PURPOSE: Recently, diagnosis of stage 1 gastric cancer has increased in number and prognosis is excellent when proper treatment is done. However, some patients have recurrence and their prognosis is poor. Thus, we investigated the risk factors of recurrence in stage 1 gastric cancer patients. METHODS: From January 2004 to December 2008, a total of 1,241 number patients were operated on for stage 1 gastric cancer at the Department of General Surgery, Kosin University Gospel Hospital. We reviewed the characteristics of all patients retrospectively and compared them to recurred group (n=24) and non-recurred group (n=1,114). We analyzed the risk factors associated with recurrence. RESULTS: Twenty-four patients with stage 1 gastric cancer were recurred after radical gastrectomy. Recurrence rate was 2.05%. The most common pattern of recurrence was hematogenous (41.7%), and lymphatic (20.8%), peritoneal seeding (16.7%), combined form (12.5%), and locoregional (8.3%). Five-year survival rate was 50.08% of recurrence group. Of clinicopathological factors, depth of invasion, lymph node metastasis, lymphatic involvement and tumor marker were statistically significant between recurred and other group. CONCLUSION: In this study, tumor marker, tumor depth, node status, lymphatic channel involvement were possible risk factors of recurrence for stage 1 gastric cancer. More intensive follow up and care is needed for those with such risk factors.
Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Seeds ; Stomach Neoplasms ; Survival Rate

BACKGROUND AND OBJECTIVES: It is well known that anti-platlet agents decrease the rate of subacute thrombosis after intracoronary stenting significantly. The aim of this study is to assess the antithrombotic effect and safety of 2-month combined regimen of cilostazol and aspirin on intracoronary stenting. METHODS: The study population consisted of 78 lesions of 57 patients (age: 58.1+/-10.3, male 47, female 10) with ischemic heart disease who were underwent successful intracoronary stenting. They were received cilostazol(200mg/day) and aspirin(100mg/day) two days before intracoronary stenting and continued for 8 weeks, and then aspirin was medicated continuously during the study. The laboratory and clinical findings were evaluated before cilostazol administration, 4 weeks, 8 weeks and 6 months after intervention. The excercise treadmill test was done at 6 months after intervention. RESULTS: Subacute thrombosis occurred in 2 patients(3.5%). Target lesion revascularization(TLR) was done in 4 patients(7.3%). Clinical restenosis (symptomatic or positive stress test, subacute thrombosis and TLR) occurred in 15 patients(26.3%). There was no granulocytopenia, or severe liver dysfunction. HDL-cholesterol was increased significantly at 2 months(36.6+/-7.4 mg/dl versus 41.6+/-9.3 mg/dl. p<0.01) and 6 months(36.6+/-7.4 mg/dl versus 42.4+/-10.6 mg/dl. p<0.01) follow up. CONCLUSION: Two-month combined regimen of cilostazol and aspirin was effective and safe after intracoronary stenting. Subacute thrombosis and clinical restenosis rate were comparable with pervious reports. Further large randomized trials are needed for the evaluation of favorable effect of cilostazol on lipid metabolism.
Agranulocytosis ; Aspirin* ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Lipid Metabolism ; Liver Diseases ; Male ; Myocardial Ischemia ; Stents* ; Thrombosis

BACKGROUND AND OBJECTIVES: It is well known that anti-platlet agents decrease the rate of subacute thrombosis after intracoronary stenting significantly. The aim of this study is to assess the antithrombotic effect and safety of 2-month combined regimen of cilostazol and aspirin on intracoronary stenting. METHODS: The study population consisted of 78 lesions of 57 patients (age: 58.1+/-10.3, male 47, female 10) with ischemic heart disease who were underwent successful intracoronary stenting. They were received cilostazol(200mg/day) and aspirin(100mg/day) two days before intracoronary stenting and continued for 8 weeks, and then aspirin was medicated continuously during the study. The laboratory and clinical findings were evaluated before cilostazol administration, 4 weeks, 8 weeks and 6 months after intervention. The excercise treadmill test was done at 6 months after intervention. RESULTS: Subacute thrombosis occurred in 2 patients(3.5%). Target lesion revascularization(TLR) was done in 4 patients(7.3%). Clinical restenosis (symptomatic or positive stress test, subacute thrombosis and TLR) occurred in 15 patients(26.3%). There was no granulocytopenia, or severe liver dysfunction. HDL-cholesterol was increased significantly at 2 months(36.6+/-7.4 mg/dl versus 41.6+/-9.3 mg/dl. p<0.01) and 6 months(36.6+/-7.4 mg/dl versus 42.4+/-10.6 mg/dl. p<0.01) follow up. CONCLUSION: Two-month combined regimen of cilostazol and aspirin was effective and safe after intracoronary stenting. Subacute thrombosis and clinical restenosis rate were comparable with pervious reports. Further large randomized trials are needed for the evaluation of favorable effect of cilostazol on lipid metabolism.
Agranulocytosis ; Aspirin* ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Lipid Metabolism ; Liver Diseases ; Male ; Myocardial Ischemia ; Stents* ; Thrombosis

BACKGROUND: The intimal thickening of coronary artery was understood as an early process in the beginning of atherosclerosis. However, the implication of intimal thickening as a morphologic change of coronary artery disease, on the coronary vascular hemodynamics has not been explored. METHODS: To evaluate the effect of intimal thickening on the coronary vascular hemodynamics, we studied the extent of intimal thickening on intravascular ultrasound(IVUS) and the coronary vascular flow and resistance by using Doppler wire in left anterior descending coronary arteries after successful intervention in 40 patients(29 males, mean age 55+/-9 years) with coronary artery disease. Mean intimal index and mean lumen cross sectional area were determined by IVUS and coronary flow average peak velocity was obtained by using Doppler wire before and after intracoronary adenosine in distal artery to the stenosis. Coronary flow velocity reserve(CFR), volumetric coronary blood flow(CBF) and coronary vascular resistance index(CVRI) were calculated. Hyperemic pressure-to-flow ratio(hyperemic mean aortic pressure/hyperemic volumetric coronary blood flow), ie, an index of minimal coronary vascular resistance(mCVR), was further derived. RESULTS: Intimal index(mean 20.0+/-8.3%) was significantly correlated with CVRI(mean 0.33+/-0.14, r=.37, p=.02) and mCVR(mean 0.81+/-0.40mmHg/ml/min, r=.36, p=.02). However, there was no correlation with CBF and CFR. CONCLUSION: The CVRI and mCVR(hyperemic pressure to flow ratio), the indices coronary microvascular resistance, were significantly related to the degree of intimal thickness of coronary artery. The extent of intimal thickness of coronary artery on IVUS study may be related to microvascular integrity.
Adenosine ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Hemodynamics ; Humans ; Male ; Vascular Resistance*

BACKGROUND AND OBJECTIVES: Recent studies indicate that in response to vasoconstrictor stimuli, the small GTPase RhoA and its down-stream effector, Rho-associated kinase 2 (ROCK)/Rho-kinase, are associated with hypercontraction of the vascular smooth muscle of coronary arteries through augmentation of myosin light chain phosphorylation and Ca2+ sensitization. Expression of ROCK/Rho-kinase mRNA was significantly increased and up-regulated in the spastic coronary artery in a porcine model, and a specific inhibitor of ROCK/Rho-kinase inhibited coronary artery spasm in humans. We therefore explored the role of ROCK2 polymorphisms in the pathogenesis of vasospastic angina (VA). SUBJECTS AND METHODS: We studied 106 patients with VA who exhibited spontaneous or provoked coronary spasm during coronary angiography and compared the prevalence of ROCK2 polymorphisms between this group of patients with VA and controls whose angiograms were normal, and in whom the ergonovine test did not cause spasm (n=107). Five single nucleotide polymorphisms (SNPs) of the ROCK2 gene were selected. SNPs were genotyped by high-resolution melting. Linkage disequilibrium and haplotype analyses were performed using the SHEsis program. RESULTS: The prevalence of genotypes of the 5 interesting SNPs in patients with VA was not different from that in the control group. In haplotype analysis, the haplotype G-T-C-T-G (in order of rs978906, rs2271621, rs2230774, rs1515210, and rs3771106) was significantly associated with a decreased risk of VA (p=0.007). CONCLUSION: The haplotype G-T-C-T-G in the ROCK2 gene had a protective effect against VA, suggesting the involvement of ROCK2 in VA pathogenesis.
Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Ergonovine ; Freezing ; Genotype ; GTP Phosphohydrolases ; Haplotypes ; Humans ; Linkage Disequilibrium ; Muscle Spasticity ; Muscle, Smooth, Vascular ; Myosin Light Chains ; Phosphorylation ; Polymorphism, Single Nucleotide ; Prevalence ; rho-Associated Kinases ; RNA, Messenger ; Spasm

PURPOSE: To assess the clinical and radiological results of mobile bearing total knee arthroplasty using the LCS system and to analyse complications arising. MATERIALS AND METHODS: From Oct. 1992 to Dec. 1998, 135 cases of total knee arthroplasty was performed using the LCS mobile bearing system. Among those are evaluated 108 cases which were followed up for a mean of 4.8 years (3-9.2 years). Retrospective analysis was done by the clinical and radiological evaluations usinga ROM, tibio-femoral alignment, HSS score and radiological loosening. RESULTS: The preoperative mean HSS score (58.6) was improved to 89.5 at final follow up. Tibio-femoral angle changed from a varus of 3 degrees to a valgus of 5 degrees. Arc of motion was reduced from 121 degrees to 116 degrees in osteoarthritis and increased from 111 degrees to 118 degrees in rheumatoid arthritis. There were 16 cases of osteolysis, but no case provoked clinical problems or more than 4 points in the radiolucent score. Complications were one polyethylene dislocation and one intraoperative tibia plateau fracture. CONCLUSION: Mobile bearing knee system showed excellent and predictable clinical and radiological results at a mean 4.8 years follow-up.
Arthritis, Rheumatoid ; Arthroplasty* ; Dislocations ; Follow-Up Studies ; Joints* ; Knee* ; Osteoarthritis ; Osteolysis ; Polyethylene ; Retrospective Studies ; Tibia

BACKGROUND AND OBJECTIVES: Circulating B-type natriuretic peptide (BNP) has been used as a marker of left ventricular hypertrophy and heart failure, and known to be increased after exercise in healthy men as well as patients with left ventricular dysfunction. However, the relationship between exercise duration and BNP level, and the determinants of circulating BNP concentration during exercise have not been fully elucidated. For these reason, we measured circulating BNP level during exercise, and exercise-induced changes of cardiac function by echocardiography in healthy men. MATERIALS AND METHODS: Ten healthy male volunteers (mean age 27+/-3 year-old) underwent symptom-limited bicycle ergometer in supine position for 30 min. The workload started at 25 W for 6 min with increment of 50 W every 3 min. Blood samples for BNP were obtained at baseline, every 1 min for first 3 min, 25 W, 75 W, 125 W, peak exercise and 10 min after resting. RESULTS: BNP level was increased only at peak exercise (mean:5.3+/-0.5 vs 7.7+/-4.1 pg/ml, median:5.0 vs 6.3 pg/ml, p<0.05), not during submaximal exercise, and sustained 10 minutes after exercise (190+/-25 watt, 14.9+/-12 min). Peak BNP level was significantly correlated with baseline BNP level (r=0.723, p<0.05), E' (0.18+/-0.04 vs 0.29+/-0.08 m/sec, r=-0.649, p<0.05) and E/E' (4.18+/- 0.87 vs 5.66+/-2.31, r=0.769 p<0.01) by bivariate correlation analysis, but correlated with only baseline BNP level by multiple linear regression analysis (p<0.05). CONCLUSION: Circulating BNP concentration was minimally increased only after peak exercise in young healthy men, not increased at submaximal exercise The BNP concentration after exercise is only determined by baseline BNP level, not by duration and workload of exercise.
Echocardiography ; Echocardiography, Stress ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular ; Linear Models ; Male ; Natriuretic Peptide, Brain* ; Supine Position ; Ventricular Dysfunction, Left ; Volunteers

PURPOSE: The length of a patient's stay in a hospital is an indication of the patient's recovery rate. The length of the hospital stay has an important economic factor for hospitals. This study was conducted to determine the relationship of the nutritional status at the time of admission to mortality and the length of the hospital stay (LOHS). METHODS: The study subjects were 1,619 patients who suffered with cancer, were admitted to Kosin University Gospel Hospital during 2005 and they met the study criteria. The patients were classified to the not at risk group, the patients having one risk factor for malnutrition were the I group, the patients having two risk factors for malnutrition were the II group, the patients having three risk factors for malnutrition were the III group and the patients having 4 risk factors for malnutrition were the IV group, based on the established criteria of serum albumin <3.0 g/dl, a total lympocyte count of <1,500 cells/mm3, a cholesterol level of > or =240 mg/dl or < or =130 mg/dl, weight for height > or =120% or <90% ideal body weight. RESULTS: 24.3% of the patients were classified into the not at risk group, 37.6% were classified into the at risk group I, 24.2% were classified into the at risk group II, 10.3% were classified into the at risk group III and 3.6% were classified into the at risk group IV. The at risk group (at risk III, at risk IV) had a significantly higher prevalence of liver disease. The relationship between liver disease and low serum albu-min levels may have confounded the data. Although the estimated LOHS was similar in all the groups, the average length of stay was 14.4+/-16.38 days in the malnourished group (at risk group IV) compared to approximately 2.8 days in the not at risk group. The more nutritional risk factors the patients had, the longer was the LOHS and the mortality rates were higher. Correlation was not observed between the risk factors and the length of the hospital stay, as well as the lack of correlation with the mortality rate. CONCLUSION: These results suggest that a patient's nutritional status upon admission has an effect on the length of the hospital stay for patients with carcinoma.
Cholesterol ; Humans ; Ideal Body Weight ; Length of Stay* ; Liver Diseases ; Malnutrition ; Mortality* ; Nutritional Status* ; Prevalence ; Risk Factors ; Serum Albumin

Bacillus species are aerobic, gram-positive, spore forming rods, and they are usually found in the surrounding environment. If they are isolated in the clinical specimen, they are generally considered as contaminants rather than a true pathogen. Infection with Bacillus licheniformis is usually associated with the immunocompromised state, trauma, an indwelling intravenous catheter or an intravenous drug abuser. This infection is easily controlled by removal of the catheter and surgical debridement of the local infected tissue as well as an appropriate antimicrobial therapy. We reported here on a case of Bacillus licheniformis bacteremia associated with a bronchoscopic procedure in an immune competent patient.
Bacillus* ; Bacteremia* ; Bronchoscopy* ; Catheters ; Debridement ; Drug Users ; Humans ; Spores

OBJECTIVE: To compare umbilical cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects and to evaluate the regulation of leptin in GDM. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human Leptin RIA kit; Linco Research, Inc. USA). We compared cord plasma leptin level between gestational diabetes (n=18 women) and control pregnancies (n=21 women). RESULTS: Maternal weight, fetal birth weight, Ponderal index and placental weight were significant variables among the demographic variables. There was statistical difference in cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects (Control subjects: 4.8 [3.7-7.9]ng/mL, GDM women: 8.0 [6.6-11.9]ng/mL, P=0.022). There was also statistical difference in the ratio between cord plasma leptin level and birth weight (Control subjects: 0.001 [0.001-0.002]ng/mL/gm, GDM women: 0.002 [0.002-0.003]ng/mL/gm (P=0.022)), and between cord plasma leptin level and Ponderal index (Control subjects: 0.280 [0.217-0.579], GDM women: 0.605 [0.452-1.005], (P=0.008)). There was no difference in gender. CONCLUSION: We found significant difference in umbilical cord plasma leptin level and adjusted leptin level for fetal birth weight, Ponderal index and placental weight between infants of mothers with gestational diabetes and infants of control subjects. It is suggested that umbilical cord plasma leptin is produced by fetal fat tissue, but it is more complicatedly regulated by placenta and other factors in gestational diabetes.
Birth Weight ; Diabetes, Gestational* ; Female ; Fetal Blood ; Fetal Weight ; Humans ; Infant ; Leptin* ; Mothers ; Parturition ; Placenta ; Plasma* ; Pregnancy ; Pregnancy* ; Radioimmunoassay ; Umbilical Cord*