PURPOSE: Chlamydia pneumoniae (CP) infection seems to be related to atherosclerotic diseases. A prospective sero- epidemiologic study was performed to analyze the relationship between CP infection and peripheral vascular disease in Korean patients. The aims of this study were to find the prevalences of CP antibody in the serum and CP antigens in the vascular tissues, and to analyze the differences between several disease groups. METHODS: Our subjects included a total of 61 patients (76 vascular tissues) who had undergone operative procedures for peripheral vascular diseases. They were classified into 3 groups: Group 1; 14 abdominal aortic aneurysm, Group 2; 15 atherosclerosis obliterans, and Group 3; 32 varicose vein cases. The CP antibody titers were determined using the microimmunofluorescence test (MIF) and the CP antigen in the vascular tissues with a semi-nested polymerase chain reaction (PCR) and an in situ hybridization technique (ISH). RESULTS: The prevalences of chronic or past CP infection from the MIF (IgG antibody titer > or = 1: 32) in Groups 1, 2 and 3 were 78.6, 73.3, and 68.8% respectively, but with statistically significant differences. The prevalences of PCR- positive tissues in Groups 1, 2 and 3 were 21.4, 6.7, and 0% respectively. There was no CP DNA detected in the venous tissue. CP DNA was detected more frequently in aneurysmal disease than atherosclerosis obliterans, but this was not statistically significant(p=0.265). In comparison with the varicose veins, aortic aneurysms showed a significantly higher PCR positivity ratio (p=0.002), and a similar result was seen with ISH. There was no relationship between CP antigen positivity and the known risk factors for atherosclerosis. CONCLUSION: A high prevalence of CP antibodies was observed in the serum of Korean patients with vascular disease, which matched that in western populations. CP DNA was also detected in atherosclerotic tissues, which was especially high in aneurysmal disease, implying a possible causative role of CP infection in the pathogenesis of the atherosclerotic disease. This is the first report on the prevalence of CP in vascular tissues in Korean population.
Aneurysm ; Antibodies ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Arterial Occlusive Diseases* ; Atherosclerosis ; Chlamydia* ; Chlamydophila pneumoniae* ; DNA ; Epidemiologic Studies ; Humans ; In Situ Hybridization ; Peripheral Vascular Diseases ; Polymerase Chain Reaction ; Prevalence ; Prospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Varicose Veins ; Vascular Diseases

No abstract available.

PURPOSE: Endoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection/endoscopic submucosal dissection endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection. MATERIALS AND METHODS: We retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital. RESULTS: There were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection. CONCLUSIONS: A gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.
Endosonography ; Gastrectomy ; Hemorrhage ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

No abstract available.

PURPOSE: The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer. MATERIALS AND METHODS: We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups. RESULTS: For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer. CONCLUSION: A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.
Gastric Bypass ; Humans ; Korea ; Laparotomy ; Length of Stay ; Life Expectancy ; Liver ; Multivariate Analysis ; Neoplasm Metastasis ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: The objectives of this study were to investigate the impact of the number of resected lymph nodes on the survival of gastric cancer patients who underwent curative resection, and to evaluate the cut-off values that can have an influence on survival on the tumor stage-stratified analysis. MATERIALS AND METHODS: The subjects were 949 gastric cancer patients who underwent curative resection at Korea University Medical Center from 1992 to 2002. They were classified according to the depth of tumor invasion, and the influence of the number of resected lymph nodes on survival was investigated. The cut-off value for the number of resected lymph nodes was determined as the smallest value that showed a significant survival difference. RESULTS: The tumor size, location, lymph node stage, the number of metastatic lymph nodes and the number of resected lymph nodes were significantly different according to the tumor stage. The average number of resected lymph nodes was about 39, and it showed linear correlation with the number of metastatic lymph nodes. On the Cox proportional hazard model, the cut-off values of the number of resected lymph nodes, as corrected by the number of metastatic lymph nodes, was 14 for all the patients, 15 for the pT1 patients, 28 for the pT2 patients and 37 for the pT3 patients, respectively. CONCLUSION: Retrieving a number of lymph nodes that is more than the cut-off value could improve the survival of gastric cancer patients. Surgeons should also make efforts to perform an exact and thorough D2 lymph node dissection. Therefore, we urge surgeons to perform D2 dissection and pathologists should examine an certain exact number of lymph nodes.
Academic Medical Centers ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Proportional Hazards Models ; Stomach Neoplasms

PURPOSE: Treatment strategies for early gastric carcinoma (EGC) should be based on achieving a complete cure, but clear indications for limited surgery have not been established. We investigated surgical outcomes for early gastric cancer to determine the optimal? treatment strategy for EGC. MATERIALS AND METHODS: Subjects included 881 patients who underwent curative surgery for EGC between 1986 and 2003. Retrospective uni & multi-variate analysis for prognostic factors, factors affecting lymph node metastasis, and risk factors for cancer recurrence were analyzed. RESULTS: In multivariate survival analyses, age, operation method, macroscopic appearance and lymph node stage proved to be independent prognostic factors. Lymph node metastasis, depth of tumor invasion, tumor size, lymphatic and venous invasion were also significant risk factors in multivariate analyses. In multivariate analyses for cancer recurrence, depth of tumor invasion and lymph node metastasis proved to be significant risk factors. CONCLUSION: Appropriate surgical treatment with lymph node dissection is necessary for EGC patients with risk factors for lymph node metastasis.
Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms

PURPOSE: The aim of this study was to investigate the optimal length of a central venous catheter (CVC) inserted through the right internal jugular vein METHODS: During a 4-month period, we prospectively studied 374 patients who required a CVC. We enrolled 39 patients who underwent chest computed tomography (CT). The skin was punctured at the anterior border of the sternocleidomastoid muscle and at mid-distance between the angle of the mandible and the sternoclavicular junction. We measured the distance from catheter insertion to the superior vena cava/right atrium (SVC/RA) junction and calculated the recommended depth. RESULTS: The optimal length of a CVC inserted via the right internal jugular vein was 15 cm, this was based on the mean distance from the CVC insertion point to the distal SVC. By using these guidelines, the initial placement of a CVC in the distal SVC was more accurate than using other formulas (92.3% vs. 76.9%). CONCLUSION: To increase the likelihood of optimal tip location within the SVC on the first attempt and elimination of reposition, we suggest using the recommended depth instead of a formula to guide catheter placement.
Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Humans ; Jugular Veins ; Mandible ; Muscles ; Prospective Studies ; Skin ; Thorax ; Tomography, X-Ray Computed

We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.
Adenocarcinoma* ; Aged ; Biopsy ; Diagnosis ; Early Diagnosis ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Melanoma* ; Recurrence ; Stomach ; Ulcer

PURPOSE: The aim of this study was to compare two methods of tumor localization during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. METHODS: From March 2014 to November 2014, patients in whom TLDG had been engaged for middle third gastric cancer enrolled in this study. The patients were allocated to either the radiography or endoscopy group based on the type of tumor localization technique. Clinicopathologic outcomes were compared between the 2 groups. RESULTS: The accrual was suspended in November 2014 when 39 patients had been enrolled because a failed localization happened in the radiography group. The radiography and endoscopy groups included 17 (43.6 %) and 22 patients (56.4 %), respectively. Mean length of the proximal resection margin did not differ between the radiography and endoscopy groups (4.0 ± 2.6 and 2.8 ± 1.2 cm, respectively; P = 0.077). Mean localization time was longer in the radiography group than in the endoscopy group (22.7 ± 11.4 and 6.9 ± 1.8 minutes, respectively, P < 0.001). There were no statistically significant differences in the incidence of severe complications between the 2 groups (5.9% and 4.5%, respectively, P = 0.851). CONCLUSION: As an intraoperative tumor localization for TLDG, radiologic method was unsafe even though other comparable parameters were not different from that of endoscopy group. Moreover, intraoperative endoscopic localization may be advantageous because it is highly accurate and contributes to reducing operation time.
Endoscopy ; Gastrectomy* ; Humans ; Incidence ; Laparoscopy ; Methods* ; Radiography ; Stomach Neoplasms*