Magnetic Resonance Imaging Analysis of Biological Ligament Healing after Suture-Tape Augmentation for Chronic Lateral Ankle Instability / 대한족부족관절학회지

Purpose@#The aim of this study was to evaluate biological ligament healing quantitatively after suture-tape augmentation for chronic lateral ankle instability. @*Materials and Methods@#Thirty-two patients underwent magnetic resonance imaging (MRI) at a minimum of 2 years after lateral ligament augmentation using suture-tape. Signaloise ratios (SNRs) and widths of anterior talofibular ligaments (ATFLs) were measured on preoperative and postoperative MRI by three researchers. ATFL biological healing degrees were analyzed using changes in SNRs and widths of ATFLs and by comparing these metrics with those of normal contralateral ankles. Clinical evaluations were performed using foot and ankle outcome scores (FAOSs), Foot and Ankle Ability Measure (FAAM) scores, and ankle stress radiographs. @*Results@#Mean FAOS and FAAM scores improved significantly from 62.4 to 93.6 and 58.3 to 92.3, respectively, at final follow-up (p<0.001). Mean SNRs and ATFL widths improved insignificantly from 8.49 to 8.21 and 2.07 to 2.15 mm, respectively, at final followup (p=0.424, p=0.718). Significant differences in mean SNRs and ATFL widths were found between ipsilateral and contralateral sides (p<0.001, p=0.002). Spearman’s correlation analysis revealed no significant association between clinical outcomes and degrees of biological healing of ATFLs based on MRI findings. @*Conclusion@#Despite improvements in clinical outcome measures, the effects of suture-tape augmentation for chronic lateral ankle instability on biological ligament healing were insignificant. In addition, no significant correlation was found between clinical outcomes and degrees of biological healing of ATFLs.

Magnetic Resonance Imaging Analysis of Biological Ligament Healing after Suture-Tape Augmentation for Chronic Lateral Ankle Instability / 대한족부족관절학회지

Purpose@#The aim of this study was to evaluate biological ligament healing quantitatively after suture-tape augmentation for chronic lateral ankle instability. @*Materials and Methods@#Thirty-two patients underwent magnetic resonance imaging (MRI) at a minimum of 2 years after lateral ligament augmentation using suture-tape. Signaloise ratios (SNRs) and widths of anterior talofibular ligaments (ATFLs) were measured on preoperative and postoperative MRI by three researchers. ATFL biological healing degrees were analyzed using changes in SNRs and widths of ATFLs and by comparing these metrics with those of normal contralateral ankles. Clinical evaluations were performed using foot and ankle outcome scores (FAOSs), Foot and Ankle Ability Measure (FAAM) scores, and ankle stress radiographs. @*Results@#Mean FAOS and FAAM scores improved significantly from 62.4 to 93.6 and 58.3 to 92.3, respectively, at final follow-up (p<0.001). Mean SNRs and ATFL widths improved insignificantly from 8.49 to 8.21 and 2.07 to 2.15 mm, respectively, at final followup (p=0.424, p=0.718). Significant differences in mean SNRs and ATFL widths were found between ipsilateral and contralateral sides (p<0.001, p=0.002). Spearman’s correlation analysis revealed no significant association between clinical outcomes and degrees of biological healing of ATFLs based on MRI findings. @*Conclusion@#Despite improvements in clinical outcome measures, the effects of suture-tape augmentation for chronic lateral ankle instability on biological ligament healing were insignificant. In addition, no significant correlation was found between clinical outcomes and degrees of biological healing of ATFLs.

Evaluation of Diagnostic Performance of Three Real-Time PCR Assays for the Detection of Mycobacteria Species / 대한임상미생물학회지

Background@#The disease burden caused by Mycobacterium tuberculosis (MTB) complex continues to decrease in most countries. However, the diseases caused by the nontuberculous mycobacteria (NTM) become a public health problem. This study aimed to compare the diagnostic accuracy of three real-time PCR assays: AdvanSure TB/NTM real-time PCR kit (AdvanSure; LG Chem., Korea), Genedia MTB/NTM detection kit (Genedia; Green Cross MS, Korea), and PowerChek MTB/NTM Real-time PCR kit (PowerChek; Kogenebiotech, Korea) for the detection of MTB complex and NTM. @*Methods@#Total 102 acid-fast bacilli (AFB) smear-positive and 177 smear-negative specimens from Korea University Medical Center, Guro Hospital, were enrolled. The AFB smear-positive and negative specimens were collected from November 2016 to October 2017 and November to December 2018, respectively. DNA extraction was performed using Genedia Mycobacteria DNA prep Kit (Green Cross MS, Korea). The statistical analysis was performed using MedCalc 18.11.6 (MedCalc Software, Belgium). @*Results@#Among 261 specimens, 64 showed MTB complex growth and 28 exhibited NTM growth. The sensitivity, specificity, positive predictive value, and negative predictive value of AdvanSure/Genedia/PowerChek kits for MTB were 96.9%/95.3%/96.9%, 98.5%/99.5%/98.5%, 58.9%/80.9%/58.9%, and 99.9%/99.9%/99.9%. Whereas those for NTM detection were 81.5%/44.4%/88.9%, 99.6%/100.0%/98.7%, 57.3%/100.0%/32.8% and 99.9%/99.6%/99.9%, respectively. The area under the receiver operating characteristic curve of AdvanSure and PowerChek for NTM detection was statistically different from that of Genedia (P<0.0001). @*Conclusion@#Three real-time PCR assays were reliable for MTB complex in AFB-positive and -negative specimens. There was a difference between these three reagents for the accuracy of NTM detection.

High white blood cell count and erythrocyte sedimentation rate are associated with perforated appendicitis in children

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients ( 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.

Anti-H Antibody Showing Agglutination in the Anti-Human Globulin Phase in a Korean Patient

No abstract available.

Anchor Plate Efficiency in Postoperative Orthodontic Treatment Following Orthognathic Surgery via Minimal Presurgical Orthodontic Treatment / 대한악안면성형재건외과학회지

PURPOSE: The efficiency of an anchor plate placed during orthognathic surgery via minimal presurgical orthodontic treatment was evaluated by analyzing the mandibular relapse rate and dental changes. METHODS: The subjects included nine patients with Class III malocclusion who had bilateral sagittal split osteotomy at the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital, after minimal presurgical orthodontic treatment. During orthognathic surgery, anchor plates were placed at both maxillary buttresses. The anchor plates were used to move maxillary teeth backward and for maximum anchorage of Class III elastics to minimize mandibular relapse during the postoperative orthodontic treatment. The lateral cephalometric X-ray was taken preoperatively (T0), postoperatively (T1), and one year after the surgery (T2). Seven measurements (distance from Pogonion to line Nasion-Nasion perpendicular [Pog-N Per.], angle of line B point-Nasion and Nasion-Sella [SNB], angle of line maxilla 1 root-maxilla 1 crown and Nasion-Sella [U1 to SN], distance from maxilla 1 crown to line A point-Nasion [U1 to NA], overbite, overjet, and interincisal angle) were taken. Measurements at T0 to T1 and T1 to T2 were compared and differences tested by standard statistical methods. RESULTS: The mean skeletal change was posterior movement by 13.87+/-4.95 mm based on pogonion from T0 to T1, and anterior movement by 1.54+/-2.18 mm from T1 to T2, showing relapse of about 10.2%. There were significant changes from T0 to T1 for both Pog-N Per. and SNB (P<0.05). However, there were no statistically significant changes from T1 to T2 for both Pog-N Per. and SNB. U1 to NA that represents the anterior-posterior changes of maxillary incisor did not differ from T0 to T1, yet there was a significant change from T1 to T2 (P<0.05). CONCLUSION: This study found that the anchor plate minimizes mandibular relapse and moves the maxillary teeth backward during the postoperative orthodontic treatment. Thus, we conclude that the anchor plate is clinically very useful.

Evaluation of the Automated Blood Bank Instrument QWALYS-3 for Cross-Matching Tests / 대한수혈학회지

BACKGROUND: The cross-matching test is regarded as an essential pre-transfusion test. It serves an important role in confirming the ABO/Rh compatibility of transfusion and screening for possible unexpected antibodies. We evaluated cross-matching tests in QWALYS-3 (DIAGAST, Loos Cedex, France), comparing the automated process to manual tube methods. METHODS: A total of 545 crossmatching tests from 169 patients, collected from RBC concentrate transfusion orders, were performed using both QWALYS-3 and manual tube methods. All patients were follow-up tested later on with antibody identification tests to confirm the presence of unexpected antibodies in plasma. RESULTS: None of the samples were ABO/Rh incompatible. The presence of unexpected antibodies was later confirmed in 277 tests in 56 patients. Out of those 277 tests, the concordance rate between two methods was 83.8% (232/277). In 268 tests which were later confirmed with no unexpected antibodies, manual tube methods did not show any positive results while five tests were false-positive (5/268, 1.9%) only in QWALYS-3. The overall concordance rate between two methods was 90.82%, and the kappa coefficient was 0.696 (P<0.05) (n=545). CONCLUSION: The QWALYS-3 system has its merits in accuracy, precision, and lack of possible human errors, however, the automated procedure showed some disadvantages, including relatively low cost-and-time-effectiveness, less effective cold antibody detection, and difficulties in handling small quantity samples. Thus, the QWALYS-3 system has meaningful, but only a limited value in the automation of routine cross-matching tests.

Influencing factor on the prognosis of arthrocentesis

OBJECTIVES: The purpose of this article is to evaluate factors influencing prognosis of arthrocentesis in patients with temporomandibular joint (TMJ) disorder. MATERIALS AND METHODS: The subjects included 145 patients treated with arthrocentesis at the Dental Center of Ajou University Hospital from 2011 to 2013 for the purpose of recovering mouth opening limitation (MOL) and pain relief. Prognosis of arthrocentesis was evaluated 1 month after the operation. Improvement on MOL was defined as an increase from below 30 mm (MOL or =40 mm), and pain relief was defined as when a group with TMJ pain with a visual analog scale (VAS) score of 4 or more (VAS > or =4) decreased to a score of 3 or more. The success of arthrocentesis was determined when either mouth opening improved or pain relief was fulfilled. To determine the factors influencing the success of arthrocentesis, the patients were classified by age, gender, diagnosis group (the anterior disc displacement without reduction group, the anterior disc displacement with reduction group, or other TMJ disorders group), time of onset and oral habits (clenching, bruxism) to investigate the correlations between these factors and prognosis. RESULTS: One hundred twenty out of 145 patients who underwent arthrocentesis (83.4%) were found to be successful. Among the influencing factors mentioned above, age, diagnosis and time of onset had no statistically significant correlation with the success of arthrocentesis. However, a group of patients in their fifties showed a lower success rate (ANOVA P=0.053) and the success rate of the group with oral habits was 71% (Pearson's chi-square test P=0.035). CONCLUSION: From this study, we find that factors influencing the success of arthrocentesis include age and oral habits. We also conclude that arthrocentesis is effective in treating mouth opening symptoms and for pain relief.

Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw

OBJECTIVES: To identify post-treatment prognostic factors for medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS: We evaluated 54 MRONJ patients who visited the Department of Dentistry, Ajou University Hospital, from May 2007 to March 2014. Twenty-one patients were surgically managed with debridement or sequestrectomy and 33 patients were conservatively managed using antibiotics. Correlations of age, sex, stage, bisphosphonate duration and type, and drug holiday with the prognosis of MRONJ were investigated. Correlations were verified by logistic regression analysis and t-tests with a significance level of 0.05. RESULTS: Clinical outcomes were evaluated on the basis of both clinical and radiographic findings. Twelve out of 21 surgically managed patients showed a favorable prognosis and nine patients relapsed. Thirty-one of the 33 conservatively managed patients showed no specific change in prognosis, and two patients worsened. Statistical analyses of the conservative management group did not reveal any correlation of the above factors with the prognosis of conservative management. Drug holiday was the only prognostic factor in the surgical management group (P=0.031 in logistic regression analysis, P=0.004 in t-test). CONCLUSION: Drug holiday is a prognostic factor in the surgical management of MRONJ. Because the drug holiday in the patients of the poor prognosis group occurred 1.5 to 4 months prior to surgical management, we recommend a drug holiday more than 4 months before surgery.

High-Resolution Melting Analysis for Genotyping Duffy Blood Group Antigens / 대한수혈학회지

BACKGROUND: Accurate typing of Duffy blood group is important because anti-Duffy antibodies cause hemolytic transfusion reaction and hemolytic disease of the newborn. The aim of this study was to evaluate a new genotyping method using high resolution melting (HRM) analysis, a rapid and inexpensive approach for high-throughput Duffy genotyping. METHODS: A total of 20 unrelated Korean blood samples were obtained and an African-black sample was used for GATA control. Phenotyping was performed by hemagglutination (DiaMed AG, Switzerland). GATA and FYA/B PCR products were obtained by PCR-restriction fragment length polymorphism (RFLP) using Taq DNA polymerase (Promega, WI) and enzymes BanI and StyI (New England Biolab, UK). For HRM, PCR amplification was performed using LightCycler 480 ResoLight Dye (Roche, USA) and Lightcycer 480 (Roche, USA). RESULTS: Phenotyping and genotyping data using PCR-RFLP and HRM analysis were compared. Different types of HRM curves were obtained according to genotypes, FYA/FYA, FYB/FYB, and FYA/FYB, and to GATA mutations, homozygote FYB-33T (T/T), heterozygote FYB-33T/33C (T/C), and homozygote FYB-33C (C/C). Phenotypes 18 Fy(a+b-), 1 Fy(a+b+), 1 Fy(a-b+), and 1 Fy(a-b-) showed complete concordance with genotyping methods. Fy(a-b-) sample was found to be a FYB-33C homozygote by both genotyping methods. CONCLUSION: Phenotyping and genotyping showed concordant results and both genotyping methods using PCR-RFLP and HRM analysis showed good agreement in finding mutation in GATA and FY gene coding regions. HRM analysis is suitable and reliable for high-throughput screening for Duffy genotyping.

ABO Genotyping of a Neonate with Mixed Field Agglutination / 대한수혈학회지

Mixed field agglutination is an important, but rare phenomenon of ABO blood grouping. Contrary to adults, neonatal red blood cells are immature and they present a weak ABO expression, and sometimes this result in a mixed field agglutination pattern. We report here on a case of a neonate who presented with mixed field agglutination on the ABO blood grouping during serologic testing and the neonate had a normal ABO genotype.

Evaluation of the Automated Instrument QWALYS-3 for Unexpected Antibody Screening / 대한수혈학회지

BACKGROUND: The use of automated techniques reduces the impact of human errors in blood banking and it improves the standardization and the quality of the achieved results. Erythrocyte Magnetized Technology (EMT) is now being widely used due to its simplicity and efficiency for detecting alloantibody. We evaluated the antibody screening test of the QWALYS-3 (DIAGAST, Loos Cedex, France). METHODS: The evaluation focused on antibody screening using the QWALYS-3 as compared to the standard manual tube method and the Ortho BioVue system in clinical samples (n=100) and frozen stored samples (n=64), which had RBC alloantibody. RESULTS: Using the manual tube method, the sensitivity of antibody screening was 100% by the QWALYS-3 and 42.8% by the Ortho BioVue in the clinical samples (n=7) and 2 results were discrepant by the QWALYS-3 for negative samples. For the known antibodies from the frozen stored samples (n=64) this correspondence rate amounted to 93.7% (n=60). CONCLUSION: The QWALYS-3 system displayed a good match rate with the Ortho BioVue system (92%). It also showed reliable results for the general accuracy when compared to the manual method (concordance rate: 98%). The QWALYS-3 system will facilitate the automation of routine antibody screening with high reliability, sensitivity and specificity compared to the standard manual methods.

Validity, Reproducibility of Visual Analogue Scales in Assessment of Appetite Sensations

BACKGROUND: Appetite control and weight reduction is important for the treatment of chronic disease such as obesity, hypertension, and diabetes mellitus. Visual analogue scales (VAS) is widely used to assess appetite. We investigated the reproducibility and the validity of the Korean version of VAS for appetite which will be helpful for clinical use. METHODS: The subjects received the same test meal and 8 VAS questionnaires between 6 weeks. They started to fill out the questionnaire before lunch, continued after lunch every hour, and ended after dinner. The questionnaire was asked about hunger, satiety, fullness, prospective consumption, sweet, salty, savoury, and fatty. During the test meal, the subjects could eat ad libitum until 'comfortable satisfaction'; and after the test meal we calculated energy intake. We assessed the correlation between test-retest VAS for each appetite and evaluated the validity of VAS for hunger with energy intake as "gold-standard". RESULTS: The VAS curves of each appetite were similar between the test and the retest. The VAS of each appetite on the test day was strongly correlated with that on the retest day. The CRs of 4.5 hour mean VAS (20~34 mm) was smaller than the CRs of fasting VAS (35~54 mm). The correlation coefficient of Hunger VAS before dinner and the energy intake was 0.436 on the test day and 0.400 on the retest day. The VAS of the sweet was correlated to the total glucose intake (P<0.05), and the VAS of salty to the salt intake. CONCLUSION: The validity of the VAS score for appetite, especially hunger, sweet and salty taste was good. Indeed, the reliability of VAS for appetite was good to use this scale in a clinical setting.

The Safety and Usefulness of Synthetic Absorbable Monofilament, Glycoside-epsilon-caprolactone- trimethylene Carbonate Interpolymer, in Gastrointestinal Anastomosis and Closure

PURPOSE: Synthetic absorbable monofilaments offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual absorption within the healing tissues. For these reasons, these suture materials are commonly used in various surgical fields such as gastroenterology, urology, gynecology, and plastic surgery. The aim of this study was to evaluate the safety and usefulness of a new synthetic absorbable monofilament, Glycoside-epsilon-caprolactone-trimethylene carbonate interpolymer (GCT), in gastrointestinal anastomosis and closure. MATERIALS AND METHODS: We evaluated 55 gastrointestinal anastomoses and closures using GCT (MONOSYNR, B. Braun, Germany) in 47 patients who underwent gastric surgery between December 2001 and May 2002 at Seoul National University Hospital. Patient's characteristics, operative procedure, surgeon's opinion of handling properties of GCT, and suture-related complications were analyzed. RESULTS: There were 34 males and 13 females (M:F= 2.6:1) with an average age of 54.2 years old. Forty-five cases of gastrointestinal anastomosis (20 gastrojejunostomies and 25 jejunojejunostomies) and 10 cases of intestinal closure (7 gastrostomy closures and 3 duodenal stump closures) were performed in 41 cases of stomach cancer, three of peptic ulcer disease, two of GIST, and one MALToma. The handling properties of GCT according to the criteria of knot breaking load, knot security, and placing property were always scored with 7 to 9 points (10=excellent, 1=very poor). Two cases of postoperative complications (3.6%) were noted. One was a leak of the gastrojejunostomy site which was successfully managed conservatively, and the other was a stricture of the gastrojejunostomy site which was managed by reoperation (side-to-side jejunojejunostomy). CONCLUSION: GCT seems to be an applicable suture material for various gastrointestinal anastomoses and closures.

Effect of Oral Intake on Nutritional Status after Gastric Resection

PURPOSE: Malnutrition is a common postoperative complication that occurs after gastric resection. Several causes for malnutrition have been proposed, which include malabsorption and poor oral calorie intake. We performed this study to evaluate whether nutritional counseling would increase oral calorie intake and improve nutritional status in patients who had undergone gastrectomy. MATENRIALS AND METHODS: Twenty-two patients were randomly selected as the study group from among patients who had undergone gastrectomy for early gastric cancer and gastric polyp between October 1999 and December 2000. Body weight, hemoglobin, serum albumin, and serum transferrin were checked before and after the gastrectomy. Oral calorie intake was evaluated by using a 3-day oral-intake diary, and one nutritionist performed outpatient-based nutritional counseling. Eighteen patients who had undergone gastrectomy for the same disease during the same period were selected as the control group. RESULTS: During an average interval of 14.8 months, the study patients received nutritional counseling an average of 3.4 times at an average interval of 4.4 months. The study group took a mean of 2055.6+/-418.1 Cal per day and the control group 1792.1+/-421.9 Cal (P=0.05). Sixty-eight percent (15 patients) of the study group patients reached the daily-required calorie intake. Postoperative bodyweights were 64.0+/-9.9 kg for the study group and 64.3+/-10.8 kg for the control group (P>0.05). No statistically significant differences were observed among the other. Sixty-five percent of the patients (26 patients) had a weight loss of less than 10% of the preoperative body weight, and 35% had more than a 10% weight loss, but there was no statistical difference between the calorie intakes of these patients. CONCLUSION: Nutritional counselling increased the oral calorie intake, but nutritional status was not improved. These results suggest that nutritional derangement after gastrectomy cannot be corrected by adequate oral intake itself.

Expression of Bombesin Family Ligands and Receptors in Human Gastric Cancer Tissues and Cell Lines

PURPOSE: Bombesin-like peptides are known to be important in the autocrine growth of a number of small cell lung cancer cell lines. The aim of this study was to investigate the extent of bombesin family ligands/receptors expression in human gastric cancer tissues and cell lines, and to evaluate the relationship between the expression of bombesin family ligands/receptor and clinicopathologic parameters. METHODS: We measured the expression of gastrin releasing peptide (GRP), neuromedin B (NMB), and their receptors, in human gastric cancer tissues and cell lines. Ligand and receptor mRNA studies were carried out on; 20 tumor and matched normal samples, and 9 gastric cell lines. The expression of mRNA of GRP/NMB, and their receptors, was examined by the reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Expression of GRP, NMB and GRPR, NMBR mRNA was found in 55%, 100%, 40%, and 100% of gastric cancer tissue, respectively. GRP/GRPR co-expression was observed in 30% of gastric cancer tissues and expression of gastric cancer was higher than that of normal mucosa. GRP and GRPR were highly expressed in the differentiated type of gastric cancer. In gastric cancer cell lines, these peptides and receptors were expressed equally. CONCLUSION: The result demonstrate that GRP, NMB, GRPR, and NMBR were expressed in gastric cancer tissues and cell lines. This result suggests that these may have a role as growth factors in gastric cancer growth, and these peptides may act in an autocrine fashion as a morphogen in gastric cancer.

Usefulness of a FDG-PET Scan in Assessing Recurrent Gastric Cancer

PURPOSE: For curative resection of recurrent gastric cancer, it is imperative that there be no unrecognized foci of tumoral disease outside the operation field. PET (positron emission tomography) with FDG (18 fluoro-2 deoxy-D-glucose) is a whole-body imaging technique that exploits the increased rate of glycolysis in tumor cells to detect disease. The authors evaluated the usefulness of FDG-PET in assessing resectability of recurrent gastric cancer. MATENRIALS AND METHODS: Seven patients with recurrent gastric cancer were studied with FDG-PET from December 1998 to October 2000. All FDG-PET images were interpreted in conjunction with conventional diagnostic methods. All imaging results were correlated with the pathological diagnosis and clinical outcome. Results: A final diagnosis of recurrence was obtained at 14 sites in all 7 patients by histology or clinical follow up. Locoregional recurrence, including distant metastasis, developed in 6 of 7 patients and distant recurrence in only one. FDG-PET detected all recurrent sites (5 locoregional and 5 distant) in 5 patients without peritoneal recurrence, but did not detect peritoneal seeding in 2 patients with peritoneal recurrence. The accuracy of FDG-PET in estimating resectability was 71.4% (5/7), and that of CT and PET together was 85.7% (6/7). A curative resection could be performed in three of the recurrent patients (2 locoregional and 1 distant recurrence). CONCLUSION: Our results suggest that FDG-PET may be useful for detecting locoregional and distant recurrence of gastric cancer and for selecting appropriate treatment. However, considering that FDG-PET was limited in detecting peritoneal seeding and determining the exact anatomical extension of tumor, it should be used in conjunction with other anatomical images.

Prediction of Peritoneal Recurrence after a Curative Resection for Gastric Cancers Based on Clinicopathologic Factors

PURPOSE: This study was designed to investigate the clinicopathologic factors related to peritoneal recurrence and to predict peritoneal recurrence based on clinicopathologic factors. METHODS: A retrospective analysis of 383 patients with peritoneal recurrence, out of 4184 patients who had undergone curative gastric resection at SNUH from 1986 through 1996 was done. RESULTS: Of the patients with peritoneal recurrence, 275 (71.8%), 97 (25.3%), and 11 (2.9%) were early (0~24 months), intermediate (24~60), and late (more than 60) recurrence, respectively. In multivariate analysis, serosal invasion, lymph node metastasis, size of tumor, Borrmann type, perineural invasion and sex were independent prognostic factors for peritoneal recurrence. After classifying all patients into 16 groups on the basis of 4 factors, serosal invasion, lymph node metastasis, Borrmann type, and size, the number and proportion of a patients with peritoneal recurrence was obtained. There was 4.2% peritoneal recurrence in the most favorable group (n = 71), which had a Borrmann type 1 or 2 lesion less than 5 cm in maximal diameter with neither serosal invasion nor lymph node metastasis. There was a 25.4% peritoneal recurrence in the most unfavorable group (n = 331), which had a Borrmann type 3 or 4 lesion more than 5 cm with serosal invasion and lymph node metastasis. CONCLUSION: Our results suggest that patients with a Borrmann 3 or 4 lesion more than 5cm in maximal diameter, with serosal invasion and lymph node metastasis have thehighest risk for peritoneal recurrence. These patients could be considered as candidates for a treatment modality such as intraperitoneal chemotherapy or hyperthermic chemotherapy.

A Clinical Analysis of Gastrointestinal Stromal Tumors in Small Intestine

PURPOSE: This study was undertaken in order to investigate the behavior of gastrointestinal stromal tumors (GIST) of small intestine and to determine the factors related to their prognosis. METHODS: We retrospectively analyzed the clinical records of 28 patients who were diagnosed and underwent surgery for the GIST of the small intestine at Seoul National University Hospital from 1990 to 1999. RESULTS: The study group comprised 12 men and 16 women. The mean age was 48.4 years (20~78 years) at the time of diagnosis. The median follow-up period was 45 months (4~124 months). The tumor sites were the duodenum in 11 cases (39.3%), jejunum in 14 cases (50.0%) and ileum in 3 cases (10.7%). The most frequent symptom in cases of GIST of the small bowel was GI bleeing (50.0%). Complete resection of the tumor had been performed in 24 patients, and they demonstrated a longer disease-free survival time than the 4 patients who had been undergone incomplete resection, although the difference was not statistically significant (P>0.05). There were no metastases of the lymph nodes in any of the 28 cases. Eleven patients among the 24 who have been undergone complete tumor resection showed recurrence (45.8%). The mean recurrence time after surgery was 28.2 months (4~82 months) and the most common site of recurrence was the liver (81.8%). As for the univariate and multivariate analysis, the prognostic factors for the disease-free survival of patients with GIST were incresed mitotic counts of the tumor (>or=2/10 high power field) and the presence of tumor necrosis (Por=5 cm vs 0.05) CONCLUSION: In cases of GIST of the small bowel, the most common symptom was GI bleeding. There were no metastases of the lymph nodes detected. The most common site of recurrence was the liver. The increased mitotic counts of the tumor and the presence of tumor necrosis were risk factors for recurrence.

A Clinicopathological Analysis of Recurrent Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was designed to investigate the correlation between the clinicopathologic characteristics and the recurrence pattern of gastric cancer and to define survival difference according to treatment modality after diagnosis of recurrence. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 4184 patients who had undergone radical surgery for primary gastric cancer from 1986 through 1996. Clinicopathologic factors were analyzed for the relationship of each factor with the pattern of recurrence. And the survival after diagnosis of recurrence was compared among the treatment modalities. RESULTS: Recurrence pattern was confirmed in 1141 patients. Loco-regional recurrence occurred in 291 patients (20.1%), peritoneal recurrence in 383 (26.5%), distant recurrence in 290 (20.1%), and mixed recurrence in 177 (12.3%), respectively. Early recurrence (less than 2 years) occurred in 767 (69.3%), intermediate recurrence (2~5 years) in 286 (25.8%), and late recurrence (more than 5 years) in 54 (4.9%). In multivariate analysis, T stage, N stage, size of tumor and perineural invasion were independent prognostic factors for recurrence. Median survival from diagnosis of recurrence was 24.2 months in the curative operation group, 7.7 months in the chemotherapy group, 7.1 months in the non-curative operation group and 3.3 months in the conservative treatment group, respectively (p=0.000). CONCLUSION: The clinicopathological analysis of recurrent gastric cancer showed recurrent patterns and prognostic factors. Curative resection is suggested to have survival benefit in recurrent gastric cancer patients, although it was possible in patients with limited extent of disease.