A 63-year-old man who had a permanent pacemaker placed 17 years ago presented to us with local inflammatory signs on his chest. The skin was opened to remove the permanent pacemaker. However, the pacing wire was not easily removed. So, the permanent pacemaker was removed from the chest with leaving the remnant wire inside. However, the local infection recurred because of the remnant wire. Right thoracotomy was performed and cardiopulmonary bypass was started. After total circulatory arrest, the right atrium was opened and the wire was completely removed.
Cardiopulmonary Bypass ; Heart Atria ; Humans ; Middle Aged ; Skin ; Thoracic Surgery ; Thoracotomy ; Thorax

The results with management of urethral stricture are disappointing, with a high rate of early and late recurrence. Recently, the success of internal urethrotomy has made us question the role of open urethroplasty in the management of urethral strictures. Thus a clinical evaluation was made on 116 patients with urethral stricture in the Department of Urology, Masan Koryo General Hospital, during the period from May 1985 to July 1991. The or stricture was incomplete in 92 cases and complete in 24 cases. The length of stricture was less than 1cm in 86 cases, 1 to 2cm in 19 cases, more than 2cm in 3 cases and multiple strictures in 8 cases. The treatment modality of incomplete urethral stricture was internal urethrotomy in 68 cases and urethroplasty in 9 cases regardless of length, and dilatation in 15 cases with mild stricture. Incomplete urethral stricture, internal urethrotomy was carried out in 7 cases with less than 1cm long stricture and urethroplasty in 17 cases regardless of length. The overall success rate in incomplete urethral stricture was 88.2 % in internal urethrotomy and 88.9 % in urethroplasty, and in complete urethral stricture, 85.7 % in internal urethrotomy and 82. 4% in urethroplasty. We think that visual internal urethrotomy is a valuable initial method, when stricture is incomplete or less than 1cm in length in cases of complete urethral stricture.
Constriction, Pathologic ; Dilatation ; Hospitals, General ; Humans ; Recurrence ; Urethral Stricture* ; Urology

Cognitive behavioral therapy, first introduced by Beck in the 1950s to treat depression by integrating cognitive and behavioral therapies, is now an established psychotherapy technique used to treat insomnia, chronic pain, and anxiety. Currently, cognitive behavioral therapy is widely used to treat tinnitus in European countries, and the efficacy and safety of the treatment have been proven through randomized clinical trials and meta-analyses. Although interest in cognitive behavioral therapy for tinnitus is increasing in Korea, there are limited reports. Because many studies so far have targeted patients in Western countries, it is difficult to apply the same to domestic patients due to cultural and linguistic differences, the absence of standardized guidelines, and limitations in clinic hours. We experienced various cases in which tinnitus was effectively treated simultaneously with pharmacotherapy and cognitive behavioral therapy, so here we report an introduction to the program along with a literature review. Cognitive behavioral therapy was performed as a 4-week program in our hospital, and progress was evaluated through Visual Analogue Scales (VAS) and tinnitus handicap inventory (THI). After each weekly 20-minute individual counseling session, a take-home writing task was given to the patient. The main goal was to guide the patient to discover and correct automatic thoughts related to their tinnitus symptoms. This paper aimed to introduce a specific scheme on how to perform cognitive behavioral therapy for domestic tinnitus patients.

BACKGROUND/AIMS: Early gastric cancer (EGC) with ulcerations can be treated via endoscopic resection (ER) when it is differentiated pathologically, limited to the mucosa, and <3 cm in diameter. The presence of ulceration is a key factor in deciding treatment strategies and is usually diagnosed during endoscopic examination. The aim of this study was to evaluate whether ulcerations in EGC can be clearly defined among endoscopists and which factors are related to the differences. METHODS: A survey questionnaire, composed of demographic features and endoscopic images of seven patients with EGC, was presented to the endoscopists via e-mail. The endoscopists were asked whether such patients have ulcerations in the lesions. RESULTS: The questionnaires were e-mailed to 197 endoscopists, and 103 doctors replied. The presence of an endoscopic ulceration was defined differently among the endoscopists, depending on the duration of endoscopic practice and the experience of endoscopic submucosal dissection. The differences were especially high in the lesions without mucosal breaks and converging folds, which were expected to be viewed as non-ulcerative. CONCLUSIONS: Before ER, endoscopic ulcerations in EGC must be reviewed by experienced endoscopists to reduce overestimations, and adequate educational programs for trainees should be established.
Electronic Mail ; Humans ; Mucous Membrane ; Stomach Neoplasms* ; Surveys and Questionnaires ; Ulcer*

Esophagopericardial fistula (EPF) is a rare and serious medical condition induced by benign and malignant causes. Surgery is the main stay of treatment for benign EPF. However, there have been few reports of benign EPF treated by endoscopic stent insertion. We performed a laparoscopic total gastrectomy for treatment of a gastric cancer located at the cardia in a 62-year-old patient. A benign EPF occurred as a postoperative complication 14 days after surgery. We successfully managed the EPF through emergent laparoscopic pericardial window formation and insertion of a fully covered self-expendable metal stent during operation. The patient is being followed up without complications in the outpatient department after stent removal.
Cardia ; Fistula* ; Gastrectomy* ; Humans ; Middle Aged ; Outpatients ; Postoperative Complications ; Stents* ; Stomach Neoplasms*

BACKGROUND/AIMS: Although colonoscopy is not indicated in patients with hematochezia, many surgeons, internists, and physicians are recommending colonoscopy for these patients in Korea. The aim of this study is to evaluate the diagnostic value of colonoscopy for patients with hematochezia. METHODS: We retrospectively reviewed the data of colonoscopy between January 2010 and December 2010. A total of 321 patients among 3,038 colonoscopies (10.6%) underwent colonoscopy to evaluate the cause of hematochezia. The patients with previous colorectal surgery (2) or polypectomy (5) were excluded. We analyzed endoscopic diagnoses. Advanced neoplastic polyps were defined as adenomas with villous histology or high grade dysplasia, or adenomas more than 10 mm in diameter. RESULTS: Hemorrhoid was the most common diagnosis (217 cases, 67.6%). Polyps were detected in 93 patients (29.0%), but advanced neoplastic polyps were found in only 14 cases (4.4%). Colorectal cancers were diagnosed in 18 patients (5.6%) including 14 rectal cancers. There was no cancer located above sigmoid-descending junction. Diverticuli were detected in 41 patients (12.8%) but there was only one case of suspected diverticular bleeding. Colitis was diagnosed in 24 patients (7.5%). Other lesions included acute anal fissure, rectal tumor, stercoral ulcer, and radiation proctitis. CONCLUSIONS: The colonoscopy had little value in patients with hematochezia because the most pathologic lesions were located below sigmoid colon. The first choice of diagnosis in patients with hematochezia is sigmoidoscopy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Colitis/complications/diagnosis ; Colonic Neoplasms/complications/diagnosis ; Colonic Polyps ; *Colonoscopy ; Colorectal Neoplasms/complications/diagnosis ; Female ; Gastrointestinal Hemorrhage/diagnosis/*etiology ; Hemorrhoids/complications/diagnosis ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

No abstract available.
Carcinoma in Situ* ; Diagnosis* ; Humans

EBV infection has been causally associated with incidence of many carcinomas. EBV-associated gastric carcinoma (EBVaGC) has been classified as a unique gastric carcinoma subset, suggesting EBV infection is related to the development of gastric cancer. In this study, general trends of EBVaGC studies for last half-decades were reviewed in several perspectives of clinical significance, virological importance and etiological interests. Throughout this comprehensive reviewing, new study trends of EBV and EBVaGC for next half-decades were suggested.
Epstein-Barr Virus Infections ; Herpesvirus 4, Human* ; Incidence ; Methylation ; Prognosis ; Stomach Neoplasms

PURPOSE: Drowning is a common preventable cause of accidental death. Although many studies about drowning injuries have been conducted, most are related to freshwater drowning. The aim of this study was to analyze the clinical features and prognostic factors in seawater drowning patients. METHODS: This study was performed retrospectively with sea water drowning patients who visited the emergency department at Pusan National University Hospital between January 2005 and December 2009. RESULTS: In total, 51 sea water drowning patients presented at the emergency department with a mean age of 48.65+/-15.40 years. The survival group included 42(82.4%) patients, and the death group was comprised of nine patients(17.6%). Fifteen patients arrested in the field, and cardiopulmonary resuscitation (CPR) was performed. Median immersion time in the death group was 15.0 minutes (range, 9.5~22.5 minutes). Among the death group, five patients had respiratory acidosis and nine showed pulmonary edema on a chest X-ray. Initial sodium level in the survival group was 146.30 mEq/L (range, 142.38~152.60 mEq/L), but the level was normalized with isotonic saline. CONCLUSION: Most drowning injuries occurred at night and in relatively young aged patients. CPR in the field did not result in good outcomes because of the longer immersion time. The death group had respiratory acidosis. Because the survival group did not show significant hypernatremia, isotonic saline as an initial fluid was thought to be appropriate. Drowning injuries occur differently based on geographic and social characteristics; therefore, local characteristics should be considered to establish preventive measures.
Acidosis, Respiratory ; Aged ; Cardiopulmonary Resuscitation ; Drowning ; Emergencies ; Fresh Water ; Humans ; Hypernatremia ; Immersion ; Prognosis ; Pulmonary Edema ; Retrospective Studies ; Seawater ; Sodium ; Thorax

PURPOSE: Peritoneal lavage cytology is regarded as a useful diagnostic test for detecting intraperitoneal micrometastsis. However, there are currently no reports about cytological examination with ThinPrep(R) (CY), a newly introduced fluid-based diagnostic system, in patients with advanced gastric cancer (AGC). This study was performed to analyze the clinical significance of intraoperative peritoneal lavage for CY in AGC patients. MATERIALS AND METHODS: 424 AGC patients were suspected to have serosal exposure macroscopically during surgery and they underwent intraoperative peritoneal lavage for CY between 2001 and 2006 at Korea Cancer Center Hospital. The clinical data, pathological data and CY results were collected and analyzed retrospectively. RESULTS: The percentage of cytology positive results was 31.1%, and this was well correlated with the T-stage, N-stage and P-stage. The 3-year survival rates of CY0 and CY1 were 68.1% and 25.9%, respectively. According to the P-stage and CY, the 3-year survival rates were 71.1% in P0CY0, 38.9% in P0CY1, 38.5% in P1/2/3CY0 and 11.0% in P1/2/3CY1. Interestingly, both the P0CY1 and P1/2/3CY0 survival curves were similar figures, but they were significantly different from those of the other groups. Multivariate analysis indicated that CY was an independent, strong prognostic factor for survival, as well as sex, the T-stage, N-stage, P-stage, other metastasis and the serum CEA. CY1 was revealed as a risk factor for peritoneal recurrence in the curative resection group. CONCLUSION: The results certify indirectly that cytological examination using ThinPrep(R) is a very reliable diagnostic method for detecting intraperitoneal micrometastasis from the fact that it is not only a strong prognostic factor, but it is also a risk factor for peritoneal recurrence in AGC patients. Therefore intraoperative peritoneal lavage should be included in the routine intraoperative staging workup for AGC, and its result will provide a good target for the treatment of peritoneal micrometastasis.
Diagnostic Tests, Routine ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Peritoneal Lavage ; Recurrence ; Risk Factors ; Stomach Neoplasms ; Survival Rate