Analysis of Postoperative Complications Following Laparoscopic Gastrectomy in 1332 Gastric Cancer Patients

PURPOSE: To analyze postoperative complications for gastric cancer patients undergoing laparoscopic gastrectomy in single institution over long period of time. METHODS: The data of 1332 consecutive patients undergoing laparoscopic gastrectomy for gastric cancer at a single institution from January 2007 to December 2015 were reviewed. The patients were classified into the early or late surgery group; the initial 100 cases were classified as the initial group. We compared between the two groups and analyzed risk factors for postoperative complications. RESULTS: A total of 265 postoperative complications occurred in 223 patients (16.7%). Major complications occurred in 38 patients (2.9%) including 1 death (0.1%). Operative time and hospital stay were significantly shorter in the late group. Blood loss was greater in the initial group. Sex, comorbidity, tumor location, D2 LND, operative method, non B-I anastomosis, co-resection, long operative time, and blood loss were significant risk factors for overall postoperative complication. In the multivariate analysis, male sex, comorbidity, D2 lymph node dissection, total or proximal gastrectomy, non B-I anastomosis, co-resection, operative time and blood loss were associated with postoperative overall complications. CONCLUSION: Sex, co-morbidity, D2 LND, operative method, co-resection, operative time and blood loss revealed as the risk factor of overall postoperative complication. And there was no significant differences of risk factor related to postoperative complication between initial and maturation surgical period. This suggests that beginners also can safely perform laparoscopic gastrectomy through the appropriate patient selection.

Postoperative Residual Juvenile Nasopharyngeal Angiofibroma Treated with Gamma Knife Surgery

Juvenile nasophayngeal angiofibroma (JNA) is a histologically benign but highly vascular, agressively expansile lesion that occurs exclusively in prepubescent or pubescent males. Traditional treatmemt strategy of JNA has included open surgical approaches for majority of tumors. However, radiosurgery has been rarely applied for juvenile nasopharyngeal angiofibroma (JNA) and cumulative reports are lacking. The authors report a case of successful treatment of postoperative residual JNA with gamma knife radiosurgery.

Very Late Recurrent Maxillary Sinus Squamous Cell Carcinoma on the Skin Graft Site 16 years after the Treatment

Maxillary sinus cancer is anatomically located adjacent to the orbit and the skull base. Local recurrence is by far the most common cause of treatment failure and the long-term survival rates is low. Local recurrence is usually happened within 2 years after initial treatment. Late recurrence is generally defined as a recurrence 5 years after initial treatment. But, late recurrence cases of maxillary sinus cancer is very rare, especially 10 years after treatment. We report a case of late recurrence on the previous skin graft site 16 years after the treatment of maxillary sinus squamous cell carcinoma in a 66-yr-old man. The patient was treated with surgical wide excision and skin graft. No recurrence was developed after one and a half year and we discussed the pathogenesis of this very late recurrent case.

A Case of Otosclerosis with Meniere's Symptom / 대한평형의학회지

It has been postulated that otosclerosis may produce vertigo by several mechanisms. An association between otosclerosis and Meniere's disease has been proposed on both a clinical and histopathologic basis but the causal relationship is controversial. We report a case of bilateral otosclerosis in a man manifesting vertiginous symptoms. Fifty one year-old man was examined for rotational vertigo and poor hearing in his both ear for ten years. The audiogram revealed left sided hearing loss of a conductive type and right sided sensorineural hearing loss, and caloric asymmetry. Meniere's disease was suspected, but temporal bone CT showed low attenuated lesion around bilateral cochlear and semicircular canal. A diagnosis of otosclerosis was made. He was recommended sodium fluoride therapy. Severe endolymphatic hydrops manifesting itself as Meniere's disease can be the result of otosclerosis, so vertiginous and concurrent hearing symptoms should not be overlooked.

Two Cases of Systemic Amyloidosis Presenting with Abnormalities in Liver Function Tests / 대한소화기학회지

Systemic amyloidosis results from the deposition of insoluble, fibrous amyloid proteins. It occurs mainly in the extracellular spaces of multiple organs and tissues including the kidney, heart, and liver. Although amyloid deposition in the liver is common in patients with systemic amyloidosis, clinically apparent liver disease is relatively rare. Indeed, most patients with systemic amyloidosis manifest only minimal to moderate hepatomegaly and trivial abnormalities in liver function tests. Recently, we experienced two cases of patients who presented with abnormalities in liver function tests and hepatomegaly as manifestations of systemic amyloidosis. We report these cases with a review of the relevant literatures.

Assessment of Quality of Life and Associated Factors in Patients with Chronic Viral Liver Disease / 대한간학회지

BACKGROUND/AIMS: The aim of this study was to measure health related quality of life (HRQOL) in patients with chronic viral hepatitis or cirrhosis and to determine factors associated with more severe impairment. METHODS: We conducted a cross-sectional study in which we documented patients' demographic and clinical characteristics and measured their HRQOL using the Korean version of Short Form-36. A total of 375 patients were enrolled in the study. We compared patients' HRQOL with that of 750 participants in a control group and assessed the association of HRQOL impairment with clinical parameters. RESULTS: In all except two domains (physical functioning, bodily pain) of SF-36, HRQOL scores were significantly lower in the patient group than in the control group (p<0.001). The difference was more prominent in those domains reflective of mental, rather than physical, health. When patient group was classified as noncirrhosis, Child A, B, or C according to modified Child-Pugh classification, severe liver disease was associated with a lower HRQOL score. Interestingly, scores of domains reflective of mental health were decreased from the early stage of disease (noncirrhosis or Child-Pugh A). Those of domains reflective of physical health, however, were decreased only in advanced stages of disease (Child-Pugh B or C). There are weak but significant correlations between SF-36 scores and age, serum albumin, serum bilirubin, and prothrombin time, but no correlation with histologic activity, transaminase level, disease duration, virus type (HBV or HCV) and HBV DNA level. CONCLUSIONS: Compared with the control group, patients with chronic viral hepatitis or cirrhosis showed substantial impairment of HRQOL, which is further affected by worsening disease severity. More concern about HRQOL should be warranted in the evaluation of health change due to disease progression or therapeutic trial.

A case of idiopathic hypereosinophilic syndrome presenting as only hepatic involvement / 대한내과학회지

Hypereosinophilic syndrome is a very rare disease characterized by marked peripheral eosinophilia and eosinophilic infiltration of organs such as the heart, nervous system, skin, liver, spleen, gastrointestinal tracts, lung and urinary system. Clinical manifestation depends on the organ involved and the severity of infiltration. The only hepatic involvement is a very rare clinical finding in hypereosinophilic syndrome. Clinical evidence of hepatic involvement typified by hepatomegaly, abnormality of liver function tests and radiologic findings such as multiple intrahepatic lesions detected in ultrasonography (USG) and computed tomography (CT). We reported a case of hypereosinophilic syndrome presenting as only hepatic involvement.

The diagnostic efficacy of endoscopic mucosal resection (EMR) in gastric flat adenoma / 대한내과학회지

BACKGROUND: EMR is an alternative to surgical removal of superficial neoplastic lesions of the gastrointestinal tracts. The aim of this study is to assess the diagnostic efficacy of EMR in gastric flat adenoma. METHODS: Ninety five lesions of gastric flat adenoma removed by EMR in 89 patients were enrolled in this study at Kyungpook National University Hospital from January 1999 to June 2002. We have analysed diagnostic efficacy of EMR in gastric flat adenoma. RESULTS: Tubular adenoma were 78 cases (82.1%), tubular adenoma with high grade dysplasia were 16 cases (16.8%) and villous adenoma was 1 case (1.1%). Locations were antrum 57 cases (60.0%), body 22 cases (23.1%), angle 14 cases (14.7%), pylorus 1 case (1.1%) and cardia 1 case (1.1%). Among 95 lesions of gastric flat adenoma, 26 cases (27.4%) revealed upgraded histologic diagnosis between endoscopic biopsy and EMR. Twenty two lesions (37.3%) among 59 lesions that were 1cm size or more were upgraded in the histologic staging to carcinoma or high grade dysplasia, compared with 4 lesions (11.1%) among 36 lesions less than 1cm size (p<0.01). Eight lesions (50.0%) among 16 lesions diagnosed in tubular adenoma with high grade dysplasia were upgraded in the histologic staging to carcinoma, compared with 12 lesions (15.4%) among 78 lesions diagnosed in tubular adenoma (p<0.01). Bleeding was the only complication and occurred in 24 lesions (25.3%). CONCLUSION: EMR resulted in upgrading of the histologic staging to carcinoma or high grade dysplasia in 27.4% of gastric flat adenomas.

Endoscopic Treatment of Spontaneous Intramural Dissection of the Esophagus: A Case Report / 대한소화기내시경학회지

Intramural dissection of the esophagus is a rare esophageal disorder which reveals characteristic endoscopic and radiologic features. Some authors have recognized that this injury is an intermediate stage between a transmural esophageal rupture (Boerhaave's syndrome) and an esophageal mucosal tear (Mallory-Weiss syndrome). Presenting symptoms are sudden severe retrosternal pain, hematemesis, odynophagia, and dysphagia. The diagnosis is made by contrast esophagography, esophageal endoscopy, or both. Conservative management is usually successful. Surgery should be reserved for the cases of protracted disease or perforation with mediastinitis. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with a conservative management. Then we treated with an endoscopic incision of the septum between the true and false lumens using a needle type papillotome.

A Case of Multiple Myeloma with Multiple Intrahepatic Extramedullary Plasmacytomas / 대한혈액학회지

Plasma cell neoplasms of the liver include primary extramedullary plasmacytoma and a local manifestation of multiple myeloma. Extramedullary plasmacytoma of the liver in multiple myeloma is extremely rare although extramedullary involvement frequently occur in extramedullary sites such as lymph nodes, lung, pleura, gastrointestinal tracts, nervous system and spleen. We experienced a case of multiple myeloma with multiple intrahepatic extramedullary plasmacytomas which initially presented as metastatic cancer of the liver. Intrahepatic extramedullary plasmacytoma confirmed by ultrasono-guided liver biopsy, which disclosed numerous neoplastic plasma cell infiltration.

Hepatic Asialoglycoprotein Receptor Scintigraphy Using 99mTc - Galactosylated Serum Albumin ( GSA ): Biodistribution Study in Mice with Thioacetamide - induced Hepatic Injury / 대한간학회지

BACKGROUND/AIMS: Tc-DTPA-galactosylated serum albumin (GSA) is a new liver imaging agent that specifically binds to asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. To evaluate the usefulness of hepatic scintigraphy with Tc-GSA in the assessment of hepatic function, we have investigated serial changes in organ uptakes of Tc-GSA in mice with thioacetamide-induced hepatic injury and compared to changes in histology or levels of hepatic enzymes. MATERIALS AND METHODS: Acute hepatic injuries were induced by intraperitoneal injection of thioacetamide in ICR (Institute of Cancer Research) mice. Hepatic injuries were serially assessed by either light microscopic examination of liver slices or measurement of hepatic enzymes. The biodistribution of Tc-GSA was measured in liver and each excised organs using gamma counter. RESULTS: Hepatic injuries in light microscopic examination were not evident at 12 hours after injection of thioacetamide but resulted in maximal centrilobular necrosis and inflammation at 24 hours. These histologic changes were progressively improved upto 72 hours. Studied hepatic enzymes were elevated at 6 hours and reached to maximal level at 24 hours after administration of thioacetamide and declined progressively after then. Hepatic uptake of Tc-GSA was lowest at 6 hours after administration of thioacetamide and serially recovered until 72 hours. CONCLUSION: The degree in the decrease of hepatic uptake of Tc-GSA was precedent to either histologic changes or elevation of hepatic enzymes and correlated with the degree of hepatic daneges in acute hepatic injury. These findings suggest that hepatic scintigraphy using Tc-GSA can be used to detect early changes and serial assessment of hepatic function in acute hepatic injury.

Hepatic Asialoglycoprotein Receptor Scintigraphy Using 99mTc - Galactosylated Serum Albumin ( GSA ): Biodistribution Study in Mice with Thioacetamide - induced Hepatic Injury / 대한간학회지

BACKGROUND/AIMS: Tc-DTPA-galactosylated serum albumin (GSA) is a new liver imaging agent that specifically binds to asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. To evaluate the usefulness of hepatic scintigraphy with Tc-GSA in the assessment of hepatic function, we have investigated serial changes in organ uptakes of Tc-GSA in mice with thioacetamide-induced hepatic injury and compared to changes in histology or levels of hepatic enzymes. MATERIALS AND METHODS: Acute hepatic injuries were induced by intraperitoneal injection of thioacetamide in ICR (Institute of Cancer Research) mice. Hepatic injuries were serially assessed by either light microscopic examination of liver slices or measurement of hepatic enzymes. The biodistribution of Tc-GSA was measured in liver and each excised organs using gamma counter. RESULTS: Hepatic injuries in light microscopic examination were not evident at 12 hours after injection of thioacetamide but resulted in maximal centrilobular necrosis and inflammation at 24 hours. These histologic changes were progressively improved upto 72 hours. Studied hepatic enzymes were elevated at 6 hours and reached to maximal level at 24 hours after administration of thioacetamide and declined progressively after then. Hepatic uptake of Tc-GSA was lowest at 6 hours after administration of thioacetamide and serially recovered until 72 hours. CONCLUSION: The degree in the decrease of hepatic uptake of Tc-GSA was precedent to either histologic changes or elevation of hepatic enzymes and correlated with the degree of hepatic daneges in acute hepatic injury. These findings suggest that hepatic scintigraphy using Tc-GSA can be used to detect early changes and serial assessment of hepatic function in acute hepatic injury.

A Case of Anaplastic Large Cell Lymphoma Misdiagnosed as Pulmonary Tuberculosis / 결핵

Anaplastic large cell lymphoma(ALCL) is a recently recognized large cell lymphoma characterized by large pleomorphic cells, with prominent nucleoli, expressing the CD3O(Ki-1) antigen. It is often misdiagnosed as metasfatic carcinoma, malignant histiocytosis or Hodgkin's disease. Primary pulmonary ALCL is extremely rare although it frequently involves extranodal sites, e.g. skin, bone, gastrointestinal tract, soft tissue and lung. We report a case of ALCL suspected as primarily involving lung.

A Case of Relapsed Multiple Myeloma Presented as lntracranial Extramedullary Plasmacytoma / 대한혈액학회지

Intracranial plasmacytoma presented by extramedullary involvement of multiple myeloma is rarely reported. Neurologic complications by intracranial extramedullary plasmacytomas are cranial nerve palsy, visual disturbance, vertigo, nystagmus, headache, paralysis, mental change and etc. We experienced a case of relapsed multiple myeloma presented as intracranial extramedullary plasmacytoma. Brain magnetic resonance imaging(MRI) disclosed a large soft tissue mass involving the sphenoidal sinus and cavernous sinus which invaded optic chiasma, occulomotor nerve and pituitary gland. Relapsed multiple myeloma with intracranial extramedullary plasmacytoma was confined by trans-sphenoidal biopsy and urine electrophoresis. Neurologic complications of the patient was improved after cranial radiotherapy and systemic chemotherapy.

A Case of Epstein-Barr Virus Infection Presented as Evans Syndrome / 대한혈액학회지

Evans syndrome refer to autoimmune hemolytic anemia accompanied by thrombocytopenia. The etiologic factors of Evans syndrome are unknown but viral infections such as Epstein-Barr virus and cytomegalovirus are suggested. Epstein-Barr virus (EBV) infection is an acute illness characterized clinically by fever, sore throat, and lymphadenopathy; serologically by the transient positive heterophil antibody; and hematologically by mononuclear leukocytosis with atypical lymphocytosis. We experienced a case of Epstein-Barr virus infection presented as Evans syndrome. Epstein-Barr virus infection was diagnosed by positive heterophil antibody and EBV viral capsid antigen IgM. Autoimmune hemolytic anemia and immune thrombocytopenic purpura were completely resolved by steroid therapy.

A Case of Invasive Aspergillosis Involving Lung and Brain in Patient with Acute Leukemia / 대한혈액학회지

Invasive aspergillosis is a life-threatening infectious disease in immunocompromised patients. Aspergillus is an ubiquitous mold present as normal flora in paranasal sinus, nose, skin and lung. The most important determinant of infection is the immune status of the patient, not the intensity of exposure. In acute leukemia and bone marrow transplantation, prolonged neutropenia is probably the most important predisposing factor. We experienced a case of invasive aspergillosis involving lung and brain in patient with acute leukemia during remission-induction chemotherapy. Invasive aspergillosis involving lung and brain was diagnosed by sputum culture, computed tomography (CT) guided lung biopsy and brain magnetic resonance imaging (MRI). Early diagnosis and prompt treatment for invasive aspergillosis are essential for lowering mortality in immunocompromised patients.

Scintigraphic Evaluation of Hematologic Diseases with Tc-99m Labeled Antigranulocyte Antibody / 대한혈액학회지

BACKGROUND: Bone marrow scintigraphy using Tc-99m labeled antigranulocyte antibody has been reported to be able to evaluate bone marrow status. We have performed antigranulocyte antibody scan and hematopoietic activity in order to identify bone marrow status in patients with hematologic diseases. METHODS: Sixty-nine patients were enrolled in this study from October 1995 to May 1997. Images were acquired at four and twenty-four hour after injecion of 20mCi 99mTc labeled antigranulocyte antibody (BW 250/183). Patients were divided into four groups according to scintigraphic findings, those with increased marrow uptake (marrow expansion), decreased uptake, focal defect and normal findings. RESULTS: Leukemias and myelodysplastic syndromes frequently showed bone marrow expansion. Seventeen of 21 patients (81%) with AML, and all of ALL and biphenotypic leukemias showed bone marrow expansion. Five of 6 with CML, all Hodgkin's diseases and 3 of 4 MDS also showed marrow expansion. In contrast, all aplastic anemia patients showed decreased marrow uptake, and extra-axial noted in 2 patients with aplastic anemia. All of ten patients with multiple myeloma and 2 of 4 (50%) with Hodgkin disease showed focal marrow defects. Three of 11 with non-Hodgkin lymphoma and 4 of 21 with AML also showed focal marrow defects. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibody has clearly demonstrated the distribution of bone marrow in various hematologic diseases. Thus, it seems to be a useful method in the assessment of bone marrow status in patients with hematologic disease.

Clinical Characteristics and Therapeutic Efficacy of Low Dose Cytarabine in High Risk Myelodysplastic Syndrome / 대한혈액학회지

BACKGROUND: High risk myelodysplastic syndrome has various clinical courses and refractoriness to various therapies. It is important to analyze clinical characteristics and therapeutic responses in high risk myelodysplastic syndrome. METHODS: Sixty nine cases of primary high risk myelodysplastic syndrome at diagnosis were enrolled in this study at Kyungpook National University Hospital and Taegu Hyosung- Catholic University Hospital from January 1987 to June 1996. We have investigated the clinical characteristics and therapeutic outcomes after low dose cytarabine chemotherapy. RESULTS: 1) The median age of the patients was 48 years. Male to female ratio was 2.1:1. The each numbers of RAEB, CMML and RAEB-T patients were 38, 11 and 20, respectively. 2) The most common chief complaint was dyspnea on exertion. General weakness, fever and dizziness were also observed. The most common physical finding was pallor. 3) The peripheral blood findings showed anemia in 65 cases (94.2%), thrombocytopenia in 64 cases (92.8%), leukopenia in 32 cases (46.4%) and pancytopenia in 26 cases (37.7%). 4) Twenty two cases transformed to acute myelogenous leukemia during the follow-up periods. Chemotherapy was done in 18 cases among 22 cases of transformed acute myelogenous leukemia. Complete remission was achieved in 3 cases (16.7%), partial remission in 4 cases (22.2%) and no response in 11 cases (61.1%). 5) Forty seven cases were treated by low dose cytarabine chemotherapy. Complete response was achieved in 11 cases (23.4%), partial response in 13 cases (27.7%) and no response in 23 cases (48.9%). Median duration of complete response was 12 weeks. 6) We made score system, which based on Sanz score and Gattermann score, according to age, hemoglobin, platelet and bone marrow blast. Overall survival was higher in group A (score or = 6). Complete response of low dose cytarabine chemotherapy was higher in group A than group B but overall survival according to low dose cytarabine chemotherapy was not different in group A and group B. CONCLUSION: Low dose cytarabine chemotherapy was not effective in survival benefit. Score system according to prognostic factors was important to predict therapeutic response and prognosis. In the future, more intensive therapeutic plan and analysis of prognostic factors should be considered.

Bone Marrow Scintigraphy with Antigranulocyte Antibody in Multiple Myeloma: Comparison with Simple Radiography and Bone Scintigraphy / 대한핵의학회잡지

PURPOSE: Simple X-ray study and bone scan have limiitations for early diagnosis of bone or bone marrow lesions in multiple myeloma. The purpose of this study was to evaluate the diagnostic usefulness of bone marrow imrnunoscintigraphy using anti-granulocyte monoclonal antibody for the evaluation of bone involvement I:n multiple myeloma. MATERIALS AND METHODS: In 22 patients (Male: 15, Female: 7) with multiple myeloma, we perforrned whole-body immunoscintigraphy using ' Tc-labelled antigranulocyte antibody (BW 250/183, Scintimum Granulozyt CIS, France) and compared the findings with those of simple bone radiography and "" Tc-MDP bone scan. Abnonnal findings in bone marrow scintigraphy were, considered to be present in case of expansion of peripheral bone marrow or focal photan defect in axial bones. RESULTS: Marrow expansion was noted in 15 of 22 patients (68%). Focal photon defects were found in 18 patients (82%). While one (33%) of 3 patients with Stage II disease showed focal defects in bone marrow scan, abnormal focal defects were observed in 17 of 19 (90%) patients with Stage III. Among 124 focal abnormal sites which were observed in bone marrow scan, bone scan or simple bone radiography, bone rnarrow scan detected 92 sites (74%), whereas 82 sites (66%) were observed in simple bone radiography(58 sites, 47%) or bone scan(40 sites, 32%). Fifty-one (41%) out of 124 bone lesions were detected by bone marrow scan only, and located mostly in thoracolumbar spine. CONCLUSION: Bone marrow scan using "" Tc-labelled antigranulocyte antibody seems to be a more sensitive procedure for the detection of pathologic bone lesions than simple bone X-ray ar bone sean in patients with multiple myeloma.

A Case of Invasive Aspergillosis Characterized by the Formation of Large Bronchial Cast in Patient with Acute Myelogenous Leukemia / 대한암학회지

Invasive aspergillosis is a life-threatening infectious disease in immunocompromised patients. Prolonged neutropenia is the most important predisposing factor. Bronchial casts are generally associated with pneumonia, bronchiectasis, asthma, chronic bronchitis, allergic bronchopulmonary aspergillosis and mucoviscidosis. We experienced.a case of invasive aspergillosis characterized by the formation of large bronchial cast in patient with acute myelogenous leukemia(AML) during induction chemotherapy. The patient expectorated a large bronchial cast without airway obstruction. Aspergillus was disclosed in intraluminal surface of bronchial cast. The patient's conditions improved after amphotericin B therapy and expectoration of a large bronchial cast.