No abstract available.
Female ; Leiomyosarcoma* ; Ovary*

Few surgeons have adopted pancreaticoduodenectomy (PD) for the treatment of advanced gastric cancer (AGC) invading the pancreas or duodenum because it remains controversial whether its prognostic benefits outweigh the high morbidity rates in such advanced cases. However, recent technical advances have revived diverse surgical procedures in minimally invasive approaches. Inspired by this trend, laparoscopic PD procedures have been performed for AGC in our institute since 2014. We recently performed a laparoscopic Whipple's operation in a case of cT4b gastric cancer with invasion of the pancreatic head and duodenum.
Duodenum ; Head ; Pancreas ; Pancreaticoduodenectomy ; Stomach Neoplasms ; Surgeons

PURPOSE: Delirium is a common and worrisome problem among elder hospitalized patients. Many studies have sought to evaluate the risk factors of delirium. Most of these studies have dealt with the intensive care unit, with virtually nothing known about the emergency room. Our study was designated to evaluate the risk factors in an emergency department. METHODS: We retrospectively reviewed 414 cases of elder patients admitted to the general ward of internal medicine via the emergency room between January 2009 and December 2009. We divided these patients into a delirium group and non-delirium group. We statistically evaluated 31 known risk factors of delirium in these two groups. RESULTS: Using chi-square test, 14 of 31 known risk factors of delirium were proven as risk factors of delirium in an emergency room. Using logistic regression, three of the 14 proven risk factors were revealed as prior factors. CONCLUSION: A variety of factors of delirium are risk factors of delirium in an emergency room. A few important known risk factors are failed to pass statistically evaluation. These results are influenced by cultural pecularities of South Korea. Also, the small sample size limited conclusive evaluation. Nonetheless, the importance of patients' past medical history, laboratory results, and choice of medication when treating elder hospitalized patients to prevent delirium is likely important in reducing mortality and morbidity.
Aged ; Delirium ; Emergencies ; Humans ; Intensive Care Units ; Internal Medicine ; Logistic Models ; Patients' Rooms ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Sample Size

PURPOSE: Daegu, Korea was severely affected by pandemic and post-pandemic H1N1 infection during August 2009 to March 2012. The aim of this study was to analyze various clinical characteristics of patients who visited the emergency department with H1N1 infection during the first three years, and to compare the results for each year. We then performed an evaluation of the differences. METHODS: The medical records of patients who visited our emergency department and conformed to H1N1 virus infection by conventional rRT-PCR during the pandemic wave from August 2009 to March 2010(wave 1) and post-pandemic waves from August 2010 to March 2011(wave 2) and from August 2011 to March 2012(wave 3) were reviewed. A total of 986 patients (wave 1; 840, wave 2; 144, wave 3; 2) were included in this study. We analyzed the clinical characteristics, proportions of pneumonia, admission rate, relationships with underlying medical conditions, and requirement for mechanical ventilation of the infected patients, and then performed a statistical evaluation of the differences between wave 1 and wave 2 that was severely affected. RESULTS: During wave 1,840 patients, during wave 2, 144 patients, and during wave 3, two patients were diagnosed as novel influenza. Age 18-39 showed a significantly higher rate(78.7%) in the wave 1 patients group. Main clinical symptoms were cough and febrile sense in both waves. Patients with underlying medical conditions in wave 2(97 cases, 67.4%) showed a higher rate than those of wave 1(101 cases, 12.0%). Chronic obstructive pulmonary disorder was the most closely related underlying disorder in wave 2(18.8%). Patients requiring admission(37.5%) and ventilatory care(6.9%) due to severe pneumonic symptoms showed a significantly higher rate in wave 2. Only two young patients were diagnosed as novel influenza. Both complained of mild fever and cough, which recovered spontaneously. CONCLUSION: Most cases of influenza A (H1N1) infection were uncomplicated, characterized by influenza-like symptoms and spontaneous recovery. The number of patients showed a marked decreased year by year, however, the severity of clinical presentations increased in wave 2. Young adults who did not have cross-reactive antibodies to novel influenza A (H1N1) from previous infection or immunization were dominant in wave 1. Older patients with underlying medical conditions were more likely to admitted and present fatal progress in wave 1 and wave 2. Because influenza viruses are unpredictable, continued national preparedness, flexible response, and careful monitoring are essential.
Antibodies ; Cough ; Emergencies* ; Emergency Service, Hospital* ; Daegu ; Epidemiology ; Fever ; Humans ; Immunization ; Influenza A Virus, H1N1 Subtype ; Influenza, Human* ; Korea ; Medical Records ; Observational Study* ; Orthomyxoviridae ; Pandemics* ; Pneumonia ; Respiration, Artificial ; Young Adult

PURPOSE: Daegu, Korea was severely affected by pandemic and post-pandemic H1N1 infection during August 2009 to March 2012. The aim of this study was to analyze various clinical characteristics of patients who visited the emergency department with H1N1 infection during the first three years, and to compare the results for each year. We then performed an evaluation of the differences. METHODS: The medical records of patients who visited our emergency department and conformed to H1N1 virus infection by conventional rRT-PCR during the pandemic wave from August 2009 to March 2010(wave 1) and post-pandemic waves from August 2010 to March 2011(wave 2) and from August 2011 to March 2012(wave 3) were reviewed. A total of 986 patients (wave 1; 840, wave 2; 144, wave 3; 2) were included in this study. We analyzed the clinical characteristics, proportions of pneumonia, admission rate, relationships with underlying medical conditions, and requirement for mechanical ventilation of the infected patients, and then performed a statistical evaluation of the differences between wave 1 and wave 2 that was severely affected. RESULTS: During wave 1,840 patients, during wave 2, 144 patients, and during wave 3, two patients were diagnosed as novel influenza. Age 18-39 showed a significantly higher rate(78.7%) in the wave 1 patients group. Main clinical symptoms were cough and febrile sense in both waves. Patients with underlying medical conditions in wave 2(97 cases, 67.4%) showed a higher rate than those of wave 1(101 cases, 12.0%). Chronic obstructive pulmonary disorder was the most closely related underlying disorder in wave 2(18.8%). Patients requiring admission(37.5%) and ventilatory care(6.9%) due to severe pneumonic symptoms showed a significantly higher rate in wave 2. Only two young patients were diagnosed as novel influenza. Both complained of mild fever and cough, which recovered spontaneously. CONCLUSION: Most cases of influenza A (H1N1) infection were uncomplicated, characterized by influenza-like symptoms and spontaneous recovery. The number of patients showed a marked decreased year by year, however, the severity of clinical presentations increased in wave 2. Young adults who did not have cross-reactive antibodies to novel influenza A (H1N1) from previous infection or immunization were dominant in wave 1. Older patients with underlying medical conditions were more likely to admitted and present fatal progress in wave 1 and wave 2. Because influenza viruses are unpredictable, continued national preparedness, flexible response, and careful monitoring are essential.
Antibodies ; Cough ; Emergencies* ; Emergency Service, Hospital* ; Daegu ; Epidemiology ; Fever ; Humans ; Immunization ; Influenza A Virus, H1N1 Subtype ; Influenza, Human* ; Korea ; Medical Records ; Observational Study* ; Orthomyxoviridae ; Pandemics* ; Pneumonia ; Respiration, Artificial ; Young Adult

Subcutaneous emphysema and pneumomediastinum are commonly derived from trauma or injury of respiratory or gastrointestinal tracts, but occasionally the origin of air was not determined at evaluation. We report on a case of severe subcutaneous emphysema detected using simple X-ray films in the emergency department, which extended to almost all of the bodies, with a review of the literature.
Edema* ; Emergency Service, Hospital ; Gastrointestinal Tract ; Mediastinal Emphysema ; Subcutaneous Emphysema* ; X-Ray Film

OBJECTIVE: This study was conducted to evaluate scorecards for early recognition of high-risk patients of delirium in the emergency department (ED). METHODS: Data from 399 consecutive patients aged 65 years or older between January 1, 2015 and December 31, 2015 were retrospectively analyzed. Delirium was identified by reviewing medical records and was confirmed by a psychiatrist. The study population was divided into a training and validation group. Predisposing factors were evaluated and validated by multivariate logistic regression analysis and a calibration plot, after which a scorecard was constructed using these factors and applying points to double odds to each regression coefficient. RESULTS: Dementia, transfer from a long-term care facility, acute acid-base imbalance, moderate pain, and stroke were independent predisposing factors for delirium in ED, with assigned scores in the scorecard of 3, 2, 2, 2, and 2, respectively. The total score of the scorecard for delirious patients was significantly higher than that for non-delirious patients in both the training and validation groups. The coefficient of determination (R²) of the calibration plot was 0.74 and 0.68 in the training and validation group, respectively. In the receiver operation characteristic curve, the cut-off point of the scorecard for delirium was 2.5 and the sensitivity, specificity, and accuracy were 75.0%, 87.8%, and 86.7% in training group, while they were 76.9%, 85.1%, and 84.2% in the validation group, respectively. CONCLUSION: The scorecard was a useful screening tool for early recognition of patients with a high-risk of developing delirium in the ED.
Acid-Base Imbalance ; Calibration ; Causality ; Delirium ; Dementia ; Emergencies ; Emergency Service, Hospital ; Humans ; Logistic Models ; Long-Term Care ; Mass Screening ; Medical Records ; Psychiatry ; Retrospective Studies ; Sensitivity and Specificity ; Stroke

The authors want to correct the title because this article.

Laparoscopic cholecystectomy has resulted in various bile duct injuries. Treatment of these injuries is usually difficult and often leads to an intractable clinical course. We herein present a case of isolated right anterior sector (RAS) duct injury induced by laparoscopic cholecystectomy. The bile duct injury was successfully treated by hepatic atrophy induction. Imaging studies revealed that the RAS duct was severed, probably due to rare anatomical variations. Considering the difficulty in surgical reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the RAS portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site to ensure percutaneous pigtail clamping, and sequential clamping and removal of pigtail catheters. This procedure took 3 months prior to pigtail catheter removal. She was free from other complications during the first 12 months and to date. She will be followed up for 5 years overall including surveillance for hepatobiliary complications. Although this therapeutic induction of atrophy approach is not universally applicable, it can be considered to be a feasible option in unique situations such as this one.
Atrophy ; Bile ; Bile Ducts ; Catheters ; Cholecystectomy, Laparoscopic ; Constriction ; Dietary Sucrose

A retrospective review of fifty patients with carcinoma of hypopharynx treated with RT+/-surgery was studied for eleven-year period from 1974 to 1984. Of the 50 patients, 46 were pyriform sinus in origin, 4 were posterior pharyngeal wall. Eighty-eight percent of patients were locoregionally advance (stage III, IV) and 78% of patients presented cervical lymphadenopathy. 5-year disease-free survival rate of the pyriform sinus ca. was 25.4% in RT alone group, 80% in combined modality group and 30.6% in overall. Local control rate with RT alone in early stage (II) was excellent (100%), however combined modality appears to be better for local control (80%) in advanced stage (III, IV) as compared with that of RT alone group (32%). On basis of this study, RT alone is effective in terms of local control and functional preservation in treatment of early stage of pyriform sinus ca. while surgery can be reserved for salvage purpose when RT fails and combined modality is recommended in patients with locally advanced stage for better local control and survival.
Disease-Free Survival ; Humans ; Hypopharynx ; Lymphatic Diseases ; Pyriform Sinus ; Radiotherapy ; Retrospective Studies