No abstract available.
Hemorrhage* ; Humans ; Incidence*

BACKGROUND: The aim of this study is to show the effectiveness and the safety of laparoscopic surgery for the treatment of complicated duodenal ulcers. METHODS: From September 1994 to July 1997, 30 hemodynamically stable patients underwent laparoscopic surgery for the treatment of complicated duodenal ulcers, including 13 free perforations, 12 obstructions and 5 intractabilities. Operations consisted of a truncal vagotomy with a drainage procedure, a proximal gastric vagotomy (posterior truncal vagotomy with anterior seromyotomy) and simple closure of the perforation in 16, 9, 5 cases, respectively. In the beginning of this study, congo-red tests were attempted in 12 patients, intraoperatively in 7 and postoperatively in 5, to assess the reliability of a laparoscopic vagotomy. Long-term follow up was evaluated using by modified Visik criteria. RESULTS: The mean operation time was 150 (80-230) minutes. Oral intake resumed on the third postoperative day. The mean hospital stay was 8.4 days. There was one intraoperative open conversion. In another case, a distal subtotal gastrectomy followed due to persistent postoperative gastric stasis. Six of 7 intraoperative congo red tests showed black-to-red discoloration of the gastric mucosa, which meant reduced gastric acidity. However, in the postoperative group, only 2 of 5 cases did. The mean follow-up period was 21 (3-38) months. There were 2 recurrent ulcers. One was on the duodenum; the other was a marginal ulcer. CONCLUSIONS: Laparoscopic surgery for the treatment of complicated duodenal ulcers is technically feasible, effective, and safe.
Congo Red* ; Congo* ; Drainage ; Duodenal Ulcer* ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Acid ; Gastric Mucosa ; Gastroparesis ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer ; Ulcer ; Vagotomy* ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

No abstract available.
Esophagus*

Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future.

Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future.

PURPOSE: Quality of life (QOL) assessment should be applied in surgical settings to compare treatment options. We compared QOL after a subtotal versus a total gastrectomy for gastric cancer to identify which resection would produce a better QOL for the patient. PATIENTS AND METHODS: We studied 362 patients with no evidence of recurrent disease after curative surgery for gastric cancer. The QOL was measured by assessing patient health perceptions according to the Spitzer index and Troidl score and by treatment-specific symptoms according to Korenaga and others with some modifications. High scores reflect a better QOL. RESULTS: The mean score of the Spitzer index was 8.87+/-1.36 after a subtotal gastrectomy and 8.80+/-1.23 after a total gastrectomy. More than 80% of the patients in both groups maintained good quality of life when measured by the Spitzer index. The mean Troidl score was 10.41+/-2.12 after a subtotal gastrectomy and 9.79+/-2.16 after a total gastrectomy (p=0.033). Swallowing difficulty was more frequent after a total gastrectomy (p=0.002). There was a statistically significant difference in the meal size (p=0.044). Other variables of the Troidl score revealed no statistically significant differences. Dizziness was significantly more frequent after a total gastrectomy than after a subtotal gastrec tomy (p=0.009). Conclusion: We conclude that in terms of postoperative quality of life, a subtotal gastrectomy has advantages over a total gastrectomy. In those cases where an adequate proximal safety margin can be achieved by a subtotal gastrectomy, that procedure is preferable to a total gastrectomy.
Deglutition ; Dizziness ; Gastrectomy* ; Humans ; Meals ; Quality of Life* ; Stomach Neoplasms*

PURPOSE: The aim of this study was to investigate the impact of a distal subtotal gastrectomy on the quality of life (QoL). MATERIALS AND METHODS: The QoL data of 126 patients were obtained on their 5th annual follow-up visit after a curative distal subtotal gastrectomy for gastric cancer (Group A). The QoL data of 130 age- and gender-adjusted healthy population were obtained from the individuals who visited the health screening center for a medical check-up (Group B). There were 42 women and 84 men in the study group and their mean age was 56.0+/-11.1 years. QoL was assessed using the Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30) and QLQ-STO22. RESULTS: The EORTC QLQ-C30 global health status and QoL scores of Group A and Group B were 63.9+/-22.7 and 61.3+/-22.1, respectively (p=0.361). Group A revealed a better score for emotional functioning (84.1+/-16.1 and 75.2+/-21.4, respectively; p<0.001), cognitive functioning (82.0+/-16.4 and 75.0+/-21.4, respectively; p=0.004) and fatigue (27.7+/-20.8 and 33.8+/-23.2, respectively; p=0.028). However, Group A revealed a worse score for nausea and vomiting (14.8+/-20.0 and 10.2+/-16.0, respectively; p=0.042), financial difficulties (14.8+/-22.9 and 7.1+/-16.1, respectively; p=0.002), reflux (16.7+/-17.7 and 10.1+/-17.0, respectively; p=0.003), eating restrictions (13.6+/-15.2 and 6.6+/-10.2, respectively; p<0.001) and body image (23.3+/-25.4 and 16.2+/-24.6, respectively; p=0.023). CONCLUSION: The QoL of long-term survivors after a distal subtotal gastrectomy is still influenced by the surgery itself even though they are considered to be free of disease.
Body Image ; Eating ; Fatigue ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Mass Screening ; Nausea ; Quality of Life ; Stomach Neoplasms ; Survivors ; Vomiting ; Surveys and Questionnaires

BACKGROUND: Correlations between the AFP, CEA, CA19-9, and CA125 levels of portal and peripheral blood were examined in 42 patients (male, 29; female, 13; mean age, 55.9) with gastric cancer in order to identify a better blood sample for measuring these tumor markers. METHODS: The levels of these tumor markers were measured by the immunoradiometric assay. The cut-off levels of positivity were 6 ng/ml for AFP, 7 ng/ml for CEA, 25 U/ml for CA19-9, and 35 U/ml for CA125. RESULTS: The positive rates of AFP, CEA, CA19-9, and CA125 were 11.9%, 19.0%, 14.3%, and 7.1% in portal blood and 9.5%, 19.0%, 14.3%, and 4.8% in peripheral blood, respectively. The positive rate of portal venous CEA was significantly higher in cases with lymph node metastasis, distant metastasis, and lymphatic invasion than those without these variables. The positive rate of peripheral venous CEA was significantly higher in cases with lymph node metastasis, distant metastasis, high stages, and large tumor size. The positive rate of peripheral venous CA19-9 was higher in cases with distant metastasis. The positive rate of CA125 in portal and peripheral blood was higher in cases of lymphatic invasion. Neither portal nor peripheral AFP correlated with pathologic factors. Regression analysis revealed that the portal venous levels of AFP, CEA, CA19-9, and CA125 could be estimated by using the peripheral venous levels of these tumor markers. CONCLUSION: We can avoid intraoperative sampling of portal blood to measure the portal venous levels of AFP, CEA, CA19-9, and CA125 because the peripheral venous level of these tumor markers reflects the portal venous levels. The measurement of peripheral venous levels of CEA and CA19-9 can be used as non-anatomical prognostic indicators for staging of gastric cancer.
Biomarkers, Tumor ; Female ; Humans ; Immunoradiometric Assay ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms*

PURPOSE: This study evaluated the changes in nutritional status based on quality of life (QoL) item-level analysis to determine whether individual QoL responses might facilitate personal clinical impact. MATERIALS AND METHODS: This study retrospectively evaluated QoL data obtained by the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Stomach (QLQ-STO22) as well as metabolic-nutritional data obtained by bioelectrical impedance analysis and blood tests. Patients were assessed preoperatively and at the 5-year follow-up. QoL was analyzed at the level of the constituent items. The patients were categorized into vulnerable and non-vulnerable QoL groups for each scale based on their responses to the QoL items and changes in the metabolic-nutritional indices were compared. RESULTS: Multiple shortcomings in the metabolic-nutritional indices were observed in the vulnerable groups for nausea/vomiting (waist-hip ratio, degree of obesity), dyspnea (hemoglobin, iron), constipation (body fat mass, percent body fat), dysphagia (body fat mass, percent body fat), reflux (body weight, hemoglobin), dry mouth (percent body fat, waist-hip ratio), and taste (body weight, total body water, soft lean mass, body fat mass). The shortcomings in a single index were observed in the vulnerable groups for emotional functioning and pain (EORTC QLQ-C30) and for eating restrictions (EORTC QLQ-STO22). CONCLUSIONS: Long-term postoperative QoL deterioration in emotional functioning, nausea/vomiting, pain, dyspnea, constipation, dysphagia, reflux, eating restrictions, dry mouth, and taste were associated with nutritional shortcomings. QoL item-level analysis, instead of scale-level analysis, may help to facilitate personalized treatment for individual QoL respondents.
Adipose Tissue ; Body Composition ; Body Water ; Constipation ; Deglutition Disorders ; Dyspnea ; Eating ; Electric Impedance ; Follow-Up Studies ; Gastrectomy* ; Hematologic Tests ; Humans ; Mouth ; Nutritional Status ; Quality of Life* ; Retrospective Studies ; Stomach Neoplasms ; Surveys and Questionnaires ; Weights and Measures*

PURPOSE: p53 is one of the most commonly mutated genes in human tumors. The aim of this study was to analyze p53 mutation in gastric cancer and its correlations with the clinicopathologic variables to clarify the usefulness of p53 mutation as a prognostic factor. MATERIALS AND METHODS: Specimens from 331 patients with gastric cancer who underwent a gastrectomy between March 1999 and April 2001 at the Kyungpook National University Hospital were used. p53 gene mutations were assessed by using a polymerase chain-reaction single-strand conformation polymorphism (PCR-SSCP) analysis. The correlations between p53 gene mutation and clinocopathologic parameters were analyzed. RESULTS: p53 mutations were found in 66 (19.9%) tumors. Among those 66 cases, mutations were seen in 23 tumors at exon 5, in 8 at exon 6, in 21 at exon 7, and in 17 at exon 8. Two mutations were shown in 3 tumors. Thirty-six (23.1%) of 156 intestinal-type tumors and 19 (13.1%) of 145 diffuse-type tumors showed p53 gene mutation (P=0.007). The frequency of p53 gene mutation didn't show any significant differences according to age, sex, stage, location, or gross type. Exon 5 mutations showed more frequently in intestinal-type tumors than in diffuse-type tumors (9.7% vs. 2.8%, P=0.024), and p53 mutation were more frequent in lymph nodes metastasis group than lymph nodes non-metastasis group with statistical significance (25.0% vs 15.6%, P=0.034). The five-year survival rate showed no statistically significant difference with p53 mutation (P=0.704). CONCLUSION: p53 mutations assessed by PCR-SSCP had little value as a prognostic factor after gastrectomy in patients with gastric cancer.
Exons ; Gastrectomy ; Genes, p53* ; Gyeongsangbuk-do ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Survival Rate