As the incidence of early gastric cancer increases, gastric tumor localization has become an important issue. Several diagnostic methods have been proposed for preoperative and intraoperative gastric tumor localization. These include endoscopic metal clipping, computed tomographic gastrography, endoscopic tattooing, and intraoperative endoscopy. However, in spite of various methods, tumor localization has its limitations; thus, new diagnostic alternatives need to be developed.

As the incidence of early gastric cancer increases, gastric tumor localization has become an important issue. Several diagnostic methods have been proposed for preoperative and intraoperative gastric tumor localization. These include endoscopic metal clipping, computed tomographic gastrography, endoscopic tattooing, and intraoperative endoscopy. However, in spite of various methods, tumor localization has its limitations; thus, new diagnostic alternatives need to be developed.

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.
Aged ; Diverticulum* ; Duodenum ; Gastrectomy* ; Gastric Bypass* ; Humans ; Laparotomy ; Stomach Neoplasms ; Vital Signs

OBJECTIVE: To obtain the mean value of physical parameters of those over 65- years of age. METHODS: Physical parameters including body weight, height, chest circumference, length of upper limb and lower limb, hand power, and range of motion of cervical, thoracic, lumbosacral spines and other major joints were measured in two hundred fourteen elderly subjects. RESULTS: Subjects were divided into three groups according to age (group 1, 65~74 years; group 2, 75~84 years; group 3, above 85 years) and sex (male; female). Descriptive statistical analysis of data provided the following results. 1) Mean measurement in order of group 1-men, group 2-men, group 3-men followed by women of each group: Body weight (kg) - 60.2, 59.6, 54.9, 56.8, 51.6, 47.2; Standing height (cm) - 156.7, 160.8, 156.6, 151.2, 146.9, 142.2; Sitting height (cm) - 99.8, 100.8, 103.1, 100.9, 104.9, 97.0; Chest circumference (cm) - 91.5, 93.5, 91.4, 92.1, 89.5, 86.4; Upper limb length (cm) - 72.3, 72.5, 71.3, 67.1, 66.9, 65.4; Lower limb length (cm) - 82.3, 82.1, 81.4, 77.3, 76.1, 74.6. 2) The hand power of grasping, tip pinch, lateral pinch, palmar pinch showed a decreasing trend in older age group in both sexes. 3) The range of motion of cervical, thoracic, and lumbosacral spine in group 1 had limitation of about 50% compared to normal range. 4) Of the major joints, limitation of motion or deformity was most common in the shoulder and knee joints. CONCLUSION: These data and knowledge of physical parameters of the elderly can aid in design of living environment and assistive devices for elderly.
Aged* ; Body Weight ; Congenital Abnormalities ; Female ; Hand ; Hand Strength ; Humans ; Joints ; Knee Joint ; Lower Extremity ; Range of Motion, Articular ; Reference Values ; Self-Help Devices ; Shoulder ; Spine ; Thorax ; Upper Extremity

The clinical significance of hepatic resection for gastric metastases is controversial, even though hepatic resection has been widely accepted as a modality for colorectal metastases. Very few patients with gastric hepatic metastases are good candidates for hepatic resection because of multiple bilateral metastases, extrahepatic disease, or advanced cancer progression, such as peritoneal dissemination or extensive lymph node metastases. Therefore, several authors have reported the clinical significance of hepatic resection for gastric metastases in a small number of patients. Considering the present results with previous reports. The number and distribution of tumors in hepatic metastases from gastric cancer was considered based on the present and previous reports. Several authors have reported significantly better survival in patients with metachronous metastasis than in those with synchronous disease. However, metachronous hepatic resection necessitates the dissection of adhesions between the pancreas, liver, and residual stomach to prepare for Pringle's maneuver. Patients with unilobar liver metastasis, and/or metastatic tumors <4 cm in diameter may be good candidates for hepatic resection. Synchronous metastasis is not a contraindication for hepatic resection. Most of the long-term survivors underwent anatomic hepatic resection with a sufficient resection margin. After hepatic resection, the most frequent site of recurrence was the remaining liver, which was associated with a high frequency of mortality within 2 years. A reasonable strategy for improvement in survival would be to prevent recurrence by means of adjuvant chemotherapy and careful follow-up studies.
Chemotherapy, Adjuvant ; Follow-Up Studies ; Gastric Stump ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Recurrence ; Stomach Neoplasms ; Survivors

Robotic bariatric surgery renders it unnecessary for surgeons to manually apply torque while simplifying intracorporeal suturing. Surgeons can comfortably manipulate instruments. Also, the three-dimensional operative field is very clear. Unfortunately, robotic bariatric surgery is still not the first choice for morbidly obese patients in Korea because it currently is not covered by the National Healthcare Insurance system. In this video, we show the totally robotic Roux-en-Y gastric bypass conducted using robotic staplers, in a morbidly obese patient with diabetes mellitus and private medical insurance.

Medullary thyroid cancer (MTC) accounts for 5% to 10% of all thyroid cancers, and originates from the parafollicular or C-cells of the thyroid gland. More than 50% of patients present with a thyroid mass and up to 75% of these patients have locoregional lymph node metastasis at the time of diagnosis. The neuroendocrine C-cells of the thyroid gland secrete calcitonin, a relatively accurate tumor marker for MTC. Plasma basal and stimulated calcitonin measurements have been used to screen patients who are at risk of developing MTC and indispensable for the detection of residual MTC after initial surgical treatment. The overall survival rate of patients with MTC is intermediate to that of patients with differentiated thyroid cancer and anaplastic thyroid cancer. Postoperative radioiodine ablation therapy, chemotherapy and radiation therapy are generally ineffective. Surgical resection, therefore, remains the only definite treatment for patients with MTC. Unfortunately, residual MTC as indicated by elevated plasma basal or stimulated calcitonin levels is common even after apparent complete initial surgical resection. We present a case of metastatic MTC in the anterior mediastinum with review of the literatures.
Calcitonin ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Mediastinum* ; Neoplasm Metastasis ; Plasma ; Survival Rate ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms*

Carcinosarcoma of the pancreas is a rare malignant tumor that shows a combined or mixed proliferation of carcinomatous and sarcomatous cells. This tumor has been variously called carcinosarcoma, pleomorphic large cell carcinoma, giant cell carcinoma, and undifferentiated carcinoma. A 52-year-old man was hospitalized for evaluation of his epigastric pain and jaundice. An abdominal computed tomography revealed the presence of a poorly enhancing mass, arising from the head of the pancreas. Pylorus preserving pancreaticoduodenectomy was performed. The final pathologic diagnosis was undifferentiated carcinoma with 2 distinct components. One component was a conventional infiltrating pancreatic ductal adenocarcinoma, and the other component was sarcoma. We present here a case of carcinosarcoma of the pancreas along with a review of the literatures.
Adenocarcinoma ; Carcinoma ; Carcinoma, Giant Cell ; Carcinoma, Large Cell ; Carcinosarcoma* ; Diagnosis ; Head ; Humans ; Jaundice ; Middle Aged ; Pancreas* ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pylorus ; Sarcoma

A biloma is an extrahepatic or intrahepatic bile collection caused by traumatic, iatrogenic, or spontaneous rupture of the biliary tree. Prior reports have documented an association of a biloma with abdominal trauma and surgery, but spontaneous bile leakage associated with other primary causes has rarely been reported. A 72-year-old man was admitted to our hospital with the complaint of epigastric pain and yellowish discoloration of the sclera. Ultrasonography and computed tomography revealed a large fluid collection in the abdominal cavity. Endoscopic retrograde cholangiography demonstrated leakage of contrast medium from a distended segmental biliary branch in the left lobe of the liver. A perihepatic biloma was confirmed by sonographically guided percutaneous aspiration, and the patient underwent a left lateral segmentectomy of the liver, a cholecystectomy and T-tube choledochostomy. Histological examination showed left lateral bile duct hyperplasia, with abscess formation and chronic cholecystitis. Herein, a case of a biloma associated with choledocholithiasis is reported, with a review of the literatures.
Abdominal Cavity ; Abscess ; Aged ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic* ; Biliary Tract ; Cholangiography ; Cholecystectomy ; Cholecystitis ; Choledocholithiasis* ; Choledochostomy ; Humans ; Hyperplasia ; Liver ; Mastectomy, Segmental ; Rupture* ; Rupture, Spontaneous ; Sclera ; Ultrasonography

PURPOSE: The specific aim of this study is to unravel a DNA copy number alterations, and to search for novel genes that are associated with the development of Korean gastric cancer. MATERIALS AND METHODS: We investigated a DNA copy number changes in 23 gastric adenocarcinomas by array-comparative genomic hybridization and quantitative real-time polymerase chain reaction analyses. Besides, the expression of UQCRFS1, which shows amplification in array-CGH, was examined in 186 gastric cancer tissues by an immunohistochemistry, and in 9 gastric cancer cell lines, as well as 24 gastric cancer tissues by immunoblotting. RESULTS: We found common gains at 48 different loci, and a common loss at 19 different loci. Amplification of UQCRFS1 gene at 19q12 was found in 5 (21.7%) of the 23 gastric cancers in an array-comparative genomic hybridization and DNA copy number were increased in 5 (20.0%) out of the 25 gastric cancer in quantitative real-time polymerase chain reaction. In immunohistochemistry, the overexpression of the protein was detected in 105 (56.5%) out of the 186 gastric cancer tissues. Statistically, there was no significant relationship between the overexpression of UQCRFS1 and clinicopathologic parameters (P>0.05). In parallel, the overexpression of UQCRFS1 protein was confirmed in 6 (66.7%) of the 9 gastric cancer cell lines, and 12 (50.0%) of the 24 gastric cancer tissues by immunoblotting. CONCLUSIONS: These results suggest that the overexpression of UQCRFS1 gene may contribute to the development and/or progression of gastric cancer, and further supported that mitochondrial change may serve as a potential cancer biomarker.
Adenocarcinoma ; Cell Line ; Coat Protein Complex I ; DNA ; DNA Copy Number Variations ; Immunohistochemistry ; Nucleic Acid Hybridization ; Real-Time Polymerase Chain Reaction ; Stomach Neoplasms