PURPOSE: Depth of wall invasion is an important prognostic factor in patients with gastric cancer, whereas the prognostic significance of intraoperative macroscopic serosal invasion (mSE) findings remain unclear when they show a discrepancy in pathologic findings. This study, therefore, assessed the prognostic significance of mSE. METHODS: Data from cohort of 2,835 patients with resectable gastric cancer who underwent surgery between 1990 and 2010 were retrospectively reviewed. RESULTS: The overall accuracy of mSE and pathologic results was 83.4%. The accuracy of mSE was 75.5% in pT2. On the other hand, the accuracy of pT3 dropped to 24.5%. According to mSE findings (+/-), the 5-year disease-specific survival (DSS) rate differed significantly in patients with pT2 (+; 74.2% vs. -; 92.0%), pT3 (+; 76.7% vs. -; 91.8%) and pT4a (+; 51.3% vs. -; 72.8%) (P < 0.001 each), but not in patients with T1 tumor. Multivariate analysis showed that mSE findings (hazard ratio [HR], 2.275; 95% confidence interval [CI], 1.148-4.509), tumor depth (HR, 6.894; 95% CI, 2.325-20.437), nodal status (HR, 5.206; 95% CI, 2.298-11.791), distant metastasis (HR, 2.881; 95% CI, 1.388-6.209), radical resection (HR, 2.002; 95% CI, 1.017-3.940), and lymphatic invasion (HR, 2.713; 95% CI, 1.424-5.167) were independent predictors of 5-year DSS rate. CONCLUSION: We observed considerable discrepancies between macroscopic and pathologic diagnosis of serosal invasion. However, macroscopic diagnosis of serosal invasion was independently prognostic of 5-year DSS. It suggests that because the pathologic results could not be perfect and the local inflammatory change with mSE(+) could affect survival, a combination of mSE(+/-) and pathologic depth may be predictive of prognosis in patients with gastric cancer.
Cohort Studies ; Diagnosis ; Hand ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Serous Membrane ; Stomach Neoplasms*

PURPOSE: Metastatic lymph node ratio (MLNR) is known as an important prognostic factor in many solid carcinomas; however, the role of MLNR in papillary thyroid carcinoma (PTC) is unclear. The purpose of this study was to determine whether MLNR has prognostic significance for recurrence in patients with pathological N1a PTC. METHODS: A retrospective analysis was conducted of 1,198 patients with PTC who underwent total thyroidectomy with central neck dissection between 2006 and 2011. Only patients with central lymph node metastasis were included in this study. Patients with lateral neck lymph node metastasis or extrathyroidal involvement were excluded. Finally, this study included 282 patients with N1a patients. MLNR was defined as the number of metastatic lymph nodes divided by the number of removed lymph nodes. RESULTS: Median age was 47.3 years (17~73 years). There were 209 female patients and 41 male patients, respectively. Median follow-up period was 53 months (36~114 months). Median value of MLNR was 0.36 (0.04~1.000). Of 250 patients, 20 patients (8.0%) developed recurrent disease. MLNR independently predicted PTC recurrence (odds ratio [OR], 6.385; 95% confidence interval [CI], 2.523-16.158; P < 0.001). In receiver operating characteristic curve analysis, 0.47 was significantly meaningful for recurrence when three or more lymph nodes were collected. CONCLUSION: MLNR is an independent predictor of PTC recurrence in patients with pathological N1a PTC. Therefore, N1a patients with MLNR > 0.47 should be monitored closely for recurrence.
Female ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Male ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; ROC Curve ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Prevalence survey of neurocysticercosis was made in a mixed epilepsy patients of Changmi Club in Korea. From February 1987 to July 1990, a total of 2,667 randomly selected patients at 27 local centers was tested for their serum levels of anti-Cysticercus antibody (IgG) by enzyme-linked immunosorbent assay. Positive rate of the antibody was 4.0% in the examined patients. The standardized antibody positive rate by provincial population was 3.1%. The rate was the highest in patients living in Cheju Do (8.4%). The patient age brackets of 0 approximately 9 years and over 50-year showed higher positive rates of the antibody. In 750 normal persons who checked up routine physical examination, the antibody positive rate was 2.1% (standardized rate was 1.8%). These seroepidemiological data disclosed for the first time the prevalence of cysticercosis in epileptic patients and in population.
Adolescent ; Adult ; Age Factors ; Aged ; Animals ; Antibodies, Helminth/*blood ; Child ; Child, Preschool ; Cysticercosis/complications/*epidemiology ; Cysticercus/*immunology ; Epilepsy/*complications ; Female ; Humans ; Infant ; Infant, Newborn ; Korea/epidemiology ; Male ; Middle Aged ; Sex Factors

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of poor prognosis in patients with various types of cancer. To date, the utility of NLR for prediction of prognosis in thyroid cancer patients has not been studied. Therefore, the aim of our study was to determine whether NLR is associated with other prognostic factors of papillary thyroid carcinoma and predictive of recurrence. METHODS: We conducted a retrospective review of 367 patients who underwent thyroidectomy for papillary thyroid carcinoma from January 2005 to December 2007. We measured the white blood cell count including neutrophil and lymphocyte within one month preoperatively. The NLR was defined as the absolute neutrophil count divided by absolute lymphocyte count. Logistic regression analysis was applied for comparison of NLR with other prognostic factors, including tumor size, lymph node metastasis, multiplicity, extrathyroidal invasion, and TNM stage. We also determined the cut-off value of NLR with a prediction for recurrence. RESULTS: Median age of patients was 47 years (16~86 years) and the rate of papillary thyroid microcarcinoma was 65.7% (241/367 cases). Median follow-up period was 1,841 days (506~3,135 days). The median value of NLR was 1.68 (0.66~6.36). NLR was not related to any other prognostic factors of papillary thyroid carcinoma. The cut-off value of NLR for prediction of recurrence was 1.73, where the sensitivity was 66.7% and specificity was 69.8%. CONCLUSION: Patients with NLR equal to or higher than 1.73 showed significantly higher recurrence of papillary thyroid carcinoma. Further validation study should be conducted for clinical use of NLR as a prognostic marker.
Follow-Up Studies ; Humans ; Leukocyte Count ; Logistic Models ; Lymph Nodes ; Lymphocyte Count ; Lymphocytes ; Neoplasm Metastasis ; Neutrophils ; Prognosis ; Recurrence ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Obesity is a known risk factor for several cancers, including breast, colon, esophagus, kidney, uterus, and thyroid. Recent studies have reported that higher body mass index (BMI) is also associated with more advanced stage. The aim of this study was to investigate the clinicopathological relevance between BMI and papillary thyroid carcinoma (PTC). METHODS: A total of 798 patients surgically treated for PTC from January 2006 to June 2010 were included in this study. Medical records and pathologic reports were reviewed retrospectively. According to BMI, patients were divided into four groups: underweight (3.1%), normal (57.3%), overweight (31.6%), and obese (8.0%). Clinicopathological factors were analyzed and compared between normal and other groups. RESULTS: According to the results, 709 patients were women (89.0%) and mean age was 48.5 years; mean follow-up period was 1,721+/-464.2 days. In comparison between the normal and underweight groups, there was significantly more extra-thyroidal invasion [Odds ratio (OR) 3.923, P=0.006] in the underweight group. In the obese group, tumor size was significantly larger (OR 1.794, P=0.007). However, there was no significant difference between the normal and overweight group. CONCLUSION: In the obese group, tumor size was the only clinical significant factor between high BMI and PTC. Interestingly, more extra-thyroidal invasion was seen in the underweight group. To confirm this result, further studies with long-term follow-up and more patients are required.
Body Mass Index* ; Breast ; Colon ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Kidney ; Medical Records ; Obesity ; Overweight ; Retrospective Studies ; Risk Factors ; Thinness ; Thyroid Gland ; Thyroid Neoplasms* ; Uterus

To evaluate the CT and MR findings of cerebral paragonimiasis (PW) and to assess the diagnostic value of the specific antibody test by enzyme-linked immunosorbent assay (ELISA) for PW, 55 CT scans and 13 MR images of 57 patients with cerebral PW were reviewed retrospectively, and correlated with the serum/CSF antibody levels. We divided the into three groups, early active(n=21), chronic(n=32), and combined stage (n=4), on the basis of CT/MR findings. In the group of early active stage the most common and characteristic findings was multiple, conglomerated, ring-like enhancing lesions in the unilateral cerebral hemisphere, which was seen in 52% on CT and 44% on MR. Other non-specific findings included a solitary ring-like or irregular enhancing lesions, ill-defined low density lesions without enhancement, localized hemorrhage with or without enhancing lesions. In the group of chronic stage there were multiple calcifications of various shapes, most commonly 1-2cm sized round shape, and associated encephalomalacia. MR was superior to CT in detecting hemorrhage and in characterizing the central contents of ring-shaped calcifications, while it was inferior to CT in identifying small calcifications. Antibody levels of serum and CSF were positive in 86% and 82% in early active group, and in 48% and 31% in chronic sgage respectively. The positive rate was significantly different between the two groups (P=0.001). CT/MR findings were characteristic in only approximately half the cases in early active cerebral PW which can be cured by traziquantel therapy. Therefore, antibody test by ELISA is recommended as a complementary tool, particularly in patients with non-specific imaging findings.
Cerebrum ; Diagnosis* ; Encephalomalacia ; Enzyme-Linked Immunosorbent Assay* ; Hemorrhage ; Humans ; Paragonimiasis* ; Praziquantel ; Retrospective Studies ; Tomography, X-Ray Computed

To evaluate the CT and MR findings of cerebral paragonimiasis (PW) and to assess the diagnostic value of the specific antibody test by enzyme-linked immunosorbent assay (ELISA) for PW, 55 CT scans and 13 MR images of 57 patients with cerebral PW were reviewed retrospectively, and correlated with the serum/CSF antibody levels. We divided the into three groups, early active(n=21), chronic(n=32), and combined stage (n=4), on the basis of CT/MR findings. In the group of early active stage the most common and characteristic findings was multiple, conglomerated, ring-like enhancing lesions in the unilateral cerebral hemisphere, which was seen in 52% on CT and 44% on MR. Other non-specific findings included a solitary ring-like or irregular enhancing lesions, ill-defined low density lesions without enhancement, localized hemorrhage with or without enhancing lesions. In the group of chronic stage there were multiple calcifications of various shapes, most commonly 1-2cm sized round shape, and associated encephalomalacia. MR was superior to CT in detecting hemorrhage and in characterizing the central contents of ring-shaped calcifications, while it was inferior to CT in identifying small calcifications. Antibody levels of serum and CSF were positive in 86% and 82% in early active group, and in 48% and 31% in chronic sgage respectively. The positive rate was significantly different between the two groups (P=0.001). CT/MR findings were characteristic in only approximately half the cases in early active cerebral PW which can be cured by traziquantel therapy. Therefore, antibody test by ELISA is recommended as a complementary tool, particularly in patients with non-specific imaging findings.
Cerebrum ; Diagnosis* ; Encephalomalacia ; Enzyme-Linked Immunosorbent Assay* ; Hemorrhage ; Humans ; Paragonimiasis* ; Praziquantel ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. MATERIALS AND METHODS: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. RESULTS: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. CONCLUSIONS: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.
Gastrectomy ; Humans ; Learning ; Learning Curve ; Lymph Nodes ; Operative Time ; Stomach

PURPOSE: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. MATERIALS AND METHODS: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. RESULTS: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. CONCLUSIONS: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.
Gastrectomy ; Humans ; Learning ; Learning Curve ; Lymph Nodes ; Operative Time ; Stomach

Purpose: The extent of surgery necessary in patients with unilateral papillary thyroid carcinoma (PTC) on preoperative radiologic imaging is still in doubt. In this study, we aimed to define risk factors that could be indicators for malignant nodules in the contralateral thyroid lobe. Methods: We included 438 patients who underwent total thyroidectomy between January 2011 and December 2014 at our institution. In this study, patients were divided into two groups according to the presence of contralateral occult carcinoma identified by postoperative pathological examination. We analyzed the clinicopathologic factors including characteristics of coexistent nodules in the contralateral lobe based on preoperative radiological imaging. Results: A total of 96 patients (21.9%) had PTC in the contralateral lobe. There were no significant differences between patients with or without contralateral occult carcinoma with respect to gender, age, primary tumor size, central lymph node metastasis, extrathyroidal extension and stage. The presence of Hashimoto’s thyroiditis was an independent predictive factor for contralateral occult carcinoma (P=0.01). Conclusion A risk factor for contralateral occult carcinoma in unilateral PTC patients is Hashimoto’s thyroiditis. Therefore, more caution is needed when determining optimal surgical methods for PTC patients with Hashimoto’s thyroiditis.