PURPOSE: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. METHODS: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using removed appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel(R) (Ethicon). We analyzed the success rate. RESULTS: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. CONCLUSION: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.
Appendectomy* ; Appendix* ; Body Mass Index ; Humans ; Laparoscopy ; Recycling ; Surgical Instruments*

The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.

The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.

No abstract available.
Aneurysm* ; Heart Septal Defects, Ventricular*

The use of semiquantitative food frequency to estimate dietary intake has become widespread in nutritional epidemiologic studies. It had been suggested that knowledge about a person's usual portion size of each meal in addition to consumption frequency will improve the accuracy of this method. This study was performed to investigate the dietary intake status(nutrient, food, and dish intake) and one portion size of commonly consumed food and dishes to develop a semiquantitative food frequency questionnaire that will be used to expore the relationship between the incidence of cardiovascular disease and diet in Korean women after menopause. Intake of food or dish in 123 elderly women were measured by 3-day food records in March to May, 1996. The results obtained in this study were summarized as follow : 1) Calcium, vitamin A, and vitamin E intakes were less adequate than Recommended dietary allowances(RDA). 2) The subjects who consumed more than 20% of the energy from fat were 35% and the subjects consumed dietary cholesterol more than 300mg were 18%. 3) The most frequently consumed foods or dishes by the subjects were Korean cabbage kimchi Aged* ; Brassica ; Calcium ; Cardiovascular Diseases ; Cholesterol, Dietary ; Delivery of Health Care ; Diet ; Female ; Humans ; Incidence ; Meals ; Menopause ; Portion Size* ; Soybeans ; Vitamin A ; Vitamin E ; Vitamins ; Surveys and Questionnaires

We implanted intraocular lenses in 41 eyes of 41 patients with traumatic cataract without associated retinal injury. All the enrolled patients had sustained injury visited the Incheon Gil Hospital between August 1988 and June 1992. We analyzed age and sex distribution, mode and site of injuries, associated injuries, postoperative complications, methods of operation, final visual results and causes of decreased vision. Nineteen patients(46.4%) achieved final visual acuity of 0.5 or better, 11 patients(26.8%) between 0.1 and 0.5, and the remaining 11(26.8%) below 0.1. Major visual prognostic factors were associated ocular injuries, the state of the posterior lens capule, intraoperative and early postoperative complications. The interval between the first and second operation had little effect on the final vision.
Cataract* ; Humans ; Incheon ; Lenses, Intraocular* ; Postoperative Complications ; Retinaldehyde ; Sex Distribution ; Visual Acuity

The study was performed retrospectively to compare the results of anterior chamber IOL(Intraocular Lens) implantation and posterior chamber IOL implantation by scleral fixation in cases of inadequate zonular or capsular support during the extracapsular cataract extraction. A total of 27 cases were reviewed of which 11 cases had anterior chamber IOL implantation and 16 cases had posterior chamber IOL implantation by scleral fixation. The follow-up period ranged from two to twenty-four months. Nine of eleven in anterior chamber IOL group and thirteen of sixteen in posterior chamber IOL group had the final corrected vision of 0.5 or better. Vision-threatening complications included two cases of cystoid macular edema in anterior chamber IOL group, whose visual acuity was 0.1 and 0.5, and three cases of vitreous hemorrhage in posterior chamber IOL group, which had little effect on visual outcome The final visual acuity didn't show statistically significant difference between the two groups.
Anterior Chamber* ; Cataract Extraction ; Follow-Up Studies ; Lenses, Intraocular* ; Macular Edema ; Retrospective Studies ; Visual Acuity ; Vitreous Hemorrhage

We report a case of gastro-colic fistula caused by ectopic gastric mucosa developed at transverse colon. Fistula was detected by colonofiberscopy. And fistulous tract was proved by barium enema. Meckel's diverticulum scan finding was similar to that of GI bleeding; e.g. injected radioactivity was secreted into the lumen and moved along the lumen. There was no bleeding. And there was no diverticulum in the colon. Absence of diverticular pouch may explain this unusuaal GI bleeding-like scan finding rather than focal collection of radioactivity, which is typical of ectopic gastric mucosa found in the Meckel's diverticulum. Ectopic gastric mucosa was confirmed by colonfiberscopic biopsy. We suggest GI bleeding-like pictures should be included differential diagnosis of Tc-99m-O4 (ectopic gastric mucosa or Meckel's diverticulum) scan.
Barium ; Biopsy ; Colon ; Colon, Transverse ; Diagnosis, Differential ; Diverticulum ; Enema ; Fistula* ; Gastric Mucosa* ; Hemorrhage ; Meckel Diverticulum ; Radioactivity ; Radionuclide Imaging ; Sodium Pertechnetate Tc 99m*

OBJECTIVES: Cadmium (Cd), a toxic and non-essential metal, is recognized as a human carcinogen, which has a tendency to accumulate in the human body. The levels of Cd in renal cortex and liver are good indicators as an index of Cd exposure in the general population. In this study, we present an estimation of reference Cd levels in tissue (renal cortex and liver) and total body burden in the general population of Korea. MEDTHODS: Cd and zinc (Zn) were analyzed in renal cortex and liver from 254 autopsies (male : 188 cases, female : 66 cases) aged 0 to 87 years. RESULTS: Geometric mean concentration of Cd was 27.4 and 3.1 ua/g wet weight in renal cortex and liver, respectively. The level of Zn in renal cortex and liver was 35.4 and 42. 6 v/g wet weight, respectively. The result suggests that kidney is the target organ for Cd accumulation. The accumulation of Cd in renal cortex was age-dependent with a biphasic pattern. The level of Cd in renal cortex increased with age up to the fifties, and then leveled off thereafter. Based on the data, the regression model for Cd accumulation in renal cortex by age is predicted by : Log KCd = 0. 2325 + 0. 0553 Age 0. 0005 Age. The highest Cd accumulation in renal cortex of Koreans was estimated at 43. 3 ua/g wet weight at 50. 8 years old. In addition, the total Cd body burden by age was estimated by the following equation: Total Cd Body Burden = -4. 5948 + l. 2278 Age - 0. 0121 Age. The highest body burden of Cd was estimated at 26. 5 mg at age 50. 7 years in the Korean general population. The positive correlation between Zn and Cd was observed in renal cortex and liver. CONCLUSIONS: The level of Cd exposure in Korean was found to be lower than in Japanese, but same as or higher than in American and Europeans.
Asian Continental Ancestry Group ; Autopsy ; Body Burden ; Cadmium* ; Child ; Female ; Human Body ; Humans ; Kidney Cortex ; Kidney* ; Korea ; Liver* ; Reference Values* ; Zinc