Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.
Acquired Immunodeficiency Syndrome ; Bronchoalveolar Lavage ; HIV ; Humans ; Incidence ; Mediastinal Emphysema* ; Methenamine ; Pneumocystis jirovecii* ; Pneumonia* ; Pneumopericardium* ; Pneumothorax* ; Respiratory Insufficiency*

Lymphedema is one of the most common complications of mastectomy. It decreases quality of life and causes functional or aesthetical problems in post-mastectomy patients. Axillary lymph needs dissection (ALND), and radiation therapy(RTx) is known as the representative factor of lymphedema. Authors discovered that breast reconstructions using latissimus dorsi(LD) myocutaneous flap decrease the incidence of lymphedema in spite of these risk factors. Therefore we compared the incidence of lymphedema between the patients who underwent breast reconstructoins by LD pedicled flap, and the patients who did not undergo breast reconstructions from January 2002 to December 2004. Lymphedema was diagnosed when difference of arm circumference was over 2cm or limitation of joint movement was greater than 20 degrees. Overall incidence of lymphedema was 14.0%, and it was 18.9% in case of ALND, and 21.1% in case of RTx, respectively. But the incidence of breast-reconstructed patients using LD pedicled flap was 3.3%. This result reveals that LD pedicled flap decreases incidence of lymphedema significantly. In the future, it is recommended to identify the causes of decrease in the incidence of lymphedema in case of breast reconstructed by LD myocutaneous pedicled flap, for example lymphoscintigraphy and so on.
Arm ; Breast* ; Female ; Humans ; Incidence ; Joints ; Lymphedema* ; Lymphoscintigraphy ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap ; Quality of Life ; Risk Factors ; Superficial Back Muscles* ; Surgical Flaps*

Purpose: Laparoscopy-assisted distal gastrectomy (LADG) has recently been accepted as a feasible and acceptable method for early gastric cancer surgery. Surgeons have long suspected that obesity might increase the intra-operative or postoperative complications. We set out to clarify the effects of obesity on LADG for early gastric cancer treatment. METHODS: We retrospectively reviewed 97 patients who had undergone LADG for early gastric cancer between May 1998 and March 2003. The degree of obesity was based on the Body Mass Index (BMI, kg/m2), with patients assigned to two groups: normal BMI (BMI <23 kg/m2) and high BMI (BMI= 23 kg/m2). RESULTS: There were no significant differences between the normal and high BMI groups in terms of patients' characteristics, surgical outcomes and postoperative courses, postoperative complication and operation time. However, there was a significant statistical difference in the operation time among the latter four groups (P=0.004). And the male with high BMI group took particularly a longer operation time than female groups with normal BMI (P=0.006) and high BMI (P=0.013). Conclusion: In LADG patients with early gastric cancer, obesity may affect the operation time, and the male high BMI group takes particularly a longer operation time than the female groups.
Body Mass Index ; Female ; Gastrectomy* ; Humans ; Male ; Obesity* ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: We evaluated the validity of laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer in elderly patients compared with younger patients. METHODS: Seventeen elderly patients (aged 70 years or more) and 113 younger patients who underwent LADG for early gastric cancer between May 1998 and July 2004, at the department of Surgery, Dong-A University Medical Center, were studied. Postoperative outcomes were compared. RESULTS: In elderly patients, co-morbidity was more common than in younger ones (P=0.0220) and postoperative complication rate was more common, too (P=0.0480). Operation time (P=0.7301), time to first flatus (P=0.4766), postoperative hospital stay (P=0.4860), mortality (P=0.2453), were similar in these two groups. CONCLUSION: Because LADG with systemic lymphadenectomy in elderly patients has more co-morbidity and complications than younger ones, great cares should be given to treat co-morbidity preoperatively and prevent complications during operation and postoperative period in elderly patients.
Academic Medical Centers ; Aged* ; Flatulence ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Node Excision* ; Mortality ; Postoperative Complications ; Postoperative Period ; Stomach Neoplasms*

PURPOSE: The effectiveness of D2 lymph node dissection in gastric cancer operation is controversial in Western countries because of the relatively high complication and mortality rates in contrast to those of Japanese studies. A generally high body mass index (BMI) of the European patients was assumed to be one of the major causes for postoperative complication. The aim of this study is to clarify the relationship between patient BMI and operative outcomes. METHODS: We studied 201 consecutive Korean patients who had undergone gastrectomy with D2 lymph node dissection for gastric cancer between Jan 2002 and Apr 2003. They were assigned to four groups according to BMI: group A, with BMI < 18.5 kg/m2; group B, with BMI of 18.5 to 23 kg/m2; group C, with BMI of 23 to 25 kg/m2; and group D, with BMI > 25 kg/m2. We analyzed differences in the length of operation time, numbers of examined lymph nodes, numbers of transfused patients, postoperative hospital stay, and postoperative complications in the four groups. RESULTS: No significant differences were found with regard to the length of operation time, the numbers of examined lymph nodes, the numbers of transfused patients, the postoperative hospital stay, and the postoperative complications in four groups. CONCLUSION: High BMI was not associated with increased operative risk or morbidity.
Asian Continental Ancestry Group ; Body Mass Index* ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Node Excision* ; Lymph Nodes ; Mortality ; Postoperative Complications ; Stomach Neoplasms

Gastrointestinal hemangiomatosis is a rare benign vascular lesion, which can produce massive or persistent blood loss. Numerous lesions, usually of the cavernous type, involve stomach, small bowel, and colon. The diagnosis of hemangiomatosis is difficult. It is diagnosed usually by endoscopic study or barium enema for bleeding or anemia evaluation in childhood. A 17-year-old female was admitted to our hospital with anemia and dizziness for several months. She was diagnosed as diffuse intestinal hemangiomatosis by gastroduodenoscopy and colonoscopy. Gastroduodenosocpic findings showed multiple, small, mound-like, reddish-purple hemangiomas on the lower body, fundus and prepyloric area of the stomach. Colonoscopic findings showed similar lesions on the ascending and descending colon. The polypoid lesion on the ascending colon was ligated by detachable snare due to bleeding. No other hemangioma was detected by ultrasonography, abdominal angiography or small bowel series. We report a case of diffuse hemangiomatosis, largely distrubuted in the stomach and colon, but without involvement of skin or other solid organ. The bleeding hemangioma on the ascending colon was treated by endoscopic ligation, and the anemia of the patient was improved.
Adolescent ; Anemia* ; Angiography ; Barium ; Colon ; Colon, Ascending ; Colon, Descending ; Colonoscopy ; Diagnosis ; Dizziness ; Endoscopy* ; Enema ; Female ; Hemangioma ; Hemorrhage ; Humans ; Ligation ; Skin ; SNARE Proteins ; Stomach ; Ultrasonography

PURPOSE: This study was undertaken to reveal the molecular mechanism underlying sulindac-induced apoptosis in the human colon cancer cell line HT-29 (mutant p53). METHODS: Apoptosis was determined by using Hoechst 33342 staining, and translocation of proteins was established by using immunofluorescence, immunoelectron microscopy, and Western blotting after ultra- fractionation. RESULTS: This type of apoptosis was associated with decreased mitochondrial membrane potential, a translocation of the apoptosis-inducing factor (AIF) to the nucleus, and morphological evidence of nuclear condensation. However, DNA electrophoresis did not elucidate the ladder pattern of DNA fragments. Instead, a pulse-field gel electrophoresis showed that sulindac led to disintegration of nuclear DNA into-high- molecular-weight DNA fragments of about 100~300 kbp. CONCLUSIONS: Our findings indicate that sulindac induces large-scale DNA fragmentation, suggesting a predominantly AIF-mediated cell-death process, through translocation of the AIF to the nucleus in HT-29 cells.
Apoptosis Inducing Factor ; Apoptosis* ; Blotting, Western ; Cell Line ; Colonic Neoplasms ; DNA Fragmentation* ; DNA* ; Electrophoresis ; Fluorescent Antibody Technique ; HT29 Cells* ; Humans ; Membrane Potential, Mitochondrial ; Microscopy, Immunoelectron ; Sulindac

PURPOSE: Intraoperative colonic distension is associated with postoperative ileus, which contributes to a delayed hospital discharge. A randomized and prospective study was conducted to evaluate the usefulness of intraoperative needle decompression of the colon (IDC) during a radical gastrectomy for gastric cancer. METHODS: Fifty patients that had received subtotal or total gastrectomy for gastric cancer were randomly assigned to either a non-decompression (n=27) or a decompression group (n=23). Prior to the main procedure, the transverse or right colon was pulled up, and a 19-gauge disposable needle connected to suction was introduced to the colon through the taenia site of the anterior wall. Any gas that collected in the colon was aspirated. The time to the first postoperative passage of flatus or feces was measured precisely in order to evaluate the restoration of bowel function. Additional measures of the outcome were the operation time, the complication rate and the length of hospital stay. RESULTS: Demographic details, pathologic features, operation times, complication rates and the length of hospital stay were not different between the two groups. A collapsed colon was required for good surgical exposure and easy manipulation. No unexpected complications related to the procedure were found. The average time to the first flatus was 6.8 hours sooner in the decompression group than in the non-decompression, although this result was not statistically significant. CONCLUSION: This technique is a simple and safe procedure for intraoperative colon decompression during a radical gastrectomy.
Colon* ; Decompression* ; Feces ; Flatulence ; Gastrectomy* ; Humans ; Ileus ; Length of Stay ; Needles* ; Prospective Studies* ; Stomach Neoplasms ; Suction ; Taenia

PURPOSE: Secretion of angiogenic factors from tumor cells is know to play an important role in neo-vascularization and metastasis. However, which angiogenic factor is related with the formation of neo-vasculature in gastric carcinomas is not well known. This study was performed to observe changes in the expression of vascular endothelial growth factor (VEGF), cyclooxygenase (COX), and nitric- oxide synthase (NOS). METHODS: Expressions of VEGF, COX, and NOS in thirty specimens resected from patients with a gastric carcinoma were investigated using the western blot method. Cultured MKN28 gastric cancer cells were treated with 100 ng/ml VEGF, and changes in the expression of COX and NOS were examined. Changes in VEGF expression were also investigated after treatment of the cells with inhibitors of COX and NOS. RESULTS: Expressions of VEGF, COX, and eNOS were increased up to 10, 60, and 30%, respectively, in tumors compared to surrounding normal tissues. VEGF-positive tumors showed a higher expression of COX-2. Human recombinant VEGF induced the expression of COX-2, but not eNOS, in the cultured MKN28 cells. The increase in expression was blocked with actinomycin D, the VEGF antibody, and anti-VEGF peptide. VEGF-induced expression of COX-2 was also blocked by pretreatment of cells with aspirin and indomethacin, suggesting that these anti-inflammatory drugs inhibit VEGF. The expression of eNOS was decreased by indomethacin in VEGF-treated cells, but COX-2 expression was not affected by inhibitors of NO production, N-arginine methylester (NAME). However, the protein level of VEGF was increased by indomethacin and NAME. CONCLUSION: This study showed that COX-2 and eNOS in gastric carcinomas seem to play an important role in the production of VEGF and that their expressions may also be affected by VEGF.
Angiogenesis Inducing Agents* ; Aspirin ; Blotting, Western ; Dactinomycin ; Humans ; Indomethacin ; Neoplasm Metastasis ; Nitric Oxide Synthase* ; Nitric Oxide* ; Prostaglandin-Endoperoxide Synthases* ; Stomach Neoplasms* ; Vascular Endothelial Growth Factor A

BACKGROUND/AIMS: The death rates of pancreaticoduodenectomy decreased dramatically in experienced centers and it depends on many variability including nutritional status, better patient selection, hospital volume. We reviewed our experience of 100 pancreaticoduodenectomy for 10 years, 1000 beds hospital METHOD: Between 1990 and 2000, 100 patients underwent a pancreaticoduodenectomy in Dong-A University hospital. Annual number of cases, the disease entity, operative procedures, operation time and transfusion, radicality, external or internal pancreatic stent methods, morbidity and mortality were analyzed retrospectively. RESULTS: 10 cases or less per year until 1998: thereafter, the number of cases increased reaching 24 cases per year recently. Diseases entities were 35 pancreas head carcinomas, 22 common bile duct carcinomas, 20 ampulla vater carcinomas, 8 duodenum carcinomas, 9 chronic pancreatitis, 3 gallbladder carcinomas etc. Operative procedures were 53 whipple's operations, 23 Total pancreaticoduodenectomy, 22 pylorus preserving pancreaticoduodenectomy, 2 hepatopancreaticoduodenectomy. Postoperative morbidity has been decreasing, however, pancreatic leakage is still unresolved problem. Under 10 case annually the overall mortality was 22%, over 15 case annually the mortality reduced 12%(P=0.242). There were no mortality consecutive 30 cases since June, 1999 after changing the internal pancreatic duct stent to external pancreatic duct stent with preoperative total parenteral nutrition, Indocyanine green (ICG) test. The death rate was reduced(P=0.156). CONCLUSION: Pancreaticoduodenectomy has been increasing due to increased incidence of indication and improved resectability. Also preoperative total parenteral nutrition, ICG test, external pancreatic duct stent, successful postoperative embolization techniques decreased mobidity & mortality. It was suggested, pancreaticoduodenectomy could be safely performed in centers with more than 15 pancreatoduodenectomy annually.
Common Bile Duct ; Duodenum ; Gallbladder ; Head ; Humans ; Incidence ; Indocyanine Green ; Mortality ; Nutritional Status ; Pancreas ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreatitis, Chronic ; Parenteral Nutrition, Total ; Patient Selection ; Pylorus ; Retrospective Studies ; Stents ; Surgical Procedures, Operative