with the other two methods. Using the GENECLEAN(R) kit, only two samples were amplifiable for the mitochondrial DNA, no samples for the male sex determination marker and M175 marker DNAs. Using the Qiaquick columns, nine samples were amplifiable for mitochondirial DNA, nine samples for male sex determination marker and six samples for M175 marker. The developed method allowed for the amplification of mitochondrial DNA from all samples, male sex determination marker from eight samples and M175 marker from eight samples. The results demonstrate that ion-exchange columns can be useful for the improved ancient DNA extraction in anthropology and archeology.
Anthropology ; Archaeology ; DNA* ; DNA, Mitochondrial ; Humans ; Korea ; Male ; Mongolia ; Polymerase Chain Reaction* ; Y Chromosome

Hyperplasia of Brunner's glands is considered an uncommon finding; its wide range of morphological variation has led to confusing identifying terminology which includes: hyperplasia, adenoma, and hamartoma. Some investigators have suggested that hyperplasia of Brunner's glands is hamartomatous in nature, whereas others have favored a causative relationship that results from gastric acid hypersecretion. Although most commonly an incidental finding, that appears as multiple small submucosal sessile nodules, usually located in the duodenal bulb, it can lead to clinically significant symptoms including gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Here, we report a case of hyperplasia of multiple cystic Brunner's glands on the duodenal bulb in a patient with acute pancreatitis; they were discovered incidentally on abdominal CT and duodenoscopy. This is the first report of hyperplasia of Brunner's glands with these morphological characteristics.
Abdominal Pain ; Adenoma ; Brunner Glands ; Duodenoscopy ; Gastric Acid ; Hamartoma ; Hemorrhage ; Humans ; Hyperplasia* ; Incidental Findings ; Intestinal Obstruction ; Pancreatitis ; Research Personnel ; Tomography, X-Ray Computed

Tracheoinnominate artery fistula is a rare complication that can happen after tracheostomy, the mortality rate is high and it reqiures urgent surgical management. The patient had received a left pneumonectomy 30 years ago and post-operative course was in uneventful. And tracheostomy was performed for acute respiratory failure due to trachea stenosis for 2 months in recent. She was improved in general condition and changed to a 11 mm silicone Montgomery T-tube. On the 3rd day after the tube changed, she had cardiac arrest due to the excessive hemorrhaging due to tracheoinnominate artery fistula. We report an successusful experience for control of bleeding by an innominate artery fistula division and the Utley maneuver for the tracheoinnominate artery fistula. We report the operation method of bleeding control.
Arteries* ; Brachiocephalic Trunk ; Constriction, Pathologic ; Fistula* ; Heart Arrest ; Hemorrhage ; Humans ; Mortality ; Pneumonectomy ; Respiratory Insufficiency ; Silicones ; Trachea ; Tracheostomy

BACKGROUND: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. MATERIAL AND METHOD: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation (ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. RESULT: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45+/-15 vs. 33+/-11 mmHg during BLS, 83+/-36 vs. 44+/-15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32+/-10 vs. 22+/-4 mmHg during BLS and 32+/-15 vs. 24+/-10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). CONCLUSION: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Blood Pressure ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation ; Dogs ; Heart Arrest ; Hemodynamics ; Humans ; Resuscitation ; Shock ; Ventricular Fibrillation

Synovial sarcoma is a malignant soft tissue tumor originated from primitive mesenchymal cell. It occurs primarily in the paraarticular regions, such as knee joint, ankle joint. We experienced a case of intrapulmonary synovial sarcoma which was originated from the lung.
Ankle Joint ; Knee Joint ; Lung ; Sarcoma ; Sarcoma, Synovial*

Tracheal stenosis is a difficult disease entity to manage. Laser ablation is one effective treatment for treacheal stenosis and can be utilized if tracheal reconstructive surgery is impossible. Potassium titanyl phosphate laser, transmitted via flexible quartz fiber, can be precisely manipulated through flexible bronchoscope under local anesthesia. We treated 7 patients with tracheal and broncheal lesion under local anesthesia with KTP laser from January 1995 to July 1996. The patients included three males and four females. The age of patients ranged from 22 to 66 years with a mean of 43.7 years. The etiology of tracheal stenosis in patients was stenosis after tracheostomy(3 cases), prolong inturbation in cases of sepsis(1 cases), and the recurrence of lung cancer within endobronchial lesion(2 cases). In the cases of tracheal stenosis treated with laser ablation, there were 2 cases of recurrence of stenosis at the anastomosis site after the operation, 3 cases of stenosis at tracheostomy site, and 2 cases of local recurrence of lung cancer. The site of the tracheal stenosis was the balloon site of the tracheostomy tube(3-4cm inferior to the tracheostomy site, 2-3cm superior to the carina) and the anastomosis site that were narrowed to less than 5mm(4 cases). For the stenosis lesion in the endobronchial area, there were 2 patients with a lesion at the anterior wall, 1 patient with a lesion at the posterior wall, 2 patients with circumferential stenosis. Laser ablation time was 25.4+/-5.9min and used energy was 1768+/-365J. We have used KTP laser via flexible bronchoscope without major complications. Adjuvant radiation therapy may prevent fibroblast proliferation which leads to restenosis. In three patients of restenosis after laser ablation, adjuvant irradiation started within 4 hours after laser ablation, and the radiation doses were 1500cGy given in five fraction. In patients with adjuvant radiation therapy, stenosis has not recurred.
Anesthesia, Local ; Bronchoscopes ; Constriction, Pathologic ; Female ; Fibroblasts ; Humans ; Laser Therapy ; Lasers, Solid-State ; Lung Neoplasms ; Male ; Potassium* ; Quartz ; Radiotherapy, Adjuvant ; Recurrence ; Tracheal Stenosis* ; Tracheostomy

PURPOSE: Recommended dietary allowance of vitamin C was determined on the basis of preventing the scurvy without considerations of the important function of the vitamin C as a first line antioxidant. So we measured the whole blood and plasma vitamin C concentrations of the contemporay healthy elementary school children in Chinju for the establishment of the optimal daily vitamin C requirment in the elementary school children. METHODS: Whole blood and plasma vitamin C concentrations were measured by the 2,4-dinitrophenylhydrazine method in 338 children from the 1st to the 6th grade of one elementary school in Chinju. RESULTS: Whole blood and plasma vitamin C concentrations were 1.36+/-0.34mg/dL and 1.07+/-0.33mg/dL respectively. There existed an close relationship between whole blood and plasma vitamin C concentrations (r=0.77, p=0.0001). Whole blood vitamin C concentration decreased as the age became older (r=-0.22 p=0.0001), but plasma vitamin C concentration did not change. There were no sex differences in the whole blood and plasma vitamin C concentrations except in the 3rd grade (p<0.05). Twenty-three of 338 elementary school children (6.8%) had the plasma vitamin C concentration less than 0.6mg/dL. CONCLUSIONS: We produced the blood and plasma vitamin C concentrations of the contemporay elementary school children in Chinju. These values were not satisfactory in consideration of the importance of the childhood health.
Ascorbic Acid* ; Child* ; Gyeongsangnam-do* ; Humans ; Plasma* ; Recommended Dietary Allowances ; Scurvy ; Sex Characteristics ; Vitamins*