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*

BACKGROUND: Malignant cells exhibit increased glycolytic metabolism, and in many cases increased glucose transporter gene expression. The authors hypothesized that GLUT1 glucose transporter expression is increased in gallbladder carcinoma, and the degree of expression might have prognostic significance. METHODS: To evaluate a possible prognostic factor, we studied the expression of GLUT1 glucose transporter by an immunohistochemical method in 56 gallbladder carcinomas from patients and we compared these results with established prognostic factors. RESULTS: Of the 56 cases, 34 (60.7%) were positive for GLUT1. The expression of GLUT1 was not associated with patient age, sex and histologic type. Whereas the expression of GLUT1 was significantly correlated with depth of tumor invasion and lymph node and distant metastases. CONCLUSIONS: GLUT1 glucose transporter expression is strongly associated with poor prognostic factors of the gallbladder carcinoma and the assessment of the extent of GLUT1 immunostaining identifies patient with poorer prognosis.
Gallbladder* ; Gene Expression ; Glucose Transport Proteins, Facilitative* ; Glucose* ; Humans ; Lymph Nodes ; Metabolism ; Neoplasm Metastasis ; Prognosis

Purpose: Laparoscopy-assisted distal gastrectomy (LADG) has recently been accepted as a feasible and acceptable method for early gastric cancer surgery. Surgeons have long suspected that obesity might increase the intra-operative or postoperative complications. We set out to clarify the effects of obesity on LADG for early gastric cancer treatment. METHODS: We retrospectively reviewed 97 patients who had undergone LADG for early gastric cancer between May 1998 and March 2003. The degree of obesity was based on the Body Mass Index (BMI, kg/m2), with patients assigned to two groups: normal BMI (BMI <23 kg/m2) and high BMI (BMI= 23 kg/m2). RESULTS: There were no significant differences between the normal and high BMI groups in terms of patients' characteristics, surgical outcomes and postoperative courses, postoperative complication and operation time. However, there was a significant statistical difference in the operation time among the latter four groups (P=0.004). And the male with high BMI group took particularly a longer operation time than female groups with normal BMI (P=0.006) and high BMI (P=0.013). Conclusion: In LADG patients with early gastric cancer, obesity may affect the operation time, and the male high BMI group takes particularly a longer operation time than the female groups.
Body Mass Index ; Female ; Gastrectomy* ; Humans ; Male ; Obesity* ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms*

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 number of gastric-cancer patients patient who has liver cirrhosis has been increasing, especially for early gastric-cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically in our degartment. RESULTS: Of the 410, 9 cases with liver cirrhosis underwent a gastric resection: 5 standard subtotal gastrectomies and 4 curative subtotal gastrectomies. Three major postoperative complications occurred in 2 patient: anastomosis leakage in one and bleeding in both. CONCLUSIONS: The purpose of this study was to report our complicated cases, to assess the causes of the complications, and to decide the appropriate operation type for improving the prognosis of these patients. Serosal flap can be the solving techniques in B-I anastomosis and complicated perforation in cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Fibrosis ; Gastrectomy ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

Gastrointestinal hemangiomatosis is a rare benign vascular lesion, which can produce massive or persistent blood loss. Numerous lesions, usually of the cavernous type, involve stomach, small bowel, and colon. The diagnosis of hemangiomatosis is difficult. It is diagnosed usually by endoscopic study or barium enema for bleeding or anemia evaluation in childhood. A 17-year-old female was admitted to our hospital with anemia and dizziness for several months. She was diagnosed as diffuse intestinal hemangiomatosis by gastroduodenoscopy and colonoscopy. Gastroduodenosocpic findings showed multiple, small, mound-like, reddish-purple hemangiomas on the lower body, fundus and prepyloric area of the stomach. Colonoscopic findings showed similar lesions on the ascending and descending colon. The polypoid lesion on the ascending colon was ligated by detachable snare due to bleeding. No other hemangioma was detected by ultrasonography, abdominal angiography or small bowel series. We report a case of diffuse hemangiomatosis, largely distrubuted in the stomach and colon, but without involvement of skin or other solid organ. The bleeding hemangioma on the ascending colon was treated by endoscopic ligation, and the anemia of the patient was improved.
Adolescent ; Anemia* ; Angiography ; Barium ; Colon ; Colon, Ascending ; Colon, Descending ; Colonoscopy ; Diagnosis ; Dizziness ; Endoscopy* ; Enema ; Female ; Hemangioma ; Hemorrhage ; Humans ; Ligation ; Skin ; SNARE Proteins ; Stomach ; Ultrasonography

Lymphedema is one of the most common complications of mastectomy. It decreases quality of life and causes functional or aesthetical problems in post-mastectomy patients. Axillary lymph needs dissection (ALND), and radiation therapy(RTx) is known as the representative factor of lymphedema. Authors discovered that breast reconstructions using latissimus dorsi(LD) myocutaneous flap decrease the incidence of lymphedema in spite of these risk factors. Therefore we compared the incidence of lymphedema between the patients who underwent breast reconstructoins by LD pedicled flap, and the patients who did not undergo breast reconstructions from January 2002 to December 2004. Lymphedema was diagnosed when difference of arm circumference was over 2cm or limitation of joint movement was greater than 20 degrees. Overall incidence of lymphedema was 14.0%, and it was 18.9% in case of ALND, and 21.1% in case of RTx, respectively. But the incidence of breast-reconstructed patients using LD pedicled flap was 3.3%. This result reveals that LD pedicled flap decreases incidence of lymphedema significantly. In the future, it is recommended to identify the causes of decrease in the incidence of lymphedema in case of breast reconstructed by LD myocutaneous pedicled flap, for example lymphoscintigraphy and so on.
Arm ; Breast* ; Female ; Humans ; Incidence ; Joints ; Lymphedema* ; Lymphoscintigraphy ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap ; Quality of Life ; Risk Factors ; Superficial Back Muscles* ; Surgical Flaps*

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