Intussusception is a rare cause of postoperative intestinal obstruction in adults. Many retrograde intussusceptions occur during the period following gastrectomy. A 77-year-old woman visited our hospital because of detected gastric adenocarcinoma. She received radical total gastrectomy with Roux-en-Y esophagojejunostomy. On the fifth postoperative day, she complained of abdominal pain, and we found leakage at the esophagojejunostomy site and dilatation of the Roux limb and the afferent limb of the jejunojejunostomy. Emergency surgery was performed. Retrograde jejunojejunal intussusception accompanied with a nasojejunal feeding tube was found at the efferent loop of the jejunojejunostomy. No ischemic change was found; therefore, manual reduction and primary repair of esophagojejunostomy was performed. She was discharged without complications on the 23rd re-postoperativeday. We suggest that the nasojejunal feeding tube acted as a trigger of intussusception because there was no definitive small bowel mass or postoperative adhesion. We present our findings here along with a brief review of the literature.
Abdominal Pain ; Adenocarcinoma ; Adult ; Aged ; Dilatation ; Emergencies ; Extremities ; Female ; Gastrectomy* ; Humans ; Intestinal Obstruction ; Intussusception*

F-18 FDG-PET/CT could be used to evaluate the surveillance of recurrent stomach cancer, but some cases reported as false-positives. The authors found an activated charcoal granuloma from intraperitoneal chemotherapy by using a curative resection and mitomycin C for stomach cancer. A mass behind the right colon that showed on CT 6 months after an operation in a 46-year-old male patient had no progression in size, but 36 months after the operation, an increase was seen on F-18 FDG-PET/CT, and a metastatic tumor was suspected. The tumor was resected by an explorative laparotomy and was diagnosed as being an activated charcoal granuloma based on the histologic finding. Based on this case, we should be reminded of the possibility of a false-positive on analysis of F-18 FDG-PET/CT caused by an activated charcoal granuloma in a patient who has intraperitoneal chemotherapy.
Charcoal* ; Colon ; Drug Therapy* ; Granuloma* ; Humans ; Laparotomy ; Male ; Middle Aged ; Mitomycin ; Stomach Neoplasms

PURPOSE: The present study is to investigate the clinical utility of tumor marker cutoff ratio (TMR) and develop a TMR combination scoring system based on preoperative tumor marker (TM) levels to prognosis prediction in gastric cancer. METHODS: We include 1,142 patients for whom two or more TMs were measured and who underwent radical gastrectomy between 1990 and 2003. RESULTS: Five-year risk of recurrence (5 YRR) for carcinoembryonic antigen (CEA) TMRs were 18.3%, 29.8%, 61.4% for TMR < 1.0, 1.0 < or = TMR < 2.0, TMR > or = 2.0 respectively. 5 YRR for carbohydrate antigen 19-9 (CA 19-9) TMR were 19.7%, 35.6%, 58.4% for TMR < 1.0, 1.0 < or = TMR < 3.0, TMR > or = 3.0, respectively. 5 YRR for carbohydrate antigen 72-4 (CA 72-4) TMR were 15.2% and 33.6% for TMR < 1.0 and TMR > or = 1.0, respectively. We defined high TMR (TMR > or = 2.0 for CEA, TMR > or = 3.0 for CA19-9), low TMR (1.0 < or = TMR < 2 for CEA, 1.0 < or = TMR < 3.0 for CA 19-9 and 1.0 < or = TMR for CA72-4) and negative TMR (TMR < 1.0 for all TMs). A TMR combination scoring system was devised with negative scored as zero points, low as 1 and high as 2 for each TMR. TMR scores were divided into four categories (score 0, 1, 2, 3 and above) based on the calculated TMR score and 5 YRR were found to be 12.8%, 23.9%, 45.5%, and 68.3%, respectively (P < 0.05). Multivariate analysis showed that our scoring system was a significant independent prognostic factor. CONCLUSION: Preoperative TMRs such as CEA, CA 19-9, and CA 72-4 show a correlation with prognosis and the TMR combination scoring system could be a useful tool for the prediction of prognosis in gastric cancer.
Biomarkers, Tumor ; Carcinoembryonic Antigen* ; Cinnarizine ; Gastrectomy ; Humans ; Multivariate Analysis ; Prognosis ; Recurrence ; Stomach Neoplasms*

BACKGROUND: The correlation between the high resolution computed tomography(HRCT) emphysema score and the physiologic parameters including resting and exercise pulmonary function test was investingated in 14 patients(60.6±10.3 years) with pulmonary emphysema. METHODS: The patients underwent a HRCT, a resting pulmonary function test, and incremental exercise testing(cycle ergometer, 10 W/min). Computed tomography scans were obtained on a GE highlight at 10 mm intervals using 10 mm collimation, from the apex to the base after a full inspiration. The emphysema scores wer determined by a CT program 'Density mask' outlining the areas with attenuation values less than -900 HU, indicating the emphysema areas, and providing an overall percentage of lung involvement by emphysema. RESULTS: Among the resing PFT parameters, only the diffusing capacity(r=-0.75) and PaO2 (r=-0.66) correlated with the emphysema score(p<0.05). Among the exercise test parameers, the emphysema score correlated significantly with the maximum power(r=-0.74), maximum oxygen consumption(r=-0.68), anaerobic threshold(V-slope method : r=-0.69), maximal O2-pulse(r=-0.73), and the physiologic dead space ratio at the maximum workload(r=-0.80)(p<0.01). CONCLUSION: We could find that exercise testing parameters showed a much better correlation with the HRCT emphysema score, which is known to have a good correlation with the pathologic severity than the resting PFT parameters. Therefore it is suggested that exercise testing is superior to resting PFT for estimating in the estimation of the physiologic disturbance in emphysema patients.
Emphysema* ; Exercise Test ; Humans ; Lung ; Oxygen ; Pulmonary Emphysema ; Respiratory Function Tests

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

BACKGROUND: Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulmatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. METHODS: We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics (lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). RESULTS: 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1 : 45. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB Positivity and histological features or clinical characteristics. CONCLUSION: Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.
Diagnosis ; Female ; Granuloma ; Humans ; Inflammation ; Lymph Nodes ; Lymphadenitis ; Male ; Necrosis ; Neutrophils ; Tuberculosis ; Tuberculosis, Lymph Node*

OBJECTIVE: This study was designed to investigate the correlation between insertion depth of artificial disc and postoperative kyphotic deformity after Prodisc-C total disc replacement surgery, and the range of artificial disc insertion depth which is effective in preventing postoperative whole cervical or segmental kyphotic deformity. METHODS: A retrospective radiological analysis was performed in 50 patients who had undergone single level total disc replacement surgery. Records were reviewed to obtain demographic data. Preoperative and postoperative radiographs were assessed to determine C2-7 Cobb's angle and segmental angle and to investigate postoperative kyphotic deformity. A formula was introduced to calculate insertion depth of Prodisc-C artificial disc. Statistical analysis was performed to search the correlation between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity, and to estimate insertion depth of Prodisc-C artificial disc to prevent postoperative kyphotic deformity. RESULTS: In this study no significant statistical correlation was observed between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity regarding C2-7 Cobb's angle. Statistical correlation between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity was observed regarding segmental angle (p<0.05). It failed to estimate proper insertion depth of Prodisc-C artificial disc effective in preventing postoperative kyphotic deformity. CONCLUSION: Postoperative segmental kyphotic deformity is associated with insertion depth of Prodisc-C artificial disc. Anterior located artificial disc leads to lordotic segmental angle and posterior located artificial disc leads to kyphotic segmental angle postoperatively. But C2-7 Cobb's angle is not affected by artificial disc location after the surgery.
Congenital Abnormalities ; Humans ; Retrospective Studies ; Total Disc Replacement

BACKGROUND: The aim of this study was to analyze the gender factors associated with good or bad prognosis after return of spontaneous circulation after out-of hospital cardiac arrest. METHODS: The patients admitted to the intensive care unit after successful resuscitation after out-of hospital cardiac arrest were retrospectively identified and evaluated. Thirty days mortality after admission, and neurologic outcome at 6 months after hospital discharge (cerebral performance category [CPC]) were evaluated. RESULTS: One hundred forty-two patients were evaluated in this study; there were 101 males (71.1%). The median age was 52 years old (43-63). Thirty days after admission, 85 patients (59.9%) survived, 40 patients had a good neurologic outcome (CPC 1-2). The factors associated 30 days mortality were cause of arrest (non-cardiac, p = 0.03), lactate in emergency department (p = 0.05) and the factors associated with good neurologic outcome were males (p = 0.007), young age (p = 0.01), body weight and height (p = 0.001), cause of death (cardiac, p = 0.000). Alcohols and smoking were not associated with mortality and neurologic outcome. In multiple logistic regression analysis, men had a 8-fold increased good neurologic outcome (CPC 1-2) (odds ratio [OR] 8.038, 95% Confidence Interval [CI] 1.079-59.903). Other factors associated with good neurologic outcome were cardiac cause of death (OR 5.523, 95% CI 1.562-19.533) and young age (OR 1.055, 95% CI 1.009-1.103). CONCLUSIONS: Men had a good neurologic outcome after return of spontaneous circulation after out-of hospital cardiac arrest in one emergency center. Other additional factors including gonadal hormones should be evaluated.
Alcohols ; Body Weight ; Cause of Death ; Emergencies ; Gonadal Hormones ; Heart Arrest ; Humans ; Intensive Care Units ; Lactic Acid ; Logistic Models ; Male ; Out-of-Hospital Cardiac Arrest ; Prognosis ; Resuscitation ; Retrospective Studies ; Smoke ; Smoking

Patients with inflammatory bowel disease who fail to respond to first-line agents such as 5-ASA compounds and corticosteroids can benefit from immunomodulating medications. In past years, the short-term effectiveness of CsA in Inflammatory bowel disease(IBD) has been reported, but the long-term efficacy, benefit, and safety of this therapy have not been fully established yet. This study was conducted using a total of 60 IBD patients with long-term follow-up from among the 82 patients who visited the IBD Clinic, Song Do Hospital, Seoul, ROK, from Jan. 1994 to Dec. 1996. The effectiveness of CsA was analyzed with respect to induction and maintenance of the remission in the 43 patients with ulcerative colitis(UC) and 17 the patients with Crohn's disease(CD). Treatment on admission was with intravenous CsA (4mg/kg/day) for 7-10 days in 15 patients with UC and in 13 patients with CD. These 28 patients were unresponsive to conventional treatment and had a recurrence of symptoms on refractory to first-line agents. Following the intravenous induction of cyclosporine, the patients continued to receive oral CsA (2.0-5.0mg/Bd.wt/day). In another group, 28 patients with UC and 4 patients with CD who were nonresponsive to or had recurrence of symptoms with first-line agents were treated with oral CsA. The mean period of treatment with CsA was an average of 10 months for CD and 7.5 months for UC. The CsA blood levels were measured by whole blood monoclonal radioimmunoassay, and levels of 200-400 ng per milliliter were obtained. Among the 43 patients with UC, 33 patients had remission (77%) within a mean induction time of 3.2 months and maintained remission for a mean of 7.1 months. Of the 15 patients with UC who had been admitted for CsA IV therapy, all the patients had remission within a mean of 2.8 months and maintained remission for 6.5 months. Among the 17 patients with CD, 9 patients had remission (52.1%) within a mean of 2.7 months and remained in remission for a mean of 8.6 months. Of the 13 patients with CD who had been admitted for CsA IV therapy, 7 patients (53.8%) had remission within a mean of 2.6 months and maintained remission for a mean of 8.0 months. During the management with an average medium dosage of CsA, no serious side effects or toxicity was observed. In this study, initial cyclosporine IV (4mg/kg/day) therapy, followed by PO (2-5mg/kg/day) therapy was effective in achieving remission in ulcerative colitis but not in Crohn's disease, and the initial continuous intravenous infusion of CsA induced a more rapid and prolonged remission than oral CsA. During the induction and maintenance of remission, serious side effects were not found during the period of this study. In cases of acute or severe and refractory inflammatory bowel disease or of recurrence after conventional therapy, the continuous intravenous infusion of CsA for 7-10 days will induce a more rapid and prolonged remission than the oral administration of CsA.
Administration, Oral ; Adrenal Cortex Hormones ; Colitis, Ulcerative* ; Crohn Disease* ; Cyclosporine* ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases* ; Infusions, Intravenous ; Music ; Radioimmunoassay ; Recurrence ; Seoul ; Ulcer*