No abstract available.
Intracranial Hemorrhage, Hypertensive*

The present study compares the outcome of adult and pediatric patients with severe diffuse brain injury, and analyzes factors affecting the prognosis related to age difference. Of 912 patients admitted with head injury during the past three years, 223(1.7%) patients were identified as severe diffuse brain injury. Among the 223 patients. 100 patients were 15 years of age or less as the pediatric group. The mortality rate for pediatric and adult group was 39.0% and 48.8%, respectively. The common factors affecting poor prognosis for both groups were Glasgow Coma Scale(GCS) of 5 or less, papillary abnormality, hypoxia(PaO2<60 mmHg), the presence of skull fracture(basilar skull fracture in children, and basilar or vault skull fracture in adult group), diffuse brain swelling, subarachnoid hemorrhage, intraventricular hemorrhage, and thin subdural hematoma. The factors affecting prognostic difference between the adult and pediatric group with diffuse brain injury were the presence of vault skull fracture(p<0.01) and diffuse brain swelling(p<0.05). In patients associated with vault skull fracture or diffuse brain swelling, adult group had a significantly poorer outcome than child group.
Adult ; Brain ; Brain Edema ; Brain Injuries* ; Child ; Coma ; Craniocerebral Trauma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Mortality ; Prognosis ; Skull ; Skull Fractures ; Subarachnoid Hemorrhage

BACKGROUNDS/AIMS: We aimed to to evaluate the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous upper abdominal surgery. METHODS: Retrospective analysis was performed on data from the attempted laparoscopic common bile duct exploration in 44 patients. Among them, 5 patients with previous lower abdominal operation were excluded. 39 patients were divided into two groups according to presence of previous upper abdominal operation; Group A: patients without history of abdominal operation. (n=27), Group B: patients with history of upper abdominal operation. Both groups (n=12) were compared to each other, with respect to clinical characteristics, operation time, postoperative hospital stay, open conversion rate, postoperative complication, duct clearance and mortality. RESULTS: All of the 39 patients received laparoscopic common bile duct exploration and choledochotomy with T-tube drainage (n=38 [97.4%]) or with primary closure (n=1). These two groups were not statistically different in gender, mean age and presence of co-morbidity, mean operation time (164.5+/-63.1 min in group A and 134.8+/-45.2 min in group B, p=0.18) and postoperative hospital stay (12.6+/-5.7 days in group A and 9.8+/-2.9 days in group B, p=0.158). Duct clearance and complication rates were comparable (p>0.05). 4 cases were converted to open in group A and 1 case in group B respectively. In group A (4 of 27 (14.8%) and 1 of 12 (8.3%) in group B, p=0.312) Trocar or Veress needle related complication did not occur in either group. CONCLUSIONS: LCBDE appears to be a safe and effective treatment even in the patients with previous upper abdominal operation if performed by experienced laparoscopic surgeon, and it can be the best alternative to failed endoscopic retrograde cholangiopancreatography for difficult cholelithiasis.
Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Common Bile Duct ; Drainage ; Humans ; Length of Stay ; Needles ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments

PURPOSE: Ductal carcinoma in situ (DCIS) is a high-risk disease for the development of invasive tumors. Although it is associated with excellent prognosis, many patients undergo extensive treatment with surgery, radiation, and endocrine therapy. This study evaluated the clinical and pathologic factors associated with invasive recurrence, particularly locoregional, distant disease after breast-conserving surgery (BCS). METHODS: This study included 431 patients diagnosed with pure DCIS after BCS between January 2000 and December 2008. The clinicopathological characteristics, margin status, adjuvant therapy, and duration of endocrine therapy were evaluated in hormone receptor-positive DCIS patients. RESULTS: The median duration of follow-up was 115 months. During this period, 37 cases (8.5%) of recurrence were observed (12 in situ and 23 invasive recurrence and 2 unknown cases). There was no distant metastasis as first event. Similarly, none of the initial in situ recurrence cases developed distant metastasis while eight (32%, 8/23) developed distant metastasis after invasive recurrence. Overall recurrence was associated with young age (≤40 years) (HR: 3.60, 95% confidence interval [CI]: 1.77–7.32) and hormone receptor negativity (HR: 3.33, 95% CI: 1.52–7.29). Invasive local recurrence was independently associated with young age (≤40 years) (HR: 3.86, 95% CI: 1.50–9.96), high nuclear grade (HR: 4.46, 95% CI: 1.62–12.27) and omission of adjuvant radiotherapy (HR: 6.45, 95% CI: 1.82–22.82). Notably, duration of endocrine treatment among the hormone receptor positive patient group, was numerically shorter for recurred patients, though not statistically significant. CONCLUSION Young age, high nuclear grade and absence of adjuvant radiotherapy were independently associated with an increased risk of invasive recurrence. Moreover, invasive locoregional recurrence as a first event was associated with worse outcomes, yet in situ recurrence didn't affect overall survival. Further studies with larger sample sizes are warranted to confirm the prognostic indicators of recurrence and the optimal strategy for adjuvant therapy in this setting.

BACKGROUND: The aim of this study was to evaluate the outcomes of surgical resection in patients with radiographically noninvasive lung adenocarcinoma according to the surgical strategy. METHODS: A retrospective study was conducted of 128 patients who underwent pulmonary resection for ground-glass opacity (GGO)–dominant nodules measuring ≤2 cm with a consolidation/tumor ratio ≤0.25 based on computed tomography between 2008 and 2015. The 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were analyzed. RESULTS: Among the 128 patients, wedge resection, segmentectomy, and lobectomy were performed in 40 (31.2%), 22 (17.2%), and 66 patients (51.6%), respectively. No significant differences were found among the groups in the mean size of tumors (p=0.119), the rate of pure-GGO nodules (p=0.814), the consolidation/tumor ratio (p=0.695), or the rate of invasive adenocarcinoma (p=0.378). Centrally located tumors were more common in the lobectomy group (21.2%) than in the wedge resection (0%) or segmentectomy (0%) groups (p=0.001). There were no significant differences in the 5-year DFS rate (100%, 100%, 92.7%, respectively; p=0.76) or 5-year OS rate (100%, 100%, 100%; p=0.223) among the wedge resection, segmentectomy, and lobectomy groups. CONCLUSION: For radiographically noninvasive lung adenocarcinoma measuring ≤2 cm with a consolidation/tumor ratio ≤0.25, wedge resection and segmentectomy could be comparable surgical options to lobectomy.
Adenocarcinoma* ; Disease-Free Survival ; Humans ; Lung* ; Mastectomy, Segmental* ; Retrospective Studies ; Solitary Pulmonary Nodule ; Thorax

PURPOSE: The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. METHODS: The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. RESULTS: Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 +/- 1.77 days vs. 3.82 +/- 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. CONCLUSION: In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.
Appendectomy* ; Appendicitis ; Diagnosis-Related Groups* ; Emergency Service, Hospital ; Follow-Up Studies ; Health Care Costs ; Hospitalization ; Humans ; Korea ; Length of Stay ; Local Government ; Prospective Payment System ; Seoul

Purpose: Factors associated with invasive recurrence (REC) of ductal carcinoma in situ (DCIS) are less known. This study was aimed at identifying better biomarkers to predict the prognosis of DCIS. Methods: RNA extracted from formalin-fixed paraffin-embedded blocks of twenty-four pure DCIS cases was subjected to differential gene expression analysis. The DCIS cases were selected by matching age and estrogen receptor status. Sixteen REC-free and 8 invasive-REC cases with disease-free interval of > 5 years were analyzed. Immunohistochemistry (IHC) staining was used to validate sixty-one independent pure DCIS cases, including invasive-REC (n = 16) and REC-free (n = 45) cases. Results: Eight differentially expressed genes (DEGs) were statistically significant (log 2-fold change [FC] < –1 or > 1 and p < 0.001). Less than ½ fold expression of CUL1, androgen receptor (AR), RPS27A, CTNNB1, MAP3K1, PRKACA, GNG12, MGMT genes was observed in the REC group compared to the no evidence of disease group. AR and histone deacetylase 1 (HDAC1) genes were selected for external validation (AR: log 2-FC − 1.35, p < 0.001, and HDAC1: log 2-FC − 0.774, p < 0.001). External validation showed that the absence of AR and high HDAC1 expression were independent risk factors for invasive REC (hazard ratio [HR], 5.04; 95% confidence interval [CI], 1.24–20.4; p = 0.023 and HR, 3.07; 95% CI, 1.04–9.04; p = 0.042). High nuclear grade 3 was also associated with long-term invasive REC. Conclusion Comparative gene expression analysis of pure DCIS revealed 8 DEGs among recurring cases. External validation with IHC suggested that the absence of AR and overexpression of HDAC1 are associated with a greater risk of long-term invasive REC of pure DCIS.