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A Novel Approach for Gastric Cancer Staging in Elderly Patients Based on the Lymph Node Ratio

  • Park, Joonseon;Jeon, Chul Hyo;Kim, So Jung;Seo, Ho Seok;Song, Kyo Young;Lee, Han Hong
    • Journal of Gastric Cancer
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    • v.21 no.1
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    • pp.84-92
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    • 2021
  • Purpose: To date, no studies have been performed on staging based on the lymph node ratio (LNR) in elderly patients with gastric cancer who may require limited lymph node (LN) dissection due to morbidity and tissue fragility. We aimed to develop a new N staging system using the LNR in elderly patients with gastric cancer. Materials and Methods: The present study included patients aged over 75 years who underwent curative gastrectomy between January 1989 and December 2018. Clinicopathological data including the number of retrieved and metastatic LNs were collected and the LNR values were obtained (LNR = the number of metastatic LNs/the number of retrieved LNs). Eleven LNR groups with intervals of 0.1 were divided into four stages based on the inflection points at which the hazard ratio (HR) increased. Survival analysis was performed to evaluate the prognostic value of the LNR. Results: The four LNR stages included LNR0 (n=364), LNR1 (n=128), LNR2 (n=103), and LNR3 (n=10). In the multivariate analysis, both N staging and LNR staging exhibited significant prognostic values for predicting survival outcomes. However, the incremental change in the hazard ratio (HR) between consecutive stages was greater for the LNR staging than for the N staging (HRs: 1.607, 2.758, and 3.675 for N staging; 1.583, 3.514, and 10.261 for LNR staging). Conclusions: LNR staging is more useful than N staging in predicting the prognosis in elderly patients with gastric cancer and may be used as a complement or alternative to N staging.

Aortocoronary Bypass Surgery; with Noncardioplegic Myocardial Protection (관상동맥 우회술;심마비액을 사용하지 않은 수술방법)

  • Seo, Dong-Man;Song, Myeong-Geun
    • Journal of Chest Surgery
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    • v.26 no.4
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    • pp.276-281
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    • 1993
  • During the 3 years through December 1992, 118 cases of coronary bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. They consisted of 80 males and 38 females with the mean age of 59. History of myocardial infarction was noted in 23 cases[20%], congestive heart failure in 11[10%], left ventricular aneurysm in 6, postinfarct VSD in 2, and mitral regurgitation in 1. The angina was stable in 13 cases, and unstable in 104 cases[89%]. Left main stem disease were 41 cases[35%], triple vessel 36[31%], double vessel 30[26%] and single vessel involvement[LAD] in 10. We performed 335 distal bypasses out of 117 cases, with single bypass in 9, double 29, triple 52, quadruple 23, and quintuple 4. Myocardial protections were cardioplegia in 29 and intermittent aortic occlusion 79 and continuous aortic perfusion 7. The ischemic time per graft was 13 minutes[intermittent aortic occlusion group] and 20 minutes [cardioplegia group] respectively, and the mean number of graft per patient is 2.85. Early mortality was 6.8% [8/117]. If we exclude the patients with LV aneurysm, the surgical mortality could be downed to 4.5% [5/111]. The causes of deaths were cardiogenic shock[6], aortic dissection[1], and neurologic complication[1]. We conclude that noncardioplegic myocardial protection may be equally beneficial or sometimes advantageous to cardioplegic technique in aortocoronary bypass graft surgery.

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A Morphological Analysis of the Facial Nerve in Korean Fetuses and Stillborn Infants

  • Lee, Won-Tae;Chung, Youn-Young;Kim, Seok-Won
    • Journal of Korean Neurosurgical Society
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    • v.40 no.6
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    • pp.445-449
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    • 2006
  • Objective : The accurate anatomy of the facial nerve is essential for successful surgical outcome. The purpose of the present study is to know such information on the facial nerve from a series of specimens. Methods : This study is based on cadaveric dissection of 41 Korean fetus and stillborn infant and describes anatomical variations of the peripheral branches of the facial nerve that pose a importance in a number of neruosurgical procedure. Results : The branching patterns were classified into six types according to modified Davis classification : the frequencies of occurrence were : type I, 4.9%; type II, 24.4%; type III, 34.1%; type IV, 19.5%; type V, 12.2%; and type VI, 4.9%. Types II, III and IV together accounted for almost 80% of the specimens. Conclusion : Compared to previous adult and western stillborn fetus cadaveric studies, there was no significant difference in the percentage of the types between the subjects in the present study, similar pattern and anatomic distribution.

Evaluation of The Neck Mass (경부종물의 진단)

  • Song, Kei-Won;Yoon, Seok-Keun;Choi, Byung-Heun
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.1-11
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    • 1986
  • As public awareness of the various warning signs of malignancy increases, so does the concern evoked by the self identified finding of mass in the head and neck area. Not all the palpable masses are always significantly abnormal, but any nontender mass especially to the adult is significant enough to warrent further full investigation and follow up, the object of which should be to determine the possibility of malignancy and urgency of treatment. Approach to the diagnosis of the neck mass is so important in that it affects decision regarding further evaluation would lead to the determination of the most efficacious mode of therapy, eventually to the good prognosis. So, it should be emphasized that approach to the diagnosis of neck mass should be planned, systematic and thorough, this begins with the taking careful history following performance of complete examination of the head and neck especially to the nasopharynx, tongue base, pyriform sinus, palatine tonsil and larynx. Then a number of laboratory and radiologic studies are available, following triple endoscopy under general anesthesia and blind biopsy if needed. The most important rule to keep is that any biopsy procedures should be delayed to the last modality of effort to the diagnosis and if it should be done, under the plan of radical neck dissection.

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Determination of Sexual Problems of Turkish Patients Receiving Gynecologic Cancer Treatment: a Cross-sectional Study

  • Demirtas, Basak;Pinar, Gul
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.16
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    • pp.6657-6663
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    • 2014
  • Background: The present study aimed to determine the prevalence and types of sexual problems of Turkish patients receiving gynecologic cancer treatment. Materials and Methods: A cross-sectional convenience sample of 168 women completed the Index of Female Sexual Function (IFSF) and a Patient Identification Form in a hospital in Ankara, Turkey. Mean IFSF scores of the patients were low ($15.7{\pm}5.72$, out of a possible 45), indicating high rates of sexual problems. Results: Women frequently reported problems with dyspareunia (97.1%), vaginal dryness (97.6%), decreased sexual desire (91.1%), and difficulties of sexual arousal (92.9%) related with the cancer treatment process. They reported increased sexual problems following the period of treatment as compared to before treatment (p<0.05). Sexual dysfunction was associated with low educational and income levels, advanced age, TAH-BSO-LND surgery (total abdominal hysterectomy-bilateral salphingoopherectomylymph node dissection), experiencing side effects of chemotherapy, receiving chemotherapy in addition to surgery and radiotherapy (CT+RT+Surgery), and having a large number of chemotherapy cycles (p<0.05). Conclusions: Patients hoped for and expected counseling from healthcare professionals about their sexual functioning in relation to cancer treatments. Nurses and physicians can help to improve the overall quality of life for gynecologic cancer patients through sexual counseling.

Feasibility and Safety of Totally Laparoscopic Radical Gastrectomy for Advanced Gastric Cancer: Comparison with Early Gastric Cancer

  • Lee, Seungyeob;Lee, Hayemin;Lee, Junhyun
    • Journal of Gastric Cancer
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    • v.18 no.2
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    • pp.152-160
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    • 2018
  • Purpose: Totally laparoscopic gastrectomy (TLG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. This study aimed to compare the oncologic feasibility and technical safety of TLG for AGC versus early gastric cancer (EGC). Materials and Methods: Between 2011 and 2016, 535 patients (EGC, 375; AGC, 160) underwent curative TLG for gastric cancer. Clinicopathologic characteristics and surgical outcomes of both patient groups were analyzed and compared. Results: Patients with AGC required a longer operation time and experienced more intraoperative blood loss than those with EGC did. However, patients from both the AGC and EGC groups demonstrated similar short-term surgical outcomes such as postoperative morbidity (14.4% vs. 13.3%, P=0.626), mortality (0% vs. 0.5%, P=0.879), time-to-first oral intake (2.7 days for both groups, P=0.830), and postoperative hospital stay (10.2 days vs. 10.1 days, P=0.886). D2 lymph node dissection could be achieved in the AGC group (95%), with an adequate number of lymph nodes being dissected ($36.0{\pm}14.9$). In the AGC group, the 3-year overall and disease-free survival rates were 80.5% and 73.7%, respectively. Conclusions: TLG is as safe and effective for AGC as it is for EGC.

Genomic Tools and Their Implications for Vegetable Breeding

  • Phan, Ngan Thi;Sim, Sung-Chur
    • Horticultural Science & Technology
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    • v.35 no.2
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    • pp.149-164
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    • 2017
  • Next generation sequencing (NGS) technologies have led to the rapid accumulation of genome sequences through whole-genome sequencing and re-sequencing of crop species. Genomic resources provide the opportunity for a new revolution in plant breeding by facilitating the dissection of complex traits. Among vegetable crops, reference genomes have been sequenced and assembled for several species in the Solanaceae and Cucurbitaceae families, including tomato, pepper, cucumber, watermelon, and melon. These reference genomes have been leveraged for re-sequencing of diverse germplasm collections to explore genome-wide sequence variations, especially single nucleotide polymorphisms (SNPs). The use of genome-wide SNPs and high-throughput genotyping methods has led to the development of new strategies for dissecting complex quantitative traits, such as genome-wide association study (GWAS). In addition, the use of multi-parent populations, including nested association mapping (NAM) and multiparent advanced generation intercross (MAGIC) populations, has helped increase the accuracy of quantitative trait loci (QTL) detection. Consequently, a number of QTL have been discovered for agronomically important traits, such as disease resistance and fruit traits, with high mapping resolution. The molecular markers for these QTL represent a useful resource for enhancing selection efficiency via marker-assisted selection (MAS) in vegetable breeding programs. In this review, we discuss current genomic resources and marker-trait association analysis to facilitate genome-assisted breeding in vegetable species in the Solanaceae and Cucurbitaceae families.

Surgical Analysis for Patients with Resected $N_2$ Lung Cancer (절제된$N_2$ 폐암환자의 생존율 분석)

  • Lee, Jin-Myeong;Park, Seung-Il;Son, Gwang-Hyeon
    • Journal of Chest Surgery
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    • v.26 no.12
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    • pp.934-939
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    • 1993
  • Mediastinal lymph node involvement [N2 disease] is generally accepted as an important factor influencing the outcome of patients with lung cancer.The long-term survival rates of completely resected patients with N2 disease are frequently reported from 15% to 30%.To improve the management and the outcome of patients with resectable N2 disease, we analyzed the survival rates and the prognostic factors for resected N2 lung cancer. Between August 1989 and September 1993, we experienced 27 patients with N2 disease of 115 surgically treated lung cancer at the Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University Medical School. Of these 27 N2 disease 4 had only an exploratory thoracotomy, and 23 underwent pulmonary resection by pneumonectomy[15], bilobectomy[3], lobectomy[4] and sleeve lobectomy[1].All of resected 23 patients received postoperative adjuvant chemotherapy[3], radiotherapy[2] or combined chemo-radiotherapy[18].Complete follow-up was obtained in 23 patients and median survival was 22 months and overall 1-year and 2-year survival rates by Kaplan-Meir method were 65 % and 45 %, respectively. Survival differences according to histology, tumor location, number of positive nodal station and operative method were not significant, statistically. Conclusively, we think that in resectable N2 lung cancer, complete tumor resection and mediastinal lymph node dissection, and postoperative adjuvant therapy should be done to improve the survival.

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The Clinical Implications of Poly Implant Proth$\grave{e}$se Breast Implants: An Overview

  • Wazir, Umar;Kasem, Abdul;Mokbel, Kefah
    • Archives of Plastic Surgery
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    • v.42 no.1
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    • pp.4-10
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    • 2015
  • Mammary implants marketed by Poly Implant Proth$\grave{e}$se (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Proth$\grave{e}$se", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

Comparison of Mechanical and Enzymatic Methods for the Isolation of Bovine Ovarian Follicles

  • Lim, Hyun-Joo;Kim, Dong-Hoon;Im, Gi-Sun;Lim, Jeong-Mook
    • Journal of Embryo Transfer
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    • v.25 no.2
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    • pp.93-96
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    • 2010
  • The isolation of preantral follicles from the ovaries of bovine was performed under mechanical and enzymatic methods. A significant increase in the total number of follicles retrieved was detected when tissue chopper was used. Micro-dissection could supply good quality, larger sized follicles (400 to $700{\mu}m$) but with the lowest yield ($9.0{\pm}1.0$). The isolated preantral and early antral follicles were cultured for 14 days. Follicles isolated by the mechanical method had a greater growth during a culture period than follicles collected enzymatically. Morphologically normal bovine oocytes from early antral follicles after 14 days culture were 59.6% after culture and after 24 h of maturation culture, 12.9% of in vitro-grown oocytes reached the second metaphase. In conclusion, this study showed that mechanical method can be used effectively to isolate intact preantral follicles from bovine ovaries.