• Clinical and Experimental Reproductive Medicine
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• v.37 no.3
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• pp.191-198
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• 2010

Uterine myomas are heterogeneous tumors in composition, size, location, and number; variation in any of these factors could possibly alter the effect on a woman's fertility status. The effect of myomas on fertility has been the subject of many studies. However, a definitive answer is still missing. The location and size of the myomas are the two parameters that influence the success of a future pregnancy. Subserosal myomas seem to have little effect on reproductive outcome. Myomas that compress the uterine cavity with an intramural portion and submucosal myomas significantly reduce pregnancy rates, and should be removed before assisted reproductive techniques are performed. Patients with intramural myomas also may have a poorer reproductive outcome, but the lacks of quality evaluations make this conclusion tenuous at best. Removal of myomas with an intra-cavitary component seems to be of benefit. However there are as yet no data to support myomectomy in the treatment of intramural myomas to improve fertility outcomes. Treatment modality for myomas located at intramural sites should be determined according to clinical status of the patient and doctor's experience.

• Journal of Gastric Cancer
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• v.18 no.4
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• pp.409-416
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• 2018

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.253-260
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• 2015

Purpose: The aim of the present study was to investigate the clinical features and outcome of eosinophilic gastroenteritis (EGE) in children. Methods: Our study enrolled 24 children who were diagnosed with EGE from 1993 to 2014 at the Department of Pediatrics, Seoul National University Children's Hospital. The patients' clinical manifestations, treatments, and outcomes were reviewed from the medical records. Results: The mean age at diagnosis was 5.3 years. Most patients had gastrointestinal symptoms including diarrhea (54.2%) and abdominal pain (45.8%). Peripheral eosinophilia was present in 91.7% of the patients. Thirteen patients (54.2%) showed anemia, and 15 patients (62.5%) had hypoalbuminemia. EGE was classified as mucosal, subserosal, or muscular in 75.0%, 20.8%, and 4.2% of cases, respectively. Three patients showed gastroduodenal ulcers upon endoscopic analysis. A history of allergy was reported in 13 patients, including atopic dermatitis, allergic rhinitis, and asthma. Five patients (20.8%) improved with food restrictions. Among the 19 patients treated with steroids, 11 (57.9%) discontinued steroid treatment without subsequent relapse, 4 (21.1%) relapsed after ceasing steroid treatment, and 4 (21.1%) showed no response to steroids. Two patients who were resistant to steroids underwent therapeutic surgery. The presence of gastroduodenal ulcers was significantly associated with relapse and steroid resistance. Conclusion: A high suspicion of EGE is warranted when children have nonspecific gastrointestinal symptoms and peripheral eosinophilia. Most patients improved with food restrictions or steroid treatment, although one-third of patients showed a relapse or steroid resistance.

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.272-276
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• 2004

Purpose: The incidence of nodal metastases is as low as 2 to $20\%$ in early gastric cancer, so there is a trend to lessen the extent of surgery. In addition, the adequate range for a lymphadenectomy is controversial, especially in early gastric cancer. In this study, we tried to find the minimal range for a lymphadenectomy by analyzing sentinel-node and solitary lymph-node metastases in gastric cancer. Materials and Methods: The total of 78 patients who underwent a curative gastrectomy with a D2 lymphadenectomy for early gastric cancer between 2000 and 2002 in the Department of Surgery, Yonsei University, Seoul, Korea, were included for the evaluation of sentinel-node metastases.. After a laparotomy, 25 mg of indocyanine green was mixed in 5 ml of normal saline, and all the dye was injected into the subserosal layer around the primary tumor. All nodes stained within 5 minutes were marked. In addition, a total of 141 patients, who underwent a curative gastrectomy between 1997 and 2001 at the Department of Surgery, Yonsei University, Seoul, Korea, were analyzed for solitary lymph- node metastases. Results: Among the 78 patients, sentinel nodes were detected in 69 patients ($88.5\%$). The sentinel nodes in 60 cases ($87.0\%$) were located in the perigastric area. However, 9 cases ($13.0\%$) had sentinel nodes in the N2 group. In the 141 cases that had a solitary metastatic node, 125 cases ($88.6\%$) demonstrated the metastatic lymph node in the perigastric area, and 16 cases ($11.4\%$) showed that the metastatic node in the N2 group. Conclusion: Taken together, removal of a perigastric lymph node could miss early metastases in gastric cancer, so a D1 lymphadenectomy should not be the minimal range of dissection if a lymphadenectomy is necessary. (J Korean Gastric Cancer Assoc 2004;4:272-276)

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.206-212
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• 2007

Purpose: The number of laparoscopy assisted distal gastrectomies (LADG) is gradually increasing for the treatment of early gastric cancer (EGC) patients as a surgical modality for improving quality of life. However, there are few reports on laparoscopy-assisted total gastrectomy (LATG), mainly because this procedure is performed relatively infrequently, and the procedure is more complicated than LADG. This study was performed to evaluate the technical feasibility, safety, and surgical results of LATG with lymphadenectomy through a review of our experience. Materials and Methods: From July 2003 to June 2007, 77 LATG with Roux-en-Y esophagojejunostomy were performed for patients with a preoperative diagnosis of EGC. The clinicopathological features and surgical outcomes were analyzed. Results: There were 49 males and 28 females in the study with a mean age of 61 years (range $30{\sim}85$ years). The mean operation time was 210 minutes (range $100{\sim}400$ minutes) and the operation time was gradually decreased as the case numbers increased. There were 13 operative morbidities (16.9%) and no operative mortalities. The restoration of bowel motility was noted at 3.2 postoperative days; a soft diet was started at 4.4 postoperative days and the duration of hospital stay was 10 days. There were 20 mucosal lesions, 32 submucosal lesions, 15 proper muscle lesions, 7 subserosal lesions and 3 serosal lesions. A total of 20 patients were treated by D2 lymph node dissection, 55 patients were treated by D1+$\beta$ lymph node dissection, and two patients were treated by D1+$\alpha$ lymph node dissection. The mean number of retrieved lymph nodes was 42 (range $11{\sim}86$). Lymph node metastases were noted in 12 patients. Conclusion: This study indicated LATG could be applied safely and effectively for patients with EGC. However, a prospective study comparing laparoscopy-assisted versus open gastrectomy for short-term and long-term surgical outcome is needed.