• Journal of Gastric Cancer
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• v.6 no.2
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• pp.109-113
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• 2006

Purpose: Various minimally invasive surgical techniques, such as an endoscopic mucosal resection and a laparoscopic gastrectomy, are becoming common practice for some cases of early gastric cancer (EGC) defined in terms of the depth of invasion being limited to the mucosa or submucosa. However, there are rare cases of early gastric cancer with massive lymph-node metastasis. Materials and Methods: From 6 university hospitals of Korea, 2,772 EGC cases were resected during the various period of analysis (1,432 cases of mucosal cancer and 1,340 of submucosal cancer). Results: As control data, we used the data from a single institute, CHA University Hospital. There were nine cases of early gastric cancer (9/2,772, 0.32%) with N3 lymph node metastasis defined by more than 15 lymph nodes being metastasized according to the UICC-TNM classification (pT1N3, stage IV). Two cases were mucosal cancer (2/1,432, 0.1 4%), and seven cases were submucosal cancer (7/1,340, 0.52%). Metastasized lymph nodes varied in number from 18 to 52. There were three male and six female patients with a mean age of 57. This is a totally reversed sex ratio compared to the usual gastric cancer or EGC. Among the total of 9 EGC patients, there were 5 who had superficial spreading carcinomas with surface areas larger than $25\;cm^2$. This is a significantly higher proportion compared to the general EGC population. When we compared the tumor size according to the LN status, the N3 group was definitely larger than the other groups. 78% of the pT1N3 cases showed lymphatic invasion, which is very high compared to the 4.7% in general EGC cases. Among the 9 cases, 6 patients had too short a follow-up period to evaluate the correct prognosis, but there was one patient with a non-curative resection and two patients with early recurrence. Although the sample size is small and the follow-up period is short, we can expect a very poor prognosis when we consider the common prognosis of EGC that is widely known and accepted. Conclusion: From these results, we can a conclude that the risk factors for pT1N3 gastric cancer are female patients, submucosal invasion, larger tumor size, and lymphatic invasion. However rare, the existence of pT1N3 gastric cancer needs to be taken into consideration, especially during the diagnosis. Furthermore, minimally invasive treatment for EGC needs to be chosen with great precaution. Since the prognosis of pT1N3 gastric cancer is expected to be poor, aggressive adjuvant chemotherapy may be necessary. (J Korean Gastric Cancer Assoc 2006;6:109-113)

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.10.3-11
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• 1982

Recently through the advancement of medical and surgical managements and the development of low pressure cuffed endotracheal tube, incidence of tracheal stenosis was decreased significantly. Though its incidence was decreased markedly, stenosis was developted unfortunately in the situations such as long term use of respirator, heavy infection, trauma of the trachea and long term intubation etc. Tracheal stenosis had been handled with various methods such as mechanical dilatation, tissue graft techniques, luminal augumentation and end to end anastomosis due to their individual advantages but their effects were not satisfactory. In 1959 Lester had been found the regenerated cartilage from the perichondrium of the rib incidentaly. Since then Skoog, Sohn and Ohlsen were reported chondrogenic potential of perichondrium through the animal experiments. Though many different materials have been tried to rebuild stenosis and gaping defect of trachea, tracheal reconstruction has been a perplexing clinical problems. We choose the perichondrium as the graft material because cartilage is the normal supporting matrix of that structure and it will be an obvious advantage to be able to position perichondrium over a defect and obtain new cartilage there. The young rabbits, which were selected as our experimental animals, were sacrified from two to eight weeks after surgery. The results of our experiment were as follows; 1) In control group, the defect site of trachea was covered with fibrosis and vessels but graft site was covered with hypertrophied perichondrium and vessels. 2) Respiratory mucosa was completely regenerated in defect sites both control and grafted groups. 3) The histologic changes of the grafted sites were as follows: 2 weeks- microvessel dilatation, inflammatory reaction, initiation of fibrosis 4 weeks- decreased microvessel engorgement, submucosal fibrosis, decreased inflammatory reaction immatured cartilage island was noted in the grafted perichondrium (one specimen) 6 weeks- mild degree vascular engorgement submucosal fibrosis. chronic inflamatory reaction cartilage island and endochondrial ossification was noted in the grafted perichondrium (Two specimens) 8 weeks- minute vascular engorgement dense submucosal fibrosis. loss of inflammatory reaction. cartilage island was noted in the grafted perichondrium (two specimens) 4) There was no significant differences in regeneration between active surface in and out groups. 5) We observed immatured cartilage islands and endochondrial ossification in the perichondrial grafted groups where as such findings were not noted in control groups except fibrosis. We concluded that perichondrium was the adequate material for the reconstruction of defected trachea but our results was not sufficient in the aspect of chondrogenic potential of perichondrium. So further research has indicated possibility of chondrogenic potential of perichondrium.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.665-671
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• 2004

Background: Lymph node metastasis is commonly reported in thoracic esophageal cancer, even in the early esophageal cancer which may be localized only in the mucosa or within the submucosal layer. Although lymph node metastasis greatly influence long-term outcome and cure of the disease, endoscopic mucosal resection or photodynamic therapy without lymph node dissection is widely attempted. The investigation of the pattern of lymph node metastasis and results of surgical resection of superficial esophageal cancer is needed. Material and Method: Pattern of lymph node metastsis and depth of tumor invasion were studied retrospectively from 44 patients with early esophageal cancer who underwent radical resection of the tumor from December, 1995 to August, 2001. Result: Lymph node metastasis was found in 10 patients (22.7%) out of total of 44 patients. Lymph node metastasis was found in 0% (0 of 3), 0% (0 of 4), 50% (2 of 4), and 24.24% (8 of 33) of tumors that invaded the intraepitherium, lamina propria, muscularis mucosa, and submucosa respectively. Anatomically distant lymph node metastases were found more frequently in recurrent laryngeal nerve node(5 cases of 10 patients) and in intraperitoneal node (8 cases of 10). than intrathoracic node (3 cases of 10). There was no operative mortality, however, there were 1 hospital death in patient with lamina propria cancer, 1 late death in patient with submucosal cancer. Three-year survival rates (except hospital death) were 100% in mucosal cancer and 97.0% in submucosal cancer (p>0.05), and 100% in the node negative group and 90.0% in the node positive group (p>0.05). Conclusion: The survival rate of superficial esophageal cancer patient who was recieved operative resection was excellent. But, lymph node metastasis were found in superficial esophageal cancer, even in esophageal cancer limited to the muscularis mucosa. Systemic lymph node dissection which includes recurrent laryngeal nerve nodes and intraperitoneal nodes was recommended for favorable outcome in superficial esophageal cancer.

• Korean Journal of Veterinary Service
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• v.20 no.1
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• pp.55-67
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• 1997

The morphological development of lungs in fetuses of 60, 90 and 120 days of gestation and neonates of Korean native goats was investigated by light, scanning and transmission electron mictroscope. The results were summarized as follows ; 1. Gross findings ; In the 60-days-old fetus, the lung was developed and differentiated into six lobes. 2. Light microscopic findings : The gland-like bronchioles were formed in loose mesenchyme at 60 days of gestation and the bronchial wall contained smooth muscles. The loose mesenchyme had been replaced by compact parenchymal tissue at 90 days of gestation and the cartilage plates appeared in bronchial wall which contained blood vessels, submucosal glands and smooth muscles. The lung parenchyma consisted of a fine network of alveoli at 120 days of gestation and the bronchial wall contained well-developed blood vessels, submucosal glands, cartilage plates and smooth muscles. In neonates, the lung tissue was similar to the mature lung tissue and the bronchial wall contained well developed cartilage plates. 3. Scanning electron microscopic findings : The epithelial cells lining the tubules were composed of cuboidal or columnar at 60 days of gestation and the epithelial cells lining the large airways were often ciliated : some were covered with stubby microvilli. The epithelial cells lining the canals were cuboidal at 90 days of gestation and the epithelial cells lining the bronchioles were ciliated cells or nonciliated(clara) cells, The clara cells contained row microvilli. The alvealor development of this stage was rapidly progressed ; the subdivision of canals by alveolar crests and assosiated wall attenuation resulted alveoli at 120 days of gestation and the respiratory bronchioles were lined by ciliated or nonciliated epithelial cells. In neonates, the epithelial cells lining the alveolar walls were mainly covered with pneumocyte type I ; Some were covered with pneu-mocyte type II. 4. Transmission electron microscopic findings : The epithelial cells lining the tubules were adhered with tight junction at apical borders of the adjacent cells at 60 days of gestation, which contained few organells and glycogen. The epithelial cells lining the canals were composed mostly of cuboidal cell at 90 days of gestation and the epithelial cells lining of the bronchioles were ciliated of nonciliated cell, which contained few organelles and abundant glycogen. The epithelial cells lining the alveolar walls were composed of pneumocyte type I and a few pneumocyte type II at 120 days of gestation. The epithelial cells lining of the bronchioles were ciliated or nonciliated cells. In neonates, pneumocyte type I was observed as flat and thin cytoplasmic extension in shape. Otherwise, pneumocyte type II was observed as cuboidal type with apical microvilli and contained osmiophillic lamellar inclusion bodies. Putting these various experiment results together, the lung development was slowly progressed at early stage, which was rapidly progressed in the late stage of gestation.

• Journal of Gastric Cancer
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• v.17 no.1
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• pp.33-42
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• 2017

Purpose: Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors. Materials and Methods: From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD. Results: Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications. Conclusions: ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

• Journal of Gastric Cancer
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• v.1 no.1
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• pp.32-37
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• 2001

Purpose: Three subgroups of stage II stomach cancer (T1N2M0, T2N1M0, T3N0M0) by UICC-TNM staging system show obvious survival difference to each other, which becomes the pitfall of the current staging system. We analyzed the survival and relapse pattern of stage II stomach cancer patients in three subgroups retrospectively to prove the need for change in staging system. Materials and Methods: From July 1989 to December 1995, curative gastric resection was performed in 1,037 patients with gastric adenocarcinoma, and among them 268 patients ($26\%$) were in stage II. The number in each of subgroups (T1N2M0, T2N1M0, and T3N0M0) were 17, 139 and 112 respectively. Survival and relapse pattern were analyzed and median follow up period was 46 months. Results: The 3-year cumulative survival rates of T1N2M0, T2N1M0, and T3N0M0 were $50\%,\;80\%,\;and\;76\%$ respectively (p=0.001). And the 3-year cumulative survival rates of T1N2M0 was comparable to those of 2 subgroups of stage IIIa (T2N2M0, T3N1M0), $47\%\;and\;45\%$ (p>0.05). Peritoneal recurrence was the most frequent in T3N0M0. And hematogenous spread was more frequent in T2N1M0 while nodal spread was more frequent in T1N2M0. Ten out of 17 cases of T1N2M0 died of recurrence. Most of them showed submucosal tumor with depressed lesion and mean tumor size was 3.3 cm. Conclusions: Up-staging of T1N2M0 should be considered because it has the lowest survival rate and the worst prognosis among the three subgroups of Stage II stomach cancer patients. In early gastric cancer patients with high-risk factors (large tumor size, invasion into the submucosal layer, and lymphatic vessel involvement), lymph node dissection and postoperative adjuvant therapy is recommended in an attempt to prevent recurrence in the form of lymph node metastasis.

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.1
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• pp.6-12
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• 2007

배경: 소아 진정 치료 시 서로 다른 용량의 chloral hydrate와 hydroxyzine을 복용 후 midazolam을 구강 점막 하 주사했을 때 행동 반응을 비교하였다. 방법: 총 32회 진정법을 통해 치과치료를 받은 30명의 나이 24-72개월, 체중 20 kg 미만의 미국 마취과학회 신체등급 I의 건강하지만 겁이 많고 협조가 안 되는 소아 환자를 대상으로 2개 치아이상의 보존 치료 및 발치를 필요로 하는 환자를 대상으로 하였다. 호흡기 질환이 있는 아이들은 이 연구에서 제외되었다. 연구 계획은 이대 목동 병원의 임상 실험 심사 위원회에 제출되었다. 1군은 chloral hydrate 50 mg/kg와 hydroxyzine 1 mg/kg 복용 후 점막 하 midazolam 0.2 mg/kg을 추가 투여했고 2군은 chloral hydrate 60 mg/kg와 hydroxyzine 1 mg/kg 복용 후 점막 하 midazolam 0.1 mg/kg을 주사 받았다. 50% nitrous oxide는 치료 중 두 군 모두 유지되었다. 전날 수면 시간과 약물 복용 태도를 기록하였으며 모든 치료 과정은 비디오로 촬영되었다. 맥박 산소 계측기를 이용하여 경피적 산소 포화도와 맥박수를 기록하였고 행동 반응은 Houpt scale을 이용하여 매 2분마다 40분 동안 기록되었다. 전반적인 행동 반응은 Houpt scale를 이용하여 평가되었다. 모든 자료는 SPSS 통계 프로그램을 이용하여 two sample independent t-test를 사용하였다. P 값은 0.05 미만인 경우를 통계학적으로 유의하다고 보았다. 결과: 두 군 간의 경피적 산소 포화도와 맥박수는 모두 정상 범위이며 유의한 차이가 없었다. 행동 반응 비교에서는 치료 처음 10분 동안 2군이 1군에 비해 점수가 높게 나왔으며(P < 0.05), 그 외에는 유의한 차이가 없었다. 전날 총 수면 시간과 약물을 복용하는 태도는 수면 치료 중의 행동 반응에 영향을 주지 않았다. 결론: Chloral hydrate 50 mg/kg 복용과 점막 하 midazolam 0.2 mg/kg은 chloral hydrate 60 mg/kg 복용과 점막 하 midazolam 0.1 mg/kg과 비교할 때 두 약물의 조합은 모두 소아 환자 수면 치료시 안전하고 효과적인 용량이다. Overall behavior와 Q (quiet)의 분포를 비교해 볼 때 두 군 모두 성공적인 진정효과를 기대할 수 있다.

• Korean Journal of Ichthyology
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• v.28 no.1
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• pp.19-27
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• 2016

The RLG (relative length of gut) is 1.52 (n=12) in the sablefish, Anoplopoma fimbria. The digestive tract has five or six pyloric caeca in the posterior region of stomach. Morphology of mucosal fold is unbranched type in the esophagus and stomach, but branched type in the intestine. The histological structure of digestive tract can be divided into mucosal layer, submucosal layer, muscular layer and serous membrane in the cross section. In the esophagus, mucosal epithelial layer is a simple, and consists of ciliated columnar epithelia and mucous cells. In the stomach, gastric gland of mucosal epithelial layer is a tubular, and is composed of chief cell, parietal cell and mucin secreting cell, which is columnar and contained secretory granules of red and blue colors in the AB-PAS (pH 2.5) reaction. In the intestine, mucosal epithelial layer is a simple, and consists of ciliated columnar epithelia and goblet cells. The submucosal layer is composed mainly of collagen fibers, and well developed in the esophagus. And the muscular layer of digestive tract is divided into longitudinal and circular muscle layer, and well developed in the stomach. The liver is composed of numerous lobular structure and bile canaliculi. Stainability of hepatocyte cytoplasm was eosinophilic, and nucleus and nucleolus showed basophilic in the H-E stain. The pancreatic tissue was scattered in the fatty tissue near the digestive tract, and acinar gland consisting of numerous exocrine cells. And cytoplasmic stainability of exocrine cell was basophilic, and contained numerous zymogen granules of eosinophilic in the H-E stain.

• Journal of Gastric Cancer
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• v.6 no.1
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• pp.47-51
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• 2006

The origin of a submucosal tumor is difficult to determine by endoscopic biopsy. One type of submucosal tumor, which originates in Schwann cell, a schwannoma represents 0.2% of all gastric tumors. We experienced the case of a 57-year-old female patient with a gastric schwannoma presenting with melena and anemia. Computed tomography and upper gastrointestinal endoscopy showed a protruded huge mass from 3 cm below the cardia to angle. Seven endoscopic biopsies indicated only necrotic debri and granulation tissue, chronic gastritis. Because we suspected an advanced gastric cancer, or lymphoma with bleeding, It was performed an operation for an exact diagnosis and a treatment for bleeding. A-post-operative histopathological, immunohistochemical examination led to the final diagnosis of a gastric schwannoma.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.198-203
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• 2008

Purpose: Multiple early gastric cancer (MEGC) accounts for between 4.5% and 11.7% of all early gastric cancers (EGC). We investigated the treatment of MEGC from the viewpoint of the clinicopathologic features of the disease. Materials and Methods: 2,281 patients with EGC underwent gastric resection at the Department of Surgery, Severance Hospital during the 11 years between January 1994 and December 2004 and we carried out a retrospective analysis of these patients. Results: There were 91 cases of synchronous MEGC (4.0%) according to the diagnostic criteria of Moertel: there were 81 double, 9 triple and 1 quadruple lesions. Of the 102 accessory lesions, 64 (62.7%) were less than 10 mm in diameter and 83 (81.4%) were located in the same region as the main lesion. The most frequent histologic type of main lesion was a well differentiated adenocarcinoma, which was found in 52 cases (57.1%). There were 49 mucosal main lesions and 42 submucosal main lesions. Lymph node metastasis was detected in 6 cases (6.6%): 1 in mucosal lesions and 5 in submucosal main lesions Conclusion: Solitary EGC and MEGC had very similar clinopathological features and a similar prognosis. Therefore, we believe that the general EGC treatment guidelines can be applied for multiple EGC. It is important to evaluate the whole stomach before and during the operation and then after examining the resected specimen.