PURPOSE: Acute appendicitis is one of the most common surgical emergencies worldwide. Laparoscopic appendectomy (LA) is being accepted as the 'gold standard' surgery for simple acute appendicitis over open appendectomy (OA); however, for complicated appendicitis, no consensus has been reached with regard to which produces better outcomes. METHODS: We analyzed the data of patients who were diagnosed as complicated appendicitis, older than 18 years old, and underwent LA or OA from January 2008 to December 2012. A total of 2,173 patients had acute appendicitis during this period and 461 (21.2%) of them had complicated appendicitis; 335 patients were finally enrolled and divided into LA (280), OA (49), and Converted to open Appendectomy (CA) groups (6), respectively. Age, sex, preoperative WBC, operating time, stapler usage, time to diet and discharge, total cost and complication among the three groups were analyzed. RESULTS: No significant differences were observed in sex, age, history of abdominal surgery, preoperative WBC, and total cost. Shorter operating time (62.3+/-30.0 vs 87.3+/-40.2, p=0.000), shorter time to diet (2.7+/-2.2 vs 3.7+/-1.6, p=0.001), shorter postoperative stay (4.8+/-2.6 vs 7.1+/-2.5, p=0.000), shorter duration of pain (3.4+/-1.7 vs 5.6+/-2.8, p=0.000), and less frequent usage of pain killer (68.2% vs 89.1%, p<.001) were observed in the laparoscopic group. Complication rate was significantly lower in the LA group (4.6% vs 18.4%, p=0.002). CONCLUSION: Results of this study provide clinical evidence that laparoscopic surgery is a feasible and safe surgical modality for complicated appendicitis. Conduct of more reliable, large scaled, randomized prospective study will be necessary in order to prove the superiority of laparoscopic surgery for complicated appendicitis.
Appendectomy* ; Appendicitis* ; Consensus ; Diet ; Emergencies ; Humans ; Laparoscopy

A case of 39-year-old diabetic patient with a calcitonin and somatostatin secreting pancreatic islet tumor is presented. He had suffered from chronic diarrhea and dyspepsia for 10 years and was diagnosed with diabetes 2 years ago. Abdominal CT revealed a huge abdominal mass which was considered as a neuroendocrine tumor after US-guided needle biopsy. A distal pancreatectomy and splenectomy were performed. Histologically, tumor cells, amanged in solid sheets, showed small nuclei without significant atypia and granular eosinophilic cytoplasm. Tumor cells showed strong immunoreacitivity for calcitonin and somatostatin. The serum clacitonin was markedly elevated (268.7 pmol/L, normal range; 0.9-7.6 pmol/L). After resection of the tumor, diarrhea and dyspepsia diappeared, and oral glucose tolerance test showed normal glucose tolerance with normalization of calcitonin.
Adult ; Biopsy, Needle ; Calcitonin* ; Cytoplasm ; Diabetes Mellitus* ; Diarrhea ; Dyspepsia ; Eosinophils ; Glucose ; Glucose Tolerance Test ; Humans ; Islets of Langerhans* ; Neuroendocrine Tumors ; Pancreatectomy ; Reference Values ; Somatostatin* ; Splenectomy ; Tomography, X-Ray Computed

PURPOSE OF STUDY: Lingual nerve damage can be caused by surgery or trauma such as physical irriatation, radiation, chemotherapy, infection and viral infection. Once nerve damage occurred, patients sometimes complain taste change and loss of taste along with serious disturbance of tongue. The purpose of this study was to evaluate the effects of unilateral lingual nerve transection on taste as well as on the maintenance of taste buds. MATERIALS AND METHODS: Male Sprague-Dawley rats weighing 220-250g received unilateral transection of lingual nerve, subjected to the preference test for various taste solutions (0.1M NaCl, 0.1M sucrose, 0.01M QHCl, or 0.01M HCl) with two bottle test paradigm at 2, 4, 6, or 8 weeks after the operation. Tongue was fixed with 8% paraformaldehyde. After fixation, they were observed with scanning electron microscope(JSM-840A(R), JEOL, JAPAN) and counted the number of the dorsal surface of the fungiform papilla for changes of fungiform papilla. And, Fungiform papilla were obtained from coronal sections of the anterior tongue(cryosection). After cryosection, immunostaining with Galpha gust(I-20)(Santa Cruz Biotechnology, USA), PLCbeta2(Q-15)(Santa Cruz Biotechnology, USA), and T1R1(Alpha Diagnostic International, USA) were done. Immunofluorescence of labeled taste bud cells was examined by confocal microscopy(F92-300., Olympus, JAPAN). RESULTS: The preference score for salty and sweet tended to be higher in the operated rats with statistical significance, compared to the sham rats. Fungiform papilla counting were decreased after lingual nerve transaction. In 2 weeks, maximum differences occurred. Gustducin and T1R1 expressions of taste receptor in 2 and 4 weeks were decreased. PLCbeta2 were not expressed in both experimental and control group. CONCLUSION: This study demonstrated that the taste recognition for sweet and salty taste changed by week 2 and 4 after unilateral lingual nerve transection. However, regeneration related taste was occurred in the presence of preserving mesoneurial tissue and the time was 6 weeks. Our results demonstrated that unilateral lingual nerve damage caused morphological and numerical change of fungiform papilla. It should be noted in our study that lingual nerve transection resulted in not only morphological and numerical change but also functional change of fungiform papillae.
Animals ; Biotechnology ; Drug Therapy ; Fluorescent Antibody Technique ; Humans ; Lingual Nerve Injuries* ; Lingual Nerve* ; Male ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Sucrose ; Taste Buds* ; Tongue

Although a metastasis to the gastrointestinal tract (GI) is rare in patients with hepatocellular carcinoma (HCC), it can occur by hematogenous or lymphatic spread, or by direct invasion of a tumor. A 61-year old woman who had a progressing large primary liver cancer presented with upper gastrointestinal (UGI) bleeding. UGI endoscopy showed a large duodenal submucosal tumor-like mass with a central ulcer and adherent blood clots. Endoscopic biopsy and coagulation using argon plasma probe were performed. The microscopic examination revealed a HCC. We report this unusual case of HCC with direct invasion of the duodenum.
Argon ; Biopsy ; Carcinoma, Hepatocellular* ; Duodenum* ; Endoscopy ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Liver Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Plasma ; Ulcer

OBJECTIVES: Alteration of hippocampus was demonstrated in the maternal social separation(MSS) pups, separated from dams on postnatal day(pnd) 14 and placed alone. Therefore, to understand the molecular events involved in the MSS, we have initiated a search for gene profiles that are up or down-regulated in the hippocampus of MSS pups. METHODS: Analysis of cDNA microarray was performed by using total RNA extracted from the hippocampus of control and MSS pups on pnd 17. Also, passive-avoidance test was demonstrated on pnd 35. RESULTS: Up-regulation of Nedd4a was observed in the hippocampus of MSS pups. Also, MSS rats showed less elongation of latency in passive avoidance test. CONCLUSION: We suggest that environmental effects of MSS may be altered the neural and/or glial differentiation and synapse formation-related genes which may lead cognitive alterations in MSS rats.
Animals ; Gene Expression* ; Hippocampus* ; Memory ; Microarray Analysis* ; Oligonucleotide Array Sequence Analysis ; Rats* ; RNA ; Synapses ; Up-Regulation

PURPOSE: The object of the present study were to clarify the effect of dialysis treatment and residual renal function on olfactory function of patients with chronic renal failure and to assess the correlations between the Cross Cultural Smell Identification Test (CC-SIT) scores and various clinical variables. METHODS: Ninety subjects were studied and divided four groups; age- and sex-matched healthy controls (Control, n=20), patients with varying degree of renal insufficiency but not on dialysis (Pre- dialysis, n=20), patients on CAPD (PD, n=22), and patients on hemodialysis (HD, n=28). We performed olfactory function test using the CC-SIT kit and compared the CC-SIT scores of each of the groups. RESULTS: The CC-SIT scores of each of the groups were; Control : 8.6+/-1.5, Pre-dialysis : 7.2+/-2.0, PD : 8.1+/-1.2, HD : 8.5+/-1.4. In Pre-dialysis group, the CC-SIT scores were significantly lower than Control group (p=0.01). But, no significant difference was observed in the CC-SIT scores between HD and PD group and control group (p>0.05). Creatinine clearance was positively correlated with the CC-SIT scores in control and Pre-dialysis group (r=0.58, p= 0.0001). Total Kt/V was positively correlated with the CC-SIT scores only in HD group (r=0.39, p= 0.03). But, no correlation was found between Kt/ Vurea, URR or residual renal function and the CC- SIT scores in HD and PD group (p>0.05). Age was negatively correlated with the CC-SIT scores only in Control group (r=-0.76, p=0.0001). CONCLUSION: Our results indicate that smell disturbance in patients with chronic renal faliure can be recovered by adequate dialysis treatment.
Creatinine ; Dialysis* ; Humans ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Insufficiency ; Smell

BACKGROUND: Small dense low density lipoprotein (sdLDL) plays a critical role in the progression of coronary vascular disease. However, regardless of the accuracy of the analytical technique, routine measurement of LDL does not precisely ascertain LDL particle size. Therefore, we evaluated the performance of a direct quantitative assay of sdLDL that combines a precipitation method with filtration (Denka Seiken, Japan). METHODS: We evaluated the precision, linearity, carry-over, and sample stability of a sdLDL reagent. A reference interval was established, and method comparison was performed with the Lipoprint LDL system using polyacrylamide gel tube electrophoresis (Quantimetrix, USA). RESULTS: The within-run precision was 0.9% to 1.4%, with a total precision of 3.2% to 3.5%. The analytical measurement ranged from 4.1 to 101.3 mg/dL. The calculated carry-over was negligible (0.1%). Based on a comparison conducted using the Lipoprint LDL system, the median sdLDL concentration of 57 individuals with phenotype non-A was found to be significantly higher than that of 51 subjects with phenotype A (43 vs. 22 mg/dL, P<0.0001). The levels in samples retested after storage showed more than 95% recovery when stored in a refrigerator (5degrees C) for 2 weeks and at -20degrees C or lower for 4 weeks. The reference interval of sdLDL was between 7.6 and 52.0 mg/dL. CONCLUSIONS: This method of sdLDL measurement showed good performance and can be easily applied to automated analysers in clinical laboratories.
Coronary Disease ; Electrophoresis ; Filtration ; Lipoproteins ; Particle Size ; Phenotype ; Reference Values ; Vascular Diseases

Doxylamine succinate is an over-the-counter drug widely used for treating insomnia. We experienced a case of severe rhabdomyolysis complicating acute renal failure after doxylamine overdose in a 24-year- old male. The maximum values of creatine kinase and creatinine level during hospitalization were 264,141 IU/L and 8.4 mg/dL, respectively. Oliguria and severe dyspnea occurred on the sixth hospital day and were treated with hemodialysis. Then, he recovered without any sequelae. To the best of our knowledge, the maximum creatine kinase level of 264,141 IU/L in the present case is the highest value among the case reports on doxylamine-induced rhabdomyolysis and this is the first case report in Korea of doxylamine-induced severe rhabdomyolysis accompanying oliguric acute renal failure and requiring treatment with hemodialysis.
Acute Kidney Injury* ; Creatine Kinase ; Creatinine ; Doxylamine* ; Dyspnea ; Hospitalization ; Humans ; Korea ; Male ; Oliguria ; Renal Dialysis ; Rhabdomyolysis* ; Sleep Initiation and Maintenance Disorders ; Succinic Acid

Blotting, Western ; Fibroblasts ; Heat-Shock Proteins ; Heat-Shock Response ; HSP27 Heat-Shock Proteins ; Immunohistochemistry ; Osseointegration ; Osteoblasts ; Primary Cell Culture ; Proteins ; Staphylococcal Protein A

PURPOSE OF STUDY: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. PATIENTS AND METHODS: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK(R). Mean follow up periods was 47.7+/-20.0 months and the average age was 38.7+/-15.3 years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. RESULTS: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. CONCLUSION: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.
Arthroplasty ; Cheek ; Deglutition ; Depression ; Diet ; Follow-Up Studies ; Head ; Humans ; Mandible* ; Mastication ; Mouth ; Postoperative Complications ; Retrospective Studies ; Temporomandibular Joint*