PURPOSE: The Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality (POSSUM), the Portsmouth-POSSUM (P-POSSUM), and the colorectal-POSSUM (Cr-POSSUM) are relative scoring systems for the prediction of postoperative morbidity and mortality. This study is designed to evaluate the usefulness of each scoring system in elderly colorectal cancer patients undergoing major colorectal surgery. METHODS: From January 2000 to May 2008, the authors retrospectively analyzed the medical records of 251 elderly colorectal cancer patients who had undergone surgery. Collected data were analyzed using the Mann-Whitney U-test, a risk stratification analysis, and a receiver-operator characteristic (ROC) curve to evaluate the usefulness and the accuracy of each scoring system. RESULTS: All the predicted morbidity and mortality rates calculated by using the three POSSUM systems were higher than the observed morbidity and mortality rates. A risk stratification analysis showed a considerable correlation in risk prediction between the observed data and the calculated data. The ROC curves showed that all three POSSUM scoring systems had quite high accuracies as predictors of postoperative morbidity and mortality. POSSUM and P-POSSUM were more accurate than Cr-POSSUM. CONCLUSION: All three scoring systems have a tendency for overestimation. The accuracies of POSSUM, P-POSSUM, and Cr-POSSUM as predictors are acceptance, and POSSUM and P-POSSUM are more accurate than Cr-POSSUM for prediting postoperative morbidity and mortality.
Aged ; Colorectal Neoplasms ; Colorectal Surgery ; Humans ; Medical Records ; Retrospective Studies ; ROC Curve

PURPOSE: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. RESULTS: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). CONCLUSIONS: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones.
Benzilates ; Emergencies ; Humans ; Lithotripsy ; Nifedipine ; Nortropanes ; Shock ; Sulfonamides ; Ureter

Despite the frequent occurrence of peritonitis in patients with continuous ambulatory peritoneal dialysis (CAPD), fungal peritonitis is uncommon and usually associated with antibiotics and immunodeficiency. Most of the fungal isolates are usually Candida albicans, Candida parapsilosis, Candida guilliermondii or Candida torulopsis. The authors report a case of fungal CAPD related peritonitis due to Candida zeylanoides that occurred in a patient with the absence of the usual risk factors for fungal peritonitis. Treatment with intravenous fluconazole was successful.
Anti-Bacterial Agents ; Candida ; Candida albicans ; Candida glabrata ; Candidiasis ; Fluconazole ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Risk Factors

OBJECTIVES: The study aimed to compare the validity of two questionnaires (NIOSH- and Nordic-style) which are used for the screening and surveillance of neck and upper extremity work-related musculoskeletal disorders. To evaluate the validity, clinical examination was used as the reference. METHODS: Two types of questionnaire were filled out by 208 workers from three different plants in Incheon, Korea. Workers underwent clinical examination by three occupational physicians. The presence of a symptom or sign in at least one body region was regarded as positive in both results of questionnaire and case definition using clinical examination. Validity was evaluated by sensitivity, specificity, positive predictive value, negative predictive value and agreement (Kappa coefficient). For the Nordic-style questionnaire, the sum of the symptom scores was used to yield the ROC curve. RESULTS: The results of the NIOSH-style questionnaire were sensitivity 59.5%, specificity 68.0%, positive predictive value 68.0%, negative predictive value 59.5%, and Kappa coefficient 0.27(95% confidence interval [CI]=0.14~0.40). The results of the Nordic-style questionnaire were sensitivity 73.9%, specificity 68.0%, positive predictive value 72.6%, negative predictive value 69.5%, and Kappa coefficient 0.42 (95% CI=0.30~0.54). For the Nordic-style questionnaire, sensitivity was 72.1% and specificity was 70.1% based on the sum of the symptom scores > or =2. CONCLUSIONS: Both questionnaires demonstrated appropriate validity for the screening and surveillance of work-related musculoskeletal disorders. The selection of questionnaire may depend on the purpose of investigation and characteristics of the work place.
Body Regions ; Hypogonadism ; Korea ; Mass Screening ; Mitochondrial Diseases ; Neck ; Ophthalmoplegia ; Questionnaires ; Sensitivity and Specificity ; Upper Extremity ; Workplace

PURPOSE: The increased use of antibiotics may be the main factor responsible for the development and spread of bacterial resistance. This study demonstrated the relation between quinolone use and the rate of isolating ciprofloxacin-resistant(CIPRO-R) Escherichia coli(E.coli) in patients with urinary tract infection(UTI). MATERIALS AND METHODS: From 2001 to 2006, we determined antimicrobial use for 2,803 in terms of the defined daily dose(DDD) and the antimicrobial use density(AUD), and we surveyed the isolation rates of CIPRO-R E.coli in UTIs in both inpatients and outpatients. We also analyzed the correlation between the number of prescriptions and the resistance rates. RESULTS: Of the 637(22.7%) CIPRO-R E.coli isolates, 297(46.6%) were from inpatients and 340(53.4%) were from outpatients. There was a statistically significant correlation between the rate of isolating CIPRO-R E.coli and the amount of quinolone use for the inpatients(r=0.815, p<0.05) as well as the outpatients(r=0.804, p<0.05). A logistic regression analysis identified previous quinolone use as the independent risk factor(odd ratio: 2.604 [95% confidence interval(CI): 1.639-4.137]) for CIPRO-R E.coli in inpatients. Also, these CIPRO-R E.coli showed low sensitivity to ampicillin and trimethoprim/sufamethoxazole(TMP/SMX) in the inpatients(10.4%, 27.3%) and outpatients(5.1%, 27.1%), respectively. CONCLUSIONS: Our study shows a significant correlation between ciprofloxacin resistance and quinolone use, and previous quinolone use seems to be the risk factor for CIPRO-R E.coli bacteriuria. It is necessary to keep antimictrobial therapy under constant surveillance for the prevention of CIPRO-R E.coli.
Ampicillin ; Anti-Bacterial Agents ; Bacteriuria ; Ciprofloxacin ; Escherichia ; Escherichia coli ; Humans ; Inpatients ; Logistic Models ; Outpatients ; Prescriptions ; Quinolones ; Risk Factors ; Urinary Tract ; Urinary Tract Infections

Skin closure is the surgeon's final operation technique. Although there have been many descriptions about the different kinds of sutures, the report on a 'three-point suture' were quite limited to the horizontal half buried suture technique up till now. The three-point suture can be met frequently in cases like irregular laceration, V-Y advancement flap, and reduction mammaplasty. Authors came up with and thereby introduce a more secure and convenient three-point suture technique, which proved to be superior to the horizontal half buried suture technique in that it gives a better skin approximation and eversion. It can also be applied to a multi- point suture such as a four-point suture or a five-point suture and a three-point mattress suture.
Female ; Lacerations ; Mammaplasty ; Skin ; Suture Techniques* ; Sutures*

Coronary artery fistula (CAF) is a rare congenital malformation, comprising less than 1% of all congenital heart disease. Most fistulas drain into the right-sided heart chambers or pulmonary artery, and termination in left heart chambers is an uncommon finding. Clinical presentation mainly depends on the severity of the left-to-right shunt, and adult patients usually do not develop any symptom. There are few case reports relating CAF manifested as an exceptional form of sudden unexpected death. We experienced a case of a 62-year-old male with a single CAF arising from left main coronary artery which drains into the left ventricle, and reported with review of the related articles.
Adult ; Cardiomegaly ; Coronary Vessels ; Death, Sudden ; Fistula ; Heart ; Heart Diseases ; Heart Ventricles ; Humans ; Male ; Middle Aged ; Pulmonary Artery

Hemimegalencephaly is a rare brain malformation characterized by congenital hypertrophy of one cerebral hemisphere, ipsilateral ventriculomegaly, hemiparesis, intractable epilepsy, and mental retardation, which often results in early death. We reported a case of hemimegalencephaly in a 1-month-old male with the chief complaint of intractable focal seizure.
Brain ; Cerebrum ; Epilepsy ; Humans ; Hypertrophy ; Infant, Newborn ; Intellectual Disability ; Male ; Malformations of Cortical Development* ; Paresis ; Seizures*

Osteoma is a slowly growing benign tumor which mainly grows on the mandible and in the paranasal sinuses of the craniofacial region. Embryological, inflammatory, and traumatic theories make up the etiological basis of osteoma, but is still unclear and yet to be studied. We can classify osteoma by morphology and pathology into eburnated, cancellous, and mixed type, of which eburnated type is relatively common. Most osteomas accompany no symptoms, so they are often discovered accidentally by a radiological examination. They never develop into a malignant form, so that periodic observation is sufficient enough for management, but when they grow and invade intraorbitally or intracranially and then compress clinically important structures, need a surgical management, because of possibility of diplopia, exophthalmos, epiphora, blindness due to optic atrophy, mucocele, brain abscess, meningitis. A 52-year-old man complaining of right eye pain, diplopia, and exophthalmos was diagnosed a 4.5x3.0x 2.0cm sized fronto-ethmoidal osteoma by means of a three dimensional computed tomography. We experienced a osteoma removal through bicoronal incision, and orbital reconstruction with both rib and calvarial bone graft, and received satisfying results after 1 year follow-up, thereby report this case with a short review of references.
Blindness ; Brain Abscess ; Diplopia ; Exophthalmos ; Eye Pain ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Mandible ; Meningitis ; Middle Aged ; Mucocele ; Optic Atrophy ; Orbit ; Osteoma* ; Paranasal Sinuses ; Pathology ; Ribs* ; Transplants*

Paralytic ileus is a common complication in critically ill patients, and can affect all parts of the gastrointestinal tract. We report a case of paralytic ileus that improved after neostigmine administration. An 80-year-old man was transferred to the intensive care unit after a diagnosis of severe colitis due to Clostridium difficile infection while under conservative treatment for paralytic ileus . The patient's colitis resolved but the ileus did not. This prompted neostigmine administration, resulting in remarkable improvements in the abdominal physical examination and radiographic images. Bowel movements recovered, oral feeding was restarted, and the patient was transferred back to the general ward.
Aged, 80 and over ; Clostridium difficile ; Colitis ; Critical Illness* ; Diagnosis ; Gastrointestinal Tract ; Humans ; Ileus ; Intensive Care Units ; Intestinal Pseudo-Obstruction* ; Neostigmine* ; Patients' Rooms ; Physical Examination