PURPOSE: Sentinel lymph node (SLN) biopsy (SLNB) for patients with melanoma and breast carcinoma has been validated as an accurate method for assessing the status of lymph nodes. Although prophylactic modified radical neck dissection for patients with papillary thyroidcarcinoma is not performed routinely, central neck node dissection is currently considered to be part of the standard initial operation. Therefore, this study was conductedto determine the feasibility of SLNB for the evaluation of central neck lymph node status in patients with papillary thyroid carcinoma. METHODS: 116 patients (108 women, 8 men) preoperatively diagnosed with papillary thyroid carcinoma between 2004 and 2006 were prospectively studied. After 0.1 to 0.3 ml of 1.0% methylene blue dye was injected into the tumor, SLNB was performed, followed by total thyroidectomy and central neck node dissection. RESULTS: Preoperatively, in cases of papillary thyroid carcinoma without evidence of cervical lymph node metastasis, the identification rate of SLN in level 6 compartments was 93.1%. In addition, the overall accuracy of SLN at predicting the nodal status was 91.7%. Furthermore, the sensitivity, specificity, positive predictive value and negative predictive values were 85.7%, 100%, 100% and 83.3% respectively. CONCLUSION: The SLNB in the central compartment for papillary thyroid carcinoma is an acceptable and feasible technique for estimating the central neck lymph node status, therefore, it may be helpful in diagnosing metastases and avoiding unnecessary lymph node dissection in cases of papillary thyroid cancer. However further studies are necessary to improve the diagnostic accuracy prior to routine clinical use.
Biopsy ; Breast Neoplasms ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melanoma ; Methods ; Methylene Blue ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Prospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Bezoars are retained concretions of undigested animal or vegetable material that can produce gastrointestinal obstruction, ulceration, and bleeding. Therapeutic options for gastric bezoars include enzyme therapy (papain, cellulase, or acetylcysteine), endoscopic disruption and removal, and surgical removal. Multiple large gastric bezoars generally require conventional surgical management through an upper abdominal incision. With the recent improvement of laparoscopy, a lot of portions of abdominal operations have been performed laparoscopically. We successfully removed multiple large gastric phytobezoars in a 52-year-old female completely through laparoscopy. This supported the feasibility of laparoscopic surgery for patients with gastric bezoars.
Animals ; Bezoars ; Cellulase ; Enzyme Therapy ; Female ; Hemorrhage ; Humans ; Laparoscopy ; Middle Aged ; Ulcer ; Vegetables

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.
Acoustics ; Aneurysm ; Atherosclerosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis ; Equidae ; Esophagus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Valves ; Humans ; Mitral Valve ; Pathology ; Thrombosis ; Transducers

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.
Adult ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Biopsy* ; Catheter Ablation ; Classification ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Female ; Heart Diseases ; Humans ; Pathology ; Tachycardia ; Tachycardia, Ventricular*

PUPOSE: This study was designed to investigate the validity of WHOQOL-BREF (Brief form of the World Health Organization Quality of Life Assessment Instrument) and to explore quality of life (QOL) by using WHOQOL-BREF in patients with stomach cancer after a curative resection. MATERIALS AND METHODS: Fifty (50) patients with stomach cancer after a curative resection were recruited with informed consents. Age- and gender matched hospital staffs served as controls. The 100-item WHOQOL instrument was employed for the all subjects. The scores of the WHOQOL-BREF, which is a short version (26 questions) of the WHOQOL, and includes four domains (physical, psychological, social, and environmental), were compared with those of WHOQOL. RESULTS: The scores of the WHOQOL-BREF were significantly correlated with those of the WHOQOL in all domains. Two domains, physical and social, were associated with worse quality of life in patients with stomach cancer after a curative resection. CONCLUSION: The WHOQOL-BREF is a valid instrument that is useful for evaluating the quality of life in patients with stomach cancer.
Humans ; Quality of Life* ; Stomach Neoplasms* ; Stomach* ; World Health Organization

PURPOSE: This study was designed to explore quality of life (QOL) in patients with stomach cancer by using the World Health Organization Quality of Life (WHOQOL) Instrument-Korean version. MATERIALS AND METHODS: Thirty-one (31) patients with stomach cancer after curative resection were recruited with informed consent. Age- and gender-matched hospital staff served as controls. The 100-item WHOQOL Instrument, including physical domain, psychological domain, social domain, independence domain, environment domain, and spiritual domain, was employed for the all subjects. RESULTS: In patients with stomach cancer after operation, only two domains, physical and independence, were associated with worse quality of life. In those domains, patients with advanced stage, with total gastrectomy, with adjuvant chemotherapy, and early or late postoperative period (< or =2 years or >5 years after operation), could be perceived of having a worse quality of life. CONCLUSION: Not only scientific objective success but also individual subjective perception of condition could be important for managing patients with stomach carcinomas after curative resection. In this context, the WHOQOL reflecting multi-dimensional state of well being could be a useful tool across a variety of cultural and value systems in the world.
Chemotherapy, Adjuvant ; Drug Therapy ; Gastrectomy ; Humans ; Informed Consent ; Postoperative Period ; Quality of Life* ; Stomach Neoplasms* ; Stomach* ; World Health Organization

PURPOSE: We wanted to evaluate the technical feasibility and safety of totally laparoscopic total gastrectomy (TLTG) for treating early gastric cancer. MATERIALS AND METHODS: The medical records of 11 consecutive patients who underwent TLTG after being diagnosed with early gastric cancer at Incheon St. Mary's Hospital, The Catholic University of Korea from February 2005 to September 2009 were retrospectively reviewed and their clinicopathologic characteristics and the surgical results were investigated. RESULTS: The mean operation time was 385.6+/-94.1 minutes, the mean time for creating an intracorporeal anastomosis was 97.5+/-60.0 minutes and the mean number of the harvested lymph nodes was 46.6+/-15.4. The mean number of days after operation until starting a liquid diet was the 6.15+/-7.6th postoperative day and the mean hospital stay after surgery was 14.2+/-11.9 days. There was no case of open conversion, but there were 2 cases of intraoperative complication and 3 cases of postoperative complication. There was one case of postoperative mortality. The patient suffered from thrombocytopenia of an unknown cause, which was refractory to platelet transfusion, on 4th postoperative day and the patient died of intraabdominal bleeding on the 6th postoperative day. CONCLUSION: TLTG was a technically feasible and relatively safe procedure. However, a long time for creating the intracoproeal anastomosis and a long operation time are still problems to be solved.
Diet ; Gastrectomy ; Hemorrhage ; Humans ; Intraoperative Complications ; Korea ; Length of Stay ; Lymph Nodes ; Medical Records ; Platelet Transfusion ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; Thrombocytopenia

PURPOSE: Gastric epithelial dysplasia (GED) was defined as "unequivocally neoplastic epithelium that may be associated with or give rise to invasive adenocarcinoma" and GED also represents a direct precursor of intestinal type adenocarcinoma of the stomach. The recommended treatment guidelines for GED in the medical literature are endoscopic mucosal resection (EMR) or surgery for high grade dysplasia (HGD) and annual endoscopic surveillance with biopsy for low grade dysplasia (LGD) The aim of this study was to determine the treatment plan for GED that is diagnosed by endoscopic biopsy. MATERIALS AND METHODS: We enrolled 148 patients who were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for GED: there were 63 patients with HGD and 85 patients with LGD and all of them were diagnosed by endoscopic biopsy from January 2006 to December 2008. The results of the final histopathologic reports after EMR or ESD were compared with the results of the endoscopic biopsies. RESULTS: The final histopathologic results of the 148 patients with GED showed 49 (33.1%) patients with adenocarcinoma, 40 (27.0%) patients with HGD and 59 (39.9%) patients with LGD. Among the 63 patients with HGD, 34 (54.0%) patients had adenocarcinoma, 20 (31.7%) patients had HGD and 9 (14.3%) patients had LGD. For the 85 patients with LGD, 15 (17.6%) patients had adenocarcinoma, 20 (23.5%) patients had HGD and 50 (58.8%) patients had LGD. CONCLUSION: Complete resection, including EMR or ESD, is needed for patients with GED diagnosed by endoscopic biopsy and they have HGD. For patients with LGD, EMR or ESD may be needed in addition to endoscopic surveillance with biopsy for making the correct diagnosis and proper treatment because of the possibility of adenocarcinoma.
Adenocarcinoma ; Biopsy ; Epithelium ; Humans ; Stomach

A laparoscopic wedge resection for a submucosal tumor, which is close to the gastroesophageal junction, is technically challenging. This can be a dilemma to both patients and surgeons when the tumor margin involves the gastroesophageal junction because a wedge resection in this situation might result in a deformity of the gastroesophageal junction or an injury to the lower esophageal sphincter, which ultimately results in lifelong gastroesophageal reflux disease. The patient was a 42 year-old male, whose preoperative endoscopic ultrasonographic finding did not rule out a gastrointestinal stromal tumor. He underwent a laparoscopic gastric wedge resection and prophylactic anterior partial fundoplication (Dor) and was discharged from hospital on the fifth postoperative day without any complications. There were no symptoms of reflux 5 months after surgery. A laparoscopic wedge resection and prophylactic anti-reflux surgery might be a good surgical option for a submucosal tumor at the gastroesophageal junction.
Congenital Abnormalities ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Fundoplication ; Gastroesophageal Reflux ; Gastrointestinal Stromal Tumors ; Humans ; Male

No abstract available.
Echocardiography, Transesophageal* ; Mitral Valve Insufficiency*