PURPOSE: A laparoscopic appendectomy is now commonly performed. The push in recent years toward reducing the number of ports required to perform this surgery has led to the development of a single-port laparoscopic appendectomy (SPA). We compared postoperative pain after an SPA using a glove port with a percutaneous organ-holding device (group 1) with that of an SPA using a commercially-available multichannel single-port device (group 2). METHODS: Between March 2010 and July 2011, a retrospective study was conducted of a total of 77 patients who underwent an SPA by three surgeons at department of surgery, Kangbuk Samsung Medical Center. Thirty-eight patients received an SPA using a glove port with a percutaneous organ-holding device. The other 39 patients received an SPA using a commercially-available multichannel single port (Octo-Port or SILS Port). Operative details and postoperative outcomes were collected and evaluated. RESULTS: There were no differences in the mean operative times, times to pass gas, postoperative hospital stays, or cosmetic satisfaction scores between the two groups. The pain score in the first 24 hours after surgery was higher in group 2 than group 1 patients (P < 0.001). Furthermore, the trocar used in group 2 was more expensive than that used in group 1. CONCLUSION: An SPA using a glove port with a percutaneous organ-holding device was associated with a lower pain score during the first 24 hours after surgery because of the shorter fascia incision length and a cheaper cost than an SPA using a commercially-available multichannel single-port device.
Appendectomy* ; Fascia ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Retrospective Studies ; Surgical Instruments

PURPOSE: This study was performed to obtain baseline information about the occupational and environmental medicine(OEM) residency programs in Korea. METHODS: We surveyed 39 residents for the present training condition, satisfaction, vision of OEM, the condition and satisfaction after residency programs by self- administered questionnaire. RESULTS: Residents want to get appropriate clinical and practical training to be a medical director in a factory or specialist of the occupational medicine based at a hospital. They report, however, that current system for OEM residency training program is not appropriate. The curricula, duration of the each curriculum, level of training hospital or institute need to be reconsidered. CONCLUSIONS: We need to develop more systematic residency program with support from government and OEM society.
Curriculum ; Education ; Environmental Medicine* ; Humans ; Internship and Residency* ; Korea* ; Occupational Medicine ; Physician Executives ; Specialization ; Surveys and Questionnaires

BACKGROUND: The aim of this study was to identify factors predicting intellectual and memory changes following anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (TLE). METHODS: The sample consisted of 31 patients who underwent ATL for treatment of medically intractable TLE. All patients were administered intellectual and memory tests preoperatively and postoperatively. RESULTS: All statistically significant intellectual and memory changes at 1-year follow-up were in the direction of improvement. Left vs. right ATL had significantly differential effects on verbal intelligence and verbal memory, reflecting greater decline (or less improvement) following a left ATL. A later onset age of seizures, an older age at surgery, and a higher presurgical cognitive performance predicted a greater cognitive decline following an ATL. CONCLUSIONS: At 1-year after ATL, most cognitive functions showed either no significant changes or significant changes in a favorable direction. Decreased verbal functions following a left ATL was the area of greatest potential neuropsychological morbidity associated with ATL. Greater cognitive decline following ATL was predicted by later onset age of recurrent seizures, older age at time of surgery, and higher presurgical cognitive performance.
Age of Onset ; Anterior Temporal Lobectomy* ; Epilepsy, Temporal Lobe* ; Follow-Up Studies* ; Humans ; Intelligence ; Memory* ; Seizures ; Temporal Lobe*

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. Although viral reactivation is associated with DRESS syndrome, its role in TEN remains unclear. An 80-year-old woman visited our hospital because of fever and skin eruption. DRESS syndrome was diagnosed and was thought to caused by the use of the drug allopurinol. She was treated by discontinuation of the drug and administration of systemic steroids. She recovered from DRESS syndrome and was discharged from the hospital with tapering doses of steroids prescribed. One week after discharge, she visited our hospital again as the skin rash recurred and oral pain as well as oral and ocular mucosal lesions developed. In addition to the skin rash, blisters and Nikolsky's sign that were different from the skin lesions present in the previous DRESS syndrome were observed. Unlike those in DRESS syndrome, the viral serological test results were positive for anti-cytomegalovirus (CMV) IgM and CMV polymerase chain reaction. Therefore, it was thought that TEN was due to reactivation of CMV and she was treated this with ganciclovir and intravenous immunoglobulin. Here, we report a case of TEN caused by viral reactivation after DRESS syndrome developed after use of allopurinol which recovered after steroid treatment.
Aged, 80 and over ; Allopurinol ; Blister ; Cytomegalovirus Infections ; Cytomegalovirus ; Drug Hypersensitivity Syndrome ; Eosinophilia ; Exanthema ; Female ; Fever ; Ganciclovir ; Humans ; Immunoglobulin M ; Immunoglobulins ; Polymerase Chain Reaction ; Serologic Tests ; Skin ; Steroids ; Stevens-Johnson Syndrome

A 73-year-old woman with long-term steroid medication for arthralgia, suffered a sudden decrement of mental status, bilateral internuclear ophthalmoplegia and ptosis. T2-weighted MR images revealed high signals in the midbrain and both thalami. In cerebrospinal fluid studies, a test for cryptococcal antigen was positive and Cryptococcus neoformans was cultured. Bilateral internuclear ophthalmoplegia and ptosis may develop in cryptococcal meningitis from ischemic complications.
Aged ; Arthralgia ; Cerebrospinal Fluid ; Cryptococcus neoformans ; Female ; Humans ; Meningitis, Cryptococcal* ; Mesencephalon ; Ocular Motility Disorders*

Postpartum cerebral angiopathy is a main cause of postpartum stroke. We describe a 27-year-old woman with postpartum cerebral angiopathy after taking bromocriptine. Her brain FLAIR MR image revealed several lesions of sulcal hyperintensity. The sulcal hyperintensity in the MR image may be a sequelae of bromocriptine-induced angiopathy during the postpartum period.
Adult ; Brain ; Bromocriptine* ; Female ; Humans ; Magnetic Resonance Imaging* ; Postpartum Period* ; Stroke

PURPOSE: As a preliminary study on the development of a new developmental screening tool, this study examined the validity of the Korean Ages and Stages Questionnaires (K-ASQ). METHODS: The clinical sample included a total of 218 Infants and children at 30, 36, 60 months of age, who were diagnosed with developmental disorders. Age- and sex-matched normal controls were selected from a national large-scale K-ASQ database. Sensitivity, specificity, and accuracy were calculated in different age and diagnosis groups, and receiver operating characteristic (ROC) curve analysis was performed as well. In addition, concurrent validity was analyzed for the clinical sample by comparing the K-ASQ with other reference scales. RESULTS: The sensitivity, specificity, and accuracy of the K-ASQ were above fair (0.82-0.96) overall, however they varied depending on age and diagnosis groups. Specifically, the sensitivity at 60 months was relatively low (0.65). Especially, the discrimination sensitivity for the language delay group was poor at 60 months (0.42). ROC analysis showed that the overall discrimination capacity was above fair in all 5 domains [area under the curve (AUC): 0.74-0.98]. However, there were some domains and age groups with relatively poor discrimination capacity. In terms of concurrent validity, the correlations between the K-ASQ domains and reference scale subscales were statistically significant overall, but weak in some domains. CONCLUSION: The overall discrimination capacity and concurrent validity of the K-ASQ were above fair, but there were some domains, age, and diagnosis groups in which the K-ASQ was not successful in identifying potentially developmentally challenged children. These findings suggested the need for the development of a new developmental screening test tool, which is suitable for Korean infants & children.
Child* ; Diagnosis ; Discrimination (Psychology) ; Humans ; Infant* ; Language Development Disorders ; Mass Screening ; Surveys and Questionnaires* ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

PURPOSE: Since National Health Screening Program for Infants and Children in Korea started from November, 2007, the need to design a new tool that can timely identify infants and chlildren with possible delayed development has been emphasized. The developmental screening devices currently used in Korea are mostly adapted from foreign tests and could be considered inappropriate for children growing in a different cultural background. Therefore, we assessed the appropriateness of Korean-Ages and Stages Questionnaires (K-ASQ) items in Korean infants and children, as a preliminary study to develop a new developmental screening test tool. METHODS: Data on K-ASQ tests that were performed in multicenters as a National Health Screening Program in Korea were analyzed to measure (1) the item difficulty and norm relevance (2) the goodness of fit for factor structure (3) the sensitivity of item for developmental evaluation. A total of 1,696 subjects, 877 boys (51.7%) and 819 girls (48.3%) were studied and with about 50 boys and 50 girls for each age of months, the sample was relatively evenly distributed. RESULTS: Analysis of K-ASQ data showed that (1) The subjects scored higher when compared to the K-ASQ's original criteria. (2) The suitability of confirmative factor structure was insufficient, especially problem solving [x2=41.063, P<0.01, CFI (Comparative Fit Index)=0.929, TLI (Turker-Lewis index)=0.834, RMSEA (Root Mean Square Error Approximation)=0.152] and personal-social domains (x2=55.208, P<0.01, CFI=0.817, TLI=0.573, RMSEA=0.182). (3) Some questions did not show significant difference in the sensitivity of item for developmental evaluation among monthly age groups. CONCLUSION: According to the analysis of previous K-ASQ data, the appropriateness of the questionnaires is good in general, but some questions of problem-solving and personal social domains are not appropriate. We suggested the development of a new developmental screening test tool, which is suitable for Korean infants and children.
Child* ; Female ; Humans ; Infant* ; Korea ; Mass Screening* ; Problem Solving ; Surveys and Questionnaires*

Placenta increta is an uncommon and life-threatening complication of pregnancy characterized by complete or partial absence of the decidua basalis. Placenta increta usually presents with vaginal bleeding during difficult placental removal in the third-trimester. Although placenta increta may complicate first and early secondtrimester pregnancy loss, the diagnosis can be very difficult during early pregnancy and thus the lesion is difficult to identify. We encountered with a woman who was diagnosed with placenta increta after receiving emergency hysterectomy due to intraperitoneal bleeding 2 months after an uncomplicated dilatation and curettage in the first trimester. Therefore, we report this case with a brief review of the literature.
Abortion, Induced/*adverse effects ; Adult ; Diagnosis, Differential ; Female ; Humans ; Placenta Accreta/*diagnosis ; Pregnancy ; Tomography, X-Ray Computed ; Treatment Outcome ; Uterine Hemorrhage/*diagnosis

The development of involuntary movement by the lesion in the brainstem and spinal cord has been rarely reported. We report a 56-year-old man who suffered from bilateral dystonic tremor and left hemiparesis by an acute cervicomedullary infarction. The patient had acute infarcted lesion on the anterior-medial cervicomedullary junction located at the inferior olivary nucleus. Current study suggests that the involvement of inferior olivary nucleus in lower medulla could be a cause to develop dystonic tremor by cervicomedullary lesions.
Brain Stem ; Dyskinesias ; Dystonia ; Humans ; Infarction* ; Middle Aged ; Olivary Nucleus ; Paresis* ; Spinal Cord ; Tremor*