Psychological Status and Associated Factors among Korean Cancer Survivors: a Cross-Sectional Analysis of the Fourth & Fifth Korea National Health and Nutrition Examination Surveys

It is important to assess psychological distress after a diagnosis for cancer survivors, a population with a high risk for psychological distress. The aim of this study is to assess psychological distress among cancer survivors and to clarify the associated factors. In this cross-sectional analysis, data were obtained from standardized questionnaires administered to 1,163 cancer survivors and 49,243 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Survey (2007-2012). We identified the adjusted rates for psychological distress and assessed factors associated with this kind of distress using multivariate logistic regression. Cancer survivors tended to have a higher adjusted rate of psychological distress than the general population. The current depressive symptom rate for cancer survivors was 16.69%, and the adjusted rate for history of depression in cancer survivors was 15.61%. The adjusted rate for higher level of stress was 25.51% in cancer survivors. Among the cancer survivors, younger subjects, female subjects, and those with limited social support were more prone to psychological distress. In addition, current smokers or risky drinkers, those with chronic diseases, and those with a poor self-perception of their health status were also identified as a high-risk group for psychological distress. As the number of cancer survivors has increased, the importance of assessing psychological distress after a cancer diagnosis should be emphasized among all cancer survivors. Further, psychological supportive care interventions for cancer survivors are needed to improve the survival rate and improve their quality of life.

Influenza Vaccination and Associated Factors among Korean Cancer Survivors : A Cross-Sectional Analysis of the Fourth & Fifth Korea National Health and Nutrition Examination Surveys

Influenza vaccination is important for cancer survivors, a population with impaired immunity. This study was designed to assess influenza vaccination patterns among Korean cancer survivors. In this cross-sectional analysis, data were obtained from standardized questionnaires from 943 cancer survivors and 41,233 non-cancer survivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys (2007-2011). We identified the adjusted influenza vaccination rates and assessed factors associated with influenza vaccination using multivariate logistic regression. Cancer survivors tended to have a higher adjusted influenza vaccination rate than the general population. The rates for influenza vaccination in specific cancer types such as stomach, hepatic, colon, and lung cancers were significantly higher than non-cancer survivors. Among all cancer survivors, those with chronic diseases, elderly subjects, and rural dwellers were more likely to receive influenza vaccination; those with cervical cancer were less likely to receive influenza vaccination. Cancer survivors were more likely to receive influenza vaccinations than non-cancer survivors, but this was not true for particular groups, especially younger cancer survivors. Cancer survivors represent a sharply growing population; therefore, immunization against influenza among cancer survivors should be concerned as their significant preventative healthcare services.

Do People Have Healthier Lifestyles in Greener Environments? An Analysis of the Association between Green Environments and Physical Activity in Seven Large Korean Cities / 가정의학회지

BACKGROUND: Recent studies suggest that neighborhood environments influence levels of health and disease in individuals. Evidence suggests that green environments have positive effects on physical and psychological health. In this study, we examined the association between public park per person (PPP) and physical activity in 7 large Korean cities with a population of over 1 million. METHODS: We obtained data from the third Korea National Health and Nutritional Survey and data on the area of PPP from the Korean national statistics office. RESULTS: Physical activity and adjusted mean of physical activity increased significantly with PPP. When stratified by family income, physical activity increased significantly in all groups in a PPP-dependent manner. Physical activity significantly increased as PPP increased (coefficient, 16.025; 95% confidence interval, 12.392 to 19.658) before and after adjustment for age, sex, and family income. Physical activity increased in all income groups including the low income group. CONCLUSION: These results show that green park spaces independently promote physical activity and influence healthy lifestyles. Therefore, the importance of PPP for physical activity and health should be emphasized in urban planning.

Factors Affecting the Prescribing Patterns of Antibiotics and Injections

There are serious problems concerning the inadequate prescription of antibiotics and overuse of injections in primary care. However, the determinants of prescription patterns in Korea are not well-documented. To examine the area characteristics affecting the prescription of antibiotics and injections in primary care practices in the treatment of respiratory tract infections (RTIs), a nationwide cross-sectional study was performed in all 250 administrative districts of Korea. The outcome was modeled as a binary variable: over-prescription or not compared with the nation-wide average. Over-prescription of antibiotics was associated with the ratio of specialists to general physicians and over-prescription in previous years in the area (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI] 1.5-14.8; and aOR, 12.0; 95% CI 5.5-25.9, respectively). Over-use of injections was associated with younger population, urban living and the number of hospital beds in the area (aOR, 0.2; 95% CI 0.1-0.4; aOR, 0.3; 95% CI 0.1-0.8; and aOR, 0.4, 95% CI 0.2-0.9; respectively). There were differences in the prescribing patterns in different districts; prescription patterns were affected more by supply factors than by demand factors. Highly competitive medical environment associated with supply factors is a significant determinant of prescription patterns in Korea.

Amylase, lipase, and volume of drainage fluid in gastrectomy for the early detection of complications caused by pancreatic leakage / 대한외과학회지

PURPOSE: Pancreatic leakage is a serious complication of gastrectomy due to stomach cancer. Therefore, we analyzed amylase and lipase concentrations in blood and drainage fluid, and evaluated the volume of drainage fluid to discern their usefulness as markers for the early detection of serious pancreatic leakage requiring reoperation after gastrectomy. METHODS: From January 2001 to December 2007, we retrospectively analyzed data from 24,072 patient samples. We divided patients into two groups; 1) complications with pancreatic leakage (CG), and 2) no complications associated with pancreatic leakage (NCG). Values of amylase and lipase in the blood and drainage fluid, volume of the drainage fluid, and relationships among the volumes, amylase values, and lipase values in the drainage fluid were evaluated, respectively in the two groups. RESULTS: The mean amylase values of CG were significantly higher than those of NCG in blood and drainage fluid (P < 0.05). For lipase, statistically significant differences were observed in drainage fluid (P < 0.05). The mean volume (standard deviation) of the drained fluid through the tube between CG (n = 22) and NCG (n = 236) on postoperative day 1 were 368.41 (266.25) and 299.26 (300.28), respectively. There were no statistically significant differences between the groups (P = 0.298). There was a correlation between the amylase and lipase values in the drainage fluid (r = 0.812, P = 0.000). CONCLUSION: Among postoperative amylase and lipase values in blood and drainage fluid, and the volume of drainage fluid, the amylase in drainage fluid was better differentiated between CG and NCG than other markers. The volume of the drainage fluid did not differ significantly between groups.

A Comparative Study of Stenting versus Surgical Bypass in Gastric Outlet Obstruction Caused by Gastric Cancer

PURPOSE: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral stenting and patients that had received a bypass gastrojejunostomy. MATERIALS AND METHODS: One hundred patients underwent palliative entering stenting and 31 patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. RESULTS: There were significant differences between the group of patients that underwent stenting and the group of patients that received a gastrojejunostomy regarding the age of patients (67+/-12 vs. 57+/-9, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 : 1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-stenting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was 4+/-2 days in the stent group of patients and 6+/-2 days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). CONCLUSION: There were no significant differences in the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the stenting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-stenting was a concern due to tumor ingrowth and stent migration.

Experience of Biliary Atresia-Long-term Survival

Biliary atresia (BA) is an uncommon neonatal surgical disease that has a fatal outcome if not properly treated. The survival rates of the patients with native liver after Kasai's operation in countries outside Japan are not so good. We reviewed the results of 22 cases of biliary atresia treated in Kosin University Hospital between October 1987 and March 2001. There were 13 males and 9 females aged from 21 to 106 days (mean 52 days). There were 3 cases of Type I (13.6%), and 3 of Type II (13.6%), and 16 Type III (72.7%). The operative methods were resection of the common bile duct remnant and cyst followed by Roux-en-Y hepaticojejunostomy in 3 cases for Type I BA; Kasai I in 15 cases, Kasai II in 1 case, and Ueda's operation in 3 cases for Types II and III BA. There was no death within the first 30 days after operation. We were able to follow 21 of the 22 patients (95.4%) for more than 5 years. The actual 5 year survival rate (YSR) was 40.9%. One Type I case received a living-related liver transplantation at 6 years of age because of the multiple intrahepatic stones and liver cirrhosis. Five YSR after biliostomy group (Kasai II and Ueda op.) was 75% (3/4) while that of Kasai I was 20% (3/15). One case had no bile duct in the resected fibrotic plaque on microscopic review and died 8 months after Kasai I operation, would have been a strong candidate for early liver transplantation. From the above result, our conclusions are as follows; (1) early liver transplantation should be considered for cases of no bile duct after pathologic examination of the resected specimen, (2) measures to prevent postoperative cholangitis and prevention of postoperative liver cirrhosis are needed, (3) liver transplantation program should be available for failed cases.

Relationship of the Nutritional Status at the Time of Admission to Mortality and the Length of the Hospital Stay

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 or =240 mg/dl or 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.

Analysis of the Relationship between Nutritional Status and Hospitalization Days after Surgery in Gastric Cancer Patients

PURPOSE: Protein and energy malnutrition are common in patients with stomach cancer. Nutritional assessment is very important because malnutrition has been shown to be associated with increased morbidity and mortality in stomach cancer. Therefore, this study analyzed the relationship between the nutritional status and the number of hospitalization days in stomach cancer patients. METHODS: The study subjects were 89 patients with stomach cancer, who were admitted to the General Surgery Department during August 2001 to December 2001. The initial nutrition status was assessed using biochemical, anthropometric, and subjective global assessment (SGA) data along with the number of hospitalization days. RESULTS: The study was showed that the mean age was 55.9, the gender ratio was 1.3 : 1 and the mean hospitalization days were 15.59 and there was no statistically significant difference. The weight changes during 1 month before surgery, weight change during 6 month before surgery, usual body weight, and serum albumin level were associated with the nutritional status. The Pearson's correlation test revealed statistically significant relationships between the number of hospitalization days and the MAC (mid-arm circumference), MAMC (mid arm muscle circumference), and serum albumin level. Moreover, according the logistic regression test, MAMC was most associated with the number of hospitalization days. According to stomach cancer stage, only the serum triglyceride level was showed a statistically significant association. However, the Pearson's correlation test revealed the MAC and serum albumin level to be associated with the number of hospitalization days. CONCLUSION: A nutritional assessment should be carried out in cancer patients pre-operatively. Moreover, the number of hospitalization days after surgery should decrease with adequate nutritional support. These results show that MAMC is most adequate data for assessing the nutritional status and could play a key role in decreasing the number of hospitalization days after surgery with adequate nutritional support. In addition, monitoring of the laboratory levels, such as albumin, triglyceride, and transferring, could be helpful in decreasing the number of hospitalization days. However, the other laboratory parameters, such as cholesterol, zinc, and total lymphocyte count, were not associated with the number of hospitalization days.

Clinicopathologic Features in T2 Gastric Cancer

PURPOSE: This study was done to evaluate the clinicopathologic features and survival rates for patients with T2 stage gastric cancer. METHODS: Ninety-six patients with T2 gastric cancer, were treated by radical gastrectomy (and D2 lymph node dissection) at Department of Surgery of Gospel Hospital, Kosin University College of Medicine from April 1996 to October 1998. We retrospectively analyzed age, gender, tumor site, tumor size, type of resection, histopathologic classification(WHO classification and Lauren classification), Borrmann type, TNM stage, blood type, perineural invasion, angioinvasion, lymphatic invasion and the survival rate. The survival rate was analyzed with the Kaplan-Meier method using the SPSS statistical program, and the other statistical analyses were performed using the cross table Chi-square test and the independent sample t-test. RESULTS: Lymph node metastasis was found in 39 patients (40.6%). There were no significant differences except for the Borrmann type, tumor size, angioinvasion and lymphatic invasion for the T2 gastric cancer with regard to patient age, gender, the histopathologic classification (WHO classification and Lauren classification), the type of resection, tumor site, blood type and perineural invasion. The 5 year survival rate for T2 gastric cancer patients was 82.3%. The TNM stage and angioinvasion were significant prognostic factors on the univariate analysis, but the TNM stage was a significant prognostic factor on the multivariate analysis (Relative risk; 10.943, P=0.001). CONCLUSION: The Borrmann type, tumor size, angioinvasion and lymphatic invasion were useful indicators of lymph node metastasis for T2 gastric cancer. The TNM stage was the only significant prognostic factor for T2 gastric cancer.

Nutritional Status in Elderly Gastric Carcinoma

BACKGROUND: Malnutrition is one of the important factors influencing morbidity and mortality in elderly patients with gastric carcinoma. METHODS: Since September to December 2001, we investigated the nutritional parameters of 44 elderly patients with gastric carcinoma by measuring anthropometric and biochemical blood indices and assessing dietary intake along with subjective global assessment. RESULTS: The mean body mass index of subjects was below the physical average of korea on the base of 64 years old. The ratio of carbohydrate, protein and lipid to energy intake was 74.0:13.5:12.5(%). There were significantly positive correlations between three groups according to subjective global assessment and height, body weight, 1 month weight loss %, 6 month weight loss %, body mass index, transferrin and nutrient intake, such as energy, protein and niacin. CONCLUSION: Mean nutrient intake, such as total energy, protein and niacin appear to be related of subjective global assessment in elderly subjects. Nutritional assessment by nutrient intake should be done in elderly patients with gastric carcinoma and be supplied with adequate nutrition for them.

Nutritional Assessment in Gastric Carcinoma

PURPOSE: Protein and energy malnutrition are common in patients with stomach cancer. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase morbidity and mortality in stomach cancer. METHODS: The study subject were 88 patients with stomach cancer admitted at Kosin university Gospel Hospital General Surgery Department during August 2001 to December. We assessed the initial nutrition status by anthropometric, biochemical and dietary intake data along with subjective global assessment (SGA) and stomach cancer stage. RESULTS: The mean body index was under weight, body fat mass and body protein mass were decreased with increase cancer stage. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count were decrease with increase cancer stage. Daily energy intake was 1997.8 kcal, energy, cabohyderate and VitB 1 was decrease with cancer stage. The patient were divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss %, 6 month weight loss %, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake CONCLUSION: The author concluded that nutritional assessment should be done in cancer patients preoperatively and that with adequate nutritional support, the morbidity and mortality would be decreased. Our data show that SGA is a clinically adequate method for assessing nutritional status.

Hepatoid Adenocarcinoma of the Stomach: A Clinical Analysis of Fourteen Cases

PURPOSE: Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. Their incidence is rare, and they usually produce large amounts of alpha-fetoprotein (AFP). They have a specific pathologic feature, frequently occur together with liver metastasis and have a poor prognosis. This study was undertaken to understand the characteristics of clinical feature. METHODS: Fourteen hepatoid adenocarcinoma cases of gastric cancer were analyzed among 3243 patients who were treated for gastric cancer at our center between Jan 1996 and August 2003 (0.43%). RESULTS: There were 13 males and one female patient, with a median age of 59 years, ranging from 40 to 75. Ten tumors were located in the antrum, 2 in the body and 2 in the fundus. The size of the tumors varied from 2.3 to 11.0 cm. Direct invasions to adjacent organ were (4 to the pancreas and 1 to the colon). Four cases had visible lymph node enlargement at the time of the operation, ranging (from 3.5 to 6.0 cm). During the operation, 2 patients were found to have metastasis to the liver, 1 to the retroperitoneum, and 1 was positive on peritoneal washing cytology. The preoperative serum CEA levels were elevated in 7 patients, and 5 in 8 patients showed very high preoperative serum AFP levels ranging from 34.5 to 3724 ng/ml. All patients underwent a gastrectomy, and a hepatectomy in cases of liver metastasis. Pathological staging revealed one in stage Ib, four in stage II, one in stage IIIb and eight in stage IV. Immunohistochemical stainings was performed on all patients. Ten cases were positive for AFP. During follow up, eight patients died due to tumor (mean survival time: 10.6 months). Five had liver metastasis and 3 a recurrence in the peritoneum. The 6 remaining patients are still alive. CONCLUSION: 1. Hepatoid adenocarcinomas are rare and preoperatively diagnosis. The preoperative diagnostic methods of pathological consideration and preoperative serum AFP levels of all gastric cancer patients are recommended. 2. Hepatoid adenocarcinomas of the stomach have frequent and early postoperative liver metastasis and a poor prognosis, not only in advanced gastric caner but also in early cancer. Therefore, a possibly curative resection and more aggressive study for liver metastasis are recommended as being mandatory, and more sufficient treatment for these cases should be investigated.

Carcinoembryonic Antigen (CEA) in the Gallbladder Bile (b-CEA) of Gastric Carcinoma Patients with Long-term Follow up

PURPOSE: Despite numorous reports on the relationship between the level of carcinoembryonic antigen (CEA) in gall bladder bile and liver metastasis in colorectal cancer, no similar studies have been carried out for gastric carcinomas. We, therefore, undertook the present study to establish the relationship between the gall bladder bile CEA and liver metastasis as well as the post-operative survival rate in gastric carcinoma patients with curative resections. MATERIALS AND METHODS: In 373 gastric cancer patients (252 males, 121 females, age 21~76 years) operated on at Kosin University Hospital between 1989~1996, the CEA concentration in the gall bladder bile was determined during the operation and the value was related to the rates of post-operative survival and liver metastasis during follow-up period. RESULTS: The overall rate of patient survival decreased gradually with increase in TNM stage. The 13-year post-operative survival rates for stages Ia, Ib, II, IIIa, and IIIb were 95.7%, 92.5%, 79.9%, 50.9%, and 43.3%, respectively, and the 10-year survival rate for stage IV was 22.6%. The patients with a high (> or =10 ng/ml) biliary CEA showed a significantly lower rate of survival than those with a low (0.10), but in those with high TNM stages (III and IV), the survival rate was significantly lower in the high CEA group (25.9%) than in the low CEA group (57.8%) (P<0.05). CONCLUSION: These result suggest that the gall bladder bile CEA level obtained in an advanced-staged gastric cancer operation may be used in predicting the post-operational survival rate and in sorting out patients with a high risk for cancer recurrence, especially in the liver area.

Diagnosis of Antibiotic-Associated Diarrhea and Pseudomembranous Colitis by Direct Detection of Clostridium difficile Toxin B Gene / 감염과화학요법

BACKGROUND: Clostridium difficile is the major cause of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC). This study was designed to investigate predisposing factors of AAD or PMC and to evaluate the efficiency of nested PCR assay for direct detection of toxin B gene in the treatment and prognosis of these diseases. METHODS: From January to December, 2002, stool specimens from 142 patients in Kosin Medical Center, Busan, were tested for the detection of toxigenic C. difficile strains. Toxin B gene in C. difficile was detected by nested PCR. And chart review was performed to investigate the antibiotics or anticancer drug history, clinical symptoms, treatment regimens, and prognosis. RESULTS: Among 142 stool specimens, 56 specimens showed positive for the toxin B gene in C. difficile strains by PCR. Forty two percents (47/113) of stool specimens from patients with AAD and all of specimens from eight patiens with PMC were C. difficile toxin B gene positive. Administration of antibiotics or anticancer drugs was stopped in 92.7% of toxin B gene-positive cases, but those were stopped in only 48.5% of toxin B gene-negative cases. The cure rate was higher in positive cases (82%) than negative ones (71%). CONCLUSION: It is concluded that nested PCR assay for the direct detection of C. difficile toxin B gene was helpful in rapid diagnosis and treatment of AAD or PMC.

Diagnosis of Antibiotic-Associated Diarrhea and Pseudomembranous Colitis by Direct Detection of Clostridium difficile Toxin B Gene / 감염과화학요법

BACKGROUND: Clostridium difficile is the major cause of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC). This study was designed to investigate predisposing factors of AAD or PMC and to evaluate the efficiency of nested PCR assay for direct detection of toxin B gene in the treatment and prognosis of these diseases. METHODS: From January to December, 2002, stool specimens from 142 patients in Kosin Medical Center, Busan, were tested for the detection of toxigenic C. difficile strains. Toxin B gene in C. difficile was detected by nested PCR. And chart review was performed to investigate the antibiotics or anticancer drug history, clinical symptoms, treatment regimens, and prognosis. RESULTS: Among 142 stool specimens, 56 specimens showed positive for the toxin B gene in C. difficile strains by PCR. Forty two percents (47/113) of stool specimens from patients with AAD and all of specimens from eight patiens with PMC were C. difficile toxin B gene positive. Administration of antibiotics or anticancer drugs was stopped in 92.7% of toxin B gene-positive cases, but those were stopped in only 48.5% of toxin B gene-negative cases. The cure rate was higher in positive cases (82%) than negative ones (71%). CONCLUSION: It is concluded that nested PCR assay for the direct detection of C. difficile toxin B gene was helpful in rapid diagnosis and treatment of AAD or PMC.

Gastric Carcinoma and Epstein-Barr Virus Association (EBVaGC): Pusan Kyungnam Area

PURPOSE: To report on the incidence of EBVaGC and its associated clinical and pathological characteristics. METHODS: Between Nov. 1998 and Mar. 2000, 183 gastric cancers were resected, and the histology and lymphocytes infiltration reviewed. The EBVaGC was determined by EBER ISH, along with the clinical characteristics, such as sex distribution, tumor location, ABO blood group, status of H. pylori and postop survival. RESULTS: Out of 183 gastric adenocarcinomas 10 were EBVaGCs (5.5%), 7/129 males and 3/54 females. The incidences of EBVaGC, according to the WHO histology, were 7.1% (4/56) for tub. po, 9.3% (4/43) tub. mo, 4.1% (2/48) tub. well, 0/11 muc., 0/3 pap. and 0/22 sig. types. The incidences of EGVaGC, in relation to the severity of lymphocytic infiltration of tumor, were 0% (0/141) for Less- than-minimal, 21% (8/38) for Moderate and 50% (2/4) for Severe infiltration of the lymphocytes (P=0.000). The incidences of EGVaGC, according to the location of gastric cancer, were 26.3% (5/19), 7.3% (3/41) and 1.8% (2/110) for the upper, middle and lower stomach, respectively (P= 0.000). The incidences of EBVaGC were 3.1% (3/96) for stages I-II and 8% (7/87) for stages III-IV. The blood type distributions of the EBVaGCs, by the ABO blood group system were 3 A type, 6 B type, no O type and 1 AB type compared with 42.8% (74), 27.1% (47), 19.6% (34) and 10.5% (18) of A, B, O and AB with the 173 non EBVaGC P=0.079). The H. pylori status was positive in 9/10 EBVaGC, and in 157/163 (96.3%) of the non-EBVaGC. The survivals of the EBVaGC and non EBVaGC were 80 and 61.4% (105/171), rspectively. CONCLUSION: The incidence of EBVaGC was 5.5%. There was no difference in the sex ratio with EBV ( )ve gastric cancer. Six out of the 10 EBVaGC were ABO blood group B.

DCC Gene and Protein Expression in Colorectal Cancer

PURPOSE: The germline, or somatic, inactivation of tumor suppressor genes, through point mutation, or deletion, plays an important role in carcinogenesis. Several gene alterations, such as adenomatous polyposis coli (APC), deleted in colorectal cancer (DCC) and p53, have been detected in the development of colorectal cancer. Within these genes, a loss of heterozygosity (LOH) at the DCC gene locus was frequently associated with colorectal tumors, and the LOH of the DCC gene, and the expression of the DCC protein, might be related to malignant formation and metastasis. The aim of this study was to determine the DCC LOH and the expression of DCC protein in colorectal cancers, and evaluate their prognostic value and relationship with the clinicopathological data. MTHODE: Fifty colorectal cancer tissues were obtained from resected specimens. Using formalin-fixed paraffin- embedded sections as a source of DNA, we examined the DCC protein in the tissue through immunohistochemical stainings and immunoblotting analysis, the DCC LOH through a polymerase chain reaction (PCR) and single strand conformation polymorphism (SSCP). RESULTS: DCC LOH was observed in 24 of the 50 patients (48.0%). The expression of the DCC protein was decreased in the cancer tissue (62.3 23.6%) compared with the adjacent normal mucosa inform the immunoblotting analysis. A decreased DCC protein expression was also observed from the immunohistochemistry, which coincided with the immunoblotting analysis. However, both the DCC LOH and the decreased DCC protein were not related to the clinical and pathological parameters, such as location of tumor, tumor size, histological type and the venous, and lymphatic invasions. There were significant correlations between the DCC protein expression and tumor progression, and hematogenous metastasis (P<.05). CONCLUSIONS: A decreased expression of the DCC protein was noted in human colorectal cancers, and there was a significant relationship between the expression of the DCC protein and distant metastasis, but there was no correlation between the DCC LOH and distant metastasis. These results suggest that the expression of the DCC protein might be related to tumor progression and metastatic potential, and the DCC protein immunoreactivity may be a useful prognostic factor in patients with colorectal cancers.

Retrograde Jejunogastric Intussusception: A Rare Complication of Gastric Surgery

Retrograde jejunogastric intussusception is a rare complication of gastric surgery. We report a case of retrograde jejunogastric intussusception that developed after a gastric resection. The patient was a 62 years old female patient who complained severe epigastric pain, vomiting and hematemesis. She had a gastric resection and Billroth II anastomosis performed using the Braun procedure 6 months prior because of early gastric cancer. At the time of admission, the plain abdomen revealed an ileus change, but the vital signs and symptoms had worsened. An emergency operation was therefore performed and a strangulated retrograde jejunogastric intussusception of efferent loop was discovered. Surgical management consisted of a segmental resection of the jejunum. It is recommended that treatment be done as early as possible in order to prevent a strangulation of the invaginated segment. This case illustrates the rare complications of a type 2b retrograde jejunogastric intussusception that developed more than 6 months after a gastric resection and a Billroth II anastomosis using the Braun procedure.

Initial nutritional status of stomach cancer patients

The purpose of this study is to investigate initial nutritional status of stomach cancer patients. The study subjects were 88 patients with stomach cancer admitted at Kosin University Gospel Hospital in Busan. We assessed the initial nutritional status by anthropometric, biochemical and dietary intake data along with subjective global assessment(SGA). The results are as follows. 1. The mean age, weight, height, triceps skinfold thickness, mid arm circumference, and mid arm muscle circumference of the subjects were 55.9+/-11.0years, 60.0+/-9.8kg, 162.4+/-8.5cm, 10.9+/-5.7mm, 26.8+/-3.8cm, and 23.4+/-3.5cm respectively. The mean body mass index was within the normal range, with 22.7+/-2.8kg/m2, while 15.4% of the patients was underweight. The result shows that body fat mass and body protein mass of the patients with stomach cancer were decreased. 2. The mean biochemical data of the subjects were 4.0+/-0.5g/dl for albumin, 174.7+/-41.9mg/dl for cholesterol, 107.6+/-57.2mg/dl for triglyceride, 92.1microgram/dl for Zn, 297.0+/-103.1mg/dl for transferrin, 1980.0+/-0.8mm3 for total lymphocyte count. 3. Daily energy intake was 1997.8+/-579.3kcal. And the ratio of carbohydrate, protein, and lipid to energy intake was 72:14:14. 4. The patients were divided into three groups according to SGA performed by an observer. Group A(well nourished) was 55.7% with 49 patients, Group B(moderately malnourished) was 22.7 % with 20 patients, and Group C(severely malnourished) was 21.6 % with 19 patients. The three groups showed a significant difference in body weight(p<0.01), 1 month weight loss %(p<0.001), 6 months weight loss %(p<0.001), body mass index(p<0.01), and mid arm circumference(p<0.05), albumin(p<0.01), energy intake(p<0.05) as well as carbohydrate intake(p<0.05). From these results, it may be concluded that SGA can be used as a nutrition screening tool, and comprehensive nutrition assessment is desirable for those malnourished.