The laparoscopic cholecystectomy, performed for the first time in France in 1987, has been accepted as in many countries the method of choice when performing a cholecystectomy. The trend toward minimally invasive surgery has prompted general surgeons to try it instead of open cholecystectomy. We performed 1000 laparoscopic cholecystectomies at the Department of General Surgery of Eulji Medical College Hospital from January 1992 to April 1997. The outcome data have been analyzed retrospectively. Moreover, we have compared the case histories of 13 patients who received cholecystostomy with those of 43 patient who did not. We also present preliminary results for an interval laparoscopic cholecystectomy which was a preceded by percutaneous cholecystostomy. The results are as follows: 1) The mean age was 54.3 years ranging from 17 to 86; there were 402 males and 598 females. 2) Of the 1000 patients, 123 patients (12.3%) had a history of abdominal surgery. 3) More than half of the patients(560 patients, 56.0%) underwent operations within 6 months of the onset of symptoms. 4) A preoperative endoscopic retrograde cholecystoscopy was performed on 220 patients (22.0%), and of these, 93 patients received endoscopic sphincterotomies because of bile duct stones. 5) The majority of patients(744 patients, 74.4%) had laparoscopic cholecystectomies which lasted 40 minutes or less. 6) More than half (54%) of the removed gallbladders showed grade II inflammation. 7) Drains were used in 142 patients (14.2%). 8) Postoperative complications were encountered in 48 patients (4.8%). 9) Postoperative oral intake was resumed within 24 hours in most patients. 10) Most patients(854 patients, 85.4%) were discharged within 3 days of the operation. 11) The pathologic diagnosis was chronic nonspecific inflammation in most cases (823 cases, 82.3%). 12) The most common microorganism in the bile was E. coli. 13) Patients who received a cholecystostomy had many benefits: a shorter operation time, a low rate of open cholecystectomy, early oral intake. 14) For the 1160 patients who underwent a cholecystectomy during the same period, the rate of open cholecystectomy was 13.8%.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystostomy* ; Diagnosis ; Female ; France ; Gallbladder ; Humans ; Inflammation ; Male ; Postoperative Complications ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Surgical Procedures, Minimally Invasive

PURPOSE:Idiopathic ketotic hypoglycemia (IKH) is an important cause of hypoglycemia in children. The purpose of this study was to determine the prevalence of ketotic hypoglycemia and to describe the clinical manifestation. METHODS:We conducted a retrospective chart review of children presenting hypoglycemia to the emergency department (ED) of Ewha Womans University Hospital between January 1995 and June 2004. Information recorded for subject included age, gender, weight, time of presentation, presenting symptoms, and laboratory data. RESULTS:Eighty two children were identified for hypoglycemia during the study period. IKH was the ultimate diagnosis for 66 patients (80.5%). Other diagnoses included hyperinsulinism (2.4%), drug adverse event (1.2%), sepsis (1.2%), and other disorder. The mean age for presentation of IKH was 37.9+/-18.6 months. Thirty eight boys and twenty eight girls were identified. The median time of presentation was 9:48 a.m. Of the 66 subjects, body weight of 46.9% patients was below 25th percentile for age. The average blood glucose was 41.4+/-14.2 mg/dL. Symptoms at presentation included lethargy (24.2%), mental change (16.7%) and vomiting (16.7%). 49 patients (74.2%) were described as having a concomitant illness. CONCLUSION: IKH was responsible for 80.4% of cases of hypoglycemia in pediatric ED and it had usually concomitant intercurrent illness which resulting in poor oral intake. Awareness of IKH, and its presenting characteristics, will be helpful in the ED when taking care of hypoglycemic children.
Blood Glucose ; Body Weight ; Child ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia* ; Lethargy ; Prevalence* ; Retrospective Studies ; Sepsis ; Vomiting

PURPOSE: The purpose of this study is to illustrate MR patterns of bone marrow of calvarium and vertebral body in normal subjects according the age distribution and to understand the course of the fatty replacement from red marrow. METHODS AND MATERIAL: We retrospectively evaluated MR examinations of the calvaria(n=71), cervical spine(n=71), thoracic spine(n=65), Imbar spine(n =68) in subjects without bone marrow abnormality whose age ranged 3 weeks to 74 years. Three distinctive patterns were categorized on Tl-weighted images of the skull. In pattern 1, uniformly low signal intensity with or without very small areas of high intensity in frontal and occipital bones is noted. In pattern 2, frontal and occipital bones have uniformly high signal intensity, and patchy area of high intensity appears in parietal bone. In pattern 3, the entire skull has uniformly high signal intensity. In the spine, four patterns were categorized on Tl-weighted MR images. In pattern 1, the vertebral body has uniformly low signal intensity except for linear areas of high intensity superior and inferior to basivertebral vein. In pattern 2, bandlike and triangular areas of high signal intensity are found in the periphery. Pattern 3 and 4 have diffusely distributed areas of high signal intensity; pattern 3 consist of numerous indistinct dots measuring a few millimeter or less, and pattern 4 consist of fairly well marginated areas ranging in size from 5 to 1.5cm. RESULT:In the calvaria, 73% of pattern 1 were younger than 20 years, pattern 2 were evenly distributed, and 86% of pattern 3 were older than 40 years. In the spine, 87% of pattern 1 were younger than 40 years, 72% of pattern 3 were in 40 to 50 years, and 87% of pattern 4 were older than 50 years. Pattern 2 were evenly distributed in the cervical and thoracic spine, but in the thoracic spine 62% were younger than 30 years. CONCLUSION:It is concluded that younger age group shows mainly pattern 1, whereas elderly group has pattern 3 or 4 in the calvarial and vertebral body marrow. This suggests that conversion to fatty marrow begin locally and progress diffusely with age.
Age Distribution* ; Aged ; Bone Marrow* ; Humans ; Occipital Bone ; Parietal Bone ; Retrospective Studies ; Skull* ; Spine ; Veins

PURPOSE: The purpose of this study was to identify attributes of the concept of cancer survivorship. METHODS: Walker & Avant's concept analysis framework (2005) was used to review the medical & nursing text books, medical and nursing research articles related to cancer survivorship and published from 1985 to 2011. RESULTS: There were nine aspects of the concept of cancer survivorship: A process, liminality, uncertainty, life-changing experience, complexity, unique experience, duality of positive and negative aspects, partnership, and need for support. Antecedents of cancer survivorship were cancer diagnosis and perception as a cancer survivor. Empirical referents of cancer survivorship were survival rate, quality of life, adaptation to the survivorship experience, and health-related hardiness, social support, spirituality, and health behavior. The consequences of cancer survivorship were effects on the physical, psychosocial, spiritual and socio-economic well-being of the patients. CONCLUSION: This concept analysis of cancer survivorship is expected to contribute to promotion of survivorship care in the clinical field by removing conceptual ambiguity and confirming the true meaning of survivorship care.
Health Behavior ; Humans ; Nursing Research ; Quality of Life ; Spirituality ; Survival Rate ; Survivors ; Uncertainty

The purpose of this study was to investigate utilization and storage management practice of the frozen and refrigerated foods in school foodservice. 222 dietitians employed in school foodservice were surveyed. In school foodservice, the refrigerated stock farm products and seafoods (78.3%) were more used rather than frozen products (47.5%). According to school foodservice characteristics, the refrigerated meats including dairy products were more frequently used in elementary and middle schools than high school foodservice. On the other hand, the foodservice in high school used more frozen seafoods and processed foods than elementary school did. The data also showed a tendency for the contracted foodservice using more frozen meats and seafoods rather than refrigerated products when comparing with the self-operated foodservice. In terms of receiving conditions, storage methods and storage time, the result indicated that frozen or refrigerated products were often delivered at inappropriate temperature. Especially some products which were needed to be shipped and stored at refrigerated temperature such as mollusks, were delivered and kept at room temperature. The most frequently used thawing method were running water (56.9%), however, the frozen products were often sitted at room temperature for the purpose of thawing. According to the results, several inappropriate handling processes for frozen and refrigerated products were found in school foodservice. In order to improve handling process for frozen and refrigerated products, recognition of food handlers' weakness about storage and distribution, development of radical standards for receiving conditions, storage and thawing methods should be debated.
Dairy Products ; Hand ; Humans ; Meat* ; Mollusca ; Nutritionists ; Running ; Seafood* ; Ships ; Water

Purpose: To compare the contrast sensitivities of type 2 diabetic patients without retinopathy and healthy subjects, and to assess the risk factors associated with a change in contrast sensitivity in diabetes. Methods: A total of 75 (diabetic patients without retinopathy) and 41 (healthy subjects) eyes were reviewed from the medical records. The threshold of contrast sensitivity was measured at 6.3°, 4.0°, 2.5°, 1.6°, 1.0°, and 0.64° under scotopic and photopic states. Optical coherence tomography (OCT) imaging was used to measure the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness in diabetic patients. Results: Diabetic patients showed a lower threshold of contrast sensitivity at all degree measures than did the controls under both scotopic and photopic states. In subgroup analyses, diabetic patients with abnormal contrast sensitivity showed a longer duration of diabetes, decreased total retinal thickness, and decreased average GC-IPL, superior RNFL, superior GC-IPL, and temporal GC-IPL thicknesses. Multivariate logistic regression analyses showed that the duration of diabetes and total retinal thickness were significant predictive factors of decreased contrast sensitivity (odds ratio = 1.117 and 0.942, respectively). Conclusions As the duration of diabetes increased, the contrast sensitivity decreased in type 2 diabetic patients. Neuroretinal degeneration changes both the inner retinal thickness and total retinal thickness and affects contrast sensitivity. Therefore, for longer-term diabetic patients, it is necessary to consider the changes in contrast sensitivity and retinal thickness on OCT evaluation, even if the patient presents with normal fundus findings.

Purpose: To compare the contrast sensitivities of type 2 diabetic patients without retinopathy and healthy subjects, and to assess the risk factors associated with a change in contrast sensitivity in diabetes. Methods: A total of 75 (diabetic patients without retinopathy) and 41 (healthy subjects) eyes were reviewed from the medical records. The threshold of contrast sensitivity was measured at 6.3°, 4.0°, 2.5°, 1.6°, 1.0°, and 0.64° under scotopic and photopic states. Optical coherence tomography (OCT) imaging was used to measure the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness in diabetic patients. Results: Diabetic patients showed a lower threshold of contrast sensitivity at all degree measures than did the controls under both scotopic and photopic states. In subgroup analyses, diabetic patients with abnormal contrast sensitivity showed a longer duration of diabetes, decreased total retinal thickness, and decreased average GC-IPL, superior RNFL, superior GC-IPL, and temporal GC-IPL thicknesses. Multivariate logistic regression analyses showed that the duration of diabetes and total retinal thickness were significant predictive factors of decreased contrast sensitivity (odds ratio = 1.117 and 0.942, respectively). Conclusions As the duration of diabetes increased, the contrast sensitivity decreased in type 2 diabetic patients. Neuroretinal degeneration changes both the inner retinal thickness and total retinal thickness and affects contrast sensitivity. Therefore, for longer-term diabetic patients, it is necessary to consider the changes in contrast sensitivity and retinal thickness on OCT evaluation, even if the patient presents with normal fundus findings.

Desmoid tumors are rare soft tissue tumors arising from the fascia or from musculoaponeurotic structures. They are commonly seen in the extremities, but are rarely found in the thorax. Thoracic desmoid tumors commonly arise from the chest wall and rarely in the thoracic cavity. Imaging diagnosis of an intrathoracic desmoid tumor is difficult because there are no specific imaging findings for a desmoid tumor that can be differentiated from the various tumors of the chest wall, including a solitary fibrous tumor of the pleura. All desmoid tumor cells show negative immunohistochemical staining for CD34 in pathological specimen, a feature that makes it possible to differentiate a desmoid tumor from a solitary fibrous tumor of the pleura. Desmoid tumors are locally aggressive and the rate of local recurrence is very high. Consequently, wide radical resection is required and a preoperative accurate diagnosis of desmoid tumors is warranted. We describe the radiological findings of various imaging studies for an intrathoracic desmoid tumor. Our findings should facilitate a proper diagnosis of desmoid tumors.
Diagnosis ; Extremities ; Fascia ; Fibromatosis, Aggressive* ; Recurrence ; Solitary Fibrous Tumor, Pleural ; Thoracic Cavity ; Thoracic Wall ; Thorax

PURPOSE: Omega-3 fatty acid is known for immunonutrition in that it has anti-inflammatory properties and improves the patients' immune function. The objective of this study was to determine the effects of a fish oil-based lipid emulsion for adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: This was a retrospective study of 90 adult allogeneic HSCT patients from July 2011 to June 2015. The patients were divided into two groups according to the lipid type provided; fish oil group (FO group, n=55) and non-fish oil group (NFO group, n=35). The demographics, parenteral nutrition and lipid emulsion duration, length of hospital stay (LOS), weight change, 30 day mortality, survival period, incidence of acute graft-versus-host disease (aGVHD), neutropenic fever, sepsis, and re-hospitalization were collected from the electronic medical records. RESULTS: The patients' characteristics including age, sex, body mass index, and underlying disease were similar in the two groups. The incidence of aGVHD and infectious complications, mortality, LOS, re-hospitalization were also similar. The FO group showed weight gains, whereas the NFO group showed weight loss (FO vs. NFO=0.34% vs. -1.08%, P=0.245). CONCLUSION: The clinical outcomes were similar in the two groups but there was a tendency for gain weight in the FO group. A large, well designed study, and a dosing study will also be needed to determine the optimal dose range for HSCT patients.
Adult ; Body Mass Index ; Demography ; Electronic Health Records ; Fatty Acids ; Fever ; Fish Oils ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Length of Stay ; Mortality ; Parenteral Nutrition* ; Retrospective Studies ; Sepsis ; Weight Gain ; Weight Loss

PURPOSE: To measure and compare the ocular blood-flow velocity of ophthalmic artery in patients with central serous chorioretinopathy (CSC); affected eyes, asymptomatic fellow eyes, and CSC resolved eyes using transcranial Doppler ultrasonography. METHODS: A total of 31 patients (age 20-52 years) with CSC were evaluated using power motion mode Doppler 150 digital transcranial Doppler ultrasonography. The peak systolic velocity (PSV), peak diastolic velocity (PDV), and resistance index (RI) were measured in the ophthalmic artery of both affected and asymptomatic fellow eyes. After 2 months, 23 patients with resolved serous retinal detachment underwent repeated measurement of the above hemodynamic indices. RESULTS: The PSV and PDV of the ophthalmic artery were 30.05 ± 5.34 cm/sec and 14.07 ± 2.90 cm/sec in affected eyes and 33.03 ± 2.00 cm/sec and 17.17 ± 2.76 cm/sec in asymptomatic fellow eyes, respectively. Both indices were significantly lower in affected eyes (p = 0.004, p < 0.001, respectively). The RI was 0.52 ± 0.08 in affected eyes and 0.43 ± 0.04 in fellow eyes, a significant difference (p < 0.001). After 2 months, in 23 eyes with resolved CSC, the PSV and PDV were 32.94 ± 6.24 cm/sec and 15.54 ± 2.88 cm/sec, respectively. Both indices were significantly higher than at baseline (p = 0.031, p = 0.045, respectively). However, RI was 0.48 ± 0.04 and was not significantly different (p = 0.073). CONCLUSIONS: The CSC-affected eyes showed lower ocular blood-flow velocity and higher RI than the asymptomatic fellow eyes. The ocular blood-flow velocity was increased as CSC was resolved. These findings provide insights into the ophthalmic arterial vascular factors related to the pathogenesis of CSC.
Central Serous Chorioretinopathy* ; Hemodynamics ; Humans ; Ophthalmic Artery ; Retinal Detachment ; Ultrasonography, Doppler, Transcranial*