No abstract available.
Krukenberg Tumor*

No abstract available.
Krukenberg Tumor*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.
Anesthesia, General* ; Anoxia ; Arrhythmias, Cardiac ; Blood Pressure ; Carbon Dioxide ; Cardiovascular System ; Head-Down Tilt* ; Heart Rate ; Hypotension ; Insufflation* ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Tidal Volume ; Vital Signs

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen’s medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

PURPOSE: To evaluate the negative pressure wound therapy for traumatic soft tissue defects by vacuum-assised closure (V.A.C.(R)). MATERIALS AND METHODS: 33 patients with traumatic soft tissue defects were treated by using V.A.C.(R) which removes edema fluid, eliminates an extrinsic cause of microcirculatory embarrassment and may directly stimulate cellular proliferation of reparative granulation tissue. We removed all necrotic tissue prior to application of the V.A.C.(R). The foam dressing was placed into direct contact with wound and was changed every 48~72 hours. The setting for vacuum pump was continuous pressure of 100 to 125 mm Hg. C-reactive protein was checked to evaluate wound infection. We measured wound size and total duration of treatment. RESULTS: Mean duration of treatment was 25.2 days and mean decrease of wound size was 31.9%. The concentration of CRP after V.A.C.(R) therapy reduced by day 8 below 1.0 mg/dl and gradually decreased to normal level by day 10. All patients showed hastened wound healing by rapid formation of granulation tissue. CONCLUSION: Negative pressure wound therapy is useful in patients with traumatic soft tissue defects, which reduces treatment duration and cost by rapid wound healing and effective infection control.
Bandages ; C-Reactive Protein ; Cell Proliferation ; Edema ; Granulation Tissue ; Humans ; Infection Control ; Negative-Pressure Wound Therapy* ; Vacuum ; Wound Healing ; Wound Infection ; Wounds and Injuries

BACKGROUND: Doppler ultrasound has recently been used to assess change in blood velocity in the uterine and umbilical arteries. Alterations in the ratio of systolic to diastolic velocity (= S/D ratio) are believed to reflect changes in placental vascular resistance. We have used this technique to assess potential beneficial or detrimental effects of epidural anesthesia on blood flow to the placenta. METHODS: Continuous wave Doppler ultrasound was used to measure the S/D ratio in the uterine and umbilical arteries of 40 patients undergoing epidural anesthesia prior to elective cesarean section. Left uterine displacement was employed throughout. Doppler ultrasound obtained at the level of umbilical artery and uterine artery. Prior to induction of anesthesia each patient received 800~1,000 ml of lactated Ringer's solution within 20~30 minutes. For epidural anesthesia 2% lidocaine 10 ml and 0.5% bupivacaine 10 ml were used. An upper level of sensory anesthesia to at least T10 was confirmed before umbilical and uterine artery waveform measurement. RESULTS: Epidural anesthesia was followed by a reduction in umbilical artery systolic : diastolic ratio from 2.48+/-0.5 to 2.24+/-0.40 (p<0.05) and in uterine artery systolic : diastolic ratio from 2.29+/-0.41 to 1.96+/- 0.25 (p<0.05). CONCLUSIONS: Epidural anesthesia for cesarean section resulted in a significant decrease in the maternal uterine artery S/D ratio and fetal umbilical artery S/D ratio. This study suggests beneficial fetal effect from the improved maternal uterine perfusion after epidural anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Blood Flow Velocity* ; Bupivacaine ; Cesarean Section* ; Female ; Humans ; Lidocaine ; Perfusion ; Placenta ; Pregnancy ; Ultrasonography ; Umbilical Arteries ; Uterine Artery ; Vascular Resistance

The widespread use of colonoscopy for early detection of colorectal pathology has increased the use of osmotic laxatives for colonic cleansing. Among these, oral sodium phosphate preparations can cause renal insufficiency through the development of acute phosphate nephropathy. Acute phosphate nephropathy can be distinguished as early symptomatic and late insidious patterns. Patients whose presentation is insidious are easily overlooked and can progress to chronic kidney disease. We report a case of complete recovery from the late insidious type of acute phosphate nephropathy.
Colon ; Colonoscopy ; Humans ; Laxatives ; Pathology ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Sodium

PURPOSE: This study analyzed the difference in survival time of patients with delirium according to sedative medication. METHODS: From January 2012 through December 2013, a retrospective cohort study was performed using the electronic medical records (EMR) of Pusan National University Hospital. Among 900 patients who died from cancer, we selected 240 who suffered delirium based on the EMR. The Nu-DESC delirium screening test was used to diagnose delirium. RESULTS: The median length of delirium period was five days. Delirium characteristics were dominated by inappropriate behaviors (35.0%). Sedatives were administered in 72.1% of the cases. The most frequently used sedative was haloperidol which was used in 59.6% of cases. The delirium period significantly differed by patients' age (F=3.96, P=0.021), cancer type (F=3.31, P=0.010), chemotherapy (t=−3.44 P=0.001). The average survival time was 16.85 days for the sedative medication group and 9.37 days for the non-medication group, which, however, was not significant (t=1.766, P=0.079). CONCLUSION: In this study, the use of sedatives did not affect patients' survival time. Thus, appropriate sedative medication can be positively recommended to comfort terminal cancer patients and their families.
Busan ; Cohort Studies* ; Delirium* ; Drug Therapy ; Electronic Health Records ; Haloperidol ; Humans ; Hypnotics and Sedatives ; Mass Screening ; Retrospective Studies* ; Survival Rate ; Terminally Ill*

PURPOSE: To review the clinical and radiological results after wire fixation for acetabular fracture, and determine its indications and advantages. MATERIALS AND METHODS: A clinical analysis was performed on 12 cases of displaced unstable acetabular fracture which had been fixed by wiring. They were evaluated after a mean follow up of 1.7 years. The fixation was done only by wires in 3 cases, wires with plates and screws in 7 cases and wires with screws in 2 cases. RESULTS: Satisfactory results were achieved in 11 cases (91.7%) on clinical grade and 10 cases (83.4%) on radiographic grade according to Epstein criteria. Deep wound infection developed in 1 case and posttraumatic arthritis in 1 case. CONCLUSIONS: The reduction and fixation could be easily performed with the use of wires in some specific cases. Wire could fix fractures with or without combined use of plates or screws. The fracture types that are thought to be ideal indication for wire fixation are (1) a fracture line that extends above the greater sciatic notch, (2) a transverse acetabular fracture that has an obliquity from anteroinferior to posterosuperior and (3) isolated anterior column fracture.
Acetabulum* ; Arthritis ; Follow-Up Studies ; Wound Infection