PURPOSE: This study was conducted to assess how extreme obesity affects 30-day mortality in this patient group. METHODS: A total of 802 patients who underwent emergency gastrointestinal surgery from January 2007 to December 2017 were retrospectively reviewed. Patients were divided into three groups according to their body mass index (BMI): group 1, normal weight (BMI: 18.5~22.9 kg/m²); group 2, overweight (BMI: 23.0~29.9 kg/m²); and group 3, obesity (BMI≥30 kg/m²). Patients with a BMI under 18.5 were excluded from the analysis. Chi-squared test, Fisher's exact test, Kaplan-Meier survival analysis, and the log-rank test were used to assess and compare 30-day mortality rates between groups. RESULTS: The mortality rates of group 1, group 2, and group 3 were 11.3%, 9.0%, and 26.9%, respectively (P < 0.017). The mortality rate did not differ significantly between group 1 and 2 (11.3% vs. 9.0%; P=0.341), but group 1 and 2 showed better survival rates than group 3 (11.3% vs. 26.9%; P=0.028, 9.0% vs. 26.9%; P=0.011). Kaplan-Meier survival analysis revealed that group 3 had higher mortality than the other two groups (P=0.001). CONCLUSION: Obesity (BMI≥30 kg/m²) was one of the risk factors influencing critically ill patients who underwent emergency surgery.
Body Mass Index ; Critical Illness* ; Emergencies ; Humans ; Kaplan-Meier Estimate ; Mortality* ; Obesity* ; Overweight ; Retrospective Studies ; Risk Factors ; Survival Rate

Extranodal Natural Killer (NK)/T-cell lymphoma, nasal type, is a subtype of non-Hodgkin lymphoma, strongly associated with Epstein-Barr virus. Extranodal NK/T-cell lymphoma mostly affects the nasal cavity and there has been no report of the disease’s occurrence at the base of tongue. Here we report a case of 43-year-old man who presented with a diffuse ulcerative lesion at the base of tongue. Because the patient had oral bleeding, tracheostomy and lingual artery ligation was performed via a transcervical approach to control bleeding and protect the upper airway. We performed a deep biopsy through the lateral pharyngotomy approach, and finally, the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. We report this rare case of extranodal NK/T cell lymphoma at the base of tongue with a literature review.

Extranodal Natural Killer (NK)/T-cell lymphoma, nasal type, is a subtype of non-Hodgkin lymphoma, strongly associated with Epstein-Barr virus. Extranodal NK/T-cell lymphoma mostly affects the nasal cavity and there has been no report of the disease’s occurrence at the base of tongue. Here we report a case of 43-year-old man who presented with a diffuse ulcerative lesion at the base of tongue. Because the patient had oral bleeding, tracheostomy and lingual artery ligation was performed via a transcervical approach to control bleeding and protect the upper airway. We performed a deep biopsy through the lateral pharyngotomy approach, and finally, the patient was diagnosed with extranodal NK/T-cell lymphoma, nasal type. We report this rare case of extranodal NK/T cell lymphoma at the base of tongue with a literature review.

BACKGROUND: Despite improved operator technique and advanced equipment designs, acute closure and restenosis remain as serious limitations to both the short and long-term success of balloon angioplasty. Atherectomy is a new transluminal interventional technique for the treatment of coronary artery obstructive disease. We evaluate preliminary experience of directonal coronary atherectomy (DCA) for complex coronary artery lesions. METHODS: We tried DCA in the 16 lesions of 15 nonrandomized sequential patients(mean age 66 years, M/F : 12/3) with coronary artery lesions that were ostial lesion in 4, ulcerated and/or eccentric in 13, restenosis after PTCA in 2 and after stent implantation in 2. The target vessel was right coronary artery in 7 and left anterior descending artery in 9. RESULTS: Primary success was achieved in 14 of 16 lesions (88%) by atherectomy and in 5(36%) by additional use of balloon angioplasty. Atherectomy retrieved tissue in 15 out of 15 attempts(100%). One patients suffered acute closure due to large dissection during the DCA which was solved successfully after stent implantation. CONCLUSIONS: Atherectomy can predictably treat selected patients with eccentric, ostial bulky coronary lesions with overall safety comparable to that of conventional balloon angioplasty, although the procedure as currently performed does not appear to prevent restenosis.
Angioplasty, Balloon ; Arteries ; Atherectomy ; Atherectomy, Coronary* ; Coronary Vessels ; Equipment Design ; Humans ; Stents ; Ulcer

A spermatic cord leiomyoma is an uncommon disease. A leiomyoma can originate anywhere, including the genitourinary system, where smooth muscle is present. 70 and 30% of spermatic cord leiomyomas are benign and malignant, respectively. The preoperative diagnosis of a leiomyoma is difficult; the only definite diagnostic method is histological confirmation. A retroperitoneal lipoma probably constitutes the largest group of solid abdominal tumors. However, their etiology is unknown and the symptoms insidious, and recurrences and sarcomatous changes frequently occur. The clinical diagnostic methods are the clinical symptoms, a physical examination and radiological evaluations, such as intravenous urography, computed tomography and angiography, and so on, but an abdominal CT scan provides the most useful information. A fifty-six-old man presented with a five-month history of a suddenly enlarging right inguinal mass. He had undergone a right inguinal hernia operation, with medication for hypertension. Herein, a rare case of a huge retroperitoneal lipoma, with a spermatic cord leiomyoma, is reported.
Angiography ; Diagnosis ; Hernia, Inguinal ; Hypertension ; Leiomyoma* ; Lipoma ; Muscle, Smooth ; Physical Examination ; Recurrence ; Retroperitoneal Space ; Spermatic Cord* ; Tomography, X-Ray Computed ; Urogenital System ; Urography

OBJECTIVES: Nurses working in a hospital operate in a special environment where patients require a 24-hour day service. In order to meet the need for manpower, nurses in the wards, ICU, and ER work in 3 shifts per day. This study was designed to evaluate their sleeping patterns and the factors that influence them. METHODS: The subjects were 114 female nurses working at a University Hospital in Kyungi-do. To evaluate their sleeping pattern, a survey containing 11 questions was used. Their were differentiated into insomnia, sleep deprivation, daytime sleepiness, and snoring. Statistical analysis was conducted with independent t test, chi-square test and analysis of covariance. RESULTS: A statistical difference was found between shiftworkers and nonshiftworkers, in terms of sleep initiation time (p<0.05). The occurrences of insomnia, sleep deprivation, daytime sleepiness and snoring differed between the two groups, but not significantly. CONCLUSIONS: Of the numerous factors affecting sleeping patterns, shiftwork has the most deteriorative effect.
Female ; Humans ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders ; Snoring

PURPOSE: This study aimed to evaluate the clinical course of childhood immune thrombocytopenia (ITP) and to assess the risk factors for developing chronic ITP. METHODS: The records of 64 children diagnosed with ITP from November 2005 and December 2014 at single center were retrospectively analyzed. RESULTS: The median age at diagnosis and the median platelet count were 1 year (range, 1 month to 15 years) and 9×10⁹/L (range, 0–84×10⁹/L), respectively. No patient experienced severe bleeding. Nineteen children (29.7%) spontaneously recovered their platelet count to ≥100×10⁹/L at a median of 10 days. In total 45 patients (70.3%) received intravenous immunoglobulin (IVIG) as first-line therapy, and showed platelet recovery at 1 week. The final diagnosis of 55 (85.9%) and 9 patients (14.1%) was acute and chronic ITP, respectively. Older age, absence of prior infection and insidious onset of symptoms were significantly associated with the development of chronic ITP. Among the patients who received IVIG, those with platelet count <45×10⁹/L at 1 month after IVIG showed a significantly higher incidence of chronic ITP compared to those with platelet count ≥45×10⁹/L (88.8% vs. 44.4%, P<0.01). CONCLUSION: In most patients, ITP runs a benign course and approximately 86% of them recover within 1 year of their initial diagnosis. The potential impact of the risk factors of chronic ITP on clinical practice needs to be explored and further studies are warranted to determine whether IVIG influences the course of ITP.
Blood Platelets ; Child ; Diagnosis ; Hemorrhage ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Risk Factors

The occlusal treatment including prosthetic treatment should be considered when the pathologic symptom was observed with the excessive discrepancy between the centric relation occlusion (CRO) and the maximum intercuspal position (MIP). Through careful diagnosis, the malocclusion and interarch relationship can be analyzed, and occlusal adjustment, restorative treatment, orthodontic therapy, or orthognathic surgery can be performed depending on the degree of disharmony. The patient in this case report complained the unstable occlusion and loss of masticatory function that had been occurring for several years. At the time of the visit, the patient showed severe occlusal disharmony, with only the upper right second molar contacting the lower jaw at the maximum intercuspal position. Based on the analysis of the occlusion, it was difficult to solve the problem with just occlusal adjustment or restorative treatment. In addition, the patient had the skeletal class II malocclusion between the upper and lower jaws. Therefore, for resolving the severe skeletal class II malocclusion, pre- and post-orthodontic treatment, bilateral sagittal split ramus osteotomy (BSSRO) was performed. After that, the occlusal adjustment was performed for stable occlusion, and the missing teeth area was restored with dental implants. During the follow-up period, a periodic follow-up visits and additional occlusal adjustments were performed to achieve a stable centric occlusion and harmonious anterior and lateral guidance. As a result, the final prosthodontic treatment was completed, and the patient’s masticatory function was restored.

BACKGROUND: Drowning represents the third most common cause of all accidental deaths worldwide. Although few studies of submersion injury were done in Korea, the subjects were mainly pediatric patients. The purpose of this study is to describe the clinical feature of submersion injury in adults. METHODS: The medical records of 31 patients with submersion injury who were >15 years of age and admitted to Kyungpook National University Hospital from July 1990 to March 2003 were retrospectively examined. RESULTS: The most common age-group, cause, and site of submersion accidents in adults were 15-24 years of age, inability to swim, and river followed by more than 65 years of age, drinking, and public bath respectively. The initial chest radiographs showed bilaterally and centrally predominant distribution of pulmonary edema at lung base in about 90% of patients with pulmonary edema represented by submersion injury but at only upper lung zone in 10%. Eventually, 25 patients (80.6%) survived without any neurologic deficit and 2 patients (6.5%) with significant neurologic deficit, and 4 patients (12.9%) died. Age, arterial gas oxygenation, and mental status among baseline variables showed significant difference for prognosis. CONCLUSIONS: More than 65 years of age, drinking, and occurrence in public bath were relatively important in submersion injury of adults, and the successful survival of 80.6% of patients suggests that cardiopulmonary resuscitation should be intensively done in even adults.
Adult* ; Baths ; Cardiopulmonary Resuscitation ; Drinking ; Drowning ; Gyeongsangbuk-do ; Humans ; Immersion* ; Korea ; Lung ; Medical Records ; Near Drowning ; Neurologic Manifestations ; Oxygen ; Prognosis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Rivers

A 31-year-old woman had a history of fatigue and hypokalemia and metabolic alkalosis and hypocalciuria. The patient had a subtotal thyroidectomy and denied ingestion of diuretic medication. Her clinical and laboratory findings were consistent with Gitelman's syndrome. Normal blood pressure, hypokalemic metabolic alkalosis, hypocalciuria were present. She confessed to us that she had been taking a pill due to constipation for 7 years. She was afraid that her husband know it. But we don't know the reason why she had concealed it Surreptious ingestion of diuretics must be excluded in any adult patient in whom a diagnosis of Bartter's or Gitelman's syndrome is considered.
Adult ; Alkalosis ; Bartter Syndrome ; Blood Pressure ; Constipation ; Diagnosis ; Diuretics ; Eating ; Fatigue ; Female ; Gitelman Syndrome* ; Humans ; Hypokalemia ; Spouses ; Thyroidectomy