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*

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*

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: 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

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

BACKGROUND/AIMS: Malignant cells exhibit increased glycolytic metabolism, and in many cases increased glucose transporter gene expression. We studied the expression of the glucose transporters in hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma(CC). also, examined the usefulness of Glut-1 glucose transporter in the discrimination of HCC from CC. METHODS AND RESULTS: 23 HCC, 15 CC and 8 normal liver tissues were investigated immunohistochemically with Glut-1 glucose transporter. Immunostaning was regarded as positive when more than 5% of cells were stained. Among 38 liver tumor cases, Glut-1 was stained in 15(40%). in 2(9%) of 23 HCC and in 13(87%) of 15 CC were positive.(P=0.001) In HCC, underlying cirrhosis, 18(78%) were negative.(P=0.04) Other prognostic factors: histologic type, lymph node metastasis, distant metastasis did not show any significant correlation. CONCLUSION: Differential diagnosis between HCC and CC could be made by Glut-1 glucose transporter expression
Carcinoma, Hepatocellular* ; Cholangiocarcinoma* ; Diagnosis, Differential ; Discrimination (Psychology) ; Fibrosis ; Gene Expression ; Glucose Transport Proteins, Facilitative* ; Glucose* ; Liver ; Lymph Nodes ; Metabolism ; Neoplasm Metastasis

BACKGROUND/AIMS: The death rates of pancreaticoduodenectomy decreased dramatically in experienced centers and it depends on many variability including nutritional status, better patient selection, hospital volume. We reviewed our experience of 100 pancreaticoduodenectomy for 10 years, 1000 beds hospital METHOD: Between 1990 and 2000, 100 patients underwent a pancreaticoduodenectomy in Dong-A University hospital. Annual number of cases, the disease entity, operative procedures, operation time and transfusion, radicality, external or internal pancreatic stent methods, morbidity and mortality were analyzed retrospectively. RESULTS: 10 cases or less per year until 1998: thereafter, the number of cases increased reaching 24 cases per year recently. Diseases entities were 35 pancreas head carcinomas, 22 common bile duct carcinomas, 20 ampulla vater carcinomas, 8 duodenum carcinomas, 9 chronic pancreatitis, 3 gallbladder carcinomas etc. Operative procedures were 53 whipple's operations, 23 Total pancreaticoduodenectomy, 22 pylorus preserving pancreaticoduodenectomy, 2 hepatopancreaticoduodenectomy. Postoperative morbidity has been decreasing, however, pancreatic leakage is still unresolved problem. Under 10 case annually the overall mortality was 22%, over 15 case annually the mortality reduced 12%(P=0.242). There were no mortality consecutive 30 cases since June, 1999 after changing the internal pancreatic duct stent to external pancreatic duct stent with preoperative total parenteral nutrition, Indocyanine green (ICG) test. The death rate was reduced(P=0.156). CONCLUSION: Pancreaticoduodenectomy has been increasing due to increased incidence of indication and improved resectability. Also preoperative total parenteral nutrition, ICG test, external pancreatic duct stent, successful postoperative embolization techniques decreased mobidity & mortality. It was suggested, pancreaticoduodenectomy could be safely performed in centers with more than 15 pancreatoduodenectomy annually.
Common Bile Duct ; Duodenum ; Gallbladder ; Head ; Humans ; Incidence ; Indocyanine Green ; Mortality ; Nutritional Status ; Pancreas ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreatitis, Chronic ; Parenteral Nutrition, Total ; Patient Selection ; Pylorus ; Retrospective Studies ; Stents ; Surgical Procedures, Operative

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: 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