No abstract available.
Thyroid Gland* ; Thyroid Nodule*

The incidence of early gastric cancer (EGC) has increased to over 50% in Korea and Japan due to rapid advances in diagnostic instrumentation and increased use of mass screening. Considering the excellent prognosies of EGC patients, the quality of life of these patients after treatment has recently been emphasized. For the better quality of life, laparoscopic surgery has emerged as an alternative therapy for EGC patients. Since Kitano et al. first performed laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer in 1991, it has been performed worldwide, especially in Japan and Korea. A number of reports have presented the excellent short term outcomes; less pain, better cosmetics, faster recovery, and shorter hospital stay. However, there is little evidence of the oncological outcome of laparoscopic gastrectomy as a treatment modality for gastric cancer. Multi-center randomized controlled trials of laparoscopic versus open gastrectomy are needed to establish the future role of laparoscopic surgery in the treatment of patients with gastric cancer.
Humans ; *Laparoscopy ; Neoplasm Staging ; Predictive Value of Tests ; Stomach Neoplasms/diagnosis/*surgery ; Surgical Procedures, Minimally Invasive/methods

The most important advantages of laparoscopic gastrectomy are the minimal invasiveness, including less postoperative pain, shorter recovery, and minimal complications. A laparoscopic distal gastrectomy is accepted widely as a standard treatment for gastric cancer. On the other hand, a laparoscopic total gastrectomy has not been popularized as a distal gastrectomy because of the complexity of a lymph node dissection and the diversity of reconstruction. In terms of laparoscopic surgery for a remnant gastrectomy, there are three key points, which are critical for safe operation: adequate lymph node dissection, meticulous adhesiolysis, and reconstruction. After radical surgery for gastric cancer, the intra-abdominal condition is greatly changed. In addition, the lymphatic anatomy around the stomach is broken and surgeons should be aware of a newly developed lymphatic system to perform adequate node dissection. An esophago-jejunal reconstruction is at risk of leakage. Until evidence that is more concrete can be obtained, experienced surgeons should consider the laparoscopic approach.
Gastrectomy ; Gastric Stump ; Hand ; Laparoscopy ; Lymph Node Excision ; Lymphatic System ; Pain, Postoperative ; Stomach ; Stomach Neoplasms ; Surgeons

The application of Enhanced Recovery After Surgery (ERAS) protocols for the various cancer surgeries is increasing. ERAS program is introduced to reduce surgery stress, accelerate the average length of postoperative functional recovery, and lower postoperative morbidity. The application of the ERAS protocols for gastric cancer has been assessed in several studies, and it has been reported that the ERAS protocol significantly improves recovery time in gastrectomy patients without significantly affecting complications.

Gangliocytic paragangliomas are rare benign neuroendocrine tumors that arise mainly in the duodenum. A total of 3 cases of duodenal gangliocytic paraganglioma have been reported in Korea. The authors encountered another case of a gangliocytic paraganglioma in the duodenum. A 48-year old man presented with a mass in the duodenum that had been found incidentally in a medical checkup. The endoscopic examination revealed a 3.5x2.2 cm sized polypoid mass in the second portion of the duodenum. The patient underwent a polypectomy in the form of a wedge resection under general anesthesia. Microscopically, the tumor was composed of epithelial cells forming paraganglioma like patterns, spindle cells and ganglion cells. Gangliocytic paragangliomas are believed to be benign tumors but regional lymph node metastasis and recurrence can occur in rare cases. During the 27-month follow-up after treatment, there was no evidence of recurrence or lymph node metastasis. We report this case to help improve the understanding of this rare disease.
Anesthesia, General ; Duodenum* ; Epithelial Cells ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Korea ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Paraganglioma* ; Rare Diseases ; Recurrence

Mesenteric fibromatoses occur as sporadic lesions or as parts of familial adenomatous polyposis, are clonal lesions prone to locally aggressive behavior, but lack metastatic capacity. Fibromatoses harbor somatic beta-catenin or adenomatous polyposis coli (APC) mutations, leading to intranuclear accumulation of b-catenin. We report a case of mesenteric fibromatosis presenting as a 5.4x4.8 cm submucosal tumor of the jejunum in a 42-year-old woman. Histologically, the tumor consisted of proliferation of bland, elongated-spindle fibroblasts with collagen deposition and a characteristic prominent vasculature. Immunohistochemically, the tumor cells showed nuclear staining for beta-catenin. Mesenteric fibromatosis should be included in the differential diagnosis of submucosal spindle cell tumors of the gastrointestinal tract, and nuclear immunoreactivity for beta-catenin may help distinguish these tumors form histological mimics.
Adenomatous Polyposis Coli ; Adult ; beta Catenin ; Collagen ; Diagnosis, Differential ; Female ; Fibroblasts ; Fibroma ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Intestine, Small ; Jejunum

A hepatodiaphragmatic interposition of the small or large intestine, which is known as Chilaiditi's syndrome, is generally asymptomatic and rarely requires surgical intervention. However, it can be associated with symptoms ranging from mild abdominal pain to a severe complicated intestinal obstruction. We report a case of Chilaiditi's syndrome associated with an ileal obstruction. A 69 year-old female patient presented with abdominal pain, vomiting and an abdominal distension. The abdominal CT and upper endoscopy findings showed an intestinal obstruction and gastric cancer, requiring surgery.
Abdominal Pain ; Aged ; Chilaiditi Syndrome* ; Endoscopy ; Female ; Humans ; Ileum* ; Intestinal Obstruction* ; Intestine, Large ; Stomach Neoplasms ; Tomography, X-Ray Computed ; Vomiting

PURPOSE: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. MATERIALS AND METHODS: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. RESULTS: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the 7th postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was 7.7% (2/26), and the variance rate was 30.8% (8/26). The mean hospital stay was 11.3 days (10~15 days) for the CP group compared with 17.5 days (9~68 days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days (7~68 days) and 8.3 days (7~12 days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group (W6,292,200) than in the CP group (W4,863,685). The charge per hospital day was higher in the CP group (W430,414) than in the non-CP group (W359,554). Patient satisfaction was higher in the CP group than in the non-CP group. CONCLUSION: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.
Critical Pathways* ; Gastrectomy ; Gastroparesis ; Humans ; Korea ; Length of Stay ; Nutritionists ; Patient Satisfaction ; Surveys and Questionnaires ; Stomach Neoplasms*

PURPOSE: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. MATERIALS AND METHODS: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. RESULTS: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the 7th postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was 7.7% (2/26), and the variance rate was 30.8% (8/26). The mean hospital stay was 11.3 days (10~15 days) for the CP group compared with 17.5 days (9~68 days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days (7~68 days) and 8.3 days (7~12 days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group (W6,292,200) than in the CP group (W4,863,685). The charge per hospital day was higher in the CP group (W430,414) than in the non-CP group (W359,554). Patient satisfaction was higher in the CP group than in the non-CP group. CONCLUSION: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.
Critical Pathways* ; Gastrectomy ; Gastroparesis ; Humans ; Korea ; Length of Stay ; Nutritionists ; Patient Satisfaction ; Surveys and Questionnaires ; Stomach Neoplasms*

PURPOSE:It is important to evaluate the healing process of avascular necrosis (AVN) involving femoral head after treatment. The purpose of this study was to assess the usefulness of pinhole bone scintigraphy in the AVN of femoral head after surgery. MATERIALS AND METHODS: We analyzed the changing pattern of pinhole bone scintigram in 21 femoral heads of 16 patients (14 lesions/11 male, 7 lesions/5 female, mean age: 39.4 yrs) before and after multiple drilling or vascularized bone grafting for AVN of the femoral head. In all patients, pre-operative scintigrams were obtained at 1 to 3 months before treatment and the first post-operative scintigrams were obtained at 1 to 3 months after treatment. All patients were followed for 2 to 4 years after operation. RESULTS: The findings of the pinhole scintigrams were divided into three patterns: 1) curvilinear, 2) scattered spotty and 3) undetermined. The 10 of 11 lesions with curvilinear pattern had good postoperative clinical and radiological follow-up findings. However, all 6 lesions with scattered spotty pattern showed poor postoperative findings, which necessitated total hip joint replacement. Of the 4 lesions with undetermined pattern, 2 required total hip joint replacement. There was significant difference in postoperative prognosis between the curvilinear and scattered spotty patterns (p<0.05). CONCLUSION: We conclude that the pattern of pinhole bone scintigram obtained within 1 to 3 months after multiple drilling or vascularized bone graft operation is a useful prognostic indicator in the AVN of femoral head.
Bone Transplantation ; Female ; Follow-Up Studies ; Head* ; Hip Joint ; Humans ; Male ; Necrosis* ; Prognosis* ; Radionuclide Imaging* ; Technetium Tc 99m Medronate ; Transplants*