BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage* ; Emergencies ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms* ; Retrospective Studies ; Ventriculostomy

Primary papillary serous carcinoma of the peritoneum is a rare primary tumor involving the peritoneum. Histologically, it is indistinguishable from serous ovarian papillary carcinoma, although it either spares the o-varies or only microscopically involves their surface. The characteristic features of this tumor are extensive peritoneal and omental masses or implants with psammomatous calcification, and ascites. In addition, it can occur focally in the pelvic peritoneum. We report the CT findings, with histopathologic correlation of primary papillary serous carcinoma of the peritoneum occurring in the upper mesorectum.
Ascites ; Carcinoma, Papillary ; Peritoneum*

Polyarteritis nodosa is a systemic inflammatory disease resulting from necrotizing angitis of small to medium sized arteries. It involves various organs, including the gastrointestinal tract, which is involved in about 50% of all cases. Numerous complications-including abdominal pain, vomiting, and hematemesis-have been reported, but the CT findings have not been described. We report the CT findings in a case of gastric polyarteritis nodosa, and correlate these with the histopathologic findings.
Abdominal Pain ; Arteries ; Arteritis ; Gastrointestinal Tract ; Polyarteritis Nodosa* ; Stomach* ; Vomiting

PURPOSE: The solid variety of cerebella r tumors in adult is relatively uncommon. This study is to describe the characteristic MR findings of various solid cerebellar tumors in adult. METHODS: Twenty three cerebellar solid tumors from 22 consecutive patients over age of 15 with surgical confirmations were retrospectively evaluated with MR imaging. H istologic diagnosis included hemangioblastoma (n=6), metastasis (n=6), high-grade astrocytoma (n=3), and medulloblastoma (n=8). The MR findings were reviewed with attention to the size, the signal intensity of the tumors, pattern of enhancement, tumoral margin, degree of peritumoral edema, signal void vascular structures within and/or around the tumor, and location in relation to attachment to the pial surface of the tumor. RESULTS: Solid hemangioblastomas consistently showed slightly low or iso signal intensity on T1 -weighted images and high intensity on T2-weighted images, dense homogeneous enhancement, and signal void vessels within and/or around the mass. Metastatic tumors showed various find ings with predominantly low or iso signal intensity on T2-weighted images. Medulloblastomas was midline and/or paramidline in location, and had larger mass formation. High-grade astrocytomas revealed nonspecific MR findings with no signal void vessels. CONCLUSION: Hemangioblastoma, metastasis, malignant astrocytoma, and medulloblastoma should be included in differential diagnosis of solid cerebellar tumors in adult. Dense homogeneous enhancement and signal void vessels are characteristic of hemangioblastoma. The signal intensity of the tumor, and presence of signal void vessels, location and enhancement pattern can be some value in differential diagnosis of solid cerebellar tumors in adult.
Adult* ; Astrocytoma ; Cerebellar Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Edema ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Neoplasm Metastasis ; Retrospective Studies

BACKGROUND: In low rectal cancer, creating a permanent stoma can be avoided by applying a low anterior resection using the double stapling technique. However, the problem of local recurrence is still a major pattern of tumor recurrence in rectal cancer. We aimed to verify the clinicopathologic variables related to exfoliation of tumor cells and searched for an efficient method to remove the tumor cells from the rectal stump during a low anterior resection. METHODS: Forty-four patients who underwent a low anterior resection using the double stapling technique were enrolled prospectively. For patient, we irrigated each rectal stump twice with 500 cc of normal saline through the anus. Two specimens from each irrigation were obtained and examined for any malignant tumor cells. Cases in which no tumor cells were found from the two specimens were defined as Group I, cases in which tumor cells were found in only the first specimen were defined as Group II, and cases in which tumor cells were found in both the first and the second specimens were defined as Group III. Clinicopathologic variables were analyzed with regard to the presence of exfoliated tumor cells in irrigated saline. RESULTS: There were sixteen (36%), fourteen (32%), and fourteen cases (32%) in Groups I, II, and III, respectively, according to the examination results. Age classification (P=0.05) and metastatic lymph nodes (P=0.013) were associated with the presence of tumor cells in irrigated saline (I vs. II, II). CONCLUSIONS: Stump irrigation during a low anterior resection using the double stapling technique is recommended as an easy and simple method to remove exfoliated tumor cells from anastomosis sites, although further study is necessary to elucidate the association between exfoliated tumor cells and local recurrence.
Anal Canal ; Classification ; Humans ; Lymph Nodes ; Prospective Studies ; Rectal Neoplasms ; Recurrence ; Surgical Stapling

PURPOSE: The clinical significance of a mucinous-type colorectal adenocarcinoma is still controversial. Mucinous colorectal adenocarcinomas have been suggested to have distinct clinicopathologic features, i.e., early-onset, right-side dominancy, and poor prognosis. We aimed to verify the biological behaviors of and survivals for mucinous adenocarcinomas compared with non-mucinous adenocarcinomas. METHODS: Using a database of colorectal cancers at Asan Medical Center between 1989 and 2000, we enrolled 121 mucinous adenocarcinoma and 2,289 non-mucinous adenocarcinoma patients in this study. Clinical, pathological characteristics of and prognoses for mucinous adenocarcinomas were analyzed and compared with those for non-mucinous adenocarcinomas, retrospectively. The median follow-up period was 24 (0~113) months for mucinous adenocarcinomas and 32 (0~130) months for non-mucinous adenocarcinoma. RESULTS: Compared to non-mucinous adenocarcinomas, mucinous adenocarcinomas showed distinctive clinicopathologic features of early-onset (P<0.001), frequent family history (P<0.001), right-side dominancy (P=0.010), advanced stage at diagnosis (P<0.001), and common peritoneal seeding at diagnosis (P<0.001). The recurrence rate in the mucinous adenocarcinoma group was 45.2% during the follow-up period: 21.6% distant metastasis, 14.3% peritoneal dissemination, 5.7% local recurrence, and 3.6% simultaneous local recurrence and distant metastasis. The five-year survival rates in stages II and III were 70% and 48.7%, respectively, for mucinous adenocarcinomas and 92% and 50.2%, respectively, for non-mucinous adenocarcinomas. This difference was statistically significant. CONCLUSIONS: Mucinous adenocarcinomas seem to have distinct biologic behaviors with different clinicopathologic features and poor prognosis. A surgical approach with a follow-up schedule considering the characteristics of mucinous adenocarcinomas is needed.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Appointments and Schedules ; Chungcheongnam-do ; Colon* ; Colorectal Neoplasms ; Diagnosis ; Follow-Up Studies ; Humans ; Mucins* ; Neoplasm Metastasis ; Prognosis* ; Rectum* ; Recurrence ; Retrospective Studies ; Survival Rate

Purpose: This study aimed to compare the short-term outcomes of the open and laparoscopic approaches to 2-stage restorative proctocolectomy (RPC) for Korean patients with ulcerative colitis (UC). Methods: We retrospectively analyzed the medical records of 73 patients with UC who underwent elective RPC between 2009 and 2016. Patient characteristics, operative details, and postoperative complications within 30 days were compared between the open and laparoscopic groups. Results: There were 26 cases (36%) in the laparoscopic group, which had a lower mean body mass index (P = 0.025), faster mean time to recovery of bowel function (P = 0.004), less intraoperative blood loss (P = 0.004), and less pain on the first and seventh postoperative days (P = 0.029 and P = 0.027, respectively) compared to open group. There were no deaths, and the overall complication rate was 43.8%. There was no between-group difference in the overall complication rate; however, postoperative ileus was more frequent in the open group (27.7% vs. 7.7%, P = 0.043). Current smoking (odds ratio [OR], 44.4; P = 0.003) and open surgery (OR, 5.4; P = 0.014) were the independent risk factors for postoperative complications after RPC. Conclusion Laparoscopic RPC was associated with acceptable morbidity and faster recovery than the open approach. The laparoscopic approach is a feasible and safe option for surgical treatment for UC in selective cases.

BACKGROUND: Doxylamine, an antihistamine with sleep inducing property, is the most commonly intoxicated drug in the urban ED. This drug is relatively safe but is known to induce rhabdomyolysis in rare occasion. The purpose of this study is to determine the incidence of rhabdomyolysis after doxylamine overdose and prognostic factors that contributes to this complication. METHOD: This study was conducted from 26 patients admitted to our hospital after doxylamine intoxication during the period from April 1999 to June 1999. Using the protocol made beforehand, the amount ingested, past history, laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase(CK) over 1,000 IU/L. Data were analyzed using SPSS program with t-test, Fisher's exact test and discriminant analysis. RESULTS: The rhabdomyolysis was diagnosed in 57.7% of patients. The amount ingested per body weight, prehospital vomiting and low arterial pCO2 predicted occurrence of rhabdomyolysis. The sensitivity of serum CK and myoglobin were 67% and 80% respectively and specificity was 100% for both. The diagnosis was possible for CK after an average of 14hr 20min time after ingestion and 8hr 12min for myoglobin. CONCLUSION: Rhabdomyolysis is a common complication of doxylamine intoxication and if the amount ingested was more than 1 tablet(25mg) per body weight, the incidence of rhabdomyolysis was higher. So, CK measurement after 14 hour postingestion and myoglobin after 8 hour is recommended to decide whether rhabdomyolysis occur.
Body Weight ; Creatine ; Diagnosis ; Doxylamine* ; Eating ; Humans ; Incidence* ; Myoglobin ; Rhabdomyolysis* ; Sensitivity and Specificity ; Vomiting

The prevailing model of osteology is that bones constantly undergo a remodeling process, and that the differentiation and functions of osteoblasts are partially regulated by leptin through different central hypothalamic pathways. The finding that bone remodeling is regulated by leptin suggested possible endocrinal effects of bones on energy metabolism. Recently, a reciprocal relationship between bones and energy metabolism was determined whereby leptin influences osteoblast functions and, in turn, the osteoblast-derived protein osteocalcin influences energy metabolism. The metabolic effects of bones are caused by the release of osteocalcin into the circulation in an uncarboxylated form due to incomplete gamma-carboxylation. In this regard, the Esp gene encoding osteotesticular protein tyrosine phosphatase is particularly interesting because it may regulate gamma-carboxylation of osteocalcin. Novel metabolic roles of osteocalcin have been identified, including increased insulin secretion and sensitivity, increased energy expenditure, fat mass reduction, and mitochondrial proliferation and functional enhancement. To date, only a positive correlation between osteocalcin and energy metabolism in humans has been detected, leaving causal effects unresolved. Further research topics include: identification of the osteocalcin receptor; the nature of osteocalcin regulation in other pathways regulating metabolism; crosstalk between nutrition, osteocalcin, and energy metabolism; and potential applications in the treatment of metabolic diseases.
Bone Remodeling/physiology ; Bone and Bones/*metabolism ; *Energy Metabolism ; Humans ; Leptin/metabolism ; Osteocalcin/genetics/*metabolism