One hundred thirty four early gastric cancer cases were analyzed to determine the clinicopathologic features influencing lymph node metastasis. Subtotal gastrectomy for 122 patients and total gastrectomy for 12 patients were carried on including lymph node dissection of node groups 1 and 2. The mean duration of the follow-up was 44.2 months. In this review, the only pathologic feature influencing lymph node metastasis was depth of invasion. The rate of lymph node metastasis was significantly higher in submucosal cancer(30.3%) than mucosal cancer(8.6%)(Chi-Square test, P=0.0009). The lymph node metastasis was the only independent prognostic factor of early gastric cancer(P=0.0006), and raise the question whether the present definition of early gastric cancer is still of value. Most important result of our study is that 20.9% of the early gastric cancer had pathologically proven lymph node metastasis, and have worse prognosis than the cases without metastasis. In stead of the currently used early gastric cancer, we propose superficial cancer for carcinoma confined to mucosa or submucosa on endoscopic finding, and to save the term of early gastric cancer for the cases in which the invasion limited to the mucosa or submucosa without lymph node metastasis.
Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mucous Membrane ; Neoplasm Metastasis* ; Prognosis ; Stomach Neoplasms*

Background: Capsular contracture is the most common serious breast surgery complication. The cause of capsular formation remains unknown, but chronic inflammation is commonly considered to cause excessive fibrosis. Curcumin has anti-inflammatory effects and thus can relieve the symptoms of inflammatory diseases, as demonstrated in animal studies. This study aimed to evaluate the effects of curcumin on the fibrous envelope covering silicone implants in a rat model. Methods: Two solid 1.8-cm oval-shaped silicone implants were placed beneath both sides of the back in 20 Sprague-Dawley rats. The control group included 10 rats that were fed a normal diet (group A), while the experimental group (group B) included the remaining 10 rats that were fed ground curcumin. En bloc excision was conducted at 8 postoperative weeks. Capsular thickness and inflammatory cell distribution were examined using a fixed tissue sample. Results: Gross findings and histologic differences between the groups were observed. The experimental group had a significantly lower mean total capsular thickness than the control group (177.4±31.4 μm vs. 145.9±32.5 μm, P=0.007). A significant decreasing tendency was found in several inflammatory cells in the experimental group (7,070±744.3/mm2 vs. 2,640±301.7/mm2, P=0.001). Conclusions Curcumin significantly reduced the inflammatory reaction, and will help to lower the risk of capsular contracture. Long-term studies are required to determine whether this hypothesis can provide a basis for a viable therapeutic strategy to reduce capsular contracture.

Background: Implant-based breast reconstruction is a technique frequently used for breast reconstruction. Infection and inflammation are considered to be the most troublesome complications of implant-based breast reconstruction and can lead to capsular contracture or implant failure. To date, however, only a few methods have been proposed to prevent these complications. Therefore, the authors introduce a simple irrigation system using indwelling drain catheters to decrease postoperative inflammation. Methods: Continuous saline irrigation was performed once per day for 3 days immediately after prosthesis-based breast reconstruction. Normal saline (500 mL) was inserted into the implant pocket through a superomedial-oriented drain catheter and drained through an inferolateral-oriented drain catheter using a suction device. Inflammatory indicators, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and postoperative complications were compared between the non-irrigation and irrigation groups. Results: This study included 37 patients divided into two groups (20 non-irrigation and 17 irrigation). An analysis of inflammatory indicators revealed that the peak CRP level in the irrigation group was significantly lower than that in the non-irrigation group, while no statistically significant differences were found for the other mediators (ESR and WBC). In the immediate postoperative period, continuous irrigation effectively washed out tissue debris and blood clots within the implant pocket, which helped maintain the function of the drain catheter and decrease pro-inflammatory mediators. Conclusions This irrigation method was simple and cost-effective for decreasing inflammation within the breast pocket. Furthermore, it can also be applied to infected breast pockets in combination with antibiotics.

A Case of primary malignant lymphoma in the uterine cervix of a 58-year-old multigravidwoman is reported. Primary malignant lymphoma localized in the uterine cervix is a rare condition.Previously, treatment of this disease has been radiation therapy, surgery or chemotherapyeither alone or in combination.We experienced one case of primary malignant lymphoma of the uterine cervix, stageI b according to FIGO, which was treated with radiation therapy and CHOP chemotherapy.The patient first underwent radiation therapy. This was followed by an chemotherapyconsisting of cyclophosphamide, adriamycin, vincristine, and prednisone.No evidence of recurrent lymphoma has been observed in 3 year after the treatment.
Cervix Uteri* ; Cyclophosphamide ; Doxorubicin ; Female ; Humans ; Lymphoma* ; Middle Aged ; Vincristine

PURPOSE: The aim of this study was to evaluate the impact of perioperative nutrition and transfusion affecting postoperative complications in gastric surgery.METHODS: From January through December in 2013, 181 patients who underwent curative gastrectomy for gastric adenocarcinoma at Korea University Guro Hospital were included. We collected general information, nutritional parameters (serum hemoglobin, albumin, total lymphocyte counts, and body mass index), operative method, perioperative transfusion and postoperative complications. The patients were divided into two groups by Clavien-Dindo classification: group I, no complication and Grade I complication; group II, above Grade II complication.RESULTS: The mean age of patients was 62.06 years, and 119 (65.7%) patients were men. The number of patients who suffered complications was 81 (44.8%), group I was 38 (21.0%) and group II was 33 (18.2%). According to the results of univariate analysis, sex, age, comorbidities, the American Society Anesthesiologists (ASA) classification and operative method had no significant effect on postoperative complications. Also in nutritional factors, serum hemoglobin, albumin, total lymphocyte counts, body mass index had no significant correlation with postoperative complications. The only independent factor correlated with postoperative complications was perioperative transfusion (odds ratio [OR], 2.424, 95% confidence interval [CI], 1.064–5.525; P=0.035) and operation time (OR, 1.007; 95% CI, 1.001–1.013; P=0.027) according to univariate analysis as well as multivariate analysis.CONCLUSION: This study suggests that perioperative transfusion may play a significant role in the development of postoperative complications.
Adenocarcinoma ; Blood Transfusion ; Body Mass Index ; Classification ; Comorbidity ; Gastrectomy ; Humans ; Korea ; Lymphocyte Count ; Male ; Methods ; Multivariate Analysis ; Nutritional Status ; Postoperative Complications ; Stomach Neoplasms

Background: Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction. Methods: We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method. Results: During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024). Conclusions Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.

OBJECTIVE: Human papillomavirus (HPV) infection is the most important risk factor for cervical cancer, which progresses from precursor lesions with no symptom if left untreated. We compared the risk of cervical dysplasia among HPV-positive Korean women based on HPV types and infection patterns. METHODS: We observed participants of a 5-year multicenter prospective cohort study, comprising HPV-positive women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion of the cervix at their enrollment. Follow-ups, comprising cytology and HPV DNA testing results, were included in the final analysis. Incidence was calculated for each infection pattern (persistent infection, incidental infection, and clearance). To investigate cervical dysplasia risk, we used Cox proportional hazard models adjusted for variables that were significantly different among infection patterns. From April 2010 to September 2017, 71 of 1,027 subjects developed cervical dysplasia more severe than high-grade squamous intraepithelial lesion of the cervix. RESULTS: Of these 71 subjects, persistent infection, incidental infection, and clearance were noted in 30, 39, and 2 individuals, respectively. Based on changes in DNA results during follow-up, cumulative incidence was 27.2%, 10.4%, and 0.5% for persistent infection, incidental infection, and clearance, respectively. Compared to clearance, the adjusted hazard ratios for cervical dysplasia were 51.6 and 24.1 for persistent and incidental infections, respectively (p < 0.001). CONCLUSION: Individuals persistently infected with the same HPV types during the follow-up period had the highest risk of severe cervical dysplasia. Hence, it is necessary to monitor HPV types and infection patterns to prevent severe cervical precancerous lesions.
Atypical Squamous Cells of the Cervix ; Cervix Uteri ; Cohort Studies ; DNA ; Female ; Follow-Up Studies ; Human Papillomavirus DNA Tests ; Humans ; Incidence ; Korea ; Papillomavirus Infections ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Risk Factors ; Squamous Intraepithelial Lesions of the Cervix ; Uterine Cervical Dysplasia ; Uterine Cervical Neoplasms

Tumors of the minor papilla are very rare and these tumors have generally been known as neuroendocrine tumors such as carcinoid tumor and somatostatinoma. As these are mostly submucosal tumors, their diagnosis is difficult by just performing endoscopic forceps biopsy, but diagnosis is possible by surgery or endoscopic resection. EUS and ERCP is an essential tool for the diagnosis of these tumors, and abdominal CT or MRI is also useful because there is the possibility of malignant tumors such as carcinoid tumor. For our present two cases, screening endoscopy revealed the polypoid lesion of the minor papilla. EUS disclosed that the submucosal tumor was limited to the submucosal layer and no abnormality was found from the abdominal CT and ERCP. Herein, we performed endoscopic resection for making the diagnosis and treatment. Histologically, these 2 tumors were diagnosed as ectopic pancreas and gangliocytic paraganglioma, respectively.
Biopsy ; Carcinoid Tumor ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Endoscopy ; Magnetic Resonance Imaging ; Mass Screening ; Neuroendocrine Tumors ; Pancreas ; Paraganglioma ; Somatostatinoma ; Surgical Instruments ; Tomography, X-Ray Computed

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.
Efficiency ; Korea ; Occupational Health ; Surveys and Questionnaires ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.
Efficiency ; Korea ; Occupational Health ; Surveys and Questionnaires ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders