PURPOSE: Laparoscopic common bile duct exploration (LCBDE) has more advantages than conventional common bile duct surgery, but the use of this route for stone removal and biliary drainage remains controversial. The goal of this study was to investigate the usefulness of LCBDE in patients who had been failed in the endoscopic stone extraction. METHODS: From November 2005 to August 2008, 52 patients underwent LCBDE due to failure of endoscopic stone extraction in Chungnam National University Hospital. Clinical data were collected and analyzed retrospectively. RESULTS: Duodenal diverticulum (23 cases, 44.2%) was the most common cause in failure of endoscopic stone extraction and large common bile duct stone 12 cases (23.1%), previous upper gastrointestinal operation 10 cases (19.2%) were followed. Twenty four patients did not have preoperative biliary drainage, such as PTBD, ENBD, PTGBD. Forty-five patients (86.5%) of the 52 participating patients underwent LCBDE successfully, but 7 cases resulted in open surgery for the following reasons: 3 cases of severe intraabdominal adhesions, 3 cases of stone impaction in ampulla portion, and 1 case of a remnant stone. External biliary drainage was performed in 41 cases with T-tube (31 cases, 68.9%), PTBD (7 cases, 15.6%), ENBD (3 cases, 6.7%). The stone clearance of LCBDE was 95.6%. Remnant stone weredetected in 2 cases (4.4%) and removed with choledochoscope via external biliary drain. Postoperative complications happened in 5 cases (9.5%). Procedure related complications happened in 2 cases (3.8%). CONCLUSION: LCBDE is useful technique in patients with failed endoscopic stone extraction, and biliary drainage may be necessary for detection and removal of latent remnant CBD stones.
Common Bile Duct ; Dioxolanes ; Diverticulum ; Drainage ; Fluorocarbons ; Humans ; Postoperative Complications

BACKGROUND: Sorbitol fermenting Escherichia coli O157 were reported. And E. coli O157:H7 produce various Shiga toxin (Stx) such as Stx1, Stx2, or variants of Stx2. In this study, we tried to establish laboratory methods that detect E. coli O157:H7 quickly and precisely by analyzing sensitivity of colony hybridization test and PCR technique. METHODS: Stx1-producing E. coli ATCC 43890, Stx2-producing E. coli ATCC 43889, and Stx2vha- producing E. coli ATCC 51435 were tested. Three strains of E. coli were diluted with 0.1 g of diarrheal stools from 107 CFU to 101 CFU respectively. The stool samples were incubated overnight in MacConkey agar plates. A mean of 63 colonies were hybridized by stx1- and stx2-specific oligonucleotide probes. PCR for stx1 gene and stx2 gene was done after overnight- incubation of stool samples in the LB broth with vancomycin (6 ug/mL). Positive colonies by colony hybridization were confirmed by PCR for stx1 gene and stx2 gene. RESULTS: Colony hybridization test could detect Stx1-producing E. coli at 103 CFU per 0.1 g of stool, Stx2-producing E. coli at 105 CFU per 0.1 g of stool, and Stx2vha-producing E. coli at 104 CFU per 0.1 g of stool. PCR technique after enrichment in LB broth with vancomycin (6 ug/mL) could detect stx1-, stx2-, and stx2vha-containing E. coli at 10 CFU per 0.1 g of stool respectively. CONCLUSOIN: A combination of colony hybridization and PCR after enrichment in broth with vancomycin (6 ug/mL) is useful for the rapid and precise diagnosis of infections of Shiga toxin-producing E. coli O157:H7.
Agar ; Diagnosis ; Escherichia coli O157 ; Escherichia coli* ; Escherichia* ; Oligonucleotide Probes ; Polymerase Chain Reaction ; Shiga Toxin ; Sorbitol ; Vancomycin

Eosinophilic gastroenteritis (EG) is a rare disease characterized by massive eosinophilic infiltration of gastrointestinal tissue, peripheral eosinophilia, and nonspecific gastrointestinal symptoms. The mucosal type of EG commonly presented with malabsorption and anemia. However, the role of food allergy as a stimulus to EG has not yet been clearly defined. A 27-year-old man was referred to the Emergency Department with dyspepsia and leg swelling. The initial laboratory test should as follows: hemoglobin level, 6.4 g/dL; white blood cell count, 7,400/microL with 24.4% of eosinophil fraction; serum total protein, 3.9 g/dL; albumin level, 2.8 g/dL. Gastric endoscopy ruled out gastrointestinal bleeding showed multiple nodular raised lesions on the gastric antrum, which revealed increased eosinophilic infiltration (above 100/high power field). He had experienced nausea whenever eating beef, porks or fish. High serum specific IgE levels to offending foods (beef, 0.82 kU/L; pork, 0.83 kU/L; egg white, 0.40 kU/L; egg yolk, 0.54 kU/L; milk, 0.81 kU/L) were noted. He was instructed strictly to avoid food allergens with oral prednisolone therapy. Approximately 6 months after offending food restriction, the eosinophil count fell down to 400/microL, the hemoglobin level was returned to 11.5 g/dL and the serum albumin level was increased to 4.1 g/dL. We report a case of EG caused by multiple food allergy which leads to malabsorption and iron-deficiency anemia.
Adult ; Allergens ; Anemia* ; Anemia, Iron-Deficiency ; Dyspepsia ; Eating ; Egg White ; Egg Yolk ; Emergency Service, Hospital ; Endoscopy ; Eosinophilia ; Eosinophils* ; Food Hypersensitivity* ; Gastroenteritis* ; Hemorrhage ; Humans ; Immunoglobulin E ; Leg ; Leukocyte Count ; Malabsorption Syndromes ; Milk ; Nausea ; Prednisolone ; Pyloric Antrum ; Rare Diseases ; Serum Albumin

OBJECTIVE: In processing high dimensional clinical data, choosing the optimal subset of features is important, not only for reduce the computational complexity but also to improve the value of the model constructed from the given data. This study proposes an efficient feature selection method with a variable threshold. METHODS: In the proposed method, the spatial distribution of labeled data, which has non-redundant attribute values in the overlapping regions, was used to evaluate the degree of intra-class separation, and the weighted average of the redundant attribute values were used to select the cut-off value of each feature. RESULTS: The effectiveness of the proposed method was demonstrated by comparing the experimental results for the dyspnea patients' dataset with 11 features selected from 55 features by clinical experts with those obtained using seven other classification methods. CONCLUSION: The proposed method can work well for clinical data mining and pattern classification applications.
Data Mining ; Dyspnea

OBJECTIVES: Cohort studies of associations between air pollution and health have used exposure prediction approaches to estimate individual-level concentrations. A common prediction method used in Korean cohort studies is ordinary kriging. In this study, performance of ordinary kriging models for long-term particulate matter less than or equal to 10 mum in diameter (PM10) concentrations in seven major Korean cities was investigated with a focus on spatial prediction ability. METHODS: We obtained hourly PM10 data for 2010 at 226 urban-ambient monitoring sites in South Korea and computed annual average PM10 concentrations at each site. Given the annual averages, we developed ordinary kriging prediction models for each of the seven major cities and for the entire country by using an exponential covariance reference model and a maximum likelihood estimation method. For model evaluation, cross-validation was performed and mean square error and R-squared (R2) statistics were computed. RESULTS: Mean annual average PM10 concentrations in the seven major cities ranged between 45.5 and 66.0 mug/m3 (standard deviation=2.40 and 9.51 mug/m3, respectively). Cross-validated R2 values in Seoul and Busan were 0.31 and 0.23, respectively, whereas the other five cities had R2 values of zero. The national model produced a higher crossvalidated R2 (0.36) than those for the city-specific models. CONCLUSIONS: In general, the ordinary kriging models performed poorly for the seven major cities and the entire country of South Korea, but the model performance was better in the national model. To improve model performance, future studies should examine different prediction approaches that incorporate PM10 source characteristics.
Air Pollution ; Busan ; Cohort Studies ; Korea ; Particulate Matter* ; Seoul ; Spatial Analysis*

Under conditions of Na+ channel hyperactivation with aconitine, the changes in action potential duration (APD) and the restitution characteristics have not been well defined in the context of aconitine-induced arrhythmogenesis. Optical mapping of voltage using RH237 was performed with eight extracted rabbit hearts that were perfused using the Langendorff system. The characteristics of APD restitution were assessed using the steady-state pacing protocol at baseline and 0.1 microM aconitine concentration. In addition, pseudo-ECG was analyzed at baseline, and with 0.1 and 1.0 microM of aconitine infusion respectively. Triggered activity was not shown in dose of 0.1 microM aconitine but overtly presented in 1.0 microM of aconitine. The slopes of the dynamic APD restitution curves were significantly steeper with 0.1 microM of aconitine than at baseline. With aconitine administration, the cycle length of initiation of APD alternans was significantly longer than at baseline (287.5 +/- 9.6 vs 247.5 +/- 15.0 msec, P = 0.016). The functional reentry following regional conduction block appears with the progression of APD alternans. Ventricular fibrillation is induced reproducibly at pacing cycle length showing a 2:1 conduction block. Low-dose aconitine produces arrhythmogenesis at an increasing restitution slope with APD alternans as well as regional conduction block that proceeds to functional reentry.
Aconitine/*pharmacology ; Action Potentials/*drug effects ; Animals ; Arrhythmias, Cardiac/*chemically induced/*physiopathology ; Cardiac Pacing, Artificial ; Electrocardiography ; Heart/physiopathology ; Heart Conduction System/physiology ; Myocardium/*pathology ; Rabbits ; Sodium Channels/drug effects/metabolism ; Ventricular Fibrillation/physiopathology

Pyogenic liver abscess (PLA) can be caused by bacteria entering the liver via the portal vein or primary bacteremia, or it can be cryptogenic. Recently, Klebsiella pneumoniae has been increasingly found as a PLA pathogen. PLA due to this bacterium often leads to formation of extrahepatic abscesses. The treatment of choice is dual therapy with insertion of percutaneous catheter drainage and antibiotic therapy. We report 2 cases of PLA due to K. pneumoniae in immunocompetent children. We successfully treated patient 1 with percutaneous catheter drainage for 18 days and 6-week course of antibiotic therapy. Patient 2 was treated with percutaneous needle aspiration and antibiotic therapy for the same period. In both patients, the PLAs showed the ultrasound-confirmed resolutions after the dual therapy.
Abscess ; Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Catheters ; Child ; Drainage ; Humans ; Immunocompetence ; Klebsiella pneumoniae ; Klebsiella ; Liver ; Liver Abscess, Pyogenic ; Needles ; Pneumonia ; Portal Vein

PURPOSE: The purpose of our study was to evaluate the relevance of a patient's critical comorbidities to his survival rate, along with factors that influence the prognosis of patients who went through in-hospital cardiac arrest. We also investigated the association between the physical burden of the patients' comorbidities and the prognosis of inhospital arrest patients using the Deyo-Charlson score. METHODS: We retrospectively reviewed data for 1,094 patients with in-hospital cardiopulmonary arrest between January 2003 and June 2009 according to the Utstein-style guidelines. Severe comorbidities included congestive heart disease, chronic renal failure, severe liver disease, pulmonary disease, and hematologic or metastatic solid malignancy. Multivariate Cox regression analysis and logistic regression models were used to assess the hazard ratio and survival factors. RESULTS: The hazard ratio of patients with severe liver disease or hematologic or metastatic solid cancer were 1.42 (95% CI, 1.14-1.76, p=0.002) and 1.60 (95% CI, 1.36-1.88, p<0.001), respectively. Shorter CPR duration and subsequent intervention were significant prognostic factors in patients with severe comorbidities. The Deyo-Charlson score was one of the independent prognostic factors in the overall study population. CONCLUSION: The six month survival rate of patients with a history of severe liver disease or hematologic or solid metastatic cancer that underwent in-hospital cardiac arrest is low.
Cardiopulmonary Resuscitation ; Comorbidity ; Estrogens, Conjugated (USP) ; Heart Arrest ; Heart Diseases ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Logistic Models ; Lung Diseases ; Prognosis ; Retrospective Studies ; Survival Rate

PURPOSE: The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. MATERIALS AND METHODS: This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. RESULTS: A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). CONCLUSION: Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea.
Adult ; Aged ; Costs and Cost Analysis ; Crowding ; Emergency Medical Services/methods/*standards ; *Emergency Service, Hospital ; Female ; *Hospitalization ; Humans ; Male ; Middle Aged ; Observation ; Prospective Studies ; Syncope/*diagnosis

Pancreaticopleural fistula is an uncommon complication of chronic pancreatitis. We report a case of pancreaticopleural fistula that was presented with right-sided hemothorax. A 49-year-old male with a history of chronic alcoholism was presented with a month of dyspnea. A chest radiography showed a right-sided massive pleural effusion with old-blood-colored fluids and amylase levels of 1,020 IU/L. On the chest computerized tomography (CT), there was pleural effusion and a well-defined tract from the posterior mediastinum to the pseudocyst in the tail of the pancreas. Even with conservative treatment with closed thoracostomy, octreotide and gabexate mesilate, he developed hemothorax. Abdominal CT revealed an increase of the hemorrhagic pancreatic pseudocyst. Distal pancreatectomy with splenectomy and external drainage of the pancreaticopleural fistula on the posterior mediasternum were performed. The patient had an uneventful course and was discharged on the 27th postoperative day. Management of pancreaticopleural fistula is multimodal included medication, endoscopic stenting and surgery. Surgery in pancreaticopleural fistula might be beneficial in selective cases.
Alcoholism ; Amylases ; Drainage ; Dyspnea ; Fistula ; Gabexate ; Hemothorax ; Humans ; Male ; Mediastinum ; Middle Aged ; Octreotide ; Pancreas ; Pancreatectomy ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Pleural Effusion ; Splenectomy ; Stents ; Thoracostomy ; Thorax