By means of hospital-based data over 8 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristic and reproduction history. From the obstetric record of all deliveries at Chung Goo Hospital between Jan. 1, 1990, and Nov. 31, 1997, we identified all women undergoing emergency cesarean hysterectomy, calculated incidence rates, conducted statistical tests of linear trends and heterogenety, and observed the clinical indicatons preceding the onset of this procedure. There were 16731 deliveries during this period, Cesarean hysterectomy was performed in 24 of 5993 cesarean sections(0.40%) and in 10 of 10738 vaginal deleveries(0.09%), so more frequently after cesarean section than vaginal delivery. The age of patients varied from 22 to 40 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(52.94%) followed by placental disorders(41.18%), uterine myoma with pregnancy(2.9%) and uterine rupture (2.9%). All patients who had hysterectomy received transfusion from 1 pint to 57 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coaguolopathy and wound disruption. There were three maternal deaths, the cause was disseminated intravascular coaguolopathy and amniotic embolism. The data identifiy uterine atony as the primary cause for gravid hysterctomy. The data also illustrated how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high.
Adult ; Cesarean Section ; Embolism ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period* ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Reproduction ; Urinary Bladder ; Uterine Inertia ; Uterine Rupture ; Wounds and Injuries

PURPOSE: This study aimed to investigate the surgical outcomes and safety of robotic sacrocolpopexy (RSC) in patients with uterine/vaginal vault prolapse. METHODS: Between January 2009 and June 2015, 16 women with apical prolapse underwent RSC. Pelvic organ prolapse quantification (POP-Q) examination was performed, and treatment success was defined as the presence of grade 0 or I apical prolapse upon POP-Q examination at the final follow-up. Pelvic floor distress inventory-short form 20 (PFDI-SF 20) was administered at every follow-up. A treatment satisfaction questionnaire was administered by telephone to evaluate patient satisfaction with the operation. RESULTS: Median age was 65 years (interquartile range [IQR], 56–68 years), and follow-up duration was 25.3 months (IQR, 5.4–34.0 months). Thirteen women (81.3%) had ≥grade III apical prolapse. Operation time was 251 minutes (IQR, 236–288 minutes), and blood loss was 75 mL (IQR, 50–150 mL). Median hospital stay was 4 days (IQR, 3–5 days). At the final follow-up, treatment success was reported in all patients, who presented grade 0 (n=8, 57.1%) and grade I (n=6, 42.9%) apical prolapse. Dramatic improvements in PFDI-SF 20 scores were noted after RSC (from 39 to 4; P=0.001). Most patients (12 of 13) were satisfied with RSC. An intraoperative complication (sacral venous plexus injury) was reported in 1 patient, and there was no conversion to open surgery. Mesh erosion was not reported. CONCLUSIONS: RSC is an efficient and safe surgical option for apical prolapse repair. Most patients were satisfied with RSC. Thus, RSC might be one of the best treatment options for apical prolapse in women.
Conversion to Open Surgery ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Length of Stay ; Patient Satisfaction ; Pelvic Floor ; Pelvic Organ Prolapse* ; Prolapse ; Robotic Surgical Procedures ; Telephone ; Uterine Prolapse

PURPOSE: To study the development of inferior shoulder subluxation after surgery for proximal humerus fractures. To analyze the mechanism development of such subluxation and the association between different types of proximal humerus fractures, quality of reduction achieved the method of operation performed. MATERIALS AND METHODS: A retrospective analysis of 45 proximal humerus fractures that were treated by surgery between March 1997 and July 2002 was done. All patients had a minimum of 12 months of postoperative follow up. Preoperative radiographs were classified by the Neer's classification. Different operative treatment methods, post reduction alignment and the degree of postoperative subluxation if present, were analysed. In order to evaluate effect of loss of negative intraarticular pressure, we compared this series with 15 cases of recurrent shoulder dislocation treated by open Bankart operation. RESULTS: 13 patients out of 45 (29%) developed immediate postoperative inferior shoulder subluxation. 3-part fractures of the proximal humerus showed a higher incidence of the same than the 2-part types. The better reduced fractures had lesser rates of subluxation. Open reduction (39%, 11 patients) results in an increased incidence of inferior subluxation than closed methods of reduction (13%, 2 patients). CONCLUSION: Inferior subluxation of the humeral head after surgery for the proximal humerus fracture can occur and persist till postoperative period of 2 months. Deltoid muscle tone affected by shortening of humeral neck plays an important role. Early active exercise for restoration deltoid tone may be effective in prevention of inferior subluxation.
Classification ; Deltoid Muscle ; Follow-Up Studies ; Head* ; Humans ; Humeral Head ; Humerus* ; Incidence ; Neck ; Postoperative Period ; Retrospective Studies ; Shoulder ; Shoulder Dislocation

PURPOSE: Many surgeons worry about postoperative voiding problems in patients with stress urinary incontinence (SUI) and detrusor underactivity (DU). This study hypothesized that adjusting the tension after surgery would benefit patients with DU, and therefore researchers evaluated the outcomes and quality of life of women with SUI and DU who underwent the readjustable sling procedure (Remeex). METHODS: The medical records of 27 patients who were treated with the Remeex system for SUI and DU between 2007 and 2013 were retrospectively analyzed. The incontinence visual analogue scale (I-VAS), incontinence quality of life questionnaire (I-QOL) and the Sandvik incontinence severity index (ISI) were used to evaluate the efficacy of the Remeex system both prior to surgery and at the last visit after surgery. The treatment was considered successful if there was no urine leakage based on the Sandvik questionnaire. RESULTS: The mean follow-up period was 38.0 months (range, 1–75 months), and the treatment success rate was 81.5%. Despite no urine leakage, 7 patients wanted the Remeex system to be removed due to persistent postoperative urinary retention within a year of surgery. One patient underwent a long-term adjustment under local anesthesia 6 years after the initial surgery. The I-VAS, ISI and all domains of the I-QOL scores improved significantly postoperatively and the maximum flow rate decreased significantly after the procedure. However, the postvoid residual did not change significantly. CONCLUSIONS: The Remeex system provided a good cure rate and improved the quality of life of women with SUI and DU. Therefore, the Remeex system should be considered as a treatment option for female patients with concomitant SUI and DU.
Anesthesia, Local ; Female* ; Follow-Up Studies ; Humans ; Medical Records ; Quality of Life ; Retrospective Studies ; Suburethral Slings ; Surgeons ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Retention

Based on the biological activity of endotoxin, we propose a possible new method for detecting endotoxin using a pH- indication system of macrophage culture media. After RAW 264.7 macrophage cells were treated with lipopolysaccharide (LPS), the addition of fluorescein to the LPS-treated media reproductively reduced its absorption and emission spectra (it was a dose-dependent reduction). The advantages of this LPS- detection method were compared with the Limulus Amebocyte Lysate (LAL) test by using purified bacterial LPS (Salmonella minnessota, Escherichia coli, and Pseudomonas aeruginosa). Additionally, the absorption and fluorescence intensity of fluorescein, following treatment of RAW 264.7 cells with a high concentration of Staphylococcus aureus (Gram-positive, lysed bacteria), could not generally be detected by the LAL test, but they were found to be reduced, in a dose-response relationship, with this new system. The macrophage culture system-method might be a good supplement to the LAL assay for detection of LPS, Gram-negative and Gram-positive bacteria.
Animals ; Biological Assay/*methods/standards ; Cells, Cultured ; Comparative Study ; *Contrast Media ; Culture Media/chemistry ; Endotoxins/*analysis ; *Fluorescein ; Hydrogen-Ion Concentration ; Limulus Test ; Lipopolysaccharides/analysis ; Macrophages/*chemistry ; Mice ; Research Support, Non-U.S. Gov't

The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.
Abscess ; Airway Obstruction ; Anti-Bacterial Agents ; Bandages ; Early Diagnosis ; Epidural Abscess ; Fasciitis ; Fasciitis, Necrotizing ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Incidence ; Mandible ; Mediastinitis ; Neck ; Osteomyelitis ; Pericarditis ; Porphyrins

PURPOSE: The aim of this study was to determine the prevalence of diabetes in patients with random serum glucose over 200 mg/dL in an emergency department. METHODS: A retrospective descriptive pilot study was conducted using chart review of patients who have visited the ED at Kangdong Sacred Heart Hospital. Between April and October 2014, patients aged 18 years and older with random serum glucose level higher than 200 mg/dL and having no prior diabetes mellitus (DM) were enrolled. Regardless of the patient's chief complaint, a history of current symptoms related to diabetes of patients was obtained and additional serum HbA1c was measured. The follow-up test was recommended on endocrinology OPD or the inpatient ward. Patients' medical records regarding diagnosis of DM were reviewed. RESULTS: A total of 296 patients with random serum glucose level estimated above 200 mg/dL without previous DM history were enrolled in this study, however only 82 patients were eligible. Among them, 34 patients (41.4%) were newly diagnosed as DM; 38 patients had current presumptive symptoms of diabetes while 44 patients had none of those symptoms. Twenty three patients (60.5%) with presumptive diabetes symptoms were diagnosed as diabetes while another 15 patients (39.5%) were not. Eleven (25.0%) patients without symptoms of diabetes were diagnosed as diabetes while 33 patients (75.0%) were not. The difference between two groups was significant. (p=0.001) CONCLUSION: The prevalence of undiagnosed DM patients in patients with random serum glucose level over 200 mg/dL in the emergency department was considerably high. Therefore emergency physicians should pay attention to opportunistic hyperglycemia and active diabetes screening.
Blood Glucose* ; Diabetes Mellitus ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Endocrinology ; Follow-Up Studies ; Heart ; Humans ; Hyperglycemia ; Inpatients ; Korea* ; Mass Screening ; Medical Records ; Pilot Projects ; Prevalence* ; Retrospective Studies

PURPOSE: This study aimed to set priorities for improving the medical device distribution structure and to suggest an innovative improvement plan for the distribution structure using the analytic hierarchy process (AHP) method, focusing on stakeholders in the medical device industry. METHODS: This study conducted a survey with 35 specialists using the AHP method, which is a multiple-criteria decisionmaking methodology, in order to set priorities for improvement plans to address the problems faced by the medical device distribution structure. RESULTS: The AHP analysis showed that supply stability was the most important factor, followed by greater transparency, efficiency, smart supply, and cost reduction. CONCLUSIONS: It is necessary to establish a stable supply system and manage crises through supply stability, as well as to provide opportunities for fair trade through greater transparency. As steps towards those goals, we propose establishing a unique device identification system, an information disclosure system, online distribution, and a group purchasing organization system in Korea.
Disclosure ; Group Purchasing ; Korea ; Methods ; Online Systems ; Specialization

OBJECTIVE: To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. METHODS: Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. RESULTS: From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. CONCLUSION: A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.
Adult ; Brain ; Deglutition Disorders ; Deglutition* ; Humans ; Hyoid Bone* ; Mandible ; Saliva ; Stroke* ; Ultrasonography* ; Water

Cellular senescence causes cell cycle arrest and promotes permanent cessation of proliferation. Since the senescence of mesenchymal stem cells (MSCs) reduces proliferation and multipotency and increases immunogenicity, aged MSCs are not suitable for cell therapy. Therefore, it is important to inhibit cellular senescence in MSCs. It has recently been reported that metabolites can control aging diseases. Therefore, we aimed to identify novel metabolites that regulate the replicative senescence in MSCs. Using a fecal metabolites library, we identified nervonic acid (NA) as a candidate metabolite for replicative senescence regulation. In replicative senescent MSCs, NA reduced senescence-associated β-galactosidase positive cells, the expression of senescence-related genes, as well as increased stemness and adipogenesis. Moreover, in non-senescent MSCs, NA treatment delayed senescence caused by sequential subculture and promoted proliferation. We confirmed, for the first time, that NA delayed and inhibited cellular senescence.Considering optimal concentration, duration, and timing of drug treatment, NA is a novel potential metabolite that can be used in the development of technologies that regulate cellular senescence.