Sun-Youl Ryu

Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly

The aim of this study was to assess the safety and short‐term value of laparoscopic gastrectomy in the elderly with gastric cancer compared with a younger cohort.

Clinicopathological characteristics of gastric carcinoma in young patients.

Background and aimsGastric carcinoma is a common disease that usually affects older patients, rarely younger patients. Although the relationship between prognosis and the age of patients with gastric carcinoma is controversial, most investigators have suggested that young patients have a poorer prognosis. This study examined the clinicopathological features of young patients with gastric carcinoma.Patients and methodsWe retrospectively reviewed the hospital records of 1,833 patients with gastric carcinoma to compare the clinicopathological findings in young (aged <36 years) and older (aged ≥ 36 years) patients during the period 1988 to 1998 in a tertiary referral center in Gwangju City. Overall survival was the main outcome measure.ResultsOf the 1,833 patients, 137 (7.5%) were in the young age group. There were no significant differences in depth of invasion, lymph node invasion, hepatic metastasis, peritoneal dissemination, tumor stage or rate of curative resection. A significantly higher percentage of young patients had poorly differentiated histology (P=0.0001). The young patients with curatively resected gastric carcinoma had a better survival rate than young patients with non-resected gastric carcinoma (P<0.001). The 5-year survival rates of young and older patients did not differ statistically (39.6% vs 42.4%; P=0.254).ConclusionYoung patients with gastric carcinoma do not have a worse prognosis than older patients. The important prognostic factor was whether the patients underwent curative resection.

Comparison of outcomes after laparoscopy-assisted and open total gastrectomy for early gastric cancer

The aim of this study was to compare the results of laparoscopy‐assisted total gastrectomy with those of open total gastrectomy for early gastric cancer.

Reduction Malarplasty Using Modified L-Shaped Osteotomy

t m Zygomatic bone, which protrudes on both sides of the midface, plays an important role in determining the facial impression. Many esthetic differences regarding the malar prominence exist between Asians and whites. In the West, augmentation malarplasty s performed mainly because a slightly prominent alar is believed to be esthetically pleasing. In ontrast, in the East, a prominent malar is believed o project an aggressive and unpleasing impression, articularly for women. Therefore, many reduction alarplasty procedures have been developed. For eduction malarplasty, bone shaving, infracture, and I-shaped and L-shaped osteotomy methods ave been used. Of these techniques, an I-shaped osteotomy can e used for a moderate or severe malar promience. This is an effective and safe method for educing the anterior zygoma with no damage to he maxillary sinus. This method, however, can esult in insufficient bone reduction ( 5 mm) and isturb the middle 0.333 of the zygoma (the most rominent area). An L-shaped osteotomy can be used for severe malar protrusion. The fracture line

Intermediate-risk grouping of cervical cancer patients treated with radical hysterectomy: a Korean Gynecologic Oncology Group study

Background:In this study, we sought to identify a criterion for the intermediate-risk grouping of patients with cervical cancer who exhibit any intermediate-risk factor after radical hysterectomy.Methods:In total, 2158 patients with pathologically proven stage IB–IIA cervical cancer with any intermediate-risk factor after radical hysterectomy were randomly assigned to two groups, a development group and a validation group, at a ratio of 3 : 1 (1620 patients:538 patients). To predict recurrence, multivariate models were developed using the development group. The ability of the models to discriminate between groups was validated using the log-rank test and receiver operating characteristic (ROC) analysis.Results:Four factors (histology, tumour size, deep stromal invasion (DSI), and lymphovascular space involvement (LVSI)) were significantly associated with disease recurrence and included in the models. Among the nine possible combinations of the four variables, models consisting of any two of the four intermediate-risk factors (tumour size ⩾3 cm, DSI of the outer third of the cervix, LVSI, and adenocarcinoma or adenosquamous carcinoma histology) demonstrated the best performance for predicting recurrence.Conclusion:This study identified a ‘four-factor model’ in which the presence of any two factors may be useful for predicting recurrence in patients with cervical cancer treated with radical hysterectomy.

Upregulation of vascular renin-angiotensin and endothelin systems in rats inhibited of nitric oxide synthesis.

The present study was aimed at investigating whether the regulation of vascular renin-angiotensin and endothelin (ET) systems is altered by a chronic blockade of nitric oxide (NO) synthesis. Male Sprague-Dawley rats were supplemented with N(G)-nitro-L-arginine methyl ester (L-NAME, 100mgl(-1)) in drinking water for 4 weeks to inhibit the endogenous synthesis of NO. The mRNA expressions of renin, angiotensin converting enzyme (ACE), type-1 angiotensin II receptor (AT1R), ET-1, type-A ET receptor (ET(A)), and neutral endopeptidase (NEP) were determined in the thoracic aorta by reverse transcription-polymerase chain reaction. The treatment with L-NAME significantly increased the blood pressure, while it decreased the tissue levels of nitrite/nitrate. The mRNA expression of renin, ACE, and AT1R was increased in the aorta. The protein expression of AT1R assessed by Western blot analysis was also increased. The expression of ET-1 and ET(A) mRNA was increased, whereas that of NEP mRNA decreased. The increased expression of renin-angiotensin and ET system genes and the decreased expression of NEP may in part be causally related with the development of hypertension induced by a chronic blockade of NO synthesis.

Odontogenic infection involving the secondary fascial space in diabetic and non-diabetic patients: a clinical comparative study.

OBJECTIVES This retrospective study was performed to evaluate the clinical impact of diabetes mellitus on the prognosis in secondary space infection. MATERIALS AND METHODS Medical records, radiographic images, computed tomography, and microbial studies of 51 patients (25 diabetic patients and 26 non-diabetic patients) were reviewed. Patients were diagnosed as secondary fascial space infections with odontogenic origin and underwent treatment at Chonnam National University Hospital, in Department of Oral and Maxillofacial Surgery, from January 2007 to February 2009. RESULTS COMPARED TO PATIENTS WITHOUT DIABETES, PATIENTS WITH DIABETES WERE PRESENTED WITH THE FOLLOWING CHARACTERISTICS: older age (diabetic patients: 62.9 years, non-diabetic patients, 47.8 years), more spaces involved (diabetic patients, 60%; non-diabetic patients, 27.3%), more intense treatment, longer hospitalization (diabetic patients, 28.9 days; non-diabetic patients, 15.4 days), higher white blood cell and C-reactive protein values, higher incidence of complication (diabetic patients, 40%; non-diabetic patients, 7.7%), and distinctive main causative microorganisms. CONCLUSION These results suggest that the prognosis of diabetic patients is poorer than that of non-diabetic patients in secondary space infections since they had greater incidence rates of involved spaces, abnormal hematologic findings, more complications, and additional procedures, such as tracheostomy.

A Simple Technique for the Treatment of Inferior Orbital Blow-Out Fracture: A Transantral Approach, Open Reduction, and Internal Fixation With Miniplate and Screws

PURPOSE Infraorbital blow-out fracture (IOBF) is an uncommon midfacial trauma, and impairs eyeball function and causes esthetic problems. The extraoral approach can lead to some complications such as scarring, ectropion, and entropion. The intraoral approach, such as a transantral approach, has advantages such as no visible scaring, it can be used to simultaneously treat a zygomaticomaxillary complex fracture (ZMCF), and the procedure is relatively easy. PATIENTS AND METHODS IOBFs were reduced from the maxillary sinus, and fixated internally using miniplates and screws with/without Medpor (Porex, Newnan, GA) via a transantral approach. We used this technique in 11 patients who had an inferior blow-out fracture. Patients records and CT scans were reviewed. RESULTS The mean age of the patients was 37 years (ranging between 15 years and 68 years). The mean follow-up period was 9.8 months, which ranged from 1 to 24 months. Before the operation, the patients had orbital symptoms: diplopia in 3 patients; enophthalmos in 4; and gaze limitation in 3. All the patients showed periorbital swelling and ecchymosis. After surgery, none of the patients had diplopia, gaze limitations, and enophthalmos. There were no orbital symptoms or sinus symptoms due to an infection or allergic reaction after surgery except in 1 patient. In 1 patient, maxillary sinusitis developed at 4 months after surgery which subsided with antibiotic therapy after plate removal. CONCLUSION We think this technique offers an easy approach, and produces reliable, satisfactory results in IOBF.

Tumor differentiation is not a risk factor for lymph node metastasis in elderly patients with early gastric cancer.

BACKGROUND The aim of this study was to identify risk factors for lymph node metastasis in elderly patients (70 years or more) with early gastric cancer. METHODS We reviewed the prospectively collected database of 6893 patients with early gastric cancer who had undergone curative gastrectomy in 3 tertiary cancer centers between January 2003 and December 2009 in Korea. Patients were sorted into 4 groups according to age: less than 50, fifties, sixties, and 70 years or more. Risk factors for lymph node metastasis in early gastric cancer were analyzed. RESULTS One thousand and thirty five patients (15.0%) were 70 years or more. As age increased, the frequency of large differentiated tumor, lymphatic and submucosa invasion increased. Old age was associated with a lower risk for lymph node metastasis in patients with early gastric cancer (Odds ratio [OR], OR, 0.622; 95% CI, 0.5466-0.830, P = 0.010). Ulceration or differentiation of tumor was not associated with lymph node metastasis in elderly patients with early gastric cancer. CONCLUSIONS Elderly patients with undifferentiated type histology early gastric cancer without other risk factors for lymph node metastasis may be candidates for endoscopic resection.

Is histologic differentiation a prognostic indicator for gastric carcinoma patients with curative resection

BACKGROUND The prognostic relevance of histologic differentiation in gastric carcinoma patients with curative resection is unclear. We analyzed the clinicopathologic features of gastric carcinoma patients with curative resection according to the histologic differentiation and evaluated surgical outcome. MATERIALS AND METHODS Of 1198 gastric carcinoma patients with curative resection (American joint committee on cancer, Stages I-III), 274 (22.9%) had well-differentiated, 331 (27.6%) had moderately differentiated and 593 (49.5%) had poorly differentiated gastric carcinomas. RESULTS Patients with the poorly differentiated type had more prominent serosal invasion, much more lymph node involvement and more advanced stage than patients with the well-differentiated type. The overall survival rate was higher for patients with a well-differentiated gastric carcinoma than for patients with a poorly differentiated type. Using Coxs proportional hazard regression model, histologic differentiation was found to be a statistically significant prognostic parameter (risk ratio, 1.41; 95% confidence interval, 1.028-1.922; P < 0.05). CONCLUSION Our results suggest that patients with a well-differentiated gastric carcinoma have a good prognosis compared with those with a poorly differentiated type. Therefore, histologic differentiation can be used as a prognostic indicator in gastric carcinoma patients with curative resection.