PURPOSE: The prognosis after potentially curative resection for stage IV gastric cancer, according to the 5th edition of AJCC/UICC classification, is poorly understood. The aim of this study was to evaluate the feasibility of the curative resection in patients with stage IV gastric cancer, which were considered potentially curable cases. METHODS: From November 1991 to June 1996, 91 patients were confirmed as having stage IV gastric cancer at Seoul Boramae Municipal Hospital. Of these 91 patients, 30 who were potentially curative resected including at least D2 type lymph node dissections were reviewed retrospectively. The average numbers of totally dissected and positive lymph nodes were 43.0 (range: 26~74) and 23.1 (range: 2~47), respectively. RESULTS: The overall 1-, 2-, and 5-year survival rates of patients were 60.0%, 36.7%, 13.3%, respectively. In comparison with stage IIIb (N=20), no significant difference in survival rate was observed (P=0.1178). In univariate analysis, we found that the presence of a recurrence (P=0.0121) and a P (positive lymph nodes)/R (total dissected lymph nodes) >0.6 were correlated with poor survival rates. Long- survivors (N=12, more than 24 months postoperatively) had a tendency to be younger, less recurrent (P=0.017) and less involvement of histological perineural invasion (P=0.028). CONCLUSION: The results of the present study indicate that stage IV patients without distant metastasis may indeed be cured by potentially curative surgery.
Classification* ; Gastrectomy* ; Hospitals, Municipal ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Stomach Neoplasms* ; Stomach* ; Survival Rate ; Survivors

Carcinoid tumors are slow growing neoplasms that arise from enterochromaffin cells, with malignant potential, and those of the duodenum are rare neoplasms, with an incidence of 2.0~8.9% of all gastrointestinal carcinoid tumors. Duodenal carcinoid tumors rarely manifest gastrointestinal symptoms and carcinoid syndrome. A healthy 43 year old woman was admitted due to an incidentally detected duodenal mass during regular health screening. An abdominal CT scan and UGI series showed a polypoid mass at the second portion of the duodenum without bowel dilatation. The duodenoscopic finding was a carcinoid tumor, which was proven by immunohistochemical staining. A pylorus- preserving pancreatoduodenectomy was performed and a 2.5x2.2 cm sized submucosal tumor found at the second portion of the duodenum, with two periduodenal lymph node enlargements. Immunohistochemical staining showed that the tumor cells to have positive reaction for NSE, chromogranin and synaptophysin. Herein, our experience of a malignant duodenal carcinoid tumor is reported.
Adult ; Carcinoid Tumor* ; Dilatation ; Duodenum ; Enterochromaffin Cells ; Female ; Humans ; Incidence ; Lymph Nodes ; Mass Screening ; Pancreaticoduodenectomy ; Synaptophysin ; Tomography, X-Ray Computed

Splenic metastasis resulting from solid tumors is a rare event, and it is most often diagnosed at the time of autopsy. In those cases of widely disseminated cancer, splenic involvement may be fairly common, but solitary splenic metastasis in the absence of other metastases is exceedingly rare. The reported primary malignancies of patients with splenic metastases include lung, colorectal, endometrial, ovarian, thyroid, pancreatic, gastric cancers and most commonly, melanoma. The author report here on a case of 55- year-old male who was found to have a solitary splenic metastasis 12 months after undergoing a left upper lobectomy for stage Ib (pT2N0M0) adenocarcinoma of the lung and he was then treated by splenectomy.
Adenocarcinoma ; Autopsy ; Humans ; Lung Neoplasms ; Lung* ; Male ; Melanoma ; Neoplasm Metastasis* ; Splenectomy ; Splenic Neoplasms ; Stomach Neoplasms ; Thyroid Gland

Obturator hernia is a rare type of pelvic hernia and occurs most commonly in elderly and debilitated women. It is still a challenge for surgeons to diagnose precisely in early stages because of its nonspecific symptoms and consequently delayed diagnosis could lead to high morbidity and mortality. We experienced a 92-year old patient who was diagnosed as obturator hernia which was confirmed by computed tomography scan of the abdomen and pelvis. The operation was delayed due to the refusal of family members but eventually done after 12 days from initial diagnosis. After manual reduction of small bowel impacted into right obturator foramen, segmental resection of impacted small bowel and anastomosis was done. The hernial defect was closed by primary closure with Dexon suture material. After the operation, the patient was discharged without significant complications. We report here successful results of delayed operation for obturator hernia.
Abdomen ; Aged ; Benzenesulfonates ; Delayed Diagnosis ; Disulfiram ; Female ; Hernia ; Hernia, Obturator ; Humans ; Pelvis ; Sutures

PURPOSE: The nodal staging of the 5th edition of the Union Internationale Contra la Cancer (UICC) TNM classification in 1997 was changed based on the number of metastatic lymph nodes. We attempted to classify nodal status according to the number of involved lymph nodes and compare with the nodal staging of the 5th UICC TNM classification in order to evaluate the rationality of the new nodal staging system. METHODS: The authors retrospectively analyzed 427 patients with gastric cancer who underwent curative resection from 1993 to 1996 at the Department of Surgery, Korea University College of Medicine. Cumulative survival rates were calculated by the Kaplan-Meier method. The difference between each nodal status was evaluated by the log rank test and the generalized Wilcoxon test. RESULTS: There were statistical differences between 0 and 1 lymph node involved, between 7 and 8, and between 15 and 16. We classified the nodal status into 4 groups according to the number of involved lymph nodes based on the following: group 1 with no lymph node involved, group 2 with 1~7, group 3 with 8~15 and group 4 with more than 15. There was a significant survival difference among the 4 groups with no survival difference between the number of positive lymph nodes in each group. We compare our results with the nodal staging of the UICC TNM classification and found that there were differences between group 2 (1~7 positive lymph nodes) and pN1 of TNM (1~6 positive lymph nodes) and between group 3 (8~15) and pN2 (7~15). CONCLUSION: We were able to classify nodal status into 4 groups according to the number of involved lymph nodes. There was little difference compared with the new nodal staging of the 5th UICC TNM classification, which suggested that the nodal classification of the UICC TNM classification based on the number of metastatic lymph nodes is acceptable. Further analysis of a larger sample size may be necessary.
Classification* ; Humans ; Korea ; Lymph Nodes* ; Retrospective Studies ; Sample Size ; Stomach Neoplasms* ; Survival Rate

The purpose of this study was to detect where the center of pressure in foot would be located at the end point of loading response and the terminal stance by the dynamic plantar pressure measurement. Seventeen adults who had the usual feet without a pathologic gait were evaulated simultaneously by the motion analysis using VICON 370, and the plantar pressure measurement using EMED-SF. Two devices were set in the 60 Hz frame. The foot was divided into 3 different zones; hindfoot, midfoot, and forefoot. The end point of loading response was located at the 1.92+/-1.46 frame distal to the hindfoot- midfoot borderline. The end point of terminal response was located at the 2.27+/-1.96 frame distal to the maximal pressure points of metatarsal head. Authors could differentiate each period of stance phase; the initial contact, loading response, mid-stance, terminal stance, and preswing, using the analysis of center of pressure by the dynamic plantar pressure measurement.
Adult ; Foot* ; Gait* ; Head ; Humans ; Metatarsal Bones

PURPOSE: Carcinoids are rare neuroendocrine tumors, mainly detected in the gastrointestinal tract. This study was performed to evaluate the incidence and necessity for additional treatment in incidental appendiceal carcinoids from patients presenting with symptoms of acute appendicitis. METHODS: Of the patients; who underwent appendicectomies, with the diagnostic impression of acute appendicitis, from 1994 to 2003, six cases were diagnosed as appendiceal carcinoids. The medical records of these patients were retrospectively reviewed. RESULTS: During the study period, a total of 2477 patients (male: 1336 and female: 1141) underwent appendicectomies due to the diagnostic impressions of acute appendicitis, with 2 male and 4 female cases diagnosed as appendiceal carcinoids by pathological examination. The rate of incidental appendiceal carcinoids in those patients was 0.24% (male: 0.15% and female: 0.35%) An appendiceal carcinoid was detected in one of 396 child patients (0.25%), but in none of 610 patients over the age of 40. Additional bowel resections were necessary in two patients (33%) in whom the carcinoids had infiltrated the serosa or mesoappendix, and were involved in the resection margins In one of these (50%), the carcinoid had metastasized to regional lymph nodes. CONCLUSION: Incidental appendiceal carcinoids are not common events in patients with symptom of acute appendicitis. However, the possibility of a metastatic disease in these incidental carcinoids warrants careful considerations for additional treatment on the basis of a close pathological examination.
Appendicitis* ; Appendix ; Carcinoid Tumor* ; Child ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Lymph Nodes ; Male ; Medical Records ; Neuroendocrine Tumors ; Retrospective Studies ; Serous Membrane

Aneurysm of deep femoral artery rarely occurs as an isolated lesion because of the anatomical position and characteristics of wall tissue. Early surgery is mandatory because the aneurysm has a tendency to become large and to rupture. We report herein a case of an isolated true deep femoral artery aneurysm in a 67-year-old female, who presented with a pulsatile mass in the groin showing rapid enlargement. CT angiography followed by conventional angiography confirmed the diagnosis and revealed no evidence of aneurysm or occlusive disease in the other arteries. Endo-aneurysmectomy with 6 mm PTFE graft interposition was performed. Acute deep vein thrombosis was developed postoperatively but was cured by short-term anticoagulation therapy. At ten-months follow-up, she resumed her normal activity with no ischemic or thrombotic symptoms.
Aged ; Aneurysm* ; Angiography ; Arteries ; Diagnosis ; Female ; Femoral Artery* ; Follow-Up Studies ; Groin ; Humans ; Polytetrafluoroethylene ; Rupture ; Transplants ; Venous Thrombosis

Whereas extramammary Paget's disease commonly occurs in the apocrine gland rich skin areas, ectopic extramammary Paget's disease develops in the skin areas that are devoid of apocrine glands. We experienced the case of a 34 year-old female patient who had a skin lesion in the upper outer quadrant of the right breast for 5 years and that lesion was diagnosed as Paget's disease according to the punch biopsy. There was no other underlying malignancy, and so wide excision was performed. The final pathologic diagnosis was Paget's disease confined to the epidermis and the size of the tumor was 3.0x1.1 cm. Positive staining for cytokeratin 7, epithelial membrane antigen and negative staining for S-100 protein and HMB-45 was observed on the immunohistochemical tests. We report here on an extremely unusual case of ectopic extramammary Paget's disease of the breast skin, and we include a review of the relevant literature.
Apocrine Glands ; Biopsy ; Breast ; Epidermis ; Female ; Humans ; Keratin-7 ; Mucin-1 ; Negative Staining ; Paget Disease, Extramammary ; S100 Proteins ; Skin

Multiple primary tumors are defined as those cases that display primary malignant tumors of different histologic origins in one person. As the diagnostic methods have developed and the average life span has been extended, the diagnosis of multiple primary tumor has also increased. We report here on a 75-year old male patient who had synchronous triple primary cancer (Early gastric cancer, Ampulla of Vater cancer, Renal cell carcinoma) with concomitant IPMN (Intraductal papillary mucinous neoplasm), and the patient underwent conventional pancreaticoduodenectomy.
Ampulla of Vater ; Carcinoma, Renal Cell ; Humans ; Male ; Mucins ; Pancreaticoduodenectomy ; Stomach Neoplasms