PURPOSE: The combination of cisplatin, epirubicin, leucovorin and 5-fluorouracil (PELF) administration, as adjuvant chemotherapy after curative resection for gastirc cancer, was compared with 5-fluorouracil (5-FU) administration alone. This paper reports the results of a prospective randomized comparison of the two regimens, PELF and 5-FU. METHODS: From August 1996 to July 1999, 54 patients were selected subsequent to being diagnosed with stage III cancer after a curative resection for gastric cancer. The patients were stratified according to stage IIIA/IIIB and subtotal/total gastrectomy, and then they were randomized into each treatment group, i.e. the PELF or 5-FU alone groups. RESULTS: 54 assessable patients were enrolled in this study: 28 received PELF and 26 received 5-FU alone. 12 patients relapsed in each group and the median follow-up duration was 42 months (range: 10~77 months). The overall survival rate and disease-free survival rate (DFS) were not significantly different between two groups, (5-year survival of PELF vs. 5-FU: 57% vs. 64%, 5-year DFS: 54% vs. 51%). The PELF combination was more toxic in terms of anemia, anorexia, nausea and diarrhea than the 5-FU. CONCLUSIONS: This study showed that the PELF combination, as an adjuvant therapy for gastric cancer after a curative resection, was a less effective treatment, and it had more toxic effects than the 5-FU.
Anemia ; Anorexia ; Chemotherapy, Adjuvant* ; Cisplatin* ; Diarrhea ; Disease-Free Survival ; Epirubicin* ; Fluorouracil* ; Follow-Up Studies ; Gastrectomy ; Humans ; Leucovorin* ; Nausea ; Prospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Lichtenstein`s tension-free repair & mesh-plug hernia repair are the most frequently used procedures for inguinal hernia repair by american surgeons. A new tension- free hernioplasty procedure, maintaining the advantages of both of these procedures, was invented by an experienced surgeon in our hospital. In this procedure, an umbrella- shaped mesh is applied to the entire posterior wall, not only to the defective area. We analyzed the results of this procedure in comparison with those from conventional repair (Bassini procedure). METHODS: From March 1998 to March 2001, 69 cases of hernioplasty were performed by one staff surgeon. Among these cases, we excluded 2 cases of bilateral inguinal hernia, 1 case of femoral hernia, and 6 cases which were impossible to follow up. In addition, we analyzed 29 cases of tension-free hernioplasty using an umbrella-shaped mesh (U group) and 31 cases of conventional repair (B group). Retrospective chart reviews and telephone interviews were carried out. Operation duration, length of hospital stay, period of analgesics use, complications, time required to return to usual activity, and recurrence were compared between these two groups. RESULTS: No significant differences were found concerning operation duration, period of hospital stay, complications, and time for return to usual activity. The period of analgesic use was significantly shorter in the U group than in the B group (p=0.001, 2.0 days vs 2.9 days). Only one recurrence occurred in B group. CONCLUSION: This new procedure has all the properties of tension free hernioplasty and plug hernia repair. This procedure can be used for all types of inguinal hernia and for a much lower cost than the preformed plug method. No incidence of recurrence was found folling the use of this procedure.
Analgesics ; Follow-Up Studies ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Incidence ; Interviews as Topic ; Length of Stay ; Recurrence ; Retrospective Studies

PURPOSE: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over 90%. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. MATENRIALS AND METHODS: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. RESULTS: Lymph node metastasis was observed in 26 patients (11.7%), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was 4.4%, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. CONCLUSION: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms* ; Survival Rate

PURPOSE:Hemorrhoidectomy is considered to be a painful operation, therefore some patients with symptomatic hemorrhoids conceal their symptoms to defer a much-needed surgical procedure. Patients who have undergone hemorrhoidectomy have experienced constipation or urinary retention due to postoperative pain. Several interventions have been used to relieve postoperative pain after hemorrhoidectomy. Nevertheless, the results are unsatisfactory. Hemorrhoidectomy with ultrasonic dissector have less thermal injury and can avoid ligation and suture. This study compared conventional semi-open Milligan hemorrhoidectomy with open ultrasonic dissector hemorrhoidectomy. METHODS:One hundred patients with prolapsed symptomatic hemorrhoids were randomly assigned to semi-open Milligan (n=50) or open ultrasonic dissector (n=50) hemorrhoidectomy. Operation time, postoperative complication, hospital stay, degree and duration of postoperative pain, pain on bowel movement, and urinary retention were recorded and analyzed. RESULTS:There was no significant difference in excised pile number. Operation time of open ultrasonic dissector hemorrhoidectomy was shorter than that of semi-open Milligan hemorrhoidectomy (P<0.05). The open ultrasonic dissector hemorrhoidectomy group resulted in less postoperative pain (P<0.05) and shorter duration of pain (P<0.05) and postoperative hospital stay (P<0.05) than semi-open Milligan hemorrhoidectomy. Urinary retention did not occur in both groups. CONCLUSIONS:Despite the higher cost, open ultrasonic dissector hemorrhoidectomy results in less postoperative pain, shorter operation time and hospital stay than the conventional hemorrhoidectomy.
Constipation ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Ligation ; Pain, Postoperative ; Postoperative Complications ; Sutures ; Ultrasonics* ; Urinary Retention

PURPOSE: The quality of life of patients who have undergone surgery for carcinoma of the esophagus, breast, or lung has been discussed, however, little is known of the results following radical surgery for gastric cancer. We evaluated the quality of life of patients who had undergone radical surgery for gastric cancer and clarified the factors that influenced the quality of life for patients with gastric cancer. METHODS: We surveyed one hundred and thirty seven patients without recurrence of disease or chronic diseases following gastrectomy for gastric cancer. A questionnaire based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 was used to analyse the correlations between six functional scales and nine symptom scales and stage, surgical methods, chemotherapy, and performance status by scoring system. RESULTS: The quality of life following gastrectomy was determined by the stage of the disease at surgery, the surgical method, the application of anticancer chemotherapy, and the patient's own performance status. Patients with more advanced stages had a lower quality of life, and those who underwent total gastrectomy were expected to have a lower quality of life than patients who received subtotal gastrectomy. However there were no differences in the quality of life between patients with gastrojejunostomy and gastroduodenostomy following subtotal gastrectomy. The severity of postoperative weight loss had no influence on the quality of life. Patients undergoing chemotherapy showed higher points in the symptom scale rather than the functional scale. The functional scale and the symptom scale both showed asignificant difference according to the patient's performance status as assessed by the surgeon after a survey of the patient. CONCLUSION: We consider the periodic evaluation of the quality of life following gastrectomy in patients with gastric cancer to be useful in obtaining information concerning the patient's postoperative course and in assessing the therapeutic efficiency of the patient.
Breast ; Chronic Disease ; Drug Therapy ; Esophagus ; Gastrectomy ; Gastric Bypass ; Humans ; Lung ; Quality of Life* ; Surveys and Questionnaires ; Recurrence ; Stomach Neoplasms* ; Weight Loss ; Weights and Measures

PURPOSE: The purpose of this experiment was to study the effects of Ox-LDL (oxidized low density lipoprotein) and Ox-VLDL (oxidized very low density lipoprotein) with or without probucol treatment on the proliferation of human vascular endothelial cells (EC) which were three dimensionally constructed vascular wall model. METHOD: The thiobarbituric acid reactive substance content of LDL and VLDL oxidized by incubation with copper irons was consistently greater than 10 nM malondialdehyde (MDA)/mg protein compared with less than 3 nM MDA/mg for unmodified lipoprotein immediately after isolation. On agarose gel electrophoresis, Ox-LDL and Ox-VLDL were shown to have greater cationic charge than unmodified lipoprotein. RESULT: In Ox-LDL stimulated ECs, the cellular enzymatic activity was markedly decreased in 50 mug/ml concentration of Ox-LDL and was protected by 10 nM probucol. And in Ox-VLDL stimulated ECs, the cellular enzymatic activity was markedly decreased in 25 and 50 mug/ml concentration of ox-VLDL and was not protected by 10 nM probucol. On scanning electron microscopy (SEM) and transmission electron microscopy (TEM), endothelial layers of control, unmodified LDL and unmodified VLDL groups showed similar appearance. But in Ox-LDL and Ox-VLDL groups, cellular edema, loosened cell-to-cell contact and loss of microvilli were shown on SEM, and marked cellular edema, distortion of cell membrane, loss of intracellular organelles and destruction of nulcleus were shown on TEM. And the protective effect of probucol was definite in Ox-LDL group but in 25 and 50 mug/ml concentration of Ox-VLDL group, there were no protective effects of probucol. CONCLLUSION: As a conclusion, three dimensionally constructed vascular wall model is to be a good experimental model for vascular research. And Ox-LDL and Ox-VLDL have toxic effects on vascular endothelial cell layer and its toxic effects are partially prevented by probucol.
Cell Membrane ; Copper ; Edema ; Electrophoresis, Agar Gel ; Endothelial Cells ; Humans ; Iron ; Lipoproteins* ; Malondialdehyde ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Microvilli ; Models, Theoretical ; Organelles ; Probucol

PURPOSE: The laparoscopic cholecystectomy has increasingly been accepted as the procedure of choice for treatment of symptomatic gall stones and chronic cholecystitis. However, its role and its timing in the management of patients with acute cholecystitis remain controversial. This retrospective study was undertaken to compare on early laparoscopic cholecystectomy with a delay one for patients with acute cholecystitis. METHODS: Between January 1995 and June 1999, 15 patients were operated on within 72 hours of symptom onset. Those patients were classified as the early laparoscopic cholecystectomy group. The 18 patients who underwent a delayed laparoscopic cholecystectomy after a percutaneous transhepatic cholecystostomy (PTCS) and conservative management were classified as the delayed laparoscopic cholecystectomy group. RESULTS: No significant differences were seen in the conversion rate (1 case in the delayed group), the operation time (early group 107.3 min., delayed group 118.6 min.), postoperative complications (early group 20.0%, delayed group 16.7%), and the postoperative hospital stay (early group 4.7 days, delayed group 7.1 days). The early group had significantly more frequent operation modifications and decreased total hospital stays than the delayed group: 86.7% and 7.0 days, for the early group and 44.4% and 22.8 days for the delayed group. CONCLUSION: Early laparoscopic cholecystectomy for acute cholecystitis did not increase the operation time, the morbidity, or the conversion rate. Although this study was not a randomized study and the sample size was small, an early laparoscopic cholecystectomy seems to be safe and feasible for patients with acute cholecystitis, having the benefit of a decreased total hospital stay.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Cholecystostomy ; Gallstones ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Sample Size

BACKGROUND: Primary lymphoma of the gastrointestinal tract is an unusual disease for which the optimal management strategy has not been clearly defined. The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. METHODS: We retrospectively reviewed the management and the outcome of 55 patients a diagnosis of gastrointestinal lymphoma who were treated at Kyung-Hee University Medical Center during the period 1986-1997. Thirty-seven of them underwent a resection for cure, and 23 patients of them underwent chemotherapy. 18 patients underwent chemotherapy only. Radiation therapy was excluded due to the small number of patients. Surgery consisted of wide local resection of the primary tumor (curative for stages I and II, and palliative for stages III and IV), and regional lymph nodes, with re-establishment of bowel continuity. Chemotherapy involved 6-10 courses of CHOP-B (cyclophosphamide, adriamicin, vincristine, prednisone, and bleomycin). Survival curves were calculated by using the Kaplan and Meier method. RESULTS: The mean age was 51 years (range: 3-82), the peak incidence of age was the fifth decades (34%), and the male-to-female ratio was 1.3:1. Common signs and symptoms at presentation were abdo minal pain (n=46), palpable mass (n=28), nausea/vomiting (n=26), and weight loss (n=18). The diagnostic sensitivities of ultrasound, contrast radiography, endoscopic biopsy, and computed tomography were 52%, 57%, 76%, and 78%, respectively. The primary tumor sites were the stomach (n=18), the terminal ileum & cecum (n=15), the small bowel (n=13), and the large bowel (n=9). The respective cumulative overall 5-year survival rates for stage I, II, III tumors were 89%, 74%, and 43% (p<0.05). The respective overall 5-year survival rate for resection only, resection with chemotherapy, and chemotherapy only were 100%, 78%, and 40% (p<0.05). By the Kaplan-Meier method, the prognostic factors of survival were stage and curative resection (p<0.05). CONCLUSION: A curative resection in a stage I, II lymphoma confined to the gastrointestinal tract and to regional involvement may improve patient survival.
Academic Medical Centers ; Biopsy ; Cecum ; Diagnosis ; Drug Therapy ; Gastrointestinal Tract* ; Humans ; Ileum ; Incidence ; Lymph Nodes ; Lymphoma* ; Prednisone ; Radiography ; Retrospective Studies ; Stomach ; Survival Rate ; Ultrasonography ; Vincristine ; Weight Loss

PURPOSE: The primary metabolic characteristic of malignant cells is an increased uptake of glucose and its anaerobic glycolysis. Recent studies have demonstrated that facilitative glucose transport across the plasma membrane is mediated by a family of proteins, i.e., glucose transporters. PURPOSE: In order to evaluate the clinicopathologic correlations of glucose transporter genes expressed in colorectal cancer, the author studied the expression of glucose transporter genes in human colorectal cancer and analyzed their expression in normal and malignant colorectal tissues. METHODS: A reverse transcriptase-polymerase chain reaction (RT-PCR) was applied to quantitatively determine the levels of the glucose transporter genes, GLUT1 and GLUT3, from Crohnes diseases (N=2), adenomatous polyps (N=4), and colorectal cancers (N=40) and their normal counterparts. RESULTS: The expresssion of the GLUT1 gene was detected in 50% of the inflammatory colonic mucosae and adenomatous polyp tissues, but the levels of expression were not significantly different from their normal counterparts. Among the 40 colorectal cancer patients, 23 patients (57.5%) showed GLUT1 gene expression and the levels of expression were increaed by 1.8 as compared to their normal counterparts (p<0.05). The expression of the GLUT3 gene was detected in almost all tissues examined, and the levels of expression were not significantly different from their normal counterparts. In colorectal cancers, there was correlation between GLUT1 expression, the extent of lymph node involvement and the stage of colorectal cancers (p<0.05). But, the correlation between the expressions of the GLUT3 gene and the clinicopathologic prognostic factors of colorectal cancers could not be determined because almost all tissues showed a GLUT3 gene expression. CONCLUSIONS: In conclusion, the GLUT1 glucose transporter expression in colorectal cancer was associated with high possibilities of lymph node metastases and poorer prognosis, and the assessment of GLUT1 expression in colorectal cancer would be useful in identifying high risk patients.
Adenomatous Polyps ; Cell Membrane ; Colon ; Colorectal Neoplasms* ; Gene Expression ; Glucose Transport Proteins, Facilitative* ; Glucose* ; Glycolysis ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Cystic neoplasms of the pancreas are rare tumor with malignant potential. Preoperative differentiation of a benign versus malignant tumor is unreliable and routine testing for this purpose is questionable. Therefore an aggressive resectional approach for cystic tumor of the pancreas was a recent trend and anticipate good prognosis. METHODS: This is a retrospective analysis of 23 patients with cystic neoplasm of the pancreas between Jun.1990 and Dec.1999. Data include patient demographics, presenting symptom, operative procedure, pathologic diagnosis, perioperative morbidity and mortality, survival follow-up data. RESULTS: The mean age of patients was 33.48 years and twenty one patients were women. There were 3 serous cystadenoma, 4 mucinous cystadenoma, 2 mucinous cystadenocarcinoma, 13 SPEN, 1 ductal ectasia. Major symptoms were abdominal pain(39.1%), palpable mass(30.4%), incidental(21.7%), melena( 4.3%), hematemesis(4.3%). Tumor site were 6 head(26.1%), 3 body(13.4%), 14 tail(60.9%). Main investigations were ultrasonography and CT. Other investigation were ERCP, MRCP, cytology. Operative procedure were 12 distal pancreatectomy and splenectomy, 4 PPPD, 2 mass enucleation, 2 distal pancreatectomy, 1 PD, 1 subtotal pancreatectomy, 1 cystojejunostomy. An accurate preoperative diagnosis of tumor type was proposed 65% pancreatic cystic tumor. Mean follow-up was 27 months(range 0.8 months to 90 months). Of these 23 patients, 20 patients were alive without recurrence during mean follow-up. One patient was died due to postoperative sepsis. Two patients was dead of unrelated cause. CONCLUSION: An aggressive resectional approach for cystic tumor of the pancreas is recommend in cystic tumor of the pancreas, if medically fit to tolerate surgery.
Cholangiopancreatography, Endoscopic Retrograde ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Demography ; Diagnosis ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Mortality ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Prognosis ; Recurrence ; Retrospective Studies ; Sepsis ; Splenectomy ; Surgical Procedures, Operative ; Ultrasonography