No abstract available.
Ulcer*

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

Emphysematous pyelonephritis is a rare complication of acute pyelonephritis that occurs in diabetics or urinary obstruction and spontaneous gas formation around renal parenchyme. Diagnosis. in appropriate clinical setting. is confirmed radiographically. Plain film demonstrates a surprising pneumonephrogram, mottled gas shadow in the renal parenchyme as well as perirenal gas. Surgical intervention after unsuccessful antibiotics and conventional medical measurement is necessary. We experienced 3 cases of emphysematous pyelonephritis which occurred in diabetic women with brief review of the literature.
Anti-Bacterial Agents ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Pyelonephritis*

PURPOSE: We evaluated the validity of laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer in elderly patients compared with younger patients. METHODS: Seventeen elderly patients (aged 70 years or more) and 113 younger patients who underwent LADG for early gastric cancer between May 1998 and July 2004, at the department of Surgery, Dong-A University Medical Center, were studied. Postoperative outcomes were compared. RESULTS: In elderly patients, co-morbidity was more common than in younger ones (P=0.0220) and postoperative complication rate was more common, too (P=0.0480). Operation time (P=0.7301), time to first flatus (P=0.4766), postoperative hospital stay (P=0.4860), mortality (P=0.2453), were similar in these two groups. CONCLUSION: Because LADG with systemic lymphadenectomy in elderly patients has more co-morbidity and complications than younger ones, great cares should be given to treat co-morbidity preoperatively and prevent complications during operation and postoperative period in elderly patients.
Academic Medical Centers ; Aged* ; Flatulence ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Node Excision* ; Mortality ; Postoperative Complications ; Postoperative Period ; Stomach Neoplasms*

PURPOSE: Intraoperative colonic distension is associated with postoperative ileus, which contributes to a delayed hospital discharge. A randomized and prospective study was conducted to evaluate the usefulness of intraoperative needle decompression of the colon (IDC) during a radical gastrectomy for gastric cancer. METHODS: Fifty patients that had received subtotal or total gastrectomy for gastric cancer were randomly assigned to either a non-decompression (n=27) or a decompression group (n=23). Prior to the main procedure, the transverse or right colon was pulled up, and a 19-gauge disposable needle connected to suction was introduced to the colon through the taenia site of the anterior wall. Any gas that collected in the colon was aspirated. The time to the first postoperative passage of flatus or feces was measured precisely in order to evaluate the restoration of bowel function. Additional measures of the outcome were the operation time, the complication rate and the length of hospital stay. RESULTS: Demographic details, pathologic features, operation times, complication rates and the length of hospital stay were not different between the two groups. A collapsed colon was required for good surgical exposure and easy manipulation. No unexpected complications related to the procedure were found. The average time to the first flatus was 6.8 hours sooner in the decompression group than in the non-decompression, although this result was not statistically significant. CONCLUSION: This technique is a simple and safe procedure for intraoperative colon decompression during a radical gastrectomy.
Colon* ; Decompression* ; Feces ; Flatulence ; Gastrectomy* ; Humans ; Ileus ; Length of Stay ; Needles* ; Prospective Studies* ; Stomach Neoplasms ; Suction ; Taenia

BACKGROUND: A tension-free herniorrhaphy has revealed encouraging results in inguinal hernia repair. However, it is still questionable whether a tension-free herniorrhaphy is the best method of inguinal hernia repair. METHODS: In our retrospective study, the postoperative results of a tension-free herniorrhaphy (n=50), a Bassini herniorrhaphy (n=50), and a Shouldice herniorrhaphy (n=50) were compared. The main endpoints were recurrence, postoperative complications, operative time, postoperative hospital stay, period of return to normal activities, postoperative pain, and the use of postoperative analgesics. RESULTS: In recurrence, there was no statistical difference among the three groups. The main postoperative complications were bleeding, hematoma, scrotal swelling, wound infection, and urinary retention. There was no significant difference in postoperative complication rate and operative time, among the three groups. However, the postoperative hospital stay and the period of return to normal activities were significantly shorter with a tension-free herniorrhaphy (3.2+/-2.1 days/13.4+/- 7.6 days) than with a Bassini herniorrhaphy (4.5+/-3.4 days/19.6+/-10.5 days) and a Shouldice herniorrhaphy (6.3+/-3.6 days/24.5+/-13.2 days), (p<0.01, f=12.56; p<0.01, f=13.56). Postoperative pain analogues (postoperaive 1 day & 3 days) were lower in the tension-free herniorrhaphy (1.6+/-0.8/1.0+/-0.5) than in the Bassini herniorrhaphy (2.7+/-1.4/2.2+/-1.6) and the Shouldice herniorrhaphy (3.7+/-1.3/3.6+/-1.8), (p<0.01, f=38.58; p<0.01, f=41.98). In the numbers of analgesic uses (operative day and postoperative 1 day), the tension- free herniorrhaphy (0.6+/-0.3/0.5+/-0.2) was also lower than the Bassini herniorrhaphy (1.9+/-0.8/1.7+/-0.7) and the Shouldice herniorrhaphy (2.4+/-1.2/2.7+/-1.3), (p<0.01, f=59.68; p<0.01, f=81.98). CONCLUSIONS: A tension-free herniorrhaphy is a ecellent method of inguinal hernia repair in adults because it offers a shorter postoperative hospital stay, a shorter period of return to normal activities, lower postoperative pain, and lower use of analgesics than other hernia repairs.
Adult ; Analgesics ; Hematoma ; Hemorrhage ; Hernia, Inguinal* ; Herniorrhaphy* ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Recurrence ; Retrospective Studies* ; Urinary Retention ; Wound Infection

PURPOSE: The effectiveness of D2 lymph node dissection in gastric cancer operation is controversial in Western countries because of the relatively high complication and mortality rates in contrast to those of Japanese studies. A generally high body mass index (BMI) of the European patients was assumed to be one of the major causes for postoperative complication. The aim of this study is to clarify the relationship between patient BMI and operative outcomes. METHODS: We studied 201 consecutive Korean patients who had undergone gastrectomy with D2 lymph node dissection for gastric cancer between Jan 2002 and Apr 2003. They were assigned to four groups according to BMI: group A, with BMI < 18.5 kg/m2; group B, with BMI of 18.5 to 23 kg/m2; group C, with BMI of 23 to 25 kg/m2; and group D, with BMI > 25 kg/m2. We analyzed differences in the length of operation time, numbers of examined lymph nodes, numbers of transfused patients, postoperative hospital stay, and postoperative complications in the four groups. RESULTS: No significant differences were found with regard to the length of operation time, the numbers of examined lymph nodes, the numbers of transfused patients, the postoperative hospital stay, and the postoperative complications in four groups. CONCLUSION: High BMI was not associated with increased operative risk or morbidity.
Asian Continental Ancestry Group ; Body Mass Index* ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Node Excision* ; Lymph Nodes ; Mortality ; Postoperative Complications ; Stomach Neoplasms

PURPOSE: This study was undertaken to reveal the molecular mechanism underlying sulindac-induced apoptosis in the human colon cancer cell line HT-29 (mutant p53). METHODS: Apoptosis was determined by using Hoechst 33342 staining, and translocation of proteins was established by using immunofluorescence, immunoelectron microscopy, and Western blotting after ultra- fractionation. RESULTS: This type of apoptosis was associated with decreased mitochondrial membrane potential, a translocation of the apoptosis-inducing factor (AIF) to the nucleus, and morphological evidence of nuclear condensation. However, DNA electrophoresis did not elucidate the ladder pattern of DNA fragments. Instead, a pulse-field gel electrophoresis showed that sulindac led to disintegration of nuclear DNA into-high- molecular-weight DNA fragments of about 100~300 kbp. CONCLUSIONS: Our findings indicate that sulindac induces large-scale DNA fragmentation, suggesting a predominantly AIF-mediated cell-death process, through translocation of the AIF to the nucleus in HT-29 cells.
Apoptosis Inducing Factor ; Apoptosis* ; Blotting, Western ; Cell Line ; Colonic Neoplasms ; DNA Fragmentation* ; DNA* ; Electrophoresis ; Fluorescent Antibody Technique ; HT29 Cells* ; Humans ; Membrane Potential, Mitochondrial ; Microscopy, Immunoelectron ; Sulindac

BACKGROUND: It has been suggested that the expression of angiogenic factors by tumor cells contributes to the increased neovascularization and vessel permeability that are associated with tumor vasculature. However, the significance of protein expression involving tumor angiogenesis in gastric cancer has yet not to be classified. METHODS: In this study, the expression of vascular endothelial growth factor (VEGF), cyclooxygenase (Cox), and nitric-oxide synthase (NOS) were investigated in 14 surgically resected human gastric carci nomas by using western blotting. RESULTS: In 6 of 14 paired cases, VEGF expression in the tumor tissue was slightly increased compared with the nonneoplastic counterpart in the same specimen. However, the expression of inducible-type Cox-2 was significantly increased in tumor tissue while the expression of constitutive-type Cox-1 was decreased. The expression of endothelial-type eNOS in cancer tissue was shown to be higher than in normal gastric resected tissues, but the expression of nNOS in cancer was lower than it was in a normal gastric mucosa. CONCLUSION: Although a direct positive correlation between VEGF expression and cyclooxygenase or nitric oxide synthase was not found in differnt stages of gastric tumor development, the cyclooxygenase and nitric-oxide synthase may play an important role in gastric cancer development.
Angiogenesis Inducing Agents* ; Blotting, Western ; Gastric Mucosa ; Humans ; Nitric Oxide Synthase ; Noma ; Permeability ; Prostaglandin-Endoperoxide Synthases ; Stomach Neoplasms* ; Vascular Endothelial Growth Factor A

PURPOSE: Secretion of angiogenic factors from tumor cells is know to play an important role in neo-vascularization and metastasis. However, which angiogenic factor is related with the formation of neo-vasculature in gastric carcinomas is not well known. This study was performed to observe changes in the expression of vascular endothelial growth factor (VEGF), cyclooxygenase (COX), and nitric- oxide synthase (NOS). METHODS: Expressions of VEGF, COX, and NOS in thirty specimens resected from patients with a gastric carcinoma were investigated using the western blot method. Cultured MKN28 gastric cancer cells were treated with 100 ng/ml VEGF, and changes in the expression of COX and NOS were examined. Changes in VEGF expression were also investigated after treatment of the cells with inhibitors of COX and NOS. RESULTS: Expressions of VEGF, COX, and eNOS were increased up to 10, 60, and 30%, respectively, in tumors compared to surrounding normal tissues. VEGF-positive tumors showed a higher expression of COX-2. Human recombinant VEGF induced the expression of COX-2, but not eNOS, in the cultured MKN28 cells. The increase in expression was blocked with actinomycin D, the VEGF antibody, and anti-VEGF peptide. VEGF-induced expression of COX-2 was also blocked by pretreatment of cells with aspirin and indomethacin, suggesting that these anti-inflammatory drugs inhibit VEGF. The expression of eNOS was decreased by indomethacin in VEGF-treated cells, but COX-2 expression was not affected by inhibitors of NO production, N-arginine methylester (NAME). However, the protein level of VEGF was increased by indomethacin and NAME. CONCLUSION: This study showed that COX-2 and eNOS in gastric carcinomas seem to play an important role in the production of VEGF and that their expressions may also be affected by VEGF.
Angiogenesis Inducing Agents* ; Aspirin ; Blotting, Western ; Dactinomycin ; Humans ; Indomethacin ; Neoplasm Metastasis ; Nitric Oxide Synthase* ; Nitric Oxide* ; Prostaglandin-Endoperoxide Synthases* ; Stomach Neoplasms* ; Vascular Endothelial Growth Factor A