PURPOSE: Laparoscopic cholecystectomy (LC) has been the treatment of choice for acute and chronic disease of the gallbladder. We have performed 621 cases of LC from January 02 2001 to April 30 2008. This study aims to clinically analyze 621 cases of LC that were performed by a single surgeon over a 7 year period and to evaluate the effectiveness and safety of laparoscopic treatment for gallbladder disease. METHODS: From January 02 2001 to April 30 2008, 621 patients underwent LC at the Department of Surgery by a single surgeon. We retrospectively analyzed the patients' ages, gender distribution and chief complaints, the operation times, the duration of hospitalization, the conversion rate to open cholecystectomy and the causes, the diagnostic methods and the postoperative complications through a review of the patients' charts. RESULTS: The mean age was 46 years and the ratio of males to females was 1:1.4. The most common chief complaint was right upper quadrant pain (52.97%). The mean operative time was 67.37 minutes and the duration of hospitalization was 5.12 days and the duration of postoperative hospitalization was 3.86 days. The conversion rate was 3.29% and the most common cause of conversion was anatomic uncertainty due to inflammatory adhesion. Abdominal sonography was the most common diagnostic method and this was performed in 73.27% of the patients. The postoperative complication rate was 1.93%. CONCLUSION: LC has become the gold standard for the treatment of benign gallbladder diseases. We think that LC is effective and safe, and even at a secondary care hospital, if the surgeon has accumulated operative experience and improved operative skill.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Chronic Disease ; Female ; Gallbladder ; Gallbladder Diseases ; Hospitalization ; Humans ; Male ; Operative Time ; Polyenes ; Postoperative Complications ; Retrospective Studies ; Secondary Care ; Uncertainty

OBJECTIVE: The aim of this study is to evaluate the effects of intracranial-extracranial arterial bypass(EIAB) surgery on cerebrovascular reserve capacity(CRC) in patients with hemodynamic cerebral ischemia and to assess the significance of transcranial doppler(TCD) examination before and after EIAB surgery. METHODS: In 29 consecutive patients who underwent EIAB surgery due to symptomatic internal carotid artery or middle cerebral artery(MCA) occlusion, 21 patients were studied using preoperative and postoperative digital subtraction angiogram(DSA), SPECT, and TCD examination. After measuring mean radioactivity count of a region of interest, relative regional cerebral blood flow(rrCBF) was quantitated by the following formula: lesional radioactivity count/contralateral radioactivity count x 100%. CRC was calculated as the percentage change from baseline flow after a vasodilatory challenge. RESULTS: Postoperative DSA showed good collateral circulation through the bypass except 4 patients. Preoperative mean value of rCRC improved significantly after EIAB surgery from -14.8+/-2.6% to 6.9+/-2.7%(p<0.01). Intraoperatively, flow velocity of superficial temporal artery(STA) and MCA just after anastomoses increased remarkably in comparison with the values just before anastomoses(p<0.01). There was no correlation between the change of pre- and postoperative flow velocity and the change of rrCBF. In patients with the increase of flow velocity after surgery manifested good collateral circulation through the bypass. The difference was statistically significant(repeated measures ANOVA, p<0.05). Over a mean follow-up period of almost 3 years, no patient had another episode of brain ischemia. CONCLUSION: We believe that the measurement of flow velocity is expected a good method to evaluate the degree of collateral circulation through the bypass.
Brain Ischemia* ; Carotid Artery, Internal ; Collateral Circulation ; Follow-Up Studies ; Hemodynamics* ; Humans ; Radioactivity ; Tomography, Emission-Computed, Single-Photon

Phytosphingosine-1-phosphate (PhS1P) was found to stimulate an intracellular calcium increase via phospholipase C but not pertussis toxin (PTX)- sensitive G-proteins in L2071 mouse fibroblasts. PhS1P also activated ERK and p38 kinase, and these activations by PhS1P were inhibited by PTX. Moreover, PhS1P stimulated the chemotactic migration of L2071 cells via PTX-sensitive Gi protein(s). In addition, the PhS1P-induced chemotactic migration of L2071 cells was also dramatically inhibited by LY294002 and SB203580 (inhibitors of phosphoinositide 3-kinase and p38 kinase, respectively). L2071 cells are known to express four S1P receptors, i.e., S1P1, S1P2, S1P3, and S1P4, and pretreatment with an S1P1 and S1P3 antagonist (VPC 23019) did not affect on PhS1P-induced chemotaxis. This study demonstrates that PhS1P stimulates at least two different signaling cascades, one is a PTX-insensitive but phospholipase C dependent intracellular calcium increase, and the other is a PTX-sensitive chemotactic migration mediated by phosphoinositide 3-kinase and p38 kinase.
1-Phosphatidylinositol 3-Kinase/metabolism ; Animals ; Calcium Signaling/drug effects ; Chemotaxis/*drug effects ; Estrenes/pharmacology ; Extracellular Signal-Regulated MAP Kinases/metabolism ; Fibroblasts/*cytology/*drug effects ; GTP-Binding Proteins/*metabolism ; Gene Expression Regulation/drug effects ; Humans ; Mice ; Pertussis Toxin/*pharmacology ; Phosphorylation/drug effects ; Pyrrolidinones/pharmacology ; RNA, Messenger/genetics/metabolism ; Receptors, Lysosphingolipid/genetics/metabolism ; Sphingosine/*analogs & derivatives/pharmacology ; p38 Mitogen-Activated Protein Kinases/metabolism

Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology which most commonly occurs in the mediastinum. We describe a case of a benign Castleman 's disease of the hyaline vascular type affecting the upper extremity, an extremely rare site of the disease.
Giant Lymph Node Hyperplasia* ; Hamartoma ; Hyalin ; Lymphoproliferative Disorders ; Mediastinum ; Upper Extremity*

OBJECTIVES: Catecholamine metabolism has been thought to be related to the pathophysiology of panic disorder. There are two human COMT alleles, coding for a low activity enzyme, COMT L(L), and a high activity enzyme, COMT H(H), respectively. We examined the distribution of COMT genotypes and the relationship between COMT genetic polymorphism and some clinical characteristics in patients with panic disorder. METHOD: We recruited 51 patients who met the DSM-IV criteria for panic disorder, and 45 normal control subjects who had neither medical nor psychiatric illnesses. Genetic polymorphism of COMT was identified in all subjects using PCR-based restriction fragment length polymorphism(RFLP) analysis. We assessed some clinical variables including treatment responses in panic patients and measured anxiety and depression levels in normal control subjects using Spielberger State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). RESULT: The frequency of the homozygous LL genotype was higher in panic patients than that in control subjects (19.6% vs. 2.2%). We found that panic disorder was significantly associated with L allele (x2=8.66, p=0.003) and LL genotype(x2=8.45, p=0.015). Panic patients with LL genotype showed poorer treatment response than those with other genotypes (F=4.98, p=0.011). CONCLUSION: These results suggest that LL genotype of the COMT gene may be related to the pathophysiology and clinical courses in some patients with panic disorder.
Alleles ; Anxiety ; Catechol O-Methyltransferase* ; Clinical Coding ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Genotype ; Humans ; Metabolism ; Panic Disorder* ; Panic* ; Pilot Projects* ; Polymorphism, Genetic*

OBJECTIVE: We wanted to evaluate the CT findings of epithelial origin ovarian carcinoma according to the degree of histologic differentiation. MATERIALS AND METHODS: This study enrolled 124 patients with 31 well differentiated, 44 moderately differentiated and 95 poorly differentiated carcinomas with epithelial origin. The CT images were retrospectively evaluated with regard to bilateral ovarian involvement, the tumor's nature, lymphadenopathy, adjacent organ invasion, peritoneal tumor seeding, a large amount of ascites and distant metastasis. In cystic, predominantly cystic and mixed tumors, the tumor wall, septa, papillary projection and necrosis in the solid portion were assessed. RESULTS: Bilateral ovarian involvement was more common in the poorly (48%) and moderately (42%) differentiated carcinomas than in the well differentiated carcinomas (7%) (p < 0.05). The frequency of a predominantly solid or solid nature was greater in the moderately and poorly differentiated carcinomas than in the well differentiated carcinomas (p < 0.0001). In the 87 tumors with a cystic, predominantly cystic or mixed nature, septa greater than 3 mm, papillary projection and necrosis in the solid portion were more common in the poorly differentiated carcinoma (91%, 91% and 77%, respectively) than in the moderately (64%, 68% and 34%, respectively) and well differentiated carcinomas (63%, 47% and 27%, respectively) (p < 0.05). Lymphadenopathy, organ invasion, tumor seeding and a large amount of ascites were more common in the poorly differentiated carcinomas (38%, 27%, 73% and 69%, respectively) than in the moderately (13%, 10%, 48% and 45%, respectively) and well differentiated carcinomas (3%, 0%, 10% and 17%, respectively) (p < 0.05). CONCLUSION: Epithelial origin ovarian carcinoma shows different CT findings according to the degree of histologic differentiation.
Ascites/radiography ; Carcinoma/*pathology/*radiography ; Contrast Media ; Female ; Humans ; Iohexol/analogs & derivatives ; Iopamidol ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Invasiveness ; Ovarian Neoplasms/*pathology/*radiography ; Retrospective Studies ; Tomography, Spiral Computed/*methods

BACKGROUND: Diabetes mellitus is the most common endocrinopathy encountered in the perioperative period. It is a disease of glucose dysregulation and carbohydrate intolerance frequently associated with acute and long-term systemic consequences, which may significantly impact morbidity and mortality This study was performed to evaluate the effects of diabetes on perioperative patients' status. METHODS: Thirty adults patients, 15 control and 15 diabetic patients, who underwent upper abdominal surgery with general anesthesia were included in this study. We investigated blood glucose levels, arterial blood gas, blood chemistry values, and calculated alveolar- arterial oxygen tension differences. Statistical analyses were performed using the Fisher's exact test, unpaired t-test, paired t-test, and repeated measure ANOVA. Data are expressed as mean +/- SD. RESULTS: The blood glucose levels were significantly higher in the diabetic group than the control group during operation. The postoperative calcium and albumin concentrations were significantly lower in the diabetic patients than the control patients. The alveolar-arterial oxygen tension differences were significantly increased in the diabetic group compared with the control group during operation. CONCLUSIONS: This study demonstrated that the blood glucose levels were significantly increased in the diabetic patients compared with the control patients during operation. This finding suggests that blood glucose levels should be monitored and controlled within an adequate range in diabetic patients perioperatively.
Adult ; Anesthesia, General ; Blood Glucose* ; Calcium ; Chemistry ; Diabetes Mellitus ; Glucose ; Humans ; Mortality ; Oxygen ; Perioperative Period

BACKGROUND: Diabetes mellitus (DM) is one of the most important chronic diseases in public health, thus optimal management of this condition is crucial. For this purpose, oral hypoglycemic agents (OHA) are commonly prescribed with their consistent use being mandatory to maintain adequate blood glucose levels. We aimed to evaluate the compliance with OHA in patients with DM, and to determine the factors associated with compliance. METHODS: From March 2006 to December 2007, we enrolled patients with type 2 DM who were newly diagnosed or had discontinued OHAs for more than four weeks. For OHA, diamicron was prescribed to the participants and response to medication was evaluated by physicians after 12 weeks. Compliance was defined as patients taking diamicron continuously or stopping the medication due to well-controlled blood sugar levels. Demographic characteristics, anthropometric measurements, fasting glucose, and lipid profiles were collected and analyzed. RESULTS: The mean age of our 326 subjects was 56.0+/-9.9 years and 74.5% was defined to be compliant. Logistic regression analysis adjusting for age and sex revealed that combined medication use (odd ratio [OR], 2.03; 95% confidence interval [CI], 1.04-3.97) and diabetes-related nutritional education (OR, 2.08; 95% CI, 1.08-4.03) (P<0.05) were factors associated with compliance with OHA. CONCLUSIONS: About three quarters of the DM patients in our study, using diamicron for the first time, showed compliance after 12 weeks of treatment. Concomitant medications and diabetes-related nutrition education were associated with compliance.
Blood Glucose ; Chronic Disease ; Compliance* ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Education ; Fasting ; Gliclazide* ; Glucose ; Humans ; Hypoglycemic Agents ; Logistic Models ; Patient Education as Topic ; Public Health

BACKGROUND: Presenteeism, a concept that has recently undergone active study, is the act of attending work while sick. This study investigates the association between presenteeism and various psychosocial factors within workplaces. METHODS: This study analyzed 29246 wage earners from the third Korean Working Conditions Survey (KWCS, 2011) data using the logistic regression analysis to investigate the association between presenteeism and various psychosocial factors within workplaces. RESULTS: Among the 29246 wage earners, 6347 (21.7 %) showed presenteeism. Those who experienced age discrimination at work (adjusted odds ratio (aOR) 1.77: 95 % CI 1.56–2.00), educational background discrimination (aOR 1.35: 95 % CI 1.22–1.51), regional discrimination (aOR 1.55: 95 % CI 1.31–1.83), sexual discrimination (aOR 1.65: 95 % CI 1.41–1.94), employment type discrimination (aOR 2.13: 95 % CI 1.89–2.40), physical violence (aOR 1.92: 95 % CI 1.45–2.55), sexual harassment (aOR 2.90: 95 % CI 2.01–4.19), job insecurity (aOR 1.36: 95 % CI 1.18–1.56), work–life imbalance (aOR 1.38: 95 % CI 1.29–1.47), low job satisfaction (aOR 2.04: 95 % CI 1.91–2.17), no colleague support (aOR 1.11: 95 % CI 1.02–1.21), job stress (aOR 1.89: 95 % CI 1.76–2.02), emotional labor (aOR 1.50: 95 % CI 1.41–1.60), high work intensity (aOR 1.31: 95 % CI 1.23–1.38), and 3 groups of job strain that are passive group (aOR 1.09: 95 % CI 1.00–1.18), active group (aOR 1.39: 95 % CI 1.28–1.51), and high strain group (aOR 1.35: 95 % CI 1.24–1.46) showed an increased risk of presenteeism compared to their respective counterparts (p < 0.01). CONCLUSIONS: The study results confirmed the association between presenteeism and various psychosocial factors within workplaces. Considering that presenteeism negatively affects productivity and the mental and physical health of individuals, managing various psychosocial factors within workplaces is proposed to reduce presenteeism.
Ageism ; Discrimination (Psychology) ; Efficiency ; Employment ; Job Satisfaction ; Logistic Models ; Odds Ratio ; Physical Abuse ; Presenteeism* ; Psychology* ; Salaries and Fringe Benefits ; Sexual Harassment

PURPOSE: This study was aimed to investigate the combination effect of endoxifen and emodin on estrogen receptor (ER) positive breast cancer cell lines and to explain the mechanism of the combination effect. METHODS: We conducted this study on MCF-7 (ER+/human epidermal growth factor receptor-2 [HER2]−), T47D (ER+/HER2−), ZR-75-1 (ER+/HER2+), and BT474 (ER+/HER2+) cell lines, which confirmed combination effect of endoxifen and emodin. Optimal concentrations for combination were determined to study the effects on proliferation of MCF-7 and ZR-75-1 cells. Analysis of the combination effect was carried out in the CompuSyn software. The combination of downstream mechanisms, and combined effects of other similar compounds were tested on the MCF-7 and ZR 75-1 cell lines. Protein expression was confirmed by western blot. RESULTS: The combination of endoxifen and emodin had antagonistic effects on MCF-7 and ZR-75-1cell lines (combination index > 1). We validated the antagonistic effect in T47D and BT474 cell lines. During the combined treatment, the results showed elevated amounts of cyclin D1 and phosphorylated extracellular signal-regulated kinase (pERK). Analysis of drug interactions showed antagonistic effect between endoxifen and chemical compounds similar to emodin, such as chrysophanol or rhein, in MCF-7 and ZR-75-1 cells. CONCLUSION: Addition of emodin attenuated tamoxifen's treatment effect via cyclin D1 and pERK up-regulation in ER-positive breast cancer cell lines.
Blotting, Western ; Breast Neoplasms ; Breast ; Cell Line ; Cyclin D1 ; Drug Interactions ; Emodin ; Epidermal Growth Factor ; Estrogens ; Phosphotransferases ; Phytoestrogens ; Tamoxifen ; Therapeutic Uses ; Up-Regulation