• Journal of Gastric Cancer
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• 제6권2호
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• pp.69-75
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• 2006

목적: 본 연구는 Saccharomyces boulardii가 위암으로 위절제술을 받은 환자에서 위장관 증상과 영양상태를 호전시키는지 평가하고자 하였다. 대상 및 방법: 2002년 12월부터 2004년 7월까지 서울대학교병원 외과에서 조기위암으로 위절제술을 받은 환자 90명을 대상으로 하여 시험군과 위약군(대조군)을 무작위 배정하여 12주 복용하게 하였다. 투약 전, 투약 12주 후, 투약종료 4주 후에 담당의사와 환자에 눈가림법을 적용하여 두 군의 위장관 증상과 영양 지표(혈액검사 및 체위)를 비교하였다. 결과: 남녀 비는 2.3 : 1이었고 평균 연령은 $56.3{\pm}10.2$세였다. 수술은 위아전절제술이 69예, 위전절제술이 21예였다. 연구가 시작된 후 중도 탈락한 환자가 14명(15.6%)이었고 이 중 시험군은 5명이었다. 위장관 증상에 있어서 시험군과 대조군 간의 의미 있는 차이는 보이지 않았다(P>0.05). 전체적으로(n=76)투약 종료 4주 후의 혈중 알부민이 시험군에서 더 높게 나왔다(P=0.046). 위아전절제술과 위전절제술을 나누어 비교하였을 때, 위아전절제술을 받은 환자들(n=57)에서 역시 투약 종료 4주 후의 알부민이 시험군에서 더 높게 나왔다(P=0.049). 결론: 위암으로 위절제술을 받은 환자에서 Saccharomyces boulardii를 투여한 시험군에서 혈중 알부민이 높게 나와 Saccharomyces boulardii가 위절제술 후 영양을 호전시키는데 도움을 줄 수 있겠다.

• 대한지역사회영양학회지
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• 제26권4호
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• pp.280-295
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• 2021

Objectives: This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools. Results: We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools. Conclusions: Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

• 대한지역사회영양학회지
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• 제27권3호
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• pp.205-222
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• 2022

Objectives: This study examined the characteristics of patients according to nutritional status assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools. Methods: A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 were included. The patients were categorized into malnutrition and normal status according to five nutritional screening tools one month after surgery. The Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each two screening tools were calculated. Results: Malnutrition was observed in 86.24% of patients based on the PG-SGA and 85.82% based on the NUTRISCORE. When NRI or CONUT were applied, the proportions of malnutrition were < 30%. Patients with malnutrition had lower intakes of energy and protein than normal patients when assessed using the PG-SGA, NUTRISCORE, or NRI. Lower levels of albumin, hemoglobin, total lymphocyte count, and total cholesterol and longer postoperative hospital stays were observed among patients with malnutrition compared to normal patients when NRI, PNI, or CONUT were applied. Relatively high agreement for NUTRISCORE relative to PG-SGA was found; the sensitivity was 90.86%, and the AUC was 0.78. When NRI, PNI, and CONUT were compared, the sensitivities were 23.72% for PNI relative to NRI, 44.53% for CONUT relative to NRI, and 90.91% for CONUT relative to PNI. The AUCs were 0.95 for NRI relative to PNI and 0.91 for CONUT relative to PNI. Conclusions: NUTRISCORE had a high sensitivity compared to PG-SGA, and CONUT had a high sensitivity compared to PNI. NRI had a high specificity compared to PNI. This relatively high sensitivity and specificity resulted in 77.00% agreement between PNI and CONUT and 77.94% agreement between NRI and PNI. Further cohort studies will be needed to determine if the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

• Nutrition Research and Practice
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• 제16권5호
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• pp.604-615
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• 2022

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1-77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01-1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08-2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49-3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27-3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36-3.87), ICU admission (HR = 1.97; 95% CI, 1.17-3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59-19.43; stage III: HR = 16.20; 95% CI, 4.99-52.59) were significantly associated with CSS. CONCLUSIONS: Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

• Child Health Nursing Research
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• 제22권4호
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• pp.326-335
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• 2016

Purpose: It is crucial to provide adequate enteral nutrition for postoperative recovery, wound healing and normal growth in infants in pediatric cardiac ICUs. This study was done to develop a feeding protocol using the vaso-active inotropic (VAI) score and to evaluate the impact of nutritional outcomes following the new feeding protocol for infants who underwent cardiac surgery. Methods: This study consisted of three phases. First, a feeding protocol was developed based on a literature review. Second, ten experts rated the content validity. Third, a comparison study was conducted to evaluate the impact of the new feeding protocol. Data were analyzed using SPSS Version 20. Results: Twenty-nine infants were enrolled in the pre-protocol group, and 22 infants in the post-protocol group. Patients in the 2 groups were similar. Time to reach feeding goal was significantly decreased from 56.0 (27-210) hours to 28.5 (10-496) hours in the post-protocol group (Z=-4.22, p<.001). Level of enteral feeding knowledge among nurses increased significantly after implementation of the protocol. Conclusion: The feeding protocol using VAI score facilitates the achievement feeding goal to decrease feeding interruptions and help nurses in their practice. Larger studies are necessary to examine clinical outcomes following the implementation of this feeding protocol.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제6권1호
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• pp.39-46
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• 2003

목 적: EBV의 초감염과 면역억제의 강도는 소아 간이식에서 PTLD 발생의 주요 위험인자로 알려져 있다. 삼성서울병원에서 6년간 경험한 PTLD 5례의 임상양상을 분석해보고자 한다. 대 상: 1996년부터 2002년 6월까지 41례의 소아간이식 환아를 대상으로 하였는데 이중 7명이 사망하였고, PTLD로 사망한 1명을 포함한 35명을 대상으로 분석하였다. 방 법: 공여자의 EBV 항체가 양성이고 수혜자가 음성일 경우 고위험군으로, 그 외의 경우를 저위험군으로 정의하였다. 위험군 분류, 면역억제제 종류, 간이식이 행하여진 나이, 수술 후 PTLD 진단까지의 기간, 수술 후 EBV 항체의 양전 시기, 거부반응에 대한 치료 여부, PTLD의 증상들인 발열, 설사, 빈혈, 장출혈 식욕부진 저알부민혈증 등의 발현 여부를 후향적으로 조사하였다. 결 과: 1) PTLD는 전체 소아 간이식 환아 41명 중 5명에서 발생하였다(12.2%). 고위험군은 16명으로 이 중 5명(31.3%)에서 PTLD가 발생하였고 저위험군 19명중에서는 한 명도 발생하지 않았다. 2) 사망례를 제외한 4명은 tacrolimus로 면역억제 치료를 받았으며 수술 당시 나이는 평균 10.8개월이었고 수술 후 PTLD 진단까지 평균 9.8개월이 걸렸 다. EBV 양전 시기는 수술 후 평균 6개월이었다. 3) 사망례를 포함한 5명 중 3명에서 PTLD 진단 이전에 간이식 거부반응이 있었고 스테로이드 pulse 치료 등 면역억제를 증가시키는 치료를 행하였었다. 4) 한 명에서 쉰 목소리 증상이 발견되어 조직검사 상 후두 PTLD와 장 PTLD로 진단하였고 나머지 네 명은 모두 혈변이 있었으며 대장 조직검사 상 장 PTLD로 진단하였다. 5) 빈혈과 저알부민 혈증은 모든 환아에서 나타나고 있었고 발열, 설사, 장출혈이 5명 중 4명에서 보였으며 식욕부진은 5명 중 3명에서 나타났다. 결 론: 10%가 넘는 발병률을 보이는 PTLD는 소아 간이식 후 매우 중요한 합병증으로서 특히 EBV의 고위험군에서 31%에 이르는 발병률을 가지고 있는 바 이들에 대하여 EBV 상태와 면역억제 유지에 대한 철저한 대비가 있어야 할 것으로 생각된다. 특히 빈혈, 저알부민혈증, 발열, 설사, 장출혈 등이 동반할 때에는 PTLD를 의심해 볼 수 있다. PTLD의 공통적인 발병양상으로는 첫째, 공여자가 EBV 양성이고 수혜자가 음성이면서, 둘째, EBV가 수술 후 6개월 경 양전되며, 셋째, 1세 전후에 수술을 시행하고 넷째, 간이식 거부반응을 겪으면서 면역억제의 강도가 높아졌을 경우 등이다.

• Journal of Chest Surgery
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• 제49권2호
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• pp.99-106
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• 2016

Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

• Journal of Gastric Cancer
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• 제2권1호
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• pp.20-25
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• 2002

Purpose: Chylous ascites is an accumulation of lymphatic fluid within the peritoneal cavity due to trauma or to an obstruction on the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. It is frequently reported after retroperitoneal dissections and results in high morbidity and mortality. However, there have been few report of such a complication following a radical gastrectomy. Therefore, we review the clinical analysis and treatment of chylous ascites based on our experience. Materials and Methods: From July 1992 to June 2001, we treated 13 cases of chylous ascites after operations for gastric cancer. We reviewed medical charts of those patients retrospectively. Results: The incidence of chylous ascites after operations for gastric cancer was $0.83\%$ (13/1552). The mean time from ingestion of a meal after the operation to the development of symptoms was 2 days (range: $1\∼6$ days). Conservative treatment by fasting, total parenteral nutrition (TPN), and repeated paracentesis was successful in all patients. The mean time from diagnosis to complete resolution was 25 days (range: $2\∼105$ days). Conclusion: Chylous ascites should be considered in any patient with a typical milky color of drainage who has recently undergone radical gastrectomy. Treatment with fasting, TPN, and repeated paracentesis usually is successful.

• Journal of Yeungnam Medical Science
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• 제15권1호
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• pp.67-74
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• 1998

Successful management of duodenal obstruction in newborn infant implies not only satisfactory nutrition but also achievement of normal growth. To aid early diagnosis and management, we evaluated the diagnostic methods, operative interventions and clinical characteristics of thirty-nine infants with congenital duodenal obstructions. In the 11-year period from July 1986 through June 1997, thirty-nine patients with congenital duodenal obstruction (23 males and 16 females) were treated and reviewed at the Department of Pediatric Surgery, Yeungnam University Hospital. The ratio of male to female was 1.4:1, and 29 cases(74.1%) among total 39 patients were newborn. There were 5 premature patients and 16 patients of small for gestational age. The most common causes of the congenital duodenal obstruction was malrotation (26 cases, 66.7%) and followed by annular pancreas (9 cases, 23.1 %), type 1 atresia (3 cases, 7.7%) and wind-sock anomaly (1 case, 2.6%). Common symptoms were vomiting, abdominal distention, jaundice. Plain abdominal X-ray study combined with upper gastrointestinal series was the most commonly used diagnostic method. The operative procedures were performed by same pediatric surgeon utilizing Ladd's procedure in 26, duodenoduodenostomy in 8, duodenojejunostomy in 4, excision of wind-sock membrane in 1. A total of 15 associated congenital anomalies were found in 9 patients. Postoperative complications occurred in 13(33.3%). Overall mortality was 2.6%(1/39). Bilious vomiting and plain abdominal radiologic study were most useful for the diagnosis of congenital duodenal obstruction. Early diagnosis and operative intervention were important to prevent complications such as sepsis and peritonitis.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.296-301
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• 2023

Background: A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. Methods: We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. Results: The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI], -32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, -2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. Conclusions: Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I.