BACKGROUND: This study was performed to evaluate our experience on laparoscopic appendectomy. METHODS: Retrospective analysis was performed on 2,856 patients who had been operated by laparoscopic appendectomy under diagnosis of acute appendicitis at the Sung-Ae Hospital and Kwang-Myoung Sung-Ae Hospital from October 1991 to July 1998. RESULTS: Among 2,856 patients who had undergone laparoscopic appendectomy,2,379 patients (83.3%) were operated due to simple acute appendicitis, 275 patients (9.6%) due to perforated appendicitis. Operation time was 44.6 minutes for simple acute appendicitis and 60.3 minutes for perforated appendicitis. In perforated appendicitis, intra-peritoneal irrigation and drain insertion was performed. The length of hospital stay in patient with simple acute appendicitis was 3.7 days (5.82 days in conventional appendectomy) and patients with perfotrated appendicitis was 6.1 days (9.91 days in conventional appen-dectomy). Complications such as wound infection, intra-abdomen abscess, trocar site bleeding, subcutaneous emphysema developed in 43 (1.5%) patients (79/1,947, 4.5% in conventional appendectomy). In 202 (7.1%) patients, appendix was normal, but another diseases were detected, including acute pelvic inflammation, ovarian cyst, mesenteric lymphadenitis, enteritis, diverticulitis in order. CONCLUSION: Overall complication rate was lower in laparoscopic appendectomy compared with conventional appendectomy and the length of hospitalization of laparoscopic appendectomy was shorter. When the acute appendicitis is suspected, especially in the reproductive women, the laparoscopic approach would be better diagnostic and therapeutic value than conventional method. Therefore laparoscopic appendectomy would be replaced with conventional appendectomy.
Abscess ; Appendectomy* ; Appendicitis ; Appendix ; Diagnosis ; Diverticulitis ; Enteritis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Inflammation ; Length of Stay ; Mesenteric Lymphadenitis ; Ovarian Cysts ; Retrospective Studies ; Subcutaneous Emphysema ; Surgical Instruments ; Wound Infection

PURPOSE: Bone involvement is known to develop in 40-70Yo of pediatric acute leukemia. We aimed to analyze the clinical course and result of therapy in pediatric acute leukemia with bone involvement. METHODS: Twenty-seven patients diagnosed as pediatric acute leukemia at Dong San Medical Center from Jan. 1996 to Aug. 1998 were evaluated. According to bone X-ray and whole body bone scan, the patients were divided into two groups. RESULTS: Twenty-seven patients were enrolled in this study with 14 patients(52Yo) showing definite bone involvement on simple X-ray or bone scan. Mean age of patients with bone involvement was 5.5 years. Regarding the type of leukemia, 9 patients(64%) were acute lymphocytic leukemia. Ten patients(71%) out of 14 with bone involvement complained of bone pain at the involved bony site. Site of involvement was most frequent in the lower extremity. On simple X-ray, osteolytic lesion was found in 7 patients(50%), diffuse osteopenia in 2 patients(14%) and pathologic fracture in 2 patients(14%). In bone scan, radioactivity was increased in whole cases of patients with bone involvement. Thirteen patients(93%) were completely remitted by chemo-therapy, but, one AML patient died due to induction failure. CONCLUSION: Bone involvement occured in 52% of pediatric acute leukemia. Bone involvement was more frequent in male patients in the lower extremity, and osteolytic lesion was the most frequent finding on simple X-ray. There was no relevence between bone involvement and prognosis. Further study will be needed to evaluate long-term survival and prognosis. (J Korean Pediatr Soc 2000;43:806-813)
Bone Diseases, Metabolic ; Fractures, Spontaneous ; Humans ; Leukemia* ; Lower Extremity ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Radioactivity

5-Fluorouracil was used for the treated of 4 cases of carcinoma of the bladder along with electrocoagulation, X-ray radiation, Cobalt teletherapy and estrogen and its effectiveness was evaluated Further experience with this druy is necessary for detailed evaluation, though the cases reported herein seems to have responded to this chemotherapy to some extent.
Cobalt ; Drug Therapy ; Electrocoagulation ; Estrogens ; Fluorouracil* ; Urinary Bladder Neoplasms ; Urinary Bladder*

Status epilepticus (SE) is a neurological emergency that requires prompt diagnosis and treatment. Prognosis of SE depends mostly on the underlying illnesses and secondary brain damage from seizure activity. For early detection of poor prognostic factors in SE, we retrospectively analyzed 121 SE patients with their medical redords, laboratory findings, and neuroimaging studies. No single factor other than the previous history of seizure was associated with their prognosis. According to presence or absence of previous seizure history, they were divided into the first-ever seizure group (53 patients) and recurrent seizure group (68 patients). We compared both two groups in respect to demographic, neurological, and radiological features, response to antiepileptic drugs (AEDs), and short-term outcome of SE. The results stggest that the patients of the first-seizure group are older and have more frequent detectable etiological diseases, poor response to AEDs, and higher mortality, hence prognosis being worse than the recurrent-seizure group.
Anticonvulsants ; Brain ; Diagnosis ; Emergencies ; Humans ; Mortality ; Neuroimaging ; Prognosis ; Retrospective Studies ; Seizures* ; Status Epilepticus*

No abstract available.
Holoprosencephaly* ; Prune Belly Syndrome*

The clinical features of cerebral infarction (CI) which cause late post-infarct epilepsy (PIE), are not well understood. We tried to identify the clinical signs which might be associated with late PIE development. We analyzed 60 consecutive patients (PIE group) who had recurrent seizures at least a week after the CI. Neuroradiological findings, clinical features during the acute phase of CI, types of seizures, and the interval between CI and first seizure were analyzed. These data were compared with those of randonly sampled nonepikptic patients with CI (60 patients with CI group). In the epikptic patients who had the history of previous CI (46 patients), hemiparesis was frequent symptom during the acute phase of CI (93.5%). Diabetes mellitus and hypertension were frequent underlying illnesses and were not different between the groups. Heart diseaseswere common in PIE group (40% vs. 13.3%) and correspondingly, the cortical CI involving the superior division of the MCA including motor area was frequent brain pathology (46.7%). Seizures usually began with focamotor activity (50%), but generalized seizure ws also common (35%). In 14 patients, silent CI was identified after the first seizure. Their usual site of CI was subcortical (42.9%), whereas the subcortical CI was infrequent in those with history of CI (13.0%). Acute PIE occurred in six patients and persisted thereafter. These findings suggest that the cortical infarct involving the motor cortex is frequent pathology in the late PIE, that acute PIE may remains as late PIE, and that silent infarct may be an important cause in adult-onset epilepsy.
Brain Diseases ; Cerebral Infarction ; Diabetes Mellitus ; Epilepsy* ; Heart ; Humans ; Hypertension ; Motor Cortex ; Paresis ; Pathology ; Seizures

This guideline is developed to provide criteria for evaluating permanent impairment of the visual system as it affects an individual's ability to perform activities of daily living. This new assessment system is based on the 5th and 6th edition of American Medical Association and McBride impairment assessment system but revised on the consideration of Korean culture and simple application. This evaluation of impairment is based on an assessment of visual acuity and visual field. Especially it weighs binocular vision and binocular visual fields and the binocular vision and binocular visual fields provide 50% of weight and the right and left eye each contribute 25%. A further adjustment of the impairment rating is included at the final step of this evaluation. Functional deficits for individual adjustments include diplopia, problem of accommodation, abnormality of eyelids, tearing, cosmetic problems from cornea opacity, glare, aphakia, and dark-adaptation. The adjustment can be added to impairment rating up to 15%. Further study is necessary to revise and update of this disability evaluation that have potential problems in actual application.
*Disability Evaluation ; Humans ; Korea ; Program Development ; Vision Disorders/classification/*diagnosis ; Visual Acuity ; Visual Fields

Background/Aims: Estrogen is known to have protective effect in colorectal cancer development. The aims of this study are to investigate whether estradiol treatment reduces inflammation in CCD841CoN, a female human colonic epithelial cell line and to uncover underlying mechanisms of estradiol effects. Methods: 17β-Estradiol (E2) effect was measured by Western blot after inducing inf lammation of CCD841CoN by tumor necrosis factor α (TNF-α). Expression levels of estrogen receptor α (ERα) and β (ERβ), cyclooxygenase-2 (COX-2), nuclear factor-κB (NF-κB), heme oxygenase-1 (HO-1), and NAD(P)H-quinone oxidoreductase-1 (NQO-1) were also evaluated. Results: E2 treatment induced expression of ERβ but did not increase that of ERα. E2 treatment for 48 hours significantly elevated the expression of anti-oxidant enzymes, HO-1 and NQO-1. TNF-α treatment significantly increased the level of activated NF-κB (p < 0.05), and this increase was significantly suppressed by treatment of 10 nM of E2 (p < 0.05). E2 treatment ameliorated TNF-α-induced COX-2 expression and decrease of HO-1 expression. 4-(2-phenyl-5,7-bis(trifluoromethyl) pyrazolo(1,5-a)pyrimidin-3-yl)phenol (PHTPP), antagonist of ERβ, removed the inhibitory effect of E2 in the TNF-α-induced COX-2 expression (p = 0.05). Conclusions Estrogen seems to inhibit inflammation in female human colonic epithelial cell lines, through down-regulation of NF-κB and COX-2 expression and induction of anti-oxidant enzymes such as HO-1 and NQO-1.

Purpose: 17β-Estradiol (E2) supplementation suppresses MC38 tumor growth by downregulating the expression of programmed death-ligand 1 (PD-L1). This study aims to figure out the gut microbiota that respond to anti–PD-L1 and/or estrogen treatment in MC38 colon cancer model. Materials and Methods: A syngeneic colon tumor model was developed by injection of MC38 cells into C57BL/6 background male and female mice. Three days before MC38 cells injection, E2 was supplemented to male mice daily for 1 week. Male and female mice with MC38 tumors (50-100 mm3) were injected with anti–PD-L1 antibody. Fresh feces were collected 26 days after injection of MC38 cells and 16S rRNA metagenomics sequencing of DNA extracted from feces was used to assess gut microbial composition. Results: At the taxonomic family level, Muribaculaceae was enriched only in the MC38 male control group. In male mice, linear discriminant analysis effect size analysis at the species level revealed that the four microorganisms were commonly regulated in single and combination treatment with anti–PD-L1 and/or E2; a decrease in PAC001068_g_uc and PAC001070_s (family Muribaculaceae) and increase in PAC001716_s and PAC001785_s (family Ruminococcaceae). Interestingly, in the anti–PD-L1 plus E2 group, a decrease in opportunistic pathogens (Enterobacteriaceae group) and an increase in commensal bacteria (Lactobacillus murinus group and Parabacteroides goldsteinii) were observed. Furthermore, the abundance of Parabacteroides goldsteinii was increased in both males and females in the anti–PD-L1 group. Conclusion Our results suggest that gut microbial changes induced by the pretreatment of estrogen before anti–PD-L1 might contribute to treatment of MC38 colon cancer.

Purpose: Sex hormones are known to affect the gut microbiota. Previously, we reported that endogenous and exogenous testosterone are associated with colorectal cancer (CRC) development and submucosal invasion. In the present study, we investigated whether the gut microbiota is affected by orchiectomy (ORX) and testosterone propionate (TP) administration using an azoxymethane/dextran sulfate sodium (AOM/DSS)-induced CRC mouse model. Materials and Methods: Gut microbiota was evaluated by means of 16S rRNA gene sequencing of stool DNA extracted from feces that were obtained at 13 weeks after AOM injection (from 22-week-old animals) and stored in a gas-generating pouch. Results: The increase in microbial diversity (Chao1 and Phylogenetic Diversity index) and Firmicutes/Bacteroidetes (F/B) ratio upon AOM/DSS treatment in ORX mice was significantly decreased by TP supplementation. The ratio of commensal bacteria to opportunistic pathogens was lower in the TP-administered females and ORX mice than in the AOM/DSS group. Opportunistic pathogens (Mucispirillum schaedleri or Akkermansia muciniphila) were identified only in the TP group. In addition, microbial diversity and F/B ratio were higher in male controls than in female and ORX controls. Flintibacter butyricus, Ruminococcus bromii, and Romboutsia timonensis showed similar changes in the male control group as those in the female and ORX controls. Conclusion In conclusion, testosterone determines the dysbiosis of gut microbiota, which suggests that it plays a role in the sex-related differences in colorectal carcinogenesis.