PURPOSE: To evaluate the necessity for additional surgical treatment after Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), we analyzed the pathologic results of patients who underwent surgical treatment. METHODS: 140 consecutive patients underwent additional surgical treatment after EMR/ESD with en bloc resection between April 2005 and November 2009 at ASAN Medical Center. Additional surgical treatments were undergone for following conditions such as incomplete dissection (involvement of margin), undifferentiated-type histology (> or =2 cm) and submucosal cancer. RESULTS: One patient with deep margin involvement displayed advanced gastric cancer after gastrectomy. Three of 74 patients with clear resection margin were confirmed to have residual cancer at ESD site and 2 of 3 patients displayed advanced gastric cancer after surgery. In univariate analysis for metastasis of lymph node, deep submucosal invasion (over sm2 or 500microm) and the presence of lymphovascular invasion showed significant differences for lymph node metastasis. Especially, lymphovascular invasion was an important predictive factor for lymph node metastasis in multivariate analysis. In analysis for residual cancer, lateral margin involvement and large tumor (>3 cm) were risk factors. And, only lateral margin involvement showed significant risk in multivariate analysis. CONCLUSION: Although EMR/ESD were fully accomplished for resection margin, gastrectomy and lymph node dissection were positively necessary for patients with deepsubmucosal invasion (over sm2 or 500microm) and the presence of lymphovascular invasion to eliminate the possibility of residual cancer or more advanced gastric cancer or metastatic lymph nodes.
Chungcheongnam-do ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm, Residual ; Risk Factors ; Stomach Neoplasms*

PURPOSE: To evaluate the effectiveness of laparoscopic assisted total gastrectomy (LATG), we compared its early surgical outcomes with those of conventional open total gastrectomy (OTG) in patients who were diagnosed as having early gastric cancer preoperatively. METHODS: We retrospectively analyzed early surgical outcomes in 190 consecutive patients who underwent total gastrectomy for early gastric cancer between January 2009 to April 2010. The patients were divided into those who underwent LATG and those who underwent OTG. Their early surgical outcomes were analyzed to evaluate the effectiveness of LATG. RESULTS: There was no significant difference in postoperative complication rates (P = 0.291). But in the analysis of other early surgical outcomes, we found that LATG could improve time to first flatus (P < 0.001), time to commencement of soft diet (P = 0.034), administration of analgesics (P = 0.024), pain score (Numeric Rating Scale), and hospital discharge (P = 0.045). CONCLUSION: Although LATG didn't show better results for postoperative complications than those of OTG, LATG contributes to the improvement of early surgical outcomes, including bowel movement, pain score and hospital discharge. Therefore, we suggest that LATG could be a method to improve early surgical outcomes in patients who need total gastrectomy.
Analgesics ; Diet ; Flatulence ; Gastrectomy ; Humans ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms

Because of advancement of medical treatment, surgical management of gastric or duodenal ulcer was indicated for treatment of perforation, massive hemorrhage and obstruction. The distal gastrectomy including ulcer was known as principle method of duodenal ulcer obstruction, but actually many surgeons have performed only bypass surgery for the difficulty of formation of duodenal stump. In our case, 61-year-old male with repetitive duodenal ulcer obstruction transferred with obstruction due to deformities and inflammations of duodenal ulcer. We had performed totally laparoscopic distal gastrectomy with ROUX-EN-Y reconstruction using the clear visibility of laparoscopy and fine dissections of harmonic scalpel. The patient started soft diet on postoperative day 5 and discharged on postoperative day 8. He returned to work after discharging immediately.
Congenital Abnormalities ; Diet ; Duodenal Ulcer ; Gastrectomy ; Hemorrhage ; Humans ; Inflammation ; Laparoscopy ; Male ; Middle Aged ; Ulcer

Piroplasms are tick-transmitted, intracellular, hemoprotozoan parasites that cause anorexia, fever, anemia, and icterus. Theileriosis is caused by Theileria sergenti and causes major economic losses in grazing cattle in Japan and Korea. In May 2003, we examined the antigenic diversity of the major piroplasm surface protein (MPSP) gene in 35 healthy Jeju black cattle that were born and raised at the National Institute of Subtropical Agriculture. On microscopic examination of Giemsa-stained blood smears, 9 of 35 cattle had intra-erythrocytic piroplasms. Hematological data were within normal range for all 35 cattle. Amplification of DNA from all blood samples using universal MPSP gene primers showed mixed infections with C, I, and B type Theileria spp. Type C was identified in 20 of 35 blood samples, and type B was identified in 17 samples. Allelic variation was seen in type B.
Animals ; Antigens, Protozoan/*genetics ; Base Sequence ; Cattle ; DNA Primers/genetics ; *Genetic Variation ; Korea ; Molecular Sequence Data ; *Phylogeny ; Protozoan Proteins/*genetics ; Sequence Analysis, DNA ; Theileria/*genetics ; Theileriasis/*parasitology

In a preliminary study, we found that benzyloxycarbonyl-Val-Ala-Asp(OMe)-fluoromethylketone (zVAD- fmk), unlike Boc-aspartyl(OMe)-fluoromethylketone (BocD-fmk), at usual dosage could not prevent genistein-induced apoptosis of p815 mastocytoma cells. This study was undertaken to reveal the mechanism underlying the incapability of zVAD-fmk in preventing this type of apoptosis. We observed that 14-3-3 protein level was reduced in genistein-treated cells and that BocD-fmk but not zVAD-fmk prevented the reduction of 14-3-3 protein level and the release of Bad from 14-3-3. We also demonstrated that truncated Bad to Bcl-xL interaction in genistein- treated cells was prevented by BocD-fmk but not by zVAD-fmk treatment. Our data indicate that BocD- fmk, compared to zVAD-fmk, has a certain preference for inhibiting 14-3-3/Bad signalling pathway. We also elucidated that this differential efficacy of BocD-fmk and zVAD-fmk resulted from the different effect in inhibiting caspase-6 and that co-treatment of zVAD-fmk and caspase-6 specific inhibitor substantially prevented genistein-induced apoptosis. Our data shows that caspase-6 plays a role on Bad/14-3-3 pathway in genistein-induced apoptosis of p815 cells, and that the usual dose of zVAD-fmk, in contrast to BocD-fmk, did not prevent caspase-6 acting on 14-3-3/Bad-mediated event.
bcl-Associated Death Protein/*metabolism ; *Signal Transduction/drug effects ; Mitochondria/drug effects ; Mice ; Mastocytoma ; Hydrocarbons, Fluorinated/*pharmacology ; Genistein/pharmacology ; Enzyme Inhibitors/*pharmacology ; Cell Line, Tumor ; Caspase 6/antagonists & inhibitors/*metabolism ; Benzyl Compounds/*pharmacology ; Apoptosis/*drug effects ; Animals ; Amino Acid Chloromethyl Ketones/pharmacology ; 14-3-3 Proteins/*metabolism

PURPOSE: The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. MATERIALS AND METHODS: Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. RESULTS: The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. CONCLUSION: Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.
Biliary Atresia* ; Cholangiography ; Cholecystography ; Cholestasis ; Cytomegalovirus ; Diagnosis ; Dilatation ; Duodenum ; Female ; Gallbladder ; Gastrointestinal Tract ; Hepatitis ; Humans ; Infant* ; Infant, Newborn ; Jaundice, Neonatal ; Male ; Needles ; Punctures ; Ultrasonography

No abstract available.
Varicocele*

Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years. In 1937 Behcet described a chronic relapsing triple symptom complex of recurrent oral ulceration, genital ulceration and ocular inflammation. Other manifestations of the syndrome include arthritis, cutaneous vasculitis, thrombophlebitis, epididymitis, ulcers of gastrointestinal tract and meningoencephalitis. Recently, a case was experienced involving intestinal Behcet's syndrome with duodenal ulcer bleeding. A 32-year-old male patient was admitted due to hematemesis, and epigastric pain. The patient had ulcers on the oral mucosa, soft palate, external genitalia, and anus. An irregularly marginated ulcer with bleeding was found on the anterior of the duodenal bulb through esophago- gastroduodenoscopic examination. The patient was diagnosed with Behcet's disease and was treated with steroids. In this paper, the case of duodenal bulb involvement of Behcet's disease is reported with a review of relevant literature.
Adult ; Anal Canal ; Arthritis ; Behcet Syndrome ; Duodenal Ulcer* ; Epididymitis ; Gastrointestinal Tract ; Genitalia ; Hematemesis ; Hemorrhage ; Humans ; Inflammation ; Male ; Meningoencephalitis ; Mouth Mucosa ; Oral Ulcer ; Palate, Soft ; Steroids ; Thrombophlebitis ; Ulcer ; Vasculitis

We analyzed the incidence and treatment of steinstrasse in 470 patients(renal units-521 cases) who underwent ESWL treatment for renal stones using a Piezolith 2300 piezoelectric lithotriptor between April 1990 and July 1993. Of 521 renal stones, a total of 44 cases(8.5%) developed steinstrasse. The most common location for steinstrasse was in the lower ureter(72.7%), followed by upper ureter(22.7%) and mid-ureter(4.6%). In these 44 cases, stone fragments passed spontaneously in 23 cases(52.3%) and mean duration to spontaneous passage was 15.7 days(range 1-43 days). Repeated ESWL was performed on steinstrasse in 20 cases. Successful treatment (no residual stone fragments in the ureter) was achieved in 18 cases(90%) and the mean number of sessions was 1.3. There was no significant complication after repeated ESWL. Only 2 patients who failed ESWL treatment required open ureterolithotomy. The remained 1 patient with mid-ureteral steinstrasse underwent ureteroscopic management. With this result, repeated ESWL seems to be effective and safe in the treatment of steinstrasse which is not expected to pass spontaneously.
Humans ; Incidence

The expression of two cell proliferation indices, the proliferating cell nuclear antigen( PCNA), using the monoclonal antibody in the immunoperoxidase method, and the nucleolar organizer regions (NORs), using silver nitrate staining technique, were assessed in formalin-fixed paraffin embedded material of transitional cell urinary bladder carcinomas. The aim of our study was to examine comparatively the expression of PCNA and the number of NORs in 37 transitional cell bladder carcinomas and to investigate how they correlate with tumor grade and the disease stage. It was noticed that the PCNA expression rate(%) related to grade was statistically significant only between grades II and III (p<0.05), while that between grades I and II was not statistically significant(p > 0.05). The mean number of AgNORs per nucleus between grades I and II and between grades II and III were statistically significant(p<0.05). As far as the correlation of PCNA expression rate(%) with the stage is concerned, PCNA expression rate (%) was higher in the invasive tumors(p<0.05) than in the superficial tumors and AgNOR Numbers was also greater in the invasive tumors(p <0.05). The linear correlation coefficient between PCNA expression rate (%) and AgNOR counts was 0.52(p <0.001) In conclusion, a considerable relationship was found between the histological grade and each of the two indices used. A good correlation was also demonstrated between each of PCNA expression rate(%) and AgNOR scores to the pathologic stage. Our results suggest that PCNA expressionrate( % ) and AgNOR scores may be prognostic induces in urinary bladder cancer.
Carcinoma, Transitional Cell* ; Cell Proliferation ; Nucleolus Organizer Region* ; Paraffin ; Proliferating Cell Nuclear Antigen ; Silver Staining ; Urinary Bladder Neoplasms ; Urinary Bladder*