PURPOSE: Band erosion is a well-known complication of laparoscopic adjustable gastric band placement. We gained experience with laparoscopic removal of an eroded gastric band. METHODS: We retrospectively reviewed the operative log of our obesity surgery unit to identify all operations performed for band erosion from March 2009 to May 2011. RESULTS: During the study period, a total of six of 96 patients (6.3%), five females and one male, were diagnosed with band erosion and underwent surgical removal of the band system. The median time interval from the initial gastric band placement to the diagnosis of band erosion was 8.5 months (range, 7 to 22 months), with most band erosion occurring within the first year (5/6, 83%). The median body mass index at band removal was 28.4 kg/m2. Upper abdominal pain was the most common symptom (5/6, 83%), and other signs and symptoms were port site infection (3/6, 50%) and loss of restriction and weight regain (1/6, 17%). All eroded bands were removed using laparoscopy. Further complications after laparoscopic removal of the band system were observed in three cases. One patient showed multiple intra-abdominal abscesses requiring insertion of a pigtail catheter for drainage. The other two patients experienced sepsis with localized peritonitis, eventually requiring laparoscopic washout and drainage. CONCLUSION: Gastric band erosion requires the removal of the gastric band. Laparoscopic removal is technically achievable in the majority of patients with eroded gastric band. The method can be challenging, has potential postoperative complications (fistula, abscess), and should be attempted only by experienced surgeons.
Abdominal Abscess ; Abdominal Pain ; Bariatric Surgery ; Body Mass Index ; Catheters ; Cytochrome P-450 CYP1A1 ; Drainage ; Female ; Humans ; Laparoscopy ; Male ; Obesity ; Obesity, Morbid ; Peritonitis ; Postoperative Complications ; Retrospective Studies ; Sepsis

Regarding the removal of a gastric bezoar, laparoscopic surgery was performed and it was shown that the laparoscopic approach is safe and feasible. However, the laparoscopic method has the risk of intraabdominal contamination, when the gastric bezoar is retrieved from the gastric lumen in the peritoneal cavity. We developed and applied a new procedure for the removal of the gastric bezoar using one surgical glove and two wound retractors as a fashion of intragastric single port surgery. Herein we present this new minimal invasive procedure, so named "hybrid access surgery" which involves the use of existing devices and overcomes the weakness of laparoscopic removal of the gastric bezoar. Our new procedure, combining the concept of intragastric and single port access, is acceptable and feasible to retrieve the gastric bezoar. In the future, this procedure may be one of the alternative procedures for retrieving gastric bezoar even when it is incarcerated in the pylorus.
Bezoars ; Gloves, Surgical ; Laparoscopy ; Peritoneal Cavity ; Pylorus

Pendipronil(R) overdose is uncommon in Korea. Pendipronil(R) is a selective herbicide used to control most annual grasses and certain broadleaf weeds in field corn, potatoes, rice, etc. and is the substance including pendimethalin and propanil. Pendimethalin is slightly to practically nontoxic by ingestion but may be mildly to moderately irritating to the linings of the mouth, nose, throat, and lungs. Propanil toxicity is evidenced by varying clinical pictures ranging from deep cyanosis in an otherwise alert normal appearing individual to restlessness, dyspnea, extensive hemolytic anemia, methemoglobinemia, sulfhemoglobinemia and serious central nervous system dysfunction. For the treatment of methemoglobinemia, gastric lavage, activated charcoal, methylene blue and exchange transfusion should be used. We experienced a case of acute massive Pendipronil(R) intoxication in 31 years old woman due to voluntary ingestion of 48g of this drug as a suicide attempt. A moderate methemoglobinemia developed, accompanied by drowsy mental status, nausea, vomiting, headache, intensive cyanosis. The patient recovered completely after intravenous methylene blue injection and cellulose coated hemoperfusion charcoal (Adsorba 300C(R)) and conservative treatment.
Adult ; Anemia, Hemolytic ; Cellulose ; Central Nervous System ; Charcoal ; Cyanosis ; Dyspnea ; Eating ; Female ; Gastric Lavage ; Headache ; Hemoperfusion* ; Humans ; Korea ; Lung ; Methemoglobinemia ; Methylene Blue* ; Mouth ; Nausea ; Nose ; Pharynx ; Poaceae ; Poisoning* ; Propanil ; Psychomotor Agitation ; Solanum tuberosum ; Suicide ; Sulfhemoglobinemia ; Vomiting ; Zea mays

BACKGROUND AND OBJECTIVES: Overexposure to intense sound can cause temporary or permanent hearing loss. Post-exposure recovery of thresholds has been assumed to indicate reversal of damage to the inner ear without persistent consequences for auditory function. However, there was a report that acoustic overexposures causing moderate temporary threshold shift caused acute loss of afferent nerve terminals and delayed degeneration of the cochlear ganglion cells while cochlear sensory cells were intact. The purpose of the study was to evaluate the numerical changes of ribbon synapses and efferents to the outer hair cells in ears with temporary noise-induced threshold shifts. MATERIALS AND METHODS: Four-week old CBA mice with normal Preyer's reflexes were used. Mice were exposed to white noise of 110 dB SPL for one hour. Auditory brainstem response (ABR) and distortion-product otoacoustic emission (DPOAE) were recorded before exposure and at four different post-exposure times, 1, 3, 5, and 7 days after noise exposure. Ribbon synapses and efferents near cochlear nerve terminals were stained and calculated in the control group mice at two post-exposure times, 3 and 5 days after the exposure. RESULTS: In the noise-exposed ears, there was no loss of hair cells, in either inner hair cells or outer hair cells. ABR and DPOAE showed maximum threshold shifts after noise-exposure; they returned to the normal pre-exposure values by at day 5. The number of ribbon synapses tended to decrease at 3 days after noise-exposure, but the number of efferent fibers was not statistically different from those of the control mice. CONCLUSION: Our results suggest that the loss of ribbon synapses could be related with the recovery course of temporary threshold shift, even to the point of full hearing recovery.
Acoustics ; Animals ; Cochlear Nerve ; Ear ; Ear, Inner ; European Continental Ancestry Group ; Evoked Potentials, Auditory, Brain Stem ; Ganglion Cysts ; Hair ; Hair Cells, Auditory ; Hearing ; Hearing Loss ; Hearing Loss, Noise-Induced ; Humans ; Mice ; Mice, Inbred CBA ; Noise ; Presynaptic Terminals ; Reflex ; Synapses

We treated a family of 3 brothers with prostate cancer, which is the first report of familial prostate cancer in Korea. Prostate cancer was diagnosed in the first brother with a prostate-specific antigen (PSA) level of 12.70 ng/ml of at the age of 68 years. He underwent a radical retropubic prostatectomy (RRP); the cancer was pathologically staged to T2cN1Mo. He received adjuvant hormonal therapy postoperatively. Three years later, prostate cancer was diagnosed in the third brother at the age of 61 years with a high PSA level of 4.45 ng/ml. He underwent RRP, which revealed the pathological stage to be T2cN0M0. Three months later, the second brother, who had visited our hospital for lower urinary tract symptoms and for a PSA screening test was diagnosed with prostate cancer at the age of 60 years (PSA level of 3.96 ng/ml). He also underwent RRP, and his cancer was staged pathologically as T2cN0M0.
Humans ; Korea ; Lower Urinary Tract Symptoms ; Mass Screening ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Siblings

OBJECTIVE: Delaying embryo transfer (ET) enables us to select among the embryos available for transfer and is associated with positive effects on implantation and pregnancy outcomes. However, the optimal day for ET of human cleavage-stage embryos remains controversial. METHODS: A retrospective study of 3,124 in vitro fertilization/intracytoplasmic sperm injection cycles (2,440 patients) was conducted. We compared the effects of day 2 and 3 ET on rates of implantation and pregnancy outcomes between young maternal age (YMA; <38 years old, n=2,295) and old maternal age (OMA; ≥38 years old, n=829) patient groups. RESULTS: The YMA and OMA groups did not differ in terms of patient characteristics except for the proportion of unexplained factor infertility, which was significantly greater in the OMA group, and the proportion of arrested embryos, which was significantly greater in the YMA group. However, the biochemical pregnancy, clinical pregnancy, ongoing pregnancy, abortion, and implantation rates per cycle were not significantly different between day 2 and 3 ET in the YMA group or the OMA group. CONCLUSION: We suggest that offering patients the opportunity to decide which day would be suitable for ET could be part of a patient-friendly protocol that takes into consideration an infertile woman's circumstances and work schedule by allowing ET to be performed on day 2 instead of the traditional transfer on day 3.
Appointments and Schedules ; Embryo Transfer* ; Embryonic Structures* ; Female ; Humans ; In Vitro Techniques ; Infertility ; Maternal Age* ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Spermatozoa

PURPOSE: To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers. MATERIALS AND METHODS: We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists. RESULTS: Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After performing PSM, surgical oncologists (82.74%) completed AC as planned more often than medical oncologists (75.9%), with statistical significance (P=0.036). No difference in the 3-year DFS rates of stage II (P=0.567) or stage III (P=0.545) gastric cancer was found between the medical and surgical oncologist groups. CONCLUSIONS: S-1 monotherapy and XELOX are a main stay of AC, regardless of whether the prescribing physician is a medical or surgical oncologist. The better compliance with AC by surgical oncologists is a valid reason to advocate that surgical oncologists perform the treatment of AC for stage II or III gastric cancers.
Capecitabine ; Chemotherapy, Adjuvant* ; Compliance ; Disease-Free Survival ; Hospitals, University ; Humans ; Korea* ; Logistic Models ; Observational Study ; Propensity Score ; Referral and Consultation ; Retrospective Studies* ; Selection Bias ; Stomach Neoplasms*

BACKGROUND: The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort. METHODS: DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 microg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a > or = 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group]. RESULTS: There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 +/- 3.4% vs. -21.0 +/- 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%). CONCLUSION: Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dobutamine ; Echocardiography ; Echocardiography, Stress* ; Humans ; Myocardial Stunning ; Sensitivity and Specificity ; Thorax

OBJECTIVE: The aim of our study was to evaluate the clinical, laboratory, and sonographic charac- teristics of struma ovarii. METHODS: Thirty three cases of struma ovarii were reviewed retrospectively over recent 5 years (1997- 2001). The presenting clinical, radiological, and pathological features of patients with consequent struma ovarii were compared, retrospectively. RESULTS: The mean age of the patients was 40.5 years (20-70). Eight women (24.2%) were postmenopausal. The mean tumor diameter was 7.6 cm (1.5-15) and occured more frequently (60.6%) in the right ovary. Ascites was present in 11 cases. The CA-125 level was normal in 30 cases and significantly increased in 3 cases. Fourteen patients had pelvic pressure symptoms such as lower abdominal discomfort or pain, lumbago, and some of these patients were examined because of irregualr vaginal bleeding. In asymptomatic 19 patients, the ovarian tumor was an incidental finding on routine examination. Although one of the patients had cervical thyroid nodule, preoperative and postoperative evidence of hyperthyroidism was not noted and any patients did not complained symptoms of hyperthyroidism. All of the tumors were diagnosed as benign on permanant pathology and only surgical excision was done as a definitive treatment. CONCLUSION: The presented clinical, laboratory and radiological features of patients with consquent struma ovarii were diverse. The diagnosis was only made later by strict pathological criteria and conservative treatment by tumor excision only may be sufficient.
Ascites ; Diagnosis ; Female ; Humans ; Hyperthyroidism ; Incidental Findings ; Low Back Pain ; Ovary ; Pathology ; Retrospective Studies ; Struma Ovarii* ; Thyroid Nodule ; Ultrasonography ; Uterine Hemorrhage

Purpose: To evaluate whether the added value of contrast leakage information from dynamic susceptibility contrast magnetic resonance imaging (DSC MRI) is a better prognostic imaging biomarker than the cerebral blood volume (CBV) value in distinguishing true progression from pseudoprogression in glioblastoma patients. Materials and Methods: Forty-nine glioblastoma patients who had undergone MRI after concurrent chemoradiotherapy with temozolomide were enrolled in this retrospective study. Twenty features were extracted from the normalized relative CBV (nCBV) and extraction fraction (EF) map of the contrast-enhancing region in each patient. After univariable analysis, we used multivariable stepwise logistic regression analysis to identify significant predictors for differentiating between pseudoprogression and true progression. Receiver operating characteristic (ROC) analysis was employed to determine the best cutoff values for the nCBV and EF features. Finally, leave-one-out cross-validation was used to validate the best predictor in differentiating between true progression and pseudoprogression. Results: Multivariable stepwise logistic regression analysis showed that MGMT (O 6 -methylguanine-DNA methyltransferase) and EF max were independent differentiating variables (P = 0.004 and P = 0.02, respectively). ROC analysis yielded the best cutoff value of 95.75 for the EF max value for differentiating the two groups (sensitivity, 61%; specificity, 84.6%; AUC, 0.681 ± 0.08; 95% CI, 0.524-0.837; P = 0.03). In the leave-one-out cross-validation of the EF max value, the cross-validated values for predicting true progression and pseudoprogression accuracies were 69.4% and 71.4%,respectively. Conclusion We demonstrated that contrast leakage information parameter from DSC MRI showed significance in differentiating true progression from pseudoprogression in glioblastoma patients.