PURPOSE: Currently, single port laparoscopic cholecystectomy (SLC) is gradually being expanded. However, its operative time and complications are reportedly variable according to the surgeon's expertise and experience. In order to overcome these problems, we introduced surgical methods using a 2 mm sized auxiliary device (NELIS, Korea) in cholecystectomy. METHODS: Between March 2010 and October 2010, laparoscopic cholecystectomy was performed in 53 patients for non-inflammatory gallbladder stones or gallbladder polyps based on the computed tomography findings. Fourteen of 53 consecutive patients underwent SLC and others underwent CLC. The patient's clinical characteristics and operative results were evaluated retrospectively. RESULTS: Comparison of clinical characteristics between SLC and CLC groups indicated that the SLC group included younger patients (p=0.008), however other characteristics (sex, mean body index, and previous abdominal operation history) were not significantly different. Operative outcomesparameters including the intensity of postoperative pain, rate of wound complication, and postoperative hospital stay did not differ significantly between the 2 groups. Operative time of the SLC group was longer than that of the CLC group (p=0.002). However, the operative time was decreased according to the increasing SLC cases. By 3 months, patients in the SLC group reported significantly better cosmesis (p=0.036). CONCLUSION: SLC with an auxiliary device (2 mm, Hold port, NELIS) is technically feasible and might be an alternative method for obtaining a critical view of safety and cosmetic results.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallbladder ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Polyps ; Retrospective Studies ; Wounds and Injuries

BACKGROUND: Acute myocardial infarction (AMI) is a common disease in older patients, and common cause of death in this age group. In the United State, more than 670,000 persons are hospitalized annually for an acute myocardial infarction, 60% of these persons are more than 65 years of age and one third are above 75 years of age. above 65 years of age and 60% above 75 years of age. Also in Korea, AMI has been increased and being a major cause of death. Especially in elderly patients, more intensive care is required, because they have more risk factors and show high mortality. For will decrease unnecessary treatment on low risk group and will do more intensive management on high risk group. This study was performed, therefore, to provide the clinical features, prognosis and prognostic factors of AMI in Korean elderly patients. METHODS: To identify the long term survival rate and prognostic factors of acute myocardial infarction of elderly persons (above 65 year old) in Korea, total 358 patients who presented between Jan. 1980 and Dec. 1997 at Seoul National University Hospital were followed for an average of 92 months. 151 patients were died during follow up period, 63 patients lost, and 144 patients were alive till the end point of the study. RESULTS: Overall survival rates (+/-standard error) were 82.1+/-2.0, 79.6+/-2.2, 76.7+/-2.3, 72.2+/-2.5, 67.4+/-2.7, 62+/-3.0, 56.9+/-3.2% at 1, 6, 12, 24, 36, 48, 60 months. In univariate analysis, old age, female, presence of history of diabetes, higher degree of Killip class, lower ejection fraction on echocardiography or gated blood pool scan, lower total cholesterol level on the time of AMI proved as poor prognostic factors of AMI with statistical significance (p<0.05). BMI, history of hypertension, myocardial infarction and angina, peak CK level, infarct site on ECG, existence of Q-wave on ECG, larger extent of coronary artery disease, residual ischemia on treadmill test or MIBI scan, patency of infarct related artery, and HDL and LDL-cholesterol level on the time of AMI, total, HDL- and LDL-cholesterol at least 3 months after AMI did not show statistical significance. In multivariate analysis, Killip class III, IV and ejection fraction on echocar-diography are proved as independent prognostic factors of AMI with statistical significance (p<0.05). CONCLUSION: The mortality of elderly AMI is composed of two component. At acute phase, within 1 month, the mortality reaches to about 18 %, and at chronic phase, after 1 month from AMI, mortality increases each 5% a year for 5 years. The other conclusion is elderly patients who have poor left ventricular systolic functions shows higher mortality.
Aged* ; Arteries ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Echocardiography ; Electrocardiography ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Critical Care ; Ischemia ; Korea ; Mortality ; Multivariate Analysis ; Myocardial Infarction* ; Prognosis ; Risk Factors ; Seoul ; Survival Rate*

Purpose: This study aimed to evaluate the use of active surgical co-management (SCM) by medical hospitalists for urology inpatient care. Materials and Methods: Since March 2019, a hospitalist-SCM program was implemented at a tertiary-care medical center, and a retrospective cohort study was conducted among co-managed urology inpatients. We assessed the clinical outcomes of urology inpatients who received SCM and compared passive SCM (co-management of patients by hospitalists only on request; March 2019 to June 2020) with active SCM (co-management of patients based on active screening by hospitalists; July 2020 to October 2021). We also evaluated the perceptions of patients who received SCM toward inpatient care quality, safety, and subjective satisfaction with inpatient care at discharge or when transferred to other wards. Results: We assessed 525 patients. Compared with the passive SCM group (n=205), patients in the active SCM group (n=320) required co-management for a significantly shorter duration (p=0.012) and tended to have a shorter length of stay at the urology ward (p=0.062) and less frequent unplanned readmissions within 30 days of discharge (p=0.095) while triggering significantly fewer events of rapid response team activation (p=0.002). No differences were found in the proportion of patients transferred to the intensive care unit, in-hospital mortality rates, or inpatient care questionnaire scores. Conclusion Active surveillance and co-management of urology inpatients by medical hospitalists can improve the quality and efficacy of inpatient care without compromising subjective inpatient satisfaction.

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*