Reasonable Time for Removal of the Nasogastric Tube after a Radical Gastrectomy

The necessity for routine prophylactic nasogastric tube decompression after a gastrectomy is still in controversy. Several reports have indicated that nasogastric tube decompression is unnecessary and that the tube may even be harmful with serious discomforts. A D2 gastrectomy (which means a D2 lymph node dissection during gastric cancer surgery) for a gastric carcinoma is an extensively destructive procedure which takes a longer operation time than a conventional gastrectomy, destroys both sympathetic and parasympathetic nerve fibers in the upper retroperitoneum, and may interfere with the gastrointestinal motility after the operation. Therefore, we have carried out a retrospective study with 206 gastrectomized gastric-cancer patients to evaluate the necessity of nasogastric tube decompression and whether the tube influences the gas-passing time, the morbidity, and mortality after operation.

A Case of Retrograde Jejunojejunal Intussusception into the Braum Anastomosis after Billroth II Operation

N/AA case of retrograde intussusception of efferent limb into Braun side-to-side jejunojenunal anastomosis after gastric surgery is presented. Intussusception is an uncommon and well-recognized complication after gastric surgery. A 60-year old female was admitted to Hanyang University Hospital with a chief complaint of epigastric pain and hematemesis of 6 hours duration. Patient had a history of distal gastrectomy with gastrojejunostomy due to early gastric cancer(Stage I) 3 years ago. Emergency abdominal CT revealed jejunojejunal intussusception into Braun anastomosis. Exploration and segmental resection of jejunum with end-to-end reanastomosis were performed.

Two Case of Squamous cell Carcinoma of the Stomach in the Antrum

Squamous cell carcinoma of the stomach is very rare with a reported incidence of 0.09% of all resected gastric malignancies. We report here two cases of squamous carcinomas and a brief review of literatures. A 74-year old female was admitted because of epigastric pain and vomiting. Abdominal CT, UGI and endoscopic findings revealed a Borrmann type III gastric cancer on the posterior wall of the antrum with pyrolic obstruction and multiple liver metastases. Palliative distal gastrectomy with gastrojejunostomy was performed. The histopathologic diagnosis was adenosquamous cell carcinoma. She died of malnutrition and multiple organ failure 5 months after the operation. The other case was a 53-year old male admitted because of indigestion. Abdominal CT, UGI and endoscopic findings revealed a Borrmann type III gastric cancer on the greater curvature of the antrum with multiple enlargements of the perigastric lymph nodes. Distal subtotal gastrectomy with gastrojejunistomy was performed. The histopathologic finding revealed squamous cell carcinoma. He was discharged after FEC(5-FU, etoposide, cispatin) chemotherapy uneventfully.

Delayed Emergence from General Anesthesia Caused by an Unnoticed Intracranial Tumor / 대한마취과학회지

Slowly growing intracranial tumors, especially located in the supratentorial compartment, permit major volume-spacial compensation. Patient with large supratentorial tumor may not even present any specific symptoms or signs related to the elevated intracranial pressure. We experienced a patient who showed delayed emergence from general anesthesia for total knee replacement without any pharmacologic or metabolic causes. Computerized tomogram scan and magnetic resonance image revealed an unnoticed large supratentorial tumor considered as a cause of delayed emergence. After removal of intracranial tumor, the patient regained consciousness and discharged from the hospital in a relatively good health.