Local recurrence was reduced considerably due to the introduction of neoadjuvant chemoradiotherapy as treatment for locally advanced rectal cancer. However, certain proportions of patients would experience local recurrence inevitably; the lateral pelvic lymph node is the primary site of rectal cancer recurrence even after administering neoadjuvant chemoradiotherapy. It remains unknown whether lateral pelvic lymph node metastasis is considered as a locoregional disease or a distant metastasis. Although the oncologic stance of lateral pelvic lymph node metastasis is controversial, there is increasing research interest in evaluating the conditional benefit of lateral pelvic lymph node dissection in a subgroup of patients. Researchers reported an improvement in local control in patients with clinically suspected lateral pelvic lymph node metastasis before/or after neoadjuvant chemoradiotherapy who underwent lateral pelvic lymph node dissection. However, there is no clear consensus regarding the indication, diagnostic method, and extent of lateral pelvic lymph node dissection.
Citations
, Tae-Jin Song, Young-Jae Kim, Ji Hoe Heo, Kyung-Yul Lee, Young Eun Kim, Min Uk Jang, Soo-Jin Cho, Suk Yun Kang Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry.
We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke.
The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3).
In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.
To correlate findings of chest radiograph with those of CT scan in aortic dissection.
We retrospectively analyzed findings of chest radiograph and CT scan of 10 aortic dissection patients(for men and six women ; aged 51-79 years old(mean 64 years)) and correlate findings of chest radiograph with those of CT scan.
Chest radiograph showed abnormal findings in nine cases(90%) with widening of wuperior mediastinum in nine(90%), disparity in size of ascending and descending aorta in four (40%), change in aortic configuration between successive examination in three (30%), bilateral pleural effusion in one(10%), and cardiomegaly in five(50%). CT scan showed atherosclerotic effusion in two(20%), pericardial effusion in one(10%), and mediastinal hematoma in two(20%). All patients with widening of superior mediastinum on chest radiograph showed aneurysm of ascending aorta and/or aortic arch on CT scan.
Chest radiograph is usually abnormal and the most common finding is wdening of superior mediastinum caused by aneurysm of ascending aorta and/or aortic arch. But normal chest radiograph may be observed in aortic dissection with mild degree aneurysm
Currently D2 lymph node dissection is considered as minimal extent of dissection in curative resection of gastric cancer. This study was conducted to investigated the patterns of lymph node metastasis of gastric cancer and to validate extent of lympn node dissection.
Among 117 patients with gastric cancer, 35 patients with early gastric cancer and 45 with advanced gastric cancer underwent curative gastric resection were enrolled in this study. Removed lymph nodes were classified as N1(1~6), N2(7~11), N3(12~16) and the boundary of dissection was classified as D1, D2, D3, D3+α according to classification of stomach cancer research association in Korea.
The priportion of early gastric cancer was 30%(35/117). Average number of metas-tatic lymph nodes was 2 in stage II, 6 in stage IIIa, 13 in stage IIIb, 21 in stage IV(p<0.05). 2 patients with early gastric cancer had metastatic lymph node(N1) and their lesions were over 3.0cm in size, depressed in shape. In terms of differentiation, 25(62%) patients with stage I, D1 dissection was carried out in two(5%), D2 dissection in eleven(28%), D3 or D3+α dissection in twenty seven (67%). In the patients with over stage II, there was no D1 dissection, D2 dissection was performed only in 3(7%), D3 or D3+α dissection in 37(92%). Extended lymph node dissection was significantly much higher in advanced cases than in early cases. The average number of resected positive lymph nodes were higher in BORRMANN type III or type IV than in type II(p<0.01, p<0.05 respectively). All patients with positive N2 or N3 lymph nodes revealed the positive N1 lymph nodes. There were 2(25%) skipped metastasis among 8 patients with positive N3 lymph nodes.
At least D2 lymph node dissection is needed for curative resection of gastric cancer in the patients with possible metastasis of N1 lymph nodes, even in the those we early gastric cancer. D3 or D3+α dissection should be performed in the patients with possible metastasis of N2 lymph nodes among advanced gastric cancer, even in the patients without metastasis of N2 lymph nodes selectiely because of skipped metastasis.
, Ji Young Yun, Kee Duk Park, Jee Hyang Jeong Vertebral artery dissection (VAD) is one of important causes of posterior circulation strokes in young age patients. Typical presentations of VAD are occipital headache or posterior neck pain, with various signs arising from brainstem or cerebellar infarctions. Muscular weakness or sensory change of an ipsilateral arm owing to cervical nerve root involvement in association with the VAD has been reported very rarely. Herein we describe two unusual manifestations of extracranial VAD, which presented with monoplegia of single upper limb.
, Tae-Hee Won, Yong-Soon Won, Jae-Jin Han, Jae-Ho Ahn, Guie-Young Lee Acute type A arotic dissection is a condition which requires emergency surgery. Surgeons want to know not only the extent of the disease but also the exact site of intimal tear as well as the presence of side branch involvement to plan the extent of surgery. Various non-invasive diagnostic tools(transthoracic and transesophageal echocardiography, conventional and spiral computed tomography and magnetic resonance imaging) and invasive angiography are available for the evaluation of the extent of dissection, site of intimal tear and side branch involvement. Each technique has its advantage and disadvantage. Especially, MRI has been accepted as a gold standard for the diagnosis of aortic dissection, but it is immobile and sometimes it cannot give us the information about the small intimal tear site. Transesophageal echocardiography has the advantage of movability and high resolution in addition to the ability of providing comprehensive information about the cardiac function. Because of these advantages, it has been widely utilized for the evaluation of patients with aortic dissection. We performed preoperative transesophageal echocardiography in addition to computed tomography in 3 cases of acute type A aortic dissection and report these cases with the review of articles.
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