PURPOSE: The diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy of the current DRG system applied to a broad spectrum of the patients with appendicitis undergoing laparoscopic appendectomy. METHODS: A retrospective review was conducted of the patients who underwent laparoscopic appendectomy. Based on the DRG codes' classification, the patients were analyzed for the amount of DRG reimbursement and the total in-patient cost in relation to the time sequence of the disease onset. Statistical analysis was performed to find factors correlated with the DRG reimbursement and total in-patient cost. RESULTS: Findings indicate that, as the symptom duration becomes prolonged, the CRP level and the use of peritoneal drainage increased. Patients with a symptom duration greater than 24 hours required approximately 5 days of hospital stay, 0.5 day longer in the length of hospital stay than that of patients with less than 12 hours of the onset time. As expected, the amount of DRG reimbursement and the total in-patient cost accumulated as the symptom duration increased. CONCLUSION: The current DRG reimbursement system for the patients undergoing laparoscopic appendectomy recompenses a broad spectrum of patients diagnosed with appendicitis effectively.
Appendectomy* ; Appendicitis ; Classification ; Diagnosis-Related Groups* ; Drainage ; Humans ; Inflammation ; Korea ; Laparoscopy ; Length of Stay ; Peritonitis ; Retrospective Studies ; Severity of Illness Index

This article was published with an error.

PURPOSE: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. METHODS: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. RESULTS: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. CONCLUSION: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.
Classification ; Colon* ; Comorbidity ; Humans ; Inflammation ; Intestinal Perforation ; Ischemia ; Mortality* ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Risk Factors* ; Sepsis

Purpose: Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up. Methods: This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid- to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre- and post-CRT, and at 12 months postoperatively. Results: Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P<0.001). Conclusion The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment.

Purpose: The robotic platform, an extension of minimally invasive procedures, is distributed nationwide and readily available. However, its application in inguinal hernia repair seems rare in Korea. This report aims to share our initial experience with robotic inguinal hernia repair. Methods: The patients who underwent robotic inguinal hernia repair by 2 different surgeons with different experiences at a single center were retrospectively analyzed. The surgical procedures were performed on all patients using the Da Vinci Xi robotic platform (Intuitive Surgical Inc). Patient demographics, operation variables, and postoperative outcomes were analyzed. Results: A total of 35 patients underwent robotic inguinal hernia repairs consecutively. The mean age was 55.03 ± 18.20 years. The majority of patients were male. The overall mean operation time was 103.98 ± 47.92 minutes for unilateral hernia surgery and 139.28 ± 46.07 minutes for bilateral surgery. None of the patients experienced intraoperative complications. However, postoperative complications were noticed in 8 patients: 3 with seroma formation, 1 with hematoma, 1 with superficial surgical site infection, and 3 with persistent pain at the operation site. Conclusion This report demonstrates an early experience of hernia surgery using the robotic platform. The robotic approach for transabdominal preperitoneal hernia repair was completed without any significant intraoperative or postoperative complications. It may be a viable option as a minimally invasive technique. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.

Standard use of neoadjuvant chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemotherapy in locally advanced rectal cancer has tremendously improved oncologic outcomes over the past several decades. However, these improvements come with costs of significant morbidity and poor quality of life. Along with developments in imaging techniques, clinical experience and evidence have identified a certain subgroup of patients that have exceptionally good clinical outcomes while preserving quality of life. Driven by patient demand and interest in preserving quality of life, numerous organ preservation treatment strategies for managing rectal cancer are rapidly evolving. Herein, the flow of research in organ preservation strategies and counter arguments are discussed.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Consolidation Chemotherapy ; Humans ; Induction Chemotherapy ; Organ Preservation ; Quality of Life ; Rectal Neoplasms

Purpose: Preoperative colonoscopic (POC) localization is recommended for patients scheduled for elective laparoscopic colectomy for early colon cancer. Among the various localization method, POC tattooing localization has been widely used. Several dyes have been used for tattooing, but dye has disadvantages, including foreign body reactions. For this reason, we have used autologous blood tattooing for POC localization. This study aimed to evaluate the safety and efficacy of the autologous blood tattooing method. Methods: This study included patients who required POC localization of the colonic neoplasm among the patients who were scheduled for elective colon resection. The indication for localization was early colon cancer (clinically T1 or T2) or colonic neoplasms that could not be resected endoscopically. POC autologous blood tattooing was performed after saline injection, and 2 hemoclips were applied. Results: A total of 45 patients who underwent autologous blood tattooing and laparoscopic colectomy were included in this study. All POC localization sites were visible in the laparoscopic view. POC localization sites showed almost perfect agreement with intraoperative surgical findings. There were no complications like bowel perforation, peritonitis, hemoperitoneum, and mesenteric hematoma. Conclusion Autologous blood is a safe and effective agent for localizing materials that can replace previous dyes. However, a large prospective case-control study is required for the routine application of this procedure in early colon cancer or colonic neoplasms.

The kinetics of cytokine mRNA expression was studied in porcine alveolar macrophages using an RT-PCR assay. The expression levels of IFN- gamma, IL-2, IL-4, IL-6, GM-CSF, IL-12 p35, and IL-12 p40 were examined after 2, 4, 14, 24, 48, and 72 h of incubation in unstimulated control and LPS-stimulated cells. The expression contents of IFN-gamma, IL-2, and IL-4 were not detected in both unstimulated and LPS-stimulated cells. On the other hand, the expression levels of IL-6, GM-CSF, and IL-12 in LPS-stimulated cells were almost always higher than those in control cells. Among those cytokines, IL-6 exhibited the predominant expression, and GM-CSF, IL-12 p40, and IL-12 p35 followed in the descending order. The times to reach the peak expression levels for IL-6, and GM-CSF, IL-12 p35, and IL-12 p40 were 14, and 24 h, respectively. After reaching the peak expression point, the expression levels of IL-6, GM-CSF, and IL-12 p40 reduced to the baseline by 72 h after stimulation, however, IL-12 p35 still kept a substantial expression by the same time. This study demonstrates that porcine alveolar macrophages primarily respond to express IL-6, GM-CSF, and IL-12 by LPS-stimulation and have a cytokine-specific expression profile during the stimulation time.
Animals ; Cells, Cultured ; Cytokines/*genetics ; Female ; Gene Expression Profiling ; Gene Expression Regulation/*drug effects ; Granulocyte-Macrophage Colony-Stimulating Factor/genetics ; Interferon Type II/genetics ; Interleukins/genetics ; Kinetics ; Lipopolysaccharides/*pharmacology ; Macrophages, Alveolar/*drug effects/*metabolism ; RNA, Messenger/genetics/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity ; Swine/*genetics

OBJECTIVE: The purpose of this study is to investigate the prognostic role of pretreatment anemia in patients with early cervical cancer who underwent radical hysterectomy. METHODS: In this study, we retrospectively enrolled patients with early cervical cancer (International Federation of Obstetrics and Gynecology stage IB to IIA) who were treated at Samsung Medical Center, Seoul, Korea, from 1996 to 2007. RESULTS: We retrospectively enrolled 805 patients. Median pretreatment hemoglobin (Hb) level was 12.8 g/dL (4.0-16.9) in all patients. Ninety-ninth out of 805 patients had pretreatment anemia (12.3%). Pretreatment anemia was significantly associated with large tumor size, advanced clinical stage, and parametrial invasion. In multivariate analysis, higher pretreatment Hb entailed better prognostic significance in disease free survival (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.078-0.99) but not in overall survival (HR, 0.94; 95% CI, 0.80-1.10). CONCLUSION: In conclusion, we found that the negative association between pretreatment Hb level and tumor size and the impact of anemia before treatment on disease free survival adjusted for other factors including clinical stage and pathological findings in early stage cervical cancer.
Anemia ; Disease-Free Survival ; Gynecology ; Humans ; Hysterectomy ; Korea ; Multivariate Analysis ; Obstetrics ; Prognosis ; Retrospective Studies ; Seoul ; Uterine Cervical Neoplasms*

Matrix metalloproteinases (MMPs) have been implicated in tissue development and re-modeling. Dynamic morphological changes of tooth germs reflect involvement of these enzymes during odontogenesis. The present study was performed to investigate expression and localization of MMP-2 and MMP-9, which have been known to have type IV collagenase activities, in rat tooth germs at different developmental stages. MMP-2 expression was increased gradually in the tooth germs from cap to crown staged germs at both transcription and translation levels. The localization of this molecule was detected in secretory ameloblasts and preameloblasts. The strong immunoreactivities were occasionally seen along the basement membrane between ameloblasts (or preameloblasts) and odontoblasts (preodontoblasts). However, weak reactivity was detected in odontoblasts and reduced enamel epithelium. The level of MMP-9 expression in the tooth germs was higher in cap stage than in crown staged germs at both transcription and translation levels. They were strongly expressed in both ameloblasts and odontoblasts. Even though reduced enamel epithelium after enamel formation and inner enamel epithelium at the cap stage exhibited weak reactivity, strong reactivity was detected in dental follicles and perifollicular tissues surrounding cap staged germs. These results suggested that MMP-2 may involve degradation of the basement membrane during hard tissue formation, whereas MMP-9 might be involved in remodeling of follicular tissues.
Ameloblasts ; Animals ; Basement Membrane ; Collagenases ; Crowns ; Dental Enamel ; Dental Sac ; Epithelium ; Matrix Metalloproteinases ; Molar ; Odontoblasts ; Odontogenesis ; Rats ; Tooth Germ