Sleep disturbance is a one of common complaints among patients with panic disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of panic disorder yet. Several previous studies suggested that the sleep disturbance in panic disorder is mediated by nocturnal panic attack. In terms of the pathophysiology of panic disorder, nocturnal panic attack seems to be closely associated with the sleep problems in panic disorder. In this article, the authors reviewed various previous studies about sleep of panic disorder and intended to give importance of evaluating sleep disturbances and nocturnal panic attack in panic disorder for both clinical and research purpose.
Humans ; Panic ; Panic Disorder

The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). The common clinical manifestation of GIST are melena and hematochezia caused by gastointestinal bleeding. However, hemoperitoneum due to GIST rupture is a very rare condition. We describe a 33-year-old man with gastric GIST causing hemoperitoneum. A preoperative CT scan demonstrated large amount of fluid collection and extraluminal mass lesion in gastric antral area. He underwent an emergent laparotomy. The antral mass was polypoid shaped and showed ruptured focus. We performed a distal gastrectomy. The tumor was revealed as GIST with intermediate malignant risk by pathologic examination. The patient had an uneventful postoperative course and remains well.
Adult ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors/complications/*diagnosis/surgery ; Hemoperitoneum/*diagnosis/etiology ; Humans ; Male ; Tomography, X-Ray Computed

No abstract available.
Catheterization* ; Catheters* ; Hemothorax* ; Subclavian Vein*

BACKGROUND: Recently, many studies have focused on human epidermal growth factor receptor 2 (HER2) status in gastric cancer due to HER2-targeted therapy using trastuzumab. We investigated HER2 overexpression and amplification and their concordance rate in Korean gastric adenocarcinomas. METHODS: Tissue microarrays were constructed with 232 gastric adenocarcinoma samples. We performed immunohistochemistry (IHC), silver-enhanced in situ hybridization (SISH) and fluorescence in situ hybridization (FISH) for HER2. RESULTS: IHC was negative in 94.8% (218/232), equivocal in 1.7% (4/232) and positive in 3.5% (8/232) of cases. HER2 protein expression was heterogeneous in 75% (9/12) of IHC 2+/3+ cancers. Gene amplification was observed in 6.5% (15/230) by SISH and the same 15 cases were also FISH-positive. We observed HER2 amplification in 1.4%, 27.3%, 25%, and 100% of IHC 0, 1+, 2+, and 3+ gastric adenocarcinomas, respectively. The concordance rate between IHC and SISH results was 95.7%. CONCLUSIONS: HER2 overexpression and amplification were less frequent in gastric adenocarcinomas than breast carcinomas. Compared to breast carcinoma, (1) there may be IHC-negative but gene amplification-positive cases for HER2 and (2) frequent intratumoral heterogeneity of IHC for HER2 in gastric adenocarcinomas.
Adenocarcinoma ; Antibodies, Monoclonal, Humanized ; Breast ; Fluorescence ; Gene Amplification ; Humans ; Immunohistochemistry ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Population Characteristics ; Receptor, Epidermal Growth Factor ; Receptor, erbB-2 ; Silver ; Stomach Neoplasms ; Trastuzumab

BACKGROUND: Cerebrospinal fluid (CSF) examination can be used to verify the presence of primary malignancies as well as cases of central nervous system (CNS) metastasis. Because of its importance, there have been several studies concerning the sensitivity of CSF cytology. To determine the practical use and reproducibility of diagnoses based on CSF cytology, we evaluated this test by analyzing cytology results from consecutive CSF samples. METHODS: Between July 2010 and June 2013, 385 CSF cytology samples from 42 patients were collected. The samples were gathered using a ventricular catheter and reservoir. CSF cytology of all patients was examined more than two times with immunocytochemistry for cytokeratin. RESULTS: Primary neoplastic sites and histologic types of patients' metastatic cancer were diverse. The overall sensitivity for detecting malignancy was 41.3%. Even within short-term intervals, diagnoses frequently changed. CONCLUSIONS: Our results were inconsistent, with low sensitivity, when compared to the results of previous studies. However, CSF evaluation can still provide valuable diagnostic and prognostic information because adjuvant treatments are now routinely performed in patients with CNS metastasis. Negative CSF cytology results should not be ignored, and continuous CSF follow-up is essential for following the clinical course of patients with metastatic cancer involving the CNS.
Catheters ; Central Nervous System ; Cerebrospinal Fluid* ; Diagnosis ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Neoplasm Metastasis

PURPOSE: The aim of this study was to examine the usefulness of positron emission tomography (PET)-computed tomography (CT) in the pre-operative staging of gastric cancer. MATERIALS AND METHODS: Between February 2006 and August 2008, PET-CT and CT were performed on 70 patients diagnosed with gastric cancer by gastrofiberscopic biopsy. The sensitivities, specificities, positive predictive value (PPV), and negative predictive value (NPV) of PET-CT and CT imaging for the detection of gastric cancer TNM staging were compared. RESULTS: The detection rates for the primary tumor were as follows: PET-CT, 81.4% (57/70); and CT, 42.9% (30/70). For both early gastric cancer (EGC) and advanced gastric cancer (AGC), PET-CT was more accurate than CT in detecting the lesions. As the size of the tumor exceeded 3 cm, the detection rate increased. The sensitivities, specificities, PPV, and NPV of PET-CT for lymph node staging were 55.6%, 81%, 86.2%, and 45.9%, while the sensitivities, specificities, PPV, and NPV of CT were 40.0%, 85.7%, 85.7% and 40%, respectively. One case of multiple liver metastasis and two cases of dual primary cancer (rectal and pancreatic cancers) were detected by PET-CT. PET-CT also had a higher detection rate for all histologic types of primary tumors. PET-CT was more accurate than CT in detecting primary gastric cancer lesions. The detection of nodal metastasis by PET-CT was similar to CT; small-sized tumors or EGC detection rates were not high. However, PET-CT provided additional information to detect distant metastases and dual primary cancers and reduced unnecessary laparotomies to detect peritoneal seeding or carcinomatosis. CONCLUSION: It would be useful to make a pre-operative diagnosis of gastric cancer and determine treatment if PET-CT were added to other routine pre-operative studies.
Biopsy ; Electrons ; Humans ; Laparotomy ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Positron-Emission Tomography ; Seeds ; Stomach Neoplasms

PURPOSE: Recently, early gastric cancer has increased in Korea. Thus, endoscopic resection and laparoscopic gastrectomy has increased in early gastric cancer patients. But, endoscopic resection of early gastric cancer has many problems such as poor long-term survival data, diverse endoscopic techniques, ambiguous follow-up strategy, nonuniform pathologic interpretation and so on. We studied patients that received additional gastrectomy after EMR/ESD. We analyzed clinicopathological characteristics states before and after EMR/ESD. METHODS: From 1998 to 2008, 56 patients received additional gastrectomy after EMR/ESD due to gastric cancer. We analyzed tumor characteristics, endoscopic resection type, reasons for gastrectomy, post-operative characteristics, etc., retrospectively from medical records. RESULTS: The ratio of male to female was 2:1. Six patient tumors were larger than 2 cm in size. Forty-five patients received EMR and 12 patients received ESD. Common macroscopic feature of endoscopic findings were superficial elevated and superficial depressed between 10 mm and 20 mm. Forty patients received immediate gastrectomy due to incomplete endoscopic resection. Sixteen patients received additional gastrectomy during follow-up period after EMR/ESD. The most common reason of immediate gastrectomy was positive resection margin. The most common reason of follow-up gastrectomy was cancer recurrence. Three patients had advanced gastric cancer in follow up gastrectomy group. Two patients died due to gastric cancer in immediate gastrectomy group and follow-up gastrectomy group. CONCLUSION: Active effort for surgical treatment is needed when the gastric cancer characteristics of patients is inadequate for endoscopic resection. Uniform pathologic interpretation is essential for confirming completeness of endoscopic resection. Treatment and follow-up strategy after endoscopic resection is important due to recurrence and new cancer occurrence. Long-term and prospective randomized study should be performed to confirm safety and difficulty of endoscopic resection.
Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Male ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). Surgery remains the only curative treatment for GIST. Resection needs to ensure tumor free margin without lymphadenectomy. Thus partial gastric resection is the treatment of choice for gastric GIST. This study aims to review clinical characteristics between open and laparoscopic wedge resection group and evaluate safety and efficacy of laparoscopic wedge resection. METHODS: Between 1997 and 2008, 74 consecutive patients undergoing open or laparoscopic wedge resection of gastric GISTs were identified in a retrospectively collected database. Preoperative and postoperative variables were analyzed. RESULTS: Wedge resection with negative margin was performed in 74 patients. Laparoscopic wedge resection was performed 19 patients. Open wedge resection was performed in 55 patients. Mean tumor size of laparoscopic group was 2.7 cm (range 0.4~6.0) and open group was 4.4 cm (range 0.4~23.0). Mean operation time of laparoscopic group was 150.0 minutes (range 80~240), and open group was 164.6 minutes (range 75~360). Mean hospital stay of laparoscopic group was 7.11 days (range 3~19), and open group was 9.38 days (range 6~20). There were no significant survival differences between groups. CONCLUSION: A laparoscopic wedge resection of gastric GIST is associated with short hospitalization and not inferior to open wedge resection in terms of morbidity and mortality. The long-term outcomes between laparoscopic and open wedge resection group in our study were no significant survival differences. Long-term and prospective randomized study should be performed to confirm oncological safety of laparoscopic wedge resection.
Dietary Sucrose ; Gastrointestinal Stromal Tumors ; Hospitalization ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Retrospective Studies ; Stomach

PURPOSE: In 2010, the new UICC/AJCC TNM classification for gastric cancer was declared. The new classification for gastric cancer has several changes from the 6th classification. We evaluated the prognostic values and differences according to the new UICC/AJCC TNM classification. METHODS: From 2000 to 2004, 1,196 patients who underwent curative resection with D1+beta or more lymph node dissection and with 15 or more lymph nodes retrieved were studied retrospectively. We analyzed clinical characteristics and survival outcomes retrospectively from medical records. RESULTS: According to UICC/AJCC 7th TNM classification, the 5-year survival rate (5YSR) of each group for depth of invasion and node metastasis were significantly different. The 5YSR of stage II in 6th classification was 82.4% and the 5YSR of stage IIa and IIb in 7th classification were 92.2% and 82.9%. The 5YSR of stage IIIa and IIIb in 6th classification were 56.3% and 33.0%. The 5YSR of stage IIIa, IIIb and IIIc in 7th classification were 72.7%, 48.4% and 26.1%. In our Cox regression multivariate analysis, N stage of the 6th UICC/AJCC TNM classification was the main independent prognostic factor. CONCLUSION: N stage of the 6th UICC/AJCC TNM classification is a more reliable prognostic factor than N stage of the 7th UICC/AJCC TNM classification. Further study should be performed to confirm the appropriateness of N stage TNM classification for gastric cancer.
Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: This study was conducted to evaluate the survival differences between curative stage IV and non-curative stage IV gastric cancers after gastrectomy. METHODS: Stage IV gastric cancer patients who received gastrectomy were selected from our surgical data-base from 1995 to 2004. These patients were separated into two groups according to the curability by surgery. We analyzed the survival differences between curative stage IV patients and non-curative stage IV patients. Survival analysis was performed by Kaplan-Meier survival analysis. RESULTS: During a 10-year period, gastrectomy was performed in 2,214 patients. 224 patients were diagnosed as stage IV. 144 patients were male and 80 patients were female. 97 patients received total gastrectomy. 127 patients received subtotal gastrectomy. 173 patients were diagnosed with curative stage IV and 51 patients were non-curative stage IV. Overall 3-year and 5-year survival rates of stage IV gastric cancer patients in this study were 31.5% and 18.4%. 3-YSR of curative and non-curative stage IV were 36.0% and 16.7% respectively (P-value=0.0204). 5-YSR of curative and non-curative stage IV was 21.9% and 4.2% (P-value=0.0169). CONCLUSION: Significant survival differences were found between curative and non-curative stage IV. Although direct tumor extension or distant metastasis exists, gastrectomy with combined resection was important to improve prognosis if it is possible to resect. When it comes to the matter of survival rate, the subclassification of stage IV gastric cancer should be considered for further management.
Female ; Gastrectomy ; Humans ; Male ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate