We report our case of laparoscopy-assisted distal gastrectomy with D1 + beta lymph node dissection for a patient with early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis. A superficial elevated lesion was found on the lesser curvature of the antrum. The preoperative diagnosis was cStage IA (cT1, cN0, cH0, cP0, cM0). A 1 cm-sized gallstone was found in the fundus through upper abdominal ultrasound. A laparoscopy-assisted distal gastrectomy with standard D2 lymph node dissection for early gastric cancer and laparoscopic cholecystectomy was successfully performed by not shifting the monitor to the left and right and not changing operator's position without additional blood loss and time. The number of retrieved lymph nodes was 36. We have not found any abnormal course of blood vessels except for the right/left inversion. Billroth I reconstruction was performed through end-to-side anastomosis. Based on a histopathological examination, a 1.5 x 1.5 cm, submucosal (sm3), moderately differentiated adenocarcinoma (pT1, pN0, sH0, sP0, sM0, stage IA) was diagnosed. The postoperative course was favorable and the patient was discharged on postoperative day 7.
Adenocarcinoma ; Blood Vessels ; Cholecystectomy, Laparoscopic ; Gallstones ; Gastrectomy ; Gastroenterostomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Organothiophosphorus Compounds ; Situs Inversus ; Stomach Neoplasms

OBJECTIVE: To know the clinical features of overuse injury in performing musicians and to evaluate related factors that may affect the overuse injury and playing related pain. METHODS: Eighty professional musicians and music college students were examined during 1 year. All were examined by a history taking, physical examination, radiologic exam and if needed electromyography. Nonparametric Sperman's correlation were used for the statistic analysis and 5 interval grading system, visual analog scale for pain, and stress, criteria of joint hypermobility were used for various measurements. RESULTS: Fifty four men were studied in 3 music colleges and a professional orchestra. Frequency of symptom was 46.3%. The string players were most frequently affected (65%), whereas the wind instrument players were least frequently affected (11.5%). The most commonly affected site was the hand and wrist (54.2%) followed by the spine. Patients were divided by the severity into 5 groups and among them the grade 1 was most common (29.6%). No significant correlation was seen between the practice hours per week but a significant correlation was noted between the stress and playing related pain. Joint hypermobility plays an important role in music playing which is dependent on the kind of instruments. CONCLUSION: Incidence of the overuse injury in musicians is high in Korea and the prevention and early treatment are essential for the good outcome of overuse syndrome.
Cumulative Trauma Disorders* ; Electromyography ; Hand ; Humans ; Incidence ; Joint Instability ; Korea ; Male ; Music ; Physical Examination ; Spine ; Visual Analog Scale ; Wind ; Wrist

The concept of bariatric surgery, which was intended to lose weight, has turned into metabolic surgery. These changes were due to the fact that the resolution of diabetes and metabolic diseases after weight loss surgery were not associated with weight loss. The key pathogenesis of type 2 diabetes is explained by increased insulin resistance and reduced insulin secretion. Therefore, postoperative resolution of diabetes can be explained by improvement of insulin secretion or insulin resistance. It is known that the improvement of insulin secretion after surgery depends on the degree of preservation of preoperative beta cell function. In this study, the method of measuring insulin resistance is concretely summarized, and the improvement of diabetes after metabolic obesity surgery is focused on the improvement of insulin resistance.
Bariatric Surgery ; Insulin Resistance* ; Insulin* ; Metabolic Diseases ; Methods ; Obesity ; Weight Loss

No abstract available.
Gangwon-do* ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Liver Diseases* ; Liver* ; Prevalence*

OBJECTIVE: To evaluate the degree of streptococcal colonization in Korean pregnant women. METHODS: The study comprised of 153 singleton pregnant women who visited Severance Hospital for delivery, and their neonates. Specimens for GBS culture were collected by a sterile cotton swab from lower vagina and cervix of pregnant women, and from ear canal and throat of neonates. They were first cultured for 48 hours in Todd-Hewitt broth and then subcultured onto Tryptose blood agar plates(Difco). Group B streptococci were confirmed by the presence of beta-hemolysis and a positive reaction with Phadebact group B Streptococci reagent(Karo Biodiagnostics AB, Huddinge, Sweden). RESULTS: The prevalence of positive cultures in pregnant women and neonates were 2.61%(4/153) and 0%(0/4), respectively. In the study population there was a case of suspicious group B streptococcual sepsis in an infant whose mother was colonized. CONCLUSIONS: In our study the GBS colonization rate in Korean pregnant women was significantly lower than that of other countries. The reason for this difference may be associated with a racial differences, or social factors such as socio-economic status or a life style.
Agar ; Cervix Uteri ; Colon ; Ear Canal ; Female ; Humans ; Infant ; Infant, Newborn ; Life Style ; Mothers ; Pharynx ; Pregnancy ; Pregnant Women* ; Prevalence ; Sepsis ; Streptococcal Infections* ; Vagina

BACKGROUND: The efficacy of tumescent liposuction in the treatment of axillary osmidrosis has been widely established. But there have been few studies that have conducted a comparative analysis according to the level of dermal curettage with respect to the efficacy and safety. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and complications of tumescent liposuction according to the degree of dermal curettage. METHODS: From September 2004 through August 2009, a total of 33 patients with axillary osmidrosis (66 axillae) were included in this study. Twelve patients (24 axillae) were treated by tumescent liposuction with dermal curettage at the level of the mid-dermis (the classical technique group), and the other 21 patients (42 axillae) were treated by tumescent liposuction with dermal curettage at the level of the dermo-subcutis junction (the modified technique group). The preoperative and postoperative disease severity was measured as 0, 1, 2 and 3. The improvement of symptoms was graded by the patient as excellent, good, fair and poor. We also evaluated the postoperative complications, including skin necrosis, scar, hematoma, sensory disturbance and infection. Biopsies of the axillary skin were performed in 7 patients to confirm the level of dermal curettage and the reduction of apocrine glands after treatment. RESULTS: The follow-up ranged from 6 to 60 months. Six months after treatment, 95.8% (23/24) of the axillae in the classical technique group and 95.2% (40/42) of the axillae in the modified technique group had reduced disease severity below 1. Among the 12 patients treated with the classical technique, 11 (91.7%) had excellent to good results, while 95.2% (20/21) of the patients treated with the modified technique had excellent to good results by the patients' own grading. The complications included skin necrosis, scar and hematoma. In the classical technique group and the modified technique group, the incidence of skin necrosis was 12.5% (3/24) and 2.4% (1/42), respectively, the incidence of scar formation was 4.2% (1/24) and 0%, respectively, and the incidence of hematoma was 8.3% (2/24) and 0%, respectively. The postoperative histologic examinations confirmed that the dermal curettage level was at the mid-dermis in the classical technique and at the dermo-subcutis junction in the modified technique. Interestingly, the histologic examination from the classical technique group revealed vacuolar alteration of keratinocytes and partial separation of the dermo-epidermal junction. CONCLUSION: The efficacy of the modified technique is compatible with that of the classical technique, but the modified technique offers fewer complications. So, the modified technique may improve the cosmetic outcome without reducing the treatment efficacy for the patient with axillary osmidrosis.
Apocrine Glands ; Axilla ; Biopsy ; Cicatrix ; Cosmetics ; Curettage ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Keratinocytes ; Lipectomy ; Necrosis ; Postoperative Complications ; Skin ; Treatment Outcome

Purpose: Obesity is associated with nonalcoholic fatty liver disease, one of the most common causes of chronic liver disease.We aimed to demonstrate the effectiveness of bariatric surgery for hepatic steatosis and fibrosis in Korean patients. Methods: A total of 32 consecutive patients were enrolled in this study. Hepatic steatosis and liver fibrosis were assessed before surgery and 6 months after surgery using transient elastography and serologic panels. Results: Thirteen patients (40.6%) were male and 19 (59.4%) were female, with a mean age of 39.3 ± 11.3 years. The body mass index was significant at the 6th month: 39.1 ± 6.7 and 30.3 ± 4.7 kg/m2 (P < 0.001), respectively. The mean preoperative controlled attenuation parameter and liver stiffness measurement values were 325.4 ± 55.9 dB/m and 7.4 ± 4.8 kPa, respectively, before surgery, and they decreased to 267.1 ± 45.1 dB/m and 5.3 ± 2.3 kPa, respectively, 6 months postoperatively (P < 0.001, respectively). Conclusion These results suggest that bariatric surgery is associated with a significant improvement in liver steatosis and fibrosis. Bariatric surgery has a beneficial effect on nonalcoholic fatty liver disease in patients with morbid obesity in Korea.

OBJECTIVE: To assess the jumper's knee for the symptoms and diagnostics by MRI and ultrasonography in basket ball players. METHOD: Twenty knees of 10 basketball players with chronic knee pain were assessed by the history taking, physical examination and diagnosis by magnetic resonance imaging and ultrasonography. Their average age was 17.4 years. Stanish classification is used for grading the symptoms of jumper's knee. RESULTS: Nine proximal patellar tendons were diagnosed as jumper's knees (45%) and 11 distal tendons were diagnosed as jumper's knees (55%). In ultrasonographic findings, average proximal patellar tendon thickness was 4.5 mm+/-1.2 mm, and distal patella tendon thickness was 7.1+/-1.1 mm. Sensitivity was 63% (12/19) and specificity was rated as 100% (21/21). By the MRI findings, sensitivity was rated as 32% (6/19) and specificity was rated as 90% (16/21). Study between the patient's clinical severity level by Stanish classification and thickness of patellar tendon showed no significant correlation (<0.5). CONCLUSION: The ultrasonography to be more convenient and easier as a diagnostic method for the jumper's knee than MRI.
Basketball ; Classification ; Diagnosis ; Knee* ; Magnetic Resonance Imaging* ; Patellar Ligament ; Physical Examination ; Sensitivity and Specificity ; Tendons ; Ultrasonography*

Diffuse neonatal hemangiomatosis is a fatal disorder characterired by multiple cutaneous and visceral hemangiomas. The organs most commonly affected are the gastrointestinal tract, brain, liver and lung. The complications are high output cardiac failure, gastrointestinal bleeding and hydrocephalus. We present a patient with diHuse neonatal hemangiomatosis associated with massive hepatic involvement and high output cardiac failure, which was successfully treated with high dose corticosteroid.
Brain ; Gastrointestinal Tract ; Heart Failure ; Hemangioma ; Hemorrhage ; Humans ; Hydrocephalus ; Liver ; Lung

Weight loss and malnutrition are common in cancer patients. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and required for the multidisciplinary approach. Subjective global assessment (SGA) is made by the patients nutritional symptoms and weight loss. The objective assessment, a significant weight loss (>10%) for 6 months is considered an indicator of nutritional deficiency. The mean body index, body fat mass and body protein mass are decreased as cancer stage increases. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count are decreased in advanced cancer stage. Daily energy intake, cabohyderate and Vit B1 intake is decreased according to cancer stage. The patients are divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss%, 6 month weight loss%, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake protein and energy malnutrition. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase in stomach cancer associated morbidity and mortality. The authors concluded that nutritional assessment should be done in cancer patients preoperatively, and with adequate nutritional support, the morbidity and mortality would be decreased.
Humans ; Neoplasm Staging ; *Nutrition Assessment ; Nutritional Status ; *Nutritional Support ; Postoperative Complications ; Preoperative Care ; Stomach Neoplasms/mortality/*pathology/surgery ; Weight Loss