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

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*

PURPOSE: A cross-calibration equation is needed to compare bone mineral density measured by different dual X-ray absoptiometry systems. We performed this study to establish appropriate cross-calibration equations between two different dual X-ray absorptiometry systems. MATERIALS AND METHODS: Bone mineral density of anterior-posterior lumbar spine (L2-4 level) and femoral neck were measured in 109 women (55+/-11yr) using two different dual X-ray absorptiometry systems (Lunar EXPERT-XL) and Hologic QDR 4500-A). Bone mineral density values measured by two systems, including area, bone mass content, bone mineral density and percentile of young normals were compared and cross-calibration equations between two systems derived. RESULTS: The bone mineral density values of 109 women measured by Lunar system were 0.958+/-0.17 g/cm2 at L2-4 and 0.768+/-0.131 g/cm2 at femur neck, which were significantly higher (13+/-6% at L2-4 and 19+/-7% at femur neck, p<0.001) than those (0.851+/-0.144 g/cm2 at L2-4 and 0.649+/-0.108 g/cm2 at femur neck) by Hologic system. Bone mineral content and percentile of young normals measured by Lunar system were also significantly higher than those by Hologic system (p<0.001), whereas there was no difference in area (p>0.05). There was a high correlation between bone mineral density values of L2-4 and femoral neck obtained with both dual X-ray absortiometry systems (r=0.96 and 0.95, respectively). Cross-calibration equations relating the bone mineral density were Lunar=1.1287xHologic-0.0027 for L2-4 and Lunar=l.1556xHologic+0.0l82 for femoral neck. CONCLUSION:: We obtained cross-calibration equations of bone mineral density between Lunar EXPERT-XL and Hologic QDR 4500-A. These equations can be useful in comparing bone mineral density obtained by different dual X-ray absorptiometry systems.
Absorptiometry, Photon* ; Bone Density* ; Female ; Femur ; Femur Neck ; Humans ; Osteoporosis ; Spine

Atrial flutter, a common rhythm disturbance, was first described over 80 years ago. Despite extensive investigations, several important issues remain unresolved concerning its exact mechanism and management. Present therapeutic strategies often appear effective to prevent and terminate atrial flutter. However, controlled trial and definitive studies comparing the various treatment options are surprisingly scarce. Here we report on a study of 9 episodes of spontaneous atrial flutter(AF)(flutter wave cycle length 224+/-39 msec) treatedd by transesophageal atrial pacing(TAP) in 9 patients(7 men and 2 women; mean age 56.9 yrs). TAP was effective in 5 patients : sinus rhythm resumption was immediate in 3 patients and followed a short period of atrial fibrillation in 2 patients. TAP was unsuccessful in 4 patients. All the patients tolerated the procedure well. These data strongly support the immediate first choice use of TAP in AF therapy.
Atrial Fibrillation ; Atrial Flutter* ; Female ; Humans ; Male

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

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

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 debate is currently ongoing about whether a large gastrointestinal stromal tumor (GIST) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination. Herein, we report a case of a large GIST of the stomach which was successfully treated by the laparoscopic approach. A 57 year old female patient visited our institution complaining of postprandial epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a 10x8 cm sized submucosal tumor at the greater curvature side of the gastric antrum. The patient underwent laparoscopic distal gastrectomy with intracorporeal Billroth-II reconstruction without any breakage of the tumor. Her postoperative course was uneventful and she was discharged on the 7th postoperative day. Even a large GIST of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon.
Endoscopy, Digestive System ; Female ; Gastrectomy ; Gastrointestinal Stromal Tumors ; Humans ; Laparoscopy ; Pyloric Antrum ; Rupture ; Stomach