PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.
Bariatric Surgery ; Gastrectomy ; Hand ; Hospitals, Private ; Hospitals, University ; Incidence ; Korea ; Methods ; Obesity

Tuberculous peritonitis in pregnancy is a rare form of extrapulmonary tuberculosis that is not easily diagnosed. The clinical presentations of tuberculous peritonitis are usually non-specific and mimic those of other diseases, such as ovarian malignancy or chronic liver disease, and this non-specificity can cause diagnostic delays and complications. The authors report the case of a 31-year-old primigravida woman who presented with uncontrolled fever, dyspnea, elevated liver enzymes, and mild abdominal distension at 13+2 weeks of gestation. At 14+2 weeks, a therapeutic abortion was conducted and tuberculous peritonitis was confirmed by laparoscopic excisional biopsy of peritoneal nodules and histopathologic examination. The patient recovered on antituberculosis therapy and abdomen and chest follow up radiographic findings have confirmed improvement.
Abdomen ; Abortion, Therapeutic ; Adult ; Biopsy ; Dyspnea ; Female ; Fever ; Follow-Up Studies ; Humans ; Liver ; Liver Diseases ; Peritonitis ; Peritonitis, Tuberculous* ; Pregnancy ; Pregnancy Trimester, First* ; Pregnancy* ; Thorax ; Tuberculosis

OBJECTIVES: To assess the ability of risk of malignancy index (RMI) 1 to discriminate between benign and malignant pelvic masses. METHODS: Between January 2007 and December 2010, 547 women with pelvic masses were evaluated. Their medical records are reviewed here retrospectively. The sensitivity, specificity and positive and negative predictive values of the cancer antigen (CA) 125 level, ultrasound findings and menopausal status in the prediction of malignant pelvic masses were calculated and compared individually or combined using the RMI 1. RESULTS: The receiver operating characteristic (ROC) curves of CA 125, the ultrasound score and the RMI 1 were all found to be relevant predictors of malignancy. ROC analysis of the RMI 1, CA 125 serum levels, ultrasound score and menopausal status showed areas under the curves of 0.795, 0.782, 0.784 and 0.594, respectively. The RMI 1 was found to be statistically significantly correlated with menopausal status (P = 0.001), while not statistically significantly correlated with CA 125 (P = 0.628) or the ultrasound score (P = 0.541). The RMI 1 at a cut-off of 150 - with a sensitivity of 77.9%, specificity of 81.1%, positive predictive value of 51.7% and negative predictive value of 93.4% - showed the highest performance in determining the malignant tendency of pelvic masses. CONCLUSION: Accepting a RMI 1 cut-off value of 150 results in statistically more significant diagnostic criteria than menopausal status for the discrimination of benign and malignant pelvic masses.
Discrimination (Psychology) ; Female ; Humans ; Medical Records ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

A 70-yr-old woman visited our hospital for shortness of breath. Chest CT showed ground glass opacity and traction bronchiectasis at right middle, lower lobe and left lingular division. Video-assisted thoracic surgical biopsy at right lower lobe and pathologic examination revealed mixed dust pneumoconiosis. Polarized optical microscopy showed lung lesions were consisted of silica and carbon materials. She was a housewife and never been exposed to silica dusts occupationally. She has taken freshwater snails as a health-promoting food for 40 yr and ground shell powder was piled up on her backyard where she spent day-time. Energy dispersive X-ray spectroscopy of snail shell and scanning electron microscopy with energy dispersive x-ray spectroscopy of lung lesion revealed that silica occupies important portion. Herein, we report the first known case of silicosis due to chronic inhalation of shell powder of freshwater snail.
Aged ; Animals ; Carbon/chemistry ; *Dust ; Female ; Humans ; *Inhalation ; Silicon Dioxide/chemistry ; Silicosis/*diagnosis/radiography ; Snails/*chemistry ; Spectrometry, X-Ray Emission ; Tomography, X-Ray Computed

An eighteen year-old female visited the ER in our hospital with fever of 38.5degrees C for 2 days. She also had cough, myalgia, and dyspnea. Chest PA and lung HRCT showed mild pulmonary edema at both hilar areas. However, she had severe hypoxia (PaO2; 58 mmHg in room air). RT-PCR for H1N1 influenza/A of pharyngeal swab was positive. Tamiflu (150 mg/d) with broad-spectrum antibiotics was prescribed. Two days later, her dyspnea aggravated and chest PA showed diffuse bilateral infiltration. PaO2 dropped to 70 mmHg (O2 10 L/min by face mask with reservoir bag). She was transferred to the MICU and the Tamiflu dose was doubled (300 mg/day). Mechanical ventilator was set aside to prepare respiratory failure. Fortunately, her symptoms and oxygenation improved and she was discharged with full recovery. Although, most cases of ARDS require mechanical ventilatory support, early and adequate dose of Tamiflu may avoid it in the case of ARDS developed by H1N1 influenza/A.
Anoxia ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Female ; Fever ; Humans ; Lung ; Masks ; Oseltamivir ; Oxygen ; Pneumonia ; Pulmonary Edema ; Respiratory Insufficiency ; Thorax ; Ventilators, Mechanical

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation

BACKGROUND: Epigallocatechin-3-gallate (EGCG) is the major catechin in green tea, and has shown antiproliferative, antiangiogenic, antimetastatic and cell cycle pertubation activity in various tumor models. Hypoxia can be induced because angiogenesis is insufficient for highly proliferating cancer. Hypoxia-inducible factor-1alpha (HIF-1alpha) and its downstream target, vascular endothelial growth factor (VEGF), are important for angiogenesis, tumor growth and metastasis. The aim of this study was to determine how hypoxia could cause changes in the cellular phenomena and microenvironment in a non-small cell culture system and to examine the effects of EGCG on a HIF-1alpha and VEGF in A549 cell line. METHODS: A549 cells, a non-small cell lung cancer cell line, were cultured with DMEM and 10% fetal bovine serum. A decrease in oxygen tension was induced using a hypoxia microchamber and a CO2-N2 gas mixture. Gas analysis and a MTT assay were performed. The A549 cells were treated with EGCG (0, 12.5, 25, 50 micromol/L), and then examined by real-time-PCR analysis of HIF-1alpha, VEGF, and beta-actin mRNA. RESULTS: Hypoxia reduced the proliferation of A549 cells from normoxic conditions. EGCG inhibited HIF-1alpha transcription in A549 cells in a dose-dependent manner. Compared to HIF-1alpha, VEGF was not inhibited by EGCG. CONCLUSION: HIF-1alpha can be inhibited by EGCG. This suggests that targeting HIF-1alpha with a EGCG treatment may have therapeutic potential in non-small cell lung cancers.
Actins ; Anoxia ; Carcinoma, Non-Small-Cell Lung ; Catechin ; Cell Culture Techniques ; Cell Cycle ; Cell Line ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Oxygen ; RNA, Messenger ; Tea ; Vascular Endothelial Growth Factor A

OBJECTIVE: To know impacts of BMI on clinical results of total laparoscopic hysterectomy (TLH). METHODS: We reviewed medical records of patients with myoma uteri who undergone TLH between March 2003 and February 2007, retrospectively. We classified group 1 when BMI was <23 kg/m2, group 2 when BMI was between 23 and 28, and group 3 when BMI was > or =28. We reviewed age, parity, body weight and height, operation time, amount of blood loss, change of hemoglobin change and days of hospital stay, and analyze these. RESULTS: There were 83 patients (Group 1; 30, Group 2; 40, Group 3; 13). The body weight distributions of Group 1, 2, and 3 were 52.2, 60.9, and 72.0 kg and there were significant differences. But there was no difference of height distributions. The age distributions were 44.3, 47.0, 43.8 year old, and there were differences. But there was no difference of parity distribution. The weight distribution of removed uterus were 250.5, 257.4, 242.7 gm and there was no difference. The operation time distributions were 155.0, 168.2, 160.8 minutes, and there was no difference. The amount distributions of bleeding were 342.7, 356.5, 396.2 ml, and there was no difference. The change distributions of hemoglobin were 2.1, 1.8, 2.2 g/dL, and there was no difference. The day distributions of hospital stay were 5.2, 5.5, 4.8, and there was no difference. CONCLUSION: We could not find any trend between operation time, amount of bleeding, change of hemoglobin, and days of postoperative hospital stay after TLH with BMI.
Age Distribution ; Body Mass Index ; Body Weight ; Female ; Hemoglobins ; Hemorrhage ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Medical Records ; Myoma ; Parity ; Retrospective Studies ; Uterus

Perivascular epithelioid cell tumors (PEComas) at the uterus are very rare tumors and about 30 cases have been reported as far as we know. As a case was experienced at our hospital, we would like to report it with a brief review of literature.
Epithelioid Cells* ; Perivascular Epithelioid Cell Neoplasms ; Uterus*

A 54-year-old male was admitted due to lung cancer and polyarthralgia involving wrist, hand, shoulder, and ankle joints. Five months ago, he had been diagnosed as adenocarcinoma of the lung, and treated with three cycles of chemotherapy using gemcitabine and cisplatin. In the course of chemotherapy, he had complained symmetrical polyarthralgia of hand and shoulder joints, resembling rheumatoid arthritis (RA). After treatment with chemotherapeutic agents, he still had severe polyarthritis refractory to anti-rheumatic drugs, including prednisolone, hydroxychloroquine, and methotrexate, and thus referred to our hospital. We changed the previous anti-cancer regimens to cisplatin plus docetaxel, a semisyntheic taxane molecule, which is known to suppress experimental polyarthritis. With additional three cycles of cisplatin plus docetaxel, RA disease activity as well as polyarthralgia was nearly completely resolved, and the extent of lung cancer was not aggravated. Although RA patients have an increased risk of malignancy, the outbreak of RA was very rare in lung cancer patients. Here we report a case of coincident lung cancer and rheumatoid arthritis, which was successfully treated by docetaxel plus cisplatin chemotherapy.
Adenocarcinoma ; Ankle Joint ; Antirheumatic Agents ; Arthralgia ; Arthritis ; Arthritis, Rheumatoid* ; Cisplatin ; Drug Therapy* ; Hand ; Humans ; Hydroxychloroquine ; Lung Neoplasms* ; Lung* ; Male ; Methotrexate ; Middle Aged ; Prednisolone ; Shoulder ; Shoulder Joint ; Wrist