Trochanteric Stress Fracture in a Female Window Cleaner / 대한고관절학회지

Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and down.

Quality of Life of Long-term Survivors after a Subtotal or a Total Gastrectomy for Gastric Cancer

PURPOSE: The aim of this study was to compare quality of life of long-term survivors after a subtotal or a total gastrectomy for gastric cancer. MATERIALS AND METHODS: The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and QLQ-STO22 questionnaire were used to assess quality of life of 166 patients on their 5th annual follow-ups after gastrectomy for gastric cancer. One hundred twenty-six patients underwent a subtotal gastrectomy and 40 patients a total gastrectomy. RESULTS: The subtotal gastrectomy group revealed a trend to have better quality of life in functional scales (physical, role, emotional, cognitive and social), fatigue, pain, dyspnea, diarrhea and financial difficulties. The total gastrectomy group showed a trend to have better quality of life in the global health status and quality of life, nausea and vomiting, insomnia, appetite loss and constipation. In all scales of the EORTC QLQ-STO22, the subtotal gastrectomy group had a trend to have better quality of life. However these did not reach the statistical significance. CONCLUSION: Surgeons may not limit the extent of resection concerning long-lasting poor quality of life. Oncologically sound resection is recommended.

Robotic Surgery for Early Gastric Cancer

Early gastric cancer (EGC) patients are annually increasing due to nationwide screening program. As long-term survival of EGC patients improved, the need for the surgical tool to improve the quality of life of the patient has risen, resulting in increased popularity of laparoscopic surgery. However, laparoscopic surgery has disadvantages such as limitation in vision and maneuverability, which has brought the invention of robotic surgical system. Robotic surgical system has merits over laparoscopic surgery in that it provides 3D visualization, endowrist with 7 degrees of freedom, and stable camera function. With these merits, the number of operations using robotic surgical system increased continually. Its method of surgery does not differ much from laparoscopic gastrectomy. Reports regarding the postoperative outcomes of robot gastrectomy so far showed that the result was no less satisfactory than those of laparoscopic surgery. However, robot surgical system has drawbacks of high cost and undefined long term postoperative results as of yet. The lack of a unique merit that can counterbalance the high cost is also a problem that has to be solved. And because the advantages of robot surgical system as a tool of minimally invasive surgery are distinct, additional randomized trials may have to be performed in order to define its merits over laparoscopic surgery.

Efficacy of Intravenous Iron Sucrose for Treating Anemia after Gastrectomy

PURPOSE: Many patients suffer with anemia after gastrectomy. Iron deficiency due to a decreased oral intake and malabsoption is the most common cause of anemia in gastrectomized patients. This study evaluated the efficacy of administering intravenous iron sucrose for treating patients with anemia. MATERIALS AND METHODS: From May 2007 to October 2007 at Yonsei University Severance Hospital, we reviewed 47 outpatients whose hemoglobin levels were below 11 g/dl after gastrectomy. Iron sucrose was used for iron supplementation. To determine the difference between before and after the treatment (at 1 week, 2 weeks, 3 weeks, 3 months and 6 months after treatment), we prospectively examined such anemia parameters as the hemoglobin level (Hgb), the hematocrit (Hct), serum iron, TIBC, ferritin and transferin. RESULTS: Out of the 47 patients, only 36 completed their treatment. Eleven were male and 25 were female. The Hgb levels, which indicate anemia, were elevated 0.6, 0.8, 1.3, 2.1 and 2.2 g/dl after 1 week, 2 weeks, 3 weeks, 3 months and 6 months after administration, respectively (P<0.001). The changes from 1 week to 3 months were statistically significant, but those from 3 to 6 months were not. The Hgb levels of 26 patients, which accounted for 72% of all the patients, elevated up to 12 g/dl or more. No side effects or complications were found, but there was one case of temporary nausea. CONCLUSION: Anemia after gastrectomy is safely treated in a relatively short time with administering iron sucrose. The patients' Hgb levels are expected to increase in a week and keep increasing up to 3 months.

Laparoscopy Assisted Total Gastrectomy with Lymph Node Dissection: 77 Consecutive Cases

PURPOSE: The number of laparoscopy assisted distal gastrectomies (LADG) is gradually increasing for the treatment of early gastric cancer (EGC) patients as a surgical modality for improving quality of life. However, there are few reports on laparoscopy-assisted total gastrectomy (LATG), mainly because this procedure is performed relatively infrequently, and the procedure is more complicated than LADG. This study was performed to evaluate the technical feasibility, safety, and surgical results of LATG with lymphadenectomy through a review of our experience. MATERIALS AND METHODS: From July 2003 to June 2007, 77 LATG with Roux-en-Y esophagojejunostomy were performed for patients with a preoperative diagnosis of EGC. The clinicopathological features and surgical outcomes were analyzed. RESULTS: There were 49 males and 28 females in the study with a mean age of 61 years (range 30~85 years). The mean operation time was 210 minutes (range 100~400 minutes) and the operation time was gradually decreased as the case numbers increased. There were 13 operative morbidities (16.9%) and no operative mortalities. The restoration of bowel motility was noted at 3.2 postoperative days; a soft diet was started at 4.4 postoperative days and the duration of hospital stay was 10 days. There were 20 mucosal lesions, 32 submucosal lesions, 15 proper muscle lesions, 7 subserosal lesions and 3 serosal lesions. A total of 20 patients were treated by D2 lymph node dissection, 55 patients were treated by D1+beta lymph node dissection, and two patients were treated by D1 + alpha lymph node dissection. The mean number of retrieved lymph nodes was 42 (range 11~86). Lymph node metastases were noted in 12 patients CONCLUSION: This study indicated LATG could be applied safely and effectively for patients with EGC. However, a prospective study comparing laparoscopy-assisted versus open gastrectomy for short-term and long-term surgical outcome is needed.