Uterine torsion is defined as the mtation of more than 45 degrees around the long axis of the uterus or a rotation which is severe enough to produce symptoms. Torsion of the human pregnant uterus is a very rare complication. The diagnosis is problematic and is often made during a cesrean section due to inhibited labor. Torsion of the human pregnant uterus can be caused by myoma or other uterine abnormalities, ovarian cysts, adhesions, abnormal fetal presentations, or fetal abnormalities ( though no cause can be found in about 20% of cases ). Uterine torsion produces symptoms of varying severity depending on the degree of rotation, and duration of the pregnancy. High mortality rates for both mother and infant have been reported. We experienced one case of the torsion of term pregnant uterus and report this case with a brief review of the concerned literature.
Axis, Cervical Vertebra ; Diagnosis ; Female ; Fetus* ; Humans ; Infant ; Mortality ; Mothers ; Myoma ; Ovarian Cysts ; Pregnancy ; Uterus*

OBJECTIVES: To propose a feasible, valid and appropriate study designs and epidemiologic methods for evaluating the adverse health effects of Agent Orange-chemical defoliants used in Vietnam- in Korea. METHODS: A literature study was performed on Agent Orange, herbicides, pesticides and dioxins. The study subjects, study design, exposure assessment and health outcomes assessment were examined in each study. The potential data sources for the study subjects, study design, exposure assessment and health outcomes assessment in Korea were investigated. RESULTS AND CONCLUSION: In earlier Korean studies, research subjects for studying the effects of Agent Orange were identified from the patients or persons who claimed to have Agent Orange-related diseases due to the difficulties in identifying the entire population of Vietnam veterans in Korea. In this study, an attempt was made to identify the total number of Vietnam veterans in Korea. As a result, the addresses of 20,000 Vietnam veterans were obtained. It is proposed that a retrospective cohort design on a sample of the total number of Vietnam veterans is a feasible and appropriate study design. Self report questionnaires and military records were proposed to assess the exposure level. It is believed that measuring the plasma or tissue TCDD should be used only for a validation study assessing the level of exposure. For the health outcomes assessment, it is possible to obtain the mortality, cancer frequency, physical examination, screening and medical insurance record data.
Citrus sinensis* ; Cohort Studies ; Data Collection ; Defoliants, Chemical ; Dioxins ; Epidemiologic Methods ; Herbicides ; Humans ; Insurance ; Korea ; Mass Screening ; Military Personnel ; Mortality ; Outcome Assessment (Health Care) ; Pesticides ; Physical Examination ; Plasma ; Questionnaires ; Research Subjects ; Retrospective Studies ; Self Report ; Tetrachlorodibenzodioxin ; Veterans* ; Vietnam*

OBJECTIVES: The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans. METHODS: Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model. RESULTS: The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status. CONCLUSIONS: The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.
2,4,5-Trichlorophenoxyacetic Acid/*poisoning ; 2,4-Dichlorophenoxyacetic Acid/*poisoning ; Adult ; Age Factors ; *Body Mass Index ; Defoliants, Chemical/*poisoning ; Humans ; Male ; Middle Aged ; Questionnaires ; Regression Analysis ; Republic of Korea/epidemiology ; Self Report ; Smoking/*blood ; Tetrachlorodibenzodioxin/*blood/poisoning ; Time Factors ; Veterans/*statistics & numerical data ; Vietnam Conflict ; Young Adult

PURPOSE: The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy. MATERIALS AND METHODS: From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux. RESULTS: No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019). CONCLUSIONS: When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.
Anastomosis, Roux-en-Y ; Bile ; Bile Reflux ; Gastrectomy ; Gastric Stump ; Hand ; Humans ; Pilot Projects ; Reconstructive Surgical Procedures ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The treatment of choice for gastric submucosal tumors (SMT) is surgical resection. Recent advanced techniques has facilitated more extensive application of laparoscopic surgery to most types of resectable gastric SMTs. The aim of this study was to verify the efficacy of laparoscopic resection for treatment of gastric SMT through analysis of outcomes obtained at a single center. METHODS: A total of 141 patients who underwent laparoscopic resection for treatment of gastric SMT were enrolled between April 2003 and June 2011. Analysis of the demographics, tumor characteristics, and surgical or oncological outcomes of these patients was performed. RESULTS: Gastrointestinal stromal tumors (GIST) were the most common pathologic findings (90 cases), and the upper third of the stomach was the most common location (70 cases). Wedge resections were performed in 128 patients and major gastrectomies were performed in 13 patients. The mean surgical time was 102 minutes, which was reduced to a stable 70 minutes after the 30th case. The surgical time for tumors located on the posterior or lesser portion of the upper third of the stomach was longer than that for other lesions. Twelve postoperative complications, including two cases of intra-abdominal bleeding, one case of marginal ulcer bleeding, and one case of leakage occurred. However, there was no occurrence of complications after the 70th case. During the follow-up period, two patients suffered recurrent GIST. CONCLUSION: Laparoscopic surgery for treatment of gastric SMT is safe and feasible, particularly as the surgeon develops greater skill with increased experience. Laparoscopic resection is useful for treatment of any type of gastric SMT.
Demography ; Follow-Up Studies ; Gastrectomy ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Laparoscopy ; Operative Time ; Peptic Ulcer ; Postoperative Complications ; Stomach ; Stomach Neoplasms

PURPOSE: Gastric cancer surgery is a common operation in East Asia, such as Korea and Japan, and there has been a significant increase in the need for this procedure due to the aging population. As a result, surgery for the treatment of gastric cancer for elderly patients is expected to increase. This study examined the effect of old age on gastric cancer surgery, and analyzed the operative risk factors for elderly patients. MATERIALS AND METHODS: From November 2008 to August 2010, 590 patients, who underwent a curative resection for gastric cancers, were enrolled. Patients who underwent palliative or emergency surgery were excluded. A retrospective analysis of the correlation between surgical outcomes and age was performed. The elderly were defined as patients who were over the age of 65 years. RESULTS: The mean age of all patients was 58.3 years, and complications occurred in 87 cases (14.7%). The most common complication was wound infection and severe complications requiring surgical, endoscopic, or radiologic intervention developed in 52 cases (8.8%). The rate of complications increased with increasing age of the patients. Univariate analysis revealed age, comorbidity, extent of resection, operation time, and combined resection to be associated with surgical complications. In particular, age over 75 years old, operation time, and comorbidity were predictive factors in multivariate analysis. In the elderly, only comorbidity was associated with surgical complications. CONCLUSIONS: The patients' age is the most important factor for predicting surgical complications. Surgeons should pay an attention to the performance of gastric cancer surgery on elderly patients. In particular, it must be performed carefully for elderly patients with a comorbidity.
Aged ; Aging ; Comorbidity ; Emergencies ; Far East ; Gastrectomy ; Humans ; Japan ; Korea ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Wound Infection

PURPOSE: Laparoscopic gastrectomy is a widely accepted surgical technique. Recently, robotic gastrectomy has been developed, as an alternative minimally invasive surgical technique. This study aimed to evaluate the question of whether robotic gastrectomy is feasible and safe for the treatment of gastric cancer, due to its learning curve. MATERIALS AND METHODS: We retrospectively reviewed the prospectively collected data of 100 consecutive robotic gastrectomy patients, from November 2008 to March 2011, and compared them to 282 conventional laparoscopy patients during the same period. The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups. RESULTS: The initial 20 robotic gastrectomy cases were defined as the initial group, due to the learning curve. The initial group had a longer average operating time (242.25+/-74.54 minutes vs. 192.56+/-39.56 minutes, P>0.001), and hospital stay (14.40+/-24.93 days vs. 8.66+/-5.39 days, P=0.001) than the experienced group. The length of hospital stay was no different between the experienced group, and the laproscopic gastrectomy group (8.66+/-5.39 days vs. 8.11+/-4.10 days, P=0.001). The average blood loss was significantly less for the robotic gastrectomy groups, than for the laparoscopic gastrectomy group (93.25+/-84.59 ml vs. 173.45+/-145.19 ml, P<0.001), but the complication rates were no different. CONCLUSIONS: Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.
Gastrectomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The aim of this study is to investigate the clinical factors affecting on the cure rate by invasive and open surgery for gastric cancer and to establish a subgroup of patients who can be applied by the early recovery after surgery program through this retrospective analysis. MATERIALS AND METHODS: In this retrospective study, we analyzed 425 patients who underwent gastric cancer surgery between January 2011 and December 2011 and were managed with conventional clinical therapies. This clinical algorithm was made when the patient was in minimally invasive surgery group and discharged from hospital one day faster than them in open surgery group. RESULTS: The completion rate of the clinical pathway was 62.4%. Despite the different applications of clinical pathway, completion rate in minimally invasive surgery group was significantly higher than that of open group (P<0.001). In multivariate analysis, the surgical procedure of minimally invasive surgery (odds ratio=4.281) was the most predictable factor to complete clinical pathway. Additionally, younger patients (odds ratio=1.933) who underwent distal gastrectomy (odds ratio=1.999) without combined resection (odds ratio=3.069) were predicted to accomplish the clinical pathway without any modifications. CONCLUSIONS: We concluded that high efficacy of the clinical pathway for gastric cancer surgery was expected to selected patients through retrospective analysis (expected completion rate=85.4%). In addition, these patients would become enrolled criteria for early recovery program in gastric cancer surgery.
Critical Pathways ; Gastrectomy ; Humans ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The goal of this study was to assess the correlation between the Helicobacter pylori status of patients who underwent curative resection for gastric adenocarcinoma and their prognosis in Eastern societies where H. pylori infection is prevalent. METHODS: Between 2006 and 2007, 192 patients who had a curative resection for the treatment of gastric adenocarcinoma were enrolled in the study. Of these patients, 18 were excluded due to an inexact evaluation of the H. pylori status, thereby leaving 174 patients in the final analysis. Serologic testing for H. pylori was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G, and the histological presence of H. pylori was identified using the Giemsa stain. RESULTS: Of the 174 patients, 111 patients (63.8%) were confirmed for H. pylori infection. H. pylori status did not correlate with the overall or disease-free survival. For patients with stage III or IV gastric cancer, a positive H. pylori status was a significant predictive factor for recurrence over that of a negative H. pylori status (P = 0.019). Negative H. pylori status was a predictive factor for recurrence in multivariable analysis (relative risk, 2.724; 95 confidence interval, 1.192 to 6.228). CONCLUSION: Helicobacter pylori status did not correlate with the clinicopathologic factors of gastric adenocarcinoma. However, a negative Helicobacter pylori status may be a predictive factor for recurrence in patients diagnosed with advanced gastric adenocarcinoma.
Adenocarcinoma ; Disease-Free Survival ; Enzyme-Linked Immunosorbent Assay ; Helicobacter ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Prognosis ; Recurrence ; Serologic Tests ; Stomach Neoplasms

OBJECTIVE: Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ≥80 years) and aged patients (60–79 years) treated with mechanical thrombectomy. METHODS: Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (≥80 years) and aged (60–79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. RESULTS: The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4–11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2–51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. CONCLUSION: Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.
Aged* ; Brain Ischemia ; Humans ; Infarction* ; Mortality ; Odds Ratio ; Retrospective Studies ; Stroke ; Thrombectomy*