• Journal of Gastric Cancer
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• v.5 no.1
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• pp.1-9
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• 2005

Purpose: The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy(THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries. Materials and Methods: In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed. Results: A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P<0.05). Post-operative complications occurred in 15 cases of TTE and 23 cases of THE. The average length of stay in the hospital was 25.6 days for a TTE and 20.6 days for a THE. The 5-year survival rate was $10\%$ for TTE patients and $28\%$ for THE patients (P>0.05). Conclusion: For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus. (J Korean Gastric Cancer Assoc 2005;5:1-9)

• Korean Journal of Veterinary Research
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• v.40 no.4
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• pp.653-660
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• 2000

In order to study the regional distribution and relative frequency of the immunoreactive endocrine cells in the gastrointestinal tract of the Mongolian gerbil, Meriones unguiculatus, the gastrointestinal tract was divided into 9 portions (cardia, fundus, pylorus, duodenum, jejunum, ileum, cecum, colon and rectum) and immunostained by immunohistochemical (PAP) method using 8 types of specific antisera against cholecystokinin (CCK)-8, gastrin, secretin, pancreatic polypeptide(PP), somatostatin, serotonin, glucagon and insulin. CCK-8-, gastrin-, somatostatin- and serotonin-immunoreactive cells were demonstrated in this study. These immunoreactive cells were found in the gastric gland regions of the pylorus or between parietal and chief cells of the fundus with round to spherical shaped, and in the interepithelial regions of the intestinal tract with spherical to spindle shaped except for jejunum where some of immunoreactive cells were also observed in the intestinal glands with round to spherical shaped. CCK-8-immunoreactive cells were restricted to the pylorus and duodenum with numerous and a few frequency, respectively. Gastrin-immunoreactive cells were restricted to the pylorus with numerous frequency. Similar to those of gastrin-immunoreactive cells, somatostatin-immunoreactive cells were restricted to pylorus with moderate frequency. Serotonin-immunoreactive cells were detected throughout whole gastrointestinal tract except for cardia and cecum with moderate or numerous frequency. However, no secretin-, PP-, glucagon- and insulin-immunoreactive cells were observed in this study. From these results, the appearance type, regional distribution and relative frequency of immunoreactive endocrine cells in the gastrointestinal tract of the Mongolian gerbils were somewhat lowered or restricted compared to those of other mammals and these differences were might be caused by feeding habits and species specification.

• Journal of fish pathology
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• v.25 no.1
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• pp.59-65
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• 2012

Overinflation of cardiac stomach occurred in farmed sterlet sturgeon (Acipenser ruthenus) fingerlings. Affected fish congregated and swam upside-down near the edges of the tanks with abdominal distension. When pressed the dilated abdomen, the fish often exhibited a normal swimming pattern for some time, then resumed their characteristic upside-down swimming patterns. Internally, the fish showed abdominal dropsy and dilated stomach filled with yellowish granular contents. When the contents in the stomach, fish feed, water and excrement in the farm inoculated on Sabouraud destrose agar (SDA) at $25^{\circ}C$ for 48 hr. Candida sp. were isolated except from the feed. Candida sp. in excrement or water in the farm may enter into the stomach with feed and then produce gases in the metabolic process, which in turn may cause the stomach overinflation.

• Development and Reproduction
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• v.11 no.2
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• pp.121-125
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• 2007

Morphological changes on digestive tract were observed using Flounder, Paralichthys olivaceus to elucidate the early developmental processes. Hatched larvae, ($2.50{\pm}0.14\;mm$ in total length: TL) has not opened its mouth and anus. The digestive tract showed linear tubular form from mouth to anus extending along with yolk. On $7{\sim}8$ days from hatching, the post-larvae, ($5.05{\pm}0.40\;mm$ TL) has developed digestive tract and activated for feeding. The digestive tract expanded into dorsal side, joined to intestine, and the stomach began to develop. The digestive tract was divided into an anterior and posterior region, and began to differentiate. In the post-larvae($6.50{\pm}0.25\;mm$ TL) on $13{\sim}14$ days from hatching, the digestive tract twisted one cycle in the anterior region, the area was expanded. The digestive tract was completely differentiated into oesophagus, anterior intestine, middle intestine, posterior intestine and arranges fundamental structure. In the embryo($12.40{\pm}0.55\;mm$ TL) after 30 days from hatching, stomach became large and could be distinguished from cardia and pyloric parts apparently. The digestive tract developed similar with that of adult flounder showing clear division of stomach, anterior intestine, middle intestine, posterior intestine and rectum. In the embryo($16.15{\pm}0.85\;mm$ TL) after 40 days from hatching, esophagus, pyloric part, anterior intestine, middle intestine, and rectum have largely expanded, and thus the morphological features are somewhot different with those of post-larvae flounder.

• Journal of Gastric Cancer
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• v.4 no.3
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• pp.143-148
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• 2004

Purpose: To determine the clinical value of the Siewert classification for gastic-cancer patients in Korea, we evaluated and compared the clinicopathologic factors of type II and type III cancer. Materials and Methods: The medical records of 89 consecutive patients who had undergone surgery for an adenocarcinoma of the gastroesophageal junction (GEJ) at the Department of Surgery, Hanyang University Hospital, between Jun. 1992 and Dec. 2003 were reviewed retrospectively. Results: There were one patient with type I, 12 pateints with type II and 77 patients with type III. During the same period, 1,341 patients underwent surgery for a gastric carcinoma, so proportion of GEJ cancer being $6.6\%$. The median followup duration was 31 months (range: $2\∼135$ months), and the follow-up rate was $100\%$. Between type II and type III cancers, there were no significant differences in the clinicopathologic variables including age, sex, gross appearance, histologic type, depth of invasion, and pathologic stage. The longest diameter of the tumor was larger in type III ($6.1\pm2.1$ cm) than in type II ($3.9\pm1.1$ cm)(P=0.001). A total gastrectomy with Roux-en-Y esophagojejunostomy was done most frequently, while jejunal interposition was done in 3 cases of type II and 2 cases of type III. More than a D2 lymphadenectomy was done all cases. The numbers of dissected lymph nodes and metastatic lymph nodes in type II were 43.8 and 5.8 respectively, while they were 49.8 and 8.1 in type III, but the difference between the two groups were not statistically significant. The mean length of the proximal resection margin was $15\pm5$ mm in type II and $21\pm13$ mm in type III, but this difference was not statistically significanct. The time to recurrence after operation was 19.3 months in type II and 16.9 months in type III. The five-year survival rates of type II and III were $68.8\%\;and\;52.7\%$ respectively, but difference was not significant. Conclusion: There were no significant differences in the clinicopathologic variables, including survival rate, between type II and type III cancers in Korean patients According to these findings, it appears to be reasonable to classify type III cancer as a cardia cancer in a broad sense.

• Journal of Yeungnam Medical Science
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• v.33 no.2
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• pp.146-149
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• 2016

Heterotopic bone formation in the gastrointestinal tract is a rare phenomenon. Most reported cases were associated with benign and malignant neoplasms, except for a case in which heterotopic bone formation was found in a patient with Barrett's esophagus. The exact pathogenesis of the disease has not yet been established. However, most heterotopic bones found in the gastrointestinal tract were associated with mucinproducing tumors of the appendix, colon, and rectum. Inflammation may also play a role in osseous metaplasia in a case with bone formation at the base of an ulcer in Barrett's esophagus. Here, we report on a patient with heterotopic bone formation in normal gastric cardiac mucosa. A 50-year-old female visited our hospital for a routine health examination. She had no gastrointestinal symptoms, and her physical examination, blood test, X-ray, urine, and stool examination results were normal. A 0.3 cm sized polypoid lesion located just below the squamocolumnar junction was observed on upper gastrointestinal endoscopy. A piece of biopsy was taken. Histologically, a lamella bone trabecula and chronic inflammatory cells were observed in the gastric cardiac mucosa. The follow-up endoscopy performed one month later showed no residual lesion.

• Journal of Yeungnam Medical Science
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• v.8 no.2
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• pp.76-83
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• 1991

A total of 53 gastric adenomas from endoscopically biopsied gastric mucosa were examined histopathologically. The average age at the time of endoscopic biopsy was 59 years, and gastric adenomas were found to be more frequent in the aged, particularly above the age of 50. The majority of adenomas occurred at the antrum. Concerning the shape of the adenomas, Yamada type II was more frequent(55%). All adenomas were accompanied by varying degree of intestinal metaplasia, and this findings suggest that gastric adenoma develops from intestinal metaplasia. In adenomas with severe atypia(grade III), endocrine cells(argyrophil and argentaffin cells)were markedly decreased or absent. Gastric adenocarcinomas coexistent with adenoma were seen in 5(9.4%) out of 53 cases, and were more frequent in male than female patients(sex ratio, 4 : 1) and the average age was 61.4 years. It is suggested that there is a necessity of thorough follow-up study for definitive correlation between gastric adenoma and adenocarcinoma.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.799-805
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• 1999

Background: Leakage, stricture formation, and tumor recurrence at the anastomotic site are serious problems after esophagectomy for cancer of the esophagus or cardia. The prevalence of these postoperative complications may be affected by whether an anastomosis is made in the neck or in the chest, therefore a comparison was made between anastomoses made at these two sites. Material and Method: Between 1987 and 1998, 36 patients with cancer of the esophagus underwent transthoracic esophagectomy with cervical(NA, n=20) or thoracic anastomosis(CA, n=16). The tumors were staged postoperatively(stage IIA, n=13; s tage IIB, n=7; stage III, n=16) and were located in the middle thoracic(n=22) or lower thoracic esophagus and cardia(n=14). Result: The overall operative mortality was 8.3%(5% for NA group, 12.5% for CA group). The anastomotic leak rate for the NA group was 15.0% and 12.5% for the CA group. The anastomotic leak rate differed according to the manual(27.3%) or stapled(8.0%) techniques(p < 0.05). The median proximal resection margins in the NA and CA groups were 9.6 cm and 5.8 cm, and the corresponding rates of anastomotic tumor recurrence were 5.3% and 28.6%(p < 0.05). The prevalence of benign stricture formation (defined as moderate/severe dysphagia) was higher in the NA group(36.8%) than in the CA group(21.4%). When an anastomosis was made by the stapled technique, smaller size of the staple increased the prevalence of stricture formation - 41.7% with 25-mm staple and 9.1% with 28-mm staple(p < 0.05). Conclusion: Wider resection margin could decrease the anastomotic tumor recurrence, and the stapled technique could decrease the anastomotic leak. The prevalence of benign stricture was higher in the cervical anastomosis but the anastomotic leak and smaller size(25-mm) of the staple should be considered as risk factors.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1977.06a
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• pp.9.3-9
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• 1977

Achalasia is the disease of nonorganic obstruction of the cardia associated with dilatation of the esophagus, and of unknown etiology characterized by failure of relaxation of the inferior esophageal sphincter and lack of normal peristalsis in the body of the esophagus. This disorder is primarily one of neuromuscular dysfunction, most probably due to a central nervous system lesion with consequent nerve, ganglion and muscle degeneration. The characteristic symptoms are dysphagia, regurgitation and epigastric pain etc. We have experienced a case of Achalasia in 43 aged female with good results by daily mercury bougienage.

• Journal of Veterinary Clinics
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• v.24 no.4
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• pp.622-626
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• 2007

A 1.6-year-old, intact male beagle dog was presented with three day history of odynophagia and anorexia. According to the history and radiographic findings, the patient was diagnosed with esophageal and gastric foreign body due to ingesting fishhooks. Gastroesophagoscopy revealed that one fishhook located in the thoracic esophagus cranial to the heart base and the other located in the cardia region were connected with a single fishing line. Gastrotomy was performed to remove the fishhook in the cardia region and to sever the connecting fishing line. After gastrotomy, endoscopic attempts to remove the esophageal fishhook with a three, five pronged endoscopic grasping forceps, and a biopsy were unsuccessful because the fishhook was embedded deeply in the mucosa membrane. A handmade cerclage wire(16G) shaped like a snare forceps was advanced into the esophagus while visualizing the fishhook endoscopically. The cerclage wire was used to hang and retract the foreign body. The fishhook was retracted orally, resulting in successful removal. Ten days after the operation, the patient fully recovered and was discharged.