OBJECTIVE: To evaluate the safety and efficacy of the laparoscopic incidental appendectomy during gynecologic laparoscopic operation. Methods: This study was evaluated for the clinical analysis of 118 patients who underwent laparoscopic assisted vaginal hysterectomy(LAVH group, 65 cases) and LAVH with laparoscopic incidental appendectomy(LAVH + IA group, 53 cases) at the Wallace Memorial Baptist Hospital from Oct. 1996 to Nov. 1998. RESULTS: The following results were obtained: 1) There was no significant difference between two groups in regard to age. The mean age was 45.7 years in LAVH group and 43.8 years in LAVH + IA group. 2) There was no significant difference between two groups in mean operative time. The mean operative time was 90.4 minutes in LAVH group and 97.5 minutes in LAVH + IA group. 3) The mean appendectomy time was 7.1 minutes. 4) The mean time recovering normal bowel activity was 46.2 hours in LAVH group and 45.8 hours in LAVH + IA group. There was no significant difference between two groups. 5) The mean hospital stay was 6.4 days in LAVH group and 5.7 days in LAVH + IA group. There was no significant difference between two groups. 6) The postoperative complications occurred in 11 cases(9.3 %). The serious complications of appendectomy was not found. 7) Of the 53 appendices removed, 5(9.4 %) were abnormal pathologic findings. CONCLUSION: Laparoscopic incidental appendectomy during laparoscopic operation was not found to influence the operation time, hospital stay, gas passing time, but there is one case of wound infection due to incidental appendectomy. Therefore, a large number of study should be performed to evaluate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic operation.
Appendectomy* ; Humans ; Length of Stay ; Operative Time ; Postoperative Complications ; Protestantism ; Wound Infection

The purpose of this study was to establish the normal values of tendon reflex in normal Korean adults. Ankle tendon reflex(ATR), patellar tendon reflex(PTR) and medial hamstring tendon reflex (MHTR) responses were recorded in 96 limbs of 48 normal Korean adults by delivering tendon taps with an electric reflex hammer. Latency to the onset of the triggered response, peak to peak amplitude and duration of the wave were measured after several repetitions. Minimum latency and duration of the elicited response were chosen to calculate normal means. Side differences were also evaluated. As amplitude showed a marked interindividual variation and side to side variation, lowest recorded value was selected to represent the lower limit of normal. Mean values of latency, duration and amplitude were 30.27?3.18 msec, 11.05?1.08 msec and 1.98?0.89 mV for ATR, 16.37?1.58 msec, 20.63?1.68 msec and 1.56?0.76 mV for PTR and 20.25?2.14 msec, 10.95?1.57 msec and 0.71?0.56 mV for MHTR. Age, height, and leg length showed significant correlation with the latency of ATR, PTR and MHTR latency(P<0.001). We believe our results can be used as guideline researches in clinical practice.
Adult* ; Ankle ; Extremities ; Humans ; Leg ; Patellar Ligament ; Reference Values* ; Reflex ; Reflex, Stretch* ; Tendons*

BACKGROUND: Cardiac tamponade is associated with the expiratory increase and the expira-tory decrease in left ventricular filling flow. With Doppler echocardiography, we analyzed the respiratory variations of mitral and tricuspid inflows, and pulmonary and hepatic venous flows in patients with cardiac tamponade. METHODS: Respiratory hemodynamic changes in mitral and tricuspid inflows and pulmonary and hepatic venous flows were evaluated using Doppler echocardiography in 13 patients (6 men and 7 women; mean age 51+/-13 years) with large pericardial effusion and clinical cardiac tamponade, and compared the results with those of 11 control subjects (3 men and 8 women, mean age 53+/-13 years). Doppler examination was repeated after pericardiocentesis in 6 patients. RESULTS: Peak velocity of early diastolic mitral inflow (E velocity) decreased during inspiration compared with expiratory increase; the mean percentage change was 40%. Peak velocity of late diastolic mitral inflow (A velocity) decreased 13% during inspiration. E/A ratio decreased 31% during inspiration. Deceleration time (DT) and isovolumic relaxation time (IVRT) increased by 26% and 44%, respectively, during inspiration. But respiratory variations of tricuspid inflow were opposite to those of mitral inflow. Tricuspid E velocity increased during inspiration and decre-ased during expiration. The mean percentage change was 123%, which was larger than thte 40% of mitral inflow. The most characteristic findings of pulmonary venous flow during respiration were the expiratory increases of peak diastolic velocity (DV) and diastolic time-velocity integral (D-TVI). The mean percentage changes of peak systolic velocity (SV), DV and D-TVI during respiration were 27%, 45% and 53% respectively. In contrast, the SV and DV of hepatic venous flow increased during inspiration and decreased during expiration. The respiratory variations of peak systolic reverse flow velocity (SR) and peak diastolic reverse flow velocity (DR) were opposite to those of SV and DV. DR notably increased during expiration, and the mean percentage change was 61%. The ratio of RFI (Inspiratory reverse flow integral) to FFI (forward flow integral) of the tamponade group was 270%. The mean percentage changes of each parameters decreased after pericardiocentesis. CONCLUSION: Patients with cardiac tamponade showed inspiratory increases of diastolic tri-cuspid filling flow and hepatic forward flow. Expiratory increases included diastolic mitral filling flow, pulmonary venous systolic and diastolic flow, and hepatic venous reverse flow. Such res-piratory variations decreased after pericardiocentesis.
Cardiac Tamponade* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Relaxation ; Respiration

Superficial dermatophytic infections are considered to be mild superficial epidermal infection. Most organisms are located superficially in stratum corneum. Sometimes, they may involve the hair follicles, producing papule, pustule, or nodule, characterized clinically as kerion. It usually occurs on scalp or beard area but may occur elsewhere on the body. We report a case of kerion on glabrous skin. The patient presented with intense, boggy mass with suppurations on left thigh. On mycologic examination, Trichophyton verrucosum was isolated. We report this atypical form of localized inflammatory infection caused by tinea.
Hair Follicle ; Humans ; Scalp ; Skin ; Thigh* ; Tinea ; Trichophyton*

Superficial dermatophytic infections are considered to be mild superficial epidermal infection. Most organisms are located superficially in stratum corneum. Sometimes, they may involve the hair follicles, producing papule, pustule, or nodule, characterized clinically as kerion. It usually occurs on scalp or beard area but may occur elsewhere on the body. We report a case of kerion on glabrous skin. The patient presented with intense, boggy mass with suppurations on left thigh. On mycologic examination, Trichophyton verrucosum was isolated. We report this atypical form of localized inflammatory infection caused by tinea.
Hair Follicle ; Humans ; Scalp ; Skin ; Thigh* ; Tinea ; Trichophyton*

According to recent studies, the immunogenetic factors are thought to be account for a part of the etiopathogenesis of autoimmune thyroid disease. In Korea, there was one report on the relationship between HLA DR5, DR8, B13 and autoimmune thyroid disease. There were also several reports on a familial hereditary transmission of autoimmune thyroid disease in other countries but not in Korea. We describe the occurrence of autoimmune thyroid disease that affected three members of a family through three generations. This is the first report on familial hereditary transmission of autoimmune thyroid disease in Korea. We report on an 80-year-old woman who presented with Hashimoto's thyroiditis, her 53-year-old daughter who had Graves' disease, and her 29-year-old grand-daughter who had Graves' disease. In order to identify the immunogenetic influence in these cases, HLA haplotypes & thyroid autoantibody were studied. HLA DRB3*02 was obseved in each of the patents. HLA DQB1*0301, DR11, DQB1*05031 and DR14 were observed in the two cases. However, HLA B13, DR5 and DR8 were not observed. The patients are currently undergoing follow-up using PTU, methimazole and synthyroid medication.
Adult ; Aged, 80 and over ; Family Characteristics ; Female ; Follow-Up Studies ; Graves Disease ; Haplotypes ; HLA-B13 Antigen ; Humans ; Immunogenetics ; Korea ; Methimazole ; Middle Aged ; Nuclear Family ; Thyroid Diseases* ; Thyroid Gland* ; Thyroiditis

Purpose: This study aimed to compare the failure patterns before and after the introduction of immunotherapy and to determine the role of thoracic radiotherapy (TRT) in extensive-stage small-cell lung cancer (ES-SCLC) treatment. Materials and Methods: We retrospectively reviewed 294 patients with ES-SCLC, of which 62.2% underwent chemotherapy alone, 13.3% underwent chemotherapy followed by consolidative TRT (TRT group), and 24.5% underwent chemotherapy with immune checkpoint inhibitor (ICI group). We performed propensity-score matching (PSM) to compare each treatment group. Results: The median follow-up duration was 10.4 months. At the first relapse, in the cohort showing objective response, the proportion of cases showing intrathoracic progression was significantly lower in the TRT group (37.8%) than in the chemotherapy-alone (77.2%, p < 0.001) and the ICI (60.3%, p=0.03) groups. Furthermore, in the subgroup analysis, TRT showed benefits related to intrathoracic progression-free survival (PFS) in comparison with ICI in patients with less than two involved extrathoracic sites (p=0.008) or without liver metastasis (p=0.02) or pleural metastasis (p=0.005) at diagnosis. After PSM, the TRT group showed significantly better intrathoracic PFS than both chemotherapy-alone and ICI groups (p < 0.001 and p=0.04, respectively), but showed no significant benefit in terms of PFS and overall survival in comparison with the ICI group (p=0.17 and p=0.31, respectively). Conclusion In ES-SCLC, intrathoracic progression was the most dominant failure pattern after immunotherapy. In the era of chemoimmunotherapy, consolidative TRT can still be considered a useful treatment strategy for locoregional control.

Purpose: We aimed to evaluate the effectiveness of prophylactic cranial irradiation (PCI) for “early brain metastasis”, which occurs before extracranial recurrence (ECR), and “late brain metastasis”, which occurs after ECR, in limited-stage small cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively analyzed 271 LS-SCLC patients who underwent definitive chemoradiation. All patients were initially staged with brain magnetic resonance imaging and positron emission tomography. Intracranial recurrence (ICR), ECR, progression-free rate (PFR), and overall survival (OS) were analyzed as clinical endpoints. The competing risk of the first recurrence with ICR (ICRfirst) was evaluated. Significantly associated variables in multivariate analysis of ECR were considered as ECR risk factors. Patients were stratified according to the number of ECR risk factors. Results: The application of PCI was associated with higher PFR (p=0.008) and OS (p=0.045). However, PCI was not associated with any of the clinical endpoints in multivariate analysis. The competing risk of ICRfirst was significantly decreased with the application of PCI (hazard ratio, 0.476; 95% confidence interval, 0.243 to 0.931; p=0.030). Stage III disease, sequential, and stable disease after thoracic radiation were selected as ECR risk factors. For patients without these risk factors, the application of PCI was significantly associated with increased OS (p=0.048) and a decreased risk of ICRfirst (p=0.026). Conclusion PCI may play a role in preventing early brain metastasis rather than late brain metastasis after ECR, suggesting that only patients with a low risk of ECR may currently benefit from PCI.

Purpose: In the treatment of concurrent chemoradiotherapy (CCRT) in limited-stage small cell lung cancer, the optimal once-daily radiotherapy (RT) dose/fractionation remain unclear although it is the most frequently used. Therefore, this study aimed to compare the treatment outcomes and toxicities of modest dose RT (≤ 54 Gy) with those of standard dose RT (> 54 Gy) and investigate the benefit of the high dose based on patient factors. Materials and Methods: Since 2004, our institution has gradually increased the thoracic RT dose. Among the 225 patients who underwent CCRT, 84 patients (37.3%) received > 54 Gy. Because the patients treated with RT > 54 Gy were not randomly assigned, propensity score matching (PSM) was performed. Results: The proportion of patients treated with > 54 Gy increased over time (p=0.014). Multivariate analysis revealed that the overall tumor stage and dose > 54 Gy (hazard ratio, 0.65; p=0.029) were independent prognostic factors for overall survival (OS). PSM confirmed that thoracic RT doses of > 54 Gy showed significantly improved progression-free survival (3-year, 42.7% vs. 24.0%; p < 0.001) and OS (3-year, 56.2% vs. 38.5%; p=0.003). Sensitivity analysis also showed that 60 Gy resulted in better survival than 54 Gy. However, in patients with underlying lung disease, OS benefit from > 54 Gy was not observed but considerable rates of severe pulmonary toxicities were observed (p=0.001). Conclusion Our analysis supports that the 60 Gy RT dose should be considered in the once-daily regimen of CCRT for limited-stage small cell lung cancer without underlying lung disease, but RT dose > 54 Gy did not seem to benefit for patients with chronic obstructive pulmonary disease or interstitial lung disease. Further study is needed to validate these results.

BACKGROUND: Atherosclerosis, a major problem in patients undergoing chronic dialysis treatment, has been characterized as an inflammatory disease. Cardiovascular disease is the major cause of mortality, accouting for approximately half of all deaths in this population. The present study was aimed whether CRP, an important inflammatory marker, might be associated with cardiovascular risk in dialysis patients. METHODS: We performed retrospective study in 77 dialysis patients. Patients were divided into the elevated CRP group (>8 mg/L, n=11) and the normal CRP group (8 mg/L) showed significant higher cardiovascular events (by chi-squre test, p=0.032). BMI, smoking, alcohol, dialysis modality, lipid parameters, BUN, serum creatinine, serum protein, serum albumin and seurm TIBC did not show significant difference between two groups. Correlation between CRP and other biochemical parameters was analysed. Only ESR was positively correlated with CRP. In a subsequent analysis, elevated CRP group had significantly higher cardiovascular risk (by stepwise logistic regression method, odd ratio = 6.59;95% CI, 1.13 to 38.28). CONCLUSION: These results suggest that CRP level is correlated with cardiovascular risk in dialysis patients.
Atherosclerosis ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases* ; Creatinine ; Dialysis* ; Ferritins ; Humans ; Inflammation ; Logistic Models ; Male ; Mortality ; Peritoneal Dialysis ; Renal Dialysis ; Retrospective Studies ; Serum Albumin ; Smoke ; Smoking