PURPOSE: To report our results on urinary continence after bladder neck preservation (BNP) and posterior urethral reconstruction (PUR) during robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: Data from 107 patients who underwent RALP were compared on the basis of whether the patients underwent BNP and PUR, BNP only, or the standard technique (ST). In group A (n=31 patients), ST was performed by using Ven velthoven continuous suturing for urethrovesical anastomosis. In group B (n=28 patients), ST with only PUR was performed. In group C (n=48 patients), both the BNP and PUR techniques were used. "Recovery of continence" was defined as the use of 1 pad (50 ml) or less within 24 hours. RESULTS: The three groups were comparable in terms of patient demographics. The mean operative time and the mean blood loss decreased significantly from group A to group C (p=0.021 for mean operative time and p=0.004 for the mean blood loss). Mean catheterization time was 8.9, 7.8, and 7.1 days in each group (p=0.047). Early return of urinary continence at 3 months was observed in group B (89.2%) and group C (90.6%) compared with group A (71%). However, continence at 6 months was comparable in the 3 groups (87.5% in group A, 92.8% in group B, and 92.3% in group C). Rates of positive surgical margins decreased from 30.2% in group A to 20% in group B and 12% in group C. CONCLUSIONS: BNP and PUR during RALP showed a favorable impact on the early postoperative recovery of continence while not affecting positive surgical margins.
Catheterization ; Catheters ; Demography ; Humans ; Neck ; Operative Time ; Prostatectomy ; Prostatic Neoplasms ; Urinary Bladder ; Urinary Incontinence

The aim of this study was to introduce the experience of diagnosis and treatment for patients with migrated acupuncture needle to pleural cavity and or lung parenchyma. We had treated 5 patients who had acupuncture needles in their thoracic cavity from January 2000 to September 2009. The mean age was 55.8 yr old. All patients suffered from the sequelae of the cerebrovascular accident and had been treated with acupuncture. They had drowsiness and hemiplegic or quadriplegic motor activity. Fever and dyspnea were main symptoms when referred to us. Diagnosis was made by the chest radiography and chest computed tomography which revealed straight metallic materials in their thoracic cavity. The needles were removed via thoracotomy or thoracoscopic procedures. Pleural decortications were also needed in four patients. Thoracoscopic surgery was successfully performed in two patients. After the removal all patients became symptomless. Although we experienced only five patients who have migrated acupuncture needles in thoracic cavity, we suggest that thoracoscopic removal of the needle with or without pleural decortication is the most optimal modality of treatment in those patients.
Acupuncture Therapy/*adverse effects/instrumentation ; Adult ; Aged ; Female ; Foreign-Body Migration/diagnosis/*etiology/*surgery ; Humans ; Male ; Middle Aged ; Needles/*adverse effects ; Pleural Cavity/radiography/surgery ; Radiography, Thoracic ; Retrospective Studies ; Stroke/therapy ; Thoracic Cavity/surgery ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Tomography, X-Ray Computed

PURPOSE: Prolonged urinary incontinence is one of the greatest concerns for patients undergoing radical prostatectomy. One of the possible causes for this urinary incontinence is a postoperative deficiency of the external striated urethral sphincter (EUS) complex and continence nerves. We evaluated the effect of posterior urethral reconstruction (PUR) in the early recovery of urinary continence after robotic-assisted radical prostatectomy. MATERIALS AND METHODS: Between January 2008 and March 2009 we performed robotic-assisted radical prostatectomy with PUR in 30 patients (PUR group) and without PUR in 30 patients (non-PUR group). We compared perioperative parameters and postoperative continence rates between the two groups. Continence was defined as no pads or one diaper per 24 hours and was assessed 1 month, 3 months, and 6 months after the procedure. RESULTS: Patients in the PUR group achieved better continence rates at 1 month (43% vs. 35%) and 3 months of follow-up (89% vs. 64%). At 6 months of follow-up, the continence rate was similar between the two groups (96% vs. 90%). No major complications were observed in the PUR group. However, 2 cases of anastomotic site leakage and 1 case of delayed bleeding were observed in the non-PUR group. CONCLUSIONS: Posterior urethral reconstruction appears to be an easy and reproducible technique in robotic-assisted radical prostatectomy. Our early experience demonstrates that PUR in robotic-assisted radical prostatectomy appears to confer early continence recovery and reduce intraoperative complications.
Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Prostatectomy ; Robotics ; Urethra ; Urinary Incontinence

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.
Diaphragm ; Hemorrhage ; Hemothorax ; Humans ; Lacerations ; Laparotomy ; Liver ; Lung ; Pleural Cavity ; Ribs ; Sutures ; Thoracoscopes ; Thorax ; Wounds, Stab

The Rastelli operation has been a standard procedure for repairing complete transposition of the great arteries combined with a ventricular septal defect and pulmonary stenosis. Yet this procedure has several shortcomings, including the risk of incurring left ventricular outflow tract obstruction on long-term follow-up. In this regard, aortic translocation has recently been regarded as a potent alternative to Rastelli's operation. We report here on a case of complete transposition of the great arteries that was combined with an inlet-extended perimembranous ventricular septal defect and pulmonary stenosis in a 2-year-old boy. All the problems were successfully repaired using the aortic translocation technique. Postoperative echocardiography showed a straight and wide left ventricular outflow tract.
Arteries ; Echocardiography ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Preschool Child ; Pulmonary Valve Stenosis ; Transposition of Great Vessels

No abstract available.

PURPOSE: The need for efficient and optimal training through a structured laparoscopic training program has become increasingly evident. Virtual reality simulation may provide a safe and efficient means of acquiring laparoscopic skills. The LAP Mentor(TM) is a high-fidelity virtual reality simulator with haptic feedback that allows a trainee to practice 9 basic laparoscopic tasks including laparoscopic suturing. The purpose of this study was to evaluate the predictive validity of performance on the LAP Mentor before surgical simulators are incorporated into training programs. MATERIALS AND METHODS: Eleven participants (6 medical students and 5 residents) underwent laparoscopic skills training on the virtual reality simulator LAP Mentor. Each participant was tested on 5 sets of 4 LAP Mentor basic laparoscopic tasks (grasping, cutting, clipping, and suturing) in a 3-week period. Total time and accuracy were measured for each task. RESULTS: There was a significant difference between the initial session and the final session for total time and accuracy in both groups. Among the medical students, as they progressed through the training step by step, total time decreased for the grasping task, the cutting task, the clipping task, and the suturing task. At the same time, accuracy improved for the grasping task, the cutting task, the clipping task, and the suturing task, respectively. The residents group showed a similar progression. CONCLUSIONS: Basic skills straining on a LAP Mentor virtual reality simulator improves learning of the basic skills for laparoscopy. Education with virtual reality simulators, therefore, may provide an effective teaching method and lead to improved operating performance.
Hand Strength ; Humans ; Laparoscopy ; Learning ; Mentors ; Sprains and Strains ; Students, Medical ; Teaching

OBJECTIVE: To determine possible similarities and differences in clinical and laboratory features and prognosis between patients with inflammatory myopathies diagnosed at Kangnam St. Mary's hospital and other reported series. METHODS: Medical records of 52 patients diagnosed as inflammatory myopathies by Bohan and Peter criteria who were admitted to Kangnam St. Mary's hospital between January 1989 and August 1994, were reviewed. The patients were further classified into 5 groups proposed by Bohan and Peter ; group I primary polymyositis(PM), group II primary dermatomyositis(DM), group III polymyositis/dermatomyositis(PM/DM) with neoplasia, group IV juvenile PM/DM, group V PM/DM associated with connective tissue disease. RESULTS: 1) There were 52 PM/DM cases with mean age at diagnosis of 34. 4 ranging from 6 to 67 years, and significantly more females(male:female = 9:43). 2) Of 52 patients, group II was the most frequent group(36.5%), and the next were as follows ; group I 28.8%, group V 25%, group IV 5.7%, group 3.8%. Systemic lupus erythematosus(SLE) was the commonest connective tissue disease, and malignancy was associated in 2 cases including breast cancer and small cell carcinoma of lung. 3) At presentation, 86.5% had proximal muscle weakness, 61.5% had arthralgia/arthritis and 44. 2% had Raynaud phenomenon. 4) The elevated serum LDH, aldolase and creatine kinase were found in 84. 6%, 84. 1%o, 71.2% of the patients respectively. Positive electromyography and muscle biopsy consistent with inflammatory myopathy were also found in 91.4%, 88.8% respectively. 5) Positive antinuclear antibody, rheumatoid factor, anti-Ro, anti-nRNP were found in 59.6%, 17.3%, 16.7%, 8.3% of patients respectively, mainly in group V. Anti-Jo-1 antibody was present in 25.8% of patients tested(8/31), including group II 4 cases, group V 3 cases and group I I case. 6) All 8 patients with anti-Jo-1 antibody had interstitial lung disease(ILD) and Raynaud phenomenon with statistical significance, compared with those without anti-Jo-1 antibody(P<0.01). 7) Among the 43 patients in whom follow up was available, 10 patients died(mortality rate 23.2%). The main cause of death were infection(4 cases), and respiratory muscle weakness, respiratory failure due to ILD, malignancy 2 cases respectively. CONCLUSION: The results of the study demonstrated that clinical expression of PM/DM were similar to previously reported series except relatively high frequency of primary dermatomyositis in this study. Anti-Jo-1 antibody was main autoantibody in inflammatory myopathies, which was associated with extramuscular manifestations, such as ILD and Raynaud's phnomenon.
Antibodies, Antinuclear ; Biopsy ; Breast Neoplasms ; Carcinoma, Small Cell ; Cause of Death ; Connective Tissue Diseases ; Creatine Kinase ; Dermatomyositis ; Diagnosis ; Electromyography ; Follow-Up Studies ; Fructose-Bisphosphate Aldolase ; Humans ; Lung ; Medical Records ; Muscle Weakness ; Myositis* ; Prognosis ; Raynaud Disease ; Respiratory Insufficiency ; Respiratory Muscles ; Rheumatoid Factor

Purpose: The incidence of gallstone disease and cholecystectomy is increasing worldwide. The aim of this study was to determine trends in the incidence of cholecystectomy in Korea. Methods: The National Health Insurance Services database was used to determine patterns in proportion of cholecystectomy and cholecystostomy in the total population of Korea from 2003 to 2017. The age-standardized rate (ASR) was calculated to compare the cholecystectomy and cholecystostomy according to changes in the population structure over time. The ASR was investigated according to patient age, sex, socioeconomic status, use of computed tomography, and type of hospital to identify trends. Results: The ASR per 100,000 based on the 2010 population of cholecystectomy cases increased markedly from 67.7 to 211.4 between 2003 and 2017. The ASR was consistently higher in female than male (71.9 vs. 63.6 in 2003, 221.8 vs. 201.8 in 2017). Furthermore, the ASR for cholecystectomy increased with age, and surgery for gallstone disease was performed more often at a specialized center than at other medical facilities. The length of hospital stay of cholecystectomy decreased steadily from 10.6 days in 2003 to 6.9 days in 2017. Conclusion This study shows that the incidence of cholecystectomy and cholecystostomy has steadily increased over the years in Korea, with a trend toward older age and higher socioeconomic status in patients undergoing cholecystectomy. Increasing use of computed tomography investigations could be a primary cause for this trend. An integrated strategy is needed to manage the increase in older patients undergoing cholecystectomy and shorten their hospital stay with medical safety.

The treatment of choice for post-intubation tracheal stenosis is partial tracheal resection and end-to-end anastomosis. The surgical treatment of tracheal restenosis that results from unsuccessful repair of post-intubation tracheal stenosis is not easy. Failed reoperation results in permanent tracheostomy and loss of voice. If the first operation fails, about 4~6 months of period for resolution of inflammatory reaction, edema, and fibrosis is needed. The exact evaluation of the patient's status is necessary and success rate of reoperation for the appropriate candidates is over 90%. We report the results of treatment in two cases of tracheal restenosis that resulted from unsuccessful repair of post-intubation tracheal stenosis with review of literatures.
Edema ; Fibrosis ; Reoperation ; Tracheal Stenosis* ; Tracheostomy ; Voice