BACKGROUND: The laparoscopy requires CO2 insufflation and posture changes for operational convenience. However, above circumstances affect the cardiopulmonary systems significantly. And then intracranial pressure (ICP) may be also influenced. METHODS: To ascertain the changes of ICP, an experimental study was performed, in which the parameters of hemodynamic status, arterial blood gas components and ICP were measured from twelve cases of Korean mongrel dogs. Pneumoperitoneum was produced by CO2 insufflation(15 mmHg) and then posture was altered from horizontal to head-down tilt of 20, 30 and 40 degree*. The measurements were obtained before (control), after CO2 insufflated horizontal position at 20, 40 and 60 minute in CO2 insufflated tilt** and CO2 deflated horizontal***. RESULTS: MAP and HR were not related to the insufflated time and degree of tilt. CVP and PCWP were significantly increased after CO2 insufflated tilt (p<0.01), but returned to control after deflated supine. PaCO2 was not significantly changed after CO2 insufflated supine, but grdually increased with degree of tilt and time (p<0.01). ICP was increased at 40 and 60 minute of 20degree, and at 20 minute of 30degree(p<0.05), then markedly increased at 40 and 60 minute of 30degree, and at 20, 40 and 60 minute of 40degreetilt (p<0.01). The increment of ICP was parallel with time and degree of tilt. But, ICP was returned to control after deflated supine. CONCLUSIONS: ICP was increased significantly during laparoscopy in head-down tilt, although it was reversible. Therefore, the patient must be given special attention during laparoscopy in whom the increment of ICP may be harmful.
Animals ; Carbon Dioxide* ; Carbon* ; Dogs ; Head-Down Tilt* ; Hemodynamics ; Humans ; Insufflation* ; Intracranial Pressure* ; Laparoscopy ; Pneumoperitoneum ; Posture

BACKGROUND: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. METHODS: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. RESULTS: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. CONCLUSION: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.
Antirheumatic Agents* ; Arthritis, Rheumatoid* ; Delivery of Health Care ; Health Care Costs ; Humans ; Injections, Subcutaneous* ; Outpatients ; Palliative Care ; Rheumatology ; Abatacept ; Adalimumab ; Etanercept

PURPOSE: Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. MATERIALS AND METHODS: A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days. RESULTS: Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence. CONCLUSIONS: Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.
Anesthesia, Local ; Anti-Bacterial Agents ; Bandages ; Dyspareunia ; Female ; Follow-Up Studies ; Humans ; Male ; Suburethral Slings ; Surgical Mesh ; Urinary Incontinence ; Vaginal Discharge

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

Salmonellosis is one of communicable disease and still occur in sporadic in Korea frequently. They are four main clinical manifestations in salmonellosis. They are gastroenteritis, typhoidal or septisemia syndrome, focal manifestation and carrier state. Among them, focal manifestation is rarely seen. Saphra, et al. reported that localized salmonella infection is about 5%. Localized salmonella infection frequently occur during salmonella bacteremia, but may also occur with enteric fever or gastroenteritis. Gray, et al reported 3390 cases of minor gunshot wound infection that bacterial isolates from infected wounds consisted of Staphylococcus aureus(90%), Streptococcus sp.(6%), and mixed organisms(4%). Incresed host susceptibility to infection secondary to lowered resistance due to debilitating disease is an important determinant of Salmonella infection. Since salmonella is seldom suspected as a cause of soft tissue infections,there is usually a dangerous delay in the institution of appropriate antimicrobial therapy and isolation procedure. We experienced one case of subcutaneous salmonella abscess developed on gunshot wound area in lung cancer patient, which was confirmed by pus culture.
Abscess* ; Bacteremia ; Carrier State ; Communicable Diseases ; Gastroenteritis ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Salmonella Infections ; Salmonella* ; Staphylococcus ; Streptococcus ; Suppuration ; Typhoid Fever ; Wounds and Injuries* ; Wounds, Gunshot

Hemorrhage into a pancreatic pseudocyst is a rare, but increasingly recognized as a cause of massive gastrointestial bleeding. Bleeding pseudocysts may rupture into the stomach, duodenum, common bile duct, and splenic vein, or can be decompressed via the duct of Wirsung. Also it will result in upper gastrointestinal bleeding. This represents a life-threatening and frequently unrecognized complication of pancreatic disease. Proper diagnostic workup and prompt surgical management afford the patient the best chance for survival. We report a patient with pseudocyst bleeding into the gastrointestinal tract via the duct of Wirsung and discuss the current diagnostic and therapeutic approach.
Common Bile Duct ; Duodenum ; Gastrointestinal Hemorrhage* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Rupture ; Splenic Vein ; Stomach

Double primary cancer of the stomach and esophagus has been revealed a very low incidence in the world except Japan and reported only 6 cases in Korea. Furthermore, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. This paper is concerned with a case of double primary cancer, which we have synchroniously confi~rmed esophageal squamous cell carcinoma and gastric adenocarcinoma with gastrofiberscopic biopsy, and then treated them by radical resec tion and systemic chemotherapy.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Drug Therapy* ; Esophageal Neoplasms ; Esophagus ; Incidence ; Japan ; Korea ; Neoplasm Metastasis ; Stomach Neoplasms

BACKGROUND AND OBJECTIVES: Assessment of left ventricular systolic function is an important clinical variable with respect to diagnosis, prognosis and treatment in various clinical situation. Automatic quantification of ventricular volume and ejection fraction by delineating 3 dimensional endocardial boundaries from the gated perfusion SPECT was validated. The purposes of this study were to assess the agreement of left ventricular ejection fraction determined by two-dimensional echocardiography and automatic quantification of perfusion SPECT and compare different echocardiographic methods with the reference method, automatic quantification of perfusion SPECT. METHOD: Twenty seven patients (20 men, 7 women; mean age 60+/-12) with acute myocardial infarction (anterior: 16, inferior: 7, lateral: 4) and twenty one patients (12 men, 9 women; mean age 60+/-12) without myocardial infarction history and regional wall motion abnormality in echocardiography were studied. All patients had two-dimensional echocardiography and 201Tl perfusion SPECT performed within 5 days of each other. Ejection fraction of left ventricle was calculated by echocardiography using modified Simpson's method and M-mode method. Also, ejection fraction of left ventricle was estimated by 201Tl perfusion SPECT using automatic software (quantitative gated SPECT[QGS]; Cedars-Sinai Medical Center, Los Angels, CA). RESULTS: The agreement of ejection fraction between M-mode method and QGS (limit of agreement -3.48, 3.2; average limit of agreement 6.68) in control group was better than that between modified Simpson's method and QGS (limit of agreement 0.04, 8.42; limit of agreement average limit of agreement 8.38). But, The agreement of ejection fraction between modified Simpson's method and QGS in the acute myocardial infarction group (limit of agreement; -15.31, 10.01; average limit of agreement 12.66) was better than that between M-mode method and QGS (limit of agreement -17.82, 13.86; average limit of agreement 15.84). The agreement of ejection fraction between modified Simpson's method and QGS (limit of agreement; -8.49, 5.74; average limit of agreement 7.12) in the anterior myocardial infarction was more accordancy than lateral and inferior wall infarction (limit of agreement; -12.11, 13.74; average limit of agreement 12.92). CONCLUSION: The M-mode method in patients without regional wall motion abnormality and modified Simpson's method in patients with regional wall motion abnormality, especially in anterior wall infarction seen to be useful method for the assessment of left ventricular ejection fraction.
Diagnosis ; Echocardiography* ; Female ; Heart Ventricles ; Humans ; Infarction ; Male ; Myocardial Infarction ; Perfusion ; Prognosis ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon*